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Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.
From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.
All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.
No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.
Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
This paper presents Parallel World Framework as a solution for simulations of complex systems within a time-varying knowledge graph and its application to the electric grid of Jurong Island in Singapore. The underlying modeling system is based on the Semantic Web Stack. Its linked data layer is described by means of ontologies, which span multiple domains. The framework is designed to allow what-if scenarios to be simulated generically, even for complex, inter-linked, cross-domain applications, as well as conducting multi-scale optimizations of complex superstructures within the system. Parallel world containers, introduced by the framework, ensure data separation and versioning of structures crossing various domain boundaries. Separation of operations, belonging to a particular version of the world, is taken care of by a scenario agent. It encapsulates functionality of operations on data and acts as a parallel world proxy to all of the other agents operating on the knowledge graph. Electric network optimization for carbon tax is demonstrated as a use case. The framework allows to model and evaluate electrical networks corresponding to set carbon tax values by retrofitting different types of power generators and optimizing the grid accordingly. The use case shows the possibility of using this solution as a tool for CO2 reduction modeling and planning at scale due to its distributed architecture.
Postoperative cognitive impairment is among the most common medical complications associated with surgical interventions – particularly in elderly patients. In our aging society, it is an urgent medical need to determine preoperative individual risk prediction to allow more accurate cost–benefit decisions prior to elective surgeries. So far, risk prediction is mainly based on clinical parameters. However, these parameters only give a rough estimate of the individual risk. At present, there are no molecular or neuroimaging biomarkers available to improve risk prediction and little is known about the etiology and pathophysiology of this clinical condition. In this short review, we summarize the current state of knowledge and briefly present the recently started BioCog project (Biomarker Development for Postoperative Cognitive Impairment in the Elderly), which is funded by the European Union. It is the goal of this research and development (R&D) project, which involves academic and industry partners throughout Europe, to deliver a multivariate algorithm based on clinical assessments as well as molecular and neuroimaging biomarkers to overcome the currently unsatisfying situation.
To identify ways that the built environment may support or disrupt safe doffing of personal protective equipment (PPE) in biocontainment units (BCU).
We observed interactions between healthcare workers (HCWs) and the built environment during 41 simulated PPE donning and doffing exercises.
The BCUs of 4 Ebola treatment facilities and 1 high-fidelity BCU mockup.
A total of 64 HCWs (41 doffing HCWs and 15 trained observers) participated in this study.
In each facility, we observed how the physical environment influences risky behaviors by the HCW. The environmental design impeded communication between trained observers (TOs) and HCWs because of limited window size or visual obstructions with louvers, which allowed unobserved errors. The size and configuration of the doffing area impacted HCW adherence to protocol, and lack of clear demarcation of zones resulted in HCWs inadvertently leaving the doffing area and stepping back into the contaminated areas. Lack of standard location for items resulted in equipment and supplies frequently shifting positions. Finally, different solutions for maintaining balance while removing shoe covers (ie, chair, hand grips, and step stool) had variable success. We identified the 5 key requirements that doffing areas must achieve to support safe doffing of PPE, and we developed a matrix of proposed design strategies that can be implemented to meet those requirements.
Simple, low-cost environmental design interventions can provide structure to support and improve HCW safety in BCUs. These interventions should be implemented in both current and future BCUs.
The functional composition of plant communities in montane regions has been studied for decades, and most recent analyses find that environmentally favourable landscapes at lower altitudes tend to be dominated by species with resource-acquisitive traits, while more resource-conservative taxa dominate higher-altitude communities. However, it is unclear the extent to which this pattern is driven by co-gradient variation within clades or changes in clade representation across the gradient. To test for co-gradient variation, species composition, phylogenetic structure and functional traits were quantified for 97 species within the plant family Melastomataceae at five locations across a 2500-m altitudinal gradient along Volcán Barva in Costa Rica. Average melastome leaf force to punch, specific leaf area and leaf size vary with altitude, while four other functional traits do not. Taxonomic dissimilarity between communities was correlated with altitudinal difference, while phylogenetic dissimilarity was correlated with altitudinal dissimilarity only when measured with a metric that emphasizes shallow turnover of the tips of the phylogeny. These results highlight how species turnover may be more pronounced than functional or phylogenetic variation along altitudinal gradients. In addition, these results highlight the conservation value of lowland tropical forests, which here harbour a disproportionate amount of phylogenetic and functional diversity.
