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Opioid Sparing at 24 h after Total Shoulder Arthroplasty by Undiluted Liposomal Bupivacaine Single Shot Interscalene Block: A Randomized Clinical Trial, First Results
Full text linkBackground: The purpose of this study was to compare postoperative opioid consumption following total shoulder arthroplasty, after: (A) a single-shot undiluted liposomal bupivacaine (LB; commercial name: Exparel) interscalene block, or (B) a Ropivacaine block (R), supplemented with continuous catheter infusion. Methods: This prospective, randomized study (NCT03739021) compared postoperative analgesic requirements in Morphine Milligram Equivalent (MME) during the first 24 h after discharge from the post-anesthesia care unit (PACU) in patients receiving total shoulder arthroplasty. Two similar groups of 30 patients each received equivalent general operative anesthesia. Preoperative interscalene block was performed with either 10mL of undiluted liposomal bupivacaine (LB) or ropivacaine (R) 0.5% plus continuous catheter infusion. Results: There were no differences between the two groups regarding age, gender, length of surgery, intraoperative narcotic usage, or length of hospital stay. The time required to administer (LB) compared to (R) was significantly reduced (5 min vs. 15 min). The LB group experienced a reduction in MME during the first 24 h after PACU discharge (25 vs. 41 MME). Conclusion: A single shot of undiluted liposomal bupivacaine (LB) provided a significant (p = 0.045) reduction in opioid use during the first 24 h after shoulder replacement surgery compared to ropivacaine (R) with continuous catheter infusion. A larger sample group will be required to bolster these results. There was no measured difference in reported pain level. LB also took less time to administer
Vaccine Literacy and Source of Information about Vaccination among Staff of Nursing Homes: A Cross-Sectional Survey Conducted in Tuscany (Italy)
Full text linkVaccine literacy (VL) mediates the transfer of information and facilitates vaccination acceptance. The aims of this study are to validate the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano—Vaccine health literacy for adults in Italian language) for the staff of nursing homes (NHs), to measure VL in such a peculiar target group, and to assess its relationship with the sources used to obtain information about vaccines and vaccinations. A survey has been conducted in a sample of Tuscan NHs using an online questionnaire. Eight-hundred and fifty-three questionnaires were analyzed. Two dimensions of the HLVa-IT appeared (functional and interactive/communicative/critical VL). The HLVa-IT interactive/communicative/critical subscale score was slightly higher than the functional subscale, although with no statistical significance. General practitioners (GPs) or other professionals have been reported as the main source of information by most of the respondents (66.1%). The HLVa-IT total score was significantly higher among those who have declared to use official vaccination campaigns (mean score: 3.25 ± 0.49; p < 0.001), GPs or other health professionals (3.26 ± 0.47; p < 0.001), and search engines (3.27 ± 0.48; p = 0.040) as the main sources of information. In conclusion, the HLVa-IT could be reliable test to investigate VL for staff of NHs, and also to highlight criticalities related to information source
Factors Influencing the Decision to Vaccinate against HPV amongst a Population of Female Health Students
Full text linkBackground: In Switzerland, HPV vaccination has been recommended since 2007 for all adolescent girls aged between 11 and 14 years. More than 10 years after the introduction of this recommendation, immunization coverage targets have not been met. Very few studies at a national level describe the reasons for the reluctance of some young women to become vaccinated. The aim of this study is to describe the socio-demographic characteristics of a population of vaccinated and unvaccinated female health students and then to compare the different factors that may have influenced their vaccine choice. Method: Female health students in the French-speaking part of Switzerland, aged between 18 and 31, were invited to participate in the study. A total of 234 female students completed a questionnaire that included questions about their socio-demographic data, sexual behavior and vaccination status. Results: 69% of the participants received at least one dose of the vaccine. Women who had not yet had sex were less likely to be vaccinated than sexually active women (ORa: 0.1, 0.0–0.4, 95% CI), the same as those who did not express an opinion about the importance of vaccination (ORa: 0.1: 0.0–0.6, 95% CI). The main reasons given for refusing vaccination were fear of side effects (26.0%), parental opposition (24.6%) and reluctance of the attending physician (13.6%). Conclusions: The main results of this study highlight a good rate of vaccine coverage in the sample population. Reasons for nonvaccination demonstrate the need to provide information on the vaccine to the target audience, as well as to parents and health professionals
Age-Dependent Dynamics of Maternally Derived Antibodies (MDAs) and Understanding MDA-Mediated Immune Tolerance in Foot-and-Mouth Disease-Vaccinated Pigs
