The effect of age on fever response among nursing home residents with SARS-COV-2 infection.

Over 15,000 veterans in 135 VA nursing homes were systematically tested for SARS-CoV-2 and had daily temperatures assessed from March to August, 2020. Lower baseline temperatures, and in SARS-CoV-2+ , lower maximum temperatures were observed with advancing age. Clinicians should be aware of the potential diminished fever response in the elderly with SARS-CoV-2.

Precursor to Gas Sensor: A Detailed Study of the Suitability of Copper Complexes as an MOCVD Precursor and their Application in Gas Sensing.

There are very few p-type semiconductors available compared to n-type semiconductors for positive sensing response for oxidizing gases and other important electronic applications. Cupric oxide (CuO) is one of the few oxides that show p-type conductivity, useful for sensing oxidizing gases. Many researchers obtained CuO using the chemical and solid-state routes, but uniformity and large-area deposition have been the main issues. Chemical vapor deposition is one such technique that provides control on several deposition parameters, which allow obtaining thin films having crystallinity and uniformity over a large area for the desired application. However, CuO-chemical vapor deposition (CVD) is still unfathomed due to the lack of suitability of copper precursors based on vapor pressure, contamination, and toxicity. Here, to address these issues, we have taken four Cu complexes (copper(II) acetylacetonate, copper(II) bis(2,2,6,6-tetramethyl-3,5-heptanedionato), copper(II) ethylacetoacetate, and copper(II) tert-butylacetoacetate), which are evaluated using thermogravimetry for suitability as a CVD precursor. The decomposition behavior of the complexes was also experimentally confirmed by depositing CuO thin films via CVD. Phase purity, decomposition, volatility, growth rate, and morphological characteristics of the films are investigated in detail. Analysis suggests that copper(II) tert-butylacetoacetate has the highest vapor pressure and growth rate at a low temperature, making it the most suitable precursor for high-throughput CVD. Further, to investigate the role of these precursors, films deposited using Cu complexes were subjected to gas sensing. The CuO gas sensor fabricated on glass shows pronounced NO2 sensing. The sensing results of CuO films have been explained from the standpoint of roughness, morphology, and unpassivated bonds present on the surface of films and vapor pressure of precursors. The higher density of surface state and the lower resistivity of the Cu(tbaoac)2 film lead to a sensor with higher responsivity and sensitivity (down to 1 ppm). These precursors can probably be utilized to improve the performance of other metal oxide gas sensors, especially Cu2O and Cu-III-O2.

COVID-19 in older adults.

The advent of the SARS-CoV-2 and COVID-19 pandemic has generated a lot of publications at a rapid pace. We know that older adults disproportionately suffer the most severe of COVID outcomes. Here we attempt to coalesce the key knowledge of SARS-CoV-2 biology to the disease and clinical care concepts in the context of older adults.

Professional development and exposure to geriatrics: medical student perspectives from narrative journals.

Teaching professionalism is an important goal in American medical education. With the aging of the U.S. population, it is critical to understand how medical students develop professional behaviors when caring for older adults. Exposure to geriatrics and older patients can enhance students' professional development with patients of all ages and across different specialties. Medical students learn explicit and implicit messages during their education. In addition to helping to evaluate curricula, reflective journaling encourages individual development and helps in revealing how medical students become professionals. In this study, medical student volunteers described their responses to new geriatrics content in their curriculum, encounters with older patients in clinical settings, and their evolving physician identities. Multidisciplinary team analysis elicited 10 themes regarding: evaluation of geriatrics within the curriculum, recognition of geriatrics principles, and attitudes regarding aging and professional development over time. This article focuses on the impact of geriatrics exposure on students' professional development, revealing ways that students think about professionalism and older patients. Medical educators should consider journaling to help foster and gauge students' professional development.

Broad immunogenicity to prior SARS-CoV-2 strains and JN.1 variant elicited by XBB.1.5 vaccination in nursing home residents.

