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The use of farrowing crates is increasingly questioned from an animal welfare point of view. Even so, since a number of attempts to develop loose farrowing systems have been unsuccessful, leading to high levels of piglet mortality due in the main to crushing, many farmers remain sceptical as to whether or not alternative systems can be viable. On the other hand, several European countries have introduced legislation requiring loose farrowing systems, thus promoting research into this type of housing and allowing for performance studies based on large samples of commercial farms. As a consequence of these recent developments, we think it timely to reconsider the evidence available on loose farrowing systems. In our review, we first address the normal peri-parturient behaviour of domestic pigs, as well as studies comparing behaviour and stress physiology in sows kept in both crates and loose systems during farrowing. We then review approaches taken to develop alternative farrowing systems in different countries, and focus lastly on pen, piglet and sow characteristics that contribute to piglet survival in loose farrowing systems. Taking scientific evidence as well as practical experience into account, we conclude that piglet mortality in loose farrowing systems need not exceed that of crate systems. To obtain good performance results, sows due to farrow should be kept individually in sufficiently large pens, structured for preference into a nest area and an activity area. Furthermore, both management and breeding aspects, resulting in high piglet viability and good maternal behaviour, are essential to achieve high production in loose farrowing systems.
Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.
This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).
To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals.
Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States.
2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports.
Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate.
In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017.
The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.
The hypothalamic-pituitary-adrenal axis (HPA) is highly relevant in depressive disorders. Some investigations suggest that the HPA axis is altered in depressive disorders as indicated by higher awakening cortisol levels. There are also some results that show relations between cortisol level, psychopathology and neuropsychological performance. However, a systematic investigation of this relationship with a large and matched sample of patients and controls is missing. We tested 59 patients with depressive disorders and 75 healthy controls with tasks from the neuropsychological CANTAB and NEUROBAT battery. Before and after these tests we collected salivary samples. The study ended followed with an extensive measurement of psychopathology (e. g. BDI, HAM-D) and mood (visual analog scales).
The study revealed a significant relationship between salivary cortisol and results in tasks to executive function in the neuropsychological assessment in the control group but not in the patient group. There was no relationship between salivary cortisol and other cognitive performances. While patients with higher salivary cortisol levels reported worse mood, higher salivary levels in healthy controls were associated with better mood. These results could be related to different stress levels and different expectations regarding the examination of the groups.
Neuropsychological impairment in depression is less concise compared to schizophrenia, dementia or other brain disorders. It is varying between patients and over time in the natural course of depression. Furthermore it depends on various co-variables. These characteristics make the detection of depressive patterns in neuropsychological performance very difficult for conventional statistics.
Artificial neural networks are highly parallel nonlinear teachable systems of information processing. They are used for pattern recognition and classification tasks in different fields and can be superior to conventional linear statistics in the analysis of complex data.
The results of 1100 neuropsychological examinations of psychiatric patients with varying diagnoses and healthy controls were used to train different kinds of neural networks. The neuropsychological battery (NEUROBAT) consists of usual test paradigms as optical reaction time, a go-nogo task, recognition and free memory recall, sensorimotor interference and a continuous performance task.
Trained multilayer perceptrons and radial basis function networks allowed a significant recognition of depressive patterns. Patients were classified correctly in up to 71% of cases, whereas up to 64% of depressive disorders were recognized correctly by linear artificial neural networks.
Recognition of depressive neuropsychological patterns seems to be possible by artificial neural networks. But sensitivity and specificity are too low for a possible support of clinical diagnostics. The superiority to linear classification models could not shown clearly. More complex hierarchical neural networks, as they are commonly used in picture recognition, should be tested in future studies in order to improve classification results.
Negative computer attitude has been shown to be a possible co-variable in computerized examinations of psychiatric patients, affecting patient-computer interaction as well as reliability and validity of assessment (Weber et al. 2002, Acta Psychiatr.Scand., 105, 126-130).
It remains still uncertain if the psychological construct of computer attitude can be dependably measured in acute psychiatric inpatients or whether it is impeded by the effects of mental illness. For that reason a German translation of the Groningen Computer Attitude Scale (GCAS) was evaluated in 160 acute psychiatric inpatients under naturalistic conditions.
General test criteria (internal structure, item analysis, internal consistency, split half reliability) to a large extent corresponded to those formerly found in healthy subjects and psychiatric outpatients. The mean GCAS score was calculated as 56.2 ± 10.8 points and a significantly better computer attitude was found in male, better educated and younger patients. Some diverging correlation patterns were found in diagnostic subgroups, indicating a possible minor impact of mental disorder on computer attitude.
Overall, the GCAS was found to be a suitable instrument for measuring computer attitude in acute psychiatric inpatients. It should be used in identifying patients with a negative attitude to computers in order to ensure reliability and validity of computerized assessment.