Full text linkVaccine-induced active immunity in young animals may be compromised via interference caused by maternally derived antibodies (MDAs). Since the level, titer, and half-life of MDAs vary per individual, it is difficult to determine the appropriate timing of foot-and-mouth disease (FMD) vaccination in the field. In order to better understand the age-dependent characteristics of MDA in sows and piglets as well as the phenomenon of reduced vaccine-mediated active immunity due to MDAs, this study sought to determine antibody titers through structural protein (SP) O, A ELISA analyses, and virus-neutralizing (VN) antibody titers as well as their half-lives in the sera of sows and piglets derived from FMD-vaccinated mother. Furthermore, immunoglobulin (Ig) subtypes, such as IgG, IgM, and IgA, in serum were also evaluated. To understand the correlation between the inhibition of vaccine-mediated active immunity by MDA-mediated passive immunity and regulatory T (Treg) cells, Treg-related cytokine levels were explored. Our findings will help to predict the optimal timing of vaccination for overcoming MDAs and inducing a robust vaccine-mediated immune response in young individuals vaccinated against FMD. They also add to our understanding of MDA characteristics and interference, providing insight for the development of innovative strategies and novel FMD vaccine for overcoming such interferenc
Detoxified O-Specific Polysaccharide (O-SP)–Protein Conjugates: Emerging Approach in the Shigella Vaccine Development Scene
Full text linkShigella is the second most common cause of moderate to severe diarrhea among children worldwide and of diarrheal disease-associated mortality in young children in low-and middle-income countries. In spite of many years of attempts to develop Shigella vaccines, no licensed vaccines are yet available. Injectable conjugate vaccines made of the detoxified lipopolysaccharide (LPS) of S. flexneri 2a, S. sonnei, and S. dysenteriae type 1 covalently bound to protein carriers were developed in the early 1990s by John B. Robbins and Rachel Schneerson at the US National Institutes of Health. This approach was novel for a disease of the gut mucosa, at a time when live, rationally attenuated oral vaccine strains that intended to mimic Shigella infection and induce a protective local immune response were extensively investigated. Of keystone support to Shigella glycoconjugates development were the findings of a strong association between pre-existent serum IgG antibodies to S. sonnei or S. flexneri 2a LPS and a lower risk of infection with the homologous Shigella serotypes among Israeli soldiers serving in field units. In view of these findings and of the successful development of the pioneering Haemophilus influenzae type b conjugate vaccines, it was hypothesized that protective immunity may be conferred by serum IgG antibodies to the O-Specific Polysaccharide (O-SP) following parenteral delivery of the conjugates. S. sonnei and S. flexneri 2a glycoconjugates induced high levels of serum IgG against the homologous LPS in phase I and II studies in healthy volunteers. The protective efficacy of a S. sonnei detoxified LPS-conjugate was further demonstrated in field trials in young adults (74%) and in children older than three years of age (71%), but not in younger ones. The evaluation of the Shigella conjugates confirmed that IgG antibodies to Shigella LPS are correlates of protection and provided solid basis for the development of a new generation of glycoconjugates and other injectable LPS-based vaccines that are currently in advanced stages of clinical evaluatio
Booster COVID-19 Vaccines for Immune-Mediated Inflammatory Disease Patients: A Systematic Review and Meta-Analysis of Efficacy and Safety
Full text linkBackground: Seroconversion and longevity of vaccine-induced immune response is blunted in immune-mediated inflammatory disease (IMID) patients owing to immunosuppressive regimens. COVID-19 booster vaccines after a primary series have been proposed with inconclusive evidence on efficacy to date. Methods: This PROSPERO-registered systematic review (CRD42022302534) was conducted according to PRISMA guidelines. PubMed, EMBASE, CENTRAL, Web of Science, CORD-19, WHO ICTRP, and medRxiv were searched up to 28 February 2022 for eligible studies. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Results: From 6647 records, 17 prospective studies were included for systematic review and 12 in meta-analysis of primary series non-responders. The risk of bias was low. Pooling 340 non-responders, a booster dose proved effective with 0.47 seroconverting (95% CI: 0.32–0.63, I2 = 82%). Rituximab therapy was associated with significant impairment, with risks of 0.25 (95% CI: 0.17–0.36, I2 = 50.7%) versus 0.81 (95% CI: 0.72–0.87, I2 = 0.0%) for those without rituximab therapy. A systematic review of antibody levels against COVID-19 showed several-fold increases across studies. Incidence of local and systemic adverse events, including disease flares, were either comparable or slightly increased after the booster dose compared to primary series. No major events such as myocarditis or death were reported. Conclusion: Our results show that booster doses are effective in eliciting seroconversion in non-responders, bolstering immunity to COVID-19. It has also not been associated with major adverse event
Who will be where: Climate driven redistribution of fish habitat in southern Germany
