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This paper presents a miniaturized tri- and quad-band power divider (PD)based on substrate integrated waveguide (SIW). By adopting different types of modified circular complementary split-ring resonators on the top surface of SIW, multiple passbands are generated propagating below the SIW cut-off frequency. The working principle is based on evanescent mode propagation that decreases the operating frequency of the PD and helps in the miniaturization of the proposed structure. The operating frequency of the proposed PD can be individually controlled by changing the dimensions of the resonator. To verify the proposed concept, a tri-band and a quad-band PD exhibiting 3 dB equal power division at 2.41/3.46/4.65 GHz and 2.42/3.78/4.74/5.8 GHz are designed using the full-wave simulator, validated through circuit model, fabricated and experimentally verified. The measured results agree well with the simulations. The proposed PDs have good performance in terms of reasonable insertion loss, isolation, minimum amplitude and phase imbalance, smaller footprint, easy fabrication and integration. The size of the fabricated prototype is 18.3 mm × 8.4 mm, which corresponds to 0.205λg × 0.094λg, λg being the guided wavelength at the first operating frequency.
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.
The force balance of rotating Rayleigh–Bénard convection regimes is investigated using direct numerical simulation on a laterally periodic domain, vertically bounded by no-slip walls. We provide a comprehensive view of the interplay between governing forces both in the bulk and near the walls. We observe, as in other prior studies, regimes of cells, convective Taylor columns, plumes, large-scale vortices (LSVs) and rotation-affected convection. Regimes of rapidly rotating convection are dominated by geostrophy, the balance between Coriolis and pressure-gradient forces. The higher-order interplay between inertial, viscous and buoyancy forces defines a subdominant balance that distinguishes the geostrophic states. It consists of viscous and buoyancy forces for cells and columns, inertial, viscous and buoyancy forces for plumes, and inertial forces for LSVs. In rotation-affected convection, inertial and pressure-gradient forces constitute the dominant balance; Coriolis, viscous and buoyancy forces form the subdominant balance. Near the walls, in geostrophic regimes, force magnitudes are larger than in the bulk; buoyancy contributes little to the subdominant balance of cells, columns and plumes. Increased force magnitudes denote increased ageostrophy near the walls. Nonetheless, the flow is geostrophic as the bulk. Inertia becomes increasingly more important compared with the bulk, and enters the subdominant balance of columns. As the bulk, the near-wall flow loses rotational constraint in rotation-affected convection. Consequently, kinetic boundary layers deviate from the expected behaviour from linear Ekman boundary layer theory. Our findings elucidate the dynamical balances of rotating thermal convection under realistic top/bottom boundary conditions, relevant to laboratory settings and large-scale natural flows.
In André Breton’s 1933 essay “Picasso in His Element” for the journal Minotaure, the surrealist poet underlines the intertwinement between Picasso’s recent sculptures and his studio environment, which the photographer Brassaï documented in such a way as to reflect Picasso’s everyday habits. Drawing on the philosophy of Hegel and Ravaisson, this chapter explores the preeminence of nature in Breton’s essay in terms of questions of materiality and habit, the latter being a common trait shared by humans and animals. In light of Roger Caillois’s contemporaneous effort to make nature the new paradigm for a revised theory of automatism, it is argued that Breton’s reading of Picasso’s work and environment advances instead a theory of art as self-reflexive nature, which recognizes the material continuity between art and nature without reducing their relationship to one of homology.
Schizophrenia has been primarily conceptualized as a disorder of high-order cognitive functions with deficits in executive brain regions. Yet due to the increasing reports of early sensory processing deficit, recent models focus more on the developmental effects of impaired sensory process on high-order functions. The present study examined whether this pathological interaction relates to an overarching system-level imbalance, specifically a disruption in macroscale hierarchy affecting integration and segregation of unimodal and transmodal networks.
We applied a novel combination of connectome gradient and stepwise connectivity analysis to resting-state fMRI to characterize the sensorimotor-to-transmodal cortical hierarchy organization (96 patients v. 122 controls).
