International Infection Control Training Partnerships: Experiences from the Egypt-University of Louisville Collaboration

Background: Healthcare-associated infection (HAI) is a global challenge that represent opportunities for international collaboration. Both the United States and Egypt prioritize HAI reduction as activities of public health importance. These shared priorities provide a foundation for interactive education and training. Objective: In the fall 2018, The United States Agency for International Development (USAID) sought a US training site where a delegation of physicians and nurses from Egypt could receive experiential training regarding HAI and prevention. The objectives of this review are to: 1) outline the training components used for the US-Egypt collaboration held at the University of Louisville in Kentucky; 2) describe the immersive and experiential approaches used to promote interprofessional education in infection control; and 3) identify some of the successes and challenges of this cultural and practice collaboration. Methods: The course curriculum consisted of a 10-day agenda that provided classroom training, live simulation, role playing, and healthcare facility visits all supporting immersive and experiential learning. Evaluation methods were based upon Kirkpatrick’s Model and included individual self-assessments, daily course evaluations, a summative course evaluation, pre-and post-course testing, and action learning plans. Results: The Egyptian cohort consisted of twenty-six physicians and nurses representing twenty-six different healthcare facilities across the country. Participants rated the course highly but had a strong desire for more interactive experiences at the hospitals. Comparing pre- and post-course knowledge, overall knowledge improved in both the physician and nurse groups. Conclusions: Results from this collaboration demonstrate an ability to provide an organized infection prevention and control training course that reached the University of Louisville team goals and met the stated expectations of the course sponsors. Both the University of Louisville team and the Egyptian delegation indicated that a longer planning horizon would have been beneficial

Multistate Hepatitis A Outbreak: Vaccination of Food Service Workers as Part of the Kentucky Outbreak Response

Background: In August 2017, a local outbreak of Hepatitis A was identified among homeless individuals in Louisville, Kentucky. This marked the first cases in what has now become recognized as the largest Hepatitis A outbreak in the US. When infection was identified in a Food Service Worker (FSW), vaccination efforts were expanded to target this group. Objective: The purpose of this study was to describe: 1) the processes used to provide access to Hepatitis A vaccine for FSWs, 2) results from the immunization activities, and 3) lessons learned from the outcomes. Methods: Through a partnership between the Louisville Metro Department of Public Health and Wellness (LMDPHW) and the University of Louisville Division of Infectious Diseases, a novel approach to vaccination was implemented. Access to vaccine was provided via on-site immunization in 66 restaurants and subsequent availability in a pop-up vaccination clinic. Data were collected using the LMDPHW data collection form and included demographics, risk factors for Hepatitis A, and vaccine documentation. Results for those vaccinated March-December 2018 were analyzed using descriptive statistics. Results: On-site vaccination was provided to 1337 FSW at 66 restaurants during the seven (7) week period from March 28-May 15, 2018. This process involved a team of 42 including Advanced Practice Registered Nurses, Registered and Licensed Practical Nurses, Physicians, and UL team members. During the 35 weeks the walk-in clinic has been in operation (May 16-December 31, 2018), 3068 additional FSW were vaccinated for a total of 4405 FSWs vaccinated as part of the outbreak response. Critical partners included the Kentucky Restaurant Association and the Kentucky Nurses Association. Conclusions: This study demonstrated a successful model for vaccination of a novel population during an infectious disease outbreak and the importance of expanding partnership networks to ensure success. The outcomes emphasized the importance of the resources available in the academic community for reliable and consistent public health emergency response

The association of depressive symptoms and pulmonary function in healthy adults

Objective: Chronic lung disease is exacerbated by comorbid psychiatric issues and treatment of depression may improve disease symptoms. We sought to add to the literature as to whether depression is associated with pulmonary function in healthy adults. Methods: In 2551 healthy adults from New York State, we studied the association of depression via the Center for Epidemiologic Studies Depression scale (CES-D) scale score and forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) using general linear models and a cross-sectional design. Results: We identified statistically significant inverse trends in FEV1, FVC, FEV1%, and FVC% by CES-D category, especially in ever-smokers and men. When adjusted for covariates, the difference in FEV1 and FEV1% for smokers with more than 18.5 lifetime pack-years from CES-D scores 0 to 3 to 16 or more (depressed) is approximately 0.25 l and 5.0% (adjusted p values for trend are <.001 and .019, respectively). In men, we also observed statistically significant inverse trends in pulmonary function with increasing CES-D. Conclusions: We identified an inverse association of depressive symptoms and pulmonary function in healthy adults, especially in men and individuals with a heavy smoking history. Further studies of these associations are essential for the development and tailoring of interventions for the prevention and treatment of chronic lung disease

Healthcare Workers Hospitalized with COVID-19: Outcomes from the Burden of COVID-19 study at the University of Louisville Center of Excellence for Research in Infectious Diseases [CERID]

