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Die Leistungsfähigkeit der Aufbereitungseinheit für Medizinprodukte (AEMP) ist essenziell für die Gesundheitsversorgung. Herausforderungen wie Fachkräftemangel und zunehmend komplexere Medizinprodukte machen kontinuierliche Prozessverbesserungen in der AEMP erforderlich. Ein datenbasierter Vergleich zwischen AEMPs kann Schwachstellen aufdecken, durch Handlungsempfehlungen Zeit und Kosten bei der Prozessverbesserung sparen und somit die Patientenversorgung verbessern. Der Lehrstuhl für Medizintechnik der RWTH Aachen entwickelt mit der DGSV e.V. eine AEMP-Benchmark zur Erfassung und Analyse von AEMP-Prozessen in Deutschland. Aufbauend auf in Vorarbeiten erhobenen Anforderungen und potenziellen Vergleichsgrößen wurde 2023 mittels einer Online-Umfrage eine Pilot-Datenerhebung für das Benchmarking durchgeführt. Die 48 erhobenen Datensätze von unterschiedlichen AEMP wurden zunächst bereinigt. Die Vergleichsgrößen wurden in Schlüssel-Leistungsindikatoren (engl.: Key Performance Indicators, KPI) und Leistungsbestimmende Faktoren (engl.: Performance Shaping Factors, PSF) unterteilt. Anschließend wurde eine statistische Analyse des Einflusses der PSFs auf die KPIs mit einem Signifikanzniveau von 0,05 durchgeführt. Die KPIs zeigten eine weite Streuung bei Qualität und Sicherheit. Für die Qualität waren das Sterilisator-Nutzvolumen und die gemeinsame Auswertung von Reklamationen mit den Kunden besonders starke Einflüsse. Für die Sicherheit der Beschäftigten waren vorhandene Einarbeitungskonzepte und häufige externe Fortbildungen besonders positive Einflüsse. Weitere signifikante Faktoren wurden identifiziert und in den praktischen Kontext eingeordnet. Insgesamt wurde damit das Ziel des Benchmarkings erreicht, Unterschiede in der Leistungsfähigkeit aufzudecken und PSF mit einem besonders starken Einfluss zu identifizieren. Eine Weiterführung des Benchmarkings erscheint sinnvoll, da zeitliche Veränderungen sichtbar gemacht werden können und durch eine größere Datenbasis eine Verbesserung der statistischen Auswertung und die Identifikation weiterer signifikanter PSF möglich ist. [ABSTRACT FROM AUTHOR]

Long non-coding RNAs (lncRNAs) play key roles in cellular pathways and disease progression, yet their molecular mechanisms remain largely understudied. The lncRNA lncTCF7 has been shown to promote tumor progression by recruiting the SWI/SNF complex to the TCF7 promoter, activating its expression and the WNT signaling pathway. However, how lncTCF7 recruits SWI/SNF remains to be determined, and lncTCF7-specific binding partners are unknown. Using RNA-pulldown and quantitative mass spectrometry, we identified a novel interacting protein partner for lncTCF7, SND1, a multifunctional RNA binding protein that can also function as a transcription co-activator. Knockdown analysis of lncTCF7 and SND1 reveals that they are both required for the expression of TCF7. Chromatin immunoprecipitation assays suggest that both SND1 and lncTCF7 are required for recruiting the SWI/SNF chromatin remodeling complex, and these functions, in tandem, activate the expression of TCF7. Finally, using structural probing and RNA-pulldown of lncTCF7 and its subdomains, we highlight the potential binding region for SND1 in the 3'-end of lncTCF7. Overall, this study highlights the critical roles lncRNAs play in regulating gene expression and provides new insights into the complex network of interactions that underlie this process. [ABSTRACT FROM AUTHOR]

BACKGROUND: During the first wave of COVID-19, we experienced problems with our hospital oxygen supply system. This study aimed to analyze factors that stressed this system and rethink the design criteria of the gas pipeline system considering the varying oxygen demand. METHODS: A retrospective study was conducted to describe problems that occurred at different stages in the oxygen supply system at our hospital due to increases in oxygen use in general, and the creation of an intermediate respiratory care unit (IRCU) and use of high-flow nasal cannula (HFNC) in particular. Herein, the characteristics and design criteria of the medical gas pipeline system are analyzed, and the steps taken to avoid future problems are outlined. RESULTS: Increases in oxygen use were observed at times of maximum occupancy, and these created vulnerabilities in the oxygen supply due to insufficient capacity in terms of cryogenic tanks, evaporators, and the piping network. The peak consumption was 3 times higher than the peak in the preceding 4 years. The use of HFNC therapy aggravated the problem; IRCU use accounting for as much as two-fifths of the total across the hospital. Steps taken subsequently prevented the recurrence of vulnerabilities. CONCLUSIONS: The design criteria for storage and distribution networks of medical gases in hospitals need to be revised considering new parameters for their implementation and the use of HFNC therapy in an IRCU. In particular, the cryogenic tanks, evaporators, and piping network for hospital wards are critical. [ABSTRACT FROM AUTHOR]

