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BACKGROUND: When establishing Physical Employment Standards, validity is dependent on the correct identification and characterisation of critical job tasks. OBJECTIVE: To develop and validate a standardised protocol for the identification, characterisation, and documentation of critical physical job tasks in military occupational specialities in the Swedish Armed Forces (SwAF), and propose a definition of critical physical job tasks for use in the SwAF. METHODS: A protocol was drafted with three content domains, including a preliminary definition. Protocol content validity was iteratively assessed in two consecutive stages where ten subject experts rated relevance and simplicity. A consensus panel revised the protocol after each stage. Content validity index (CVI) was calculated as item-CVI (I-CVI) per each feature and as scale average (S-CVI/Ave) per content domain. Acceptable content validity thresholds were 0.78 and 0.90, respectively. RESULTS: The validated protocol consisted of 35 items with an I-CVI≥0.90 and≥0.80 for relevance and simplicity, respectively. The S-CVI/Ave was 0.97 for relevance and 0.98 for simplicity. The protocol was language reviewed, reorganised for easy use, and approved by the consensus panel. The final protocol includes: background and aim of the protocol, the accepted generic and critical physical job task definitions, protocol instructions, subject expert-qualifications, job task source and characteristics. CONCLUSION: A standardised protocol for identification and characterisation of critical job tasks in SwAF military occupational specialties was developed. The protocol content was rated relevant and simple by experts and will be of importance in future work establishing physical requirements in the SwAF.

Introduction: In literature, there have been many studies conducted to research the alternatives of standard interlocking intramedullary nailing. The expandable wedge locked nail fixation, which is thought as a new alternative to the standard interlocking nailing, has been presented in previous numerical studies. The antegrade usage of the wedge locked nail fixation has provided promising results. From this point, the aim of the study is to evaluate mechanical behavior of its retrograde usage on femur models. Additionally, another aim of the study is to investigate the effect of fracture level on mechanical properties of the fixation. Materials and methods: The mechanical behaviors of the wedge locked nail and standard interlocking nail fixations were compared by finite element methods. Sawbones femurs having osteotomies at five different levels to simulate different fractures were fixed with wedge locked nail or interlocking nail by using retrograde approach. With respect to the fracture level, two different nail lengths were used. Axial compression load was applied to fixations. The mechanical behaviors of the fixations were evaluated with respect to stiffness of the fixations and stresses occurred on both implants and bones. Results: Any of the wedge locked nail fixation did not slip at canal. The stress and stiffness results were mostly close with each other for both nail types. The maximum stresses at locking elements or bones contacting these elements increased with decreased distance between the fracture and relevant locking elements. Discussion: The wedge locked nail fixation showed comparable results to the standard interlocking nail fixation with respect to the stiffness and stress. Under axial loading, wedge locked nail provided a secured fixation without any slippage and preserved its position inside the medullary canal. It may be thought as a safe alternative to the standard interlocking nail fixation for retrograde usage. Additionally, according to str

BACKGROUND: When establishing Physical Employment Standards, validity is dependent on the correct identification and characterisation of critical job tasks. OBJECTIVE: To develop and validate a standardised protocol for the identification, characterisation, and documentation of critical physical job tasks in military occupational specialities in the Swedish Armed Forces (SwAF), and propose a definition of critical physical job tasks for use in the SwAF. METHODS: A protocol was drafted with three content domains, including a preliminary definition. Protocol content validity was iteratively assessed in two consecutive stages where ten subject experts rated relevance and simplicity. A consensus panel revised the protocol after each stage. Content validity index (CVI) was calculated as item-CVI (I-CVI) per each feature and as scale average (S-CVI/Ave) per content domain. Acceptable content validity thresholds were 0.78 and 0.90, respectively. RESULTS: The validated protocol consisted of 35 items with an I-CVI≥0.90 and≥0.80 for relevance and simplicity, respectively. The S-CVI/Ave was 0.97 for relevance and 0.98 for simplicity. The protocol was language reviewed, reorganised for easy use, and approved by the consensus panel. The final protocol includes: background and aim of the protocol, the accepted generic and critical physical job task definitions, protocol instructions, subject expert-qualifications, job task source and characteristics. CONCLUSION: A standardised protocol for identification and characterisation of critical job tasks in SwAF military occupational specialties was developed. The protocol content was rated relevant and simple by experts and will be of importance in future work establishing physical requirements in the SwAF.

Background The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge-Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. Methods The educational intervention for nursing home professionals consisted of five 2-h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow-up) the intervention. Descriptive and inferential statistics were calculated. Results The positive effects at follow-up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. Conclusions This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow-up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change.

Background: A deeper understanding of how contextual factors affect the ability to participate in the life area of work and employment despite chronic musculoskeletal pain is needed as a basis for interprofessional rehabilitation programs. Objective: To investigate which contextual factors influence rehabilitation program clients’ ability to participate in the life area of work and employment, and how they do this. Methods: Nested case study using a realist evaluation framework of interprofessional interventions. Qualitative content analysis of problem-centered interviews to identify influential context-mechanism-outcome configurations. Results: We identified several important context-mechanism-outcome configurations. In the pre-interventional phase, socioeconomic and environmental factors affected two mechanisms, “exhaustion” and “discrimination”. In the intra-interventional phase, the social skills of health professionals and opportunities for discussion with peers affected the ability of program participants to engage with program content. In the post-intervention phase, volitional competences of the social system affected the sustainable application of program content in everyday life. Conclusion: The identified context-mechanism-outcome configurations shows that the ability to participate in the life area of work is interdependent with the ability to participate in other areas of life. In practice and research, assessment and treatment should be carried out based on this understanding.

Background: Pseudomonas aeruginosa (PA) is the third leading aetiological agent in healthcare-associated infections (HAIs) and the one most frequently found in patients with pneumonia associated with mechanical ventilation. In intensive care units (ICU), its appearance is associated with higher mortality, an increase in the days spent on ventilation, and hospital stay length and costs. Thus, evaluating strategies for preventing these infections is essential for their control. Therefore, our objective was to evaluate the effectiveness of the systematic use of antimicrobial filters in preventing PA infections in critical care units. Methods: This was an open experimental crossover study. A total of 2,156 patients admitted for more than 24 hours in critical care units were included, 1,129 of them in units with filters, and 1,027 in units without filters. The study groups were followed-up for 24 months and HAIs were checked for the presence of PA. Chi-squared test were used to compare the rate of HAIs between groups and we calculated 95% confidence intervals adjusted by Poisson regression for the rate ratio (RR) of the association magnitude. Results: Both groups were homogeneous in terms of intrinsic and extrinsic patient factors. The incidence of PA infections in the units with filters was 5.5 cases/1,000 hospitalized days and 5.4/1,000 hospitalized days for the units without water filters (RR = 1.09 [0.67-1.79]). Conclusions: Routine placing antimicrobial filters in the water taps in critical care units was not an effective means of preventing the emergence of HAIs caused by PA.

