scholarly journals Implementation of a Web-Based Symptom Checker to Manage the Quarantine of the USS Theodore Roosevelt Crew Following a Shipboard Outbreak of SARS-CoV-2

2021 ◽  
Author(s):  
Robert L Fenequito ◽  
Daniel Houskamp ◽  
Vincent Siu ◽  
Jamal Rorie ◽  
Nikunj Bhatt ◽  
...  
Keyword(s):  
Medical Staff ◽  
Time Course ◽  
Cohort Analysis ◽  
Large Population ◽  
Medical Provider ◽  
Aircraft Carrier ◽  
Theodore Roosevelt ◽  
Web Based ◽  
Social Distancing ◽  
Positive Contact

Introduction: In late March 2020, the USS Theodore Roosevelt (TR), a nuclear-powered aircraft carrier, pulled into port in the US territory of Guam to assess the severity of a developing outbreak of COVID-19 aboard the ship. A small staff contingent of 60 personnel from US Naval Hospital (USNH) Guam was tasked with the medical care of 4,079 sailors who were placed in single room quarantine amongst 11 hotels across the island of Guam. With the assistance of the Defense Digital Service, the USNH Guam staff implemented a web-based symptom checker, which allowed for monitoring of developing COVID symptoms, and selective testing of symptomatic individuals. Materials and Methods: Sailors from the TR were placed in quarantine or isolation cohorts upon debarking the ship. Sailors not positive for COVID-19 were quarantined amongst 11 hotels on Guam. Sailors positive for COVID-19 were isolated aboard Naval Base Guam (NBG). A retrospective cohort analysis and subgroup analyses were performed on symptom data obtained from sailors in quarantine. The sailors recorded their symptoms and temperature in a web-based symptom checker that assigned a symptom severity score (SSS). Sailors with a SSS >50 were evaluated by a medical provider and re-tested. Data were collected from 4 April 2020 to 1 May 2020. Sailors required two negative tests to exit quarantine and re-embark the ship. The time course, and most common cluster of symptoms associated with a positive COVID-19 PCR test were determined retrospectively after data collection. Results: The web-based symptom checker was successful in establishing daily positive contact and symptom monitoring of susceptible individuals in quarantine. 4,079 sailors in quarantine maintained positive contact with medical staff via the symptom checker, with at least 81% of the sailors recording their symptoms on a daily basis. Individuals with high symptom scores were quickly identified and underwent further evaluation and repeat COVID-19 testing. A cohort of 331 sailors tested positive for COVID-19 while in quarantine and recorded symptoms in the symptom checker before and after a positive COVID-19 test. In this cohort, the most frequent symptoms reported prior to a positive test were headache, anosmia, followed by cough. The symptom of anosmia was reported more frequently in sailors positive for COVID-19, compared to a cohort of matched controls. A small medical staff was able to monitor developing symptoms in a large quarantined population, while efficiently allocating resources, preserving personal protective equipment (PPE), and maintaining isolation and social distancing protocols. Conclusions and Relevance: The application provided a tool for broad health surveillance over a large population while maintaining strict quarantine and social distancing protocols. Highly symptomatic sailors were quickly identified, triaged, and transferred to a higher level of care if indicated. The symptom checker and predictive model generated from the data can be utilized by military and civilian public health officials to triage large populations and make rapid decisions on isolation measures, resource allocation, selective testing.

Theodore Roosevelt (CVN 71) Construction Schedule Compression

1986 ◽  
Vol 2 (02) ◽  
pp. 59-62
Author(s):  
Irving D. Halper
Keyword(s):  
Business Strategy ◽  
Sole Source ◽  
Industrial Processes ◽  
Aircraft Carrier ◽  
Theodore Roosevelt ◽  
Shipbuilding Industry ◽  
Ship Construction ◽  
Schedule Compression ◽  
Construction Schedule ◽  
Increases In Risk

This paper examines the environment in which improvements in ship construction can occur and looks at the type of planning that must be done to ensure benefits are realized. The Navy is now the major customer of the U.S. shipbuilding industry, and even with the increased emphasis on competitive procurement, by necessity, contracts for a significant amount of sole-source ship construction will exist due to technical or facility constraints. For these contracts, as well as many others, the shipbuilder has a limited incentive to accept the increases in risk inherent in changing his business strategy and existing industrial processes. Recognizing this problem, the Navy began, successfully, to change the environment for aircraft carrier construction. This paper describes the Navy's efforts.

scholarly journals Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study (Preprint)

2020 ◽  
Author(s):  
Ziqiu Guo ◽  
Sheng Zhi Zhao ◽  
Ningyuan Guo ◽  
Yongda Wu ◽  
Xue Weng ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Hong Kong ◽  
Drainage System ◽  
Socioeconomic Disparities ◽  
Preventive Behaviors ◽  
Web Based ◽  
Social Distancing ◽  
Ehealth Literacy ◽  
Surgical Masks ◽  
High Adherence

BACKGROUND eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. OBJECTIVE This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. METHODS The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. RESULTS The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, <i>P</i> for trend&lt;.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. CONCLUSIONS Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic.

