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To describe the pattern of transmission of SARS-CoV-2 during 2 nosocomial outbreaks of COVID-19 with regard to the possibility of airborne transmission.
Contact investigations with active case finding were used to assess the pattern of spread from 2 COVID-19 index patients.
A community hospital and university medical center in the United States, in February and March, 2020, early in the COVID-19 pandemic.
Two index patients and 421 exposed health care workers.
Exposed staff were identified by analyzing the EMR and conducting active case finding in combination with structured interviews. Staff were tested for COVID-19 by obtaining oropharyngeal/nasopharyngeal specimens, with RT-PCR testing to detect SARS-CoV-2.
Two separate index patients were admitted in February and March 2020, without initial suspicion for COVID-19 and without contact or droplet precautions in place; both patients underwent several aerosol generating procedures in this context. A total of 421 health care workers were exposed in total, and the results of the case contact investigations identified 8 secondary infections in health care workers. In all 8 cases, the staff had close contact with the index patients without sufficient personal protective equipment. Importantly, despite multiple aerosol generating procedures, there was no evidence of airborne transmission.
These observations suggest that, at least in a healthcare setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission.
We assessed Clostridioides difficile toxin testing and positivity for all patients in Manitoba hospitals during June 2016–November 2018. The testing rate was 30 per 10,000 patient bed days (95% confidence interval [CI], 30–31) and the incidence rate was 3.5 per 10,000 patient bed days (95% CI, 3.3–3.7). The context of testing is essential to the interpretation of data among jurisdictions.
We present a calibration component for the Murchison Widefield Array All-Sky Virtual Observatory (MWA ASVO) utilising a newly developed PostgreSQL database of calibration solutions. Since its inauguration in 2013, the MWA has recorded over 34 petabytes of data archived at the Pawsey Supercomputing Centre. According to the MWA Data Access policy, data become publicly available 18 months after collection. Therefore, most of the archival data are now available to the public. Access to public data was provided in 2017 via the MWA ASVO interface, which allowed researchers worldwide to download MWA uncalibrated data in standard radio astronomy data formats (CASA measurement sets or UV FITS files). The addition of the MWA ASVO calibration feature opens a new, powerful avenue for researchers without a detailed knowledge of the MWA telescope and data processing to download calibrated visibility data and create images using standard radio astronomy software packages. In order to populate the database with calibration solutions from the last 6 yr we developed fully automated pipelines. A near-real-time pipeline has been used to process new calibration observations as soon as they are collected and upload calibration solutions to the database, which enables monitoring of the interferometric performance of the telescope. Based on this database, we present an analysis of the stability of the MWA calibration solutions over long time intervals.
Wetlands embedded in agroecosystems provide vital ecosystem services (i.e., freeze protection, water retention, nutrient cycling, biodiversity support). However, they are particularly susceptible to invasion by nonnative species. West Indian marsh grass [Hymenachne amplexicaulis (Rudge) Nees] is a major wetland invader in Florida. Despite the documented consequences of H. amplexicaulis invasions, the landscape factors influencing the spread of this species are poorly understood. In this study, we asked whether landscape factors associated with wetland isolation, connectivity, and land management influence the presence of H. amplexicaulis among wetlands embedded in pastures. We recorded the presence or absence of H. amplexicaulis in 158 seasonal wetlands embedded in different pasture types (semi-natural vs. intensively managed). Wetland area, isolation from neighboring wetlands, isolation from the nearest source ditch, and connectivity were determined using a geographic information system (GIS). We related landscape factors to H. amplexicaulis using generalized linear models and model selection based on the second-order Akaike information criterion. Hymenachne amplexicaulis was first detected at the study site in the early 2000s. By 2018, we observed this species in 66% of the surveyed wetlands. The likelihood of observing H. amplexicaulis was higher in wetlands embedded in semi-natural pastures and higher in less isolated wetlands, especially when connected to a ditch. These results indicate that H. amplexicaulis spreads both overland (during seasonal flooding) and via the ditch network. Future work is needed to understand whether seeds or stolons are the primary invasion propagule and whether the species forms a persistent seed bank that could slow down restoration efforts. Additionally, further research is required to understand the ecological impact of this highly invasive plant in Florida wetlands.
