Krevende personalsaker En studie av skoleleders håndtering av lederansvaret

Sammendrag Problemstilling: Hvordan må en leder opptre i en vanskelig personalsak for å ivareta organisasjonen som helhet? Etter åtte år som skoleleder, har jeg gjort meg noen erfaringer fra vanskelige personalsaker og det er dette som er hovedårsaken til at jeg ønsker å arbeide med dette i min studie. Andres master -og doktorgrader har også inspirert meg, og gjort meg motivert for eget arbeid med dette temaet. Jeg har valgt å bruke kvalitativ metode, og benytter semistrukturert intervju. Jeg har kombinert dette med fokusgruppeintervju. Det er tre hovedtillitsvalgte for Utdanningsforbundet som er mine intervjupersoner. Alle de tre intervjupersonene var opptatt av utfordringer knyttet til både sin egen og andres rolle i de mest krevende sakene. Dermed dreier funnene i stor grad om hvilken form for lederstøtte som trengs i håndteringen av vanskelige personalsaker, i tillegg til hvordan hovedtillitsvalgte kan påvirke og medvirke i slike saker. Andre funn i studien handler om at det kan være avgjørende for leder å bygge legitimitet i personalet i fredstid. Det kom videre fram at det er viktig å unngå unnfallenhet, ved at leder er på – og tar tak i kritikkverdige forhold fortløpende og ikke samler det opp til en stor sak. Betydningen av å unngå saksbehandlingsfeil er også et sentralt funn. Det som kanskje er aller mest framtredende i oppgaven, handler om at det er svært vanskelig å lykkes i de aller mest krevende personalsakene, nesten uansett hva leder gjør, og at utfallet i verste fall kan gi negative konsekvenser for alle involverte parter

Late HDV RNA relapse after peginterferon alpha-based therapy of chronic hepatitis delta

Interferon alpha is the only treatment option for hepatitis delta virus (HDV). Trials investigating the efficacy of pegylated interferon alpha (PEG-IFNa) showed HDV RNA negativity rates of 25-30% 24 weeks after therapy. However, the clinical and virological long-term outcome of HDV-infected patients treated with PEG-IFNa is unknown. We performed a retrospective-prospective follow-up of 77 patients treated for 48 weeks with either PEG-alfa-2a and adefovir (ADV) or either drug alone in the Hep-Net-International-Delta-Hepatitis-Intervention-Study 1 (HIDIT-1) trial. Long-term follow-up data were available for 58 out of 77 patients (75%) with a median time of follow-up of 4.5 (0.5-5.5) years and a median 3 visits per patient. Patients treated with ADV alone received retreatment with PEG-IFNa (48% versus 19%; P = 0.02) more often. Hepatitis B virus surface antigen (HBsAg) became negative in six PEG-IFNa-treated patients until the end of long-term follow-up (10%). Sixteen patients tested HDV RNA-negative 6 months after PEG-IFNa treatment who were entered in the long-term follow-up study. Out of these, nine individuals tested HDV RNA-positive at least once during further long-term follow-up, with seven patients being HDV RNA-positive at the most recent visit. Clinical endpoints (liver-related death, liver transplantation, hepatic decompensation, hepatocellular carcinoma) were observed in three PEG-IFNa-treated (8%) and three ADV-treated (14%) patients during posttreatment long-term follow-up with an overall annual event rate of 2.5% (4.9% in cirrhosis). Sequencing confirmed the reappearance of pretreatment virus strains in all cases. Conclusion: Late HDV RNA relapses may occur after PEG-IFNa therapy of hepatitis delta and thus the term sustained virological response should be avoided in HDV infection. The annual posttreatment rate of clinical events in hepatitis delta patients eligible for PEG-IFNa therapy is about 2.5% and 4.9% in patients with cirrhosis.Hep-Net Study House; German Liver Foundation; HepNet e.V.; Integrated Research and Treatment Center Transplantation (IFB-Tx Project 37) [01EO0802]; Hannover Medical School; German Centre for Infection Research (DZIF)Supported by the Hep-Net Study House, the German Liver Foundation, the HepNet e.V. as well as in part by the Integrated Research and Treatment Center Transplantation (IFB-Tx Project 37; Reference No.: 01EO0802), Hannover Medical School, and the German Centre for Infection Research (DZIF

