Month Of Previous Year Research Articles

The Effect of the COVID-19 Pandemic and Lockdown on Operative Traumatic Brain Injury in Northern Virginia.

COVID-19 is a disease that causes flu-like symptoms and difficulty breathing. Emerging in 2019, the COVID-19 pandemic has affected the entire world through restrictions and lockdowns. Multiple studies have compared the effects of COVID-19 on different types of head trauma, with each one producing different results. The goal of this study was to use state and hospital data to determine whether the COVID-19 pandemic had a significant impact on surgeries for traumatic brain injury (TBI). Public state data on COVID-19 incidence, sourced from the Virginia Department of Health, was compared to hospital data of 352 patients receiving surgeries for TBI from a single major level-one trauma hospital in Northern Virginia. We used data from the three years before COVID-19 and the two years during the pandemic, using t-tests and Pearson correlation to analyze the data. This is a retrospective case review study on the number and age of patients receiving TBI surgery from March 2017 through February 2022 at Inova Fairfax Hospital in Northern Virginia to determine the impact of the COVID-19 pandemic on these factors. When comparing the data, there was a 60% reduction in cases of operative TBI during the peak months of COVID-19 compared to the same months in previous years (p<0.005). Comparing data on the number of Virginia and Northern Virginia COVID-19 cases and data on the age of individuals undergoing TBI surgery four weeks later showed a statistically significant negative correlation (p<0.05) in which the average age of individuals undergoing TBI surgery was lower in the four-week block following a four-week block of increased COVID-19 incidence. Our findings indicate a correlation between the period of decreased activity from COVID-19 restrictions in Virginia and a decline in both the number of TBI surgeries and the age of individuals undergoing these surgeries.

Temporal and spatial impact of lockdown during COVID-19 on air quality index in Haryana, India

This paper presents the evaluation of air quality in different districts of Haryana. Geo-spatial techniques were used to estimate gaseous and particulate pollutant's spatial and temporal variation during complete nationwide lockdown period and same month of previous year 2019 (March to May). Data of six fixed pollutants were collected from Central Pollution Control Board (CPCB). In this context, the data of air pollutants (PM10, PM2.5, O3, NOx, SO2, and CO) were analyzed for 2019 and 2020. The Spatio-temporal distribution of the Air Quality Index (AQI) clearly depicts difference in lockdown and unlock period. The result was showed that the air quality was very poor to satisfactory in 2019 and an improvement was observed from satisfactory to good in 2020 due to COVID-19 lockdown. On the basis of result, it will be concluded that automobile and industry are the major contributor in increase the pollutant concentration.

Community antibiotic prescriptions during COVID-19 era: a population-based cohort study among adults

ObjectivesThis study investigated the association between the COVID-19 pandemic and antibiotic prescription ratios and the determinants of antibiotic prescription in the community. MethodsThe study was based on a retrospective population cohort of adults in a community setting. Antibiotic prescription ratios from March 1, 2020 to February 28, 2021 (COVID-19 period) were compared to similar months in previous years. Differences in visit type, infectious disease–related visit, and antibiotic prescription ratios during these visits were compared. A logistic regression model was used to identify independent determinants of antibiotic prescription during the study period. ResultsThe cohort included almost 3 million individuals with more than 33 million community medical encounters per year. In the COVID-19 period, the antibiotic prescription ratio decreased 45% (from 34.2 prescriptions/100 patients to 19.1/100) compared to the previous year. Visits due to an infectious disease etiology decreased by 10% and prescriptions per visit decreased by 39% (from 1 034 425 prescriptions/3 764 235 infectious disease visits to 587 379/3 426 451 respectively). This decrease was observed in both sexes and all age groups. Telemedicine visits were characterized by a 10% lower prescription ratio compared to in-person visits. Thus, a threefold increase in telemedicine visits resulted in a further decrease in prescription ratios. The COVID-19 period was independently associated with a decrease in antibiotic prescription, with an OR of 0.852 (95% CI 0.848–0.857). DiscussionWe describe a significant decrease in antibiotic prescription ratios during the COVID-19 periods that was likely related to a decrease in the incidence of certain infectious diseases, the transfer to telemedicine, and a change in prescription practices among community-based physicians.

