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Due to shortages of N95 respirators during the coronavirus disease 2019 (COVID-19) pandemic, it is necessary to estimate the number of N95s required for healthcare workers (HCWs) to inform manufacturing targets and resource allocation.
We developed a model to determine the number of N95 respirators needed for HCWs both in a single acute-care hospital and the United States.
For an acute-care hospital with 400 all-cause monthly admissions, the number of N95 respirators needed to manage COVID-19 patients admitted during a month ranges from 113 (95% interpercentile range [IPR], 50–229) if 0.5% of admissions are COVID-19 patients to 22,101 (95% IPR, 5,904–25,881) if 100% of admissions are COVID-19 patients (assuming single use per respirator, and 10 encounters between HCWs and each COVID-19 patient per day). The number of N95s needed decreases to a range of 22 (95% IPR, 10–43) to 4,445 (95% IPR, 1,975–8,684) if each N95 is used for 5 patient encounters. Varying monthly all-cause admissions to 2,000 requires 6,645–13,404 respirators with a 60% COVID-19 admission prevalence, 10 HCW–patient encounters, and reusing N95s 5–10 times. Nationally, the number of N95 respirators needed over the course of the pandemic ranges from 86 million (95% IPR, 37.1–200.6 million) to 1.6 billion (95% IPR, 0.7–3.6 billion) as 5%–90% of the population is exposed (single-use). This number ranges from 17.4 million (95% IPR, 7.3–41 million) to 312.3 million (95% IPR, 131.5–737.3 million) using each respirator for 5 encounters.
We quantified the number of N95 respirators needed for a given acute-care hospital and nationally during the COVID-19 pandemic under varying conditions.
Vitamin C deficiency has been a historical disease rarely seen nowadays. We illustrate a case of a boy with autism presenting with severe pulmonary hypertension and refusal to walk secondary to vitamin C deficiency. Initiating treatment with high-dose vitamin C reversed his symptoms and he regained full power of his lower limbs with total normalisation of his pulmonary pressures.
Families facing end-stage nonmalignant chronic diseases (NMCDs) are presented with similar symptom burdens and need for psycho-social–spiritual support as their counterparts with advanced cancers. However, NMCD patients tend to face more variable disease trajectories, and thus may require different anticipatory supports, delivered in familiar environments. The Life Rainbow Programme (LRP) provides holistic, transdisciplinary, community-based end-of-life care for patients with NMCDs and their caregivers. This paper reports on the 3-month outcomes using a single-group, pre–post comparison.
Patients with end-stage NMCDs were screened for eligibility by a medical team before being referred to the LRP. Patients were assessed at baseline (T0), 1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale (IPOS). Their hospital use in the previous month was also measured by presentations at accident and emergency services, admissions to intensive care units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 using the Chinese version of the Modified Caregiver Strain Index, and self-reported health, psychological, spiritual, and overall well-being. Over-time changes in outcomes for patients, and caregivers, were tested using paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests.
Seventy-four patients and 36 caregivers participated in this research study. Patients reported significant improvements in all IPOS domains at both 1 and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and information needs fulfilled)]. Average hospital bed-days in the previous month fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, caregiver strain was significantly reduced (r = 0.332), while spiritual well-being was enhanced (r = 0.333).
After receiving 3 month's LRP services, patients with end-stage NMCDs and their caregivers experienced significant improvements in the quality of life and well-being, and their hospital bed-days were reduced.
