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Prior reports of healthcare-associated respiratory syncytial virus (RSV) have been limited to cases diagnosed after the third day of hospitalization. The omission of other healthcare settings where RSV transmission may occur underestimates the true incidence of healthcare-associated RSV.
Design:
Retrospective cross-sectional study.
Setting:
United States RSV Hospitalization Surveillance Network (RSV-NET) during 2016–2017 through 2018–2019 seasons.
Patients:
Laboratory-confirmed RSV-related hospitalizations in an eight-county catchment area in Tennessee.
Methods:
Surveillance data from RSV-NET were used to evaluate the population-level burden of healthcare-associated RSV. The incidence of healthcare-associated RSV was determined using the traditional definition (i.e., positive RSV test after hospital day 3) in addition to often under-recognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a non-RSV illness in the preceding 7 days.
Results:
Among the 900 laboratory-confirmed RSV-related hospitalizations, 41 (4.6%) had traditionally defined healthcare-associated RSV. Including patients with a positive RSV test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a non-RSV illness in the preceding 7 days identified an additional 95 cases (10.6% of all RSV-related hospitalizations).
Conclusions:
RSV is an often under-recognized healthcare-associated infection. Capturing other healthcare exposures that may serve as the initial site of viral transmission may provide more comprehensive estimates of the burden of healthcare-associated RSV and inform improved infection prevention strategies and vaccination efforts.
Functional cognitive disorder is an increasingly recognised subtype of functional neurological disorder for which treatment options are currently limited. We have developed a brief online group acceptance and commitment therapy (ACT)-based intervention.
Aims
To assess the feasibility of conducting a randomised controlled trial of this intervention versus treatment as usual (TAU).
Method
The study was a parallel-group, single-blind randomised controlled trial, with participants recruited from cognitive neurology, neuropsychiatry and memory clinics in London. Participants were randomised into two groups: ACT + TAU or TAU alone. Feasibility was assessed on the basis of recruitment and retention rates, the acceptability of the intervention, and signal of efficacy on the primary outcome measure (Acceptance and Action Questionnaire II (AAQ-II)) score, although the study was not powered to demonstrate this statistically. Outcome measures were collected at baseline and at 2, 4 and 6 months post-intervention, including assessments of quality of life, memory, anxiety, depression and healthcare use.
Results
We randomised 44 participants, with a participation rate of 51.1% (95% CI 40.8–61.5%); 36% of referred participants declined involvement, but retention was high, with 81.8% of ACT participants attending at least four sessions, and 64.3% of ACT participants reported being ‘satisfied’ or ‘very satisfied’ compared with 0% in the TAU group. Psychological flexibility as measured using the AAQ-II showed a trend towards modest improvement in the ACT group at 6 months. Other measures (quality of life, mood, memory satisfaction) also demonstrated small to modest positive trends.
Conclusions
It has proven feasible to conduct a randomised controlled trial of ACT versus TAU.
Understanding wave kinematics is crucial for analysing the thermodynamic effects of sloshing, which can lead to pressure drops in non-isothermal cryogenic fuel tanks. In the research reported here, Faraday waves in a horizontal circular tank (partially filled with water) under vertical excitation are investigated. The tank geometry is referred to as a horizontal circular tank throughout, with its circular face oriented perpendicular to the horizontal plane. Firstly, this paper addresses the eigenvalue problem through linear potential flow theory, in order to provide theoretical evidence of Faraday waves in horizontal circular tanks, the impact the density ratio has on the eigenvalues is then considered. Secondly, an experimental investigation testing multiple liquid fill levels is conducted. A soft-spring nonlinear response is demonstrated throughout the parameter space. The results showed larger sloshing amplitudes for low fill levels and smaller sloshing amplitudes for high fill levels. Asymmetry between anti-nodes at the container sidewalls and through the tank centreline are evident for low fill levels. Moreover, the sloshing wave amplitude at which breaking waves occur is smaller for high fill level conditions. Finally, period tripling was observed for all fill levels tested, confirming nonlinear mode interactions before the onset to wave breaking.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Childhood bullying is a public health priority. We evaluated the effectiveness and costs of KiVa, a whole-school anti-bullying program that targets the peer context.
