Recommendations For Monitoring Research Articles

Implementation of the WHO core components of an infection prevention and control programme in two sub-saharan African acute health-care facilities: a mixed methods study

BackgroundThe coronavirus pandemic again highlighted the need for robust health care facility infection prevention and control (IPC) programmes. WHO guidelines on the core components (CCs) of IPC programmes provides guidance for facilities, but their implementation can be difficult to achieve in resource-limited settings. We aimed to gather evidence on an initial WHO IPC implementation experience using a mixed methods approach.MethodsA five-day training on the WHO IPC CCs was conducted at two reference acute health care facilities in the Democratic Republic of Congo and Burkina Faso. This was accompanied by a three-part mixed-methods evaluation consisting of a: (1) baseline and follow-up survey of participants’ knowledge, attitudes and practices (KAP), (2) qualitative assessment of plenary discussion transcripts and (3) deployment of the WHO IPC assessment framework (IPCAF) tool. Results were analysed descriptively and with a qualitative inductive thematic approach.ResultsTwenty-two and twenty-four participants were trained at each facility, respectively. Baseline and follow-up KAP results suggested increases in knowledge related to the necessity of a dedicated IPC focal person and annual evaluations of IPC training although lack of recognition on the importance of including hospital leadership in IPC training and hand hygiene monitoring recommendations remained. Most participants reported rarely attending IPC meetings or participating in IPC action planning although attitudes shifted towards stronger agreement with the feeling of IPC responsibility and importance of an IPC team. A reocurring theme in plenary discussions was related to limited resources as a barrier to IPC implementation, namely lack of reliable water access. However, participants recognised the importance of IPC improvement efforts such as practical IPC training methods or the use of data to improve quality of care. The facilities’ IPCAF scores reflected a ‘basic/intermediate’ IPC implementation level.ConclusionsThe training and mixed methods evaluation revealed initial IPC implementation experiences that could be used to inform stepwise approaches to facility IPC improvement in resource-limited settings. Implementation strategies should consider both global standards such as the WHO IPC CCs and specific local contexts. The early involvement of all relevant stakeholders and parallel efforts to advocate for sufficient resources and health system infrastructure are critical.

The Saudi consensus recommendations for the management of psoriatic arthritis (2023).

Psoriatic arthritis (PsA) is a complex inflammatory disease characterized by musculoskeletal and non-musculoskeletal manifestations. It is a distinct disease entity at the interface between rheumatology and dermatology, making it challenging to manage. The diverse clinical presentation and severity of PsA require a multidisciplinary approach for optimal care. Early diagnosis and management are necessary to improving quality of life for patients. In Saudi Arabia, there is currently no unified national consensus on the best practices for managing PsA. This lack of consensus leads to debate and uncertainty in the treatment of the disease, resulting in over or under prescribing of biological agents. To address this issue, a multidisciplinary work group was formed by the Saudi Ministry of Health. This group, consisting of dermatologists, rheumatologists, and pharmacists, aimed to develop evidence-based consensus recommendations for he use and monitoring of biological therapy in PsA management. The work group conducted five consensus workshops between December 2021 to March 2022. Using the nominal group technique, they discussed various aspects of PsA management, including eligibility criteria for biological treatment, monitoring of disease activity, treatment goals, screening, precautions, and management of PsA with biologic therapies. The group also considered special considerations for patients with comorbidities, pregnant and lactating women, as well as pediatric and adolescent populations. The resulting consensus document provides recommendations that are applicable to the Saudi setting, taking into account international guidelines and the specific needs of PsA patients in the country. The consensus document will be regularly updated to incorporate new data and therapeutic agents as they become available. Key Points • In Saudi Arabia, there is a lack of unified national consensus on the optimal management of PsA, therefore, this article aims to provide up-to-date evidence-based consensus recommendations for the optimal use and monitoring of biologic therapy in the management of PsA in Saudi Arabia. • The consensus development process was undertaken by a multidisciplinary work group of 13 experts, including two dermatologists, six rheumatologists, and five pharmacists. • There is more than one disease activity tool used in PsA disease, depending on the disease domain - peripheral arthritis Disease Activity Index in Psoriatic Arthritis (DAPSA) or Minimal Disease Activity (MDA), axial PsA Ankylosing Spondylitis Disease Activity Score (ASDAS), and dactylitis and enthesitis MDA. • The main goal of therapy in all patients with PsA is to achieve the target of remission, or alternatively, low disease activity in all disease domains and improve quality of life (QoL).

