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The present study aims to develop and discuss an extension of hospital-acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections (HA-SIs) definition which goes beyond the use of time parameters alone.
Design:
A confirmatory factor analysis was carried out to test a suitable definition for HA-SI.
Setting and Patients:
A two-center cohort study was carried out at two tertiary public hospitals in the German state of lower Saxony. The study involved a population of 366 laboratory-confirmed SARS-CoV-2-infected inpatients enrolled between March 2020 and August 2023.
Results:
The proposed model shows adequate fit indices (CFI.scaled = 0.959, RMSEA = 0.049). A descriptive comparison with existing classifications revealed strong features of our model, particularly its adaptability to specific regional outbreaks.
Conclusion:
The use of the regional incidence as a proxy variable to better define HA-SI cases represents a pragmatic and novel approach. The model aligns well with the latest scientific results in the literature. This work successfully unifies, within a single model, variables which the recent literature described as significant for the onset of HA-SI. Further potential improvements and adaptations of the model and its applications, such as automating the categorization process (in terms of hospital acquisition) or employing a comparable model for hospital-acquired influenza classification, are subjects open for discussion.
In the context of the COVID-19 pandemic, which required urgent responses from health systems, and ongoing decision making in a context of limited and evolving evidence, modeling played a significant role in supporting public policy making. Nonetheless, particularly in low and middle-income countries, modeling groups are scarce, and usually not routinely involved in supporting public health policy making. We aimed to appraise COVID-19 modeling work in Brazil during the pandemic.
Methods
We performed a scoping review following PRISMA guidelines to identify groups conducting COVID-19 modeling to support health decision-making in Brazil. Search strategies were applied to MEDLINE, LILACS, Embase, ArXiv, and also included National data repositories and gray literature. We excluded reports of models without modeling results. Titles, abstracts, data repository descriptions and full-text articles identified were read and selected by two reviewers. Data extracted included modeling questions, model characteristics (structure, type, and programming), epidemiologic data sources, main outcomes reported, and parameters. To further identify modeling groups that might have not yet published results, snowball sampling was performed, and a short survey was sent electronically. Investigators and policymakers were invited to an online interview, to obtain further information on how they interacted, communicated, and used modeling results.
Results
We retrieved 1,061 references. After removing duplicates (127), 1,016 abstracts and titles were screened. From an initial selection of 142 abstracts, 133 research groups were identified, of which 67 didn’t meet the eligibility criteria. Of these, 66 groups were invited for an interview, of which 24 were available, including 18 modeling groups from academic institutions, and four groups from State Health departments. Most models assessed the impact of mitigation measures in cases/hospitalization/deaths and healthcare service demand. Interaction and communication with decision-makers were not well established in most groups.
Conclusions
Despite a large number of modeling groups in Brazil, we observed a significant gap in modeling demand and communicating its results to support the decision-making process during the COVID-19 pandemic.
This paper assesses the influence of heat and drought stress on the economic performance of the European dairy sector. Climatic data from the Gridded Agro-Meteorological data in Europe were combined with dairy enterprise data from the Farm Accountancy Data Network, resulting in a data set of 4412 farms in 22 European Union (EU) countries over the period 2007–2013. Since the performance of dairy farms is influenced by the context in which they operate, farms were grouped into areas representing similar climatic conditions through the use of a latent class analysis. Technical efficiency (TE) and economic downside risk were used as performance indicators against which the effect of climatic stress factors was evaluated. TE was estimated using a ‘true-fixed’ effect stochastic frontier model. Economic downside risk was based on gross margin deviations. Regression analysis suggests a significant negative effect of drought and heat stress on both TE and the downside gross margin difference in most climatic classes, with few exceptions. Results imply that both drought and heat stress-related issues need to be considered when designing adaptation strategies to address threats to the economic performance of the EU dairy sector.
This paper analyses the role that companion policies have had in the reduction of emissions regulated by the EU Emissions Trading System (EU ETS) and the related policy interactions, with a view to identifying relevant insights for China's forthcoming Emissions Trading System (ETS). The investigation rests on: (a) the observation of the EU's and China's ETSs and policy mixes; (b) economic theory concerning companion policies and ETS design; and (c) empirical ex-post evidence from the EU ETS. Three main conclusions emerge from the analysis. First, China's ETS, while not imposing a fixed cap on emissions, will not be immune to waterbed effects of companion policies. Second, the European experience stresses the importance of making explicit the objectives pursued by companion policies, and of balancing policies for innovation and policies for adoption of low-carbon technologies. Third, in the presence of a major market surplus, only permanent adjustments to allowance supply can be effective in raising prices.