Background: SARS-CoV-2 vaccination has reduced hospitalization and mortality for nursing home residents (NHRs). However, emerging variants coupled with waning immunity, immunosenescence, and variability of vaccine efficacy undermine vaccine effectiveness. We therefore need to update our understanding of the immunogenicity of the most recent XBB.1.5 monovalent vaccine to variant strains among NHRs. Methods: The current study focuses on a subset of participants from a longitudinal study of consented NHRs and HCWs who have received serial blood draws to assess immunogenicity with each SARS-CoV-2 mRNA vaccine dose. We report data on participants who received the XBB.1.5 monovalent vaccine after FDA approval in Fall 2023. NHRs were classified based on whether they had an interval SARS-CoV-2 infection between their first bivalent vaccine dose and their XBB.1.5 monovalent vaccination. Results: The sample included 61 NHRs [median age 76 (IQR 68-86), 51% female] and 28 HCWs [median age 45 (IQR 31-58), 46% female). Following XBB.1.5 monovalent vaccination, there was a robust geometric mean fold rise (GMFR) in XBB.1.5-specific neutralizing antibody titers of 17.3 (95% confidence interval [CI] 9.3, 32.4) and 11.3 (95% CI 5, 25.4) in NHRs with and without interval infection, respectively. The GMFR in HCWs was 13.6 (95% CI 8.4,22). Similarly, we noted a robust GMFR in JN.1-specific neutralizing antibody titers of 14.9 (95% CI 7.9, 28) and 6.5 (95% CI 3.3, 13.1) among NHRs with and without interval infection, and a GMFR of 11.4 (95% CI 6.2, 20.9) in HCWs. NHRs with interval SARS-CoV-2 infection had higher neutralizing antibody titers across all analyzed strains following XBB.1.5 monovalent vaccination, compared to NHRs without interval infection. Conclusion: The XBB.1.5 monovalent vaccine significantly elevates Omicron-specific neutralizing antibody titers to XBB.1.5 and JN.1 strains in both NHRs and HCWs. This response was more pronounced in individuals known to be infected with SARS-CoV-2 since bivalent vaccination. Impact Statement: All authors certify that this work entitled " Broad immunogenicity to prior strains and JN.1 variant elicited by XBB.1.5 vaccination in nursing home residents " is novel. It shows that the XBB.1.5 monovalent vaccine significantly elevates Omicron-specific neutralizing antibody titers in both nursing home residents and healthcare workers to XBB and BA.28.6/JN.1 strains. This work is important since JN.1 increased from less than 0.1% to 94% of COVID-19 cases from October 2023 to February 2024 in the US. This information is timely given the CDC's latest recommendation that adults age 65 and older receive a Spring 2024 XBB booster. Since the XBB.1.5 monovalent vaccine produces compelling immunogenicity to the most prevalent circulating JN.1 strain in nursing home residents, our findings add important support and rationale to encourage vaccine uptake. Key Points: Emerging SARS-CoV-2 variants together with waning immunity, immunosenescence, and variable vaccine efficacy reduce SARS-CoV-2 vaccine effectiveness in nursing home residents.XBB.1.5 monovalent vaccination elicited robust response in both XBB.1.5 and JN.1 neutralizing antibodies in nursing home residents and healthcare workers, although the absolute titers to JN.1 were less than titers to XBB.1.5Why does this paper matter? Among nursing home residents, the XBB.1.5 monovalent SARS-CoV-2 vaccine produces compelling immunogenicity to the JN.1 strain, which represents 94% of all COVID-19 cases in the U.S. as of February 2024.

Preparing to care for an aging population: medical student reflections on their clinical mentors within a new geriatrics curriculum.

Reflective writing techniques such as journaling help provide insights into the process by which medical students are mentored and develop into practicing physicians. The authors sought to analyze medical students' journals regarding their mentored experiences within a new geriatrics curriculum at a U.S. medical school. Thirty preclinical and clinical medical student journalers participated in this project. The authors employed qualitative analytic techniques using an interdisciplinary team process. Three major themes emerged: (a) exposure to clinical mentors challenged medical students' preconceptions regarding older adults and geriatric medicine; (b) students learned new medical knowledge and techniques from observing their mentors; and (c) students provided positive and negative assessments of their mentors. Reflective journaling provides important insights into the process by which medical students draw upon mentored clinical experiences during their training. Such mentorship may be particularly relevant to promoting their interest in geriatrics.

