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To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
Flexible laryngoscopy is a commonly performed procedure in otolaryngology. Although this procedure is not considered painful, many patients describe it as uncomfortable. This study investigated the role of visual distraction as a form of pain relief during flexible laryngoscopy.
The study included patients undergoing flexible laryngoscopy at the University Hospital Southampton. Patients were self-allocated to one of four groups: with or without co-phenylcaine anaesthetic spray; and with and without visual distraction. Visual distraction involved the patient watching the procedure concurrently with the clinician, via a video monitor. Pre- and post-procedural discomfort was assessed using a visual analogue scale.
The use of topical anaesthetic spray was not associated with significantly reduced discomfort scores (p > 0.05). Discomfort scores were significantly reduced in the visual distraction groups (p = 0.04), irrespective of the use of topical anaesthetic spray.
This small study showed that visual distraction should be considered as a simple and cost-effective alternative to local anaesthetic for flexible laryngoscopy.
Up to 70 per cent of the population search online for medical or health-related information. This study aimed to assess the quality of online health resources available to educate patients on a variety of otolaryngological conditions.
Two clinicians independently analysed the quality and content of educational websites (patient.co.uk and wikipedia.org) for common and uncommon diagnoses, with cancerresearchuk.org also used to assess two head and neck cancers.
Cancerresearchuk.org, followed by patient.co.uk, scored most highly in their ability to inform readers on a selection of otolaryngological conditions. Although wikipedia.org was less likely to include all relevant information and was more difficult to read, it still provided mostly accurate information.
Where possible, patients should be advised to access professionally maintained health information websites (patient.co.uk and cancerresearchuk.org). However, wikipedia.org can provide adequate information, although it lacks depth and can be difficult to understand.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
Without a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.
A retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.
A range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.
Neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.
WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments. Prehosp Disaster Med. 2016;31(6):675–679.
The linear polarization of the Crab pulsar as a function of pulse phase was observed by the High Speed Photometer on the Hubble Space Telescope in March, 1993. Observations were obtained in a bandpass centered on 2770 A using a 0.25 ms sample time, corresponding to a time resolution of 0.0075 in pulse phase. The UV polarization of the pulsar [Fig. 1] is strikingly similar to that observed in the visible (cf. Smith et al. 1988). The same values of polarization and the same swing of position angle occur through the main and secondary pulses. The polarization pulse profile must be essentially wavelength independent at frequencies above the infrared.
This study aimed to ascertain otolaryngologists’ current knowledge of new (e.g. apixaban, rivaroxaban) and old (e.g. warfarin) anticoagulant medications, and to provide an educational overview of new anticoagulants for use by surgeons.
A questionnaire survey was distributed across the Wessex region, UK, to ascertain the levels of knowledge of and confidence in managing patients taking various anticoagulants. In total, 50 questionnaires were completed (41 by trainees and 9 by consultants). A literature review of new anticoagulant medications was then conducted.
In general, there was poor clinical and pharmacokinetic knowledge of newly licensed anticoagulant medications. Respondents were more confident in the use of older vs newer forms of anticoagulants. This was true across all grades of doctors, but particularly at the senior level. All respondents stated that they would like to see an educational resource on anticoagulants.
Knowledge of newly licensed anticoagulation medications is poor. This study has produced an educational resource for the management of anticoagulant agents. A thorough knowledge of these drugs is essential for the acute management of bleeding patients and in peri-operative surgical planning.
YouTube is an internet-based repository of user-generated content. This study aimed to determine whether YouTube represented a valid and reliable patient information resource for the lay person on the topic of rhinosinusitis.
The study included the first 100 YouTube videos found using the search term ‘sinusitis’. Videos were graded on their ability to inform the lay person on the subject of rhinosinusitis.
Forty-five per cent of the videos were deemed to provide some useful information. Fifty-five per cent of the videos contained little or no useful facts, 27 per cent of which contained potentially misleading or even dangerous information. Videos uploaded by medical professionals or those from health information websites contained more useful information than those uploaded by independent users.