Hepatitis E virus is highly resistant to alcohol-based disinfectants

Background The Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis worldwide and mainly transmitted via the fecal-oral route or consumption of contaminated food products. Due to the lack of efficient cell culture systems for the propagation of HEV, limited data regarding HEV sensitivity to chemical disinfectants are available. Consequently, preventive and evidence-based hygienic guidelines on HEV disinfection are lacking. Methods We used a robust HEV genotype 3 cell culture model which allows quantification of viral infection of quasi-enveloped and naked HEV particles. For HEV genotype 1 infections the primary isolate Sar55 in a faecal suspension was applied. Standardized quantitative suspension tests using end point dilution and large-volume-plating were performed for the determination of virucidal activity of alcohols (1-propanol, 2-propanol, ethanol), WHO disinfectant formulations and five different commercial hand disinfectants against HEV. Iodixanol gradients were conducted to elucidate the influence of ethanol on quasi-enveloped viral particles. Results Naked and quasi-enveloped HEV was resistant to alcohols as well as alcohol-based formulations recommended by WHO. Of the tested commercial hand disinfectants only one product displayed a virucidal activity against HEV. This activity could be linked to phosphoric acid as essential ingredient. Finally, we observed that ethanol and possibly non-active alcohol-based disinfectants disrupt the quasi-envelope structure of HEV particles, while leaving the highly transmissible and infectious naked virions intact. Conclusions Different alcohols and alcohol-based hand disinfectants were insufficient to eliminate HEV infectivity with the exception of one commercial ethanol-based product including phosphoric acid. These findings have strong implications for the efficient prevention measures to reduce viral transmission in clinical practice. Lay summary Hepatitis E virus (HEV) showed a strong stability against alcohols and alcohol-based hand disinfectants. With phosphoric acid one essential substance could be identified to active ethanol in its virucidal activity against HEV, which allows to improve hygiene measures for the prevention of HEV transmissions

Rapid Detection of Chlamydia trachomatis and Typing of the Lymphogranuloma venereum associated L-Serovars by TaqMan PCR

<p>Abstract</p> <p>Background</p> <p>Infection due to <it>Chlamydia trachomatis </it>is the most common sexually transmitted bacterial disease of global health significance, and especially the L-serovars causing lymphogranuloma venereum are increasingly being found in Europe in men who have sex with men.</p> <p>Results</p> <p>The design and evaluation of a rapid, multiplex, real-time PCR targeting the major outer membrane protein (<it>omp-1</it>) -gene and a L-serovar-specific region of the polymorphic protein H (<it>pmp-H</it>) -gene for the detection of <it>Chlamydia trachomatis </it>is reported here. The PCR takes place as a single reaction with an internal control. For L1-, L2- and L3-serovar differentiation a second set of real-time PCRs was evaluated based on the amplification of serovar-specific <it>omp-1</it>-regions. The detection limit of each real-time PCR, multiplexed or not, was 50 genome copies per reaction with an efficiency ranging from 90,5–95,2%.</p> <p>In a retrospective analysis of 50 ocular, rectal and urogenital specimens formerly tested to be positive for <it>C. trachomatis </it>we identified six L2-serovars in rectal specimens of HIV-positive men, one in a double-infection with L3, and one L2 in a urethral specimen of an HIV-negative male.</p> <p>Conclusion</p> <p>This unique real-time PCR is specific and convenient for the rapid routine-diagnostic detection of lymphogranuloma venereum-associated L-serovars and enables the subsequent differentiation of L1, L2 and L3 for epidemiologic studies.</p

