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The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations.
Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019.
HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped.
We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b.
A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.
A growing body of research suggests that deficient emotional self-regulation (DESR) is common and morbid among attention-deficit/hyperactivity disorder (ADHD) patients. The main aim of the present study was to assess whether high and low levels of DESR in adult ADHD patients can be operationalized and whether they are clinically useful.
A total of 441 newly referred 18- to 55-year-old adults of both sexes with Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5) ADHD completed self-reported rating scales. We operationalized DESR using items from the Barkley Current Behavior Scale. We used receiver operator characteristic (ROC) curves to identify the optimal cut-off on the Barkley Emotional Dysregulation (ED) Scale to categorize patients as having high- versus low-level DESR and compared demographic and clinical characteristics between the groups.
We averaged the optimal Barkley ED Scale cut-points from the ROC curve analyses across all subscales and categorized ADHD patients as having high- (N = 191) or low-level (N = 250) DESR (total Barkley ED Scale score ≥8 or <8, respectively). Those with high-level DESR had significantly more severe symptoms of ADHD, executive dysfunction, autistic traits, levels of psychopathology, and worse quality of life compared with those with low-level DESR. There were no major differences in outcomes among medicated and unmedicated patients.
High levels of DESR are common in adults with ADHD and when present represent a burdensome source of added morbidity and disability worthy of further clinical and scientific attention.
Environmental rights, also known as the human rights or constitutional rights that are used for the protection of the environment, have proliferated over the last forty-five years. However, the precise levels of protection that they represent has since been a major question associated with this phenomenon. Environmental Rights: The Development of Standards systematically investigates this question by analyzing the emerging standards of environmental protection that are associated with such rights and the way that those associations are becoming formalized. It covers all of the relevant human rights treaties to illustrate how environmental rights standards are emerging in this dynamic area. Bringing together an elite group of scholars, this book discusses significant new insights into the way that environmental rights are developing, the standards of protection that they confer, and the way that standards in the field of environmental rights can potentially be further developed in the future.
To investigate whether specific symptoms of attention deficit hyperactivity disorder (ADHD) can help identify ADHD patients with mind wandering.
Subjects were adults ages 18–55 of both sexes (n=41) who completed the Mind-Wandering Questionnaire (MWQ) and the ADHD module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children Epidemiologic Version. We used Spearman’s rank correlation and Pearson’s χ2 analyses to examine associations between the ADHD module and the MWQ and receiver operator characteristic (ROC) analyses to evaluate the diagnostic efficiency of the ADHD module.
Out of the three ADHD domains, the inattentive ADHD scores had the strongest association with the MWQ (total: rs=0.34, df=39, p=0.03; inattentive: rs=0.38, df=39, p=0.02; Hyperactive: rs=0.17, df=39, p=0.28). Correlation analyses between individual items on the ADHD module and the MWQ showed that two inattention items (‘failure to pay attention to detail’ and ‘trouble following instructions’) were positively associated with total scores on the MWQ (p=0.02). These two inattention items had the strongest association with the MWQ (rs=0.45, df=38, p=0.004). ROC analyses showed that the combined score of the two significant inattention items had the highest efficiency (AUC=0.71) in classifying high-level mind wanderers as defined by scores greater than the median split on the MWQ. The combined score of the two inattention items best identified high-level mind wanderers.
Results suggest a way to operationalise mind wandering using the symptoms of ADHD.
Cryptosporidium parvum is the major cause of livestock and zoonotically-acquired human cryptosporidiosis. The ability to track sources of contamination and routes of transmission by further differentiation of isolates would assist risk assessment and outbreak investigations. Multiple-locus variable-number of tandem-repeats (VNTR) analysis provides a means for rapid characterization by fragment sizing and estimation of copy numbers, but structured, harmonized development has been lacking for Cryptosporidium spp. To investigate potential for application in C. parvum surveillance and outbreak investigations, we studied nine commonly used VNTR loci (MSA, MSD, MSF, MM5, MM18, MM19, MS9-Mallon, GP60 and TP14) for chromosome distribution, repeat unit length and heterogeneity, and flanking region proximity and conservation. To investigate performance in vitro, we compared these loci in 14 C. parvum samples by capillary electrophoresis in three laboratories. We found that many loci did not contain simple repeat units but were more complex, hindering calculations of repeat unit copy number for standardized reporting nomenclature. However, sequenced reference DNA enabled reproducible fragment sizing and inter-laboratory allele assignation based on size normalized to that of the sequenced fragments by both single round and nested polymerase chain reactions. Additional Cryptosporidium loci need to be identified and validated for robust inter-laboratory surveillance and outbreak investigations.