We compared rotavirus detection patterns before (2001–2006) and after (2008–2015) rotavirus vaccine introduction. We also compared rotavirus detection patterns in odd (2009, 2011, 2013, 2015) and even (2008, 2010, 2012, 2014) years post-vaccine separately. Results of stool rotavirus antigen testing from inpatient, outpatient and emergency department encounters from July 2000 to July 2015 at two paediatric hospital laboratories in Atlanta, Georgia were reviewed. Post-vaccine, rotavirus detection declined (30.2% vs. 13.7% (overall 54.6% decline, P <0.001)), occurred more frequently outside the rotavirus season (19.8% vs. 3.5%; P < 0.001), and was more common among older children (26 vs. 13 median months of age; P < 0.001). During odd years post-vaccine, rotavirus detection was significantly higher than even years (20.2% vs. 6.4%; P < 0.001). Rotavirus detection declined substantially and developed a biennial pattern in the post-vaccine era. The intensity and temporality of rotavirus detection in odd years post-vaccine resembled that observed pre-vaccine, although considerably reduced in magnitude.
A number of laser facilities coming online all over the world promise the capability of high-power laser experiments with shot repetition rates between 1 and 10 Hz. Target availability and technical issues related to the interaction environment could become a bottleneck for the exploitation of such facilities. In this paper, we report on target needs for three different classes of experiments: dynamic compression physics, electron transport and isochoric heating, and laser-driven particle and radiation sources. We also review some of the most challenging issues in target fabrication and high repetition rate operation. Finally, we discuss current target supply strategies and future perspectives to establish a sustainable target provision infrastructure for advanced laser facilities.
To describe current Ebola treatment center (ETC) locations, their capacity to care for Ebola virus disease patients, and infection control infrastructure features.
A 19-question survey was distributed electronically in April 2015. Responses were collected via email by June 2015 and analyzed in an electronic spreadsheet.
The survey was sent to and completed by site representatives of each ETC.
The survey was sent to all 55 ETCs; 47 (85%) responded.
Of the 47 responding ETCs, there are 84 isolation beds available for adults and 91 for children; of these pediatric beds, 35 (38%) are in children’s hospitals. In total, the simultaneous capacity of the 47 reporting ETCs is 121 beds. On the basis of the current US census, there are 0.38 beds per million population. Most ETCs have negative pressure isolation rooms, anterooms, and a process for category A waste sterilization, although only 11 facilities (23%) have the capability to sterilize infectious waste on site.
Facilities developed ETCs on the basis of Centers for Disease Control and Prevention guidance, but specific capabilities are not mandated at this present time. Owing to the complex and costly nature of Ebola virus disease treatment and variability in capabilities from facility to facility, in conjunction with the lack of regulations, nationwide capacity in specialized facilities is limited. Further assessments should determine whether ETCs can adapt to safely manage other highly infectious disease threats.
Infect. Control Hosp. Epidemiol. 2016;37(3):313–318
The process of East Asian regionalism received a shot in the arm in 2008 with the proposal made by Australian Prime Minister Kevin Rudd about restructuring the Asia-Pacific regional architecture. This was followed by the proposal made by Japanese Prime Minister Yukio Hatoyama on an East Asian community. There are substantive differences between the two concepts (one being that the former has been much more developed over time while the latter has been left for further discussion). Both, however, have attracted quite a bit of attention, not primarily because of their substantive content but more because of their implications for how currently existing regional institutions seem to be falling short of expectation thus creating the need to explore alternative arrangements. In an indirect way, this is reflective of how much its partners are beginning to grow weary of the ASEAN Way and of the way ASEAN has driven the process.
The very success, however, of ASEAN in managing intra-ASEAN relations to the point of being able to make the prospect of conflict between ASEAN member states unlikely (as well as its involvement in the Cambodian conflict) gave it an international stature out of proportion to the status of its individual member states. This was in fact recognized by its dialogue partners when they accepted the idea that the Association should chair the post-Cold War forum that would oversee discussions and dialogue on the security of the Asia-Pacific region. The fact that it was also called the ASEAN Regional Forum (ARF) when it was established in 1994 more than stamped the ASEAN mark upon it — it signified the adoption of ASEAN norms (especially the consensus-based method of decision-making) as the foundation for what was effectively a nascent attempt at extra-ASEAN regionalism. That it did so with much misgiving did not detract from its determination to show the applicability of the ASEAN “model” to a wider Asia-Pacific scope. This started ASEAN on its way to a significant shift in the evolution of its identity — from an association dedicated to keeping the Southeast Asian region free from being enmeshed in great power rivalries to one which accepted its “centrality” in a wider East Asian and Asia-Pacific regionalism, a process that would entail accepting the involvement of and engaging the major powers in the context of the region.
