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Coronavirus disease 2019 (COVID-19) has migrated to regions that were initially spared, and it is likely that different populations are currently at risk for illness. Herein, we present our observations of the change in characteristics and resource use of COVID-19 patients over time in a national system of community hospitals to help inform those managing surge planning, operational management, and future policy decisions.
To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.
Retrospective analysis of patient data collected from the routine care of COVID-19 patients.
System of >180 acute-care facilities in the United States.
All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.
Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.
In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06–1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06–1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21–2.03; P < .001).
The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
Background: Trauma care represents a complex patient journey, requiring multi-disciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, cooperation and coordination across diverse groups. Aim Statement: We aimed to define and set the agenda for improvement of the relational aspects of trauma care at a large tertiary care hospital. Measures & Design: We conducted a mixed-methods collaborative ethnography using the Relational Coordination survey – an established tool to analyze the relational dimensions of multidisciplinary teamwork – participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Evaluation/Results: We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants and are now being implemented and evaluated by various trauma care providers. Discussion/Impact: Through engagement of clinicians spanning organizational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage health care leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
Studies estimating the human health impact of the foodborne disease often include estimates of the number of gastroenteritis hospitalisations. The aims of this study were to examine the degree to which hospital discharge data underreport hospitalisations due to bacterial gastroenteritis and to estimate the frequency of stool sample submission among patients presenting with gastroenteritis. Using linked laboratory and hospital discharge data from a healthcare organisation and its affiliated hospital, we examined the International Classification of Disease (ICD-9-CM) diagnosis codes assigned to hospitalised adults with culture-confirmed Campylobacter, Salmonella, or Escherichia coli O157 infections and determined the frequency of stool sample submission. Among 138 hospitalised patients with culture-confirmed infections, 43% of Campylobacter patients, 56% of Salmonella patients and 35% of E. coli O157 patients had that pathogen-specific code listed on the discharge record. Among patients without their infection listed as a diagnosis, 65% were assigned a nonspecific gastroenteritis code. Submitting a specimen for culture ⩾3 days before discharge was significantly associated with having the pathogen-specific diagnosis listed. Of 6181 patients assigned a nonspecific gastroenteritis code, 69% had submitted a stool sample for bacterial culture. This study can be used to understand differences and adjust for the underreporting and underdiagnosed of Campylobacter, Salmonella and E. coli O157 in hospital discharge and surveillance data, respectively.
The James Webb Space Telescope (JWST) is scheduled for launch in 2018. To operate and observe efficiently, JWST will rely on various external astrometric and photometric catalogues, in particular the HST Guide Star Catalog (GSC), for instance to locate sources accurately on the sky. The incorporation of the Gaia astrometric catalog will improve the absolute astrometry of the GSC and is therefore relevant for JWST operations. We outline how the JWST Science and Operations Center hosted at the Space Telescope Science Institute (STScI) intends to use the Gaia survey results to improve upon operational aspects such as the guiding and the geometric focal plane characterisation of JWST.
A synthesis of the upper Moscovian sedimentological and palaeontological record of terrestrial habitats across the Variscan foreland and adjacent intramontane basins (an area which is referred to here as Variscan Euramerica) suggests a contraction and progressive westward shift of the coal swamps. These changes can be correlated with pulses of tectonic activity (tectonic phases) resulting from the northwards migration of the Variscan Front. This tectonic activity caused disruption to the landscapes and drainage patterns where the coal swamps were growing, which became less suitable to growth of the dominant plants of the swamps, the arborescent lycopsids. They were progressively replaced by vegetation dominated by marattialean ferns, which through a combination of slower growth and larger canopies resulted in less evapo-transpiration. This in turn caused localised reductions in rainfall, which further affected the ability of the lycopsids to dominate the swamp vegetation. These changes were initially localised and where the coal swamps were able to survive the lycopsids and pteridosperms show little change in either species diversity or biogeography, indicating that at this time there was minimal regional-scale climate change taking place. By Asturian times, however, the process had accelerated and the swamps in Variscan Euramerica became progressively replaced by predominantly conifer and cordaite vegetation that favoured much drier substrates. Except in localised pockets in intramontane basins of the Variscan Mountains, the last development of coal swamps in Variscan Euramerica was of early Cantabrian age. Further west, lycopsid-dominated coal swamps persisted for a little longer. The last remnants of the lycopsid-dominated coal swamps in the Illinois Basin disappeared probably by middle-late Cantabrian times, as the cycle of contracting wetlands and regional reductions in rainfall generated its own momentum, and no longer needed the impetus of tectonic instability. This tectonically-driven decline in the Euramerican coal swamps was probably responsible for an annual increase in atmospheric CO2 of c. 0.37 ppm, and may have been implicated in the marked increase in global temperatures near the Moscovian – Kasimovian boundary, and the onset of the Late Pennsylvanian interglacial.
