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This study aims to capture perspectives of healthcare workers (HCWs) on COVID-19 and infection prevention and control (IPAC) measures implemented during the early phase of the COVID-19 pandemic.
A cross-sectional survey of HCWs was conducted.
HCWs from the Hospital for Sick Children, Toronto, Canada.
A self-administered survey was distributed to HCWs. We analyzed factors influencing HCWs’ knowledge and self-reported use of personal protective equipment (PPE), concerns of contracting COVID-19 and acceptance of the recommended IPAC precautions for COVID-19.
A total of 175 HCWs (35 (20%) staff physicians, 24 (14%) residents or fellows, 72 (41%) nurses, 14 (8%) respiratory therapists, 14 (8%) administration staff and 14 (8%) other employees) completed the survey between March 6th and March 10th. Most of the respondents were from the emergency department (n=58; 33%) and the Intensive Care Unit (n=58; 33%). Eighty-six respondents (50%) identified the correct donning order. Only 60 (35%) identified the correct doffing order, but the majority (n=113, 70%) indicated the need to wash their hands immediately prior to removal of their mask and eye protection. Ninety-one (54%) respondents felt comfortable with recommendations for droplet/contact precautions for routine care of patients with COVID-19. HCWs’ occupation and concerns about contracting COVID-19 outside of work were associated with non-acceptance of the recommendation (p = 0.016 and p=0.036 respectively).
As part of their pandemic response plans, healthcare institutions should have ongoing trainings for HCWs that focus on appropriate PPE doffing and discussions around modes of transmission of COVID-19.
Morning coffee is a common remedy following disrupted sleep yet each factor can independently impair glucose tolerance and insulin sensitivity in healthy adults. Remarkably, the combined effects of sleep fragmentation and coffee on glucose control upon waking per se have never been investigated.
In a randomised cross-over design, 29 adults (Mean ± SD; age: 21 ± 1 years, BMI: 24.4 ± 3.3 kg·m-2) underwent three oral glucose tolerance tests (OGTT). One following a habitual night of sleep (Control; in bed, lights-off trying to sleep ~2300-0700 h) the others following a night of sleep fragmentation (as Control but waking hourly for 5 min), once with and once without morning coffee ~1 h after waking (~300 mg caffeine as black coffee 30 min prior to OGTT).
Peak plasma glucose and insulin concentrations were unaffected by sleep quality but were higher following coffee consumption (Mean [normalised confidence interval] for Control, Fragmented, and Fragmented+Coffee, respectively; Glucose: 8.20 [7.93-8.47] mmol∙L-1versus 8.23 [7.96-8.50] mmol∙L-1versus 8.96 [8.70-9.22] mmol.L-1; Insulin: 265 [247-283] pmol∙L-1; and 235 [218-253] pmol∙L-1; and 310 [284-337] pmol∙L-1). Likewise, iAUC for plasma glucose was higher in the Fragmented+Coffee trial compared to Fragmented.
Whilst sleep fragmentation did not alter glycaemic or insulinaemic responses to morning glucose ingestion, if a strong caffeinated coffee is consumed then a reduction in glucose tolerance can be expected.
Clay minerals from the Indus Canyon and eastern clinoform since ~12 ka are uniformly rich in smectite and illite, similar to those from the Holocene Indus flood plains. A systematic enrichment of smectite in the proximal delta compared to the canyon and eastern clinoform argues for preferential capture of smectite close to the river mouth since ~12 ka. There is a rapid shift to a more smectite-rich assemblage in the canyon and eastern clinoform after ~5 ka. This change is probably caused by a change in sediment source, with less direct flux from the Himalaya and more erosion of older, weathered, smectite-rich sediment from the Indus River flood plains, driven by incision of the Indus and its tributaries into the floodplain as summer monsoon rains weakened. This influx of smectite is consistent with lower kaolinite/smectite values since ~5 ka. The onset of large-scale agricultural activities since ~5 ka, especially starting with the Harappan Civilization, may also have enhanced incision and erosion of floodplain sediments over the same time period. This study reports for the first time how monsoon strength variations since ~12 ka affected the clay mineral assemblages and sediment provenance in a major submarine canyon.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Objectives: The Tower of London (TOL) test has probably become the most often used task to assess planning ability in clinical and experimental settings. Since its implementation, efforts were made to provide a task version with adequate psychometric properties, but extensive normative data are not publicly available until now. The computerized TOL-Freiburg Version (TOL-F) was developed based on theory-grounded task analyses, and its psychometric adequacy has been repeatedly demonstrated in several studies but often with small and selective samples. Method: In the present study, we now report reliability estimates and normative data for the TOL-F stratified for age, sex, and education from a large population-representative sample collected in the Gutenberg Health Study in Mainz, Germany (n=7703; 40–80 years). Results: The present data confirm previously reported adequate indices of reliability (>.70) of the TOL-F. We also provide normative data for the TOL-F stratified for age (5-year intervals), sex, and education (low vs. high education). Conclusions: Together, its adequate reliability and the representative age-, sex-, and education-fair normative data render the computerized TOL-F a suitable diagnostic instrument to assess planning ability. (JINS, 2019, 25, 520–529)
Though compact polarimetric approaches have been developed and applied in space and geo researching systems they have not been taken into consideration in automotive applications, yet. A sensor system has been designed to conduct polarimetric measurements in the 77 GHz frequency band, which is permitted for automotive usage. This system is able to transceive linearly as well as circularly polarized electromagnetic continuous waves. Depending on the case of application, the frequency output can be set statically or modulated over time within adjustable parameters. Hence, a variety of compact polarimetric modes can be performed and compared with full polarimetric approaches. Two compact polarimetric modes, dual-circular polarimetric mode, and circular-transmit-linear-receive, will be introduced and applied in this contribution. Their operability in this frequency range will be investigated after the microstrip antennas as well as the beam focusing dielectrical lense are characterized. Finally, results of a realistical measurement set-up will confirm the practicability of compact polarimetric approaches for double bounce recognition.
