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Background: Long-term care facility (LTCF) employees pose potential risk for COVID-19 outbreaks. Association between employee infection prevention (IP) adherence with facility COVID-19 outbreaks remains a knowledge gap. Methods: From April through December 2020, prior to COVID-19 vaccination, we tested asymptomatic Veterans’ Affairs (VA) community living center (CLC) residents twice weekly and employees monthly, which increased to weekly with known exposure, for SARS-CoV-2 via nasopharyngeal PCR. Employees voluntarily completed multiple choice questionnaires assessing self-reported IP adherence at and outside work. Surveys were longitudinally administered in April, June, July, and October 2020. Changes in paired employee responses for each period were analyzed using the McNemar test. We obtained COVID-19 community rates from surrounding Davidson and Rutherford counties from the Tennessee Department of Health public data set. CLC resident COVID-19 cases were obtained from VA IP data. Incidence rate and number of positive tests were calculated. Results: Between April and December 2020, 444 employees completed at least 1 survey; 177 completed surveys in both April and June, 179 completed surveys in both June and July, and 140 completed surveys in both July and October (Fig. 1). Across periods, employee surveys demonstrated an increase in masking at work and outside work between April and June (63% to 95% [P < .01] and 36% to 63% [P < .01], respectively), and June to July (95% to 99% [P < .05] and 71% to 84% [P < .01], respectively) that were both maintained between July and October (Fig. 2). Distancing at work and limiting social contacts outside work significantly decreased from April to June but increased in subsequent periods, although not significantly. COVID-19 community incidence peaked in July and again in December, but CLC resident COVID-19 cases peaked in August, declined, and remained low through December (Fig. 3). Discussion: Wearing a mask at work, which was mandatory, increased, and voluntary employee masking outside work also increased. CLC COVID-19 cases mirrored community increases in July and August; however, community cases increased again later in 2020 while CLC cases remained low. Employees reporting distancing at work and limiting social contacts outside work decreased preceding the initial rise in CLC cases but increased and remained high after July. Conclusions: These data from the pre–COVID-19 vaccination era suggest that widespread, increased support for and emphasis on LTCF IP adherence, especially masking, may have effectively prevented COVID-19 outbreaks in the vulnerable LTCF population.
Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.
To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.
We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.
The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.
In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.
Understand how the built environment can affect safety and efficiency outcomes during doffing of personal protective equipment (PPE) in the context of coronavirus disease 2019 (COVID-19) patient care.
We conducted (1) field observations and surveys administered to healthcare workers (HCWs) performing PPE doffing, (2) focus groups with HCWs and infection prevention experts, and (3) a with healthcare design experts.
This study was conducted in 4 inpatient units treating patients with COVID-19, in 3 hospitals of a single healthcare system.
The study included 24 nurses, 2 physicians, 1 respiratory therapist, and 2 infection preventionists.
The doffing task sequence and the layout of doffing spaces varied considerably across sites, with field observations showing most doffing tasks occurring around the patient room door and PPE support stations. Behaviors perceived as most risky included touching contaminated items and inadequate hand hygiene. Doffing space layout and types of PPE storage and work surfaces were often associated with inadequate cleaning and improper storage of PPE. Focus groups and the design charrette provided insights on how design affording standardization, accessibility, and flexibility can support PPE doffing safety and efficiency in this context.
There is a need to define, organize and standardize PPE doffing spaces in healthcare settings and to understand the environmental implications of COVID-19–specific issues related to supply shortage and staff workload. Low-effort and low-cost design adaptations of the layout and design of PPE doffing spaces may improve HCW safety and efficiency in existing healthcare facilities.
The rapid growth in web-based grocery food purchasing has outpaced federal regulatory attention to the online provision of nutrition and allergen information historically required on food product labels. We sought to characterise the extent and variability that online retailers disclose required and regulated information and identify the legal authorities for the federal government to require online food retailers to disclose such information.
We performed a limited scan of ten products across nine national online retailers and conducted legal research using LexisNexis to analyse federal regulatory agencies’ authorities.
The scan of products revealed that required information (Nutrition Facts Panels, ingredient lists, common food allergens and per cent juice for fruit drinks) was present, conspicuous and legible for an average of only 36·5 % of the products surveyed, ranging from 11·4 % for potential allergens to 54·2 % for ingredients lists. More commonly, voluntary nutrition-related claims were prominently and conspicuously displayed (63·5 % across retailers and products). Our legal examination found that the Food and Drug Administration, Federal Trade Commission and United States Department of Agriculture have existing regulatory authority over labelling, online sales and advertising, and Supplemental Nutrition Assistance Programme retailers that can be utilised to address deficiencies in the provision of required information in the online food retail environment.