Uneven domestic tourism demand in times of pandemic

This study investigates the short-run impact of the COVID-19 pandemic on the number of domestic overnight stays at the regional level in the summer season 2020. Official data for 65 regions in four countries are used for the analysis (Austria, the Czech Republic, Germany and Switzerland). Dynamic panel data models are employed to estimate a tourism demand equation (real GDP and price fluctuations) augmented by average temperatures. Estimation results reveal that domestic overnight stays evolve unevenly in the first summer after the outbreak of the COVID-19 pandemic. The short-run effects show that the number of domestic overnight stays in densely populated regions decreases by 27% in July as well as in August 2020, in comparison with the same months in previous years, ceteris paribus. To the contrary, there is a surge of 27 and 10%, respectively, for sparsely populated areas in the same months. JEL: Z3, R11 and R12.

High-resolution seasonal and decadal inventory of anthropogenic gas-phase and particle emissions for Argentina

Abstract. This work presents the integration of a gas-phase and particulate atmospheric emission inventory (AEI) for Argentina in high spatial resolution (0.025∘×0.025∘; approx. 2.5 km×2.5 km) considering monthly variability from 1995 to 2020. The new inventory, called GEAA-AEIv3.0M, includes the following activities: energy production, fugitive emissions from oil and gas production, industrial fuel consumption and production, transport (road, maritime, and air), agriculture, livestock production, manufacturing, residential, commercial, and biomass and agricultural waste burning. The following species, grouped by atmospheric reactivity, are considered: (i) greenhouse gases (GHGs) – CO2, CH4, and N2O; (ii) ozone precursors – CO, NOx (NO+NO2), and non-methane volatile organic compounds (NMVOCs); (iii) acidifying gases – NH3 and SO2; and (iv) particulate matter (PM) – PM10, PM2.5, total suspended particles (TSPs), and black carbon (BC). The main objective of the GEAA-AEIv3.0M high-resolution emission inventory is to provide temporally resolved emission maps to support air quality and climate modeling oriented to evaluate pollutant mitigation strategies by local governments. This is of major concern, especially in countries where air quality monitoring networks are scarce, and the development of regional and seasonal emissions inventories would result in remarkable improvements in the time and space chemical prediction achieved by air quality models. Despite distinguishing among different sectoral and activity databases as well as introducing a novel spatial distribution approach based on census radii, our high-resolution GEAA-AEIv3.0M shows equivalent national-wide total emissions compared to the Third National Communication of Argentina (TNCA), which compiles annual GHG emissions from 1990 through 2014 (agreement within ±7.5 %). However, the GEAA-AEIv3.0M includes acidifying gases and PM species not considered in TNCA. Temporal comparisons were also performed against two international databases: Community Emissions Data System (CEDS) and EDGAR HTAPv5.0 for several pollutants; for EDGAR it also includes a spatial comparison. The agreement was acceptable within less than 30 % for most of the pollutants and activities, although a &gt;90 % discrepancy was obtained for methane from fuel production and fugitive emissions and &gt;120 % for biomass burning. Finally, the updated seasonal series clearly showed the pollution reduction due to the COVID-19 lockdown during the first quarter of year 2020 with respect to same months in previous years. Through an open-access data repository, we present the GEAA-AEIv3.0M inventory as the largest and more detailed spatial resolution dataset for the Argentine Republic, which includes monthly gridded emissions for 12 species and 15 stors between 1995 and 2020. The datasets are available at https://doi.org/10.17632/d6xrhpmzdp.2 (Puliafito et al., 2021), under a CC-BY 4 license.

Surveillance of a vomiting outbreak in dogs in the UK using owner-derived and internet search data.