Independent sector and peri-operative cardiac arrest as reported to the 7th National Audit Project of the Royal College of Anaesthetists.

The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied peri-operative cardiac arrest including those that occurred in the independent healthcare sector, which provides around 1 in 6 NHS-funded care episodes. In total, 174 (39%) of 442 independent hospitals contacted agreed to participate. A survey examining provider preparedness for cardiac arrest had a response rate of 23 (13%), preventing useful analysis. An activity survey with 1912 responses (from a maximum of 45% of participating hospitals) showed that, compared with the NHS caseload, the independent sector caseload was less comorbid, with fewer patients at the extremes of age or who were severely obese, and with a large proportion of elective orthopaedic surgery undertaken during weekday working hours. The survey suggested suboptimal compliance rates with monitoring recommendations. Seventeen reports of independent sector peri-operative cardiac arrest comprised 2% of NAP7 reports and underreporting is likely. These patients were lower risk than NHS cases, reflecting the sector's case mix, but included cases of haemorrhage, anaphylaxis, cardiac arrhythmia and pulmonary embolus. Good and poor quality care were seen, the latter including delayed recognition and treatment of patient deterioration, and poor care delivery. Independent sector outcomes were similar to those in the NHS, though due to the case mix, improved outcomes might be anticipated. Assessment of quality of care was less often favourable for independent sector reports than NHS reports, though assessments were often uncertain, reflecting poor quality reports. Overall, NAP7 is unable to determine whether peri-operative care relating to cardiac arrest is more, equally or less safe than in the NHS.

Review and Evaluation of European National Clinical Practice Guidelines for the Treatment and Management of Active Charcot Neuro-Osteoarthropathy in Diabetes Using the AGREE-II Tool Identifies an Absence of Evidence-Based Recommendations.

Background: Charcot neuro-osteoarthropathy (CNO) is a rare but devastating complication of diabetes associated with high rates of morbidity; yet, many nonfoot specialists are unaware of it, resulting in missed and delayed diagnosis. Clinical practice guidelines (CPGs) have proven useful in improving quality of care and standardizing practice in diabetes and diabetic foot care. However, little is known about the consistency in recommendations for identification and management of active CNO. Aim: The aim of this study is to review European national diabetes CPGs for the diagnosis and management of active CNO and to assess their methodological rigor and transparency. Methods: A systematic search was performed to identify diabetes national CPGs across Europe. Guidelines in any language were reviewed to explore whether they provided a definition for active CNO and recommendations for diagnosis, monitoring, and management. Methodological rigor and transparency were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) tool, which comprises 23 key items organized within six domains with an overall guideline assessment score of ≥ 60% considered to be of adequate quality to recommend use. Each guideline was assessed by two reviewers, and inter-rater agreement (Kendall's W) was calculated for AGREE-II scores. Results: Seventeen CPGs met the inclusion criteria. Breadth of CNO content varied across guidelines (median (IQR) word count: 327; Q1 = 151; Q3 = 790), and 53% provided a definition for active CNO. Recommendations for diagnosis and monitoring were provided by 82% and 53%, respectively, with offloading being the most common management recommendation (88%). Four guidelines (24%) reached threshold for recommendation for use in clinical practice (≥ 60%) with the scope and purpose domain scoring highest (mean (SD): 67%, ± 23%). The remaining domains had average scores ranging between 19% and 53%. Inter-rater agreement was strong (W = 0.882; p < 0.001). Conclusions: European national CPGs for diabetes provide limited recommendations on active CNO. All guidelines showcased deficits in their methodology, suggesting that more rigorous methods should be employed for diabetes CPG development across Europe.

