Period Of High Incidence Research Articles

Meningococcal carriage in periods of high and low invasive meningococcal disease incidence in the UK: comparison of UKMenCar1–4 cross-sectional survey results

SummaryBackgroundThe incidence of invasive meningococcal disease in the UK decreased by approximately four times from 1999 to 2014, with reductions in serogroup C and serogroup B disease. Lower serogroup C invasive meningococcal disease incidence was attributable to implementation of the meningococcal serogroup C conjugate vaccine in 1999, through direct and indirect protection, but no vaccine was implemented against serogroup B disease. UK Meningococcal Carriage surveys 1–3 (UKMenCar1–3), conducted in 1999, 2000, and 2001, were essential for understanding the impact of vaccination. To investigate the decline in invasive meningococcal disease incidence, we did a large oropharyngeal carriage survey in 2014–15, immediately before the changes to meningococcal vaccines in the UK national immunisation schedule.MethodsUKMenCar4 was a cross-sectional survey in adolescents aged 15–19 years who were enrolled from schools and colleges geographically local to one of 11 UK sampling centres between Sept 1, 2014, and March 30, 2015. Participants provided an oropharyngeal swab sample and completed a questionnaire on risk factors for carriage, including social behaviours. Samples were cultured for putative Neisseria spp, which were characterised with serogrouping and whole-genome sequencing. Data from this study were compared with the results from the UKMenCar1–3 surveys (1999–2001).FindingsFrom the 19 641 participants (11 332 female, 8242 male, 67 not stated) in UKMenCar4 with culturable swabs and completed risk-factor questionnaires, 1420 meningococci were isolated, with a carriage prevalence of 7·23% (95% CI 6·88–7·60). Carriage prevalence was substantially lower in UKMenCar4 than in the previous surveys: carriage prevalence was 16·6% (95% CI 15·89–17·22; 2306/13 901) in UKMenCar1 (1999), 17·6% (17·05–18·22; 2873/16 295) in UKMenCar2 (2000), and 18·7% (18·12–19·27; 3283/17 569) in UKMenCar3 (2001). Carriage prevalence was lower for all serogroups in UKMenCar4 than in UKMenCar1–3, except for serogroup Y, which was unchanged. The prevalence of carriage-promoting social behaviours decreased from 1999 to 2014–15, with individuals reporting regular cigarette smoking decreasing from 2932 (21·5%) of 13 650 to 2202 (11·2%) of 19 641, kissing in the past week from 6127 (44·8%) of 13 679 to 7320 (37·3%) of 19 641, and attendance at pubs and nightclubs in the past week from 8436 (62·1%) of 13 594 to 7662 (39·0%) of 19 641 (all p<0·0001).InterpretationWe show that meningococcal carriage prevalence in adolescents sampled nationally during a low incidence period (2014–15) was less than half of that in an equivalent population during a high incidence period (1999–2001). Disease and carriage caused by serogroup C was well controlled by ongoing vaccination. The prevalence of behaviours associated with carriage declined, suggesting that public health policies aimed at influencing behaviour might have further reduced disease.FundingWellcome Trust, UK Department of Health, and National Institute for Health Research.

Comprehensive surveillance data suggest a prominent role of parvovirus B19 infection in Belarus and the presence of a third subtype within subgenotype 1a

Human parvovirus B19 (B19V) infection is not notifiable in Belarus and its most common clinical presentation erythema infectiosum (EI) is often difficult to distinguish from other exanthematous diseases. The objective of this study was to provide comprehensive data about EI epidemiology in Belarus based on the serological and molecular investigation of samples from measles and rubella discarded cases collected between 2005 and 2019. Overall, 4919 sera were investigated for IgM antibodies against B19V and the positive cases were analysed according to year, season and age. B19V DNA was amplified by PCR in a total of 238 sera from all over the country, and sequenced for phylogenetic analyses. B19V infection was confirmed in 1377 (27.8%) measles and rubella discarded cases. Two high incidence periods and a seasonal increase of EI between mid-February to mid-July were identified. Children from 4 to 6 and from 7 to 10 years of age represented the largest groups of patients (22.51% and 22.66% of all cases, respectively), followed by adults between 20 and 29 years of age (14.23%). Among the 238 B19Vs sequenced, one belonged to subgenotype 3b and 237 to subgenotype 1a with 81 (34.2%) clustering with subtypes 1a1 and 153 (64.6%) with 1a2. Three strains (1.2%) formed an additional, well-supported cluster suggesting the presence of another subtype of 1a, tentatively named 1a3. The epidemiological and molecular analyses highlighted not only the prominent role of B19V in exanthematous diseases in Belarus, but also suggested a previously underestimated diversity of subgenotype 1a sequences with a third subtype 1a3.

