Managing hospital visitor admission during Covid-19: A discrete-event simulation by the data of a German University Hospital

The Corona pandemic and the associated need for visitor restrictions have defined an entirely new management task in hospitals: The hospital visitor management. The admission process of hospital visitors and the implementation of associated infection-prevention strategies such as the delivery of face masks thereby pose major challenges. In this work, we evaluate both implemented and planned admission processes in a German University Hospital based on a discrete-event simulation model and provide distinct recommendations for hospital visitor management with special consideration of digitalization, antigen testing, waiting times, space and staff utilization. We find the extraordinary potential of digitalization with a reduction of visitor waiting and service times of up to 90 percent, the significant burden for personnel and room capacity, in terms of antigen testing, especially, and the need for visitor restrictions in terms of a maximum number of visitors per inpatient

Prevalência do Diagnóstico de DPOC em Pacientes internados com Cardiopatia Isquêmica em um Hospital Universitário no interior do Estado do Rio Grande do Sul

Background and objectives: the Chronic Obstructive Pulmonary Disease (COPD) appears as a public health problem and has received increasing attention in recent years. We sought to evaluate the proportion of patients who were hospitalized for ischemic heart disease (IHD), had a history of exposure to risk factors and / or had been diagnosed with COPD. Methods: Cross-sectional, observational study prospectively. We selected all patients over 40 years admitted from September 2014 to June 2015, with the diagnosis of IC. Data were analyzed using SPSS 22.0 program. Results: The study included 69 patients who were hospitalized with a diagnosis of IC in the years 2014 and 2015. The average age of patients was 65 years and of these, 35 (50.7%) were male. The mean duration of hospitalization of these patients was 3 days. Patients who were diagnosed with COPD and were treated were six (8.69%), and those who had undergone previous spirometry totaled 5 (7.24%). As for respiratory symptoms in patients with IC, 25 patients (64.1%) had cough, sputum or dyspnea. There was a 8.7% of patients reported have been previously diagnosed with COPD. Conclusions: Despite the high prevalence of respiratory symptoms and exposure to risk factors, patients with COPD have more events and increased mortality from ischemic heart disease, our study suggests that there is a high percentage of underdiagnosis of COPD patients hospitalized for ischemic heart disease in our midst. KEYWORDS: Pulmonary Disease, Chronic Obstructive. Myocardial Ischemia. Risk Factors.Antecedentes y objetivos: La Enfermedad Pulmonar Obstructiva Crónica (EPOC) constituye un problema de salud pública y ha recibido creciente atención en los últimos años. Se buscó evaluar cuál era la proporción de pacientes hospitalizados por cardiopatía isquémica (CI) que contaba con historia de exposición a factores de riesgo y/o habían sido diagnosticados con EPOC. Métodos: Estudio transversal, observacional, del tipo prospectivo. Se seleccionaron todos los pacientes mayores de 18 años, lúcidos, que aceptaran participar del estudio, ingresados desde septiembre 2014 a junio 2015 con diagnóstico de CI. Datos analizados mediante programa SPSS 22.0. Resultados: Fueron incluidos 69 pacientes hospitalizados con diagnóstico de CI en 2014 y 2015. La media etaria fue de 65 años; de estos, 35 (50,7%) eran de sexo masculino. El promedio de duración de la internación de los pacientes fue de 3 días. Los pacientes con diagnóstico de EPOC que estaban en tratamiento fueron 6 (8,69%), y los que habían realizado espirometría anterior totalizaron 5 (7,24%). En cuanto a los síntomas respiratorios en pacientes con CI, 25 pacientes (64,1%) tenían tos, expectoración o disnea. Hubo reporte de que el 8,7% de los pacientes ya había sido diagnosticado previamente con EPOC. Conclusiones: A pesar de que la alta prevalencia de síntomas respiratorios y exposición a factores de riesgo hace que los pacientes con EPOC sufran mayor número de eventos y mayor mortalidad por cardiopatía isquémica, nuestro estudio sugiere que existe un alto porcentaje de subdiagnóstico de EPOC en pacientes internados por cardiopatía isquémica en nuestro medio. Palabras clave: Enfermedad pulmonar obstructiva crónica. La cardiopatía isquémica. Factores de riesgo.Justificativa e objetivos: A Doença Pulmonar Obstrutiva Crônica (DPOC) é um problema de saúde pública e tem recebido crescente atenção nos últimos anos. Buscouse avaliar qual a proporção dos pacientes que internaram por cardiopatia isquêmica (CI) tinham história de exposição a fatores de risco e/ou haviam sido diagnosticados como portadores de DPOC. Métodos: estudo transversal, observacional, do tipo prospectivo. Foram selecionados todos os pacientes, acima de 18 anos, lúcidos e que concordaram em participar do estudo, internados no período de setembro de 2014 a junho de 2015, com o diagnóstico de CI. Os dados analisados foram analisados no programa SPSS 22.0. Resultados: foram incluídos 69 pacientes que internaram com diagnóstico de CI nos anos de 2014 e 2015. A média de idade dos pacientes foi de 65 anos e destes, 35 (50,7%) eram do sexo masculino. A média da duração de internação desses pacientes foi de 3 dias. Os pacientes que apresentavam diagnóstico de DPOC e estavam em tratamento eram 6 (8,69%), e os que haviam realizado espirometria prévia totalizavam 5 (7,24%). Quanto às manifestações respiratórias nos pacientes com CI, 25 pacientes (64,1%) apresentavam tosse, expectoração ou dispneia. Houve um relato de 8,7% dos pacientes já terem sido diagnosticados previamente como portadores de DPOC. Conclusões: Apesar da alta prevalência de sintomas respiratórios e exposição a fatores de risco, pacientes com DPOC tem maior número de eventos e maior mortalidade por cardiopatia isquêmica, nosso estudo sugere que existe uma alta porcentagem de subdiagnóstico de DPOC em pacientes internados por cardiopatia isquêmica em nosso meio.portadores de DPOC. Conclusões: Apesar da alta prevalência de sintomas respiratórios e exposição a fatores de risco, pacientes com DPOC tem maior número de eventos e maior mortalidade por cardiopatia isquêmica, nosso estudo sugere que existe uma alta porcentagem de subdiagnóstico de DPOC em pacientes internados por cardiopatia isquêmica em nosso meio. DESCRITORES: Doença Pulmonar Obstrutiva Crônica. Cardiopatia Isquêmica. Fatores de risco