Incomplete systemic lupus erythematosus. Own observation and literature review

The term of “incomplete” systemic lupus erythematosus (iSLE) is used when patients have typical clinical and immunological signs of lupus without fulfilling the classification criteria for SLE. Autoantibodies appear in patients years before diagnosis, and the most common clinical manifestations are nonspecific and may be the only symptom of the disease for some time. Progression to definite SLE occurs in 5–57% of patients with iSLE within 1–10 years. There are currently no recommendations for monitoring and treatment of iSLE patients. This article presents the results of our own research and literature analysis on clinical and pathogenetic problems of iSLE.

Gastroenterology integration in specialized clinics for late complications after colorectal cancer surgery

The integration of gastroenterology expertise in clinics managing late complications of colorectal and anal cancer surgery is an advancement in patient care. This paper explores the multifaceted role of gastroenterologists in such settings, emphasizing diagnostic evaluation, personalized treatment planning, and the management of complex gastrointestinal symptoms. There is an obvious necessity for gastroenterological expertise to address complex issues such as diarrhea, malabsorption, discomfort, pain, bleeding, and incontinence, which are frequently under-treated in routine colorectal surgical outpatient care. In the article, we give recommendations for initial assessment, diagnostic workup, treatment strategies, follow-up, and monitoring of these issues. Highlighting the importance of a multidisciplinary approach, we discuss how gastroenterologists contribute to improved treatment outcomes and patient quality of life after surgery for colorectal and anal cancer.

Modelling plastic fluxes with INCA-macroplastics in the Imus catchment: impacts of long-term accumulation and extreme events

Plastic environmental pollution is threatening water resources, aquatic ecosystems, and human wellbeing but is still highly uncertain with global fluxes to sea of 0.4–13 Mt\\yr, and up to 517 Mt of mismanaged plastics on land. Catchment modelling tools are required to challenge current knowledge, simulate impacts of management initiatives, and complement global and observation-based studies. Here we present the first spatiotemporally explicit model for mismanaged plastic mobilization and transport from land to sea from the INtegrated CAtchment (INCA) family. INCA-Macroplastics encompasses all components of the catchment, is driven by available data (weather, population, solid waste) and enables calibration and validation against diverse observations (river monitoring, household surveys). INCA-Macroplastics was applied to the Imus River, Philippines, one of World’s most polluted rivers. Given large uncertainties on catchment plastic retention, two calibrations and two emission scenarios were developed to describe catchment plastic fluxes, residence time and stocks over 1990–2020. Plastic fluxes to the sea are highly variable over years and seasons (55–75% exported during the wet season) and have increased exponentially over 1990–2020 from 5–100 to 2000–15000 tons\\yr. INCA-Macroplastics is the first model handling plastic accumulation on land and highlights the importance of extreme flooding events in mobilizing and transporting legacy plastics. Model outputs explicitly show that current land plastic pollution can impact fluxes to the ocean for up to 30 years into the future. INCA-Macroplastics is useful to provide tailored recommendations for local monitoring, testing waste management scenarios and pointing towards future research avenues.

Adherence to the monitoring of metabolic syndrome in patients receiving antipsychotics in outpatient clinics in Saudi Arabia.

Monitoring protocols have been developed because patients taking atypical antipsychotics are more prone to developing metabolic syndrome, which leads to possible increased mortality and morbidity. The aim of this study was to assess the degree of adherence to the recommendations of metabolic syndrome monitoring. This study was conducted in two large psychiatric facilities in the Eastern Province of Saudi Arabia. A retrospective analysis of the medical records of 350 patients taking antipsychotic medications was done, and an assessment was made of the frequency of metabolic monitoring at each of the intervals as suggested by the American Diabetes Association. Data was analyzed using SPSS; descriptive statistics. were computed and Chi-square test was used to determine statistical significance for association between categorical variable. The mean age of the patients was 34.9 ± 18 years; 64.6% were males. Olanzapine was the most prescribed medication (43.7%, n = 153), followed by quetiapine (17.4%, n = 61). Only one-third of the patients (29.6%) completed all the baseline parameters. Documentation of baseline parameters was low for glucose level (38.9%), lipid panel (17.3%), weight (25.2%), and waist circumference (1.4%). Adherence to yearly monitoring was much lower than at baseline (mean percentage: 29.6% vs. 1.7%). Furthermore, 45% of the patients were classified as obese and 10% had metabolic comorbidity. Individuals with mental illness who were taking antipsychotics did not undergo proper metabolic screening during antipsychotic treatment. Barriers to adherence to the monitoring guidelines should be examined and addressed. Giving assistance to practitioners to recall the required laboratory tests and vitals at certain intervals could help improve metabolic monitoring practices.

