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A daily prompt to offer vaccination to inpatients awaiting transfer to rehabilitation resulted in increased SARS-CoV-2 (OR 5.64, 95% CI 3.3–10.15; P < 0.001) and influenza (OR 3.80, 95% CI 2.45–6.06; P < 0.001) vaccination. Compared to baseline, this intervention was associated with reduced incidence of viral respiratory infection during subsequent admission to rehabilitation.
To implement and evaluate a point-of-care (POC) molecular testing platform for respiratory viruses in congregate living settings (CLS).
Design:
Prospective quality improvement study.
Setting:
Seven CLS, including three nursing homes and four independent-living facilities.
Participants:
Residents of CLS.
Methods:
A POC platform for COVID-19, influenza A and B, and respiratory syncytial virus was implemented at participating CLS from December 1, 2022 to April 15, 2023. Residents with respiratory symptoms underwent paired testing, with respiratory specimens tested first with the POC platform and then delivered to an off-site laboratory for multiplex respiratory virus panel (MRVP) polymerase chain reaction (PCR) as per standard protocol. Turn-around time and diagnostic accuracy of the POC platform were compared against MRVP PCR. In an exploratory analysis, time to outbreak declaration among participating CLS was compared against a convenience sample of 19 CLS that did not use the POC platform.
Results:
A total of 290 specimens that underwent paired testing were included. Turn-around time to result was significantly shorter with the POC platform compared to MRVP PCR, with median difference of 36.2 hours (interquartile range 21.8–46.4 hours). The POC platform had excellent diagnostic accuracy compared to MRVP PCR, with area under the curve statistic of .96. Time to outbreak declaration was shorter in CLS that used the POC platform compared to CLS that did not.
Conclusion:
Rapid POC testing platforms for respiratory viruses can be implemented in CLS, with high diagnostic accuracy, expedited turn-around times, and shorter time to outbreak declaration.
Older adults residing in congregate living settings (CLS) such as nursing homes and independent living facilities remain at increased risk of morbidity and mortality from coronavirus disease 2019. We performed a prospective multicenter study of consecutive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposures to identify predictors of transmission in this setting.
Methods:
Consecutive resident SARS-CoV-2 exposures across 17 CLS were prospectively characterized from 1 September 2022 to 1 March 2023, including factors related to environment, source, and exposed resident. Room size, humidity, and ventilation were measured in locations where exposures occurred. Predictors were incorporated in a generalized estimating equation model adjusting for the correlation within CLS.
Results:
Among 670 consecutive exposures to SARS-CoV-2 across 17 CLS, transmission occurred among 328 (49.0%). Increased risk was associated with nursing homes (odds ratio (OR) = 90.8; 95% CI, 7.8–1047.4), Jack and Jill rooms (OR = 2.2; 95% CI, 1.3–3.6), from source who was pre-symptomatic (OR = 11.2; 95% CI, 4.1–30.9), symptomatic (OR = 6.5; 95% CI, 1.4–29.9), or rapid antigen test positive (OR = 35.6; 95% CI, 5.6–225.6), and in the presence of secondary exposure (OR = 6.3; 95% CI, 1.6–24.0). Exposure in dining room was associated with reduced risk (OR = 0.02; 95% CI, 0.005–0.08) as was medium room size (OR = 0.3; 95% CI, 0.2–0.6). Recent vaccination of exposed resident (OR = 0.5; 95% CI, 0.3–1.0) and increased ventilation of room (OR = 0.9; 95% CI, 0.8–1.0) were marginally associated with reduced risk.
Conclusion:
Prospective assessment of SARS-CoV-2 exposures in CLS suggests that source characteristics and location of exposure are most predictive of resident transmission. These findings can inform risk assessment and further opportunities to prevent transmission in CLS.
We conducted a tabletop exercise on influenza outbreak preparedness that engaged a large group of congregate living settings (CLS), with improvements in self-reported knowledge and readiness. This proactive approach to responding to communicable disease threats has potential to build infection prevention and control capacity beyond COVID-19 in the CLS sector.
The ethical implications of infection prevention and control (IPAC) are recognized, yet a framework to guide the application of ethical principles is lacking. We adapted an ethical framework to provide a systematic approach for fair and transparent IPAC decision making.
Methods:
We conducted a literature search for existing ethical frameworks in IPAC. Working with practicing healthcare ethicists, an existing ethical framework was adapted for use in IPAC. Indications were developed for application to practice, with integration of ethical principles and process conditions specifically relevant to IPAC. Practical refinements were made to the framework based on end-user feedback and application to 2 real-world situations.
