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The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)–integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care.
To describe our institution’s creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.
Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.
Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19–specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19–specific pathways for a 6-month period (March 1–September 1, 2020), and we have described their impact using case studies.
In total, 45 COVID-19–specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.
E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.
Capacity development is critical to long-term conservation success, yet we lack a robust and rigorous understanding of how well its effects are being evaluated. A comprehensive summary of who is monitoring and evaluating capacity development interventions, what is being evaluated and how, would help in the development of evidence-based guidance to inform design and implementation decisions for future capacity development interventions and evaluations of their effectiveness. We built an evidence map by reviewing peer-reviewed and grey literature published since 2000, to identify case studies evaluating capacity development interventions in biodiversity conservation and natural resource management. We used inductive and deductive approaches to develop a coding strategy for studies that met our criteria, extracting data on the type of capacity development intervention, evaluation methods, data and analysis types, categories of outputs and outcomes assessed, and whether the study had a clear causal model and/or used a systems approach. We found that almost all studies assessed multiple outcome types: most frequent was change in knowledge, followed by behaviour, then attitude. Few studies evaluated conservation outcomes. Less than half included an explicit causal model linking interventions to expected outcomes. Half of the studies considered external factors that could influence the efficacy of the capacity development intervention, and few used an explicit systems approach. We used framework synthesis to situate our evidence map within the broader literature on capacity development evaluation. Our evidence map (including a visual heat map) highlights areas of low and high representation in investment in research on the evaluation of capacity development.
This paper presents a preliminary study into the spatial features that can be used to distinguish creativity andefficiency in design layouts, and the distinct pattern of cognitive and metacognitive activity that is associated with creative design. In a design experiment, a group of 12 architects were handed a design brief. Their drawing activity was recorded and they were required to externalize their thoughts during the design process. Both design solutions and verbal comments were analysed and modelled. A separate group of experienced architects used their expert knowledge to assign creativity and efficiency scores to the 12 design solutions. The design solutions were evaluated spatially. Protocol analysis studies including linkography and macroscopic analysis were used to discern distinctive patterns in the cognitive and metacognition activity of designs marked with the highest and least creativity scores. Entropy models of the linkographs and knowledge graphs were further introduced Finally, we assessed how creativity and efficiency correlates to experiment variables, cognitive activity, metacognitive activity, spatial and functional distribution of spaces in the design solutions, and the number and type of design constraints applied through the course of design. Through this investigation, we suggest that expert knowledge can be used to assess creativity and efficiency in designs. Our findings indicate that efficient layouts have distinct spatial features, and that cognitive and metacognitive activity in design that yields a highly creative outcome corresponds to higher frequencies of design moves and higher linkages between design moves.
Pooling of samples in detecting the presence of virus is an effective and efficient strategy in screening carriers in a large population with low infection rate, leading to reduction in cost and time. There are a number of pooling test methods, some being simple and others being complicated. In such pooling tests, the most important parameter to decide is the pool or group size, which can be optimised mathematically. Two pooling methods are relatively simple. The minimum numbers required in these two tests for a population with known infection rate are discussed and compared. Results are useful for identifying asymptomatic carriers in a short time and in implementing health codes systems.
The root-knot nematode, Meloidogyne javanica, is a major problem for the production of Sacha Inchi plants. We examined the effects of strip intercropping of Sacha Inchi/Chinese leek of 3–4 years on the seasonal dynamics of plant and soil traits in tropical China. Results indicated that in the intercropping system, a partially temporal divergence of belowground resource acquisition via niche separation occurred throughout the growing seasons, besides a complete spatially-separated plant height between the two crops. Compared with Sacha Inchi monoculture, the increased seed yield per unit area in the intercropping system was mainly attributed to the higher plant survival rate, rather than the enhanced plant traits of healthy plants. Intercropping greatly suppressed M. javanica populations only in the wet season, compared with monoculture; which may be associated with the combined effects of the direct allelopathy and indigenous microbe induced-suppressiveness. Intercropping did not affect microbial richness and α-diversity in the rhizosphere, except for the decreased fungal richness. Both bacterial and fungal composition and structure were diverged between monoculture v. intercropping system. The relative abundances of the dominant bacterial genera (Bacillus, Gaiellales, Lactococcus, Massilia and Lysobacter, etc.) differed significantly between the two cropping systems. For fungi, intercropping decreased the relative abundances of Fusarium and Gibberella, but increased those of Nectriaceae_unclassified, Chaetomiaceae, Humicola and Mortierella. Overall, Sacha Inchi/Chinese leek intercropping suppressed M. javanica populations and shifted microbial compositions (especially decreased pathogen-containing Fusarium). The increased yield and economic returns in this intercropping system provide valid information for the effective agricultural management.