Methods
A two-arm pragmatic multicenter cluster randomized controlled trial with embedded economic evaluation. Schools were randomized to KiVa-intervention or usual practice (UP), stratified on school size and Free School Meals eligibility. KiVa was delivered by trained teachers across one school year. Follow-up was at 12 months post randomization. Primary outcome: student-reported bullying-victimization; secondary outcomes: self-reported bullying-perpetration, participant roles in bullying, empathy and teacher-reported Strengths and Difficulties Questionnaire. Outcomes were analyzed using multilevel linear and logistic regression models.
Findings
Between 8/11/2019–12/02/2021, 118 primary schools were recruited in four trial sites, 11 111 students in primary analysis (KiVa-intervention: n = 5944; 49.6% female; UP: n = 5167, 49.0% female). At baseline, 21.6% of students reported being bullied in the UP group and 20.3% in the KiVa-intervention group, reducing to 20.7% in the UP group and 17.7% in the KiVa-intervention group at follow-up (odds ratio 0.87; 95% confidence interval 0.78 to 0.97, p value = 0.009). Students in the KiVa group had significantly higher empathy and reduced peer problems. We found no differences in bullying perpetration, school wellbeing, emotional or behavioral problems. A priori subgroup analyses revealed no differences in effectiveness by socioeconomic gradient, or by gender. KiVa costs £20.78 more per pupil than usual practice in the first year, and £1.65 more per pupil in subsequent years.
Interpretation
The KiVa anti-bullying program is effective at reducing bullying victimization with small-moderate effects of public health importance.
Funding
The study was funded by the UK National Institute for Health and Care Research (NIHR) Public Health Research program (17-92-11). Intervention costs were funded by the Rayne Foundation, GwE North Wales Regional School Improvement Service, Children's Services, Devon County Council and HSBC Global Services (UK) Ltd.
While clinical research intends to improve health outcomes for all, access to research participation is often limited and inequitable. Geographic proximity is a recognized barrier, thus, systemic infrastructure solutions through federal programs including General Clinical Research Centers and Clinical and Translational Science Awards have sought to improve accessibility. Even with such support, academic medical centers often have limited clinical research-dedicated space apart from shared exam rooms in difficult-to-navigate hospitals or clinics. In 2019, the Duke University School of Medicine looked beyond its medical center campus to identify free-standing sites within Durham communities for participant study visits. Catalyzed by the COVID-19 pandemic, Duke Research at Pickett, a 22 000-square-foot building with a laboratory, 30 exam rooms, and on-site parking, opened in October 2020 to support vaccine and treatment trials. Upon the lifting of many COVID-19 restrictions, and in partnership with the Research Equity and Diversity Initiative (READI) Community Advisory Council, the building was transformed to encourage community gatherings, education, and training programs. To date, Duke Research at Pickett has hosted 2692 participants in 78 research trials and 14 community-engaged activities.
The composition of clay mineral suites derived from Triassic argillite and shale were compared with those of the consolidated parent sediments. Lockatong argillite, near the weathered zone, is composed mainly of illite, chlorite, and feldspar. In the clay horizon immediately above it, illite replaces the feldspar and kaolinite increases with distance from the contact until, near the top of the weathered zone, it is almost the only clay mineral present. A similar study was carried out on Brunswick shale. Here the parent rock consists mainly of illite, and some kaolinite, montmorrilonite, quartz, and feldspar. The kaolinite increases gradually as one progresses upward through the weathered zone, montmorillonite decreases, but approximately 30 per cent illite is still found in the top layers. Chlorite in the argillite near the weathered zone is randomly oriented while illite shows strong preferred orientation, probably indicating that chlorite formed in place during weathering. Illite in the Brunswick shale shows strong preferred orientation.
