Detection of SARS-CoV-2 in aerosols in long term care facilities and other indoor spaces with known COVID-19 outbreaks.

Coronavirus outbreaks are likely to occur in crowded and congregate indoor spaces, and their effects are most severe in vulnerable long term care facilities (LTCFs) residents. Public health officers benefit from tools that allow them to control COVID-19 outbreaks in vulnerable settings such as LTCFs, but which could be translated in the future to control other known and future virus outbreaks. This study aims to develop and test a methodology based on detection of SARS-CoV-2 in aerosol samples collected with personal pumps that could be easily implemented by public health officers. The proposed methodology was used to investigate the levels of SARS-CoV-2 in aerosol in indoor settings, mainly focusing on LTCFs, suffering COVID-19 outbreaks, or in the presence of known COVID-19 cases, and targeting the initial days after diagnosis. Aerosol samples (N = 18) were collected between November 2020 and March 2022 in Castelló (Spain) from LTCFs, merchant ships and a private home with recently infected COVID-19 cases. Sampling was performed for 24-h, onto 47 mm polytetrafluoroethylene (PTFE) and quartz filters, connected to personal pumps at 2 and 4 L/min respectively. RNA from filters was extracted and SARS-CoV-2 was determined by detection of regions N1 and N2 of the nucleocapsid gene alongside the E gene using RT-PCR technique. SARS-CoV-2 genetic material was detected in 87.5% samples. Concentrations ranged ND-19,525 gc/m3 (gene E). No genetic traces were detected in rooms from contacts that were isolated as a preventative measure. Very high levels were also measured at locations with poor ventilation. Aerosol measurement conducted with the proposed methodology provided useful information to public health officers and contributed to manage and control 12 different COVID-19 outbreaks. SARS-CoV-2 was detected in aerosol samples collected during outbreaks in congregate spaces. Indoor aerosol sampling is a useful tool in the early detection and management of COVID-19 outbreaks and supports epidemiological investigations.

Vulnerability of a top marine predator to coastal storms: a relationship between hydrodynamic drivers and stranding rates of newborn pinnipeds.

Coastal storms have increased in recent decades, affecting many species, including the South American sea lion (Otaria byronia). Reports of stranded sea lion pups are becoming common in Chile, presumably due to the increase in the frequency and intensity of coastal storms. To validate this assumption, a 10-year database was built by coupling wave generation and coastal propagation models to correlate pure wave parameters (significant wave height Hs, peak period Tp, normalized wave power Hs2 Tp) and wave parameters including the tidal level (maximum surface elevation η, modified wave power η2 Tp) with records of stranded pups in Cobquecura, the largest breeding colony in central Chile. The correlation between the number of pups stranded per day and wave parameters in the first half of January and the last half of February is poor, while they are stronger for the second half of January and the first half of February. The higher number of stranded pups coincide with coastal storms with normalized wave power values exceeding a threshold of 100 m2/s. Conversely, below this threshold there is wide dispersion between the number of strandings and wave parameters. Identifying wave parameter thresholds could be used to predict when newborn pups will be most affected by coastal storms, and thus help institutions to develop remediation techniques for animals at risk.

