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Determining the factors that impact the risk for infection with SARS-CoV-2 is a priority as the virus continues to infect people worldwide. The objective was to determine the effectiveness of vaccines and other factors associated with infection among Canadian healthcare workers (HCWs) followed from 15 June 2020 to 1 December 2023. We also investigate the association between antibodies to SARS-CoV-2 and subsequent infections with SARS-CoV-2. Of the 2474 eligible participants, 2133 (86%) were female, 33% were nurses, the median age was 41 years, and 99.3% had received at least two doses of COVID-19 vaccine by 31 December 2021. The incidence of SARS-CoV-2 was 0.91 per 1000 person-days. Prior to the circulation of the Omicron variants, vaccine effectiveness (VE) was estimated at 85% (95% CI 1, 98) for participants who received the primary series of vaccine. During the Omicron period, relative adjusted VE was 43% (95% CI 29, 54), 56% (95% CI 42, 67), and 46% (95% CI 24, 62) for 3, 4, and ≥ 5 doses compared with those who received primary series after adjusting for previous infection and other covariates. Exposure to infected household members, coworkers, or friends in the previous 14 days were risk factor for infection, while contact with an infected patient was not statistically significant. Participants with higher levels of immunoglobulin G (IgG) anti-receptor binding domain (RBD) antibodies had lower rates of infection than those with the lowest levels. COVID-19 vaccines remained effective throughout the follow-up of this cohort of highly vaccinated HCWs. IgG anti-RBD antibody levels may be useful as correlates of protection for issues such as vaccine development and testing. There remains a need to increase the awareness among HCWs about the risk of contracting SARS-CoV-2 from contacts at a variety of venues.
Over the last 25 years, radiowave detection of neutrino-generated signals, using cold polar ice as the neutrino target, has emerged as perhaps the most promising technique for detection of extragalactic ultra-high energy neutrinos (corresponding to neutrino energies in excess of 0.01 Joules, or 1017 electron volts). During the summer of 2021 and in tandem with the initial deployment of the Radio Neutrino Observatory in Greenland (RNO-G), we conducted radioglaciological measurements at Summit Station, Greenland to refine our understanding of the ice target. We report the result of one such measurement, the radio-frequency electric field attenuation length $L_\alpha$. We find an approximately linear dependence of $L_\alpha$ on frequency with the best fit of the average field attenuation for the upper 1500 m of ice: $\langle L_\alpha \rangle = ( ( 1154 \pm 121) - ( 0.81 \pm 0.14) \, ( \nu /{\rm MHz}) ) \,{\rm m}$ for frequencies ν ∈ [145 − 350] MHz.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Jurassic dykes of western Dronning Maud Land (Antarctica) form a minor component of the Karoo large igneous province. An extensive local dyke swarm intrudes Neoproterozoic gneisses and Jurassic syenite plutons on the margins of the Jutulstraumen palaeo rift in the Svedrupfjella region. The dykes were intruded in three distinct episodes (~204, ~176 and ~170 Ma). The 204 Ma dykes are overwhelminglylow-Ti, olivine tholeiites including some primitive (picritic) compositions (MgO >12 wt.%; Fe2O3 >12 wt.%; Cr >1000 ppm; Ni >600 ppm). This 204 Ma event precedes the main Karoo volcanic event by~25 Ma, so anycorrelations to the wider province are difficult to make. However, it mayrecord the earliest phase of rift activity along the Jutulstraumen. The 176 Ma dyke event is more intimately associated with the two syenite plutons. The dykes are alkaline (basanite/ tephrite) and were small-degree melts from an enriched, locallyderived source and underwent at least some degree of interaction with a syenitic contaminant. This ~176 Ma dyke event is widespread elsewhere in the Karoo (southern Africa and Dronning Maud Land). Later-stage (170 Ma) felsic (phonolite–comendite) dykes intrude the 176 Ma basanite–tephrite suite and represent the last phase of magmatic activityin the region.
To test the hypothesis that long-term care facility (LTCF) residents with Clostridium difficile infection (CDI) or asymptomatic carriage of toxigenic strains are an important source of transmission in the LTCF and in the hospital during acute-care admissions.
Design
A 6-month cohort study with identification of transmission events was conducted based on tracking of patient movement combined with restriction endonuclease analysis (REA) and whole-genome sequencing (WGS).
