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During March 27–July 14, 2020, the Centers for Disease Control and Prevention’s National Healthcare Safety Network extended its surveillance to hospital capacities responding to COVID-19 pandemic. The data showed wide variations across hospitals in case burden, bed occupancies, ventilator usage, and healthcare personnel and supply status. These data were used to inform emergency responses.
The aim of this study was to determine the extent that appropriate personal protective equipment (PPE), per Centers for Disease Control and Prevention (CDC) guidance, was used during the coronavirus diseases 2019 (COVID-19) pandemic by health-care personnel (HCP) in Louisiana in 5 clinical settings.
An online questionnaire was distributed to the LA Nursery registry. Appropriate use of PPE in each of the 5 clinical scenarios was defined by the authors based on CDC guidelines. The scenarios ranged from communal hospital space to carrying out aerosol generating procedures (AGPs). A total of 1760 HCP participated between June and July 2020.
The average adherence in LA was lowest for the scenario of carrying out AGPs at 39.5% compliance and highest for the scenario of patient contact when COVID-19 not suspected at 82.8% compliance. Adherence among parishes varied widely. Commentary to suggest a shortage of PPE supply and the practice of re-using PPE was strong.
Use of appropriate PPE varied by setting. It was higher in scenarios where only face masks (or respirators) were the standard (ie, community hospital or when COVID-19 not suspected) and lower in scenarios where additional PPE (eg, gloves, eye protection, and isolation gown) was required.
Bipolar disorder (BD) is a severe psychiatric disorder associated with structural and functional brain abnormalities, some of which have been found in unaffected relatives as well. In this study, we examined the potential role of decreased fractional anisotropy (FA) as a BD endophenotype, in adolescents at high risk for BD.
We included 15 offspring of patients with BD, 16 pediatric BD patients, and 16 matched controls. Diffusion weighted scans were obtained on a 3T scanner using an echo-planar sequence. Scans were segmented using FreeSurfer.
Our results showed significantly decreased FA in six brain areas of offspring group; left superior temporal gyrus (LSTG; P < .0001), left transverse temporal gyrus (LTTG; P = .002), left banks of the superior temporal sulcus (LBSTS; P = .002), left anterior cingulum (LAC; P = .003), right temporal pole (RTP; P = .004) and left frontal pole (LFP; P = .017). On analysis, LSTG, LAC, and RTP demonstrated a potential to be an endophenotype when comparing all three groups. FA values in three regions, LBSTS, LTTG, and LFP were increased only in controls.
Our findings point at decreased FA as a possible endophenotype for BD, as they were found in children of patients with BD. Most of these areas were previously found to have morphological and functional changes in adult and pediatric BD, and are thought to play important roles in affected domains of functioning. Prospective follow up studies should be performed to detect reliability of decreased FA as an endophenotype and effects of treatment on FA.
The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
Protecting frontline health care workers with personal protective equipment (PPE) is critical during the coronavirus disease (COVID-19) pandemic. Through an online survey, we demonstrated variable adherence to the Centers for Disease Control and Prevention (CDC) PPE guidelines among health care personnel (HCP).
CDC guidelines for optimal and acceptable PPE usage in common situations faced by frontline health care workers were referenced to create a short online survey. The survey was distributed to national, statewide, and local professional organizations across the United States and to HCP, using a snowball sampling technique. Responses were collected between June 15 and July 17, 2020.
Responses totaling 2245 were received from doctors, nurses, midwives, paramedics, and medical technicians in 44 states. Eight states with n > 20 (Arizona, California, Colorado, Louisiana, Oregon, South Carolina, Texas, and Washington) and a total of 436 responses are included in the quantitative analysis. Adherence to CDC guidelines was observed to be highest in the scenario of patient contact when COVID-19 was not suspected (86.47%) and lowest when carrying out aerosol generating procedures (AGPs) (42.47%).
Further research is urgently needed to identify the reasons underlying variability between professions and regions to pinpoint strategies for maximizing adherence and improving the safety of HCPs.
To examine associations between geographic information systems (GIS)-assessed accessibility to small food stores, shopping patterns and dietary behaviours among small food store customers.