Information regularly provided to consumers in conventional settings is not being uniformly provided online. Congress or the federal agencies can require online food retailers disclose required nutrition and allergen information to support health, nutrition, equity and informed consumer decision-making.
Jennifer Morgan describes how civil society worked to secure a fair and ambitious multilateral agreement as seen from her perspective as Global Director of the Climate Program at the World Resources Institute at the time. In her view, civil society had four different roles and functions: civil society (1) gathered together idea generators, analysts, and researchers ahead of time, (2) provided informal intelligence and diplomatic service combined with high-trust networks, (3) brought the voices of people into the negotiations, and (4) explained COP 21’s complexities and alerted the outside world. Morgan concludes that no single function or role of civil society made the difference in Paris, but the combination of them all did so. She highlights the “bursting of the UNFCCC bubble” as a main function and assesses that the 1.5°C goal, came into the Paris Agreement as a result of peoples’ voices being heard and listened to. Without the NGO contribution, it would have been much more difficult, perhaps impossible, to sow the seeds of change. Morgan suggests that civil society can use its principled and objective-based approach to its advantage and listen to allies in their movement.
Recent cannabis exposure has been associated with lower rates of neurocognitive impairment in people with HIV (PWH). Cannabis’s anti-inflammatory properties may underlie this relationship by reducing chronic neuroinflammation in PWH. This study examined relations between cannabis use and inflammatory biomarkers in cerebrospinal fluid (CSF) and plasma, and cognitive correlates of these biomarkers within a community-based sample of PWH.
263 individuals were categorized into four groups: HIV− non-cannabis users (n = 65), HIV+ non-cannabis users (n = 105), HIV+ moderate cannabis users (n = 62), and HIV+ daily cannabis users (n = 31). Differences in pro-inflammatory biomarkers (IL-6, MCP-1/CCL2, IP-10/CXCL10, sCD14, sTNFR-II, TNF-α) by study group were determined by Kruskal–Wallis tests. Multivariable linear regressions examined relationships between biomarkers and seven cognitive domains, adjusting for age, sex/gender, race, education, and current CD4 count.
HIV+ daily cannabis users showed lower MCP-1 and IP-10 levels in CSF compared to HIV+ non-cannabis users (p = .015; p = .039) and were similar to HIV− non-cannabis users. Plasma biomarkers showed no differences by cannabis use. Among PWH, lower CSF MCP-1 and lower CSF IP-10 were associated with better learning performance (all ps < .05).
Current daily cannabis use was associated with lower levels of pro-inflammatory chemokines implicated in HIV pathogenesis and these chemokines were linked to the cognitive domain of learning which is commonly impaired in PWH. Cannabinoid-related reductions of MCP-1 and IP-10, if confirmed, suggest a role for medicinal cannabis in the mitigation of persistent inflammation and cognitive impacts of HIV.
To develop an international template to support patient submissions in Health Technology Assessments (HTAs). This was to be based on the experience and feedback from the implementation and use of the Scottish Medicines Consortium's (SMC) Summary Information for Patient Groups (SIP).
To gather feedback on the SMC experience, web-based surveys were conducted with pharmaceutical companies and patient groups familiar with the SMC SIP. Semistructured interviews with representatives from HTA bodies were undertaken, along with patient group discussions with those less familiar with the SIP, to explore issues around the approach. These qualitative data informed the development of an international SIP template.
Survey data indicated that 82 percent (18 of 22 respondents) of pharmaceutical company representatives felt that the SIP was worthwhile; 88 percent (15/17) of patient group respondents found the SIP helpful. Both groups highlighted the need for additional support and guidance around plain language summaries. Further suggestions included provision of a glossary of terms and cost-effectiveness information. Patient group interviews supported the survey findings and led to the development of a new template. HTA bodies raised potential challenges around buy-in, timing, and bias connected to the SIP approach.
The international SIP template is another approach to support deliberative processes in HTA. Although challenges remain around writing summaries for lay audiences, along with feasibility considerations for HTA bodies, the SIP approach should support more meaningful patient involvement in HTAs.