These two Triassic sediments are less than 5 miles apart and one may assume that they had a similar post-depositional environment. The difference in diagenetic development is striking and must be attributed mainly to the chemical composition and lithology of the parent sediment.
The orientation of clay particles in the solid rock was studied with the aid of an X-ray diffraction technique based on the analysis of cylindrical samples. Three-dimensional intensity data thus obtained were presented by vectors whose ends form a surface which is characteristic of the orientation of the particles. Generally the vectors generate hemispherical normal distributions whose principal vector coincides with the normal to the bedding plane.
OBJECTIVES/GOALS: Uterine fibroids are benign tumors of the uterus with a high disease prevalence and burden, yet there are few multi-ancestry genetic studies. This is the largest and most diverse fibroid GWAS to-date. Our goal is to identify novel genetic variants and gene expression pathways associated with fibroids and characterize their biological relevance. METHODS/STUDY POPULATION: We performed a cross-ancestry meta-analysis of GWAS summary statistics from eight datasets. The total sample size was 74,294 cases and 465,810 controls with participants of European (80% of sample), African (4%), East Asian, and Central South Asian (16%) ancestry. We mapped variants to genes with OpenTarget Genetics and used Functional Mapping and Annotation to conduct tissue expression gene-set enrichment and identify lead variants. We used S-PrediXcan to estimate genetically predicted gene expression (GPGE) associated with fibroid risk. This was with models that predicted gene expression across 49 different tissue types. Ingenuity Pathway Analysis compiled significant GPGE genes and their weights with a scientific literature database to identify overlapping pathways. RESULTS/ANTICIPATED RESULTS: We identified 370 independent significant variants. Among these, we identified variants mapped to three novel genes (PAX2, VIP, FOXO3) and eight genes not previously validated (TEKT1, SLC16A11, RPEL1, RASL11B, ASGR1, SLC12A7, TTC28, POLR2A). Many loci have roles in cell cycle regulation or are associated with fibroid risk factors like blood pressure, BMI, and vitamin D levels. Loci were significantly enriched in DNA damage and cell cycle pathways. Of 588 significant predicted expression gene-tissue pairs, 173 unique genes were novel fibroid associations. These genes are also associated with cancers, estradiol, and endometriosis. Top enriched pathways included p53 signaling, HOTAIR, BRCA1DNA damage response, and pulmonary fibrosis signaling. In uterine tissue there were 15 novel GPGE associations. DISCUSSION/SIGNIFICANCE: Using this large and diverse data, we identified novel loci associated with fibroids that are enriched in hormone-response, DNA damage, and cell-cycle pathways. GPGE loci were in tumorigenesis and fibrosis pathways. These novel genetic loci and uterine gene expression findings may provide translational opportunities for novel fibroid treatments.
We report the discovery of a bow-shock pulsar wind nebula (PWN), named Potoroo, and the detection of a young pulsar J1638$-$4713 that powers the nebula. We present a radio continuum study of the PWN based on 20-cm observations obtained from the Australian Square Kilometre Array Pathfinder (ASKAP) and MeerKAT. PSR J1638$-$4713 was identified using Parkes radio telescope observations at frequencies above 3 GHz. The pulsar has the second-highest dispersion measure of all known radio pulsars (1 553 pc cm$^{-3}$), a spin period of 65.74 ms and a spin-down luminosity of $\dot{E}=6.1\times10^{36}$ erg s$^{-1}$. The PWN has a cometary morphology and one of the greatest projected lengths among all the observed pulsar radio tails, measuring over 21 pc for an assumed distance of 10 kpc. The remarkably long tail and atypically steep radio spectral index are attributed to the interplay of a supernova reverse shock and the PWN. The originating supernova remnant is not known so far. We estimated the pulsar kick velocity to be in the range of 1 000–2 000 km s$^{-1}$ for ages between 23 and 10 kyr. The X-ray counterpart found in Chandra data, CXOU J163802.6$-$471358, shows the same tail morphology as the radio source but is shorter by a factor of 10. The peak of the X-ray emission is offset from the peak of the radio total intensity (Stokes $\rm I$) emission by approximately 4.7$^{\prime\prime}$, but coincides well with circularly polarised (Stokes $\rm V$) emission. No infrared counterpart was found.
