Clinical Facilities Research Articles

Gender and postoperative surgical margin status in MIBC: An analysis of the National Cancer Database.

4599 Background: Women with muscle-invasive bladder cancer (MIBC) continue to experience persistent disparities in health outcomes despite accounting for less than 1/3 of newly diagnosed bladder cancer cases. Multiple studies have acknowledged the aggressive profile of female bladder cancer. This study aims to identify tangible areas to intervene and improve the delivery of oncologic care. Methods: The National Cancer Database (NCDB) was queried from 2004-2017 to conduct a retrospective cohort analysis of men and women with MIBC (cT2a-T4). N=41,037 patients with MIBC were reviewed, (30,313 male; 10,724 female). The primary endpoints were OS and surgical margin status. Logistic regression was performed to determine whether female sex conferred differential impact on surgical margin status when controlling for baseline clinical stage, age, receipt of neoadjuvant chemotherapy (NAC), Charleson-Deyo Comorbidity Classification (CDCC), and facility type. Cox proportional hazards assessed the impact of age, gender, margin status, CDCC and NAC on OS. Results: Logistic regression showed that sex, age, baseline clinical stage, CDCC, facility type and NAC were significant predictors of surgical margin status (p<.001). Female sex was found to have a 14.4% higher probability of having positive residual margins (HR 1.144 (95% CI: 1.07-1.23), p<.001). When adjusting for age, margin status, CDCC and NAC, Female gender (OS HR 1.063 (95% CI: 1.03-1.09), p<.001), positive microscopic margins (OS HR 2.0 (95% CI: 1.90-2.10), p<.001) and positive macroscopic margins (OS HR 2.62 (95% CI: 2.40-2.90), p<.001) independently portended poorer OS and necessitated increased adjuvant XRT (p<.001). Unexpected demographic findings included a significantly greater number of females than expected with a median household income <$38,000 (p= 0.047) and a greater number of females in the upper quartile of patients without a HS diploma (p<.001). The median days from diagnosis to definitive surgical treatment was significantly lower compared to males (58 vs 67 days; p<.001). Conclusions: Women with MIBC faced obstacles to getting treatment (less education and lower median income). Despite these hurdles they may be more proactive with their health as seen by a shorter time from diagnosis to the surgical table. However, this proactivity has yet to pay off as women undergoing surgical treatment for MIBC were significantly less likely to have clear margins post-operatively. The urologic community must mirror female patient’s proactivity and further investigate the gender disparity in surgical treatment of MIBC. [Table: see text]

Method for estimation of apoptotic cell fraction of cytotherapy using in vivo fluorine-19 magnetic resonance: pilot study in a patient with head and neck carcinoma receiving tumor-infiltrating lymphocytes labeled with perfluorocarbon nanoemulsion

BackgroundAdoptive transfer of T cells is a burgeoning cancer therapeutic approach. However, the fate of the cells, once transferred, is most often unknown. We describe the first clinical experience with...

A case report of pulmonary edema associated with left cardiac failure secondary with mitral insufficiency in dog

The cardiac left insufficiency with mitral dysfunction is a relevant cardiac pathology with importante repercussion in the lung, leads to pulmonary edema. Pulmonary edema corresponds to the accumulation of fluid in the lung parenchyma and alveoli, and can be classified as cardiogenic or non-cardiogenic. Clinical signs and symptoms include presence of dyspnea, cough, tachypnea, and alteration of normal sounds during lung auscultation. In this case report, a 16 year old female Lhasa Apso dog breed was presented to the clinical facility with signals of apathy, hyporexia, cough and dyspnea. After emergency treatment with oxygen therapy to stabilize the respiratory condition, imaging tests (radiography, Doppler echocardiography) were performed, confirming the suspicion of cardiogenic pulmonary edema due to left heart disease. The treatment of cardiac dysfunction was recommended through the use of pimobendan, which has a positive inotropic effect on the heart, and benzepril, an angiotensin-converting enzyme inhibitor. These drugs are important to control pulmonary vascular pressure, reducing the risk of developing pulmonary edema. Even though it is a veterinary clinical emergency, cardiogenic pulmonary edema when treated immediately and correctly tends to present a favorable prognosis in affected dogs.

