Status of infection prevention and control (IPC) as per the WHO standardised Infection Prevention and Control Assessment Framework (IPCAF) tool: existing evidence and its implication

Healthcare settings have a high prevalence of infectious agents. This narrative review examines the existing evidence regarding infection prevention and control (IPC) using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool in healthcare facilities. A total of 13 full length papers from Africa, Asia and Europe were considered for this review. The findings showed that there are discrepancies in the IPCAF values from insufficient to advanced level. The current review shows an advanced IPCAF level in middle income and high income countries. Low income countries showed a lower IPCAF score. There is a need to enhance the IPC capacity building and to supply infection prevention resources to prevent healthcare associated infection (HAI) with a focus on low income countries.

Bacteriocins and Antimicrobial Peptides Symposium, Part of International Probiotic Conference, Prague 18-20 June 2024

It has become a tradition for the BAMP (Bacteriocins and Antimicrobial Peptides) symposium to be a part of the IPC (International Probiotic Conference). In 2024, IPC/BAMP will be held on the 18th-20th of June in Prague, Czech Republic ( www.probiotic-conference.net ) and will reunite scientists, students, and representatives from industry and regulations agencies from all around the world. The meeting will serve as a platform for the exchange of knowledge and ideas regarding the past, present, and future of beneficial microbes, probiotics, antimicrobials, and proteins, and their influence on a prosperous and healthier future.

"It Looks Good on Paper, But It Was Never Meant to Be Real": Mixed-Gender Events in the Paralympic Movement

Although the Paralympic Games have been around for over 60 years, women remain underrepresented in almost all aspects of the Paralympic Movement. It has been suggested that a way to increase women's involvement is through the implementation of mixed-gender events. On paper, this approach makes sense. However, when it comes to the implementation of mixed-gender opportunities for women, it is less clear how effective these events are in increasing participation by women in Para sport. Through document analysis and interviews with athletes and organizers of mixed-gender Paralympic sport, we explore the various strategies that four mixed-gender sports have used to address the issue of gender parity. Using critical feminist theories, we illustrate how larger social, political, and cultural ideas about gender influence women's experiences within these events and discuss the potential of using mixed-gender initiatives to address gender parity within the Paralympic Movement.

Intensified perfusion culture (IPC) reduced recombinant protein fragmentation

Mammalian cells remain the mainstay of biological production host. In industry, cultivating and harvest strategies are sorted in batch mode (e.g., batch, fed-batch, concentrated fed-batch and intensified fed-batch) and continuous mode (e.g., perfusion). To retrieve greater productivity and better product quality, especially for the sensitive products prone to fragmentation, culture modes with various modifications are innovated (e.g., intensified perfusion culture [IPC]). In our study, we demonstrated that the fragmentation of Fc-fusion product (Molecule A) is time-dependent in traditional fed-batch (TFB) culture. The fragmentation proportion increased from 3.8% to 12.4% for Clone A, 0.8% to 1.7% for Clone B and 0.9% to 2.0% for Clone C from Day 10 to Day 14. By applying a novel bioprocess, IPC, which allows continuous feeding of the fresh medium and constant removal of the spent medium without bleeding cells to maintain a defined constant viable cell density, the fragmentation was reduced to 0.3% while the productivity was increased from 2.96 g/L to 15.51 g/L for Clone A. To validate whether the fragmentation reduction is product-sensitive, plasmids carrying the DNA sequences of two other Fc-fusion molecules (Molecule B and Molecule C) were transfected into the host. The results showed consistent fragmentation reducing effect by using IPC. Furthermore, the cultivation scale was expanded to 50 L and 1000 L. A minimum fragmentation level below 0.1% was observed for Molecule C. Our study revealed the capability of IPC in reducing Fc-fusion protein fragmentation and the reproducibility when scaling up while maintaining high productivity.

Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh

BACKGROUND

Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh.

AIM

Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh.

METHODS

We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities.

RESULTS

The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level.

CONCLUSION

The integrated intervention package improved IPCAF score in all facilities.

Estimating the return on investment of selected infection prevention and control interventions in healthcare settings for preparing against novel respiratory viruses: modelling the experience from SARS-CoV-2 among health workers

Background

Insufficient infection prevention and control (IPC) practices in healthcare settings increase the SARS-CoV-2 infection risk among health workers. This study aimed to examine the level of preparedness for future outbreaks.

Methods

We modelled the experience from the COVID-19 pandemic and assessed the return on investment on a global scale of three IPC interventions to prevent SARS-CoV-2 infections among health workers: enhancing hand hygiene; increasing access to personal protective equipment (PPE); and combining PPE, with a scale-up of IPC training and education (PPE+). Our analysis covered seven geographic regions, representing a combination of World Health Organization (WHO) regions and the Organisation for Economic Co-operation and Development (OECD) countries. Across all regions, we focused on the first 180 days of the pandemic in 2020 between January 1st and June 30th. We used an extended version of a susceptible-infectious-recovered compartmental model to measure the level of IPC preparedness. Data were sourced from the WHO COVID-19 Detailed Surveillance Database.

Findings

In all regions, the PPE + intervention would have averted the highest number of new SARS-CoV-2 infections compared to the other two interventions, ranging from 6562 (95% CI 4873-8779) to 38,170 (95% CI 33,853-41,901) new infections per 100,000 health workers in OECD countries and in the South-East Asia region, respectively. Countries in the South-East Asia region and non-OECD countries in the Western Pacific region were poised to achieve the highest level of savings by scaling up the PPE + intervention.

Interpretation

Our results not only support efforts to make an economic case for continuing investments in IPC interventions to halt the COVID-19 pandemic and protect health workers, but could also contribute to efforts to improve preparedness for future outbreaks.

Funding

This work was funded by WHO, with support by the German Federal Ministry of Health for the WHOResearch and Development Blueprint for COVID-19.

A pediatric HIV outbreak in Pakistan

Background

Following reports of an outbreak of HIV infection among children in Larkana District, Pakistan, an international team investigated the extent and cause of the outbreak between April and June 2019.

Aims

To investigate the incidence of HIV among children in Larkana District, Pakistan and describe the distribution of cases by time, place and person.

Methods

Self-referred persons were tested for HIV using the national testing protocol. Local epidemiology of HIV was reviewed to generate hypotheses. An infection prevention and control (IPC) team conducted site visits and reviewed IPC practices.

Results

Between 25 April and 27 June 2019, a total of 30 191 persons were tested for HIV in Larkana District, and 876 of them tested positive. Of those who tested positive, 719 (82%) were children aged <15 years. Traditional skin piercing procedures and transmission from high-risk populations to children were ruled out during the investigation. Informative interviews with parents or guardians of a convenience sample of 211 children aged <15 years showed that 99% of children had an injection or infusion for medical treatment within the past 12 months. Our investigation identified lack of HIV prevalence data for the general population including tuberculosis patients and those who attended antenatal care services.

Conclusions

Investigations indicate that unsafe healthcare practices in formal and informal healthcare settings as the most likely cause of the 2019 outbreak of HIV infection in Larkana, Pakistan. Measures should be taken to improve IPC practices at the facility level, especially in pediatric and antenatal care clinics.

Formulating a Community-Centric Indicator Framework to Quantify One Health Drivers of Antibiotic Resistance: A Preliminary Step towards Fostering 'Antibiotic-Smart Communities'

Antibiotic resistance (ABR) is increasing the mortality and morbidity associated with infectious diseases, besides increasing the cost of healthcare, saturating health system capacity, and adversely affecting food security. Framing an appropriate narrative and engaging local communities through the 'One Health' approach is essential to complement top-down measures. However, the absence of objective criteria to measure the performance of ABR interventions in community settings makes it difficult to mobilize interest and investment for such interventions. An exercise was therefore carried out to develop an indicator framework for this purpose. A comprehensive list of indicators was developed from experiences gathered through community engagement work in a local panchayat (small administrative area) in Kerala, India and a consultative process with health, veterinary, environment, and development experts. A prioritization exercise was carried out by global experts on ABR, looking at appropriateness, feasibility, and validity. A 15-point indicator framework was designed based on the prioritization process. The final set of indicators covers human health, animal health, environment management, and Water Sanitation and Hygiene (WASH) domains. The indicator framework was piloted in the panchayat (located in Kerala), which attained a score of 34 (maximum 45). The score increased when interventions were implemented to mitigate the ABR drives, indicating that the framework is sensitive to change. The indicator framework was tested in four sites from three other Indian states with different socioeconomic and health profiles, yielding different scores. Those collecting the field data were able to use the framework with minimal training. It is hoped that, this indicator framework can help policymakers broadly understand the factors contributing to ABR and measure the performance of interventions they choose to implement in the community as part of National Action Plan on AMR.

