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Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.
Evidence suggests that autism and schizophrenia share similarities in genetic, neuropsychological and behavioural aspects. Although both disorders are associated with theory of mind (ToM) impairments, a few studies have directly compared ToM between autism patients and schizophrenia patients. This study aimed to investigate to what extent high-functioning autism patients and schizophrenia patients share and differ in ToM performance.
Thirty high-functioning autism patients, 30 schizophrenia patients and 30 healthy individuals were recruited. Participants were matched in age, gender and estimated intelligence quotient. The verbal-based Faux Pas Task and the visual-based Yoni Task were utilised to examine first- and higher-order, affective and cognitive ToM. The task/item difficulty of two paradigms was examined using mixed model analyses of variance (ANOVAs). Multiple ANOVAs and mixed model ANOVAs were used to examine group differences in ToM.
The Faux Pas Task was more difficult than the Yoni Task. High-functioning autism patients showed more severely impaired verbal-based ToM in the Faux Pas Task, but shared similar visual-based ToM impairments in the Yoni Task with schizophrenia patients.
The findings that individuals with high-functioning autism shared similar but more severe impairments in verbal ToM than individuals with schizophrenia support the autism–schizophrenia continuum. The finding that verbal-based but not visual-based ToM was more impaired in high-functioning autism patients than schizophrenia patients could be attributable to the varied task/item difficulty between the two paradigms.
To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness.
This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015.
The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing.
We assessed various components of all-hazards preparedness using a 25-item questionnaire. Backward logistic regression was used to identify factors associated with perceived preparedness.
A total of 107 responses were analyzed. Respondents lacked training in disaster management, emergency communication, psychological first aid, public health interventions, disaster law and ethics, media handling, and humanitarian response in an overseas setting. High perceived workplace preparedness, length of practice, and willingness to respond were associated with high perceived personal preparedness.
Given the current gaps in and needs for increased disaster preparedness training, ED doctors and nurses in Hong Kong may benefit from the development of core-competency-based training targeting the under-trained areas, measures to improve staff confidence in their workplaces, and efforts to remove barriers to staff willingness to respond. (Disaster Med Public Health Preparedness. 2018; 12: 329–336)
To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).
We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.
Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).
Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.
Limitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).
To incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.
Retrospective cohort study.
Kaiser Permanente Southern California.
Members of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.
Hospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.
A total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.
Although type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.
Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416
Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.
Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.
Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.
The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.
To investigate and compare the performance of head mirrors and headlights during otolaryngological examination.
The illuminance and illumination field of each device were measured and compared. Visual identification and visual acuity were also measured, in 13 medical students and 10 otolaryngology specialists.
The illuminance (mean ± standard deviation) of the LumiView, Kimscope 1 W and Kimscope 3 W headlights and a standard head mirror were 352.3 ± 9, 92.3 ± 4.5, 438 ± 15.7 and 68.3 ± 1.2 lux, respectively. The illumination field of the head mirror (mean ± standard deviation) was 348 ± 29.8 grids, significantly greater than that of the Kimscope 3 W headlight (183 ± 9.2 grids) (p = 0.0017). The student group showed no statistically significant difference between visual identification with the best headlight and the head mirror (score means ± standard deviations: 56.2 ± 9 and 53.3 ± 14.1, respectively; p = 0.3). The expert group scored significantly higher for visual identification with head mirrors versus headlights (59.7 ± 3.3 vs 55.2 ± 5.8, respectively; p = 0.0035), but showed no difference for visual acuity.
Despite the advantages of headlight illumination, head mirrors provided better, shadow-free illumination. Despite no differences amongst students, head mirrors performed better than headlights in experienced hands.
In this paper, the first-order ordinary differential constitutive equations of endochronic theory were combined with the principle of virtual work for simulating the response of creep (moment is kept constant for a period of time) or relaxation (curvature is kept constant for a period of time) of thin-walled tubes subjected to pure bending with different curvature-rates at the preloading stage. A group of Fourier series was used to describe the circumferential displacements of the tube. Thus, a system of nonlinear algebraic equations was determined. This system of equations can be solved by numerical method. Experimental data tested by Pan and Fan  were compared with the theoretical simulations in this study. It is shown that the theoretical formulations effectively simulate the experimental data.
The Sichuan earthquake on 12 May 2008 with a magnitude of 8.0 killed > 87,000 people. The response of the Hong Kong Red Cross (HKRC) included a basic healthcare team to a small rural town called Yanmen three weeks after the earthquake. The objective of this study was to review HKRC's medical records to identify the disease pattern in the Chinese rural setting post earthquake.
A cross-sectional, record-based study of all patients treated by the HKRC basic healthcare team from 01 June to 19 June 2008. This retrospective study studied the medical records collected during the clinical consultations, and descriptive analysis was performed for the demographic and clinical information. Blood pressure measurement was classified according to the JNC-7 classification, and the age- and gender-specific prevalence of hypertension was sought.
A total of 2,034 cases were seen during the 19-day period with daily attendance ranging from 73 to 153 cases. Musculoskeletal, respiratory, and gastrointestinal problems were the top three categories and accounted for 30.4, 17.4, and 12.7% respectively. Trauma accounted for 5.4% of the cases attended, and 26.0% of the injuries were related to the earthquake. A total of 38.7% of the consultations were for medical problems that existed before the earthquake. A total of 43.4% patients with blood pressure measurements were above the recognized cutoff for hypertension.
