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Understanding the extent of aerosol-based transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is important for tailoring interventions for control of the coronavirus disease 2019 (COVID-19) pandemic. Multiple studies have reported the detection of SARS-CoV-2 nucleic acid in air samples, but only one study has successfully recovered viable virus, although it is limited by its small sample size.
We aimed to determine the extent of shedding of viable SARS-CoV-2 in respiratory aerosols from COVID-19 patients.
In this observational air sampling study, air samples from airborne-infection isolation rooms (AIIRs) and a community isolation facility (CIF) housing COVID-19 patients were collected using a water vapor condensation method into liquid collection media. Samples were tested for presence of SARS-CoV-2 nucleic acid using quantitative real-time polymerase chain reaction (qRT-PCR), and qRT-PCR-positive samples were tested for viability using viral culture.
Samples from 6 (50%) of the 12 sampling cycles in hospital rooms were positive for SARS-CoV-2 RNA, including aerosols ranging from <1 µm to >4 µm in diameter. Of 9 samples from the CIF, 1 was positive via qRT-PCR. Viral RNA concentrations ranged from 179 to 2,738 ORF1ab gene copies per cubic meter of air. Virus cultures were negative after 4 blind passages.
Although SARS-CoV-2 is readily captured in aerosols, virus culture remains challenging despite optimized sampling methodologies to preserve virus viability. Further studies on aerosol-based transmission and control of SARS-CoV-2 are needed.
Given the dynamic characteristic of an individual’s drinking behaviors, comprehensive consideration of alcohol consumption variation using repeated measures may improve insight into the nature of its association with blood pressure (BP) change. We examined the association between longitudinal alcohol consumption (trajectory and quantity) and changes in BP and pulse pressure (PP) among Korean aged ≥40 years living in rural areas. Totally, 1682 hypertension-free participants who completed all three health examinations (median, 5.3 years) were included. All three visits were used to determine the cumulative trajectory of and quantity of alcohol consumption and the latest two visits and the last visit were used for the recent trajectory and the most recent quantity of alcohol consumption, respectively. Changes in BP and PP from the baseline to the 3rd visit were used as outcome. In men, ≥30 ml/d cumulative average alcohol consumption was associated with the greatest increase in systolic BP (SBP) in both baseline outcome-unadjusted (2.9 mmHg, p-value = 0.032) and -adjusted models (3.6 mmHg, p-value = 0.001) and the given association for the most recent alcohol consumption was observed in the baseline outcome-adjusted model (3.9 mmHg, p-value = 0.003). For PP, similar associations were observed only in the baseline outcome-adjusted model. No meaningful associations in diastolic BP in men and any BP or PP in women existed. The quantity of alcohol consumption than the trajectory may be significantly related to raised SBP and a possible short-term influence of the most recent alcohol consumption may exist when baseline SBP adjusted in men.
We calculated the human resources required for an antimicrobial stewardship program (ASP) in Korean hospitals.
Multicenter retrospective study.
Eight Korean hospitals ranging in size from 295 to 1,337 beds.
The time required for performing ASP activities for all hospitalized patients under antibiotic therapy was estimated and converted into hours per week. The actual time spent on patient reviews of each ASP activity was measured with a small number of cases, then the total time was estimated by applying the determined times to a larger number of cases. Full-time equivalents (FTEs) were measured according to labor laws in Korea (52 hours per week).
In total, 225 cases were reviewed to measure time spent on patient reviews. The median time spent per patient review for ASP activities ranged from 10 to 16 minutes. The total time spent on the review for all hospitalized patients was estimated using the observed number of ASP activities for 1,534 patients who underwent antibiotic therapy on surveillance days. The most commonly observed ASP activity was ‘review of surgical prophylactic antibiotics’ (32.7%), followed by ‘appropriate antibiotics recommendations for patients with suspected infection without a proven site of infection but without causative pathogens’ (28.6%). The personnel requirement was calculated as 1.20 FTEs (interquartile range [IQR], 1.02–1.38) per 100 beds and 2.28 FTEs (IQR, 1.93–2.62) per 100 patients who underwent antibiotic therapy, respectively.