Emergency Medical Services (EMS) systems have developed protocols for prehospital activation of the cardiac catheterization laboratory for patients with suspected ST-elevation myocardial infarction (STEMI) to decrease first-medical-contact-to-balloon time (FMC2B). The rate of “false positive” prehospital activations is high. In order to decrease this rate and expedite care for patients with true STEMI, the American Heart Association (AHA; Dallas, Texas USA) developed the Mission Lifeline PreAct STEMI algorithm, which was implemented in Los Angeles County (LAC; California USA) in 2015. The hypothesis of this study was that implementation of the PreAct algorithm would increase the positive predictive value (PPV) of prehospital activation.
This is an observational pre-/post-study of the effect of the implementation of the PreAct algorithm for patients with suspected STEMI transported to one of five STEMI Receiving Centers (SRCs) within the LAC Regional System. The primary outcome was the PPV of cardiac catheterization laboratory activation for percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The secondary outcome was FMC2B.
A total of 1,877 patients were analyzed for the primary outcome in the pre-intervention period and 405 patients in the post-intervention period. There was an overall decrease in cardiac catheterization laboratory activations, from 67% in the pre-intervention period to 49% in the post-intervention period (95% CI for the difference, -14% to -22%). The overall rate of cardiac catheterization declined in post-intervention period as compared the pre-intervention period, from 34% to 30% (95% CI, for the difference -7.6% to 0.4%), but actually increased for subjects who had activation (48% versus 58%; 95% CI, 4.6%-15.0%). Implementation of the PreAct algorithm was associated with an increase in the PPV of activation for PCI or CABG from 37.9% to 48.6%. The overall odds ratio (OR) associated with the intervention was 1.4 (95% CI, 1.1-1.8). The effect of the intervention was to decrease variability between medical centers. There was no associated change in average FMC2B.
The implementation of the PreAct algorithm in the LAC EMS system was associated with an overall increase in the PPV of cardiac catheterization laboratory activation.
This work presents an experimental validation study of Isaacs’ incompressible unsteady-airfoil theory at Reynolds numbers above
, and explores the validity of the classical Kutta condition applied to surging flows. Harmonic variation of the free-stream velocity was produced by rotating choke vanes in an unsteady transonic wind tunnel, with time-resolved lift coefficients determined from surface pressure measurements on a NACA 0018 airfoil. Unsteady lift results demonstrate the same trends with reduced frequency and velocity amplitude ratio that are predicted by Isaacs’ theory. However, significant deviations of the lift magnitude and phase angle are observed. In order to understand the cause of these deviations, the background-oriented schlieren technique was used to visualize density gradients in the immediate vicinity of the airfoil trailing edge. The time-resolved background-oriented schlieren displacement field indicates oscillatory behaviour of the trailing-edge stagnation streakline, which violates the classical Kutta condition for this unsteady surging flow.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Field studies were conducted on organic soils in Belle Glade, FL, in 2016 to 2017 to evaluate sugarcane tolerance and fall panicum control with topramezone applied alone or in combination with triazine herbicides (atrazine, metribuzin, ametryn). Treatments included topramezone (25 and 50 g ai ha−1) applied alone or in combination with atrazine (2,240 g ai ha−1), metribuzin (2,240 g ai ha−1), and ametryn (440 g ha−1) on four plant cane varieties to evaluate tolerance, and on second ratoon fields to determine efficacy on fall panicum control. Topramezone applied alone had no effect on sugarcane chlorophyll fluorescence (i.e., the ratio of variable fluorescence to maximum fluorescence), total chlorophyll, and carotenoid 7 to 28 d after treatment (DAT), suggesting sugarcane tolerance. Significant reduction of these parameters occured 7 to 14 DAT when topramezone (50 g ai ha−1) was applied with ametryn or metribuzin; however, reductions were not detected thereafter, indicating recovery. Sugarcane yield was not affected by topramezone applied alone or in combination with the triazine herbicides. Topramezone (50 g ai ha−1) plus metribuzin resulted in acceptable control of fall panicum (84%) with limited to no regrowth of meristematic tissue at sugarcane canopy closure, equivalent to 56 to 70 DAT. These results indicate that when sequential applications of topramezone, applied alone or in combination with these triazine herbicides, are required for efficacious weed control, topramezone applications alone can be made after 7 d, whereas the combinations can be made after 14 or 21 d, depending on sugarcane sensitivity.