Assessment of healthcare accessibility in Guangdong-Hong Kong-Macao Greater Bay Area

Hospitals play a crucial role in promoting public health and well-being, but their distribution and accessibility can significantly affect healthcare outcomes. The Guangdong-Hong Kong-Macau Greater Bay Area (GBA) boasts an abundance of healthcare resources; however, access to these facilities can be challenging due to population clustering and inadequate resource allocation. Unfortunately, quantifying residents' access to healthcare is complicated by the lack of a centralized database and complex transportation systems. To address these limitations, we developed a comprehensive healthcare facility dataset comprising 54,902 sites, utilizing internet maps' precise location services. Furthermore, we developed a novel framework for real-time driving-based path planning that integrates facility geographic coordinates and population density data. Our analysis revealed that 6.7% (4.8 million people) could not reach a healthcare facility within 30 min. Even after accounting for rural clinic facilities, 2.5% (1.8 million people) remained unable to access healthcare, mainly in peripheral cities. Finally, we simulated a scenario in which 12 new hospitals were added to demonstrate the effectiveness of reasonable hospital placement in improving healthcare accessibility. By investigating GBA's experience, we can derive best practices, pinpoint areas for improvement, and inform policy development aimed at enhancing healthcare accessibility for all residents. Our findings can serve as a blueprint for other provinces in China and provide insights into healthcare accessibility and resource allocation strategies for other nations with similar hierarchical healthcare systems.

Peter Goadsby: knowledge of politics, politics of knowledge

If you work in headache and migraine, you don't need me to tell who Peter Goadsby is, but just in case, he is professor of neurology and director of the National Institute for Health Research's clinical research facility at King's College London, consultant neurologist at King's College Hospital and Great Ormond Street Hospital (both London, UK), and professor emeritus of neurology at the University of California (Los Angeles, CA, USA). I am sure you'll know that he challenged the received vascular mechanism of migraine to unravel one based on dysfunctional neuropeptide production in the trigeminal nerve. You will also know his work lies behind the advent of drugs targeting calcitonin gene-related peptide (CGRP) and its receptor—monoclonal antibodies for keeping migraine at bay, and gepants, which have given relief to many migraineurs. You might even know about his being co-recipient of the 2021 Brain Prize, and his election as a fellow to the Royal Society in May, 2022. But you won't be aware that he initially told me he was so focused on his work that he'd be pretty dull to write about. Well, that was hardly true: especially when he told me he once thought he'd become a politician—a politician with knowledge.

World Health Organization's global oral health status report: Paediatric dentistry in the spotlight.

World Health Organization's global oral health status report: Paediatric dentistry in the spotlight.

Greater attention to flexible hospital designs and ventilated clinical facilities are a pre-requisite for coping with the next airborne pandemic

Greater attention to flexible hospital designs and ventilated clinical facilities are a pre-requisite for coping with the next airborne pandemic

Clinical Documentation During Clinical Placements: Perspectives of Physiotherapy Students and Clinical Educators

Background: Clinical documentation is a critical form of communication in healthcare settings. As defined by the Physiotherapy Practice Thresholds, clinical documentation that complies with relevant professional and legal obligations is a requirement for all physiotherapists in Australia and New Zealand. Aims: The aims of this study were to explore the experiences of clinical documentation and perceived support and training needs for physiotherapy students whilst on clinical placement, from the perspective of students and clinical educators. Method: A qualitative approach was used to investigate physiotherapy student (n=18) and clinical educator (n=17) experiences and perspectives. Interviews from eight focus groups were professionally transcribed, and reflexive thematic analysis was applied to the data to determine common themes. Results: Four overarching themes were generated; 1) Recognising the value of documentation, 2) Variance of expectations, 3) Challenges in measuring performance, and 4) Clinical placement readiness and requirements. Conclusion: The main findings from this study identify the unique challenges that students experience to meet documentation requirements on clinical placement. This study highlights the shared responsibility of university education providers and clinical placement facilities to support students to understand the importance of clinical documentation and assist in improving their documentation skills.

