Multiple Sources Of Evidence Research Articles

84 What works and why for interprofessional collaboration in older people’s care integration: realist evidence synthesis

Abstract Background Interdisciplinary Community Specialist Teams for older people (CSTs) are a novel innovation in Irish health service delivery and require, over time, a shift in cultures of care to allow for the development of interprofessional collaboration. However, there is limited international guidance on how to foster, enhance and sustain meaningful interprofessional collaboration in the context of interdisciplinary team-based care integration for older people. This realist review presents initial programme theories of what works and why in fostering competencies for interprofessional collaboration in CSTs for older persons. Methods Realist reviews are an interpretive theory-driven approach to evidence synthesis which uses multiple sources of evidence including published peer-reviewed studies, policy documents and grey literature. This evidence is combined with stakeholder theories and explanations of how interventions might work. Four stakeholder cohorts were identified: public and patient representatives of older people and family carers, healthcare professionals who are members of CSTs; team leads responsible for the operational management of CSTs, and healthcare managers responsible for national clinical programme design. Results This synthesis resulted in a series of evidence-based Initial Programme Theories (IPT) in the form of statements that explain the Mechanisms (M) and Resources (R), generated within particular Contexts (C) in response to interprofessional collaboration, that are thought to lead enhanced care Outcomes (O). For example: Where CST members have professional experience in different areas of service delivery (C), they bring to the team pre-existing relationships with other HCPs (R), enabling good cross-sectoral communication and trust (M) leading to enhanced continuity of care (O). Conclusion The IPTs generated from this realist synthesis of international literature support workforce education, development and planning. They also provide healthcare leaders with knowledge of the resources and supports required to harness the benefits of interprofessional collaboration and realise the goals of care integration for older people.

Who Pays for Environmental Policy? Business Power and the Design of State-Level Climate Policies

To what extent and through which means do private actors shape public policy? Research into these questions has been complicated by actors’ tendency to obscure or misrepresent their policy preferences and by the difficulty of operationalizing policy substance. This theory-building study uses qualitative methods and triangulation of multiple sources of evidence to mitigate these challenges. Confronted with puzzling patterns of variation in the design of state-level climate and renewable energy policies, I show how a two-dimensional framework attentive to the economically motivated preferences of business actors explains policy design. Drawing on policy texts, archival documents, and 111 policy-focused interviews, I find business preferences were fragmented, but that a single type of private actor, investor-owned utilities, ultimately prevailed in achieving their preferences in every case. I theorize the sources of their unmatched influence, and find that their distinctiveness is precisely what makes them powerful. My findings have implications for the study of business power and understanding obstacles to equitable climate policymaking.

A Community–Academic Partnership to Explore and Address Cancer Disparities in Southwest Chicago Arab Americans

Abstract: Background: Despite the need to consider multiple sources of evidence to guide locally and culturally relevant interventions, few studies have documented the process by which evidence is integrated. Objectives: We leveraged a community–academic partnership to describe a participatory approach to integrating community and academic sources of evidence to inform cancer programming priorities in the Arab American (ArA) community in Southwest Chicago. Methods: Informed by Intervention Mapping, this study comprised three phases led by community and academic partners: 1) qualitative assessment of cancer-related priorities through eight focus groups with 48 ArA community members, 2) a focused literature review to identify models of cancer interventions implemented with ArAs, and 3) integration of focus group and literature review findings and development of a strategy for a community-based cancer program administered by the community partner. Results: Focus groups revealed attitudes and beliefs across the cancer control continuum. The literature review highlighted two cancer interventions utilizing education, community health workers, and patient navigation components. Through facilitated discussions with community partners, we integrated community and academic sources of evidence to develop a comprehensive cancer program plan that is informed by the data we generated as well as our community partners' preferences and organizational capacity. Conclusions: Our participatory approach for integrating community and academic sources of evidence generated a locally relevant strategy to address cancer burden in the ArA community in Chicago. We discuss the benefits and challenges of utilizing this approach in intervention development.