En España se inició el programa de vacunación en un contexto de alta transmisión y baja disponibilidad de vacunas. El objetivo de este artículo es revisar el programa de vacunación frente a la COVID-19 (3-3-2022) y valorar los obstáculos, los desafíos y las oportunidades que plantea el control de esta enfermedad. Se dispone actualmente de cinco vacunas: dos basadas en la tecnología ARNm (Comirnaty® y Spikevax®), dos basadas en un vector no replicativo (Vaxzevria® y Janssen) y una basada en la subunidad S (Novavax®). Las autoridades sanitarias han desarrollado estrategias de vacunación priorizando la prevención de hospitalizaciones y defunciones. En marzo de 2022 se superó el 90% de la población diana con vacunación completa y el 95% de cobertura en mayores de 50 años. El nuevo reto es conseguir coberturas similares para una tercera dosis. La vacunación en la infancia y la adolescencia se ha convertido en una prioridad por las implicaciones educativas y sociales que comporta la COVID-19. Se deberán renovar las estrategias comunicativas y eliminar las barreras de acceso para conseguir buenas coberturas. En España se han publicado estudios que muestran una alta efectividad de la vacunación. La principal estrategia para el control de la pandemia y para recuperar la actividad social es la vacunación, pero todo indica que serán necesarios niveles muy altos de cobertura vacunal y seguir con medidas no farmacológicas. En un mundo globalizado, el control de la COVID-19 solo se alcanzará con una estrategia global coordinada y el apoyo a la vacunación en los países con pocos recursos., In Spain, the vaccination program began in a context of high transmission and low availability of vaccines. The objective of this article is to review the vaccination program against COVID-19 in Europe (3/03/2022) and assess the obstacles, challenges and opportunities posed by the control of this disease. Five vaccines are currently available in Europe: two based on mRNA technology (Comirnaty® and Spikevax®); two based on a non-replicative vector (Vaxzevria® and Janssen); and another based on subunit S (Novavax®). Health authorities have developed comprehensive vaccination strategies prioritizing the prevention of hospitalizations and deaths. In January 2022, 90% of the population was exceeded with full vaccination and 95% coverage in people over 50 years of age. The new challenge is to achieve similar coverage in the rest of the age groups. Vaccination in children and adolescents has become a priority due to the educational and social implications derived from COVID-19 in this population. Communication strategies must be renewed and access barriers eliminated to achieve good coverage. In Spain, studies have been published that find a high effectiveness of vaccination. The main strategy for controlling the pandemic and recovering social activity is the vaccination, but everything indicates that very high levels of vaccination coverage will be necessary and to follow with the non-pharmaceutical measures. In a globalized world, COVID-19 control will only be achieved with a coordinated global strategy and technical and economic support for the vaccination strategy in resource-poor countries.

Persistent and semi-persistent halogenated compounds cause health problems for the animals occupying the upper level of the food web in the Baltic Sea. Atlantic salmon (Salmo salar), being a top piscivore in the Baltic Sea, has been observed to carry a large body burden of halogenated toxins. Here, a mixture of nine halogenated compounds belonging to different groups was created, based on the observed composition of halogenated toxins in salmon serum. The toxicokinetic properties of the compounds were studied in zebrafish (Danio rerio) embryos to achieve the same proportions between the internal doses of the compounds in the zebrafish as in the salmon. Toxicity was evaluated for the compounds dosed individually as well as in a mixture. Perfluorooctanesulfonic acid (PFOS) was the dominant compound in the salmon and was observed to be the driving force for effects on swimbladder inflation caused by the mixture with a 50% effect concentration of 4.8 µM nominal dose, or 1300 µMD based on the area under the internal concentration-time curve (AUC). The driving compound for other severe effects caused by the mixture, including lethality, spinal deformity, and edemas, was the hydroxylated polybrominated diphenyl ether 6-OH-BDE47, which was observed to have a 50% lethality concentration of 93 nM, corresponding to 94 µMD based on internal dose (AUC). The individual compounds were observed to act additively on most of the documented outcomes when dosed as a mixture.

Background: Defining the relationship between a headache and stroke is essential. The current diagnostic criteria of the ICHD-3 for acute headache attributed to ischemic stroke are based primarily on the opinion of experts rather than on published clinical evidence based on extensive case-control studies in patients with first-ever stroke. Diagnostic criteria for sentinel headache before ischemic stroke do not exist. The present study aimed to develop explicit diagnostic criteria for headache attributed to ischemic stroke and for sentinel headache. Methods: This prospective case-control study included 550 patients (mean age 63.1, 54% males) with first-ever ischemic stroke and 192 control patients (mean age 58.7, 36% males) admitted to the emergency room without any acute neurological deficits or severe disorders. Standardized semi-structured interview forms were used to evaluate past and present headaches during face-to-face interviews by a neurologist on admission to the emergency room in both groups of patients. All headaches were diagnosed according to the ICHD-3. We tabulated the onset of different headaches before a first-ever ischemic stroke and at the time of onset of stroke. We divided them into three groups: a new type of headache, the previous headache with altered characteristics and previous unaltered headaches. The same was done for headaches in control patients within one week before admission to the hospital and at the time of entry. These data were used to create and test diagnostic criteria for acute headache attributed to stroke and sentinel headache. Results: Our previous studies showed that headache at onset of ischemic stroke was present in 82 (14.9%) of 550 patients, and 81 (14.7%) patients had sentinel headache within the last week before a stroke. Only 60% of the headaches at stroke onset fulfilled the diagnostic criteria of ICHD-3. Therefore, we proposed alternative criteria with a sensitivity of 100% and specificity of 97%. Besides, we deve

Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively

Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively

Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively

Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively

Direct oral anticoagulants (DOACs) administration significantly interferes with coagulation as-says. The aim of the study was to evaluate the effect of DOACs and DOAC-Remove® on coagulation assays dur-ing thrombophilia testing. Methods. The study was car-ried out from January 2019 to the end of June 2020. It in-cluded 30 DOAC-treated patients, 14 females and 16 males aged 23 to 63 (median age 47.6 years), tested for thrombophilia due to venous thromboembolism (VTE). Thrombophilia testing was performed using DOAC-Remove® tablets (activated charcoal). The results before and after DOAC-Remove® were compared. Results. Posi-tive lupus anticoagulant (LA) results were observed in 20% apixaban, 100% dabigatran, and 70% rivaroxaban-treated patients, while in samples after DOAC-Remove®, the LA positivity was observed only in one from the apix-aban group. Before DOAC-Remove®, the activated pro-tein C (APC) resistance (APC-R) was measurable in 40% dabigatran and 80% rivaroxaban-treated patients, while, after using DOAC-Remove®, the APC-R was measurable in all cases. Comparing the results obtained from the sam-ples before and after DOAC-Remove®, a difference was noted in relation to all dilute Russell's viper venom time (dRVVT) coagulation tests, except for the dRVVT ratio in the apixaban group. Clot-based methods for detecting the APC resistance were significantly affected by dabigatran and less by rivaroxaban. Conclusion. DOACs were prac-tically inactivated after the addition of the DOAC-Remove®, which made it possible to perform analyses for the LA and APC-R testing freely and obtain relevant re-sults., Primena direktnih oralnih antikoagulansa (DOAK)značajno utiče na testove koagulacije. Cilj rada bio je da se pro-ceni uticaj DOAK i DOAC-Remove® tableta (aktivni ugalj) natestove koagulacije tokom ispitivanja trombofilije. Metode.Istraživanjem, sprovedenim od januara 2019. do juna 2020.godine, obuhvaćeno je 30 bolesnika lečenih DOAK-om itestiranih na trombofiliju zbog venskog tromboembolzma(VTE). Bilo je 14 žena i 16 muškaraca, starosti od 23 do 63godine (medijana 47,6 godina). Ispitivanje trombofilije izvršenoje upotrebom DOAC-Remove® tableta (aktivni ugalj).Upoređivani su rezultati pre i posle primene DOAC-Remove®.Rezultati. Pozitivni rezultati za lupus antikoagulantni (LA) testdobijeni su kod 20% bolesnika lečenih apiksabanom, kod100% bolesnika lečenih dabigatranom i kod 70% lečenih riva-roksabanom, a u uzorcima posle DOAC-Remove® pozitivnostna LA dobijena je samo kod jednog bolesnika iz grupe lečnihapiksabanom. Pre primene DOAC-Remove®, rezistencija naaktivisani protein C (activated protein C resistance – APC-R) bila jemerljiva kod 40% i 80% bolesnika lečenih dabigatranom, od-nosno rivaroksabanom, dok je posle primene DOAC-Remove®, APC-R bila merljiva u svim slučajevima.Upoređivanjem rezultata dobijenih iz uzoraka pre i posleprimene DOAC-Remove®, primećena je razlika u odnosu nasve testove vremena koagulacije izvršene razblaženim Russell-ovim zmijskim otrovom (dilute Russell’s viper venom time –dRVVT), osim dRVVT u grupi bolesnika lečenih apiksabanom.Na koagulacionu metodu za otkrivanje APC-R značajno je uti-cao dabigatran, a manje rivaroksaban. Zaključak. Nakonprimene DOAC-Remove® tableta, DOAK su praktičnoinaktivisani što je omogućilo izvođenje analiza za LA i APC-R idobijanje relevantnih rezultata testova.