Textured Lead-Free Piezoelectric Ceramics for Flexible Energy Harvesters.

A lead-free (K,Na)NbO3-based piezoelectric ceramic is textured along the (001) direction using the NaNbO3 (NN) seeds. The composition 0.96(K0.5Na0.5)(Nb0.965Sb0.035)O3-0.01CaZrO3-0.03(Bi0.5K0.5)HfO3 (KNN) is found to provide an excellent combination of electromechanical coefficients at room temperature. The textured composition with 5 wt % NN template (KNN-5NN) exhibits considerably improved electromechanical coefficients, d33 ∼ 590 pC/N, k31 ∼ 0.46, and d31 ∼ 215 ×10-12 C/N, at room temperature. A flexible piezoelectric energy harvester (F-PEH) is fabricated using the textured KNN-5NN ceramic and tested under cyclic force. F-PEH exhibits enhanced output voltage (Voc ∼ 25 V), current (I ∼ 0.4 µA), and power density (PD ∼ 5.5 mW/m2) (RL of 10 MΩ) in the off-resonance frequency regime. In comparison to the random ceramic KNN-0NN-based F-PEH (Voc ∼ 8 V and I ∼ 0.1 µA), the textured F-PEH significantly outperformed energy harvesting capability due to the large figure-of-merit value (d31 × g31) ∼ 3354 ×10-15 m3/J. This work provides a methodology for texturing lead-free materials and further implementing them in flexible energy harvesting devices and sensors.

Factors Affecting SARS-CoV-2 Test Discordance in Skilled Nursing Facilities.

OBJECTIVES: Reverse transcription polymerase chain reaction (PCR) and antigen tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are sometimes discordant. We evaluated the discordance between antigen and PCR tests sampled in skilled nursing facilities (SNFs) to assess the relationship of symptom presence, timing between tests, and the presence of a facility outbreak. DESIGN: Observational study using electronic health record data. SETTING AND PARTICIPANTS: Residents of 306 SNFs in 23 states, operated by 1 company. METHODS: We identified all rapid antigen and PCR tests conducted in study SNFs as of January 10, 2021, and classified whether symptoms were present and whether the facility was in outbreak at time of testing. We calculated the proportions of antigen tests with discordant follow-up PCR results conducted no more than 2 days after the antigen test. RESULTS: Of the 171,280 antigen tests in 34,437 SNF residents, 20,991 (12.3%) were followed by a PCR test within 2 days. A total of 1324 negative antigen tests were followed by a positive PCR result, representing 0.8% of all antigen tests and 6.3% of repeated antigen tests; while 337 positive antigen tests were followed by a negative PCR result, representing 0.2% of all antigen tests and 1.6% of repeated antigen tests. Discordance more often occurred when residents were symptomatic at time of antigen testing, during known facility outbreaks, and when the antigen test was compared with a PCR test done within 2 days vs 1 day. CONCLUSIONS AND IMPLICATIONS: Overall, discordance between SARS-CoV-2 antigen and PCR tests was low. Discordance was more common when the individual was symptomatic at time of antigen testing and during facility outbreaks. This suggests that a testing strategy which couples widespread use of antigen tests with clinical thresholds to conduct follow-up confirmatory PCR testing appears to perform well in SNFs, where timely and accurate SARS-CoV-2 case identification are critical.

Adverse events following third dose of mRNA COVID-19 vaccination among nursing home residents who received the primary series.

