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We assessed the magnitude of unidentified coronavirus disease 2019 (COVID-19) in our healthcare personnel (HCP) early in the COVID-19 pandemic, and we evaluated risk factors for infection to identify areas for improvement in infection control practice in a northern California academic medical center.
We reviewed anti–severe acute respiratory coronavirus virus 2 (SARS-CoV-2) receptor-binding domain (RBD) IgG serologic test results and self-reported risk factors for seropositivity among 10,449 asymptomatic HCP who underwent voluntary serology testing between April 20 and May 20, 2020.
In total, 136 employees (1.3%) tested positive for SARS-CoV-2 IgG. This included 41 individuals (30.1%) who had previously tested positive for SARS-CoV-2 by nasopharyngeal reverse-transcription polymerase chain reaction (RT-PCR) between March 13 and April 16, 2020. In multivariable analysis, employees of Hispanic ethnicity (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.22–3.46) and those working in environmental services, food services, or patient transport (OR, 4.81; 95% CI, 2.08–10.30) were at increased risk for seropositivity compared to other groups. Employees reporting a household contact with COVID-19 were also at higher risk for seropositivity (OR, 3.25; 95% CI, 1.47–6.44), but those with a work, exposure alone were not (OR, 1.27; 95% CI, 0.58–2.47). Importantly, one-third of seropositive individuals reported no prior symptoms, no suspected exposures, and no prior positive RT-PCR test.
In this study, SARS-CoV-2 seropositivity among HCP early in the northern California epidemic appeared to be quite low and was more likely attributable to community rather than occupational exposure.
The purpose of this article was to determine the impact of employing a telephone clinic for follow-up of patients with stable lateral skull-base tumours.
An analysis of 1515 patients in the national lateral skull-base service was performed, and 148 patients enrolled in the telephone clinic to date were identified. The length of time that patients waited for results of their follow-up scans and the travel distance saved by patients not having to attend the hospital for their results was determined.
The mean time from scan to receiving results was 30.5 ± 32 days, 14 days sooner than in the face-to-face group (p = 0.0016). The average round-trip distance travelled by patients to the hospital for results of their scans was 256 ± 131 km.
The telephone clinic led to a significant reduction in time until patients received their scan results and helped reduce travel distance and clinic numbers in traditional face-to-face clinics.
Troodon formosus, a theropod from the Late Cretaceous, is one of the few species of dinosaurs with multiple nest sites uncovered. It has been consistently demonstrated that eggs within these nests would have been partially buried in life—an exceedingly rare state in modern vertebrates. There has been debate over Troodon's capacity to engage in thermoregulatory contact incubation, especially regarding an adult's ability to efficiently supply partially buried eggs with energy. An actualistic investigation was undertaken to determine the thermodynamic efficiency of contact incubating partially buried eggs. An efficient system would keep eggs at temperatures closer to the surrogate parent than the ambient, without prohibitively high energy input. For the experiment, a surrogate dinosaur was created and used in both indoor controlled ambient temperature trials and in an outdoor variant. Even with ambient temperatures that were likely cooler than Cretaceous averages, the results showed that contact incubating partially buried eggs did seem to confer an energetic advantage; egg temperatures remained closer to the surrogate than ambient in both indoor and outdoor tests. Still, critics of contact incubating partially buried eggs are correct in that there is a depth at which adult energy would fail to make much of an impact—perhaps more relevant to buried eggs, as partially buried eggs would be in contact with an adult and likely above the thermal input threshold. Additionally, results from this experiment provide evidence for a possible evolutionary path from guarding behavior to thermoregulatory contact incubation.
What are the ethics behind caring, preserving, and displaying artwork created by Residential School Survivors? By looking at sketches and small handicrafts held by the Shingwauk Residential Schools Centre this piece examines the possibilities for caring for this unique type of Indigenous artwork in a culturally appropriate and ethical manner.