Analysis and Countermeasures of 101 Inpatients with Falls in Internal Medicine Department

Falling of inpatients can cause serious injuries to patients, family members and caregivers. It damages patients’ physical and mental health, increases the remedy cost of medical institution, and affects the quality of nursing service in hospital. The aim of this study is to analyze the current situation of falls of inpatients in internal medicine department, so as to provide reference information for improving patient safety management and hospital quality control. With the help of the method of retrospective investigation, the number of inpatients with falls in the First Affiliated Hospital of Jinan University from January to December 2019 was reviewed, and the incidence, causes, time and nurse patient ratio were analyzed. There were total 101 falls of inpatients in internal medicine department in year 2019, accounting for 58% of the fall patients in the hospital, the fall rate of internal medicine department inpatients was 0.5‰. The injury rate of grade1 and above was 54.45%. The incidence of falls has three epidemiological characteristics, mainly for the elderly over 60 years old, accounting for 71.3%, the most commonplace to fall is the toilet, the high incidence period is 22:01-07:00. Drugs are one of the main factors leading to falls, with sedative-hypnoticdrugs (benzodiazepines) being the most common, followed by antidiabetic drugs, antihypertensive drugs and diuretics. Patients at high risk of falling, despite the presence of caregivers is 69.3%, had a higher incidence of falls. A nurse on duty attended to 10 to 50 patients in the falling event. From the above outcome, it is illustrated that the incidence of fall injury in medical inpatients is higher. The main population is the elderly and patients taking sedatives, sleeping pills or hypoglycemic drugs. Nurses need to keep an eye out for patients who take medications that can easily lead to falls. Hospital management departments should strengthen the training of nursing staff and new nurses, establish safety culture and improve nurses’ consciousness of fall prevention. Head nurses should take flexible shift system to effectively reduce the incidence of falls.

Damage levels of sunburn in pineapple fruits submitted to natural and artificial protection

Pineapple sunburn (SB) occurs mostly in regions with a high incidence of sunlight and temperature, causing damage to the fruits and financial losses for the producer. The objective of this study was to evaluate natural and artificial protection in the reduction of physical and physiological damage in pineapple, submitted to high temperature and sunlight. The experimental design was in randomized blocks with seven treatments: single planting of pineapple (cv. Pérola), with and without the protection of fruits with woven fabrics (TNT) and intercropping with cassava (cv. Amazonas) in different spacing in the row (0.40; 0. 60; 0.80; 1.00; and1.20 m), and three replications. For the study, a scale of damage level (DL) to the pineapple by SB was established, ranging from 0 to 4 (DL0 - 4). Chlorophyll content, mass of fruits and crown, percentage of fruits with SB, and commercial fruits were evaluated. The TNT uses showed maximum protection for the fruits, being all suitable for fresh consumption no damage (DL0). In intercropping, the spacing of 0.80 and 1.20 m is indicated to maximize fruit production and protection. The absence of fruit protection caused damage up to N4, with fruits strictly suitable for industry (70%) and disposal (13%). In an environment with high temperature and irradiation, the adoption of fruit protection is necessary. The planning of floral induction allows the fruiting to not coincide with the critical period of high solar incidence and temperature and can avoid the use of protection strategies. The intercropping of pineapple and cassava protects pineapple fruits against sunburn; moreover, its use does not leave inorganic residues in the environment; therefore, it is strongly recommended as a strategy to reduce sunburn in pineapple fruits.

Structured reporting in portable chest radiographs: An essential tool in the diagnosis of COVID-19