Is noun dominance in early lexical acquisition a widespread or a language-specific phenomenon? Thirty Singaporean bilingual English–Mandarin learning toddlers and their mothers were observed in a mother-child play interaction. For both English and Mandarin, toddlers’ speech and reported vocabulary contained more nouns than verbs across book reading and toy playing. In contrast, their mothers’ speech contained more verbs than nouns in both English and Mandarin but differed depending on the context of the interaction. Although toddlers demonstrated a noun bias for both languages, the noun bias was more pronounced in English than in Mandarin. Together, these findings support early noun dominance as a widespread phenomenon in the lexical acquisition debate but also provide evidence that language specificity also plays a minor role in children's early lexical development.
Extreme wave runup around a simplified representative floating production, storage and offloading vessel hull with a vertical bow is studied using computational fluid dynamics, complemented by experimental and diffraction analysis. This is a highly nonlinear system involving large vessel motions and extreme surface waves, and the behaviour is important for offshore design and operations. A separation method based on phase manipulation is carried out to facilitate the extraction of harmonics associated with the Stokes expansion of nonlinear waves. The separation method is applied to numerical and experimental data, and found to work well even for a highly nonlinear wave field scattered from a freely floating ship-shaped body. It is found that both low- and high-frequency second harmonic components can lead to wave runup at significantly higher levels than predicted by a linear analysis, while the vessel motions are very close to linear. The nonlinearity in the local wave field rather than vessel motion is key for the excitation of nonlinear extreme runup.
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.
The risk of antipsychotic-associated cardiovascular and metabolic events may differ among countries, and limited real-world evidence has been available comparing the corresponding risks among children and young adults. We, therefore, evaluated the risks of cardiovascular and metabolic events in children and young adults receiving antipsychotics.
We conducted a multinational self-controlled case series (SCCS) study and included patients aged 6–30 years old who had both exposure to antipsychotics and study outcomes from four nationwide databases of Taiwan (2004–2012), Korea (2010–2016), Hong Kong (2001–2014) and the UK (1997–2016) that covers a total of approximately 100 million individuals. We investigated three antipsychotics exposure windows (i.e., 90 days pre-exposure, 1–30 days, 30–90 days and 90 + days of exposure). The outcomes were cardiovascular events (stroke, ischaemic heart disease and acute myocardial infarction), or metabolic events (hypertension, type 2 diabetes mellitus and dyslipidaemia).
We included a total of 48 515 individuals in the SCCS analysis. We found an increased risk of metabolic events only in the risk window with more than 90-day exposure, with a pooled IRR of 1.29 (95% CI 1.20–1.38). The pooled IRR was 0.98 (0.90–1.06) for 1–30 days and 0.88 (0.76–1.02) for 31–90 days. We found no association in any exposure window for cardiovascular events. The pooled IRR was 1.86 (0.74–4.64) for 1–30 days, 1.35 (0.74–2.47) for 31–90 days and 1.29 (0.98–1.70) for 90 + days.
Long-term exposure to antipsychotics was associated with an increased risk of metabolic events but did not trigger cardiovascular events in children and young adults.
Three tapeworm species belonging to the genus Atractolytocestus Anthony, 1958 (Cestoda: Caryophyllidea) were reported from the common carp, Cyprinus carpio L., 1758 in the People's Republic of China so far: Atractolytocestus sagittatus; Atractolytocestus tenuicollis; and Atractolytocestus huronensis. In this study, we identified a putatively new tapeworm species in common carp from the Danjiangkou Reservoir in Central China (Hubei Province). The species is morphologically similar to A. sagittatus, but it differed conspicuously in sequences of three molecular markers. Ribosomal internal transcribed spacers 2 sequence identity of the new species was 94.7–95.5%, 91.8–92.7% and 80.0–83.9% with A. huronensis, A. tenuicollis and A. sagittatus, respectively. cytochrome c oxidase and NADH dehydrogenase subunit 3 sequence identity with these three species was lower than 92%. We conclude that this is a new tapeworm species, and we named it after the locality: Atractolytocestus danjiangkouensis n. sp.
The current study investigated associations between variation in the bovine perilipin-2 gene (PLIN2) and milk traits (milk fat content, milk protein content, milk yield and milk fatty acid (FA) component levels) in 409 New Zealand pasture-grazed Holstein-Friesian × Jersey-cross (HF × J-cross or Kiwicross™) cows. Five nucleotide sequence variants were found in three regions of the gene, including c.17C>T in exon 2, c.53A>G in exon 3, c.595+23G>A and c.595+104_595+108del in intron 5, and c.*302T>C in the 3′-untranslated region. The c.*302T>C substitution produces two nucleotide sequence variants (A5 and B5), and this variation was associated with variation in milk protein content and milkfat composition for C10:0, C11:0, C12:0, C13:0 and C16:0 FA and medium-chain fatty acid (MCFA) and long-chain fatty acid (LCFA) groups. After correcting for the effect of variation in the diacylglycerol acyl-CoA acyltransferase 1 gene (DGAT1) that results in the amino acid substitution p.K232A, variation in the FA binding protein 4 gene (FABP4) and variation in the stearoyl-CoA desaturase (Δ-9-desaturase) gene (SCD) that results in the amino acids substitution p.A293V, significant differences between A5A5 and B5B5 cows were found for C10:0, C11:0, C12:0, C13:0, C16:0, and the MCFA, LCFA, total saturated FA and C10:1 index groups. This suggests that nucleotide sequence variation in PLIN2 may be affecting milk FA component levels.