The estimated time required for human resources performing extensive ASP activities on all hospitalized patients undergoing antibiotic therapy in Korean hospitals was ~1.20 FTEs (IQR, 1.02–1.38) per 100 beds.
The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities.
In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards.
In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture.
Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.
Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
A new species of chionelasmatid sessile vent barnacle, Eochionelasmus coreana sp. nov., is described and illustrated on the basis of specimens collected from the Solitaire hydrothermal vent field in the Central Indian Ridge of the Indian Ocean. This new species is morphologically very similar to E. ohtai, the type species of the genus Eochionelasmus. However, it differs from E. ohtai in its distribution, the status of the notch on the maxillule, and the positions of rl1 and cl1 on whorls of the imbricating plates. In addition, a molecular phylogenetic tree indicated that the chionelasmatid Eochionelasmus was closely related to the waikalasmatid Waikalasma with high supporting values rather than the other chionelasmatid Chionelasmus. The new species is not only the first record of a sessile vent barnacle from outside of the Pacific Ocean, but is also the first sessile barnacle from the Indian Ocean.
In this chapter, we have introduced existing solutions in the literature aiming to improve the performance of ambient backscatter communication systems (ABCSs). We have first provided the reviews on several multiple access schemes that allows multiple transmitters backscatter data to the receiver. Then, solutions focusing on improving the communication range, bitrate, reliability, and robustness are presented in details. Finally, we have discussed challenges and future research directions to further improve the performance of ABCSs.
In this chapter, we have provided an overview of ambient backscatter communication systems. Firstly, we have introduced the fundamentals of modulated backscatter and its three main configurations, i.e., monostatic, bistatic, and ambient backscatter communication systems. Then, key channel-coding and modulation techniques in modulated backscatter communication systems are discussed. Two major types of backscatter communication channels and their link budgets are also introduced. Next, theoretical analyses and experimental measurements of backscatter channels are reviewed. Finally, we have discussed some research challenges of backscatter communication systems, especially ambient backscatter communication systems.
This chapter discussed open issues and potential research directions for future developemnt of ambient backscatter communication. Many emerging research directions are presented in this chapter such as full-duplex ambient backscatter, ultra-wideband backscatter, visible-light backscactter, and millimeter-wave backscatter.
The performance analysis for ambient backscatter communication systems is fundamentally different from that of traditional communication systems. The carrier signal of backscatter communication is opportunistically exploited from the existing active radio-frequency communication systems. As it is vulnerable to channel variations, different detection and encoding mechanisms have been proposed and analyzed to improve the system throughput or ergodic capacity. In this chapter, we have focused on the analysis of signal detection and bit-error rate (BER) performance for backscatter communication. We have reviewed the different system models for backscatter communication systems and various signal detection approaches under different resource and physical constraints.
In this chapter, we have introduced the fundamentals of self-sustaining wireless communication networks. We have first provided the overviews of conventional energy harvesting networks, i.e., wireless-powered transfer, wireless-powered communication network, and simultaneous wireless information and power transfer, as well as their applications in the literature. Then, we have introduced ambient backscatter communications in terms of architecture, design, advantages, and limitations. Finally, we have discussed potential applications and implementation of ambient backscatter communication system networks such as smart world, biomedical, and logistics.
In this chapter, we first give a brief overview about the development of cognitive radio networks (CRNs), from traditional CRNs to the recent development of wireless energy harvesting for CRNs. Then, we discuss how to integrate ambient backscatter communication techniques to radio-frequency (RF)-powered CRNs, and present two fundamental models for this integration. After that, we discuss recent advanced models of RF-powered CRNs with ambient backscatter communication with more details about system design, communication protocols, and performance optimization problems. Finally, some open issues for the development of RF-powered backscatter CRNs are presented.