It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
They are seen as a beacon of hope for energy-saving electronics and the high-tech of the future: topological quantum materials. One of their properties is the conduction of spin-polarized electrons on their surface - even though they are actually non-conductive inside. To put this into perspective: In spin-polarized electrons, the intrinsic angular momentum, i.e. the direction of rotation of the particles (spin), is not purely randomly aligned.
To distinguish topological materials from conventional ones, scientists used to study their surface currents. However, an electron’s topology is closely linked to its quantum mechanical wave properties and its spin. This relationship has now been demonstrated directly by means of the photoelectric effect – a phenomenon in which electrons are released from a material, such as metal, with the aid of light.
Visualizing the topology of electrons with “3D glasses”
Prof. Giorgio Sangiovanni, a founding member of ct.qmat in Würzburg and one of the theoretical physicists in the project, likened this discovery to using 3D glasses to visualize the topology of electrons. As he explains: “Electrons and photons can be described quantum mechanically as both waves and particles. Therefore, electrons have a spin that we can measure thanks to the photoelectric effect.”
To do this, the team used circularly polarized X-ray light – light particles possessing a torque. Sangiovanni elaborates: “When a photon meets an electron, the signal coming from the quantum material depends on whether the photon has a right- or a left-handed polarization. In other words, the orientation of the electron’s spin determines the relative strength of the signal between left- and right-polarized beams. Therefore, this experiment can be thought of like polarized glasses in a 3D cinema, where differently oriented beams of light are also used. Our ‘3D glasses’ make electrons’ topology visible.”
Headed by the Würzburg-Dresden Cluster of Excellence ct.qmat – Complexity and Topology in Quantum Matter – this ground-breaking experiment, along with its theoretical description, is the first successful attempt at characterizing quantum materials topologically. Sangiovanni points out the essential role of a particle accelerator in the experiment, stating: “We need the synchrotron particle accelerator to generate this special X-ray light and to create the ‘3D cinema’ effect.”
Quantum matter, particle accelerators and supercomputers
The journey to this monumental success spanned a period of three years for the researchers. Their starting point was the kagome metal TbV6Sn6, a quantum material. In this special class of materials, the atomic lattice has a mixture of triangular and honeycomb lattices in a structure reminiscent of a Japanese basket weave. Kagome metals play an important role in ct.qmat’s materials research.
“Before our experimental colleagues could start the synchrotron experiment, we needed to simulate the results to make sure we were on the right track. In the first step, we devised theoretical models and ran calculations on a supercomputer,” says Dr. Domenico di Sante, the project lead and a theoretical physicist, who is also an associate member of the Würzburg Collaborative Research Center (SFB) 1170 ToCoTronics. The findings from the measurements lined up perfectly with the theoretical predictions, enabling the team to visualize and confirm the topology of the kagome metals.
International research network
The research project involved scientists from Italy (Bologna, Milan, Trieste, Venice), the UK (St. Andrews), the USA (Boston, Santa Barbara), and Würzburg. The supercomputer used for the simulations is in Munich, and the synchrotron experiments were performed in Trieste. “These research findings perfectly illustrate the remarkable results theoretical and experimental physics can produce when working in tandem,” concludes Prof. Sangiovanni.
IMAGE: IN THEIR EXPERIMENT, THE JEDI SCIENTISTS UTILIZED A SPECIAL FEATURE OF THE JÜLICH PARTICLE ACCELERATOR COSY: THE USE OF POLARIZED BEAMS.view more
About 80 % of the matter in the universe consists of an unknown and invisible substance. This “dark matter” had already been postulated about 90 years ago. “This was the only way to reconcile the velocity distribution of visible matter within galaxies with existing knowledge,” explains Jörg Pretz, one of the study’s co-authors, who is also deputy director at Forschungszentrum Jülich’s Nuclear Physics Institute and professor at RWTH Aachen University. “A ‘dark’ form of matter, previously unobserved, must additionally stabilize the galaxies.”