YouTube appears to be an unreliable resource for accurate and up to date medical information relating to rhinosinusitis. However, it may provide some useful information if mechanisms existed to direct lay people to verifiable and credible sources.
There is currently little published guidance on the management of anticoagulant and antiplatelet medication in patients admitted with epistaxis. The routine practice of withholding such medication in an attempt to control the epistaxis is common in the UK. However, this practice is not evidence-based, is often unnecessary, and can be associated with significant morbidity. This study introduces a treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients, validated through a completed audit cycle.
One hundred patients admitted with epistaxis to the University Hospital Southampton NHS Foundation Trust were studied via a two-audit cycle covering the implementation of a new treatment algorithm formulated jointly by the otolaryngology and haematology departments.
On admission, 58 per cent of patients were taking some form of anticoagulant or antiplatelet medication. The number of patients having such medication withheld decreased significantly between the two audits, for all drugs studied (i.e. aspirin, clopidogrel and warfarin). There was no significant increase in re-bleeding or re-admission rates between the audits.
Implementation of this treatment algorithm would help standardise management for epistaxis patients taking anticoagulant or antiplatelet drugs, and should reduce morbidity associated with unnecessary routine discontinuation of such medication.
Ferroelectric liquid crystalline polymer films exhibit a number of unique physical properties and have been extensively studied during the last few years. Ferroelectric polymer films exhibiting a high level of piezoelectric activity would provide a new route to piezo- and pyro-electric sensors.
We report the fabrication of free-standing ferroelectric liquid crystal films which exhibit piezoelectric coefficients up to 4.4pC/N. We also report the investigation of the physical properties of these films by dynamic mechanical analysis.
For the past three decades, scholars of social movements have debated whether collective protest is the product of prior organization, as predicted by resource mobilization and political process theories. In this chapter, we consider the other side of this relationship: whether the diffusion of protest leads to the growth of movement organizations. This tackles the third question posed by Givan, Roberts, and Soule in the introduction to this volume: What is the impact of diffusion? This question is rarely asked, as studies of diffusion devote much greater attention to the onset and spread of innovations than to their long-term consequences (Soule 2004; Strang and Soule 1998). Although the consequences of the diffusion of protest for movement organization have attracted remarkably little attention, various theories converge on the prediction that the effect will be positive. People drawn into protest are available to be recruited as new members, and activists have reason to consolidate the enthusiasm of defiance by expanding existing organizations or founding new ones.
This chapter considers a historically and theoretically influential case: the 1960 sit-ins by black college students in the American South. The sit-ins have been credited with revitalizing a civil rights struggle that had been floundering in the late 1950s. Local campaigns were set in motion, new leaders emerged, established organizations increased their efforts, and a new organization was created – the Student Nonviolent Coordinating Committee (SNCC).
The Antikythera Mechanism is the most sophisticated extant ancient astronomical instrument and analogue computer known and was assembled sometime between 150 and 100 BCE, almost a century after the death of Archimedes. The mechanism has a great educational potential as it appeals to inquiring minds as an astonishing artefact of science and technology. The latest research findings reveal significant cultural and social functions in its operations. This astonishing astronomical instrument has a clear interdisciplinary valueand it has that it may be used as an educational medium, to engage the general public, and especially to attract students both to/from exact sciences and to/from the humanities. The astronomical and technical knowledge embedded in the mechanism can also be used to introduce some aspects of modern science through the unknown technological achievements of Hellenic antiquity.
The problem of linear wave scattering by an ice sheet of variable thickness floating on water of variable quiescent depth is considered by applying the Rayleigh–Ritz method in conjunction with a variational principle. By using a multi-mode expansion to approximate the velocity potential that represents the fluid motion, Porter & Porter (J. Fluid Mech. vol. 509, 2004, p. 145) is extended and the solution of the problem may be obtained to any desired accuracy. Explicit solution methods are formulated for waves that are obliquely incident on two-dimensional geometry, comparisons are made with existing work and a range of new examples that includes both total and partial ice-cover is considered.
