Till evolution do us part: The diversity of symbiotic associations across populations of Philaenus spittlebugs.

Symbiotic bacteria have played crucial roles in the evolution of sap-feeding insects and can strongly affect host function. However, their diversity and distribution within species are not well understood; we do not know to what extent environmental factors or associations with other species may affect microbial community profiles. We addressed this question in Philaenus spittlebugs by surveying both insect and bacterial marker gene amplicons across multiple host populations. Host mitochondrial sequence data confirmed morphology-based identification of six species and revealed two divergent clades of Philaenus spumarius. All of them hosted the primary symbiont Sulcia that was almost always accompanied by Sodalis. Interestingly, populations and individuals often differed in the presence of Sodalis sequence variants, suggestive of intra-genome 16S rRNA variant polymorphism combined with rapid genome evolution and/or recent additional infections or replacements of the co-primary symbiont. The prevalence of facultative endosymbionts, including Wolbachia, Rickettsia, and Spiroplasma, varied among populations. Notably, cytochrome I oxidase (COI) amplicon data also showed that nearly a quarter of P. spumarius were infected by parasitoid flies (Verralia aucta). One of the Wolbachia operational taxonomic units (OTUs) was exclusively present in Verralia-parasitized specimens, suggestive of parasitoids as their source and highlighting the utility of host gene amplicon sequencing in microbiome studies.

Ovary structure and symbiotic associates of a ground mealybug, Rhizoecus albidus (Hemiptera, Coccomorpha: Rhizoecidae) and their phylogenetic implications.

The ovary structure and the organization of its symbiotic system of the ground mealybug, Rhizoecus albidus (Rhizoecidae), were examined by means of microscopic and molecular methods. Each of the paired elongated ovaries of R. albidus is composed of circa one hundred short telotrophic-meroistic ovarioles, which are radially arranged along the distal part of the lateral oviduct. Analysis of serial sections revealed that each ovariole contains four germ cells: three trophocytes (nurse cells) occupying the tropharium and a single oocyte in the vitellarium. The ovaries are accompanied by giant cells termed bacteriocytes which are tightly packed with large pleomorphic bacteria. Their identity as Brownia rhizoecola (Bacteroidetes) was confirmed by means of amplicon sequencing and fluorescence in situ hybridization techniques. Moreover, to our knowledge, this is the first report on the morphology and ultrastructure of the Brownia rhizoecola bacterium. In the bacteriocyte cytoplasm bacteria Brownia co-reside with sporadic rod-shaped smaller bacteria, namely Wolbachia (Proteobacteria: Alphaproteobacteria). Both symbionts are transmitted to the next generation vertically (maternally), that is, via female germline cells. We documented that, at the time when ovarioles contain oocytes at the vitellogenic stage, these symbionts leave the bacteriocytes and move toward the neck region of ovarioles (i.e. the region between tropharium and vitellarium). Next, the bacteria enter the cytoplasm of follicular cells surrounding the basal part of the tropharium, leave them and enter the space between the follicular epithelium and surface of the nutritive cord connecting the tropharium and vitellarium. Finally, they gather in the deep depression of the oolemma at the anterior pole of the oocyte in the form of a 'symbiont ball'. Our results provide further arguments strongly supporting the validity of the recent changes in the classification of mealybugs, which involved excluding ground mealybugs from the Pseudococcidae family and raising them to the rank of their own family Rhizoecidae.

Preferences of women with low obstetric risk for cesarean or vaginal birth in Poland: Areas for intervention.