Assessing the quality of science teachers' lesson plans: Evaluation and application of a novel instrument

AbstractLesson planning is a core part of teachers' professional competence. Written lesson plans play a significant role in science teacher education as a preparation for demonstration lessons during the final teacher certification exam. However, the few existing scoring rubrics on lesson plans are not particularly theoretically sound and are barely tested for the validity of score interpretations. In response to the demand for transparent and applicable criteria, we developed the rubric to assess science lesson plans (RALP) to assess science teachers' lesson plan quality. We employed a mixed‐methods approach: First, we present multiple sources of validity evidence (based on test content, internal structure, relations to other variables, and consequences of testing) as mainly quantitative indicators for the quality of the RALP. Based upon that, we applied the RALP to lesson plans written by preservice and trainee science teachers (N = 100) and provided a qualitative analysis of six cases to illustrate common patterns in these lesson plans. Results indicate that teacher educators consider the RALP criteria (N = 24) relevant and objectively applicable. Correlation analyses of the scores and two teacher educators' holistic quality assessment of all lesson plans provide convincing evidence that the RALP can discriminate lesson plan quality levels. Moreover, comparisons between preservice science teachers and trainee science teachers reveal that trainee teachers score significantly higher than preservice teachers, indicating that the RALP is sensitive to differences in teaching and planning experience. The application and in‐depth analysis of three criteria of the RALP illustrate these differences in levels of planning quality. We discuss possible applications of the RALP in science teacher education and research in science teaching.

Trace amine-associated receptor 1 (TAAR1) agonists for psychosis: protocol for a living systematic review and meta-analysis of human and non-human studies.

There is an urgent need to develop more effective and safer antipsychotics beyond dopamine 2 receptor antagonists. An emerging and promising approach is TAAR1 agonism. Therefore, we will conduct a living systematic review and meta-analysis to synthesize and triangulate the evidence from preclinical animal experiments and clinical studies on the efficacy, safety, and underlying mechanism of action of TAAR1 agonism for psychosis. Independent searches will be conducted in multiple electronic databases to identify clinical and animal experimental studies comparing TAAR1 agonists with licensed antipsychotics or other control conditions in individuals with psychosis or animal models for psychosis, respectively. The primary outcomes will be overall psychotic symptoms and their behavioural proxies in animals. Secondary outcomes will include side effects and neurobiological measures. Two independent reviewers will conduct study selection, data extraction using predefined forms, and risk of bias assessment using suitable tools based on the study design. Ontologies will be developed to facilitate study identification and data extraction. Data from clinical and animal studies will be synthesized separately using random-effects meta-analysis if appropriate, or synthesis without meta-analysis. Study characteristics will be investigated as potential sources of heterogeneity. Confidence in the evidence for each outcome and source of evidence will be evaluated, considering the summary of the association, potential concerns regarding internal and external validity, and reporting biases. When multiple sources of evidence are available for an outcome, an overall conclusion will be drawn in a triangulation meeting involving a multidisciplinary team of experts. We plan trimonthly updates of the review, and any modifications in the protocol will be documented. The review will be co-produced by multiple stakeholders aiming to produce impactful and relevant results and bridge the gap between preclinical and clinical research on psychosis. PROSPERO-ID: CRD42023451628.

The changing landscape of doctoral education in the UK

ABSTRACT As elsewhere across the globe, for the past two decades doctoral education in the UK has been in the throes of change. This article seeks to describe and analyse developments in 1) the national framework for doctoral education, 2) institutional structures, 3) doctoral programmes, 4) doctoral candidacy, 5) doctoral supervision and 6) doctoral examination. Multiple sources of evidence, including official documentation and the results of investigations of the public-facing websites of the 150 institutions providing doctoral programmes, are used. The conclusion shows that these changes have been far-reaching, particularly for supervisors, and a call is made for greater recognition of their contributions to doctoral education.

