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Keywords: Chronic granulomatous disease; COVID-19; immunodeficiency EN Chronic granulomatous disease COVID-19 immunodeficiency 23 25 3 02/01/21 20210101 NES 210101 To the Editor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first discovered in December 2019, has led to an ongoing, unprecedented global pandemic due to coronavirus disease 2019 (COVID-19). The majority of pediatric COVID-19 cases are mild, and while our patient was hospitalized, he recovered without respiratory support, antiviral therapy for SARS-CoV-2 infection, or anti-inflammatory therapy for COVID-19. There are limited studies of COVID-19 in primary immunodeficiency patients, but the effect of immunodeficiencies on COVID-19 risk and how they may lead to enhanced susceptibility or even protection will improve as our understanding of the immunopathogenesis of this infection evolves and clinical cases are described. [Extracted from the article]

Background. Midwifery is an internationally mobile profession, but there is a lack of research investigating the experiences of internationally qualified midwives practising in Australia. Aim. To investigate the experiences of internationally qualified midwives integrating into the Australian midwifery system. Methods. Phase one of a two-phased sequential explanatory mixed methods study included an e-survey of 66 internationally qualified midwives who were recruited via a non-probability purposive sampling strategy. Ethical approval. This study was approved by the University of South Australia Human Research Ethics Committee (protocol number: 0000036397). Findings. Almost all of the respondents (n=62; 94%) reported diversity in midwifery practices and 51 (77%) reported diversity in the work-based culture between their country of midwifery qualification and Australia. Forty-nine (74%) internationally qualified midwives felt they received adequate support at their workplace and 52 (79%) reported that they experienced respect from women they had cared for. Over half of the respondents (n=41; 62%) perceived inequity of opportunity, and a sixth of respondents (n=11; 17%) felt discriminated against in the Australian midwifery workforce. Conclusion. This study, while limited in scope, provides insight into specific challenges experienced by internationally qualified midwives and may better inform approaches to support future transition into the Australian multicultural midwifery workforce. Diversity in midwifery practice and work-based culture, as well as the possibility of experience of discrimination and inequity of opportunity can influence negatively on future internationally qualified midwives' professional lives. Implications. Understanding the challenges that internationally qualified midwives confront in Australia and enhancing strategies to provide a smooth transition for IQMs are necessary. A supportive work environment is critical to ensure that diversity is valued, and internationally qualified midwives are provided equal opportunity [ABSTRACT FROM AUTHOR]

Abstract Clinical placement is a core feature of Australian midwifery education programs, with clinical supervision acknowledged as a key component for student success. The aim of this study was to evaluate the clinical facilitation models in South Australia, specifically the quality of clinical supervision to facilitate learning, and key stakeholder satisfaction. A mixed method evaluation research design was used to compare three models of clinical facilitation for midwifery students undertaking clinical placement across five venues. Midwifery students (n = 174), across two universities completed an anonymous e-survey utilising the validated Clinical Placement Experience Questionnaire. Midwives (n = 149) across five venues completed an anonymous purpose-designed questionnaire on their experience providing clinical supervision to midwifery students and Clinical Facilitators (n = 8) representing three facilitation models completed a self-report e-diary for two weeks and engaged in a focus group. Few differences were identified between the quality of student support and learning opportunities. Students in all models were well orientated and prepared for the clinical environment. Clinical Facilitators were supportive, educative and valuable for the students to achieve their learning objectives. One significant difference was that facilitators employed in the 'Shared' model were more able to provide support to midwives supervising students and maintain good liaison with the universities. Highlights • Clinical facilitation across all models supports clinical supervision in midwifery education. • Clinical facilitation which includes education support for midwives working with students may improve clinical supervision. • Clinical facilitation with a fulltime facilitator employed by the hospital represented a best practice model. [ABSTRACT FROM AUTHOR]

