Rethinking the Healthcare Facilities: The Role of the Buffer Space

OBJECTIVES

A working group conducted a survey on the use of the principle of buffer space (BS), which in case of emergencies, could benefit healthcare settings. The aim of the preliminary investigation is to define new research lines in hospitals' functional design.

BACKGROUND

The global experience of the COVID-19 pandemic highlighted challenges faced by hospitals when responding promptly to emergencies, including spatial reorganization and suspension of ordinary medical activities for ensuring adequate management of the emergency surge of patients.

METHODS

The group designed questionnaires to be administered to healthcare staff and healthcare designers aimed at understanding varied conceptions and features of BSs. Content across the two surveys overlapped significantly, allowing for direct comparisons of responses, while also including tailored questions in relation to the respective experience and skills of the two groups of respondents.

RESULTS

102 healthcare professionals and 56 designers took part to the survey. Analysis of the responses permitted for initial recommendations regarding BS typology including (a) proximity to the emergency department (ED), intensive care units (ICUs), and inpatient wards (IWs); (b) location within hospitals but separate from other medical areas; (c) need for independent access; (d) organizational and spatial features similar to ED, ICUs, and IWs; (e) existing as a fully flexible operational space; and (f) BS bed capacity to be approximately 12% of ED beds.

CONCLUSIONS

Although the analysis is related to the Italian context, the expansion of this preliminary research to alternate healthcare facilities and geographic areas is necessary for reaching a wide consensus by different professionals on this field. It serves as a starting point for future investigations regarding the implementation of BS in hospital settings.

Vitrification of Iberian wolf (Canis lupus signatus) sperm: A possible alternative to conventional cryopreservation

Sperm vitrification is a simple, inexpensive method that allows the cryopreservation of sperm in the field and for endangered species is a useful alternative to conventional freezing. The study, therefore, is focused on the suitability of vitrification for cryopreserving Iberian wolf sperm and utilizing plasma testosterone concentration as a marker for procedure efficacy. Sperm and blood samples were collected from 17 wolves. There were 14 samples suitable for cryopreservation (12 ejaculated and two epididymal). Immediately after collection, these samples were proportioned into two aliquots for conventional freezing using a Tris-citric acid-glucose based extender (TCG) or vitrification utilizing an animal protein free extender (HTF®). Vitrification occurred by directly plunging a sperm suspension into liquid nitrogen. Sperm were assessed for motility, membrane integrity, acrosomal status and DNA integrity before and after cryopreservation. With both techniques, there were similar post-thaw/warming results (P > 0.05) with respect to progressive motility, kinetic variables VCL, VSL, VAP and BCF, DNA fragmentation, sperm membrane functionality and morphological abnormalities. Total motile sperm, progression ratios LIN, STR, and WOB, the ALH, sperm viability and sperm with intact membrane and acrosome were greater (P < 0.05) in the conventional frozen-thawed sperm than vitrified-warmed sperm. Plasma testosterone concentrations varied from 0.0 ng/mL to 7.7 ng/mL. For epididymal sperm, sperm motility and viability following thawing were greater in vitrified-warmed samples than conventionally-frozen samples; however, small sample numbers precluded statistical analysis. When considered together, these results indicate vitrification may be a possible alternative for wolf sperm cryopreservation.

Zoo animals as sentinels for Schmallenberg virus monitoring in Spain

Schmallenberg virus (SBV) is a newly emerged vector-borne pathogen that affects many domestic and wild animal species. A serosurvey was carried out to assess SBV exposure in zoo animals in Spain and to determine the dynamics of seropositivity in longitudinally sampled individuals. Between 2002 and 2019, sera from 278 animals belonging to 73 different species were collected from five zoos (A-E). Thirty-one of these animals were longitudinally sampled at three of these zoo parks during the study period. Seropositivity was detected in 28 (10.1 %) of 278 animals analyzed by blocking ELISA. Specific anti-SBV antibodies were confirmed in 20 (7.2 %; 95 %CI: 4.2-10.3) animals of six different species using virus neutralization test (VNT). The multiple logistic regression model showed that "order" (Artiodactyla) and "zoo provenance" (zoo B; southern Spain) were risk factors potentially associated with SBV exposure. Two (8.7 %) of the 31 longitudinally-sampled individuals showed specific antibodies against SBV at all samplings whereas seroconversion was detected in one mouflon (Ovis aries musimon) and one Asian elephant (Elephas maximus) in 2016 and 2019, respectively. To the best of the author's knowledge, this is the first surveillance conducted on SBV in zoos in Spain. The results confirm SBV exposure in zoo animals in this country and indicate circulation of the virus before the first Schmallenberg disease outbreak was reported in Spain. Surveillance in zoological parks could be a complementary approach to monitoring SBV activity. Further studies are warranted to assess the impact of this virus on the health status of susceptible zoo animals.

Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis

BACKGROUND AND AIMS

Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs).

METHODS AND RESULTS

Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L).

CONCLUSIONS

RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.

Sediment metal enrichment and ecological risk assessment of ten ports and estuaries in the World Harbours Project

Ten global harbours were assessed for sediment quality by quantifying the magnitude of anthropogenic change and ecological risk. Anthropogenic change (enrichment) was high for Derwent River and Sydney estuary, moderate for Santander Harbour, Rio de Janeiro and Dublin Port, slight for Hong Kong, minimal for Darwin. All 10 enrichment indices used showed similar results. Derwent River sediment was rated at high ecological risk, followed by Sydney and Santander estuaries with moderate risk. Auckland and Darwin sediments exhibited minimal ecological risk and sediment in the remaining harbours (Dublin, Hong Kong, Ravenna, Ria de Vigo and Rio de Janeiro) were assessed at slight ecological risk. The extraordinary variety of environments and types/quantities/qualities of data investigated resulted in as much a critique and development of methodology, as an assessment of human impact, including unique techniques for elemental normalisation and contaminant classification. Recommendations for an improved technical framework for sediment quality assessment are provided.

Health literacy and physical activity as buffers to counter act work related stress

Background

Stress health problems affect 47.8% of the work force in Portugal. It is predicted that, in the next decade, these problems will overcome musculoskeletal disorders, the first cause of employee’s withdrawal from work. Research indicates connections between stress and dimensions of the work place (like job satisfaction). Nevertheless the conceptual understanding of these relationships is sparse. In order to better understand these relationships, this research focus on the use of job–specific models of stress, associating them with health literacy (HL) - in the context of the European Health Literacy Survey framework (HLS-EU) - and physical exercise.

Methods

A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores &lt;30).

Results

Out of the 748 participants (58.7% males, average age of 39 years), 80.4% sometimes and very often experience stress and tension in the workplace. Less than one in every two (44.4%) practice physical activity several times a week. Of the participants, 7.1% have inadequate, 39.0% problematic, 36.6% sufficient and 17.3% excellent HL (HLS-EU-PT). Employees that are more active are those who experience lower levels of stress.

Conclusions

The research of the effects of HL combined with physical exercise, as buffer variables to problems related to the effects of work stress, is a new area of research that may help understand patterns of adherence to activities that can help workers deal with everyday working conditions. More research is needed to integrate HL strategies in the work place.

Key messages

Stress health problems affect 47.8% of the work force in Portugal. Employees that are more active are those who experience lower levels of stress.

Health literacy and physical activity as buffers to counter act work related stress

Background

Stress health problems affect 47.8% of the work force in Portugal. It is predicted that, in the next decade, these problems will overcome musculoskeletal disorders, the first cause of employee’s withdrawal from work. Research indicates connections between stress and dimensions of the work place (like job satisfaction). Nevertheless the conceptual understanding of these relationships is sparse. In order to better understand these relationships, this research focus on the use of job–specific models of stress, associating them with health literacy (HL) - in the context of the European Health Literacy Survey framework (HLS-EU) - and physical exercise.

Methods

A total of 748 participants from the different offices of a company in the financial sector (Portugal, main land and autonomous territories) participated in a cross sectional survey (CAWI). Age ranged from 25 to 65 years and HL was measured using the HLS-EU instrument validated to Portuguese (HLS-EU-PT). Each participant was allocated to one of the groups, either of satisfactory HL (when scores ≥30) or insufficient HL (when scores &lt;30).

Results

Out of the 748 participants (58.7% males, average age of 39 years), 80.4% sometimes and very often experience stress and tension in the workplace. Less than one in every two (44.4%) practice physical activity several times a week. Of the participants, 7.1% have inadequate, 39.0% problematic, 36.6% sufficient and 17.3% excellent HL (HLS-EU-PT). Employees that are more active are those who experience lower levels of stress.

Conclusions

The research of the effects of HL combined with physical exercise, as buffer variables to problems related to the effects of work stress, is a new area of research that may help understand patterns of adherence to activities that can help workers deal with everyday working conditions. More research is needed to integrate HL strategies in the work place.

