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Staff surveillance is crucial during the containment phase of a pandemic to help reduce potential healthcare-associated transmission and sustain good staff morale. During an outbreak of SARS-COV-2 with community transmission, our institution used an integrated strategy for early detection and containment of COVID-19 cases among healthcare workers (HCWs).
Our strategy comprised 3 key components: (1) enforcing reporting of HCWs with acute respiratory illness (ARI) to our institution’s staff clinic for monitoring; (2) conducting ongoing syndromic surveillance to obtain early warning of potential clusters of COVID-19; and (3) outbreak investigation and management.
Over a 16-week surveillance period, we detected 14 cases of COVID-19 among HCWs with ARI symptoms. Two of the cases were linked epidemiologically and thus constituted a COVID-19 cluster with intrahospital HCW–HCW transmission; we also detected 1 family cluster and 2 clusters among HCWs who shared accommodation. No transmission to HCWs or patients was detected after containment measures were instituted. Early detection minimized the number of HCWs requiring quarantine, hence preserving continuity of service during an ongoing pandemic.
An integrated surveillance strategy, outbreak management, and encouraging individual responsibility were successful in early detection of clusters of COVID-19 among HCWs. With ongoing local transmission, vigilance must be maintained for intrahospital spread in nonclinical areas where social mingling of HCWs occurs. Because most individuals with COVID-19 have mild symptoms, addressing presenteeism is crucial to minimize potential staff and patient exposure.
Prenatal alcohol exposure and attention-deficit/hyperactivity disorder (ADHD) result in behavioral issues related to poor executive function (EF). This overlap may hinder clinical identification of alcohol-exposed children. This study examined the relation between parent and neuropsychological measures of EF and whether parent ratings aid in differential diagnosis. Neuropsychological measures of EF, including the Delis-Kaplan Executive Function System (D-KEFS), were administered to four groups of children (8–16 years): alcohol-exposed with ADHD (AE+, n=80), alcohol-exposed without ADHD (AE−, n=36), non-exposed with ADHD (ADHD, n=93), and controls (CON, n=167). Primary caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF). For parent ratings, multivariate analyses of variance revealed main effects of Exposure and ADHD and an interaction between these factors, with significant differences between all groups on nearly all BRIEF scales. For neuropsychological measures, results indicated main effects of Exposure and ADHD, but no interaction. Discriminant function analysis indicated the BRIEF accurately classifies groups. These findings confirm compounded behavioral, but not neuropsychological, effects in the AE+ group over the other clinical groups. Parent-report was not correlated with neuropsychological performance in the clinical groups and may provide unique information about neurobehavior. Parent-report measures are clinically useful in predicting alcohol exposure regardless of ADHD. Results contribute to a neurobehavioral profile of prenatal alcohol exposure. (JINS, 2014, 20, 1–13)
In this article we ask what kind of phenomenon is internet sex addiction. From the perspectives of two practising psychiatrists, one of whom has worked in a weekly sexual disorders clinic for 12 years, and an anthropologist we explore whether a moral panic is emerging over sexual behaviour and the internet, and whether internet sex addiction forms part of any such panic. We ask whether many individuals who diagnose themselves as addicted to internet-based sex do so more out of a media-activated sensibility than a clinical reality. We also consider what developments in DSM-5 hold for this area.
Recent research indicates that n–3 fatty acids can inhibit cognitive decline,
perhaps differentially by hypertensive status.
We tested these hypotheses in a prospective cohort study (the Atherosclerosis
Risk in Communities). Dietary assessment using a food-frequency
questionnaire and plasma fatty acid exposure by gas chromatography were
completed in 1987–1989 (visit 1), while cognitive assessment with
three screening tools – the Delayed Word Recall Test, the Digit
Symbol Substitution Test of the Wechsler Adult Intelligence
Scale–Revised and the Word Fluency Test (WFT) – was
completed in 1990–1992 (visit 2) and 1996–1998 (visit
4). Regression calibration and simulation extrapolation were used to control
for measurement error in dietary exposures.
