Grade Medical (Czechia)

BackgroundUtilizing the Meyer and Allen (1991) model of organizational commitment, we investigated gender-based differences in physicians’ perceptions of their affective, continuance, and normative commitment, particularly concerning preferences for emigration.MethodsThe study sample comprised 1,553 physicians (1,002 males and 532 females), mean age of 43 years and tenure of 15 years. Upon giving informed consent, they responded to the anonymous online questionnaire, which was distributed via the Medical Chamber of Serbia in September 2020. We explored gender-based differences with the Pearson Chi-Square (p < 0.05).ResultsA higher proportion of female respondents reported that their institution holds personal significance for them, compared to male respondents (45.6% vs. 35.1%, p < 0.001) but do not feel guilty about leaving the institution immediately (47.6% vs. 39.1%, p = 0.005). A larger proportion of women than men would consider working abroad for better training and advancement opportunities (51.9% vs. 42.5%, p < 0.001), improved working conditions and salary (54.7% vs. 43.5%, p < 0.001), and the belief that employees in the Serbian healthcare sector are placed in a subordinate position compared to their colleagues in other European countries (77.2% vs. 72.3%, p = 0.043). More men than women underscore the importance of remaining loyal to their employer and institution (57.7% vs. 49.7%, p < 0.001) and believe that much of their lives will be disrupted if they decide to leave the institution (p = 0.02). Additionally, more men than women see separation from family as a barrier to working abroad (55.8% vs. 36.7%, p < 0.001). About two-fifths of all respondents do not cite a sense of moral obligation as a reason for continuing to work at the institution; however, nearly two-thirds are convinced that their institution has growth potential.ConclusionsFemale physicians exhibited higher levels of affective and lower levels of normative commitment than their male counterparts.Key messages• The gender interaction with job commitment components may significantly influence employee retention.• There is a need for further research into the role of organizational support for staff of different gender.

Group B Streptococcus(GBS) is important since almost 1/3 of pregnant women are colonized with GBS, and as much as 50% passes to the newborns, sometimes resulting in severe neonatal infections; that is why there are mandatory guidelines for antepartum screening for GBS vaginal/rectal colonization. Also, bacteria other than GBS and yeasts may affect newborns; therefore, an increase in the current knowledge and improving the guidelines related to the prediction and prevention of neonatal early-onset infections are needed. A systematic review was performed to investigate risks, types of specimens, sampling methods, media for GBS recovery, identification tests, gestation week for testing, GBS prevalence, sensitivity, specificity, turnover time for cultures, antigen, and molecular-based tests. A literature search was conducted through the Web of Science, Scopus, and PubMed. A total of 20 studies were identified with 10,288 patients and 1,334 GBS positive (13%). Eight studies were performed in adequate gestation week and revealed prevalence from 0.2 to 20.8% (conventional tests) and 37 to 45% (molecular tests). In only three studies, vaginal/rectal swab recommended by guidelines was applied. The heterogeneity of the detection and identification of GBS reduces the scientific and clinical utility of laboratory-based data, and universal antepartum screening with affordable, high-sensitivity traditional tests is needed.

Background and objectivesEfavirenz (EFV) exhibits substantial inter-patient pharmacokinetics (PK) variability. Polymorphisms in genes involved in EFV metabolism have been associated with EFV exposure, but they have not been fully implemented to inform dosing in treatment guidelines. This work aimed to develop a population pharmacokinetic-pharmacogenetic (PopPK-PGx) model of EFV in human immunodeficiency virus type 1 (HIV-1)-positive patients, and to simultaneously explore the influence of CYP2B6 (516G>T and c.485-18C>T) and NR1I3 polymorphisms, as well as patient characteristics on EFV PK parameters. Additionally, this study aimed to simulate the combined effects of genetic polymorphisms and nonadherence patterns on EFV plasma concentrations.MethodologyData from 89 patients receiving 600 mg EFV once daily were analyzed using NONMEM (v7.3) (ICON Development Solutions: Ellicott City, MD). For the structural model, considering a sparse sampling design, a one-compartment model was chosen to describe the distribution of EFV concentrations, with the oral volume of distribution (V/F) and constant rate of absorption (kA) fixed to literature-reported values. Bootstrapping and normalized prediction distribution errors (NPDE) were used for internal validation of the final model. Simulation of concentration-time profiles was conducted using the final PopPK-PGx model, following the recommended dosing regimen for typical individuals, to assess the probability of achieving target concentrations (1000-4000 ng/mL) under different PGx backgrounds and the effect of various nonadherence scenarios.ResultTypical oral clearance (CL/F) was 13.9 L/h with 13.1% interindividual variability (IIV). CYP2B6 516G>T, and CYP2B6 c.485-18C>T were associated with EFV CL/F. On average, EFV CL/F was 36.4% lower in heterozygote patients for CYP2B6 516G>T. Moreover, on average, there is a 26.8% decrease in CL/F in patients with the TT genotype of CYP2B6 c.485-18C>T. The NPDE distribution plots confirmed that the model accurately predicted EFV concentrations. For individuals carrying either the CYP2B6 516G>T or CYP2B6 c.485-18C>T polymorphisms, missing two consecutive standard doses of 600 mg/day was estimated to be sufficient to drive EFV concentrations out of the therapeutic range, while for those not carrying any CYP2B6 polymorphisms, one missed dose was estimated to result in EFV concentrations falling below the therapeutic range.ConclusionThese findings support the need for genotype-adherence-guided EFV dose adjustments to achieve optimal therapeutic levels. The CYP2B6 516G>T and c.485-18C>T variants were found to significantly reduce efavirenz rate of elimination, resulting in prolonged drug exposure. This insight could inform personalized strategies to maintain therapeutic concentrations in patients with varying adherence patterns.

International audience

Astrophysical observations provide compelling evidence for gravitationally interacting dark matter in the universe that cannot be explained by the standard model of particle physics. The extraordinary amount of data from the CERN LHC presents a unique opportunity to shed light on the nature of dark matter at unprecedented collision energies. This Report comprehensively reviews the most recent searches with the CMS experiment for particles and interactions belonging to a dark sector and for dark-sector mediators. Models with invisible massive particles are probed by searches for signatures of missing transverse momentum recoiling against visible standard model particles. Searches for mediators are also conducted via fully visible final states. The results of these searches are compared with those obtained from direct-detection experiments. Searches for alternative scenarios predicting more complex dark sectors with multiple new particles and new forces are also presented. Many of these models include long-lived particles, which could manifest themselves with striking unconventional signatures with relatively small amounts of background. Searches for such particles are discussed and their impact on dark-sector scenarios is evaluated. Many results and interpretations have been newly obtained for this Report.