Physicists have been searching for this matter since the 1930s. Science has no shortage of theories, but no one has yet succeeded in actually detecting dark matter. “This is because the nature of dark matter is still completely unclear,” says Dr. Volker Hejny, who is also from Jülich’s Nuclear Physics Institute and, like his colleague Jörg Pretz, is a member of the international JEDI collaboration that conducted the experiment. JEDI stands for Jülich Electric Dipole moment Investigations and scientists involved in the collaboration have been working on the measurement of the electric dipole moments of charged particles since 2011. “Dark matter is not visible and has so far only revealed itself indirectly through its gravity. Its effect is comparatively tiny, which is why it only really becomes apparent in the case of enormously large masses – such as entire galaxies."
Theoretical physicists have already proposed a number of hypothetical elementary particles that dark matter could be composed of. Depending on the properties of these particles, various methods could be used to detect them – methods that do not require the highly complex detection of gravitational effects. These methods include axions and axion-like particles. “Originally, axions were intended to solve a problem in the theory of the strong interaction of quantum chromodynamics,” explains Pretz. “The name axion can be traced back to the winner of the Nobel Prize in Physics, Frank Wilczek, and refers to a brand of detergent: the existence of the particles was supposed to ‘clean up’ the theory of physics, so to speak.”
To detect the axions, scientists in the JEDI collaboration used the spins of particles. “Spin is a unique property of quantum mechanics that makes particles behave like small bar magnets,” explains Hejny. “This property is utilized, for example, in medical imaging for magnetic resonance imaging, or MRI for short. As part of this process, the spins of atomic nuclei are excited by strong external magnetic fields.”
MRI technology is also used to search for dark matter. While in normal MRI the atoms are at rest, in an accelerator the particles move almost at the speed of light. This makes the examinations in some areas much more sensitive and the measurements more accurate.
In their experiment, the JEDI scientists utilized a special feature of the Jülich particle accelerator COSY, namely the use of polarized beams. “In a conventional particle beam, the spins of the particles point in random directions,” says Pretz. “In a polarized particle beam, however, the spins are aligned in one direction.” There are only a few accelerators worldwide that have this capability.
If, as the scientists suspect, a background field of axions surrounds us, then this would influence the motion of the spins – and could therefore ultimately be detected in the experiment. However, the anticipated effect is tiny. The measurements are not yet accurate enough. However, although the JEDI experiment has not yet found evidence for dark matter particles, the researchers have managed to further narrow down the possible interaction effect. And perhaps even more significant, they were able to establish a new and promising method in the search for dark matter.
Original publication: First Search for Axionlike Particles in a Storage Ring Using a Polarized Deuteron Beam, S. Karanth et al. (JEDI Collaboration), Phys. Rev. X 13, 031004 – Published 12 July 2023, DOI: 10.1103/PhysRevX.13.031004
IMAGE: FIGURE 2 FROM THE AUTHORS’ STUDY, DEPICTING FUSARIUM HEAD BLIGHT (FHB) SYMPTOMS IN WHEAT HEADS POINT INOCULATED WITH FUSARIUM GRAMINEARUM ∆TRI5 MUTANTS AND THEIR RESPECTIVE PARENT STRAINS. SPIKELETS OF WHEAT CV. NORM WERE POINT-INOCULATED WITH A CONIDIA SUSPENSION. PHOTOGRAPHS WERE TAKEN AT 21 DAYS POSTINOCULATION.view more
CREDIT: GUIXIA HAO ET AL., THE AMERICAN PHYTOPATHOLOGICAL SOCIETY, AND THE INTERNATIONAL SOCIETY FOR MOLECULAR PLANT-MICROBE INTERACTIONS
Although wheat was among the first domesticated food crops, it remains a global dietary staple several millennia later. Grown on every continent except Antarctica, wheat is the second highest produced grain worldwide, with nearly 800,000 metric tons grown each year (Food and Agriculture Organization). However, a fungal pathogen named Fusarium graminearum causes the devastating disease Fusarium head blight (FHB) on wheat and contaminates grains with harmful toxins called trichothecenes. One such trichothecene, called deoxynivalenol (DON), is produced by most F. graminearum strains in the United States, and it is an essential virulence factor that increases the pathogen’s spread within a wheat head. This tiny yet powerful fungus threatens the economic security of millions of people and the food security/safety of billions more.
