Definite Changes Research Articles

Predictors of Erythropoiesis-Stimulating Agent Failure in Lower-Risk Myelodysplastic Syndromes: Systematic Literature Review

Introduction: Patients with lower-risk myelodysplastic syndromes (LR-MDS) commonly experience chronic progressive anemia, which is initially treated with erythropoiesis-stimulating agents (ESAs). However, many patients do not respond to ESAs, thereby putting them at risk of earlier disease progression, which can require invasive and/or costly treatments, including blood transfusions or hypomethylating agents. A systematic literature review (SLR) was conducted to assess quantitative associations between prognostic factors and response to treatment with ESAs in patients with LR-MDS. Methods: An electronic search for relevant literature was conducted on February 25, 2022, across Embase and MEDLINE via OvidSP. Also, proceedings from the American Society of Hematology, European Hematology Association, American Society of Clinical Oncology, Academy of Managed Care Pharmacy, and European Society for Medical Oncology meetings from 2019 to 2022 were searched via OvidSP or manually if not indexed in databases. Articles written in languages other than English were excluded. Adult patients with LR-MDS were included in the analysis. Studies reporting measures of effect between prognostic factors and ESA response were included, as were studies reporting quantitative data pertaining to differences in patient characteristics between ESA responders and non-responders. Studies reporting both univariate and multivariate analyses were included. No geographic or temporal limits were applied to the search strategy, except for congress proceedings, which were limited to 2019 onwards. Results: In total, 38 studies were eligible for inclusion in this SLR, and 8 prognostic factors of interest were most frequently reported: baseline serum erythropoietin (EPO), hemoglobin (Hb), transfusion independence, bone marrow blast count, ferritin levels, International Prognostic Scoring System (IPSS) risk status, age, and karyotype status. Regarding study design, most were retrospective cohort studies (N = 15) or single-arm trials (N = 12), and were conducted in Europe (N = 24). Within the identified publications, ESA response was often assessed using the International Working Group (IWG) MDS 2000 or 2006 criteria in publications after 2000. Studies published prior to 2000 did not use a standardized method of refining response, but still classified patients according to changes in Hb levels or transfusion requirements. The literature available in LR-MDS demonstrated statistically significant relationships suggesting that patients with low serum EPO levels (vs higher EPO levels), high Hb levels (vs lower levels), and transfusion independence (vs transfusion dependent) are more likely to respond to ESA treatment (Table). This relationship was consistent across both univariate and multivariate analyses. The evidence for bone marrow blasts and ferritin levels was inconclusive, but could potentially be influenced in the future by the publication of studies with larger patient populations. There was no published evidence that ESA response was related to IPSS risk status, age, and karyotype status. The associated data for these prognostic factors in responders versus non-responders showed similar patterns. Conclusion: All studies assessing quantitative associations between ESA response and prognostic factors were published after 2000, hence ESA response was assessed according to IWG 2000 or 2006 criteria. The studies demonstrate a clear link between response to ESA treatment and lower serum EPO levels, higher Hb levels, and transfusion independence. The other prognostic factors were either not significant or inconclusive, and more research is needed to clarify whether they have a prognostic impact on ESA response in patients with LR-MDS. Some of the studies comparing prognostic factors for responders versus non-responders to ESA treatment were published before 2000 and did not use standardized methods to describe response. Due to changes in ESA treatment response definitions over time, some patients in the included studies may be classified differently with a more recent version of the IWG MDS criteria. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Value of Inpatient Inherited Thrombophilia Testing Following Acute VTE: A 3-Year Retrospective Study