We demonstrated compression of the cortical hierarchy organization in schizophrenia, with a prominent compression from the sensorimotor region and a less prominent compression from the frontal−parietal region, resulting in a diminished separation between sensory and fronto-parietal cognitive systems. Further analyses suggested reduced differentiation related to atypical functional connectome transition from unimodal to transmodal brain areas. Specifically, we found hypo-connectivity within unimodal regions and hyper-connectivity between unimodal regions and fronto-parietal and ventral attention regions along the classical sensation-to-cognition continuum (voxel-level corrected, p < 0.05).
The compression of cortical hierarchy organization represents a novel and integrative system-level substrate underlying the pathological interaction of early sensory and cognitive function in schizophrenia. This abnormal cortical hierarchy organization suggests cascading impairments from the disruption of the somatosensory−motor system and inefficient integration of bottom-up sensory information with attentional demands and executive control processes partially account for high-level cognitive deficits characteristic of schizophrenia.
SEP-363856 is a novel psychotropic agent without dopamine D2 receptor occupancy. Although its mechanism of action has not been fully elucidated, preclinical data suggest that agonism at trace amine receptor 1 (TAAR1) and the serotonin 5-H1A receptor contributes to its efficacy. In a double-blind (DB), placebo-controlled study, SEP−363856 demonstrated significant efficacy in the treatment of an exacerbation of schizophrenia (Koblan et al, NEJM 2020; 82:1497–1506). We present results of a 6-month extension study whose aim was to evaluate the safety and effectiveness of longer-term treatment with SEP−363856.
Patients with an acute exacerbation of schizophrenia who completed a 4-week, DB, placebo-controlled, flexible-dose (50 or 75 mg) study of SEP−363856 were given the option to enroll in an extension study in which they were treated, open-label (OL), with flexible doses (25/50/75 mg/d) of SEP−363856 for 26-weeks. The primary outcomes were safety measures; effectiveness outcomes were secondary and included the PANSS total score and the Brief Negative Symptom Scale (BNSS) total score.
A total of 193 patients completed the 4-week DB study, and 156 (80.8%) were dosed in the OL extension study and received at least one dose of SEP−363856 (safety population). Study completer rate was 66.9%; reasons for discontinuation consisted of adverse event (11.5%), withdrawal of consent (10.2%), lack of efficacy (5.1%), and other (6.4%). 15 patients experienced an SAE: schizophrenia (n=11); acute psychosis (N=1); uterine hemorrhage and suicidal ideation (N=1 each); there were no deaths in the study. Individual AEs with an incidence =2% were schizophrenia (12.2%), headache (11.5%), insomnia (8.3%), anxiety (5.1%), somnolence (4.5%), nasopharyngitis (4.5%), nausea (3.8%), irritability (3.2%), influenza (3.2%), weight decreased (3.2%), and prolactin increased (2.6%). On movement scales, minimal mean change from OL-baseline to Week 26 occurred on the Barnes total score (−0.1), AIMS total score (0.0) and SAS score (−0.1). Mean month 6 change from DB baseline in weight was −0.3 kg. No clinically meaningful median changes were observed at week 26 in metabolic laboratory parameters (total and LDL cholesterol, triglycerides, hemoglobin A1c) or in prolactin levels. During 6 months of OL treatment, one patient had an increase in QTcF =60 msec; no patients had a QTcF interval =480 msec. Treatment with SEP−363856 was associated with significant improvement from OL baseline to week 26 in PANSS total score (−22.6) and BNSS total score (−11.3).
Treatment with SEP−363856 was associated with continued improvement from open-label baseline in the PANSS total (−22.6) and BNSS total (−11.3) scores. The most frequently reported adverse events (= 5%) were schizophrenia, headache, insomnia and anxiety. SEP−363856 had minimal effects on weight, lipids, glycemic indices, prolactin, and was associated with minimal risk of extrapyramidal symptom.