Mortality Rates of Patients with Proximal Femoral Fracture in a Worldwide Pandemic: Preliminary Results of the Spanish HIP-COVID Observational Study.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), in December 2019 in Wuhan, People's Republic of China, has developed into an unprecedented pandemic with enormous pressure on health-care providers around the world. A higher mortality rate has been described in older infected individuals. Patients with hip fracture are a particularly vulnerable population during this pandemic because older age is associated with a higher mortality rate. Our aim was to describe the early mortality rate and demographic variables in a hip fracture sample population in Spain during the coronavirus pandemic. METHODS: This is a multicenter, observational, retrospective, descriptive study. We collected data from 13 major hospitals in Spain from the beginning of the national state of alarm (declared on March 14, 2020, by the Spanish government) until the end of our study period on April 4, 2020. All patients who were ≥65 years of age, presented to the Emergency Department of the participating hospitals during this period with a diagnosis of proximal femoral fracture, and had a minimum follow-up of 10 days were included in the cohort. In addition to mortality, demographic and other potential prognostic variables were also collected. RESULTS: In this study, 136 patients with a hip fracture were included. Of these patients, 124 underwent a surgical procedure and 12 were managed nonoperatively. The total mortality rate was 9.6%. Sixty-two patients were tested for COVID-19, with 23 patients being positive. The mortality rate for these 23 patients was 30.4% (7 of 23 patients) at a mean follow-up of 14 days. The mortality rate was 10.3% (4 of 39) for patients who had been tested and had a negative result and 2.7% (2 of 74) for patients who had not been tested. Of the 12 patients who were managed nonoperatively, 8 (67%) died, whereas, of the 124 patients who were surgically treated, 5 (4%) died. Results differed among centers. CONCLUSIONS: There is a higher mortality rate in patients with a hip fracture and an associated positive test for COVID-19. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Community strengthening and mental health system linking after flooding in two informal human settlements in Peru: a model for small-scale disaster response.

BACKGROUND: Mental health is an important factor in responding to natural disasters. Observations of unmet mental health needs motivated the subsequent development of a community-based mental health intervention following one such disaster affecting Peru in 2017. METHODS: Two informal human settlements on the outskirts of Lima were selected for a mental health intervention that included: (1) screening for depression and domestic violence, (2) children's activities to strengthen social and emotional skills and diminish stress, (3) participatory theater activities to support conflict resolution and community resilience, and (4) community health worker (CHW) accompaniment to government health services. RESULTS: A total of 129 people were screened across both conditions, of whom 12/116 (10%) presented with depression and 21/58 (36%) reported domestic violence. 27 unique individuals were identified with at least one problem. Thirteen people (48%) initially accepted CHW accompaniment to government-provided services. CONCLUSIONS: This intervention provides a model for a small-scale response to disasters that can effectively and acceptably identify individuals in need of mental health services and link them to a health system that may otherwise remain inaccessible.

Haploidentical IL-15/41BBL activated and expanded natural killer cell infusion therapy after salvage chemotherapy in children with relapsed and refractory leukemia.

Primary refractory or relapsed pediatric leukemia yield significant morbidity and mortality, with long-term survival rates <40%. Here we present a post-hoc analysis assessing safety and efficacy of infusing activated and expanded Natural Killer cells (NKAE) from haploidentical donors in patients from 2 clinical trials. In total, 18 children, adolescents and young adults with relapse or refractory acute leukemia were treated with two cycles of rescue chemotherapy followed by fresh NKAE cells infusions and low doses of IL-2. The overall response rate, complete remission achievement at the end of the study, was 72% (13 of 18). We infused 52 NKAE cell products containing a median of 6.76 × 106 NK cells/kg (0.7-34.16) and 0.49 × 106 T cells/kg (0-11). All infusions were well tolerated with no graft versus host disease nor other serious adverse events. Among the 14 patients who completed treatment, 4 of them are alive and leukemia-free more than 750 days post-transplant. We conclude that infusion of fresh NKAE cell therapy is feasible and safe in heavily pretreated pediatric population, and should be further investigated in advanced-phase clinical trials as well as a consolidation therapy to decrease relapse in patients with high-risk leukemia. TRIALS REGISTRATION: Registered at www.clinicaltrials.gov as NCT01944982 and NCT02074657.