Interest in hydrotalcite-like compounds has grown due to their role in controlling the mobility of aqueous metals in the environment as well as their use as catalysts, catalyst precursors and specialty chemicals. Although these materials have been studied in a number of contexts, little is known of their thermodynamic properties. High-temperature oxide melt solution calorimetry was used to measure the standard enthalpy of formation for compounds M(II)1−xAlx(OH)2(CO3)x/2·mH2O (0.2 < x < 0.4, M(II) = Mg, Co, Ni and Zn). The enthalpy of formation of these compounds from the relevant single cation phases was also determined. The formation of HTLCs results in a 5–20 kJ/mol enthalpy stabilization from the single cation hydroxides and carbonates and water. The data are correlated to two variables: the ratio of divalent to trivalent cation in the solid (M(II)/Al) and the identity of the divalent cation. It was observed that the M(II)/Al ratio exerts a minor influence on the enthalpy of formation from single-cation phases, while greater differences in stabilization resulted from changes in the chemical nature of the divalent cation. However, the data do not support any statistically significant correlation between the composition of HTLCs and their heats of formation. Equilibrium geochemical calculations based upon the thermodynamic data illustrate the effect of HTLCs on the speciation of metals in natural waters. These calculations show that, in many cases, HTLCs form even in waters that are undersaturated with respect to the individual divalent metal hydroxides and carbonates. Phase diagrams and stability diagrams involving Ni-bearing HTLCs and the single-cation components are presented. The Ni(II) concentration as a function of pH as well as the stability diagram for the equilibrium among minerals in the CaO-NiO-Al2O3-SiO2-CO2-H2O system at 298 K are plotted.
The IntCal family of radiocarbon (14C) calibration curves is based on research spanning more than three decades. The IntCal group have collated the 14C and calendar age data (mostly derived from primary publications with other types of data and meta-data) and, since 2010, made them available for other sorts of analysis through an open-access database. This has ensured transparency in terms of the data used in the construction of the ratified calibration curves. As the IntCal database expands, work is underway to facilitate best practice for new data submissions, make more of the associated metadata available in a structured form, and help those wishing to process the data with programming languages such as R, Python, and MATLAB. The data and metadata are complex because of the range of different types of archives. A restructured interface, based on the “IntChron” open-access data model, includes tools which allow the data to be plotted and compared without the need for export. The intention is to include complementary information which can be used alongside the main 14C series to provide new insights into the global carbon cycle, as well as facilitating access to the data for other research applications. Overall, this work aims to streamline the generation of new calibration curves.
Edited by
Ziwei Qi, Fort Hays State University, Kansas,April N. Terry, Fort Hays State University, Kansas,Tamara J. Lynn, Fort Hays State University, Kansas
As a research team tasked with developing local initiatives for juvenile justice practices, our entry into rural research sites was built on listening tours and semi-structured gatherings involving more than 100 community stakeholders. At every point, we were surprised to see almost no reference to gender or the unique experiences of systeminvolved girls. (Sue, personal narrative, 15 March 2020)
The noteworthy long silences about gender encountered during fieldwork in rural communities stand in sharp contrast to the ubiquity of genderbased inequities around the globe. Gender-based violence (GBV) is a deeply entrenched issue of gender inequality and discrimination (Council of Europe, 2011), including emotional and psychological harm (Ott, 2017), deprivation of liberty (United Nations General Assembly, 1993) and human rights violations (European Institute for Gender Equality, 2020). According to a study conducted by the World Health Organization (WHO), one in three women who have been in a relationship have experienced physical and/or sexual violence by an intimate partner or sexual violence from a non-partner at some point in their lives (WHO, 2021).