ABSTRACT IMPACT: We report a novel metric for assessing clinical informatics fellows relative to their personal goals, using standardized milestones that have been approved for the field by ACGME. OBJECTIVES/GOALS: ACGME has defined 20 milestones that serve as the goals for fellows in clinical informatics. Each fellow is rated from 1 to 5 on the achievement of each milestone, where 1 is entry-level, 4 is the level expected of a graduating fellow, and 5 is aspirational. We assessed fellows’ progress toward the personal goal levels that they set for each milestone. METHODS/STUDY POPULATION: At the start of the fellowship, we asked each fellow to rate the personal target levels that they want to achieve for each milestone. Since the default target level of achievement for a graduating fellow is a 4, we asked fellows to document exceptions from this target. We calculated a metric for each fellow’s achievement of each milestone as their achievement rating (assigned by mentors and rotation leaders during the semi-annual Clinical Competency Committee meeting) divided by the fellow’s desired level of achievement. In summarizing across the milestones, we counted those milestones having achievement metrics >=1.0 as ‘achieved,’ and then for milestones that were not achieved, we calculated an average for the fellow. RESULTS/ANTICIPATED RESULTS: As of June, 2020, our two graduating 2nd-year fellows had fully met 9/20 and 18/20 milestones, respectively. For the unmet milestones they averaged 81% and 85% achievement. The largest shortfalls were 75% achievements in Assessing User Needs for one fellow, and in Recognition of Errors for the other. One of our three 1st-year fellows had fully met 3/20 milestones; the other two had met none at 1st-year’s end. For unmet milestones, the 1st-year fellows’ average achievement metrics were 69%, 67%, and 52%. The greatest shortfalls were in Resource Utilization (creating job descriptions, budgeting etc.) and in Communication with Patients and Families. However, the rotations that would expose them to project management and to patient-facing systems such as MyChart come in our 2nd-year. DISCUSSION/SIGNIFICANCE OF FINDINGS: Assessing milestones met plus the percent achievement for those not yet met provides a useful metric for comparing fellows and identifying areas in need of more training. Although milestones will soon change to reflect the recent practice analysis for clinical informatics, we expect that this approach to assessing fellows will remain equally useful.
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.
Adequate dietary intake is critical to prevent adverse pregnancy outcomes. India has a high burden of maternal and child morbidity and mortality, but there is a lack of adequate tools to assess dietary intake. We validate an FFQ, New Interactive Nutrition Assistant - Diet in India Study of Health (NINA-DISH), among pregnant women living with and without HIV in Pune, India. Women were selected from a cohort study investigating immune responses to HIV and latent tuberculosis during pregnancy. The FFQ was administered during the third trimester and validated against multiple 24-h dietary recalls (24-HDR) collected in second and third trimesters. Data for analysis were available from fifty-eight women out of seventy enrolled into this sub-study, after excluding those with incomplete data or implausible energy intake. The median (Q1, Q3) age of study participants was 23 (20, 25) years. Median (Q1, Q3) daily energy intakes were 10 552 (8000, 11 958) and 10 673 (8510, 13 962) kJ by 24-HDR and FFQ, respectively, with FFQ overestimating nutrient intake. Pearson correlations between log-transformed estimates from FFQ and 24-HDR for energy, protein, carbohydrate, fat, Fe and Zn were 0·47, 0·48, 0·45, 0·33, 0·4 and 0·54, respectively. Energy-adjusted and de-attenuated correlations ranged from 0·41 (saturated fat) to 0·73 (Na). The highest misclassification into extreme tertiles was observed for fat (22 %), saturated fat (21 %) and Na (21 %). Bias existed at higher intake levels as observed by Bland–Altman plots. In conclusion, NINA-DISH is a valid and feasible tool for estimating dietary intakes among urban pregnant women in Western India.
A superstrate loaded cylindrical dielectric resonator antenna is developed and demonstrated for dual-band circular polarization. The proposed antenna employs a microstrip-fed rotated cross-shaped slot coupling technique for exciting the dielectric resonator (DR). The design is developed in a straight forward way. Firstly, the DR is coupled with a conventional plus-shaped slot and operates in linear polarization mode at 7.4 and 11.2 GHz. Secondly, the slot is rotated by 10° to enable out-of-phase excitation and ensure circular polarization at the above-mentioned frequencies. In the third step, a square dielectric superstrate is placed above the DR which creates multiple reflection and enhance the gain up to ~8 dBi in both the frequencies without affecting other performances. The development stages are discussed in detail. The proposed design is demonstrated through prototype fabrication and characterization. This antenna can be used for X-band satellite communications.
