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Direct numerical simulations in a low-curvature viscoelastic turbulent Taylor vortex flow, with Reynolds numbers ranging from 1500 to 8000 and maximum chain extensibility ($L$) from 50 to 200, reveal a maximum drag reduction (MDR) asymptote. Compared with the classical MDR observed in planar wall-bounded shear flows, that is, drag reduction (DR) is $\sim -80\, \%$, this MDR state achieves only moderate levels of DR ($\sim -60\,\%$). This is due to the existence of large-scale structures (LSSs). A careful examination of the flow structures reveals that the polymer–turbulence interaction suppresses small-scale vortices and stabilizes the LSSs. These structural changes in turn lead to a reduction of Reynolds stress, and consequently to a DR flow state. Although Reynolds stress does not vanish as observed in classical MDR states, the small-scale vortices that heavily populate the near-wall region are also almost completely eliminated in this flow state. Concurrently, significant polymer stresses develop as a consequence of the interaction between polymer chains and LSSs that partially offset the magnitude of DR, leading to MDR asymptotes with moderate levels of DR. Moreover, we demonstrate that polymer deformation, i.e. deviation from the equilibrium state, is directly correlated with the LSSs dynamics, while the polymer deformation fluctuation displays a universal property in the MDR state. Hence, it is not surprising that the extent of DR exhibits a non-monotonic dependence on the maximum chain extensibility. Specifically, the variation in $L$ alters the incoherent and coherent angular momentum transport by small- and large-scale flow structures, respectively. To that end, the most DR flow state occurs at a moderate value $L=100$. Overall, this study further supports the universal property of polymer-induced asymptotic states in wall-bounded turbulence and paves the way for mechanistic understanding of drag modification that arises from the interaction of polymers with small- and large-scale flow structures.
Crowd crush disasters result in psychological risks such as anxiety, depression, and post-traumatic stress disorder (PTSD). This descriptive research study identified the mental health status of Koreans after the Itaewon crowd crush disaster and explored related factors.
Methods
Data were collected May 2-9, 2023 using an online survey. Participants included 205 adults aged 19-69 years recruited through South Korean local and online university communities. Their mental health and related factors were measured at 6 months post-disaster. Data were analyzed using IBM® SPSS® Statistics 26.0. and R 3.4.2.
Results
Significant differences in anxiety, depression, and PTSD among participants who experienced the disaster as victims; changes in drinking frequency and alcohol consumption; and differences in anxiety and PTSD according to family type were observed. Comparing the 3 and 6 month surveys, there were no significant changes in anxiety, depression, PTSD, general mental health, or mental well-being. When mental health severity was divided according to victimization, a significant difference in the severity of anxiety, depression, and PTSD was observed.
Conclusions
Participants’ levels of anxiety, depression, and PTSD varied according to their direct and indirect experience of the disaster, with higher levels of PTSD even without direct experience with the disaster.
Turbulent flow induced by elastorotational instability in viscoelastic Taylor–Couette flow (TCF) with Keplerian rotation is analogous to a turbulent accretion disk destabilized by magnetorotational instability. We examine this novel viscoelastic Keplerian turbulence via direct numerical simulations (DNS) for the shear Reynolds number ($Re$) ranging from $10^2$ to $10^4$. The observed characteristic flow structure consists of penetrating streamwise vortices with axial length scales much smaller than the gap width, distinct from the classic centrifugally induced Taylor vortices, which have axial lengths of the gap width. These intriguing vortices persist for the wide $Re$ range considered and give rise to intriguing scaling behaviour in key flow quantities. Specifically, the characteristic axial length of the penetrating vortices is shown to scale as $Re^{-0.22}$; the angular momentum transport scales as $Re^{0.42}$; the kinetic and elastic boundary-layer thicknesses based on angular velocity and hoop stress near the inner cylinder wall scale as $Re^{-0.48}$ and $Re^{-0.49}$, respectively. This implies that the viscoelastic Keplerian turbulence belongs to the classical turbulent regime of TCF with the Prandtl–Blasius-type boundary layer. Furthermore, we present an analytical relation between the viscous and elastic dissipation rates of kinetic energy and the angular momentum transport and in turn demonstrate its validity using our DNS data. This study has paved the way for future research to explore astrophysics-related Keplerian turbulence and angular momentum transport via the scaling relations of the analogous TCF of dilute polymeric solutions.