Recycled PET Composites Reinforced with Stainless Steel Lattice Structures Made by AM

Polyethylene terephthalate (PET) recycling is one of the most important environmental issues, assuring a cleaner environment and reducing the carbon footprint of technological products, taking into account the quantities used year by year. The recycling possibilities depend on the quality of the collected material and on the targeted product. Current research aims to increase recycling quantities by putting together recycled PET in an innovative way as a filler for the additive manufactured metallic lattice structure. Starting from the structures mentioned above, a new range of composite materials was created: IPC (interpenetrating phase composites), materials with a complex architecture in which a solid phase, the reinforcement, is uniquely combined with the other phase, heated to the temperature of melting. The lattice structure was modeled by the intersection of two rings using Solid Works, which generates the lattice structure, which was further produced by an additive manufacturing technique from 316L stainless steel. The compressive strength shows low values for recycled PET, of about 26 MPa, while the stainless-steel lattice structure has about 47 MPa. Recycled PET molding into the lattice structure increases its compressive strength at 53 MPa. The Young's moduli are influenced by the recycled PET reinforcement by an increase from about 1400 MPa for the bare lattice structure to about 1750 MPa for the reinforced structure. This sustains the idea that recycled PET improves the composite elastic behavior due to its superior Young's modulus of about 1570 MPa, acting synergically with the stainless-steel lattice structure. The morphology was investigated with SEM microscopy, revealing the binding ability of recycled PET to the 316L surface, assuring a coherent composite. The failure was also investigated using SEM microscopy, revealing that the microstructural unevenness may act as a local tensor, which promotes the interfacial failure within local de-laminations that weakens the composite, which finally breaks.

Personalized intermittent pneumatic calf compression frequency for augmenting foot blood perfusion: The optimized effect and a personalized mode predicting method

Intermittent pneumatic compression (IPC) therapy has been adopted in prevention and treatment of ischemic-related peripheral vascular diseases. The aim of this study is to provide an approach to personalize the compression strategy of IPC therapy for maximizing foot skin blood flow. In this study, we presented a method to predict the optimized compression mode (OCM) for each subject based on biomechanical features extracted from experimental data tested with multiple IPC modes. First, to demonstrate the blood flow enhancing effect by applying the personalized OCM, four IPC modes of different frequency settings were tested on a total of 24 subjects. The frequency settings were adjusted by deflating-waiting time, which was defined as the total time length from the start of cuff deflation to the start of next compression. The foot skin blood perfusion and IPC air cuff pressure were monitored during the experiments. The personalized OCM was defined as the certain IPC mode that has the highest blood perfusion augmentation (BPA). Compared with the rest stage blood perfusion, the personalized OCM settings resulted in >50% of augmentation for 75% of healthy subjects (maximum augmentation at 244%) and >20% augmentation for 75% of patients with diabetes (maximum augmentation at 180%). Second, for predicting the OCM, we establish a random forest model based on the features extracted from the experimental data. The binary classification resulted in acceptable prediction performance (AUC > 0.7). This study might inspire new IPC strategies for improving foot microcirculation.

Educational intervention to improve infection prevention and control practices in four companion animal clinics in Switzerland

BACKGROUND

Infection prevention and control (IPC) practices vary among companion animal clinics, and outbreaks with carbapenemase-producing Enterobacterales (CPE) have been described.

AIM

To investigate the effect of an IPC intervention (introduction of IPC protocols, IPC lectures, hand hygiene campaign) in four companion animal clinics.

METHODS

IPC practices, environmental and hand contamination with antimicrobial-resistant micro-organisms (ARM) and hand hygiene (HH) were assessed at baseline, and 1 and 5 months after the intervention.

RESULTS

Median IPC scores (% maximum score) improved from 57.8% (range 48.0-59.8%) to 82.9% (range 81.4-86.3%) at 1-month follow-up. Median cleaning frequency assessed by fluorescent tagging increased from 16.7% (range 8.9-18.9%) to 30.6% (range 27.8-52.2%) at 1-month follow-up and 32.8% (range 32.2-33.3%) at 5-month follow-up. ARM contamination was low in three clinics at baseline and undetectable after the intervention. One clinic showed extensive contamination with ARM including CPE before and after the intervention (7.5-16.0% ARM-positive samples and 5.0-11.5% CPE-positive samples). Mean HH compliance improved from 20.9% [95% confidence interval (CI) 19.2-22.8%] to 42.5% (95% CI 40.4-44.7%) at 1-month follow-up and 38.7% (95% CI 35.7-41.7%) at 5-month follow-up. Compliance was lowest in the pre-operative preparation area at baseline (11.8%, 95% CI 9.3-14.8%) and in the intensive care unit after the intervention (28.8%, 95% CI 23.3-35.1%). HH compliance was similar in veterinarians (21.5%, 95% CI 19.0-24.3%) and nurses (20.2%, 95% CI 17.9-22.7%) at baseline, but was higher in veterinarians (46.0%, 95% CI 42.9-49.1%) than nurses (39.0%, 95% CI 36.0-42.1%) at 1-month follow-up.

CONCLUSION

The IPC intervention improved IPC scores, cleaning frequency and HH compliance in all clinics. Adapted approaches may be needed in outbreak situations.

Dissecting WASH Assessment Tools and Recommending a Comprehensive Tool for Indian Healthcare Facilities

Providing adequate Water Sanitation and Hygiene (WASH) in Health Care Facilities (HCFs) has many benefits, including achieving Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC). However, there is a significant shortage of statistics on the status of WASH in Healthcare Facilities (WinHCF), resulting in roadblocks in developing improvement strategies. Further, there is a lack of detailed comparison of WASH components covered in available tools against the standards. The present study aims to dissect the national and international tools for WASH assessment in HCFs to suggest comprehensive WASH indicators. The databases like PubMed, Scopus, ScopeMed, Cochrane and Google Scholar were used to extract the available tools. The assessment process, methodology, and components of national and various international tools were compared and synthesized. A total of seven tools, namely WASH FIT 2, Facet, SARA, SPA, TOOL BOX-II, CDC and Kayakalp, were compared on eight components: water, sanitation, hand hygiene, healthcare waste, environmental cleaning and hygiene, infrastructure, workforce management, policy and protocols. Although most tools have covered the same indicators, the methodology and definitions differ. Few of the tools fail to capture the basic indicators defined by Joint Monitoring Programme (JMP). The critical indicators of policy and protocols are only covered in WASH FIT 2, Kayakalp, and TOOL BOX-II. Likewise, most tools fail to capture the indicator of cleaning, IPC practices and climate resilience. The present review also highlighted the limitations of selected tools regarding definitions, methodology and implementation. Hence, based on the review findings, a comprehensive short tool has been developed to monitor WASH in HCF of India. It comprises all the essential fundamental indicators identified from various tools, and recommended by the JMP service ladder with proper definitions. This tool can be helpful for hospital staff and managers for the routine monitoring of WASH in HCFs and improve the quality of care and IPC practices in HCFs.

A 'train the trainers' approach to infection prevention and control training in pandemic conditions

Background

The first wave of the SARS-CoV-2 global pandemic in early 2020 required a rapid roll-out of infection prevention and control (IPC) training for healthcare workers (HCW), including use of appropriate personal protective equipment (PPE). Education about respiratory droplet and aerosol transmission was of paramount importance to ensure safe working practices and improve confidence.

Methods

A joint working group of Infectious Diseases and IPC staff developed a 'train the trainers' programme, to be rapidly deployed over a three-week period. This model utilised a snowballing approach, training selected staff with the intention that they would train their teams, facilitating swift cascading of information. Targeted invitations prompted staff from diverse departments of the hospital to attend. Pre- and post-session questionnaires evaluated staff confidence with regard to appropriate PPE use.

Results

The programme trained 130 HCW over a three week period, was well received and led to increased confidence with PPE use amongst staff. Real-time evaluation ensured content could be adapted to the specific needs of HCW involved. We highlight perceived gaps in training despite existing and enhanced training structures.