From Student to Mentor in Clinical Practice: Health Care Students' Experiences in a Mentoring Course

Clinical practice is a compulsory and essential part of health care studies in Finland. However, there are not enough trained mentors at clinical practice facilities. The objective of this mentoring course was to provide students training at the earliest possible stage. Students from various health care disciplines participated in the mentoring course. The course was conducted entirely online, and learning methods included lectures, small-group exercises, and discussion forums. Students' responses indicated the mentoring course enabled them to learn about a mentor's role and about various mentoring theories. The mentoring course helped prepare health care students for their future work life and for the clinical mentoring of students. The course expanded students' views on a mentor's duties and helped them reflect on their personal strengths and weaknesses. [J Nurs Educ. 2023;62(5):298-301.].

Human heart explant-derived cell extracellular vesicles inhibit NLRP3 inflammasome activation in macrophages

Background: Abnormal activation of NLRP3 (NOD-, LRR- and pyrin domain-containing protein 3) inflammasome plays a crucial role in promoting myocardial inflammation and adverse remodeling. Extracellular vesicles (EVs) secreted by heart explant-derived cells (HDCs) have been shown to reduce inflammation and confer cardioprotection in animal models of myocardial infarction. These salutary effects are suggested to be mediated by antiinflammatory microRNA (miRNA) cargo found within the EVs. However, whether HDC EVs can modulate NLRP3 inflammasome activation is not known. Hypothesis & Study Objective: Given their antiinflammatory effects and abundantly enriched miRNA transcripts, we hypothesized that HDC EVs attenuate NLRP3 inflammasome activation. Therefore, the objective of this study was to assess the inhibitory effect of HDC EVs on NLRP3 inflammasome activation in macrophages-a major proinflammatory cell type recruited to myocardium after an ischemic insult. Methods: Human HDCs were cultured from cardiac biopsies in a clinical grade cell manufacturing facility. EVs were isolated from conditioned media (ultracentrifugation) and characterized for their identity (Nanosight & antibody array). Monocytes (THP-1) were differentiated into macrophages with phorbol-myristate acetate (PMA; 3 days) and treated with EVs (4E+10 EVs/mL; 20 hours) before priming (lipopolysaccharide; 4 hours) and activating (nigericin; 1 hour) NLRP3 inflammasome. Caspase-1 activity, IL-1β and IL-18 levels in the culture supernatants were measured using a Caspase-Glo® 1 assay and ELISA respectively. EV miRNA cargo was profiled using nCounter ® human miRNA expression assay. Functional enrichment analysis and miRNA target prediction were performed using bioinformatic tools (Tam 2.0 & miRWalk v3). Results: EV size (160±2 nm) and markers (ICAM, ALIX, CD81, CD63, EPCAM, ANXAS, TSG101, FLOT-1) confirmed EV identity. EV treatment significantly inhibited NLRP3 inflammasome induced caspase-1 activity (67% lower vs. no EV treated, n=4-6, p<0.0001). Further, EV treated macrophages showed a significant reduction in IL-18 (623±8 vs.1462±43 pg/mL, n=3, p=0.0025) and a trend towards reduction in IL-1β levels (1292±115 vs. 2535±115 pg/mL, n=3, p=0.08). MicroRNA set analysis revealed that EVs are enriched with 22 anti-inflammatory miRNAs and importantly 3 of the top 10 significantly enriched functional terms (overrepresentation, p<0.05) are found to be related to immunity and inflammation. Interestingly, EVs are enriched with 4 miRNAs (miR-100, miR-181a, miR-21, miR-22) predicted to inhibit NLRP3 inflammasome. Conclusion: Our findings show that human heart explant-derived cell EVs inhibit activation of NLRP3 inflammasome in macrophages and this effect in part is possibly mediated via transfer of their anti-inflammatory miRNA cargo. These preliminary findings encourage a preclinical investigation to assess EV modulatory effect on NLRP3 inflammasome in models of ischemic heart disease. Canadian Institutes of Health Research Project Grant 410103 (DRD) and University of Ottawa Heart Institute Strategic Research Endowed Fellowship (RV) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Current Practice of Physical Therapists: An evidence-based practice survey

