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Cadnum JL, Memic S, Eckstein EC, Donskey CJ. Evaluation of ventilation during partial shutdown of a hospital heating, ventilation, and air conditioning system for maintenance. Infect Control Hosp Epidemiol 2023; 44:2099-2100. [PMID: 37528772 DOI: 10.1017/ice.2023.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland Veterans' Affairs (VA) Medical Center, Cleveland, Ohio, USA
| | - Samir Memic
- Research Service, Louis Stokes Cleveland Veterans' Affairs (VA) Medical Center, Cleveland, Ohio, USA
| | - Elizabeth C Eckstein
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Cantillo-Negrete J, Carino-Escobar RI, Ortega-Robles E, Arias-Carrión O. A comprehensive guide to BCI-based stroke neurorehabilitation interventions. MethodsX 2023; 11:102452. [PMID: 38023311 PMCID: PMC10630643 DOI: 10.1016/j.mex.2023.102452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Brain-Computer Interfaces (BCIs) offer the potential to facilitate neurorehabilitation in stroke patients by decoding user intentions from the central nervous system, thereby enabling control over external devices. Despite their promise, the diverse range of intervention parameters and technical challenges in clinical settings have hindered the accumulation of substantial evidence supporting the efficacy and effectiveness of BCIs in stroke rehabilitation. This article introduces a practical guide designed to navigate through these challenges in conducting BCI interventions for stroke rehabilitation. Applicable regardless of infrastructure and study design limitations, this guide acts as a comprehensive reference for executing BCI-based stroke interventions. Furthermore, it encapsulates insights gleaned from administering hundreds of BCI rehabilitation sessions to stroke patients.•Presents a comprehensive methodology for implementing BCI-based upper extremity therapy in stroke patients.•Provides detailed guidance on the number of sessions, trials, as well as the necessary hardware and software for effective intervention.
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Affiliation(s)
- Jessica Cantillo-Negrete
- División de Investigación en Neurociencias Clínica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra, Mexico City, NM 14389, Mexico
| | - Ruben I. Carino-Escobar
- División de Investigación en Neurociencias Clínica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra, Mexico City, NM 14389, Mexico
| | - Emmanuel Ortega-Robles
- Unidad de Trastornos del Movimiento y Sueño, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico
| | - Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño, Hospital General Dr. Manuel Gea González, Mexico City 14080, Mexico
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Donskey CJ. High technology and low technology measures to reduce risk of SARS-CoV-2 transmission. Am J Infect Control 2023; 51:A126-A133. [PMID: 37890942 DOI: 10.1016/j.ajic.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 10/29/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, a variety of low technology and high technology measures have been proposed to reduce the risk for transmission. Identifying those measures likely to be useful in reducing viral transmission without undue expense or potential for adverse effects has been a challenge for infection control programs. The challenge has been compounded by the lack of tools that can be used to assess the risk for viral transmission in different settings. This review discusses practical tools that can be used to assess ventilation and airflow and evaluates some of the low technology and high technology measures that have been proposed as control measures for COVID-19. Some typical questions posed to infection control programs during the pandemic are presented to illustrate real-world application of the concepts being discussed.
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Affiliation(s)
- Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
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Donlon JD, McAloon CG, Hyde R, Aly S, Pardon B, Mee JF. A systematic review of the relationship between housing environmental factors and bovine respiratory disease in preweaned calves - Part 2: Temperature, relative humidity and bedding. Vet J 2023; 300-302:106032. [PMID: 37757972 DOI: 10.1016/j.tvjl.2023.106032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
Bovine respiratory disease (BRD) is a challenge in all housed farming systems that raise calves. Farm to farm variation in BRD prevalence can be partially attributed to variation in host immunity, pathogens and housing environment. Unlike host immunity and BRD pathogens, housing environment has not been well investigated. The objective of this systematic review was to identify the measurable environmental variables associated with BRD in housed preweaned calves. Pubmed, CAB Direct and Scopus databases were searched. To be considered for inclusion publications had to be published in English, before 24 November, 2022 and include at least one measurable/ manipulated environmental variable and a standardized method of BRD detection. In total 12 publications were included in this review. In this second part of the systematic review the environmental variables identified were; temperature (9 publications); relative humidity (8 publications); bedding (5 publications); ventilation (1 publication); air CO2 concentration (1 publication) and air velocity (4 publications). Of the publications that were examined a statistically significant relationship to BRD was identified in 4/9 publications examining temperature, 3/8 examining relative humidity, 2/4 examining air velocity, 2/5 examining bedding, 0/1 examining ventilation rates and 0/1 examining CO2 concentration. From this review it is clear high airspeed at calf level should be avoided as should deep, wet pack bedding. The relationship between BRD prevalence and both high and low temperature requires more investigation to identify temperature thresholds associated with increased risk of BRD as well as the most influential modifiers. An optimal environment for housed calves could not be clearly identified in this review.