Antecedentes: La investigación de resultados o outcomes research, es el estudio de la efectividad de las diferentes intervenciones sanitarias. En el contexto constantemente cambiante de las ciencias de la salud, se hace necesario evaluar si una estrategia, un abordaje o una medida sanitaria demuestra su efectividad, entendida esta como el modo en que una intervención alcanza sus objetivos cuando se aplica en las condiciones habituales de trabajo ya que cuando se aplica en condiciones reales, suele tener una efectividad inferior a sus condiciones ideales de eficacia. Por todo ello, se hace necesario evaluar de una manera sistemática y rigurosa su efectividad. Objetivos: Los tres objetivos de esta tesis doctoral son: 1) Evaluar la efectividad de un programa de prevención y control de infecciones por COVID-19 en los profesionales sanitarios del servicio de urgencias de un hospital de tercer nivel; 2) Estimar la prevalencia de anticuerpos IgG frente a SARS-CoV-2 en profesionales sanitarios de un departamento de salud; y por último 3) Evaluar la efectividad del uso sistemático de filtros antimicrobianos en los grifos de agua de las unidades de cuidados críticos para la prevención de las infecciones asociadas a los cuidados de la salud por Pseudomonas aeruginosa. Metodología: Tesis por compendio de publicaciones. Se compone de tres publicaciones en revistas indexadas en el JCR. La metodología difiere en función del estudio, para el primer objetivo un estudio observacional en profesionales del servicio de urgencias para estudiar el impacto de la recomendación de uso de mascarilla y el de la declaración de estado de alarma mediante el programa de evaluación de riesgo biológico. Para evaluar el impacto del uso de mascarilla y el impacto del estado de alarma se comparó la incidencia acumulada en los periodos pre y post exposición y para cuantificar la magnitud de asociación y el impacto se calcularon el riesgo relativo, el riesgo atribuible y la fracción de prevención. Para e

Background: Trauma care faces challenges to innovating their services, such as with mobile health (mHealth) app, to improve the quality of care and patients’ health experience. Systematic needs inquiries and collaborations with professional and patient end users are highly recommended to develop and prepare future implementations of such innovations. Objective: This study aimed to develop a trauma mHealth app for patient information and support in accordance with the Center for eHealth Research and Disease Management road map and describe experiences of unmet information and support needs among injured patients with trauma, barriers to and facilitators of the provision of information and support among trauma care professionals, and drivers of value of an mHealth app in patients with trauma and trauma care professionals. Methods: Formative evaluations were conducted using quantitative and qualitative methods. Ten semistructured interviews with patients with trauma and a focus group with 4 trauma care professionals were conducted for contextual inquiry and value specification. User requirements and value drivers were applied in prototyping. Furthermore, a complementary quantitative discrete choice experiment (DCE) was conducted with 109 Dutch trauma surgeons, which enabled triangulation on value specification results. In the DCE, preferences were stated for hypothetical mHealth products with various attributes. Panel data from the DCE were analyzed using conditional and mixed logit models. Results: Patients disclosed a need for more psychosocial support and easy access to more extensive information on their injury, its consequences, and future prospects. Health care professionals designated workload as an essential issue; a digital solution should not require additional time. The conditional logit model of DCE results suggested that access to patient app data through electronic medical record integration (odds ratio [OR] 3.3

En España se inició el programa de vacunación en un contexto de alta transmisión y baja disponibilidad de vacunas. El objetivo de este artículo es revisar el programa de vacunación frente a la COVID-19 (3-3-2022) y valorar los obstáculos, los desafíos y las oportunidades que plantea el control de esta enfermedad. Se dispone actualmente de cinco vacunas: dos basadas en la tecnología ARNm (Comirnaty® y Spikevax®), dos basadas en un vector no replicativo (Vaxzevria® y Janssen) y una basada en la subunidad S (Novavax®). Las autoridades sanitarias han desarrollado estrategias de vacunación priorizando la prevención de hospitalizaciones y defunciones. En marzo de 2022 se superó el 90% de la población diana con vacunación completa y el 95% de cobertura en mayores de 50 años. El nuevo reto es conseguir coberturas similares para una tercera dosis. La vacunación en la infancia y la adolescencia se ha convertido en una prioridad por las implicaciones educativas y sociales que comporta la COVID-19. Se deberán renovar las estrategias comunicativas y eliminar las barreras de acceso para conseguir buenas coberturas. En España se han publicado estudios que muestran una alta efectividad de la vacunación. La principal estrategia para el control de la pandemia y para recuperar la actividad social es la vacunación, pero todo indica que serán necesarios niveles muy altos de cobertura vacunal y seguir con medidas no farmacológicas. En un mundo globalizado, el control de la COVID-19 solo se alcanzará con una estrategia global coordinada y el apoyo a la vacunación en los países con pocos recursos., In Spain, the vaccination program began in a context of high transmission and low availability of vaccines. The objective of this article is to review the vaccination program against COVID-19 in Europe (3/03/2022) and assess the obstacles, challenges and opportunities posed by the control of this disease. Five vaccines are currently available in Europe: two based on mRNA technology (Comirnaty® and Spikevax®); two based on a non-replicative vector (Vaxzevria® and Janssen); and another based on subunit S (Novavax®). Health authorities have developed comprehensive vaccination strategies prioritizing the prevention of hospitalizations and deaths. In January 2022, 90% of the population was exceeded with full vaccination and 95% coverage in people over 50 years of age. The new challenge is to achieve similar coverage in the rest of the age groups. Vaccination in children and adolescents has become a priority due to the educational and social implications derived from COVID-19 in this population. Communication strategies must be renewed and access barriers eliminated to achieve good coverage. In Spain, studies have been published that find a high effectiveness of vaccination. The main strategy for controlling the pandemic and recovering social activity is the vaccination, but everything indicates that very high levels of vaccination coverage will be necessary and to follow with the non-pharmaceutical measures. In a globalized world, COVID-19 control will only be achieved with a coordinated global strategy and technical and economic support for the vaccination strategy in resource-poor countries.

