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To assess extent of a healthcare-associated outbreak of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and to evaluate the effectiveness of infection control measures, including universal masking.
Outbreak investigation including 4 large-scale point-prevalence surveys.
Integrated VA healthcare system with 2 facilities and 330 beds.
Index patient and 250 exposed patients and staff.
We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and an assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth face masks. We conducted 4 point-prevalence surveys of patient and staff subsets using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2.
Among 250 potentially exposed patients and staff, 14 confirmed cases of coronavirus disease 2019 (COVID-19) were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of COVID-19, without evidence of healthcare-associated transmission.
Universal masking with medical face masks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.
Listeners can adapt to errors in foreign-accented speech, but not all errors are alike. We investigated whether exposure to unsystematic tone errors in second language Mandarin impacts responses to accurately produced words. Native Mandarin speakers completed a cross-modal priming task with words produced by foreign-accented talkers who either produced consistently correct tones, or frequent tone errors. Facilitation from primes bearing correct tones was unaffected by the presence of tone errors elsewhere in the talker's speech. However, primes bearing tone errors inhibited recognition of real words and elicited stronger accentedness ratings. We consider theoretical implications for tone in foreign-accent adaptation.
Some centres favour early intervention for ureteral colic while others prefer trial of spontaneous passage, and relative outcomes are poorly described. Calgary and Vancouver have similar populations and physician expertise, but differing approaches to ureteral colic. We studied 60-day hospitalization and intervention rates for patients having a first emergency department (ED) visit for ureteral colic in these diverse systems.
We used administrative data and structured chart review to study all Vancouver and Calgary patients with an index visit for ureteral colic during 2014. Patient demographics, arrival characteristics and triage category were captured from ED information systems, while ED visits and admissions were captured from linked regional hospital databases. Laboratory results were obtained from electronic health records and stone characteristics were abstracted from diagnostic imaging reports. Our primary outcome was hospitalization or urological intervention from 0 to 60 days. Secondary outcomes included ED revisits, readmissions and rescue interventions. Time to event analysis was conducted and Cox Proportional Hazards modelling was performed to adjust for covariate imbalance.
We studied 3283 patients with CT-defined stones. Patient and stone characteristics were similar for the cities. Hospitalization or intervention occurred in 60.9% of Calgary patients and 31.3% of Vancouver patients (p<0.001). Calgary patients had higher index intervention rates (52.1% v. 7.5%), and experienced more ED revisits and hospital readmissions during follow-up. The data suggest that outcome events were associated with overtreatment of small stones in one city and undertreatment of large stones in the other.
An early interventional approach was associated with higher ED revisit, hospitalization and intervention rates. If these events are markers of patient disability, then a less interventional approach to small stones and earlier definitive management of large stones may reduce system utilization and improve outcomes for patients with acute ureteral colic.
Digital imaging technologies have enhanced archaeological research and profoundly expanded the scale of the discipline’s potentialities. As illustrators and archaeologists move away from using hand-drawn images (of hand-held, real-life objects) to depict artifacts and other archaeological information, certain capabilities of the traditional illustrative process are lost. One such loss is the ability to present a complete and informed representation of an artifact free of the distortions and visual limitations that single-perspective (i.e., digital or photographic) imagery produces. This is accomplished by the illustrator through the unification of multiple views of the artifact from various perspectives into a single two-dimensional image that communicates to the viewer important attributes of the artifact, free of distortion and remaining true to the measured, analytical conventions of the illustrative process. Liberation from the single-viewpoint perspective was one of the fundamental elements of the Cubist movement. Traditional archaeological illustrators utilize Cubist principles to communicate visually to the viewer a complete, accurate, and undistorted package of information about an artifact. The supplanting of hand-drawn illustrations by digital images in today’s archaeological publications threatens to revert the visual representation of data back to uninformed, surficial “snapshots” of incomplete objects.
Pulmonary aspiration of gastric contents occurs 20 to 30% of the time during cardiopulmonary resuscitation (CPR) of cardiac arrest due to loss of protective airway reflexes, pressure changes generated during CPR, and positive pressure ventilation (PPV). Although the American Heart Association has recommended the laryngeal mask airway (LMA) as an acceptable alternative airway for use by emergency medical service personnel, concerns over the capacity of the device to protect from pulmonary aspiration remain.We sought to determine the occurrence of aspiration after LMA placement, CPR, and PPV.
We inserted a size 4 LMA, modified so that a vacuum catheter could be advanced past the LMA diaphragm, into the hypopharynx of 16 consecutive postexperimental mixed-breed domestic swine. Fifteen millilitres of heparinized blood was instilled into the oropharynx. Chest compressions were performed for 60 seconds with asynchronous ventilation via a mechanical ventilator. We then suctioned through the LMA for 1 minute. The catheter was removed and inspected for signs of blood. The LMA cuff was deflated, removed, and inspected for signs of blood.
None of 16 animals (95% CI 0-17%) had a positive test for the presence of blood in both the vacuum catheter and the intima of the LMA diaphragm.