Streamlined Patient Care With Smart Monitoring and Deep Learning-based Recommendations Using Categorical Cross Entropy Optimization

Streamlined Patient Care With Smart Monitoring and Deep Learning-based Recommendations Using Categorical Cross Entropy Optimization

Sampling Duration and Season Recommendations for Passive Acoustic Monitoring of Bats after White-Nose Syndrome

Abstract Since 2006, white-nose syndrome has caused drastic declines in populations of several hibernating bat species throughout eastern North America. Thus, there is a growing need to establish long-term monitoring programs to assess changes in bat populations over time. Information on the seasonal timing of species occurrence and the sampling effort required to acoustically detect individual bat species and obtain complete inventories will enable researchers to design and implement more effective monitoring programs. From April to October 2018 to 2021, we passively sampled for bats using full-spectrum detectors at eight permanent sites at Fort Indiantown Gap National Guard Training Center, Pennsylvania. We examined seasonal activity patterns and estimated bat species richness among sites and seasons using species accumulation curves. We also estimated probability of detection (p) and site occupancy (Ψ) using single-season occupancy models in PRESENCE software and then determined the minimum number of sampling nights needed to reliably infer the absence of each species. We identified 286,131 bat passes of eight species in 4,107 detector-nights. Seasonal patterns of activity varied among species. We needed approximately 20 sampling nights to detect 90% of the total bat species richness among sites, and we needed 4 to 10 nights to detect 90% of species richness among seasons. We needed relatively few nights (≤12 nights) to detect most species during summer; however, we needed many more nights to detect acoustically rare species. Our results indicate that the acoustic sampling effort currently required to determine the presence or probable absence of Indiana myotis Myotis sodalis, northern long-eared myotis M. septentrionalis, and tricolored bats Perimyotis subflavus during summer may not be adequate for these species in some areas and that a considerable level of effort (&amp;gt;40 nights) is needed to detect little brown myotis M. lucifugus. Monitoring programs that incorporate efficient sampling methodologies will be critical for future conservation efforts as populations of several bat species continue to decline.

Diagnosis and treatment of transthyretin amyloidosis cardiomyopathy: A position statement of the Polish Cardiac Society.

Considering the rare incidence of transthyretin amyloidosis cardiomyopathy (ATTR-CM) in Poland, patients encounter difficulties at the stages of diagnosis and treatment. For successful diagnosis, it is vital to raise the suspicion of ATTR-CM, that is, to identify typical clinical scenarios such as heart failure with preserved ejection fraction or the red flags of amyloidosis. In most cases, it is possible to establish the diagnosis on the basis of noninvasive tests. This article presents the recommended diagnostic algorithms including laboratory workup, imaging tests (in particular, isotope scanning), and genetic tests. Since ATTR-CM should be differentiated from light chain amyloidosis, we also discuss aspects related to hematological manifestations and invasive diagnosis. We describe neurological signs and symptoms in patients with amyloidosis and present therapeutic options, including the causative treatment of ATTR-CM with the only currently approved drug, tafamidis. We also discuss drugs that are being assessed in ongoing clinical trials. We outline differences in the symptomatic treatment of heart failure in ATTR-CM and recommendations for nonpharmacological treatment and monitoring of the disease. Finally, we underline the need for providing access to the causative treatment with tafamidis as part of a drug program, as in other rare diseases, so that patients with ATTR-CM can be treated according to the European Society of Cardiology guidelines on heart failure and cardiomyopathy.

Primary Biliary Cholangitis (PBC)-Autoimmune Hepatitis (AIH) Variant Syndrome: Clinical Features, Response to Therapy and Long-Term Outcome.