The Straw-headed Bulbul Pycnonotus zeylanicus is one of South-East Asia’s most threatened songbirds due to relentless demand for the regional cage-bird trade. The species was recently uplisted from ‘Endangered’ to ‘Critically Endangered’ only two years after its previous uplisting. Intriguingly, populations in highly urbanised Singapore appear relatively secure. However, the last Singaporean density estimates, derived from traditional census methods, were obtained nearly two decades ago in 2001. A recent population estimate in 2016 was derived from the census work in 2001 coupled with relative abundance indices from population trends. We thus performed systematic field surveys using the distance sampling method, estimating 573 ± 185 individuals nation-wide, with a break-down of 217 ± 81 on the main island of Singapore and 356 ± 104 birds on the satellite of Pulau Ubin. Taken together, the total population estimate reported here comprises 22.9–57.3% of the global wild population, underscoring the importance of Singapore as a stronghold for the species. In spite of its apparently secure status in Singapore, the species remains susceptible to local and foreign trapping pressures. Based on our assessment, we propose a number of local and regional conservation measures to ensure the continued survival of populations in Singapore.
A study of low-speed streaks (LSSs) embedded in the near-wall region of a turbulent boundary layer is performed using selective visualization and analysis of time-resolved tomographic particle image velocimetry (tomo-PIV). First, a three-dimensional velocity field database is acquired using time-resolved tomo-PIV for an early turbulent boundary layer. Second, detailed time-line flow patterns are obtained from the low-order reconstructed database using ‘tomographic visualizations’ by Lagrangian tracking. These time-line patterns compare remarkably well with previously observed patterns using hydrogen bubble flow visualization, and allow local identification of LSSs within the database. Third, the flow behaviour in proximity to selected LSSs is examined at varying wall distances (
$10 < y^+ < 100$
) and assessed using time-line and material surface evolution, to reveal the flow structure and evolution of a streak, and the flow structure evolving from streak development. It is observed that three-dimensional wave behaviour of the detected LSSs appears to develop into associated near-wall vortex flow structures, in a process somewhat similar to transitional boundary layer behaviour. Fourth, the presence of Lagrangian coherent structures is assessed in proximity to the LSSs using a Lagrangian-averaged vorticity deviation process. It is observed that quasi-streamwise vortices, adjacent to the sides of the streak-associated three-dimensional wave, precipitate an interaction with the streak. Finally, a hypothesis based on the behaviour of soliton-like coherent structures is made which explains the process of LSS formation, bursting behaviour and the generation of hairpin vortices. Comparison with other models is also discussed.
The AIDS Malignancy Consortium (AMC) conducts clinical trials of therapeutic and prevention strategies for cancer in people living with HIV. With its recent expansion to Sub-Saharan Africa and Latin America, there was a need to increase the competence of clinical investigators (CIs) to implement clinical trials in these regions.
AMC CIs were invited to complete a survey to assess role-relevance and self-perceived competence based on the Joint Task Force for Clinical Trials Competency domains.
A total of 40 AMC CIs were invited to complete the questionnaire and 35 responded to the survey. The data management and informatics and engaging with communities’ domains were lowest in the average proportion of CIs rating themselves high (scores of 3–4) for self-perceived competency (46.6% and 44.2%) and role-relevance (61.6% and 67.5%), whereas, the ethical and participant safety considerations domain resulted in the highest score for competency (86.6%) and role-relevance (93.3%). In the scientific concepts and research design domain, a high proportion rated for competency in evaluating study designs and scientific literature (71.4% and 74.3%) but a low proportion for competency for designing trials and specimen collection protocols (51.4% and 54.3%).
Given the complexity of AMC clinical research, these results provide evidence of the need to develop training for clinical research professionals across domains where self-perceived competence is low. This assessment will be used to tailor and prioritize the AMC Training Program in clinical trial development and management for AMC CIs.
The events surrounding the prodemocracy movement in Hong Kong from 2013 to 2015 represent the latest chapter in a long and torturous struggle for democracy that can be dated back to the early 1980s when Britain and China held their negotiations over the city’s future (So, 1998). The Occupy Central Movement (OCM), initiated by three prodemocracy activists, exhorted supporters to block major roads and exercise civil disobedience in the struggle for full democracy. It soon provoked the Chinese Communist Party-state (“party-state”) to initiate a campaign to counter OCM. Executed mainly through their unofficial agents and sponsored organizations in Hong Kong, its scale of operation was almost unprecedented, at least since the social riot in 1967 (which was largely the spillover of the Cultural Revolution).