BACKGROUND: Inherited thrombophilia testing following venous thromboembolism (VTE) is of limited utility and, performed in the setting of an acute thrombotic episode, is especially unreliable. Studies suggest that inpatient thrombophilia workups, often performed in the context of acute VTE or stroke, lead to high rates of false positives and can result in inappropriate long-term management decisions. Therefore, various professional societies advise against such testing, especially in acute care settings. These include Choosing Wisely recommendations from the American Society of Hematology, who recommend against routine testing following first episode of provoked VTE, and the American Society for Clinical Pathology, who advise against ordering these tests during an active clotting event. However, these studies continue to be ordered regularly, increasing the overall cost of health care with limited clinical benefit. METHODS: We carried out a retrospective chart review of all inpatient inherited thrombophilia tests ordered between January 1st, 2019 and December 31st, 2021 at Thomas Jefferson University Hospitals, including its 3 primary hospitals in Philadelphia, PA. The goal was to determine indications for testing, rate of positivity, and whether positive results changed patients’ clinical management. Tests included in the study were for the following conditions: Factor V Leiden (FVL); prothrombin G20210A variant (PTG20210A); Protein C, S, and antithrombin deficiency; hyperhomocysteinemia; and plasminogen activator inhibitor-1 (PAI-1) elevation. The study included 152 patients, among whom 574 unique tests were ordered. Tests sent for non-thrombotic indications or in patients with a known factor deficiency were excluded. RESULTS: Patient demographics, clinical presentations, and VTE risk factors are summarized in Table 1. Median age of the patients was 49 years (IQR 34-62) and 53.9% were under age 50. 93 patients (61.2%) were female. VTE was associated with a major transient risk factor or cancer in 44.7% of patients. Conditions for which testing was ordered included FVL (24.7%), PTG20210A (20.4%) Protein S deficiency (16.5%), Protein C deficiency (14.8%), antithrombin deficiency (13.0%), hyperhomocysteinemia (10.3%), and PAI-1 elevation (0.2%). Overall, 81.9% of tests were normal. Among unique tests, MTHFR analysis was most frequently abnormal (71.4% of ordered tests), followed by antithrombin (44.0%), Protein C antigen (27.3%), total Protein S (26.7%), Protein C function (25.7%), and free protein S (20.0%). Certain tests, including antithrombin activity, Protein C antigen and function, and total Protein S, have reference ranges in our lab that start well above 50%, so results that fell below normal but >60% were termed "borderline positive” and considered to be likely false positives. Among individual patients, 62/152 (40.8%) had at least one abnormal result and 47/152 (30.9%) had at least one positive result not considered borderline. There was no significant difference in rate of having at least one non-borderline positive result between patients with unprovoked VTE (27/84, 32.1%) and those with a major transient risk factor, estrogen use/pregnancy, or cancer (20/68, 29.4%; χ2, P=.717). There was also no difference in positive test rate between patients age < 50 years (24/82, 29.3%) and those ≥ 50 years (23/70, 32.9%; P=.633) (Figure 1). All charts were reviewed for inpatient and outpatient documentation to determine short- and long-term clinical decision-making. In 2/152 (1.3%) patients, documentation supported a definitive change in management because of a positive thrombophilia test result. These included a 20-year-old woman with large PE while on a combined oral contraceptive and a 33-year-old man with provoked DVT following severe spinal cord injury (resulting in tetraplegia) who were continued on long-term anticoagulation for Protein S deficiency and double heterozygosity for FVL and PTG20210A, respectively. Based on query of the hospital chargemaster, all tests during the study period totaled $264,913 in charges. CONCLUSION: Our single-institution study found that following acute VTE, inpatient testing for inherited thrombophilias was frequently done in patients with provoked events and resulted in many abnormal tests likely comprising false positives, rarely changed clinical management, and was associated with high costs. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

The Domestic Abuse Act 2021 England and Wales: implications for nurses.

As the COVID-19 pandemic enveloped the globe there was a parallel increase in the incidence of domestic abuse (DA). This has been ascribed to the restrictions in movement and growing tensions during lockdown periods. The Domestic Abuse Act covering England and Wales was about to be passed prior to the COVID-19 outbreak, but progress halted as attention focused on managing infection control and treatment nationally. The unfolding DA 'shadow pandemic' led to pressure groups lobbying for specific changes to the Act which, in its revised form, became law in April 2021. This article sets out the changes in definition, statutory response and prevention of DA and relates these to nursing practice. Health education and promotion theory is considered and linked to nursing practice with those who are both victims/survivors and perpetrators of DA.