Background: Patient/client management is comprehensive multidirectional process. It includes patient client examination, evaluation, diagnosis, prognosis, intervention and then discharge plans from supervised treatment to follow ups. The process of examination includes comprehensive history taking, performing systemic review and special tests and measures. Aim: To investigate Pakistani physiotherapists’ current practice, skills and understanding of evidence-based practice in order to improve the utilization of the evidence base in physiotherapy in the country. Methods: This observational cross section study was done in Pakistan Institute of Medical Sciences and Islamabad Medical and Dental College, Islamabad between January 2021 and March 2021. Physiotherapists(n=369) were contacted through non-probability convenience sampling technique. Respondents were contacted at clinical facilities in the twin cities of Pakistan. The content of the questionnaire was validated using the literature and the method of Lynn MR et al. The results were extracted, conclusion was drawn, suggestions and recommendations were made. Results: The participants mean age was 27.58±7.41 years. The male/female ratio was almost same. Approximately half of the respondents 50.4% were agreed about the role of EBP in practice.57% respondents were agreed that EBP removes the art from clinical practice. 58.5% respondents were agreed about benefit of EBP and EBP improves clinical outcomes and 53.4%respondents were agreed about help of EBP in decision making. Attitude and knowledge need analysis was positive but there found compromise in utilization of this evidence-based practice, while this study showed more utilization. Conclusion: Five steps of evidence-based practice were found being infrequently practiced. Physiotherapists had good to fair understanding of evidence-based practice. Physiotherapists had fair to poor appraisal skills. Keywords: Clinician practice; Data base; Evidence-based practice; Physical therapist; Practice guideline; Patient management.

Supporting Midwifery Students During Clinical Practice: Results of a Systematic Scoping Review.

Midwifery educators are highly concerned about the quality of clinical support offered to midwifery students during clinical placement. The unpreparedness of midwifery practitioners in mentorship roles and responsibilities affects the competence levels of the next-generation midwives being produced. The aim of this paper is to highlight various clinical support interventions to support midwifery students globally and propose a framework to guide mentorship training in South Africa. This paper adopts a mixed methodology approach guided by the Arksey and O'Malley framework. Keywords such as midwifery students, clinical support, mentorship, preceptorship, and midwifery clinical practice were used during the literature search. The review included primary quantitative, qualitative, and mixed methods design papers published between 2010 and 2020, and studies on clinical support interventions available to midwifery students during clinical placement. The search strategy followed a 3-stage system of title, abstract, and full-text screening using inclusion and exclusion criteria. All included papers were quality appraised with a mixed methods appraisal tool. Extracted data were analyzed and presented in themes following a thematic content analysis approach. The screening results attained 10 papers for data extraction. In total, 7 of the 10 (70%) studies implemented a mentorship training program, 2 (20%) used a training workshop, and 1 (10%) used an intervention guide to support midwifery students in clinical practice. Of these 10 papers, 5 were qualitative, 4 mixed methods, and 1 quantitative in approach. In total, 9 of the 10 (90%) studies were conducted in high-income countries with only 1 study done in Uganda but supported by the United Kingdom. The quality of included papers ranged between 50% and 100%, showing moderate to high appraisal results. Significant findings highlighted that the responsibility of mentorship is shared between key role players (midwifery practitioners, students, and educators) and thus a 3-fold approach to mentorship. Mentorship training and support are essential to strengthen the clinical support of midwifery students during placement. The main findings produced 2 main themes and 2 subthemes each. The main themes included strengthening partnerships and consultation; and providing mentor support through training. The 4 subthemes were: establishing stronger partnerships between nursing education institutions and clinical facilities; improving consultation between midwifery educators, practitioners, and students; the quality of clinical support depends on the training content; and the training duration and structure. Hence, the researchers proposed these subthemes in a framework to guide mentorship training. Mentorship training and support for midwifery practitioners will likely strengthen the quality of midwifery clinical support. A framework to guide mentorship training will encourage midwifery educators to develop and conduct mentorship training with ease. More studies using quantitative approaches in research and related to midwifery clinical support are required in African countries. RR2-10.2196/29707.

