Research Priorities of Applying Low-Cost PM2.5 Sensors in Southeast Asian Countries.

The low-cost and easy-to-use nature of rapidly developed PM2.5 sensors provide an opportunity to bring breakthroughs in PM2.5 research to resource-limited countries in Southeast Asia (SEA). This review provides an evaluation of the currently available literature and identifies research priorities in applying low-cost sensors (LCS) in PM2.5 environmental and health research in SEA. The research priority is an outcome of a series of participatory workshops under the umbrella of the International Global Atmospheric Chemistry Project-Monsoon Asia and Oceania Networking Group (IGAC-MANGO). A literature review and research prioritization are conducted with a transdisciplinary perspective of providing useful scientific evidence in assisting authorities in formulating targeted strategies to reduce severe PM2.5 pollution and health risks in this region. The PM2.5 research gaps that could be filled by LCS application are identified in five categories: source evaluation, especially for the distinctive sources in the SEA countries; hot spot investigation; peak exposure assessment; exposure-health evaluation on acute health impacts; and short-term standards. The affordability of LCS, methodology transferability, international collaboration, and stakeholder engagement are keys to success in such transdisciplinary PM2.5 research. Unique contributions to the international science community and challenges with LCS application in PM2.5 research in SEA are also discussed.

Comparative evaluation of a dual-target real-time RT-PCR assay for COVID-19 diagnosis and assessment of performance in pooled saliva and nasopharyngeal swab samples.

OBJECTIVES: Sensitive molecular diagnostic assays are essential for COVID-19 diagnosis. We evaluated the Hecin Scientific SARS-CoV-2 nucleic acid test kit, a dual-target real-time RT-PCR assay targeting the SARS-CoV-2 N and ORF1ab genes. METHODS: The Hecin test kit's diagnostic performance in detecting SARS-CoV-2 RNA was compared to the LightMix Modular SARS and Wuhan CoV E-gene kit (TIB Molbiol) and an in-house single-tube nested real-time RT-PCR using 296 clinical specimens, 11 proficiency testing samples, and 30 low-positive deep throat saliva and nasopharyngeal swab (NPS) samples pooled into negative samples in ratios of 1:5, 1:10, and 1:30. RESULTS: The limit-of-detection of the Hecin test kit was around 500 dC/mL for the N and ORF1ab targets. Sensitivity and specificity of the Hecin test kit were 98.1% (95% CI: 93.4-99.8%) and 100% (98.1-100%), respectively, when measured against the reference method. The Hecin test kit showed fair sensitivity (80%) in low-positive NPS samples pooled in ratios of 1:5 and 1:10. Its performance in pooled samples could be dramatically improved by adjusting the assay Ct cutoff. CONCLUSION: The Hecin test kit enables sensitive and specific detection of SARS-CoV-2 in clinical samples and pooled samples.

Association Between Trimester and Outcomes after Cholecystectomy During Pregnancy.

BACKGROUND: Conventional philosophy promotes the second trimester as the ideal time during pregnancy for cholecystectomy. However, literature supporting this belief is sparse. The purpose of this study is to examine the association of trimester and clinical outcomes after cholecystectomy during pregnancy. STUDY DESIGN: The National Inpatient Sample was queried for pregnant women who underwent cholecystectomy between October 2015 and December 2017. Patients were categorized by trimester. Multivariable logistic and continuous outcome regression models were used to evaluate the association of trimester and outcomes, including maternal and fetal complications, length of stay, and hospital charges. The primary outcome was any complication-a composite of specific clinical complications, each of which were designated as secondary outcomes. RESULTS: A total of 819 pregnant women satisfied our inclusion criteria. Of these, 217 (26.5%) were in the first trimester, 381 (47.5%) were in the second trimester, and 221 (27.0%) were in the third trimester. Median age was 27 years (interquartile range: 23-31 years). Compared with the second trimester, cholecystectomy during the first trimester was not associated with higher rates of complications (adjusted odds ratio [AOR] 0.88, 95% confidence interval [CI]: 0.47-1.63, p = 0.68). However, cholecystectomy during the third trimester was associated with a higher rate of preterm delivery (AOR 7.20, 95% CI 3.09-16.77, p < 0.001) and overall maternal and fetal complications (AOR 2.78, 95% CI 1.71-4.53, p < 0.001). Compared with the second trimester, the third trimester was associated with 21.3% higher total hospital charges (p = 0.003). CONCLUSIONS: Our results suggest that cholecystectomy can be performed in the first trimester without significantly increased risk of maternal and fetal complications, compared to the second trimester. In contrast, cholecystectomy during pregnancy should not be delayed until the third trimester.