Based on the database of 56 supernovae (SNe) events discovered in 3838 galaxies of the southern hemisphere, we compute the rate of SNe of different types along the Hubble sequence normalized to the optical and near-infrared (NIR) luminosities as well as to the stellar mass of the galaxies. We find that the rates of Type Ia SNe show a dependence on both morphology and colors of the galaxies, and therefore, on the star-formation activity. The rate of SNe Ia can be explained by assuming that at least 15% of Ia events in spiral galaxies originate in relatively young stellar populations. We also find that the rates show no modulation with nuclear activity or environment.
Uncertainties exist regarding the population risks of hospitalization due to pandemic influenza A(H1N1). Understanding these risks is important for patients, clinicians and policy makers. This study aimed to clarify these uncertainties. A national surveillance system was established for patients hospitalized with laboratory-confirmed pandemic influenza A(H1N1) in England. Information was captured on demographics, pre-existing conditions, treatment and outcomes. The relative risks of hospitalization associated with pre-existing conditions were estimated by combining the captured data with population prevalence estimates. A total of 2416 hospitalizations were reported up to 6 January 2010. Within the population, 4·7 people/100 000 were hospitalized with pandemic influenza A(H1N1). The estimated hospitalization rate of cases showed a U-shaped distribution with age. Chronic kidney disease, chronic neurological disease, chronic respiratory disease and immunosuppression were each associated with a 10- to 20-fold increased risk of hospitalization. Patients who received antiviral medication within 48 h of symptom onset were less likely to be admitted to critical care than those who received them after this time (adjusted odds ratio 0·64, 95% confidence interval 0·44–0·94, P=0·024). In England the risk of hospitalization with pandemic influenza A(H1N1) has been concentrated in the young and those with pre-existing conditions. By quantifying these risks, this study will prove useful in planning for the next winter in the northern and southern hemispheres, and for future pandemics.
The UK was one of few European countries to document a substantial wave of pandemic (H1N1) 2009 influenza in summer 2009. The First Few Hundred (FF100) project ran from April–June 2009 gathering information on early laboratory-confirmed cases across the UK. In total, 392 confirmed cases were followed up. Children were predominantly affected (median age 15 years, IQR 10–27). Symptoms were mild and similar to seasonal influenza, with the exception of diarrhoea, which was reported by 27%. Eleven per cent of all cases had an underlying medical condition, similar to the general population. The majority (92%) were treated with antiviral drugs with 12% reporting adverse effects, mainly nausea and other gastrointestinal complaints. Duration of illness was significantly shorter when antivirals were given within 48 h of onset (median 5 vs. 9 days, P=0·01). No patients died, although 14 were hospitalized, of whom three required mechanical ventilation. The FF100 identified key clinical and epidemiological characteristics of infection with this novel virus in near real-time.