Residential addresses and customer shopping patterns (frequency of shopping, and previous purchase of fruits and vegetables) were gathered through customer intercept surveys. Addresses were geocoded, and GIS-assessed distance and driving time from the participants’ residence to the store were calculated. Dietary status and behaviours were assessed using an objective non-invasive measure of skin carotenoids, the National Cancer Institute Fruit and Vegetable Screener, and items to assess sugary beverage intake. Associations between distance and driving time, demographics, shopping frequency, prior reported purchase of fruits and vegetables at the store and dietary behaviours were examined.
Small food stores (n 22) across North Carolina.
Cross-sectional convenience samples of English-speaking customers aged 18 years or older (n 692).
Participants living closer to the small store had lower income and formal education, were more likely to be Black, more likely to have previously bought fruits and vegetables at the store and more frequently shopped at the store. In adjusted models, skin carotenoids (n 644) were positively associated with distance to the store from home in miles (P = 0·01).
Customers who lived closer to the stores were more frequent shoppers and more likely to have previously purchased fruits and vegetables at the store yet had lower skin carotenoids. These results support continued efforts to examine how to increase the availability and promotion of healthful foods at small food retail stores.
This article uses data gathered from a survey that probed the career orientations and values of more than 1,000 law students in Beijing, Hong Kong and Taipei to examine the legal professionalism of future lawyers being trained under different legal education systems in Greater China. Our findings suggest that these future lawyers have a “materialistic” career orientation, although those studying in a system whose legal education goal is to train professional lawyers are more inclined to pursue professional legal ideals, and those trained in a system that emphasizes legal ethics are more likely to pursue public interest issues. On the basis of the findings, we argue that legal education systems in Greater China, while different in their traditions, share the same need to strengthen legal professionalism by according greater emphasis to legal ethics in their respective law school curricula.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6−2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2–3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7–24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4–17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients.
Toxoplasma gondii rhoptry protein TgROP18 is a polymorphic virulence effector that targets immunity-related GTPases (IRGs) in rodents. Given that IRGs are uniquely diversified in rodents and not in other T. gondii intermediate hosts, the role of TgROP18 in manipulating non-rodent cells is unclear. Here we show that in human cells TgROP18I interacts with the interferon-gamma-inducible protein N-myc and STAT interactor (NMI) and that this is a property that is unique to the type I TgROP18 allele. Specifically, when expressed ectopically in mammalian cells only TgROP18I co-immunoprecipitates with NMI in IFN-γ-treated cells, while TgROP18II does not. In parasites expressing TgROP18I or TgROP18II, NMI only co-immunoprecipitates with TgROP18I and this is associated with allele-specific immunolocalization of NMI on the parasitophorous vacuolar membrane (PVM). We also found that TgROP18I reduces NMI association with IFN-γ-activated sequences (GAS) in the IRF1 gene promoter. Finally, we determined that polymorphisms in the C-terminal kinase domain of TgROP18I are required for allele-specific effects on NMI. Together, these data further define new host pathway targeted by TgROP18I and provide the first function driven by allelic differences in the highly polymorphic ROP18 locus.
The dendrite morphologies of the cast nickel-based superalloy CMSX-4® (CMSX-4® is registered trademarks of the Cannon-Muskegon Corporation) and the austenitic stainless steel HP microalloy have been obtained via an automated serial-sectioning process which allows three-dimensional (3D) microstructural characterization. The dendrite arm spacing, volume fraction of segregation, and fraction of porosity have been determined. This technique not only increases the depth, scope, and level of detailed microstructural characterization but also delivers microstructural data for modeling and simulation.
To evaluate the effect of definitive radiotherapy dose on survival in patients with human papillomavirus positive oropharyngeal carcinoma.
Human papillomavirus positive oropharyngeal carcinoma patients staged T1–3 and N0–2c, who received definitive radiotherapy (fraction sizes of 180 cGy to less than 220 cGy), were identified from the National Cancer Database 2010–2014 and stratified by radiation dose (50 Gy to less than 66 Gy, or 66 Gy or more).