Four US communities – Forsyth County (North Carolina), Jackson
(Mississippi), suburbs of Minneapolis (Minnesota) and Washington County
Men and women aged 50–65 years at visit 1 with complete dietary
data (n = 7814); white men and women in
same age group in the Minnesota field centre with complete plasma fatty acid
data (n = 2251).
Findings indicated that an increase of one standard deviation in dietary
long-chain n–3 fatty acids (%
of energy intake) and balancing long-chain n−3/n–6 decreased the risk of 6-year cognitive decline in
verbal fluency with an odds ratio (95% confidence interval) of 0.79
(0.66–0.95) and 0.81 (0.68–0.96), respectively, among
hypertensives. An interaction with hypertensive status was found for dietary
long-chain n–3 fatty acids (g
day−1) and WFT decline (likelihood ratio test,
P = 0.06). This exposure in plasma
cholesteryl esters was also protective against WFT decline, particularly
among hypertensives (OR = 0.51, P
One implication from our study is that diets rich in fatty acids of marine
origin should be considered for middle-aged hypertensive subjects. To this
end, randomised clinical trials are needed.
Resort development and coastal beach erosion have led to declines in beach
breeding habitat for the near-threatened Malaysian Plover (Charadrius peronii) in the Gulf of Thailand.
Semi-natural saltflats may provide supplementary nesting areas. We compared the
environmental conditions, incubation behaviour and nesting success of plovers
breeding on sandy beaches and saltflats in Thailand. In total we monitored 21
and nine nesting attempts in 2004 (beaches and saltflats, respectively) and 26
and 22 nesting attempts in 2005. Despite higher air temperatures in the
saltflats (P < 0.0001), we
detected no significant differences in nest attendance (P = 0.542 and P = 0.885 for
2004 and 2005, respectively), number of incubator changes between parents
(P = 0.776 and P = 0.823) or number of parental nest departures (P = 0.087 and P
= 0.712) during 120 incubation observations on 55 nests. There was also no
difference in hatching success between beaches in 2004 (beach = 0.65, saltflat =
0.55; P = 0.692, n = 26) and 2005 (beach = 0.46, saltflat = 0.35; P = 0.539, n =
41). These results suggest that saltflats may provide nesting habitat for
Malaysian Plovers and could help enhance overall hatching success rates by
reducing nesting densities on beaches. Although there are few remaining intact
saltflats in coastal Thailand, there are currently vast areas of abandoned tiger
prawn aquaculture ponds that could be rehabilitated into saltflats at relatively
low cost. Given the large area of disused aquaculture ponds throughout Thailand
and South-East Asia and the substantial human pressure on coastal habitats,
there could be considerable conservation benefits to the restoration of
We have used Raman spectroscopy with 3 different laser excitation wavelengths (near infrared: 785 nm, green 514 nm, and ultraviolet 325 nm) to study diamond particles as a function of particle size, ranging from 5 nm to 100's of μm. We find that the position of the 1332 cm−1 diamond line varies with particle size as a direct result of heating by the laser. This effect is more significant for lower wavelengths, probably as a result of the increased absorbance by nanodiamond particles in the UV.
It has been proposed that certain cell-surface proteins undergo
redox reactions, that is, transfer of hydrogens and electrons between
closely spaced cysteine thiols that can lead to reduction, formation,
or interchange of disulfide bonds. This concept was tested using a
membrane-impermeable trivalent arsenical to identify closely spaced
thiols in cell-surface proteins. We attached the trivalent arsenical,
phenylarsenoxide, to the thiol of reduced glutathione to produce
(GSAO). GSAO bound tightly to synthetic, peptide, and protein
dithiols like thioredoxin, but not to monothiols. To identify
cell-surface proteins that contain closely spaced thiols, we attached
a biotin moiety through a spacer arm to the primary amino group of
the γ-glutamyl residue of GSAO (GSAO-B). Incorporation of GSAO-B
into proteins was assessed by measuring the biotin using
streptavidin-peroxidase. Up to 12 distinct proteins were labeled with
GSAO-B on the surface of endothelial and fibrosarcoma cells. The
pattern of labeled proteins differed between the different cell types.