Background: The role of cytoreductive nephrectomy (CN) in the treatment of metastatic renal cell carcinoma (mRCC) remains unclear in the immuno-oncology (IO) era. The results of two randomized trials, CARMENA and SURTIME, questioned the role and timing of CN. However, despite the latest advances in the systemic treatment of mRCC, previous trials have only used targeted therapy, and no studies have fully investigated the role of CN in immune checkpoint inhibitor (CPI) settings, and there is an urgent need for future studies to better define the role and timing of CN. Methods: This study is an open-label, multi-center, parallel, prospective, randomized, interventional clinical study to evaluate the efficacy of CN in combination with CPIs in mRCC patients with International mRCC Database Consortium (IMDC) intermediate- and poor-risk. Synchronous mRCC patients with ≤ 3 IMDC risk features will be randomly allocated to three groups (1, upfront CN; 2, deferred CN; and 3, systemic therapy [ST] only). For ST, the nivolumab plus ipilimumab combination regimen, one of the standard regimens for intermediate- and poor-risk mRCC, is chosen. The primary endpoint is overall survival. The secondary endpoints are progression-free survival, objective response rate, number of participants with treatment-related adverse events, and number of participants with surgical morbidity. We will analyze the genetic mutation profiles of the tumor tissue, circulating tumor DNA, urine tumor DNA, and tumor-infiltrating lymphocytes. The gut and urine microbial communities will be analyzed. The study will begin in 2022 and will enroll 55 patients. Discussion: This study is one of the few prospective randomized trials to evaluate the benefit of CN in the treatment of synchronous mRCC in the IO era. The SEVURO-CN trial will help identify the role and timing of CN, thereby rediscovering the value of CN. Trial registration: ClinicalTrials.gov, NCT05753839. Registered on 3 March 2023. [ABSTRACT FROM AUTHOR]

Aims: Patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) are eligible for first‐line immune checkpoint inhibition if their tumour is positive for programmed death ligand 1 (PD‐L1) determined by the combined positive score (CPS). This nationwide study, using real‐world data, investigated the developing PD‐L1 testing landscape in the first 3 years after introduction of the test in HNSCC and examined interlaboratory variation in PD‐L1 positivity rates. Methods: Pathology reports of HNSCC patients mentioning PD‐L1 were extracted from the Dutch Pathology Registry (Palga). Tumour and PD‐L1 testing characteristics were analysed per year and interlaboratory variation in PD‐L1 positivity rates was assessed using funnel plots with 95% confidence limits around the overall mean. Results: A total of 817 PD‐L1 tests were reported in 702 patients among 19 laboratories; 85.2% of the tests on histological material were stated to be positive. The national PD‐L1 positivity rate differed significantly per year during the study period (79.7–89.9%). The use of the recommended 22C3 antibody increased from 59.9 to 74.3%. A total of 673 PD‐L1 tests on histological material from 12 laboratories were analysed to investigate interlaboratory variation. Four (33%) deviated significantly from the national mean of PD‐L1‐positive cases using CPS ≥ 1 cut‐off, while two (17%) deviated significantly for CPS ≥ 20 cut‐off. Conclusion: In the first 3 years of PD‐L1 assessment in HNSCC, the testing landscape became more uniform. However, interlaboratory variation in PD‐L1 positivity rates between Dutch laboratories was substantial. This implies that there is a need for further test standardisation to reduce this variation. [ABSTRACT FROM AUTHOR]

Introduction: In the battle against multidrug-resistant bacterial infections, ceftazidime-avibactam (CZA) stands as a pivotal defense, particularly against carbapenemresistant (CR) Gram-negative pathogens. However, the rise in resistance against this drug poses a significant threat to its effectiveness, highlighting the critical need for in-depth studies about its resistance mechanisms. Methods: This research focuses on the genomic characterization of CR- and CZA-resistant Escherichia coli (n=26) and Klebsiella pneumoniae (n=34) strains, harboring the blaNDM and/or blaOXA-48-like genes, at a major Lebanese tertiary care medical center, using whole genome sequencing (WGS). Results: Our findings revealed a notable prevalence of blaNDM in all K. pneumoniae strains isolates, with 27 of these also harboring blaOXA-48.On the other hand, E. coli strains predominantly carried the blaNDM-5 gene. Whole genome sequencing (WGS) identified a predominance of ST383 among K. pneumoniae strains, which possessed a multi-replicon IncFIB-IncHI1B plasmid harboring the blaNDM-5. Additionally, various Inc group plasmids in K. pneumoniae across multiple sequence types were found to carry the blaNDM. Similarly, diverse STs of E. coli were observed to carry blaNDM-5 on different plasmids. Discussion: The study underscores NDM carbapenemases as a paramount resistance mechanism in Lebanon, jeopardizing critical last-resort treatments. It also illuminates the role of varied sequence types and mobile genetic elements in the spread of NDM resistance, stressing the urgent need for strategies to mitigate this threat, especially in nosocomial infections. [ABSTRACT FROM AUTHOR]