Background: Pseudomonas aeruginosa (PA) is the third leading aetiological agent in healthcare-associated infections (HAIs) and the one most frequently found in patients with pneumonia associated with mechanical ventilation. In intensive care units (ICU), its appearance is associated with higher mortality, an increase in the days spent on ventilation, and hospital stay length and costs. Thus, evaluating strategies for preventing these infections is essential for their control. Therefore, our objective was to evaluate the effectiveness of the systematic use of antimicrobial filters in preventing PA infections in critical care units. Methods: This was an open experimental crossover study. A total of 2,156 patients admitted for more than 24 hours in critical care units were included, 1,129 of them in units with filters, and 1,027 in units without filters. The study groups were followed-up for 24 months and HAIs were checked for the presence of PA. Chi-squared test were used to compare the rate of HAIs between groups and we calculated 95% confidence intervals adjusted by Poisson regression for the rate ratio (RR) of the association magnitude. Results: Both groups were homogeneous in terms of intrinsic and extrinsic patient factors. The incidence of PA infections in the units with filters was 5.5 cases/1,000 hospitalized days and 5.4/1,000 hospitalized days for the units without water filters (RR = 1.09 [0.67-1.79]). Conclusions: Routine placing antimicrobial filters in the water taps in critical care units was not an effective means of preventing the emergence of HAIs caused by PA.

Background: A deeper understanding of how contextual factors affect the ability to participate in the life area of work and employment despite chronic musculoskeletal pain is needed as a basis for interprofessional rehabilitation programs. Objective: To investigate which contextual factors influence rehabilitation program clients’ ability to participate in the life area of work and employment, and how they do this. Methods: Nested case study using a realist evaluation framework of interprofessional interventions. Qualitative content analysis of problem-centered interviews to identify influential context-mechanism-outcome configurations. Results: We identified several important context-mechanism-outcome configurations. In the pre-interventional phase, socioeconomic and environmental factors affected two mechanisms, “exhaustion” and “discrimination”. In the intra-interventional phase, the social skills of health professionals and opportunities for discussion with peers affected the ability of program participants to engage with program content. In the post-intervention phase, volitional competences of the social system affected the sustainable application of program content in everyday life. Conclusion: The identified context-mechanism-outcome configurations shows that the ability to participate in the life area of work is interdependent with the ability to participate in other areas of life. In practice and research, assessment and treatment should be carried out based on this understanding.

Background Work-related stress problems, i.e., burnout, depression, and anxiety, is a rising global health challenge. Poor mental health also appears to be a challenge for the construction industry, even though the occupational health focus has traditionally been on the physical work environment and musculoskeletal disorders. Yet, studies targeting the organisational level (i.e., work environment, policy) to enhance mental health within the construction industry are scant. Therefore, our first objective was to evaluate the effectiveness of a co-created occupational health intervention on stress and psychosocial working conditions within the construction industry in Sweden. The second objective was to evaluate whether the intervention was implemented as intended, i.e., implementation fidelity. The trial is registered in the ISRCTN clinical trial registry (ISRCTN16548039, ). Methods This is a controlled trial with one intervention and one matched control group. We co-created the program logic with stakeholders from the intervention group. The essence of the chosen intervention components, duties clarification, and structured roundmaking was enhanced planning and role clarification. We assessed adherence to the intervention and dose delivered (i.e., fidelity). We collected data on the outcomes (role clarity, team effectiveness, planning, staffing, quantitative demands, and the psychosocial safety climate) with online questionnaires at baseline, 12, and 24 months. Marginal means models adjusting for missing data patterns were applied to estimate potential differences in outcomes between groups over time. Results Fidelity was considered reasonably high. Yet, we found no intervention effects on the primary outcome stress. All outcomes, except role clarity deteriorated during the trial in the intervention and control group. However, the results indicate a positive effect of the intervention components on professionals' role clarity. The pandemic appears to have negatively

We evaluate a large scale network change in Amsterdam, the Netherlands, where a regional network of many direct bus lines is replaced by a new metro line as a trunk line and buses serving as feeder lines. For the analysis we use realized trip times from automated vehicle location data and ridership details from smart card data. In the new network, we observe a strong shift to the new transfer stations. On the other hand, stops and lines keeping their direct connection in the new feeder network are used more than other stops and lines. From northern direction, the leg on the faster trunk line is too short to compensate for the additional transfer, leading to a slight increase in travel time. From the south, travel time has become shorter: a longer leg is travelled on the new metro line. Finally, all new feeder lines operate more reliably than the former direct lines. These findings can help guide ex-ante evaluations for other networks considering transition to a trunk and feeder system., Accepted Author Manuscript, Transport and Planning

Online meal delivery platforms are growing worldwide. Nevertheless, the takeaway business model is currently the major source of plastic packaging waste generation. The alarming growth of plastic pollution leads to action among governments worldwide resulting in single-use plastic bans. A handful of start-ups offer reusable food container services. However, no online meal delivery platform has adopted such as service. The market size of these initiatives is therefore still small. There is no proof of concept on a larger scale. For this purpose, this study identifies, defines, and evaluates reusable food container handling methods in the meal delivery industry. We conduct a simulation study to measure the environmental- and economical performance of different container handling methods. Our experimental findings suggest that: (i) food container returnment by drivers results in the largest amount of cost- and emission savings, (ii) customer returnment to any random reusable restaurant results in a less controllable system, resulting in more redistribution events, higher costs, and more emissions, (iii) the hybrid container handling method gives two options for return which enlarges the convenience for return by a wide variety of customers. We thus conclude that the passive handling method results in the largest cost- and emission savings, however, the practical implications i.a. concept convenience remains an important topic for further research.

Introduction This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5-17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison. Methods and analysis Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child's perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology. Ethics and dissemination Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council's guidelines. Research findings will be presented at international cancer and paediatric conferences

Introduction This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5-17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison. Methods and analysis Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child's perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology. Ethics and dissemination Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council's guidelines. Research findings will be presented at international cancer and paediatric conferences