Fatty liver and mortality: a cohort population study in South Italy

OBJECTIVE

Alcoholic fatty liver (AFLD) and non-alcoholic fatty liver (NAFLD) are two common conditions. However, if they can increase the risk of death is poorly explored. We therefore aimed to investigate the potential association between the presence and severity of liver steatosis and mortality in a large sample of older people.

DESIGN

Prospective.

SETTING

Community.

PARTICIPANTS

Women and men randomly sampled from the electoral rolls of the population of Castellana Grotte, a town in Southern Italy (Apulia region) between 2005 and 2006. Among 1942 initially contacted, 1708 (=87.9%) participated to the baseline survey (Multicentrica Colelitiasi III (MICOL III)). This specific study included 1445 older participants (mean age=65.2 years, females=44.2%).

EXPOSURE

NAFLD or AFLD.

PRIMARY AND SECONDARY OUTCOMES

Mortality (all-cause and specific-cause).

RESULTS

After a median of 12 years, 312 participants (=21.6%) died. After adjusting for nine potential confounders, the presence of steatosis was not associated with any increased risk of death in both NAFLD and AFLD. The severity of liver steatosis was not associated with any increased risk of mortality in NAFLD, while in AFLD, the presence of moderate steatosis significantly increased the risk of overall (HR=2.16; 95% CI 1.19 to 3.91) and cancer-specific (HR=3.54; 95% CI 1.16 to 10.87) death.

CONCLUSIONS

Liver steatosis is not associated with any increased risk of death in NAFLD, while moderate steatosis could be a risk factor for mortality (particularly due to cancer) in people affected by AFLD.

Reducing NAFLD-screening time: A comparative study of eight diagnostic methods offering an alternative to ultrasound scans

BACKGROUND & AIMS

The use of ultrasound scan (US) in non-alcoholic fatty liver disease (NAFLD) screening overloads US waiting lists. We hypothesized and tested a hybrid two-step method, consisting of applying a formula, to exclude subjects at low risk, before US.

METHODS

The sample included 2970 males and females (937 with NAFLD) diagnosed by US. We selected eight formulas: Fatty Liver Index (FLI), Hepatic Steatosis Index (HIS), body mass index (BMI), waist circumference (WC), Abdominal Volume Index (AVI), waist-to-height ratio (WHtR), waist/height^0.5 (WHT.5R) and Body Roundness Index (BRI), and calculated their performance in the two-step method evaluating percentage reduction of the number of liver US (US reduction percentage), percentage of false negative and percentage of NAFLD identified.

RESULTS

The US reductions percentage were 52.2% (WHtR), 52.1% (HIS), 51.8% (FLI), 50.8% (BRI), 50.7% (BMI and WHt_5R), 46.5% (WC) and 45.2% (AVI). The false negative percentage were 8.5% (WHtR), 7.9% (BRI), 7.3% (WHt_5R), 7.2% (BMI), 6.7% (HIS), 6.6% (FLI), 5.6% (WC) and 5.2% (AVI). The best percentage of NALFD identified was obtained using AVI (83.6%) before US, then WC (82.2%), FLI (79%), HIS (78.9%), BMI (77.3%), WHt_5R (76.9%), BRI (74.8%) and WHtR (73%).

CONCLUSION

The best formula to use in two-step diagnostic NAFLD screening was AVI, which showed a low false negative rate and a higher percentage of identified NAFLD. Other studies evaluating the economic advantages of this screening method are warranted.

Lifted graphene nanoribbons on gold: from smooth sliding to multiple stick-slip regimes

Graphene nanoribbons (GNRs) physisorbed on a Au(111) surface can be picked up, lifted at one end, and made to slide by means of the tip of an atomic-force microscope. The dynamic transition from smooth sliding to multiple stick-slip regimes, the pushing/pulling force asymmetry, the presence of pinning, and its origin are real frictional processes in a nutshell, in need of a theoretical description. To this purpose, we conduct classical simulations of frictional manipulations of a 30 nm-long GNR, one end of which is pushed or pulled horizontally while held at different heights above the Au surface. These simulations allow us to clarify theoretically the emergence of stick-slip originating from the short 1D edges rather than the 2D "bulk", the role of adhesion, of lifting, and of graphene bending elasticity in determining the GNR sliding friction. The understanding obtained in this simple context is of additional value for more general cases.