A total of 2173 patients were included, of whom 124 (6 per cent) received a radiation dose of 50 Gy to less than 66 Gy. With a median follow up of 33.8 months, patients had a 3-year overall survival rate of 88.6 per cent (95 per cent confidence interval = 87.1–90.1 per cent). On multivariate Cox analysis, a radiotherapy dose of 50 Gy to less than 66 Gy (hazard ratio = 0.95, 95 per cent confidence interval = 0.52–1.74, p = 0.86) was not a predictor of increased mortality risk.
Human papillomavirus positive oropharyngeal carcinoma patients had excellent outcomes with definitive radiotherapy doses of 50 Gy to less than 66 Gy. These results further support patients enrolling into clinical trials for radiation dose de-escalation.
Involvement with illicit drugs among young people has been explained by a risk-factor matrix. This study aims to compare childhood psychopathology as a predictor between self-reported illicit drug use without registered drug offending and police informed drug offending among males in a prospective birth cohort study.
A general population sample of 2946 8-year-old Finnish boys was followed up from age 8 to 18. In 1989, childhood psychopathology was assessed using the Rutter scale and Child Depression inventory. Information about self-reported drug use at age 18 or police-registered drug offending during years 16 to 20 years was collected from 79.3% (n=2336) of the subjects.
Childhood psychopathology predicted exclusively police registered drug offending. After adjusting for family background, both severe and moderate conduct problems and ADHD symptoms were associated with subsequent police-registered drug offence. Self-reported illicit drug use was predicted only by non-intact family structure.
Our results demonstrate a clear difference, occurring already in childhood, between young men with self reported illicit drug use and those with police registered drug offending. More severe illicit drug involvement, such as police-registered drug offending, is a continuum of a childhood externalizing problem behaviour, while self-reported occasional illicit drug use does not inevitably associate with psychopathological problems in childhood. Accordingly, the preventive needs and the age period for intervention may be dissimilar for young people with divergent involvement with illicit drugs.
Previous studies have shown that African American youth are over-represented in the Criminal Justice System (CJS). Substance use problems are common among those with CJS involvement. However, less is known regarding racial disparities, among youth with CJS involvement, in receiving substance use treatment services.
To examine racial disparities with regard to receiving treatment services for substance use related problems, among youth with (CJS) involvement.
Data were obtained from the 2006–2008 United States National Survey on Drug Use and Health (NSDUH) in USA. Among White and African American adolescents (Ages 12–17) with recent CJS involvement and who met criteria for alcohol or illicit drug abuse or dependence (N = 602), racial differences in receiving treatment services for substance use problems were examined. Multiple logistic regression analyses were performed to identify predictors of service access among the adolescents, to see if the racial disparity could be explained by individual-level, family-level, and criminal justice system involvement factors.
While 31.2% of White adolescent substance abusers with CJS involvement had received treatment for substance use related problems, only 11.6% of their African American counterparts had received such treatment (P = 0.0005). Multiple logistic regression analyses showed that access to treatment services can be predicted by substance use related delinquent behaviors, but that racial disparities in treatment still exist after adjusting for these factors (AOR = 0.24, 95%CI = (0.09,0.59), P = 0.0027).
There is an urgent need to reduce racial disparities in receiving substance use treatment among U.S. youth with CJS involvement.
Post-stroke depression (PSD) is the most common psychiatric complication facing stroke survivors and has been associated with increased distress, physical disability, poor rehabilitation, and suicidal ideation. However, the pathophysiological mechanisms underlying PSD remain unknown, and no objective laboratory-based test is available to aid PSD diagnosis or monitor progression.
Here, an isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomic approach was performed to identify differentially expressed proteins in plasma samples obtained from PSD, stroke, and healthy control subjects.
The significantly differentiated proteins were primarily involved in lipid metabolism and immunoregulation. Six proteins associated with these processes – apolipoprotein A-IV (ApoA-IV), apolipoprotein C-II (ApoC-II), C-reactive protein (CRP), gelsolin, haptoglobin, and leucine-rich alpha-2-glycoprotein (LRG) – were selected for Western blotting validation. ApoA-IV expression was significantly upregulated in PSD as compared to stroke subjects. ApoC-II, LRG, and CRP expression were significantly downregulated in both PSD and HC subjects relative to stroke subjects. Gelsolin and haptoglobin expression were significantly dysregulated across all three groups with the following expression profiles: gelsolin, healthy control > PSD > stroke subjects; haptoglobin, stroke > PSD > healthy control.