Currently, there are no known wheat (or barley) varieties that can completely resist Fusarium infection, prompting continual studies on FHB virulence factors. Recent studies have identified an F. graminearum population that produces a new trichothecene, called NX, with a slightly different chemical structure than DON. Dr. Guixia Hao and colleagues from the USDA-Agricultural Research Service investigated whether these NX trichothecenes contribute to FHB of wheat like DON. The results of their study, published in the journal Molecular Plant-Microbe Interactions (MPMI), reveal that NX trichothecenes play an important role in F. graminearum initial infection as well as FHB spread.
By deleting the first gene for trichothecene biosynthesis production, TRI5,from strains representing DON trichothecenes and NX trichothecenes, the researchers were able to assess FHB severity on susceptible wheat heads inoculated with these parent strains and the genetic mutants resulting from the deletion. Evaluation and further testing showed a higher amount of toxin produced by the NX-producing strain than the DON-producing strain. This reveals that deletion of one gene eliminates NX toxin production and decreases both fungal infection and disease spread in wheat, confirming that NX plays a similar role as DON in pathogen aggression and uniquely intensifies pathogen infection.
Commenting on the novelty of this finding, Dr. Hao says, “To the best of our knowledge, this is the first time that a mycotoxin (any toxic substance produced by a fungus) has been found to play a role in enhancing both pathogen infection and disease spread in wheat head."
This novel finding is especially exciting since it can be used to protect the quantity and quality of cereal grain crops. “The information we discovered provides a new way to potentially control infection (not merely reduce symptoms), FHB spread, and mycotoxin poisoning simultaneously by targeting the fungus’s ability to produce NX,” Dr. Hao explains, “And this study ultimately improves our understanding of how the fungus uses toxins as a new weapon to attack the plant.”
This knowledge can also inspire further studies on NX trichothecenes. Dr. Hao and colleagues are working on a follow-up study to generate transgenic plants that target the NX biosynthesis gene by ribonucleic acid interference (RNAi) to reduce disease and mycotoxin production.
Molecular Plant-Microbe Interactions® is a gold open access journal that publishes fundamental and advanced applied research on the genetics, genomics, molecular biology, biochemistry, and biophysics of pathological, symbiotic, and associative interactions of microbes, insects, nematodes, or parasitic plants with plants.
SAN FRANCISCO—Schmidt Marine Technology Partners, a program of the Schmidt Family Foundation, has awarded $3.5 million in grants to ten organizations and universities in seven countries for the development of new tools and innovations that will improve the sustainability of global fisheries, the program announced today.
“Tens of millions of jobs around the world depend on fisheries, and seafood is the primary protein source for 3 billion people,” said Wendy Schmidt, president and co-founder of the Schmidt Family Foundation. “The innovators chosen to receive these grants are ensuring that fishers and fisheries—and by extension all of us who rely on them—are secure and sustainable worldwide.”
Although more investors are funding ocean technology today than in years past, developers need considerable early-stage support to advance from an idea to wide use of a technology. The sustainable fisheries initiative—to which Schmidt Marine has committed $2 million in new funding, with partners Oceankind and Builders Initiative contributing the additional $1.5 million—aims to address that gap.
“Increasing the sustainability of fisheries is challenging, but we think that both technology and philanthropy have important roles to play,” said Mark Schrope, director of Schmidt Marine Technology Partners. “We try to take a realistic approach by focusing on solutions that offer significant benefits not just for the environment, but also for the fishers themselves.”
The 10 projects selected for grants—ranging from $150,000 to $500,000—seek to reduce bycatch, prevent illegal fishing, improve data collection on fisheries and fish populations, and increase the transparency of a fish’s journey from ocean to table. A team of seven expert advisers and additional tech reviewers from nonprofits, government, and industry helped evaluate proposals from a pool of 200 applications from 20 countries across six continents. Schmidt Marine selected grantees based on the environmental benefits of their proposed ideas, as well as their incorporation of sound fisheries science and management principles, and, where applicable, the practical appeal of the new technologies to fishers.
The funding recipients are:
Katchi Technologies (Yarmouth, Nova Scotia, Canada): An alternative trawling net outfitted with a cable-mounted system that ensures the net stays open and is automatically controlled to prevent contact with the seafloor. The system also reduces drag by an estimated 30%, which in turn further reduces carbon emissions, fuel costs and bycatch while also increasing fisher safety.