It is known that in steady-state potential flows, the separation of a gravity-driven free surface from a solid exhibits a number of peculiar characteristics. For example, it can be shown that the fluid must separate from the body so as to form one of three possible in-fluid angles: (i)
or (iii) an angle such that the surface is locally perpendicular to the direction of gravity. These necessary separation conditions were notably remarked upon by Dagan & Tulin (J. Fluid Mech., vol. 51 (3), 1972, pp. 529–543) in the context of ship hydrodynamics, but they are of crucial importance in many potential-flow applications. It is not particularly well understood why there is such a drastic change in the local separation behaviours when the global flow is altered. The question that motivates this work is the following: outside of a formal balance-of-terms argument, why must cases (i)–(iii) occur and furthermore, what are the connections between them? In this work, we seek to explain the transitions between the three cases in terms of the singularity structure of the associated solutions once they are extended into the complex plane. A numerical scheme is presented for the analytic continuation of a vertical jet (or alternatively a rising bubble). It will be shown that the transition between the three cases can be predicted by observing the coalescence of singularities as the speed of the jet is modified. A scaling law is derived for the coalescence rate of singularities.
We introduce the asprilo1 framework to facilitate experimental studies of approaches addressing complex dynamic applications. For this purpose, we have chosen the domain of robotic intra-logistics. This domain is not only highly relevant in the context of today's fourth industrial revolution but it moreover combines a multitude of challenging issues within a single uniform framework. This includes multi-agent planning, reasoning about action, change, resources, strategies, etc. In return, asprilo allows users to study alternative solutions as regards effectiveness and scalability. Although asprilo relies on Answer Set Programming and Python, it is readily usable by any system complying with its fact-oriented interface format. This makes it attractive for benchmarking and teaching well beyond logic programming. More precisely, asprilo consists of a versatile benchmark generator, solution checker and visualizer as well as a bunch of reference encodings featuring various ASP techniques. Importantly, the visualizer's animation capabilities are indispensable for complex scenarios like intra-logistics in order to inspect valid as well as invalid solution candidates. Also, it allows for graphically editing benchmark layouts that can be used as a basis for generating benchmark suites.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Little is known about terrestrial climate dynamics in the Levant during the penultimate interglacial-glacial period. To decipher the palaeoclimatic history of the Marine Oxygen Isotope Stage (MIS) 6 glacial period, a well-dated stalagmite (~194 to ~154 ka) from Kanaan Cave on the Mediterranean coast in Lebanon was analyzed for its petrography, growth history, and stable isotope geochemistry. A resolved climate record has been recovered from this precisely U–Th dated speleothem, spanning the late MIS 7 and early MIS 6 at low resolution and the mid–MIS 6 at higher resolution. The stalagmite grew discontinuously from ~194 to ~163 ka. More consistent growth and higher growth rates between ~163 and ~154 ka are most probably linked to increased water recharge and thus more humid conditions. More distinct layering in the upper part of the speleothem suggests strong seasonality from ~163 ka to ~154 ka. Short-term oxygen and carbon isotope excursions were found between ~155 and ~163 ka. The inferred Kanaan Cave humid intervals during the mid–MIS 6 follow variations of pollen records in the Mediterranean basins and correlate well with the synthetic Greenland record and East Asian summer monsoon interstadial periods, indicating short warm/wet periods similar to the Dansgaard-Oeschger events during MIS 4–3 in the eastern Mediterranean region.
Based on vector network analyzer Measurements, a model for the specular reflection behavior of printed circuit boards in the Terahertz range has been derived. It has been calibrated to suit the behavior of the measurements using a simulated annealing algorithm. The model has been tailored for integration to ray-tracing-based propagation modeling.
