Pilot randomized experimental study evaluating isopropyl alcohol and ultraviolet-C radiation in the disinfection of healthcare workers' smartphones

BACKGROUND

Smartphones in medical settings pose infection risks due to harbouring pathogenic bacteria.

AIM

This pilot study assessed the effectiveness duration of sanitization methods, focusing on 70% isopropyl alcohol wipes and ultraviolet-C (UVC) boxes, aiming to obtain preliminary data on the reduction in total bacterial load 3 h post-sanitization.

METHODS

A randomized monocentric trial with two intervention arms (wipes and UVC boxes) was designed. As participants, healthcare workers from three wards at Fondazione Policlinico Universitario 'A. Gemelli' IRCCS Hospital were recruited, stratified by ward, and block randomized within each ward to control confounders.

FINDINGS

Seventy-one healthcare workers, mostly nurses (62%) were included in the study. Initial bacterial load reduction was significant with both disinfection techniques, but after 3 h both methods showed increased bacterial levels, with wipes displaying potentially higher residual efficacy (P=0.056). To adequately size a trial (89% power, significance level 0.05) for assessing the residual efficacy of alcohol-impregnated wipes compared with UVC boxes at 3 h post-sanitization, 503 professionals per group were required.

CONCLUSION

This study highlights the necessity for guidelines on hospital smartphone sanitization and educational initiatives for healthcare workers and patients. Further studies, adequately sized, are necessary to determine optimal sanitization intervals and assess pathogen transmission risks.

[Anaesthesia, a process common to all living organisms]

Because of their interest in medicine, most studies of anaesthesia focus on the nervous system of metazoans, and the fact that any life form can be anaesthetised is often underlooked. If electrical signalling is an essential phenomenon for the success of animals, it appears to be widespread beyond metazoans. Indeed, anaesthesia targets Na+/Ca2+ voltage-gated channels that exist in a wide variety of species and originate from ancestral channels that predate eukaryotes in the course of evolution. The fact that the anaesthetic capacity that leads to loss of sensitivity is common to all phyla may lead to two hypotheses: to be investigated is the evolutionary maintenance of the ability to be anaesthetised due to an adaptive advantage or to a simple intrinsic defect in ion channels? The study of anaesthesia in organisms phylogenetically distant from animals opens up promising prospects for the discovery of new anaesthetic treatments. Moreover, it should also lead to a better understanding of a still poorly understood phenomenon that yet unifies all living organisms. We hope that this new understanding of the unity of life will help humans to assume their responsibilities towards all species, at a time when we are threatening biodiversity with mass extinction.

Impact of a multidisciplinary intervention on Mediterranean diet adherence and cardiovascular health

Background

Cardiovascular diseases represent a significant public health issue, and the promotion of healthy lifestyles plays a major role in their prevention. Good adherence to the Mediterranean diet has a protective effect on cardiovascular health and may reduce the risk of developing cardiovascular disease. Our prospective study aimed to evaluate the impact of educational lifestyle interventions on cardiovascular risk parameters and the improvement in adherence to the Mediterranean diet of the involved population.

Methods

Participants have been recruited by General Practitioners in Torresina neighborhood in Rome. From December 2018 to June 2020, 41 patients were involved in nutritional, psychological, and physical activity meetings by a multidisciplinary team of healthcare professionals. In particular, a nutritionist provided information to patients on balanced nutrition, considering the Mediterranean diet as a dietary model. Information on lifestyle, dietary habits and physical activity, anthropometric data and laboratory measurements were collected at baseline and after 12 months. The variations of the evaluated parameters were analyzed by paired t-test e Wilcoxon signed-rank test.

Results

The analysis showed statistically significant decreases in weight (p = 0.03) and BMI (p = 0.02), as well as in systolic (p < 0.001) and diastolic (p = 0.001) blood pressure and in total (p = 0.02) and LDL (p = 0.01) cholesterol level. Results also showed an improvement in the adherence to the Mediterranean diet (p = 0.001): the frequency of consumption of fruits and vegetables, legumes, cereals and fish has increased significantly, while the consumption of meat, milk and dairy products and alcohol decreased.

Conclusions

This study highlights that a multidisciplinary educational program can be effective in improving healthy habits and in reducing cardiovascular risk factors, supporting its implementation in primary prevention at the community level.

Key messages

• Promoting healthy lifestyle through primary prevention and health promotion actions is critical to reduce the onset of cardiovascular diseases.

• A population-based multidisciplinary educational intervention may be effective in improving adherence to a healthy, balanced diet and decreasing cardiovascular risk factors.

Flu shot in the era of COVID-19 vaccination: findings from a research hospital of Rome

 

Influenza represents a major burden for public health. Healthcare workers (HCWs) are a priority target group for flu vaccination. During the COVID-19 pandemic, when SARS-CoV-2 vaccines were not yet available, susceptibility to influenza vaccination especially by HCWs increased. The aim of this study is to analyze the flu vaccination coverage among HCWs and to study which factors affected their adherence given the concomitant COVID-19 vaccination. The retrospective study was conducted in an Italian research hospital from October 2021 to January 2022. A total of 7,048 individuals was included. Age class, gender and job category variables were analyzed. Statistically significant differences among groups were tested through χ2 test. Univariate and multivariate analyses (p < 0,005) were performed to assess differences towards vaccination attitude. The flu vaccination coverage rate was 24.6%. Among the selected job categories, 29.8% of physicians, 19.9% of nurses and 19.7% of other HCWs were vaccinated with a statistically significant decrease (p < 0.001) across all categories respect with the last campaign. The findings of the logistic regression depicted that the 40-59 years old age class, compared with the youngest age class (OR 1.30, 95% CI 1.12-1.43) as well as being physician (OR 2.79, 95% CI 1.87-3.41) with the respect to being nurses, had a higher adherence to vaccination. Interestingly, being male, is associated with a statistically significant reduction (OR 0.71, 95% CI 0.59-0.87) in vaccination uptake. Study findings showed a several decline in the flu vaccination coverage comparing with previous campaigns, probably due to the concomitant administration of the booster dose against SARS-CoV-2. This alarm should not be underestimated and requires timely and innovative organizational approaches (i.e., combined vaccine). Further studies are needed to analyze the reasons for this poor adhesion and the strategies to be adopted to increase the awareness of the HCWs.

Key messages

• Reaching high coverage rates and restore a positive trend for the future campaign for flu vaccination it is essential strategy to protect HCWs themselves, their patients and the hospital community.

• Decision-makers should implement consistent communication strategies to lessen vaccine hesitancy among HCWs.