Standardization of diagnostic criteria of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) variant syndrome (AIH-PBC VS) has not been achieved so far and evidence-based recommendations for monitoring and treatment of the disease are still lacking. Our study aimed to assess the prevalence, biochemical, and serological features, as well as the clinical course, of VS. We performed a retrospective study including all patients with VS between 1999 and 2020 in four German centers. Data on demographic parameters, biochemical and serological tests, treatment, and outcome were collected. Of 90 patients (3.1%) meeting Paris criteria for VS diagnosis, 65.6% showed AIH and PBC histological features, while biochemical Paris criteria were observed comparatively rarely. Further antibodies, which were not part of the diagnostic criteria of VS, were found in a subgroup of patients with available data (ACA: 30.0%; anti-CENP-A: 25.0%; anti-CENP-B: 33.3%; anti-SP100: 21.4%). Biochemical response was more frequently observed in patients treated with a combined therapy of ursodeoxycholic acid (UDCA) and immunosuppression (IS). Liver cirrhosis was detected in 31 patients (34.4%) and 25 patients (27.8%) developed clinical manifestations of portal hypertension. Biochemical Paris criteria of VS were rarely detected, thus implying that these cut-off values should be redefined. Regarding pharmacological treatment, combined therapy of UDCA and IS appeared to be more effective than monotherapy with UDCA.

Assessing Cognitive Apprenticeship Impact on Clinical Reasoning in Third-Year Student Pharmacists

ObjectiveThe objective of this study was to evaluate the impact of implementing a cognitive apprenticeship theory (CAT) model into a Doctor of Pharmacy course in improving clinical reasoning skills of third-year student pharmacists over time and preparing them for Advanced Pharmacy Practice Experiences (APPEs). MethodsThis was a single center, nonrandomized, observational before-and-after study from January 2022 through May 2022. Third-year student pharmacists enrolled in the Critical Care Integrated Drugs and Disease pharmacotherapy course at the University of Kentucky College of Pharmacy were administered a well-established and nationally recognized clinical patient case assessment on weeks 1 and 15 of the course. Students were asked to prioritize patient problems and provide recommendations for therapy, goals, and monitoring. Responses were then scored using a predefined case key. In addition, student pharmacists were asked to self-evaluate their confidence in APPE readiness on a 5-point Likert scale. ResultsOf the 136 student pharmacists enrolled in the course, 92 (68%) student pharmacists completed both week 1 and week 15 clinical cases and self-assessment surveys, provided informed consent, and were included. Cumulative clinical case scores were significantly increased from week 1 to week 15 (34.8 vs 39.7). In addition, significant improvement was seen in overall problem prioritization, overall recommendations, and self-perceived preparedness for APPE rotations. ConclusionThe use of a CAT model into a 15-week pharmacotherapy course improved comprehensive scores of clinical reasoning assessment in third-year student pharmacists and was associated with increased self-perceived confidence and readiness for APPEs.

A Proposal for the Comprehensive Care of Men on Androgen Deprivation Therapy: Recommendations From the Multidisciplinary Prostate Cancer 360 Working Group.

To promote comprehensive care of patients throughout the androgen deprivation therapy (ADT) prescribing process, the Prostate Cancer 360 (PC360) Working Group developed monitoring and management recommendations intended to mitigate or prevent ADT-associated adverse events. The PC360 Working Group included 14 interdisciplinary experts with a dedicated clinical interest in prostate cancer and ADT management. The working group defined challenges associated with ADT adverse event management and then collaboratively developed comprehensive care recommendations intended to be practical for ADT prescribers. The PC360 Working Group developed both overarching recommendations for ADT adverse event management and specific recommendations across 5 domains (cardiometabolic, bone, sexual, psychological, and lifestyle). The working group recommends an interdisciplinary, team-based approach wherein the ADT prescriber retains an oversight role for ADT management while empowering patients and their primary and specialty care providers to manage risk factors. The PC360 recommendations also emphasize the importance of proactive patient education that involves partners or other support providers. Recommended monitoring and assessment tools, risk factor management, and patient counseling points are also included for the 5 identified domains, with an emphasis on lifestyle and behavioral interventions that can improve quality of life and reduce the risk for ADT-associated complications. Comprehensive care of patients receiving ADT requires early and ongoing coordinated management of a variety of health domains, including cardiometabolic, bone, sexual, psychological health. Patient education and primary care provider involvement should begin prior to ADT initiation and continue throughout treatment to improve patient and partner quality of life.