In early 2020, the Small Animal Veterinary Surveillance Network reported evidence of an outbreak of acute prolific vomiting in dogs in the UK. The aims of this study were to investigate whether there was evidence for a vomiting outbreak in Dogslife and Google Trends data and to describe its characteristics. Incidence of Dogslife vomiting reports and the Google search index for 'dog vomiting' and 'puppy vomiting' between December 2019 and March 2020 was compared to the respective data from the same months in previous years. Risks for dogs vomiting and factors influencing veterinary attendance in Dogslife were identified using multivariable logistic regression. This study confirmed a vomiting outbreak was evident in UK dogs between December 2019 and March 2020 using data from Dogslife and Google Trends. The odds of a vomiting incident being reported to Dogslife was 1.51 (95% CI: 1.24-1.84) in comparison to previous years. Dogslife data identified differences in owner-decision making when seeking veterinary attention and identified factors associated with dogs at higher odds of experiencing a vomiting episode. Owner-derived data including questionnaires and internet search queries should be considered a valid, valuable source of information for veterinary population health surveillance.

139. Impact of Pharmacist Driven Outpatient Fluoroquinolone Stewardship Initiative in Community Based Setting

BackgroundAntimicrobial stewardship initiatives and efforts have historically had a greater emphasis in the inpatient hospital setting. There is a need for outpatient stewardship, and additionally, accreditation standards are starting to require antimicrobial stewardship efforts in the ambulatory care setting. Fluoroquinolones are a target for antimicrobial stewardship based on their broad-spectrum activity, pharmacokinetics/pharmacodynamics, safety profile, downstream resistance, and risk of super infections. The objective of this study was to compare outpatient fluoroquinolone prescribing rates before and after pharmacist led initiative.MethodsThis was a prospective, quality improvement initiative between October 1, 2019 to June 1, 2020 at a community-based physician network across Indiana. The pharmacist initiative incorporated a live, educational presentation with intervention 1 and an informational letter to healthcare providers across the outpatient physician network with intervention 2. Data was collected from a computer-generated, prescription report. The primary outcome was fluoroquinolone prescribing rates at Central Indiana (CI) sites before and after pharmacist led interventions. Rate of fluoroquinolone prescribing was defined as total number of fluoroquinolone prescriptions per month. The secondary outcome included percentage of fluoroquinolone use at CI sites. Percentage of fluoroquinolone use was defined as monthly number of fluoroquinolones prescriptions compared to monthly number of all oral antibiotic prescriptions.ResultsThere was a 29.8% decrease (382 vs 268 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 1 compared to same month of previous year. There was a 43.7% decrease (428 vs 241 prescriptions) in outpatient fluoroquinolone prescriptions at CI sites after intervention 2. There was an overall 2.4% decrease (4.9% vs 2.5%) in percentage of fluoroquinolone use compared to all oral antibiotics at CI sites after intervention 2 compared to same month of previous year.ConclusionThese findings suggest the pharmacist led outpatient antimicrobial stewardship initiative successfully decreased fluoroquinolone prescribing rates across the network.DisclosuresChristian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

Effect of Pandemic-Related Confinement on Vitamin D Status Among Children Aged 0-6 Years in Guangzhou, China: A Cross-Sectional Study.

PurposePandemic-related confinement helps to contain the transmission of the novel coronavirus disease (COVID-19) but restricts children’s exposure to sunlight, thereby possibly affecting their 25-hydroxyvitamin D [25(OH)D] levels. This study aimed to examine the effect of COVID-19 measures on 25(OH)D levels in children.Patients and MethodsThis study included children who underwent health checks between March 1 and June 30, 2020, and those over the equivalent period during 2017–2019 (N = 3600). Children’s 25(OH)D levels and the proportion of children with vitamin D deficiency were compared between different observation periods.ResultsThe mean serum 25(OH)D level was 84 ± 25nmol/L. The overall proportion of children with vitamin D deficiency (25(OH)D level <50 nmol/L) was 4.6%. Home confinement led to an increase in the proportion of children aged 3–6 years with vitamin D deficiency during March 1–June 30, 2020 compared with the same months in previous years, and the most noticeable increase was found in March 2020. In children aged 3–6 years, 25(OH)D levels were lower in 2020 (65 ± 17nmol/L) than during 2017–2019, and the proportion of those with vitamin D deficiency was higher in 2020 (19.0%) than in previous years. Among children aged 0.5–1 and 1–3 years, 25(OH)D levels were higher (97 ± 25 nmol/L, 91 ± 27 nmol/L), while the proportion of children with vitamin D deficiency was lower in 2020 (2.3%, 3.0%) than during 2017–2019.ConclusionThe 25(OH)D levels tended to decrease gradually with increasing age. Reduced sunlight exposure during confinement is associated with lower 25(OH)D levels among children aged 3–6 years. Therefore, vitamin D supplementation for children aged >3 years is recommended.