The remnant phase of a radio galaxy begins when the jets launched from an active galactic nucleus are switched off. To study the fraction of radio galaxies in a remnant phase, we take advantage of a $8.31$ deg$^2$ subregion of the GAMA 23 field which comprises of surveys covering the frequency range 0.1–9 GHz. We present a sample of 104 radio galaxies compiled from observations conducted by the Murchison Widefield Array (216 MHz), the Australia Square Kilometer Array Pathfinder (887 MHz), and the Australia Telescope Compact Array (5.5 GHz). We adopt an ‘absent radio core’ criterion to identify 10 radio galaxies showing no evidence for an active nucleus. We classify these as new candidate remnant radio galaxies. Seven of these objects still display compact emitting regions within the lobes at 5.5 GHz; at this frequency the emission is short-lived, implying a recent jet switch off. On the other hand, only three show evidence of aged lobe plasma by the presence of an ultra-steep-spectrum ($\alpha<-1.2$) and a diffuse, low surface brightness radio morphology. The predominant fraction of young remnants is consistent with a rapid fading during the remnant phase. Within our sample of radio galaxies, our observations constrain the remnant fraction to $4\%\lesssim f_{\mathrm{rem}} \lesssim 10\%$; the lower limit comes from the limiting case in which all remnant candidates with hotspots are simply active radio galaxies with faint, undetected radio cores. Finally, we model the synchrotron spectrum arising from a hotspot to show they can persist for 5–10 Myr at 5.5 GHz after the jets switch of—radio emission arising from such hotspots can therefore be expected in an appreciable fraction of genuine remnants.
Fever (pyretotherapy) was used for psychosis during the turn of the 19th century, but pyretotherapy (ie, the treatment of a disorder by inducing fever) fell out of use after the introduction of convulsive methods. Here, we report on a case of schizoaffective disorder and review classical and recent literature on fever and psychosis. The patient developed auditory hallucinations, persecutory delusional ideas, and was terrified soon upon his arrival in a foreign country. After being treated for 12 days with olanzapine and haloperidol, he developed a fever due to urinary infection; his creatine phosphokinase levels were high, prompting the suspension of antipsychotics. Psychotic symptom resolution followed immediately fever abatement. Antipsychotics were reintroduced at lower dosages. He was discharged asymptomatic with a prescription of olanzapine 15 mg/day and haloperidol 3 mg/day. The time course of symptom resolution in this patient suggests that fever had a beneficial role in this case. The associations between body temperature changes and psychotic symptoms need to be further studied.
Bone chemical treatment for radiocarbon dating has drawn the attention of different laboratories because dates of bones and charcoals found in the same layer often disagree. Excluding diet-related reservoir effects, this observation is likely due to a nonoptimized procedure of contaminant removal from the extracted collagen. In this study, systematic work on the bone chemical treatment was performed with the aim to investigate the effect of each known procedure (i.e. AAA, GEL, and ULTR) on the collagen used for 14C dating. Isolation and purification of lipids from animal tissues were performed to estimate eventual offsets induced by the applied methods, by comparing the 14C ages of lipids with those of collagen. Moreover, cremated bones were treated for the first time at CIRCE. Measured 14C isotopic ratios on these samples were used to evaluate the accuracy of the applied procedure by comparing against the results for charcoals found in the same archaeological context as the bones.
Pediatric multiple sclerosis (MS), once considered a rare childhood illness, has been increasingly recognized as a disabling acquired pediatric neurological disease requiring early recognition and intervention. Males get affected with before puberty while females are more often hit around or after puberty. Race, ethnicity, and ancestry may also influence disease susceptibility and course differently. Epidemiological data clearly indicate that adult MS is a geographically related disease, with disease rates rising with an increased distance from the equator in both northern and southern hemispheres. A few candidates have been identified as associated with pediatric MS in a few epidemiological studies (neurotropic viruses, Chlamydia pneumonia, passive smoking). Seroepidemiologic and pathologic evidences have strongly suggested that prior infection with members of the Herpesviridae family may be associated with the development of MS in adulthood. The most studied member of the Herpesviridae family in MS patients has been Epstein-Barr virus (EBV).
To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI).
Design and Setting.
Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006.
Patients.
Twenty-five patients with BCC-BSI.
Design.
After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using Spel.
Results.
The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals.
Conclusion.
Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.
A 69-year-old man presented with Cotard's delusions, insomnia, profound depression, amnesia, difficulty concentrating, and cognitive deficit after two different surgical interventions. Brain imaging showed frontotemporal-subcortical atrophy and lateral ventricular enlargement. He responded poorly to a combination of sertraline, amisulpride and mirtazapine, with modest benefit on insomnia, and developed hypotension. After 18 days he was switched to olanzapine and venlafaxine, but his cognition worsened. He underwent bilateral electroconvulsive therapy (ECT). His mood improved, cognitive performance increased and anxiety symptoms remitted. This improvement persisted through the one-month post-discharge follow-up and depression eventually remitted.