Search

Abstract Background Climate change and increased awareness of planetary health have made reducing ecological footprints a priority for healthcare organizations. However, improving healthcare’s environmental impact remains difficult. Numerous researchers argue these difficulties are caused by healthcare’s environmental impact being multidimensional, influenced throughout the healthcare chain, and often has downstream consequences that are hard to identify or to measure. Even though existing research describes many successful approaches to reduce healthcare’s environmental impact, a robust multidimensional framework to assess this impact is lacking. This research aims at developing a maturity model for sustainable healthcare that could be used for self-assessment by healthcare professionals to identify improvement actions and for sharing best practices in environmental sustainability. Methods A design-oriented approach for maturity model development was combined with an expert panel and six case studies to develop, refine and expand the maturity model for environmentally sustainable healthcare. Results A maturity model was developed containing four domains: ‘Governance’, ‘Organization Structures’, ‘Processes’, and ‘Outcomes and Control’. Applying the model in real-world environments demonstrated the model’s understandability, ease of use, usefulness, practicality and ability to identify improvement actions for environmental sustainability in healthcare organizations. Conclusions This study found that healthcare practitioners could apply the maturity model developed and tested in this study in several hours without training to help them gain valuable insights into the environment footprint of the healthcare setting they worked in. Systematically implementing the model developed in this study could help address the urgent need to mitigate the substantial environmental impact of healthcare. These implementations can help evaluate and improve the maturity model.

Abstract Macrophages are pivotal innate immune cells which exhibit high phenotypic plasticity and can exist in different polarization states dependent on exposure to external stimuli. Numerous methods have been employed to simulate macrophage polarization states to test their function in vitro. However, limited research has explored whether these polarization methods yield comparable populations beyond key gene, cytokine, and cell surface marker expression. Here, we employ an unbiased comprehensive analysis using data organized through the all RNA-seq and ChIP-seq sample and signature search (ARCHS4) database, which compiles all RNAseq data deposited into the National Center for Biotechnology Information (NCBI) Sequence Read Archive (SRA). In silico analyses were carried out demonstrating that commonly employed macrophage polarization methods generate distinct gene expression profiles in macrophage subsets that remained poorly described until now. Our analyses confirm existing knowledge on broad macrophage polarization, while expanding nuanced differences between M2a and M2c subsets, suggesting non-interchangeable stimuli for M2a polarization. Furthermore, we characterize divergent gene expression patterns in M1 macrophages following standard polarization protocols, indicating significant subset distinctions. Consequently, equivalence cannot be assumed among polarization regimens for in vitro macrophage studies, particularly in simulating diverse pathogen responses.

Ocean alkalinity enhancement (OAE) stands as a promising carbon dioxide removal technology. Yet, this solution to climate change entails shifts in environmental drivers with unknown consequences for marine fish that are critical to ecosystem health and food security. Fish and their supporting food webs may be stressed by the novel carbonate chemistry or the nutrients contained in the deployed minerals. With a mesocosm experiment on natural plankton communities, we studied early life stages of fish under alkalinity (+600 µmol kg−1) and silicate (+75 µmol L−1) addition. Larvae and young juveniles of temperate coastal species, including Atlantic herring (Clupea harengus) and cod (Gadus morhua), were exposed to direct physiological and indirect food-web-mediated effects of OAE for 49 d. Neither in the shorter nor in the longer term did we find an impairment of fish growth and survival. Alkalization even led to an increase in fish biomass. This resistance to OAE was despite using non-CO2-equilibrated deployment that induces more severe perturbations in carbonate chemistry (ΔpH =+0.7, pCO2=75 µatm) compared to alternative scenarios. Overall, our community-level study suggests that some fish populations, including key fisheries' species, may be resilient to the water chemistry changes under OAE. Whilst these results give cause for optimism regarding the large-scale application of OAE, other life history stages (embryos) and habitats (open ocean) may prove more vulnerable.