Objective Work-related musculoskeletal disorders are one of dentists’ most common occupational health problems. Human error is considered one of the critical factors of medical error. Musculoskeletal abnormality due to inappropriate work postures and mental workload are two important causes of human error in dental operations. Hence, this study investigates dentists’ mental workload and the incidence of skeletal-muscular disorders. Materials & Methods A cross-sectional descriptive study was conducted in Shahid Shukri Dental Hospital in 2021. The sampling was done via the targeted sampling method and 42 individuals were included in the study. The NASA task load index and the Nordic questionnaire were used to collect the data. Data analysis was done using the SPSS software, version 26, at the significance level of 0.05. Results The average percentage of disorders were as follows: Neck area=30.1%, left shoulder=11.76%, right shoulder=13.74%, right elbow=9.23%, left elbow=6.56%, right wrist=28%, left-hand wrist=25.06%, upper back area=20.1%, waist=13.8%, hip and thigh=17.1%, knee=26% and ankle=23.46%. Age and work experience had a significant relationship with the prevalence of musculoskeletal disorders (P<0.05). The effort component with a Mean±SD of 74.95±22.16 received the highest score and discouragement with a Mean±SD of 49.92±26 got the lowest score compared to other components. The central sterilization department, with a mean of 67.41±24.86, exhibited a higher mental workload than other departments. In contrast, the admission department, with a mean of 50.72±26.59, reported a lower mental workload than other cases. Conclusion Musculoskeletal disorders are related to workload and work capacity. Creating suitable working conditions, providing more training programs to employees, and strengthening their mental workload capacity can help prevent occupational injuries in the workplace. [ABSTRACT FROM AUTHOR]

Background: Complete surgical removal of pancreatic ductal adenocarcinoma (PDAC) is central to all curative treatment approaches for this aggressive disease, yet this is only possible in patients technically amenable to resection. Hence, an accurate assessment of whether patients are suitable for surgery is of paramount importance. The SCANPatient trial aims to test whether implementing a structured synoptic radiological report results in increased institutional accuracy in defining surgical resectability of non-metastatic PDAC. Methods: SCANPatient is a batched, stepped wedge, comparative effectiveness, cluster randomised clinical trial. The trial will be conducted at 33 Australian hospitals all of which hold regular multi-disciplinary team meetings (MDMs) to discuss newly diagnosed patients with PDAC. Each site is required to manage a minimum of 20 patients per year (across all stages). Hospitals will be randomised to begin synoptic reporting within a batched, stepped wedge design. Initially all hospitals will continue to use their current reporting method; within each batch, after each 6-month period, a randomly selected group of hospitals will commence using the synoptic reports, until all hospitals are using synoptic reporting. Each hospital will provide data from patients who (i) are aged 18 or older; (ii) have suspected PDAC and have an abdominal CT scan, and (iii) are presented at a participating MDM. Non-metastatic patients will be documented as one of the following categories: (1) locally advanced and surgically unresectable; (2) borderline resectable; or (3) anatomically clearly resectable (Note: Metastatic disease is treated as a separate category). Data collection will last for 36 months in each batch, and a total of 2400 patients will be included. Discussion: Better classifying patients with non-metastatic PDAC as having tumours that are either clearly resectable, borderline or locally advanced and unresectable may improve patient outcomes by optimising care and treatment planning. The borderline resectable group are a small but important cohort in whom surgery with curative intent may be considered; however, inconsistencies with definitions and an understanding of resectability status means these patients are often incorrectly classified and hence overlooked for curative options. Trial registration: The SCANPatient trial was registered on 17th May 2023 in the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12623000508673). [ABSTRACT FROM AUTHOR]

This study aimed to register and analyse outcomes after iatrogenic ureteral injuries (IUI) with special emphasis on potential consequences of a delayed diagnosis, and further to analyse if the incidence of IUI has changed during the study period. 108 patients treated for an IUI during 2001–2021 were included. Injuries due to endourological procedures, planned tumour resection and traumatic injuries were excluded. All relevant information to answer the research questions were entered into a database. Chi-square and t-tests were used for categorical and continuous variables respectively. Regression analysis was used to evaluate potential change of incidence in IUIs over time. Our results showed that most IUIs (74, 69%) were caused by gynaecological surgery. 49 (45%) had a delayed diagnosis (not diagnosed intraoperatively). Younger age (mean 50 vs 62 years, p < 0.001) and benign indication for laparoscopic hysterectomy (OR 8.0, p < 0.001) predisposed for a delayed diagnosis. Patients with a delayed diagnosis had a higher number of secondary injury related procedures (mean 4.6 vs 1.7, p < 0.001), hospital admissions (mean 3.0 vs 0.8, p < 0.001) and longer hospital stays (mean 20.6 vs 3.9 days p < 0.001) compared to patients with an intraoperative diagnosis. There was complete recovery for 91% of the patients. We did not observe any changes in IUI incidence during the study period. In conclusion, our study underlines that IUI can cause major morbidity for the patient affected if not diagnosed intraoperatively. Benign indication and younger age are predictors for a delayed diagnosis. The prognosis is good, with 91% full recovery. No significant changes in incidence of IUIs were observed. [ABSTRACT FROM AUTHOR]