Management Strategies for Pediatric Burns During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has been challenging global health, in many countries all non-urgent medical treatments were postponed in order to focus health systems, workforce and other resources on crucial treatments for COVID-19 patients. The pediatric cases are a minority of all COVID-19 patients and might present atypically. Due to an increase in pediatric burn cases we decided to establish an outpatient pre-hospital clinic as an intermediate "station", in order to triage pediatric burn patients into those who present at our hospital, and those treated via telemedicine. We divided our tactics into environmental and patient management both in hospitalized and outpatient patients, also medical staff management including preventive care, surgery, and bedside procedures. We found that patients and their escorts waited longer before arriving to the Emergency Room, apparently trying to avoid the hospital visit. A higher proportion of patients was hospitalized during the pandemic (4.5% in 2020, compared to 2.6% and 2.0% in 2019 and 2018, respectively). However, the length of stay was similar to routine periods, the surgery rate and length of follow up until healing was similar to that of the same month in previous years. We assume that these factors reflect treatment quality, which was not affected, due to the use of telemedicine, and that our treatment standards were maintained. It is important to have a good regulation system of prevention and care, including the tactics described below.

COVID-19's Limited Impact on Drug Shortages in Canada.

Using data from the Drug Shortages Canada website, we ask whether the first months of the coronavirus disease 2019 (COVID-19) pandemic were associated with a significant increase in drug shortages in Canada. We find an increase of 147 shortages (32 percent) reported by manufacturers during March and April 2020 relative to the same months in previous years. The upsurge was concentrated during the two-week period from 25 March to 7 April 2020, after which report counts returned to usual levels. Excess reports cite both supply-side and demand-side causes for shortages. Increases were noted in therapeutic classes associated with COVID-19 care.

Strandings of cetaceans on the Espírito Santo coast, southeast Brazil, 1975-2015.

Espírito Santo state is located on the eastern margin of Brazil, in a transitional tropical-subtropical area (18°S–21°S) dominated by oligotrophic waters. With the exception of humpback whales (Megaptera novaeangliae), the cetacean community of Espírito Santo has been understudied. In addition to the chronic impacts from fisheries, marine pollution, urban development, and coastal habitat degradation, in November 2015 the cetacean communities of Espírito Santo were challenged by the greatest environmental disaster in Brazil’s history. The Mariana dam disaster caused 60 million cubic meters of mining waste to be washed into the Doce River, which ultimately flowed to the coastal waters of Espírito Santo, with a high concentration of heavy metals. This study reviews and updates information on cetacean strandings in the state of Espírito Santo (excluding humpback whales) prior to this disaster. From 1975 to September 2015, there were 461 recorded cetacean strandings, representing 20 species. An average 1.18 strandings per 100 km per month were recorded since a state-wide daily beach survey program was implemented in October 2010, contrasting with the 0.14 strandings per 100 km per month in previous years. Six species comprised the majority (94.7%) of stranding events: Guiana dolphin (Sotalia guianensis), Franciscana (Pontoporia blainvillei), rough-toothed dolphin (Steno bredanensis), bottlenose dolphin (Tursiops truncatus), sperm whale (Physeter macrocephalus), and melon-headed whale (Peponocephala electra). Oceanic cetaceans stranded most frequently on the southern portion of Espírito Santo, where the continental platform is narrower, whereas the strandings of coastal cetaceans such as Guiana dolphins and Franciscanas were concentrated near estuaries, especially the Doce River. This is particularly concerning in face of the Mariana dam disaster, which drastically altered the estuarine and coastal environment associated with the Doce River.