Trygg Mat Tracking (Oslo, Norway): Data-rich and easy-to-use software that enables countries to make quick and informed decisions on who can enter their ports and what to target in their inspections to stop illegal fish landings.
Abalobi (Cape Town, South Africa): Development and deployment of software that integrates fishing data with processing plant data to provide ocean-to-market tracking that helps prevent illegal fishing and connects small businesses to larger markets.
University of Haifa, work led byRoee Diamant, Ph.D. (Haifa, Israel):A “swarm” of low-cost underwater autonomous robots that coordinate for better acoustic detection and size estimation of fish populations.
Centro de Ciencas do Mar (Center for Marine Science) (Faro, Portugal): A redesigned fishing net, developed in partnership with fishers, that could reduce bycatch in certain squid and other fisheries by 40%, reducing net damage and protecting sensitive habitats.
Cornell University, work led by Aaron Rice, Ph.D., (Ithaca, N.Y.)in partnership with Marc Dantzker, Ph.D. of Fisheye Acoustics(Arlington, Va.): A new autonomous audio/video technology that allows researchers to identify fish species based on the specific unique sounds they emit. With this information, inexpensive passive acoustic monitoring techniques will be better able to track and estimate fish populations for conservation, sustainability and research.
Allen Institute for AI (AI2), in association withOcean Aero (Gulfport, Miss.) and ThayerMahan (Groton, Conn.): Tools to improve the detection, interdiction and prosecution of illegal, unreported, and unregulated (IUU) fishing activities. The integration of AI driven detections from Skylight AI and a modified ThayerMahan acoustic system into the TRITON—an environmentally powered Autonomous Underwater and Surface Vehicle (AUSV)—promises a revolutionary approach to securing our oceans against IUU fishing.
Arizona State University, work led by Jesse Senko, Ph.D., (Tempe, Ariz.): Low-cost lights, powered by solar energy, that easily hook on to fishing nets and reduce bycatch of threatened species including sea turtles and sharks.
Wildaid Marine (San Francisco, Calif.): An app that provides accurate fishing and vessel data to rangers to help them deter illegal fishing in marine areas and better protect marine wildlife and the coastal communities that depend on them.
Fishtek Marine (Devon, England): An evaluation of the effectiveness of multiple bycatch reduction tools such as a shark-repellent device for longline fishing.
About Schmidt Marine Technology Partners Schmidt Marine Technology Partners supports scientists, engineers and entrepreneurs in developing technologies that restore ocean health. Schmidt Marine is one of two grant-making and investment programs of the Schmidt Family Foundation, founded by Eric and Wendy Schmidt. For more information, visit schmidtmarine.org.
About the Schmidt Family Foundation Established in 2006 by Eric and Wendy Schmidt, the Schmidt Family Foundation works to restore a balanced relationship between people and planet. Through grantmaking and investments, the foundation partners with communities around the world in working for renewable energy, resilient food systems, healthy oceans and the protection of human rights. The foundation makes grants and impact investments through two programs: 11th Hour Project and Schmidt Marine Technology Partners.
MEDICINE
Home blood pressure monitoring saves lives, cuts costs, and reduces healthcare disparities
New research in the American Journal of Preventive Medicine confirms that regular self-testing better controls hypertension, especially among underserved patients
Ann Arbor, July 13, 2023 – Expanding home blood pressure monitoring among US adults with hypertension could substantially reduce the burden of cardiovascular disease and save healthcare costs in the long term, according to a new study in the American Journal of Preventive Medicine, published by Elsevier. The results of the study show that expanding home monitoring has the potential to address pervasive health disparities facing racial and ethnic minorities and rural residents because it would reduce cardiovascular events among US adults.
Co-lead investigator Yan Li, PhD, Professor, School of Public Health, Shanghai Jiao Tong University School of Medicine, explained, “Our study is among the first to assess the potential health and economic impact of adopting home blood pressure monitoring among American adults with hypertension. We found that it facilitates early detection, timely intervention, and prevention of complications, leading to improved control and better health outcomes.”
Analyzing data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), investigators projected that implementing home blood pressure monitoring, as opposed to traditional clinic-based care, could result in a reduction of myocardial infarction (MI) cases by 4.9% and stroke cases by 3.8% over 20 years.