Challenges in identifying studies to include in a systematic literature review: an analysis of the organizational growth and decline topics

Purpose This paper aims to check the fragmentation of knowledge across multiple sources of evidence, identifying, scrutinizing and outlining suggestions concerning the challenges researchers face when using multiple sources of data to identify studies. Design/methodology/approach This study produced a comprehensive database of 15,848 items from Scopus, Web of Science and EBSCO on the organizational growth and decline topics. The analyses carried out to check the fragmentation of scientific knowledge and the challenges in identifying studies have made use of the basic data frame functions in R’s language and the Bibliometrix and Corpus R’s packages. Findings This study confirms the fragmentation of scientific knowledge as well as it identifies the following challenges: missing information in key fields, nonexistence of standards in terminology, limitations on data extraction, duplicates and multiple formats of cited reference. Additionally, it suggests practical coping procedures and advances implications for stakeholders and an agenda for future research. Originality/value This study provides valuable and practical examples with empirical confirmation of scientific knowledge fragmentation and offers an integrated view of many challenges in the process of identifying studies. Moreover, by offering suggestions to address these challenges, this study not only offers a practical guide to scientific researchers but also initiates a wider discussion regarding knowledge organizing in social sciences.

The Historic Built Environment As a Long-Term Geochemical Archive: Telling the Time on the Urban "Pollution Clock".

This study introduces a novel methodology for utilizing historic built environments as reliable long-term geochemical archives, addressing a gap in the reconstruction of past anthropogenic pollution levels in urban settings. For the first time, we employ high-resolution laser ablation mass spectrometry for lead isotope (206Pb/207Pb and 208Pb/206Pb) analysis on 350-year-old black crust stratigraphies found on historic built structures, providing insights into past air pollution signatures. Our findings reveal a gradual shift in the crust stratigraphy toward lower 206Pb/207Pb and higher 208Pb/206Pb isotope ratios from the older to the younger layers, indicating changes in lead sources over time. Mass balance analysis of the isotope data shows black crust layers formed since 1669 primarily contain over 90% Pb from coal burning, while other lead sources from a set of modern pollution including but not limited to leaded gasoline (introduced after 1920) become dominant (up to 60%) from 1875 onward. In contrast to global archives such as ice cores that provide integrated signals of long-distance pollution, our study contributes to a deeper understanding of localized pollution levels, specifically in urban settings. Our approach complements multiple sources of evidence, enhancing our understanding of air pollution dynamics and trends, and the impact of human activities on urban environments.

Primary care blood tests show lipid profile changes in pre-symptomatic amyotrophic lateral sclerosis.

Multiple sources of evidence suggest that changes in metabolism may precede the onset of motor symptoms in amyotrophic lateral sclerosis. This study aimed to seek evidence for alterations in the levels of blood indices collected routinely in the primary care setting prior to the onset of motor symptoms in amyotrophic lateral sclerosis. Premorbid data, measured as part of routine health screening, for total cholesterol, high-density and low-density lipoprotein cholesterol, triglyceride, glycated haemoglobin A1c and creatinine were collected retrospectively from (i) a cohort of amyotrophic lateral sclerosis patients attending a specialist clinic (n = 143) and (ii) from primary care-linked data within UK Biobank. Data were fitted using linear mixed effects models with linear b-splines to identify inflection points, controlling for age and sex. In specialist amyotrophic lateral sclerosis clinic cases, models indicated decreasing levels of total and low-density lipoprotein cholesterol prior to an inflection point in the years before symptom onset (total cholesterol 3.25 years, low-density lipoprotein cholesterol 1.25 years), after which they stabilized or rose. A similar pattern was observed in amyotrophic lateral sclerosis cases within UK Biobank, occurring several years prior to diagnosis (total cholesterol 7 years, low-density lipoprotein cholesterol 7.25 years), differing significantly from matched controls. High-density lipoprotein cholesterol followed a similar pattern but was less robust to sensitivity analyses. Levels of triglyceride remained stable throughout. Glycated haemoglobin temporal profiles were not consistent between the clinic and biobank cohorts. Creatinine level trajectories prior to amyotrophic lateral sclerosis did not differ significantly from controls but decreased significantly in the symptomatic period after an inflection point of 0.25 years after symptom onset (clinic cohort) or 0.5 years before diagnosis (UK Biobank). These data provide further evidence for a pre-symptomatic period of dynamic metabolic change in amyotrophic lateral sclerosis, consistently associated with alterations in blood cholesterols. Such changes may ultimately contribute to biomarkers applicable to population screening and for pathways guiding the targeting of preventative therapy.