Sera from 218 of 1574 (14%) small mammals collected in the Yukon Territory between 14 May and 13 August 1972 neutralized a Yukon strain of California encephalitis virus (snowshoe-hare subtype). These included 133 of 319 (42%) snowshoe hares (Lepus americanus), 84 of 1243 (7%) ground squirrels (Citellus undulatus) and 1 of 12 (8%) tree squirrels (Tamiasciurus hudsonicus). California encephalitis virus (snow-shoe hare subtype) was isolated from four pools of unengorged Aedes communis mosquitoes collected near Whitehorse (61° N., 135° W.) and on one occasion each from pools of the same species collected at Hunker Creek (64° N., 138° W.) and at mile 125, Dempster Highway (66° N., 138° W.) during July 1972. Replication of a Yukon strain of California encephalitis virus was observed in wild-caught Culiseta inornata and Aedes canadensis mosquitoes after intrathoracic injection and holding at temperatures of 80°, 50° and 40° F.
Texel muscling quantitative trait locus (TM-QTL) is a QTL on chromosome 18, originally identified in purebred UK Texel sheep, which was reported to increase ultrasonically measured muscle depth at the third lumbar vertebra by around 4% to 7%. The objective of the present study was to comprehensively evaluate the TM-QTL and to determine whether it could provide benefits to the UK sheep industry through increased carcass meat yield in crossbred slaughter lambs. Effects of this QTL on a range of carcass traits, including those measured in vivo and by dissection, were evaluated in heterozygous carrier and non-carrier lambs produced by crossing heterozygous carrier Texel rams with non-carrier Mule (Bluefaced Leicester × Scottish Blackface) ewes from a lowland flock. The TM-QTL was found to increase loin muscling in crossbred lambs at a given live weight or carcass weight, as measured by ultrasound, X-ray computed tomography (CT) and carcass dissection. Depth of M. longissimus lumborum (MLL) was greater in TM-QTL carrier lambs compared to non-carriers as measured by both ultrasound at the third lumbar vertebra (+4.5%; P = 0.033) and CT scanning at the fifth lumbar vertebra (+6.7%; P = 0.004). Width and area of MLL measured using CT were also greater in TM-QTL carrier lambs compared to non-carriers (+3.0%; P = 0.013 and +5.1%; P = 0.047, respectively). Loin muscle volume measured using CT was greater in TM-QTL carriers than in non-carriers (+5.9%; P = 0.005) and the dissected weight of the MLL was +7.1% greater in TM-QTL carriers compared to non-carriers (P < 0.001). The proportion of the total carcass lean meat yield (LMY) that was contained within the loin region was slightly higher in TM-QTL carriers than in non-carriers (0.154 v. 0.145; P = 0.006). However, TM-QTL was found to have no significant effect on the total weight or proportion of LMY or of saleable meat yield in the carcass measured by dissection, or on muscling in the hind leg measured by CT or dissection. This work has verified that the inheritance of TM-QTL is associated with increased loin muscling in crossbred lambs, as has previously been reported for purebred Texel lambs.
A QTL (TM-QTL) identified on ovine chromosome 18 (Walling et al., 2004), which increases loin muscle depth by 4-8% in UK Texel sheep, is of interest for the sheep industry as a potential means to increase carcass value. Since the contribution of Texel genes to the UK slaughter generation is generally through use of Texel sires to produce crossbred slaughter lambs (e.g. Texel x Mule lambs), it is necessary to verify the effects of the TM-QTL on loin muscularity and other carcass traits in such crossbred progeny of Texel sires before explotiation of the TM-QTL in commercial sheep populations.
A rise in invasive Haemophilus influenzae type b (Hib) infections occurred 8 years after vaccine introduction in the United Kingdom. Aspects of Hib vaccine delivery unique to the United Kingdom have been implicated. The authors developed a fully age-structured deterministic susceptible–infected–resistant–susceptible mathematical model, expressed as a set of partial differential equations, to better understand the causes of declining vaccine effectiveness. We also investigated the consequences of the vaccine's impact on reducing Hib transmission for maintenance of immunity. Our findings emphasized the importance of maintaining high post-immunization antibody titres among age groups at greatest risk of invasive infections. In keeping with UK population-based estimates, low direct efficacy of immunological memory against disease was found, cautioning against over-reliance on evidence of priming alone as a correlate of population protection. The contribution of herd immunity to disease control was reinforced. Possible intervention strategies will be explored in subsequent work.