BACKGROUND: In Poland, the rate of cesarean birth (CB) is 43%, which is much higher than the European average of 27%. Optimizing the CB birth rate is of critical importance, especially among women with low-risk pregnancies. However, the determinants of cesarean preference among low-risk women in Poland have not been well explored. METHODS: This cross-sectional study included 1011 pregnant women and aimed to identify associations between selected determinants of women's preferences for CB vs. vaginal birth (VB) in Poland. A descriptive questionnaire was distributed online, and a theoretical model was validated against empirically gathered data. Group comparisons were performed using the Welch t test for continuous data or chi-square test for categorical data. All statistical analyses were performed using R (R Core Team, 2018). RESULTS: The mean age of women preferring CB (30.46 years) was 1.25 years higher than that of women preferring VB (29.21 years). Pregnant women who expressed a preference for CB tended to be multigravid, inhabited cities, and were characterized by higher levels of anxiety and depression. Moreover, the majority of women who underwent a previous CB asserted their intention to repeat the procedure for the current pregnancy. CONCLUSIONS: The primary factors that were correlated with high CB preference among the low-risk group included age, previous childbirth experiences, and anxiety. The underlying reasons that drive birth preferences remain poorly understood. However, women who have previously undergone difficult childbirth experiences and are afraid of pain require specialized care.

Multiple origins of interdependent endosymbiotic complexes in a genus of cicadas.

Bacterial endosymbionts that provide nutrients to hosts often have genomes that are extremely stable in structure and gene content. In contrast, the genome of the endosymbiont Hodgkinia cicadicola has fractured into multiple distinct lineages in some species of the cicada genus Tettigades To better understand the frequency, timing, and outcomes of Hodgkinia lineage splitting throughout this cicada genus, we sampled cicadas over three field seasons in Chile and performed genomics and microscopy on representative samples. We found that a single ancestral Hodgkinia lineage has split at least six independent times in Tettigades over the last 4 million years, resulting in complexes of between two and six distinct Hodgkinia lineages per host. Individual genomes in these symbiotic complexes differ dramatically in relative abundance, genome size, organization, and gene content. Each Hodgkinia lineage retains a small set of core genes involved in genetic information processing, but the high level of gene loss experienced by all genomes suggests that extensive sharing of gene products among symbiont cells must occur. In total, Hodgkinia complexes that consist of multiple lineages encode nearly complete sets of genes present on the ancestral single lineage and presumably perform the same functions as symbionts that have not undergone splitting. However, differences in the timing of the splits, along with dissimilar gene loss patterns on the resulting genomes, have led to very different outcomes of lineage splitting in extant cicadas.

Coexistence of novel gammaproteobacterial and Arsenophonus symbionts in the scale insect Greenisca brachypodii (Hemiptera, Coccomorpha: Eriococcidae).

Scale insects are commonly associated with obligate, intracellular microorganisms which play important roles in complementing their hosts with essential nutrients. Here we characterized the symbiotic system of Greenisca brachypodii, a member of the family Eriococcidae. Histological and ultrastructural analyses have indicated that G. brachypodii is stably associated with coccoid and rod-shaped bacteria. Phylogenetic analyses have revealed that the coccoid bacteria represent a sister group to the secondary symbiont of the mealybug Melanococcus albizziae, whereas the rod-shaped symbionts are close relatives of Arsenophonus symbionts in insects - to our knowledge, this is the first report of the presence of Arsenophonus bacterium in scale insects. As a comparison of 16S and 23S rRNA genes sequences of the G. brachypodii coccoid symbiont with other gammaprotebacterial sequences showed only low similarity (∼90%), we propose the name 'Candidatus Kotejella greeniscae' for its tentative classification. Both symbionts are transovarially transmitted from one generation to the next. The infection takes place in the neck region of the ovariole. The bacteria migrate between follicular cells, as well as through the cytoplasm of those cells to the perivitelline space, where they form a characteristic 'symbiont ball'. Our findings provide evidence for a polyphyletic origin of symbionts of Eriococcidae.

Dual "Bacterial-Fungal" Symbiosis in Deltocephalinae Leafhoppers (Insecta, Hemiptera, Cicadomorpha: Cicadellidae).