Foros virtuales y construcción de conocimiento en profesionales de la salud / Virtual forums and knowledge building among health professionals / Foros virtuais e construção de conhecimento em professionais da saúde

La modalidad e-learning se ha convertido en un método que ha permitido a los profesionales de la salud actualizar sus conocimientos. Esta forma de enseñanza facilita la construcción de aprendizaje colaborativo entre quienes participan en foros de discusión. Objetivo: Describir la construcción de conocimiento colaborativo de profesionales de la salud de las comunidades virtuales de aprendizaje que participan en cursos del Programa de Educación Continua de la Escuela de Enfermería de la Universidad Católica de Chile en 2014. Método: Estudio mixto cuantitativo descriptivo y cualitativo con análisis de contenido según Earl Babbie y basado en el modelo de Gunawardena. Resultados: La construcción de conocimiento se realiza, predominantemente, en las fases I y II del modelo de Gunawardena. Conclusión: Si bien los foros permiten la construcción de conocimiento colaborativo, en áreas específicas del saber, al igual que algunos otros estudios reportados en la literatura, el conocimiento alcanza solo las primeras etapas del modelo de Gunawardena, que implicaría que comparten información y establecen desacuerdos entre los argumentos, pero no se lograría un mayor aprendizaje, es decir, generan una propuesta con las ideas del grupo, contrastan lo discutido con la experiencia personal o información existente, sin embargo no aplican los nuevos conocimientos construidos.

E-learning modality has become a method which has allowed health professionals to update their knowledge. It is a teaching strategy which facilitates the collaborative knowledge building among those participating in the discussion forums. Objective: To describe collaborative knowledge building among health professionals in learning virtual communities who participate in courses of the Continuous Education Program of the Nursing School of the Catholic University of Chile in 2014. Method: This is a quantitative, descriptive, and qualitative study with content analysis following the guidelines of Earl Babbie and based on the Gunawardena model. Results: Knowledge building takes place, mainly, in stages II and II of the Gunawardena model. Conclusion: While these forums allow the building of collaborative knowledge in some specifiareas, as it was reported in other studies, this knowledge only reaches the first stages of the Gunawardena model, which means that there is information sharing, and arguments are agreed or disagreed, but there is no further learning; in other words, the proposed group's ideas contrast the discussions around personal experiences or existing knowledge, however, the new built knowledge is not applied.

Resumo: A modalidade e-learning tornou-se em um método que permitiu aos profissionais da saúde atualizar seus conhecimentos. Esta forma de ensino facilita a construção de aprendizagem colaborativa entre quem participa em foros de discussão. Objetivo: Descrever a construção de conhecimento colaborativo de profissionais da saúde das comunidades virtuais de aprendizagem que participam em cursos do Programa de Educação Continuada da Escola de Enfermagem da Universidade Católica do Chile em 2014. Método: Estudo misto quantitativo descritivo e qualitativo com análise de conteúdo segundo Earl Babbie e baseado no modelo de Gunawardena. Resultados: A construção de conhecimento realiza-se, predominantemente, nas fase I e II modelo de Gunawardena. Conclusão: Se bem os foros permitem a construção de conhecimento colaborativo, em áreas específicas do saber, ao igual que alguns outros estudos reportados na literatura, o conhecimento só atinge as primeiras etapas do modelo de Gunawardena, que implicaria que compartilham informação e estabelecem desacordos entre os argumentos, mas não se consegue uma maior aprendizagem, quer dizer, geram uma proposta com as ideias do grupo, contrastam o discutido com a experiência pessoal ou informação existente, no entanto, não aplicam os novos conhecimentos construídos.

Determination of the optimal tolerance for MLC positioning in sliding window and VMAT techniques.