A total of 5478 fishes were sampled between 2009 and 2020 to assess length–weight, length–length and weight–weight relationships in 39 marine species from 10 families caught in the Seychelles waters by the artisanal fishery. Two types of length (total length TL, fork length FL) and three types of weight (whole weight WT, gutted weight GW and gilled-gutted weight GGW) were measured. The parameters of the relationships were estimated using the log-transformed allometric model with bias correction. Our results include length–weight, length–length and weight–weight relationships for 39, 20 and 18 species, respectively. Our length–weight data and resulting relationships were compared against FishBase database for 36 species and were in the Bayesian 95% confidence interval of the relationships available for 33 species and above for Gnathanodon speciosus, Lutjanus gibbus and Variola louti. Finally, for five abundant and widely dispersed species we tested for spatial differences in morphometric relationships between the Mahé Plateau and three southern atoll groups. Significant differences were found for two species only, but their magnitude was small. We thus argue for the regression relationships based on pooled data to be used for most types of population and community analyses. The availability of these morphometric relationships will support the application of accurate size-based analyses for Seychelles fisheries survey data, and so enhance understanding of the ecology of the reef-associated fish component of marine ecosystems and food webs, and improve fisheries research management.
Optical tracking systems typically trade off between astrometric precision and field of view. In this work, we showcase a networked approach to optical tracking using very wide field-of-view imagers that have relatively low astrometric precision on the scheduled OSIRIS-REx slingshot manoeuvre around Earth on 22 Sep 2017. As part of a trajectory designed to get OSIRIS-REx to NEO 101955 Bennu, this flyby event was viewed from 13 remote sensors spread across Australia and New Zealand to promote triangulatable observations. Each observatory in this portable network was constructed to be as lightweight and portable as possible, with hardware based off the successful design of the Desert Fireball Network. Over a 4-h collection window, we gathered 15 439 images of the night sky in the predicted direction of the OSIRIS-REx spacecraft. Using a specially developed streak detection and orbit determination data pipeline, we detected 2 090 line-of-sight observations. Our fitted orbit was determined to be within about 10 km of orbital telemetry along the observed 109 262 km length of OSIRIS-REx trajectory, and thus demonstrating the impressive capability of a networked approach to Space Surveillance and Tracking.
Following Canadian estimates of frailty, academic researchers and the Chiefs of Ontario came together to create the first Ontario-wide profile of aging in First Nations people in Ontario. Using self-reported data from First Nations adults who participated in the Ontario First Nations Regional Health Survey Phase 2, we found that First Nations people in Ontario experience higher rates of frailty than the general Canadian population and early onset frailty appears to affect First Nations communities. This is important to consider as communities plan for health care needs of an aging population and is particularly relevant in the face of Covid-19, as we know severity is exacerbated by underlying health conditions.
Young-onset dementia (YOD) is defined as the onset of dementia symptoms before the age of 65 years and accounts for 2–8% of dementia. YOD patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients at a rural and remote memory clinic in Western Canada.
A total of 333 consecutive patients (YOD = 61, LOD = 272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests.
YOD patients were more likely to be married, employed, current smokers and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Both YOD and LOD patient groups were equally likely to have a driver’s licence.
Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress and barriers to services.
We used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.
To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care.
Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.
A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals.
A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital’s quality of care. Also, 29% of respondents’ hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line–associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone.
Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates.
In recent years, several initiatives have sought to encourage redemption of food assistance benefits at direct-to-consumer (DTC) market venues such as community supported agriculture programs and farmers’ markets in the USA, with the dual goal of increasing access to healthy foods for low-income families and sales of locally-grown foods for farmers. Proponents of these interventions assert that these programs have a positive impact on local economies yet there is limited evidence to validate this argument. This research project used a customized input-output model to simulate potential economic impacts of programs and policies that enable Supplemental Nutrition Assistance Program (SNAP) recipients to shift purchases from traditional food retailers to DTC venues in four states. Two different scenarios were explored: (1) increased outreach to low-income consumers and (2) financial support for using SNAP benefits at DTC market channels. We found a positive, though modest, economic impact at the state level under both scenarios when accounting for (a) business losses in the food retail and wholesale sectors, (b) a shift in acreage from commodity to specialty crops and (c) the cost to taxpayers. Since most of the increased economic activity would be in the produce farming sector, we discuss the opportunities and challenges for this sector along with potential policy implications.