Non-Hispanic Blacks, women, and rural residents had more averted cardiovascular events and greater cost savings related to adopting home blood pressure monitoring compared to non-Hispanic Whites, men, and urban residents. Adopting home blood pressure monitoring in rural areas would lead to a potential reduction of 21,278 MI cases per one million people compared to 11,012 MI cases per one million people in urban areas. Rural residents tend to have a higher prevalence of hypertension and uncontrolled hypertension than urban residents and often face additional barriers in accessing primary care services.
Estimating healthcare cost parameters based on actual healthcare payment data from the Medical Expenditure Panel Survey (MEPS), researchers projected an average of 4.4% per person annual savings and an average of $7,794 in healthcare costs per person over a span of 20 years in this population due to home blood pressure monitoring adoption and the subsequent reduced cardiovascular disease cases. Previous economic evaluations of home blood pressure monitoring have primarily focused on local health systems or conducted short-term, small-scale randomized controlled trials.
Hypertension -- systolic blood pressure (BP) greater than 130 mmHg or a diastolic BP greater than 80 mmHg or being on medication for it -- is a pressing public health challenge in the US, with significant implications for the development of heart disease and stroke and leads to substantial healthcare costs. Traditional clinic monitoring, the common method for BP measurement and hypertension diagnosis, has a number of drawbacks: Patients may not visit clinics often enough to pick up the problem, and when they do, accuracy may be compromised by the “white coat” (high office BP but normal BP on home measurements) or “masked” (normal/high normal BP in the office but elevated at home) effects.
Home blood pressure monitoring eliminates these impediments and provides more comprehensive and accurate data compared to sporadic measurements obtained during clinic visits. Yet, the highly effective practice has not been widely adopted in the US because of inadequate health insurance coverage, lack of investment in preventive services, and limited health promotion efforts provided by primary care physicians. However, the landscape has changed between 2020 and 2022 when home blood pressure monitoring attracted increasing attention due to healthcare disruptions caused by the COVID-19 pandemic.
Co-lead investigator Donglan Zhang, PhD, Associate Professor, Center for Population Health and Health Services Research, New York University Long Island School of Medicine, commented, “Given that almost half of all adults in the US (47%) are affected by high blood pressure, and considering the persistent health disparities in cardiovascular health, it is very important to advocate for the widespread adoption of effective and cost-saving strategies. Home blood pressure monitoring empowers patients to take a more active role in managing their chronic conditions. Our findings provide compelling evidence for healthcare systems and payers supporting the broader implementation of this intervention.”
ARLINGTON, Va. (July 11, 2023) — Five medical societies have published a set of recommendations for operationalizing strategies for infection prevention in acute care settings that account for conditions within the facility, including the culture and communications style of teams, hospital policies, resources available, leadership support and staff buy-in.
“There is no best way to implement a practice, but implementation need not be overly complex,” said Joshua Schaffzin, MD, a pediatric infectious disease physician and a senior author of Implementing Strategies to Prevent Infections in Acute Care Settings published as a new section of the Compendium, a set of guidelines for infection prevention. “This new section is a compilation of a number of options and practical tools you can use to find your best way to implement successfully. It’s a way to take the Compendium from paper to bedside to improve practices for patient safety.”
The new chapter summarizes seven models for implementing other Compendium recommendations for preventing common healthcare-associated infections. It is meant to help bridge the “knowing-doing” gap, a term that describes why healthcare practices often diverge from published evidence to prevent infections that harm patients.
The complexity of healthcare systems makes it difficult for healthcare teams to implement best practices in infection prevention. Understanding factors that promote and hinder adoption within a given setting is an important step to identifying the best framework to deploy in that setting.
“Spending time listening and exploring your context, including local factors such as operational support, informatics resources, familiarity and experience, willingness to change, and safety, is of tremendous value and will guide you to success,” Schaffzin said. “People are rarely eager to change. It’s ok to be discouraged, but don’t give up.”
Schaffzin compared establishing new infection prevention strategies to convincing a young child to try a new food. Sometimes it’s easy, and other times you have to try different tactics, but you can’t force new behaviors.