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Emerging literature suggests fathers may contribute uniquely to child development and emotional health through play. In the present study, a multiple mediational model was analyzed using data from 476 families that participated in the NICHD Study of Early Child Care and Youth Development. After accounting for infant–mother attachment, infant temperament, and family income and stability, a significant indirect effect from father–child play quality to adolescent internalizing symptoms was found through father-reported child emotional dysregulation, B = –.05, 95% confidence interval; CI [–.14, –.01]. Specifically, in first grade, dyads where fathers were rated highly on sensitivity and stimulation during play, and children demonstrated high felt security and affective mutuality during play, had children with fewer father-reported emotional dysregulation problems in third grade, B = –.23, 95% CI [–.39, –.06]. Children with fewer emotional dysregulation problems had lower self-reported internalizing symptoms at age 15, B = .23, 95% CI [.01, .45]. Mothers’ ratings of children's emotional dysregulation were not a significant mediator. Results are discussed regarding the importance of father–child play for children's adjustment as well as the usefulness of inclusion of fathers in child developmental research.
Life span bias potentially alters species abundance in death assemblages through the overrepresentation of short-lived organisms compared with their long-lived counterparts. Although previous work found that life span bias did not contribute significantly to live–dead discordance in bivalve assemblages, life span bias better explained discordance in two groups: longer-lived bivalve species and species with known life spans. More studies using local, rather than global, species-wide life spans and mortality rates would help to determine the prevalence of life span bias, especially for long-lived species with known life spans. Here, we conducted a field study at two sites in North Carolina to assess potential life span bias between Mercenaria mercenaria and Chione elevata, two long-lived bivalve species that can be aged directly. We compared the ability of directly measured local life spans with that of regional and global life spans to predict live–dead discordance between these two species. The shorter-lived species (C. elevata) was overrepresented in the death assemblage compared with its live abundance, and local life span data largely predicted the amount of live–dead discordance; local life spans predicted 43% to 88% of discordance. Furthermore, the global maximum life span for M. mercenaria resulted in substantial overpredictions of discordance (1.4 to 1.6 times the observed live–dead discordance). The results of this study suggest that life span bias should be considered as a factor affecting proportional abundances of species in death assemblages and that using life span estimates appropriate to the study locality improves predictions of discordance based on life span compared with using global life span estimates.
In the Upper Mississippi River Region, invasive faucet snails (Bithynia tentaculata) and their trematode parasites have been implicated in more than 182 000 waterfowl deaths since 1996. Estimating transmission potential depends on accurate assessments of susceptible host population size. However, little is known about the mechanisms underlying snail–host susceptibility in this system. Prior field studies suggest that very small, likely young, faucet snails are less suitable secondary intermediate hosts. Here, we test whether the patterns observed in the field are because small snails (1) are refractory to infection by cercariae, (2) die from infection and are removed from sampled populations, and/or (3) are not preferred by cercariae. Our own field collections were consistent with the observation that smaller faucet snails exhibit lower metacercarial infection prevalence and abundance than larger snails. However, laboratory-based experiments show that smaller snails were actually more susceptible to infection than larger snails. Moreover, the smallest snail size class had significantly higher mortality than larger snails following infection, which may explain their reduced infection levels observed in the field. Our study demonstrates the importance of pairing field and laboratory studies to better understand mechanisms underlying patterns of infection.
