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The surface environment in rooms of coronavirus disease 2019 (COVID-19) patients may be persistently contaminated despite disinfection. A continuously active disinfectant demonstrated excellent sustained antiviral activity following a 48-hour period of wear and abrasion exposures with reinoculations. Reductions of >4-log10 were achieved within a 1-minute contact time for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and the human coronavirus, 229E.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
X-ray fluorescence (XRF) has been employed as one of several orthogonal means of screening materials to prevent counterfeit and adulterated products from entering the product stream. We document the use of principal component analysis (PCA) of XRF data on compositionally similar and dissimilar stainless steels for the purpose of testing the feasibility of employing XRF spectra to parse and bin these alloys as the same or significantly different alloy materials. The results indicate that XRF spectra can separate and assign alloys via PCA, but that important corrections for detector drift and scaling must be performed in order to achieve valid results.
The Outer Banks barrier islands of North Carolina, USA, contain a geologic record of inlet activity that extends from ca. 2200 cal yr BP to the present, and can be used as a proxy for storm activity. Optically stimulated luminescence (OSL) dating (26 samples) of inlet-fill and flood tide delta deposits, recognized in cores and geophysical data, provides the basis for understanding the chronology of storm impacts and comparison to other paleoclimate proxy data. OSL ages of historical inlet fill compare favorably to historical documentation of inlet activity, providing confidence in the technique. Comparison suggests that the Medieval Warm Period (MWP) and Little Ice Age (LIA) were both characterized by elevated storm conditions as indicated by much greater inlet activity relative to today. Given present understanding of atmospheric circulation patterns and sea-surface temperatures during the MWP and LIA, we suggest that increased inlet activity during the MWP responded to intensified hurricane impacts, while elevated inlet activity during the LIA was in response to increased nor'easter activity. A general decrease in storminess at mid-latitudes in the North Atlantic over the last 300 yr has allowed the system to evolve into a more continuous barrier with few inlets.
Long sediment cores (12.5 and 13.5 m) from two lakes in Yunnan Province were used to infer the paleoclimate of southwest China over the past 50,000 yr. During the Holocene and marine isotope stage (MIS 3), bio-induced carbonate precipitation and organic matter (OM) production was high, suggesting warm temperatures and high primary productivity. In contrast, sediment inorganic carbon (IC) and organic carbon (OC) concentrations were low in last glacial deposits from 38,000 to 12,000 cal yr B.P., indicating cool temperatures and low productivity. The 50,000-yr record has alternating peaks of carbonate and coarse-grain (>38 μm) quartz that reflect warm, moist interglacial or interstadial conditions alternating with cold, dry glacial or stadial conditions, respectively. Spectral analysis of the carbonate and quartz signals reveals power concentrated at periods of 7200 and 8900 cal yr, respectively, that may reflect a nonlinear climate response to precessional forcing at a time of reduced eccentricity modulation (McIntyre and Molfino, 1996). Oxygen isotope values of calcite from Yunnan lake cores indicate the summer monsoon was weak during the last glaciation from 50,000 to 12,000 cal yr B.P. The summer monsoon intensified between 12,000 and 8000 cal yr B.P., but weakened gradually in response to insolation forcing during the mid-to-late Holocene. Our results support the Overpeck et al. (1996) model that posits a weak summer monsoon during the last glaciation that responded nonlinearly to insolation forcing when its intensity was affected by Eurasian snow cover and ice-sheet extent. The summer monsoon intensified and responded linearly to seasonal insolation forcing in the Holocene when ice volume diminished.
Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.
To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).
Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).
Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.
Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.
An estimated 20–30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI.
We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated.
A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24–2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52–2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13–2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14–2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28–1.57; P<.00001).
Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.
Of 82 patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, 67 (82%) had positive hand cultures for MRSA. A single application of alcohol gel (2 mL) consistently reduced the burden of MRSA on hands. However, incomplete removal of MRSA was common, particularly in those with a high baseline level of recovery.
