Infection Control for a Carbapenem-Resistant Enterobacteriaceae Outbreak in an Advanced Emergency Medical Services Center

Background: A carbapenem-resistant Enterobacteriaceae (CRE) outbreak occurred in an advanced emergency medical service center [hereafter referred to as the intensive care unit (ICU)] between 2016 and 2017. Aim: Our objective was to evaluate the infection control measures for CRE outbreaks. Methods: CRE strains were detected in 16 inpatients located at multiple sites. Environmental cultures were performed and CRE strains were detected in 3 of 38 sites tested. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and detection of β-lactamase genes were performed against 25 CRE strains. Findings: Molecular typing showed the PFGE patterns of two of four Klebsiella pneumoniae strains were closely related and the same MLST (ST2388), and four of five Enterobacter cloacae strains were closely related and same MLST (ST252). Twenty-three of 25 CRE strains harbored the IMP-1 β-lactamase gene and 15 of 23 CRE strains possessed IncFIIA replicon regions. Despite interventions by the infection control team, new inpatients with the CRE strain continued to appear. Therefore, the ICU was partially closed and the inpatients with CRE were isolated, and the ICU staff was divided into two groups between inpatients with CRE and non-CRE strains to avoid cross-contamination. Although the occurrence of new cases dissipated quickly after the partial closure, a few months were required to eradicate the CRE outbreak. Conclusion: Our data suggest that the various and combined measures that were used for infection control were essential in stopping this CRE outbreak. In particular, partial closure to isolate the ICU and division of the ICU staff were effective.

Ultrasonographic characteristics and outcome of Type III umbilical-portal-systemic venous shunt

Aims: According to a novel in-utero classification termed “umbilical-portal-systemic venous shunt (UPSVS)” recently proposed for an abnormal umbilical, portal and ductal venous system, the portal-systemic shunt belongs to type III UPSVS. This study was designed to examine the ultrasonographic characteristics and outcome of type III UPSVS.Material and methods: All cases of Type III UPSVS diagnosed at our department from April 2016 to December 2020 were retrospectively studied.Results: Seventeen patients with type III UPSVS including 12 type IIIa and 5 IIIb cases were identified. Sonography showed a shunt between the inferior left portal vein and the left hepatic vein in all type IIIa cases. Three cases of type IIIb had a combination of another shunt (2 with type I and one with type IIIa). Integrate intrahepatic portal vein system was not seen in those 2 cases of type IIIb combined with type I UPSVS, leading to termination of pregnancy (TOP). TOP occurred in 4 patients with type IIIa as requested by the parents. Two cases (type IIIa and type IIIb each) underwent surgical procedure for the closure of the shunt. Spontaneous complete closure in 4 type IIIa cases and partial closure in one type IIIb case occurred during a period of 3-16 months.Conclusions: The majority of patients had type IIIa UPSVS presenting a good outcome. The lack of integrate intrahepatic portal vein system was the main reason for TOP in patients with type IIIb UPSVS. These data suggest the UPSVS classification is a useful tool for a prognosis prediction of type III UPSVS.

The cooperation between kindergartens and families during the kindergarten closure in Slovenia due to the COVID-19 pandemic

During 2020, kindergartens in Slovenia were fully closed in the first and partially closed in the second wave of the COVID-19 pandemic. Therefore, the kindergarten practice of cooperation with the families changed. In order to obtain an insight into the new situation in this field, our research focused on the organization of the cooperation between kindergartens and families during the kindergarten closure. In November 2020, we developed an online questionnaire for parents who had at least one child enrolled in kindergarten. The questionnaire was filled in by 944 parents. More than half of the parents answered that contacts with preschool professionals had supported them during the full and/or partial closure of their kindergarten. About one half of parents answered that the kindergarten had contacted them once a week, mainly with proposals for activities and information in case the kindergarten remained closed. Most parents answered that the additional contact with the professionals had not represented an additional workload. Three quarters of parents believe that it is necessary to maintain contact even during the closure. Still, as the pandemic situation is completely new, it is still difficult to assess in what way it makes sense to maintain cooperation during the closure. With the study, we obtained insight into the importance of cooperation from the parents' perspective, which we need to consider in similar situations ahead.

ON PARTIAL CLOSURE OF VARIABLE WIDTH SLIT WITH END ZONES OF PLASTIC DEFORMATIONS IN A ROCK

Рассматривается задача о сжатии изотропной горной среды с щелью переменной ширины с концевыми пластическими зонами. Считается, что взаимодействие поверхностей щели под действием тектонических и гравитационных усилий в массиве горной породы может приводить к возникновению зон контакта. Исследуется случай возникновения нескольких участков контакта берегов щели. При этом считается, что на некоторой части площадки контакта возникает сцепление берегов, на остальной части возможно проскальзывание. Нахождение неизвестных параметров, характеризующих частичное закрытие щели, сводится к решению системы сингулярных интегральных уравнений. Определены контактные напряжения, значения размеров участков контакта и концевых зон пластических деформаций. The problem of compression of an isotropic rock medium with a slit of variable width is considered. The slit has end plastic zones. It is assumed that the interaction of slit surfaces under tectonic and gravitational forces in a rock mass can lead to the formation of contact zones. The case of the occurrence of several contact areas of the slit faces is considered. It is assumed that the cohesion of the faces occurs on some part of the contact area, and slippage is possible on the rest. Finding unknown parameters characterizing the partial closure of the slit is reduced to solving a system of singular integral equations. The contact stresses, sizes of contact areas and end zones of plastic deformations are determined.