Radiocarbon (14C) ages cannot provide absolutely dated chronologies for archaeological or paleoenvironmental studies directly but must be converted to calendar age equivalents using a calibration curve compensating for fluctuations in atmospheric 14C concentration. Although calibration curves are constructed from independently dated archives, they invariably require revision as new data become available and our understanding of the Earth system improves. In this volume the international 14C calibration curves for both the Northern and Southern Hemispheres, as well as for the ocean surface layer, have been updated to include a wealth of new data and extended to 55,000 cal BP. Based on tree rings, IntCal20 now extends as a fully atmospheric record to ca. 13,900 cal BP. For the older part of the timescale, IntCal20 comprises statistically integrated evidence from floating tree-ring chronologies, lacustrine and marine sediments, speleothems, and corals. We utilized improved evaluation of the timescales and location variable 14C offsets from the atmosphere (reservoir age, dead carbon fraction) for each dataset. New statistical methods have refined the structure of the calibration curves while maintaining a robust treatment of uncertainties in the 14C ages, the calendar ages and other corrections. The inclusion of modeled marine reservoir ages derived from a three-dimensional ocean circulation model has allowed us to apply more appropriate reservoir corrections to the marine 14C data rather than the previous use of constant regional offsets from the atmosphere. Here we provide an overview of the new and revised datasets and the associated methods used for the construction of the IntCal20 curve and explore potential regional offsets for tree-ring data. We discuss the main differences with respect to the previous calibration curve, IntCal13, and some of the implications for archaeology and geosciences ranging from the recent past to the time of the extinction of the Neanderthals.
Phytase has long been used to decrease the inorganic phosphorus (Pi) input in poultry diet. The current study was conducted to investigate the effects of Pi supplementation on laying performance, egg quality and phosphate–calcium metabolism in Hy-Line Brown laying hens fed phytase. Layers (n = 504, 29 weeks old) were randomly assigned to seven treatments with six replicates of 12 birds. The corn–soybean meal-based diet contained 0.12% non-phytate phosphorus (nPP), 3.8% calcium, 2415 IU/kg vitamin D3 and 2000 FTU/kg phytase. Inorganic phosphorus (in the form of mono-dicalcium phosphate) was added into the basal diet to construct seven experimental diets; the final dietary nPP levels were 0.12%, 0.17%, 0.22%, 0.27%, 0.32%, 0.37% and 0.42%. The feeding trial lasted 12 weeks (hens from 29 to 40 weeks of age). Laying performance (housed laying rate, egg weight, egg mass, daily feed intake and feed conversion ratio) was weekly calculated. Egg quality (egg shape index, shell strength, shell thickness, albumen height, yolk colour and Haugh units), serum parameters (calcium, phosphorus, parathyroid hormone, calcitonin and 1,25-dihydroxyvitamin D), tibia quality (breaking strength, and calcium, phosphorus and ash contents), intestinal gene expression (type IIb sodium-dependent phosphate cotransporter, NaPi-IIb) and phosphorus excretion were determined at the end of the trial. No differences were observed on laying performance, egg quality, serum parameters and tibia quality. Hens fed 0.17% nPP had increased (P < 0.01) duodenum NaPi-IIb expression compared to all other treatments. Phosphorus excretion linearly increased with an increase in dietary nPP (phosphorus excretion = 1.7916 × nPP + 0.2157; R2 = 0.9609, P = 0.001). In conclusion, corn–soybean meal-based diets containing 0.12% nPP, 3.8% calcium, 2415 IU/kg vitamin D3 and 2000 FTU/kg phytase would meet the requirements for egg production in Hy-Line Brown laying hens (29 to 40 weeks of age).
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.