P6293Assessment of testosterone/estradiol ratio, DHEA-S level and correlation with coronary inflammatory markers IL-1 & 6, TNF-1 and hsCRP predict 5 years risk of cardiovascular disease in men

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Sen ◽  
S Tanwar ◽  
A Jain ◽  
J Sharma ◽  
R K Gokhroo ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Inflammatory Markers ◽  
Cohort Analysis ◽  
Large Population ◽  
Fold Increase ◽  
Male Population ◽  
Adjusted Risk ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Previous data showed the adrenal sex hormone dehydroepiandrosterone (DHEA) which is present in serum mainly as the sulfate DHEA-S is the most abundant steroid hormone and another hormones like testosterone, estradiol are related to cardiovascular risk in men. Literatures revealed vascular and metabolic actions of DHEA/-S, evidence for an association between DHEA/-S levels and cardiovascular events is controversy. Objectives Our aim is to review and clear the contradictory point regarding cardiovascular risk and correlation of testeosterone/ estradiol ratio, DHEA-S level with coronary inflammatory markers in men. Methods Large population based cohort study done at multi centre of cardiology from 2013- 2018 in India. We enrolled total 23631 normal healthy male population age between 40 to 60 years and divided into two groups based on testosterone/estradiol ratio (Group A (n=2450) lower value of T/E ratio and Group B (n=21181) normal or higher T/E ratio. We did cohort analysis for 5 years and evaluated DHEA-S level and correlated it with coronary inflammatory markers and cardiovascular risk. Results In group A (low T/E ratio) we found low level of DHEA-S (98% of individual) and higher value of interleukins IL-1 (68%),IL-6 (74%) and tumor necrosis factor TNF-1 (71%) and high sensitive C-reactive protein (hsCRP) (73% of individual). Data revealed two fold increase of high blood pressure and LDL cholesterol level as compared to group B (normal or high T/E ratio and normal or high value of DHEA-S). 2.5 fold higher rate of coronary heart disease (CHD) found in group A versus in group B. We did not found as much significant difference in stroke, carotid and peripheral artery disease. T/E ratio and DHEA-S levels were inversely associated with the age-adjusted risk of a CHD event; the hazard ratios and 95% confidence intervals per standard deviation (SD) increase were 0.76 (0.66 to 0.91) and 0.82 (0.72 to 0.93), respectively. Conclusions Decrease ratio of testosterone/estradiol levels correlate decreased levels of DHEA-S which may increase the risk of CHD in men. For future aspect, correction of T/E ratio, DHEA-S and increase its awareness should be at mass level for prevention of CHD.

Synchronization properties of spindle oscillations in a thalamic reticular nucleus model

1994 ◽  
Vol 72 (3) ◽  
pp. 1109-1126 ◽  
Author(s):  
D. Golomb ◽  
X. J. Wang ◽  
J. Rinzel
Keyword(s):  
Time Course ◽  
Cluster State ◽  
Large Population ◽  
Reversal Potential ◽  
Ionic Currents ◽  
Thalamic Reticular Nucleus ◽  
Reticular Nucleus ◽  
Quiescent State ◽  
Gamma Aminobutyric Acid ◽  
Cluster States