The use of multi-pronged screening strategy to understand the epidemiology of carbapenemase-producing Enterobacteriaceae in Hong Kong: transition from epidemic to endemic setting.

A multi-pronged carbapenemase-producing Enterobacteriaceae (CPE) screening strategy was implemented in Hong Kong West healthcare network. Of 199,192 fecal specimens from 77,194 patients screening from 1 July 2011 to 30 June 2019, the incidence of CPE per 1000 patient admission significantly increased from 0.01 (2012) to 1.9 (2018) (p<0.01). With appropriate infection control measures, the incidence of nosocomial CPE per 1000 CPE colonization day decreased from 22.34 (2014) to 10.65 (2018) (p=0.0094). Exposure to wet market for purchasing raw pork (p=0.007), beef (p=0.017), chicken (p=0.026), and vegetable (p=0.034) for >3 times per week significantly associated with community acquisition of CPE. Strategic CPE control measures should be implemented in both the hospital and the community.

Concurrent assessment of personal, indoor, and outdoor PM2.5 and PM1 levels and source contributions using novel low-cost sensing devices.

The intensity, frequency, duration, and contribution of distinct PM2.5 sources in Asian households have seldom been assessed; these are evaluated in this work with concurrent personal, indoor, and outdoor PM2.5 and PM1 monitoring using novel low-cost sensing (LCS) devices, AS-LUNG. GRIMM-comparable observations were acquired by the corrected AS-LUNG readings, with R2 up to 0.998. Twenty-six non-smoking healthy adults were recruited in Taiwan in 2018 for 7-day personal, home indoor, and home outdoor PM monitoring. The results showed 5-min PM2.5 and PM1 exposures of 11.2 ± 10.9 and 10.5 ± 9.8 µg/m3 , respectively. Cooking occurred most frequently; cooking with and without solid fuel contributed to high PM2.5 increments of 76.5 and 183.8 µg/m3 (1 min), respectively. Incense burning had the highest mean PM2.5 indoor/outdoor (1.44 ± 1.44) ratios at home and on average the highest 5-min PM2.5 increments (15.0 µg/m3 ) to indoor levels, among all single sources. Certain events accounted for 14.0%-39.6% of subjects' daily exposures. With the high resolution of AS-LUNG data and detailed time-activity diaries, the impacts of sources and ventilations were assessed in detail.

Application of Machine Learning for the in-Field Correction of a PM2.5 Low-Cost Sensor Network.

Many low-cost sensors (LCSs) are distributed for air monitoring without any rigorous calibrations. This work applies machine learning with PM2.5 from Taiwan monitoring stations to conduct in-field corrections on a network of 39 PM2.5 LCSs from July 2017 to December 2018. Three candidate models were evaluated: Multiple linear regression (MLR), support vector regression (SVR), and random forest regression (RFR). The model-corrected PM2.5 levels were compared with those of GRIMM-calibrated PM2.5. RFR was superior to MLR and SVR in its correction accuracy and computing efficiency. Compared to SVR, the root mean square errors (RMSEs) of RFR were 35% and 85% lower for the training and validation sets, respectively, and the computational speed was 35 times faster. An RFR with 300 decision trees was chosen as the optimal setting considering both the correction performance and the modeling time. An RFR with a nighttime pattern was established as the optimal correction model, and the RMSEs were 5.9 ± 2.0 µg/m3, reduced from 18.4 ± 6.5 µg/m3 before correction. This is the first work to correct LCSs at locations without monitoring stations, validated using laboratory-calibrated data. Similar models could be established in other countries to greatly enhance the usefulness of their PM2.5 sensor networks.

Laboratory Evaluations of Correction Equations with Multiple Choices for Seed Low-Cost Particle Sensing Devices in Sensor Networks.