Abstract Background Exposure to military burn pit smoke during deployment is associated with different respiratory and non-respiratory diseases. However, information linking smoke exposure to human pulmonary health is lacking. This study examined the effects of simulated burn pit smoke condensates on human airway epithelial cells (HAECs) from twelve donors (smokers/non-smokers, biological female/male) cultured at an air-liquid interface and exposed to condensates from three simulated burn pit waste materials (cardboard, plywood, and plastic) incinerated at two combustion conditions: smoldering and flaming. Cellular gene expression was analyzed using bulk RNA sequencing, and basolateral media cytokine levels were assessed using multiplex immunoassay. Results Flaming smoke condensates caused more significant differentially expressed genes (DEGs) with plywood flaming smoke being the most potent in altering gene expression and modulating cytokine release. Cardboard and plywood flaming condensates primarily activated detoxification pathways, whereas plastic flaming affected genes related to anti-microbial and inflammatory responses. Correlation analysis between smoke condensate chemicals and gene expression to understand the underlying mechanism revealed crucial role of oxygenated polycyclic aromatic hydrocarbons (PAHs) and aluminum, molybdenum, and silicon elements; IL6 expression was positively correlated with most PAHs. Stratification of data based on HAEC donor demographics suggests that these affect gene expression changes. Enrichment analysis indicated similarity with several deployment-related presumptive and reported diseases, including asthma, emphysema, and cancer of different organs. Conclusions This study highlights that simulated burn pit smoke exposure of HAECs causes gene expression changes indicative of deployment-related diseases with more pronounced effects seen in smokers and females. Future studies are needed to further characterize how sex and smoking status affect deployment-related diseases.

Correction to: Molecular Psychiatry, published online 2 May 2023 In this article Honami Arai, Irene Bollettini, Rosa Calvo Escalona, Ana Coelho, Federica Colombo, Leila Darwich, Martine Fontaine, Toshikazu Ikuta, Jonathan C. Ipser, Asier Juaneda-Seguí, Hitomi Kitagawa, Gerd Kvale, Mafalda Machado-Sousa, Astrid Morer, Takashi Nakamae, Jin Narumoto, Joseph O’Neill, Sho Okawa, Eva Real, Veit Roessner, Joao R. Sato, Cinto Segalàs, Roseli G. Shavitt, Dick J. Veltman, Kei Yamada were missing from the author list indexed under the ENIGMA-OCD Working Group. Additionally, there was an error regarding Tokiko Yoshida’s name, where the first name and last name were written in the wrong order. The original article has been corrected.

Current knowledge about functional connectivity in obsessive-compulsive disorder (OCD) is based on small-scale studies, limiting the generalizability of results. Moreover, the majority of studies have focused only on predefined regions or functional networks rather than connectivity throughout the entire brain. Here, we investigated differences in resting-state functional connectivity between OCD patients and healthy controls (HC) using mega-analysis of data from 1024 OCD patients and 1028 HC from 28 independent samples of the ENIGMA-OCD consortium. We assessed group differences in whole-brain functional connectivity at both the regional and network level, and investigated whether functional connectivity could serve as biomarker to identify patient status at the individual level using machine learning analysis. The mega-analyses revealed widespread abnormalities in functional connectivity in OCD, with global hypo-connectivity (Cohens d: -0.27 to -0.13) and few hyper-connections, mainly with the thalamus (Cohens d: 0.19 to 0.22). Most hypo-connections were located within the sensorimotor network and no fronto-striatal abnormalities were found. Overall, classification performances were poor, with area-under-the-receiver-operating-characteristic curve (AUC) scores ranging between 0.567 and 0.673, with better classification for medicated (AUC = 0.702) than unmedicated (AUC = 0.608) patients versus healthy controls. These findings provide partial support for existing pathophysiological models of OCD and highlight the important role of the sensorimotor network in OCD. However, resting-state connectivity does not so far provide an accurate biomarker for identifying patients at the individual level.

Abstract Background X-linked adrenoleukodystrophy (ALD) is a neurometabolic disorder caused by pathogenic variants in ABCD1 resulting very long-chain fatty acids (VLCFA) accumulation in plasma and tissues. Males can present with various clinical manifestations, including adrenal insufficiency, spinal cord disease, and leukodystrophy. Female patients typically develop spinal cord disease and peripheral neuropathy. Predicting the clinical outcome of an individual patient remains impossible due to the lack of genotype-phenotype correlation and predictive biomarkers. Methods The availability of a large prospective cohort of well-characterized patients and associated biobank samples allowed us to investigate the relationship between lipidome and disease severity in ALD. We performed a lipidomic analysis of plasma samples from 24 healthy controls, 92 male and 65 female ALD patients. Results Here we show that VLCFA are incorporated into different lipid classes, including lysophosphatidylcholines, phosphatidylcholines, triglycerides, and sphingomyelins. Our results show a strong association between higher levels of VLCFA-containing lipids and the presence of leukodystrophy, adrenal insufficiency, and severe spinal cord disease in male ALD patients. In female ALD patients, VLCFA-lipid levels correlate with X-inactivation patterns in blood mononuclear cells, and higher levels are associated with more severe disease manifestations. Finally, hematopoietic stem cell transplantation significantly reduces, but does not normalize, plasma C26:0-lysophosphatidylcholine levels in male ALD patients. Our findings are supported by the concordance of C26:0-lysophosphatidylcholine and total VLCFA analysis with the lipidomics results. Conclusions This study reveals the profound impact of ALD on the lipidome and provides potential biomarkers for predicting clinical outcomes in ALD patients.