Metabolic and inflammatory dysfunction is prevalent in middle-aged people with major mood disorders, but less is known about young people. We investigated the trajectories of sensitive metabolic (Homeostatic Model Assessment for Insulin Resistance [HOMA2-IR]) and inflammatory markers (C-reactive protein [CRP]) in 155 young people (26.9 ± 5.6 years) accessing mental health services. We examined demographic and clinical correlates, longitudinal trajectories and relationships with specific illness subtypes. Additionally, we compared the HOMA2-IR with fasting blood glucose (FBG) for sensitivity. We observed a significant increase in HOMA2-IR and CRP over time with higher baseline levels predicting greater increases, although the rate of increase diminished in those with higher baseline levels. Body mass index predicted increases in HOMA2-IR (p < 0.001), but not CRP (p = 0.135). Multinomial logistic regression revealed that higher HOMA2-IR levels were associated with 2.3-fold increased odds of the “circadian-bipolar spectrum” subtype (p = 0.033), while higher CRP levels were associated with a reduced risk of the “neurodevelopmental psychosis” subtype (p = 0.033). Standard FBG measures were insensitive in detecting early metabolic dysregulation in young people with depression. The study supports the use of more sensitive markers of metabolic dysfunction to address the longitudinal relationships between immune-metabolic dysregulation and mood disorders in young people.
Background: Data on antimicrobial use at the national level is crucial to establish domestic antimicrobial stewardship policies and enable medical institutions to benchmark against each other. This study aimed to analyze antimicrobial use in Korean hospitals. Methods: We investigated the antimicrobials prescribed in Korean hospitals between 2018 and 2021, using data from the Health Insurance Review and Assessment. Primary care hospitals (PCHs), secondary care hospitals (SCHs), and tertiary care hospitals (TCHs) were included in this analysis. Antimicrobials were categorized according to the Korea National Antimicrobial Use Analysis System (KONAS) classification, which is suitable for measuring antimicrobial use in Korean hospitals. Results: Out of more than 1,900 hospitals, PCHs and TCHs represented the largest and lowest percentage of hospitals, respectively. The most frequently prescribed antimicrobial in 2021 was piperacillin/β-lactamase inhibitor (9.3%) in TCHs, ceftriaxone (11.0%) in SCHs, and cefazedone (18.9%) in PCHs. Between 2018 and 2021, the most used antimicrobial class according to the KONAS classification was ‘broad-spectrum antibacterial agents predominantly used for community-acquired infections’ in TCHs and SCHs, and 'narrow spectrum beta-lactam agents' in PCH. Total consumption of antimicrobials has decreased from 951.7 to 929.9 days of therapy (DOT)/1,000 patient-days in TCHs and from 817.8 to 752.2 DOT/1,000 patient-days in SCHs during study period, but not in PCHs (from 504.3 to 527.2 DOT/1,000 patient-days). Moreover, in 2021, while use of reserve antimicrobials has decreased from 13.6 to 10.7 DOT/1,000 patient-days in TCHs and from 4.6 to 3.3 DOT/1,000 patient-days in SCHs, it has increased from 0.7 to 0.8 DOT/1,000 patient-days in PCHs. Conclusion: This study confirms that antimicrobial use differs by hospital type in Korea. Recent increases of use of antimicrobials, including reserve antimicrobials, in PCHs reflect the challenges that must be addressed.
As societies become more complex, disasters are increasing in frequency and magnitude. To respond to the psychological problems that may arise in such situations, it is necessary to develop the psychological first aid (PFA) training program that is more engaging for disaster relief workers and less limited in time and space. This study aimed to investigate the effectiveness of a web-based PFA simulation game for disaster relief workers to provide to fire disaster victims.
Methods:
This was a non-randomized controlled experimental study with 30 participants in the experimental and control groups. The experimental group learned through the web-based PFA simulation game developed in this study, and the control group was provided with written educational materials regarding general disaster. The effects of time between groups and interaction between groups were tested.