1. We address the hypothesis of Steriade and colleagues that the thalamic reticular nucleus (RE) is a pacemaker for thalamocortical spindle oscillations by developing and analyzing a model of a large population of all-to-all coupled inhibitory RE neurons. 2. Each RE neuron has three ionic currents: a low-threshold T-type Ca2+ current (ICa-T), a calcium-activated potassium current (IAHP) and a leakage current (IL). ICa-T underlies a cell's postinhibitory rebound properties, whereas IAHP hyperpolarizes the neuron after a burst. Each neuron, which is a conditional oscillator, is coupled to all other RE neurons via fast gamma-aminobutyric acid-A (GABAA) and slow GABAB synapses. 3. For generating network oscillations IAHP may not be necessary. Synaptic inhibition can provide the hyperpolarization for deinactivating ICa-T that causes bursting if the reversal potentials for GABAA and GABAB synapses are sufficiently negative. 4. If model neurons display sufficiently powerful rebound excitability, an isolated RE network of such neurons oscillates with partial but typically not full synchrony. The neurons spontaneously segregate themselves into several macroscopic clusters. The neurons within a cluster follow the same time course, but the clusters oscillate differently from one another. In addition to activity patterns in which clusters burst sequentially (e.g., 2 or 3 clusters bursting alternately), a two-cluster state may occur with one cluster active and one quiescent. Because the neurons are all-to-all coupled, the cluster states do not have any spatial structure. 5. We have explored the sensitivity of such partially synchronized patterns to heterogeneity in cells' intrinsic properties and to simulated neuroelectric noise. Although either precludes precise clustering, modest levels of heterogeneity or noise lead to approximate clustering of active cells. The population-averaged voltage may oscillate almost regularly but individual cells burst at nearly every second cycle or less frequently. The active-quiescent state is not robust at all to heterogeneity or noise. Total asynchrony is observed when heterogeneity or noise is too large, e.g., even at 25% heterogeneity for our reference set of parameter values. 6. The fast GABAA inhibition (with a reversal potential more negative than, say, -65 mV) favors the cluster states and prevents full synchrony. Our simulation results suggest two mechanisms that can fully synchronize the isolated RE network model. With GABAA removed or almost totally blocked, GABAB inhibition (because it is slow) can lead to full synchrony, which is partially robust to heterogeneity and noise.(ABSTRACT TRUNCATED AT 400 WORDS)

scholarly journals Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis

2020 ◽  
Author(s):  
Jason A Sharpe ◽  
Brook I Martin ◽  
Julie M Fritz ◽  
Michael G Newman ◽  
John Magel ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Retrospective Cohort ◽  
Physical Therapist ◽  
Characteristic Curve ◽  
Cohort Analysis ◽  
Past Research ◽  
Urgent Care ◽  
Medical Provider ◽  
Primary Analysis ◽  
Musculoskeletal Conditions

Abstract Background Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged. Objective Our retrospective cohort study describes the rate of physical therapy use after referral for a variety of musculoskeletal diagnoses while comparing users and non-users of physical therapy services after referral. Methods The study sample included patients in the University of Utah Health system who received care from a medical provider for a musculoskeletal condition. We included a comprehensive set of variables available in the electronic data warehouse possibly associated with attending physical therapy. Our primary analysis compared differences in patient factors between physical therapy users and non-users using Poisson regression. Results 15 877 (16%) patients had a referral to physical therapy, and 3812 (24%) of these patients accessed physical therapy after referral. Most of the factors included in the model were associated with physical therapy use except for sex and number of comorbidities. The receiver operating characteristic curve was 0.63 suggesting poor predictability of the model but it is likely related to the heterogeneity of the sample. Conclusions We found that obesity, ethnicity, public insurance and urgent care referrals were associated with poor adherence to physical therapy referral. However, the limited predictive power of our model suggests a need for a deeper examination into factors that influence patients access to a physical therapist.

KAMEDO Report No. 83 European Union Summit in Göteborg, 2001

2006 ◽  
Vol 21 (2) ◽  
pp. 127-128
Author(s):  
Eva Fellenius ◽  
Håkan Lindberg ◽  
Annika Hedelin ◽  
Per Örtenwall ◽  
Louis Riddez
Keyword(s):  
European Union ◽  
Medical Staff ◽  
Medical Provider ◽  
Emergency Medical ◽  
The Media ◽  
Clear Communication ◽  
Basic Facts ◽  
City Agencies ◽  
The Eu ◽  
Command Center

AbstractA European Union (EU) Summit in Göteborg, Sweden, was held 15–16 June 2001. This meeting presented various security and medical concerns to city officials. In preparation for a large meeting such as the EU Summit, a plan should be established that includes basic facts, management organization, and guidelines. Clear communication beteween city agencies also must be established. Hospital inventories should be recorded daily and reported to medical staff. A command center must be in place for police and medical command. An emergency medical provider should ride in each police vehicle, so in case of a riot situation, victims can be treated quickly. An information officer should be assigned with the task of providing information regarding the injured to the media.

scholarly journals Early estimates of COVID-19 infections in small, medium and large population clusters