Understanding dementia care pathways for policy development and service planning in Kenya.

In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families. To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice. The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes. We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow. Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.

Demographic Factors Associated with Presenting for Eye Evaluation in the Partnership for Research on Vaccines and Infectious Diseases in Liberia III Natural History Study of Ebola Virus Disease.

Survivors of Ebola virus disease (EVD) are at risk for ocular complications after infection. We sought to identify demographic factors associated with the likelihood to present for eye examination among Ebola survivors enrolled in a longitudinal natural history study of EVD. The Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL) III Ebola natural history study is a 5-year study that seeks to identify long-term sequelae of EVD, including ocular sequelae. All survivors enrolled in the PREVAIL parent study from June 2015 to March 2016 were asked to return for comprehensive eye examination through June 2016. Logistic regression was conducted using self-reported survivor status, age, gender, and distance from the hospital as covariates. A total of 1448 subjects enrolled in the parent PREVAIL III longitudinal cohort during the defined window, of which 1375 (95.0%) followed up for baseline eye examination. Ebola survivors (635/661, 96.1%) and adult close contacts (727/767, 94.8%) demonstrated a comparable likelihood for presenting for eye examination (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.36-1.28). In an adjusted model, age over 50 (OR 10.2, 95% CI 1.35-77.3) and living outside Montserrado County (OR 0.18, 95% CI 0.10-0.33) were associated with the likelihood of presenting for a baseline comprehensive eye examination. Most EVD survivors and their close contacts who enrolled during the study window presented for eye examinations. Older participants and those who lived closer to clinical facilities were most likely to present. Focused strategies accounting for these factors may assist with organizations planning survivor care in the setting of EVD.

Tuberculosis service disruptions and adaptations during the first year of the COVID-19 pandemic in the private health sector of two urban settings in Nigeria-A mixed methods study.

Nigeria has the second largest share of undiagnosed TB cases in the world and a large private health sector estimated to be the point of initial care-seeking for 67% of TB patients. There is evidence that COVID-19 restrictions disrupted private healthcare provision, but insufficient data on how private healthcare provision changed as a result of the pandemic. We conducted qualitative interviews and a survey to assess the impact of the pandemic, and government response on private healthcare provision, and the disruptions providers experienced, particularly for TB services. Using mixed methods, we targeted policymakers, and a network of clinical facilities, laboratories, community pharmacies, and medicine vendors in Kano and Lagos, Nigeria. We interviewed 11 policymakers, surveyed participants in 2,412 private facilities. Most (n = 1,676, 70%) facilities remained open during the initial lockdown period, and most (n = 1,667, 69%) offered TB screening. TB notifications dipped during the lockdown periods but quickly recovered. Clinical facilities reported disruptions in availability of medical supplies, staff, required renovations, patient volume and income. Few private providers (n = 119, 11% in Kano; n = 323, 25% in Lagos) offered any COVID-19 screening up to the time of the survey, as these were only available in designated facilities. These findings aligned with the interviews as policymakers reported a gradual return to pre-COVID services after initial disruptions and diversion of resources to the pandemic response. Our results show that COVID-19 and control measures had a temporary impact on private sector TB care. Although some facilities saw decreases in TB notifications, private facilities continued to provide care for individuals with TB who otherwise might have been unable to seek care in the public sector. Our findings highlight resilience in the private sector as they recovered fairly quickly from pandemic-related disruptions, and the important role private providers can play in supporting TB control efforts.