The assessment of undergraduate bachelor of nursing students in the collaborative clusters education model: A qualitative descriptive design

BackgroundWorldwide, undergraduate Bachelor of Nursing students are required to complete experiential learning placements in health care settings as part of the curriculum. There are a variety of facilitation models that support student learning and assessment on clinical placement. As workforce pressures increase globally, innovative approaches to clinical facilitation are required. In the Collaborative Clusters Education Model of clinical facilitation, hospital-employed clinical facilitators work collaboratively within peer groups (clusters) to collectively participate in a process of facilitating student learning and conducting assessment and moderation of student performance. The assessment process in this collaborative clinical facilitation model is not well described. AimTo describe how the assessment of undergraduate nursing students is achieved in the Collaborative Clusters Education Model. DesignA qualitative descriptive approach was employed. MethodsIn March 2021 individual and group interviews were conducted with seven clinical facilitators working in the Collaborative Clusters Education Model in one health service in southeast Queensland, Australia. Content analysis of transcribed interviews was performed. ResultsAssessment was achieved through two processes, situational scoring and moderation. In the process of situational scoring, clinical facilitators balanced the students’ perception of their role in assessment, accounted for the type of experiences available, considered multiple sources of evidence and used the Australian Nursing Standards Assessment Tool. In the process of moderation, clinical facilitators communicated with their cluster colleagues to determine a shared understanding of student history, considered data from multiple evidence sources and collaboratively evaluated the trustworthiness of student performance evaluation decisions. ConclusionsIn the Collaborative Clusters Education Model, the input of multiple assessors, working in a small team, ensured transparency in assessment processes. Furthermore, this transparency in assessment practices normalised on-going moderation, an in-built quality-check and, as such, an innovative component of assessment in the Collaborative Clusters Education Model. As nursing directors and managers seek to ameliorate the impact of nursing workforce pressures, this innovative model of collaborative assessment may serve as a valuable addition to nursing clinical assessment toolkits. Tweetable abstractThe Collaborative Clusters Education Model of Clinical Facilitation enables transparency in assessment processes and normalises moderation.

Organ Donation in Croatia: The Importance of a National Champion, a Comprehensive Plan, and International Collaborations.

The Republic of Croatia is a global leader in organ donation and transplantation despite having fewer resources and more modest healthcare expenditures than other countries in the European Union. The results of an extensive literature review were combined with expert input in an iterative multi-step data collection and evaluation process designed to assess trends in Croatian organ donation and transplantation and identify key elements, policy changes, and drivers of the system that have contributed to its success. Multiple sources of evidence were used in this study, including primary documents, national and international transplantation reports, and insights from critical informants and content experts. The results highlight several key organizational reforms that have substantially improved the performance of the Croatian transplant program. Our findings emphasize the importance of strong central governance led by an empowered national clinical leader acting under the direct auspices of the Ministry of Health and a comprehensive and progressive national plan. The Croatian transplant system is notable for its integrated approach and efficient manner of managing scarce health resources. Collectively, the results suggest that Croatia has become nearly self-sufficient due to its systematic implementation of the guiding principles for organ donation and transplantation.