Wild parsnip is an invasive species with a global distribution in temperate climates. Parsnips are native to Eurasia and have been cultivated for more than five centuries. It is unclear whether the global invasion of this species is a consequence of escape from cultivation or the accidental introduction of a Eurasian wild subspecies. In this study, we used nuclear ribosomal DNA internal transcribed spacer (ITS) and chloroplast DNA (cpDNA) markers to evaluate the genetic structure of wild parsnip in its native range (Europe) and in three distinct geographic regions where it is considered invasive: eastern North America, western North America, and New Zealand. We also compared wild and cultivated parsnips to determine whether they are genetically distinct. From 112 individuals, we recovered 14 ITS and 27 cpDNA haplotypes. One ITS haplotype was widespread; few haplotypes were rare singletons. In contrast, at least two lineages of cpDNA haplotypes were recovered, with several novel haplotypes restricted to Europe. Cultivated parsnips were not genetically distinct from wild parsnips, and numerous wild parsnip populations shared haplotypes with cultivars. High genetic diversity was recovered in all three regions, suggesting multiple introductions.
The terminal lake systems of central Australia are key sites for the reconstruction of late Quaternary paleoenvironments. Paleoshoreline deposits around these lakes reflect repeated lake filling episodes and such landforms have enabled the establishment of a luminescence-based chronology for filling events in previous studies. Here we present a detailed documentation of the morphology and chemistry of soils developed in four well-preserved beach ridges of late Pleistocene and mid-to-late Holocene age at Lake Callabonna to assess changes in dominant pedogenic processes. All soil profiles contain evidence for the incorporation of eolian-derived material, likely via the formation of desert pavements and vesicular horizons, and limited illuviation due to generally shallow wetting fronts. Even though soil properties in the four studied profiles also provide examples of parent material influence or site-specific processes related to the geomorphic setting, there is an overall trend of increasing enrichment of eolian-derived material since at least ~ 33 ka. Compared to the Holocene profiles, the derived average accumulation rates for the late Pleistocene profiles are significantly lower and may suggest that soils record important regional changes in paleoenvironments and dust dynamics related to shifts in the Southern Hemisphere westerlies.
High-quality evidence on morale in the mental health workforce is
To describe staff well-being and satisfaction in a multicentre UK
National Health Service (NHS) sample and explore associated factors.
A questionnaire-based survey (n = 2258) was conducted in
100 wards and 36 community teams in England. Measures included a set of
frequently used indicators of staff morale, and measures of perceived job
characteristics based on Karasek's demand–control–support model.
Staff well-being and job satisfaction were fairly good on most
indicators, but emotional exhaustion was high among acute general ward
and community mental health team (CMHT) staff and among social workers.
Most morale indicators were moderately but significantly intercorrelated.
Principal components analysis yielded two components, one appearing to
reflect emotional strain, the other positive engagement with work. In
multilevel regression analyses factors associated with greater emotional
strain included working in a CMHT or psychiatric intensive care unit
(PICU), high job demands, low autonomy, limited support from managers and
colleagues, age under 45 years and junior grade. Greater positive
engagement was associated with high job demands, autonomy and support
from managers and colleagues, Black or Asian ethnic group, being a
psychiatrist or service manager and shorter length of service.
Potential foci for interventions to increase morale include CMHTs, PICUs
and general acute wards. The explanatory value of the
demand–support–control model was confirmed, but job characteristics did
not fully explain differences in morale indicators across service types