BACKGROUND: We sought to compare rates of adverse events among nursing home residents who received an mRNA COVID-19 vaccine booster dose with those who had not yet received their booster. METHODS: We assessed a prospective cohort of 11,200 nursing home residents who received a primary COVID-19 mRNA vaccine series at least 6 months prior to September 22, 2021 and received a third "booster dose" between September 22, 2021 and February 2, 2022. Residents lived in 239 nursing homes operated by Genesis HealthCare, spanning 21 U.S. states. We screened electronic health records for 20 serious vaccine-related adverse events that are monitored following receipt of COVID-19 vaccination by the CDC's Vaccine Safety Datalink. We matched boosted and yet-to-be boosted residents during the same time period, comparing rates of events occurring 14 days after booster administration with those occurring 14 days prior to booster administration. To supplement previously reported background rates of adverse events, we report background rates of medical conditions among nursing home residents during 2020, before COVID-19 vaccines were administered in nursing homes. Events occurring in 2021-2022 were confirmed by physician chart review. We report unadjusted rates of adverse events and used a false discovery rate procedure to adjust for multiplicity of events tested. RESULTS: No adverse events were reported during the 14 days post-booster. A few adverse events occurred prior to booster (ischemic stroke: 49.4 per 100,000 residents, 95% CI: 21.2, 115.7; venous thromboembolism: 9.9 per 100,000 residents, 95% CI: 1.7, 56.0), though differences in event rates pre- versus post-booster were not statistically significant (p < 0.05) after adjusting for multiple comparisons. No significant differences were detected between post-booster vaccination rates and prior year 14-day background rates of medical conditions. CONCLUSIONS: No safety signals were detected following a COVID-19 mRNA vaccine booster dose in this large multi-state sample of nursing home residents.

Dementia prevalence, a contextual factor associated with SARS-CoV-2 in veterans affairs community living centers.

BACKGROUND: Alzheimer's disease and related dementias (ADRD) impact the diagnosis and infection control of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in nursing homes (NH) by influencing the behavior of residents and their caregivers. Health system data show an association between ADRD and SARS-CoV-2. Whether this association is present in NH populations remains unknown. How increased SARS-CoV-2 risk among residents with ADRD impacts the greater NH population also remains unknown. METHODS: This retrospective cohort study used electronic health record data on Veterans residing in 133 Veterans Affairs Community Living Centers (CLC) and 15 spinal cord injury units from March 1, 2020 to December 13, 2020. We measured ADRD using diagnostic codes 12 months before an index SARS-CoV-2 test date for each resident. We used Poisson regression to determine the relative risk of SARS-CoV-2 for the highest quartile of facility ADRD prevalence versus the lowest, stratifying by individual ADRD status, and adjusting for covariates, with and without a random intercept to account for facility clustering. RESULTS: Across the study period, 15,043 residents resided in CLCs, 1952 (13.0%) had SARS-CoV-2, and 8067 (53.6%) had ADRD. There was an estimated 60% increased risk of SARS-CoV-2 in facilities with highest dementia prevalence versus lowest (relative risk, 1.6 [95% confidence interval 0.95, 2.7]). CONCLUSIONS: CLC residents had a greater likelihood of SARS-CoV-2 infection in facilities with greater ADRD prevalence. Facility characteristics other than ADRD prevalence may account for this association.

Can we use temperature measurements to identify pre-symptomatic SARS-CoV-2 infection in nursing home residents?

BACKGROUND: COVID-19 has had a severe impact on morbidity and mortality among nursing home (NH) residents. Earlier detection of SARS-CoV-2 may position us to better mitigate the risk of spread. Both asymptomatic and pre-symptomatic transmission are common in outbreaks, and threshold temperatures, such as 38C, for screening for infection could miss timely detection in the majority of residents. We hypothesized that in long-term care residents, temperature trends with SARS-CoV-2 infection could identify infection in pre-symptomatic individuals earlier than standard screening. METHODS: We conducted a retrospective cohort study using electronic health records in 6176 residents of the VA NHs who underwent SARS-CoV-2 testing triggered by symptoms. We collected information about age and other demographics, baseline temperature, and specific comorbidities. We created standardized definitions, and a hypothetical model to test measures of temperature variation and compare outcomes to the VA standard of care. RESULTS: We showed that a change from baseline of 0.4C identified 47% of NH residents who became SARS-CoV-2 positive, earlier than standard testing by an average of 42.2 h. Temperature variability of 0.5C over 3 days when paired with a 37.2C temperature cutoff identified 55% of NH residents who became SARS-CoV-2 positive earlier than the standard of care testing by an average of 44.4 h. A change from baseline temperature of 0.4C when combined with temperature variability of 0.7C over 3 days identified 52% of NH residents who became SARS-CoV-2 positive, earlier than standard testing by an average of 40 h, and by more than 3 days in 22% of the residents. This earlier detection comes at the expense of triggering 57,793 tests, as compared to the number of trigger tests ordered in the VA system of 40,691. CONCLUSIONS: Our model suggests that early temperature trends with SARS-CoV-2 infection may identify infection in pre-symptomatic long-term care residents.

