Evaluating the Effectiveness of School Closure in COVID-19-Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study.

BACKGROUND: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. OBJECTIVE: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19-related syndromes in an outpatient syndromic surveillance system. METHODS: We calculated the incidence of COVID-19-related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19-related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. RESULTS: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19-related syndromes in 2021 for 2 weeks after the intervention (coefficient -1.24, 95% CI -2.40 to -0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. CONCLUSIONS: Overall, school closure effectively suppresses COVID-19-related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home.

Lactiplantibacillus plantarum Postbiotics: Alternative of Antibiotic Growth Promoter to Ameliorate Gut Health in Broiler Chickens.

The postbiotic produced from Lactiplantibacillus plantarum has been revealed as a potential alternative to antibiotic growth promoters (AGP). It helps to stimulate growth performance, improve nutrient digestibility, intestinal histomorphology, immune response, and improve meat quality in livestock. However, there is a paucity of information on the effects of L. plantarum postbiotic produced by formulated media on the gut health and immune response. Therefore, this study was conducted by using three strains of dietary L. plantarum postbiotics to determine the growth performance, intestinal histomorphology, intestinal mucin production, and immune status in broiler chickens. A 245 male Cobb 500-day-old birds were assigned randomly to five treatments, namely, NC: basal diet only (negative control), OTC: basal diet + 0.01% (w/w) oxytetracycline (positive control), RG11: basal diet + 0.1% (v/w) Postbiotic RG11, RI11: basal diet + 0.1% (v/w) Postbiotic RI11, and RS5: basal diet + 0.1% (v/w) Postbiotic RS5. The body weight and feed intake were taken weekly. The small intestine and its mucus, ceca digesta were collected on days 21 and 42. Fresh excreta for crude mucin production were collected 3 days before slaughter on day 42. From the findings, RS5 recorded a significant highest (p < 0.05) final body weight, body weight gain, and significant lowest (p < 0.05) feed conversion ratio. The concentrations of glutathione peroxidase, superoxide dismutase (SOD), acidic mucin, sulfated mucin, and intestinal trefoil factor were significantly higher (p < 0.05) in the birds fed with RI11 and RS5. Postbiotics RI11 and RS5 had up-regulated expression of intestinal Mucin 2, occludin, and secretory immunoglobulin A. The antibiotic-fed chickens also showed a reduced (p < 0.05) total bacteria and Bifidobacterium population but a significantly increased (p < 0.05) the population of Escherichia coli in the jejunum. In conclusion, the supplementation of L. plantarum postbiotic can be used to substitute AGP as it promoted growth performance, mucin production, ameliorated tight junction permeability, and immune status in broiler chickens due to improved gut health and beneficial bacteria colonization.

Comparative Studies of Inhibitory and Antioxidant Activities, and Organic Acids Compositions of Postbiotics Produced by Probiotic Lactiplantibacillus plantarum Strains Isolated From Malaysian Foods.

Despite inflammation being a protective natural defense against imbalance stressors in the body, chronic inflammation could lead to the deterioration of immune response, low production, and poor performance in livestock as well as severe economic losses to the farmers. Postbiotics produced by Lactiplantibacillus plantarum has been reported recently to be a natural source of antioxidant, promoting growth performance, anti-inflammation, and immune responses. However, the effects of fermentation media on the compositions of L. plantarum postbiotic have not been reported elsewhere. Hence, a comparative study was conducted to compare the volatile compounds, organic acid composition, and antioxidant and antimicrobial activities of postbiotics produced by six strains of L. plantarum cultivated by using formulated media and the commercial de Man, Rogosa, and Sharpe (MRS) medium as a control. Postbiotics RG14, RI11, and UL4 produced by using formulated media exhibited higher inhibitory activity against Pediococcus acidilactici 446, Escherichia coli E-30, Salmonella enterica CS3, and vancomycin-resistant Enterococci except for Listeria monocytogenes LS55. As for the antioxidant activity, hydroxyl radical scavenging activity was enhanced in formulated media, whereas reducing power activity was the highest in postbiotic RI11. Three organic acids, namely, acetic acid, caproic acid, and lactic acid, were detected in the postbiotic produced by various L. plantarum strains. The concentration of acetic acid was influenced by the fermentation media, whereas caproic acid was detected as the highest in postbiotic RG11. Lactic acid was the predominant compound detected in all the postbiotics and had the significantly highest concentration in postbiotic RS5 when produced by using the MRS medium. Intermediary and pyrrole compounds were the other main compounds that were detected by using GC-MS. Positive correlations were found between organic acid production and inhibitory activity, as well as antioxidant activity exhibited by postbiotics. In conclusion, the compositions and functional characteristics of postbiotics produced by the six strains of L. plantarum were strain-dependent and affected greatly by the fermentation medium. The effects of postbiotic composition on the functional characteristics of postbiotics were elucidated in this study to warrant their applications as a promising beneficial natural growth promoter for the livestock industry.

Massive expansion of EBV+ monoclonal T cells with CD5 down regulation in EBV-associated haemophagocytic lymphohistiocytosis.

