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Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acutely disturbed behaviour are managed.
Aims
To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder.
Method
Analysis of clinical audit data collected in 2024 by the Prescribing Observatory for Mental Health, as part of a quality improvement programme addressing the pharmacological management of acutely disturbed behaviour. Data were collected from clinical records using a bespoke proforma.
Results
Sixty-two mental health Trusts submitted data on 951 episodes of acutely disturbed behaviour involving patients with a personality disorder, with this being the sole psychiatric diagnosis in 471 (50%). Of the total, 782 (82%) episodes occurred in female patients. Compared with males, episodes in females were three times more likely to involve self-harming behaviour or be considered to pose such a risk (22% and 70% respectively: p < 0.001). Parenteral medication (rapid tranquillisation) was administered twice as often in episodes involving females than in males (64 and 34% respectively: p < 0.001).
Conclusions
Our findings suggest that there are a large number of episodes of acutely disturbed behaviour on psychiatric wards in women with a diagnosis of personality disorder. These episodes are characterised by self-harm and regularly prompt the administration of rapid tranquillisation. This has potential implications for service design, staff training, and research.
This paper investigates the association between potential serum biomarkers and diabetes status in older Australians by employing traditional and machine learning methods. Data from Sydney Memory and Ageing Study (MAS) were interrogated cross-sectionally in 801 participants aged 70–90 years (n = 801). Twenty-eight serum biomarkers and 6 other factors were investigated as potential indicators that may distinguish diabetes status. Diabetes status was categorised as No-Diabetes, Pre-diabetes, and Type 2 diabetes (T2D). Diabetes is defined as follows when using fasting plasma glucose: no diabetes/ normal: < 5.6 mmol/L; prediabetes: 5.6–6.9 mmol/L; and diabetes: ≥ 7 mmol/L(1). Variable selection was executed using two distinct regression methods (i) multinomial logistic regression with backward selection and (ii) machine learning using elasticNet regression. Multiple imputation was used to address missing data. Age and sex were included as a priori covariates in the multinomial regression model. Using a multinomial logistic regression, Malondialdehyde (MDA), Macrophage inhibiting cytokine 1 (MIC1), and vitamin E were associated with diabetes status. MDA was strongly associated with diabetes with relative risk ratio (RRR) of 4.78 (95% CI = 3.39, 6.75; p < 0.001) when comparing to no diabetes, surpassing usual markers insulin, triglycerides, and waist-to-hip (WHR). Diabetes was associated with lower vitamin E levels, compared to no diabetes, with an RRR of 0.54 (95% CI:0.38, 0.75; p < 0.001). Comparing diabetes to prediabetes, RRR for lower vitamin E levels was 0.71 (95% CI: 0.51, 0.98; p = 0.035). MIC1 distinguished between diabetes and prediabetes status (RRR: 1.84; 95% CI:1.41, 2.41; p < 0.001). Consistent with the traditional methods, machine learning also identified MDA as being associated with T2D, with an odds ratio (OR) of 1.9, followed hierarchically by insulin (OR = 1.23), WHR (OR = 1.22) and triglyceride (OR = 1.13). Higher serum Vitamin E were associated with a lower risk of being in diabetes category (OR = 0.84). MIC1, urate, IL1b, HDL, and carotene were identified by the machine learning model, but showed minimal association. These results suggest that the oxidative stress and inflammation markers distinguish the state of having T2D.
I.B.M. tabulating equipment can be of considerable help in reducing the time and increasing the accuracy of multiple factor analysis, even if used for only a part of the calculations. Once the plugboard is wired and those cards punched which are used over and over again, problems involving any number of variables can be handled with dispatch. The correlation matrix is listed, the totals verified, and the signs changed on the tabulator. Then the factors and the residual coefficients are calculated by means of a calculator. Tucker's procedure has been modified by using a calculator instead of a multiplying punch, by reducing the number of cards used, by simplifying checks on calculations, by simplifying plugboard wiring, and by preparing work sheets on tabulator paper. Extraction of factors from 24 variables at the rate of one in four hour's time seems to justify the use of the tabulating equipment on small problems.