An interdisciplinary intervention for health prevention and promotion in a Roman neighborhood

 

Influencing behavioral patterns through primary prevention, possibly addressing more risk factors at a time, is the most effective means to tackle cardiovascular diseases. Many interdisciplinary prevention activities have been coordinated by community nurses outside of specialist centers, resulting in a more effective control of risk factors. Our study aims at describing the impact of an 18-month prevention and promotion, interdisciplinary intervention on lifestyle habits and cardiovascular risk. From December 2018 to May 2020, patients were recruited by 4 General Practitioners (GPs) in the Roman neighborhood of Torresina and received nutritional, physical and psychological counselling to learn healthy lifestyles. Until May 2020 patients had to self-manage their new healthy habits, but during this phase the SARS-CoV-2 pandemic broke out. Patients were assessed at baseline, 6, 12 and 18 months by a nutritionist, a physiotherapist, a psychologist, the 4 GPs and community nurses, and the cardiovascular risk score (CRS) was estimated at every examination. 76 patients were included, with a mean age of 54,6 years. Mean CRS showed a significant reduction between baseline and 12 months (from 4.9 to 3.8, p < 0.001), but this trend was not maintained at 18 months. As for variables included in the calculation of the cardiovascular risk score, both total cholesterol and systolic blood pressure significantly decreased at 6 months of follow up (respectively, from 211.1 to 192 (p < 0.001) and from 133.1 to 123.1(p < 0.001)). Nontheless, the reduction was maintained in the remaining points in time only for systolic blood pressure. Our interdisciplinary educational intervention in a primary care setting resulted in a CRS improvement at 12 months, but this changes where not maintained at 18 months. Community nurses were facilitators in improving health outcomes and patient's satisfaction in the described primary care setting.

Key messages

Impact of COVID-19 on flu vaccination among pregnant women in a Teaching Hospital in Rome

Background

According to WHO, UNICEF, GAVI and the Sabin Vaccine Institute data, the COVID-19 pandemic caused the disruption of routine vaccinations in at least 68 countries. In March ‘20, the WHO published a guide to help countries continuing their provision safely to prevent unnecessary visits and hospitalizations: especially flu vaccination is paramount to reduce respiratory illnesses and their burden on healthcare systems. For the flu season 2021-22, the Italian Ministry of Health recommended prioritizing flu vaccination for pregnant women. This study aims at comparing flu vaccination rates between pre-pandemic and pandemic periods in pregnant women attending a birthing preparation course at the Fondazione Policlinico Universitario A.Gemelli IRCCS (FPG) in Rome.

Methods

A repeated cross-sectional study was carried out in FPG during two flu epidemic seasons (October ‘19-January ‘20 and September ‘20-January ‘21), when two different cycles of birthing preparation courses were held (face-to-face and online, respectively). Pregnant women and their partners attending them were offered flu vaccination at FPG. A χ2 test was performed to compare vaccination rates, with statistical significance set at p = 0.05.

Results

In 2019-20, 48 out of 119 women and 39 men out of 119 attending the course accepted flu vaccination, while in 2020-21 they were respectively 88 out of 317 and 89 out of 317. Overall vaccination compliance among pregnant women was significantly higher in 2019-20 than in 2020-21 (40.3% and 27.8% respectively, p = 0.012), while the difference was not significant among their partners (32.8% and 28.1% respectively, p = 0.337).

Conclusions

The COVID-19 pandemic negatively affected flu vaccination adherence among the pregnant women involved. Fear of contagion and access to facilities closer to their home could be potential key drivers. These results represent an important warning on flu vaccination attitudes during the pandemic: more actions are needed to improve compliance.

Key messages

• COVID-19 might have hindered access to immunization services for at-risk populations, such as that of pregnant women.

• From a Public Health point of view, more actions are needed to harmonize interactions between hospitals and local national health services to improve vaccination compliance.

Coevolution of the olfactory organ and its receptor repertoire in ray-finned fishes

Background

Ray-finned fishes (Actinopterygii) perceive their environment through a range of sensory modalities, including olfaction. Anatomical diversity of the olfactory organ suggests that olfaction is differentially important among species. To explore this topic, we studied the evolutionary dynamics of the four main gene families (OR, TAAR, ORA/VR1 and OlfC/VR2) coding for olfactory receptors in 185 species of ray-finned fishes.

Results

The large variation in the number of functional genes, between 28 in the ocean sunfish Mola mola and 1317 in the reedfish Erpetoichthys calabaricus, is the result of parallel expansions and contractions of the four main gene families. Several ancient and independent simplifications of the olfactory organ are associated with massive gene losses. In contrast, Polypteriformes, which have a unique and complex olfactory organ, have almost twice as many olfactory receptor genes as any other ray-finned fish.

Conclusions

We document a functional link between morphology of the olfactory organ and richness of the olfactory receptor repertoire. Further, our results demonstrate that the genomic underpinning of olfaction in ray-finned fishes is heterogeneous and presents a dynamic pattern of evolutionary expansions, simplifications, and reacquisitions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12915-022-01397-x.

Our sisters the plants? notes from phylogenetics and botany on plant kinship blindness

Before the upheaval brought about by phylogenetic classification, classical taxonomy separated living beings into two distinct kingdoms, animals and plants. Rooted in 'naturalist' cosmology, Western science has built its theoretical apparatus on this dichotomy mostly based on ancient Aristotelian ideas. Nowadays, despite the adoption of the Darwinian paradigm that unifies living organisms as a kinship, the concept of the "scale of beings" continues to structure our analysis and understanding of living species. Our aim is to combine developments in phylogeny, recent advances in biology, and renewed interest in plant agency to craft an interdisciplinary stance on the living realm. The lines at the origin of plant or animal have a common evolutionary history dating back to about 3.9 Ga, separating only 1.6 Ga ago. From a phylogenetic perspective of living species history, plants and animals belong to sister groups. With recent data related to the field of Plant Neurobiology, our aim is to discuss some socio-cultural obstacles, mainly in Western naturalist epistemology, that have prevented the integration of living organisms as relatives, while suggesting a few avenues inspired by practices principally from other ontologies that could help overcome these obstacles and build bridges between different ways of connecting to life.