Protein disulfide isomerase was one of the proteins on the endothelial
and fibrosarcoma cell surface that incorporated GSAO-B. These findings
demonstrate that the cell-surface environment can support the existence
of closely spaced protein thiols and suggest that at least some of these
thiols are redox active.
Macrophages are important in inflammatory processes in heart
disease and in transplantation rejection. A
resurgence of interest in the macrophage has emanated from recent
evidence implicating it as an effector cell
in atherosclerosis and transplantation rejection. The detailed distribution
of the macrophage within the
normal human heart is unknown. We quantified macrophage numbers in the
different chambers of the heart. Large tissue blocks
(1.5–2.0 cm3) were removed from specific sites in 5
‘normal’ control hearts (2 males, 3
females, age range 19–46 y). Paraffin-embedded sections were stained
with a CD68 pan macrophage marker.
Positive cells were enumerated within 20 random fields. Results were analysed
using a generalised linear
modelling method using the Poisson distribution. Macrophages were identified
within septa, and often close
to blood vessels, in the myocardium, and in the majority of areas in all
hearts. Macrophage numbers varied
significantly between areas (range 0–6 cells/high power field;
P<0.001), and between the 5 hearts analysed
(P<0.001). In general, there were significantly more macrophages
in the ventricles (RV P<0.01, LV P<0.05), but
these differences were affected by heart differences. This study provides
a baseline for the range of
macrophage numbers within normal hearts, thus enabling comparisons with
macrophage numbers within diseased and transplanted hearts.
Standard of living reflects the objective dimension of how well the basic needs of life are met, while quality of life is the patient's own subjective view of well-being and satisfaction with her/his life. Sixty-one schizophrenic out-patients completed self-report inventories and participated in interviews about quality of life and standard of living. When living standards were met by a well functioning social service system, patients' perceptions of their quality of life and their standard of living appeared to be independent. Subsequent analyses revealed that ‘inner experiences' was one quality-of-life domain frequently reported as unsatisfactory. Moreover, differences in quality of life were found across patients' age, education, and work status.
Forty-eight newly admitted schizophrenic patients were treated with a fixed, conservative (6·6 mg/kg) dose of chlorpromazine (CPZ) for 28 days. CPZ plasma levels were measured by a gas chromatography mass spectrometry method (GCMS) using 2H6-chlorpromazine as an internal standard. At the end of the fixed-dose period, ‘responders’ had the same plasma levels as ‘non-responders’, suggesting that lack of response is primarily a matter of the illness' sensitivity to CPZ, not to a plasma level below some therapeutic window. After the fixed-dose period, the dosage of CPZ was increased in the ‘non-responders’ by physician's choice. Improvement occurred over a wide range of 10–225 picomoles (3–72 ng)/ml. Above 300 picomoles (95 ng/ml) 4 inaccessible patients eventually became much worse, suggesting psychotoxicity. It is in the inaccessible patient whose illness is only minimally, or not at all, sensitive to CPZ that a plasma level might be especially useful.
Interpretation of plasma levels is complicated by the speed of response: some initial non-responders improved by the 56th day of treatment on very conservative plasma levels.
A recent note by Karon and VandenBos (1) on psychotherapy of schizophrenic patients claims to have demonstrated that additional psychotherapy produced significantly better results than the usual hospital treatment; and that outcome depended strikingly on an interaction between the use of drugs and the experience of the therapist. In presenting their findings as a challenge to a report by May and Tuma, they fail to point out that their results run contrary also to the general trend in other studies of psychotherapy and schizophrenia. These indicate that, even when given by experienced therapists, psychotherapy for hospitalized schizophrenic patients is, in general, relatively ineffective, while drug therapy enhances results regardless of the therapist's experience.