Design and Implementation of a Regional Inpatient Psychiatry Unit for Patients who are Positive for Asymptomatic SARS-CoV-2.

BACKGROUND: Patients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion. OBJECTIVE: With this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere. CONCLUSION: A major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.

Biological variation of resting measures of ventilation and gas exchange in a large healthy cohort.

PURPOSE: Resting measures of ventilation and gas exchange are impacted by a variety of physiological stressors, such as those resulting from a research intervention or an extreme environment. However, the biological variation of these parameters, an important statistical consideration for identifying a meaningful physiological change, has not been quantified. METHODS: We performed a retrospective analysis of 21 studies completed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) from 1985 to present, totaling 411 healthy volunteers. First, we determined the intraindividual, interindividual, and analytic coefficients of variation (CVI, CVG, and CVA, respectively) and subsequently the index of individuality and heterogeneity (II and IH, respectively). Second, when deemed appropriate via these outcomes, we defined the accompanying static and dynamic thresholds, beyond which a significant deviation from normal is indicated. RESULTS: End-tidal partial pressure of oxygen (PETO2) and the respiratory exchange ratio (RER) approached the II threshold required to be considered useful in the static assessment of physiological deviations from normal. PETO2 and peripheral oxygen saturation (SpO2) approached the IH threshold required to be considered useful in the dynamic assessment of physiological deviations from normal. CONCLUSIONS: This analysis identifies RER and PETO2 as parameters that might be most useful when aiming to identify a meaningful ventilatory change following a research intervention or stressor. Alternatively, other parameters of ventilation and gas exchange, such as PETCO2 and VE, may be less useful for observing an anticipated physiological change.

Modeling the resiliency of energy-efficient retrofits in low-income multifamily housing.

Residential energy efficiency and ventilation retrofits (eg, building weatherization, local exhaust ventilation, HVAC filtration) can influence indoor air quality (IAQ) and occupant health, but these measures' impact varies by occupant activity. In this study, we used the multizone airflow and IAQ analysis program CONTAM to simulate the impacts of energy retrofits on indoor concentrations of PM2.5 and NO2 in a low-income multifamily housing complex in Boston, Massachusetts (USA). We evaluated the differential impact of residential activities, such as low- and high-emission cooking, cigarette smoking, and window opening, on IAQ across two seasons. We found that a comprehensive package of energy and ventilation retrofits was resilient to a range of occupant activities, while less holistic approaches without ventilation improvements led to increases in indoor PM2.5 or NO2 for some populations. In general, homes with simulated concentration increases included those with heavy cooking and no local exhaust ventilation, and smoking homes without HVAC filtration. Our analytical framework can be used to identify energy-efficient home interventions with indoor retrofit resiliency (ie, those that provide IAQ benefits regardless of occupant activity), as well as less resilient retrofits that can be coupled with behavioral interventions (eg, smoking cessation) to provide cost-effective, widespread benefits.

Integrated Management of Residential Indoor Air Quality: A Call for Stakeholders in a Changing Climate.

A paradigm change in the management of environmental health issues has been observed in recent years: instead of managing specific risks individually, a holistic vision of environmental problems would assure sustainable solutions. However, concrete actions that could help translate these recommendations into interventions are lacking. This review presents the relevance of using an integrated indoor air quality management approach to ensure occupant health and comfort. At the nexus of three basic concepts (reducing contaminants at the source, improving ventilation, and, when relevant, purifying the indoor air), this approach can help maintain and improve indoor air quality and limit exposure to several contaminants. Its application is particularly relevant in a climate change context since the evolving outdoor conditions have to be taken into account during building construction and renovation. The measures presented through this approach target public health players, building managers, owners, occupants, and professionals involved in building design, construction, renovation, and maintenance. The findings of this review will help the various stakeholders initiate a strategic reflection on the importance of indoor air quality and climate change issues for existing and future buildings. Several new avenues and recommendations are presented to set the path for future research activities.

Relationship between nutritional status and mortality during the first 2 weeks following treatment for cervical spinal cord injury.