Results:
In total, 7 articles were identified that discussed ethical principles within IPAC, but none proposed a systematic framework to guide ethical decision making. The adapted framework, named the Ethical Infection Prevention and Control (EIPAC) framework, takes the user through 4 intuitive and actionable steps, centering key ethical principles that facilitate reasoned and just decision making. In applying the EIPAC framework to practice, weighing the predefined ethical principles in different scenarios was a challenge. Although no hierarchy of principles can apply to all contexts in IPAC, our experience highlighted that the equitable distribution of benefits and burdens, and the proportional impacts of options under review, are particularly important considerations for IPAC.
Conclusions:
The EIPAC framework can serve as an actionable ethical principles-based decision-making tool for use by IPAC professionals encountering complex situations in any healthcare context.
In this prospective study, universal admission testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) averted transmission in shared patient rooms especially since the emergence of the SARS-CoV-2 omicron variant when the yield in identifying infectious asymptomatic cases more than doubled. This change may be due to the higher rate of asymptomatic infection with the omicron variant, the broader community prevalence during the omicron era, or both.
This study aimed to evaluate the effectiveness of tai chi on balance in patients with improved but persistent dizziness and imbalance following completion of traditional vestibular rehabilitation therapy.
Method
Patients who completed vestibular rehabilitation therapy with persistent imbalance were prospectively enrolled in a tai chi programme comprising eight weekly classes. Balance was assessed before the first and after the eighth session using the Dynamic Gait Index, Activities-Specific Balance Confidence scale and Dizziness Handicap Inventory.
Results
A total of 37 participants (34 females, 3 males) completed the programme with balance testing. Mean age was 76.8 years (range, 56–91 years). Mean Dynamic Gait Index significantly increased after completion of tai chi (p < 0.00001). Mean Activities-Specific Balance Confidence scale score increased from 63.6 to 67.9 per cent (p = 0.046). A subset (n = 18) of patients completed a Dizziness Handicap Inventory without significant post-therapeutic change (p = 0.62). Most (36 of 37; 97.3 per cent) patients demonstrated post-therapy improvement on one or more assessments.
Conclusion
Tai chi is a viable adjunct to improve balance in patients who complete a vestibular rehabilitation therapy programme.
Background: Canadian Stroke Best Practice Recommendations recommend both cardiac monitoring and transthoracic echocardiography (TTE) to assess for cardioembolic sources of stroke. TTE has a diagnostic yield, which is historically low at 5-10%. The goal of this project was to evaluate the practicality of a bedside, focused approach to TTE in ischemic stroke. Methods: A cross-sectional study evaluating patients undergoing echocardiography for evidence of possible cardioembolic stroke was developed. It compared the standard and focused TTE imaging approaches. Of the 61 patients reported, data is currently available for 15 participants. Independent samples t-test were performed to compare measurements. Results: Mean time to finish image acquisition for the focused, bedside TTE was significantly shorter than the complete TTE (12 min or less vs 30 min or more) (p<0.0001). No cardiac sources of stroke were found by either mechanism in this cohort, representing 100% agreement between the two modalities. Conclusions: Focused, bedside echocardiography studies are quicker to execute and employ more affordable, portable, digital TTE devices. The test is done at bedside, reducing the need for patient transport. Image acquisition takes approximately half the time to obtain, potentially allowing for more rapid clinical decision making and facilitation of discharge from hospital.
Root-lesion nematodes (Pratylenchus spp.) are a group of economically important pathogens that have caused serious economic losses in many crops. In 2019, root-lesion nematodes were recovered from tomato (Solanum lycopersicum) root samples collected from Sichuan Province, People's Republic of China (PRC). Extracted nematodes were disinfected, and one individual female was cultured on a carrot disc for propagation at 25 °C by parthenogenesis and designated the SC isolate. Afterwards, the isolate was identified on the basis of morphometric and molecular markers. Both morphometric characters and molecular analysis of the internal transcribed spacer region gene (ITS) of ribosomal DNA, the D2-D3 expansion region of the 28S rDNA gene and the mitochondrial cytochrome oxidase I (mtDNA-COI) gene revealed that the species of root-lesion nematode was Pratylenchus scribneri. The Bayesian tree inferred from the ITS rDNA, 28S rDNA and mtDNA-COI gene sequences also showed that this isolate formed a highly supported clade with other P. scribneri isolates. The pathogenicity of the root-lesion nematode SC isolate on tomato was assessed, showing that tomato was a suitable host for P. scribneri. To the best of our knowledge, this is the first report of P. scribneri on tomato in Sichuan Province, PRC. These are also the first molecular data obtained from P. scribneri on tomato in the PRC, and the pathogenicity of P. scribneri to tomato was studied for the first time. This study provides scientific data for the detection, identification and control of tomato root-lesion nematode disease.