PURPOSE: Several authors have recommended a 2 mm tolerance for multileaf collimator (MLC) positioning in sliding window treatments. In volumetric modulated arc therapy (VMAT) treatments, however, the optimal tolerance for MLC positioning remains unknown. In this paper, the authors present the results of a multicenter study to determine the optimal tolerance for both techniques. METHODS: The procedure used is based on dynalog file analysis. The study was carried out using seven Varian linear accelerators from five different centers. Dynalogs were collected from over 100,000 clinical treatments and in-house software was used to compute the number of tolerance faults as a function of the user-defined tolerance. Thus, the optimal value for this tolerance, defined as the lowest achievable value, was investigated. RESULTS: Dynalog files accurately predict the number of tolerance faults as a function of the tolerance value, especially for low fault incidences. All MLCs behaved similarly and the Millennium120 and the HD120 models yielded comparable results. In sliding window techniques, the number of beams with an incidence of hold-offs >1% rapidly decreases for a tolerance of 1.5 mm. In VMAT techniques, the number of tolerance faults sharply drops for tolerances around 2 mm. For a tolerance of 2.5 mm, less than 0.1% of the VMAT arcs presented tolerance faults. CONCLUSIONS: Dynalog analysis provides a feasible method for investigating the optimal tolerance for MLC positioning in dynamic fields. In sliding window treatments, the tolerance of 2 mm was found to be adequate, although it can be reduced to 1.5 mm. In VMAT treatments, the typically used 5 mm tolerance is excessively high. Instead, a tolerance of 2.5 mm is recommended.

Characterization of the Exradin W1 scintillator for use in radiotherapy.

PURPOSE: To evaluate the main characteristics of the Exradin W1 scintillator as a dosimeter and to estimate measurement uncertainties when used in radiotherapy. METHODS: We studied the calibration procedure, energy and modality dependence, short-term repeatability, dose-response linearity, angular dependence, temperature dependence, time to reach thermal equilibrium, dose-rate dependence, water-equivalent depth of the effective measurement point, and long-term stability. An uncertainty budget was derived for relative and absolute dose measurements in photon and electron beams. RESULTS: Exradin W1 showed a temperature dependence of -0.225% °C(-1). The loss of sensitivity with accumulated dose decreased with use. The sensitivity of Exradin W1 was energy independent for high-energy photon and electron beams. All remaining dependencies of Exradin W1 were around or below 0.5%, leading to an uncertainty budget of about 1%. When a dual channel electrometer with automatic trigger was not used, timing effects became significant, increasing uncertainties by one order of magnitude. CONCLUSIONS: The Exradin W1 response is energy independent for high energy x-rays and electron beams, and only one calibration coefficient is needed. A temperature correction factor should be applied to keep uncertainties around 2% for absolute dose measurements and around 1% for relative measurements in high-energy photon and electron beams. The Exradin W1 scintillator is an excellent alternative to detectors such as diodes for relative dose measurements.

On the suitability of ultrathin detectors for absorbed dose assessment in the presence of high-density heterogeneities.

PURPOSE: The aim of this study was to evaluate the suitability of several detectors for the determination of absorbed dose in bone. METHODS: Three types of ultrathin LiF-based thermoluminescent dosimeters (TLDs)-two LiF:Mg,Cu,P-based (MCP-Ns and TLD-2000F) and a (7)Li-enriched LiF:Mg,Ti-based (MTS-7s)-as well as EBT2 Gafchromic films were used to measure percentage depth-dose distributions (PDDs) in a water-equivalent phantom with a bone-equivalent heterogeneity for 6 and 18 MV and a set of field sizes ranging from 5 x 5 cm2 to 20 x 20 cm2. MCP-Ns, TLD-2000F, MTS-7s, and EBT2 have active layers of 50, 20, 50, and 30 µm, respectively. Monte Carlo (MC) dose calculations (PENELOPE code) were used as the reference and helped to understand the experimental results and to evaluate the potential perturbation of the fluence in bone caused by the presence of the detectors. The energy dependence and linearity of the TLDs' response was evaluated. RESULTS: TLDs exhibited flat energy responses (within 2.5%) and linearity with dose (within 1.1%) within the range of interest for the selected beams. The results revealed that all considered detectors perturb the electron fluence with respect to the energy inside the bone-equivalent material. MCP-Ns and MTS-7s underestimated the absorbed dose in bone by 4%-5%. EBT2 exhibited comparable accuracy to MTS-7s and MCP-Ns. TLD-2000F was able to determine the dose within 2% accuracy. No dependence on the beam energy or field size was observed. The MC calculations showed that a[Formula: see text] thick detector can provide reliable dose estimations in bone regardless of whether it is made of LiF, water or EBT's active layer material. CONCLUSIONS: TLD-2000F was found to be suitable for providing reliable absorbed dose measurements in the presence of bone for high-energy x-ray beams.