At the crossroad between nutrient supply and requirements, the liver plays a central role in partitioning nitrogenous nutrients among tissues. The present review examines the utilisation of amino acids (AA) within the liver in various physiopathological states in mammals and how the fates of AA are regulated. AA uptake by the liver is generally driven by the net portal appearance of AA. This coordination is lost when demands by peripheral tissues is important (rapid growth or lactation), or when certain metabolic pathways within the liver become a priority (synthesis of acute-phase proteins). Data obtained in various species have shown that oxidation of AA and export protein synthesis usually responds to nutrient supply. Gluconeogenesis from AA is less dependent on hepatic delivery and the nature of nutrients supplied, and hormones like insulin are involved in the regulatory processes. Gluconeogenesis is regulated by nutritional factors very differently between mammals (glucose absorbed from the diet is important in single-stomached animals, while in carnivores, glucose from endogenous origin is key). The underlying mechanisms explaining how the liver adapts its AA utilisation to the body requirements are complex. The highly adaptable hepatic metabolism must be capable to deal with the various nutritional/physiological challenges that mammals have to face to maintain homeostasis. Whereas the liver responds generally to nutritional parameters in various physiological states occurring throughout life, other complex signalling pathways at systemic and tissue level (hormones, cytokines, nutrients, etc.) are involved additionally in specific physiological/nutritional states to prioritise certain metabolic pathways (pathological states or when nutritional requirements are uncovered).
To determine whether the duration of relief from symptoms in patients with essential blepharospasm (EB) or hemifacial spasm (HFS) who receive serial treatments with botulinum toxin type A (BtA) changes over the long-term.
Retrospective longitudinal comparative analysis. The main outcome measure is the mean duration of relief from symptoms after an injection with BtA. Participants included 34 patients who received 30 or more serial BtA treatments for facial dyskinesia (EB or HFS). Repeated measures and linear regression analyses were used to determine trends and the mean duration of relief from symptoms was compared between early (first ten effective treatments) and late (last ten treatments) sessions in each group.
In the EB group (18 patients), the mean duration of relief was 13.5 weeks for the early and 11.4 weeks for the late sessions (P=0.04). In the HFS group (16 patients) the mean duration of relief was 12.4 weeks in both treatment periods (P=0.91). The duration of relief had a small negative correlation with mean late session BtA dose in the EB group (P=0.03) but no correlation in the HFS group (P=0.12).
There was a trend towards a decreased duration of relief from symptoms in patients with EB over the long-term, but no changes for HFS. The treatment remains effective in relieving symptoms and signs for both conditions.
One of the most incongruous characteristics of Philippine society is the popularity of basketball among a people not noted for their height. The greater interest is in the professional game which is played in quarters rather than according to the amateur rule of dividing the game into two halves. To the Filipino fan, nothing evokes a greater thrill than the fourth-quarter rally, a situation where nothing that the favoured team does can go wrong and allows it to catch up with and surpass the score of the opposing team in the span of the last twelve minutes of the game. Moves are executed perfectly, a very high percentage of the shots go in, loose balls generally end up in or near the hands of their players, and close calls by the referee favour them. In other words, the hard work and skill of the players combined with good luck allow the favoured team to make up for what had generally been bad first three quarters to, as the cliché goes, snatch victory from the jaws of defeat. Conversely, the most dismaying development for the fan would be a situation where their favoured team has built a comfortable lead through three very competently played quarters but is suddenly unable to do anything right to protect the hard-earned lead in the last. The fourth-quarter collapse is a syndrome that has affected even the very best teams. Teams with the most disciplined and highly trained and skilled players can find themselves in situations where nothing works in the fourth quarter, and end up handing over to the opposing team what looked in the first part of the game like certain victory.
The analogy of the fourth-quarter collapse is a way of describing the Philippines in 2009. The end of 2008 did not give much room for confidence. There was concern about how the Philippines would cope with the long-term effects of the global financial crisis. There were projections of overseas Filipino workers being laid off and forced to come back to the country. Not only would the volume of remittances upon which the Philippine economy had become so reliant diminish, it would also intensify the expected effects of the financial crisis on the unemployment situation.
This paper looks at how the global financial crisis impacts on the ASEAN aspiration to build an ASEAN Community. In particular, it looks at the crisis' effect on the establishment of an ASEAN Political-Security Community (APSC). It argues three points. First, the most important contribution of the APSC is in the normative foundations it outlines for ASEAN. These foundations are first and foremost directed at ensuring domestic stability and harmony, it has its principal objective in strengthening ASEAN's position in East Asian regionalism and in maintaining security in Southeast Asia and the broader context of the Asia-Pacific region. The normative commitments outlined in the APSC, however, also imply the need for a certain degree of institutionalization — an outcome that ASEAN does not seem to be as committed to. This brings out the second point — ASEAN, despite its rhetorical commitment to a particular set of normative structures, will continue to be bogged down in setting up the institutional mechanisms needed to realize these normative structures. Third, the intra-ASEAN dynamics at the centre of this issue will be further complicated by the effects of the global financial crisis. In general, ASEAN will continue to be burdened by the inherent contradiction between the normative aspirations expressed in the APSC Blueprint and its desire to maintain existing institutional structural arrangements.