From infections to preventive actions monitoring in health facilities: an experience on MDROs

 

Healthcare-Associated Infections (HAIs) and Antimicrobial Resistance (AMR) involve high costs both in health and economic terms for patients and health systems. Implementing Infection Prevention and Control (IPC) programs is critical to decrease infectious agents' transmission in healthcare settings. The aim of this study is to assess if the monitoring of Contact Precautions could decrease the incidence of Multi-Drug Resistant Organisms (MRDOs) infections. This pilot study was conducted in a teaching hospital in Rome. A checklist of 16 items was developed to assess the compliance to Contact Precautions in 11 hospital wards in which MRDOs were detected between November and December 2020. It was administered on-site both interviewing healthcare professionals and through direct observation. A paired t-test with α = 5% was used to compare the number of alert organisms in the first quarter of 2020 respect to the first quarter of 2021 before and after implementing the surveillance checklist. A total of 30 checklists were analyzed. The rate of compliance to Contact Precautions was high for the proper use of personal protective equipment (100%), the intensified room cleaning (100%) and the presence of isolation mark (100%), while it was low for the active screening of contacts (53%). Mean MDROs infections rate decreased from 4.94 to 4.37 for every 1000 hospitalization day, with an average decrease of 0.57. However, the paired t-test showed that there was no statistically significant difference between the mean number of MDROs infections before and after the implementation of the checklist (p > 0.05). Despite the good adherence to IPC program, the low infection rate decrease, is probably due to the impact of COVID-19 on the HAIs surveillance and prevention practices. Even if the check-list administration could be a useful tool to reduce MDROs infections, it should be associated to other prevention strategies during the COVID-19 pandemic in order to achieve a successful outcome.

Key messages

Preventing Healthcare-Associated Infections represents a priority public health challenge in order to improve patient safety and health system economic sustainability.

The COVID-19 pandemic has shown that healthcare facilities should enhance efforts in their IPC programs to reduce Healthcare-Associated Infections.

Machine learning and COVID-19: a tool for healthcare setting choice by primary care physicians

Background

Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. Machine learning provides science-based tools that can be used for clinical decision-making which have already been applied to the fight against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) both in the therapeutic and the prevention area. The aim of this study was to develop a machine learning-based tool to support primary care physicians to decide between home monitoring and hospitalization for their patients before diagnostic test results are available.

Methods

A retrospective cohort study with data from a hospital setting was performed. Patients' medical history and clinical, laboratory and radiological findings were collected and the dataset was used to train a predictive model for COVID-19 severity. The patients were divided between confirmed and suspect cases on the basis of the positivity of the nasopharyngeal RT-PCR test results. A splitting algorithm was recursively used to choose the predictor. A decision tree was built.

Results

A total of 198 subjects were enrolled for the study. Out of them, 28 cases were classified as mild disease, 62 as moderate disease, 64 as severe disease, and 44 as critical disease, according to WHO guidelines. The G2 value was used to determine the contribution of each obtained value to build the decision tree. The tree was, therefore, built choosing values that maximized G2 and LogWorth. SpO2 (cut point = 92%) was chosen for the optimal first split. The correspondence between inputs and outcomes was validated.

Conclusions

Our tool provides accurate clinical severity prediction for both confirmed and suspect COVID-19 patients. We, therefore, propose its implementation in the everyday life challenges of primary care physicians to support their clinical decision-making in providing appropriate and timely care for their patients.

Key messages

Primary care physicians have a crucial role in determining the appropriate healthcare setting for their confirmed or suspect COVID-19 patients. We propose a tool that provides an accurate clinical severity prediction for both confirmed and suspect COVID-19 patients to help choosing the appropriate healthcare setting for them.

Flu vaccination during COVID-19 pandemic: a lesson from an Italian teaching hospital

 

Influenza is an acute viral respiratory infection that causes significant morbidity and mortality worldwide, with indirect costs considerably exceeding direct costs on patients and society. Flu vaccination is one of the major strategies for preventing it, especially among healthcare workers (HCWs), to avoid onward transmission to patients and colleagues. The aim of this research is to analyze the flu vaccination coverage rate among HCWs and to study which factors conditioned their adherence. The observational study was conducted in an Italian teaching hospital located in Rome (Italy) and data were collected from October to December 2020. A total of 6,568 HCWs was included considering physicians, nurses and other HCWs as job categories. Age class, gender and job category variables were analyzed. Statistically significant differences among groups were tested through χ2 test. Univariate analyses and a multivariate logistic regression (p &lt; 0.05) were performed to assess differences in flu vaccination adherence. The flu vaccination coverage rate was 60.94%. Considering the job categories, physicians reached the highest coverage (76.09%) followed by others HCWs (64.25%) and nurses (49.09%). According to the logistic regression, belonging to 20-40 age class was significantly associated with higher flu vaccination adherence, as well as being nurses (OR 0.26, 95% CI 0.22-0.31) or other HCWs (OR 0.48, 95% CI 0.40-0.58). Findings showed an encouraging vaccination coverage rate among HCWs. Deeper knowledge of the value of vaccination among younger HCWs could be probably a reason for higher adherence as well as the wrong perception of being at low risk of illness or transmitting infections may explains job categories differences. Especially when considering the disrupting impact of the SARS-CoV-2 pandemic, an improved attitude towards flu vaccination would reduce stress on hospitals and preserve scarce medical resources.

Key messages

Reaching high coverage rates for flu vaccination could save healthcare resources. It is crucial to preserve this positive trend for the future years by spreading the message to all the involved stakeholders.

Covid-19 vaccination in a teaching hospital in Rome: preliminary results from a retrospective study

 

Healthcare workers (HCWs) are on the frontline fight against the ongoing pandemic with an increased risk of infection from COVID-19. As of December 27, 2020, approximately 89,879 COVID-19 cases had been reported among HCWs in Italy. Vaccination plans recommend that initial supplies of COVID-19 vaccine be allocated to HCWs because their early protection is crucial to preserve capacity to care for patients. The aim of this study is threefold: to investigate the factors influencing the likelihood towards vaccination, to estimate the vaccine efficacy (VE) in a hospital setting and to assess the frequency of adverse reactions (AR). This retrospective study was conducted in an Italian teaching hospital from December 28, 2020 to March 31, 2021 (before the introduction of mandatory vaccination for HCWs). A total of 6,649 individuals was included. HCWs were divided into physicians, nurses and other HCWs. Univariate analyses and a multivariate logistic regression were run with an alpha of 0.05. VE was estimated as the proportionate reduction in disease attack rate between the unvaccinated and vaccinated. Out of 6,649 HCWs, 5,162 were fully vaccinated against COVID-19. Among the selected job categories, 82% of physicians, 79% of nurses and 68% of other HCWs were vaccinated. The findings of the logistic regression depicted that the 41-60 years old age class, compared with the youngest age class, was statistically significant (OR 1.17, 95% CI 1.03-1.33) in influencing vaccination, as well as being nurses (OR 0.80, 95% CI 0.69-0.92) or other HCWs (OR 0.45, 95% CI 0.39-0.52) in comparison with physicians. VE equaled 92.83% (p &lt; 0.05). The frequency of serious and not serious AR was 0.03% and 2.9%, respectively. Sustaining and boosting COVID-19 vaccination campaigns is effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination among HCWs is a critical public health measure to safeguard HCWs themselves, patients and the hospital community.