Abstract Background Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder characterized by recurrent edema, facial palsies, and nerve dysfunctions often associated with the plicata tongue. Although the etiology of MRS is not well understood, there is growing evidence suggesting an autoimmune involvement. Case presentation This paper presents a case report of a 25-year-old male with MRS as the initial symptom, followed by temporomandibular joint osteoarthritis (TMJ-OA). A comprehensive diagnosis and multidisciplinary treatment approach including surgery, local injections, and oral medication were implemented, resulting in a favorable prognosis. Conclusions These findings support the hypothesis that MRS is a systemic granulomatous disease caused by autoimmunity, which may also influence the occurrence and development of TMJ-OA through immune-related mechanisms. This study emphasizes the significance of systemic immune regulation in the treatment of patients with MRS and TMJ-OA comorbid conditions.

Abstract Background Effective teamwork is crucial to providing safe and high-quality patient care, especially in acute care. Crew Resource Management (CRM) principles are often used for training teamwork in these situations, with escape rooms forming a promising new tool. However, little is known about escape room design characteristics and their effect on learning outcomes. We investigated the current status of design characteristics and their effect on learning outcomes for escape room-based CRM/teamwork training for acute care professionals. We also aimed to identify gaps in literature to guide further research. Methods Multiple databases were searched for studies describing the design and effect of escape rooms aimed training CRM/teamwork in acute care professionals and in situations that share characteristics. A standardized process was used for screening and selection. An evidence table that included study characteristics, design characteristics and effect of the escape room on learning outcomes was used to extract data. Learning outcomes were graded according to IPE expanded typology of Kirkpatrick’s levels of learning outcome and Medical Education Research Study Quality Instrument (MERSQI) scores were calculated to assess methodology. Results Fourteen studies were included. Common design characteristics were a team size of 4–6 participants, a 40-minute time limit, linear puzzle organization and use of briefing and structured debriefing. Information on alignment was only available in five studies and reporting on several other educational and escape room design characteristics was low. Twelve studies evaluated the effect of the escape room on teamwork: nine evaluated reaction (Kirkpatrick level 1; n = 9), two evaluated learning (Kirkpatrick level 2) and one evaluated both. Overall effect on teamwork was overtly positive, with little difference between studies. Together with a mean MERSQI score of 7.0, this precluded connecting specific design characteristics to the effect on learning outcomes. Conclusions There is insufficient evidence if and how design characteristics affect learning outcomes in escape rooms aimed at training CRM/teamwork in acute care professionals. Alignment of teamwork with learning goals is insufficiently reported. More complete reporting of escape rooms aimed at training CRM/teamwork in acute care professionals is needed, with a research focus on maximizing learning potential through design.

Relatively little attention has been paid to the underlying mechanisms determining the dominance of non-indigenous species (NIS) once established, despite being regarded as a proxy of invasion success and potential impacts in recipient communities. To bridge this knowledge gap, here we evaluate the potential direct and indirect effects of community filters on the dominance of two widespread NIS in the Baltic Sea: Marenzelleria spp. and the round goby (Neogobius melanostomus) within their corresponding communities. We applied a structural equation modelling approach to assess the direct and indirect effects amongst multiple abiotic and biotic variables on the relative biomass (as proxy of dominance) of NIS. The biotic variables represented the taxonomic- and functional diversity of the recipient communities, as well as the trait similarity between NIS and native species. We observed a comparable influence of abiotic and biotic drivers on the dominance of both NIS, with biotic variables having a somewhat stronger overall direct effect. Specifically, the dominance of both NIS was similarly affected negatively by the richness and positively by the evenness of the native communities. However, we also detected that both NIS might need different ecological strategies to become dominant in their recipient communities, which underwent similar assembly processes. Such strategies were partly highlighted by the different degrees of trait similarity between each NIS and their respective co-occurring native species. A better understanding of the underlying processes affecting NIS dominance is of high relevance to mitigate potential impacts of NIS once established. Furthermore, the provided approach could be further applied to unveil the potential strategies that NIS might follow in other regions and ecosystem types.