Antibiotics are commonly used in intensive care units (ICUs), yet differences in antibiotic use across ICUs are unknown. Herein, we studied antibiotic use across ICUs and examined factors that contributed to variation.
We conducted a retrospective cohort study using data from Ontario’s Critical Care Information System (CCIS), which included 201 adult ICUs and 2,013,397 patient days from January 2012 to June 2016. Antibiotic use was measured in days of therapy (DOT) per 1,000 patient days. ICU factors included ability to provide ventilator support (level 3) or not (level 2), ICU type (medical-surgical or other), and academic status. Patient factors included severity of illness using multiple-organ dysfunction score (MODS), ventilatory support, and central venous catheter (CVC) use. We analyzed the effect of these factors on variation in antibiotic use.
Overall, 269,351 patients (56%) received antibiotics during their ICU stay. The mean antibiotic use was 624 (range 3–1460) DOT per 1,000 patient days. Antibiotic use was significantly higher in medical-surgical ICUs compared to other ICUs (697 vs 410 DOT per 1,000 patient days; P < .0001) and in level 3 ICUs compared to level 2 ICUs (751 vs 513 DOT per 1,000 patient days; P < .0001). Higher antibiotic use was associated with higher severity of illness and intensity of treatment. ICU and patient factors explained 47% of the variation in antibiotic use across ICUs.
Antibiotic use varies widely across ICUs, which is partially associated with ICUs and patient characteristics. These differences highlight the importance of antimicrobial stewardship to ensure appropriate use of antibiotics in ICU patients.
Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension.
We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007–December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011–2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430–437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified.
In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03–1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00–1.67).
Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.
OBJECTIVES/GOALS: We sought to examine: 1) variability in center acceptance patterns for heart allografts offered to the highest-priority candidates, 2) impact of this acceptance behavior on candidate survival, and 3) post-transplantation outcomes in candidates who accepted first rank offer vs. previously declined offer. METHODS/STUDY POPULATION: In this retrospective cohort study, the US national transplant registry was queried for all match runs of adult candidates listed for isolated heart transplantation between 2007-2017. We examined center acceptance rates for heart allografts offered to the highest-priority candidates and accounted for covariates in multivariable logistic regression. Competing risks analysis was performed to assess the relationship between center acceptance rate and waitlist mortality. Post-transplantation outcomes (patient survival and graft failure) between candidates who accepted their first-rank offers vs those who accepted previously declined offers were compared using Fine-Gray subdistribution hazards model. RESULTS/ANTICIPATED RESULTS: Among 19,703 unique organ offers, 6,302 (32%) were accepted for first-ranked candidates. After adjustment for donor, recipient, and geographic covariates, transplant centers varied markedly in acceptance rates (12%-62%) of offers made to first-ranked candidates. Lowest acceptance rate centers (<25%) associated with highest cumulative incidence of waitlist mortality. For every 10% increase in adjusted center acceptance rate, waitlist mortality risk decreased by 27% (SHR 0.73, 95% CI 0.67-0.80). No significant difference was observed in 5-year adjusted post-Tx survival and graft failure between hearts accepted at the first-rank vs lower-rank positions. DISCUSSION/SIGNIFICANCE OF IMPACT: Wide variability in heart acceptance rates exists among centers, with candidates listed at low acceptance rate centers more likely to die waiting. Similar post-Tx survival suggests previously declined allografts function as well as those accepted at first offer. Center-level decision is a modifiable behavior associated with waitlist mortality.
To assess the Framingham risk score as a prognostic tool for idiopathic sudden sensorineural hearing loss patients.
Medical records were reviewed for unilateral idiopathic sudden sensorineural hearing loss patients between January 2010 and October 2017. The 10-year risk of developing cardiovascular disease was calculated. Patients were subdivided into groups: group 1 – Framingham risk score of less than 10 per cent (n = 28); group 2 – score of 10 to less than 20 per cent (n = 6); and group 3 – score of 20 per cent or higher (n = 5).