Leucine-Rich Repeat Kinase 2 Modulates Retinoic Acid-Induced Neuronal Differentiation of Murine Embryonic Stem Cells

Background: Dominant mutations in the leucine-rich repeat kinase 2 (LRRK2) gene are the most prevalent cause of Parkinson’s disease, however, little is known about the biological function of LRRK2 protein. LRRK2 is expressed in neural precursor cells suggesting a role in neurodevelopment. Methodology/Principal Findings: In the present study, differential gene expression profiling revealed a faster silencing of pluripotency-associated genes, like Nanog, Oct4, and Lin28, during retinoic acid-induced neuronal differentiation of LRRK2deficient mouse embryonic stem cells compared to wildtype cultures. By contrast, expression of neurotransmitter receptors and neurotransmitter release was increased in LRRK2+/2 cultures indicating that LRRK2 promotes neuronal differentiation. Consistently, the number of neural progenitor cells was higher in the hippocampal dentate gyrus of adult LRRK2-deficient mice. Alterations in phosphorylation of the putative LRRK2 substrates, translation initiation factor 4E binding protein 1 and moesin, do not appear to be involved in altered differentiation, rather there is indirect evidence that a regulatory signaling network comprising retinoic acid receptors, let-7 miRNA and downstream target genes/mRNAs may be affected in LRRK2deficient stem cells in culture. Conclusion/Significance: Parkinson’s disease-linked LRRK2 mutations that associated with enhanced kinase activity may affect retinoic acid receptor signaling during neurodevelopment and/or neuronal maintenance as has been shown in othe

COVID-19 pandemic and student reading achievement: findings from a school panel study

Since 2020, the COVID-19 pandemic had an impact on education worldwide. There is increased discussion of possible negative effects on students’ learning outcomes and the need for targeted support. We examined fourth graders’ reading achievement based on a school panel study, representative on the student level, with N = 111 elementary schools in Germany (total: N = 4,290 students, age: 9–10 years). The students were tested with the Progress in International Reading Literacy Study instruments in 2016 and 2021. The analysis focused on (1) total average differences in reading achievement between 2016 and 2021, (2) average differences controlling for student composition, and (3) changes in achievement gaps between student subgroups (i.e., immigration background, socio-cultural capital, and gender). The methodological approach met international standards for the analysis of large-scale assessments (i.e., multiple multi-level imputation, plausible values, and clustered mixed-effect regression). The results showed a substantial decline in mean reading achievement. The decline corresponds to one-third of a year of learning, even after controlling for changes in student composition. We found no statistically significant changes of achievement gaps between student subgroups, despite numerical tendencies toward a widening of achievement gaps between students with and without immigration background. It is likely that this sharp achievement decline was related to the COVID-19 pandemic. The findings are discussed in terms of further research needs, practical implications for educating current student cohorts, and educational policy decisions regarding actions in crises such as the COVID-19 pandemic