Setting
Veterans Affairs hospital and affiliated LTCF.
Participants
The study included 29 LTCF residents identified as asymptomatic carriers of toxigenic C. difficile based on every other week perirectal screening and 37 healthcare facility-associated CDI cases (ie, diagnosis >3 days after admission or within 4 weeks of discharge to the community), including 26 hospital-associated and 11 LTCF-associated cases.
Results
Of the 37 CDI cases, 7 (18·9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage, including 3 of 26 hospital-associated CDI cases (11·5%) and 4 of 11 LTCF-associated cases (36·4%). Of the 7 transmissions linked to LTCF residents, 5 (71·4%) were linked to asymptomatic carriers versus 2 (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains. No incident hospital-associated CDI cases were linked to other hospital-associated CDI cases.
Conclusions
Our findings suggest that LTCF residents with asymptomatic carriage of C. difficile or CDI contribute to transmission both in the LTCF and in the affiliated hospital during acute-care admissions. Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.
Terbacil tolerance was investigated in field-selected alfalfa strain ‘OK 182.’ Growth response studies indicated a 78% increase in tolerance over the unselected parental cultivar ‘Cimarron.’ Photosynthetic electron transport was inhibited similarly in both cultivars when isolated thylakoids were exposed to a wide range of terbacil concentration indicating that tolerance was not due to reduced sensitivity at the site-of-action. ‘OK 182’ took up an average of 22% less 14C-terbacil over the 6-d labeling period. A similar proportion of total radiolabel was translocated in both strains indicating that differential translocation was not a factor in the tolerance mechanism. Once in the leaves, terbacil was rapidly metabolized to a glucosidic conjugate by both strains. Terbacil and total concentration of metabolites in leaf tissues were 17% and 33% lower in ‘OK 182’ than in ‘Cimarron,’ respectively. Enhanced tolerance to terbacil in ‘OK 182’ was attributed to decreased terbacil uptake.
Numerical models used to simulate the lofting mechanisms of runway stones were developed to assess the threat to aircraft structures from runway debris impacts. An inflated aircraft tyre model, which was validated by comparison with experimental indentation tests, showed that over-rolling of stones under typical take-off conditions led to only modest vertical loft velocities of less than 5 m/s. Experiments using a drop weight impactor simulated a section of aircraft tyre descending upon stones. These tests demonstrated that lofting was achieved for impacts with low rubber thickness. However, for impacts with greater rubber thickness, lofting was suppressed. Using more realistic tyre geometries resulted in launches with backspin, but only horizontally along the ground in the direction of the tyre axis. The speed at which launches occurred was proportional to the rate of descent of the tyre section and would consequently determine the loft speeds due to potential asperity lofting.
Placebo responses raise significant challenges for the design of clinical trials. We report changes in agitation outcomes in the placebo arm of a recent trial of citalopram for agitation in Alzheimer's disease (CitAD).
Methods:
In the CitAD study, all participants and caregivers received a psychosocial intervention and 92 were assigned to placebo for nine weeks. Outcomes included Neurobehavioral Rating Scale agitation subscale (NBRS-A), modified AD Cooperative Study-Clinical Global Impression of Change (CGIC), Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (NPI A/A) and Total (NPI-Total) and ADLs. Continuous outcomes were analyzed with mixed-effects modeling and dichotomous outcomes with logistic regression.
Results:
Agitation outcomes improved over nine weeks: NBRS-A mean (SD) decreased from 7.8 (3.0) at baseline to 5.4 (3.2), CMAI from 28.7 (6.7) to 26.7 (7.4), NPI A/A from 8.0 (2.4) to 4.9 (3.8), and NPI-Total from 37.3 (17.7) to 28.4 (22.1). The proportion of CGI-C agitation responders ranged from 21 to 29% and was significantly different from zero. MMSE improved from 14.4 (6.9) to 15.7 (7.2) and ADLs similarly improved. Most of the improvement was observed by three weeks and was sustained through nine weeks. The major predictor of improvement in each agitation measure was a higher baseline score in that measure.
Conclusions:
We observed significant placebo response which may be due to regression to the mean, response to a psychosocial intervention, natural course of symptoms, or nonspecific benefits of participation in a trial.