Analysis of Passenger Inspection during the Covid-19 Period at Zainuddin Abdul Madjid International Airport, Lombok, West Nusa Tenggara

Domestic travel by airplane during the COVID-19 pandemic requires several new things regulated in dynamic regulations that are adjusted to the conditions of the development of COVID-19 in the community and the control carried out by the government. Some new things that passengers must do during security checks by Aviation Security at SCP-1 and PSCP. The purpose of this study is to explain the passenger inspection procedures and obstacles faced by Avsec officers in conducting passenger checks on SCP-1 and PSCP during the Covid-19 pandemic at Zainuddin Abdul Madjid International Airport, Lombok, NTB. This study used descriptive qualitative methods, the informants interviewed consisted of 1 Supervisor and 1 Squad leader at SCP-1 and 1 Officer at PSCP, with data collection techniques using interview, observation and documentation methods. validity of qualitative data using triangulation method. The results found that passenger inspection procedures by Avsec officers at SCP-1 and PSCP underwent changes with several additional procedures. Additional procedures are implemented in accordance with the Circular Letter of the Minister of Transportation Number SE 82 of 2022, the Circular Letter regulates various matters related to health protocols, completeness of vaccination and matters related to safety from Covid-19 transmission during travel. The obstacles faced by Avsec officers when conducting passenger checks are related to compliance with health protocols, completeness of vaccinations, long queues so that the inspection time is longer than usual. The solution is in the form of adding emergency clinic facilities for passengers who need vaccination and maximizing services by existing Avsec officers.

DESIGN OF AN EYE CLINIC SHIP WITH A HYBRID ELECTRIC ENERGY SOURCE FOR THE NUSA TENGGARA ISLANDS

The World Health Organization reports that cataracts are responsible for up to 77.7% of visually impaired individuals in Southeast Asia, with Indonesia having the largest population of such individuals. Cataracts can grow faster in areas exposed to much exposure to ultraviolet rays, such as the Nusa Tenggara Islands, which cover 3 provinces, namely Bali, West Nusa Tenggara (NTB), and East Nusa Tenggara (NTT). The availability of ophthalmologists in NTB and NTT is still lacking. One ophthalmologist serves 261,969 people in NTB and 871,510 people in NTT. This condition contrasts the target distribution of ophthalmologists according to the 2017-2030 Roadmap for Management of Visual Impairment in Indonesia. The development of the shipping industry has had a negative impact on world carbon dioxide (CO2) emissions. The use of a multi-energy hybrid system is believed to be able to effectively reduce energy consumption and emissions from ships. So, in this study, an innovation in the design of an Eye Clinic Vessel with a hybrid electric energy source was designed using the Spiral Design method. This paper aims to obtain operational patterns, payload, main dimensions, technical calculations, lines plan, general arrangements, safety plans, and 3D models. The ship will serve 14 areas with a ratio of ophthalmologists with a population of more than 1:250,000. Two ships will be built, which will be divided into 2 routes, namely the North Route and the South Route. Each area will be served for one week, so 1 round trip of the Eye Clinic Ship takes around 52 days. This ship has a payload in the form of a minimum deck area for clinical facilities of 228.2 m2 and can accommodate 25 patients with a length overall (Loa) of 38.27 m; Width (B) 10 m; Height (H) 3 m; Draft (T) 1.8 m; and Service Speed (Vs) 13 knots. The ship uses 86 units of solar panels with 120 batteries to store electrical energy. This solar panel can save fuel usage up to 54%.

Characterization of SARS-CoV-2 Distribution and Microbial Succession in a Clinical Microbiology Testing Facility during the SARS-CoV-2 Pandemic.

