New Strategies in Enhancing Spinal Fusion

HSS Journal ® - The biologic steps involved in creating a bony fusion between adjacent segments of the spine are a complex and highly coordinated series of events. There have been significant...     

Evaluating Linear and Non-linear Genotype–Environment Interactions in Pearl Millet

The nature of genotype–environment (GE) interactions was investigated for two F₁ hybrids and eight open pollinated varieties (OPVs) of pearl millet for grain yield in 12 environments spread over 2 years (2010 and 2011) across the pearl millet growing belt of Sudan. The joint regression analysis showed significant linear and non-linear GE interactions corresponding to heterogeneity and remainder mean squares. However, the GE interactions of all genotypes except PGO9PM1 were explained by the linear regression model. Six OPVs and hybrid PGO9PM3 showed general adaptation with b ≈ 1.0 and non-significant remainder mean squares. Of these genotypes, while hybrid PMO9PM3 was the highest yielding (917 kg ha⁻¹) farmers could adopt any genotype by trading off between their desirable traits such as mean grain yield, earliness, fodder yield and quality criteria etc. Two varieties (ISC-III and MCNELC), were specifically adapted to below average environments with their mean grain yields non-significantly different from the other six OPVs. The highest yielding hybrid PMO9PM1, on the other hand, showed specific adaptation to favourable environments but also had large remainder mean squares. More complex models such as quadratic, 2-intersecting-straight lines, 3-intersecting-straight lines were fitted which, however, could not account for the large remainder mean squares. A 3-lines model with quadratic component in the higher yielding segment of environments was found adequate showing that the upper threshold value for the hybrid was not reached and it would continue responding to higher yielding environments.

     

Evidence-Based Strategies for Clinical Organizations to Address COVID-19 Vaccine Hesitancy

The success of vaccination programs is contingent upon irrefutable scientific safety data combined with high rates of public acceptance and population coverage. Vaccine hesitancy, characterized by lack of confidence in vaccination and/or complacency about vaccination that may lead to delay or refusal of vaccination despite the availability of services, threatens to undermine the success of coronavirus disease 2019 (COVID-19) vaccination programs. The rapid pace of vaccine development, misinformation in popular and social media, the polarized sociopolitical environment, and the inherent complexities of large-scale vaccination efforts may undermine vaccination confidence and increase complacency about COVID-19 vaccination. Although the experience of recent lethal surges of COVID-19 infections has underscored the value of COVID-19 vaccines, ensuring population uptake of COVID-19 vaccination will require application of multilevel, evidence-based strategies to influence behavior change and address vaccine hesitancy. Recent survey research evaluating public attitudes in the United States toward the COVID-19 vaccine reveals substantial vaccine hesitancy. Building upon efforts at the policy and community level to ensure population access to COVID-19 vaccination, a strong health care system response is critical to address vaccine hesitancy. Drawing on the evidence base in social, behavioral, communication, and implementation science, we review, summarize, and encourage use of interpersonal, individual-level, and organizational interventions within clinical organizations to address this critical gap and improve population adoption of COVID-19 vaccination.     

Postexposure chemoprophylaxis for occupational exposure to human immunodeficiency virus in traveling health care workers

BACKGROUND: There has been little research on the use of human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) for occupational exposure in traveling health care workers (HCWs). Although PEP is the standard of care for occupational exposure to HIV in the United States, in third-world countries such medications are often unavailable and risks to the HCW may be higher. The aims of this study were to assess the incidence and types of blood and body fluid exposure and subsequent use of PEP in traveling HCWs seen at a large travel clinic prior to travel. METHODS: To determine the utility of PEP, we retrospectively evaluated all HCWs presenting for counseling prior to travel for health care delivery. All employees who were seen at the Mayo Travel and Tropical Medicine Clinic from 1999 until July 2002 were included. Analysis was conducted via a chart review as well as an approved questionnaire mailed to all employees still at the Mayo Clinic. RESULTS: Eighty-six HCWs were included in the analysis, and 58 responded to the questionnaire. Of the 86 HCWs reviewed, 55 (64%) were determined to be at high risk for occupational exposure to HIV. Seventy-eight percent of the high-risk HCWs were documented to have been counseled about needlestick avoidance, and 55% brought PEP with them. In the 58 HCWs who returned the questionnaire, there were no reported deep needlesticks. One of the 39 high-risk HCWs who returned the questionnaire (2.6%) had a superficial needle exposure, but the source patient had pretested negative for HIV and therefore the HCW did not use PEP. Nine of the 39 (23%) had a blood splash onto intact skin, and one of these involved a large volume. This source patient also had pretested negative for HIV. None of the HCWs exposed to blood splash took PEP. Two HCWs (5.1%) at high risk had an exposure that would have required PEP if the source patient had not been pretested. CONCLUSIONS: Needlestick exposure and HIV PEP counseling is important for HCWs traveling for health care delivery. Exposure risks appear low but high enough to warrant supplying high-risk HCWs with PEP. HCWs are able to use the recommendations appropriately. Pretesting of surgical patients decreases the likelihood of starting PEP. Carrying a common supply of PEP for a larger group can decrease the cost of PEP.