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Presenteeism is an expensive and challenging problem in the healthcare industry. In anticipation of the staffing challenges expected with the COVID-19 pandemic, we examined a decade of payroll data for a healthcare workforce. We aimed to determine the effect of seasonal influenza-like illness (ILI) on absences to support COVID-19 staffing plans. Both hours worked and unscheduled absences were significantly related to the community prevalence of influenza-like illness in our cohort. These effects were stronger in hourly employees suggesting that organizations should target their messaging at encouraging salaried staff to stay home when ill.
Preclinical studies have suggested that continuous, long-term opiate exposure may be neurotoxic. There is accumulating evidence for neural and neuropsychological abnormalities in diverse human drug addiction populations. However, the structural and behavioural correlates of human opiate dependency have been less studied than other drugs.
We investigated brain structure and neuropsychological functioning in opiate dependent, treatment-seeking patients receiving Methadone Maintenance Treatment, to test hypotheses of regional grey matter reductions correlating with methadone exposure and neuropsychological measures.
Cambridge Gambling Task (CGT) data were acquired from 47 patients receiving MMT and 51 controls. T1 weighted Magnetic Resonance Images were acquired from a representative subset of these volunteers.
MMT patients exhibited grey matter reductions in the orbito-medial prefrontal cortex and basal ganglia. Additionally, patients exhibited significant abnormalities on CGT behavioural measures; risk adjustment, risk taking and impulsivity. Both the initial titration dose of methadone at the commencement of MMT following protocolised tolerance testing, and methadone dose at the time of scanning, correlated with grey matter reductions in the globus pallidus. Abnormal risk adjustment behaviour correlated with reductions in globus pallidus grey matter, increased risk taking with orbitofrontal grey matter reductions, and increased impulsivity with cingulate cortex reductions.
These findings support an interpretation of heightened risk taking and impulsivity in patients receiving MMT. However, the anatomically restricted correlates with indices of methadone exposure suggest that most structural brain abnormalities are not opiate linked, with the possible exception of the globus pallidus.
To describe an investigation into 5 clinical cases of carbapenem-resistant Acinetobacter baumannii (CRAB).
Epidemiological investigation supplemented by whole-genome sequencing (WGS) of clinical and environmental isolates.
A tertiary-care academic health center in Boston, Massachusetts.
Patients or participants:
Individuals identified with CRAB clinical infections.
A detailed review of patient demographic and clinical data was conducted. Clinical isolates underwent phenotypic antimicrobial susceptibility testing and WGS. Infection control practices were evaluated, and CRAB isolates obtained through environmental sampling were assessed by WGS. Genomic relatedness was measured by single-nucleotide polymorphism (SNP) analysis.
Four clinical cases spanning 4 months were linked to a single index case; isolates differed by 1–7 SNPs and belonged to a single cluster. The index patient and 3 case patients were admitted to the same room prior to their development of CRAB infection, and 2 case patients were admitted to the same room within 48 hours of admission. A fourth case patient was admitted to a different unit. Environmental sampling identified highly contaminated areas, and WGS of 5 environmental isolates revealed that they were highly related to the clinical cluster.
We report a cluster of highly resistant Acinetobacter baumannii that occurred in a burn ICU over 5 months and then spread to a separate ICU. Two case patients developed infections classified as community acquired under standard epidemiological definitions, but WGS revealed clonality, highlighting the risk of burn patients for early-onset nosocomial infections. An extensive investigation identified the role of environmental reservoirs.
Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.
We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.
Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).
Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
SDG 15 requires the maintenance of life on land and endorses priorities already established through international conventions and agreements. The scale, and complexity, of tropical forest loss and biodiversity decline versus the limited resources for conservation and forestry pose many challenges. The main innovation of SDG 15 is that decision makers will see this goal as one to integrate with other SDGs; the risk is that short-term priorities and a ‘business as usual’ approach will undermine this. We examine these opportunities and challenges, the factors that impinge upon them and how they may play out over the next decade. There will be trade-offs between SDG 15 and other SDGs resulting from competition for land, but there are also synergies and opportunities that require recognition. We encourage conservation and development professionals to engage with those responsible for all the Agenda 2030 targets to ensure that SDG 15 is a priority in all SDG related processes.
Public awareness of ‘red flag’ symptoms for head and neck cancer is low. There is a lack of evidence regarding patient concerns and expectations in consultations for cancer assessment.
This prospective questionnaire study examined the symptoms, concerns and expectations of 250 consecutive patients attending an ‘urgent suspicion of cancer’ clinic at a tertiary referral centre.
The patients’ most frequent responses regarding their concerns were ‘no concerns’ (n = 72, 29 per cent); ‘all symptoms’ were a cause for concern (n = 65, 26 per cent) and ‘neck lump’ was a symptom causing concern (n = 37, 17 per cent). The expectations of patients attending clinic were that they would find out what was wrong with them, followed by having no expectations at all. Overall patient knowledge of red flag symptoms was lacking and their expectations were low.