Association between antenatal corticosteroid treatment and severe adverse events in pregnant women

BackgroundAntenatal corticosteroids are considered the standard of care for pregnant women at risk for preterm birth, but studies examining their potential risks are scarce. We aimed to estimate the associations of antenatal corticosteroids with three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding, in pregnant women.MethodsOf 2,157,321 pregnant women, 52,119 at 24 weeks 0/7 days to 36 weeks 6/7 days of gestation were included in this self-controlled case series study during the study period of 2009–2018. We estimated incidence rates of three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding. Conditional Poisson regression was used to calculate incidence rate ratios (IRRs) for comparing incidence rates of the adverse events in each post-treatment period compared to those during the baseline period among pregnant women exposed to a single course of antenatal corticosteroid treatment.ResultsAmong 52,119 eligible participants who received antenatal corticosteroid treatment, the estimated incidence rates per 1000 person-years were 0.76 (95% confidence interval (CI): 0.69–0.83) for sepsis, 0.31 (95% CI: 0.27–0.36) for heart failure, and 11.57 (95% CI: 11.27–11.87) for gastrointestinal bleeding. The IRRs at 5 ~ 60 days after administration of antenatal corticosteroids were 5.91 (95% CI: 3.10–11.30) for sepsis and 4.45 (95% CI: 2.63–7.55) for heart failure, and 1.26 (95% CI: 1.02–1.55) for gastrointestinal bleeding; and the IRRs for days 61 ~ 180 were 2.00 (95% CI: 1.01–3.96) for sepsis, 3.65 (95% CI: 2.14–6.22) for heart failure, and 1.81 (95% CI: 1.56–2.10) for gastrointestinal bleeding.ConclusionsThis nationwide population-based study suggests that a single course of antenatal corticosteroids is significantly associated with a 1.3- to 5.9-fold increased risk of sepsis, heart failure, and gastrointestinal bleeding in pregnant women. Maternal health considerations, including recommendations for adverse event monitoring, should be included in future guidelines for antenatal corticosteroid treatment.

ОТСРОЧЕННЫЕ ПОСЛЕДСТВИЯ КОРОНОВИРУСНОЙ ИНФЕКЦИИ У ДЕТЕЙ

In recent years, the pandemic of the new coronavirus infection (COVID-19) has become one of the most significant global threats to public health. To date, there is more and more evidence indicating that children are also at risk of infection and the development of severe consequences [1]. Therefore, the study of the impact of coronavirus infection on the health of children is an important task of our time. The purpose of our study was to assess the impact of the disease of the new coronavirus infection (COVID-19) on the health of children in different periods of time: during the illness, after a month, after three months and after six months. Based on the results of: analyses, ECGs performed during the illness and in delayed periods, the impact of the disease on the child's health was assessed at each stage. Postcovid disorders in children were manifested in the period from 3 to 6 months after the disease. The analysis of the studies made it possible to determine the most common symptoms of postcovid syndrome. This proves the importance of studying this problem and the need for longer monitoring of children who have suffered a new coronavirus infection with the involvement of specialized specialists and the development of rehabilitation programs. Our research is applied in nature and can make a valuable contribution to the development of effective prevention and health management measures for children with coronavirus. It can also help identify potential long-term effects of COVID-19 in children and influence the development of recommendations for follow-up monitoring and treatment. Therefore, we consider it necessary to expand the range and conduct extensive studies with a large sample size.