Prospective longitudinal studies of idiopathic autism spectrum disorder (ASD) have provided insights into early symptoms and predictors of ASD during infancy, well before ASD can be diagnosed at age 2–3 years. However, research on the emergence of ASD in disorders with a known genetic etiology, contextualized in a developmental framework, is currently lacking. Using a biobehavioral multimethod approach, we (a) determined the rate of ASD in N = 51 preschoolers with fragile X syndrome (FXS) using a clinical best estimate (CBE) procedure with differential diagnoses of comorbid psychiatric disorders and (b) investigated trajectories of ASD symptoms and physiological arousal across infancy as predictors of ASD in preschoolers with FXS. ASD was not diagnosed if intellectual ability or psychiatric disorders better accounted for the symptoms. Our results determined that 60.7% of preschoolers with FXS met the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) criteria for ASD using the CBE procedure. In addition, 92% of these preschoolers presented with developmental delay and 45.4% also met criteria for psychiatric disorders, either anxiety, ADHD, or both. ASD diagnoses in preschoolers with FXS were predicted by elevated scores on traditional ASD screeners in addition to elevated autonomic arousal and avoidant eye contact from infancy.
Background: Catheter-associated urinary tract infections (CAUTIs) are among the most prevalent healthcare-associated infections (HAIs) globally, contributing to increased morbidity, prolonged hospital stays, and increased healthcare costs. Interventions that support prompt removal of the urinary catheter are evidence-based actions to effectively reduce CAUTI rates.1Objective: At the National Hospital of Tropical Disease (NHTD), catheter removal interventions in the intensive care unit (ICU) were implemented using quality improvement (QI) methodology to reduce CAUTI incidence and urinary catheter device utilization. Methods: Training was performed for ICU clinical staff with knowledge checks before and after the program. A bedside visual reminder of CAUTI risk and checklist to assess catheter need were implemented. Weekly compliance of provided visual reminders and checklists were measured using a simple audit tool. Device utilization ratios (DURs, ratios of device days to patient days), and CAUTI incidence rates (per 1,000 device days) were collected at baseline (July–September 2018) and quarterly thereafter until June 2019. Statistical significance was determined by an independent t test. Results: In the first quarter (October–December 2018), the CAUTI incidence rate decreased from 8.9 to 1.3 per 1,000 device days (P = .036). The ICU staff trained in CAUTI prevention, mean knowledge scores before and after training increased from 68% to 87%. The DUR decreased slightly from 0.59 to 0.55 after the first-quarter training then steadily increased in the following quarter (0.60; January–March 2019) and after the intervention (0.54; April–June 2019). CAUTI incidence rates also increased but were still lower than at baseline: 4.8 and 6.3 per 1,000 days of device use. Compliance of reminders was 51% during the first quarter, increased slightly in the second quarter 62%, then decreased to 40% during the last quarter. The nurses’ adherence to the daily checklist remained stable (>75%). Conclusions: This CAUTI prevention project was the first use of quality improvement methodology to implement change at NHTD. A trend decrease in CAUTI was observed, though a greater decrease occurred at the beginning of the intervention. Limited compliance of daily reminders is likely reflected in no statistically significant decrease in DUR. Possibly, this quality improvement project raised awareness among clinicians to improve general CAUTI prevention practices in the ICU without decreasing DUR. Given limited compliance with reminder and checklists, the intervention will be revised during the next PDSA cycle to improve adherence.
1Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277–289.
The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.
Prospective memory (PM) is the memory used when intentions are to be carried out in the future. Little research has been conducted examining PM after stroke. This study aimed to determine if PM is impaired after stroke through comparison of individuals with stroke to healthy controls. Additionally, it aimed to explore the predictors of PM performance post-stroke.
Twenty-eight individuals with stroke and 27 neurologically healthy controls completed the Cambridge Prospective Memory Test (CAMPROMPT), 2 self-report PM questionnaires, and multiple cognitive measures.