Workplace bullying among nurses is a prevalent and serious problem in health care settings around the world with detrimental physical, psychological, and organizational consequences. Nursing students and novice nurses are more likely to encounter incidents of workplace bullying in their clinical settings. Although workplace bullying is one of the biggest challenges that the nursing profession faces today, there is a scarceness of interventional research aimed at educating nursing students on effective responses to workplace bullying. Thus, the primary aim of this study was to evaluate the effectiveness of an online educational tool in enhancing knowledge about workplace bullying and in improving self-efficacy and intent to intervene related to workplace bullying among undergraduate nursing students in two Canadian schools of nursing. The study design was quasi-experimental, using a one group pre-test/post-test. Forty-one undergraduate nursing students participated. Recruitment ceased with the onset of the COVID-19 pandemic. Participants completed a demographic questionnaire, a 20-item, self-developed Workplace Bullying Knowledge Assessment tool and the Self-Efficacy to Respond to Disruptive Behaviours (SERDB) scale with an additional item about intent to intervene. Results relative to the effectiveness of the intervention to enhance participants' knowledge, self-efficacy, and intent to intervene are presented from the paired samples t-test and Wilcoxon-Signed Rank test of pre- and post-intervention differences. Additionally, a regression analysis tested for interaction effects of independent participants' variables. Although the educational intervention enhanced nursing students' knowledge about workplace bullying, self-efficacy, and intent to intervene, caution is needed in the interpretation of the statistically significant results due to the small sample size. This study highlighted the importance of including evidence-based educational tools about workplace bull

Workplace bullying among nurses is a prevalent and serious problem in health care settings around the world with detrimental physical, psychological, and organizational consequences. Nursing students and novice nurses are more likely to encounter incidents of workplace bullying in their clinical settings. Although workplace bullying is one of the biggest challenges that the nursing profession faces today, there is a scarceness of interventional research aimed at educating nursing students on effective responses to workplace bullying. Thus, the primary aim of this study was to evaluate the effectiveness of an online educational tool in enhancing knowledge about workplace bullying and in improving self-efficacy and intent to intervene related to workplace bullying among undergraduate nursing students in two Canadian schools of nursing. The study design was quasi-experimental, using a one group pre-test/post-test. Forty-one undergraduate nursing students participated. Recruitment ceased with the onset of the COVID-19 pandemic. Participants completed a demographic questionnaire, a 20-item, self-developed Workplace Bullying Knowledge Assessment tool and the Self-Efficacy to Respond to Disruptive Behaviours (SERDB) scale with an additional item about intent to intervene. Results relative to the effectiveness of the intervention to enhance participants' knowledge, self-efficacy, and intent to intervene are presented from the paired samples t-test and Wilcoxon-Signed Rank test of pre- and post-intervention differences. Additionally, a regression analysis tested for interaction effects of independent participants' variables. Although the educational intervention enhanced nursing students' knowledge about workplace bullying, self-efficacy, and intent to intervene, caution is needed in the interpretation of the statistically significant results due to the small sample size. This study highlighted the importance of including evidence-based educational tools about workplace bull

Among many dermal armors, fish scales have become a source of inspiration in the pursuit of “next-generation” structural materials. Although fish scales function in a hydrated environment, the role of water and intermolecular hydrogen bonding to their unique structural behavior has not been elucidated. Water molecules reside within and adjacent to the interpeptide locations of the collagen fibrils of the elasmodine and provide lubrication to the protein molecules during deformation. We evaluated the contributions of this lubrication and the intermolecular bonding to the mechanical behavior of elasmodine scales from the Black Carp (Mylopharyngodon piceus). Scales were exposed to polar solvents, followed by axial loading to failure and the deformation mechanisms were characterized via optical mechanics. Displacement of intermolecular water molecules by liquid polar solvents caused significant (p = 0.05) increases in stiffness, strength and toughness of the scales. Removal of this lubrication decreased the capacity for non-linear deformation and toughness, which results from the increased resistance to fibril rotations and sliding caused by molecular friction. The intermolecular lubrication is a key component of the “protecto-flexibility” of scales and these natural armors as a system; it can serve as an important component of biomimetic-driven designs for flexible armor systems. Statement of Significance: The natural armor of fish has become a topic of substantial scientific interest. Hydration is important to these materials as water molecules reside within the interpeptide locations of the collagen fibrils of the elasmodine and provide lubrication to the protein molecules during deformation. We explored the opportunity for tuning the mechanical behavior of scales as a model for next-generation engineering materials by adjusting the extent of hydrogen bonding with polar solvents and the corresponding interpeptide molecular lubrication. Removal of this lubrication dec

We evaluate a large scale network change in Amsterdam, the Netherlands, where a regional network of many direct bus lines is replaced by a new metro line as a trunk line and buses serving as feeder lines. For the analysis we use realized trip times from automated vehicle location data and ridership details from smart card data. In the new network, we observe a strong shift to the new transfer stations. On the other hand, stops and lines keeping their direct connection in the new feeder network are used more than other stops and lines. From northern direction, the leg on the faster trunk line is too short to compensate for the additional transfer, leading to a slight increase in travel time. From the south, travel time has become shorter: a longer leg is travelled on the new metro line. Finally, all new feeder lines operate more reliably than the former direct lines. These findings can help guide ex-ante evaluations for other networks considering transition to a trunk and feeder system., Accepted Author Manuscript, Transport and Planning

Online meal delivery platforms are growing worldwide. Nevertheless, the takeaway business model is currently the major source of plastic packaging waste generation. The alarming growth of plastic pollution leads to action among governments worldwide resulting in single-use plastic bans. A handful of start-ups offer reusable food container services. However, no online meal delivery platform has adopted such as service. The market size of these initiatives is therefore still small. There is no proof of concept on a larger scale. For this purpose, this study identifies, defines, and evaluates reusable food container handling methods in the meal delivery industry. We conduct a simulation study to measure the environmental- and economical performance of different container handling methods. Our experimental findings suggest that: (i) food container returnment by drivers results in the largest amount of cost- and emission savings, (ii) customer returnment to any random reusable restaurant results in a less controllable system, resulting in more redistribution events, higher costs, and more emissions, (iii) the hybrid container handling method gives two options for return which enlarges the convenience for return by a wide variety of customers. We thus conclude that the passive handling method results in the largest cost- and emission savings, however, the practical implications i.a. concept convenience remains an important topic for further research.

Workplace bullying among nurses is a prevalent and serious problem in health care settings around the world with detrimental physical, psychological, and organizational consequences. Nursing students and novice nurses are more likely to encounter incidents of workplace bullying in their clinical settings. Although workplace bullying is one of the biggest challenges that the nursing profession faces today, there is a scarceness of interventional research aimed at educating nursing students on effective responses to workplace bullying. Thus, the primary aim of this study was to evaluate the effectiveness of an online educational tool in enhancing knowledge about workplace bullying and in improving self-efficacy and intent to intervene related to workplace bullying among undergraduate nursing students in two Canadian schools of nursing. The study design was quasi-experimental, using a one group pre-test/post-test. Forty-one undergraduate nursing students participated. Recruitment ceased with the onset of the COVID-19 pandemic. Participants completed a demographic questionnaire, a 20-item, self-developed Workplace Bullying Knowledge Assessment tool and the Self-Efficacy to Respond to Disruptive Behaviours (SERDB) scale with an additional item about intent to intervene. Results relative to the effectiveness of the intervention to enhance participants' knowledge, self-efficacy, and intent to intervene are presented from the paired samples t-test and Wilcoxon-Signed Rank test of pre- and post-intervention differences. Additionally, a regression analysis tested for interaction effects of independent participants' variables. Although the educational intervention enhanced nursing students' knowledge about workplace bullying, self-efficacy, and intent to intervene, caution is needed in the interpretation of the statistically significant results due to the small sample size. This study highlighted the importance of including evidence-based educational tools about workplace bull