The hot ISM in early-type galaxies (ETGs) plays a crucial role in understanding their formation and evolution. The structural features of the hot gas identified by Chandra observations point to key evolutionary mechanisms, (e.g., kim12). In our Chandra Galaxy Atlas (CGA) project, taking full advantage of the Chandra capabilities, we systematically analyzed the archival Chandra data of 72 ETGs and produced uniform data products of the hot gas properties. The main data products include spatially resolved 2D spectral maps of the hot gas from individual galaxies. We emphasize that new features can be identified in the spectral maps which are not easily visible in the surface brightness maps. The high-level images can be viewed at the dedicated CGA website, and the CGA data products can be downloaded to compare with other wavelength data and to perform user-specific analyses. Utilizing our data products, we will further address focused science topics.
Families express a need for information to support people with severe anorexia nervosa.
To examine the impact of the addition of a skills training intervention for caregivers (Experienced Caregivers Helping Others, ECHO) to standard care.
Patients over the age of 12 (mean age 26 years, duration 72 months illness) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK. Families were randomised to ECHO (a book, DVDs and five coaching sessions per caregiver) or treatment as usual. Patient (n=178) and caregiver (n=268) outcomes were measured at discharge and 6 and 12 months after discharge.
Patients with caregivers in the ECHO group had reduced eating disorder psychopathology (EDE-Q) and improved quality of life (WHO-Quol; both effects small) and reduced in-patient bed days (7–12 months post-discharge). Caregivers in the ECHO group had reduced burden (Eating Disorder Symptom Impact Scale, EDSIS), expressed emotion (Family Questionnaire, FQ) and time spent caregiving at 6 months but these effects were diminished at 12 months.
Small but sustained improvements in symptoms and bed use are seen in the intervention group. Moreover, caregivers were less burdened and spent less time providing care. Caregivers had most benefit at 6 months suggesting that booster sessions, perhaps jointly with the patients, may be needed to maintain the effect. Sharing skills and information with caregivers may be an effective way to improve outcomes. This randomised controlled trial (RCT) was registered with Current Controlled Trials ISRCTN06149665.
Objectives: The Internet is a fundamental tool for completing many different instrumental activities of daily living (IADL), including shopping and banking. Persons with HIV−associated Neurocognitive Disorders (HAND) are at heightened risk for IADL problems, but the extent to which HAND interferes with the performance of Internet-based household IADLs is not known. Methods: Ninety-three individuals with HIV disease, 43 of whom were diagnosed with HAND, and 42 HIV− comparison participants completed Internet-based tests of shopping and banking. Participants used mock credentials to log in to an experimenter-controlled Web site and independently performed a series of typical online shopping (e.g., purchasing household goods) and banking (e.g., transferring funds between accounts) tasks. Results: Individuals with HAND were significantly more likely to fail the online shopping task than neurocognitively normal HIV+ and HIV− participants. HAND was also associated with poorer overall performance versus HIV+ normals on the online banking task. In the HAND group, Internet-based task scores were correlated with episodic memory, executive functions, motor skills, and numeracy. In the HIV+ sample as a whole, lower Internet-based task scores were uniquely associated with poorer performance-based functional capacity and self-reported declines in shopping and financial management in daily life, but not with global manifest functional status. Conclusions: Findings indicate that HAND is associated with difficulties in using the Internet to complete important household everyday functioning tasks. The development and validation of effective Internet training and compensatory strategies may help to improve the household management of persons with HAND. (JINS, 2017, 23, 605–615)
Hospital Ebola preparation is underway in the United States and other countries; however, the best approach and resources involved are unknown.
To examine costs and challenges associated with hospital Ebola preparation by means of a survey of Society for Healthcare Epidemiology of America (SHEA) members.
Electronic survey of infection prevention experts.
A total of 257 members completed the survey (221 US, 36 international) representing institutions in 41 US states, the District of Columbia, and 18 countries. The 221 US respondents represented 158 (43.1%) of 367 major medical centers that have SHEA members and included 21 (60%) of 35 institutions recently defined by the US Centers for Disease Control and Prevention as Ebola virus disease treatment centers. From October 13 through October 19, 2014, Ebola consumed 80% of hospital epidemiology time and only 30% of routine infection prevention activities were completed. Routine care was delayed in 27% of hospitals evaluating patients for Ebola.
Convenience sample of SHEA members with a moderate response rate.
Hospital Ebola preparations required extraordinary resources, which were diverted from routine infection prevention activities. Patients being evaluated for Ebola faced delays and potential limitations in management of other diseases that are more common in travelers returning from West Africa.