The symbiotic systems (types of symbionts, their distribution in the host insect body, and their transovarial transmission between generations) of four Deltocephalinae leafhoppers: Fieberiella septentrionalis, Graphocraerus ventralis, Orientus ishidae, and Cicadula quadrinotata have been examined by means of histological, ultrastructural, and molecular techniques. In all four species, two types of symbionts are present: bacterium Sulcia (phylum Bacteroidetes) and yeast-like symbionts closely related to the entomopathogenic fungi (phylum Ascomycota, class Sordariomycetes). Sulcia bacteria are always harbored in giant bacteriocytes, which are grouped into large organs termed "bacteriomes." In F. septentrionalis, G. ventralis, and O. ishidae, numerous yeast-like microorganisms are localized in cells of the fat body, whereas in C. quadrinotata, they occupy the cells of midgut epithelium in large number. Additionally, in C. quadrinotata, a small amount of yeast-like microorganisms occurs intracellularly in the fat body cells and, extracellularly, in the hemolymph. Sulcia bacteria in F. septentrionalis, G. ventralis, O. ishidae, and C. quadrinotata, and the yeast-like symbionts residing in the fat body of F. septentrionalis, G. ventralis, and O. ishidae are transovarially transmitted; i.e., they infect the ovarioles which constitute the ovaries.

The Use of Spatial Data Infrastructure in Environmental Management:an Example from the Spatial Planning Practice in Poland.

Today's technology plays a crucial role in the effective use of environmental information. This includes geographic information systems and infrastructures. The purpose of this research is to identify the way in which the Polish spatial data infrastructure (PSDI) supports policies and activities that may have an impact on the environment in relation to one group of users, namely urban planners, and their tasks concerning environmental management. The study is based on a survey conducted in July and August, 2014. Moreover, the authors' expert knowledge gained through urban development practice and the analysis of the environmental conservation regulations and spatial planning in Poland has been used to define the scope of environmental management in both spatial planning studies and spatial data sources. The research included assessment of data availability, infrastructure usability, and its impact on decision-making process. The results showed that the PSDI is valuable because it allows for the acquisition of data on environmental monitoring, agricultural and aquaculture facilities. It also has a positive impact on decision-making processes and improves numerous planners' activities concerning both the inclusion of environmental indicators in spatial plans and the support of nature conservation and environmental management in the process of working on future land use. However, even though the infrastructure solves certain problems with data accessibility, further improvements might be proposed. The importance of the SDI in environmental management is noticeable and could be considered from many standpoints: Data, communities engaged in policy or decision-making concerning environmental issues, and data providers.

[The key role of AMP-activated protein kinase (AMPK) in aging process]. / Kluczowa rola kinazy bialkowej aktywowanej przez AMP (AMPK) w procesach starzenia.

Aging is one of the most extensively studied biological process and yet still some of its aspects remain elusive. It appears that AMP - activated protein kinase (AMPK) plays an important role in many processes of aging, but this fact is often neglected in the studies on aging. This work summarizes the information about AMPK participation in the aging process. AMPK participation in the regulation of aging was indicated in the mechanisms dependent on: caloric restriction, mTOR, p53, sirtuins, autophagy, inflammation and the effects caused by polyphenols.

Facultatively intrabacterial localization of a planthopper endosymbiont as an adaptation to its vertical transmission.

Transovarial transmission is the most reliable way of passing on essential nutrient-providing endosymbionts from mothers to offspring. However, not all endosymbiotic microbes follow the complex path through the female host tissues to oocytes on their own. Here, we demonstrate an unusual transmission strategy adopted by one of the endosymbionts of the planthopper Trypetimorpha occidentalis (Hemiptera: Tropiduchidae) from Bulgaria. In this species, an Acetobacteraceae endosymbiont is transmitted transovarially within deep invaginations of cellular membranes of an ancient endosymbiont Sulcia-strikingly resembling recently described plant virus transmission. However, in males, Acetobacteraceae colonizes the same bacteriocytes as Sulcia but remains unenveloped. Then, the unusual endobacterial localization of Acetobacteraceae observed in females appears to be a unique adaptation to maternal transmission. Further, the symbiont's genomic features, including encoding essential amino acid biosynthetic pathways and its similarity to a recently described psyllid symbiont, suggest a unique combination of the ability to horizontally transmit among species and confer nutritional benefits. The close association with Acetobacteraceae symbiont correlates with the so-far-unreported level of genomic erosion of ancient nutritional symbionts of this planthopper. In Sulcia, this is reflected in substantial changes in genomic organization, reported for the first time in the symbiont renowned for its genomic stability. In Vidania, substantial gene loss resulted in one of the smallest genomes known, at 108.6 kb. Thus, the symbionts of T. occidentalis display a combination of unusual adaptations and genomic features that expand our understanding of how insect-microbe symbioses may transmit and evolve.IMPORTANCEReliable transmission across host generations is a major challenge for bacteria that associate with insects, and independently established symbionts have addressed this challenge in different ways. The facultatively endobacterial localization of Acetobacteraceae symbiont, enveloped by cells of ancient nutritional endosymbiont Sulcia in females but not males of the planthopper Trypetimorpha occidentalis, appears to be a unique adaptation to maternal transmission. Acetobacteraceae's genomic features indicate its unusual evolutionary history, and the genomic erosion experienced by ancient nutritional symbionts demonstrates the apparent consequences of such close association. Combined, this multi-partite symbiosis expands our understanding of the diversity of strategies that insect symbioses form and some of their evolutionary consequences.

