scholarly journals Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients

2021 ◽  
pp. CJN.03180321
Author(s):  
Ben Caplin ◽  
Damien Ashby ◽  
Kieran McCafferty ◽  
Richard Hull ◽  
Elham Asgari ◽  
...  
Keyword(s):  
Infection Control ◽  
Local Community ◽  
Control Strategies ◽  
Event Analysis ◽  
Unit Size ◽  
Dialysis Unit ◽  
Suspected Infection ◽  
Asymptomatic Patients ◽  
Community Transmission

Background Patients receiving in-center hemodialysis treatment face unique challenges during the COVID-19 pandemic, specifically the need to attend for treatment that prevents self-isolation. Dialysis unit attributes and isolation strategies that might reduce dialysis center COVID-19 infection rates have not been previously examined. Methods We explored the role of variables including community disease burden, dialysis unit attributes (size, layout) and infection control strategies, on rates of COVID-19 among patients receiving in center hemodialysis in London, UK, between March 2nd 2020 and May 31st 2020. The two outcomes were defined as (i) a positive test for infection or admission with suspected COVID19 and (ii) admission to the hospital with suspected infection. Associations were examined using a discrete-time multi-level time-to-event analysis. Results Data on 5,755 patients, dialysing in 51 units were analysed. 990 (17%) tested positive and 465 (8%) were admitted with suspected COVID-19 between 2nd March and 31st May 2020. Outcomes were associated with age, diabetes, local community COVID-19 rates and dialysis unit size. Greater number of available side rooms and introduction of mask policies for asymptomatic patients were inversely associated with outcomes. No association was seen with sex, ethnicity, or deprivation indices nor with any of the different isolation strategies. Conclusions Rates of COVID-19 in the in center-hemodialysis population relate to individual factors, underlying community transmission, unit size and layout.

scholarly journals Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

2020 ◽  
Author(s):  
Lloyd A.C. Chapman ◽  
Margot Kushel ◽  
Sarah N. Cox ◽  
Ashley Scarborough ◽  
Caroline Cawley ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Local Community ◽  
Control Strategies ◽  
The United States ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Cross Sectional ◽  
Risk Environments ◽  
Symptom Screening

AbstractBackgroundMultiple COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.MethodsWe developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase-chain-reaction (PCR) surveys conducted during COVID-19 outbreaks in five shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak in a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing and universal mask wearing.ResultsThe proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6% to 51.6%, which translated to basic reproduction number (R0) estimates of 2.9−6.2. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. With moderate community incidence (∼30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0=1.5), moderate-risk (R0=2.9), and high-risk (R0=6.2) shelter were, respectively: 0.33, 0.11 and 0.03 for daily symptom-based screening; 0.52, 0.27, and 0.04 for twice-weekly PCR testing; 0.47, 0.20 and 0.06 for universal masking; and 0.68, 0.40 and 0.08 for these strategies combined.ConclusionsIn high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom-screening, frequent PCR testing and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be adopted to reduce outbreak risk.

scholarly journals Haemosporidian taxonomic composition, network centrality and partner fidelity between resident and migratory avian hosts

2021 ◽  
Author(s):  
Daniela de Angeli Dutra ◽  
Alan Fecchio ◽  
Erika Martins Braga ◽  
Robert Poulin
Keyword(s):  
Local Community ◽  
Taxonomic Composition ◽  
Network Centrality ◽  
Migratory Species ◽  
Haemosporidian Parasites ◽  
Host Parasite Interactions ◽  
Community Transmission ◽  
Avian Haemosporidians ◽  
Host Parasite