Leader–member exchange (LMX), a well-researched leadership theory that focuses on the dyadic relationships between leaders and subordinates, is associated with positive subordinates’ outcomes. However, the contexts outside the LMX dyadic relationship might influence those favorable outcomes. In this study, we investigate the cross-level moderating effect of leader’s feelings of violation, as a contextual boundary, on LMX outcomes. Based on social exchange theory, crossover model, and the psychological contract literature, we discuss how the relationship between a subordinate’s perceived LMX and favorable subordinate attitudes and behaviors, such as performance, task-focused citizenship behaviors, and organizational commitment, is reduced when the leader experiences feelings of violation toward the organization. Using a three-wave time-lagged multilevel design with a sample of 226 subordinates and 39 leaders, we find that leader’s feelings of violation mitigate the positive association of perceived LMX on citizenship behavior and commitment but have no effect on performance. Research and practical implications are discussed.
Depression is an independent risk factor for cardiovascular disease (CVD), but it is unknown if successful depression treatment reduces CVD risk.
Methods
Using eIMPACT trial data, we examined the effect of modernized collaborative care for depression on indicators of CVD risk. A total of 216 primary care patients with depression and elevated CVD risk were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. CVD-relevant health behaviors (self-reported CVD prevention medication adherence, sedentary behavior, and sleep quality) and traditional CVD risk factors (blood pressure and lipid fractions) were assessed over 12 months. Incident CVD events were tracked over four years using a statewide health information exchange.
Results
The intervention group exhibited greater improvement in depressive symptoms (p < 0.01) and sleep quality (p < 0.01) than the usual care group, but there was no intervention effect on systolic blood pressure (p = 0.36), low-density lipoprotein cholesterol (p = 0.38), high-density lipoprotein cholesterol (p = 0.79), triglycerides (p = 0.76), CVD prevention medication adherence (p = 0.64), or sedentary behavior (p = 0.57). There was an intervention effect on diastolic blood pressure that favored the usual care group (p = 0.02). The likelihood of an incident CVD event did not differ between the intervention (13/107, 12.1%) and usual care (9/109, 8.3%) groups (p = 0.39).
Conclusions
Successful depression treatment alone is not sufficient to lower the heightened CVD risk of people with depression. Alternative approaches are needed.
We present radio observations of the galaxy cluster Abell S1136 at 888 MHz, using the Australian Square Kilometre Array Pathfinder radio telescope, as part of the Evolutionary Map of the Universe Early Science program. We compare these findings with data from the Murchison Widefield Array, XMM-Newton, the Wide-field Infrared Survey Explorer, the Digitised Sky Survey, and the Australia Telescope Compact Array. Our analysis shows the X-ray and radio emission in Abell S1136 are closely aligned and centered on the Brightest Cluster Galaxy, while the X-ray temperature profile shows a relaxed cluster with no evidence of a cool core. We find that the diffuse radio emission in the centre of the cluster shows more structure than seen in previous low-resolution observations of this source, which appeared formerly as an amorphous radio blob, similar in appearance to a radio halo; our observations show the diffuse emission in the Abell S1136 galaxy cluster contains three narrow filamentary structures visible at 888 MHz, between $\sim$80 and 140 kpc in length; however, the properties of the diffuse emission do not fully match that of a radio (mini-)halo or (fossil) tailed radio source.
Edited by
William J. Brady, University of Virginia,Mark R. Sochor, University of Virginia,Paul E. Pepe, Metropolitan EMS Medical Directors Global Alliance, Florida,John C. Maino II, Michigan International Speedway, Brooklyn,K. Sophia Dyer, Boston University Chobanian and Avedisian School of Medicine, Massachusetts
The involvement of dignitaries within mass gathering events can often impose several difficult levels of complexity, both during the planning phases and throughout the event itself. Whether the dignitaries are the reason for the mass gathering or they are on location as additional special attendees of the event, so-called “very important persons” (VIPs) such as celebrities, royalty, or major political figures can affect the planning and preparations for medical management contingencies as well as the operational aspects of such events [1–3]. Beyond the typical challenges of mass gathering medicine and protective security aspects, the concepts and practice of executive medicine, concierge medicine, or “protective medicine” pose unique and often unfamiliar and uncomfortable adaptations in terms of delivering medical advice and care. Medically, there is often limited access and reticence to expose the VIP to unfamiliar practitioners. Requests for medications or therapies in the absence of directly seeing the patient is more common. There is also an expectation that the medical care provider will come to see the VIP at the site and not at an off-site medical facility.