Limited variation in microbial communities across populations of Macrosteles leafhoppers (Hemiptera: Cicadellidae).

Microbial symbionts play crucial roles in insect biology, yet their diversity, distribution, and temporal dynamics across host populations remain poorly understood. In this study, we investigated the spatio-temporal distribution of bacterial symbionts within the widely distributed and economically significant leafhopper genus Macrosteles, with a focus on Macrosteles laevis. Using host and symbiont marker gene amplicon sequencing, we explored the intricate relationships between these insects and their microbial partners. Our analysis of the cytochrome oxidase subunit I (COI) gene data revealed several intriguing findings. First, there was no strong genetic differentiation across M. laevis populations, suggesting gene flow among them. Second, we observed significant levels of heteroplasmy, indicating the presence of multiple mitochondrial haplotypes within individuals. Third, parasitoid infections were prevalent, highlighting the complex ecological interactions involving leafhoppers. The 16S rRNA data confirmed the universal presence of ancient nutritional endosymbionts-Sulcia and Nasuia-in M. laevis. Additionally, we found a high prevalence of Arsenophonus, another common symbiont. Interestingly, unlike most previously studied species, M. laevis exhibited only occasional cases of infection with known facultative endosymbionts and other bacteria. Notably, there was no significant variation in symbiont prevalence across different populations or among sampling years within the same population. Comparatively, facultative endosymbionts such as Rickettsia, Wolbachia, Cardinium and Lariskella were more common in other Macrosteles species. These findings underscore the importance of considering both host and symbiont dynamics when studying microbial associations. By simultaneously characterizing host and symbiont marker gene amplicons in large insect collections, we gain valuable insights into the intricate interplay between insects and their microbial partners. Understanding these dynamics contributes to our broader comprehension of host-microbe interactions in natural ecosystems.

The Assessment of Natural Vaginal Delivery in Relation to Pregnancy-Related Anxiety-A Single-Center Pilot Study.

BACKGROUND: Pregnancy-related anxiety (PrA) is a specific type of anxiety experienced during the perinatal period. It may concern a person's health and physical appearance, fetal development, hospital and health care experiences, impending childbirth, and early parenthood. PrA is considered to be a stronger predictor of adverse pregnancy outcomes than general anxiety and depression. The purpose of this research was to conduct a pilot study and evaluate the course of vaginal birth (VB) in relation to PrA levels in a population of pregnant women with low obstetrical risk. METHODS: This cross-sectional exploratory study included 84 pregnant women (with a mean age of 28.61 ± 4.99) (without cesarean section (CS) indications and with a low risk of complications during VB). Research questionnaires were distributed and filled in in person during the course of hospitalization. Groups that varied at the level of PrA were compared using the Wilcoxon rank-sum test, Fisher's exact test, or chi-square test of independence, as appropriate. RESULTS: More than two-thirds of the respondents (72.6%) were medicated in labor. Women with high PrA, selected based on a cut-off point with a total PRAQ-R2 score of 60, experienced significantly longer first (start of established labor to fully dilated cervix) and second (lasts from when cervix is fully dilated until the birth) periods of labor, instrumental delivery, or emergency CS. In the group with high PrA levels, a episiotMmentation of evidence-based recommendations for the affected population to identify and further treat women with elevated levels of PrA.