Key messages

In light of the encouraging efficacy and safety of COVID-19 vaccination, it represents an essential strategy to protect HCWs themselves, their patients and the hospital community. Despite the introduction of mandatory vaccination, policy-makers should set up tailored strategies of clear communication to reduce reluctancy to vaccination among HCWs.

Italian health workers’ knowledge, attitudes and behaviours towards COVID-19 vaccination

Background

Vaccine hesitancy is the reluctance or refusal to be vaccinated. While it has been widely studied for various contagious diseases, there is still a lack of knowledge about this phenomenon for COVID-19, especially if health workers' hesitancy is considered.

Methods

An extensive review of the literature was conducted to identify the main determinants of vaccine hesitancy in health workers, as well as to find already validated surveys to evaluate the knowledge, attitudes and behaviors (KAB) of health workers towards vaccination, both in general and with specific regard to COVID-19. Building on the available information, a new survey was developed to assess the KAB of Italian health care workers towards COVID-19 vaccination after validation with a pilot study in a diverse sample of 30 Italian health workers.

Results

A new survey was validated to assess the KAB of health workers towards COVID-19 vaccination in Italian health workers. The survey requires about 6 minutes to complete and is composed of 30 questions, investigating different domains: socio-demographic and professional characteristics (6); health status (2); attitudes (11); behaviors (6); knowledge (4). The survey will be administered to a representative sample of at least 385 Italian health workers through the web platform SurveyMonkey in the period June-September 2021. Preliminary results will be available by the end of October 2021.

Conclusions

By analyzing KAB towards COVID-19 vaccination with a new tool, the magnitude and determinants of health worker's COVID-19 vaccine hesitancy will be evaluated to understand how to improve health workers' perception towards COVID-19 vaccination and, consequently, foster their positive influence on the general population.

Key messages

We explore the knowledge, attitudes and behaviors towards COVID-19 vaccination in all categories of health workers operating on the Italian territory to understand the reasons of vaccine hesitancy.

Understanding the determinants of COVID-19 vaccine hesitancy in Italian health workers is necessary given their influence on the perception of the general population in Italy.

The Clean Care Contest: promoting hand hygiene among healthcare and medical students

INTRODUCTION

Despite continuing efforts, compliance rates and knowledge of best practices in hand hygiene remain disappointing. Recognizing that conventional educational tools seem out of touch with young people and that the med and messages contents need refreshing, the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health devised a novel approach to promote the creation of innovative educational tools for improving knowledge of, and compliance with, hand hygiene rules among healthcare and medical students.

METHODS

A contest in creating educational material on hand hygiene practices involved university students of nursing and medicine, and of other healthcare degrees. Students from the universities of the GISIO network were invited to create educational material (e.g., videos, posters, presentations, leaflets, and screensavers) to be presented by May 5th 2019 during the World Hand Hygiene Day / Save Lives: Clean Your Hands Global Annual Initiative of the World Health Organization). A local and a national winners were awarded.

RESULTS

Three different local and national contests were performed during 2016, 2017 and 2018. During the three-year period, more than 270 educational tools have been developed: 130 (48%) were judged useful for hand hygiene promotion campaigns. The most frequent projects participating in the contests were videos (39%), posters (29%), leaflets (14%), and others (18%) submitted by more than 1,500 students of nursing (40%), medicine (31%), dentistry (7%), and of other healthcare courses in 14 universities. Products were evaluated by a local committee and, subsequently, local winners represented their University in a national contest.

CONCLUSIONS

The contest provided a framework for the creation of innovative and potentially effective educational tools via an engaging approach that leveraged student creativity. Given the need to improve compliance rates, this study suggests that new ways can be advantageously explored to teach hand hygiene procedures and increase awareness of the importance of their consistent use among healthcare and medical students.

L'emergenza COVID-19 nell'ottica del finanziamento del Servizio Sanitario Nazionale: analisi e proposte

The COVID-19 pandemic crisis has strongly stressed national health systems and resulted in a global economic crisis. This paper aims to frame and evaluate the funding disbursed and the costs incurred by the National Health Service, in relation to the COVID-19 emergency. It also intends to assess current monetary policies. It aims also to suggest and provide proposals in the context of strengthening the NHS. A narrative review of the grey literature was conducted querying OpenGray, WONDER e Pro-quest's Digital Dissertations e Conference Papers Index and the major institutional websites. The ALTEMS COVID-19 Instant Reports and reports published by regional, national and European institutional bodies were used as main information sources. The discussion begins with the presentation of the economic-health and epidemiological situation, and ends with the proposal of possible initiatives aimed at economic and financial reinforcement of the NHS.

Evolutionary dynamics of the OR gene repertoire in teleost fishes: evidence of an association with changes in olfactory epithelium shape

Teleost fishes perceive their environment through a range of sensory modalities, among which olfaction often plays an important role. Richness of the olfactory repertoire depends on the diversity of receptors coded by homologous genes classified into four families: OR, TAAR, VR1, and VR2. Herein, we focus on the OR gene repertoire. While independent large contractions of the OR gene repertoire associated with ecological transitions have been found in mammals, little is known about the diversity of the OR gene repertoire and its evolution in teleost fishes, a group that includes more than 34,000 living species. We analyzed genomes of 163 species representing diversity in this large group. We found a large range of variation in the number of functional OR genes, from 15 in the Broad-nose Pipefish Syngnathus typhle and the Ocean Sunfish Mola mola, to 429 in the Zig-zag Eel Mastacembelus armatus. The number of OR genes was higher in species when a multilamellar olfactory rosette was present. Moreover, the number of lamellae was correlated with the richness of the OR gene repertoire. While a slow and balanced birth-and-death process generally drives the evolution of the OR gene repertoire, we inferred several episodes of high rates of gene loss, sometimes followed by large gains in the number of OR genes. These gains coincide with morphological changes of the olfactory organ and suggest a strong functional association between changes in the morphology and the evolution of the OR gene repertoire.