Explicit expressions are derived for the inverses of operators of a particular class that includes the operator corresponding to a system of coupled integral equations having weighted difference kernels. The inverses are expressed in terms of a finite number of functions and a systematic way of generating different sets of these functions is devised. The theory generalizes those previously derived for a single integral equation and an integral-equation system with pure difference kernels. The connection is made between the finite generation of inverses and embedding.
Background. The present study provides additional data on the psychometric properties of the 30-item Inventory of Depressive Symptomatology (IDS) and of the recently developed Quick Inventory of Depressive Symptomatology (QIDS), a brief 16-item symptom severity rating scale that was derived from the longer form. Both the IDS and QIDS are available in matched clinician-rated (IDS-C30; QIDS-C16) and self-report (IDS-SR30; QIDS-SR16) formats.
Method. The patient samples included 544 out-patients with major depressive disorder (MDD) and 402 out-patients with bipolar disorder (BD) drawn from 19 regionally and ethnicically diverse clinics as part of the Texas Medication Algorithm Project (TMAP). Psychometric analyses including sensitivity to change with treatment were conducted.
Results. Internal consistencies (Cronbach's alpha) ranged from 0·81 to 0·94 for all four scales (QIDS-C16, QIDS-SR16, IDS-C30 and IDS-SR30) in both MDD and BD patients. Sad mood, involvement, energy, concentration and self-outlook had the highest item-total correlations among patients with MDD and BD across all four scales. QIDS-SR16 and IDS-SR30 total scores were highly correlated among patients with MDD at exit (c=0·83). QIDS-C16 and IDS-C30 total scores were also highly correlated among patients with MDD (c=0·82) and patients with BD (c=0·81). The IDS-SR30, IDS-C30, QIDS-SR16, and QIDS-C16 were equivalently sensitive to symptom change, indicating high concurrent validity for all four scales. High concurrent validity was also documented based on the SF-12 Mental Health Summary score for the population divided in quintiles based on their IDS or QIDS score.
Conclusion. The QIDS-SR16 and QIDS-C16, as well as the longer 30-item versions, have highly acceptable psychometric properties and are treatment sensitive measures of symptom severity in depression.
Previous polynya flux models have specified a constant value for the collection
thickness of frazil ice, H, at the polynya edge. In certain circumstances, this approach
can cause the frazil ice depth, h, within the polynya, to exceed H, a result which
violates assumptions made in the formulation of the ice flux balance equations at
the polynya edge. To overcome this problem, a parameterization for H is derived
in terms of the depth of frazil ice arriving at the polynya edge and the component,
normal to the polynya edge, of the frazil ice velocity relative to the velocity of the
consolidated ice pack. Thus, H is coupled to the unknown polynya edge. Using the
new parameterization for H, an analysis of the unsteady one-dimensional opening
of a coastal polynya is presented. Analytical solutions are also derived, using the
new parameterization for H, for steady-state two-dimensional polynyas adjacent to a
semi-infinite and finite-length coastal barrier, the latter case representing a prototype
island. In all cases, the solutions show close qualitative and quantitative agreement
with those derived using a constant value for H. However, the steady-state two-dimensional polynya edge can, in certain circumstances, exhibit a corner at the point
where the offshore equilibrium width is reached. Precise conditions for the existence
of a corner are derived in terms of the orientation of the frazil ice velocity (u) and
the consolidated ice velocity (U). Upper and lower bounds are also obtained for the
area of the steady-state island polynya, and it is shown that over a large range of
orientations of u and U, the area exceeds that associated with the island polynya
with constant H. Finally, two simulations of the St. Lawrence Island Polynya are
presented using the new parameterization for H, and the results are compared with
the H-constant theory.