Performance of antigen testing for diagnosis of COVID-19: a direct comparison of a lateral flow device to nucleic acid amplification based tests

Abstract Objectives The gold standard for diagnosing an infection with SARS-CoV-2 is detection of viral RNA by nucleic acid amplification techniques. Test capacities, however, are limited. Therefore, numerous easy-to-use rapid antigen tests based on lateral flow technology have been developed. Manufacturer-reported performance data seem convincing, but real-world data are missing. Methods We retrospectively analysed all prospectively collected antigen tests results performed between 23.06.2020 and 26.11.2020, generated by non-laboratory personnel at the point-of-care from oro- or nasopharyngeal swab samples at the University Hospital Augsburg and compared them to concomitantly (within 24 h.) generated results from molecular tests. Results For a total of 3630 antigen tests, 3110 NAAT results were available. Overall, sensitivity, specificity, NPV and PPV of antigen testing were 59.4%, 99.0%, 98.7% and 64.8%, respectively. Sensitivity and PPV were lower in asymptomatic patients (47.6% and 44.4%, respectively) and only slightly higher in patients with clinical symptoms (66.7% and 85.0%, respectively). Some samples with very low Ct-values (minimum Ct 13) were not detected by antigen testing. 31 false positive results occurred. ROC curve analysis showed that reducing the COI cut-off from 1, as suggested by the manufacturer, to 0.9 is optimal, albeit with an AUC of only 0.66. Conclusion In real life, performance of lateral-flow-based antigen tests are well below the manufacturer's specifications, irrespective of patient’s symptoms. Their use for detection of individual patients infected with SARS-CoV2 should be discouraged. This does not preclude their usefulness in large-scale screening programs to reduce transmission events on a population-wide scale

Comparative vegetation survey with focus on cryptogamic covers in the high Arctic along two differing catenas

Although cryptogamic covers are important ecosystem engineers in high Arctic tundra, they were often neglected in vegetation surveys. Hence we conducted a systematic survey of cryptogamic cover and vascular plant coverage and composition at two representative, but differing Arctic sites (Ny-angstrom lesund, Svalbard) along catenas with a natural soil moisture gradient, and integrated these data with physical-chemical soil properties. Soil samples were taken for comprehensive pedological and mineralogical analyses. Vegetation surveys were conducted based on classification by functional groups. Vascular plants were identified to species level. Correlation and multivariate statistical analysis were applied to determine the key environmental factors explaining vegetation patterns along the soil moisture gradients. We observed significant differences in gravimetric water, soil organic matter and nutrient contents along the moisture gradients. These differences were coincident with a shift in vegetation cover and species composition. While chloro- and cyanolichens were abundant at the drier sites, mosses dominated the wetter and vascular plants the intermediate plots. Twenty four vascular plant species could be identified, of which only six were present at both sites. Cryptogamic covers generally dominated with maximum areal coverage up to 70% and hence should be considered as a new additional syntaxon in future ground-truth and remote sensing based vegetation surveys of Svalbard. Multivariate analysis revealed that soil moisture showed the strongest relation between vegetation patterns, together with NH4-N and pH. In conclusion, soil moisture is a key driver in controlling cryptogamic cover and vegetation coverage and vascular plant species composition in high Arctic tundra

4Pi Microscopy of the Nuclear Pore Complex

To explore whether super-resolution fluorescence microscopy is able to resolve topographic features of single cellular protein complexes, a two-photon 4Pi microscope was used to study the nuclear pore complex (NPC). The microscope had an axial resolution of 110–130 nm and a two-color localization accuracy of 5–10 nm. In immune-labeled HeLa cells, NPCs could be resolved much better by 4Pi than by confocal microscopy. When two epitopes of the NPC, one localized at the tip of the cytoplasmic filaments and the other at the ring of the nuclear basket, were immune-labeled, they could be clearly resolved in single NPCs, with the distance between them determined to be 152 ± 30 nm. In cells expressing a green fluorescent protein construct localized at the NPC center, the distances between the ring of the nuclear filaments and the NPC center was 76 ± 12 (Potorous tridactylus cells) or 91 ± 21 nm (normal rat kidney cells), whereas the distance between the NPC center and the tips of the cytoplasmic filaments was 84 ± 18 nm, all values in good agreement with previous electron or single-molecule fluorescence estimates. We conclude that super-resolution fluorescence microscopy is a powerful method for analyzing single protein complexes and the cellular nanomachinery in general