Due to the impact and time phase post disaster, trauma, and injuries directly resulting from the earthquake did not contribute to a large number of cases. However, the management of chronic illness was an important issue, especially with the excessive prevalence of high blood pressure found in this study. Further studies to investigate the relationship between chronic diseases including hypertension and post-earthquake conditions are needed.
Nosocomial outbreaks of norovirus infection pose a great challenge to the infection control team.
Between November 1, 2009, and February 28, 2010, strategic infection control measures were implemented in a hospital network. In addition to timely staff education and promotion of directly observed hand hygiene, reverse-transcription polymerase chain reaction for norovirus was performed as an added test by the microbiology laboratory for all fecal specimens irrespective of the request for testing. Laboratory-confirmed cases were followed up by the infection control team for timely intervention. The incidence of hospital-acquired norovirus infection per 1,000 potentially infectious patient-days was compared with the corresponding period in the preceding 12 months, and the incidence in the other 6 hospital networks in Hong Kong was chosen as the concurrent control. Phylogenetic analysis of norovirus isolates was performed.
Of the 988 patients who were tested, 242 (25%) were positive for norovirus; 114 (47%) of those 242 patients had norovirus detected by our added test. Compared with the corresponding period in the preceding 12 months, the incidence of hospital-acquired norovirus infection decreased from 131 to 16 cases per 1,000 potentially infectious patient-days (P < .001 ), although the number of hospital-acquired infections was low in both the study period (n = 8) and the historical control periods (n = 11). The incidence of hospital-acquired norovirus infection in our hospital network (0.03 cases per 1,000 patient-days) was significantly lower than that of the concurrent control (0.06 cases per 1,000 patient-days) (P = .015). Forty-three (93%) of 46 norovirus isolates sequenced belonged to the genogroup II.4 variant.
Strategic infection control measures with an added test maybe useful in controlling nosocomial transmission of norovirus.
In this paper, an experimental investigation on the variation of ovalization for sharp-notched circular tubes subjected to cyclic bending is discussed. The tube bending machine and curvature-ovalization measurement apparatus were used to test the unnotched and sharp-notched 304 stainless steel tubes. For sharp-notched tubes, five different notch depths (0.2, 0.4, 0.6, 0.8 and 1.0mm) were considered in this study. It was found that the experimental curve of the ovalization and the number of cycles could be divided into three stages-an initial, secondary and tertiary stage. An empirical relationship was proposed for simulating the aforementioned curve for the initial and secondary stages in this study. It has been shown that the derived empirical relationship was in good agreement with the experimental data.
A theoretical approach for an optical lens tip on a single-mode fiber end to improve power coupling from laser diode is presented in this work. The lens shape considered here is an ellipsoid. Based on scalar diffraction and Gaussian mode shapes for the laser and fiber fields, a theoretical model is developed to predict the coupling performance of this microlens. Theoretically, both a high coupling efficiency up to 77% and a large alignment tolerance for 10% off-peak are achieved. The proposed method facilitates mass production to achieve a high-yield and high-coupling efficiency that is suitable to be used in the commercial fiber transmission industry.
Daily and hourly variations in microbial indicators densities in the beach-waters of Hong Kong have been described. The levels of Escherichia coli at a number of beaches was observed to be influenced by tide, and for staphylococci, by bather numbers. The tidal influence was most obvious during spring tides; and for the effect of bathers, during neap tides. Both organisms are present in high densities in external sources of faecal pollution of bathing beaches, with the average staphylococci to E. coli ratios being 0·04–3. Staphylococci may serve as an indicator of bather density and the risk of cross-infection amongst bathers (rather than as another indicator of faecal contamination) when the average staphylococci to E. coli ratio for a bathing beach is considerably higher than 3. The variability of microbial indicator densities means the routine sampling of bathing beaches should be carried out on weekend days with maximum numbers of swimmers exposed to the water, and spread throughout the bathing season.
Prospective epidemiological studies of beach water pollution were conducted in Hong Kong in the summers of 1986 and 1987. For the main study in 1987, a total of 18741 usable responses were obtained from beachgoers on nine beaches at weekends. The study indicated the overall perceived symptom rates for gastrointestinal, ear, eye, skin, respiratory, fever and total illness were significantly higher for swimmers than non-swimmers; and the swimming-associated symptom rates for gastrointestinal, skin, respiratory and total illness were higher at ‘barely acceptable’ beaches than at ‘relatively unpolluted’ ones. Escherichia coli was found to be the best indicator of the health effects associated with swimming in the beaches of Hong Kong. It showed the highest correlation with combined swimming-associated gastroenteritis and skin symptom rates when compared with other microbial indicators. A linear relationship between E. coli and the combined symptom rates was established. Staphylococci were correlated with ear, respiratory and total illness, but could not be used for predicting swimming-associated health risks. They should be used to complement E. coli. The setting of health-related bathing-water quality standards based on such a study is discussed.
We examine the possibility that Ultraluminous X-ray sources (ULXs) represent the extreme end of the black hole X-ray binary (XRB) population. Based on their X-ray properties, we suggest that ULXs are persistently in a high/hard spectral state and we propose a new disk–jet model that can accomodate both a high accretion rate and a hard X-ray spectrum. Our model predicts that the modified disk emission can be substantially softer than that predicted by a standard disk as a result of jet cooling and this may explain the unusually soft components that are sometimes present in the spectra of bright ULXs. We also show that relativistic beaming of jet emission can indeed account for the high X-ray luminosities of ULXs, but strong beaming produces hard X-ray spectra that are inconsistent with observations. We predict the beamed synchrotron radio emission should have a flat spectrum with a flux density ≲0.01 mJy.