Individuals with stroke performed significantly lower on both event- and time-based PM than controls on the CAMPROMPT, indicating PM impairment. Event-based PM after stroke was significantly predicted by age, retrospective memory (RM), and global cognitive function, whereas time-based PM was only predicted by the metacognitive skill of note-taking. Age and note-taking predicted time-based PM for controls, whereas only age predicted event-based PM for control participants.
The findings of this study have helped to confirm that PM impairment does exist after stroke, particularly when using a standardised PM measure. Furthermore, PM impairment may be predicted by variables, such as age, strategy use, RM, and cognitive ability.
Does Kant regard mathematical inference as a nonanalytic mode of inference relying essentially on pure intuition, or rather as advancing through strict conceptual analysis from synthetic premises? Commentators have found textual support for both readings, leading to incompatible accounts of the synthetic character of mathematical judgment. This paper develops a new argument establishing that Kant views mathematical inference as essentially dependent on extraconceptual resources. The paper also establishes that Kant employs “analysis” and its cognates in a number of senses in the critical period. In particular, he recognizes a notion of analysis directed to intuitions, thus distinct from conceptual analysis. This finding leads to a new reading of his famous description of mathematical inference as “proceeding in accordance with the Principle of Contradiction” (B14). Kant’s choice of the B14 formulation is explained as reflecting his desire to distance his own antilogicist theory of mathematical inference with its essential dependence on pure intuition from C. A. Crusius’s antiformalist theory of inference grounded in thinkability.
Time is of the essence to continue the pandemic disaster cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan and operation at the local, regional and state level.The second wave of COVID-19 pandemic response are not the ripples of acute COVID-19 patient clusters that will persist until a vaccine strategy is designed and implemented to effect herd immunity. The COVID-19 second wave are the patients that have had their primary and specialty care delayed. This exponential wave of patients requires prompt health care delivery system planning and response.
This paper examines the stability of egocentric networks as reported over time using a novel touchscreen-based participant-aided sociogram. Past work has noted the instability of nominated network alters, with a large proportion leaving and reappearing between interview observations. To explain this instability of networks over time, researchers often look to structural embeddedness, namely the notion that alters are connected to other alters within egocentric networks. Recent research has also asked whether the interview situation itself may play a role in conditioning respondents to what might be the appropriate size and shape of a social network, and thereby which alters ought to be nominated or not. We report on change in these networks across three waves and assess whether this change appears to be the result of natural churn in the network or whether changes might be the result of factors in the interview itself, particularly anchoring and motivated underreporting. Our results indicate little change in average network size across waves, particularly for indirect tie nominations. Slight, significant changes were noted between waves one and two particularly among those with the largest networks. Almost no significant differences were observed between waves two and three, either in terms of network size, composition, or density. Data come from three waves of a Chicago-based panel study of young men who have sex with men.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
Bathymetric data of unprecedented resolution are used to provide insights into former ice dynamics and glacial processes in a western Antarctic Peninsula embayment. An assemblage of submarine glacial landforms, which includes subglacially produced streamlined features and ice-marginal ridges, reveals the former pattern of ice flow and retreat. A group of more than 250 small (< 1–3 m high, 10–20 m wide) and relatively evenly spaced recessional moraines was identified beyond the margin of Philippa Glacier. The small recessional moraines are interpreted to have been produced during short-lived, possibly annual re-advances of a grounded ice margin during overall retreat. This is the first time that these features have been shown to be part of the assemblage of landforms produced by tidewater glaciers on the Antarctic Peninsula. Glacier-terminus changes during the last four decades, mapped from LANDSAT satellite images, were analysed to determine whether the moraines were produced during recent still-stands or re-advances of Philippa Glacier and to further investigate the short-term (annual to decadal) variability in ice-marginal position in tidewater glacier systems. The asynchronous response of individual tidewater glaciers in Darbel Bay is interpreted to be controlled mainly by local topography rather than by glacier catchment-area size.