Patients with non-cancer symptoms are frequently referred with suspected cancer. Patients with red flag symptoms are not aware of their significance and they have low expectations of healthcare.
Lipid-based nutrient supplements (LNS) may be beneficial for malnourished HIV-infected patients starting antiretroviral therapy (ART). We assessed the effect of adding vitamins and minerals to LNS on body composition and handgrip strength during ART initiation. ART-eligible HIV-infected patients with BMI <18·5 kg/m2 were randomised to LNS or LNS with added high-dose vitamins and minerals (LNS-VM) from referral for ART to 6 weeks post-ART and followed up until 12 weeks. Body composition by bioelectrical impedance analysis (BIA), deuterium (2H) diluted water (D2O) and air displacement plethysmography (ADP), and handgrip strength were determined at baseline and at 6 and 12 weeks post-ART, and effects of LNS-VM v. LNS at 6 and 12 weeks investigated. BIA data were available for 1461, D2O data for 479, ADP data for 498 and handgrip strength data for 1752 patients. Fat mass tended to be lower, and fat-free mass correspondingly higher, by BIA than by ADP or D2O. At 6 weeks post-ART, LNS-VM led to a higher regain of BIA-assessed fat mass (0·4 (95 % CI 0·05, 0·8) kg), but not fat-free mass, and a borderline significant increase in handgrip strength (0·72 (95 % CI −0·03, 1·5) kg). These effects were not sustained at 12 weeks. Similar effects as for BIA were seen using ADP or D2O but no differences reached statistical significance. In conclusion, LNS-VM led to a higher regain of fat mass at 6 weeks and to a borderline significant beneficial effect on handgrip strength. Further research is needed to determine appropriate timing and supplement composition to optimise nutritional interventions in malnourished HIV patients.
Rayleigh–Bénard convection is one of the most well-studied models in fluid mechanics. Atmospheric convection, one of the most important components of the climate system, is by comparison complicated and poorly understood. A key attribute of atmospheric convection is the buoyancy source provided by the condensation of water vapour, but the presence of radiation, compressibility, liquid water and ice further complicate the system and our understanding of it. In this paper we present an idealized model of moist convection by taking the Boussinesq limit of the ideal-gas equations and adding a condensate that obeys a simplified Clausius–Clapeyron relation. The system allows moist convection to be explored at a fundamental level and reduces to the classical Rayleigh–Bénard model if the latent heat of condensation is taken to be zero. The model has an exact, Rayleigh-number-independent ‘drizzle’ solution in which the diffusion of water vapour from a saturated lower surface is balanced by condensation, with the temperature field (and so the saturation value of the moisture) determined self-consistently by the heat released in the condensation. This state is the moist analogue of the conductive solution in the classical problem. We numerically determine the linear stability properties of this solution as a function of Rayleigh number and a non-dimensional latent-heat parameter. We also present some two-dimensional, time-dependent, nonlinear solutions at various values of Rayleigh number and the non-dimensional condensational parameters. At sufficiently low Rayleigh number the system converges to the drizzle solution, and we find no evidence that two-dimensional self-sustained convection can occur when that solution is stable. The flow transitions from steady to turbulent as the Rayleigh number or the effects of condensation are increased, with plumes triggered by gravity waves emanating from other plumes. The interior dries as the level of turbulence increases, because the plumes entrain more dry air and because the saturated boundary layer at the top becomes thinner. The flow develops a broad relative humidity minimum in the domain interior, only weakly dependent on Rayleigh number when that is high.
A robust biomedical informatics infrastructure is essential for academic health centers engaged in translational research. There are no templates for what such an infrastructure encompasses or how it is funded. An informatics workgroup within the Clinical and Translational Science Awards network conducted an analysis to identify the scope, governance, and funding of this infrastructure. After we identified the essential components of an informatics infrastructure, we surveyed informatics leaders at network institutions about the governance and sustainability of the different components. Results from 42 survey respondents showed significant variations in governance and sustainability; however, some trends also emerged. Core informatics components such as electronic data capture systems, electronic health records data repositories, and related tools had mixed models of funding including, fee-for-service, extramural grants, and institutional support. Several key components such as regulatory systems (e.g., electronic Institutional Review Board [IRB] systems, grants, and contracts), security systems, data warehouses, and clinical trials management systems were overwhelmingly supported as institutional infrastructure. The findings highlighted in this report are worth noting for academic health centers and funding agencies involved in planning current and future informatics infrastructure, which provides the foundation for a robust, data-driven clinical and translational research program.
The progenitors of many core-collapse supernovae (CCSNe) are expected to be in binary systems. By performing a series of three-dimensional hydrodynamical simulations, we investigate how CCSN explosions affect their binary companion. We find that the amount of removed stellar mass, the resulting impact velocity, and the chemical contamination of the companion that results from the impact of the SN ejecta, strongly increases with decreasing binary separation and increasing explosion energy. Also, it is foud that the impact effects of CCSN ejecta on the structure of main-sequence (MS) companions, and thus their long term post-explosion evolution, are in general not dramatic.