The swelling of an n-butylammonium vermiculite in solutions of n-butylammonium chloride has been studied by neutron diffraction as a function of temperature and the concentration of the soaking solution. On heating a swollen sample a transition to the crystalline phase took place at a well-defined temperature, the c-axis spacing changing from 120 to 19.4 Å at 14°C in a 0.1 M solution and from 330 to 19.4 Å at 33°C in a 0.01 M solution. The phase transition was completely reversible, and a study of the temperature-concentration phase diagram was made as high as 50°C The swollen phase was studied in a range of concentrations of the external solution between 0.2 M and 5 × 10-4 M, for which the c-axis spacings were 85 and 910 Å, respectively. The reversibility, sharpness, and reproducibility of the phase change from crystalline to swollen gel suggest that the transition is truly thermodynamic, which is not in accord with DLVO theory. The concentration dependence of the observed d-values also could not be explained satisfactorily by DLVO theory.
We present source detection and catalogue construction pipelines to build the first catalogue of radio galaxies from the 270 $\rm deg^2$ pilot survey of the Evolutionary Map of the Universe (EMU-PS) conducted with the Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The detection pipeline uses Gal-DINO computer vision networks (Gupta et al. 2024, PASA, 41, e001) to predict the categories of radio morphology and bounding boxes for radio sources, as well as their potential infrared host positions. The Gal-DINO network is trained and evaluated on approximately 5 000 visually inspected radio galaxies and their infrared hosts, encompassing both compact and extended radio morphologies. We find that the Intersection over Union (IoU) for the predicted and ground-truth bounding boxes is larger than 0.5 for 99% of the radio sources, and 98% of predicted host positions are within $3^{\prime \prime}$ of the ground-truth infrared host in the evaluation set. The catalogue construction pipeline uses the predictions of the trained network on the radio and infrared image cutouts based on the catalogue of radio components identified using the Selavy source finder algorithm. Confidence scores of the predictions are then used to prioritise Selavy components with higher scores and incorporate them first into the catalogue. This results in identifications for a total of 211 625 radio sources, with 201 211 classified as compact and unresolved. The remaining 10 414 are categorised as extended radio morphologies, including 582 FR-I, 5 602 FR-II, 1 494 FR-x (uncertain whether FR-I or FR-II), 2 375 R (single-peak resolved) radio galaxies, and 361 with peculiar and other rare morphologies. Each source in the catalogue includes a confidence score. We cross-match the radio sources in the catalogue with the infrared and optical catalogues, finding infrared cross-matches for 73% and photometric redshifts for 36% of the radio galaxies. The EMU-PS catalogue and the detection pipelines presented here will be used towards constructing catalogues for the main EMU survey covering the full southern sky.
The thermal effects, as well as the survivability and origins of microorganisms in Cretaceous rocks, are evaluated from the timing and extent of the smectite to illite transformation in Cretaceous bentonites collected from cores outside the thermal aureole of the Pliocene Cerro Negro volcanic neck. Overall, randomly ordered mixed-layered illite-smectite (I-S) is the predominant clay mineral in these bentonites, and the K-Ar ages of I-S range from 36 to 48 Ma (21 analyses, two additional analyses were outside this range). Increased temperature from burial is thought to be the primary factor forming I-S in these bentonites. Kinetic model calculations of the smectite to illite transformation are also consistent with I-S formed by burial without any appreciable thermal effects due to the emplacement of Cerro Negro. In a core angled toward Cerro Negro, the percentages of illite layers in I-S from the bentonite closest to Cerro Negro are slightly higher (32-37%) than in most other bentonites in this study. The K-Ar ages of the closest I-S are slightly younger as a group (38-43 Ma; Average = 41 Ma; N = 4) than those of I-S further from Cerro Negro in the same core (41-48 Ma; Average = 44 Ma; N = 6). A small amount of illite in this I-S may have formed by heat from the emplacement of Cerro Negro, but most illite formed from burial. Vitrinite reflectance, however, appears to record the effects of heating from Cerro Negro better than I-S. Tentatively, the temperature of this heat pulse, based on vitrinite data alone, ranged from 100 to 125°C and this is most evident in the CNAR core. The upper temperature, 125°C, approximates the sterilization temperatures for most microorganisms, and these temperatures probably reduced a significant portion of the microbial population. Thermophiles may have survived the increased temperatures from the combined effects of burial and the intrusion of Cerro Negro.