There is a wide range of feed additives deliberately designed to be used in sheep diets that can improve production performance. Whereas herbal supplementation is gaining popularity not only for improving sheep productivity and mutton quality but also for safe application without any harmful residual effects. The present study was designed to investigate the effect of plantain (Plantago lanceolata L.) and/or garlic leaf (Allium sativum) dietary supplementation on growth performance, immunity, rumen histology, serum antioxidants and meat quality of sheep. The experiment consisted of a completely randomized design with 32 one-year-old sheep (initial mean live weight 9 ± 0.2 kg) allocated to four groups (8 sheep per group). Rice straw and concentrates-based total mixed ration pellets (2390 kcal/kg DM, CP = 15.1%) were offered as a control diet (CL diet). Herbal treatment diets included (i) CL diet + 10 g DM of plantain herb (PL diet), (ii) CL diet + 10 g DM of garlic leaf (GL diet) and (iii) CL diet + 5 g DM of PL and 5 g DM of GL (PG diet). Compared with the CL diet group, the live weight gain and feed conversion ratio were 18% to 26% and 13% to 20% higher in herbal-supplemented groups, respectively. Moreover, the herbal-supplemented groups, especially the PL diet group had higher serum immunoglobulin concentration, antioxidant capacity and rumen papillae size compared to the control. Besides, the lowest caul fat and pelvic fat levels were observed in the PL diet group followed by PG, GL and CL diet groups. In addition, lower mutton ether extract and saturated fatty acid along with higher polyunsaturated fatty acid levels were found in all herbal-supplemented groups. In conclusion, dietary supplementation with PL and/or GL might be used as an alternative in sheep to promote growth, health status and lean mutton production.
OBJECTIVES/GOALS: In young women, there is significant symptomatic overlap among lower urinary tract conditions, including bladder and pelvic pain, leading to misdiagnosis and delayed care. The epidemiology of pelvic pain suggests a microbial involvement, but previous studies have not definitively identified specific bacteria associated with pain diagnoses. METHODS/STUDY POPULATION: We examined urinary bacterial associations with specific symptom clusters, not diagnoses. Catheterized urinary samples were obtained from 78 pre-menopausal controls and cases with bladder and pelvic pain. 16S next-generation sequencing (NGS) characterized urinary microbial populations; validated questionnaires quantified symptom type and severity. K means unsupervised clustering analysis of NGS data assigned subjects to urotypes based on the urinary bacterial community state types. Quantitative PCR (qPCR) confirmed the NGS results and provided objective concentrations for critical taxa. Linear regression analysis confirmed the associations of bacterial concentrations and specific symptoms. RESULTS/ANTICIPATED RESULTS: In a pilot study of 35 reproductive-age women with a variety of complaints NGS revealed four urotypes that correlated with symptomatology. Isolated urgency incontinence was rare; the majority of subjects with symptoms complained of genitourinary pain. Bladder-specific pain (worse with filling, relieved by voiding) was associated with Lactobacillus iners. Asymptomatic patients almost universally had a non-iners, Lactobacillus-predominant microbiota. Vaginal and urethral pain unrelated to voiding correlated with increasing Enterobacteriaceae, primarily Escherichia coli. Detection of these species by qPCR in a validation population (n = 43) was highly predictive of each phenotype (P < 0.00001). Pathologic bacteria were associated with the severity of specific pain symptoms. DISCUSSION/SIGNIFICANCE OF IMPACT: Our results implicate a microbial role in genitourinary pain. We describe clinically-useful bacterial biomarkers for specific pelvic and bladder pain phenotypes. This objective, rapid, and inexpensive testing to classify bladder and pelvic pain would allow more accurate diagnosis and improve treatment. CONFLICT OF INTEREST DESCRIPTION: Dr. Anger is an expert witness for Boston Scientific. Dr. Eilber is an investigator and expert witness for Boston Scientific, an investigator for Aquinox, and a consultant for Boston Scientific and Allergan. Dr. Ackerman is an expert witness for Cynosure.
The coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2 virus) has been sustained in China since December 2019, and has become a pandemic. The mental health of frontline medical staff is a concern. In this study, we aimed to identify the factors influencing medical worker anxiety in China during the COVID-19 outbreak. We conducted a cross-sectional study to estimate the prevalence of anxiety among medical staff in China from 10 February 2020 to 20 February 2020 using the Zung Self-rating Anxiety Scale (SAS) to assess anxiety, with the criteria of normal (⩽49), mild (50–59), moderate (60–70) and severe anxiety (⩾70). We used multivariable linear regression to determine the factors (e.g. having direct contact when treating infected patients, being a medical staff worker from Hubei province, being a suspect case) for anxiety. We also used adjusted models to confirm independent factors for anxiety after adjusting for gender, age, education and marital status. Of 512 medical staff in China, 164 (32.03%) had had direct contact treating infected patients. The prevalence of anxiety was 12.5%, with 53 workers suffering from mild (10.35%), seven workers suffering from moderate (1.36%) and four workers suffering from severe anxiety (0.78%). After adjusting for sociodemographic characteristics (gender, age, education and marital status), medical staff who had had direct contact treating infected patients experienced higher anxiety scores than those who had not had direct contact (β value = 2.33, confidence interval (CI) 0.65–4.00; P = 0.0068). A similar trend was observed in medical staff from Hubei province, compared with those from other parts of China (β value = 3.67, CI 1.44–5.89; P = 0.0013). The most important variable was suspect cases with high anxiety scores, compared to non-suspect cases (β value = 4.44, CI 1.55–7.33; P = 0.0028). In this survey of hospital medical workers during the COVID-19 outbreak in China, we found that study participants experienced anxiety symptoms, especially those who had direct clinical contact with infected patients; as did those in the worst affected areas, including Hubei province; and those who were suspect cases. Governments and healthcare authorities should proactively implement appropriate psychological intervention programmes, to prevent, alleviate or treat increased anxiety.