Eta Carinae is the most massive active binary within 10,000 light-years. While famous for the largest non-terminal stellar explosion ever recorded, observations reveal a supermassive (∼120 M⊙) binary consisting of an LBV and either a WR or extreme O star in a very eccentric orbit (e=0.9) with a 5.54-year period. Dramatic changes across multiple wavelengths are routinely observed as the stars move about in their highly elliptical orbits, especially around periastron when the hot (∼40 kK) companion star delves deep into the denser and much cooler (∼15 kK) extended wind photosphere of the LBV primary. Many of these changes are due to a dynamic wind-wind collision region (WWCR) that forms between the stars, plus expanding radiation-illuminated fossil WWCRs formed one, two, and three 5.54-year orbital cycles ago. These fossil WWCRs have been spatially and spectrally resolved by the Hubble Space Telescope/Space Telescope Imaging Spectrograph (HST/STIS) at multiple epochs, resulting in data cubes that spatially map Eta Carinae’s innermost WWCRs and follow temporal changes in several forbidden emission lines (e.g. [Fe iii] 4659 Å, [Fe ii] 4815 Å) across the 5.54-year cycle. We present initial results of 3D time-dependent hydrodynamical and radiative-transfer simulations of the Eta Carinae binary and its WWCRs with the goal of producing synthetic data cubes of forbidden emission lines for comparison to the available HST/STIS observations. Comparison of the theoretical models to the observations reveals important details about the binary’s orbital motion, photoionization properties, and recent (5–15year) mass loss history. Such an analysis also provides a baseline for following future changes in Eta Carinae, essential for understanding the late-stage evolution of a nearby supernova progenitor. Our modeling methods can also be adapted to a number of other colliding wind binary systems (e.g. WR 140) that are scheduled to be studied with future observatories (e.g. the James Webb Space Telescope).
Ultra-luminous X-ray sources (ULXs) are off-nuclear point sources in nearby galaxies with luminosities well exceeding the Eddington limit for stellar-mass objects. It has been recognized after the discovery of pulsating ULXs (PULXs) that a fraction of these sources could be accreting neutron stars in high-mass X-ray binaries (HMXBs) though the majority of ULXs are lacking in coherent pulsations. The earliest stage of some HMXBs may harbor rapidly rotating neutron stars propelling out the matter transferred by the massive companion. The spin-down power transferred by the neutron-star magnetosphere to the accretion disk at this stage can well exceed the Eddington luminosities and the system appears as a non-pulsating ULX. In this picture, PULXs appear as super-critical mass-accreting descendants of non-pulsating ULXs. We present this evolutionary scenario within a self-consistent model of magnetosphere-disk interaction and discuss the implications of our results on the spin and magnetic field of the neutron star.
The stellar winds of hot stars have an important impact on both stellar and galactic evolution, yet their structure and internal processes are not fully understood in detail. One of the best nearby laboratories for studying such massive stellar winds is the O4I(n)fp star ζ Pup. After briefly discussing existing X-ray observations from Chandra and XMM, we present a simulation of X-ray emission line profile measurements for the upcoming 840 kilosecond Chandra HETGS observation. This simulation indicates that the increased S/N of this new observation will allow several major steps forward in the understanding of massive stellar winds. By measuring X-ray emission line strengths and profiles, we should be able to differentiate between various stellar wind models and map the entire wind structure in temperature and density. This legacy X-ray spectrum of ζ Pup will be a useful benchmark for future X-ray missions.
Long-term and short-term multicolor photometric variations of the X-ray binary system Her X-1 (HZ Her) has been studied. We obtained new VRI observations of the system by using the 60cm Robotic telescope at the TÜBİTAK National Observatory (TUG) in 2018. Using newly obtained data, we modified the orbital period of the binary system with a neutron star component.
We presented long-term optical observations of the high mass X-ray binary system SS 433 (V1343 Aql) with a black hole component. New observations have been obtained by using the 0.6m telescope at the TÜBİTAK National Observatory (TUG) in B, V, R and I filters. We aim to investigate the long-term photometric behavior of the system.
The X-ray binary Her X-1 consists of an accreting neutron star and the optical companion HZ Her. The 35-day X-ray variability of this system is known since its discovery in 1972 by the UHURU satellite and is believed to be caused by forced precession of the warped accretion disk tilted to the orbital plane. We argue that the observed features of the optical variability of HZ Her can be explained by free precession of the neutron star with a period close to that of the forced disk precession. The model parameters include a) the intensity (power) of the stream of matter flowing out of the optical star; b) the X-ray luminosity of the neutron star; c) the optical flux of the accretion disk; d) the X-ray irradiation pattern on the donor star; e) the tilt of the inner and outer edge of the accretion disk. A possible synchronization mechanism based on the coupling between the neutron star free precession and the dynamical action of non-stationary gas streams is discussed shortly.