The hypothesis that chemical remanent magnetization (CRM) in argillaceous rocks may be due to release of Fe during smectite illitization has been tested by study of spatial and temporal relationships of CRM acquisition, smectite illitization, and organic-matter maturation to deformation in the Montana Disturbed Belt. New K-Ar ages and stacking order and percentages of illite layers in illite-smectite (I-S) are consistent with conclusions from previous studies that smectite illitization of bentonites in Subbelts I and II of the Disturbed Belt was produced by thrust-sheet burial resulting from the Laramide Orogeny. Internally concordant, early Paleogene, K-Ar age values (55–57 Ma) were obtained from clay subfractions of thick bentonites which were significantly different in terms of their ages (i.e. Jurassic Ellis Formation and late Cretaceous Marias River Shale), further supporting a model of smectite illitization as a result of the Laramide Orogeny. Internally concordant K-Ar ages were found also for clay sub-fractions from a thick bentonite at Pishkun Canal (54 Ma) and from an undeformed bentonite near Vaughn on the Sweetgrass Arch (48 Ma). In Subbelts I and II, a greater degree of smectite illitization corresponds to increased thermal maturation, increased natural remanent magnetization intensity, and increased deformation (dip of beds). A dissolution-precipitation model over a short duration is proposed for the formation of illite layers in Subbelts I and II. A characteristic remanent magnetization was developed before or just after folding began in the early Paleogene. More smectite-rich I-S, low thermal maturity, and the absence of a CRM were noted in one outcrop of an undeformed rock on the Sweetgrass Arch. Strontium isotope data allow for the possibility that internal or externally derived fluids may have influenced illitization, but the K-Ar age values suggest that illitization was probably in response to conductive heating after the overthrusting had occurred. The differences in K-Ar dates among the bentonites studied herein may be due to differences in the timing of peak temperature related to differences in distance below the overthrust slab, in rates of burial and exhumation, and in initial temperature.
Sorption and fixation of Cs by the upland soils of the US Department of Energy’s Savannah River Site (SRS) have been attributed to micaceous grains consisting mostly of hydroxy-interlayered vermiculite (HIV). Results of experiments to characterize SRS soil samples, to examine aspects of their radiocesium sorption, and to determine how much of their natural Cs is accessible for chemical extraction and isotope dilution are presented in support of mechanistic hypotheses to explain Cs sorption and fixation in HIV grains. The HIV is responsible for most of the soil cation exchange capacity, and concentrations of naturally occurring Cs, Rb, and K in soil samples are closely related to the concentration of HIV. Experiments with 137Cs to examine (1) sorption kinetics, (2) blocking of exchange sites with silver thiourea, and (3) susceptibility of sorbed 137Cs to chemical extraction, support the idea that added Cs is sorbed at different kinds of cation exchange sites in HIV grains. Sites highly selective for Cs but relatively few in number are inferred to exist in interlayer wedge zones within such grains. Little of the naturally occurring Cs in the soil samples was extractable by chemical agents that would remove Cs from ordinary cation-exchange sites and from within non-silicate soil components. Furthermore, most of the natural Cs was inaccessible for isotope dilution under slightly acidic conditions approximating the natural soil environment. These observations support the idea that most of the Cs in these soils has become effectively fixed in the narrower parts of interlayer wedge zones. Control of Cs uptake and fixation by highly Csselective interlayer wedge sites would account for the large distribution coefficients found for 137Cs at the low aqueous Cs concentrations typical of environmental systems and also for the relatively large concentrations of stable Cs in the SRS soils.