PurposeTo date, the majority of chest imaging studies in COVID-19 pneumonia have focused on CT. Evidence for the utility of chest radiographs (CXRs) in this population is less robust. Our objectives were to develop a systematic approach for reporting likelihood of COVID-19 pneumonia on CXRs, to measure the interobserver variability of this approach and to evaluate the diagnostic performance of CXRs compared to real-time reverse transcription polymerase chain reaction (RT-PCR). MethodRetrospective review of patients suspected of having COVID-19 pneumonia who attended our emergency department and underwent both CXR and a RT-PCR were included. Two radiologists reviewed the CXRs, blind to the RT-PCR, and classified them according to a structured reporting template with five categories (Characteristic, High Suspicion, Indeterminate, Unlikely and Normal) which we devised. For analysis of diagnostic accuracy, Characteristic and High Suspicion CXRs were considered positive and the remaining categories negative. Concordance between the two assessors was also measured. ResultsOf 582 patients (51 +/- 20 years), 143/582 (24.6 %) had a positive RT-PCR. The absolute concordance between the two assessors was 71.1 % (414/582) with a Fleiss-Cohen-weighted Cohen’s κ of 0.81 (95 % confidence interval, 0.78-0.85). A patient with a positive CXR had an 88 % (95 % CI 80–96 %) probability of having a positive RT-PCR during a period of high incidence, early in the COVID-19 pandemic. ConclusionUsing a structured approach, a positive CXR had a high likelihood of predicting a positive RT-PCR, with good interrater reliability. CXRs can be useful in identifying new cases of COVID-19.

Epidemic character and environmental factors in epidemic areas of severe fever with thrombocytopenia syndrome in Shandong Province

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging lethal tick-borne disease that has been widely prevalent in East Asia in recent years, and raised an important public health problem in China. However, a comprehensive and thorough understanding of the current SFTS epidemic areas in Shandong Province is not available. Accordingly, a descriptive analysis was applied to explore the demographic and spatio-temporal features of SFTS cases in Shandong Province from 2010 to 2015. The division between epidemic areas and non-epidemic areas was given by maximum entropy niche model (MaxEnt) based on environmental factors such as temperature and precipitation. There were 1,786 SFTS cases between 2010 and 2015 in Shandong, mainly involving middle-aged and elderly individuals (age:40–80) and farmers (84.6 %). May–October was the high-incidence period and the SFTS cases were mostly clustered in the central and eastern regions of Shandong Province. In light of MaxEnt, 3 specific environmental features between dichotomous areas were identified, including 1) most epidemic areas are covered by acidic soils (Constituent ratio: 63.8 %) while 29.1 % coverage appears in non-epidemic areas, 2) compared with non-epidemic areas, the identical kinds of agricultural areas accounted for a higher constituent ratio (64.9 % vs. 42.7 %), and 3) lower level of annual temperature in epidemic areas compared to non-epidemic areas [Median: 13.2℃ vs. 14.2℃; (25th IQR, 75th IQR): (12.5, 13.7) vs. (13.6, 14.9)]. Our study suggests middle-aged and elderly farmers are high-risk population to be focused on in future prevention and acidic soils, agricultural activities as well lower temperature that may be related to increased SFTS incidence.

COVID-19 Contact Tracing in Two Counties - North Carolina, June-July 2020.

Contact tracing is a strategy implemented to minimize the spread of communicable diseases (1,2). Prompt contact tracing, testing, and self-quarantine can reduce the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (3,4). Community engagement is important to encourage participation in and cooperation with SARS-CoV-2 contact tracing (5). Substantial investments have been made to scale up contact tracing for COVID-19 in the United States. During June 1-July 12, 2020, the incidence of COVID-19 cases in North Carolina increased 183%, from seven to 19 per 100,000 persons per day* (6). To assess local COVID-19 contact tracing implementation, data from two counties in North Carolina were analyzed during a period of high incidence. Health department staff members investigated 5,514 (77%) persons with COVID-19 in Mecklenburg County and 584 (99%) in Randolph Counties. No contacts were reported for 48% of cases in Mecklenburg and for 35% in Randolph. Among contacts provided, 25% in Mecklenburg and 48% in Randolph could not be reached by telephone and were classified as nonresponsive after at least one attempt on 3 consecutive days of failed attempts. The median interval from specimen collection from the index patient to notification of identified contacts was 6 days in both counties. Despite aggressive efforts by health department staff members to perform case investigations and contact tracing, many persons with COVID-19 did not report contacts, and many contacts were not reached. These findings indicate that improved timeliness of contact tracing, community engagement, and increased use of community-wide mitigation are needed to interrupt SARS-CoV-2 transmission.

Transcriptomic and Proteomic Analysis Revealed the Effect of Funneliformis mosseae in Soybean Roots Differential Expression Genes and Proteins.