[Minimally invasive dynamic hip screw technique: Shorter surgical time with similar post-surgical results compared to conventional DHS technique. A retrospective cohort study]. / Técnica DHS mínimamente invasiva: menor tiempo quirúrgico con similares resultados en el postoperatorio inmediato respecto al DHS convencional. Estudio retrospectivo de cohortes.

AIM: The treatment of intertrochanteric fractures using a minimally invasive dynamic hip screw (MIDHS) technique has been reported to provide better results than the conventional technique (CDHS). The present study aims to determine whether there are any differences in terms of transfusion needs, morbidity, length of hospital stay, and economical costs, based on a study of two retrospective cohorts. MATERIAL AND METHOD: Cohorts study of 80 patients with intertrochanteric femoral fractures (31-A1 and 31-A2.1) who underwent DHS procedure from July 2005 to September 2007; 40 of them were treated using the traditional technique (CDHS), and the other 40 using the minimally invasive technique (MIDHS). RESULTS: No differences were found in terms of blood loss, transfusion requirements or morbidity. Mean hospital stay for MIDHS group was 1.3 days lower, reducing the costs regarding the CDHS group by €306.3, but this difference was not statistically significant (P=.3). The time required to perform the surgery was shorter for the MIDHS group: 49.3 versus 78.8minutes (p=0.0001). DISCUSSION: Contrary to previous studies published, the present study did not show any advantage for the MIDHS technique, except for a shorter surgical time to perform the procedure. We consider that the MIDHS could help in improving operating room productivity and efficiency.

Immunotherapy reduces CD40L expression and modifies cytokine production in the CD4 cells of pollen allergy patients.

BACKGROUND: Allergen-specific immunotherapy (SIT) is the only intervention for IgE-mediated respiratory disorders. OBJECTIVE: The aim of the study was to investigate the immunological modifications induced by SIT in patients allergic to olive and/or grass pollen by attempting to establish an association between these modifications and clinical improvements. METHODS: We studied 29 patients who were allergic to olive and/or grass pollen. Patients were randomized to 2 groups: an active treatment group, comprising 19 allergic patients who received SIT, and a control group, formed by 10 allergic patients who received pharmacological treatment for their allergic symptoms but not immunotherapy. We used flow cytometry to analyze intracellular expression of the cytokines IL-4, IFN-gamma, IL-10, and TGF-beta1 in CD4+ T cells, as well as expression of Foxp3, the costimulatory CTLA-4 molecule, and the non-costimulatory CD40L molecule. To assess clinical changes, patients recorded their medication consumption, symptoms, and the limitation of daily activities using diary cards and quality of life questionnaires. RESULTS: Six months after initiation of SIT, we recorded a reduction in cell surface CD40L expression in the CD4+ T-cell population and a shift in the cytokine production profile (decrease in IL-4-producing CD4+ T cells and increase in IFN-gamma, IL-10, and TGF-beta1). These changes persisted after 12 months. Simultaneously, a clinical improvement was observed. CONCLUSIONS: SIT-induced clinical improvement is the result of immunological modifications such as a reduction in CD40L expression on CD4 cells and alteration in the cytokine production profile.

[Association of the incidence of type 1 diabetes mellitus with environmental factors in Chile during the period 2000-2007]. / Estudio temporal de diabetes mellitus tipo 1 en Chile: asociación con factores ambientales durante el período 2000-2007.

BACKGROUND: Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. AIM: To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15 years, and environmental factors, such as air pollution and viruses. MATERIAL AND METHODS: Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15 years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. RESULTS: Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. CONCLUSIONS: These results show that environmental factors could be related to peaks of type 1 diabetes incidence.