Conclusion

Provision of face-to-face training in transmission-based precautions, including PPE use, is required to maintain confidence in safe and appropriate IPC amongst hospital staff. We highlight the importance of including non-clinical staff in PPE educational programmes, recognising that these roles are vital for patient care and are frequently patient-facing. We recommend adopting the train the trainers model to facilitate rapid dissemination of education, with interactive multidisciplinary training in future outbreaks to improve HCW confidence and effective IPC.

Intensive care unit nurses' knowledge, attitudes and practices of COVID-19 infection prevention and control

Background

Intensive care units (ICUs) had to rapidly adapt infection prevention and control (IPC) practices during the coronavirus disease 2019 (COVID-19) pandemic.

Objectives

To determine ICU nurses' COVID-19 IPC-related knowledge, attitudes, practices, and perceptions.

Method

A mixed-methods study was conducted at the Groote Schuur Hospital ICU, Cape Town, South Africa (20 April 2021 and 30 May 2021). Participants completed anonymous, self-administered, knowledge, attitudes and practices (KAP) questionnaires. Individual interviews were conducted regarding nurses' lived experiences and perceptions of COVID-19 IPC in critical care.

Results

In total, 116 ICU nurses participated (93.5% response rate) including 57 professional nurses (49%), 34 enrolled nurses (29%) and 25 enrolled nursing assistants (22%); young females (31-49 years) predominating (n = 99; 85.3%). Nurses' overall COVID-19 IPC knowledge scores were moderately good (78%); professional nurses had greater knowledge of COVID-19 transmission (p < 0.001). Intensive care unit nurses' attitude scores towards COVID-19 IPC were low (55%), influenced by limited IPC training, insufficient time to implement IPC and shortages of personal protective equipment (PPE). Respondents' scores for self-reported COVID-19 IPC practices were moderate (65%); highest compliance rates were for hand hygiene after touching patient surroundings (68%). Only 47% ICU nurses underwent N95 respirator fit-testing despite working in a COVID-19 ICU.

Conclusion

Regular COVID-19 IPC training is needed to equip ICU nurses with the knowledge and skills to prevent healthcare-associated COVID-19 transmission. Enhanced IPC training and consistent PPE availability may support more favourable attitudes and better IPC practices. Comprehensive IPC and occupational health support should be offered to ensure ICU nurses' wellbeing during pandemics.

Contribution

Enhanced IPC training and consistent PPE availability may support better attitudes and IPC practices.

Hepatitis B infection prevention: Audit of selected healthcare facilities in the Greater Accra Region, Ghana

Introduction

The risk of occupational exposure to Hepatitis B Virus (HBV) is high among healthcare workers (HCWs), especially in developing countries like Ghana where the prevalence of HBV is high. Unfortunately, in such regions, HCW protection does not appear to be a priority, and healthcare facilities (HFs) have been reported to have unsatisfactory levels of implementing preventive strategies to protect HCWs from blood-borne infections including HBV.

Methods

A cross-sectional and Q audit was performed involving 255 HFs selected by proportional allocation and systematic random sampling. Data was collected using a structured pretested questionnaire with HF managers being the respondents. Data were analysed using IBM ® SPSS® (Statistical Package for the Social Sciences, version 21.0) where univariate, bivariate, and multivariate analysis was done with the level of significance set at <0.05.

Results

Overall adherence to recommended strategies, structures, and programs for HBV prevention among the HFs was generally low, with a mean score of 37.02 (95% CI = 33.98-40.05). There was a statistically significant difference in the level of adherence between the HF categories (F = 9.698; P = <0.001). Being a hospital (OR = 3.9: CI = 1.68-9.29), possessing infection, prevention and control (IPC) guidelines (OR = 6.69: CI = 3.29-13.63) as well as having functional IPC committees in place (OR = 7.9: CI = 3.59-17.34) were associated with good adherence to HF-level HBV preventive strategies.

Conclusion

Overall adherence to HF-level prevention of HBV is sub-optimal. Higher-level facilities were better resourced with HBV vaccine and Hepatitis B immunoglobulin (HBIG). Adherence to HBV prevention strategies depends on the type of HF and the availability of IPC committees and their respective IPC coordinators.

Interprofessional Education: Models That Promote Shared Clinical Decision-Making

Description Interprofessional education continues to be emphasized as an area that needs to continue to grow by agencies that accredit higher education professional degree programs. Teams of healthcare professionals need to learn more about each other, collaborate, and understand what matters most to the patient when care is needed in an acute or ambulatory care setting. Settings that promote clinical shared decision-making and collaboration with pharmacists among the team and increase communication between members and the patient will decrease medical errors, increase patient safety, and improve the quality of life for the patient.

Metabolic Activation of Pesticide Isoprocarb Mediated by CYP3A4 and the Possible Correlation with Its Cytotoxicity

Isoprocarb (IPC), one of the most important carbamate pesticides, is used to control pests, such as rice planthoppers in crops. Studies have found that IPC induced hepatotoxicity in poultry chicken. However, the mechanisms of IPC-induced hepatotoxicity are unclear. The objectives of this study were to characterize reactive metabolites of IPC in vitro and in vivo, to identify cytochrome P450 enzymes for metabolic activation, and to define a possible correlation between the metabolic activation and cytotoxicity of IPC. In GSH- or NAC-supplemented microsomal incubations, one GSH conjugate (M6) and two NAC conjugates (M7 and M8) were detected after exposure to IPC. The corresponding GSH conjugate and NAC conjugates were found in the liver homogenates and urine of mice after IPC administration. IPC was found to be metabolized to a quinone intermediate reactive to GSH in vitro and in vivo. IPC was found to induce marked cytotoxicity in cultured mouse primary hepatocytes. Ketoconazole, a selective CYP3A4/5 enzyme inhibitor, attenuated the susceptibility of hepatocytes to IPC cytotoxicity.

A robotic arm for safe and accurate control of biomedical equipment during COVID-19

Purpose

Hospital facilities and social life, along with the global economy, have been severely challenged by COVID-19 since the World Health Organization (WHO) declared it a pandemic in March 2020. Since then, countless ordinary citizens, as well as healthcare workers, have contracted the virus by just coming into contact with infected surfaces. In order to minimise the risk of getting infected by contact with such surfaces, our study aims to design, prototype, and test a new device able to connect users, such as common citizens, doctors or paramedics, with either common-use interfaces (e.g., lift and snack machine keyboards, traffic light push-buttons) or medical-use interfaces (e.g., any medical equipment keypad).

Method

To this purpose, the device was designed with the help of Unified Modelling Language (UML) schemes, and was informed by a risk analysis, that highlighted some of its essential requirements and specifications. Consequently, the chosen constructive solution of the robotic system, i.e., a robotic-arm structure, was designed and manufactured using computer-aided design and 3D printing.

Result

The final prototype included a properly programmed micro-controller, linked via Bluetooth to a multi-platform mobile phone app, which represents the user interface. The system was then successfully tested on different physical keypads and touch screens. Better performance of the system can be foreseen by introducing improvements in the industrial production phase.

Conclusion

This first prototype paves the way for further research in this area, allowing for better management and preparedness of next pandemic emergencies.

Ischemic preconditioning/ischemic postconditioning alleviates anoxia/reoxygenation injury via the Notch1/Hes1/VDAC1 axis

Ischemic preconditioning (IPC), and ischemic postconditioning (IPost) have a significant protective effect on myocardial ischemia/reperfusion (MI/R) injury by alleviating oxidative stress and mitochondrial disturbances, although the underlying molecular mechanisms are unclear. The study was to demonstrate that cardioprotection against anoxia/reoxygenation (A/R) injury is transduced via the Notch1/Hes1/VDAC1 signaling pathway. Using mass spectrometry and tandem affinity purification (TAP), to screen for differentially expressed proteins associated with Hes1, followed by standard bioinformatics analysis. The co-immunoprecipitation (Co-IP) assay confirmed an interaction between Hes1 and VDAC1 proteins. H9c2 cells were transfected with Hes1 adenoviral N-terminal TAP vector (AD-NTAP/Hes1) and Hes1-short hairpin RNA adenoviral vector (AD-Hes1-shRNA) to establish A/R injury, IPC, and IPost models, respectively. The expression of Hes1 and VDAC1 proteins were measured by western blot analysis, while the levels of reactive oxygen species (ROS), mitochondrial membrane potential (ΔΨm), and apoptosis were evaluated by flow cytometry. AD-NTAP/Hes1 can activate the exogenous protein expression of Hes1, thus decreasing creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) activity and promoting cell viability. The study found that VDAC1 was a potential target protein for Hes1 and the overexpression of Hes1 protein expression downregulated protein expression levels of VDAC1, reduced ROS production, stabilized ΔΨm, and inhibited apoptosis in H9c2 cells. Additionally, downregulation of Hes1 protein expression also upregulated VDAC1 protein expression, increased ROS production, imbalanced ΔΨm, promoted cell apoptosis, and attenuated the cardioprotection afforded by IPC and IPost. The Notch1/Hes1 signaling pathway activated by IPC/IPost can directly downregulate the protein expression of VDAC1 and consequently relieve A/R injury.