Fisheries bycatch threatens populations of marine megafauna such as marine mammals, turtles, seabirds, sharks and rays, but fisheries impacts on non-target populations are often difficult to assess due to factors such as data limitation, poorly defined management objectives and lack of quantitative bycatch reduction targets. Limit reference points can be used to address these issues and thereby facilitate adoption and implementation of mitigation efforts. Reference points based on catch data and life history analysis can identify sustainability limits for bycatch with respect to defined population goals even when data are quite limited. This can expedite assessments for large numbers of species and enable prioritization of management actions based on mitigation urgency and efficacy. This paper reviews limit reference point estimators for marine megafauna bycatch, with the aim of highlighting their utility in fisheries management and promoting best practices for use. Different estimators share a common basic structure that can be flexibly applied to different contexts depending on species life history and available data types. Information on demographic vital rates and abundance is required; of these, abundance is the most data-dependent and thus most limiting factor for application. There are different approaches for handling management risk stemming from uncertainty in reference point and bycatch estimates. Risk tolerance can be incorporated explicitly into the reference point estimator itself, or probability distributions may be used to describe uncertainties in bycatch and reference point estimates, and risk tolerance may guide how those are factored into the management process. Either approach requires simulation-based performance testing such as management strategy evaluation to ensure that management objectives can be achieved. Factoring potential sources of bias into such evaluations is critical. This paper reviews the technical, operational, and political challenges to widespread application of reference points for management of marine megafauna bycatch, while emphasizing the importance of developing assessment frameworks that can facilitate sustainable fishing practices.
We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.
Setting.
A 160-bed VA LTCF.
Methods.
Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.
Results.
Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P = .008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001), and β lactam/β-lactamase inhibitor combinations (28%; P<.001). The rate of positive C. difficile tests at the LTCF declined in the postintervention period relative to preintervention rates (P = .04).
Conclusions.
Implementation of an LTCF ID service led to a significant reduction in total antimicrobial use. Bringing providers with ID expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.
The impact of antimicrobial scrubs on healthcare worker (HCW) bacterial burden is unknown.
Objective.
To determine die effectiveness of antimicrobial scrubs on hand and apparel bacterial burden.
Design.
Prospective, crossover trial.
Setting and Participants.
Thirty HCWs randomized to study versus control scrubs in an intensive care unit.
Methods.
Weekly microbiology samples were obtained from scrub abdominal area, cargo pocket, and hands. Mean log colony-forming unit (CFU) counts were calculated. Compliance with hand hygiene practices was measured. Apparel and hand mean log CFU counts were compared.
Results.
Adherence measures were 78% (910/1,173) for hand hygiene and 82% (223/273) for scrubs. Culture compliance was 67% (306/460). No differences were observed in bacterial hand burden or in HCWs with unique positive scrub cultures. No difference in vancomycin-resistant enterococci (VRE) and gram-negative rod (GNR) burden was observed. A difference in mean log mediicillin-resistant Staphylococcus aureus (MRSA) CFU count was found between study and control scrubs for leg cargo pocket (mean log CFUs, 11.84 control scrub vs 6.71 study scrub; P = .0002), abdominal area (mean log CFUs, 11.35 control scrub vs 7.54 study scrub; P = .0056), leg cargo pocket at die beginning of shift (mean log CFUs, 11.96 control scrub vs 4.87 study scrub; P = .0028), and abdominal area pocket at die end of shift (mean log CFUs, 12.14 control scrubs vs 8.22 study scrub; P = .0054).
Conclusions.
Study scrubs were associated witfi a 4–7 mean log reduction in MRSA burden but not VRE or GNRs. A prospective trial is needed to measure die impact of antimicrobial impregnated apparel on MRSA transmission rates.