Kommentar zu den neuen Leitlinien (2021) der Europäischen Gesellschaft für Kardiologie (ESC) zur kardiovaskulären Prävention

The new ESC guidelines on cardiovascular disease prevention in clinical practice have introduced a number of new features into the guidelines: 1. The new SCORE2 system was developed based on recent European cohort studies with a total of 677,684 participants, a significant update compared to the old SCORE system, which was based on studies dating back to the 1970s and 1980s. For the first time SCORE2-OP enables the calculation of the individual risk in people> 69 years of age. SCORE2 also marks a change in the risk definition: instead of mortality risk it now provides an estimate of morbidity and mortality risks for cardiovascular diseases. 2. The thresholds for risk categorization based on SCORE2 are now dynamic with age: below 50 years of age individuals with a SCORE2 risk of ≥ 7.5% are very high-risk, while those between 50 and 69 years need to surpass ≥ 10% and those ≥ 70 years should be above 15% SCORE2 risk to be classified as very high risk. This change was made to reflect the lifetime exposure, which is greater at a younger age. 3. The novel 2‑step approach separates a general recommendation for prevention for all from the final prevention goals that should be reached in selected patients based on life years gained, comorbidities, frailty and patient wishes. There is a certain danger that this may dilute the prevention goals because many patients and physicians may not go beyond step 1. Not all effects of the new SCORE2 system and the readjusted risk thresholds have yet become clear. A close monitoring of how the new guidelines affect the number of patients in whom, e.g. statin treatment is recommended, is warranted in the different risk regions. Additionally, the freedom of choice with respect to prevention intensity remains a potential threat to optimal guideline implementation. Therefore, implementation studies are needed to continue the virtuous cycle of guideline development.

Changes to pediatric brain tumors in 2021 World Health Organization classification of tumors of the central nervous system.

New tumor types are continuously being described with advances in molecular testing and genomic analysis resulting in better prognostics, new targeted therapy options and improved patient outcomes. As a result of these advances, pathological classification of tumors is periodically updated with new editions of the World Health Organization (WHO) Classification of Tumors books. In 2021, WHO Classification of Tumors of the Central Nervous System, 5th edition (CNS5), was published with major changes in pediatric brain tumors officially recognized including pediatric gliomas being separated from adult gliomas, ependymomas being categorized based on anatomical compartment and many new tumor types, most of them seen in children. Additional general changes, such as tumor grading now being done within tumor types rather than across entities and changes in definition of glioblastoma, are also relevant to pediatric neuro-oncology practice. The purpose of this manuscript is to highlight the major changes in pediatric brain tumors in CNS5 most relevant to radiologists. Additionally, brief descriptions of newly recognized entities will be presented with a focus on imaging findings.

A comparative study of characteristics in diploid and tetraploid Anoectochilus roxburghii.

Artificial induction of polyploidy is an efficient technique for improving biological properties and developing new varieties of many plants. In this study, we analyzed and compared differences in characteristics (morphological and biological) of diploid and tetraploid Anoectochilus roxburghii plants. We found significant differences between tetraploid plants and their diploid counterparts. The tetraploid plants exhibited dwarfing and stockiness. They were also bigger and had more voluminous roots and larger stomata than the diploid plants. Moreover, the biochemical analyses showed that the contents of some amino acids and minerals elements were significantly higher in tetraploid plants. The chlorophyll content of the leaves exhibited no definitive changes, but the photosynthetic performance was higher in the tetraploid plants. In addition, contents of major bioactive compounds, such as kinsenoside and some flavonoids, were enhanced in tetraploids. This is the first detailed analysis of characteristics in diploid and tetraploid A. roxburghii plants. The results may facilitate breeding programs with the species.

Is Cementless Total Knee Arthroplasty Safe in Women Over 75 Y of Age?