Mushroom cap is a key trait in the growth process and its phenotypic parameters are essential for automatic cultivation and smart breeding. However, the edible mushrooms are usually grown densely with mutual occlusion, which is difficult to obtain the phenotypic parameters non-destructively. Although deep learning methods achieve impressive performance with superior generalization capabilities, they require a large amount of ground truth label of the occluded target, which is a challenging task due to the substantial workload. To overcome this obstacle, a novel synthetic cap occlusion image method was proposed for rapidly generating edible mushroom occlusion datasets using raw images, in which the ground truth is obtained from the real world and the occlusion is randomly generated for simulating real scenes. Moreover, variants of amodal instance segmentation models with different backbone were trained and evaluated on our synthetic occlusion image datasets. Finally, an amodal mask-based size estimation method was presented to calculate the width and length of the cap. The experimental results showed that the amodal instance segmentation achieved an AP@[0.5:0.95] of 82%, 93% and 96% on Oudemansiella raphanipes, Agrocybe cylindraceas and Pholiota nameko synthetic cap datasets, respectively, with a size of 1024 × 1024 px, which indicates that our occlusion image synthesis method can effectively simulate the real cap occlusion situation. The size estimation method achieved an R 2 of 0.95 and 0.98 between predictive amodal caps and manually labeled caps for the length and width of Agrocybe cylindraceas cap, respectively, which can be applied to obtain the phenotypic parameters of each cap effectively and accurately. These methods not only meet the demand for automatic monitoring of edible mushroom morphology in factories but also provide technical support for intelligent breeding. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursing & Health is the property of Journal of Nursing & Health (JONAH) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Surgical team members in perioperative environments experience high physical demands. Interventions such as exoskeletons, external wearable devices that support users, have the potential to reduce these work-related physical demands. However, barriers such as workplace environment and task compatibility may limit exoskeleton implementation. This study gathered the perspectives of 33 surgical team members: 12 surgeons, four surgical residents, seven operating room (OR) nurses, seven surgical technicians (STs), two central processing technicians (CPTs), and one infection control nurse to understand their workplace compatibility. Team members were introduced to passive exoskeletons via demonstrations, after which surgical staff (OR nurses, STs, and CPTs) were led through a simulated workflow walkthrough where they completed tasks representative of their workday. Five themes emerged from the interviews (workflow, user needs, hindrances, motivation for intervention, and acceptance) with unique subthemes for each population. Overall, exoskeletons were largely compatible with the duties and workflow of surgical team members. The goal of this study was to identify exoskeleton compatibility across various surgical team members through a thematic analysis of interviews and a simulated workflow walkthrough. Results revealed five unique themes (workflow, user needs, hinderances, motivation for intervention, acceptance) and that exoskeletons were largely compatible with daily duties. [ABSTRACT FROM AUTHOR]

Background: This study aimed to improve and implement the central sterile supply department (CSSD) training program through action research and to evaluate its effect. Materials and methods: The project was underpinned by action research. The problems that occurred in training were identified following scenario analysis, interviews, group discussions, and expert consultation to develop improvement measures. The training program characterized by CSSD was developed in the spiral circular process of "Plan-Act-Observe-Reflect". Results: After the two rounds of training, the CSSD nurses significantly improved their professional knowledge, skills, and satisfaction with training compared with those before improvement. The nurses' overall satisfaction with the training and their performance improved. Conclusions: The implementation of the training program designed based on action research can improve CSSD nurses' professional knowledge and skills and increase their enthusiasm for learning, laying the foundation for CSSD talent development. [ABSTRACT FROM AUTHOR]

The continuous supply of hydrogen sulfide (H 2 S) gas at high concentrations to tumors is considered a promising and safe strategy for tumor therapy. However, the absence of a durable and cost-effective H 2 S-producing donor hampers its extensive application. Sulfate-reducing bacteria (SRB) can serve as an excellent H 2 S factory due to their ability to metabolize sulfate into H 2 S. Herein, a novel injectable chondroitin sulfate (ChS) hydrogel loaded with SRB (SRB@ChS Gel) is proposed to sustainably produce H 2 S in tumor tissues to overcome the limitations of current H 2 S gas therapy. In vitro , the ChS Gel not only supports the growth of encapsulated SRB, but also supplies a sulfate source to the SRB to produce high concentrations of H 2 S for at least 7 days, resulting in mitochondrial damage and immunogenic cell death. Once injected into tumor tissue, the SRB@ChS Gel can constantly produce H 2 S for >5 days, significantly inhibiting tumor growth. Furthermore, such treatment activates systemic anti-tumor immune responses, suppresses the growth of distant and recurrent tumors, as well as lung metastases, meanwhile with negligible side effects. Therefore, the injectable SRB@ChS Gel, as a safe and long-term, self-sustained H 2 S-generating factory, provides a promising strategy for anti-tumor therapy. [Display omitted] • Injectable chondroitin sulfate hydrogel was used to load sulfate reducing bacteria. • The bacteria metabolize sulfate groups of the chondroitin sulfate to H 2 S. • The produced H 2 S causes mitochondrial damage and immunogenic cell death. • The SRB@ChS Gel can sustainably produce H 2 S with a high concentration in tumors. • The generated H 2 S suppresses the tumor growth and enhances the anti-tumor immunity. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on a study that analyzes impact of nosocomial infection in patient during treatment and cost of hospitalization of the patient. Topics discused include measures for reduction of associated costs and nosocomial infection, impact of reduced infection on reduction and saving in medical costs associated with work process of patient isolation, and study of patients in intensive care units (ICU) due to the infection.