Glycine max is easily infected with root rot in continuous cropping systems, which can severely affect crop yield. Arbuscular mycorrhizal fungi (AMF) can reduce the incidence of root rot and increase plant height and biomass indices. However, the molecular changes that occur during soybean symbiosis with AMF remain largely unknown. To better understand the molecular mechanism underlying soybean symbiosis with AMF, we performed transcriptomic and proteomic analyses to explore the changes in protein expression during a high-incidence period (79 days) in asymbiotic and symbiotic plants and to identify the key proteins that regulate the mechanism of soybean symbiosis with AMF. A total of 10 104 genes were identified in the CK-vs-F comparison, and 11 562 genes were significantly differentially expressed in the AF group compared with the F group. A total of 9488 proteins were identified, with 256 differentially expressed proteins (DEPs) in the CK-vs-F comparison and 651 DEPs in the F-vs-AF comparison. Key pathways and DEPs were found to be involved in processes associated with "phenylalanine metabolism", "plant hormone signal transduction", "plant-pathogen interaction", and "metabolic pathways". The expression of phenylalanine ammonia-lyase (PAL), calcium-dependent protein kinase (CPK), and other defense-related proteins was upregulated by Funneliformis mosseae, indicating that inoculation promotes the development of soybean and increases disease resistance. Our results suggest that symbiosis promotes the growth and development of soybean and increases disease resistance. This study provides new insight into the molecular basis of the mechanism by which AMF affect plant disease resistance.

Development of a PHMB hydrogel‐modified wound scaffold dressing with antibacterial activity

Current wound scaffold dressing constructs can facilitate wound healing but do not exhibit antibacterial activity, resulting in high infection rates. We aimed to endow wound scaffold dressing with anti-infective ability by polyhexamethylenebiguanide (PHMB). We prepared PHMB hydrogel at varying concentrations (0.25%, 0.5%, 1%, 2%) and assessed release and cytotoxicity. PHMB hydrogel was added to the wound scaffold dressing to generate a PHMB hydrogel-modified wound scaffold dressing. Wound healing and infection prevention were evaluated using a full-thickness skin defect model in rats. In vitro, the hydrogel PHMB release time positively correlated with PHMB concentration, with 1% allowing sufficiently long release time to encompass the high-incidence period (3-5 days) of infection following wound scaffold dressing implantation. Implantation of 1% PHMB hydrogel into the skin did not cause adverse responses. in vitro cytotoxicity assays showed the PHMB hydrogel-modified wound scaffold dressing did not significantly affect proliferation of fibroblasts or vascular endothelial cells, 99.90% vs 99.84% for fibroblasts and 100.21% vs 99.28% for vascular endothelial cells at 21 days. Transplantation of PHMB hydrogel-modified wound scaffold dressing/unmodified wound scaffold dressing on the non-infected wounds of rats yielded no significant difference in relative vascularization rate, 47.40 vs 50.87 per view at 21 days, whereas bacterial content of the wound tissue in the PHMB hydrogel-modified wound scaffold dressing group was significantly lower than the unmodified wound scaffold dressing group, (1.80 ± 0.35) × 103 vs (9.34 ± 0.45) × 103 at 14 days. Prevalence of persistent wound infection in the rats receiving PHMB hydrogel-modified wound scaffold dressing transplantation onto infected wounds was significantly lower than the unmodified wound scaffold dressing group, 30% vs 100%. PHMB hydrogel-modified wound scaffold dressing exhibited suitable antibacterial ability, and its biological activity did not significantly differ from that of the unmodified wound scaffold dressing, thereby allowing it to effectively prevent infection following wound scaffold dressing implantation.

Parent–child relationships and mobile phone addiction tendency among Chinese adolescents: The mediating role of psychological needs satisfaction and the moderating role of peer relationships

Adolescence is a period of high incidence of mobile phone addiction, which can lead to negative effects on adolescents’ physical and mental health. Previous studies have revealed that family relationships are the core factors that trigger adolescents’ mobile phone addiction tendency. The present study explores the underlying mechanism that connects parent–child relationships and mobile phone addiction tendency among adolescents. It does so by testing the mediating role of psychological needs satisfaction and the moderating role of peer relationships. Data was collected from a sample of 1767 Chinese adolescents (from 10 to 18 years of age) using a questionnaire survey. Our results showed that: (1) psychological needs satisfaction can partially mediate the relationship between parent–child relationships and mobile phone addiction tendency; (2) peer relationships can moderate the direct and indirect links between parent–child relationships and mobile phone addiction tendency. These moderation effects were stronger for adolescents with positive peer relationships than for those with negative peer relationships. This study improves our knowledge of how and when parent–child relationships lead to mobile phone addiction tendency in adolescents and could lead to the development of effective prevention and intervention strategies.