Growth-Temperature Dependent Unpassivated Oxygen Bonds Determine the Gas Sensing Abilities of Chemical Vapor Deposition-Grown CuO Thin Films.

CuO is a multifunctional metal oxide excellent for chemiresistive gas sensors. In this work, we report CuO-based NO2 sensors fabricated via chemical vapor deposition (CVD). CVD allows great control on composition, stoichiometry, impurity, roughness, and grain size of films. This endows sensors with high selectivity, responsivity, sensitivity, and repeatability, low hysteresis, and quick recovery. All these are achieved without the need of expensive and unscalable nanostructures, or heterojunctions, with a technologically mature CVD. Films deposited at very low temperatures (≤350 °C) are sensitive but slow due to traps and small grains. Films deposited at high temperatures (≥550 °C) are not hysteretic but suffer from low sensitivity and slow response due to lack of surface states. Films deposited at optimum temperatures (350-450 °C) combine the best aspects of both regimes to yield NO2 sensors with a response of 300 % at 5 ppm, sensitivity limit of 300 ppb, hysteresis of <20%, repeatable performance, and recovery time of ∼1 min. The work demonstrates that CVD might be a more effective way to deposit oxide films for gas sensors.

Rhino-Orbital Cerebral Mucormycosis in Non-Diabetic Patients with COVID-19.

Rhino-orbital Cerebral Mucormycosis (ROCM), a rare invasive fungal infection, affects diabetic and immunocompromised individuals. Recent reports have raised the alarm for invasive ROCM associated with SARS-CoV-2 infection. SARS-CoV-2 infection causes immune cell dysregulation, cytokine dysregulation, and is associated with invasive fungal infections. Immunosuppressive treatment of COVID-19 with corticosteroids increases the risk of opportunistic infection. We present a series of 3 cases of invasive ROCM with different outcomes in immunocompetent nondiabetic patients who all received corticosteroids at doses higher than those recommended by the World Health Organization, and who received oxygen during their SARS-CoV-2 treatment course. Immune dysregulatory effects of COVID-19 and high-dose corticosteroids may both have caused predisposition to ROCM in these cases. Additionally, health system stress caused by responding to COVID-19 surges may have predisposed patients to exposure to mucormycosis-causing fungi through use of non-sterilized water for oxygen humidification. In light of these cases, we encourage guideline-based corticosteroid dosing in the management of COVID-19 as well as vigilance for invasive mucormycosis and prompt treatment in corticosteroid-treated patients.

SARS-CoV-2 antibody detection in skilled nursing facility residents.

OBJECTIVE: To describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS-CoV-2 infection. DESIGN: Retrospective analysis of SNF electronic health records. SETTING: Qualitative SARS-CoV-2 antibody test results were available from 81 SNFs in 16 states. PARTICIPANTS: Six hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2. MEASUREMENTS: Presence of SARS-CoV-2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non-cases. RESULTS: Among 397 residents with PCR-confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7-14 days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15-30 days; in 182 of 219 (83.1%) tested within 31-60 days; and in 110 of 124 (88.7%) tested after 60 days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7-14 days of their first PCR test; in 41 of 81 (50.6%) tested within 15-30 days; in 65 of 148 (43.9%) tested within 31-60 days; and in 9 of 34 (26.5%) tested after 60 days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies. CONCLUSIONS: These findings suggest that vulnerable older adults can mount an antibody response to SARS-CoV-2, and that antibodies are most likely to be detected within 15-30 days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS-CoV-2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS-CoV-2 prevalence remains high.

Adverse events following mRNA SARS-CoV-2 vaccination among U.S. nursing home residents.