Nordic countries are considered international leaders in producing combinable data on their citizens' encounters with public institutions, as well as the digitalisation of public services. Public-sector professionals increasingly collaborate with private IT companies in developing data analytics products for cost saving and cost-efficiency. This article presents the results of a two-year ethnographic study of a collaboration between the Knowledge Team of a public-sector organisation and a private-sector IT company for developing and maintaining a data management system in one Finnish regional healthcare and social service organisation. The data management system is defined as a data analytics product that provides management with information about clinical and financial aspects of organisation management. We combine perspectives of science and technology studies and the sociology of professions to situate our research on the data management system as a boundary object within the broader context of professional work. Via our theoretical framework, we examine the negotiation process through which the data management system becomes a boundary object in practice. This process includes not only the accommodation of diverse epistemic cultures but also organisational and professional hierarchies that empower some experts to shape the data management system towards their visions and interests. This article applies the 'boundary object' concept to elucidate structural power differentials in public–private partnerships and multi-professional collaborations. [ABSTRACT FROM AUTHOR]

Municipalities across Finland are promoting wooden multistorey construction as a low-carbon alternative for building construction. However, do attitudes towards implementing these alternatives stem from the opportunity to reduce carbon emissions or because these alternatives are perceived to improve local economies? This research employs a survey to collects the attitudes of Finnish municipal civil servants towards implementing wooden multistorey buildings in their municipalities. The respondents represent a mix of administrative professionals such as planners, real estate managers, building inspectors and other strategic managerial professionals (n = 273, 8% response rate). Their responses reflect views from approximately 8% of all municipal civil servants working on municipal land use and planning issues during 2019. The findings reveal attitudes towards implementing wooden multistorey buildings are engendered by fulfilling ecological development, economic development, technical quality and output efficiency goals. Furthermore, comparing municipal planners to other municipal administrators reveals dissimilar planning logics. Municipal planners holistically prioritize the project's ecological and economic development outcomes. Other administrators chiefly prioritize economic development outcomes. Hence, some municipal administrators may value wooden multistorey construction primarily as an activity to improve municipal vitality rather than as a holistic spatial planning solution. Future research should identify whether these divergences lead to planning tensions within municipal administrations. [ABSTRACT FROM AUTHOR]

Adaptability is one key aspect in making housing more sustainable. One major approach to adaptability is internal transformability of buildings, i.e. the possibility to make modifications to the spaces and their equipment within the existing building envelope. This aspect is often taken into consideration in the design and implementation of office buildings. However, in housing the situation is different, and internal transformability is very seldom implemented in apartment buildings. There is a lack of studies for the reasons for this. In this article we take a look at the barriers to internal transformability of apartment buildings in two Nordic countries, Finland and Denmark. We compare the situations in both countries, and highlight their similarities and differences. The research is based on interviews of Finnish and Danish architects who have been involved in designing such buildings within the last 20 years. The interviews show that the disinterest of housing developers has been the main barrier to implementing internal transformability. Another important barrier is the developers' cost-optimization. Secondary barriers were related to lack of solutions in building services that would support internal transformability. Additionally, secondary barriers were related to common construction techniques, regulations, and building conventions. Major barriers were similar in both countries. However, some differences in the secondary and other barriers between the two countries also exist. [ABSTRACT FROM AUTHOR]

This article provides a comprehensive understanding of small house practices, including the perspective of Finnish architectural experts, by conducting semi-structured in-depth interviews and proposing an individually designed house case study with a particular focus on cost and quality. Key findings based on main themes including the role and qualifications of the architect, architect's involvement, architect's fee, reasons to hire an architect, implementation, quality, and cost, highlighted that: (1) architect can assist small house projects in many ways, such as accurately identifying the client's needs, choosing the most suitable layout, and applications for building permits; (2) allocating sufficient time for planning an average of six months is critical for the thoughts of both the architect and the client to mature in peace; (3) the share of architectural design in the total cost of the project is around 3–5%; (4) it is estimated that the total amount of small houses designed by an architect is between 10–20%; (5) an architect's typical client is reported to be those who dream of a long-term home and are concerned with aesthetics as well as functional quality; (6) the client is always satisfied with the quality of the house designed by the architect; (7) while an individually designed home may seem more costly than a prefab home, an architect-designed home can be affordable as long as the budget is known from the start of the project. It is believed that this paper will encourage the participation of architects in small house projects that will be expanded and established in the Finnish residential construction industry. [ABSTRACT FROM AUTHOR]