In January 2009, the IAEA EMRAS II (Environmental Modelling for Radiation Safety II) program was launched. The goal of the program is to develop, compare and test models for the assessment of radiological impacts to the public and the environment due to radionuclides being released or already existing in the environment; to help countries build and harmonize their capabilities; and to model the movement of radionuclides in the environment. Within EMRAS II, nine working groups are active; this paper will focus on the activities of Working Group 1: Reference Methodologies for Controlling Discharges of Routine Releases. Within this working group environmental transfer and dose assessment models are tested under different scenarios by participating countries and the results compared. This process allows each participating country to identify characteristics of their models that need to be refined. The goal of this working group is to identify reference methodologies for the assessment of exposures to the public due to routine discharges of radionuclides to the terrestrial and aquatic environments. Several different models are being applied to estimate the transfer of radionuclides in the environment for various scenarios. The first phase of the project involves a scenario of nuclear power reactor with a coastal location which routinely (continuously) discharges 60Co, 85Kr, 131I, and 137Cs to the atmosphere and 60Co, 137Cs, and 90Sr to the marine environment. In this scenario many of the parameters and characteristics of the representative group were given to the modellers and cannot be altered. Various models have been used by the different participants in this inter-comparison (PC-CREAM, CROM, IMPACT, CLRP POSEIDON, SYMBIOSE and others). This first scenario is to enable a comparison of the radionuclide transport and dose modelling. These scenarios will facilitate the development of reference methodologies for controlled discharges.
Field-Assisted Simultaneous Synthesis and Transfer (FASST®) process offers a controllable and cost-effective method to produce Copper Indium Gallium Selenide (CIGS) films for high efficiency photovoltaic devices. In the first stage of the two-stage FASST® process two separate precursor films are formed, one deposited on the substrate and the other on a reusable printing plate. In the second stage, the precursors are brought into intimate contact and rapidly reacted under pressure in the presence of an applied electrostatic field, effectively creating a sealed micro-reactor that ensures high material utilization efficiency, direct control of reaction pressure, and low thermal budget. The unique ability to control both precursor films independently allows for composition and deposition technique optimization, eliminating pre-reaction prior to the synthesis of CIGS. This flexibility has proven immensely valuable as is demonstrated in the results of depositing the two-reactant films by various combinations of low-cost solution-based and conventional vacuum-based physical vapor deposition techniques, producing in several minutes' high quality “hybrid” CIGS with large grains on the order of several microns. Cell efficiencies as high as 12.2% have been achieved using the FASST® method.
Hospital-acquired Legionella pneumonia has a fatality rate of 28%, and the source is the water distribution system. Two prevention strategies have been advocated. One approach to prevention is clinical surveillance for disease without routine environmental monitoring. Another approach recommends environmental monitoring even in the absence of known cases of Legionella pneumonia. We determined the Legionella colonization status of water systems in hospitals to establish whether the results of environmental surveillance correlated with discovery of disease. None of these hospitals had previously experienced endemic hospital-acquired Legionella pneumonia.
Design.
Cohort study.
Setting.
Twenty US hospitals in 13 states.
Interventions.
Hospitals performed clinical and environmental surveillance for Legionella from 2000 through 2002. All specimens were shipped to the Special Pathogens Laboratory at the Veterans Affairs Pittsburgh Medical Center.
Results.
Legionella pneumophila and Legionella anisa were isolated from 14 (70%) of 20 hospital water systems. Of 676 environmental samples, 198 (29%) were positive for Legionella species. High-level colonization of the water system (30% or more of the distal outlets were positive for L. pneumophila) was demonstrated for 6 (43%) of the 14 hospitals with positive findings. L. pneumophila serogroup 1 was detected in 5 of these 6 hospitals, whereas 1 hospital was colonized with L. pneumophila serogroup 5. A total of 633 patients were evaluated for Legionella pneumonia from 12 (60%) of the 20 hospitals: 377 by urinary antigen testing and 577 by sputum culture. Hospital-acquired Legionella pneumonia was identified in 4 hospitals, all of which were hospitals withL. pneumophila serogroup 1 found in 30% or more of the distal outlets. No cases of disease due to other serogroups or species (L. anisa) were identified.
Conclusion.
Environmental monitoring followed by clinical surveillance was successful in uncovering previously unrecognized cases of hospital-acquired Legionella pneumonia.
We investigated knowledge, attitudes, and behaviors of prescribers concerning piperacillin-tazobactam use at 4 Emory University-affiliated hospitals. Discussions during focus groups indicated that the participants' perceived knowledge of clinical criteria for appropriate piperacillin-tazobactam use was inadequate. Retrospective review of medical records identified inappropriate practices. These findings have influenced ongoing interventions aimed at optimizing piperacillin-tazobactam use.