Leveraging Federal Policies to Prevent and Respond to Communicable Disease Outbreaks

Leveraging Federal Policies to Prevent and Respond to Communicable Disease Outbreaks in Skilled Nursing Facilities Objective: The coronavirus (COVID-19) pandemic significantly impacted the health, safety and well-being of patients and healthcare workers in skilled nursing facilities (SNFs) across the United States (US), resulting in approximately 1.2 million confirmed cases, and 134,000 deaths as of May 30, 2021. The purpose of this study was to apply principles of legal research to identify federal policies aimed at preventing and responding to communicable disease outbreaks in SNFs, to assess these policies based on current evidence and expert opinions, and to provide policy proposals to address identified gaps. Methods: An environmental scan of the Library of Congress, Google Scholar, the Federal Register, Centers for Medicare and Medicaid Services (CMS), and Westlaw Edge databases was conducted to identify federal policies relevant to the prevention and response to communicable disease outbreaks in SNFs. Results were reviewed against study inclusion and exclusion criteria to identify policies to be included in the final analysis. The CDC’s Policy Analysis Framework was then used to assess current policies relative to current evidence as well as their overall public health impact, feasibility of implementation, and the economic impact. Gaps in existing policies were identified and policy proposals were made based on the analysis. Results: The environmental scan identified 571 policies across the five databases. Application of inclusion and exclusion criteria resulted in the elimination of 563, leaving a total of eight policies for review and analysis. Policies were categorized as preventative, responsive, or both. Nursing services (preventative) and Infection Prevention and Control/Training Requirements (responsive and preventative) were identified as policies needing modification to better improve patient care and safety. Conclusion: While there are many federal policies to prevent and respond to communicable disease outbreaks in SNFs, some of those policies do not reflect the best available scientific evidence. To improve the quality of care and safety for patients in these facilities, changes are needed to existing policies to ensure the appropriate prevention and response to communicable disease outbreaks such as COVID-19, among this vulnerable population

Oud word je niet alleen. Een enquête over eenzaamheid en sociaal isolement bij ouderen in België

Koning Boudewinjstichtin

Characterization of a proximal Sp1 response element in the mouse Dlk2 gene promoter

<p>Abstract</p> <p>Background</p> <p>DLK2 is an EGF-like membrane protein, closely related to DLK1, which is involved in adipogenesis. Both proteins interact with the NOTCH1 receptor and are able to modulate its activation. The expression of the gene <it>Dlk2 </it>is coordinated with that of <it>Dlk1 </it>in several tissues and cell lines. Unlike <it>Dlk1</it>, the mouse <it>Dlk2 </it>gene and its locus at chromosome 17 are not fully characterized.</p> <p>Results</p> <p>The goal of this work was the characterization of <it>Dlk2 </it>mRNA, as well as the analysis of the mechanisms that control its basal transcription. First, we analyzed the <it>Dlk2 </it>transcripts expressed by several mouse cells lines and tissues, and mapped the transcription start site by 5' Rapid Amplification of cDNA Ends. <it>In silico </it>analysis revealed that <it>Dlk2 </it>possesses a TATA-less promoter containing minimal promoter elements associated with a CpG island, and sequences for Inr and DPE elements. Besides, it possesses six GC-boxes, considered as consensus sites for the transcription factor Sp1. Indeed, we report that Sp1 directly binds to the <it>Dlk2 </it>promoter, activates its transcription, and regulates its level of expression.</p> <p>Conclusions</p> <p>Our results provide the first characterization of <it>Dlk2 </it>transcripts, map the location of the <it>Dlk2 </it>core promoter, and show the role of Sp1 as a key regulator of <it>Dlk2 </it>transcription, providing new insights into the molecular mechanisms that contribute to the expression of the <it>Dlk2 </it>gene.</p

Sine-Gordon Model - Renormalization Group Solutions and Applications

The sine-Gordon model is discussed and analyzed within the framework of the renormalization group theory. A perturbative renormalization group procedure is carried out through a decomposition of the sine-Gordon field in slow and fast modes. An effective slow modes's theory is derived and re-scaled to obtain the model's flow equations. The resulting Kosterlitz-Thouless phase diagram is obtained and discussed in detail. The theory's gap is estimated in terms of the sine-Gordon model paramaters. The mapping between the sine-Gordon model and models for interacting electrons in one dimension, such as the g-ology model and Hubbard model, is discussed and the previous renormalization group results, obtained for the sine-Gordon model, are thus borrowed to describe different aspects of Luttinger liquid systems, such as the nature of its excitations and phase transitions. The calculations are carried out in a thorough and pedagogical manner, aiming the reader with no previous experience with the sine-Gordon model or the renormalization group approach.Comment: 44 pages, 7 figure

Acute encephalitis syndrome surveillance, Kushinagar district, Uttar Pradesh, India, 2011-2012