Adoption of image surface parameters under moving edge computing in the construction of mountain fire warning method.

In order to cope with the problems of high frequency and multiple causes of mountain fires, it is very important to adopt appropriate technologies to monitor and warn mountain fires through a few surface parameters. At the same time, the existing mobile terminal equipment is insufficient in image processing and storage capacity, and the energy consumption is high in the data transmission process, which requires calculation unloading. For this circumstance, first, a hierarchical discriminant analysis algorithm based on image feature extraction is introduced, and the image acquisition software in the mobile edge computing environment in the android system is designed and installed. Based on the remote sensing data, the land surface parameters of mountain fire are obtained, and the application of image recognition optimization algorithm in the mobile edge computing (MEC) environment is realized to solve the problem of transmission delay caused by traditional mobile cloud computing (MCC). Then, according to the forest fire sensitivity index, a forest fire early warning model based on MEC is designed. Finally, the image recognition response time and bandwidth consumption of the algorithm are studied, and the occurrence probability of mountain fire in Muli county, Liangshan prefecture, Sichuan is predicted. The results show that, compared with the MCC architecture, the algorithm presented in this study has shorter recognition and response time to different images in WiFi network environment; compared with MCC, MEC architecture can identify close users and transmit less data, which can effectively reduce the bandwidth pressure of the network. In most areas of Muli county, Liangshan prefecture, the probability of mountain fire is relatively low, the probability of mountain fire caused by non-surface environment is about 8 times that of the surface environment, and the influence of non-surface environment in the period of high incidence of mountain fire is lower than that in the period of low incidence. In conclusion, the surface parameters of MEC can be used to effectively predict the mountain fire and provide preventive measures in time.

Consecutive outbreaks of Burkholderia cepacia complex caused by intrinsically contaminated chlorhexidine mouthwashes

We report 2 consecutive outbreaks of the Burkholderia cepacia complex (Bcc) in an intensive care unit (ICU) and describe its characteristics and consequences. Over a 72-day period, a multidisciplinary ICU team detected 2 distinct periods of high and unusual incidence of Bcc isolates that were recovered from cultures of endotracheal aspirate. Cultures of tap water, ultrasound gel and mouthwash (opened and unopened bottles) were performed. Bcc was identified with the BD-Phoenix and MALDI-TOF MS systems, with molecular typing using the enterobacterial repetitive intergenic consensus-polymerase chain reaction technique. In both outbreak 1 (6 patients) and outbreak 2 (5 patients), the point sources of Bcc were chlorhexidine mouthwashes of 2 different brands, both of them intrinsically contaminated. All patients had a clinical diagnosis of ventilator-associated pneumonia (VAP), and 6 died. MALDI-TOF MS identified 2 species of Bcc (B. cenocepacia and B. cepacia). Enterobacterial repetitive intergenic consensus-polymerase chain reaction typing confirmed 100% genetic similarity between patient and mouthwash isolates from each period. The first outbreak was controlled in 20 days and the second in 6 days. The surveillance program for multidrug-resistant organisms, especially in high-risk patients, with the active participation of a multidisciplinary team, was crucial for success in controlling these outbreaks.

Vinyl sulfone-based inhibitors of trypanosomal cysteine protease rhodesain with improved antitrypanosomal activities

The number of reported cases of Human African Trypanosmiasis (HAT), caused by kinetoplastid protozoan parasite Trypanosoma brucei, is declining in sub-Saharan Africa. Historically, such declines are generally followed by periods of higher incidence, and one of the lingering public health challenges of HAT is that its drug development pipeline is historically sparse. As a continuation of our work on new antitrypanosomal agents, we found that partially saturated quinoline-based vinyl sulfone compounds selectively inhibit the growth of T. brucei but displayed relatively weak inhibitory activity towards T. brucei’s cysteine protease rhodesain. While two nitroaromatic analogues of the quinoline-based vinyl sulfone compounds displayed potent inhibition of T. brucei and rhodesain. The quinoline derivatives and the nitroaromatic-based compounds discovered in this work can serve as leads for ADME-based optimization and pre-clinical investigations.