Vulnerable learners in the age of COVID-19: A scoping review

This scoping review provides an overview of COVID-19 approaches to managing unanticipated school closures and available literature related to young people learning outside-of-school. A range of material has been drawn upon to highlight educational issues of this learning context, including psychosocial and emotional repercussions. Globally, while some countries opted for a mass school shut-down, many schools remained open for students from disadvantaged backgrounds. This partial closure not only enabled learning in smaller targeted groups but also offered a safe sanctuary for those who needed a regulated and secure environment. In Australia, if full school closures were to be enforced over a long period, a significant proportion of students from more vulnerable backgrounds would likely experience persistent disadvantage through a range of barriers: long-term educational disengagement, digital exclusion, poor technology management, and increased psychosocial challenges. This scoping review combines research on technology availability and learning, with analysis of the long-term educational impacts of navigating the COVID-19 disruption.

Live Poultry Market Closure and Avian Influenza A (H7N9) infection in cities of China, 2013-2017: An ecological study

Background: Previous studies have proven that the closure of live poultry markets (LPMs) was an effective intervention to reduce human risk of avian influenza A (H7N9) infection, but evidence is limited on the impact of scale and duration of LPMs closure on the transmission of H7N9. Method: Five cities (i.e., Shanghai, Suzhou, Shenzhen, Guangzhou and Hangzhou) with the largest number of H7N9 cases in mainland China from 2013 to 2017 were selected in this study. Data on laboratory-confirmed H7N9 human cases in those five cities were obtained from the Chinese National Influenza Centre. The detailed information of LPMs closure (i.e., area and duration) was obtained from the Ministry of Agriculture. We used a generalized linear model with a Poisson link to estimate the effect of LPMs closure, reported as relative risk reduction (RRR). We used classification and regression trees (CARTs) model to select and quantify the dominant factor of H7N9 infection. Results: All five cities implemented the LPMs closure, and the risk of H7N9 infection decreased significantly after LPMs closure with RRR ranging from 0.80 to 0.93. Respectively, a long-term LPMs closure for 10-13 weeks elicited a sustained and highly significant risk reduction of H7N9 infection (RRR = 0.98). Short-time LPMs closure with 2 weeks in every epidemic did not reduce the risk of H7N9 infection (p>0.05). Partially closed LPMs in some suburbs contributed only 35% for reduction rate (RRR=0.35). Shenzhen implemented partial closure for first 3 epidemics (p>0.05) and all closure in the latest 2 epidemic waves (RRR=0.64). Conclusion: Our findings suggest that LPMs all closure in whole city can be a highly effective measure comparing with partial closure (i.e. only urban closure, suburb and rural remain open). Extend the duration of closure and consider permanently closing the LPMs will help improve the control effect. The effect of LPMs closure seems greater than that of meteorology on H7N9 transmission.

Live Poultry Market Closure and Avian Influenza A (H7N9) infection in cities of China, 2013-2017: An ecological study

Background Previous studies have proven that the closure of live poultry markets (LPMs) was an effective intervention to reduce human risk of avian influenza A (H7N9) infection, but evidence is limited on the impact of scale and duration of LPMs closure on the transmission of H7N9. Method Five cities (i.e., Shanghai, Suzhou, Shenzhen, Guangzhou and Hangzhou) with the largest number of H7N9 cases in mainland China from 2013-2017 were selected in this study. Data on laboratory-confirmed H7N9 human cases in those five cities were obtained from the Chinese National Influenza Centre. The detailed information of LPMs closure (i.e., area and duration) was obtained from the Ministry of Agriculture. We used a generalized linear model with a Poisson link to estimate the effect of LPMs closure, reported as relative risk reduction (RRR). We used classification and regression trees (CARTs) to select and quantify the dominant factor of H7N9 infection. Results All five cities implemented the LPMs closure, and the risk of H7N9 infection decreased significantly after LPMs closure with RRR ranging from 0.80-0.93. Respectively, a long-term LPMs closure for 10-13 weeks elicited a sustained and highly significant risk reduction of H7N9 infection (RRR = 0.98). Short-time LPMs closure with 2 weeks in every epidemic did not reduce the risk of H7N9 infection (p>0.05). Partially closed LPMs in some suburbs contributed only 35% for reduction rate (RRR=0.35). Shenzhen implemented partial closure for first 3 epidemics (p>0.05) and all closure in the latest 2 epidemic waves (RRR=0.64). Conclusion Our findings suggest that LPMs all closure in whole city can be a highly effective measure comparing with partial closure (i.e. only urban closure, suburb and country remain open). Extend the duration of closure and consider permanently closing the LPMs will help improve the control effect. The effect of LPMs closure is greater than that of meteorology on H7N9 transmission.