BackgroundCementless total knee arthroplasty (TKA) is the subject of renewed interest. Previous concerns about survivorship have been addressed and there is an appeal in terms of biological fixation and surgical efficiency. However, even surgeon advocates have concerns about the risk of marked subsidence when using this technology in older patients at risk for osteoporosis. MethodsThis was a retrospective analysis of 1,000 consecutive fully cementless mobile bearing TKAs performed at a single institution on women over 75 years of age who had postoperative and 1-year x-rays. The primary outcome was the incidence of subsidence. ResultsThere were three asymptomatic cases with definite subsidence and change in alignment. In a fourth symptomatic case, the femoral component subsided into varus and the tibia into valgus, thus maintaining alignment which facilitated nonoperative treatment in a 92-year-old. Overall, at 1 year, there were two- liner revisions for infection without recurrence. Five patients had further surgery, of which three were washouts and two were for periprosthetic fractures sustained postoperatively within 1 year. Seven patients had further anesthesia, of which five were manipulations and two were nonrecurrent closed reductions for spinouts. ConclusionCementless TKA did not have a high risk of subsidence in this at-risk population. In the hands of experienced surgeons, these procedures can be used safely irrespective of bone quality.

Factors associated withspontaneous nystagmus changes in acute Ménière's disease.

Neuro-otological factors that influence changes in spontaneous nystagmus (SN) during vertigo attacks in Ménière's disease (MD) remain unclear. To identify neuro-otological factors that might influence the initial direction of SN and the directional change of SN. A prospective, observational study of 22 patients with definite MD to evaluate the initial direction and directional change of SN during vertigo attacks, endolymphatic hydrops (EH) volume, and the function of horizontal semicircular canal and hearing levels. SN consistently began as irritative in 17 of 22 cases, and 9 of 17 cases showed a definite change in direction after onset. SN consistently began as paralytic in 5 of 22 cases, and 3 of 5 cases showed a definite change in direction after onset. Subjects in the irritative initial SN group had less severe degrees of hearing loss, smaller cochlear and vestibular EH volume than the paralytic initial SN group (P = 0.017, < 0.001, and 0.009, respectively). Subjects in the SN direction change group had significantly smaller maximum slow phase velocity, percentage of caloric weakness and canal paresis than the no SN direction change group (P = 0.001, 0.006, and 0.001, respectively). Simple logistic regression analysis showed that smaller EH volume was significantly associated with initial irritative SN (OR = 0.867, 95% CI 0.762-0.988, P = 0.032) and that the degree of canal paresis was negatively associated with the presence of directional change of SN (OR = 0.022, 95% CI 0.002-0.289, P = 0.004). The morphology of EH and canal paresis may independently affect the characteristics of SN in patients with MD.

Plain old Bess in a different dress? Disruptions of public relations in the digital age

This paper focuses on the disruptions in the digital age through the lens of public relations experts from the private sector. In order to understand whether the PR profession is undergoing a major or just a minor change, this study focuses on expert attitudes toward the disruptions and the perceived change of their identity, strategy, and structure of PR. The analysis of semi-structured in-depth interviews yielded six themes: changes that are shaping the industry, changes in organizational identity, occupational definitions and roles, structural aspects, the difference between PR communication strategy and digital PR-strategy, new methods, tools, and measurement models and finally predictions for the future. Three main conclusions arise from these themes: PR agency self-identity is in a process of change from media-relations to strategic consultants; the main source of the change is perceived as media disruption rather than digital disruption (although they are interrelated); and the future in PR is predicted as the all-in-one marketing communications agency, which might develop into a new, hybrid, profession.

High-Tech Mimarlığın Geçmişi ve Geleceği

High-tech architecture is a postmodern architectural movement that began in the 1960s and continues today. It has been heavily influenced by the changing world and technological innovations in architecture and has become a new trend. Like most architectural movements, high-tech architecture has tried to avoid associations with the past. Steel, glass and concrete are seen as the most common building materials in the structures that have been created under the effect of this trend. As the movement evolved, the materials used in high-tech architecture have also been devolved under its influence. Transparency has come to the forefront in high-tech architecture, sometimes by explosion of the structure to the ecterior and sometimes by making it visible in interior. Hence, the definition of high-tech structure has changed day by day. This paper intends to study the history of high-tech architecture since the 18th century and to reveal the changes in definition. The future of high-tech architecture is examined through futuristic cinema of the 21st century.

