Objectives: Studies have revealed that a relatively high incidence of severe infection and mortality in COVID-19 patients is attributed to healthcare-associated infections (HAIs). We implemented a study in 2 field hospitals dedicated to COVID-19 treatment in Da Nang, Vietnam (July–August 2020), and Ho Chi Minh City, Vietnam (August–October 2021), to identify pathogens, risk factors, and outcomes associated with HAIs. Methods: We applied a prospective study tool to estimate HAI incidence among 1,454 patients. HAIs are diagnosed and ascertained using surveillance criteria established by the US Centers for Disease Control and Prevention. All patients hospitalized for COVID-19 for at least 2 days were enrolled in this assessment of HAI risks, pathogens, and outcomes. Results: Among 1,454 sampled patients, 391 patients had 423 HAIs (27.1%). The highest proportion occurred in ICUs, with 422 HAI patients (34.1%). Pneumonia (n = 331, 78.3%) and bloodstream infections (n = 55, 13.1%) were the most common HAIs. Multidrug-resistant (MDR) bacteria, such as Klebsiella pneumonia (27.9%) and Acinetobacter baumannii (25.3%), were the most commonly isolated organisms. Ventilators and central venous catheters were independently associated with HAIs. Regarding the mortality rates, 55% of deaths occurred in intensive care units. Patients with HAIs (70.3%) were twice as likely to die compared to patients without HAIs (38.8%). HAIs leading to septic shock caused almost triple mortality (n = 58, 90.6%) compared with non-HAI patients (n = 412, 38.8%). HAIs prolonged hospital stay: 24.7 days for patients with HAIs and 19.1 days for patients without HAIs (P < .001). Conclusions: Patients with COVID-19–related critical illnesses are at high risk of HAIs from multidrug-resistant (MDR) bacteria. HAIs prolong hospitalization, whereas HAIs with septic shock almost tripled mortality. Guidelines and procedures to prevent and control HAIs caused by MDR bacteria as well as training and monitoring on aseptic-compliant techniques during invasive clinical procedures are needed.

Objectives: SARS-CoV-2 is a novel and highly infectious virus. An effective response requires rapid training of healthcare workers (HCWs). We measured the change in knowledge related to COVID-19 and associated factors before and after training of HCWs in Vietnam. Methods: A quasi-experimental design was used to evaluate HCW knowledge related to prevention and control of SARS-CoV-2 before and after attending a 2-day training-of-trainers course. Between June and September 2020, 963 HCWs from 194 hospitals in 21 provinces received the training. HCW knowledge was assessed using a 20-item questionnaire consisting of multiple-choice questions at the beginning and closing of the training course. A participant received 1 point for each correct answer. He or she was considered to have improved knowledge the posttest score was higher than the pretest score with a score ≥15 on the posttest. We applied the McNemar test and logistic regression model to test the level of association between demographic factors and change in knowledge of COVID-19. Results: Overall, 100% of HCWs completed both the pretest and posttest. At baseline, only 14.7% scored ≥15. Following the training, 78.4% scored ≥15 and 64.3% had improved knowledge according to the predetermined definition. Questions related to the order of PPE donning and doffing and respiratory specimen collection procedures were identified as having the greatest improvement (44.6% and 60.7%, respectively). Being female (OR, 1.5; 95% CI, 1.1–2.0), having a postgraduate degree (OR, 2.5; 95% CI, 1.4–4.4), working in a nonmanager position (OR, 1.5; 95% CI, 1.1–2.1), previous contact with a COVID-19 patient (OR, 1.5; 95% CI, 1.1–2.0), and working in northern Vietnam (OR, 2.0; 95% CI, 1.4–2.6), were associated with greater knowledge improvement. Conclusions: Most HCWs demonstrated improved knowledge of COVID-19 prevention and control after attending the training. Particular groups may benefit from additional training: those who are male, leaders and managers, those who hold an undergraduate degree, and those who work in the southern provinces.

We extend a result of Lieb [‘On the lowest eigenvalue of the Laplacian for the intersection of two domains’, Invent. Math. 74(3) (1983), 441–448] to the fractional setting. We prove that if A and B are two bounded domains in $\mathbb R^N$ and $\lambda _s(A)$, $\lambda _s(B)$ are the lowest eigenvalues of $(-\Delta )^s$, $0<s<1$, with Dirichlet boundary conditions, there exists some translation $B_x$ of B such that $\lambda _s(A\cap B_x)< \lambda _s(A)+\lambda _s(B)$. Moreover, without the boundedness assumption on A and B, we show that for any $\varepsilon>0$, there exists some translation $B_x$ of B such that $\lambda _s(A\cap B_x)< \lambda _s(A)+\lambda _s(B)+\varepsilon .$