2020 ◽  
Vol 5 (9) ◽  
pp. e003055
Author(s):  
Amir Siraj ◽  
Alemayehu Worku ◽  
Kiros Berhane ◽  
Maru Aregawi ◽  
Munir Eshetu ◽  
...  
Keyword(s):  
Large Population ◽  
Face Mask ◽  
Sub Saharan Africa ◽  
Contact Tracing ◽  
Local Context ◽  
African Region ◽  
Social Distancing ◽  
Population Sizes ◽  
Sub Saharan ◽  
The Impact

IntroductionSince its emergence in late December 2019, COVID-19 has rapidly developed into a pandemic in mid of March with many countries suffering heavy human loss and declaring emergency conditions to contain its spread. The impact of the disease, while it has been relatively low in the sub-Saharan Africa (SSA) as of May 2020, is feared to be potentially devastating given the less developed and fragmented healthcare system in the continent. In addition, most emergency measures practised may not be effective due to their limited affordability as well as the communal way people in SSA live in relative isolation in clusters of large as well as smaller population centres.MethodsTo address the acute need for estimates of the potential impacts of the disease once it sweeps through the African region, we developed a process-based model with key parameters obtained from recent studies, taking local context into consideration. We further used the model to estimate the number of infections within a year of sustained local transmissions under scenarios that cover different population sizes, urban status, effectiveness and coverage of social distancing, contact tracing and usage of cloth face mask.ResultsWe showed that when implemented early, 50% coverage of contact tracing and face mask, with 33% effective social distancing policies can bringing the epidemic to a manageable level for all population sizes and settings we assessed. Relaxing of social distancing in urban settings from 33% to 25% could be matched by introduction and maintenance of face mask use at 43%.ConclusionsIn SSA countries with limited healthcare workforce, hospital resources and intensive care units, a robust system of social distancing, contact tracing and face mask use could yield in outcomes that prevent several millions of infections and thousands of deaths across the continent.

scholarly journals 0154 A new, efficient web-based tool to collect and code lifetime job histories in large population-based studies: the COPD project in the UK Biobank cohort

2014 ◽  
Vol 71 (Suppl 1) ◽  
pp. A19.1-A19
Author(s):  
Sara De Matteis ◽  
Lesley Rushton ◽  
Debbie Jarvis ◽  
Magda Wheatley ◽  
Hadia Azhar ◽  
...  
Keyword(s):  
Large Population ◽  
Population Based ◽  
Uk Biobank ◽  
Web Based ◽  
The Uk

scholarly journals Incidence and Outcomes of Desmoplastic Small Round Cell Tumor: Results from the Surveillance, Epidemiology, and End Results Database

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Christina K. Lettieri ◽  
Pamela Garcia-Filion ◽  
Pooja Hingorani
Keyword(s):  
Radiation Therapy ◽  
Cohort Analysis ◽  
Large Population ◽  
Incidence Rates ◽  
Cell Tumor ◽  
Round Cell ◽  
Round Cell Tumor ◽  
Small Round Cell Tumor ◽  
Small Round Cell ◽  
Significant Difference

Desmoplastic small round cell tumor (DSRCT) is a rare but highly fatal malignancy. Due to the rarity of this neoplasm, no large population based studies exist.Procedure. This is a retrospective cohort analysis. Incidence rates were calculated based on sex and ethnicity and compared statistically. Gender-, ethnicity-, and treatment- based survival were calculated using the Kaplan-Meier method.Results. A total of 192 cases of DSRCT were identified. Peak incidence age was between 20 and 24 years. Age-adjusted incidence rate for blacks was 0.5 cases/million and for whites was 0.2 cases/million (P=0.037). There was no statistically significant difference in survival based on gender or ethnicity. When adjusted for age, there was no statistically significant difference in survival amongst patients who received radiation therapy compared to those who did not (HRadj = 0.73; 95% CI 0.49, 1.11). There was a statistically significant survival advantage for patients who received radiation after surgery compared to those who did not (HR 0.49; 95% CI 0.30, 0.79).Conclusion. DSRCT is more common in males and in people of African-American descent. Although overall survival remains poor, radiation therapy following surgery seems to improve outcome in these patients.

A new web-based tool to collect and code lifetime job-histories in large population-based studies

2015 ◽  
Author(s):  
Sara De Matteis ◽  
Debbie Jarvis ◽  
Magda Wheatley ◽  
Alan Young ◽  
Heather Young ◽  
...  
Keyword(s):  
Large Population ◽  
Population Based ◽  
Web Based
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