Changes to country-specific hepatitis A travel vaccination recommendation for UK travellers in 2017—responding to a vaccine shortage in the national context

ObjectivesA routine review of hepatitis A travel vaccination recommendations was brought forward in June 2017 due to hepatitis A vaccine shortages and a concurrent outbreak in men who have sex with men (MSM). There were three objectives: first, to document the review process for changing the recommendations for the UK travellers in June 2017. Second, to study the impact of these changes on prescribing in general practice in 2017 compared with the previous 5 years. Third, to study any changes in hepatitis A notifications in June–October 2017 compared with the previous 5 years. Study designThis is an observational study. MethodsTravel vaccination recommendations for countries with either low-risk (<20%) or high-risk (>90%) status according to child hepatitis A seroprevalence were not changed. A total of 67 intermediate-risk countries with existing recommendations for most travellers and with new data on rural sanitation levels were shortlisted for the analysis. Data on child hepatitis A seroprevalence, country income status, access to sanitation in rural areas and traveller volumes were obtained. Information about the vaccine supply was obtained from Public Health England. Changes to the existing classification were made through expert consensus, based on countries' hepatitis A seroprevalence, sanitation levels, level of income, volume of travel and hepatitis A traveller cases. Data on the number of combined and monovalent hepatitis A–containing vaccines prescribed in England, 2012–2017, were obtained from the National Health Service Business Service Authorities. The number of monthly prescriptions for January–September 2017 was compared with the mean number of prescriptions for the same month in the previous 5 years (t-test, α = 5%, df = 4). The number of hepatitis A cases notified in June–October 2017 not related to the MSM outbreak was compared with the number of notifications in the same months in previous years. ResultsA total of 36 countries were downgraded based on good access (80+% of population) to sanitation in rural areas and the intermediate-risk status in terms of child hepatitis A seroprevalence. For these countries, vaccination would only be recommended to travellers staying long term, visiting friends and relatives or staying in areas without good sanitation. There was a significant decline in hepatitis A vaccine prescriptions in June–September 2017, and there was no increase in the number of notifications. ConclusionsHepatitis A vaccination recommendations for travel were revised in 2017 following a systematic approach to maintain continuity of supply after a hepatitis A vaccine shortage and increased hepatitis A vaccine demand related to a large outbreak. Improved access to good sanitation in rural areas and low seroprevalence estimates among children have led to 36 countries to no longer require vaccination for most travellers. These changes do not seem to have impacted on hepatitis A notifications in England, although further research will be needed to quantify the impact more precisely.

Phytoplankton response to a weak El Niño event

The western coast of South America is a very productive upwelling zone. However, during El Niño events, phytoplankton productivity in the equatorial Pacific declines sharply. A weak El Niño event occurred in 2014. Oceanographic anomalies included an increase in sea surface temperature and water transparency and a decrease in salinity. Phytoplankton composition also changed throughout time reflecting different El Niño stages. Before the El Niño, the community was mainly dominated by species typical of nutrient rich waters, such as large diatoms or silicoflagellates. At the onset of the event, the number of species and the turnover component of beta diversity increased, indicating that previously predominant species now co-occurred with new species transported by warmer surface water masses. At this initial stage, warm water dinoflagellates were indicator species, while a diatom bloom of Dactyliosolen fragilissimus indicated nutrient availability and some degree of turbulence in the water column. Finally, the overall abundance of phytoplankton was similar to the homologous months in previous years, but under El Niño conditions the community was dominated by smaller cells. Consequently, primary production attained a minimum, as inferred from the highest values of water transparency. There was no evidence of seasonality. It is concluded that the effect of El Niño on the phytoplankton community in the eastern equatorial Pacific is appreciable even during weak events.