The performance of a Central Sterile Supply Department (CSSD) is crucial for patient care. However, there is currently no standardized, data-based way to compare the performance assessment and evaluation of CSSDs. Best practices as well as any deficiencies and any needs for novel solutions could be identified by comparing performance indicators and their determining factors. A proven method for comparing processes is benchmarking. In preparation for the development of a CSSD benchmark, the question is what requirements for a CSSD benchmark can be derived based on the literature on existing benchmarks. Thirty-six journals and six databases were searched for publications on the creation of benchmarks, as well as existing benchmarks for CSSDs, hospitals or manufacturing processes. The 375 matches found were filtered by evaluating abstracts, with the remaining 71 publications examined and categorized by content. The literature review documented numerous requirements in the categories of organization, field of participants, data and criteria for comparison. The derivation of action plans was identified as a critical step. The list of requirements thus obtained allows users to evaluate CSSD benchmarks but can also be used as a basis for developing one. Building on this work, the next steps will be to compile a glossary with uniform definitions of terms, to develop tools for the implementation of CSSD benchmarks and to develop practical units of reference as an alternative to the established “sterilization unit” (StU) to capture the complexity and effort of processing per tray. [ABSTRACT FROM AUTHOR]

Purpose: According to the IMvigor130 trial, adding atezolizumab to platinumbased chemotherapy was effective in the treatment of metastatic urothelial cancer (mUC). Based on the perspective of the United States and China, the current study evaluated cost-effectiveness of atezolizumab plus chemotherapy for mUC patients in the first-line setting. Methods: A partitioned survival model was adopted for mUC patients. The survival data were derived from the IMvigor130 trial. Direct cost values were collected from the Centers for Medicare and Medicaid Services (CMS), Chinese Drug Bidding Database, and published literatures. The utility and toxicity data were gathered from related research studies and IMvigor130 trial. The incremental cost–utility ratios (ICURs) and incremental cost-effectiveness ratios (ICERs) were calculated and analyzed. Scenario analyses and sensitivity analyses were performed to observe the outputs and uncertainties. Results: The base-case analysis showed that the ICUR of atezolizumab plus chemotherapy versus chemotherapy in American and Chinese settings is $ 737,371 /QALY and $ 385,384 /QALY, respectively. One-way sensitivity analyses showed that the ICUR ranged from $ 555,372/QALY to $ 828,205/QALY for the United States. Also, the range was from $ 303,099/QALY to $ 433,849/QALY in the Chinese setting. A probabilistic sensitivity analysis showed the likelihood that atezolizumab plus chemotherapy becoming the preferred strategy was a little low even if the price reduction strategy was applied. Conclusion: Adding atezolizumab to chemotherapy improved survival time, but it is not a cost-saving option compared to chemotherapy for metastatic urothelial cancer patients in the American and Chinese settings. [ABSTRACT FROM AUTHOR]

Objective. A case-control study was conducted to explore the application value of PDCA cycle regulation combined with nursing label in nursing safety and quality regulation in disinfection supply centers. Methods. The medical staff in the disinfection supply center of our hospital from January 2020 to December 2020 and from January 2021 to December 2021 were included in the control group (routine nursing regulation, n = 13) and the research group (PDCA circulation nursing regulation, n = 13). The differences in quality evaluation, disinfection qualification, quality regulation effect, supply satisfaction, job satisfaction, safety awareness, and comprehensive operation skills of nursing staff were compared, and the application value of PDCA cycle regulation combined with nursing label in nursing safety and quality regulation of disinfection supply center was comprehensively analyzed. Results. The quality score of nursing staff, and quality evaluation in the study group was significantly higher than that in the control group, and the difference was statistically significant (P < 0.05). The disinfection qualification rate of nurses in the research group was significantly higher, and the difference was statistically significant (P < 0.05). The effect of device quality supervision in the study group was significantly improved, and the difference was statistically significant (P < 0.05). The scores of various supervisions in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The safety recognition ability, risk prevention awareness, service awareness, and theory and operation scores of nurses in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The incidence of adverse events in the study group was lower, and the difference was statistically significant (P < 0.05). The satisfaction of the research group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion. In summary, the implementation of the PDCA cycle supervision method in the supervision of the sterile supply center in conjunction with the nursing logo is conducive to improving the quality of supervision and sterilization of all work aspects of the sterile supply center, reducing the occurrence of adverse nursing events and promoting the job satisfaction of nurses. In addition, it is conducive to standardizing the operational processes of staff, improving self-learning awareness enhancement, and improving work quality and efficiency. [ABSTRACT FROM AUTHOR]