The paucity of attention to GBV for at-risk girls and subsequent involvement within the juvenile justice system is even more stark. First, age matters. While intimate partner violence is the most prevalent form of violence against women, younger women remain at highest risk (WHO, 2021). Leading studies (such as WHO, 2021) document the damaging consequences of violence on women's health, including risks for injuries, depression, anxiety disorders, sexually transmitted infections and other health problems. Little attention is directed towards ‘hidden harms’ for at-risk girls, and especially those in rural areas, and the existing few have focused exclusively on urban locations, ignoring the unique sociopolitical differences of rural communities. The current study directs attention towards this continued oversight, demanding intentional efforts towards gender-responsive needs, including indirect forms of GBV, for at-risk girls everywhere, including rural areas.
These authors conducted a two-year research project on juvenile justice issues in isolated areas of western Kansas within the United States. As background, in 2016, the state of Kansas passed a comprehensive juvenile justice reform bill, Senate Bill 367 (SB 367) (Kansas Legislative Session, 2017).
Precision Medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle. Autoimmune diseases are those in which the body’s natural defense system loses discriminating power between its own cells and foreign cells, causing the body to mistakenly attack healthy tissues. These conditions are very heterogeneous in their presentation and therefore difficult to diagnose and treat. Achieving precision medicine in autoimmune diseases has been challenging due to the complex etiologies of these conditions, involving an interplay between genetic, epigenetic, and environmental factors. However, recent technological and computational advances in molecular profiling have helped identify patient subtypes and molecular pathways which can be used to improve diagnostics and therapeutics. This review discusses the current understanding of the disease mechanisms, heterogeneity, and pathogenic autoantigens in autoimmune diseases gained from genomic and transcriptomic studies and highlights how these findings can be applied to better understand disease heterogeneity in the context of disease diagnostics and therapeutics.
To provide comprehensive population-level estimates of the burden of healthcare-associated influenza.
Design:
Retrospective cross-sectional study.
Setting:
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2012–2013 through 2018–2019 influenza seasons.
Patients:
Laboratory-confirmed influenza-related hospitalizations in an 8-county catchment area in Tennessee.
Methods:
The incidence of healthcare-associated influenza was determined using the traditional definition (ie, positive influenza test after hospital day 3) in addition to often underrecognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a noninfluenza illness in the preceding 7 days.
Results:
Among the 5,904 laboratory-confirmed influenza-related hospitalizations, 147 (2.5%) had traditionally defined healthcare-associated influenza. When we included patients with a positive influenza test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a noninfluenza illness in the preceding 7 days, we identified an additional 1,031 cases (17.5% of all influenza-related hospitalizations).
Conclusions:
Including influenza cases associated with preadmission healthcare exposures with traditionally defined cases resulted in an 8-fold higher incidence of healthcare-associated influenza. These results emphasize the importance of capturing other healthcare exposures that may serve as the initial site of viral transmission to provide more comprehensive estimates of the burden of healthcare-associated influenza and to inform improved infection prevention strategies.
To describe the clinical impact of healthcare-associated (HA) respiratory syncytial virus (RSV) in hospitalized adults.
Design:
Retrospective cohort study within a prospective, population-based, surveillance study of RSV-infected hospitalized adults during 3 respiratory seasons: October 2017–April 2018, October 2018–April 2019, and October 2019–March 2020.
Setting:
The study was conducted in 2 academically affiliated medical centers.
Patients:
Each HA-RSV patient (in whom RSV was detected by PCR test ≥4 days after hospital admission) was matched (age, sex, season) with 2 community-onset (CO) RSV patients (in whom RSV was detected ≤3 days of admission).
Methods:
Risk factors and outcomes were compared among HA-RSV versus CO-RSV patients using conditional logistic regression. Escalation of respiratory support associated with RSV detection (day 0) from day −2 to day +4 was explored among HA-RSV patients.