Nutrient supplementation by genome-eroded Burkholderia symbionts of scale insects.

Hemipterans are known as hosts to bacterial or fungal symbionts that supplement their unbalanced diet with essential nutrients. Among them, scale insects (Coccomorpha) are characterized by a particularly large diversity of symbiotic systems. Here, using microscopic and genomic approaches, we functionally characterized the symbionts of two scale insects belonging to the Eriococcidae family, Acanthococcus aceris and Gossyparia spuria. These species host Burkholderia bacteria that are localized in the cytoplasm of the fat body cells. Metagenome sequencing revealed very similar and highly reduced genomes (<900KBp) with a low GC content (~38%), making them the smallest and most AT-biased Burkholderia genomes yet sequenced. In their eroded genomes, both symbionts retain biosynthetic pathways for the essential amino acids leucine, isoleucine, valine, threonine, lysine, arginine, histidine, phenylalanine, and precursors for the semi-essential amino acid tyrosine, as well as the cobalamin-dependent methionine synthase MetH. A tryptophan biosynthesis pathway is conserved in the symbiont of G. spuria, but appeared pseudogenized in A. aceris, suggesting differential availability of tryptophan in the two host species' diets. In addition to the pathways for essential amino acid biosynthesis, both symbionts maintain biosynthetic pathways for multiple cofactors, including riboflavin, cobalamin, thiamine, and folate. The localization of Burkholderia symbionts and their genome traits indicate that the symbiosis between Burkholderia and eriococcids is younger than other hemipteran symbioses, but is functionally convergent. Our results add to the emerging picture of dynamic symbiont replacements in sap-sucking Hemiptera and highlight Burkholderia as widespread and versatile intra- and extracellular symbionts of animals, plants, and fungi.

Variable organization of symbiont-containing tissue across planthoppers hosting different heritable endosymbionts.

Sap-feeding hemipteran insects live in associations with diverse heritable symbiotic microorganisms (bacteria and fungi) that provide essential nutrients deficient in their hosts' diets. These symbionts typically reside in highly specialized organs called bacteriomes (with bacterial symbionts) or mycetomes (with fungal symbionts). The organization of these organs varies between insect clades that are ancestrally associated with different microbes. As these symbioses evolve and additional microorganisms complement or replace the ancient associates, the organization of the symbiont-containing tissue becomes even more variable. Planthoppers (Hemiptera: Fulgoromorpha) are ancestrally associated with bacterial symbionts Sulcia and Vidania, but in many of the planthopper lineages, these symbionts are now accompanied or have been replaced by other heritable bacteria (e.g., Sodalis, Arsenophonus, Purcelliella) or fungi. We know the identity of many of these microbes, but the symbiont distribution within the host tissues and the bacteriome organization have not been systematically studied using modern microscopy techniques. Here, we combine light, fluorescence, and transmission electron microscopy with phylogenomic data to compare symbiont tissue distributions and the bacteriome organization across planthoppers representing 15 families. We identify and describe seven primary types of symbiont localization and seven types of the organization of the bacteriome. We show that Sulcia and Vidania, when present, usually occupy distinct bacteriomes distributed within the body cavity. The more recently acquired gammaproteobacterial and fungal symbionts generally occupy separate groups of cells organized into distinct bacteriomes or mycetomes, distinct from those with Sulcia and Vidania. They can also be localized in the cytoplasm of fat body cells. Alphaproteobacterial symbionts colonize a wider range of host body habitats: Asaia-like symbionts often colonize the host gut lumen, whereas Wolbachia and Rickettsia are usually scattered across insect tissues and cell types, including cells containing other symbionts, bacteriome sheath, fat body cells, gut epithelium, as well as hemolymph. However, there are exceptions, including Gammaproteobacteria that share bacteriome with Vidania, or Alphaproteobacteria that colonize Sulcia cells. We discuss how planthopper symbiont localization correlates with their acquisition and replacement patterns and the symbionts' likely functions. We also discuss the evolutionary consequences, constraints, and significance of these findings.

Division of labor within psyllids: metagenomics reveals an ancient dual endosymbiosis with metabolic complementarity in the genus Cacopsylla.