BACKGROUND: The effects of nutrition on the mortality of cervical spinal cord injury (CSCI) patients, unlike other risk factors, are poorly documented. Objective The relationship between dynamic nutritional status change and mortality in patients treated for CSCI was investigated. METHODS: A retrospective study of 128 patients treated for CSCI at the Beijing Army General Hospital was conducted between March 2006 and March 2011. Age, spinal segment damage (C1-C4 and C5-C7), American Spinal Injury Association (ASIA) grade, hospitalization duration, ventilatory support, and serum protein levels (total protein, serum albumin, and serum prealbumin) were assessed during early-stage treatment (<14 days). Survival (n = 109) and death (n = 19) groups were assigned by final disposition of acute hospitalization. RESULTS: The survival group evidenced no significant changes in total protein levels during early-stage treatment, although these values decreased in the death group. Serum prealbumin and albumin levels significantly declined by treatment day 1 and throughout treatment (P < 0.05). By days 3-5 and thereafter, significantly lower serum proteins were observed in the death group compared to the survival group (P < 0.05). Multiple segment damage, elevated ASIA, and longer ventilatory support duration were more prevalent in the death group (P < 0.001) CONCLUSIONS: Lower serum protein levels associated with hypoproteinemia and malnutrition are significant indicators of mortality in patients with CSCI, along with higher levels of lesions, elevated ASIA grades, and longer ventilatory support durations. Early corrective action for hypoalbuminemia may help to reduce mortality in patients with CSCI.

Radiological design aspects of the National Ignition Facility.

The National Ignition Facility (NIF) has been designed to accommodate some challenging radiological conditions. The high prompt neutron source (up to 1.6 × 10(19) neutrons per shot) results in the need for significant fixed shielding. Concrete shielding approximately 2 m thick is used for the primary (target bay) shield. Penetrations in this shield, including those required for 192 laser beams, utilities, diagnostics, and 19 shielded personnel access doors, make the design challenging. An additional 28 shield doors are part of the secondary shield. In addition, the prompt neutron pulse results in activated air within the target bay, requiring special ventilation considerations. Finally, targets can use a number of hazardous and radioactive materials including tritium, beryllium, and depleted uranium (the latter of which results in the generation of small quantities of fission products). Frequent access is required to the associated potentially contaminated volumes for experimental setup, facilitating the need for local exhaust ventilation to manage these hazards. This paper reviews some of these challenges, design considerations, and the engineering solutions to these design requirements.

An integrated occupational hygiene consultation model for the catering industry.

Vegetable oil used in food processing, during high-temperature exposure, will generate particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs), which are carcinogenic chemical compounds, with the potential to cause lung disease for restaurant kitchen staff. This study's design includes a three-stage consultation process with eight major consultation items, in order to build an integrated consultation model for occupational hygiene. This model combines inspection and consultation, targeting Chinese restaurants in the catering industry. Characteristics of the integrated consultation model include cooperation between different government departments and collaboration with nongovernmental, professional consulting organizations. An additional benefit of the model is the building of a good partnership relationship with the Catering Trade Association. The consultation model helps Chinese restaurants attain improvements in their work environments with minimal investment. Postconsultation, results show a 63.35% and 61.98% (P < 0.001) decrease in the mean time-weighted concentration of exposure to PM and PAHs, respectively. The overall regulation compliance rate of Chinese restaurants significantly increased from 34.3% to 89.6%. These results show that the integrated consultation model for occupational hygiene not only helps small and medium enterprises reduce exposure concentrations in the workplace but also has specific potential for successful implementation in Taiwan.

[Impacts of different aeration modes on nutrients conservation during swine manure composting with magnesium salt addition].

Experiments were carried out to investigate the effect of two aeration modes on nutrients conservation in the thermophilic stage of swine manure composting with adding magnesium chloride. These results indicated that in the end of thermophilic stage of composting, the ammonia nitrogen losses of the piles with the intermittent aeration and with continuous aeration, were 23.56 g and 56.98 g, respectively, which means the loss of ammonia nitrogen of swine composting by the intermittent aeration was just 41.35% of that by the continuous aeration. Such loss of ammonia nitrogen resulted in 9.8% higher of the total kjeldahl nitrogen (TKN) concentration in the pile with the intermittent aeration than that with the continuous aeration. No significant difference occurred between two piles in orthophosphate, sequential extraction phosphorus and the total phosphorus (TP). However, in the pile with intermittent aeration, the percentage of the easily dissolved phosphorous forms such as H2O-P and NaHCO3-P was increased from 27.6% of TP to 66.5%, and the other pile from 27.6% to 64.9%. The TP concentrations in both piles were 17.2 g/kg in the end of thermophilic composting stage. The mixed crystals containing magnesium and phosphorus were formed in both piles of swine composting.

[Air monitoring and method of air sterilization of long-term senile patient wards].

The air culture was monitored in the wards for aged long-term inpatients and the air sterilizing method was evaluated. The study showed that the natural ventilation was the most practical procedure to reduce the number of bacteria in the air of the wards. The use of Chinese herbal medicine prenaration to eradicate the bacteria in the air by comparison with the ultraviolet light method was proaed to have no sigaificant difference (P > 0.05). The Chinese herbal medicine method was superior to the ultraviolet light in its safly, reliability, easy operation, moisturizing air, and eradicating the side effect of the ultraviolet light. So it is especially suitable to the wards for aged inpatient.