Haemophagocytic lymphohistiocytosis (HLH) comprises primary and secondary forms; the secondary form is most commonly triggered by the Epstein-Barr virus (EBV; EBV-HLH). Patients with EBV-HLH usually exhibit oligoclonal or monoclonal T cell proliferation, which may mimic T cell lymphoproliferative disorder (T-LPD). This article reports on EBV-HLH in a 17-month-old girl with an extreme surge of reactive T lymphocytosis (absolute count 167x10(9)/l) with CD5 down regulation. Bone marrow aspirate and trephine contained florid haemophagocytosis and massive infiltration of CD3+ Epstein-Barr virus-encoded RNA+ lymphocytes, as seen by double labelling. These lymphocytes were monoclonal for EBV and T cell receptor gamma chain gene rearrangement. The patient responded dramatically to intravenous immunoglobulin, interferon alpha2b, ganciclovir and prednisolone, suggesting restoration of her immune system and eradication of the clonal T cells through these immunoregulatory agents. Thus, careful clinicopathological correlation is warranted in the interpretation of immunophenotyping and clonality data in T cell proliferation in association with EBV-HLH to avoid erroneous diagnosis of T-LPD.

Chinese Version of Psychometric Evaluation of Self-Reflection and Insight Scale on Taiwanese Nursing Students.

BACKGROUND: Self-reflection (also known as reflection) is an internal process that is difficult to perceive or assess. An instrument that is able to measure self-reflection may serve as a resource for educators to assess the learning process of students and to tailor education approaches to student needs. PURPOSE: The aim of this study was to translate the Self-Reflection and Insight Scale (SRIS) into Chinese and evaluate its psychometric properties for use with Taiwanese nursing students. METHODS: For this cross-sectional study, nursing students were recruited from two nursing schools in southern Taiwan in two phases: Phase 1, which included 361 fourth-year students, and Phase 2, which included 703 fifth-year students. Data were collected in December 2012 and May 2013 using the Chinese version of the SRIS (SRIS-C), Taiwan Critical Thinking Disposition Inventory, and the Perceived Identity as a Nurse Questionnaire, which was developed by the author. In Phase 1, exploratory factor analysis was used to explore the factor structure of the SRIS-C in the fourth-year student participants. In Phase 2, confirmatory factor analysis was used to determine the fitness of the model for the fifth-year student participants. RESULTS: Eight items were deleted from the original SRIS to create the SRIS-C. Thus, the Chinese-version measure had 12 items and two factors (self-reflection and insight) that fit the data well. The Cronbach's alpha coefficients for the total scale and its two subscales were .79, .87, and .83, respectively. The 3-week test-retest reliability was .74. SRIS-C scores correlated significantly with scores on the Taiwan Critical Thinking Disposition Inventory and the Perceived Identity as a Nurse Questionnaire, indicating good convergent validity for the SRIS-C. CONCLUSIONS: The current study showed that the SRIS-C has sound psychometric properties. This instrument provides nurse educators with information that may be used to evaluate the self-reflection and insight of students and to develop interventions to effectively improve these skills in Chinese-language-based nursing education.

Diabetes mellitus and risk of subsequent depression: a longitudinal study.

BACKGROUND: Findings of previous studies on the association between diabetes and the risk of depression are contradictory. Furthermore, much less is known concerning the association among young adults. OBJECTIVE: To investigate whether diabetes is associated with an increased risk of subsequent development of depression, with emphasis on age-specific variations. DESIGN: A cohort study. SETTING: Claims data of one million subjects randomly selected from 23 million people covered by the Taiwan National Health Insurance program. PARTICIPANTS: From the claims data, we identified 14,048 patients aged ≥ 20 years with newly diagnosed diabetes in 2000-2002 and randomly selected 55,608 non-diabetic subjects for comparison, that were frequency-matched by calendar year, age, and gender. Incidence rates of depression to the end of 2007 were identified, and risks were compared between the two groups. RESULTS: The incidence of depression was 1.80-times higher in the diabetic group than in nondiabetic subjects over a median follow-up of 6.5 years (adjusted hazard ratio [HR]=1.46, 95% confidence interval [CI]: 1.24-1.71). Age-specific HRs for incidence of depression in relation to diabetes were not statistically different between the patient subgroups aged 20-39, 40-49, 50-59, 60-69 and ≥ 70 years (p value for age-diabetes interaction=0.33). Stratified analyses showed that the association was much stronger for subjects without comorbid cardiovascular disease than for those with this comorbidity. Insulin treatment was associated with a 43% reduced risk of depression in diabetic patients. CONCLUSIONS: In this population-based study, diabetic patients were at a higher risk for subsequent depression. Adequate treatment reduced the risk.

Mantle cell lymphoma in Taiwan: clinicopathological and molecular study of 21 cases including one cyclin D1-negative tumor expressing cyclin D2.

Mantle cell lymphoma (MCL) is a rare B-cell lymphoma that has never been characterized in Taiwan. The purpose of the present paper was to retrospectively identify 21 cases in male patients, with a median age of 61, involving lymph node (91%), marrow (71%), and peripheral blood (23%). Eighteen (86%) were in stages III/IV with 1 and 5 year survival rates of 78% and 17%, respectively. Mixed nodular and diffuse pattern (45%) was most common while interstitial pattern (92%) predominated in marrow. Eighteen (86%) were of classical morphology, two were pleomorphic and one was blastic. The tumors expressed IgM and bcl-2 (100%), cyclin D1 (95%), CD5 (86%), CD43 and IgD (62%), CD52 (60%), and bcl-6 (5%). Ki-67 index>or=30% (P=0.1834) was associated with a trend toward poorer survival while p21, p27, or p53 expression was not statistically significant for survival. Real-time polymerase chain reaction for cyclin D1 (CCND1) gene mRNA expression showed high levels in nine cyclin D1-positive patients and a low level in the single cyclin D1-negative patient. The latter patient was cyclin D2 positive and negative for immunoglubuin heavy chain gene and CCND1 gene translocation by locus-specific interphase fluorescent in situ hybridization. In conclusion, it is confirmed that the usual morphological variants and aberrant immunophenotype of MCL in the West occur in Taiwan and that this disease carries a poor prognosis.