To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.
Leg weakness (LW) issues are a great concern for pig breeding industry. And it also has a serious impact on animal welfare. To dissect the genetic architecture of limb-and-hoof firmness in commercial pigs, a genome-wide association study was conducted on bone mineral density (BMD) in three sow populations, including Duroc, Landrace and Yorkshire. The BMD data were obtained by ultrasound technology from 812 pigs (including Duroc 115, Landrace 243 and Yorkshire 454). In addition, all pigs were genotyped using genome-by-sequencing and a total of 224 162 single-nucleotide polymorphisms (SNPs) were obtained. After quality control, 218 141 SNPs were used for subsequent genome-wide association analysis. Nine significant associations were identified on chromosomes 3, 5, 6, 7, 9, 10, 12 and 18 that passed Bonferroni correction threshold of 0.05/(total SNP numbers). The most significant locus that associated with BMD (P value = 1.92e−14) was detected at approximately 41.7 Mb on SSC6 (SSC stands for Sus scrofa chromosome). CUL7, PTK7, SRF, VEGFA, RHEB, PRKAR1A and TPO that are located near the lead SNP of significant loci were highlighted as functionally plausible candidate genes for sow limb-and-hoof firmness. Moreover, we also applied a new method to measure the BMD data of pigs by ultrasound technology. The results provide an insight into the genetic architecture of LW and can also help to improve animal welfare in pigs.
The volume of evidence from scientific research and wider observation is greater than ever before, but much is inconsistent and scattered in fragments over increasingly diverse sources, making it hard for decision-makers to find, access and interpret all the relevant information on a particular topic, resolve seemingly contradictory results or simply identify where there is a lack of evidence. Evidence synthesis is the process of searching for and summarising a body of research on a specific topic in order to inform decisions, but is often poorly conducted and susceptible to bias. In response to these problems, more rigorous methodologies have been developed and subsequently made available to the conservation and environmental management community by the Collaboration for Environmental Evidence. We explain when and why these methods are appropriate, and how evidence can be synthesised, shared, used as a public good and benefit wider society. We discuss new developments with potential to address barriers to evidence synthesis and communication and how these practices might be mainstreamed in the process of decision-making in conservation.
To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.
A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.
From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106 copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask.
Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.
Uranium–35 wt.% zirconium (U–35 wt.% Zr) alloy was annealed for 1 h and 24 h at 650 °C and characterized to understand the early-stage microstructure evolution. Dendritic microstructure with fine (∼300 nm in length) α-U precipitates clustered between dendrite branches were observed in the 1-h annealed sample. After 24-h annealing at 650 °C, the α-U precipitates coarsened, and the dendritic microstructure disappeared because of microstructure homogenization. Furthermore, microchemical homogenization observed with energy-dispersive X-ray spectroscopy analysis suggests that α-U precipitates are approaching thermodynamic equilibrium in the 24-h annealed sample. The findings from this study have potential impacts on the manufacturing and computer modeling of metallic nuclear fuel.
Previous chapters in this book have focused on domestic (or municipal) law within Hong Kong. This chapter examines the interface between Hong Kong law and international law and Chinese law (PRC law). It looks at the distinct international legal personality that Hong Kong possesses, Hong Kong’s engagement with international entities and the application of international law in Hong Kong. Previous chapters have discussed certain aspects of the interface between Hong Kong and the PRC legal system, and this chapter builds on this by focusing on mutual legal assistance between the two legal systems, access to the Mainland market for legal services from Hong Kong and cross-border crime.
With the increasing popularity of alternative methods of resolving disputes to lessen the burden on courts, a separate chapter must be dedicated to this topic. One may not typically think of alternative methods of resolving disputes as part of the legal system, but this chapter shows otherwise. Particularly with the Civil Justice Reform, alternative dispute resolution has played and will continue to play an even larger role in solving legal disputes in Hong Kong. The two main methods of alternative dispute resolution, namely mediation and arbitration, are examined.
This chapter looks at law at an abstract level and the fundamental questions of ‘What is law?’ and ‘Why have laws?’ are explored by discussing the functions and concepts of law. This chapter examines the macro and micro functions of law, as well as the major perspectives of law including natural law, legal positivism, sociology of law and critical legal theory. It concludes by exploring various classifications of legal systems and the way in which the law is divided within them, such as the difference between the common law and civil law systems, national and international law, substantive and procedural law, and public and private law.