Background There is little published research that has examined practitioners’ views and experiences of pain relieving measures commonly used during labour and birth, particularly for non-pharmacological measures such as water immersion. Furthermore, there is minimal published research examining the process of policy and guideline development, that is, the translation of published research to usable practice guidance. Aims The aims of phase three of a larger study were to explore midwives knowledge, experiences and support for the option of water immersion for labour and birth in practice and their involvement, if any, in development of policy and guidelines pertaining to the option. Methods Phase three of a three phased mixed methods study included a web based survey of 234 Australian midwives who had facilitated and/or been involved in the development of policies and/or guidelines relating to the practice of water immersion. Findings Midwives who participated in this study were supportive of both water immersion for labour and birth reiterating documented benefits of reduced pain, maternal relaxation and a positive birth experience. The most significant concerns were maternal collapse, the difficulty of estimating blood loss and postpartum haemorrhage whilst barriers included lack of accredited staff, lifting equipment and negative attitudes. Midwives indicated that policy/guideline documents limited their ability to facilitate water immersion and did not always to support women’s informed choice. Conclusion Midwives who participated in this study supported the practice of water immersion reiterating the benefits documented in the literature and minimal risk to the woman and baby. Ethical considerations The Human Research Ethics Committee of the University of South Australia approved the research. [ABSTRACT FROM AUTHOR]

Background Accessibility of water immersion for labour and/or birth is often dependent on the care provider and also the policies/guidelines that underpin practice. With little high quality research about the safety and practicality of water immersion, particularly for birth, policies/guidelines informing the practice may lack the evidence necessary to ensure practitioner confidence surrounding the option thereby limiting accessibility and women’s autonomy. Aim The aims of the study were to determine how water immersion policies and/or guidelines are informed, who interprets the evidence to inform policies/guidelines and to what extent the policy/guideline facilitates the option for labour and birth. Method Phase one of a three-phase mixed-methods study critically analysed 25 Australian water immersion policies/guidelines using critical discourse analysis. Findings Policies/guidelines pertaining to the practice of water immersion reflect subjective opinions and views of the current literature base in favour of the risk-focused obstetric and biomedical discursive practices. Written with hegemonic influence, policies and guidelines impact on the autonomy of both women and practitioners. Conclusion Policies and guidelines pertaining to water immersion, particularly for birth reflect opinion and varied interpretations of the current literature base. A degree of hegemonic influence was noted prompting recommendations for future maternity care policy and guidelines’. Ethical considerations The Human Research Ethics Committee of the University of South Australia approved the research. [ABSTRACT FROM AUTHOR]

Inborn errors of immunity (IEI) are a diverse group of monogenic disorders of the immune system due to germline variants in genes important for the immune response. Over the past decade there has been increasing recognition that acquired somatic variants present in a subset of cells can also lead to immune disorders or 'phenocopies' of IEI. Discovery of somatic mosaicism causing IEI has largely arisen from investigation of seemingly sporadic cases of IEI with predominant symptoms of autoinflammation and/or autoimmunity in which germline disease-causing variants are not detected. Disease-causing somatic mosaicism has been identified in genes that also cause germline IEI, such as FAS , and in genes without significant corresponding germline disease, such as UBA1 and TLR8. There are challenges in detecting low-level somatic variants, and it is likely that the extent of the somatic mosaicism causing IEI is largely uncharted. Here we review the field of somatic mosaicism leading to IEI and discuss challenges and methods for somatic variant detection, including diagnostic approaches for molecular diagnoses of patients. [ABSTRACT FROM AUTHOR]

Lupus mesenteric vasculitis (LMV) is a severe and potentially fatal complication of systemic lupus erythematosus (SLE). Although LMV is always a consideration in adolescents and adult patients with SLE, who present with acute abdominal pain, diagnosis and management remain a great challenge. We describe the cases of five patients age 14 to 21 years old diagnosed with LMV. All five patients had active SLE and typical clinical presentation suspicious of LMV. Abdominal CT was the preferred imaging modality and was useful in four patients. Corticosteroids were the mainstay of treatment for all five patients. All five patients survived and complete remission of symptoms was achieved in four out of five patients with the addition of cyclophosphamide and in one out of five with rituximab. A review of the literature was performed including a systemic review of the case reports and case series published in the English literature over the last 20 years. [ABSTRACT FROM AUTHOR]

The article talks about natural killer (NK) cells that kill tumor targets and they have been demonstrated for a wide variety of antigens, such as haptens.