Results:
Compared to the control group, the experimental group showed significant effects on core competencies in disaster response, self-efficacy, and problem-solving process, and the persistence of the effects was also significantly different.
Conclusion:
The web-based PFA simulation game was found to be effective in improving core competencies in disaster response, self-efficacy, and problem-solving process of disaster relief workers. These results suggest that simulation games can be an effective learning method for learning PFA for disaster relief workers. Since it is difficult to learn through direct participation in disaster situations, a web-based simulation game may be a more effective way to improve and maintain the competence of PFA.
Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear.
Aims
To describe the emergency department presentation patterns of a help-seeking youth mental health cohort.
Method
Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12–30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other).
Results
During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86–0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086–1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation.
Conclusions
Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.
The Functioning Assessment Short Test (FAST) is a relatively specific test for bipolar disorders designed to assess the main functioning problems experienced by patients.
Objectives
FAST includes 24 items assessing impairment or disability in 6 domains of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure time. It has already been translated into standardized versions in several languages. The aim of this study is to measure the validity and reliability of the Korean version of FAST (K-FAST).
Methods
A total of 209 bipolar disorder patients were recruited from 14 centers in Korea. K-FAST, Young Mania Rating Scale (YMRS), Bipolar Depression Rating Scale (BDRS), Global Assessment of Functioning (GAF) and the World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF) were administered, and psychometric analysis of the K-FAST was conducted
Results
The internal consistency (Cronbach’s alpha) of the K-FAST was 0.95. Test-retest reliability analysis showed a strong correlation between the two measures assessed at a 1-week interval (ICC = 0.97; p < 0.001). The K-FAST exhibited significant correlations with GAF (r=-0.771), WHOQOL-BREF (r=-0.326), YMRS (r=0.509) and BDRS (r=0.598). A strong negative correlation with GAF pointed to a reasonable degree of concurrent validity. Although the exploratory factor analysis showed 4 factors, the confirmatory factor analysis of questionnaires had a good fit for a six factors model (CFI=0.925; TLI=0.912; RMSEA=0.078).Table.
Model fit index of confirmatory factor analysis (n=209)
Measure of fit
4-factor model
6-factor model
Acceptable value
χ2/df
2.832
2.267
<3
RMSEA (90% CI)
0.094(0.086-0.102)
0.078 (0.069-0.087)
<0.08
CFI
0.887
0.925
>0.9
TLI
0.873
0.912
>0.9
χ2, chi-square; df, degrees of freedom; RMSEA, root mean square error of approximation; CFI, comparative fit index; TLI, Tucker-Lewis index.
Conclusions
The K-FAST has good psychometric properties, good internal consistency, and can be applicable and acceptable to the Korean context.
Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies.
Aims
To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality.
Method
State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident.
Results
There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6–2.6) but higher for males (5.3, 95% CI 3.8–7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13–9.09) and psychiatric admission (HR 4.01, 95% CI 1.81–8.88) were the strongest predictors of mortality.
Conclusion
Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.
Three-dimensional elastic turbulence in Taylor–Couette flows of dilute polymer solutions has been realized and thoroughly investigated via direct numerical simulations. A novel flow transition pathway from elastically dominated turbulence to solitary vortex pairs (or diwhirls) and eventually to elastic turbulence is observed by decreasing the fluid inertia ($Re$) over seven orders of magnitude, i.e. from $Re=1000$ to $0.0001$. The dominant spatio-temporal flow features in the elastic turbulence regime are those of large-scale unsteady diwhirls and small-scale axial and azimuthal travelling waves in the outer and inner halves of the gap, respectively. Moreover, it is conclusively shown that production of turbulent kinetic energy in purely elastic turbulence solely arises due to the stochastic nature of polymer stretch/relaxation. Overall, based on this comprehensive numerical investigation, the differences in the underlying fluid physics that give rise to turbulent fluctuations in elastically dominated and purely elastic turbulence have been delineated.