Herein, we propose a convenient method to enable pretreatment of target objects using digital holographic microscopy (DHM). As a test sample, we used diatom frustules (Nitzschia sp.) as the target objects. In the generally used sample preparation method, the frustule suspension is added dropwise onto a glass substrate or into a glass chamber. While our work confirms good observation of purified frustules using the typical sample preparation method, we also demonstrate a new procedure to observe unseparated structures of frustules prepared by baking them on a mica surface. The baked frustules on the mica surface were transferred to a glass chamber with 1% sodium dodecyl sulfate solution. In this manner, the unseparated structures of the diatom frustules were clearly observed. Furthermore, metal-coated frustules prepared by sputtering onto them on a mica surface were also clearly observed using the same procedure. Our method can be applied for the observation of any target object that is pretreated on a solid surface. We expect our proposed method to be a basis for establishing DHM techniques for microscopic observations of biomaterials.

One of the three Critically Endangered and endemic primate species in Viet Nam, Delacour's langur Trachypithecus delacouri, is restricted to the north of the country. The largest remaining population is in Van Long Nature Reserve, Ninh Binh Province, and the second largest is in nearby Kim Bang Protection Forest, Ha Nam Province, with other populations believed to be too small for recovery. The population in Van Long has been well studied but the status of that of Kim Bang has not previously been adequately evaluated. To address this, a survey was conducted during 10 August–7 October 2018. In total, we recorded 13 groups comprising a total of at least 73 individuals, almost doubling the highest number reported in previous studies. We documented six new groups in Lien Son and Ba Sao communes in Kim Bang. Our findings indicate there is a high likelihood that Delacour's langur population in Kim Bang will recover and could be important for the long-term conservation of this Critically Endangered species. However, immediate and appropriate conservation measures need to be implemented to protect the population from major anthropogenic threats, namely poaching and habitat destruction, detected during our survey.

In this study, we investigate the intial value problem (IVP) for a time-fractional fourth-order equation with nonlinear source terms. More specifically, we consider the time-fractional biharmonic with exponential nonlinearity and the time-fractional Cahn–Hilliard equation. By using the Fourier transform concept, the generalized formula for the mild solution as well as the smoothing effects of resolvent operators are proved. For the IVP associated with the first one, by using the Orlicz space with the function $\Xi (z)={\textrm {e}}^{|z|^{p}}-1$ and some embeddings between it and the usual Lebesgue spaces, we prove that the solution is a global-in-time solution or it shall blow up in a finite time if the initial value is regular. In the case of singular initial data, the local-in-time/global-in-time existence and uniqueness are derived. Also, the regularity of the mild solution is investigated. For the IVP associated with the second one, some modifications to the generalized formula are made to deal with the nonlinear term. We also establish some important estimates for the derivatives of resolvent operators, they are the basis for using the Picard sequence to prove the local-in-time existence of the solution.

In hot environments, collagen, which is normally targeted when radiocarbon (14C) dating bone, rapidly degrades. With little other skeletal material suitable for 14C dating, it can be impossible to obtain dates directly on skeletal materials. A small amount of carbonate occurs in hydroxyapatite, the mineral phase of bone and tooth enamel, and has been used as an alternative to collagen. Unfortunately, the mineral phase is often heavily contaminated with exogenous carbonate causing 14C dates to underestimate the true age of a sample. Although tooth enamel, with its larger, more stable crystals and lower porosity, is likely to be more robust to diagenesis than bone, little work has been undertaken to investigate how exogenous carbonate can be effectively removed prior to 14C dating. Typically, acid is used to dissolve calcite and etch the surface of the enamel, but it is unclear which acid is most effective. This study repeats and extends earlier work using a wider range of samples and acids and chelating agents (hydrochloric, lactic, acetic and propionic acids, and EDTA). We find that weaker acids remove carbonate contaminants more effectively than stronger acids, and acetic acid is the most effective. However, accurate dates cannot always be obtained.

We study the fractional parabolic Lichnerowicz equation

$$ \begin{align*} v_t+(-\Delta)^s v=v^{-p-2}-v^p \quad\mbox{in } \mathbb R^N\times\mathbb R \end{align*} $$

$p>0$

$ 0<s<1 $

$p>1$

$0<p\leq 1$

$$ \begin{align*} (-\Delta)^s u=u^{-p-2}-u^p \quad\mbox{in }\mathbb R^N \end{align*} $$

$p>0$

$0<s<1$

Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.