Reusable Ontology Modelling Patterns for Biodiversity Data with Reasonable Ontology Templates (OTTR)

The Norwegian Biodiversity Information Centre (NBIC) is currently building a traitbank for Norwegian species. The purpose of the NBIC TraitBank is to enhance sharing of traits and other information about species to support conservation actions and ecological research. The traitbank will cover a subset of traits for all multicellular species and taxa that are found in Norway. Observations of traits, collected through citizen science as well as by experts, are connected to the NBIC TraitBank ontology, forming a knowledge base. We have modeled TraitBank’s ontology in accordance with NBIC’s data management requirements, focusing on the domain knowledge necessary for ontology-based data integration of internal databases and queries specified by use cases. Our initial steps in ontology construction included outlining competency questions, which are natural language sentences expressing the questions system users expect an ontology to answer (Bezerra et al. 2013, Ren et al. 2014). The ontology for the TraitBank is populated using expert input (manual entry) and through harvesting of traits from existing internal databases at NBIC. We will present our experiences with implementing Reasonable Ontology Templates (OTTR) (Skjæveland et al. 2021) as the means for modeling the ontology and populating the TraitBank ontology. OTTR is a language for formally representing and instantiating ontology modeling patterns and is designed to support knowledge base construction and interaction at a higher level of abstraction. In the case of the TraitBank, ontology patterns are edited and published using a Semantic MediaWiki (SMW) extension for OTTR (FloSchroeder 2022), thereby providing a tool for the domain expert to work directly with templates. We build the TraitBank ontology by instantiating the templates directly in SMW as wiki pages. We argue that templates are an effective means to support the integration and use of digital biodiversity data in transparent ways, leading to successful collaboration and reuse of data. Following the "Don't repeat yourself" (DRY) principle of software development (Hunt and Thomas 1999), OTTR templates lend themselves well to easier ontology maintenance, allowing updates to occur through changes in individual template definitions rather than to repeated statements spread throughout the ontology. OTTR reshapes how domain experts work with ontologies and the data connected to the knowledge base, lifting the biodiversity expert away from dealing directly with logical axioms and Web Ontology Language (OWL). The template libraries have the power to improve international collaboration, making it easier to exchange and reuse specific templates and suggest improvements. Our templates include mappings to standards developed by Biodiversity Information Standards (TDWG) and biodiversity-related ontologies, linking to the international community. Use of OTTR supports the principles of Findable, Accessible, Interoperable, and Reusable (FAIR) data and demonstrates a new technology that can support the creation of an extensive online network of knowledge. Example: Scientific Name The NBIC uses Scientific Name as the main identifier and means to track a species. The OTTR template shown below captures the NBIC’s modelling pattern for Scientific Name. The signature of the template specifies the Internationalized Resource Identifier (IRI) of the template (adb-t:ScientificName), and six parameters (where ?iri is the 1st parameter). The parameters are used in the body of the template and define how instances of the template are expanded to Resource Description Framework (RDF) statements. Template instance expansion is done in a recursive manner, similar to many macro programming languages. With the OTTR template definition given in Fig. 1, a template instance can be expanded, as shown in the example for Metopa glacialis Fig. 2. The benefits of using the OTTR framework is that modeling patterns are explicitly represented as an OTTR template, allowing for instances of patterns to be compactly and consistently captured. The format of template instances lends itself to instantiation from tabular data sources like spreadsheets and databases.

The external validation of the asthma prediction tool in the French ELFE cohort.