Background: Canadian Stroke Best Practice Recommendations recommend both cardiac monitoring and transthoracic echocardiography (TTE) to assess for cardioembolic sources of stroke. TTE has a diagnostic yield which is historically low at 5-10%. The goal of this project was to evaluate the practicality of a bedside, focused approach to TTE in ischemic stroke. Methods: This is a cross-sectional study evaluating patients undergoing echocardiography for evidence of possible cardioembolic stroke. It compared the standard and focused TTE imaging approaches. Of the 61 patients reported, data is currently available for 15 participants. Independent samples t-test were performed to compare measurements. Results: Mean time to finish image acquisition for the focused TTE was significantly shorter than the complete TTE (12 min or less vs 30 min or more) (p<0.0001). No cardiac sources of stroke were found by either mechanism in this cohort, representing 100% agreement between the two modalities. Conclusions: Focused echocardiography studies are quicker to execute and employ more affordable, portable, digital TTE devices. The test is done at bedside, reducing the need for patient transport. Image acquisition takes approximately half the time to obtain. This potentially allows for more rapid clinical decision making and can facilitate discharge from the hospital.
Masturbation is a common sexual practice in men, and saliva is often used as a lubricant during masturbation by men who have sex with men. However, the role of saliva use during masturbation in the transmission of chlamydia is still unclear. We developed population-level, susceptible-infected-susceptible compartmental models to explore the role of saliva use during masturbation on the transmission of chlamydia at multiple anatomical sites. In this study, we simulated both solo masturbation and mutual masturbation. Our baseline model did not include masturbation but included transmission routes (anal sex, oral-penile sex, rimming, kissing and sequential sexual practices) we have previously validated (model 1). We added masturbation to model 1 to develop the second model (model 2). We calibrated the model to five clinical datasets separately to assess the effects of masturbation on the prevalence of site-specific infection. The inclusion of masturbation (model 2) significantly worsened the ability of the models to replicate the prevalence of C. trachomatis. Using model 2 and the five data sets, we estimated that saliva use during masturbation was responsible for between 3.9% [95% confidence interval (CI) 2.0–6.8] and 6.2% (95% CI 3.8–10.5) of incident chlamydia cases at all sites. Our models suggest that saliva use during masturbation is unlikely to play a major role in chlamydia transmission between men, and even if it does have a role, about one in seven cases of urethral chlamydia might arise from masturbation.
In order to elucidate the physical connection between the propulsive performance and the unsteadiness of jet flow, the transient development of the impulse and thrust of laminar starting jets with finite fluid discharged is investigated numerically for cases with different velocity programmes and jet stroke ratios. The simulation quantitatively demonstrates that the impulse and thrust generated are highly sensitive to the jet kinematics and its near-wake dynamics. The momentum flux contribution to the jet impulse is found to be significant and is associated closely with the jet kinematics. On the other hand, although the over pressure effect at the jet initiation stage has been identified previously as the main reason for the enhanced propulsive performance of the starting jet, the current results indicate that its contribution is in fact weakened by the negative local pressure, induced by the formation of the leading vortex ring as well as jet development during the deceleration stage. Contrary to the effects of the leading vortex ring, the stopping vortex formed near the nozzle exit plane during the jet deceleration stage is found to contribute positively to the pressure impulse production, albeit it is relatively small. By augmenting the over pressure effect and mitigating the negative-pressure effect, the cases with the fast acceleration and slow deceleration velocity programme is capable of producing the maximum pressure impulse, leading to additional impulse production over what would be expected from the jet momentum flux alone.
Based on an accurate numerical solution of the kinetic equation using well-resolved spatial and velocity grids, the separation of rarefied gas flow in a microchannel with double rectangular bends is investigated over a wide range of Knudsen and Reynolds numbers. Rarefaction effects are found to play different roles in flow separation (vortex formation) at the concave and convex corners. Flow separations near the concave and convex corners are only observed for a Knudsen number up to $0.04$ and $0.01$, respectively. With further increase of the Knudsen number, flow separation disappears. Due to the velocity slip at the solid walls, the concave (convex) vortex is suppressed (enhanced), which leads to the late (early) onset of separation of rarefied gas flows with respect to the Reynolds number. The critical Reynolds numbers for the emergence of concave and convex vortices are found to be as low as $0.32\times 10^{-3}$ and $30.8$, respectively. The slip velocity near the concave (convex) corner is found to increase (decrease) when the Knudsen number increases. An adverse pressure gradient appears near the concave corner for all the examined Knudsen numbers, while for the convex corner it only occurs when the Knudsen number is less than $0.1$. Due to the secondary flow and adverse pressure gradient near the rectangular bends, the mass flow rate ratio between the bent and straight channels of the same length is a non-monotonic function of the Knudsen number. Our results clarify the diversified and often contradictory observations reported in the literature about flow rate enhancement and vortex formation in bent microchannels.