Jeju Island, designated by UNESCO as a world heritage site, continues to face the anthropogenic pressures of reckless development for regional tourism and economic revitalization purposes. Because land use/land cover (LULC) affects ecosystem services and human well-being, it is crucial to comprehensively identify the causes of changes in LULC based on long-term analyses. This study examined LULC changes on Jeju Island over 47 years from 1973 to 2019 and quantified changes in four ecosystem services: habitat quality, carbon stock, water yield and cumulative viewshed. From 1973 to 1998, forest land increased from 22% to 56%, but these restoration efforts were conducted in grassland, reducing that land type from 42% to 17%. This process increased the areas of highest habitat quality from 68% to 73%, and carbon stock increased from 20 to 30 million tonnes. Between 1998 and 2009, the area of cropland more than doubled from 21% to 44%. As a result, the areas of highest habitat quality decreased from 73% to 49%, and carbon stock decreased from 3.0 million tonnes to 2.3 million tonnes. Our analysis could help stakeholders and policymakers to develop their management planning and improve ecosystem services through restoration and conservation policies on Jeju Island.
Many waterflooding oil fields, injecting water into an oil-bearing reservoir for pressure maintenance, are in their middle to late stages of development. To explore the geological conditions and improve oilfield recovery of the most important well group of the Hu 136 block, located on the border areas of three provinces (Henan, Shandong, and Hebei), Zhongyuan Oilfield, Sinopec, central China, a 14C cross-well tracer monitoring technology was developed and applied in monitoring the development status and recognize the heterogeneity of oil reservoirs. The tracer response in the production well was tracked, and the water drive speed, swept volume of the injection fluid were obtained. Finally, the reservoir heterogeneity characteristics, such as the dilution coefficient, porosity, permeability, and average pore-throat radius, were fitted according to the mathematical model of the heterogeneous multi-layer inter-well theory. The 14C-AMS technique developed in this work is expected to be a potential analytical method for evaluating underground reservoir characteristics and providing crucial scientific guidance for the mid to late oil field recovery process.
Nosocomial transmission of COVID-19 among immunocompromised hosts can have a serious impact on COVID-19 severity, underlying disease progression and SARS-CoV-2 transmission to other patients and healthcare workers within hospitals. We experienced a nosocomial outbreak of COVID-19 in the setting of a daycare unit for paediatric and young adult cancer patients. Between 9 and 18 November 2020, 473 individuals (181 patients, 247 caregivers/siblings and 45 staff members) were exposed to the index case, who was a nursing staff. Among them, three patients and four caregivers were infected. Two 5-year-old cancer patients with COVID-19 were not severely ill, but a 25-year-old cancer patient showed prolonged shedding of SARS-CoV-2 RNA for at least 12 weeks, which probably infected his mother at home approximately 7–8 weeks after the initial diagnosis. Except for this case, no secondary transmission was observed from the confirmed cases in either the hospital or the community. To conclude, in the day care setting of immunocompromised children and young adults, the rate of in-hospital transmission of SARS-CoV-2 was 1.6% when applying the stringent policy of infection prevention and control, including universal mask application and rapid and extensive contact investigation. Severely immunocompromised children/young adults with COVID-19 would have to be carefully managed after the mandatory isolation period while keeping the possibility of prolonged shedding of live virus in mind.
A high-order transition route from inertial to elasticity-dominated turbulence (EDT) in Taylor–Couette flows of polymeric solutions has been discovered via direct numerical simulations. This novel two-step transition route is realized by enhancing the extensional viscosity and hoop stresses of the polymeric solution via increasing the maximum chain extension at a fixed polymer concentration. Specifically, in the first step inertial turbulence is stabilized to a laminar flow much like the modulated wavy vortex flow. The second step destabilizes this laminar flow state to EDT, i.e. a spatially smooth and temporally random flow with a $-3.5$ scaling law of the energy spectrum reminiscent of elastic turbulence. The flow states involved are distinctly different to those observed in the reverse transition route from inertial turbulence via a relaminarization of the flow to elasto-inertial turbulence in parallel shear flows, underscoring the importance of polymer-induced hoop stresses in realizing EDT that are absent in parallel shear flows.