One health implications of fur farming

Fur farming involves the captive-breeding, rearing, and killing of between 85 – 100 million animals annually for their pelts. The purpose of this report is to summarise key areas of significance and concern regarding fur farming, and discuss these matters and their one-health considerations. We conducted primary literature searches using Google Scholar and PubMed that focused on issues of animal welfare, zoonoses and public health, and environmental impacts of fur farming, and examined 280 reports. We identified that at least 15 species are farmed for fur across at least 19 countries. We found 16 categories of animal welfare concern (e.g., deprivation, stress, abnormal behaviours, insanitary conditions, forced obesity, and high morbidity and mortality), 18 reported endemic pathogens and diseases with confirmed or potential zoonotic and cross-species implications (e.g., bacterial n = 6, viral n = 5, and parasitic n = 7), and four main categories of environmental concern (e.g., greenhouse gas emissions, invasive alien species, toxic chemicals, and eutrophication) associated with fur farming. Despite numerous efforts to systematically monitor and control animal welfare at fur farms, practices continue to fail to meet normal scientific principles and models used in other animal welfare situations. In our view, limited available data does not currently indicate that fur farms are major sources of zoonotic epidemics and pandemics. The environmental problems caused by fur farming are significant, and relate mainly to invasive species, toxic chemical release and eutrophication of water bodies. We offer some recommendations for monitoring and controlling particular fur farming practices, in line with many governments and other investigators we conclude that inherent problems are essentially unresolvable and advocate complete prohibitions on the sector.

Enhancing Landfill Monitoring and Assessment: A Proposal Combining GIS-Based Analytic Hierarchy Processes and Fuzzy Artificial Intelligence

The global surge in urbanization and population growth has led to a significant increase in municipal solid waste generation, posing a considerable challenge in identifying suitable landfill sites. This study proposes a novel framework that enhances landfill site monitoring and assessment by combining GIS-based hierarchical analytical processes with a fuzzy inference system (FIS). The study employs a systematic approach involving phases such as feature selection, spatial analysis, criteria weighting, FIS building, and a case study conducted in São Paulo State, Brazil. The proposed framework effectively assesses landfill suitability and offers practical recommendations for landfill management and future site selection. This framework provides actionable recommendations for landfill monitoring and assessment, supporting landfill management while minimizing environmental and social impacts. It offers a comprehensive approach to landfill assessment, enhancing the sustainability of waste management practices. Further research can improve the proposed framework by refining feature selection and incorporating real-time data for continuous monitoring. Additionally, exploring the integration of emerging technologies, such as remote sensing and artificial intelligence, can further enhance landfill site monitoring and assessment.

Transmission, seroprevalence, and maternal-fetal impact of lymphocytic choriomeningitis virus.

Congenital infections can have devastating short- and long-term impacts on the developing fetus. Lymphocytic choriomeningitis virus (LCMV) is a zoonotic pathogen of concern that causes a severe congenital syndrome but is under-recognized and under-studied. Herein we review data on the natural animal reservoirs of LCMV, modes of transmission to humans, seroprevalence of LCMV worldwide in both pregnant and non-pregnant individuals, mechanisms of viral dissemination to placenta and fetus, and impact of climate change on viral transmission. We highlight opportunities to enhance awareness of congenital LCMV and provide recommendations for prevention and monitoring among at-risk pregnant people. IMPACT: Key message of the article: LCMV is a zoonotic virus that poses a major threat to maternal-fetal health. Adds to the existing literature: We comprehensively address transmission of LCMV from the natural reservoir to the pregnant individual, placenta, and fetus. Impact: Available data call for enhanced patient and provider awareness about congenital LCMV during pregnancy, as well as a need for efforts to better define the seroprevalence and impact of congenital LCMV worldwide.

An overview of iron deficiency anaemia and its management options

This paper considers the common presentation of iron-deficiency anaemia. It discusses the prevalence, aetiology and signs and symptoms, as well as the importance of thorough history-taking. The article also explores investigations and diagnosis, before considering management options in primary care. These options include when to refer to secondary care for further investigations and intravenous (IV) iron therapy, if oral treatment fails to correct the haemoglobin and underlying iron deficiency. IV iron is considered, including the evidence base for its use in various conditions, available preparations and the associated risks. The importance of patient involvement in decision-making and valid consent to treatment is discussed. Guidance on IV iron administration to minimise the associated risks is offered, along with recommendations for long-term monitoring and the use of blood transfusion. While the paper is based on practice within the UK, evidence and guidance from around the world is used. Although this is an international issue, country and continent-specific guidance may have variations.