Biphasic activation of survival and death pathways in Arabidopsis thaliana cultured cells by sorbitol-induced hyperosmotic stress

Hyperosmotic stresses represent some of the most serious abiotic factors that adversely affect plants growth, development and fitness. Despite their central role, the early cellular events that lead to plant adaptive responses remain largely unknown. In this study, using Arabidopsis thaliana cultured cells we analyzed early cellular responses to sorbitol-induced hyperosmotic stress. We observed biphasic and dual responses of A. thaliana cultured cells to sorbitol-induced hyperosmotic stress. A first set of events, namely singlet oxygen (¹O₂) production and cell hyperpolarization due to a decrease in anion channel activity could participate to signaling and osmotic adjustment allowing cell adaptation and survival. A second set of events, namely superoxide anion (O₂^-) production by RBOHD-NADPH-oxidases and SLAC1 anion channel activation could participate in programmed cell death (PCD) of a part of the cell population. This set of events raises the question of how a survival pathway and a death pathway could be induced by the same hyperosmotic condition and what could be the meaning of the induction of two different behaviors in response to hyperosmotic stress.

Gemelli decision tree Algorithm to Predict the need for home monitoring or hospitalization of confirmed and unconfirmed COVID-19 patients (GAP-Covid19): preliminary results from a retrospective cohort study

OBJECTIVE

To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring.

PATIENTS AND METHODS

We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity.

RESULTS

Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated.

CONCLUSIONS

We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Multidisciplinary community approach to reduce cardiovascular risk factors in a neighborhood in Rome

Cardiovascular Diseases (CVDs) are one of the main causes of death and morbidity worldwide. To reduce the risk of occurrence it is necessary to promote a healthy lifestyle and consider health as a collective benefit. This study aims to evaluate how the implementation of preventive interventions and health promotion could reduce the impact of CVDs on the involved population.

This prospective study started 1 year ago and will last 18 months (July 2020). Participants have been recruited in General Practice clinic in Torresina neighbourhood in Rome. The intervention was a full year of multidisciplinary meetings scheduled with general practitioners, community nurses, dedicated professionals (nutritionist, physiotherapist, psychologist) and outdoor events with a coach to promote group physical activity, assisted by the use of social networks. Anthropometric data, blood chemistry tests and information about lifestyle, nutritional habits and physical activity were collected at time 0 and every 2-month follow-up and, additionally, the individual cardiovascular risk score (CVRS) was calculated. After 12 and up to 18 months, instead, the self-management ability of a correct lifestyle will be evaluated on the basis of the measured outcomes. Statistical analysis was performed using a paired t test with Jamovi software.

The sample size was 62 patients, 50% male with an average age of 54.6 years (±7.8). During the analyzed period there was a reduction in the percentage of smokers from 30.6% at baseline to 22.6% after 12 months. The baseline CVRS was 4.9% (±6.3). At 12 months the CVRS significantly decreased to 3.8% (±4.0) (p &lt; 0.01). Total cholesterol level was 211.1 mg/dl (±32.8) at baseline, with a significant reduction at 12 months (202.5 ± 37.8) (p = 0.01). The results are preliminary.

Multidisciplinary interventions resulted in a significant reduction of CVRS and cholesterol levels during the study period. Further studies are necessary to evaluate our approach.

Key messages

Cardiovascular Diseases are the main causes of deaths among the population, so primary prevention through tailored educational interventions is fundamental. A multidisciplinary approach has proven to be effective in reducing the risk of cardiovascular disease and the level of cholesterol.

Effect of ClO2 on the distribution of Legionella pneumophila serogroups in a Teaching Hospital

The prevention of Legionella colonization of water systems is one of the goals of hospital management. Among chemical disinfection methods, chlorine dioxide (ClO2) has been largely used to control Legionella in water systems. We analysed the distribution of Legionella pneumophila serogroups (sg) and Legionella other spp before (PRE) and after (POST) installation of chlorine dioxide (ClO2) continuous disinfection systems in a Teaching Hospital in Rome.

According to the Italian National Guidelines, our surveillance plan involved a systematic sampling of the water system. The sampling was performed from Jan. 2010 to Dec. 2019. From 2011 to 2019, ClO2 continuous disinfection systems were installed in all hot water system of the hospital, and maintained at a concentration of 0.25 mg/l at the end point. The isolated strains of Legionella were first serotyped using a kit that identifies sg1, other species and that discriminate sg from 2 to 15.

1505 hot water samples were collected from the Hospital and analysed. 363 samples are PRE and 1142 are POST activation of ClO2. Only the 16.74% of monitored sampling points were colonized by Legionella during the study period. This percentage decrease from 31.40% of PRE samples, to 12.08% of POST samples (p ≤ 0.000). The sg isolated were: sg3 (60.31%), sg8 (17.12%), sg1 (16.73%), sg6 (1.95%) and other species (3.89%). Comparing the distribution of sg between the PRE and POST samples, the sg8 showed a high increase (+136.84%) and the sg3 a slight decrease (-17.94%). These variations were statistically significative.

The results showed a predominance of Legionella pneumophila sg3, compared to what was observed in a multicenter study conducted between different hospitals of various regions of Italy, where sg6 was the major isolate. The ClO2 affect the distribution of sg, in particular for sg8. This interesting result will be further investigated.

Key messages

Our data deriving from an environmental monitoring plan, show that the ClO2 affects the distribution of Legionella’s serogroups. The ClO2 reduces the percentage of samples colonized by Legionella. The ClO2 reduces the percentage of samples colonized by Legionella.

FLUChallenge: an innovative strategy to increase flu vaccination in two Italian Teaching Hospitals

In Europe flu vaccination among healthcare workers (HCWs) is strongly recommended even though not mandatory such as elsewhere (USA). Despite this, vaccination coverage in EU countries is usually low: 30.2% in 2016-17. In Italy, at the end of the same season it was 15.6%. Aim of this study is to describe and evaluate the new strategy adopted by Gemelli and Humanitas Research Hospitals, two Italian Teaching Hospitals (THs) part of the MIRO Public Health Center, to increase the vaccination coverage among their HCWs.

Before the 2019-20 campaign, experts of the two THs met up to identify a common strategy to promote flu vaccination among HCWs in addition to the ones already implemented. It was decided to launch a FLUChallenge: a platform of monitoring updated bi-weekly and available on the THs' internal websites with the vaccination coverage overall and stratified by job category and macro-areas of activity. Descriptive and inferential analysis were performed.

Preliminary Results

6673 HCWs included (4241 Gemelli, 2432 Humanitas). The overall flu vaccination coverage at the end of the 2019-20 campaign was 28.4% (1026 HCWs vaccinated Gemelli, equal to 24.2%; 869 HCWs vaccinated Humanitas, 35.7%). Both THs significantly increased the vaccination coverage compared to the previous year (+10% Gemelli, 22% in 2018-19, p = 0.01; +45.7% Humanitas, 24.5% in 2018-19, p &lt; 0.001). Physicians had the highest coverage both in Gemelli (483/1320, 36.6%) and Humanitas (443/979, 45.2%), while the lowest was registered among nurses in Gemelli (357/2017, 17.7%) and other HCWs in Humanitas (134/605, 22.1%). Infectious disease was the macro-area with highest coverage in Gemelli (32.3%), while in Humanitas the emergency department (63.9%).