Workplace bullying among nurses is a prevalent and serious problem in health care settings around the world with detrimental physical, psychological, and organizational consequences. Nursing students and novice nurses are more likely to encounter incidents of workplace bullying in their clinical settings. Although workplace bullying is one of the biggest challenges that the nursing profession faces today, there is a scarceness of interventional research aimed at educating nursing students on effective responses to workplace bullying. Thus, the primary aim of this study was to evaluate the effectiveness of an online educational tool in enhancing knowledge about workplace bullying and in improving self-efficacy and intent to intervene related to workplace bullying among undergraduate nursing students in two Canadian schools of nursing. The study design was quasi-experimental, using a one group pre-test/post-test. Forty-one undergraduate nursing students participated. Recruitment ceased with the onset of the COVID-19 pandemic. Participants completed a demographic questionnaire, a 20-item, self-developed Workplace Bullying Knowledge Assessment tool and the Self-Efficacy to Respond to Disruptive Behaviours (SERDB) scale with an additional item about intent to intervene. Results relative to the effectiveness of the intervention to enhance participants' knowledge, self-efficacy, and intent to intervene are presented from the paired samples t-test and Wilcoxon-Signed Rank test of pre- and post-intervention differences. Additionally, a regression analysis tested for interaction effects of independent participants' variables. Although the educational intervention enhanced nursing students' knowledge about workplace bullying, self-efficacy, and intent to intervene, caution is needed in the interpretation of the statistically significant results due to the small sample size. This study highlighted the importance of including evidence-based educational tools about workplace bull

Gestational diabetes (GDM) increases the risk of pregnancy complications. However, these risks are not the same for all affected women and may be mediated by inter-related factors including ethnicity, body mass index and gestational weight gain. This study was conducted to identify, compare, and critically appraise prognostic prediction models for pregnancy complications in women with gestational diabetes (GDM). A systematic review of prognostic prediction models for pregnancy complications in women with GDM was conducted. Critical appraisal was conducted using the prediction model risk of bias assessment tool (PROBAST). Five prediction modelling studies were identified, from which ten prognostic models primarily intended to predict pregnancy complications related to GDM were developed. While the composition of the pregnancy complications predicted varied, the delivery of a large-for-gestational age neonate was the subject of prediction in four studies, either alone or as a component of a composite outcome. Glycaemic measures and body mass index were selected as predictors in four studies. Model evaluation was limited to internal validation in four studies and not reported in the fifth. Performance was inadequately reported with no useful measures of calibration nor formal evaluation of clinical usefulness. Critical appraisal using PROBAST revealed that all studies were subject to a high risk of bias overall driven by methodologic limitations in statistical analysis. This review demonstrates the potential for prediction models to provide an individualised absolute risk of pregnancy complications for women affected by GDM. However, at present, a lack of external validation and high risk of bias limit clinical application. Future model development and validation should utilise the latest methodological advances in prediction modelling to achieve the evolution required to create a useful clinical tool. Such a tool may enhance clinical decision-making and support a risk

Introduction: Beta-adrenoreceptor antagonist (beta-blocker) poisoning is a common overdose which can lead to significant morbidity and mortality. Objective(s): To evaluate the effects of treatments for beta-adrenoreceptor antagonist poisoning. Method(s): Searches were conducted across MEDLINE (1946-26 November 2019, Ovid); Embase (1974-26 November 2019, Ovid); and the Cochrane Central Register of Controlled Trials (CENTRAL, to 26 November 2019) utilising a combination of subject headings and free text. The search strategy identified 15, 553 citations. Two reviewers screened titles and abstracts prior to selecting 141 articles (Kappa on articles included = 0.982, 95% CI 0.980-0.985). Primary outcomes included mortality and improvement in haemodynamic parameters (e.g., heart rate, blood pressure or a composite measure able to quantitate a haemodynamic response). Result(s): The risk of bias was high for all interventions. Gastric decontamination: Fifteen case reports described the administration of activated charcoal and five detailed the use of gastric lavage. As there was concurrent utilisation of multiple interventions, it was difficult to draw definitive conclusions regarding the relative contribution of these interventions to mortality or survival. Catecholamines, inotropes and vasopressors: The use of catecholamines in treating beta-blocker toxicity was reported in 16 case reports, 3 case series and 2 animal studies. These agents most likely provided a survival benefit and improved haemodynamics. Atropine: Multiple intravenous boluses of atropine were associated with improvement in heart rate and blood pressure in one case report. Calcium: Intravenous calcium was associated with an improvement in haemodynamics in three out of six case reports but in association with multiple other therapies as well as in two animal studies. High-dose insulin euglycaemic therapy: The use of this therapy was associated with mortality benefit in 10 case series. Two case reports show

The study involves the testing of a novel laparoscopic training model by surgeons of various levels of experience. Background(s): There has been an increasing requirement for low-cost simulation. Our aim was to evaluate the construct validity of a low-cost model for teaching core laparoscopic skills. Method(s): The Double-Glove model was made from 2 latex gloves, one placed in the other. The inner glove was filled with water and 3 ovals were drawn on the outer glove. Participants were required to dissect the middle oval out without perforating the inner glove or leaving the line border of the middle oval. The task was assessed using a previously validated scoring system (minimum - 120; maximum 80). Result(s): Ninety-five participants completed the task: 40 novices, 45 intermediates, and 10 experts. The model revealed statistical significance between the three groups. Experts scored higher than novices (58/80 vs 11.7/80; p < 0.0001) and intermediates (58/80 vs 29.1/80; p = 0.0004), and intermediates scored higher than novices (29.1/80 vs 11.7/80; p = 0.014). Novices took more time to complete the task compared to intermediates (10 min vs 7.87 min; p < 0.0001) and experts (10 min vs 6.98 min; p < 0.0001). No correlation between time taken and score obtained was seen (r = - 0.06, r = 0.01, r = - 0.2 for novice, intermediate, and expert groups). Conclusion(s): By differentiating between groups of variable experience, the model demonstrated construct validity. It offers an inexpensive model that can be utilized in low-cost laparoscopic simulation. Type of Study: Study of a diagnostic test. Level of Evidence: II.Copyright © 2019 Elsevier Inc.

STUDY QUESTION: Do randomised controlled trials (RCTs) evaluating endometrial scratching suffer from methodological issues including insufficient trial registration, statistical errors or irreproducibility, randomisation errors or miscellaneous issues? SUMMARY ANSWER: The majority of RCTs investigating endometrial scratching have methodological issues. WHAT IS KNOWN ALREADY: A large number of small RCTs investigating the effectiveness of endometrial scratching prior to in vitro fertilisation (IVF) and intrauterine insemination (IUI)/intercourse have reported favourable findings. Subsequently, systematic reviews incorporating these RCTs yielded meta-analyses in favour of endometrial scratching. Endometrial scratching has been widely adopted by infertility specialists around the world. Recently, an international RCT including 1364 women reported no benefit from endometrial scratching before IVF. STUDY DESIGN, SIZE, DURATION: We evaluated several methodological issues of RCTs investigating the effectiveness of endometrial scratching prior to IVF and IUI/intercourse. We identified 25 RCTs for IVF and 12 RCTs for IUI/intercourse with full-text publication. PARTICIPANTS/MATERIALS, SETTING, METHODS: We assessed the RCTs on the following criteria: adequacy of trial registration, statistical issues (description of statistical methods and reproducibility of univariable statistical analysis), excessive similarity or difference in baseline characteristics that is not compatible with chance (Monte Carlo simulations and Kolmogorov-Smirnov test) and miscellaneous methodological issues. MAIN RESULTS AND THE ROLE OF CHANCE: Of 25 RCTs evaluating endometrial scratching prior to IVF, only eight (32%) had adequate trial registration. In total, 10 (40%) RCTs had issues regarding statistical methods. Nine (69%, 13 applicable) RCTs had at least one inconsistency between reported and reproduced univariable statistical analysis for categorical baseline/intermediate characteristics. Statisti