This investigation examined the relationship between teachers’ beliefs and their preferences for classroom interventions for behaviours consistent with attention-deficit/hyperactivity disorder (ADHD). Teacher ratings of intervention acceptability, effectiveness, and rate of change were compared across United States and New Zealand samples. Beliefs examined were personal teaching efficacy, general teaching efficacy, and pupil control ideology (PCI). Samples were compared regarding their preferences for the daily report card, response cost technique, classroom lottery, and medication as classroom strategies for managing ADHD-related behavioural concerns. Data were analysed using general linear modelling techniques, and an interaction was demonstrated between ADHD intervention x PCI x nationality. Differences were observed for ADHD interventions across samples based upon pupil control orientations. Implications for educators and their classroom practices are discussed.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates “Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management.
This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.
The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%).
When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment.
This white paper identifies knowledge gaps and new challenges in healthcare epidemiology research, assesses the progress made toward addressing research priorities, provides the Society for Healthcare Epidemiology of America (SHEA) Research Committee's recommendations for high-priority research topics, and proposes a road map for making progress toward these goals. It updates the 2010 SHEA Research Committee document, “Charting the Course for the Future of Science in Healthcare Epidemiology: Results of a Survey of the Membership of SHEA,” which called for a national approach to healthcare-associated infections (HAIs) and a prioritized research agenda. This paper highlights recent studies that have advanced our understanding of HAIs, the establishment of the SHEA Research Network as a collaborative infrastructure to address research questions, prevention initiatives at state and national levels, changes in reporting and payment requirements, and new patterns in antimicrobial resistance.
Engaging and exciting students about the environment remains a challenge in contemporary society, even while objective measures show the rapid state of the world's environment declining. To illuminate the integration of drama and environmental education as a means of engaging students in environmental issues, the work of performance companies Evergreen Theatre, Leapfish and Eaton Gorge Theatre Company, the ecological oratorio Plague and the Moonflower, and a school-based trial of play-building were examined through survey data and participant observations. These case studies employed drama in different ways — theatre-in-education, play-building, and large-scale performance event. The four case studies provide quantitative and qualitative evidence for drama-based activities leading to an improvement in knowledge about the environment and understandings about the consequences of one's actions. In observing and participating in these case studies, we reflect that drama is a means of synthesising and presenting scientific research in ways that are creative and multi-layered, and which excite students, helping maintain their attention and facilitating their engagement.
More than 50% of the global population already lives in urban settlements and urban areas are projected to absorb almost all the global population growth to 2050, amounting to some additional three billion people. Over the next decades the increase in rural population in many developing countries will be overshadowed by population flows to cities. Rural populations globally are expected to peak at a level of 3.5 billion people by around 2020 and decline thereafter, albeit with heterogeneous regional trends. This adds urgency in addressing rural energy access, but our common future will be predominantly urban. Most of urban growth will continue to occur in small-to medium-sized urban centers. Growth in these smaller cities poses serious policy challenges, especially in the developing world. In small cities, data and information to guide policy are largely absent, local resources to tackle development challenges are limited, and governance and institutional capacities are weak, requiring serious efforts in capacity building, novel applications of remote sensing, information, and decision support techniques, and new institutional partnerships. While ‘megacities’ with more than 10 million inhabitants have distinctive challenges, their contribution to global urban growth will remain comparatively small.
Energy-wise, the world is already predominantly urban. This assessment estimates that between 60–80% of final energy use globally is urban, with a central estimate of 75%. Applying national energy (or GHG inventory) reporting formats to the urban scale and to urban administrative boundaries is often referred to as a ‘production’ accounting approach and underlies the above GEA estimate.
Freshwater ecosystems play a key role in the European nitrogen (N) cycle, both as a reactive agent that transfers, stores and processes N loadings from the atmosphere and terrestrial ecosystems, and as a natural environment severely impacted by the increase of these loadings.
This chapter is a review of major processes and factors controlling N transport and transformations for running waters, standing waters, groundwaters and riparian wetlands.
Key findings/state of knowledge
The major factor controlling N processes in freshwater ecosystems is the residence time of water, which varies widely both in space and in time, and which is sensitive to changes in climate, land use and management.