Results:
In total, 84 HA-RSV patients were matched to 160 CO-RSV patients. In HA-RSV patients, chronic kidney disease was more common, while chronic respiratory conditions and obesity were less common. HA-RSV patients were not more likely to be admitted to an ICU or require mechanical ventilation, but they more often required a higher level of care at discharge compared with CO-RSV patients (44% vs 14%, respectively). Also, 29% of evaluable HA-RSV patients required respiratory support escalation; these patients were older and more likely to have respiratory comorbidities, to have been admitted to intensive care, and to die during hospitalization.
Conclusions:
HA-RSV in adults may be associated with escalation in respiratory support and an increased level of support in living situation at discharge. Infection prevention and control strategies and RSV vaccination of high-risk adults could mitigate the risk of HA-RSV.
During the coronavirus disease 2019 (COVID-19) pandemic, navigating the implementation of public health measures in a politically charged environment for a large state entity was challenging. However, Louisiana State University (LSU) leadership developed and deployed an effective, multi-layered mitigation plan and successfully opened in-person learning while managing cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the fourth surge. We describe the plan to provide a framework for other institutions during this and future responses. The goals were 3-fold: maintain a quality learning environment, mitigate risk to the campus community, and ensure that LSU operations did not contribute to health-care stress. As of September 2022, LSU has achieved high compliance with interventions and relatively low virus activity on campus compared with peer institutions. This university model can serve as a template for similar implementation plans in the context of complex socio-political and economic considerations.
Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a disorder of the elderly with progressive worsening of gait and balance, cognition, and urinary control which requires assessment using criteria recommended by International iNPH guidelines. Methods: Adult Hydrocephalus Clinical Research Network (AHCRN) prospective registry data from 5-centers over a 50-month interval included entry criteria; demographics; comorbidities; examination findings using standard AHCRN gait and neuropsychology assessments; shunt procedures, complications of CSF drainage, complications within 30 days of surgery, and 1-year postoperative follow-up. Results: 547 patients were referred for assessment of suspected-iNPH. 123 patients(21.6%) did not meet clinical criteria to proceed with further testing. 424 patients(74.4%;mean age 76.7 ± 6.0 years;males=269) underwent an LP or lumbar drain, and 193(45.6%) underwent insertion of a ventriculoperitoneal shunt. By 8-12 months after shunt surgery, gait velocity was 0.96±0.35m/s (54% faster than pre-CSF-drainage). Mean MoCA scores increased from 21.0 ± 5.0(median=22.0) at baseline to 22.6±5.5(median=24) 12-months post-surgery. Gait and cognitive improvements were clinically significant. No deaths occurred. 8% of shunt-surgery patients experienced minor complications. The 30-day reoperation rate was 4.1%. Conclusions: This AHCRN study demonstrated that CSF-drainage testing of patients with suspected-iNPH successfully identified those who could undergo CSF-shunt surgery with a high rate of improvement and a low rate of complications.