The Pursuit of Gaining Legitimacy through Marketing Strategy: A Case of Social Enterprises in UAE

Social entrepreneurship is in its nascent stages in the UAE. The social and economic value created by the social enterprise may only be sustained through a process of legitimisation. It is imperative for social enterprises to adopt a strategic approach to marketing in attaining legitimacy. The purpose of this study is to investigate how marketing practices support social enterprises in increasing legitimacy. A qualitative multiple case study methodology is adopted. Multiple sources of evidence are used from seven social enterprises participating in this study. The main conclusion is that the strategic use of marketing for legitimacy purposes that goes beyond moral legitimacy, is not sufficiently taken advantage of within social enterprises in the UAE. This study has important implications and recommendations for social entrepreneurs, as well as experts in the field of digital marketing.

Hospitality internships and green leaders: analysing the engagement of interns with hotel sustainable development practices

PurposeThe aim is to provide insights on the inclusion of sustainability training during internship and the engagement of interns in the sustainability practices of the hotel. The paper investigates how aspects of knowledge and participation in sustainable practices can bring about a positive change in the industry's future and also aid in the creation of smart green leaders.Design/methodology/approachThe paper utilizes qualitative research methodology and draws on in-depth interviews with students and learning and development managers using multiple sources of evidence to derive a holistic picture.FindingsThe paper aims to highlight the importance of incorporating sustainability training as an indispensable part of hotel internships. It also reveals the positive impact and long-term behavioural changes of students along with presenting strategies to create student stewards for sustainability.Research limitations/implicationsThe limitations of the study arise from its small sample size, which nonetheless generated some rich insights.Originality/valueThere has been much research in the area of hospitality internships, however, it has not been considered from the perspective of sustainability development or green internships. In this sense, the paper is novel as it challenges the traditional expectations of hospitality internships.

GEJS: A Generalized Evidential Divergence Measure for Multisource Information Fusion

Multisource information fusion (MSIF) technologies play an important role in various fields and practical applications. As a useful methodology to represent and handle uncertain information, the Dempster–Shafer evidence theory has been broadly used in many fields of MSIF. In evidence theory, however, Dempster’s combination rule (DCR) may result in counterintuitive results when fusing highly conflicting evidence. To address this issue, in this article, a novel MSIF method based on a newly defined generalized evidential divergence measure among multiple sources of evidence is proposed for decision making. Specifically, we first design a new generalized evidential Jensen–Shannon (GEJS) divergence to measure the conflict and discrepancy among multiple sources of evidence. The proposed GEJS divergence has three main characteristics, which are beneficial for evidential divergence measurement: 1) it measures the divergence among multiple sources of evidence, not just two, and thus provides a more generalized framework; 2) it considers different weights of multiple sources of evidence to measure divergence among them, which is desirable for application requirements; and 3) it considers the cardinality of propositions of multiple sources of evidence to measure divergence by considering features of evidential subsets. Given these advantages of GEJS, an appropriate weight for each source of evidence can be obtained. Next, according to the corresponding weights, we amend the bodies of evidence to generate a weighted average evidence. DCR is then used to fuse the weighted average evidence, and the final result is used to support decision making. Finally, we present a case study of fault diagnosis and a sensitivity analysis to demonstrate that the proposed MSIF is effective and robust for addressing conflicting situations compared to related works. Additionally, an application of classification validates the practicability of the proposed MSIF with a good decision level.

A taxonomic treatment of the violets (Violaceae) of the northeastern United States and adjacent Canada 1

A taxonomic treatment is presented for the violets (Violaceae) confirmed in the range described in the second edition of Gleason and Cronquist's Manual of Vascular Plants of Northeastern United States and Adjacent Canada, in advance of the new treatment of this manual that is in preparation. Recent field, herbarium, and laboratory investigations of eastern North America's violet flora by the author and students have reexamined eastern North American violet taxa and utilized multiple sources of evidence filtered through modern species concepts to delimit taxa and assign appropriate taxonomic rank. Results have led to the recognition of 58 native and eight introduced species, one subspecies, one variety and one form, 10 informal variants, and 113 wild hybrids in our region, representing the genera Cubelium, Pombalia, and Viola. In Viola, two new species are described and three new combinations are made (one to species rank, one to subspecies, and one to forma), and eight names are typified. Viola taxa are distributed across five sections and nine subsections and are representative of most of the infrageneric taxonomic diversity in North America overall. Anomalous variants in Viola emarginata, Viola palmata, Viola septentrionalis, and Viola sororia currently lack sufficient information for taxonomic decisions but are presented to encourage study, collection, and documentation. Six potential taxa occur adjacent to or very near our region and may eventually be discovered in our area; they are included in the keys and briefly described with figures. The treatment includes introductory text, dichotomous keys, synonymy with some type information, detailed descriptions, and other information, as well as color figures of habit and plant structures and US county-level geographic distribution maps for nearly all included taxa.