To tackle the challenge of the data accuracy issues of low-cost sensors (LCSs), the objective of this work was to obtain robust correction equations to convert LCS signals into data comparable to that of research-grade instruments using side-by-side comparisons. Limited sets of seed LCS devices, after laboratory evaluations, can be installed strategically in areas of interest without official monitoring stations to enable reading adjustments of other uncalibrated LCS devices to enhance the data quality of sensor networks. The robustness of these equations for LCS devices (AS-LUNG with PMS3003 sensor) under a hood and a chamber with two different burnt materials and before and after 1.5 years of field campaigns were evaluated. Correction equations with incense or mosquito coils burning inside a chamber with segmented regressions had a high R2 of 0.999, less than 6.0% variability in the slopes, and a mean RMSE of 1.18 µg/m3 for 0.1-200 µg/m3 of PM2.5, with a slightly higher RMSE for 0.1-400 µg/m3 compared to EDM-180. Similar results were obtained for PM1, with an upper limit of 200 µg/m3. Sensor signals drifted 19-24% after 1.5 years in the field. Practical recommendations are given to obtain equations for Federal-Equivalent-Method-comparable measurements considering variability and cost.

Policies and practices of SHEA Research Network hospitals during the COVID-19 pandemic.

To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.

A versatile low-cost sensing device for assessing PM2.5 spatiotemporal variation and quantifying source contribution.

This study evaluated a newly developed sensing device, AS-LUNG-O, against a research-grade GRIMM in laboratory and ambient conditions and used AS-LUNG-O to assess PM2.5 spatiotemporal variations at street levels of an Asian mountain community, which represented residents' exposure (at the interface of atmosphere and human bodies leading to potential health impacts). In laboratory, R2 of 1-min AS-LUNG-O and GRIMM was 0.95 ± 0.04 (n = 64,179 for 40 sets). After conversion with individual correction equations, their correlation in ambient tests was 0.93 ± 0.05, with absolute % difference of only 10 ± 9%. Ten AS-LUNG-O sets were installed at street sites with another one at 10 m above ground on July 1-28 and December 2-31, 2017 in Nantou, Taiwan. Important source contributions to PM2.5 were quantified with regression analysis. Temporal variation expressed as the daily max/mean of 5-min PM2.5 reached 13.7 in July and 12.2 in December. Spatial variation expressed as the percent coefficients of variance (%CV) across ten community locations was 22% ± 20% (max: 199%) in July and 19 ± 18% (max: 206%) in December. Incremental contribution from the stop-and-go traffic, market, temple, and fried-chicken vendor to PM2.5 at 3-5 m away were 4.38, 3.90, 2.72, and 1.80 µg/m3, respectively. Significant spatiotemporal variations and community source contributions revealed the importance of assessing neighborhood air quality for public health protection. For long-term air quality monitoring, the percentage of available power and signals of G-sensor provided indicative information of maintenance required. Advantages of low cost (USD 650), small size, light weight, solar power supply, backup data storage, waterproof housing, multiple-sensor flexibility, and high precision and accuracy (after correction) enable AS-LUNG-O to be widely applied in environmental studies.

The growth of peer support: an international charter.

Objective: While mental health peer support originated in its contemporary form in English-speaking countries, it is now spreading rapidly across the globe. This rapid growth presents two major challenges. The first pertains to "role integrity" and the second to the possible culture-bound nature of peer support; a concern which has attended the emergence of peer support in countries that have significantly different worldviews.Method: Recognizing the growth of peer support and the resulting challenges, this report results from the convening of an international consortium of peer leaders from six continents (all but Antarctica). Following an environmental scan of the state of peer support globally, this group moved to develop consensus on a common, core set of guiding principles and values to ensure a robust future for the development of effective, culturally responsive forms of peer support.Findings: Key principles, values and practices considered essential to peer support are presented.Conclusions and implications for practice: Assuming that sufficient political and community support are generated, there can be considerable enthusiasm for the expansion of peer support around the globe. Peer leaders are encouraged, however, to develop and deliver peer support both with integrity to its founding values in a civil rights and social justice framework and with responsiveness to local cultural worldviews.

Application of a dual target PCR-high resolution melting (HRM) method for rapid nontuberculous mycobacteria identification.

Species differentiation of nontuberculous mycobacteria (NTM) has long been a difficult task in clinical laboratories. This study demonstrated and evaluated a simple and cost-effective method using the real-time PCR with high-resolution melting (PCR-HRM) analysis technique, which could differentiate at least 14 different medically related NTM.

Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China.

Antimicrobial-resistant bacteria are either highly prevalent or increasing rapidly in Hong Kong and China. Treatment options for these bacteria are generally limited, less effective and more expensive. The emergence and dynamics of antimicrobial resistance genes in bacteria circulating between animals, the environment and humans are not entirely known. Nonetheless, selective pressure by antibiotics on the microbiomes of animal and human, and their associated environments (especially farms and healthcare institutions), sewage systems and soil are likely to confer survival advantages upon bacteria with antimicrobial-resistance genes, which may be further disseminated through plasmids or transposons with integrons. Therefore, antibiotic use must be tightly regulated to eliminate such selective pressure, including the illegalization of antibiotics as growth promoters in animal feed and regulation of antibiotic use in veterinary practice and human medicine. Heightened awareness of infection control measures to reduce the risk of acquiring resistant bacteria is essential, especially during antimicrobial use or institutionalization in healthcare facilities. The transmission cycle must be interrupted by proper hand hygiene, environmental cleaning, avoidance of undercooked or raw food and compliance with infection control measures by healthcare workers, visitors and patients, especially during treatment with antibiotics. In addition to these routine measures, proactive microbiological screening of hospitalized patients with risk factors for carrying resistant bacteria, including history of travel to endemic countries, transfer from other hospitals, and prolonged hospitalization; directly observed hand hygiene before oral intake of drugs, food and drinks; and targeted disinfection of high-touch or mutual-touch items, such as bed rails and bed curtains, are important. Transparency of surveillance data from each institute for public scrutiny provides an incentive for controlling antimicrobial resistance in healthcare settings at an administrative level.

Direct bacterial identification in positive blood cultures by use of two commercial matrix-assisted laser desorption ionization-time of flight mass spectrometry systems.

Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of bacteria and fungi was recently introduced in microbiology laboratories. This technology could greatly improve the clinical management of patients and guidance for chemotherapy. In this study, we used a commercial MALDI Sepsityper extraction method to evaluate the performance of two commercial MALDI-TOF MS systems, the Vitek MS IVD (bioMérieux) and the Microflex LT Biotyper (Bruker Daltonics) for direct bacterial identification in positive blood cultures. In 181 monomicrobial cultures, both systems generated genus to species level identifications for >90% of the specimens (Biotyper, 177/181 [97.8%]; Vitek MS IVD, 167/181 [92.3%]). Overall, the Biotyper system generated significantly more accurate identifications than the Vitek MS IVD system (P = 0.016; 177 versus 167 out of 181 specimens). The Biotyper system identified the minority species among polymicrobial blood cultures. We also compared the performance of an in-house extraction method with that of the Sepsityper on both MALDI-TOF MS systems. The in-house method generated more correct identifications at the genus level than the Sepsityper (96.7% versus 93.5%) on the Biotyper system, whereas the two methods exhibited the same performance level (88.0% versus 88.0%) on the Vitek MS IVD system. Our study confirmed the practical advantages of MALDI-TOF MS, and our in-house extraction method reduced the reagent cost to $1 per specimen, with a shorter turnaround time of 3 h, which is highly cost-effective for a diagnostic microbiology service.

The use of high-resolution melting analysis for rapid spa typing on methicillin-resistant Staphylococcus aureus clinical isolates.

Methicillin-resistant Staphylococcus aureus (MRSA) has been endemic in Hong Kong for three decades. This study evaluated the practical use of high-resolution melting (HRM) real-time PCR analysis on MRSA staphylococcal Protein A (spa) typing on local MRSA isolates. Among 55 clinical MRSA isolates collected in 2011, 12 different spa types were observed by the conventional PCR-sequencing method including the locally predominant spa type t1081 and two locally predominant community acquired MRSA spa types t019 and t437. By using the HRM method, it could differentiate all 12 spa genotypes by distinct melting curves and HRM difference plot analysis. These two methods demonstrated 100% concordance whereas the HRM method required only 3h of turnaround time and one-fifth of reagent cost compared to the conventional method. Our study confirmed that the cost effective and rapid HRM typing approach is practically useful for MRSA community transmission monitoring and nosocomial outbreak control in Hong Kong.