Background: In the context of the pandemic, the rapid emergency use authorisation of diagnostic assays for SARS-CoV-2 has meant there are few peer-reviewed published studies of clinical performance of commercial assays. Aim(s): To evaluate the clinical performance of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2. Method(s): We reviewed the results following implementation of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, and compared with an in-house RT-PCR assay at our State Reference Laboratory. Result(s): Initial validation using AusDiagnostics coronavirus multiplex tandem PCR assay including SARS-CoV-2 demonstrated good concordance with the State Reference Laboratory. After implementing the AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, we tested 7839 samples. 127 samples in which SARS-CoV-2 was detected using the AusDiagnostics assay were referred for testing at the State Reference Laboratory, with concordant results in 118/127 (92.9%) of samples. After resolution of discrepancies, 125/127 (98.4%) of AusDiagnostics results were determined to be true positive results. Out of 7839 samples tested for SARS-CoV-2 during this period, only 2 tests (0.02%) were indeterminate results. Conclusion(s): The AusDiagnostics respiratory MT-PCR assay is a reliable assay for detection of SARS-CoV-2.Copyright © 2020

Introduction Multimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician champions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED. Methods A single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random sample of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed Long-term follow-up'). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 ( Pre-Intervention' and Immediately Post-Intervention') to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected. Results In our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI. Conclusion An MMI aimed at reducing unused PIVC in

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Gestational diabetes (GDM) increases the risk of pregnancy complications. However, these risks are not the same for all affected women and may be mediated by inter-related factors including ethnicity, body mass index and gestational weight gain. This study was conducted to identify, compare, and critically appraise prognostic prediction models for pregnancy complications in women with gestational diabetes (GDM). A systematic review of prognostic prediction models for pregnancy complications in women with GDM was conducted. Critical appraisal was conducted using the prediction model risk of bias assessment tool (PROBAST). Five prediction modelling studies were identified, from which ten prognostic models primarily intended to predict pregnancy complications related to GDM were developed. While the composition of the pregnancy complications predicted varied, the delivery of a large-for-gestational age neonate was the subject of prediction in four studies, either alone or as a component of a composite outcome. Glycaemic measures and body mass index were selected as predictors in four studies. Model evaluation was limited to internal validation in four studies and not reported in the fifth. Performance was inadequately reported with no useful measures of calibration nor formal evaluation of clinical usefulness. Critical appraisal using PROBAST revealed that all studies were subject to a high risk of bias overall driven by methodologic limitations in statistical analysis. This review demonstrates the potential for prediction models to provide an individualised absolute risk of pregnancy complications for women affected by GDM. However, at present, a lack of external validation and high risk of bias limit clinical application. Future model development and validation should utilise the latest methodological advances in prediction modelling to achieve the evolution required to create a useful clinical tool. Such a tool may enhance clinical decision-making and support a risk

The study involves the testing of a novel laparoscopic training model by surgeons of various levels of experience. Background(s): There has been an increasing requirement for low-cost simulation. Our aim was to evaluate the construct validity of a low-cost model for teaching core laparoscopic skills. Method(s): The Double-Glove model was made from 2 latex gloves, one placed in the other. The inner glove was filled with water and 3 ovals were drawn on the outer glove. Participants were required to dissect the middle oval out without perforating the inner glove or leaving the line border of the middle oval. The task was assessed using a previously validated scoring system (minimum - 120; maximum 80). Result(s): Ninety-five participants completed the task: 40 novices, 45 intermediates, and 10 experts. The model revealed statistical significance between the three groups. Experts scored higher than novices (58/80 vs 11.7/80; p < 0.0001) and intermediates (58/80 vs 29.1/80; p = 0.0004), and intermediates scored higher than novices (29.1/80 vs 11.7/80; p = 0.014). Novices took more time to complete the task compared to intermediates (10 min vs 7.87 min; p < 0.0001) and experts (10 min vs 6.98 min; p < 0.0001). No correlation between time taken and score obtained was seen (r = - 0.06, r = 0.01, r = - 0.2 for novice, intermediate, and expert groups). Conclusion(s): By differentiating between groups of variable experience, the model demonstrated construct validity. It offers an inexpensive model that can be utilized in low-cost laparoscopic simulation. Type of Study: Study of a diagnostic test. Level of Evidence: II.Copyright © 2019 Elsevier Inc.

Introduction: Beta-adrenoreceptor antagonist (beta-blocker) poisoning is a common overdose which can lead to significant morbidity and mortality. Objective(s): To evaluate the effects of treatments for beta-adrenoreceptor antagonist poisoning. Method(s): Searches were conducted across MEDLINE (1946-26 November 2019, Ovid); Embase (1974-26 November 2019, Ovid); and the Cochrane Central Register of Controlled Trials (CENTRAL, to 26 November 2019) utilising a combination of subject headings and free text. The search strategy identified 15, 553 citations. Two reviewers screened titles and abstracts prior to selecting 141 articles (Kappa on articles included = 0.982, 95% CI 0.980-0.985). Primary outcomes included mortality and improvement in haemodynamic parameters (e.g., heart rate, blood pressure or a composite measure able to quantitate a haemodynamic response). Result(s): The risk of bias was high for all interventions. Gastric decontamination: Fifteen case reports described the administration of activated charcoal and five detailed the use of gastric lavage. As there was concurrent utilisation of multiple interventions, it was difficult to draw definitive conclusions regarding the relative contribution of these interventions to mortality or survival. Catecholamines, inotropes and vasopressors: The use of catecholamines in treating beta-blocker toxicity was reported in 16 case reports, 3 case series and 2 animal studies. These agents most likely provided a survival benefit and improved haemodynamics. Atropine: Multiple intravenous boluses of atropine were associated with improvement in heart rate and blood pressure in one case report. Calcium: Intravenous calcium was associated with an improvement in haemodynamics in three out of six case reports but in association with multiple other therapies as well as in two animal studies. High-dose insulin euglycaemic therapy: The use of this therapy was associated with mortality benefit in 10 case series. Two case reports show