Existing predictive scores for early identification of children at high risk of developing asthma include invasive procedures, and hence have limited utility in a primary care setting. The Leicestershire respiratory cohort (LRC) has developed a noninvasive asthma prediction tool (APT) for children with promising results. We aimed to perform its external validation in the French general population Étude Longitudinale Française depuis l'Enfance(ELFE) cohort. Predictive scores were determined at Age 1 and the primary outcome of asthma was defined as parental reporting of "asthma ever or "wheezing in the past 12 months" at Age 5. Logistic regression was used to calculate the odds ratio (OR) and performance measures, and discriminative performance was reported using thereceiver operating curve and area under curve(AUC). Calibration was assessed using Hosmer-Lemeshow goodness-of-fit test and visualized with a calibration plot. Overall performance was determined using Brier scores. Of the 10,689 children analyzed: 84.9% were at low, 13.1% medium, and 2% at high risk of developing asthma at Age 5. Children in the medium-risk category were three times more likely to develop asthma (OR = 3.3, 95% confidence interval [CI] = 2.97-3.78) whereas 13 times more likely in the high-risk category (OR = 13.8, 95% CI = 10.2-18.8). The tool's AUC was comparable: LRC 0.74 versusELFE 0.68; as were the Brier scores LRC 0.16 versusELFE 0.14. The tool's performance was robust to changes in inclusion criteria and outcome definitions. Results of the present study and previous validation studies performed in high-risk populations provide a comprehensive measure of the effectiveness of the APT, providing encouragement for its application by general practitioners.

Investigating the power of eyes open resting state EEG for assisting in dementia diagnosis

IntroductionThe differentiation of Lewy body dementia from other common dementia types clinically is difficult, with a considerable number of cases only being found post-mortem. Consequently, there is a clear need for inexpensive and accurate diagnostic approaches for clinical use. Electroencephalography (EEG) is one potential candidate due to its relatively low cost and non-invasive nature. Previous studies examining the use of EEG as a dementia diagnostic have focussed on the eyes closed (EC) resting state; however, eyes open (EO) EEG may also be a useful adjunct to quantitative analysis due to clinical availability.MethodsWe extracted spectral properties from EEG signals recorded under research study protocols (1024 Hz sampling rate, 10:5 EEG layout). The data stems from a total of 40 dementia patients with an average age of 74.42, 75.81 and 73.88 years for Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), respectively, and 15 healthy controls (HC) with an average age of 76.93 years. We utilised k-nearest neighbour, support vector machine and logistic regression machine learning to differentiate between groups utilising spectral data from the delta, theta, high theta, alpha and beta EEG bands.ResultsWe found that the combination of EC and EO resting state EEG data significantly increased inter-group classification accuracy compared to methods not using EO data. Secondly, we observed a distinct increase in the dominant frequency variance for HC between the EO and EC state, which was not observed within any dementia subgroup. For inter-group classification, we achieved a specificity of 0.87 and sensitivity of 0.92 for HC vs dementia classification and 0.75 specificity and 0.91 sensitivity for AD vs DLB classification, with a k-nearest neighbour machine learning model which outperformed other machine learning methods.ConclusionsThe findings of our study indicate that the combination of both EC and EO quantitative EEG features improves overall classification accuracy when classifying dementia types in older age adults. In addition, we demonstrate that healthy controls display a definite change in dominant frequency variance between the EC and EO state. In future, a validation cohort should be utilised to further solidify these findings.

Predictors of progression from a first demyelinating event to clinically definite multiple sclerosis.