Rapid scale-up of COVID-19 training for frontline health workers in 11 African countries

BACKGROUND

The global spread of the SARS-CoV-2 virus highlights both the importance of frontline healthcare workers (HCW) in pandemic response and their heightened vulnerability during infectious disease outbreaks. Adequate preparation, including the development of human resources for health (HRH) is essential to an effective response. ICAP at Columbia University (ICAP) partnered with Resolve to Save Lives and MOHs to design an emergency training initiative for frontline HCW in 11 African countries, using a competency-based backward-design approach and tailoring training delivery and health facility selection based on country context, location and known COVID-19 community transmission.

METHODS

Pre- and post-test assessments were conducted on participants completing the COVID-19 training. Parametric and non-parametric methods were used to examine average individual-level changes from pre- to post-test, and compare performance between countries, cadres, sex and facility types. A post-evaluation online training survey using Qualtrics was distributed to assess participants' satisfaction and explore training relevance and impact on their ability to address COVID-19 in their facilities and communities.

RESULTS

A total of 8797 HCW at 945 health facilities were trained between June 2020 and October 2020. Training duration ranged from 1 to 8 days (median: 3 days) and consisted of in person, virtual or self guided training. Of the 8105 (92%) HCW working at health facilities, the majority (62%) worked at secondary level facilities as these were the HF targeted for COVID-19 patients. Paired pre- and post-test results were available for 2370 (25%) trainees, and 1768 (18%) participants completed the post-evaluation training survey. On average, participants increased their pre- to post-test scores by 15 percentage points (95% CI 0.14, 0.15). While confidence in their ability to manage COVID-19 was high following the training, respondents reported that lack of access to testing kits (55%) and PPE (50%), limited space in the facility to isolate patients (45%), and understaffing (39%) were major barriers.

CONCLUSION

Ongoing investment in health systems and focused attention to health workforce capacity building is critical to outbreak response. Successful implementation of an emergency response training such as this short-term IPC training initiative in response to the COVID-19 pandemic, requires speed, rigor and flexibility of its design and delivery while building on pre-existing systems, resources, and partnerships.

Intermittent pneumatic compression (IPC) combined with an electric stimulator in the prevention of venous thromboembolism in stroke patients

OBJECTIVE

To explore the clinical value of intermittent pneumatic compression (IPC) combined with an electric stimulator in the prevention of venous thromboembolism in stroke patients.

METHODS

58 stroke patients with hemiplegia admitted to the Department of Neurology in our hospital were recruited as the study cohort and randomly placed into a control group or an observation group, with 29 patients in each group. The control group was administered routine care and IPC, and the observation group was administered electric stimulation in addition to the treatment administered to the control group. We conducted a comparison and an analysis of the occurrences of thrombosis, the blood rheology indexes, the femoral vein flow rates, and the nursing satisfaction levels in the two groups. The circumferences of the hemiplegia patients' lower extremities were measured and recorded, and the circumferences of the healthy sides and the affected limbs were compared.

RESULTS

On the 7th day after the intervention, the observation group had a higher incidence of deep vein thrombosis (DVT) than the control group (6.90% vs. 31.03%, P<0.05). The hemorheology indexes were lower after the treatment, and the hemorheology indexes in the observation group were higher compared with the control group (P<0.05). The observation group had a higher femoral vein flow velocity than the control group (P<0.05). On the 7th and 14th days after the intervention, the peak flow and average flow velocities in the observation group exceeded those of the control group (P<0.05). The nursing satisfaction rate in the observation group was higher than it was in the control group (96.55% vs. 82.76%, P<0.05). After 7 and 14 days of treatment, smaller changes in the hemiplegic limbs of the observation group were observed, compared to the control group (P<0.05).

CONCLUSION

IPC combined with an electrical stimulator can enhance the patients' blood hypercoagulability, effectively prevent the occurrence of DVT, and improve the nursing satisfaction levels.

Forecasting transitions in the state of food security with machine learning using transferable features

Food insecurity is a growing concern due to man-made conflicts, climate change, and economic downturns. Forecasting the state of food insecurity is essential to be able to trigger early actions, for example, by humanitarian actors. To measure the actual state of food insecurity, expert and consensus-based approaches and surveys are currently used. Both require substantial manpower, time, and budget. This paper introduces an extreme gradient-boosting machine learning model to forecast monthly transitions in the state of food security in Ethiopia, at a spatial granularity of livelihood zones, and for lead times of one to 12 months, using open-source data. The transition in the state of food security, hereafter referred to as predictand, is represented by the Integrated Food Security Phase Classification Data. From 19 categories of datasets, 130 variables were derived and used as predictors of the transition in the state of food security. The predictors represent changes in climate and land, market, conflict, infrastructure, demographics and livelihood zone characteristics. The most relevant predictors are found to be food security history and surface soil moisture. Overall, the model performs best for forecasting Deteriorations and Improvements in the state of food security compared to the baselines. The proposed method performs (F1 macro score) at least twice as well as the best baseline (a dummy classifier) for a Deterioration. The model performs better when forecasting long-term (7 months; F1 macro average = 0.61) compared to short-term (3 months; F1 macro average = 0.51). Combining machine learning, Integrated Phase Classification (IPC) ratings from monitoring systems, and open data can add value to existing consensus-based forecasting approaches as this combination provides longer lead times and more regular updates. Our approach can also be transferred to other countries as most of the data on the predictors are openly available from global data repositories.

The COVID-19 pandemic and N95 masks: reusability and decontamination methods

BACKGROUND

With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality.

AIM

The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination.

METHODS

In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions.

RESULTS

This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them.

CONCLUSION

We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.

A Case Study: Analysis of Patents on Coronaviruses and Covid-19 for Technological Assessment and Future Research

BACKGROUND

Protecting intellectual property rights are important and particularly pertinent for inventions that are an outcome of rigorous research and development. While the grant of patents is subject to establishing novelty and inventive step, it further indicates the technological development and is helpful for researchers working in the same technical domain. The aim of the present research work is to map the existing work through an analysis of patent literature in the field of Coronaviruses (CoV), particularly COVID-19 (2019-nCoV). CoV is a large family of viruses known to cause illness in humans and animals, particularly known for causing respiratory infections, as evidenced in earlier times, such as in MERS i.e., Middle East Respiratory Syndrome; and SRS i.e., Severe Acute Respiratory Syndrome. A recently identified novel-coronavirus, known as COVID-19, has caused pandemic situations across the globe.

OBJECTIVE

To expand the analysis of patents related to CoV and 2019-nCoV, an evaluation has been conducted by patenting trends of particular strains of identified CoV diseases by present legal status, main concerned countries via the earliest priority years and its assignee types and inventors of identified relevant patents. The global patent documents were analyzed to check the scope of claims along with focuses and trends of the published patent documents for the entire CoV family, including 2019-nCoV through the present landscape.

METHODS

To extract the results, the Derwent Innovation database was used by a combination of different keystrings. Approximately 3800 patents were obtained and further scrutinized and analyzed. The present write-up also discusses the recent progress of patent applications in a period of the year 2010 to 2020 (present) along with the recent developments in India for the treatment options for CoV and 2019-nCoV.

RESULTS

Present analysis showed that key areas of the inventions were the vaccines and diagnostic kits apart from the composition for the treatment of CoV. It was also observed that no specific vaccine treatments are available for the treatment of 2019-nCov; however, developing novel chemical or biological drugs and kits for early diagnosis, prevention, and disease management is the primary governing topic among the patented inventions. The present study also indicates potential research opportunities for the future, particularly to combat 2019-nCoV.