Introduction: On March 6, 2020, the current ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also known as COVID-19 reached the commonwealth of Kentucky. Within days the first cases of infection and hospitalization were identified among healthcare workers (HCW) in Kentucky, other states in the U.S., and around the world. There is little information available regarding the impact of COVID-19 on the HCW population within this area. The objective of this study is to describe the baseline characteristics of hospitalized HCWs infected with COVID-19. Methods: Data collection was performed as part of a retrospective study of patients hospitalized with COVID-19 in any of nine acute care hospitals in Louisville. COVID-19 infection was confirmed using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). Descriptive statistics were performed on clinical and epidemiological characteristics of hospitalized patients with COVID-19 who had indicated healthcare as their occupation. Results: Of the 700 adults hospitalized with COVID-19 from March 7 through July 1, 2020, 23 were HCWs. The mean age was 51 years and 78% were female. The majority of hospitalized HCWs had comorbidities including obesity (70%), hypertension (57%), hyperlipidemia (35%) and diabetes (26%). Common symptoms reported were fever (70%), dyspnea (78%), cough (78%) and fatigue (57%). Nine HCWs (39%) were admitted to the intensive care unit (ICU) and 6 (26%) developed acute respiratory distress syndrome (ARDS). Two (9%) patients developed a new, serious arrhythmia, two sustained cardiac arrest (9%), and two (9%) died in-hospital. Conclusions: Older adult HCWs with underlying health conditions such as obesity and hypertension were more likely to be hospitalized and have severe in-hospital complications. One HCW death due to COVID-19 was identified in this small population. These findings can help to identify and strengthen approaches to protect HCWs from SARS-CoV-2 infection and from long term effects of COVID-19

Epidemiology and Outcomes of Hospitalized Adults with SARS-CoV-2 Community-Acquired Pneumonia in Louisville, Kentucky

Background: During the ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV-2 community-acquired pneumonia (CAP) has been the primary cause of hospitalization. The objective of this study was to evaluate the clinical characteristics and outcomes of 1,013 patients hospitalized with SARS-CoV-2 CAP from September 2020 through March 2021 in Louisville, Kentucky. Methods: This was a retrospective observational study of 1,013 patients hospitalized with SARS-CoV-2 CAP at eight of the adult hospitals in the city of Louisville from September 2020 through March 2021. Patients with 1) a positive reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate on chest imaging were defined as having SARS-CoV-2 CAP. Data were abstracted from each hospital’s electronic health record. Descriptive statistics were performed on clinical and epidemiological characteristics of hospitalized patients with SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. Data were analyzed by descriptive and inferential statistics using R version 3.4.0. Results: Of the 1,013 patients hospitalized with SARS-CoV-2 CAP, the median age was 65 years, 53% were males, 24% reported their race as African American or Black, and 6% identified as Hispanic. The most frequent comorbidities were hypertension (73%), obesity (56%), and diabetes (43%). At the time of admission, 60% required supplemental oxygen. The mortality rate was 19% for the total population and 45% for the 359 patients admitted to the intensive care unit (ICU). For each comorbidity, the proportion of hospitalized patients with SARS-CoV-2 CAP was significantly different from the Louisville population (P Conclusions: The elderly, males, and patients with a history of coronary artery disease, cerebrovascular disease, chronic obstructive pulmonary disease, hypertension, diabetes, renal disease, or obesity are overrepresented among hospitalized patients with SARS-CoV-2 CAP compared to the Louisville population. These patients are also more likely to require ICU care and experience worse clinical outcomes, with death occurring in approximately one in every five hospitalizations

Genome-wide Characterization of Shared and Distinct Genetic Components that Influence Blood Lipid Levels in Ethnically Diverse Human Populations

Blood lipid concentrations are heritable risk factors associated with atherosclerosis and cardiovascular diseases. Lipid traits exhibit considerable variation among populations of distinct ancestral origin as well as between individuals within a population. We performed association analyses to identify genetic loci influencing lipid concentrations in African American and Hispanic American women in the Women’s Health Initiative SNP Health Association Resource. We validated one African-specific high-density lipoprotein cholesterol locus at CD36 as well as 14 known lipid loci that have been previously implicated in studies of European populations. Moreover, we demonstrate striking similarities in genetic architecture (loci influencing the trait, direction and magnitude of genetic effects, and proportions of phenotypic variation explained) of lipid traits across populations. In particular, we found that a disproportionate fraction of lipid variation in African Americans and Hispanic Americans can be attributed to genomic loci exhibiting statistical evidence of association in Europeans, even though the precise genes and variants remain unknown. At the same time, we found substantial allelic heterogeneity within shared loci, characterized both by population-specific rare variants and variants shared among multiple populations that occur at disparate frequencies. The allelic heterogeneity emphasizes the importance of including diverse populations in future genetic association studies of complex traits such as lipids; furthermore, the overlap in lipid loci across populations of diverse ancestral origin argues that additional knowledge can be gleaned from multiple populations

Endemic Human Coronaviruses in Hospitalized Adults with Community-Acquired Pneumonia: Results from the Louisville Pneumonia Study

