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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.
To evaluate dyslipidaemia risk among patients with schizophrenia treated with aripiprazole or olanzapine.
Pooled analysis of the aripiprazole clinical database, including studies of ≥7 days with at least an oral aripiprazole monotherapy arm. Mean changes from baseline to endpoint and shifts from normal to abnormal lipid levels were calculated.
Seventeen placebo- and five olanzapine-controlled studies (3 weeks->3 years) of adult patients (≥18 years) were included. Mean changes (LOCF) in lipids were similar between aripiprazole and placebo for all lipid parameters; aripiprazole showed significant improvements versus olanzapine (p≤0.01). the incidence (OC) of switching to abnormal lipid levels from baseline normal was similar between placebo and aripiprazole, and significantly lower with aripiprazole than olanzapine for most measures.
Despite limitations inherent to pooled analyses, these findings lend further support to the differential profile of atypicals, with aripiprazole showing effects on lipids comparable with placebo.
Suicide by burning is considered like a violent suicide mechanism.
In our western countries, suicide by burning is relatively rare. But the number of cases seems to increase.
It is important to be able to differenciate suicidal, accidental and criminal burning. It could help physicians, particularly when a patient try to dissimulate a self immolation.
The aim of our study is to find criterias which can differenciate suicidal, accidental and criminal burning.
We collected all the cases of burning related deaths and burning wounds in alive patients, treated at the Forensic Department of the University Hospital Center of Tours, France, at the request of the Prosecutor, between 2000 and 2011. The aspects of death (suicidal, accidental, or criminal) were done by the police officers. In each case we studied sociodemographic and psychopathological datas.
We collected 53 cases, divided into three groups : accident (25), suicide (18), and crime (10). Mean age was 43,9. In cases of accidental burning, 73% had a psychiatric history, and 50% an alcohol abuse. In all these cases of suicide by burning, depression is the major diagnostic (69%).
In cases of accidental burning, we defined two specific groups. In cases of criminal burning, the victimes were aged between 20 and 40, and under alcohol during the offense. In cases of suicide by burning, the mean age is about 48, principally men, who use violent suicide methods. They have generally a documented psychiatric history.
Our group has reported the imprint formation of biological material on polycarbonate nuclear track detectors by UV-C exposure, which is used as an approach to simultaneously visualize cell imprints and nuclear tracks coming from the boron neutron capture reaction. Considering that the cell nucleus has a higher UV-C absorption than the cytoplasm and that hematoxylin preferentially stains the nucleus, we proposed to enhance the contrast between these two main cell structures by hematoxylin staining before UV-C sensitization. In this study, several experiments were performed in order to optimize UV-C exposure parameters and chemical etching conditions for cell imprint formation using the SK-BR-3 breast cancer cell line. The proposed method improves significantly the resolution of the cell imprints. It allows clear differentiation of the nucleus from the rest of the cell, together with nuclear tracks pits. Moreover, it reduces considerably the UV-C exposure time, an important experimental issue. The proposed methodology can be applied to study the boron distribution independently from the chosen cell line and/or boron compounds.
To quantitatively test the hypothesis that older patients have increased thyroarytenoid muscle atrophy by comparing thyroarytenoid muscle volumes across different age groups.
A retrospective chart review was conducted. The study included 111 patients with no history of laryngeal pathology. Two investigators reviewed magnetic resonance imaging studies of these patients and manually traced the thyroarytenoid muscles on multiple slices bilaterally. Thyroarytenoid muscle volumes were then computed using imaging analysis software. Patients were stratified into three age groups (18–50 years, 51–64 years, and 65 years or older) for comparison.
Intra- and inter-rater reliabilities were excellent for all measurements (intraclass correlation co-efficient > 0.90). There was no statistically significant difference in the mean volumes of left and right thyroarytenoid muscles in all age and gender groups.
Given the lack of statistically significant difference in thyroarytenoid muscle volume between age groups on magnetic resonance imaging, the prevailing assumption that age-related thyroarytenoid muscle atrophy contributes to presbyphonia should be re-examined.