CONCLUSION

The present paper analyzes the existing patents in the field of Coronaviruses and 2019-nCoV and suggests a way forward for the effective contribution in this upcoming research area. From the trend analysis, an increase in the filing of the overall trend of patent families was observed for a period of 2010 to the current year. This multifaceted analysis of identified patent literature provides an understanding of the focuses on present ongoing research and a grey area in terms of the trends of technological innovations in disease management in patients with CoV and 2019-nCoV. Furthermore, the findings and outcome of the present study offer insights for the proposed research and innovation opportunities and provide actionable information in order to facilitate policymakers, academia, research-driven institutes and also investors to make better decisions regarding programmed steps for research and development for the diagnosis, treatment and taking preventive measures for CoV and 2019-nCoV. The present article also emphasizes the need for future development and the role of academia and collaboration with industry for speedy research with a rationale.

The Predominant microRNAs in β-cell Clusters for Insulin Regulation and Diabetic Control

micro (mi)-RNAs are vital regulators of multiple processes including insulin signaling pathways and glucose metabolism. Pancreatic β-cells function is dependent on some miRNAs and their target mRNA, which together form a complex regulative network. Several miRNAs are known to be directly involved in β-cells functions such as insulin expression and secretion. These small RNAs may also play significant roles in the fate of β-cells such as proliferation, differentiation, survival and apoptosis. Among the miRNAs, miR-7, miR-9, miR-375, miR-130 and miR-124 are of particular interest due to being highly expressed in these cells. Under diabetic conditions, although no specific miRNA profile has been noticed, the expression of some miRNAs and their target mRNAs are altered by posttranscriptional mechanisms, exerting diverse signs in the pathobiology of various diabetic complications. The aim of this review article is to discuss miRNAs involved in the process of stem cells differentiation into β-cells, resulting in enhanced β-cell functions with respect to diabetic disorders. This paper will also look into the impact of miRNA expression patterns on in vitro proliferation and differentiation of β-cells. The efficacy of the computational genomics and biochemical analysis to link the changes in miRNA expression profiles of stem cell-derived β-cells to therapeutically relevant outputs will be discussed as well.

Utilization of greenhouse effect for the treatment of COVID-19 contaminated disposable waste - A simple technology for developing countries

Countries with abundant solar radiation have the potential to invest in simple technologies for deactivation of many bacteria and viruses in medical solid waste. In addition to the traditional Infection and Prevention Control (IPC) measures, these simple technologies contribute to better protection of health care workers in countries with compromised solid management schemes. Monitoring of temperature, relative humidity and ultraviolet inside containers soundly designed to collect disposal infectious waste illustrated to deactivate several viruses and bacteria. Casanova et al., 2010, used some surrogate viruses to overcome the challenges of working with SARS-CoV, concluded that by temperature above 40 °C most of viruses become below levels of detection after 90 min. Here we are proposing a model of a simple transparent container almost 200 L in volume that allow solar energy to be accumulated inside. In summer conditions in the testing site, temperature inside the container reached above 50 °C when the ambient air temperature was around 30 °C. The container was built using epoxy glass to guarantee maximum heat penetration. Actual temperature measurement inside the container was measured in real time against ambient air temperature. We present a mathematical model for predication of maximum temperature at different positions inside the container and their relation to different ambient air temperature scenarios. The mathematical formulas used are based on the conservation laws and a good agreement of a full month of field measurements were obtained. Even in winter conditions in many of developing countries air temperature can maintain levels above 20 °C, which will produce temperature around 30 °C and viruses can reach levels below detection limit in maximum 3 h.

Removal of fluoride from water by using a coagulant (inorganic polymeric coagulant)

Excess fluoride (F) ion of drinking water is a major problem in many areas of India and causes harmful effects such as dental and skeletal fluorosis. The World Health Organization (WHO 2004) recommends an upper limit of 1.5 mg/L fluoride in drinking water, and the concentration of fluoride in groundwater has been found 10-20 times higher in many of the States in India. In this study, the performance of inorganic polymeric coagulant (IPC) named as IPC-23, IPC-13, IPC-17, and alum for fluoride removal from drinking water was investigated. The amount of IPC was decided according to the Al₂O₃ amount present in the alum dose recommended in the batch Nalgonda defluoridation technique. The effects of coagulant dosage (IPC) at different pH and initial concentrations of fluoride on fluoride removal have been studied. The synthetic sample having a fluoride concentration of 2 to 6 mg/L was treated at the optimized dosage and residual fluoride was reduced to 1.0 to 1.2 ppm with IPC-17. Residual aluminum in treated water was well within WHO norms (< 200 μg/L) for drinking water. Optimum pH for fluoride removal was 6.5, and there was deterioration in the performance of IPC at both lower and higher pH.

Assessment of Sensor Concepts for 100% In-Process Control of Low-Volume Aseptic Fill-Finish Processes

The pharmaceutical industry is currently being confronted with new and complex challenges regarding the aseptic filling of parenterals, especially monoclonal antibodies, particularly for fill volumes <200 µL, which have become increasingly important with the increasing and continued development of intravitreal drugs and highly concentrated formulations. Not only does low-volume filling pose challenges to aseptic manufacturing, but the development of suitable in-process control to ensure reliable and robust filling processes for low-volume conditions has also been difficult. In particular, fill volumes <200 µL exceed limits of accuracy and robustness for the well-established method of gravimetric fill-volume control. Therefore, the present study aimed to evaluate and test novel sensors, which may allow the accurate and precise 100% contact-free measurement of drug-product formulations, with respect to filling volumes. These sensors were designed to be less influenced by inevitable noise factors, such as unidirectional airflow and vibrations. We designed the study using five different sensor concepts, to screen and identify suitable alternatives to gravimetric fill-volume control. The examined sensor concepts were based on airflow, capacitive pressure, light obscuration. and capacitive measurements. Our results demonstrated that all of the tested sensor types worked in the desired low-volume range of 10-150 µL and showed remarkable results, in terms of accuracy and precision, when compared with a high-precision gravimetric balance. A sensor based on capacitance measurement was identified as the most promising candidate for future sensor implementation into an aseptic filling line. This sensor design proved to be superior in terms of both sensitivity and precision compared with the other tested sensors. We concluded that this technology may allow the pharmaceutical industry to overcome existing challenges with respect to the reliable measurement of aseptic fill volumes <200 µL. This technology has the potential to fundamentally change how the pharmaceutical industry verifies fill volumes by facilitating 100% in-process control, even at high machine speeds.

Infection control in dentistry during COVID - 19 pandemic: what has changed?

The novel coronavirus (COVID-19) pandemic has emerged disrupting many socio-economical and healthcare aspects across the world. This virus can be transmitted by symptomatic and asymptomatic individuals through saliva and contact. Due to its airborne transmission, aerosols created by natural activities and during dental treatment of infected individuals have become a potential vehicle of transmission and threat. The objective of this review was to assess the existing infection control measures taken in dental health-care settings and suggest modifications to reduce the transmission of novel coronavirus. This is a general review publication. Literature search was made at National Library of Medicine, Pubmed using key words such as "dentistry and COVID", "dentistry and COVID and infection control". Publications related to behaviour, education, ethics, treatment and childcare were excluded. Publications describing general aspects of infection control were reviewed. Keyword "Dentistry and COVID and Infection control" generated 70 publications which were reviewed. Infection control measures in dentistry are designed to minimise cross transmission mainly of blood borne pathogens. The unique nature of COVID-19 including highly infectious and transmissibility, and the ability to survive for a long time in the environment requires special attention and modification to the existing infection control measures which are highlighted here. In conclusion, a modified infection prevention and control (IPC) regime will protect the dental practitioner, assistant and staff, patients and the community. During the pandemic, drastic measures are necessary, however, during an endemic period measures can be remodified as necessary.

Ischemic Preconditioning Does Not Improve Time Trial Performance in Recreational Runners

Some evidence indicates that ischemic preconditioning (IPC) may positively affect endurance exercise performance, but IPC's effect on running performance is unclear. This study's purpose was to examine the effect of IPC on running performance in recreational runners. Participants (n=12) completed IPC, a sham (SH) condition, and a leg elevation without blood restriction (LE) control condition on separate days (order randomized). For IPC, blood was restricted using blood pressure cuffs inflated to 220 mmHg at the thigh. For SH, the cuffs were inflated to only 20 mmHg. For LE, participants positioned their legs at 90 degrees against a wall while laying supine. The duration of each protocol was 30 minutes (three 5-minute bouts with 5-minute breaks). Following each protocol, participants ran 2.4 kilometers as fast as possible on a motorized treadmill. Run time, heart rate, and perceived exertion were measured and statistically compared, using repeated-measures ANOVA, each 0.8 kilometers. There were no differences in heart rate or time trial performance across protocols (p>0.05; IPC, 612.5±61.2 sec; SH, 608.1±57.9 sec; LE, 612.7±59.1 sec). Rating of perceived exertion at 0.8 kilometers was significantly lower for the IPC protocol than SH in females only (~5.7%, or ~0.8 points on a 6-20 scale; p<0.05). Our IPC protocol did not improve running performance or physiological parameters during a time trial run in recreational runners. The performance benefit seen in this study's most fit individuals suggests that fitness level may influence IPC's efficacy for improving endurance running performance.