The flow physics of inertio-elastic turbulent Taylor–Couette flow for a radius ratio of $0.5$ in the Reynolds number ($Re$) range of $500$ to $8000$ is investigated via direct numerical simulation. It is shown that as $Re$ is increased the turbulence dynamics can be subdivided into two distinct regimes: (i) a low $Re \leqslant 1000$ regime where the flow physics is essentially dominated by nonlinear elastic forces and the main contribution to transport and mixing of momentum, stress and energy comes from large-scale flow structures in the bulk region and (ii) a high $Re \geqslant 5000$ regime where inertial forces govern the flow physics and the flow dynamics is mainly governed by small-scale flow structures in the near-wall region. Flow–microstructure coupling analysis reveals that the elastic Görtler instability in the near-wall region is triggered via significant polymer extension and commensurately high hoop stresses. This instability gives rise to small-scale elastic vortical structures identified as elastic Görtler vortices which are present at all $Re$ considered. In fact, these vortices develop herringbone streaks near the inner wall that have a longer average life span than their Newtonian counterparts due to their elastic origin. Examination of the budgets of mean streamwise enstrophy, mean kinetic energy, turbulent kinetic energy and Reynolds shear stress demonstrates that increasing fluid inertia hinders the generation of elastic stresses, leading to a monotonic reduction of the elastic-related effects on the flow physics.
Regional planning may help to ensure that the specific measures implemented as part of a national suicide prevention strategy are aligned with the varying needs of local services and communities; however, there are concerns that the reliability of local programme development may be limited in practice.
Aims
The potential impacts of independent regional planning on the effectiveness of suicide prevention programmes in the Australian state of New South Wales were quantified using a system dynamics model of mental health services provision and suicidal behaviour in each of the state's ten Primary Health Network (PHN) catchments.
Method
Reductions in projected suicide mortality over the period 2021–2031 were calculated for scenarios in which combinations of four and five suicide prevention and mental health services interventions (selected from 13 possible interventions) are implemented separately in each PHN catchment. State-level impacts were estimated by summing reductions in projected suicide mortality for each intervention combination across PHN catchments.
Results
The most effective state-level combinations of four and five interventions prevent, respectively, 20.3% and 22.9% of 10 312 suicides projected under a business-as-usual scenario (i.e. no new policies or programmes, constant services capacity growth). Projected numbers of suicides under the optimal intervention scenarios for each PHN are up to 6% lower than corresponding numbers of suicides projected for the optimal state-level intervention combinations.
Conclusions
Regional suicide prevention planning may contribute to significant reductions in suicide mortality where local health authorities are provided with the necessary resources and tools to support reliable, evidence-based decision-making.
The aim of this study was to explore the effects and mechanisms of different starvation treatments on the compensatory growth of Acipenser dabryanus. A total of 120 fish (60·532 (sem 0·284) g) were randomly assigned to four groups (fasting 0, 3, 7 or 14 d and then refed for 14 d). During fasting, middle body weight decreased significantly with prolonged starvation. The whole-body and muscle composition, serum biochemical indexes, visceral indexes and digestive enzyme activities had been effected with varying degrees of changes. The growth hormone (GH) level in serum was significantly increased in 14D; however, insulin-like growth factor-1 (IGF-1) showed the opposite trend. The neuropeptide Y (npy) mRNA level in brain was significantly improved in 7D; peptide YY (pyy) mRNA level in intestine was significantly decreased during fasting. After refeeding, the final body weight, percentage weight gain, specific growth rate, feed intake, feed efficiency and protein efficiency ratio showed no difference between 0D and 3D. The changes of whole-body and muscle composition, serum biochemical indexes, visceral indexes and digestive enzyme activities had taken place in varying degrees. GH levels in 3D and 7D were significantly higher than those in the 0D; the IGF-1 content decreased significantly during refeeding. There was no significant difference in npy and pyy mRNA levels. These results indicated that short-term fasting followed by refeeding resulted in full compensation and the physiological and biochemical effects on A. dabryanus were the lowest after 3 d of starvation and 14 d of refeeding. Additionally, compensation in A. dabryanus may be mediated by appetite genes and GH, and the degree of compensation is also affected by the duration of starvation.
Predictors of compliance with aspirin in children following cardiac catheterisation have not been identified. The aim of this study is to identify the caregivers’ knowledge, compliance with aspirin medication, and predictors of compliance with aspirin in children with Congenital Heart Disease (CHD) post-percutaneous transcatheter occlusion.