“Studies in implementation science make it clear that identifying effective interventions is a necessary first step before transferring them into real-world settings in an intentional process,” said Kavita Trivedi, M.D., Director of Clinical Guidance and Communicable Disease Controller at the Alameda County Public Health Department in California and the lead author of the chapter. “Here we provide the reader with the resources to think about implementation and evaluate the contextual determinants of behavior in order to design more successful, customized interventions.”
Implementing Strategies to Prevent Infections in Acute Care Settings is a new section to the Compendium, first published in 2008. The Compendium is sponsored by the Society for Healthcare Epidemiology (SHEA) and is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of several organizations and societies with content expertise. It is a multiyear, highly collaborative guidance-writing effort by over 100 experts from around the world.
An update of strategies to prevent catheter-associated urinary tract infections will be published in coming weeks. The societies also recently updated strategies for preventing methicillin-resistant Staphylococcus aureus infections, Clostridioides difficile infections, surgical site infections, central line-associated bloodstream infections, ventilator and non-ventilator associated pneumonia and events, and strategies to prevent healthcare-associated infections through hand hygiene.
Each Compendium article contains infection prevention strategies, performance measures, and approaches to implementation. Compendium recommendations are derived from a synthesis of systematic literature review, evaluation of the evidence, practical and implementation-based considerations, and expert consensus.
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About Infection Control & Hospital Epidemiology Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 24th out of 94 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
About the Society for Healthcare Epidemiology of America (SHEA)
The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online atshea-online.org,facebook.com/SHEApreventingHAIsandtwitter.com/SHEA_Epi.
JOURNAL
Infection Control and Hospital Epidemiology
METHOD OF RESEARCH
Literature review
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Implementing Strategies to Prevent Infections in Acute Care Settings
ARTICLE PUBLICATION DATE
11-Jul-2023
Caesarean birth injury rates have risen for mums and babies but training and a new device could change that
IMAGE: FETAL PILLOW. IMAGE REPRODUCED COURTESY OF COOPER SURGICAL, INC.view more
CREDIT: BJOG: AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY
Over 34% of women in Australia have a caesarean birth, and a significant proportion of these happen in late labour when the fetal head is deep in the mother’s pelvis and can be impacted which makes delivering a baby challenging and poses serious risks to both the mother and the baby.
It’s estimated the baby’s head is wedged, known as impacted fetal head (IFH) in around 10% of all emergency caesarean births (CB). This makes it difficult for the doctor to get their hand below the baby’s head to deliver it, which leads to longer delivery times.
Recent statistics show that while the majority of babies born following IFH sustain minor damage, 2% of these infants die or suffer serious injuries with lifelong consequences.The NHS Resolution report in the UK states that 9% of avoidable brain injuries at birth are caused by impacted fetal head (IFH).
Complications for the mother include increased blood loss, an increased risk of infection, bladder and urinary tract damage, uterine tears that require repair and may cause issues in subsequent pregnancies, or even a hysterectomy. While complications for the baby include lacerations and bruising to the head and face, skull fractures, and haemorrhages, there have also been reports of eye injuries.
A Scientific Impact Paper published in BJOG: an International Journal of Obstetrics & Gynaecology by the Royal College of Obtsetricians & Gynaecologists in the UK and Professor Annette Briley at Flinders University has reported a significant rise in cases of IFH injuries in recent years, with maternity staff implementing varied approaches and no consensus regarding the definition or training regarding management to help deliver the baby during CB.
Approaches to managing this obstetric emergency include having an assistant push the baby's head up during birth, delivering the baby feet first, using an inflatable balloon device (Fetal Pillow) designed to elevate the baby’s head, and administering medication to relax the mother’s womb.
However, this scientific impact paper reviewed the available evidence, concluding there is currently no consensus on the best approach for these risky cases.
Various manoeuvres and some devices have been introduced to help with the delivery of the baby in this situation, but to date there is no consensus on which is best for mothers and babies or the training required for staff managing this emergency situation.
Most commonly, an assistant is asked to push up from below, although some evidence suggests reverse breech extraction may be associated with better outcomes. A UK-wide survey reported that more than half of obstetric registrars did not feel confident performing reverse breech extraction, and fewer than one in 10 are familiar with the Patwardhan technique.