Novel coronavirus pandemic: A clinical overview

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emergent public health crisis threatening the current world health establishment. The SARS-Co-2 was first identified in Wuhan, Hubei Province, China, in December 2019. There have been about 6.5 million reported cases of coronavirus disease 2019 (COVID-19) and about 350 000 reported deaths throughout the world within the last 6 months from the onset of the epidemic. The virus is primarily transmitted by inhalation or contact with infected droplets. The COVID-19 patient usually presents with fever, cough, sore throat and breathlessness. Currently, available data indicate that the majority of people with the disease have mild symptoms, while about 20% present with moderate-to-severe disease. About 5% of these may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction. To date, there is no recommended medical treatment, and supportive measures are a crucial part of management. The case fatality rate of SARS-CoV-2 is lower than that of its two coronavirus predecessors, that is, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). The full impact of this new pandemic on health, social and economic well-being of humankind is yet to be ascertained.

Meta-Analysis of the Role of Intermittent Pneumatic Compression of the Lower Limbs to Prevent Venous Thromboembolism in Critically Ill Patients

Critically ill patients (patients treated in a medical or surgical intensive care unit) are at high risk of venous thromboembolism (VTE) development (deep vein thrombosis [DVT] and/or pulmonary embolism). Multiple thromboprophylaxis strategies have been used for the prevention of VTE in this population with various outcomes. Therefore, we aimed to evaluate the efficacy of intermittent pneumatic compression (IPC) prophylaxis in the lower limb compared with no treatment, anticoagulant use, or their combinations in reducing risk. A comprehensive electronic database search was conducted for all randomized clinical trials (RCTs) comparing the clinical outcomes of IPC versus anticoagulants or no treatment or their combinations for the prevention of VTE for critically ill patients. The primary outcome was VTE. The secondary outcome was DVT. We performed a Bayesian network meta-analysis to calculate odds ratios (ORs) and 95% credible intervals (CrIs). We included 5 RCTs with 3133 total patients, represented by a mean age of 49.61 ± 18 years, while 60.28% were male. There was a significant reduction of the primary outcome (incidence of VTE events) when no treatment was compared with IPC (OR = 0.36; 95% CrI = 0.18-0.71), anticoagulation alone (OR = 0.30; 95% CrI = 0.12-0.68), or anticoagulation with IPC (OR = 0.34; 95% CrI = 0.13-0.81). In addition, there was a significant reduction in DVT when no treatment was compared with IPC (OR = 0.45; 95% CrI = 0.21-0.9), anticoagulation alone (OR = 0.16; 95% CrI = 0.03-0.66), or anticoagulation with IPC (OR = 0.18; 95% CrI = 0.03-0.84). However, there were no significant differences between other comparisons (IPC vs anticoagulation alone, anticoagulation alone vs anticoagulation with IPC, or anticoagulation with IPC vs IPC alone) regarding VTE or DVT incidence. Among critically ill patients, IPC alone, anticoagulation alone, and IPC with anticoagulation were associated with a significant reduction of VTE and DVT incidence compared with no treatment. However, there was no significant difference between these modalities when compared together. Therefore, further larger studies comparing those different thromboprophylaxis modalities and their combinations are needed to provide more robust results for future clinical recommendations.

COVID-19: Infection prevention and control guidance for all ultrasound practitioners

The severe acute respiratory syndrome coronavirus (SARS‐CoV‐2), an enveloped virus, is the causative agent of the disease known as COVID‐19 (coronavirus disease‐2019). Proper infection prevention and control measures and good hygiene practices are essential to prevent spread of COVID‐19 and protect both patients and the healthcare worker. These guidelines are relevant to all ultrasound practitioners and provides guidance on cleaning and disinfection of ultrasound equipment, the environment and PPE (protective personal equipment) during the COVID‐19 outbreak in the Australasian region.

Comparative efficacy and safety of pharmacological prophylaxis and intermittent pneumatic compression for prevention of venous thromboembolism in adult undergoing neurosurgery: a systematic review and network meta-analysis

Whether intermittent pneumatic compression (IPC) is a more effective form of thromboprophylaxis than anticoagulants in individuals undergoing neurosurgery remains controversial. Relevant studies are sparse and inconsistent. Therefore, direct comparisons are difficult to perform and impractical. Hence, we summarized and compared the efficacy and safety of IPC and anticoagulants for the prevention of venous thromboembolism (VTE) in adults undergoing cranial or spinal procedures. Several electronic databases were searched for randomized controlled trials on the use of IPC and anticoagulants for thromboembolism prevention in neurosurgical patients, from inception to August 6, 2019. Studies reporting the selected endpoints were included in direct and Bayesian network meta-analyses to estimate the relative effects of the interventions. Overall, our analysis included 18 trials comprising 2474 patients. Both IPC (RR, 0.41; 95% CrI, 0.26-0.60) and chemical prophylaxis (RR, 0.48; 95% CrI, 0.28-0.68) were found to be more efficacious than the placebo in reducing the risk of deep vein thrombosis (DVT). In addition, our analysis also demonstrated that both IPC (RR, 0.10; 95% CrI, 0.01-0.60) and chemical prophylaxis (RR, 0.31; 95% CrI, 0.05-1.00) reduced the risk of pulmonary embolism (PE) significantly more than the placebo. Based on the available evidence of moderate-to-good quality, IPC is equivalent to anticoagulants for thromboprophylaxis in terms of efficacy. Evidence to support or negate the use of pharmacological prophylaxis in terms of safety is lacking. The results of ongoing and future large randomized clinical trials are needed.

Protecting children across borders - child protection in an international context (Germany/Switzerland) as an interprofessional teaching unit

Introduction: Interprofessional collaboration (IPC) in everyday clinical practice is a prerequisite for good patient care but currently this is not sufficiently anchored in the education of health care professionals. Project description: A course on child protection in the interprofessional and international domain was established at the Medical School, University of Freiburg. In this course, students of medicine, nursing science and social work acquire skills for successful interprofessional cooperation. Its participants learn across professional and national borders, not only with but also from and about each other. In this way, they deepen their insights into international IPC through a key topic that is relevant to many disciplines. The course is run as a one-day campus day. This paper presents the course setup and evaluation results. Methods: The evaluation was carried out online and in writing in a before and after format using the Freiburg Questionnaire for Interprofessional Learning Evaluation (FILE) in addition to oral feedback. Learning objectives for IPC and child protection were formulated and the participants were asked about their subjective achievements. Results: From summer semester (SuSe) 2017 to SuSe 2018, 39 participants took part in the course. It was rated as m=1.5 (using German school grades where 1=very good, 6=unsatisfactory). In 18 of the 26 FILE items, participants report a self-assessed increase in knowledge or skills/abilities. This growth in learning coincides with the learning objectives set. Discussion & conclusion: From the perspective of the participants, the course teaches interprofessional competencies in an international setting and is seen as an informative course offer. The continuation or expansion of such courses as a supplement to purely single-country interprofessional courses is desirable.

Characterization of neurogenic niches in the telencephalon of juvenile and adult sharks

Neurogenesis is a multistep process by which progenitor cells become terminally differentiated neurons. Adult neurogenesis has gathered increasing interest with the aim of developing new cell-based treatments for neurodegenerative diseases in humans. Active sites of adult neurogenesis exist from fish to mammals, although in the adult mammalian brain the number and extension of neurogenic areas is considerably reduced in comparison to non-mammalian vertebrates and they become mostly reduced to the telencephalon. Much of our understanding in this field is based in studies on mammals and zebrafish, a modern bony fish. The use of the cartilaginous fish Scyliorhinus canicula (representative of basal gnathostomes) as a model expands the comparative framework to a species that shows highly neurogenic activity in the adult brain. In this work, we studied the proliferation pattern in the telencephalon of juvenile and adult specimens of S. canicula using antibodies against the proliferation marker proliferating cell nuclear antigen (PCNA). We have characterized proliferating niches using stem cell markers (Sex determining region Y-box 2), glial markers (glial fibrillary acidic protein, brain lipid binding protein and glutamine synthase), intermediate progenitor cell markers (Dlx2 and Tbr2) and markers for migrating neuroblasts (Doublecortin). Based in the expression pattern of these markers, we demonstrate the existence of different cell subtypes within the PCNA immunoreactive zones including non-glial stem cells, glial progenitors, intermediate progenitor-like cells and migratory neuroblasts, which were widely distributed in the ventricular zone of the pallium, suggesting that the main progenitor types that constitute the neurogenic niche in mammals are already present in cartilaginous fishes.