Topical Nonsteroidal Anti-Inflammatory Drugs in Uncomplicated Cataract Surgery: Effect of Sodium Naproxen

Purpose

To investigate whether topical nonsteroidal anti inflammatory drugs (NSAIDs) are useful, in the absence of concomitant corticosteroid therapy, in limiting postoperative inflammation after uncomplicated cataract surgery.

Methods

A total of 328 patients were enrolled in a prospective, randomized, double-masked, parallel-group, active-controlled study. Anterior chamber inflammation (ACI) was evaluated as the primary efficacy parameter. Only patients with moderate inflammation (ACI score of ≤4) the day after surgery were randomized and treated with NSAIDs. A novel topical formulation containing 0.2% sodium naproxen was compared with 0.1% diclofenac. Both were administered three times a day for 14 consecutive days. Ocular inflammation was measured after 7 and 14 days by using slit-lamp biomicroscopy. Safety parameters were also evaluated at the same time.

Results

Both treatments were equally effective in controlling postsurgical inflammation. No statistically significant differences between treatment groups were observed for the safety variables. No serious adverse events (AEs) occurred during the course of the study. The most frequent AE reported with naproxen was eye redness.

Conclusions

NSAIDs can effectively be used without concurrent administration of corticosteroids to control postoperative inflammation after uncomplicated cataract surgery. In addition, naproxen ophthalmic solution may be considered a suitable alternative to the currently available NSAIDs.

Friction and nonlinear dynamics

The nonlinear dynamics associated with sliding friction forms a broad interdisciplinary research field that involves complex dynamical processes and patterns covering a broad range of time and length scales. Progress in experimental techniques and computational resources has stimulated the development of more refined and accurate mathematical and numerical models, capable of capturing many of the essentially nonlinear phenomena involved in friction.

Effectiveness of pre-travel consultation in the prevention of travel-related diseases: a retrospective cohort study

BACKGROUND

This study aims to evaluate the effectiveness of pre-travel counselling carried out in Travel Clinics.

METHODS

This is a retrospective cohort. Three hundred international travellers were enrolled; 150 people were from users of Bari Travel Clinic, 150 were users of a travel agency. Enrolled subjects were interviewed using a questionnaire.

RESULTS

The average age of the enrolled subjects was 37.5 ± 13.9, without statistically significant differences between the two groups. 86% of cases and 19.3% of the controls reported the use of anti-malaria prophylaxis (p < 0.0001). Vaccination against cholera was given to 62% of cases and 7.3% of the controls (p < 0.001). Travel Clinic users, 6% reported diarrhoea and these figures were 27% in the control group (p < 0.0001). The proportion of those interviewed who reported fever (3.7) or insomnia (1.3) did not differ between the two groups. Mosquito bites were reported by 8% of cases and 20% of the controls (p = 0.003). Three cases of malaria were reported among the controls but no cases were detected among the cases (chi-square = 3.03; p = 0.08).

CONCLUSIONS

Our study demonstrated the effectiveness of pre-travel counselling; in the future, new studies must investigate the cost-effectiveness of pre-travel prevention measures.

The mobility gap between older men and women: the embodiment of gender

OBJECTIVES

To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies.

METHODS

Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios.

RESULTS

Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men.

DISCUSSION

Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.

Mucoperiosteal Exostoses in the Tympanic Bulla of African Lions (Panthera leo)

Mucoperiosteal exostoses (MpEs) of the tympanic bulla (TB), also referred as middle-ear otoliths, have been occasionally described in dogs and cats in association with clinical signs of otitis media or as an incidental finding, but they have not been recorded in other species. In this report, we describe the radiographic, gross, and histopathologic features of MpEs in 8 African lions ( Panthera leo). All animals (5 males and 3 females) were adults that had been kept in captivity and had their skeletons conserved as part of an anatomic academic collection. A radiographic study revealed mineralized structures in the TB consistent with MpEs in 7 of the 16 examined TB; a computed tomography study identified MpEs in 12 of the 16 TB. Six TB from 4 lions were sectioned, and several MpEs were demineralized for histopathologic analysis. Grossly, MpEs appeared variable in number and shape. Some were globular structures that were loosely attached to the mucosal surface of the TB; others were isolated to coalescent bone spicules extending from the mucoperiosteum. Position was also variable, but MpEs frequently developed in the hypotympanum, especially on the ventromedial aspect of the TB wall. Microscopically, MpEs were composed of osteonal bone growing from the periosteum and not by dystrophic calcification of necrotic tissue debris, as is hypothesized in dogs.

