Objectives: At the onset of COVID-19, whenever SARS-CoV-2 was detected at Children’s Hospital 1 (CH1), the related department or building was closed for extensive tracing, testing, and medical isolation. This process disrupted hospital activities, reduced the efficiency of patient care, and used medical resources. To address this problem, CH1 implemented a system of grouping inpatients to color-coded areas from June to December 2021. Methods: In this retrospective study, we describe the system of grouping inpatients to color-coded areas based on SARS-CoV-2 test result at a 1,600-bed, national pediatric hospital in Ho Chi Minh City. Results: Inpatients were first separated into those with or without respiratory symptoms, and secondly to different color-coded areas based on SARS-CoV-2 test result and hospitalization length: red zone (days 1–3), orange zone (days 3–7), and green zone (day 7 onward). Prior to admission, all patients were tested with a SARS-CoV-2 rapid diagnostic test. If negative, the patient was admitted to the red zone. On days 3 and 7 of hospitalization, the patient was tested using a pooled RT-PCR method. Patients negative on day 3 were relocated to the orange zone; patients negative on day 7 were relocated to the green zone. A patient with a positive test result at any time point was transferred to a COVID-19 zone. One caregiver was allowed to stay with 1 patient with similar testing regimen. A mobile transportation team was set up to deliver food and other necessities; thus, movement was restricted and interaction was prevented among zones. After this system was implemented, COVID-19 cases were detected early, with most positive cases in the red zone (19.6%) and the orange zone (2.8%), with only 1 case in the green zone (0.7%). Conclusions: The system of grouping patients to color-coded areas helped prevent SARS-CoV-2 transmission within the hospital, allowing undisrupted operation.

Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.

Funding: None

Disclosures: None

This paper considers an optimal endogenous growth model where the production function is assumed to exhibit increasing returns to scale and two types of resource (renewable and nonrenewable) are imperfect substitutes. Natural resources, labor, and physical capital are used in the final goods sector and in the accumulation of knowledge. Based on results in the calculus of variations, a direct proof of the existence of an optimal solution is provided. Analytical solutions for the planner case, balanced growth paths, and steady states are found for a specific CRRA utility and Cobb–Douglas production function. It is possible to have long-run growth where both energy resources are used simultaneously along the equilibrium path. As the law of motion of the technological change is not concave, reflecting the increasing returns to scale, so that the Arrow–Mangasarian sufficiency conditions do not apply, we provide a sufficient condition directly. Transitional dynamics to the steady state from the theoretical model are used to derive three convergence equations of output intensity growth rate, exhaustible resource growth rate, and renewable resource growth rate, which are tested based on OECD data on production and energy consumption.

This paper proves the existence of competitive equilibrium in a single-sector dynamic economy with heterogeneous agents, elastic labor supply, and complete asset markets. The method of proof relies on some recent results concerning the existence of Lagrange multipliers in infinite-dimensional spaces and their representation as a summable sequence and a direct application of the inward-boundary fixed point theorem.

The ideal strengths of metals and alloys at finite temperatures have been studied using the statistical moment method. The tensile and shear strengths of the body-centered cubic (bcc) transition metals like Mo and W (refractory metals), and ordered FeAl (B2) and Fe3Al (DO3) alloys are calculated as a function of the temperature. The orthogonal tight-binding method is used for bcc transition elements, while the universal binding-energy relation (UBER)-type of pairwise potentials, derived from ab initio density-functional theory, is used for the FeAl and Fe3Al alloys. We discuss the temperature dependence of the tensile and shear strengths of the metals and alloys in conjunction with those of the second-order elastic constants.

A rare case of incomplete tracheal duplication with severe unilateral lung hypoplasia is presented. Photo-documentation of the gross post-mortem specimens is presented so that the anatomical aspects of this unusual anomaly can be recognized and appreciated. Clinical information is presented in the hope that successful premorbid identification of potential complications of this anomaly could be made by future physicians. To our knowledge, this is the first reported case of pathologically-confirmed duplication of the trachea.