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Affiliation(s)
- J D Donlon
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland; Animal and Bioscience Research Department, Teagasc, Animal and Grassland Research and Innovation Centre, Grange, Dunsany, Co, Meath C15 PW93, Ireland.
| | - C G McAloon
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - R Hyde
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, UK
| | - S Aly
- Veterinary Medicine Teaching and Research Center, School of Veterinary Medicine, University of California Davis, Tulare 93274, USA; Department of Population Health and Reproduction, School of Veterinary Medicine, University of California Davis, Tulare 95616, USA
| | - B Pardon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke 9820, Belgium
| | - J F Mee
- Moorepark Dairy Production Research Centre, Teagasc, Fermoy, Co, Cork, Ireland
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Ha W, Stiefel MA, Gries JR, Cadnum JL, Torres-Teran MM, Wilson BM, Donskey CJ. Evaluation of Interventions to Improve Ventilation in Households to Reduce Risk for Transmission of Severe Acute Respiratory Syndrome Coronavirus 2. Pathog Immun 2022; 7:120-130. [PMID: 36655199 PMCID: PMC9836208 DOI: 10.20411/pai.v7i2.553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background Inadequate ventilation may contribute to the high risk for household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We evaluated the effectiveness of several interventions recommended to improve ventilation in households. In 7 residential homes, carbon dioxide monitoring was conducted to assess ventilation in occupied open areas such as family rooms and in bedrooms and/or offices. Carbon dioxide levels above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present. In 1 of the 7 homes, various interventions to improve ventilation or to filter air were assessed in a kitchen area by measuring clearance of aerosol particles produced using an aerosol-based spray system and carbon dioxide generated by cooking with a gas stove. Results Carbon dioxide levels rose above 800 ppm in bedrooms and offices with 2 occupants when windows and doors were closed and in open areas during gatherings of 5 to 10 people; carbon dioxide levels decreased when windows or doors were opened. Clearance of carbon dioxide and aerosol particles significantly increased with interventions including running fans, operating portable air cleaners, and opening windows, particularly when there was a noticeable breeze or when a window fan was used to blow contaminated air outside. Conclusion In households, several measures to improve ventilation or air filtration were effective in reducing carbon dioxide accumulation or enhancing clearance of carbon dioxide and aerosol particles. Studies are needed to determine if interventions to improve ventilation can reduce the risk for airborne transmission of SARS-CoV-2 in households.
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Affiliation(s)
- Wilson Ha
- John Carroll University, University Heights, Ohio
| | | | | | - Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | | | - Brigid M. Wilson
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Shrimpton AJ, Pickering AE. Aerosols: time to clear the air? Anaesthesia 2022; 77:1193-1196. [DOI: 10.1111/anae.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience University of Bristol UK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience University of Bristol UK
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If you can’t measure it, you can’t improve it: Practical tools to assess ventilation and airflow patterns to reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 and other airborne pathogens. Infect Control Hosp Epidemiol 2022; 43:915-917. [PMID: 35379373 PMCID: PMC9021581 DOI: 10.1017/ice.2022.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cadnum JL, Jencson AL, Alhmidi H, Zabarsky TF, Donskey CJ. Airflow Patterns in Double-Occupancy Patient Rooms May Contribute to Roommate-to-Roommate Transmission of Severe Acute Respiratory Syndrome Coronavirus 2. Clin Infect Dis 2022; 75:2128-2134. [PMID: 35476020 PMCID: PMC9129113 DOI: 10.1093/cid/ciac334] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hospitalized patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from roommates with unrecognized coronavirus disease 2019 (COVID-19). We hypothesized that airflow patterns might contribute to SARS-CoV-2 transmission in double-occupancy patient rooms. METHODS A device emitting condensed moisture was used to identify airflow patterns in double-occupancy patient rooms. Simulations were conducted to assess transfer of fluorescent microspheres, 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 between patient beds 3 meters apart and to assess the effectiveness of privacy curtains and portable air cleaners in reducing transfer. RESULTS Air flowed from inlet vents in the center of the room to an outlet vent near the door, resulting in air currents flowing toward the bed adjacent to the outlet vent. Fluorescent microspheres (212-250-µm diameter), 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 released from the inner bed were carried on air currents toward the bed adjacent to the outlet vent. Closing curtains between the patient beds reduced transfer of each of the particles. Operation of a portable air cleaner reduced aerosol transfer to the bed adjacent to the outlet vent but did not offer a benefit over closing the curtains alone, and in some situations, resulted in an increase in aerosol exposure. CONCLUSIONS Airflow patterns in double-occupancy patient rooms may contribute to risk for transmission of SARS-CoV-2 between roommates. Keeping curtains closed between beds may be beneficial in reducing risk.