Methods:
A cross-sectional explorative design was adopted using a self-administered questionnaire and conducted between May 2017 and May 2018. Recruited were 220 caregivers of children with CHD post-percutaneous transcatheter occlusion. Questionnaires included child and caregivers’ characteristics, a self-designed and tested knowledge about aspirin scale (scoring scale 0–2), and the 8-item Morisky Medication Adherence Scale (scoring scale 0–8). Data were analysed using multivariate binary logistic regression analysis to identify predictors of compliance with aspirin.
Results:
Of the 220 eligible children and caregivers, 210 (95.5%) responded and 209 surveys were included in the analysis. The mean score of knowledge was 7.25 (standard deviation 2.27). The mean score of compliance was 5.65 (standard deviation 1.36). Child’s age, length of aspirin use, health insurance policies, relationship to child, monthly income, and knowledge about aspirin of caregivers were independent predictors of compliance with aspirin (p < 0.05).
Conclusion:
Caregivers of children with CHD had an adequate level of knowledge about aspirin. Compliance to aspirin medication reported by caregivers was low. Predictors of medium to high compliance with aspirin were related to the child’s age and socio-economic reasons. Further studies are needed to identify effective strategies to improve knowledge, compliance with medication, and long-term outcomes of children with CHD.
We report our experience with an emergency room (ER) shutdown related to an accidental exposure to a patient with coronavirus disease 2019 (COVID-19) who had not been isolated.
Setting:
A 635-bed, tertiary-care hospital in Daegu, South Korea.
Methods:
To prevent nosocomial transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. Severe acute respiratory coronavirus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction assays (RT-PCR) were performed for most patients requiring hospitalization. A universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. We analyzed effects of these interventions.
Results:
From the pre-shutdown period (February 10–25, 2020) to the post-shutdown period (February 28 to March 16, 2020), the mean hourly turnaround time decreased from 23:31 ±6:43 hours to 9:27 ±3:41 hours (P < .001). As a result, the proportion of the patients tested increased from 5.8% (N=1,037) to 64.6% (N=690) (P < .001) and the average number of tests per day increased from 3.8±4.3 to 24.7±5.0 (P < .001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or nosocomial transmission. After the shutdown, several metrics increased. The median duration of stay in the ER among hospitalized patients increased from 4:30 hours (interquartile range [IQR], 2:17–9:48) to 14:33 hours (IQR, 6:55–24:50) (P < .001). Rates of intensive care unit admissions increased from 1.4% to 2.9% (P = .023), and mortality increased from 0.9% to 3.0% (P = .001).
Conclusions:
Problematic accidental exposure and nosocomial transmission of COVID-19 can be successfully prevented through active isolation and surveillance policies and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during a severe COVID-19 outbreak.
To identify the association of the glucokinase gene (GCK) rs4607517 polymorphism with gestational diabetes mellitus (GDM) and determine whether sweets consumption could interact with the polymorphism on GDM in Chinese women.
Design:
We conducted a case–control study at a hospital including 1015 participants (562 GDM cases and 453 controls). We collected the data of pre-pregnancy BMI, sweets consumption and performed genotyping of the GCK rs4607517 polymorphism. Logistic regression was performed to test the association between the rs4607517 polymorphism and GDM, and the stratified analyses by sweets consumption were conducted, using an additive genetic model.
Setting:
A case–control study of women at a hospital in Beijing, China.
Participants
One thousand and fifteen Chinese women.
Results:
The GCK rs4607517 A allele was significantly associated with GDM (OR 1·35, 95 % CI 1·03, 1·77; P = 0·028). Furthermore, stratified analyses showed that the A allele increased the risk of GDM only in women who had a habitual consumption of sweet foods (sweets consumption ≥ once per week) (OR 1·61, 95 % CI 1·17, 2·21; P = 0·003). Significant interaction on GDM was found between the rs4607517 A allele and sweets consumption (P = 0·004).
Conclusions:
This study for the first time reported the interaction between the GCK rs4607517 polymorphism and sweets consumption on GDM. The results provided novel evidence for risk assessment and personalised prevention of GDM.