K-Ar measurements were used in this study of upland Savannah River Site soils to distinguish between sorbed K and the K remaining in remnants of primary minerals. Study of sorbed K contributes to understanding further the interaction of alkali metals (Cs in particular) with the soils. Primary mineral K and the associated radiogenic Ar were studied to characterize soil mica with respect to its provenance and its relationship to hydroxy-interlayered vermiculite. K-Ar age values of Na-saturated clay fractions from five samples of these soils range in age from 270 to 370 Ma. After a moderate acid treatment (6% HNO3 v/v, ~1 mol dm-3, 3 h, 80°C) of the clay fractions, K-Ar age values (270-325 Ma) were little changed on the whole, but they were more closely grouped near 300 Ma. Earlier work had shown that most of the K in these soils is found in material resistant to moderate acid extraction. The K-Ar age values show that this acid-resistant material is much older than any pedogenic minerals could be, even much older than the sedimentary parent rocks from which the soils were derived. These observations support earlier inferences by others that the K in these well leached soils is largely in remnants of primary muscovite from the parent sediments. Age values near 300 Ma suggest that the muscovite is largely from proximal Piedmont terranes of the Appalachian orogen, where the K-Ar relationship in most micas was set by Alleghanian tectonic processes late in the Paleozoic Era. The structural location of the K within mica, shown by the retention of the associated radiogenic Ar, is in contrast to the sorption-dominated behavior of the Cs and most of the Rb in these soils during pedogenesis. Stronger acid treatment (~6 mol dm-3 HNO3, 3 h, 100°C) extracted substantial fractions of both the K and the radiogenic Ar from bulk-soil portions, indicating destruction of some of the primary mica. K-Ar age values for the sand-rich bulk soils were not useful for this study because the sand contains excess radiogenic Ar, probably in sand-sized vein quartz.
Physical activity and social interaction among rural older adults are important, particularly during the COVID-19 pandemic when restrictions on physical gatherings were placed. The purpose of this qualitative study was to gain a deeper understanding of rural older adults’ experience with physical activity and social interaction during the COVID-19 pandemic. An interpretative phenomenological approach was used to explore the experience of 10 older adults, 67–82 years of age, from rural communities throughout Saskatchewan. Findings revealed that many rural older adults acknowledged the health benefits of physical and social activities and experienced loneliness when COVID-19 restrictions were placed, even when living with a partner. For some, the restrictions placed on physical and social activity provided a welcome break from daily responsibilities. Rural communities, often at a disadvantage, were also perceived by participants as being protected against COVID-19. The resilience demonstrated among rural participants to persevere and adapt to their changing environment during the pandemic was evident in the findings.
To increase inclusivity, diversity, equity and accessibility in Antarctic science, we must build more positive and inclusive Antarctic field work environments. The International Thwaites Glacier Collaboration (ITGC) has engaged in efforts to contribute to that goal through a variety of activities since 2018, including creating an open-access ‘Field and Ship Best Practices’ guide, engaging in pre-field season team dynamics meetings, and surveying post-field season reflections and experiences. We report specific actions taken by ITGC and their outcomes. We found that strong and supported early career researchers brought new and important perspectives regarding strategies for transforming culture. We discovered that engaged and involved senior leadership was also critical for expanding participation and securing funding to support efforts. Pre-field discussions involving all field team members were particularly helpful for setting expectations, improving sense of belonging, describing field work best practices, and co-creating a positive work culture.