Bacillus baekryungensis MS1 regulates the growth, non-specific immune parameters and gut microbiota of the sea cucumber Apostichopus japonicus

Winter is a high incidence period of skin ulceration syndrome in the sea cucumber Apostichopus japonicus. Disease control during the overwintering of sea cucumber can help increase yield and reduce losses. The purpose of this study was to study the effect of the low temperature-resistant probiotic Bacillus baekryungensis MS1 on the growth and immune parameters of sea cucumbers and preliminarily investigate the molecular mechanism of the effects. A low temperature-resistant bacterium, B. baekryungensis MS1, was isolated from a sea cucumber pond in winter and used for culture experiments. After 10 days of prefeeding, the experiment was divided into the control group (fed with commercial diet) and the MS1 group (fed with diet containing B. baekryungensis MS1 at 107 cfu g−1) for a total of 60 days. The specific growth rate was measured at the end of the culture period to evaluate the growth performance of the sea cucumber. Samples were taken on days 30 and 60 to determine the immune parameters (including superoxide dismutase activity, catalase activity, alkaline phosphatase activity, acid phosphatase activity, nitric oxide synthetase activity, phagocytosis and respiratory burst), aquaculture water microbiota and gut microbiota of the sea cucumber. Finally, transcriptome sequencing and qRT-PCR verification of the two groups of sea cucumbers were performed to study the mechanism of B. baekryungensis MS1 to improve the immunity of the sea cucumber. The results showed that after 60 days of feeding, B. baekryungensis MS1 significantly improved the growth performance and immune enzyme activity and formed a healthier structure of the gut microbiota in the sea cucumber. The challenge test showed that B. baekryungensis MS1 significantly reduced the mortality of sea cucumbers infected with Vibrio splendidus. Transcriptome and gene expression analysis indicated that B. baekryungensis MS1 activated the ubiquitin-mediated proteolysis pathway and inhibited the mTOR signaling pathway to regulate the immunity of the sea cucumber. In summary, the low temperature-resistant bacterium B. baekryungensis MS1 could be applied for the aquiculture of sea cucumber in winter to improve health status and resist pathogenic bacteria such as V. splendidus.

Experience in the treatment of burn patients combined with inhalation injury during the epidemic of coronavirus disease 2019

Objective: To introduce the experience in treating burn patients with inhalation injury during the epidemic of coronavirus disease 2019 (COVID-19). Methods: Six burn patients combined with inhalation injury were hospitalized in Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from February 1 to March 1 in 2020 during the high-incidence period of COVID-19, including 4 males and 2 females, aged 21-63 years, admitted at 2-4 hours after burns, with total burn areas of 1%-20% total body surface area (TBSA) and full-thickness burn areas of 1%-12% TBSA. Among them, 1 case had severe inhalation injury, 2 cases had mild inhalation injury, and 3 cases had moderate inhalation injury. The body temperatures of the patients were normal at the time of admission, with no fever or cough in the past 2 weeks. At admission, chest CT of one patient showed double lower lobes and left upper lobes had multiple slices and slightly high-density shadow of nodules. Chest CT of two patients showed thickening of bilateral lung texture, and the chest CT of remaining patients were normal. After admission, 6 patients were given routine treatment, the medical staffs paid attention to the protection and screened for COVID-19 according to the diagnosis and treatment plan of COVID-19. On post injury day (PID) 1, 3, 6, and 9, vein blood of patients were collected for determination of white blood cell (WBC) count, neutrophil, lymphocyte absolute value, and level of procalcitonin (PCT). Nucleic acid of novel coronavirus was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction on PID 3 and 6. The temperatures of patients were recorded after admission. The results of chest CT within one week after injury and the prognosis of the patients were recorded. Measurement data distributed normally were expressed as x±s, and measurement data distributed abnormally were expressed as M(P(25), P(75)). Results: (1) On PID 1, 3, 6, and 9, WBC counts of patients were respectively (19.8±3.8)×10(9)/L, (17.2±3.4)×10(9)/L, (13.3±3.1)×10(9)/L, and (11.1±1.6)×10(9)/L, neutrophils of patients were respectively 0.919±0.019, 0.899±0.011, 0.855±0.034, and 0.811±0.035, absolute values of lymphocytes of patients were respectively (0.65±0.18)×10(9)/L, (0.65±0.24)×10(9)/L, (0.91±0.34)×10(9)/L, and (1.23±0.42)×10(9)/L, and PCT values of patients were respectively 0.49 (0.36, 1.64), 0.39 (0.26, 0.73), 0.28 (0.18, 0.33), and 0.12 (0.11, 0.20) ng/mL. The values of WBC and neutrophils of patients were higher than the normal value, showing a downward trend. The absolute values of lymphocyte of patients returned to the normal value from PID 6. The PCT values of patients were higher than the normal value. (2) Nucleic acid test results of novel coronavirus of 6 patients were negative on PID 3 and 6. The temperatures of 6 patients ranged from 36.5 to 38.6 ℃. The typical imaging features of COVID-19 were not found in 6 patients within 1 week after injury by chest CT. After treatment for 14-32 days, 6 patients were cured and discharged. Conclusions: During COVID-19 pandemic, burn patients combined with inhalation injury should be treated under condition of good protection for doctors and nurses. Meanwhile, virus should be actively screened to reduce the risk of COVID-19 infection among doctors and patients.