The ASEAN Political-Security Community
On 3 June 2003, Rizal Sukma of the Centre for Strategic and International Studies in Jakarta presented a paper conceptualizing an ASEAN security community at a seminar, “ASEAN Cooperation: Challenges and Prospects in the Current lnternational Situation”. Sukma pointed to the need for the establishment of an ASEAN security community that would pursue a comprehensive framework of security that gives equal importance to both traditional and non-military security issues and responses (Sukma 2003, p. 3). The paper was conceived in reaction to the proposal of the Singaporean Government to establish an ASEAN Economic Community (AEC) that went beyond the ASEAN Free Trade Area (AFTA). Sukma argued that “ASEAN can no longer pretend that peace, stability, and prosperity can only be achieved through economic cooperation” (Sukma 2003, p. 2). This paper eventually became the departure point for the Indonesian Government's initiative on the establishment of the ASEAN Security Community.
Restriction enzyme fingerprints were generated from purified plasmid DNA from 324 clinical isolates that belonged to 7 enterobacterial genera and 88 single plasmids in Escherichia coli K12 according to the following strategy.
Purified plasmid DNA was digested with PstI. The number of fragments detected in a 0·8 agarose gel was used to determine which 2 of 6 restriction enzymes including Pstl was most likely to provide a fingerprint comprising sufficient fragments to ensure specificity but sufficiently few to allow easy visual assessment and minimize coincidental matching. When PstI produced > 20 fragments, Eco RI and HindIII were used; when PstI generated < 6 fragments Bsp 1286 and AvaII were used and SmaI was employed when between 6 and 20 fragments were obtained from PstI digests. Using a minimum of 12 fragments from a combination of 2 enzymes as the criterion for characterizing a strain/plasmid, satisfactory 2-enzyme fingerprints were obtained from 87% of the strains and plasmids studied using PstI and no more than two additional enzymes per strain. Of the remaining 54 strains, 51 harboured only small plasmids (< 10 kb) and 3 produced satisfactory fingerprints when digested with a fourth enzyme.
Four hundred and seven clinical isolates of Escherichia coli were examined for the presence of plasmids. These isolates comprised 189 which were collected irrespective of antimicrobial resistance (VP) and 218 which were collected on the basis of high-level trimethoprim resistance (TPR). The VP isolates were divided into drug sensitive (VPS) and drug-resistant (VPR) subpopulations.
Plasmids were detected in 88% of VP isolates (81% of VPS and 94% of VPR) and 98% of TPR isolates. The distribution of plasmids in both groups and subpopulations was very similar. However, there were small but statistically significant differences between the plasmid distributions. These showed that more isolates in the resistant groups harboured plasmids than in the sensitive subpopulation (VPS) and that the number of plasmids carried by resistant isolates was greater. Multiple drug resistance was significantly more common among TPR isolates than the VPR subpopulation and this was paralleled by increased numbers of plasmids.
Fifty-eight per cent of VPR and 57% of TPR isolates transferred antimicrobial resistance and plasmids to E. coli K12. Of the R+ isolates, 60% carried small plasmids (MW < 20Md) and 52% of these co-transferred with R-plasmids. These results are discussed.
Purpose: To evaluate the role of retrograde urethrography in treatment planning for salvage external beam radiotherapy in patients with increasing prostate-specific antigen levels after radical prostatectomy.
Methods and Materials: From July 1988 to December 2002, 173 consecutive patients received external beam radiotherapy for increasing prostate-specific antigen levels after radical prostatectomy. All 173 simulation films were reviewed, and retrograde urethrography was performed in 148 patients (86%). The distance between the line connecting the lower poles of the ischial tuberosities and site of abrupt narrowing of contrast material was measured in all 148 patients. This distance was compared with that measured in 148 consecutive patients with intact prostates who had retrograde urethrography while undergoing treatment planning for definitive radiotherapy.
Results: The mean (median) distance from the line connecting the lower poles of the ischial tuberosities to the abrupt narrowing seen in the urethrogram in patients with increasing prostate-specific antigen levels was 1.54cm (1.50cm) compared with 1.73cm (1.80cm) in those with intact prostates (p = 0.0145).
Conclusion: Retrograde urethrography is important in treatment planning for salvage radiotherapy of the prostate bed after radical prostatectomy to adequately treat the apex of the prostate bed.