Full text linkTo improve the robustness of projections of freshwater fish distributions under climate change, species distribution models (SDMs) were calculated for six fish species in southwestern Germany with different ecological requirements along an upstream-downstream gradient in a multi-general circulation model (GCM) approach. Using the maximum entropy (Maxent) algorithm and a high number of occurrence records (N = 4684), species distributions were projected to future climate conditions derived from 13 GCMs across the most likely representative carbon pathways (RCP4.5 and 8.5) and two time spans (near future 2050, and far future 2070), resulting in 104 distribution maps per species that were then used for the statistical analysis of future trends. Climate change is likely to affect the distribution of four of the six fish species. The potential ranges of salmonids are predicted to decline by up to 92% (brown trout) and 75% (grayling). In contrast, habitat suitability for perch and roach is predicted to increase by up to 108% and 53%, respectively. Even when accounting for broad variation in GCMs and realistic RCPs, these results suggest climate change will drive a significant redistribution of fish habitat. Salmonid-dominated communities in headwaters seem more sensitive to climate change than the fish communities of downstream sections. Because headwaters are a prevailing element of the hydrographic network in southwestern Germany, such changes may result in large-scale regressions of valuable fish communities that currently occupy broad geographic niches
Mental health, a neglected aftershock of climate disasters
Full text linkClimate disasters, which are becoming more frequent and damaging, cause trauma, grief, and disruption and have profound and sustained mental health impacts. To limit the impact of climate disasters, it is important to acknowledge and address the mental health issues that arise. This opinion article will highlight the significant and accelerating impact of climate disasters on mental health and describe how the issue has been neglected in current policy and relief support. It will subsequently offer recommendations for how policymakers can improve mental health outcomes during climate disasters.
The scale of the problem
Mental health issues arising from climate disasters cause significant health, financial and social costs. Although the mental health impact is not well quantified, the Johns Hopkins Center for Public Health Preparedness estimates that after disasters, the number of people with psychological trauma exceeds the number of people with physical injury by as much as 40 to 1 [1]. Specifically, data has shown that there is a clear relationship between experiencing the effects of climate disasters and worsening mental health. This includes low mood and depression, extreme distress, post-traumatic stress disorder [2] and suicidality [3]. In conjunction, those with existing mental illnesses also experience exacerbations in their conditions, especially those with affective and psychotic conditions [4].
The reasons for this are multifaceted. As well as the visible and devastating effects on communities and people, the displacement from home and support structures, heightened economic and social vulnerability, and the fear of exposure to future events are somewhat unique aspects of climate disasters [5]. Further, damage to infrastructure and decreased access to mental health services diminishes the availability of mental health support
A spatially aware likelihood test to detect sweeps from haplotype distributions
Full text linkThe inference of positive selection in genomes is a problem of great interest in evolutionary genomics. By identifying putative regions of the genome that contain adaptive mutations, we are able to learn about the biology of organisms and their evolutionary history. Here we introduce a composite likelihood method that identifies recently completed or ongoing positive selection by searching for extreme distortions in the spatial distribution of the haplotype frequency spectrum along the genome relative to the genome-wide expectation taken as neutrality. Furthermore, the method simultaneously infers two parameters of the sweep: the number of sweeping haplotypes and the “width” of the sweep, which is related to the strength and timing of selection. We demonstrate that this method outperforms the leading haplotype-based selection statistics, though strong signals in low-recombination regions merit extra scrutiny. As a positive control, we apply it to two well-studied human populations from the 1000 Genomes Project and examine haplotype frequency spectrum patterns at the LCT and MHC loci. We also apply it to a data set of brown rats sampled in NYC and identify genes related to olfactory perception. To facilitate use of this method, we have implemented it in user-friendly open source software
Filling gaps in bacterial catabolic pathways with computation and high-throughput genetics
Full text linkTo discover novel catabolic enzymes and transporters, we combined high-throughput genetic data from 29 bacteria with an automated tool to find gaps in their catabolic pathways. GapMind for carbon sources automatically annotates the uptake and catabolism of 62 compounds in bacterial and archaeal genomes. For the compounds that are utilized by the 29 bacteria, we systematically examined the gaps in GapMind’s predicted pathways, and we used the mutant fitness data to find additional genes that were involved in their utilization. We identified novel pathways or enzymes for the utilization of glucosamine, citrulline, myo-inositol, lactose, and phenylacetate, and we annotated 299 diverged enzymes and transporters. We also curated 125 proteins from published reports. For the 29 bacteria with genetic data, GapMind finds high-confidence paths for 85% of utilized carbon sources. In diverse bacteria and archaea, 38% of utilized carbon sources have high-confidence paths, which was improved from 27% by incorporating the fitness-based annotations and our curation. GapMind for carbon sources is available as a web server (http://papers.genomics.lbl.gov/carbon) and takes just 30 seconds for the typical genome