IMPORTANCE: Heritable beneficial bacterial endosymbionts have been crucial for the evolutionary success of numerous insects by enabling the exploitation of nutritionally limited food sources. Herein, we describe a previously unknown dual endosymbiosis in the psyllid genus Cacopsylla, consisting of the primary endosymbiont "Candidatus Carsonella ruddii" and a co-occurring Enterobacteriaceae bacterium for which we propose the name "Candidatus Psyllophila symbiotica." Its localization within the bacteriome and its small genome size confirm that Psyllophila is a co-primary endosymbiont widespread within the genus Cacopsylla. Despite its highly eroded genome, Psyllophila perfectly complements the tryptophan biosynthesis pathway that is incomplete in the co-occurring Carsonella. Moreover, the genome of Psyllophila is almost as small as Carsonella's, suggesting an ancient dual endosymbiosis that has now reached a precarious stage where any additional gene loss would make the system collapse. Hence, our results shed light on the dynamic interactions of psyllids and their endosymbionts over evolutionary time.

Genome Comparison Reveals Inversions and Alternative Evolutionary History of Nutritional Endosymbionts in Planthoppers (Hemiptera: Fulgoromorpha).

The evolutionary success of sap-feeding hemipteran insects in the suborder Auchenorrhyncha was enabled by nutritional contributions from their heritable endosymbiotic bacteria. However, the symbiont diversity, functions, and evolutionary origins in this large insect group have not been broadly characterized using genomic tools. In particular, the origins and relationships among ancient betaproteobacterial symbionts Vidania (in Fulgoromorpha) and Nasuia/Zinderia (in Cicadomorpha) are uncertain. Here, we characterized the genomes of Vidania and Sulcia from three Pyrops planthoppers (family Fulgoridae) to understand their metabolic functions and evolutionary histories. We find that, like in previously characterized planthoppers, these symbionts share nutritional responsibilities, with Vidania providing seven out of ten essential amino acids. Sulcia lineages across the Auchenorrhyncha have a highly conserved genome but with multiple independent rearrangements occurring in an early ancestor of Cicadomorpha or Fulgoromorpha and in a few succeeding lineages. Genomic synteny was also observed within each of the betaproteobacterial symbiont genera Nasuia, Zinderia, and Vidania, but not across them, which challenges the expectation of a shared ancestry for these symbionts. The further comparison of other biological traits strongly suggests an independent origin of Vidania early in the planthopper evolution and possibly of Nasuia and Zinderia in their respective host lineages. This hypothesis further links the potential acquisition of novel nutritional endosymbiont lineages with the emergence of auchenorrhynchan superfamilies.

Breastfeeding vs. Formula Feeding and Maternal Sexuality among Polish Women: A Preliminary Report.

Although postpartum sexual problems are common, there is a poor understanding of the underlying influencing factors and the impact of the infant feeding method on the mother's sexual life. A cross-sectional control study was conducted with a group of 253 women during their postpartum period. This study aimed to investigate the effects of different infant feeding methods on female sexual life after childbirth. The study followed the STROBE guidelines for cross-sectional control analysis. The study design included a questionnaire characterizing sociodemographic, obstetric and breastfeeding variables and the PL-FSFI (Female Sexual Function Index). The authors collected the data in compliance with the CAWI (Computer-Assisted Web Interview) research methodology-an interview conducted via an Internet channel. Each respondent received and completed the survey provided to them via the same online link. This study included women in the postpartum period: 170 breastfeeding women (study group) and 83 formula-feeding women (control group). There were statistically significant difference between the groups that practiced different types of breastfeeding. Out of all the PL-FSFI-assessing domains, the highest average score for the whole group correlated with satisfaction and the lowest score correlated with lubrication use. Our findings indicate that women practicing only breastfeeding are more likely to develop sexual problems. In order to maintain sexual health and promote long-term breastfeeding, extensive and professional counseling is needed for couples about postpartum sexuality and the factors that affect it, such as breastfeeding.

Safety and Feasibility of Radiation Therapy Combined with CDK 4/6 Inhibitors in the Management of Advanced Breast Cancer.