Endogenous BMP-4/ROS/COX-2 Mediated IPC and Resveratrol Alleviated Brain Damage

The objective of the study was to examine the therapeutic role of combined ischemic preconditioning (IPC) and resveratrol (RES) on brain ischemia/reperfusion injury (BI/RI) by modulating endogenous bone morphogenetic protein-4 (BMP-4)/reactive oxygen species (ROS)/cyclooxygenase-2 (COX-2) in rats. Sprague Dawley (SD) rats were pretreated with 20 mg/kg RES (20 mg/kg RES was administered once a day via intraperitoneal injection 7 days prior to the I/R procedure) and IPC (equal volumes of saline were administered once a day by intraperitoneal injection over 7 days, and the bilateral common carotid arteries were separated for clamp 5 minutes followed by 5 minutes of reperfusion prior to the I/R procedure), and then subjected to 2 hours of ischemia and 22 hours of reperfusion. Blood and cerebral tissues were collected, cerebral pathological injuries and infarct sizes were investigated, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were measured, the activities of superoxide dismutase (SOD) and ROS were calculated, the contents of methane dicarboxylic aldehyde (MDA), IL-6, TNF-α and hemodynamic change were estimated, and expression levels of b-cell lymphoma-2 (Bcl-2), bcl-2-associated x (Bax), BMP-4 and COX-2 were assessed in cerebral tissues. IPC, RES and a combination of IPC and RES preconditioning ameliorated the pathological damage and infarct sizes, reduced cerebral oxidative stress damage, alleviated inflammatory damage, restrained apoptosis, and downregulated the expression levels of BMP-4 and COX-2 compared with those of the ischemia/reperfusion (I/R) group. This study suggested a combined strategy that could enhance protection against BI/RI in clinical brain disease.

Fundc1-dependent mitophagy is obligatory to ischemic preconditioning-conferred renoprotection in ischemic AKI via suppression of Drp1-mediated mitochondrial fission

FUN14 domain-containing protein 1 (Fundc1)-dependent mitophagy, mainly activated by ischemic/hypoxic preconditioning, benefits acute myocardial reperfusion injury and chronic metabolic syndrome via sustaining mitochondrial homeostasis. Mitochondrial fission plays a pathogenic role in ischemic acute kidney injury (AKI) through perturbation of mitochondrial quality and activation of mitochondrial apoptosis. The aim of our study was to explore the role of Fundc1 mitophagy in ischemia preconditioning (IPC)-mediated renoprotection. Proximal tubule-specific Fundc1 knockout (Fundc1^PTKO) mice were subjected to ischemia reperfusion injury (IRI) and IPC prior to assessment of renal function, mitophagy, mitochondrial quality control, and Drp1-related mitochondrial fission. Following exposure to IPC, Fundc1 mitophagy was activated through post-transcriptional phosphorylation at Ser17. Interestingly, IRI-mediated renal injury, inflammation, and tubule cell death were mitigated by IPC whereas proximal tubule-specific Fundc1 knockout (Fundc1PTKO) mice abolished IPC-offered renoprotection. Mechanistically, IRI-evoked mitochondrial damage was improved by IPC whereas Fundc1 deficiency provoked mitochondrial abnormality, manifested by impaired mitochondrial quality and hyperactivated Drp1-dependent mitochondrial fission. Interestingly, Fundc1 deficiency-associated mitochondrial dysfunction was reversed by pharmacological inhibition of mitochondrial fission. In vivo, Fundc1 deletion-caused renal injury, severe pro-inflammatory response, and tubule cell death could be nullified by way of knockout Drp1 on Fundc1PTKO background. Finally, we also revealed that IPC triggered Fundc1 mitophagy activation through UNC-51-like kinase 1 (Ulk1) and Ulk1 ablation interrupted IPC-mediated Fundc1 activation and thus attenuated IPC-induced renoprotection. Fundc1 mitophagy, primarily driven by IPC, confers resistance to AKI through reconciliation of mitochondrial fission, implicating the therapeutic potential of targeting mitochondrial homeostasis for AKI.

Impact of 8 weeks of repeated ischemic preconditioning on running performance

PURPOSE

To examine if repeated exposure to IPC treatment prior to training sessions improves oxygen uptake and 1-km running performance in highly trained middle-distance runners.

METHODS

Fourteen highly trained endurance runners (11 male/3 female, 19 ± 2 years, 64 ± 5 ml kg^-1 min^-1) completed a baseline maximal oxygen consumption ([Formula: see text]) test and 1-km running performance test before random assignment to an IPC or control group. Both groups were prescribed identical endurance training over an 8-week varsity season; however, the IPC group performed an IPC protocol (5 min ischemia, repeated 3 times, each separated by 5 min reperfusion) before every training session. After 8 weeks of training, participants completed a follow-up [Formula: see text] test and 1-km time trial.

RESULTS

[Formula: see text] did not increase from baseline in either group following the 8-week training bout (P = 0.2), and neither group varied more than the other ([Formula: see text] = IPC 0.6 ± 2 ml kg^-1 min^-1; control 1.5 ± 2 ml kg^-1 min^-1, P = 0.6) or beyond typical measurement error. The IPC decreased 1-km time trial time by 0.4% (0.5 ± 2 s), while the control group decreased by 1% (1.5 ± 3 s), but neither change was significant compared to baseline (P = 0.2). There was also no difference in time trial improvement between IPC and control (P = 0.6). However, there was a trend towards IPC significantly improving running economy at low intensity (P = 0.057).

CONCLUSION

Our data suggest that over a normal 8-week season in a population of highly trained middle-distance runners there is no benefit of undergoing chronic, repeated IPC treatments before training for augmenting maximal aerobic power or 1-km performance time.

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

BACKGROUND

Venous thromboembolism (VTE) is a complication following surgery. Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are efficacious but come with inherent bleeding risk. Mechanical prophylaxis, such as intermittent pneumatic compression (IPC), does not induce bleeding but may be difficult to implement beyond the immediate post-operative period. This study compared the cost and quality-adjusted life years (QALYs) saved of commonly used VTE prophylaxis regimens after lower limb arthroplasty.

METHODS

A previously published cost-utility model considering major efficacy and safety endpoints was updated to estimate the 1-year cost-effectiveness of different VTE prophylaxis regimens. The VTE strategies assessed included apixaban, dabigatran, rivaroxaban, LMWH, IPC, IPC + LMWH and IPC + apixaban. Efficacy data were derived from studies in PubMed, and cost data came from the 2017 Australian AR-DRG and PBS pricing schemes.

RESULTS

Costs for VTE prophylaxis including treatment of its associated complications over the first year after surgery ranged from AUD $644 (IPC) to AUD $956 (rivaroxaban). Across 500 simulations, IPC was the cheapest measure in 73% of simulations. In 97% of simulations, a DOAC was associated with the highest resulting QALYs. Compared to IPC, apixaban was cost-effective in 76.4% of simulations and apixaban + IPC in 87.8% of simulations. For VTE events avoided, the DOACs and IPC were on par. LMWH and LMWH + IPC were negatively dominated.

CONCLUSIONS

Apixaban, IPC or a sequential/simultaneous combination of both is currently the most cost-effective VTE prophylaxis regimens. The choice between them is best guided by the relative VTE and bleeding risks of individual patients.

Intermittent pneumatic compression is a cost-effective method of orthopedic postsurgical venous thromboembolism prophylaxis

Background

Venous thromboembolism (VTE) is a major complication after lower-limb arthroplasty that increases costs and reduces patient’s quality of life. Using anticoagulants for 10–35 days following arthroplasty is the standard prophylaxis, but its cost-effectiveness after accounting for bleeding complications remains unproven.