Background: Cleaning is one of the most important steps in preparing surgical instruments for reuse. Thorough cleaning can ensure more effective sterilization, protect treatment teams and patients from transmissible infections, and extend the life of surgical instruments. This study was conducted to compare the manual, automated, and ultrasonic methods of cleaning surgical instruments. Methods: In this quasi-experimental study, three types of surgical instruments, namely curved hemostats, suction tips, and Metzenbaum scissors, (n=90) from among 20 surgical sets were randomly selected and assigned to three cleaning groups viz manual, automated, and ultrasonic. After the instruments were cleaned, surface protein and blood residue swab tests were conducted and the results were recorded on a data-registration form. Data were analyzed using SPSS version 16 and descriptive and inferential statistical methods. Results: According to the research results, in manually cleaned instruments group, 8 (26.7%) tested positive for blood and 10 (33.3%) tested positive for protein. Of the 30 automatically cleaned instruments, 6 (20%) tested positive for blood and 7 (23.3%) tested positive for protein and of the 30 ultrasonically cleaned instruments, 1 (3.3%) tested positive for blood and protein. The chi-square test showed a statistically significant difference between the three methods of cleaning residual blood and protein from the surgical instruments (p<0.05). Conclusion: The results revealed that according to the research results, of the three cleaning methods, ultrasonic cleaning was by far the most effective in removing blood and protein residues from the surgical instruments. Hence, we suggest that ultrasonic cleaning can be routinely utilized as an efficient cleaning method in medical centers. [ABSTRACT FROM AUTHOR]

Radiomics-based machine learning classifiers have shown potential for detecting bone metastases (BM) and for evaluating BM response to radiotherapy (RT). However, current radiomics models require large datasets of images with expert-segmented 3D regions of interest (ROIs). Full ROI segmentation is time consuming and oncologists often outline just RT treatment fields in clinical practice. This presents a challenge for real-world radiomics research. As such, a method that simplifies BM identification but does not compromise the power of radiomics is needed. The objective of this study was to investigate the feasibility of radiomics models for BM detection using lesion-center-based geometric ROIs. The planning-CT images of 170 patients with non-metastatic lung cancer and 189 patients with spinal BM were used. The point locations of 631 BM and 674 healthy bone (HB) regions were identified by experts. ROIs with various geometric shapes were centered and automatically delineated on the identified locations, and 107 radiomics features were extracted. Various feature selection methods and machine learning classifiers were evaluated. Our point-based radiomics pipeline was successful in differentiating BM from HB. Lesion-center-based segmentation approach greatly simplifies the process of preparing images for use in radiomics studies and avoids the bottleneck of full ROI segmentation. [ABSTRACT FROM AUTHOR]

Background: Cost analysis in central sterile supply department (CSSD) helps to achieve financial sustainability and improved efficiency for optimal field operations. This research intends to propose strategies to reduce re-sterilization of CSSD items and formulate alternatives for direct purchase of consumable items by suggesting in-house manufacture of these items. Methods: An observational prospective study using cost analysis tools such as activity-based costing and cost–benefit analysis was conducted in a tertiary care corporate hospital. Primary data collection was done with the help of semi-structured interview questions and checklist. Results: The analysed data indicated that on an average 150 sets per month were sent back for steam re-sterilisation which incurred the cost for re-packing, re-sterilisation and re-storage. Additionally, crucial study findings indicate that gauze swabs and dressing pads (consumable items) have been consumed in large quantities per month (20,000 Qty) leading to profligacy. Conclusion: In-house preparation of dressing pads and gauze swabs has amassed sufficient amount of savings of about ₹70,377 and ₹24,104 per month on an average with the available resources. Moreover, techniques to avoid re-sterilization will help decrease resource consumption that includes electricity and exhaustive use of manpower. [ABSTRACT FROM AUTHOR]

Background: Globally, hundreds of millions of people are affected every year by avoidable infections in healthcare (healthcare-associated infections, [HAIs]). Through knowledge, best practices and infection prevention and control (IPC), we can prevent HAI to patients and health workers. Following recent threats caused by widespread epidemics and increasing awareness about the spread of antimicrobial resistance, several countries are paying more attention and investing resources to strengthening IPC infrastructures and improving practices. Objective: The objective was to assess the practices by the healthcare staff regarding the sterilisation process in the central sterilisation service department (CSSD) and to bring about improvements in the practices in the hospital. Materials and Methods: A cross-sectional study was conducted where the healthcare staff were given a set of questionnaires on sterilisation in the CSSD. The staff who participated in the study included doctors, intensive care unit nursing staff, infection control nurses, operation theatre nursing staff, CSSD staff and outpatient department nursing staff. Results: The questionnaire was administered to 120 health staff. All the staff agreed that instruments should be cleaned at the source. The majority of the participants (82%) believed that medical devices should be reprocessed centrally in CSSD; however, very few of them (18%) have felt otherwise. Almost 70% of staff did not know about the indicators used in CSSD and the zones in CSSD. The expiry date of the items once received from CSSD, 60% said it is not mentioned on the pack and 40% of participants agreed that it is mentioned on the pack. Conclusion: The processes of sterilisation and decontamination are complex, require specific infrastructure and equipment and involve several steps that need to be correct, from device collection, receipt by the unit, processing, storage and distribution them throughout the facility. Quality control measures to evaluate the proper functioning of the equipment are of the utmost importance. [ABSTRACT FROM AUTHOR]