The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i combination with radiotherapy (RT) are conflicting. A retrospective evaluation of 288 advanced breast cancer patients (pts) treated with CDK4/6i was performed, and 100 pts also received RT. Forty-six pts received 63 RT courses concurrently and fifty-four sequentially before CDK4/6i initiation (76 RT courses). Neutropenia was common (79%) and more frequent during and after concurrent RT than sequential RT (86% vs. 76%); however, CDK4/6i dose reduction rates were similar. In patients treated with CDK4/6i alone, the dose reduction rate was 42% (79 pts) versus 38% with combined therapy, and 5% discontinued treatment due to toxicity in the combined group. The risk of CDK4/6i dose reduction was correlated with neutropenia grade, RT performed within the first two CDK4/6i cycles, and more than one concurrent RT; a tendency was observed in concurrent bone irradiation. However, on multivariate regression analysis, only ECOG 1 performance status and severe neutropenia at the beginning of the second cycle were found to be associated with a higher risk of CDK4/6i dose reduction. This largest single-center experience published to date confirmed the acceptable safety profile of the CDK4/6i and RT combination without a significantly increased toxicity compared with CDK4/6i alone. However, one might delay RT for the first two CDK4/6i cycles, when myelotoxic AE are most common.

A Cross-Sectional, Exploratory Study on the Impact of Night Shift Work on Midwives' Reproductive and Sexual Health.

BACKGROUND: Shift work is the basis for health care system functioning. The non-standard schedules enforce abrupt changes in the timing of sleep and light-dark exposure. It can contribute to the increased risk of various medical conditions, including reproductive and sexual health issues. The purpose of the study was to assess the impact of shift work with night shifts on midwives' reproductive and sexual health. METHODS: This cross-sectional, exploratory study included 520 midwives. A descriptive questionnaire was distributed in person (414) and online (106) from July 2019 to May 2020. We used the Female Sexual Function Index (PL-FSFI) standardized questionnaire and proprietary research tools (applicable to demographic and social data and reproductive health). All statistical calculations were performed with the IBM SPSS 23 statistical package. RESULTS: Shift work affects midwives' reproductive and sexual health. Midwives working night shifts are more likely to experience reproductive problems and sexual dysfunctions. The most pronounced differences are observed in the experience of infertility and the number of miscarriages. PL-FSFI results clearly showed the adverse impact of working shifts including night shifts on functioning in various dimensions of sexual health. CONCLUSION: Shift work negatively affects reproductive and sexual health and causes work-life conflict experience. It is necessary to develop procedures that minimize shift rotation and implement work schedules that allow for recuperation or rest and ensure proper family and social life.

Factors Associated with Vaginal/Cesarean Birth Attitudes among Medical Students.

BACKGROUND: Polish perinatal care is facing a high, ever-increasing cesarean section (CS) rate that is currently at 43%. Crucially, reports have revealed that the attitudes, experiences, and skills of clinicians directly contribute to this elevated CS rate. METHODS: This cross-sectional study, which included 748 Polish medical students, aimed to identify medical students' attitudes regarding birth methods. A descriptive questionnaire was distributed via the academic email addresses of surveyed medical students. Group comparisons were performed using Welch's t-test for continuous data or a Chi-squared test for categorical data. We also used the Mann-Whitney U test and Kruskal-Wallis H test. RESULTS: Midwifery students (96.2%) were the most unified group of students, with most agreeing that VB (vaginal birth) presents a safer option for women at low risk for VB-related complications vs. cesarean section. Of Medical Faculty students, 68% believed that fewer complications typically occur during vaginal birth than during CS. Students in their final vs. initial years of study furthermore considered VB more beneficial for women than CS. CONCLUSIONS: An important factor identified at the individual clinician level is the presence of leadership and executive support. For medical students, we can interpret this as support from their trainers and supervisors.

Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study.

BACKGROUND: Traditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the "Prevention of Hospital Infections by Intervention and Training" (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect. METHODS: We included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman's rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns. RESULTS: In total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18-0.97], and their median HH increase (ρ = 0.79 [0.08-0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance. CONCLUSIONS: Both the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs' overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.