Background: Nearly one-third of patients on hemodialysis receive intravenous (IV) antibiotics annually, but national data characterizing antibiotic use in this population are limited. Using NHSN surveillance data for outpatient dialysis facilities, we estimated temporal changes in the rate of IV antibiotic starts (IVAS) among hemodialysis patients as well as the proportion of IVAS that were not supported by a reported clinical indication. Methods: IVAS events were obtained from the NHSN Dialysis Event module between 2016 and 2020, excluding patients who were out of network, receiving peritoneal or home dialysis, or with unspecified vascular access. IVAS unsupported by documentation were defined as new IVAS without a collected or positive blood culture, pus, redness or swelling event, or an associated clinical symptom. Pooled mean rates of total and unsupported IVAS were estimated per 100 patient months yearly and stratified by vascular access type. Differences in IVAS rates by year were estimated with negative binomial regression. Results: Between 2016 and 2020, 7,278 facilities reported 648,410 IVAS events; 161,317 (25%) were unsupported by documentation (Table 1). In 2016, 3,340 (54%) facilities with ≥1 IVAS event reported an IVAS unsupported by documentation, which increased to 4,994 (73%) in 2020. Total IVAS rates decreased by an average of 8.2% annually (95% CI, 7.1%–9.3%; P < .001). The average annual percentage decrease did not differ significantly by vascular access site. The total IVAS rate was lowest in 2020 (2.17 per 100 patient months; 95% CI, 2.18–2.17). IVAS rates in 2020 were greatest for patients with catheter access (4.79 per 100 patient months; 95% CI, 4.75–4.83), followed by graft (1.71 per 100 patient months; 95% CI, 1.68–1.73), and lowest for patients with fistulas (1.30 per 100 patient months; 95% CI, 1.29–1.31). The overall pooled mean rate of unsupported IVAS was 0.64 per 100 patient months (95% CI, 0.63–0.64), which did not significantly change by year (Fig. 1). Conclusions: Total IVAS rates among outpatient hemodialysis patients have decreased since 2016, and rates among catheter patients remain highest compared to patients with fistulas or grafts. However, unsupported IVAS rates did not change, and the proportion of facilities reporting an unsupported IVAS increased annually. Targeted efforts to engage facilities with unsupported IVAS may help improve accurate reporting and prescribing practices.
Background: Understanding SARS-CoV-2 persistence on surfaces can help inform transmission risk from surfaces in healthcare and community settings. A sensitive viral infectivity assay is crucial for the detection of infective virus in environmental investigations. The conventional cell culture-based infectivity assay is limited by the time dependence, subjectivity, and insensitivity of cytopathic effect (CPE) scoring. We validated an integrated cell-culture and reverse-transcription quantitative RT-PCR method (cc-RT-qPCR) to improve SARS-CoV-2 detection and reduce detection time. We compared cc-RT-qPCR with CPE-scored cell culture to evaluate assay sensitivity of recovered virus from stainless-steel coupons simulating nonporous healthcare surfaces. Method: Human β-coronavirus OC43, a model strain for SARS-CoV-2, was propagated on HRT-18G cells in growth medium at 33°C in a 5% CO2 incubator. The OC43 infectivity was determined by cell culture with a 10-fold dilution series of viral samples in 96-well plates, and incubation for 7 days at 33°C to confirm CPE. Plates were CPE-scored and TCID50 was calculated using the Reed-Muench method. For the cc-RT-qPCR assay, CPE-negative wells were interrogated for viral intracellular replication using RT-PCR; infectivity was based on a titer increase of ≥ 2 logs 7 days after inoculation using RT-qPCR. CPE-positive or replicative virus-harboring cells were enumerated to determine TCID50. The sensitivity of both CPE-scored cell culture and cc-RT-qPCR assays were evaluated by inoculating 105 TCID50/mL OC43 in infection media and artificial saliva matrices onto coupons and dried in an environmental chamber at 26°C and 57% relative humidity for 6 hours. Viral eluates from coupons served as test samples. Results: Low-titer infectious OC43 (0.75 log10) was detected by both methods 7 days after incubation; however, infectivity confirmation required 4 and 6 days after incubation, respectively, for cc-RT-qPCR and CPE-scored cell culture methods. When cells were inoculated with OC43 at titer range 1.75–4.75 log10, CPE presented at 4–5 days after incubation, while viral replication was already detected at 3 days after incubation via RT-PCR. Upon virus titration, cc-RT-qPCR demonstrated greater sensitivity, detecting up to 1 log10 higher of infectious OC43 than cell culture alone at 0 and 6 hours (P ≤ .05) dried in infection medium and 0 hours (P ≤ .05) in saliva. Conclusions: Our data demonstrated greater sensitivity and shorter times to detect viral replication by cc-RT-qPCR, minimizing potential for false-negative results with cell culture alone. This sensitive assay may provide investigators with quicker results for informing infection control practices to reduce risk of transmission from deposited bodily fluids on surfaces, eg, coughing and sneezing.