The exchange of microbes between humans and the built environment is a dynamic process that has significant impact on health. Most studies exploring the microbiome of the built environment have been predicated on improving our understanding of pathogen emergence, persistence, and transmission. Previous studies have demonstrated that SARS-CoV-2 presence significantly correlates with the proportional abundance of specific bacteria on surfaces in the built environment. However, in these studies, SARS-CoV-2 originated from infected patients. Here, we perform a similar assessment for a clinical microbiology lab while staff were handling SARS-CoV-2 infected samples. The goal of this study was to understand the distribution and dynamics of microbial population on various surfaces within different sections of a clinical microbiology lab during a short period of 2020 Coronavirus disease (COVID-19) pandemic. We sampled floors, benches, and sinks in 3 sections (bacteriology, molecular microbiology, and COVID) of an active clinical microbiology lab over a 3-month period. Although floor samples harbored SARS-CoV-2, it was rarely identified on other surfaces, and bacterial diversity was significantly greater on floors than sinks and benches. The floors were primarily colonized by bacteria common to natural environments (e.g., soils), and benchtops harbored a greater proportion of human-associated microbes, including Staphylococcus and Streptococcus. Finally, we show that the microbial composition of these surfaces did not change over time and remained stable. Despite finding viruses on the floors, no lab-acquired infections were reported during the study period, which suggests that lab safety protocols and sanitation practices were sufficient to prevent pathogen exposures. IMPORTANCE For decades, diagnostic clinical laboratories have been an integral part of the health care systems that perform diagnostic tests on patient's specimens in bulk on a regular basis. Understanding their microbiota should assist in designing and implementing disinfection, and cleaning regime in more effective way. To our knowledge, there is a lack of information on the composition and dynamics of microbiota in the clinical laboratory environments, and, through this study, we have tried to fill that gap. This study has wider implications as understanding the makeup of microbes on various surfaces within clinical laboratories could help identify any pathogenic bacterial taxa that could have colonized these surfaces, and might act as a potential source of laboratory-acquired infections. Mapping the microbial community within these built environments may also be critical in assessing the reliability of laboratory safety and sanitation practices to lower any potential risk of exposures to health care workers.

Symptom Assessment of Patients with Allergic Rhinitis Using an Allergen Exposure Chamber

Allergen exposure chambers (AECs) are clinical facilities that allow the exposure of participants to allergenic and non-allergenic airborne particles. They provide stable particle concentrations under controlled environmental conditions. This is of great importance both for diagnostic purposes and for the monitoring of treatment effects. Here, a protocol and the technical prerequisites for performing a safe and effective allergen challenge in subjects sensitized to airborne allergens (i.e., house dust mite [HDM]) in the ALL-MED AEC are presented. With this method, triggering allergic symptoms corresponds to natural exposure. This can be used for an allergy diagnosis or as a plausible endpoint in clinical trials, particularly for allergen immunotherapy (AIT). A controlled environment (temperature, humidity, and carbon dioxide [CO2]) in the chamber must be maintained. Allergen particles must be dispersed evenly within the AEC at stable levels throughout the challenge. For this presentation, allergic rhinitis (AR) patients sensitive to HDM allergens were enrolled. AR symptoms were assessed by the following parameters: total nasal symptom score (TNSS), acoustic rhinometry (ARM), peak nasal inspiratory flow (PNIF), and nasal secretion weight. The safety of the procedure was assessed by the peak expiratory flow rate (PEFR) and the forced expiratory volume in the first second (FEV1). The allergic subjects developed symptoms within 120 min of the trial. On average, the most intense symptoms appeared after 60-90 min and, after reaching a plateau, remained stable until the end of the trial.

Screening Technologies to Support Infection Prevention and Control in Long-Term Care

Many clinical environments implemented Coronavirus Disease 2019 (COVID-19) screening technologies at entry points to identify and isolate cases. Despite the widespread adoption of screening technologies in vulnerable care settings, such as in long-term care (LTC) homes, implementations and protocols have yet to be thoroughly reviewed in the literature. Therefore, the Dynamic Sustainability Framework was applied to identify the limitations of various screening technology implementations. Based on identified limitations, design recommendations are put forward to support healthcare planning and design teams of long-term care homes, and clinical facilities to improve infection prevention and control (IPC).