Background: AHEM is a rare form of acute disseminated encephalomyelitis (ADEM) characterized by fulminant encephalopathy with hemorrhagic necrosis and most often fatal outcome. Methods: A case report and review of literature. Results: A 6-year-old girl known SCD presented an acute demyelinating syndrome (ADS) with diplopia due to unilateral fourth nerve palsy. She received (20mg/kg/day for 5 days) of IVMP (intravenous methylprednisolone). Two weeks after steroid weaning, she presented right hemiplegia. Brain MRI showed a left frontal necrotico-hemorrhagic lesion and new areas of demyelination. She showed signs of herniation and underwent craniotomy. Investigations ruled out vascular and infectious process in both events. The deterioration stopped concomitantly to the initiation of IVMP. She was discharged with a longer oral wean. Later, she was diagnosed with Crohn’s disease and primary sclerosing cholangitis. We considered AHEM as the most plausible diagnosis based on the clinical and radiological presentation, the preceding ADS, the exclusion of other etiologies, and the response to IVMP including resolution of non-necrotic lesions. Similar - but fatal - AHEM has been reported in 2 SCD patients. Conclusions: In any ADS occurring in the context of SCD and/or auto-immune condition, we recommend to slowly wean steroids, and to closely monitor the patient after weaning to quickly treat any recurrence with IVMP.
Background: Optic pathway gliomas (OPG) represent 5% of pediatric brain tumours. Visual acuity measures are used to evaluate treatment response. Current clinical tests to assess visual field integrity are subjective and require verbal cooperation. Thus, the objective of this study was to evaluate the clinical effectiveness of Steady State Visual Evoked Potentials (ssVEPs) to measure visual field integrity in a non-invasive and objective manner. Methods: SsVEPs were obtained in ten children with OPGs and 42 controls ages 3 to 21. The stimuli consisted of two circular dartboard patterns stimulating fovea and peripheral zones at two flickering frequencies, so that central and peripheral visual fields could be assessed simultaneously. The test consisted of eight stimuli presentations of 10 seconds. Results: Results indicate significantly lower ssVEP amplitudes in children with OPGs (M=2.52, 95% CI [1.13, 3.92]) compared to controls (M=13.26, 95% CI [8.85, 17.67]) in the central visual field (p=.021). However, no between group differences were detected in the peripheral field (p >.05). There were no significant differences between age groups (p>0.05). Conclusions: This objective, affordable, and non-invasive method appears to be effective in detecting central visual field deficits in children with OPGs rapidly and consistently.
The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non–VA nursing homes.
VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire.
A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004).
Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
To assess knowledge about infection prevention among nursing home personnel and identify gaps potentially addressable through a quality improvement collaborative.
Baseline knowledge assessment of catheter-associated urinary tract infection, asymptomatic bacteriuria, antimicrobial stewardship, and general infection prevention practices for healthcare-associated infections.
Nursing homes across 14 states participating in the national “Agency for Healthcare Research and Quality Safety Program for Long-Term Care: Healthcare-Associated Infections/Catheter-Associated Urinary Tract Infection.”
Each facility aimed to obtain responses from at least 10 employees (5 licensed and 5 unlicensed). We assessed the percentage of correct responses.
A total of 184 (78%) of 236 participating facilities provided 1 response or more. Of the 1,626 respondents, 822 (50.6%) were licensed; 117 facilities (63.6%) were for-profit. While 99.1% of licensed personnel recognized the definition of asymptomatic bacteriuria, only 36.1% knew that pyuria could not distinguish a urinary tract infection from asymptomatic bacteriuria. Among unlicensed personnel, 99.6% knew to notify a nurse if a resident developed fever or confusion, but only 27.7% knew that cloudy, smelly urine should not routinely be cultured. Although 100% of respondents reported receiving training in hand hygiene, less than 30% knew how long to rub hands (28.5% licensed, 25.2% unlicensed) or the most effective agent to use (11.7% licensed, 10.6% unlicensed).
This national assessment demonstrates an important need to enhance infection prevention knowledge among healthcare personnel working in nursing homes to improve resident safety and quality of care.
Rosette nanotubes (RNTs) are tubular architectures generated through the hierarchical self-assembly of the guanine-cytosine (G∧C) motif 1 or 2 (Figure 1). Motif 2 differs from 1 by the substitution at the N-atom in the G-ring with a C-atom as shown in red. In this paper, we prepare a new tricyclic G∧C base 3 from a functionalized derivative of 2 and demonstrate its self-assembly into fluorescent helical RNTs in N,N-dimethylformamide (DMF). The self-assembly and fluorescent properties of RNTs 3 were established using scanning electron microscopy (SEM), transmission electron microscopy (TEM), atomic force microscopy (AFM) and UV-visible spectroscopy.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA). the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Ferroelectric epitaxial Pb(Zr,Ti)O3 (PZT) layers were grown by pulsed laser deposition on SrTiO3/GaAs templates fabricated by molecular beam epitaxy. The templates present an excellent structural quality and the SrTiO3/GaAs is abrupt at the atomic scale thanks to surface Ti pre-treatment. The PZT layers contain a- and c- domains, as shown by X-Ray diffraction analyses. Piezoforce microscopy experiments and macroscopic electrical characterizations indicate that PZT is ferroelectric. A relative dielectric permittivity of 164 is extracted from these measurements.