Open Access to JRC Research Infrastructures

The European Commission‘s Joint Research Centre (JRC) gives leading researchers from across Europe and beyond access to its world-class facilities and laboratories, enabling state-of-the-art experimental research, collaboration and capacity building with a European dimension. It does so through the programme for Open access to JRC research infrastructures. The JRC hosts 56 high-value research infrastructures, most of which are unique at European and international level. Of these, 39 are suitable for opening access to external users in various fields of science: nuclear and radiological, chemistry, biosciences and life sciences, physical sciences and ICT. JRC’s research infrastructures are located in Ispra (Italy), Geel (Belgium), Karlsruhe (Germany) and Petten (The Netherlands). These infrastructures (i.e. laboratories) are fit for experimental work generating data for users’ analyses. The main objectives of opening access to JRC research infrastructures are to: a) Establish a fair, clear and transparent procedure for giving access of external users to JRC physical research infrastructures; b) Maximise the use to the full potential of JRC physical research infrastructures in collaboration with researchers and industry. Benefits of opening up JRC research infrastructures are multi-fold: granting access fulfils scientific needs and provides benefit to the research of external users accessing JRC facilities. These benefits can be summarised as follows: - Access to JRC research infrastructures based on open calls for competitive access allows European users not traditionally engaged with the JRC to have access through a transparent procedure - Research infrastructures attract talent and stimulate innovation and development. Enabling access to the JRC research infrastructures enhance competitiveness, through pre- and co-normative research, and contributes to bridging the gap from research to industry, e.g., through the setting up of demonstration projects for product validation - Access of users to JRC research infrastructures contributes to the dissemination of knowledge, improves related methods and skills, provides education and training and fosters collaboration at European level - Granting access within a structured framework maximises the return on taxpayer funded investment that the JRC has made on its research infrastructures, making them available to external users in view of the limited resources now existing in Europe.JRC.A.5 - Scientific Developmen

Insertion of a transjugular intrahepatic portosystemic shunt leads to sustained reversal of systemic inflammation in patients with decompensated liver cirrhosis

Background/Aims Systemic Inflammation (SI) is considered a key mechanism in disease progression and development of complications in decompensated liver cirrhosis. SI is mainly driven by portal hypertension and bacterial translocation. Transjugular intrahepatic portosystemic shunt (TIPS) insertion represents an effective treatment for portal hypertension. This study aims to investigate the impact of TIPS insertion on SI and bacterial translocation. Methods We prospectively included 59 cirrhotic patients undergoing TIPS insertion. Blood samples were collected at TIPS insertion and follow-up (FU) 1, 3, 6, and 12 months thereafter. At all time points, we performed a comprehensive analysis of SI including 43 soluble inflammatory markers (SIMs), and surrogates of bacterial translocation (sCD14, sCD163). To investigate long-term kinetics of SI, C-reactive protein (CRP) and white blood cells (WBC) were retrospectively analyzed in a cohort of 177 patients up to 3 years after TIPS insertion. Results At TIPS insertion, 30/43 SIMs, sCD14, and sCD163 measured significantly higher in cirrhotic patients compared to healthy controls. By FU6 25 SIMs and sCD14 measured at significantly lower levels compared to baseline. Interestingly, in patients with TIPS indication of refractory ascites, IL-6 decreased to levels documented in earlier stages of cirrhosis. In long-term follow-up, CRP levels significantly decreased after TIPS insertion, which translated into lower mortality in Cox regression analysis (HR 0.968, P=0.042). Notably, patients with residual ascites post-TIPS showed significantly higher CRP and IL-6 levels across all follow-ups compared to patients with resolved ascites. Conclusions Decreasing portal hypertension via TIPS insertion leads to a significant attenuation of SI and bacterial translocation over time

A time-resolved proteomic and prognostic map of COVID-19

COVID-19 is highly variable in its clinical presentation, ranging from asymptomatic infection to severe organ damage and death. We characterized the time-dependent progression of the disease in 139 COVID-19 inpatients by measuring 86 accredited diagnostic parameters, such as blood cell counts and enzyme activities, as well as untargeted plasma proteomes at 687 sampling points. We report an initial spike in a systemic inflammatory response, which is gradually alleviated and followed by a protein signature indicative of tissue repair, metabolic reconstitution, and immunomodulation. We identify prognostic marker signatures for devising risk-adapted treatment strategies and use machine learning to classify therapeutic needs. We show that the machine learning models based on the proteome are transferable to an independent cohort. Our study presents a map linking routinely used clinical diagnostic parameters to plasma proteomes and their dynamics in an infectious disease