We aimed to ascertain the factors associated with lack of isolation precautions (IP) in patients infected or colonized by third-generation cephalosporin-resistant Enterobacteriaceae (3GCR-E) and methicillin-resistant Staphylococcus aureus (MRSA) in hospital settings.
Prospective surveillance and audit of practices.
The study included 4 university hospitals in Lyon, France.
All patients hospitalized between April and June in 2013 and 2015 were included. Case patients had ≥1 clinical sample positive for MRSA and/or 3GCR-E.
Factors associated with the lack of IP implementation were identified using multivariate logistic regression. The incidence of MDRO infections was expressed per 10,000 patient days.
Overall, 57,222 patients accounting for 192,234 patient days of hospitalization were included, and 635 (1.1%) MDRO cases were identified. MRSA incidence was 2.5 per 10,000 patient days (95% confidence interval [95% CI], 2.1–3.0) and 3GCR-E incidence was 10.1 per 10,000 patient days (95% CI, 9.2–11.0), with no crude difference between 2013 and 2015 (P=.15 and P=.11, respectively). Among 3GCR-E, the main species were Escherichia coli (43.8%) and Klebsiella pneumoniae (31.0%). Isolation precautions were implemented in 78.5% of cases. Lack of IP implementation was independently associated with patient age, year, specialty, hospital, colonization compared with infection, and lack of medical prescription for IPs (adjusted odds ratio, 17.4; 95% CI, 8.5–35.8; P<.001).
MRSA and 3GCR-E infections and/or colonizations are frequent in healthcare settings, and IPs are implemented in most cases. When IPs are lacking, the main factor is the absence of medical prescription for IPs, underscoring the need for alerts to physicians by the microbiological laboratory and/or the infection control team.
In Côte d'Ivoire, the world's largest cocoa producer, cacao (Theobroma cacao L.) is usually grown from seed. The genetics consist of a mix of amelonado, trinitario and selected hybrids. This mix of varieties generates high phenotypic variabilities, including variability in tree productivity, within cacao populations in both smallholder and industrial plantations. Tree-to-tree variability in yield has been reported in cacao breeding trials under different environmental conditions. However, it has never been considered a limiting factor for agronomical performance of seedling-based cacao plantations. Around 10 000 cacao trees from seven plots under different environmental conditions in a cacao plantation in Côte d'Ivoire were monitored for 2 years. Pod production of individual trees was recorded and annual average tree pod yields were assessed. High heterogeneity in cacao-tree yields was observed in all plots, with coefficients of variation ranging from 56 to 102%. The distribution of cacao-tree yields in each plot was positively skewed. Analysis of these distributions showed that unproductive trees represented a significant proportion of cacao tree populations (7%), and the 20% least productive trees accounted for 3% of production. The 20% most productive trees were responsible for 46% of the total pod production of a plot. This heterogeneity reflects a major imbalance in the agronomical performances of low- and high-yielding trees and also represents possible efficiency gaps in seedling-based cacao plantations, which could be overcome through innovative corrective strategies, opening new pathways for improvement of cacao-based cropping systems.
Childhood maltreatment has been discussed as a risk factor for the development and maintenance of depression.
To examine the relationship between childhood maltreatment and adult depression with regard to depression incidence, severity, age at onset, course of illness and treatment response.
We conducted meta-analyses of original articles reporting an association between childhood maltreatment and depression outcomes in adult populations.
In total, 184 studies met inclusion criteria. Nearly half of patients with depression reported a history of childhood maltreatment. Maltreated individuals were 2.66 (95% CI 2.38–2.98) to 3.73 (95% CI 2.88–4.83) times more likely to develop depression in adulthood, had an earlier depression onset and were twice as likely to develop chronic or treatment-resistant depression. Depression severity was most prominently linked to childhood emotional maltreatment.
Childhood maltreatment, especially emotional abuse and neglect, represents a risk factor for severe, early-onset, treatment-resistant depression with a chronic course.
Interactions between human lysozyme (HL) and the lipopolysaccharide (LPS) of Klebsiella pneumoniae O1, a causative agent of lung infection, were identified by surface plasmon resonance. To characterize the molecular mechanism of this interaction, HL binding to synthetic disaccharides and tetrasaccharides representing one and two repeating units, respectively, of the O-chain of this LPS were studied. pH-dependent structural rearrangements of HL after interaction with the disaccharide were observed through nuclear magnetic resonance. The crystal structure of the HL-tetrasaccharide complex revealed carbohydrate chain packing into the A, B, C, and D binding sites of HL, which primarily occurred through residue-specific, direct or water-mediated hydrogen bonds and hydrophobic contacts. Overall, these results support a crucial role of the Glu35/Asp53/Trp63/Asp102 residues in HL binding to the tetrasaccharide. These observations suggest an unknown glycan-guided mechanism that underlies recognition of the bacterial cell wall by lysozyme and may complement the HL immune defense function.