Electronic Health Record-Based Surveillance for Community Transmitted COVID-19 in the Emergency Department

Introduction: SARS-CoV-2, a novel coronavirus, manifests as a respiratory syndrome (COVID-19) and is the cause of an ongoing pandemic. The response to COVID-19 in the United States has been hampered by an overall lack of diagnostic testing capacity. To address uncertainty about ongoing levels of SARS-CoV-2 community transmission early in the pandemic, we aimed to develop a surveillance tool using readily available emergency department (ED) operations data extracted from the electronic health record (EHR). This involved optimizing the identification of acute respiratory infection (ARI)-related encounters and then comparing metrics for these encounters before and after the confirmation of SARS-CoV-2 community transmission.Methods: We performed an observational study using operational EHR data from two Midwest EDs with a combined annual census of over 80,000. Data were collected three weeks before and after the first confirmed case of local SARS-CoV-2 community transmission. To optimize capture of ARI cases, we compared various metrics including chief complaint, discharge diagnoses, and ARI-related orders. Operational metrics for ARI cases, including volume, pathogen identification, and illness severity, were compared between the pre- and post-community transmission timeframes using chi-square tests of independence.Results: Compared to our combined definition of ARI, chief complaint, discharge diagnoses, and isolation orders individually identified less than half of the cases. Respiratory pathogen testing was the top performing individual ARI definition but still only identified 72.2% of cases. From the pre to post periods, we observed significant increases in ED volumes due to ARI and ARI cases without identified pathogen.Conclusion: Certain methods for identifying ARI cases in the ED may be inadequate and multiple criteria should be used to optimize capture. In the absence of widely available SARS-CoV-2 testing, operational metrics for ARI-related encounters, especially the proportion of cases involving negative pathogen testing, are useful indicators for active surveillance of potential COVID-19 related ED visits

The techno-ecological practice as the politics of ontological coalitions

The paper focuses on the art projects aimed at visualizing (grasping) the physical or biological phenomena through interfaces and / or installations designed specifically for such purpose. Such works often mirror the post-­digital condition of our time where the digital technologies constitute the common background for everyday activities, no longer having the allure of "new" and "exciting" (Berry, Dieter et al., 2015). In this process, both the networked technologies of wireless communication and the act of crossing the boundaries between the digital and the physical play the crucial role as the post-­digital networked imagery increasingly becomes directly connected to the physical environment. I would like to ponder on the questions of processuality and relationality involved in such instances where the complexity of the hybrid works of art clearly transgresses the paradigm of representationalism (Thrift, 2008;; Anderson and Harrison, 2010;; Kember and Zylinska, 2012). The particular attention is given to the fact that such artworks bond different ontological realms (discursive, physical, digital) and different agents (human and non-­human, carbon-­based and software-­based) forging “ontological coalitions” (Malafouris, 2013). Throughout the article the mutlirealist and relational perspective is offered, inspired by the propositions of Gilbert Simondon and Etienne Souriau. Based on the research project supported by National Science Centre Poland ("The aesthetics of post-­digital imagery: between new materialism and object-­oriented philosophy", 2016/21/B/HS2/00746)

Young children, gender and the heterosexual matrix

In this paper I consider the adult focus of current mainstream gender theory. I relate this to how the concept of the heterosexual matrix originates in a social contract which excludes children from civil society. I argue that this exclusion is problematic both for theoretical reasons and from the perspective of children themselves. I start by discussing the nature of the heterosexual matrix and its foundations. I consider the implications for participation which arise from being named as a child, how that affects children’s attempts to claim participation in civil society, and how this is related to children’s naming of themselves as gendered. I then briefly consider the possibility that, because of their exclusion, children might also be considered to be exempt from the heterosexual matrix. However, I argue, there is considerable evidence that children are actively sexual beings who also work hard to claim inclusion in local practices of heterosexuality. I end by suggesting that there are three key reasons for this: that the discourses of normative sexuality provide children with a language to express sexual feelings; that self-insertion in the heterosexual matrix is a way for children to claim rights to participation; and that taking up heterosexual formations is a means whereby children can experience the power of naming themselves as part of the social world

Characterization of the role of BGS13 in the secretory mechanism of Pichia pastoris

The methylotrophic yeast Pichia pastoris has been utilized for heterologous protein expression for over 30 years. Because P. pastoris secretes few of its own proteins, the exported recombinant protein is the major polypeptide in the extracellular medium, making purification relatively easy. Unfortunately, some recombinant proteins intended for secretion are retained within the cell. A mutant strain isolated in our laboratory, containing a disruption of the BGS13 gene, displayed elevated levels of secretion for a variety of reporter proteins. The Bgs13 peptide (Bgs13p) is similar to the Saccharomyces cerevisiae protein kinase C 1 protein (Pkc1p), but its specific mode of action is currently unclear. To illuminate differences in the secretion mechanism between the wild-type (wt) strain and the bgs13 strain, we determined that the disrupted bgs13 gene expressed a truncated protein that had reduced protein kinase C activity and a different location in the cell, compared to the wt protein. Because the Pkc1p of baker’s yeast plays a significant role in cell wall integrity, we investigated the sensitivity of the mutant strain’s cell wall to growth antagonists and extraction by dithiothreitol, determining that the bgs13 strain cell wall suffered from inherent structural problems although its porosity was normal. A proteomic investigation of the bgs13 strain secretome and cell wall-extracted peptides demonstrated that, compared to its wt parent, the bgs13 strain also displayed increased release of an array of normally secreted, endogenous proteins, as well as endoplasmic reticulum-resident chaperone proteins, suggesting that Bgs13p helps regulate the unfolded protein response and protein sorting on a global scale. IMPORTANCE The yeast Pichia pastoris is used as a host system for the expression of recombinant proteins. Many of these products, including antibodies, vaccine antigens, and therapeutic proteins such as insulin, are currently on the market or in late stages of development. However, one major weakness is that sometimes these proteins are not secreted from the yeast cell efficiently, which impedes and raises the cost of purification of these vital proteins. Our laboratory has isolated a mutant strain of Pichia pastoris that shows enhanced secretion of many proteins. The mutant produces a modified version of Bgs13p. Our goal is to understand how the change in the Bgs13p function leads to improved secretion. Once the Bgs13p mechanism is illuminated, we should be able to apply this understanding to engineer new P. pastoris strains that efficiently produce and secrete life-saving recombinant proteins, providing medical and economic benefits