Chimeric Antigen Receptor (CAR) T cell therapy has produced revolutionary success in hematological cancers such as leukemia and lymphoma. Nonetheless, its translation to solid tumors faces challenges due to manufacturing complexities, short-lived in vivo persistence, and transient therapeutic impact. We introduce 'Drydux' - an innovative macroporous biomaterial scaffold designed for rapid, efficient in-situ generation of tumor-specific CAR T cells. Drydux expedites CAR T cell preparation with a mere three-day turnaround from patient blood collection, presenting a cost-effective, streamlined alternative to conventional methodologies. Notably, Drydux-enabled CAR T cells provide prolonged in vivo release, functionality, and enhanced persistence exceeding 150 days, with cells transitioning to memory phenotypes. Unlike conventional CAR T cell therapy, which offered only temporary tumor control, equivalent Drydux cell doses induced lasting tumor remission in various animal tumor models, including systemic lymphoma, peritoneal ovarian cancer, metastatic lung cancer, and orthotopic pancreatic cancer. Drydux's approach holds promise in revolutionizing solid tumor CAR T cell therapy by delivering durable, rapid, and cost-effective treatments and broadening patient accessibility to this groundbreaking therapy. Schematics showing conventional CAR T cell manufacturing requiring ∼2 weeks (A) compared to simplified and rapid Drydux mediated in vivo CAR T cell manufacturing (B). [Display omitted] Implantable CAR T cell factories enhance CAR T cell therapy and drastically improve their function and persistence, offering a more effective and accessible cancer treatment. [ABSTRACT FROM AUTHOR]

Background: Sleep-disordered breathing (SDB) has been associated with a greater aggressiveness of melanoma tumors, but the association with other cancers is unknown. This study investigates the relationship between the severity of SDB and the aggressiveness of prostate cancer (PC).Methods: 165 patients under 66 years consecutively diagnosed with PC in three University Hospitals underwent a home respiratory polygraphy. SDB severity was assessed by means of the apnea-hypopnea index (AHI) as well as several oximetric parameters. The primary marker of the aggressiveness of PC was the Gleason score, while secondary markers included the tumor stage and metastatic spreading.Results: The patients had a median (P 25-75) age of 60 (56-63) years, AHI of 13.3 (5.7-25.8), and 4% oxygen desaturation index of 8.7 (2.9-17.8). The prevalence of an AHI≥5 and AHI≥15 was 78.2% and 46.7%, respectively. The median AHI was similar in patients with Gleason 6 and > 6 [13.7 (5.6-28.7) vs 12.2 (5.7-23.2), p = 0.44], tumor stage I-II and III-IV [13.5 (5.3-26.5) vs 11.7 (7.8-21.1), p = 0.67], and presence or absence of metastasis [14.2 (9.6-31.8) vs 13.3 (5.2-24.6), p = 0.46]. The prevalence of an AHI≥5 and AHI≥15 was similar in patients with Gleason 6 and > 6 (79.2% vs 77.2%; p = 0.85, and 49.3% vs 44.33%; p = 0.53, respectively). These results did not change when different oximetric variables were analyzed instead of the AHI.Conclusions: Despite the high prevalence of SDB in patients with PC, our results do not support any association between the severity of SDB and PC aggressiveness. [ABSTRACT FROM AUTHOR]

The multifunctional protein translationally controlled tumour protein (TCTP) was previously identified as necessary for infection by the potyvirus pepper yellow mosaic virus. Using turnip mosaic virus (TuMV) as a model to study potyvirus biology, we confirmed that TCTP has a positive effect on virus infection. Living cell confocal microscopy demonstrated that TCTP colocalises with 6K2‐tagged replication vesicles and with a perinuclear globular structure typically observed during potyvirus infection. Also, TCTP silenced protoplasts showed reduced virus accumulation, quantified by qRT‐PCR, which suggests an effect on virus replication, translation or other intracellular process. Finally, TCTP silencing in plants reduced the accumulation of two species belonging to Orthotospovirus and a Begomovirus genus, which are not closely related to potyviruses. The results suggest that TCTP is a general susceptibility factor to several unrelated viruses. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rubia plants are one of the most important plant resources possessing significant commercial and medicinal values. Plant endophytes could benefit their host plants in different ways. Rubiaceae‐type cyclopeptides (RAs), mainly isolated from Rubia plants, have attracted considerable attentions for their distinctive bicyclic structures and significant antitumor activities, but their contents in plants are low. The aim of this study is to investigate the diversity of endophytic fungi in Rubia plants and their potential for production of RAs. In this work, 143 endophytic fungi isolates were obtained from two Rubia plants. Phylogenetic analysis was performed based on the ITS rDNA sequences, and the isolates were classified into 29 genera. Among them, four endophytic fungal strains were found to produce anti‐tumour RAs by LC‐MS/MS analysis. This work successfully provides valuable knowledges of endophytic fungi microbiome in Rubia plants for agricultural and industrial applications, and exploits a new environmental‐friendly resource of RAs. [ABSTRACT FROM AUTHOR]