The accuracy of sea-ice motion products provided by the National Snow and Ice Data Center (NSIDC) and the Ocean and Sea Ice Satellite Application Facility (OSI-SAF) was validated with data collected by ice drifters that were deployed in the western Arctic Ocean in 2014 and 2016. Data from both NSIDC and OSI-SAF products exhibited statistically significant (p < 0.001) correlation with drifter data. The OSI-SAF product tended to overestimate ice speed, while underestimation was demonstrated for the NSIDC product, especially for the melt season and the marginal ice zone. Monthly Lagrangian trajectories of ice floes were reconstructed using the products. Larger spatial variability in the deviation between NSIDC and drifter trajectories was observed than that of OSI-SAF, and seasonal variability in the deviation for NSIDC was observed. Furthermore, trajectories reconstructed using the NSIDC product were sensitive to variations in sea-ice concentration. The feasibility of using remote-sensing products to characterize sea-ice deformation was assessed by evaluating the distance between two arbitrary positions as estimated by the products. Compared with the OSI-SAF product, relative errors are lower (<11.6%), and spatial-temporal resolutions are higher in the NSIDC product, which makes it more suitable for estimating sea-ice deformation.
Hip joint arthroplasty is considered to be a safe, successful and cost-effective procedure to restore hip joint functionality. However, a successful hip joint arthroplasty affects different stakeholders e.g. patient and surgeon and depends on various influencing factors within the product life cycle as well as the applied technological opportunities. Due to the complex dependencies between influencing factors, technological opportunities and stakeholders, this contribution introduces an IPD-based approach to improve the quality of total hip arthroplasties.
Copy number variations (CNVs), as an important source of genetic variation, can affect a wide range of phenotypes by diverse mechanisms. The somatostatin receptor 2 (SSTR2) gene plays important roles in cell proliferation and apoptosis. Recently, this gene was mapped to a CNV region, which encompasses quantitative trait loci of cattle economic traits including body weight, marbling score, etc. Therefore, SSTR2 CNV may exhibit phenotypic effects on cattle growth traits. In the current study, distribution of SSTR2 gene CNVs was investigated in six Chinese cattle breeds (XN, QC, NY, JA, LX and PN), and the results showed higher CNV polymorphisms in XN, QC and NY cattle. Next, association analysis between growth traits and SSTR2 CNV was performed for XN, QC and NY cattle. In NY, individuals with fewer copies showed better performance than those with more copies. Further, the effects of SSTR2 CNV on the SSTR2 mRNA level were also investigated, but revealed no significant correlation in either muscle or adipose tissue of adult NY cattle. The results suggested the potential for use of SSTR2 CNV as a marker for the molecular breeding of NY cattle.
Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.
Thermal imaging diagnostics was used as a surface temperature mapping tool to characterize the energy density distribution of a high-intensity pulsed ion beam. This approach was tested on the TEMP-6 accelerator (200–250 kV, 150 ns). The beam composition included carbon ions (85%) and protons, and the energy density in the focus was 5–12 J/cm2. Targets of stainless steel, titanium, brass, copper, and tungsten were examined. Our observations show that the maximum energy density measured with the thermal imaging diagnostics considerably exceeds the ablation threshold of the targets. An analysis of the overheating mechanisms of each target was carried out, including metastable overheating of the target to above its boiling temperature during rapid heating; formation, migration, and the subsequent annealing of fast radiation-induced defects in the target under ion beam irradiation. This expands the range of energy density measurement for this thermal imaging diagnostics from 2–3 J/cm2 up to 10–12 J/cm2 but introduces error into the results of measurement. For a stainless steel target, this error exceeds 15% at an energy density of more than 4 J/cm2. A method of correcting the results of the thermal imaging diagnostics is developed for a pulsed ion beam under conditions of intense ablation of the target material.
The oriental armyworm, Mythimna separata is an important crop pest in eastern Asia. Nocturnal insects, including nocturnal moths, have phototactic behavior to an artificial light source. Phototactic behavior in insects is species-specific in response to different wavelengths of light sources. Our previous study showed that green (520 nm) light emitting diode (LED) light resulted in a significantly higher phototactic behavior in M. separata moths compared to the other wavelength LED lights. The goal of the present study is to investigate the influence of green light illumination on biological characteristics of different developmental stages in M. separata. Our results revealed that when different developmental stages of M. separata were exposed to the green light illumination in a dark period, several biological characteristics in all developmental stages except for egg stage were positively changed, but those of F1 generation M. separata which are next generation of the adults exposed to the green light did not significantly change compared with the control level. These findings suggest that green light illumination at night (or dark period) has a positive effect on the development and longevity of M. separata.