Implementation of a Device Briefing Tool reduces interruptions in surgery: A nonrandomized controlled pilot trial.

Background: Interruptions in operative flow are known to increase team stress and errors in the operating room. Device-related interruptions are an increasing area of focus for surgical safety, but common safety processes such as the Surgical Safety Checklist do not adequately address surgical devices. We assessed the impact of the Device Briefing Tool, a communication instrument for surgical teams, on device-related interruptions in a large academic referral center in Singapore.

Utility of a Device Briefing Tool to Improve Surgical Safety.

Introduction: Clear communication around surgical device use is crucial to patient safety. We evaluated the utility of the Device Briefing Tool (DBT) as an adjunct to the Surgical Safety Checklist.

Methods: A nonrandomized, controlled pilot of the DBT was conducted with surgical teams at an academic referral center.

Human Papillomavirus Vaccination and Human Papillomavirus-Associated Cancer Rates Within Florida Counties.

Introduction: To direct interventions, the Florida counties with the greatest risk of current and future human papillomavirus‒associated cancers were identified by estimating county-level (1) percentages of adolescents aged 13-17 years who initiated (≥1 dose) and were up to date (2-3 doses) for the human papillomavirus vaccine and (2) human papillomavirus‒associated cancer incidence rates.

Methods: Records were obtained for human papillomavirus vaccinations from the Florida immunization registry (2006-2019), incident cancer cases from the Florida registry (2013-2017), and annual population counts from the Florida Department of Health (2006-2019). In 2020, annual county-level human papillomavirus vaccine initiation, human papillomavirus vaccine up-to-date, and age-adjusted human papillomavirus‒associated cancer incidence rates were estimated.

Comparison of reactions of antibodies to rat collagen and to rat kidney in the basement membranes of rat renal glomeruli.

By in vivo and in vitro methods of immunofluorescence, antibody to rat collagen and to rat kidney show the same regular, linear fluorescence following the outlines of the renal glomerular capillaries. Absorption of each antiserum with its homologous antigen completely removed the antibody for immunofluorescence, while absorption with the heterologous antigen had no effect. The nephrotoxicity persisted in the anti-kidney serum absorbed with collagen.

Demonstration by immunofluorescence of the fixation of perfused antibody to human collagen in human kidney.

Rabbit serum containing antibody to human collagen, perfused through human infant kidneys obtained at autopsy, gives an immunofluorescent reaction with an antigen in the basement membranes of the glomeruli and the tubules. This reaction was shown to be specific by the absence of reaction with normal rabbit serum, antibody to carp collagen, or anti-human collagen serum absorbed with human collagen. Slight cross-reactions were found in the human kidneys with antibody to chicken or rat collagen.

Immunologic relations among various animal collagens.

By the use of complement fixation and in vivo immunofluorescence with cross-absorption studies it was shown that acid soluble collagens prepared from rat, mouse, guinea pig, chicken, carp, and man exhibit species specificity. Rat and mouse collagens were found to be indistinguishable and to cross-react with guinea pig collagen. Cross-reactions also occurred between the collagens of rat and man and chicken and man.

Antigenicity of rat collagen. Distribution of antibody to rat collagen injected into rats.

Antibody to rat collagen, prepared in rabbits and injected into the circulation of normal or adjuvant-prepared rats, becomes fixed to its antigen and can then be identified in tissue sections under ultraviolet light by its fluorescence after application of fluorescein-conjugated anti-rabbit globulin. In heart, lung, liver, spleen, adrenal, kidney, jejunum, lymph node, thymus, joint synovia, peripheral nerve, aorta, skeletal muscle, eye, and brain, the antibody was found at all sites where collagen and reticulin are normally present, but except for the kidneys of the adjuvant-prepared rats, no pathological abnormalities were demonstrated. It was not found within cells.

Antigenicity of rat collagen. Demonstration of antibody to rat collagen in the renal glomeruli of rats by fluorescence microscopy.

Rabbit serum or globulin, containing antibody to rat collagen, injected intravenously or intracardially into normal or adjuvant-prepared rats becomes fixed in the basement membranes of renal glomeruli and, to a slight extent, of the tubules. When examined by ultraviolet light, this antibody can be identified in tissue sections by the yellow-green fluorescence occurring where the rabbit globulin, associated with the fixed collagen antibody, has reacted with fluorescein-conjugated anti-rabbit globulin from ducks. The reaction of the antibody to rat collagen with its antigen in the kidney is a primary factor in the production of the renal glomerular injury which occurs in rats prepared with adjuvant.

Renal glomerular lesions induced by rabbit antirat collagen serum in rats prepared with adjuvant.

Renal glomerular lesions were induced by rabbit serum containing antibody to rat collagen injected intravenously into rats prepared with subcutaneously administered Freund adjuvant. Neither the anti-collagen serum nor the adjuvant alone induced the lesion. The lesions were characterized by diffuse glomerular injury with swelling, shredding, and fusion of the basement membranes, crescent formation, cellular proliferation, numerous multinuclear giant cells, and capillary hyaline thrombi.

Antigenicity of rat collagen; reverse anaphylaxis induced in rats by anti-rat collagen serum.

Reverse anaphylactic shock was induced in rats by intravenous injection of serum containing complement-fixing antibodies, obtamed by immunization of rabbits with purified preparations of rat tail collagen. Normal rabbit serum or serum containing antibodies to collagen from tunica of carp swim bladder was without effect. The clinical and pathological findings resembled those described by previous workers studying direct and reverse anaphylactic reactions induced in the rat with other antigens.

The antigenicity of rat collagen.

A method is described for preparing purified collagen from the tail tendons of rats with minimal alteration from its native state. This purified collagen is soluble in dilute acetic acid and when injected intraperitoneally into rabbits induces complement-fixing antibodies in low titer. It has been demonstrated by the use of certain immunological tests, enzymatic analyses, and electron microscopy that these antibodies are probably directed specifically toward collagen rather than toward accompanying impurities such as tissue proteins or polysaccharides.

Protective effect of hyaluronidase and type-specific anti-M serum on experimental group A streptococcus infection in mice.

Five strains of encapsulated group A streptococci of different serological types, each with a glossy and a matt variant, were studied to compare the rôles of the M substance and the hyaluronic acid capsule in virulence of these microorganisms. The results indicated that both contribute to the virulence of group A streptococci but that the M antigen is the more fundamental factor. Encapsulated variants, both glossy and matt, were slightly less susceptible to phagocytosis than those from which the capsule had been removed with hyaluronidase.