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Affiliation(s)
- Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Annette L. Jencson
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Heba Alhmidi
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Trina F. Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Curtis J. Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA,Corresponding author: Curtis J. Donskey, Infectious Diseases Section 1110W, Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106, USA;
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Cadnum JL, Alhmidi H, Donskey CJ. Planes, Trains, and Automobiles: Use of Carbon Dioxide Monitoring to Assess Ventilation During Travel. Pathog Immun 2022; 7:31-40. [PMID: 35316971 PMCID: PMC8932639 DOI: 10.20411/pai.v7i1.495] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Travel poses a risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. Poorly ventilated indoor settings pose a particularly high risk for transmission.
Methods: We used carbon dioxide measurements to assess adequacy of ventilation during 5 trips that included air travel. During selected parts of each trip that involved indoor settings, we monitored carbon dioxide levels every 1 minute and recorded peak levels and the number of people present. Carbon dioxide readings above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation.
Results: Carbon dioxide levels remained below 800 ppm during train rides to and from the airport and inside airports except in a crowded boarding area with ~300 people present. Carbon dioxide levels exceeded 800 ppm inside the airplanes, but the air was filtered with high efficiency particulate air filters. Carbon dioxide levels remained below 800 ppm in common areas of a hotel but exceeded 800 ppm in a hotel room with 2 to 3 occupants and in a fitness center with 3 people exercising. In restaurants, carbon dioxide levels increased above 800 ppm during crowded conditions with 24 or more people present and 75% or more seat occupancy.
Conclusion: Our results suggest that ventilation may be sufficient to minimize the risk for airborne transmission in many situations during travel. However, ventilation may be suboptimal in some areas or under certain conditions such as in hotel rooms or when restaurants, fitness centers, or airplane boarding areas are crowded. There is a need for larger scale studies to assess the quality of ventilation in a wide range of community settings.
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Affiliation(s)
- Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Heba Alhmidi
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Curtis J. Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- CORRESPONDING AUTHOR Curtis J. Donskey, Infectious Diseases Section 1110W, Louis Stokes Cleveland VA Medical Center 10701 East Boulevard, Cleveland, Ohio 44106; Phone: 216-791-3800 ext. 64788; Fax: 216-229-8509;
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Haq MF, Cadnum JL, Carlisle M, Hecker MT, Donskey CJ. SARS in Cars: Carbon Dioxide Levels Provide a Simple Means to Assess Ventilation in Motor Vehicles. Pathog Immun 2022; 7:19-30. [PMID: 35178491 PMCID: PMC8843085 DOI: 10.20411/pai.v7i1.493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Poorly ventilated enclosed spaces pose a risk for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. Limited information is available on ventilation in motor vehicles under differing driving conditions. Methods: We conducted carbon dioxide measurements to assess ventilation in motor vehicles under varying driving conditions with 2 to 3 vehicle occupants. During routine driving, carbon dioxide produced by the breathing of vehicle occupants was measured inside 5 cars and a van under a variety of driving conditions with or without the ventilation fan on and with windows open or closed. Carbon dioxide readings above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation. Results: Carbon dioxide levels remained below 800 ppm in all vehicles if the ventilation fan was on and/or the windows were open while parked or during city or highway driving. With the ventilation system set on non-recirculation mode, carbon dioxide levels rose above 800 ppm in all vehicles when the fan was off and the windows were closed while parked and during city driving, and in 2 of the 6 vehicles during highway driving. With the ventilation system set on recirculation mode, carbon dioxide rose above 800 ppm within 10 minutes in all vehicles tested. Conclusion: Carbon dioxide measurements could provide a practical and rapid method to assess ventilation in motor vehicles. Simple measures such as opening windows, turning on the fan, and avoiding the recirculation mode greatly improve ventilation.
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Affiliation(s)
- Muhammed F. Haq
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Matthew Carlisle
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Michelle T. Hecker
- Department of Infectious Diseases, MetroHealth Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Curtis J. Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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