Introduction: Blood transfusions continue to be a critical intervention in patients presenting to emergency departments (ED). Improved understanding of the adverse events associated with transfusions has led to new research to inform and delineate transfusion guidelines. The Nova Scotia Guideline for Blood Component Utilization in Adults and Pediatrics was implemented in June 2017 to reflect current best practice in transfusion medicine. The guideline includes a lowering of the hemoglobin threshold from 80 g/L to 70 g/L for transfusion initiation, to be used in conjunction with the patient's hemodynamic assessment before and after transfusions. Our study aims to augment understanding of transfusion guideline adherence and ED physician transfusing practices at the Halifax Infirmary Emergency Department in Nova Scotia. Methods: A retrospective chart review was conducted on one third of all ED visits involving red-cell transfusions for one year prior to and one year following the guideline implementation. A total of 350 charts were reviewed. The primary data abstracted for the initial transfusion, and subsequent transfusion if applicable, from each reviewed chart included clinical and laboratory data reflective of the transfusion guideline. Based on these data, the transfusion event was classified one of three ways: indicated based on hemoglobin level, indicated based on patient's symptomatic presentation, or unable to determine if transfusion indicated based on charting. Results: The year before guideline implementation, the total number of transfusions initiated at a hemoglobin of between 71-80 was 31 of 146 total transfusions. This number dropped by 23.6% to 22 of 136 in the year following guideline implementation. The number of single-unit transfusions increased by 28.0% from 47 of 146 in the year prior to 56 of 136 in the year after guideline implementation. The initial indication for transfusion being unable to be determined based on charting provided increased by 120%. The indication for subsequent transfusions being unable to be determined based on charting increased by 1500% (P < 0.05). Conclusion: These data suggest that implementing transfusion guidelines effectively reduced the number of transfusions given in the ED setting and increased the number of single-unit transfusions administered. However, the data also suggest the need for better education around transfusion indications and proper documentation clearly outlining the rationale behind the decision to transfuse.
Background: In patients with acute hip fracture, a fascia iliaca compartment block (FICB) has been shown to provide effective non-opioid analgesia, reduce the incidence of pneumonia, and potentially decrease the rate of delirium . However, this procedure was infrequently used in the St. Michael's Hospital (SMH) emergency department (ED). Aim Statement: Our aim was to increase the proportion of patients with hip fracture receiving FICB in the ED to 50% in six months. Measures & Design: We completed two Plan-Do-Study-Act (PDSA) cycles, measuring rates of FICB before and after each cycle. The first was a departmental rounds presentation with information about the process and benefits of FICB, addressing barriers identified by surveying the group. The second cycle included a bundle of interventions comprising of an “instruction card” with the steps required to do the procedure, access to a video tutorial, and a list of experienced physicians willing to help less experienced providers perform FICB. Evaluation/Results: In the three months prior to the project, the rate of FICB in the ED was 12.5% (3/24). For the three months after the first PDSA cycle, the rate increased to 22.2% (8/36). Then, the second cycle was performed. In the following two months the rate further increased to 36.8% (7/19). Discussion/Impact: Despite the clear increase in FICB rate, these changes were not statistically significant (p = 0.063). Our methodology was shown to be safe and effective, and our model can be applied to other ED groups looking to increase their rates of FICB.