Abstract Background The number of cancer survivors has increased in recent decades, and the majority of them suffer from sequelae of their disease and treatment. This study, which is part of the larger research project OPTILATER, aims to explore different aspects of care services for long-term survivors (≥ 5 years after initial cancer diagnosis) in Germany. The study places an emphasis on the situation of people from different age groups, with different socio-demographic and cultural backgrounds, and sexually and gender diverse individuals. Methods To investigate experiences related to follow-up care, focus groups (n = 2) will be conducted with members of patient advisory councils and advocacy groups, representatives of communities, healthcare workers and networks, as well as members of Associations of Statutory Health Insurance Physicians. Guided interviews will be carried out with patients and relatives (n = 40) to investigate needs, barriers and obstacles in terms of follow-up care. On this basis, additional focus groups (n = 2) will be carried out to derive possible scenarios for improving the consideration of needs. Focus groups and interviews will follow a semi-structured format and will be analysed content-analytically. Focus groups and interviews will be conducted online, recorded, transcribed, and analysed independently by two persons. Discussion The qualitative approach is considered suitable because of the exploratory research aims. The identification of experiences and barriers can reveal disparities and optimization potential in the care of long-term cancer survivors.

The diversity and distribution of gelatinous macrozooplankton is described by presenting qualitative and quantitative data of the jellyfish and comb jelly community encountered in the North Sea and Skagerrak/Kattegat during January/February 2022. Data were generated as part of the North Sea Midwater Ring Net (MIK) survey [1], an ichthyoplankton survey conducted at night-time during the quarter 1 (Q1) International Bottom Trawl Survey (IBTS), aboard the Danish R/V DANA (DTU Aqua) and the Swedish R/V Svea (SLU). A total of 100 stations were investigated using a 13 m long Midwater Ring Net (MIK net) with an opening diameter of 2 m and a mesh size of 1.6 mm, which is 0.5 mm meshed for the last meter of the net and the cod end [2]. Samples were collected by double oblique hauls from the surface to 5 m above the seafloor [2]. Twelve gelatinous macrozooplankton species were encountered during the Q1 2022 survey. Species encountered included the hydrozoan jellyfish i) Aequorea vitrina, ii) Aglantha digitale, iii) Clytia spp., iv) Leuckartiara octona, v) Tima bairdii, vi) Muggiaea atlantica; the two scyphozoan jellyfish i) Cyanea capillata and ii) Cyanea lamarckii as well as the comb jelly (ctenophora) species i) Beroe spp., ii) Bolinopsis infundibulum, iii) Pleurobrachia pileus and iv) the non-indigenous Mnemiopsis leidyi. In total 4882 individual specimens from samples and sub-samples were analyzed and extrapolated to 71,888 records of gelatinous macrozooplankton in the investigation area. For rare species, the entire sample was analyzed, while for abundant taxa, sub-samples were used to assess abundances. The raw counts were converted to volume-specific densities (individuals m-3) and area-specific abundances (individuals m-2), based on calibrated flow meter recordings and recorded maximum depth of the MIK net during each haul. Further, size data for the different species were obtained from a total of 4775 individual gelatinous macrozooplankton organisms. Size data are presented in the accompanying database and was used to calculate species-specific wet weights, using published size-weight regressions [3]. In addition, we present spatial distribution patterns of the weight specific biomass for the total gelatinous macrozooplankton community as well as the sub-groups i) hydrozoa, ii) scyphozoa and iii) ctenophora across the investigation area. The presented data contribute to a baseline describing the gelatinous macrozooplankton diversity and distribution in the extended North Sea area during winter [3,4] and summer [5]. The data can contribute to address the question if gelatinous macrozooplankton densities increase due to global change pressures and will help to understand their interaction with commercially important fish species, which are assessed during the same surveys. As such, this data paper presents a valuable resource on biodiversity and non-indigenous species records and highlights the importance of monitoring gelatinous macrozooplankton to facilitate an ecosystem approach to assess if the ecosystem state meets a ‘good environmental status (GES)’, as demanded by the EU Marine Strategy Framework Directive (MSFD).