Early perturbation of lipid metabolism and immunoregulation may be involved in the pathophysiology of PSD. The combination of increased gelsolin levels accompanied by decreased haptoglobin levels shows promise as a plasma-based diagnostic biomarker panel for detecting increased PSD risk in post-stroke patients.
Many MRI studies have cited major depression, with or without anti-depressive treatment, associated with structural plasticity changing in several brain regions. Few of these studies researched the effect of the anti-depressive treatment, electroconvulsive therapy (ECT), on depression.
To assess the influence of ECT on the brain structure change during the treatment process by utilizing the voxel-based morphometry (VBM) analysis.
To determine whether ECT alter brain structure.
We performed HAMD ratings and MRI scans on 12 depressive patients during ECT, analyzing the data by VBM with SPM8 software's family-wise error correction (FWE).
The researchers found volumes changes in white matter in 37 regions between pre-ECT and post-ECT1, but only one region changing between pre-ECT and post-ECT8. Seven regions changing in grey matter between pre-ECT and post-ECT 1⌧but none regions changing between pre-ECT and post-ECT8.
The density changes in several brain regions after a single ECT stimuli, but return to the original level after completing the eighth ECT. Our finding supports that ECT may play a temporary role in treating major depression but do not permanently alter the structures of brain.
Several questions still exist in the literature on the relationship between cumulative exposure to work-related incidents and posttraumatic stress disorder (PTSD) in First Responders (FR).
To address three unanswered questions in the field.
(1) Are different cumulative exposure scoring algorithms similarly related to PTSD?
(2) Is PTSD associated only with incidents rated as severe and traumatic?
(3) Can we identify cut-off scores of cumulative exposure that maximize sensitivity and specificity to predict PTSD?
To better characterize the relationship between cumulative exposure and PTSD in FR.
The association between exposure and PTSD was examined with logistic and linear regression and with receiver operating characteristic analysis in 349 FR.
(1) The strength of the association between PTSD and total cumulative exposure indexes varied across different scoring algorithms.
(2) Compared to total cumulative exposure indexes and to sub-scores of exposure to non-traumatic and/or less severe incidents, sub-scores indexing exposure to severe traumatic events only were more strongly and significantly associated with PTSD.
(3) The use of two cut-off scores maximizes sensitivity and specificity to predict PTSD.
(1) The relationship between current PTSD and cumulative exposure is partially dependent on the approach used to quantify exposure.
(2) Focusing on the assessment of cumulative exposure to severe traumatic events is sufficient to predict PTSD, and might be more useful and effective in research and clinical decision-making.
(3) Sensitivity and specificity of exposure scores might help improve secondary prevention (early detection and effective intervention) of individuals at risk.
The heterogeneity in the manifestation of PSTD symptomatology has never been described in a developmental period spanning from middle childhood through adolescence. The examination of developmental influences on PTSD symptomatic expression is a high priority for DSM-V and could inform research on the etiology and treatment of PTSD.
To examine the symptom structure of PTSD across different age, gender, and exposure groups, and in association with impairment and other disorders.
To identify homogeneous latent classes of PTSD symptoms in children and adolescents.
Latent class analysis (LCA) was applied to 6,733 New York City students (4th–12th grades) exposed to 9/11-related potentially traumatic events. LCA was first applied to PTSD symptoms only, stratified by age, gender and empirically defined exposure groups, and then in combination with impairment indicators. The resultant classes were studied in association with other disorders.
LCA identified 4 classes that vary in severity and symptom configuration. Only the most severe profile, qualitatively characterized by the presence of traumatic memories in combination with avoidance and sleep-related problems, showed high levels of impairment and high rates of other disorders. Girls after puberty and subjects indirectly exposed to 9/11 are at increased risk of severe disturbance.
The 4-class model describes quantitative and qualitative differences in the structure of PTSD across age, gender and exposure. These findings support the inclusion of developmental considerations into DSM-V PTSD diagnostic criteria and suggest that also gender and the nature of traumatic exposure inflence PTSD phenomenology in children and adolescents.