Lifting mobility restrictions and the effect of superspreading events on the short-term dynamics of COVID-19.

SARS-CoV-2 has now infected 15 million people and produced more than six hundred thousand deaths around the world. Due to high transmission levels, many governments implemented social distancing and confinement measures with different levels of required compliance to mitigate the COVID-19 epidemic. In several countries, these measures were effective, and it was possible to flatten the epidemic curve and control it. In others, this objective was not or has not been achieved. In far too many cities around the world, rebounds of the epidemic are occurring or, in others, plateaulike states have appeared, where high incidence rates remain constant for relatively long periods of time. Nonetheless, faced with the challenge of urgent social need to reactivate their economies, many countries have decided to lift mitigation measures at times of high incidence. In this paper, we use a mathematical model to characterize the impact of short duration transmission events within the confinement period previous but close to the epidemic peak. The model also describes the possible consequences on the disease dynamics after mitigation measures are lifted. We use Mexico City as a case study. The results show that events of high mobility may produce either a later higher peak, a long plateau with relatively constant but high incidence or the same peak as in the original baseline epidemic curve, but with a post-peak interval of slower decay. Finally, we also show the importance of carefully timing the lifting of mitigation measures. If this occurs during a period of high incidence, then the disease transmission will rapidly increase, unless the effective contact rate keeps decreasing, which will be very difficult to achieve once the population is released.

The Impact of Regional Variation in Clinical Practice on Thyroid Cancer Diagnosis: A National Population-Based Study

Objective: Regional variation in thyroid cancer incidence in Belgium, most pronounced for low risk cancer, was previously shown to be related to variation in clinical practice, with higher thyroid surgery rates and lower proportions of preoperative fine-needle aspiration (FNA) in regions with high thyroid cancer incidence (period 2004–2006). The objective of this study was to investigate regional thyroid cancer incidence variation in relation with variation in thyroid surgery threshold in a more recent Belgian thyroid cancer cohort. Methods: A population-based cohort of thyroid cancer patients that underwent a (near) total thyroidectomy in the period 2009–2011 (n = 2,329 patients) was identified and studied by linking data from the Belgian cancer registry and the Belgian health insurance companies, and case-by-case study of the pathology protocols. The execution of preoperative FNA and the thyroid resection specimen weight were compared between high and low thyroid cancer incidence regions. Thyroid weight in the pT1a-restricted group was studied as a proxy for surgical threshold for benign nodular goiter. Furthermore, time trend analyses were performed for the execution of FNA for the period 2004–2012. Results: Although a lower proportion of FNA in the high thyroid cancer incidence region persisted in the period 2009–2011 (41.2% [31.9–50.9] vs. 72.9% [64.9–79.7] in the low-incidence region (LIR), p < 0.001), a positive time trend was observed for the period 2004–2012. The median thyroid surgical specimen weight was lower in the high incidence region compared to the LIR (27.0 g [IQR 18.0–45.3] vs. 36.0 g [IQR 22.0–73.0], p < 0.0001), and this finding was corroborated in the pT1a-restricted group. Conclusion: Interregional differences in use of FNA and surgical thyroid specimen weight are consistent with an inverse relation between thyroid cancer incidence and thyroid surgery threshold, carrying risk for overdiagnosis.