Determinants of varicella breakthrough: results of a 2012 case control study

This study aims to evaluate the determinants of breakthrough infection after one dose of varicella vaccine. We designed a retrospective case-control study. Breakthrough cases were children, aged 1-15, who presented varicella symptoms ≥ 42 days after the first dose of varicella vaccine (breakthrough). Controls were children, aged 1-15 years, who attended the same class (in a school or in a kindergarten) than the cases in the year of the breakthrough onset; they received a dose of varicella vaccine ≥ 42 days before the case rash onset and they did not develop varicella symptoms. We enrolled 45 cases and 135 controls. 40% of cases (n = 18; 95% CI = 25.4-54.6) presented at least one risk factor; this proportion was 39.2% (95% CI = 30.9-47.6) among the controls (chi-square = 0.0078; P = 0.93). Time between vaccination and virus exposure was longer among cases. Logistic regression showed that breakthrough disease was associated with duration of time from vaccination.

Phlebotominae of epidemiological importance in cutaneous leishmaniasis in northwestern Argentina: risk maps and ecological niche models

In Argentina, 58.2% out of the 8126 Cutaneous Leishmaniasis (CL) incident cases accumulated from 1954 to 2006 were reported in the provinces of Salta and Jujuy. The aim of this study was to develop an exploratory risk map and a potential distribution map of the vector, in order to offer recommendations for CL prevention. A total of 12 079 Phlebotominae (Diptera: Psychodidae) belonging to the species Lutzomyia neivai (Pinto), Lu. migonei (França), Lu. cortelezzii (Brèthes), Lu. shannoni (Dyar), Lu. quinquefer (Dyar) and Brumptomyia spp. (França & Parrot) were captured. Potential distribution models were created for two species, Lu. neivai (incriminated vector of Leishmania braziliensis) and Lu. migonei, associated with domestic animals in Argentina and that in turn could be involved as a link between zoonotic transmission cycles and anthropozoonotic. The Maximum Entropy Modeling System (MaxEnt) was used. The Jackknife test was performed, and the 'rainfall of the driest month' was the variable that best generalized the models. Accuracy was evaluated by the area under the curve (AUC) and validated by the Cohen's kappa index. This approximation provides a new analytical resource of high potential for the prevention of the disease, in order to allocate resources properly and to develop the most suitable strategies for action.

Household contact investigation of multidrug-resistant and extensively drug-resistant tuberculosis in a high HIV prevalence setting

SETTING

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are now a nationwide epidemic in South Africa. Epidemiological data suggest nosocomial transmission as the primary route of spread; however, transmission among household contacts has not yet been investigated.

OBJECTIVE

To determine the incidence rates of MDR- and XDR-TB among household contacts of MDR- and XDR-TB index cases diagnosed between January 2005 and September 2008 in a high human immunodeficiency virus prevalence setting.

DESIGN

Prospective, observational study evaluating adult household contacts for active TB by culture and drug susceptibility testing at index case diagnosis and again 1 year later. Outcomes were incidence and time to diagnosis of MDR- and XDR-TB.

RESULTS

A total of 1766 contacts of 221 MDR-TB and 287 XDR-TB index cases were screened. Of 793 contacts of MDR-TB index cases, 14 (1.8%) were diagnosed with MDR-TB (incidence 1765/100 000); 19 (2.0%) of 973 XDR-TB contacts had XDR-TB (incidence 1952/100 000). Median time to diagnosis of household cases was 70 days (interquartile range 57-89).

CONCLUSION

Incidence rates of MDR- and XDR-TB among household contacts were extremely high, with most secondary cases occurring shortly after the diagnosis of the index case. Active case finding of drug-resistant TB is a high-yield public health activity and must be a priority, as early diagnosis may stem further disease spread and improve survival.

Controlling microscopic friction through mechanical oscillations

We study in detail the recent suggestions by Tshiprut [Phys. Rev. Lett. 95, 016101 (2005)] to tune tribological properties at the nanoscale by subjecting a substrate to periodic mechanical oscillations. We show that both in stick-slip and sliding regimes of motion friction can be tuned and reduced by controlling the frequency and amplitude of the imposed substrate lateral excitations. We demonstrate that the mechanisms of oscillation-induced reduction of friction are different for stick-slip and sliding dynamics. In the first regime the effect results from a giant enhancement of surface diffusion, while in the second regime it is due to the interplay between washboard and oscillation frequencies that leads to the occurrence of parametric resonances. Moreover, we show that for a particular set of parameters it is possible to sustain the motion with only the oscillations.