Migration can modify interaction dynamics between parasites and their hosts with migrant hosts able to disperse parasites and impact local community transmission. Thus, studying the relationships among migratory hosts and their parasites is fundamental to elucidate how migration shapes host-parasite interactions. Avian haemosporidian parasites are some of the most prevalent, diverse, and important wildlife parasites, and are also widely used as models in ecological and evolutionary research. Here, we contrast parasite taxonomic composition, network centrality and partner fidelity among resident and non-resident hosts using avian haemosporidians as study model. In order to evaluate parasite taxonomic composition, we performed permutational multivariate analyses of variance to quantify dissimilarity in haemosporidian lineages infecting different host migratory categories. Additionally, we ran multilevel Bayesian models to assess the role of migration in determining centrality and partner fidelity in host-parasite networks of avian hosts and their respective haemosporidian parasites. We observed similar parasite taxonomic composition and partner fidelity among resident and migratory hosts. Conversely, we demonstrate that migratory hosts play a more central role in host-parasite networks than residents. However, when evaluating partially and fully migratory hosts separately, we observed that only partially migratory species presented higher network centrality when compared to resident birds. Therefore, migration does not lead to differences in both parasite taxonomic composition and partner fidelity. However, migratory behavior is positively associated with network centrality, indicating migratory hosts play more important roles in shaping host-parasite interactions and influence local transmission.

scholarly journals Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lloyd A. C. Chapman ◽  
Margot Kushel ◽  
Sarah N. Cox ◽  
Ashley Scarborough ◽  
Caroline Cawley ◽  
...  
Keyword(s):  
High Risk ◽  
Infection Control ◽  
Local Community ◽  
Control Strategies ◽  
The United States ◽  
Homeless Shelters ◽  
Homeless Shelter ◽  
Cross Sectional ◽  
Symptom Screening ◽  
Exposed Individual

Abstract Background COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks. Methods We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing. Results The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0 = 1.5), moderate-risk (R0 = 2.9), and high-risk (R0 = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. Conclusions In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.

A Court in Decline? Examining the Regality Court Records of Melrose, Roxburghshire, 1657–84

2020 ◽  
Vol 40 (1) ◽  
pp. 1-16
Author(s):  
Vivienne Dunstan
Keyword(s):  
Seventeenth Century ◽  
Local Community ◽  
Local Population ◽  
Local Area ◽  
Vital Role ◽  
Local Communities ◽  
Court Records ◽  
Seminal Work

McIntyre, in his seminal work on Scottish franchise courts, argues that these courts were in decline in this period, and of little relevance to their local population. 1 But was that really the case? This paper explores that question, using a particularly rich set of local court records. By analysing the functions and significance of one particular court it assesses the role of this one court within its local area, and considers whether it really was in decline at this time, or if it continued to perform a vital role in its local community. The period studied is the mid to late seventeenth century, a period of considerable upheaval in Scottish life, that has attracted considerable attention from scholars, though often less on the experiences of local communities and people.

Confronting the Problems of Professional Sports: A Public Policy Response to Franchise Relocation and Stadium Subsidization

2005 ◽  
Vol 1 ◽  
Author(s):  
Taylor F Brinkman
Keyword(s):  
Local Community ◽  
Professional Sports ◽  
The United States ◽  
Direct Result ◽  
Sports Organizations ◽  
Sports Leagues ◽  
Sports Finance ◽  
Sports Venues ◽  
Benefits And Costs

During the past decade, forty-six professional sports venues were constructed in the United States, while only 16 expansion teams were created by the major sports leagues. Nearly two thirds of these newly built stadiums and arenas were funded with public tax revenues, despite substantial evidence showing no positive economic impact of new sports stadium construction on local communities. In reviewing the economic literature, this article investigates the role of professional sports organizations in the construction and public subsidization of new sports venues. Franchise relocation and public stadium subsidization is a direct result of the monopoly power of professional sports leagues, whose franchise owners extract large subsidies from their host communities by threatening to relocate to viable alternative locations. After explaining how the most common methods of stadium subsidization project a disproportionate allocation of the benefits and costs of hosting a professional team to local community interests, this article outlines several considerations for local policymakers who seek to reinvigorate public discussion of equity concerns in professional sports finance.