Understanding the predictors of progression from a first to a second demyelinating event (and formerly, a diagnosis of clinically definite multiple sclerosis) is important clinically. Previous studies have focused on predictors within a single domain, e.g. radiological, lacking prospective data across multiple domains. We tested a comprehensive set of personal, environmental, neurological, MRI and genetic characteristics, considered together, as predictors of progression from a first demyelinating event to clinically definite multiple sclerosis. Participants were aged 18–59 years and had a first demyelinating event during the study recruitment period (1 November 2003–31 December 2006) for the Ausimmune Study (n = 216) and had follow-up data to 2–3 years post-initial interview. Detailed baseline data were available on a broad range of demographic and environmental factors, MRI, and genetic and viral studies. Follow-up data included confirmation of clinically definite multiple sclerosis (or not) and changes in environmental exposures during the follow-up period. We used multivariable logistic regression and Cox proportional hazards regression modelling to test predictors of, and time to, conversion to clinically definite multiple sclerosis. On review, one participant had an undiagnosed event prior to study recruitment and was excluded (n = 215). Data on progression to clinically definite multiple sclerosis were available for 91.2% (n = 196); 77% were diagnosed as clinically definite multiple sclerosis at follow-up. Mean (standard deviation) duration of follow-up was 2.7 (0.7) years. The set of predictors retained in the best predictive model for progression from a first demyelinating event to clinically definite multiple sclerosis were as follows: younger age at first demyelinating event [adjusted odds ratio (aOR) = 0.92, 95% confidence interval (CI) = 0.87–0.97, per additional year of age); being a smoker at baseline (versus not) (aOR = 2.55, 95% CI 0.85–7.69); lower sun exposure at age 6–18 years (aOR = 0.86, 95% CI 0.74–1.00, per 100 kJ/m2 increment in ultraviolet radiation dose), presence (versus absence) of infratentorial lesions on baseline magnetic resonance imaging (aOR = 7.41, 95% CI 2.08–26.41); and single nucleotide polymorphisms in human leukocyte antigen (HLA)-B (rs2523393, aOR = 0.25, 95% CI 0.09–0.68, for any G versus A:A), TNFRSF1A (rs1800693, aOR = 5.82, 95% CI 2.10–16.12, for any C versus T:T), and a vitamin D-binding protein gene (rs7041, aOR = 3.76, 95% CI 1.41–9.99, for any A versus C:C). The final model explained 36% of the variance. Predictors of more rapid progression to clinically definite multiple sclerosis (Cox proportional hazards regression) were similar. Genetic and magnetic resonance imaging characteristics as well as demographic and environmental factors predicted progression, and more rapid progression, from a first demyelinating event to a second event and clinically definite multiple sclerosis.

Vaccination Gaps of Employees in Institutions of Preschool Childcare before Introduction of the Measles Protection Act

The measles protection act and the updated recommendations of the permanent commission of vaccination (STIKO) include the obligatory proof of a double vaccination against measles for employees (born after 1970) in childcare. In addition, the standard and professional recommendations for vaccinations should be respected. A retrolective evaluation of vaccination gaps of employees in institutions for preschool childcare was performed. The database of 2018 and 2019 of the B·A·D-Health center Erlangen have 1300 recorded cases of occupational medical consultations in preschool childcare. Double consultations and consultations with insufficient data were excluded. 1016 contacts were analyzed with regard to vaccination gaps of measles, mumps, rubella, varicella, pertussis, hepatitis A+B and early summer meningoencephalitis. The evaluation was primarily based on the employees' vaccination cards. Vaccination gaps were assumed in case of missing, commenced or incomplete vaccination protection. In this cohort of 1016 employees, the vaccination gap for measles increased from 16.2% to 20.6%, when applying the updated STIKO recommendation and the resulting change of definition of complete vaccination protection from measles. Further gaps were 22.7% for mumps, 18.9% for rubella, 2.3% for varicella, 27.8% for pertussis, 61.1% for hepatitis A and 60.5% and tick-borne encephalitis. The age group <30 years showed less vaccination gaps than the age group ≥30 years. The evaluation of the health center in Erlangen showed considerable age-dependent vaccination gaps in the cohort of employees of preschool childcare. The measles protection act that makes vaccination against measles mandatory contributes to closing this gap. There is room for counselling as well as for action regarding vaccine-preventable diseases in occupational medicine.