The effects of increased N loadings to European freshwaters include acidification in semi-natural environments, and eutrophication in more disturbed ecosystems, with associated loss of biodiversity in both cases.
An important part of the nitrogen transferred by surface waters is in the form of organic N, as dissolved organic N (DON) and particulate organic N (PON). This part is dominant in semi-natural catchments throughout Europe and remains a significant component of the total N load even in nitrate enriched rivers.
In eutrophicated standing freshwaters N can be a factor limiting or co-limiting biological production, and control of both N and phosphorus (P) loading is often needed in impacted areas, if ecological quality is to be restored.
A low temperature amorphous zinc indium oxide (ZIO) thin film transistor (TFT) backplane technology for high information content flexible organic light emitting diode (OLED) displays has been developed. We have fabricated 4.1-in. diagonal OLED backplanes on the Flexible Display Center’s six-inch wafer-scale pilot line using ZIO as the active layer. The ZIO based TFTs exhibited an effective saturation mobility of 18.6 cm2/V-s and a threshold voltage shift of 2.2 Volts or less under positive and negative gate bias DC stress for 10000 seconds. We report on the critical steps in the evolution of the backplane process: the qualification of the low temperature (200°C) ZIO process, the stability of the devices under forward and reverse bias stress, the transfer of the process to flexible plastic substrates, and the fabrication of white organic light emitting diode (OLED) displays.
Assessments of infectious disease spread in hospitals seldom account for interfacility patient sharing. This is particularly important for pathogens with prolonged incubation periods or carrier states.
We quantified patient sharing among all 32 hospitals in Orange County (OC), California, using hospital discharge data. Same-day transfers between hospitals were considered “direct” transfers, and events in which patients were shared between hospitals after an intervening stay at home or elsewhere were considered “indirect” patient-sharing events. We assessed the frequency of readmissions to another OC hospital within various time points from discharge and examined interhospital sharing of patients with Clostridium difficile infection.
In 2005, OC hospitals had 319,918 admissions. Twenty-nine percent of patients were admitted at least twice, with a median interval between discharge and readmission of 53 days. Of the patients with 2 or more admissions, 75% were admitted to more than 1 hospital. Ninety-four percent of interhospital patient sharing occurred indirectly. When we used 10 shared patients as a measure of potential interhospital exposure, 6 (19%) of 32 hospitals “exposed” more than 50% of all OC hospitals within 6 months, and 17 (53%) exposed more than 50% within 12 months. Hospitals shared 1 or more patient with a median of 28 other hospitals. When we evaluated patients with C. difficile infection, 25% were readmitted within 12 weeks; 41% were readmitted to different hospitals, and less than 30% of these readmissions were direct transfers.
In a large metropolitan county, interhospital patient sharing was a potential avenue for transmission of infectious agents. Indirect sharing with an intervening stay at home or elsewhere composed the bulk of potential exposures and occurred unbeknownst to hospitals.
Detection and tracking of stem cell state are difficult due to insufficient means for rapidly screening cell state in a noninvasive manner. This challenge is compounded when stem cells are cultured in aggregates or three-dimensional (3D) constructs because living cells in this form are difficult to analyze without disrupting cellular contacts. Multiphoton laser scanning microscopy is uniquely suited to analyze 3D structures due to the broad tunability of excitation sources, deep sectioning capacity, and minimal phototoxicity but is throughput limited. A novel multiphoton fluorescence excitation flow cytometry (MPFC) instrument could be used to accurately probe cells in the interior of multicell aggregates or tissue constructs in an enhanced-throughput manner and measure corresponding fluorescent properties. By exciting endogenous fluorophores as intrinsic biomarkers or exciting extrinsic reporter molecules, the properties of cells in aggregates can be understood while the viable cellular aggregates are maintained. Here we introduce a first generation MPFC system and show appropriate speed and accuracy of image capture and measured fluorescence intensity, including intrinsic fluorescence intensity. Thus, this novel instrument enables rapid characterization of stem cells and corresponding aggregates in a noninvasive manner and could dramatically transform how stem cells are studied in the laboratory and utilized in the clinic.