Introduction: There are four endemic serotypes of human coronavirus (HCoV) that may cause community-acquired pneumonia (CAP) in humans. The clinical syndrome of CAP due to HCoVs is not well characterized. The objectives of this study were to evaluate incidence, epidemiology, and outcomes of CAP in adults due to HCoV and to compare them with CAP due to influenza. Methods: The Louisville Pneumonia Study (LPS) is a prospective observational study of hospitalized adult patients with CAP in the city of Louisville. Patients enrolled in the LPS in whom a respiratory viral panel polymerase chain reaction (PCR) was obtained were evaluated. Incidence, epidemiology, and outcomes were compared for patients with a positive PCR for HCoV versus patients with a positive PCR for influenza. Results: From 1,974 CAP patients with a PCR performed, HCoV was identified in 65 patients (3.3%), corresponding to the following serotypes: HCoV-229E in 12 patients, HCoV-OC43 in 38 patients, HCoV-NL63 in 6 patients and HCoV-HKU1 in 9 patients. No differences were observed in clinical presentation and early outcomes for patients with CAP due to HCoV compared to 244 patients with CAP due to influenza. One-year mortality after hospitalization was 32% for patients with CAP due to HCoV versus 13% for patients with CAP due to influenza. Conclusions: When compared to patients with CAP due to influenza, the clinical presentation of patients with CAP due to HCoV is similar, but these patients have significantly worse outcomes one year after hospitalization

Community-Acquired Pneumonia due to Endemic Human Coronaviruses compared to 2019 Novel Coronavirus: A Review

The human coronaviruses (HCoVs) are an important etiology of community-acquired respiratory tract infections. Community-acquired pneumonia (CAP) may be caused by serotypes of endemic HCoVs or highly pathogenic HCoVs. In this review we compared the clinical characteristic, management, outcomes, and infection control practices for patients with CAP due to endemic HCoVs versus patients with CAP due to 2019 novel coronavirus

Age and sex influence social interactions, but not associations, within a killer whale pod

This is the author accepted manuscript. The final version is available from the Royal Society via the DOI in this record.Data accessibility: The processed contact, surfacing, and association networks, measures of dyadic sampling effort, estimated maternal kinship, individual attributes, and functions to conduct GLMQAP and general double-semi-partialling are included in the “aninet” R package on GitHub (https://github.com/MNWeiss/aninet). The raw time-series of detections and interactions, and R code necessary to reproduce all analyses, are available in the online supplementary material.Social structure is a fundamental aspect of animal populations. In order to understand the function and evolution of animal societies, it is important to quantify how individual attributes, such as age and sex, shape social relationships. Detecting these influences in wild populations under natural conditions can be challenging, especially when social interactions are difficult to observe and broad-scale measures of association are used as a proxy. In this study, we use unoccupied aerial systems to observe association, synchronous surfacing, and physical contact within a pod of southern resident killer whales (Orcinus orca). We show that interactions do not occur randomly between associated individuals, and that interaction types are not interchangeable. While age and sex did not detectably influence association network structure, both interaction networks showed significant social homophily by age and sex, and centrality within the contact network was higher among females and young individuals. These results suggest killer whales exhibit interesting parallels in social bond formation and social life histories with primates and other terrestrial social mammals, and demonstrate how important patterns can be missed when using associations as a proxy for interactions in animal social network studies.Natural Environment Research Council (NERC)National Fish and Wildlife FoundationPaul G Allen Family FoundationUW Center for Conservation BiologyCenter for Whale Researc

No difference in clinical outcomes for African American and White patients hospitalized with SARS-CoV-2 pneumonia in Louisville, Kentucky

Introduction: Current literature indicates that African American individuals are at increased risk of becoming infected with the SARS-CoV-2 virus and suffer higher SARS-CoV-2-related mortality rates. However, there is a lack of consensus as to how the clinical outcomes of African American patients differ from those of other groups. The objective of this study was to define the clinical outcomes of African American and White hospitalized patients with SARS-CoV-2 community-acquired pneumonia (CAP) in Louisville, Kentucky. Methods: This was a retrospective cohort study of hospitalized patients with SARS-CoV-2 CAP at eight hospitals in Louisville, Kentucky. Severity of CAP at time of hospitalization was evaluated using the pneumonia severity index (PSI), CURB-65 score and SARS-CoV-2 viral load. The following thirteen clinical outcomes were compared: discharge alive to home, time to home discharge, admission to the ICU, length of ICU stay, need for invasive mechanical ventilation (IMV), duration of IMV, development of acute respiratory distress syndrome (ARDS), development of septic shock, need for vasopressors, development of cardiovascular events, time to cardiovascular events, in-hospital mortality, and time to death. Results: A total of 541 patients were eligible for this study, 343 White (63%) and 198 African American (37%). None of the thirteen clinical outcomes were statistically significantly different between the two groups. Conclusions: This study indicates that African American and White patients do not have different clinical outcomes after the point of hospitalization due to SARS-CoV-2 CAP