The United Nations (UN) established an umbrella of organizations to manage distinct clusters of humanitarian aid. The World Health Organization (WHO) oversees the health cluster, giving it responsibility for global, national, and local medical responses to natural disasters. However, this centralized structure insufficiently engages local players, impeding robust local implementation. The Gorkha earthquake struck Nepal on April 25, 2015, becoming Nepal’s most severe natural disaster since the 1934 Nepal-Bihar earthquake. In coordinated response, 2 organizations, Empower Nepali Girls and International Neurosurgical Children’s Association, used a hybrid approach integrating continuous communication with local recipients. Each organization mobilized its principal resource strengths—material medical supplies or human capital—thereby efficiently deploying resources to maximize the impact of the medical response. In addition to efficient resource use, this approach facilitates dynamic medical responses from highly mobile organizations. Importantly, in addition to future earthquakes in Nepal, this medical response strategy is easily scalable to other natural disaster contexts and other medical relief organizations. Preemptively identifying partner organizations with complementary strengths, continuous engagement with recipient populations, and creating disaster- and region-specific response teams may represent viable variations of the WHO cluster model with greater efficacy in local implementation of treatment in acute disaster scenarios.
Some human settlements endure for millennia, while others are founded and abandoned within a few decades or centuries. The reasons for variation in the duration of site occupation, however, are rarely addressed. Here, the authors introduce a new approach for the analysis of settlement longevity or persistence. Using seven regional case studies comprising both survey and excavation data, they demonstrate how the median persistence of individual settlements varies widely within and among regions. In turn, this variability is linked to the effects of environmental potential. In seeking to identify the drivers of settlement persistence in the past, it is suggested that archaeologists can contribute to understanding of the sustainability and resilience of contemporary cities.
Scholarship on “stealth democracy” finds that many citizens want to avoid the debate and conflict that often come with democratic governance. This scholarship has argued that citizens adopt this posture because they are uncomfortable with disagreement and desire a more expedient political process that enables leaders to make decisions without discussion or compromise. We revisit this argument in light of recent political developments that suggest another reason why citizens may desire a more expedient political process. We examine the possibility that some citizens are not merely uncomfortable with disagreement but also want leaders who will aggressively protect them and champion their interests. Using a nationally representative survey, we ask citizens about their preferences for stealth democracy. We also ask questions that tap into their willingness to support leaders who would “bend the rules for supporters” and take aggressive action against political opponents. We find that a substantial component of the electorate continues to prefer a stealth version of democracy. However, we also find that many “stealth democrats” are willing to support leadership practices that would threaten or even undermine democratic norms. We argue that this evidence indicates that, in recent years, many citizens who appear to desire “stealth democracy” pose a threat to democracy itself.
We aimed to demonstrate the role of real-time, on-site, whole-genome sequencing (WGS) of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the management of hospital outbreaks of coronavirus disease 2019 (COVID-19).
Design:
This retrospective study was undertaken at our institutions in Sydney, New South Wales, Australia, between July 2021 and April 2022. We included SARS-CoV-2 outbreaks due to SARS-CoV-2 δ (delta) and ο (omicron) variants. All unexpected SARS-CoV-2–positive cases identified within the hospital were managed by the infection control team. An outbreak was defined as 2 or more cases acquired on a single ward. We included only outbreaks with 2 or more suspected transmission events in which WGS was utilized to assist with outbreak assessment and management.
Results:
We studied 8 outbreaks involving 266 patients and 486 staff, of whom 73 (27.4%) and 39 (8.0%), respectively, tested positive for SARS-CoV-2 during the outbreak management. WGS was used to evaluate the source of the outbreak, to establish transmission chains, to highlight deficiencies in infection control practices, and to delineate between community and healthcare acquired infection.
Conclusions:
Real-time, on-site WGS combined with epidemiologic assessment is a useful tool to guide management of hospital SARS-CoV-2 outbreaks. WGS allowed us (1) to establish likely transmission events due to personal protective equipment (PPE) breaches; (2) to detect inadequacies in infection control infrastructure including ventilation; and (3) to confirm multiple viral introductions during periods of high community SARS-CoV-2 transmission. Insights gained from WGS-guides outbreak management directly influenced policy including modifying PPE requirements, instituting routine inpatient SARS-CoV-2 surveillance, and confirmatory SARS-CoV-2 testing prior to placing patients in a cohort setting.