Pricing decisions during the FIFA 2014 World Cup: São Paulo and Rio de Janeiro

Purpose: This report explores the host destination’s response to the 2014 FIFA World Cup. The study establishes how the hotel Key Performance Indicators (KPIs) of two of the main cities in Brazil reacted to the World Cup. Originality/value: Exploring Brazilian hotel revenue managers’ responses to a major sporting event in Latin America is the main contribution of this research report. Relevance of the topic: Several business sectors in the travel and hospitality industry experience distinctive positive and negative performance for hosting mega-sporting events. The findings of this research report will be helpful for hotel revenue managers who regularly propose strategic pricing strategies. This report examines the response to the 2014 FIFA World Cup which is determined by the variance in the hotel key performance indexes: occupancy, average daily rate (ADR), revenue per available room (RevPAR), and supply. Design/methodology/approach: Using data gathered from Smith Travel Research (STR), this research report distinctly displays how two of the main Brazilian host cities (São Paulo and Rio de Janeiro) reacted to the World Cup. The obtained hotel KPIs represented annual data three years before the event and year after the event. The STR data entailed monthly hotel-level performance information, rooms revenue and rooms sold (demand) from the period of 2011-2015 containing a broad sample of Brazilian hotels in São Paulo and Rio de Janeiro. Key findings: Results of the analysis for São Paulo suggest that supply level did not increase drastically during the sporting event. However, ADR levels increased significantly during the event. Additionally, the variances in occupancy in 2014 echo with the variances in ADR in the same time, showing the elasticity of price. Results of the analysis for Rio de Janeiro suggest that supply volumes stay consistent before, during, and after the sporting event. The findings suggest that ADR and RevPAR were quite related, with notable increases and declines before and after the event during the comparable months in previous years. Implications for practice and policy: Our findings contained expected and unexpected results for hotel managers. For instance, Rio de Janeiro experienced growth of hotel room supply during the mega event. For this city, the drastic increase in ADR and supply did not result in a sharp decrease of their hotel occupancy rate. Other results suggest that São Paulo did not experience any changes in their hotel room supply level during the event. The performance of the occupancy rate still shows differences. For São Paulo, although there is no supply increase of the hotel industry, the occupancy rate still dropped during the mega event. This report lends support to the theory of price inelasticity of demand during mega sporting events, such as the FIFA World Cup.

Demand forecasting for production planning in remanufacturing

Remanufacturing is effective for energy and material savings; however, production planning and control in remanufacturing are more complex than those in traditional manufacturing. Developing a reliable forecasting method is critical for facilitating effective production planning and control. This study examined the effectiveness of demand forecasting in remanufacturing by time series analysis. Most existing methods of demand forecasting in remanufacturing assume that the time distributions of new product sales are known and that the time distributions of the demands of remanufactured products are determined by adding the product lifespan to the time distribution of new product sales. In addition, most previous studies focused on relatively long-term demand trends without considering the seasonality of demands. In this study, we examined the Holt–Winters model and the autoregressive integrated moving average (ARIMA) model, both representative time series analysis methods. These methods do not require information regarding the time distributions of new product sales and can handle the seasonality of demands. To examine the effectiveness of these methods, the time series data of the sales of 160 types of remanufactured alternators and starters manufactured by an independent auto parts remanufacturer over a period of 12 years was used. The results of demand forecasting for 2 months yielded average errors of 26.7 % for alternators and 18.4 % for starters, which represent an average improvement of 6.5 points compared to the method involving referencing the demands of the same month of previous year. The implications of the results and future steps are also discussed.

Exceptionally low rotavirus incidence in the Netherlands in 2013/14 in the absence of rotavirus vaccination.

An unexpected drop in rotavirus (RV) detections was observed in the Netherlands in 2014, without RV vaccination. The estimated decrease in RV detections and gastroenteritis consultations in under five year-olds, in January-April 2014, compared to the same months in previous years, was 72% and 36%, respectively. The low birth rate, mild winter, high RV incidence in the previous year and the introduction of RV vaccination in neighbouring countries may have contributed to this decrease.

感性情報による購買行動創出モデルについての一考察―非計画購買における購買行動のプロセスと媒体の組合せに着目して―

This paper attempts to describe the causality phenomenon of ”Kansei information” and its effects on buying behavior. We focus on information taken in through the five senses and processed within the brain to cause positive affect, which we refer to as ”Kansei information.” Since the year 2000, in various different industries throughout Japan, we have been researching the phenomenon of Kansei information and its effects on buying behavior. Based on our observations of this phenomenon and the marketing and sales activity it results in, we have been researching the possibility of creating a model in which the effects of Kansei information constitute the main component. In this paper, we present the developed ”Kansei information buying behavior model” and examine the model by focusing on non-planned purchases in supermarkets. We will also present the results of an experiment where Kansei information was used in actual store fronts to affect buying behavior. Sales of the product, which had been around 20 pieces per month in previous years, dramatically improved and reached 280 pieces in the first month after using Kansei information. Sales at six months had grown constantly to reach 1,000 pieces per month. We then examine the possibility of making a simulation model based on the experimental results.