Initial pure tone average and Framingham risk score were not significantly associated (p = 0.32). Thirteen patients in group 1 recovered completely (46.4 per cent), but none in groups 2 and 3 showed complete recovery. Initial pure tone average and Framingham risk score were significantly associated in multivariable linear regression analysis (R2 = 0.36). The regression coefficient was 0.33 (p = 0.003) for initial pure tone average and −0.67 (p = 0.005) for Framingham risk score.
Framingham risk score may be useful in predicting outcomes for idiopathic sudden sensorineural hearing loss patients, as those with a higher score showed poorer hearing recovery.
Earlier studies examining structural brain abnormalities associated with cognitively derived subgroups were mainly cross-sectional in design and had mixed findings. Thus, we obtained cross-sectional and longitudinal data to characterize the extent and trajectory of brain structure abnormalities underlying distinct cognitive subtypes (“preserved,” “deteriorated,” and “compromised”) seen in psychotic spectrum disorders.
Data from 364 subjects (225 patients with psychotic conditions and 139 healthy controls) were first used to determine the relationship of cognitive subtypes with cross-sectional measures of subcortical volume and cortical thickness. To probe neurodevelopmental abnormalities, brain structure laterality was examined. To examine whether neuroprogressive abnormalities persist, longitudinal brain structural changes over 5 years were examined within a subset of 101 subjects. Subsequent discriminant analysis using the identified brain measures was performed on an independent subject group.
Cross-sectional comparisons showed that cortical thinning and limbic volume reductions were most widespread in “deteriorated” cognitive subtype. Laterality comparisons showed more rightward amygdala lateralization in “compromised” than “preserved” subtype. Longitudinal comparisons revealed progressive hippocampal shrinkage in “deteriorated” compared with healthy controls and “preserved” subtype, which correlated with worse negative symptoms, cognitive and psychosocial functioning. Post-hoc discrimination analysis on an independent group of 52 subjects using the identified brain structures found an overall accuracy of 71% for classification of cognitive subtypes.
These findings point toward distinct extent and trajectory of corticolimbic abnormalities associated with cognitive subtypes in psychosis, which can allow further understanding of the biological course of cognitive functioning over illness course and with treatment.
Suicide is a serious phenomenon associated with psychiatric disorders.
In the present study, we investigated factors that can predict follow-up at the psychiatric clinic after medical care at the emergency room (ER).
Medical records of the 145 patients treated at the ER following suicide attempt from Jan 1, 2009 to July 31, 2009 were reviewed. Age, sex, past psychiatric history, impulsiveness and medical severity of suicide attempt, risk-rescue rating scores, reasons for suicide attempt and methods of suicide were examined. Psychiatric diagnoses were made by psychiatrists at the initial interview with patients at ER.
The mean age of the patients was 42.9 ± 15.7 years, and 68.3 % were women and 31.7% were men. Among the suicide methods, psychotropics were the most common (69%), and ingestion of pesticides was the second (19.3%). Interpersonal problems were the most common precipitating event (57.9%), and depression was the most common (89%). About a half had previous psychiatric disorders and about one third had previous suicide attempt. Fifteen patients (10.3%) attempted planned suicide and 124 patients (85.5%) attempted impulsively. Mean risk and rescue rating scores was 8.6 ±1.6 and 12.3 ± 2.2. About one third had a follow-up psychiatric visit. The most important predictor of psychiatric follow-up was risk rating scores.
This study suggests that women with interpersonal problems and depression should be carefully monitored to reduce suicide attempt. Patients commit less risky suicide attempts tend to more loss to psychiatric follow-up, thus, need more attention to prevent suicide re-attempts.