The FLUChallenge intervention was an effective strategy to increase flu vaccination coverage in the two TH. The website platform was useful for the purpose of accountability and able to create a positive challenge between the HCWs working in the two THs involved.

Key messages

Flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission. It is important to promote new engagement and innovative strategies to increase flu vaccination coverage among HCWs, when it is not mandatory.

Influenza vaccination among pregnant women: increasing awareness and coverage

Influenza is a serious public health issue and pregnant women are one of the categories at higher risk of complications. Vaccination represents a safe and effective tool for prevention but the importance is not well perceived and the coverage is low (ECDC: 25% median in 2016/17). A program of education and free vaccination has been proposed to pregnant women following birthing classes. The aim was to increase pregnant awareness and to increase vaccination coverage of both parents. Classes about vaccinations, their timing and efficacy were given and a dedicated ambulatory operating twice a month during the flu season was set up. After the classes, the women were addressed to the ambulatory to be vaccinated. Vaccination was offered to the partners of the pregnant as well. General data, anamnesis and data about previous vaccinations were asked and then entered into a database.

The number of women participating to the birthing classes from October 2019 to January 2020 was 119. Of those, from the beginning of the vaccination sessions on November 14th 2019 until January 16th 2020, 46 were vaccinated in the dedicated ambulatory (plus 2 in the resident ambulatory of the hospital). The compliance to vaccination was 40.34%. An additional number of 39 partners was also vaccinated. November was the month with the highest number of people vaccinated (20 women and 14 partners), while January had the lowest (7 women and 8 partners).

As expected a higher number of people got vaccinated at the beginning of the flu season. A considerable number of partners decided to vaccinate, showing the parents understanding of the importance of herd immunity. Sensitising the women towards vaccination and increasing their awareness is crucial to improve women and new-borns' health status. Even though the compliance was considerable, a lot of work has to be done to improve vaccination coverage and to make the importance of vaccination clear.

Key messages

Providing a programme of sensitisation could improve influenza vaccination coverage. The compliance, although satisfactory, can be further improved providing different and steady educational strategies.

Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital

Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units.

This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified.

During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p &lt; 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital.

This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible.

Key messages

It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.

Flu vaccination coverage among healthcare workers: the example of younger generations

Flu vaccination is highly recommended among Healthcare Workers (HCWs). The low coverage in Italy among HCWs (mean 15.6% for 2016/17 flu season, ECDC) calls for new approaches. The aim of this study was to evaluate in which measure the vaccination coverage among HCWs registered during the 2019-2020 flu vaccination campaign in a large Teaching Hospital in Rome was affected by age and education.

A retrospective observational quasi-experimental study was conducted. Descriptive and inferential statistical analysis (chi-square test, significance level of 0.05) were performed. The 2019-2020 flu vaccination campaign was aimed at more than 4000 employed HCWs (total coverage 24.2%). Vaccination was also extended to not-employed HCWs such as Medical Residents (MRs) and Medical Students (MSs) in clinical training. The coverage in this groups was higher (46.0% and 63.2% respectively) and the difference between them and the coverage among employed HCWs was statistically significant (p &lt; 0.05); Further analysis was performed comparing MRs / MSs in clinical training with their respective professional group of employed HCWs, with a percentage of vaccinated Medical Doctors (MD) of 36.6%. MRs / MSs in clinical training coverage was higher than MDs coverage and the difference still proved to be statistically significant (p &lt; 0.05).

The higher coverage among MRs / MSs in clinical training could be explained, in general, in light of the more open-mindedness to prevention and to healthy lifestyles that characterizes young people with an up-to-date education. It could also be explained considering the specific culture and sense of responsibility of Medical Students and Medical Residents towards their high-demanding educational path and clinical training as an incentive not to get ill.

Flu vaccination is highly recommended among HCWs. Younger generations, who represent the future of Healthcare, prove to be more open-minded and responsible towards good prevention practices such as this.

Key messages

Flu vaccination is highly recommended among HCWs. Younger generations, who represent the future of Healthcare, prove to be more open-minded and responsible towards good prevention practices.

Evaluation of a food safety training intervention in an asylum-seeking population in Rome

The integration of asylum seekers is a public health issue in various contexts, including food, where they often work. According to European legislation, every food operator is obliged to follow training courses on food safety knowledge in order to prevent food-borne diseases. This study aims to evaluate a food safety training intervention in a population of asylum seekers in Rome through the use of a specific tool validated by the WHO, to introduce them in of catering.

The 'Five Key Points for Safer Food' manual was used to deliver the course. An evaluation test for participants to assess the impact of the food safety training is included, divided into 4 categories: General Information, Knowledge (11 items), Attitudes (10) and Behavior (10). The involved food handlers received the same test before and after training. In order to evaluate the effectiveness of the training intervention, the difference in the average of correct pre and post-test answers, overall and by category, was analyzed.

Overall, the 69 food handlers comprised 34 (49.3%) females and 35 (50.7%) males, from different continents (36.2% from Africa, 30.5% Central-South America and 33.3% Asia). The 57.3% has previously worked as cook or waiter. The average age was 36.6 (±12.5) with 11.4 (±3.9) years of education. Overall, the average of correct answers increases of 11.6% (from 76.4% to 88.0% correct answers pre and post-test; p &lt; 0.0001). Knowledge pre test was 7.7 (±1.4), while post test was 8.9 (±1.7) (p &lt; 0.0001). Attitude pre test was 8.3 (±2.2), post test was 9.6 (±0.9) (p &lt; 0.0001). Behavior pre test was 7.7 (±2.2), post test 8.8 (±1.9) (p &lt; 0.0001).

Despite cultural and linguistic differences, our training intervention has been effective in improving knowledge, attitudes and behaviors on food safety in the target population. The food safety in these contexts cannot be understood only as the fulfilment of a regulatory obligation, but also as an opportunity for aggregation and social integration.

Key messages

Food cooking represents a social integration tool: asylum seekers from the most disadvantaged countries could prepare safe multi-ethnic dinners based on the typical courses of their country of origin. WHO training intervention on food safety was effective in improving knowledge, attitudes and behaviors in the target population.

Vaccination attitude assessment among attendees the birthing preparation course: a pre-post study

Background

Vaccinations are among the most effective and safe ways to prevent the spreading and the complications of infectious diseases. In order to reduce risks and to protect children from the early beginning of their life, most vaccinations are recommended within the 15th month of life. In Italy, the law provides 10 compulsory vaccinations to the 0-16 age group. A training program was carried on by a Public Health specialist during the birthing preparation course, aimed at increasing the attitude to vaccination in maternal-child age.