An outbreak of cardiovascular syndromes requiring urgent medical treatment and its association with environmental factors: an ecological study

BackgroundIn April 2005, syndromic surveillance based on statistical control chart methods in Sydney, Australia, signalled increasing incidence of urgent emergency department visits for cardiovascular and chest pain syndromes compared to the preceding twelve months. This paper aimed to determine whether environmental factors could have been responsible for this 'outbreak'.MethodsThe outcome studied was daily counts of emergency department visits for cardiovascular or chest pain syndromes that were considered immediately or imminently life threatening on arrival at hospital. The outbreak had a mean daily count of 5.7 visits sustained for eight weeks, compared with 4.0 in the same months in previous years. Poisson regression was used to systematically assess the emergency department visits in relation to available daily weather and pollution variables by first finding the best model that explained short-term variation in the outcome over the period 25 January 2002 to 31 May 2005, and then assessing interactions of all available variables with the 'outbreak' period, April-May 2005. Rate ratios were estimated for an interquartile increase in each variable meaning that the ratio measures the relative increase (or decrease) in the emergency department visits for an interquartile increase in the weather or pollution variable. The rate ratios for the outbreak period measure the relative increase (or decrease) in the emergency department visits for an interquartile increase in the weather or pollution variable during the outbreak period only.ResultsThe best fitting model over the whole study period included minimum temperature with a rate ratio (RR) of 0.86 (95% confidence interval (CI), 0.77–0.96), maximum relative humidity of 1.09 (95% CI 1.05–1.14) and minimum daily particulate matter less than 10 microns (PM10) of 1.05 (95% CI, 1.01–1.09). During the outbreak period, maximum temperature (RR 1.27, 95% CI 1.03–1.57), solar radiation (RR 1.44, 95% CI, 1.00–2.07) and ozone (RR 1.13, 95% CI 1.01–1.26) were associated with the outcome.ConclusionThe increase may have been associated with photochemical pollution. Syndromic surveillance can identify outbreaks of non-communicable diseases associated with environmental factors.

Treatment Recommendations for Clostridium difficile, Treatment Failures, and Impact on Active Diarrheal Days

ISSUE: Much like many health care facilities, the VANJHCS had experienced an increase in the incidence rate of Clostridium difficile associated diarrhea (CDAD). We had gone from an average of 3 cases per month in previous years to as high as >10 cases for one month. Current recommendations to control the spread of CDAD include contact isolation, environmental cleaning, and stopping antibiotics. Oral metronidazole for 14 days is the drug of choice for initial CDAD episode. Oral vancomycin is an option for patients who cannot take or fail treatment with metronidazole. However in a number of the patients it had been noted that they were failing these recommended antibiotic treatments, thus the adequacy of the 14 days treatment regimen was questioned. The treatment failures also are challenging for Infection Control Professionals because this prolongs the need for contact isolation and hospital stay thus increasing hospital cost.

Mesospheric standing waves near South Pole

Optical measurements of mesospheric winds near South Pole, during August 1996, show the presence of large‐scale standing waves with periods of 51.3‐hr and 107‐hr, respectively. In addition, a 11.6‐hr period zonal wavenumber‐one oscillation with a westward phase progression was also observed. The direction of the observed mean wind has changed nearly 60° westward from the typical wind direction observed during the same month in previous years. The direction of the presently observed mean wind is nearly parallel to wind direction of the 51.3‐hr standing oscillation, suggesting an interaction between the mean wind field and the wave during this observation. Based on the simultaneous observation at Scott Base of an uncommon wave with 11.53‐hr periodicity with short (∼20 km) vertical wavelength of propagation, the 11.6‐hr wave observed from South Pole can be identified as a zonal wavenumber one inertio‐gravity mode of oscillation. Because of the transience of this wave and its closeness to the inertial period, we also discuss another approach to the interpretation of such waves as possible forced oscillations.