An Information Management Model for Addressing Residents’ Complaints through Artificial Intelligence Techniques

Construction companies usually record customer complaints as unstructured texts, resulting in unsuitable information to understand defect occurrences. Moreover, complaint databases are often manually classified, which is time-consuming and error-prone. However, previous studies have not provided guidance on how to improve customer complaint data collection and analysis. This research aims to devise an information management model for customer complaints in residential projects. Using Design Science Research, a study was undertaken at a Brazilian residential building company. Multiple sources of evidence were used, including interviews, participant observations, and analysis of an existing database. Natural language processing (NLP) was used to build a word menu for customers to lodge a complaint. Moreover, a recommendation system was proposed based on machine learning (ML) and hierarchical defect classification. The system was designed to indicate which defects should be investigated during inspections. The main outcome of this investigation is an information management model that provides an effective classification system for customer complaints, supported by artificial intelligence (AI) applications that improve data collection, and introduce some degree of automation to warranty services. The main theoretical contribution of the study is the use of advanced data management approaches for managing complaints in residential building projects, resulting in the combination of inputs from technical and customer perspectives to support decision-making.

A Unified Forensics Analysis Approach to Digital Investigation

Digital forensics is now essential in addressing cybercrime and cyber-enabled crime but potentially it can have a role in almost every other type of crime. Given technology's continuous development and prevalence, the widespread adoption of technologies among society and the subsequent digital footprints that exist, the analysis of these technologies can help support investigations. The abundance of interconnected technologies and telecommunication platforms has significantly changed the nature of digital evidence. Subsequently, the nature and characteristics of digital forensic cases involve an enormous volume of data heterogeneity, scattered across multiple evidence sources, technologies, applications, and services. It is indisputable that the outspread and connections between existing technologies have raised the need to integrate, harmonise, unify and correlate evidence across data sources in an automated fashion. Unfortunately, the current state of the art in digital forensics leads to siloed approaches focussed upon specific technologies or support of a particular part of digital investigation. Due to this shortcoming, the digital investigator examines each data source independently, trawls through interconnected data across various sources, and often has to conduct data correlation manually, thus restricting the digital investigator’s ability to answer high-level questions in a timely manner with a low cognitive load. Therefore, this research paper investigates the limitations of the current state of the art in the digital forensics discipline and categorises common investigation crimes with the necessary corresponding digital analyses to define the characteristics of the next-generation approach. Based on these observations, it discusses the future capabilities of the next-generation unified forensics analysis tool (U-FAT), with a workflow example that illustrates data unification, correlation and visualisation processes within the proposed method.

Adaptation of a Behavioural Activation Intervention for Depression in People with Diabetes in Bangladesh and Pakistan: DiaDeM Intervention