Infants with prenatally diagnosed CHD are at high risk for adverse outcomes owing to multiple physiologic and psychosocial factors. Lack of immediate physical postnatal contact because of rapid initiation of medical therapy impairs maternal–infant bonding. On the basis of expected physiology, maternal–infant bonding may be safe for select cardiac diagnoses.
This is a single-centre study to assess safety of maternal–infant bonding in prenatal CHD.
In total, 157 fetuses with prenatally diagnosed CHD were reviewed. On the basis of cardiac diagnosis, 91 fetuses (58%) were prenatally approved for bonding and successfully bonded, 38 fetuses (24%) were prenatally approved but deemed not suitable for bonding at delivery, and 28 (18%) were not prenatally approved to bond. There were no complications attributable to bonding. Those who successfully bonded were larger in weight (3.26 versus 2.6 kg, p<0.001) and at later gestation (39 versus 38 weeks, p<0.001). Those unsuccessful at bonding were more likely to have been delivered via Caesarean section (74 versus 49%, p=0.011) and have additional non-cardiac diagnoses (53 versus 29%, p=0.014). There was no significant difference regarding the need for cardiac intervention before hospital discharge. Infants who bonded had shorter hospital (7 versus 26 days, p=0.02) and ICU lengths of stay (5 versus 23 days, p=0.002) and higher survival (98 versus 76%, p<0.001).
Fetal echocardiography combined with a structured bonding programme can permit mothers and infants with select types of CHD to successfully bond before ICU admission and intervention.
The links between low socioeconomic status and poor health are well established, yet despite adversity, some individuals with low socioeconomic status appear to avoid these negative consequences through adaptive coping. Previous research found a set of strategies, called shift-and-persist (shifting the self to stressors while persisting by finding meaning), to be particularly adaptive for individuals with low socioeconomic status, who typically face more uncontrollable stressors. This study tested (a) whether perceived social status, similar to objective socioeconomic status, would moderate the link between shift-and-persist and health, and (b) whether a specific uncontrollable stressor, unfair treatment, would similarly moderate the health correlates of shift-and-persist. A sample of 308 youth (Meanage = 13.0, range 8–17), physician diagnosed with asthma, completed measures of shift-and-persist, unfair treatment, asthma control, and quality of life in the lab, and 2 weeks of daily diaries about their asthma symptoms. Parents reported on perceived family social status. Results indicated that shift-and-persist was associated with better asthma profiles, only among youth from families with lower (vs. higher) parent-reported perceived social status. Shift-and-persist was also associated with better asthma profiles, only among youth who experienced more (vs. less) unfair treatment. These findings suggest that the adaptive values of coping strategies for youth with asthma depend on the family's perceived social status and on the stressor experienced.
Malformed data-structures can lead to runtime errors such as arbitrary memory access or corruption. Despite this, reasoning over data-structure properties for low-level heap manipulating programs remains challenging. In this paper we present a constraint-based program analysis that checks data-structure integrity, w.r.t. given target data-structure properties, as the heap is manipulated by the program. Our approach is to automatically generate a solver for properties using the type definitions from the target program. The generated solver is implemented using a Constraint Handling Rules (CHR) extension of built-in heap, integer and equality solvers. A key property of our program analysis is that the target data-structure properties are shape neutral, i.e., the analysis does not check for properties relating to a given data-structure graph shape, such as doubly-linked-lists versus trees. Nevertheless, the analysis can detect errors in a wide range of data-structure manipulating programs, including those that use lists, trees, DAGs, graphs, etc. We present an implementation that uses the Satisfiability Modulo Constraint Handling Rules (SMCHR) system. Experimental results show that our approach works well for real-world C programs.