2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility

BackgroundLong-term care patients are at high risk of C. difficile infections (CDI) due to advanced age, high comorbid illness burden, and frequent antibiotic use. Primary infection prevention of CDI is challenging and not frequently studied. Following a period of high CDI incidence, the Long-Term Care facility at Sharp Coronado Hospital implemented a bundle of strategies.MethodsPatient census, the incidence of CDI (primary and recurrent cases), transfers to acute care and length-of-stay were collected from Jul 2008 through December 2018. In the first phase, 2010, a bundle of CDI prevention strategies was initiated, including an Antimicrobial Stewardship Program (ASP), reduction of acid suppression, and L. acidophilus and S. boulardii probiotics with antibiotic use. From 2012, there was further refinement of the ASP and the probiotic was changed to capsules of a 3-species combination of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, 100 Billion CFU daily. In October 2016, a protocol was put in place delegating authority to pharmacists to add probiotics to all antibiotic courses. The average CDI rates were calculated and compared for each time period. The net cost of CDI was calculated from the number of CDI cases, hospital length-of-stay and probiotic purchases.ResultsThe incidence of facility-onset CDI cases decreased significantly with each policy change from 7.6 cases/10,000 patient-days (2008–09), to 2.8 (2010–11, p = 0.028), to 0.91 (2012-Q3 2016, p = 0.0015) and to the present incidence 0.24 (Q4 2016–2018, p = 0.048). The annual cost of facility-onset CDI was $214k initially. The annual cost, including the purchase of probiotic, decreased to $161k with introduction of the bundle, to $57k in switching probiotics, and to $18k with initiation of a probiotic policy.ConclusionImplementing a bundle of concurrent infection prevention strategies resulted in a significant reduction in CDI incidence. Refinements to the bundle led to significant reductions in CDI incidence, along with switching the type of probiotic, and delegating ordering authority to pharmacists to ensure probiotic compliance. Cumulatively, there was a 95% decrease in CDI incidence at the Long-Term Care facility and meaningful cost savings with each refinement. Disclosures All authors: No reported disclosures.

Spatial-temporal characteristics of other infectious diarrhea in Jiangsu province, 2010-2017

Objective: To analyze the spatial-temporal characteristics of other infectious diarrhea (OID) in Jiangsu province from 2010 to 2017, and to provide evidence for setting up prevention and control programs of the disease. Methods: Data was from the Chinese Center for Disease Control and Prevention and the Statistics Bureau of Jiangsu province. Descriptive methods were used to illustrate the epidemiological characteristics of OID from 2010 to 2017. Global autocorrelation statistics method (Moran's I) was used to detect the spatial autocorrelation of OID, annually. Kulldorff M spatiotemporal scan statistics was used to analyze the spatial-temporal clustering of OID. ArcGIS 10.0 software, SaTScan 9.4 software and Excel 2017 software were also applied. Results: A total of 126 341 OID cases were found in Jiangsu province from 2010 to 2017 with an average annual incidence as 19.96/100 000. Children under five accounted for 55.08% (69 590/126 341) of the total cases. Obvious seasonal backshift with the increasing trends of the OID was noticed. There appeared four areas with high incidence of OID in the whole province, including Wuxi, Suzhou, Yancheng and Xuzhou. OID showed positive spatial autocorrelation at the county level with higher Moran's I from 0.19 to 0.33 (P<0.01). There appeared four positive clusters, all occurred in the high incidence period of OID, including the cluster area from the intersection areas of Changzhou and Wuxi (RR=7.61, LLR=2 605.80, P<0.01), respectively. Conclusion: With the increasing trends and the seasonal backshift of OID cases, pathogen surveillance programs set for those scattered children under five, in clustered regions and epidemic seasons should be strengthened.

Fabrication of pH-Sensitive Tetramycin Releasing Gel and Its Antibacterial Bioactivity against Ralstonia solanacearum.

Ralstonia solanacearum (R. solanacearum)-induced bacterial wilt of the nightshade family causes a great loss in agricultural production annually. Although there has been some efficient pesticides against R. solanacearum, inaccurate pesticide releasing according to the onset time of bacterial wilt during the use of pesticides still hinders the disease management efficiency. Herein, on the basis of the soil pH change during R. solanacearum growth, and pH sensitivity of the Schiff base structure, a pH-sensitive oxidized alginate-based double-crosslinked gel was fabricated as a pesticide carrier. The gel was prepared by crosslinking oxidized sodium alginate (OSA) via adipic dihydrazide (ADH) and Ca2+. After loading tetramycin into the gel, it showed a pH-dependent pesticide releasing behavior and anti-bacterial activity against R. solanacearum. Further study also showed that the inhibition rate of the tetramycin-loaded gel was higher than that of industrial pesticide difenoconazole. This work aimed to reduce the difficulty of pesticide administration in the high incidence period of bacterial wilt and we believe it has a great application potential in nightshade production.