The cultural tailoring of interventions is a cost-effective approach to reach underserved populations. There are multiple frameworks for intervention adaptation, however, information on their use in practice, and sources to guide the adaptations is limited. The aim of this paper is to describe our experience using intervention adaptation frameworks and illustrate the adaptation process of a behavioural activation intervention for depression in people with type 2 diabetes in Bangladesh and Pakistan. We were guided by the intervention mapping adaptation framework for development and evaluation of health interventions and the Bernal and the Escoffery frameworks to address the cultural components of the adaptation. We performed a needs assessment, developed a logic model and systematically searched for available evidence-based interventions. To obtain evidence to guide the adaptations, we conducted a literature review, a qualitative study and workshops with community, expert advisory panels and a co-design group which systematically fed into the adaptation process. We co-produced the materials (training manual and booklet) with stakeholders. Finally, an implementation and evaluation plan was produced to test the feasibility and effectiveness of the intervention. We selected 3 interventions that had a good fit for our target population. Guided by the logic model, we identified core components of these interventions that could not be changed. We made changes in the language, pictures, illustrations, intervention dose and delivery (self-guided versus facilitator), inclusion of carers and/or family members, and training intensity. We developed a protocol to test the feasibility and effectiveness of the intervention considering key changes from the original intervention and the characteristics of the new setting and target population. Intervention adaptation frameworks proved to be valuable tools to guide the intervention process, and ensure the inclusion of multiple sources of evidence and key stakeholders.

A new species of jupati, genusMetachirusBurmeister 1854 (Didelphimorphia, Didelphidae) for the Brazilian Amazon

AbstractThe brown or pouchless four-eyed opossums or jupatis represent the genusMetachiruswith a wide geographical range in the Neotropics. Recent studies show distinct monophyletic clades with high genetic divergence and recognized two species,Metachirus nudicaudatusandMetachirus myosuros. Nevertheless, there is a need for systematic revision with multiple sources of evidence on the taxonomy ofMetachirus, which has never been fully revised. Here we describe a new species ofMetachirusfor the Brazilian Amazon from the Xingu/Tocantins interfluve using the unification of concepts and evolutionary significant units, morphological, genetic, and geographic data. Our analysis reveals a new species withinMetachirusas a differentiated Amazonian clade from the Serra dos Carajás region and the Caxiuanã National Forest, both in the Xingu endemism centre. This new species can be distinguished from the type species,M. nudicaudatusand fromM. myosurosthrough discrete external morphological characters, including cranium and dentition, and molecular data with an average degree of divergence, but ancient divergence time for the mitochondrial cytochromebgene. The Amazon River delimits the distribution of the new species, which also occurs in areas under strong anthropogenic pressure, reinforcing the importance to guide conservation strategies for the region.

Risk of within-hotel transmission of SARS-CoV-2 during on-arrival quarantine in Hong Kong: an epidemiological and phylogenomic investigation

On-arrival quarantine has been one of the primary measures to prevent the introduction of SARS-CoV-2 into Hong Kong since the start of the pandemic. Most on-arrival quarantines have been done in hotels, with the duration of quarantine and testing frequency during quarantine modified over time along with other pandemic control measures. However, hotels are not designed with infection control in mind. We aimed to systematically study the potential risk of acquisition of SARS-CoV-2 infection among individuals undergoing hotel quarantine. We examined data on each laboratory-confirmed COVID-19 case identified in on-arrival quarantine in a hotel in Hong Kong between 1 May 2020 and 31 January 2022. We sequenced the whole genomes of viruses from cases that overlapped with other confirmed cases in terms of the hotel of stay, date of arrival and date of testing positive. By combining multiple sources of evidence, we identify probable and plausible transmission events and calculate the overall risk of transmission. Among 221 imported cases that overlapped with other cases detected during hotel quarantine with available sequence data, phylogenomic analyses identified five probable and two plausible clusters of within-hotel transmission. Only two of these clusters were recognised at the time. Including other clusters reported in Hong Kong, we estimate that 8-11 per 1000 cases identified in hotel quarantine may be infected by another unlinked case during quarantine, or 2-3 per 100,000 overseas arrivals. We have identified additional undetected occurrences of COVID-19 transmission within hotel quarantine in Hong Kong. Although hotels provide suboptimal infection control as improvised quarantine facilities, the risk of contracting infection whilst in quarantine is low. However, these unlikely events could have high consequences by allowing the virus to spread into immunologically naïve communities. Additional vigilance should be taken in the absence of improved controls to identify such events. If on-arrival quarantine is expected to be used for a long time, quarantine facilities could be purpose-built to minimise the risk of transmission. Health and Medical Research Fund, Hong Kong.