Objective: The Halle continuum (HaKom) is a course for doctors undergoing postgraduate medical training in southern Saxony-Anhalt. It revises the skills and knowledge acquired during undergraduate medical training and develops them on an individual and needs-driven basis. The development and establishment of the three-day ready for (resident on-call) duty () course, which has been held four times a year since 2020, will be used as an example to present the overall HaKom curriculum.Methodology: The HaKom comprises a total of eight courses already established and four further courses still being planned, the order of which can be adapted individually. One of the HaKom courses is the ready for duty course, the structure and development of which will be explained below. The course content was developed in line with the KERN model using a questionnaire-based needs assessment conducted between 2019 and 2020 among 77 participants from ten different specialty areas.Results: In the in-person ready for duty course, 16 participants learn relevant content for their first (on-call) duty using simulations, communication training and practical skills stations at the learning centre of Halle University Hospital. Participants can study theoretical content in detail in a blended-learning approach. Evaluations of the curriculum taught to the first 12 cohorts – comprising a total of 205 participants – were conducted with a response rate of 65% and the course content was adapted on the basis of these evaluations. All of the respondents (100%) said that the course was useful in preparing them at the beginning of their medical career.Conclusion: As part of the overall HaKom curriculum, the ready for duty course builds on and goes beyond undergraduate medical training. By improving the quality of postgraduate medical training, it is designed to guarantee adequate patient care and can also promote local networking among the participants.

BackgroundAcute decompensation (AD) in patients with liver cirrhosis is associated with a dramatic deterioration in prognosis. Immediate initiation of appropriate recompensation measures is essential to improve patient’s outcome, although objective parameters for evaluating the success of recompensation are still lacking. Spleen stiffness measurements (SSM) have emerged as promising non-invasive tool to assess clinically significant portal hypertension (CSPH), which is the main driver of acute decompensation. However, while SSM accurately predicts CSPH and its complication, currently no data are available on its diagnostic performance during recompensation. This pilot-study aimed at evaluating changes in spleen stiffness following the initiation of recompensation measures in cirrhotic patients hospitalized due to AD.MethodsIn this prospective pilot-study, 60 patients with cirrhosis showing AD were included. Liver stiffness measurements (LSM) and SSM were performed on admission and repetitive SSM on day 3 and 5, respectivele, during recompensation measures. A cohort of patients (n = 10) with compensated cirrhosis served as control.ResultsA total of 36 data sets from the originally enrolled 60 patients were eligible for final analysis. On admission, patients with AD revealed a significantly increased spleen stiffness compared to the control group (70.51 vs. 29.06 kPa, p

BackgroundTeledermoscopy has demonstrated benefits such as decreased costs and enhanced access to dermatology care for skin cancer detection. However, the heterogeneity among teledermoscopy studies hinders the systematic reviews’ synopsis of diagnostic outcomes, impeding trust and adoption in general practice and limiting overall health care benefits. ObjectiveThis study aims to improve understanding and standardization of teledermoscopy diagnostic studies, by identifying and categorizing study characteristics contributing to heterogeneity. Subsequently, the variability and consistency of these characteristics were assessed. MethodsA review of systematic reviews regarding the diagnostic outcomes of teledermoscopy was performed to discern reported study characteristics contributing to heterogeneity. These characteristics were thematically grouped into 3 domains (population, index test, and reference standard), forming a data extraction framework. A scoping review on teledermoscopy diagnostic outcomes studies was performed, guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Data pertaining to study characteristics from included studies were extracted and analyzed through descriptive content analysis. Systematic reviews’ reference lists validated the scoping review query. ResultsThe literature search yielded 4 systematic reviews, revealing 15 heterogeneous studies across the population, index test, and reference standard domains. The scoping review identified 49 studies, with 27 overlapping with the systematic reviews. Population characteristics varied, with one-third (16/49, 33%) of studies reporting fewer than 100 samples; most studies (41/49, 84%) reported on the type of lesion, and most (20/49, 41%) teledermoscopy consultations took place in secondary care. One-fifth (11/49, 22%) did not describe inclusion or exclusion criteria, or the criteria varied highly. Index test characteristics showed differences in clinical expertise, profession, and training in dermatoscopic photography, and 59% (29/49) did not report on 1 or more index test characteristics. Image quality and clinical information reporting likewise varied. Reference standard characteristics involved teledermatologists’ assessment, but 16 studies did not report teledermatologists’ experience levels. Most studies (26/49, 53%) used histopathology as a gold standard. ConclusionsThe heterogeneity in the population, index tests, and reference standard domains across teledermoscopy diagnostic outcome studies underscores the need for standardized reporting. This hinders the synopsis of teledermoscopy diagnostic outcomes in systematic reviews and limits the integration of research results into practice. Adopting a (tailored) STARD (Standards for Reporting Diagnostic Accuracy Studies) checklist for teledermoscopy diagnostic outcome studies is recommended to enhance the consistency and comparability of outcomes. We suggest performing a Delphi study to gather consensus on the tailored STARD guideline.