"The aim of this scientific impact paper was to examine all the current available evidence regarding different manoeuvres and devices currently in use to manage IFH, with the results integrated into the findings of a systematic review commissioned by the National Guideline Alliance (UK)," says research co-author and midwife at Flinders University, Dr. Annette Briley.
The researchers say key steps need to be taken to improve standards:
• High-quality adequately powered RCTs comparing techniques to manage and prevent IFH are required. (Those currently available have significant weaknesses.) • A universally accepted definition of IFH would facilitate future research and education. • Women and their partners need to inform research around the language and management of IFH. • The development and implementation of an evidence-based multi-professional educational package would lead to consistent management of this obstetric emergency. • More research is required around the efficacy and cost-effectiveness of the Fetal Pillow
Dr Briley says the data clearly shows that there has been a significant rise in caesarean sections in late labour and associated cases of IFH-related injuries in recent years, and further education is needed to develop consistent management of this obstetric emergency.
"We’ve reviewed the existing evidence on strategies to identify, prevent, and manage the IFH during births to provide guidance and recommendations that improve outcomes for mothers and babies when this potentially serious complication occurs. It’s essential that clinicians use the best evidence to inform care for women and babies, including the optimal techniques to reduce the potentially devastating complications associated with IFH."
Dr Briley is also part of a research team developing and evaluating the Tydeman tube, an innovative single-use, hollow silicone tube inserted to elevate the baby’s head. Its designed to minimise applied pressure to the head and reduce any suction effect once access has been achieved.
"A minimal number of Tydeman Tubes have been used clinically; further research in a clinical setting, compared with appropriately trained and executed manual disimpaction, is required to investigate its efficacy and safety before use."
JOURNAL
International Journal of Obstetrics and Gynaecology
Management of Impacted Fetal Head at Caesarean Birth
Chagas Disease is also
underdiagnosed in Spain
A new study of nearly 3,000 Latin Americans who visited the Hospital Clinic over 17 years shows that 47% were infected with the parasite that causes the disease, and more than 10% had heart lesions
A high percentage of people from Latin America are infected with the parasite that causes Chagas disease. This is the conclusion of an analysis of nearly 3,000 people from countries where the disease is endemic and who attended the International Health Service at Barcelona’s Hospital Clinic, over a 17-year period. The study, published in PLOS Neglected Tropical Diseases, was led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by "la Caixa" Foundation.
Nearly 7 million people in the world are estimated to be infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Although the vector that transmits the parasite (the kissing bug) is endemic in 21 Latin American countries, the parasite has spread globally due to migratory flows. In non-endemic countries, the parasite can be transmitted vertically, from mother to child or, less commonly, through blood or organ donations. In 30-40% of cases, the infection ends up damaging the heart and digestive system, causing Chagas disease.
"It is therefore recommended that Latin Americans arriving in the country be tested in order to treat them if they are infected and, in the case of women of childbearing age, to prevent the vertical transmission of the parasite," explains Irene Losada, coordinator of the Chagas Initiative and first co-author of the study, along with Pedro Laynez-Roldán, ISGlobal researcher and physician at the Clínic’s International Health Service.
This retrospective study describes one of the largest samples of people at risk of infection in a non-endemic country: 2,820 Latin Americans, the vast majority from Bolivia, who attended the International Health Service of the Hospital Clinic of Barcelona between 2002 and 2019. Of the total number of people analysed, almost half (47%) were infected with T. cruzi and 17% had heart lesions typical of the disease. Although in most cases an electrocardiogram was sufficient to detect the lesions, an echocardiogram was needed in 10% of cases. "These results reinforce the importance of echocardiograms in the initial assessment of patients with T. cruzi infection," says Laynez-Roldán.
An underdiagnosis problem
The authors note that many people arriving from highly endemic regions of Latin America, such as Bolivia, had never been tested before. "The infection is clearly under-diagnosed even in Spain, one of the European countries with the highest diagnostic coverage," warns Maria Jesús Pinazo, last author of the study, former researcher at ISGlobal and currently at DNDi.
The majority of the cases are women of working age, reflecting the migratory flows of recent years, which allows for better targeting of screening and prevention programmes.
Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement
