scholarly journals Agent-based simulations for protecting nursing homes with prevention and vaccination strategies

2021 ◽  
Vol 18 (185) ◽  
Author(s):  
Jana Lasser ◽  
Johannes Zuber ◽  
Johannes Sorger ◽  
Elma Dervic ◽  
Katharina Ledebur ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Index Case ◽  
Detection Threshold ◽  
High Viral Load ◽  
Turnover Time ◽  
Central Importance ◽  
Test Procedures ◽  
Agent Based ◽  
Virus Genomes ◽  
Test Result

Due to its high lethality among older people, the safety of nursing homes has been of central importance during the COVID-19 pandemic. With test procedures and vaccines becoming available at scale, nursing homes might relax prohibitory measures while controlling the spread of infections. By control we mean that each index case infects less than one other person on average. Here, we develop an agent-based epidemiological model for the spread of SARS-CoV-2 calibrated to Austrian nursing homes to identify optimal prevention strategies. We find that the effectiveness of mitigation testing depends critically on test turnover time (time until test result), the detection threshold of tests and mitigation testing frequencies. Under realistic conditions and in absence of vaccinations, we find that mitigation testing of employees only might be sufficient to control outbreaks if tests have low turnover times and detection thresholds. If vaccines that are 60% effective against high viral load and transmission are available, control is achieved if 80% or more of the residents are vaccinated, even without mitigation testing and if residents are allowed to have visitors. Since these results strongly depend on vaccine efficacy against infection, retention of testing infrastructures, regular testing and sequencing of virus genomes is advised to enable early identification of new variants of concern.

scholarly journals The Potential Regional Impact of Contact Precaution Use in Nursing Homes to Control Methicillin-ResistantStaphylococcus aureus

2013 ◽  
Vol 34 (2) ◽  
pp. 151-160 ◽  
Author(s):  
Bruce Y. Lee ◽  
Ashima Singh ◽  
Sarah M. Bartsch ◽  
Kim F. Wong ◽  
Diane S. Kim ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Policy Making ◽  
Orange County ◽  
Nursing Home Residents ◽  
Contact Precaution ◽  
Agent Based ◽  
Contact Precautions ◽  
Relative Decrease ◽  
Multiple Health ◽  
Over Time

Objective.Implementation of contact precautions in nursing homes to prevent methicillm-resistantStaphylococcus aureus(MRSA) transmission could cost time and effort and may have wide-ranging effects throughout multiple health facilities. Computational modeling could forecast the potential effects and guide policy making.Design.Our multihospital computational agent-based model, Regional Healthcare Ecosystem Analyst (RHEA).Setting.All hospitals and nursing homes in Orange County, California.Methods.Our simulation model compared the following 3 contact precaution strategies: (1) no contact precautions applied to any nursing home residents, (2) contact precautions applied to those with clinically apparent MRSA infections, and (3) contact precautions applied to all known MRSA carriers as determined by MRSA screening performed by hospitals.Results.Our model demonstrated that contact precautions for patients with clinically apparent MRSA infections in nursing homes resulted in a median 0.4% (range, 0%–1.6%) relative decrease in MRSA prevalence in nursing homes (with 50% adherence) but had no effect on hospital MRSA prevalence, even 5 years after initiation. Implementation of contact precautions (with 50% adherence) in nursing homes for all known MRSA carriers was associated with a median 14.2% (range, 2.1%–21.8%) relative decrease in MRSA prevalence in nursing homes and a 2.3% decrease (range, 0%–7.1%) in hospitals 1 year after implementation. Benefits accrued over time and increased with increasing compliance.Conclusions.Our modeling study demonstrated the substantial benefits of extending contact precautions in nursing homes from just those residents with clinically apparent infection to all MRSA carriers, which suggests the benefits of hospitals and nursing homes sharing and coordinating information on MRSA surveillance and carriage status.

Comparison of effects of dry versus wet swallowing on Eustachian tube function via a nine-step inflation/deflation test

2005 ◽  
Vol 119 (9) ◽  
pp. 704-708 ◽  
Author(s):  
M Kemal Adali ◽  
Cem Uzun
Keyword(s):  
Middle Ear ◽  
Test Procedure ◽  
Step Test ◽  
Eustachian Tube Function ◽  
Single Session ◽  
Test Procedures ◽  
Tube Function ◽  
The Difference ◽  
Test Result ◽  
First Session

The aim of the present study is to evaluate the effect of swallowing type (dry versus wet) on the outcome of a nine-step inflation/deflation tympanometric Eustachian tubefunction (ETF) test in healthy adults.Fourteen normal healthy volunteers, between 19 and 28 years of age, were included in the study. The nine-step test was performed in two different test procedures: (1) test with dry swallows (dry test procedure) and (2) test with liquid swallows (wet test procedure). If the equilibration of middle-ear (ME) pressure was successful in all the steps of the nine-step test, ETF was considered ‘Good’. Otherwise, the test was considered ‘Poor’, and the test was repeated at a second session.In the dry test procedure, ETF was ‘Good’ in 21 ears at the first session and in 24 ears after the second session (p > 0.05). However, in the wet test procedure, ETF was ‘Good’ in 13 ears at the first session and in 21 ears after the second session (p < 0.05).At the first session, ETF was ’Good’ in 21 and 13 ears in the dry and wet test procedures, respectively. The difference was statistically significant (p < 0.05). However, after the second session, the overall number of ears with ‘Good’ tubal function was almost the same in both test procedures (24 ears at dry test procedures versus 21 ears at wet test procedures;p > 0.05).Dry swallowing seems to be more effective for the equilibration of ME pressure. Thus, a single-session dependent evaluation of ETF may be efficient for the dry test procedure of the nine-step test. Swallowing with water may be easier for subjects, but a repetition of the test at a second session may be necessary when the test result is ‘Poor’.

scholarly journals Direct Comparison of SARS Co-V-2 Nasal RT- PCR and Rapid Antigen Test (BinaxNOWTM) at a Community Testing Site During an Omicron Surge

2022 ◽  
Author(s):  
John Schrom ◽  
Carina Marquez ◽  
Genay Pilarowski ◽  
Grace Wang ◽  
Anthea Mitchell ◽  
...  
Keyword(s):  
San Francisco ◽  
High Viral Load ◽  
Antigen Test ◽  
Rt Pcr ◽  
Repeat Testing ◽  
Single Antigen ◽  
Testing Site ◽  
Antigen Testing ◽  
Test Result ◽  
Community Site

In 731 persons seeking COVID-19 testing at a walk-up San Francisco community site in January 2022, simultaneous nasal rapid antigen testing (BinaxNOWTM) and RT-PCR testing was performed. There were 296 (40.5%) positive tests by RT-PCR; 97% of a random sample were the omicron variant. Sensitivity of a single antigen test was 95.2% (95% CI 92-98%); 82.1% (95% CI 77-87%) and 65.2% (95% CI 60-70%) for Ct threshold of < 30, < 35 and no threshold, respectively. A single BinaxNowTM rapid antigen test detected 95% of high viral load omicron cases from nasal specimens. As currently recommended, repeat testing should be done for high- risk persons with an initial negative antigen test result.

HUBUNGAN PELAKSANAAN SCREENING TEST MENELAN DENGAN KEJADIAN DISFAGIA PADA PASIEN BARU YANG MENDERITA STROKE AKUT

2017 ◽  
Vol 4 (2) ◽  
pp. 47-53
Author(s):  
Muhammad Arif
Keyword(s):  
Acute Stroke ◽  
Screening Test ◽  
P Value ◽  
Stroke Patients ◽  
Test Procedures ◽  
Chi Square ◽  
Chi Square Test ◽  
Relationship Of ◽  
The Relationship ◽  
Test Result

According to the NINDS 2015, States that a stroke occurs when the blood supply to brain fails suddenly interrupted due to a blockage or rupture of blood vessels were. Basic Health Research results that show an increase in the prevalence of stroke symptoms in Indonesia increased from 8.3 at 1000 in 2007 to 12.1 and at 1000 in 2013. One of the problems that arise due to stroke is a disorder of swallowing or dysphagia. According to the World Stroke Academy Learning Moduls in 2012 the prevalence of dysphagia in stroke sufferers range from 36 to 67%. In the year 2016 in RSSN dysphagia in stroke patients 22,94%. For early detection of dysphagia screening test required to swallow as a first step in identifying the risks due to dysphagia and aspiration in stroke patients. The purpose of this research is to know the relationship of the implementation of the screening test to swallow with dysphagia in acute stroke patients in the room just entered inpatient Neurology RSSN Bukittinggi in 2017. This research method using analytic, descriptive, then the data was processed using the Chi Square test. The sample in this study as many as 54 people respondents. Test result statistics retrieved value p value = 0.002 (p < α) then it can be inferred the existence of a relationship between the implementation of the screening test to swallow with dysphagia in acute stroke patients the new entry. Analysis of the results obtained OR = 9.281 meaning respondents who perform screening test procedures in accordance with the swallow has a chance of  9.281 times in detecting the occurrence of dysphagia. Suggestions in this study is the implementation of a screening test this swallow can be included in SPO for nurses in Bukittinggi in the room especially RSSN Neurology in detecting the onset of dysphagia in acute stroke patients.

scholarly journals Frequent testing and immunity-based staffing will help mitigate outbreaks in nursing home settings

2020 ◽  
Author(s):  
Inga Holmdahl ◽  
Rebecca Kahn ◽  
James Hay ◽  
Caroline O. Buckee ◽  
Michael Mina
Keyword(s):  
Nursing Homes ◽  
Screening Tests ◽  
Testing Strategy ◽  
Final Size ◽  
Term Care ◽  
Agent Based ◽  
Targeted Interventions ◽  
Testing Strategies ◽  
Antigen Testing

AbstractBackgroundNursing homes and other long term care facilities have been disproportionately impacted by the COVID-19 pandemic. Strategies are urgently needed to reduce transmission in these vulnerable populations. We aim to evaluate the reduction in transmission in nursing homes achieved through contact-targeted interventions and testing.MethodsWe developed an agent-based Susceptible–Exposed– Infectious(Asymptomatic/Symptomatic)–Recovered (SEIR) model to examine SARS-CoV-2 transmission in nursing homes. Residents and staff are modelled individually; residents are split into two cohorts based on COVID-19 diagnosis. We evaluate the effectiveness of two contact-targeted interventions. In the resident cohorting intervention, recovered residents are moved back from the COVID (infected) cohort to the non-COVID (susceptible/uninfected) cohort. In the immunity-based staffing intervention, recovered staff, who we assume have protective immunity, are assigned to work in the non-COVID cohort, while susceptible staff work in the COVID cohort and are assumed to have high levels of protection from personal protective equipment. These interventions aim to reduce the fraction of people’s contacts that are presumed susceptible (and therefore potentially infected) and replace them with recovered (immune) contacts. We further evaluate two types of screening tests conducted with varying frequency: 1) rapid antigen testing and 2) PCR testing.ResultsThe frequency and type of testing has a larger impact on the size of outbreaks than the cohorting and staffing interventions. The most effective testing strategy modeled is daily antigen testing. Under all screening testing strategies, the resident cohorting intervention and the immunity-based staffing intervention reduce the final size of the outbreak among residents, with the latter reducing it more. The efficacy of these interventions among staff varies by testing strategy and outbreak size.ConclusionsIncreasing the frequency of screening testing of all residents and staff, or even staff alone, in nursing homes has the potential to greatly reduce outbreaks in this vulnerable setting. Immunity-based staffing can further reduce spread at little or no additional cost and becomes particularly important when daily testing is not feasible.

scholarly journals Testing and Vaccination to Reduce the Impact of COVID-19 in Nursing Homes: An Agent-Based Approach

2021 ◽  
Author(s):  
Jose Pablo Gómez-Vázquez ◽  
yury García ◽  
Alec J Schmidt ◽  
Beatriz Martínez-López ◽  
Miriam Nuño
Keyword(s):  
Nursing Home ◽  
Los Angeles ◽  
Nursing Homes ◽  
Attack Rate ◽  
Cumulative Number ◽  
Block Transmission ◽  
Agent Based ◽  
Hypothetical Scenario ◽  
The Impact ◽  
Pharmaceutical Interventions

Background: Efforts to protect residents in nursing homes involve non-pharmaceutical interventions, testing, and vaccine. We sought to quantify the effect of testing and vaccine strategies on the attack rate, length of the epidemic, and hospitalization. Methods: We developed an agent-based model to simulate the dynamics of SARS-CoV-2 transmission in a nursing home with resident and staff agents. Interactions between 172 residents and 170 staff were assumed based on data from a nursing home in Los Angeles, CA. We simulated scenarios assuming different levels of non-pharmaceutical interventions, testing frequencies, and vaccine efficacy to block transmission. Results: Under the hypothetical scenario of widespread SARS-CoV-2 in the community, 3-day testing frequency minimized the attack rate and the time to eradicate an outbreak. Prioritization of vaccine among staff or staff and residents minimized the cumulative number of infections and hospitalization, particularly in the scenario of high probability of an introduction. Reducing the probability of a virus introduction reduced the demand on testing and vaccine to reduce infections and hospitalizations. Conclusions: Improving frequency of testing from 7-days to 3-days minimized the number of infections and hospitalizations, despite widespread community transmission. Vaccine prioritization of staff provides the best protection strategy, despite high risk of a virus introduction.

USING PRE-TEST PROBABILITIES TO MORE EFFECTIVELY UTILIZE POINT-OF-CARE COVID-19 TESTING IN NURSING HOMES.

2020 ◽  
Vol 7 (11) ◽  
pp. 1-6
Keyword(s):  
Nursing Homes ◽  
Risk Mitigation ◽  
Point Of Care ◽  
Nursing Home Residents ◽  
Infectious Agent ◽  
Care Workers ◽  
Increased Risk ◽  
Post Test ◽  
Test Result ◽  
Test Probability

Nursing home residents are at increased risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative infectious agent of COVID-19, as a result of exposure to asymptomatic or pre-symptomatic health care workers. In an effort to reopen nursing homes safely, federal agencies have proposed guidelines for testing of staff and residents at regular intervals. To mitigate testing shortages, facilities received antigen point-of-care (POC) testing devices for COVID-19 but without clear guidance on when to select an antigen vs. molecular based test and how to act on a positive or negative test result. This special article presents an algorithm for how to approach pre-test probability in the selection of a certain test and how to use post-test probability to act on a test result in the context of risk mitigation.

scholarly journals Mathematical modeling to inform vaccination strategies and testing approaches for COVID-19 in nursing homes

2021 ◽  
Author(s):  
Rebecca Kahn ◽  
Inga Holmdahl ◽  
Sujan Reddy ◽  
John Jernigan ◽  
Michael J Mina ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Vaccination Coverage ◽  
Nursing Home Residents ◽  
The United States ◽  
Limited Data ◽  
Agent Based ◽  
Symptomatic Disease ◽  
Testing Strategies ◽  
Protection Against Infection

Background: Nursing home residents and staff were included in the first phase of COVID-19 vaccination in the United States. Because the primary trial endpoint was vaccine efficacy (VE) against symptomatic disease, there are limited data on the extent to which vaccines protect against SARS-CoV-2 infection and the ability to infect others (infectiousness). Assumptions about VE against infection and infectiousness have implications for possible changes to infection prevention guidance for vaccinated populations, including testing strategies. Methods: We use a stochastic agent-based SEIR model of a nursing home to simulate SARS-CoV-2 transmission. We model three scenarios, varying VE against infection, infectiousness, and symptoms, to understand the expected impact of vaccination in nursing homes, increasing staff vaccination coverage, and different screening testing strategies under each scenario. Results: Increasing vaccination coverage in staff decreases total symptomatic cases in each scenario. When there is low VE against infection and infectiousness, increasing staff coverage reduces symptomatic cases among residents. If vaccination only protects against symptoms, but asymptomatic cases remain infectious, increased staff coverage increases symptomatic cases among residents through exposure to asymptomatic but infected staff. High frequency testing is needed to reduce total symptomatic cases if the vaccine has low efficacy against infection and infectiousness, or only protects against symptoms. Conclusions: Encouraging staff vaccination is not only important for protecting staff, but might also reduce symptomatic cases in residents if a vaccine confers at least some protection against infection or infectiousness.

scholarly journals High-Throughput Sequencing of Small RNAs for Diagnostics of Grapevine Viruses and Viroids in Russia

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2432
Author(s):  
Emiliya Navrotskaya ◽  
Elena Porotikova ◽  
Eugeniya Yurchenko ◽  
Zsuzsanna Nagyne Galbacs ◽  
Eva Varallyay ◽  
...  
Keyword(s):  
High Throughput ◽  
Small Rnas ◽  
High Throughput Sequencing ◽  
Integrated Approach ◽  
High Viral Load ◽  
Bioinformatic Analysis ◽  
High Genetic Diversity ◽  
Krasnodar Krai ◽  
Raspberry Bushy Dwarf Virus ◽  
Virus Genomes

The use of high-throughput sequencing (HTS) technology has led to significant progress in the identification of many viruses and their genetic variants. In this study, we used the HTS platform to sequence small RNAs (sRNAs) of grapevine to study the virome. Isolation of RNA was performed using symptomatic grapevines collected from commercial vineyards in Krasnodar Krai in 2017–2018. To determine the viromes of vineyards, we used an integrated approach that included a bioinformatic analysis of the results of sRNA HTS and the molecular method RT-PCR, which made it possible to identify 13 viruses and 4 viroids. Grapevine leafroll-associated virus 4 (GLRaV-4), Grapevine Syrah Virus-1 (GSyV-1), Raspberry bushy dwarf virus (RBDV), Australian grapevine viroid (AGVd), and Grapevine yellow speckle viroid 2 (GYSVd-2) were identified for the first time in Russia. Out of 38 samples analyzed, 37 had mixed infections with 4–11 viruses, indicating a high viral load. Analysis of the obtained sequences of fragments of virus genomes made it possible to identify recombination events in GLRaV-1, GLRaV-2, GLRaV-3, GLRaV-4, GVT, GPGV, GRSPaV, GVA, and GFLV. The obtained results indicate a wide spread of the viruses and a high genetic diversity in the vineyards of Krasnodar Krai and emphasize the urgent need to develop and implement long-term strategies for the control of viral grapevine diseases.

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