BACKGROUND: The devastating impact of the SARS-CoV-2 pandemic prompted the development and emergency use authorization of two mRNA vaccines in early 2020. Vaccine trials excluded nursing home (NH) residents, limiting adverse event data that directly apply to this population. METHODS: To prospectively monitor for potential adverse events associated with vaccination, we used Electronic Health Record (EHR) data from Genesis HealthCare, the largest NH provider in the United States. EHR data on vaccinations and pre-specified adverse events were updated daily and monitored for signal detection among residents of 147 facilities who received the first dose of vaccine between December 18, 2020 and January 3, 2021. For comparison, unvaccinated residents during the same time period were included from 137 facilities that started vaccinating at least 15 days after the vaccinating-facilities. RESULTS: As of January 3, 2021, 8553 NH residents had received one dose of SARS-CoV-2 vaccine and by February 20, 2021, 8371 residents had received their second dose of vaccine; 11,072 were included in the unvaccinated comparator group. No significant associations were noted for neurologic outcomes, anaphylaxis, or cardiac events. CONCLUSIONS: No major safety problems were detected following the first or second dose of the vaccine to prevent COVID-19 in the study cohort from December 18, 2020 through March 7, 2021.

Adverse Events Following One Dose of mRNA COVID-19 Vaccination Among US Nursing Home Residents With and Without a Previous SARS-CoV-2 Infection.

OBJECTIVES: To compare rates of adverse events following Coronavirus Disease 2019 (COVID-19) vaccination among nursing home residents with and without previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN: Prospective cohort. SETTING AND PARTICIPANTS: A total of 20,918 nursing home residents who received the first dose of messenger RNA COVID-19 vaccine from December 18, 2020, through February 14, 2021, in 284 facilities within Genesis Healthcare, a large nursing home provider spanning 24 US states. METHODS: We screened the electronic health record for adverse events, classified by the Brighton Collaboration, occurring within 15 days of a resident's first COVID-19 vaccine dose. All events were confirmed by physician chart review. To obtain risk ratios, multilevel logistic regression model that accounted for clustering (variability) across nursing homes was implemented. To balance the probability of prior SARS-CoV-2 infection (previous positive test or diagnosis by the International Classification of Diseases, 10th Revision, Clinical Modification) more than 20 days before vaccination, we used inverse probability weighting. To adjust for multiplicity of adverse events tested, we used a false discovery rate procedure. RESULTS: Statistically significant differences existed between those without (n = 13,163) and with previous SARS-CoV-2 infection [symptomatic (n = 5617) and asymptomatic (n = 2138)] for all baseline characteristics assessed. Only 1 adverse event was reported among those with previous SARS-CoV-2 infection (asymptomatic), venous thromboembolism [46.8 per 100,000 residents 95% confidence interval (CI) 8.3-264.5], which was not significantly different from the rate reported for those without previous infection (30.4 per 100,000 95% CI 11.8-78.1). Several other adverse events were observed for those with no previous infection, but were not statistically significantly higher than those reported with previous infection after adjustments for multiple comparisons. CONCLUSIONS AND IMPLICATIONS: Although reactogenicity increases with preexisting immunity, we did not find that vaccination among those with previous SARS-CoV-2 infection resulted in higher rates of adverse events than those without previous infection. This study stresses the importance of monitoring novel vaccines for adverse events in this vulnerable population.

Can we clinically identify pre-symptomatic and asymptomatic COVID-19?

OBJECTIVES: COVID-19 has had a severe impact on morbidity and mortality among nursing home (NH) residents. Earlier detection of SARS-CoV-2 may position us to better mitigate risk of spread. Both asymptomatic or pre-symptomatic transmission are common in outbreaks, and threshold temperatures, such as 38C, for screening for infection could miss timely detection in the majority. DESIGN: Retrospective cohort study using electronic health records. METHODS: We hypothesized that in long-term care residents, temperature trends with SARS-CoV-2 infection could identify infection in pre-symptomatic and asymptomatic individuals earlier. We collected information about age and other demographics, baseline temperature, and specific comorbidities. We created standardized definitions, and an alternative hypothetical model to test measures of temperature variation and compare outcomes to the VA reality. SETTINGS AND PARTICIPANTS: Our subjects were 6,176 residents of the VA NHs who underwent SARS-CoV-2 trigger testing. RESULTS: We showed that a change from baseline of >0.4C identifies 47% of the SARS-CoV-2 positive NH residents early, and achieves earlier detection by 42.2 hours. Range improves early detection to 55% when paired with a 37.2C cutoff, and achieves earlier detection by 44.4 hours. Temperature elevation >0.4C from baseline, when combined with a 0.7C range, would detect 52% early, leading to earlier detection by more than 3 days in 22% of the residents. This earlier detection comes at the expense of triggering 57,793 tests, as compared to the number of trigger tests ordered in the VA system of 40,691. CONCLUSION AND IMPLICATIONS: Our model suggests that current clinical screening for SARS-CoV-2 in NHs can be substantially improved upon by triggering testing using a patient-derived baseline temperature with a 0.4C degree relative elevation or temperature variability of 0.7C trigger threshold for SARS-CoV2 testing. Such triggers could be automated in facilities that track temperatures in their electronic records.