STUDY QUESTION: Do randomised controlled trials (RCTs) evaluating endometrial scratching suffer from methodological issues including insufficient trial registration, statistical errors or irreproducibility, randomisation errors or miscellaneous issues? SUMMARY ANSWER: The majority of RCTs investigating endometrial scratching have methodological issues. WHAT IS KNOWN ALREADY: A large number of small RCTs investigating the effectiveness of endometrial scratching prior to in vitro fertilisation (IVF) and intrauterine insemination (IUI)/intercourse have reported favourable findings. Subsequently, systematic reviews incorporating these RCTs yielded meta-analyses in favour of endometrial scratching. Endometrial scratching has been widely adopted by infertility specialists around the world. Recently, an international RCT including 1364 women reported no benefit from endometrial scratching before IVF. STUDY DESIGN, SIZE, DURATION: We evaluated several methodological issues of RCTs investigating the effectiveness of endometrial scratching prior to IVF and IUI/intercourse. We identified 25 RCTs for IVF and 12 RCTs for IUI/intercourse with full-text publication. PARTICIPANTS/MATERIALS, SETTING, METHODS: We assessed the RCTs on the following criteria: adequacy of trial registration, statistical issues (description of statistical methods and reproducibility of univariable statistical analysis), excessive similarity or difference in baseline characteristics that is not compatible with chance (Monte Carlo simulations and Kolmogorov-Smirnov test) and miscellaneous methodological issues. MAIN RESULTS AND THE ROLE OF CHANCE: Of 25 RCTs evaluating endometrial scratching prior to IVF, only eight (32%) had adequate trial registration. In total, 10 (40%) RCTs had issues regarding statistical methods. Nine (69%, 13 applicable) RCTs had at least one inconsistency between reported and reproduced univariable statistical analysis for categorical baseline/intermediate characteristics. Statisti

Background: In the context of the pandemic, the rapid emergency use authorisation of diagnostic assays for SARS-CoV-2 has meant there are few peer-reviewed published studies of clinical performance of commercial assays. Aim(s): To evaluate the clinical performance of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2. Method(s): We reviewed the results following implementation of AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, and compared with an in-house RT-PCR assay at our State Reference Laboratory. Result(s): Initial validation using AusDiagnostics coronavirus multiplex tandem PCR assay including SARS-CoV-2 demonstrated good concordance with the State Reference Laboratory. After implementing the AusDiagnostics respiratory multiplex tandem PCR assay including SARS-CoV-2, we tested 7839 samples. 127 samples in which SARS-CoV-2 was detected using the AusDiagnostics assay were referred for testing at the State Reference Laboratory, with concordant results in 118/127 (92.9%) of samples. After resolution of discrepancies, 125/127 (98.4%) of AusDiagnostics results were determined to be true positive results. Out of 7839 samples tested for SARS-CoV-2 during this period, only 2 tests (0.02%) were indeterminate results. Conclusion(s): The AusDiagnostics respiratory MT-PCR assay is a reliable assay for detection of SARS-CoV-2.Copyright © 2020

Introduction Multimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan ED used clinician champions, guidelines, education sessions and promotional materials to encourage a reduction in unused and inappropriate peripheral intravenous cannulas (PIVC). A 60-day postintervention demonstrated a successful reduction in the number of unused PIVCs without changes in appropriate insertions. We aimed to investigate if this MMI produced a sustained effect in reducing the frequency of unused PIVCs inserted in this ED. Methods A single-centre retrospective cohort study of adult patients presenting to the above ED in Victoria, Australia, was conducted in April 2018. A random sample of 380 patients with a PIVC inserted in ED was assessed to determine if the PIVC was used (termed Long-term follow-up'). The appropriateness of unused PIVCs was assessed. Our findings were compared with previously collected data in 2013 ( Pre-Intervention' and Immediately Post-Intervention') to determine a sustained reduction in the frequency of unused PIVC insertions was achieved. Long-term analysis of the MMI, including the overall frequency of PIVC insertions in ED before and after the MMI, was also collected. Results In our Long-term follow-up cohort, 101 of 373 (27.1%, 95% CI 22.6% to 31.9%) PIVCs were unused (seven cases excluded). This was significantly lower than the Pre-Intervention cohort (139/376, 37.0%, 95% CI 32.1% to 42.1%). While not significant, the frequency of unused PIVCs in the Post-Intervention cohort was lower in comparison (73/378, 19.3%, 95% CI 15.4% to 23.7%). No significant change in the appropriateness of unused PIVCs was observed between the Post-Intervention and Long-term follow-up. The overall proportion of patients receiving a PIVC has remained low since the MMI. Conclusion An MMI aimed at reducing unused PIVC in

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

Objective: Evaluate the data quality, the opportunity and the representativeness of the dengue epidemiological surveillance system in Natal. Methods: Evaluative research, with data from suspected or confirmed dengue cases notified in the Notifiable Diseases Information System (Sinan), from 2012 to 2017. Results: A total of 49,655 cases were reported in this period. The overall completeness and consistency were outstanding, ranging from 94.8% to 100.0% and 91.1% to 100.0%. Completeness was regular for the variables on case evolution, race/skin color and schooling level. The system was considered timely, with an average of 3.4 to 6.8 days between symptom onset and notification. It was considered representative due to the high correlation between the number of hospitalizations for dengue obtained in Sinan and the Hospital Information System. Conclusion: The dengue surveillance system was considered complete, consistent, timely and representative, configuring itself as an important tool for the guidance of actions., Objetivo: avaliar a qualidade dos dados, a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue em Natal. Métodos: Pesquisa avaliativa, com dados dos casos suspeitos ou confirmados de dengue notificados no Sistema de Informação de Agravos de Notificação (Sinan), de 2012 a 2017. Resultados: Foram notificados 49.655 casos no período. A completude geral e a consistência foram excelentes, variando de 94,8% a 100,0% e de 91,1% a 100,0% respectivamente. A completude foi regular para as variáveis evolução do caso, raça/cor da pele e escolaridade. O sistema foi considerado oportuno, com média de 3,4 a 6,8 dias entre o início dos sintomas e a notificação. Foi considerado representativo devido a elevada correlação entre números de internações por dengue obtidos no Sinan e no Sistema de Informações Hospitalares. Conclusão: O sistema de vigilância da dengue foi considerado completo, consistente, oportuno e representativo, configurando-se importante para o direcionamento de ações de vigilância.

OBJECTIVES: To evaluate the performance of the ResistancePlus GC (beta) assay for the simultaneous detection of Neisseria gonorrhoeae and gyrA S91 markers of resistance (S91F) and susceptibility (WT) to ciprofloxacin, from both clinical specimens and isolates. METHODS: Performance was assessed on several sample banks, including N. gonorrhoeae isolates (n = 822), non-gonococcal isolates (n = 110), N. gonorrhoeae-positive clinical specimens (n = 402) and N. gonorrhoeae-negative specimens (n = 290). Results were compared with previous testing data, including S91 genotyping and phenotypic resistance profiles. RESULTS: Overall, the assay demonstrated 100% sensitivity for N. gonorrhoeae detection in clinical isolates. For gyrA S91 mutation detection in clinical isolates, the assay showed 100% sensitivity/specificity compared with the genotype, and >99%/>97% sensitivity/specificity when compared with phenotype. For positive clinical specimens, the assay demonstrated >96% sensitivity for N. gonorrhoeae detection and 100% sensitivity/specificity for gyrA S91 mutation detection. The assay demonstrated >99% specificity for N. gonorrhoeae detection against non-gonococcal isolates and 100% specificity for negative clinical specimens. CONCLUSIONS: The ResistancePlus GC (beta) assay is suitable for the detection of N. gonorrhoeae and gyrA markers associated with resistance/susceptibility to ciprofloxacin directly in clinical samples. This assay could be implemented for the individualized treatment of gonorrhoea infections as well as to enhance current antimicrobial resistance surveillance methods.