In order to increase farm incomes, hill sheep farmers must improve the productivity and quality of their flocks. Recent changes to farm support schemes have focused attention on a number of options, including a change of ewe breed, genetic improvement of the flock, the use of crossbred ewes, or crossbred lamb production from native hill breeds. A switch to crossbred lamb production could lead to an immediate increase in the quality of production from hill ewes whilst maintaining a dam that is adapted to the hill environment. The aim of this work was to evaluate the performance of crossbred lambs from Welsh Mountain ewes.
Livestock farming is a traditional and important contributor to the rural economy in the hills and uplands of the UK. However, significant areas of the uplands have seen a decline in the condition of heath and mire habitats and the loss of dwarf shrubs as a result of over-grazing. Attempts to halt the decline and improve the condition of upland heath and mire habitats have been undertaken by the introduction of agri-environment schemes. In the main, such schemes rely on the reduction of sheep numbers. However, recent Defra funded research (LS1508) has indicated that this can result in dominance by competitive and/or unpalatable species such as purple moor-grass (Molinia caerulea ) or mat-grass (Nardus stricta ), leading in time to a reduction in the physical and financial performance of the flock. The objective of this study is to assess the impact of cattle grazing on Nardus stricta dominated pasture on sheep and cattle performance. It is being carried out as part of a wider project to determine environmentally sustainable and economically viable grazing systems for heather moorland.
We have undertaken an adaptive optics imaging survey of extra-solar planetary systems and stars showing interesting radial velocity trends from high precision radial velocity searches. Adaptive Optics increases the resolution and dynamic range of an image, substantially improving the detectability of faint close companions. This survey is sensitive to objects less luminous than the bottom of the main sequence at separations as close as 1″. We have detected stellar companions to the planet bearing stars HD 114762 and Tau Boo. We have also detected a companion to the non-planet bearing star 16 Cyg A.
This research is comprised of understanding the linear photophysical properties of various dyes to better understand the more complicated nonlinear optical properties. Determining structure property relationships of a series of structurally closely related chromophores is the key in understanding the drivers for the various photophysical properties. In this paper we survey the effect of physically changing the Pt poly-yne structure on the S0-S1 and T1-Tn absorption properties for each of the chromophores. A series of structurally modified platinum poly-ynes have been studied using experimental methods including UV/Vis absorption and nanosecond laser flash photolysis. We found that with extension of the ligand length both the ground and triplet excited state absorption shift to lower energies. Comparing the absorption properties of the ligands and butadiynes with the platinum containing versions reveal that the S1 and Tn exciton is localized on one portion of the ligand with extension and not conjugated through the whole molecule. Changing the phosphine R group results in little effect to the absorption properties except when the R group is conjugated in the case of phenyl. However, changing the R group results in varied materials properties.
As part of an effort to develop a spectroscopic structure-property relationship in platinum acetylide oligomers, we have prepared a series of bidentate Pt(PBu3)2L2 compounds. The ligand was the series o-syd-C6H4-CΞC-(C6H4-CΞC)n-H, n = 0,1,2. The terminal oligomer unit consisted of a sydnone group ortho to the acetylene carbon. The compounds were characterized by various methods, including 13C-NMR, ground state absorption, fluorescence, phosphorescence and laser flash photolysis. The acetylenic 13C-NMR resonances showed sydnone influences that decreased with increasing number of monomer units. The ground state absorption spectra were slightly red shifted from those of the baseline oligomers not having a sydnone group. The low temperature emission and excitation spectra showed complex dependence on excitation and emission wavelengths, suggesting the chromphores resided in a distribution of solvent environments and conformations. Finally, broad triplet state absorption spectra were observed, with absorption throughout the visible and near infrared regions.