In this swine model of regurgitation after LMA placement, there were no cases with evidence of blood beyond the seal created by the LMA cuff. Future studies are needed to determine the frequency of pulmonary aspiration after LMA placement during CPR and PPV in the clinical setting.
Field studies were conducted in 2008 and 2009 near Crowley, LA to evaluate the addition of a herbicide with soil-residual activity in mixture with imazethapyr applied very early POST followed by an application of imazethapyr or imazamox 2 wk after the initial application. Weeds evaluated included red rice, barnyardgrass, and alligatorweed. Weed control with treatments including a herbicide with soil-residual activity was equivalent to or higher than imazethapyr applied alone followed by imazethapyr or imazamox. Yield and economical returns were maximized with quinclorac or penoxsulam mixed with imazethapyr followed by imazethapyr or imazamox. The addition of quinclorac or penoxsulam proved to be beneficial in a total weed management program.
Field studies were conducted in Crowley, LA, and Stoneville, MS, in drill-seeded rice to evaluate economical returns of weed control with imazethapyr. Red rice and barnyardgrass control was evaluated with imazethapyr alone at various rates and application timings. Imazethapyr, averaged across rate, controlled red rice 89% and barnyardgrass 90% when the initial application of imazethapyr was applied at emergence followed by a second application of imazethapyr 2 wk later. No difference in red rice and barnyardgrass control was observed with imazethapyr, averaged across timing. Yield and economical returns were maximized when the initial application of imazethapyr was applied at rice emergence followed by a second application of imazethapyr 2 wk later.
Septal nuclei, components of basal forebrain, are strongly and reciprocally connected with hippocampus, and have been shown in animals to play a critical role in memory. In humans, the septal forebrain has received little attention. To examine the role of human septal forebrain in memory, we acquired high-resolution magnetic resonance imaging scans from 25 healthy subjects and calculated septal forebrain volume using recently developed probabilistic cytoarchitectonic maps. We indexed memory with the California Verbal Learning Test-II. Linear regression showed that bilateral septal forebrain volume was a significant positive predictor of recognition memory accuracy. More specifically, larger septal forebrain volume was associated with the ability to recall item source/context accuracy. Results indicate specific involvement of septal forebrain in human source memory, and recall the need for additional research into the role of septal nuclei in memory and other impairments associated with human diseases. (JINS, 2012, 18, 157–161)
Field studies were conducted in 2008 and 2009 near Crowley, Louisiana, to evaluate the addition of different propanil formulations in mixture with a standard imazethapyr program of 70 g ai ha−1 early postemergence followed by (fb) 70 g ha−1 late postemergence. Weeds evaluated included red rice, barnyardgrass, Texasweed, and alligatorweed. Control of all species with treatments, including a propanil formulation applied at 3,400 g ai ha−1, was equivalent to, or greater than, the standard imazethapyr program. Rough rice yield and economic returns were maximized when the propanil formulations of Propanil 1 or Propanil 3 were mixed with imazethapyr in the early postemergence applications. The addition of propanil to imazethapyr increased rough rice yield and economic returns because of improved weed control.
4H SiC is a promising material because of its mechanical, electrical, and physical properties. However, SiC material defects have had a rate limiting effect on the widespread adoption of SiC. Micropipes, basal plane dislocations (BPD), elementary screw dislocations (SDD) and threading edge dislocations (TED) have all been identified as limiting to device operation and/or performance. An ideal PVT strategy for manufacturing SiC crystals would be capable of driving defects out the crystal via a combination of thermal field control and defect dissociation pathways. In this work a PVT technology was realized which is capable of continuously improving the crystal quality. A low defect PVT process was conceived and optimized using iterative experiment and simulation methods. During the maturation of the process it was observed that the crystal defect density repeatedly decreased relative to the seed crystal, as evaluated by x-ray topography, x-ray diffraction, and molten salt etching. The process improvements were leveraged successfully to achieve 4H n+ SiC wafers at 76-100 mm diameter with MPD <1 cm-2, SDD <500 cm-2, and BPD <500 cm-2. This paper will illustrate the defect reduction pathways leading to state of the art defect density 4H SiC crystals and the impact of the improved crystal on epitaxy defects and simple device experiments.
In June 1637, Anthony Sparrow and Sylvester Adams, two Cambridge scholars, preached in Great St. Mary’s Church on the subject of confessing sins. Their sermons caused such a scandal that a deeply divided vice-chancellor’s court had to act. These sermons have not gone unnoticed by historians, but they have not been contextualized in a way that makes complete sense both of the sermons and of their reception. Sparrow’s sermon, published shortly after it was delivered, is the better-known of the two, but not the more radical. Although no complete text of Adams’s sermon survives, there are manuscript sources that make it possible to reconstruct the gist of it and to prove that it made novel claims concerning the necessity of confession for salvation. Moreover, in defending Adams his supporters challenged the sources of doctrinal authority in the English Church in unprecedented ways.