Effective infection prevention and control strategies in a large accredited psychiatric facility in Singapore

2020 ◽  
Author(s):  
Daniel Poremski ◽  
Sandra Henrietta Subner ◽  
Grace Lam Fong Kin ◽  
Raveen Dev Ram Dev ◽  
Mok Yee Ming ◽  
...  
Keyword(s):  
Mental Health ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Control Strategies ◽  
Infection Prevention And Control ◽  
Psychiatric Facility ◽  
Essential Services ◽  
Community Transmission ◽  
And Control

The Institute of Mental Health in Singapore continues to attempt to prevent the introduction of COVID-19, despite community transmission. Essential services are maintained and quarantine measures are currently unnecessary. To help similar organizations, strategies are listed along three themes: sustaining essential services, preventing infection, and managing human and consumable resources.

The fundamental role of educational intervention on improving health care workers’ knowledge, attitude and practice towards infection control precautions

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Rasha H. Bassyouni ◽  
Ahmed-Ashraf Wegdan ◽  
Naglaa A El-Sherbiny
Keyword(s):  
Health Care ◽  
Infection Control ◽  
Educational Intervention ◽  
Health Care Workers ◽  
Standard Precautions ◽  
Attitude And Practice ◽  
Care Workers ◽  
Atp Bioluminescence ◽  
Knowledge Attitude And Practice

To evaluate the role of educational intervention on health care workers' (HCWs) compliance to standard precautions and cleaning of frequently touched surfaces at critical care units, forty-nine HCWs at 2 intensive care units (ICUs) and one neonatology unit at Fayoum University hospital were evaluated for knowledge, attitude and practice (KAP) towards standard precautions as well as obstacles affecting their compliance to standard precautions before and after a 32-hour purposed-designed infection control education program. A structured self-administrated questionnaire as well as observational checklists were used. Assessment of Environmental cleaning was investigated by observational checklist, ATP bioluminescence and aerobic bacteriological culture for 118 frequently touched surfaces. Pre-intervention assessment revealed that 78.6% of HCWs were with good knowledge, 82.8% with good attitude and 80.8% had good practice. Obstacles identified by HCWs were as follow: making patient-care very technical (65.3%), deficiency of hand washing facilities (59.2%), skin irritation resulting from hand hygiene products (51%), and unavailability of PPE (38.8%). High significant improvements of knowledge, attitude and practice were detected after one month of educational intervention (P= 0.000). During the pre-interventional period only 30.5% of surfaces were considered clean versus 97.45% post intervention (P< 0.05). The highest Median ATP bioluminescence values were obtained from telephone handset, light switches and Blood pressure cuffs. S. aureus was the most common isolated organism followed by Enterococcus spp and E.coli (52, 38 and 19 surfaces respectively). In conclusion, contentious training of HCWs on standard precautions should be considered a mandatory element in infection control programs

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

Myocardial Noncompaction

2018 ◽  
Vol 69 (8) ◽  
pp. 2209-2212
Author(s):  
Alexandru Radu Mihailovici ◽  
Vlad Padureanu ◽  
Carmen Valeria Albu ◽  
Venera Cristina Dinescu ◽  
Mihai Cristian Pirlog ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
Genetic Transmission ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Patients With Heart Failure

Left ventricular noncompaction is a primary cardiomyopathy with genetic transmission in the vast majority of autosomal dominant cases. It is characterized by the presence of excessive myocardial trabecularities that generally affect the left ventricle. In diagnosing this condition, echocardiography is the gold standard, although this method involves an increased risk of overdiagnosis and underdiagnosis. There are also uncertain cases where echocardiography is inconclusive, a multimodal approach is needed, correlating echocardiographic results with those obtained by magnetic resonance imaging. The clinical picture may range from asymptomatic patients to patients with heart failure, supraventricular or ventricular arrhythmias, thromboembolic events and even sudden cardiac death. There is no specific treatment of left ventricular noncompaction, but the treatment is aimed at preventing and treating the complications of the disease. We will present the case of a young patient with left ventricular noncompactioncardiomyopathy and highlight the essential role of transthoracic echocardiography in diagnosing this rare heart disease.

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