Bupropion is a catecholamine reuptake inhibitor and also a potent noncompetitive ion channel site antagonist at the nicotinic acetylcholine receptor. Bupropion is indicated for use in combination with behavioral modification programs for smoking cessation. There have been a few studies about the effect of bupropion on smoking cessation in schizophrenia. Therefore, we aimed investigated the change of the symptomatology after smoking cessation with bupropion in the patients with schizophrenia.
There were fifty-six patients with smoking in the psychiatric ward of Hapcheon Korea Hospital. among them, thirty-nine inpatients meeting the DSM-IV criteria for schizophrenia were recruited. for 4 weeks, treatment team persuaded the patients to enter the program of smoking cessation. with the exception, if the patients did not agree the program, the patients were able to be transferred to another ward that smoking was permitted. All patients agreed to the program. Postive and Negative Symptom Scale (PANSS), Temperament and Character Inventory(TCI), State-Trait Anxiety Inventory(STAI), Fagerstrom Test for Nicotine Dependence(FTND) were evaluated at the beginning of the study and 12 weeks of Bupropion treatment.
At 12 weeks after successful smoking cessation with bupropion, FTND scores were significantly decreased after smoking cessation. the scores of STAI and PANSS were not significantly changed. the subcale of TCI, Novelty Seeking showed decreasing tendency after smoking cessation, although there was no statistical significance(p=0.054).
These results suggest that bupropion is an effective antidepressant on smoking cessation and does not aggravate the psychotic symptoms in schizophrenia. Further investigation with larger number of subjects is needed.
Little is known about medication adherence among Asians and Asian Americans in psychiatric treatment.
We conducted a systematic review of studies of Asian American and Asian patients with depression or schizophrenia to understand adherence rates and tools used to measure adherence.
A key word search of PubMED and PsycINFO, restricted to journal articles available in English or Chinese and published between 1960 and March 2010 was performed. Reference lists of studies meeting inclusion criteria were manually reviewed and content experts were consulted. Two investigators independently reviewed all identified publications for inclusion using predetermined criteria and a pilot tested data-abstraction form.
Of the 1520 journal articles retrieved, 10 met criteria for inclusion. Adherence rates among patients with schizophrenia ranged from 5–71%; adherence rates among patients with depression ranged from 16–67%. Adherence rates varied among Asian sub-populations: Chinese patients’ rates ranged from 6–56%; Taiwanese patients’ rate was 46–61%; Asian American patients’ rate was 16%; Japanese patients’ rate was 56–71%; and Singaporean patients’ rate was 4.3%. Adherence was measured by: self-report; blood levels; refill rates; chart review; or physician/nurse or family caregiver report.
Medication adherence rates varied across clinical populations and country of origin. Nearly all of the rates are lower than many clinicians would consider acceptable. A critical step to research on improving adherence will involve reaching consensus on how to measure rates.
The aims of this study were to examine whether different domains of quality of life (QOL) are differently affected by depressive disorders by comparing QOL of subjects with and without depressive disorders, and to examine the association of QOL with self-stigma, insight and adverse effects of medication among subjects with depressive disorders.
The QOL on the four domains of the WHOQOL-BREF Taiwan version were compared between the 229 subjects with depressive disorders and 106 control subjects without depressive disorder. Among the subjects in the depressive group, the association between the four QOL domains and subjects' self-stigma, insight, and adverse effects of medication were examined using multiple regression analyses by controlling for the influence of depression, socio-demographic and clinical characteristics and family function.
The results found that subjects with depressive disorders had poorer QOL on the physical, psychological and social relationship domains than the non-depressive control group. The depressive subjects who had more severe self-stigma had poorer QOL on all four domains. The depressive subjects who had higher levels of awareness of illness had poorer QOL on the physical and psychological domains. The depressive subjects who perceived more severe adverse effects from medication had poorer QOL on the physical, psychological and environmental domains.
The results of this study demonstrate that different domains of QOL are differently affected by depressive disorders, and that clinicians must consider the negative influences of self-stigma, insight and adverse effects from medication on QOL of subjects with depressive disorders.