Methods

A training session in the birthing preparation course was specifically carried out to raise awareness about vaccination during both pregnancy and puerperium and in early childhood; a questionnaire on vaccination awareness was administered before and after the training session.

Results

Out of 119 pregnant women attended the birthing preparation course from October 2019 to January 2020. As a result of the interventions, the percentage of the participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% pre-intervention to 64.56% post-intervention (p &lt; 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get, out of the 12 vaccinations proposed in the questionnaire: 9.68/12 pre-intervention versus 10.57/12 post-intervention (p = 0.021). Participants supporting the mandatory vaccinations are 96.04% pre-intervention and rise to 98.73% post-intervention.

Conclusions

Attitude and knowledge related to vaccination are crucial values for maternal-child health: they significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, labor and childbirth, according the life-course approach to health, from the Public Health perspective.

Key messages

The childbirth preparation courses for pregnant should be valuable as a precious opportunity to raise parents’ awareness and their attitude to vaccinations, if dedicated sessions are included in them. The mandatory nature of vaccines is very well received by pregnant women.

Influenza vaccination campaigns targeted at healthcare workers:results of four hospitals in Rome

Background

Seasonal influenza vaccination (SIV) of health care workers (HCWs) is well recognized as a public health measure that can protect both HCWs from infection and patients from the risk of influenza complications. Nevertheless, vaccination coverage rates among this specific population result generally lower than the recommended target. With our study, we aimed to describe the activities and the outcomes of four different SIV campaigns targeted at HCWs and organized during the season 2018/2019 in four hospitals in Rome.

Methods

A cross-sectional study involving four teaching hospitals was performed. The collected data were synthetized into a set of descriptors and indicators, validated through a previous study that had involved the same Centers.

Results

The Medical Directorates, in collaboration with the University Hygiene and Public Health Units of the four hospitals organized different strategies: Hospital 1, 3 and 4 realized educational courses for HCWs and actively promoted the campaigns through e-mail invitations to all HCWs. As for the access to vaccination, all the hospitals provided a dedicated unit for SIV; Hospital 1 and Hospital 4 organized also on-site vaccination sessions in the hospital wards, that required a large number of staff. The vaccination coverage rates resulted: 22.37% in Hospital 1, 18.10% in Hospital 4, 9.28% in Hospital 2 and 8,51% in Hospital 3.

Conclusions

Our results demonstrate that multi-activity campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of SIV. Our findings suggest that on-site vaccination may play a key role in determining a higher vaccination coverage.

Key messages

Multi-activity vaccination campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of seasonal influenza vaccination for HCWs. On-site vaccination may play a key role in determining a higher vaccination coverage.

Flu vaccination coverage in a large Italian teaching hospital: the example of the leaders

Key messages

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. This study shows the growing flu vaccination coverage rate in our teaching hospital and the effectiveness of the example given by the vaccinated leaders in increasing the coverage among all HCWs.

A six-years point prevalence survey of healthcare-associated infections in an Italian hospital

Key messages

Point prevalence from 2013 to 2018 seems to be stable. An accurate incidence survey is needed in order to identify the main risk factors of HAI and to realize more specific hospital programmes. Length of stay at the moment of detection is useful to meaningfully predict HAIs prevalence although the cause-and-effect relationship is still not clear.

Incidence study of surgical site infections in a large University Hospital in Rome, first results

Background

Surgical Site Infections (SSI) represent about a quarter of healthcare associated infections (HAI), increase the risk of mortality and hospital stay and extend healthcare costs. The aim of this work is to evaluate the incidence of SSI in patients undergoing surgical procedures of Hospital Units in the Fondazione Policlinico A. Gemelli IRCCS (FPG).

Methods

This descriptive observational monocentric study has a 30-months duration: the first phase was conducted between July 2018 and March 2019. Patients undergoing abdominal surgery procedures were enrolled. Active infection surveillance was performed, according to the ECDC, during the hospital stay and the surgical outpatient visits. We also performed a post-discharge surveillance (PDS) at 30 days (or 90 days if an implant has been inserted), through a telephone interview, made by a medical doctor resident in Public Health.

Results

During the first phase were enrolled 431 procedures in 2 Hospital Units, about emergency and hepatobiliary surgery. There were 53 cases of surgical site infection (SSI) highlighted in these procedures. Therefore, SSI’s were reported in 12.09% of the procedures. In particular, in 6.28% of cases, SSIs were diagnosed during the hospital stay. The results of this study showed statistically significant differences (p &lt; 0.005) in incidence rate of emergency (10,70%) and hepatobiliary tract (13,17%) procedures. The average hospital stay was significant higher (p &lt; 0.001) in patients who developed an SSI (17.27 days) than in patients without SSI (4.89 days).

Conclusions

These preliminary results show that the incidence rate of SSI for gastrointestinal procedures is similar to other European Countries (9.6%). The Hospital Health Management of FPG take care to the surveillance of hospital infections and monitor the correct application of the procedures, in line with the standards defined by Joint Commission International for guarantee high level in patients’ care.

Key messages

Performing a survey to measure the incidence of surgical site infections for surgery procedures is very important to define it and to improve surveillance systems of hospital infections in FPG. Active surveillance of surgical site infections may allow to enhance appropriate preventive measures.

Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network

BACKGROUND

Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project.

STUDY DESIGN

Prospective multicenter study.

METHODS

The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance.

RESULTS

During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without.

CONCLUSION

Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.

Pourquoi le taux de mutation n’est-il jamais égal à zéro ?

Alfred H. Sturtevant fut le premier à s’en étonner : le taux de mutation est faible mais n’atteint jamais zéro. Pourtant, la plupart des mutations qui modifient le phénotype ont un effet délétère, les individus qui produisent le moins de mutants génèrent donc plus de descendants viables et fertiles. La sélection naturelle devrait ainsi progressivement faire tendre le taux de mutation vers zéro au cours des générations. Des analyses récentes suggèrent que ce taux dépend principalement de la taille efficace des génomes et de l’effectif efficace des populations. Le maintien de taux de mutation plus élevés que nécessaire illustrerait les limites de la sélection naturelle dans un monde vivant constitué de populations de taille finie.