In India, quality surveillance for acute encephalitis syndrome (AES), including laboratory testing, is necessary for understanding the epidemiology and etiology of AES, planning interventions, and developing policy. We reviewed AES surveillance data for January 2011-June 2012 from Kushinagar District, Uttar Pradesh, India. Data were cleaned, incidence was determined, and demographic characteristics of cases and data quality were analyzed. A total of 812 AES case records were identified, of which 23\% had illogical entries. AES incidence was highest among boys<6 years of age, and cases peaked during monsoon season. Records for laboratory results (available for Japanese encephalitis but not AES) and vaccination history were largely incomplete, so inferences about the epidemiology and etiology of AES could not be made. The low-quality AES/Japanese encephalitis surveillance data in this area provide little evidence to support development of prevention and control measures, estimate the effect of interventions, and avoid the waste of public health resources

Sticking under wet conditions: the remarkable attachment abilities of the torrent frog, staurois guttatus

Tree frogs climb smooth surfaces utilising capillary forces arising from an air-fluid interface around their toe pads, whereas torrent frogs are able to climb in wet environments near waterfalls where the integrity of the meniscus is at risk. This study compares the adhesive capabilities of a torrent frog to a tree frog, investigating possible adaptations for adhesion under wet conditions. We challenged both frog species to cling to a platform which could be tilted from the horizontal to an upside-down orientation, testing the frogs on different levels of roughness and water flow. On dry, smooth surfaces, both frog species stayed attached to overhanging slopes equally well. In contrast, under both low and high flow rate conditions, the torrent frogs performed significantly better, even adhering under conditions where their toe pads were submerged in water, abolishing the meniscus that underlies capillarity. Using a transparent platform where areas of contact are illuminated, we measured the contact area of frogs during platform rotation under dry conditions. Both frog species not only used the contact area of their pads to adhere, but also large parts of their belly and thigh skin. In the tree frogs, the belly and thighs often detached on steeper slopes, whereas the torrent frogs increased the use of these areas as the slope angle increased. Probing small areas of the different skin parts with a force transducer revealed that forces declined significantly in wet conditions, with only minor differences between the frog species. The superior abilities of the torrent frogs were thus due to the large contact area they used on steep, overhanging surfaces. SEM images revealed slightly elongated cells in the periphery of the toe pads in the torrent frogs, with straightened channels in between them which could facilitate drainage of excess fluid underneath the pad

Activation of Human Stearoyl-Coenzyme A Desaturase 1 Contributes to the Lipogenic Effect of PXR in HepG2 Cells

The pregnane X receptor (PXR) was previously known as a xenobiotic receptor. Several recent studies suggested that PXR also played an important role in lipid homeostasis but the underlying mechanism remains to be clearly defined. In this study, we found that rifampicin, an agonist of human PXR, induced lipid accumulation in HepG2 cells. Lipid analysis showed the total cholesterol level increased. However, the free cholesterol and triglyceride levels were not changed. Treatment of HepG2 cells with rifampicin induced the expression of the free fatty acid transporter CD36 and ABCG1, as well as several lipogenic enzymes, including stearoyl-CoA desaturase-1 (SCD1), long chain free fatty acid elongase (FAE), and lecithin-cholesterol acyltransferase (LCAT), while the expression of acyl:cholesterol acetyltransferase(ACAT1) was not affected. Moreover, in PXR over-expressing HepG2 cells (HepG2-PXR), the SCD1 expression was significantly higher than in HepG2-Vector cells, even in the absence of rifampicin. Down-regulation of PXR by shRNA abolished the rifampicin-induced SCD1 gene expression in HepG2 cells. Promoter analysis showed that the human SCD1 gene promoter is activated by PXR and a novel DR-7 type PXR response element (PXRE) response element was located at -338 bp of the SCD1 gene promoter. Taken together, these results indicated that PXR activation promoted lipid synthesis in HepG2 cells and SCD1 is a novel PXR target gene. © 2013 Zhang et al

Quantum jumps of light recording the birth and death of a photon in a cavity

A microscopic system under continuous observation exhibits at random times sudden jumps between its states. The detection of this essential quantum feature requires a quantum non-demolition (QND) measurement repeated many times during the system evolution. Quantum jumps of trapped massive particles (electrons, ions or molecules) have been observed, which is not the case of the jumps of light quanta. Usual photodetectors absorb light and are thus unable to detect the same photon twice. They must be replaced by a transparent counter 'seeing' photons without destroying them3. Moreover, the light has to be stored over a duration much longer than the QND detection time. We have fulfilled these challenging conditions and observed photon number quantum jumps. Microwave photons are stored in a superconducting cavity for times in the second range. They are repeatedly probed by a stream of non-absorbing atoms. An atom interferometer measures the atomic dipole phase shift induced by the non-resonant cavity field, so that the final atom state reveals directly the presence of a single photon in the cavity. Sequences of hundreds of atoms highly correlated in the same state, are interrupted by sudden state-switchings. These telegraphic signals record, for the first time, the birth, life and death of individual photons. Applying a similar QND procedure to mesoscopic fields with tens of photons opens new perspectives for the exploration of the quantum to classical boundary