Ultrasonication assisted fabrication of a tungsten sulfide/tungstite heterostructure for ppb-level ammonia detection at room temperature.

A heterostructure of WS2/WO3·H2O has been prepared by partial oxidation of WS2 nanosheets by exposing bulk WS2 micron powder to ultrasonic waves in a bath sonicator. The as-prepared nanomaterial was used as a sensing film in an interdigitated electrode-based gas detecting device. The device was found to be specific towards ammonia gas among a group oxidizing and reducing gases. In particular, a response of as high as 11.36-254.66% was recorded for ammonia concentrations of 50 ppb to 2 ppm with excellent repeatability and reproducibility at room temperature. The response time and recovery time of the device was found to be a few tens of seconds suggesting its practicability. A plausible mechanism based on different active sites present in the receptor film is proposed and a logical reason behind its specificity towards ammonia gas is also inferred based on the Lewis acidic centers on the nano-surfaces. Overall, this proposed nanomaterial has very high potential for practical use as a room temperature ammonia sensor.

Boron nanostructures obtained via ultrasonic irradiation for high performance chemiresistive methane sensors.

We report on a chemiresistive gas sensor using boron nanostructures as the sensing layer, to detect methane gas down to 50 ppm. The sensor showed an excellent response of 43.5-153.1% for a methane concentration of 50 ppm to 105 ppm, with linear behaviour and good response and recovery time. The stability, repeatability, reproducibility, and shelf life of the sensor are promising for next generation methane gas detection.

Association between dementia and psychiatric disorders in long-term care residents: An observational clinical study.

We examine the relationship between dementia and psychiatric disorder diagnoses among long-term care residents in nursing homes across the state of Rhode Island (RI), USA.Observational clinical study.Two hundred fifty-five residents with and without the diagnosis of dementia were included in this study.Prevalence analysis was used to elucidate information on psychiatric disorders in the overall cohort, and among residents with dementia. Questions from the quality of life questionnaire (EQ-5D-3L) that provides information on self-care, anxiety/depression, and resident's view of how healthy they are, were used to evaluate their association with dementia and psychiatric disorders. A logistic regression analysis was conducted to understand the relationship between dementia and mental illness diagnoses in long-term care facilities. Finally, a subgroup logistic regression analysis was performed for residents with Alzheimer disease.65.1% of all residents suffered from at least 1 psychiatric disorder. Anxiety was the most common diagnosis (36.5%), followed by depression (28.6%), and insomnia (14.9%). There was a positive and statistically significant association between any mental illness diagnosis and dementia (adjusted OR: 3.73; 95% CI: 1.34-10.41). Bipolar disorder and insomnia were negatively and statistically significantly associated with dementia (adjusted OR: 0.17; 95% CI: 0.03-0.89 AND adjusted OR: 0.39; 95% CI: 0.16-0.96 respectively). Age and COPD were also statistically associated with dementia (adjusted OR: 1.07; 95% CI: 1.03-1.11 AND adjusted OR: 0.28, 95% CI: 0.12-0.66). Alzheimer disease was positively and significantly associated with the diagnosis of any mental illness (adjusted OR: 3.77; 95% CI: 1.17-12.20).We studied the relationship between dementia and diagnoses of psychiatric disorders present in long-term care residents. We found that residents with a diagnosis of dementia were more likely to suffer from at least 1 psychiatric disorder. Further work is needed to establish the neuropathophysiological relationship between psychiatric disorders and dementia.