Catheter-associated urinary tract infection (CAUTI) represents a significant proportion of healthcare-associated infections (HAIs). The US Department of Health and Human Services issued a plan to reduce HAIs with a target 25% reduction of CAUTI by 2013. Michigan's successful collaborative to reduce unnecessary use of urinary catheters and CAUTI was based on a partnership between diverse hospitals, the state hospital association (SHA), and academic medical centers. Taking the lessons learned from Michigan, we are now spreading this work throughout the 50 states. This national spread leverages the expertise of different groups and organizations for the unified goal of reducing catheter-related harm. The key components of the project are (1) centralized coordination of the effort and dissemination of information to SHAs and hospitals, (2) data collection based on established definitions and approaches, (3) focused guidance on the technical practices that will prevent CAUTI, (4) emphasis on understanding the socioadaptive aspects (both the general, unit-wide issues and CAUTI-specific challenges), and (5) partnering with specialty organizations and governmental agencies who have expertise in the relevant subject area. The work may serve in the future as a model for other large improvement efforts to address other hospital-acquired conditions, such as venous thromboembolism and falls.
Over the last few decades, the steady progress achieved in reducing planned exposures of
both workers and the public has been admirable in the nuclear sector. However, the
disproportionate focus on tiny public exposures and radioactive discharges associated with
normal operations came at a high price, and the quasi-denial of a risk of major accident
and related weaknesses in emergency preparedness and response came at even higher price.
Fukushima has unfortunately taught us that radiological protection (RP) for emergency and
post-emergency can be much more than a simple evacuation that lasts 24 to 48 hours with
people safely returning to their homes shortly afterward. On optimization of emergency and
post-emergency exposures, the only “show in town” in terms of international RP policies
improvements has been the issuance of the ICRP’s new general recommendations. However, no
matter how genuine these improvements were, they have not been “road tested” to the
practical reality of severe accidents. Post-Fukushima, there is a compelling case to
review the practical adequacy of key RP notions such as optimization, evacuation,
sheltering, reference levels for workers and the public, and to amend these notions with a
view to make the international RP system more useful in the event of a severe accident. In
pursuing further improvements to the international RP system, it should be clearly borne
in mind that the system is generally based on protection against the risk of cancer and
hereditary diseases. The system also protects against deterministic non-cancer effects on
tissues and organs. In seeking refinements of such protection notions, we invite ICRP to
pay increased attention to the fact that a continued balance must be struck between
beneficial activities which cause exposures, and protection. The global nuclear industry
is committed to help overcoming the above key RP issues as part of the RP community’s
upcoming international deliberations towards a more efficient international RP system.
Nanoindentation-induced phase transformations in both crystalline silicon (c-Si) (100) and ion-implanted amorphous silicon have been studied at temperatures up to 200 °C. The region under the indenter undergoes rapid volume expansion at temperatures above 125 °C during unloading, which is indicated by “bowing” behavior in the load–displacement curve. Polycrystalline Si-I is the predominant end phase for indentation in crystalline silicon whereas high-pressure Si-III/Si-XII phases are the result of indentation in amorphous silicon. We suggest that the Si-II phase is unstable in a c-Si matrix at elevated temperatures and can directly transform to Si-I during the early stages of unloading.
Indium phosphide (InP) nanowires (NWs) were grown by molecular beam epitaxy on various substrates including SrTiO3 (001), Si (001) and InP (111) at a growth temperature of 380°C. We used the Vapor Liquid Solid assisted method with Au as a metal catalyst. The composition of the catalyst particles and the crystalline structure of the nanowires were compared using reflection high energy electron diffraction, scanning electron microscopy and high resolution transmission electron microscope. It is found that InP nanowires grown onto InP and SrTiO3 substrates are structurally defects free with a wurtzite structure. On Si (001) substrates, the presence of stacking faults and cubic phase insertion along the growth direction is observed. The effect of the substrate on the composition of catalyst droplets and consequently on the crystalline quality of the nanowires is discussed for the conditions of nucleation and defect formation.