Funding: None

Disclosures: None

In engineering applications, it is pretty often to have domain heat source involved inside. This article proposes an approach using the boundary element method to study thermal stresses in 3D anisotropic solids when internal domain heat source is involved. As has been well noticed, thermal effect will give rise to a volume integral, where its direct evaluation will need domain discretization. This shall definitely destroy the most distinctive notion of the boundary element method that only boundary discretization is required. The present work presents an analytical transformation of the volume integral in the boundary integral equation due to the presence of internal volume heat source. For simplicity, distribution of the heat source is modeled by a quadratic function. When needed, the formulations can be further extended to treat higher-ordered volume heat sources. Indeed, the present work has completely restored the boundary discretization feature of the boundary element method for treating 3D anisotropic thermoelasticity involving volume heat source.

This experimental study investigates the effect of a uniform lateral inflow on the aerodynamic characteristics of flapping wings. Seven designated sideward ratios in the hovering condition and in the presence of a contralateral wing and a body were taken into account as variables in order to secure a better understanding of wing–wing and/or wing–body interactions under the lateral inflow. Our results from the single-wing cases clarified that an inflow running from the wingroot strengthened the leading-edge vortex, thereby augmenting the aerodynamic force/moment. The inflow running in the opposite direction drastically bent the leading-edge vortex to the trailing edge, but the cycle-averaged aerodynamic force/moment was barely changed. This led to substantial imbalances in the force/moment on the two wings. The roll moment on a centre of gravity and the static margin suggested flight instability in the lateral direction, similar to previous studies. We found that the wing–wing interaction was not completely negligible overall under a lateral inflow. A massive downwash induced by the wing on the windward side nearly neutralized the aerodynamic force/moment augmentations on the other wing with lower effective angles of attack. The wing–wing interaction also gave rise to a low-lift high-drag situation during the pitching-up wing rotation, resulting in greater side force derivatives than the theory of flapping counterforce. Further calculations of the roll moment and the static margin with the centre of gravity showed that the wing–wing interaction can improve static stability in the lateral direction. This mainly stemmed from both the attenuation of the lift augmentation and the elimination of the positive roll moment of the flapping-wing system.

The Annamite mountains of Viet Nam and the Lao People's Democratic Republic (Lao) are an area of exceptional mammalian endemism but intensive poaching has defaunated much of the region, creating an extinction crisis for the endemic species. To make efficient use of limited conservation resources, it is imperative that conservation stakeholders obtain basic information about poorly known and threatened endemics. We present the first comprehensive information on the ecology, distribution and status of the little-known endemic Annamite striped rabbit Nesolagus timminsi. We used a systematic camera-trapping design to study the species in five areas in Viet Nam and Lao. In 29,180 camera-trap-nights we recorded 152 independent events at 36 of 266 stations. We obtained an additional 143 independent detections across 12 stations from a supplementary non-systematic survey. We analysed activity patterns and social behaviour. We also used single-species occupancy models to assess factors that influence occupancy at the landscape scale. We used N-mixture models to obtain local abundance estimates in one target area. The Annamite striped rabbit was found to be nocturnal and primarily solitary. Species occupancy was best explained by a proxy for past hunting pressure, with no significant relationships to current anthropogenic or environmental factors. Local abundance was 0.57 individuals per camera-trap station for one of our sites, and estimated to be zero at the other site where hunting appears to have been more intense. Our results provide information on priority areas for targeted anti-poaching efforts and give the first conservation baseline for the species.

Leptothrix discophora SP-6, a type of manganese(Mn)-oxidizing bacteria, has been known to accumulate Mn oxides from the aqueous environment and thus play a key role in microbiologically influenced corrosion by increasing the electrochemical potential of steel and other metals. Similarly, this bacterium was found to modify the surface of glassy carbon in aqueous solution and increase its potential (i.e. ennoblement). In the latter case, biomineralized Mn oxides can be used as cathodic reactants for a new generation of microbial fuel cells featuring a bio-cathode. In this preliminary study, factors affecting the biofilm formation and biomineralization processes were examined. The inflow of air into the culture medium was found essential to sustain the ennoblement of substrate electrodes. The OCP and FESEM/EDS data indicated that a smoother initial substrate surface generally led to better ennoblement. Polarizing the carbon electrode at +500mVSCE for 15 minutes was found to facilitate the ennoblement on carbon electrodes, and so did the coating with a poly(L-lysine) layer. Independent of substrate material, initial surface roughness and pretreatment, there were three parameters in the EIS equivalent circuit that correlated well with the OCP indicating the level of ennoblement by L. discophora SP-6, i.e., electrolyte resistance, double-layer capacitance, and low-frequencies capacitance. These fascinating findings merit further investigation as they may shed light on the fundamental bacteria/substrate interactions and help advance the knowledge base needed for the engineering applications.