‘If it can't be coded, it doesn't exist’. A historical-philosophical analysis of the new ICD-11 classification of chronic pain

Chronic pain entails a large burden of disease and high social costs, but is seldom ‘in the picture’ and barely understood. Until recently, it was not systematically classified but instead viewed as a symptom or sign. In the new International Classification of Diseases, (ICD)-11, to be implemented in 2022, ‘chronic’ pain is now classified as a separate disease category and, to a certain extent, approached as a ‘disease in its own right’. Reasons that have been given for this are not based so much on new scientific insights, but are rather of pragmatic nature. To explore the background of these recent changes in definition and classification of chronic pain, this paper provides a historical-philosophical analysis. By sketching a brief history of how pain experts have been working on the definition and taxonomy since the 1970s, we demonstrate the various social and practical functions that underlie the new ICD-11 classification of chronic pain. Building on this historical-empirical basis, we discuss philosophical issues regarding defining and classifying chronic pain, in particular performativity and pragmatism, and discuss their implications for the broader philosophical debate on health and disease.

Intraspecific Genetic Variation of Anisakis typica in Indian Mackerel Caught from the Gulf of Thailand, Samut Songkhram Province.

Anisakis nematodes infecting Indian mackerel (Rastrelliger kanagurta) were initially discovered in Thailand in our preliminary investigation. Nevertheless, the species of Anisakis collected has not been determined nor has its genetic variation been researched. Thus, this study aimed to molecularly identify the species of Anisakis specimens using the internal transcribed spacer (ITS) region of ribosomal DNA sequences. In addition, the intraspecific genetic variation was also determined using mitochondrial cytochrome oxidase subunit II (COII) gene sequences. The phylogenetic relationships of the ITS region classified all samples into Anisakis typica; however, the genetic variation between them could not be distinguished. By contrast, the phylogenetic tree analysis of the COII region identified all samples as A. typica, with 17 different haplotypes by 66 polymorphic sites and five of the substitutions resulted in amino acid change. Additionally, the distribution pattern of the COII region can be separated into two groups between South America and Asian countries. All our haplotypes belong to Asian countries. Compared with the two genetic markers used in this investigation, COII appears to be a better candidate for studying genetic variation sensitive to environmental changes and intermediate or definitive host behavioral changes.

Epidemiology and Response to the COVID-19 Pandemic in Kerala, India, 2020-2021: A Cross-Sectional Study.

Kerala, a southern state in India, experienced a slightly different COVID-19 pandemic than the rest of India. Using data from daily COVID-19 bulletins and two other Kerala health information systems, this study reported on epidemiological characteristics and response measures of the COVID-19 pandemic between January 2020 and December 2021. After the first six months, Kerala experienced three distinct phases, with COVID-19 cases peaking in October 2020, May 2021, and August 2021. This contrasts with India, which experienced two main peaks in September 2020 and May 2021. The demographic profile of cases aligned with the national profile except for a slight increase of COVID-19 in persons aged ≥60 years. Monthly COVID-19 deaths increased dramatically from May 2021 onwards in line with case numbers but also reflecting changes in definitions of COVID-19 deaths. Case fatality for the two years was significantly higher in males than females, increased with increasing age groups, and varied between districts (p < 0.001). Trends in bed occupancy in field hospitals, hospitals for severe disease, intensive care units, and mechanical ventilation mirrored the different phases of the pandemic. The monitoring system in Kerala allowed certain aspects of the pandemic to be mapped, but it would benefit from further strengthening.

The Many Endings of Recent Epidemics: HIV/AIDS, Swine Flu 2009, and Policy

Studying national and local contexts is essential for understanding the ending of epidemics and related policy responses. This article examines HIV/AIDS in the 1980s and 1990s and swine flu in 2009-2010 in the UK as comparative “tracer epidemics” to understand the multiplicity of endings from the perspective of the contemporary history of policy. Such endings can include: the political ending, changes in definition away from epidemic, the medical end, different endings for different “risk groups,” local endings, and media endings. This multiplicity of endings throws light on the nature of political and institutional structures and their change over time.

Public Procurement Corruption in Bosnia and Herzegovina

Abstract Public procurement system, which is being implemented in Bosnia and Herzegovina, is an integrated system that includes a large number of actors. This system is described, including the identified competencies and responsibilities of all participants, by law and bylaws. And, corruption is one of the social phenomena whose definitions change in time and space. Many behaviors that are considered corruption today have been an integral part of regular behavior in the past.