Methods

A comprehensive, clinical model of VTE was created using the incidences, clinical effects (including bleeding), and costs of VTE and prophylaxis from randomized controlled trials, meta-analyses, and large observational studies. Over 50 years, the total health care costs and clinical impact of three prophylaxis strategies, that are as follows, were compared: low-molecular-weight heparin (LMWH) alone, intermittent pneumatic compression (IPC), and IPC with LMWH (IPC+LMWH). The cost per VTE event that was avoided and cost per quality-adjusted life year (QALY) gained in both the US and Australian health care settings were calculated.

Results

For every 2,000 patients, the expected number of VTE and major bleeding events with LMWH were 151 and 6 in the USA and 160 and 46 in Australia, resulting in a mean of 11.3 and 9.1 QALYs per patient, respectively. IPC reduced the expected VTE events by 11 and 8 in the USA and Australia, respectively, compared to using LMWH alone. IPC reduced major bleeding events compared to LMWH, preventing 1 event in the US and 7 in Australia. IPC+LMWH only reduced VTE events. Neither intervention substantially impacted QALYs but both increased QALYs versus LMWH. IPC was cost-effective followed by IPC+LMWH.

Conclusion

IPC and IPC+LMWH are cost-effective versus LMWH after lower-limb arthroplasty in the USA and Australia. The choice between IPC and IPC+LMWH depends on expected bleeding risks.

Enhancing Ebola Virus Disease Surveillance and Prevention in Counties Without Confirmed Cases in Rural Liberia: Experiences from Sinoe County During the Flare-up in Monrovia, April to June, 2016

Introduction:

During the flare-ups of Ebola virus disease (EVD) in Liberia, Sinoe County reactivated the multi-sectorial EVD control strategy in order to be ready to respond to the eventual reintroduction of cases. This paper describes the impacts of the interventions implemented in Sinoe County during the last flare-up in Monrovia, from April 1 to June 9, 2016, using the resources provided during the original outbreak that ended a year ago.

Methods:

We conducted a descriptive study to describe the key interventions implemented in Sinoe County, the capacity available, the implications for the reactivation of the multi-sectoral EVD control strategy, and the results of the same. We also conducted a cross-sectional study to analyze the impact of the interventions on the surveillance and on infection prevention and control (IPC).

Results:

The attrition of the staff trained during the original outbreak was low, and most of the supplies, equipment, and infrastructure from the original outbreak remained available. With an additional USD 1755, improvements were observed in the IPC indicators of triage, which increased from a mean of 60% at the first assessment to 77% (P=0.002). Additionally, personnel/staff training improved from 78% to 89% (P=0.04). The percentage of EVD death alerts per expected deaths investigated increased from 26% to 63% (P<0.0001).

Discussion:

The low attrition of the trained staff and the availability of most supplies, equipment, and infrastructure made the reactivation of the multi-sectoral EVD control strategy fast and affordable. The improvement of the EVD surveillance was possibly affected by the community engagement activities, awareness and mentoring of the health workers, and improved availability of clinicians in the facilities during the flare-up. The community engagement may contribute to the report of community-based events, specifically community deaths. The mentoring of the staff during the supportive supervisions also contributed to improve the IPC indicators.

Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial

Background

School-aged children are rarely targeted by malaria control programmes, yet the prevalence of Plasmodium infection in primary school children often exceeds that seen in younger children and could affect haemoglobin concentration and school performance.

Methods

A cluster-randomised trial was carried out in 80 primary schools in southern Mali to evaluate the impact of a school-based malaria intervention package. Intervention schools received two interventions sequentially: (1) teacher-led participatory malaria prevention education, combined with distribution of long-lasting insecticidal nets (LLINs), followed 7 months later at the end of the transmission season by (2) mass delivery of artesunate and sulfadoxine-pyrimethamine administered by teachers, termed intermittent parasite clearance in schools (IPCs). Control schools received LLINs as part of the national universal net distribution programme. The impact of the interventions on malaria and anaemia was evaluated over 20 months using cross-sectional surveys in a random subset of 38 schools(all classes), with a range of cognitive measures (sustained attention, visual search, numeracy, vocabulary and writing) assessed in a longitudinal cohort of children aged 9–12 years in all 80 schools.

Results

Delivery of a single round of IPCs was associated with dramatic reductions in malaria parasitaemia (OR 0.005, 95% CI 0.002 to 0.011, p<0.001) and gametocyte carriage (OR 0.02, 95% CI 0.00 to 0.17, p<0.001) in intervention compared with control schools. This effect was sustained for 6 months until the beginning of the next transmission season. IPCs was also associated with a significant decrease in anaemia (OR 0.56, 95% CI 0.40 to 0.78, p=0.001), and increase in sustained attention (difference +0.23, 95% CI 0.10 to 0.36, p<0.001). There was no evidence of impact on other cognitive measures.

Conclusion

The combination of malaria prevention education, LLINs and IPCs can reduce anaemia and improve sustained attention of school children in areas of highly seasonal transmission. These findings highlight the impact of asymptomatic malaria infection on cognitive performance in schoolchildren and the benefit of IPCs in reducing this burden. Additionally, malaria control in schools can help diminish the infectious reservoir that sustains Plasmodium transmission.

A randomized controlled trial comparing indwelling pleural catheters with talc pleurodesis (NVALT-14)

BACKGROUND

Symptomatic malignant pleural effusion (MPE) occurs frequently in patients with metastatic cancer. The associated prognosis is poor and the success rate of talc pleurodesis (TP) is low. Indwelling pleural catheters (IPCs) are commonly inserted when TP has been unsuccessful.

METHODS

We compared talc pleurodesis with the use of an indwelling pleural catheter in patients with recurrent MPE in a multicenter randomized controlled trial (superiority design). The primary endpoint was improvement from baseline in Modified Borg Score (MBS) 6weeks after randomized treatment. Secondary endpoints were hospitalization days, re-interventions, and adverse events.

RESULTS

Dyspnea improved significantly (p<0.01) after either treatment, but the magnitude of this improvement did not differ significantly between arms (median 3 and 1 for TP:IPC respectively in rest, p=0.16, (TP 13:IPC 16) and 3 and 1 during exercise, p=0.72 (TP 13:IPC 17)). There was no difference in dyspnea during exercise between TP and IPC at week 6 following treatment, while at rest TP patients (n=13) reported less dyspnea than IPC patients (n=18) (median 0 vs 1, p=0.002). Compared to TP, patients with an IPC had significantly less hospital days during randomized treatment (median: 0 vs 5, p<0.0001), and total hospitalizations for all causes (median: 1.6 vs 1.0, p=0.0035). Fewer IPC patients underwent more than one re-intervention (7/45 vs 15/43, p=0.09). The mean number of re-interventions was lower following IPC (0.21 vs 0.53, p=0.05). Equal number of adverse events occurred.

CONCLUSIONS

IPC was not superior in the primary endpoint, improvement of the modified Borg scale (MBS). However, IPC patients had lower hospital stay, fewer admissions and fewer re-interventions. The IPC is an effective treatment modality in patients with symptomatic malignant pleural effusion.

Intellectual assets management and transfer in food science sector in Indian research and development organizations

In recent years, the food science sector has gained importance since the society is focusing on high-quality and safety foods. With a specific end goal to meet this societal need, the research and development organizations in India have adopted innovative technical and research processes, which gave more accentuation on intellectual assessment in food processing industry. The global Intellectual Property regime in food science sector had witnessed an increment in the number of patents filed and granted during 2006-2010. Ever since there has been a gradual increase in the number of patents applied mainly in food processing industries by research organizations related to food sciences, for example, those working under the aegis of ICAR and CSIR in India. In this study, a review has been done on the intellectual assets generated by ICAR and other national research organizations in India, in the food science sector. Emphasis has been given on the global relevance of these assets, modes of IP protection and technology transfer mechanisms followed by different public and private organizations.

A Review of the CDC Recommendations for Prevention of HAIs in Outpatient Settings

According to the Centers for Disease Control and Prevention (CDC), most health care-associated infections (HAIs) are caused by contamination from the hands of health care providers or patients, contamination from the environment, and contamination from the patient's own skin. To mitigate common sources of infection transmission, frontline health care providers must be compliant with basic infection-prevention interventions, including hand hygiene, environmental cleaning and disinfection, safe injection practices, and designation of a trained health care professional to be responsible for the infection prevention and control program. Integration of CDC recommendations should incorporate a bundled approach to these interventions and should be part of a comprehensive approach to infection prevention and control. Effective infection-prevention practices in outpatient settings are critical for reducing the risk of infection transmission, improving patient safety and patient outcomes, and reducing costs associated with health care delivery.