Cellular mechanisms to survive salt in the halophyte Cakile maritima

We recently identified two behaviours in cultured cells of the salt accumulating halophyte Cakile maritima: one related to a sustained depolarization due to Na⁺ influx through the non-selective cation channels leading to programmed cell death of these cells, a second one related to a transient depolarization allowing cells to survive (Ben Hamed-Laouti, 2016). In this study, we considered at the cellular level mechanisms that could participate to the exclusion of Na⁺ out of the cell and thus participate in the regulation of the internal contents of Na⁺ and cell survival. Upon addition of NaCl in the culture medium of suspension cells of C. maritima, we observed a rapid influx of Na⁺ followed by an efflux dependent of the activity of plasma membrane H⁺-ATPases, in accordance with the functioning of a Na⁺/H⁺ antiporter and the ability of some cells to repolarize. The Na⁺ efflux was shown to be dependent on Na⁺-dependent on Ca²⁺ influx like the SOS1 Na⁺/H⁺ antiporter. We further could observe in response to salt addition, an early production of singlet oxygen (¹O₂) probably due to peroxidase activities. This early ¹O₂ production seemed to be a prerequisite to the Na⁺ efflux. Our findings suggest that in addition to the pathway leading to PCD (Ben Hamed-Laouti, 2016), a second pathway comprising an SOS-like system could participate to the survival of a part of the C. maritima cultured cells challenged by salt stress.

[The CRISPR case, « ready-made » mutations and Lamarckian evolution of an adaptive immunity system]

Since genetics has shown that mutation predates selection, biology has developed within the Darwinian paradigm framework. However, a mechanism that produces favorable mutations preferentially in response to adaptive constraints has been recently identified. This mechanism, the CRISPR-Cas adaptive immunity system, is considered as a bona fide example of Lamarckian evolution, even if it only reflects loosely Lamarck's ideas. This unusual evolutionary process is made possible by two prokaryotic properties: i) somatic and germinal cells are not distinct sets of cells; ii) Archae and Bacteria very frequently integrate DNA fragments from the environment, and they therefore have access to a source of "ready-made" useful genetic information. The CRISPR-Cas is a defense system against viruses and plasmids that is based on the integration of genomic fragments of these infectious agents into the host genome, and that protects the host against subsequent infections. Therefore, this mechanism does produce advantageous mutations by integrating DNA from the environment and allowing its transmission to descendants. In conclusion, most of the time evolution relies on purely Darwinian processes, i.e. mutations occurring at random, but in a small minority of cases the occurrence of mutations is more or less biased, and is therefore more or less Lamarckian. Although they are rare, such processes are nevertheless important to our understanding of the plurality of modes of evolution.

Mode of reduction in the number of pharyngeal segments within the sarcopterygians

BACKGROUND

Pharyngeal segmentation is a defining feature of vertebrate embryos and is apparent as a series of bulges found on the lateral surface of the embryonic head, the pharyngeal arches. The ancestral condition for gnathostomes is to have seven pharyngeal segments: jaw, hyoid, and five posterior branchial arches. However, within the sarcopterygians, the pharyngeal region has undergone extensive remodelling that resulted in a reduction in the number of pharyngeal segments, such that amniotes have only five pharyngeal arches. The aim of this study is to probe the developmental basis of this loss of pharyngeal segments.

RESULTS

We have therefore compared the development of the pharyngeal arches in an amniote, the chick, which has five segments, with those of a chondrichthyan, the catshark, which has seven segments. We have analysed the early phase of pharyngeal segmentation and we find that in both the most anterior segments form first with the posterior segments being added sequentially. We also documented the patterns of innervation of the pharynx in several vertebrates and note that the three most anterior segments receive distinct innervation: the first arch being innervated by the Vth nerve, the second by the VIIth and the third by the IXth. Finally, we have analysed Hox gene expression, and show that the anterior limit of Hoxa2 aligns with the second pouch and arch in both chick and catshark, while Hoxa3 is transiently associated with the third arch and pouch. Surprisingly, we have found that Hoxb1 expression is spatially and temporally dynamic and that it is always associated with the last most recently formed pouch and that this domains moves caudally as additional pouches are generated.

CONCLUSION

We propose that the first three pharyngeal segments are homologous, as is the posterior limit of the pharynx, and that the loss of segments occurred between these two points. We suggest that this loss results from a curtailment of the posterior expansion of the pharyngeal endoderm in amniotes at relatively earlier time point, and thus the generation of fewer segments.

[ENCODE apophenia or a panglossian analysis of the human genome]

In September 2012, a batch of more than 30 articles presenting the results of the ENCODE (Encyclopaedia of DNA Elements) project was released. Many of these articles appeared in Nature and Science, the two most prestigious interdisciplinary scientific journals. Since that time, hundreds of other articles dedicated to the further analyses of the Encode data have been published. The time of hundreds of scientists and hundreds of millions of dollars were not invested in vain since this project had led to an apparent paradigm shift: contrary to the classical view, 80% of the human genome is not junk DNA, but is functional. This hypothesis has been criticized by evolutionary biologists, sometimes eagerly, and detailed refutations have been published in specialized journals with impact factors far below those that published the main contribution of the Encode project to our understanding of genome architecture. In 2014, the Encode consortium released a new batch of articles that neither suggested that 80% of the genome is functional nor commented on the disappearance of their 2012 scientific breakthrough. Unfortunately, by that time many biologists had accepted the idea that 80% of the genome is functional, or at least, that this idea is a valid alternative to the long held evolutionary genetic view that it is not. In order to understand the dynamics of the genome, it is necessary to re-examine the basics of evolutionary genetics because, not only are they well established, they also will allow us to avoid the pitfall of a panglossian interpretation of Encode. Actually, the architecture of the genome and its dynamics are the product of trade-offs between various evolutionary forces, and many structural features are not related to functional properties. In other words, evolution does not produce the best of all worlds, not even the best of all possible worlds, but only one possible world.

The coelacanth: Can a "living fossil" have active transposable elements in its genome?

The coelacanth has long been regarded as a "living fossil," with extant specimens looking very similar to fossils dating back to the Cretaceous period. The hypothesis of a slowly or even not evolving genome has been proposed to account for this apparent morphological stasis. While this assumption seems to be sustained by different evolutionary analyses on protein-coding genes, recent studies on transposable elements have provided more conflicting results. Indeed, the coelacanth genome contains many transposable elements and has been shaped by several major bursts of transposition during evolution. In addition, comparison of orthologous genomic regions from the genomes of the 2 extant coelacanth species L. chalumnae and L. menadoensis revealed multiple species-specific insertions, indicating transposable element recent activity and contribution to post-speciation genome divergence. These observations, which do not support the genome stasis hypothesis, challenge either the impact of transposable elements on organismal evolution or the status of the coelacanth as a "living fossil." Closer inspection of fossil and molecular data indicate that, even if coelacanths might evolve more slowly than some other lineages due to demographic and/or ecological factors, this variation is still in the range of a "non-fossil" vertebrate species.