Middle East respiratory syndrome coronavirus: current situation and travel-associated concerns

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.The emergence of Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012 brought back memories of the occurrence of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002. More than 1500 MERS-CoV cases were recorded in 42 months with a case fatality rate (CFR) of 40%. Meanwhile, 8000 cases of SARS-CoV were confirmed in six months with a CFR of 10%. The clinical presentation of MERS-CoV ranges from mild and non-specific presentation to progressive and severe pneumonia. No predictive signs or symptoms exist to differentiate MERS-CoV from community-acquired pneumonia in hospitalized patients. An apparent heterogeneity was observed in transmission. Most MERS-CoV cases were secondary to large outbreaks in healthcare settings. These cases were secondary to community-acquired cases, which may also cause family outbreaks. Travel-associated MERS infection remains low. However, the virus exhibited a clear tendency to cause large outbreaks outside the Arabian Peninsula as exemplified by the outbreak in the Republic of Korea. In this review, we summarize the current knowledge about MERS-CoV and highlight travel-related issues

Possible spin-orbit driven spin-liquid ground state in the double perovskite phase of Ba3YIr2O9

We report the structural transformation of hexagonal Ba3YIr2O9 to a cubic double perovskite form (stable in ambient conditions) under an applied pressure of 8GPa at 1273K. While the ambient pressure (AP) synthesized sample undergoes long-range magnetic ordering at 4K, the high pressure(HP) synthesized sample does not order down to 2K as evidenced from our susceptibility, heat capacity and nuclear magnetic resonance (NMR) measurements. Further, for the HP sample, our heat capacity data have the form gamma*T+beta*T3 in the temperature (T) range of 2-10K with the Sommerfeld coefficient gamma=10mJ/mol-Ir K2. The 89Y NMR shift has no T-dependence in the range of 4-120K and its spin-lattice relaxation rate varies linearly with T in the range of 8-45K (above which it is T-independent). Resistance measurements of both the samples confirm that they are semiconducting. Our data provide evidence for the formation of a 5d based, gapless, quantum spin-liquid (QSL) in the cubic (HP) phase of Ba3YIr2O9. In this picture, the T term in the heat capacity and the linear variation of 89Y 1/T1 arises from excitations out of a spinon Fermi surface. Our findings lend credence to the theoretical suggestion [G. Chen, R. Pereira, and L. Balents, Phys. Rev. B 82, 174440 (2010)] that strong spin-orbit coupling can enhance quantum fluctuations and lead to a QSL state in the double perovskite lattice.Comment: 6 pages 5 figure

Identifying factors affecting about outsourcing in paraclinical services: a systematic review of literature

Objective: Outsourcing refers to the transfer of services or functions to an outsider supplier, which controls them through a contract or cooperative. The main problem of senior managers in health organizations is determining the services which should be outsourced. The present study seeks to identify the factors that affect decision about outsourcing.Methods: We systematically searched relevant databases including Pub Med, Scopus, Science Direct and Web of Science databases using terms “Outsourcing AND Decision Making OR Policy AND health OR hospital OR health care OR health services OR healthcare”. Studies were identified and screened in accordance with the preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) published in English or Farsi, determining factors that affect making decision about outsourcing a health organization services.Results: The search retrieved (2585) citation of which 14 studies were eligible. Across the eligible articles,10 overarching themes including 40subthemes that affectdecision maker to outsource a service or not, emerged.Conclusions: Results of this study offer evidence for a comprehensive approach todesign and implement a strategic planthat can be used as guidance for policy makers, micro and macro healthcare authorities and managers, and other stakeholders in this area to select and apply the best strategies to make outsourcing in the best possible way.Keywords: Outsourcing, Health Services, Effective factors, Health Organizatio

Short-course treatment in neurobrucellosis: A study in Iran

Neurobrucellosis is a rare neurological complication of brucellosis. This report describes 19 patients of neurobrucellosis and they accounted for 8% of all cases of brucellosis admitted to Shiraz University Hospitals over a period of eight years. Headache, fever, fatigue, drowsiness and neck stiffness were the common clinical features. Cerebrospinal fluid (CSF) showed pleocytosis in 100%, elevated protein levels in 89% and low glucose level in 47% of the patients. All the patients improved with specific antibiotic treatment. Of the 19 patients, 10 (52.5%) patients received treatment for 8 to 28 weeks. Duration of antibiotic treatment was: 8-14 weeks in 8 (42%) patients; 24-28 weeks in 2 (10.5%) patients; 6 months in 7 (37%) patients; 12 months in 1 (5.3%) patient; and 18 months in 1 (5.3%) patient. Clinicians in endemic areas should consider the likelihood of neurobrucellosis in patients with unexplained neurological and psychiatric symptoms

Right coronary artery-to-pulmonary artery fistula, the role of echocardiography

Coronary artery fistula is an uncommon but hemodynamically significant anomaly of the coronary arteries, occurring as an incidental finding in 0.1% to 0.2% of coronary angiograms. Although half of the patients with a coronary artery fistula remain asymptomatic, the other half develops CHF, infective endocarditis, myocardial ischemia, or rupture of an aneurysm. This report is illustrative of the right coronary artery fistula to the right pulmonary artery in a 57-year-old male. The definitive diagnosis was made during transesophageal echocardiography and confirmed at operation

Uncertainty Quantification of Heavy Gas Release Over a Barrier

In this study a procedure for input uncertainty quantification (UQ) in computational fluid dynamics (CFD) simulations is proposed. The suggested procedure has been applied to a test case. The test case concerns the modeling of a heavy gas release into an atmospheric boundary layer over a barrier. The following uncertain parameters are investigated in their respective intervals: release velocity (18 m/s, 22 m/s), release temperature (270 K, 310 K) and the atmospheric boundary layer velocity (3 m/s, 7 m/s). The Stochastic Collocation (SC) method is used to perform the probabilistic propagation of the uncertain parameters. The uncertainty analysis was performed with two sets of sampling grids (full and sparse grids) for the uncertain parameters. The results show which of the selected uncertain parameters have the largest impact on the dispersed gas plume and the local concentrations in the gas cloud. Additionally, using sparse grids shows potential to reduce the computational effort of the uncertainty analysis

The effect of intra-wound vancomycin powder application in reducing surgical site infections after total hip arthroplasty

Post-operative total hip arthroplasty surgical wound infections are associated with substantial morbidity, mortality, and economic burden. Intra-wound vancomycin powder application may prevent infections after hip surgery. The objectives of this study is to answer the question as to whether the application of 2 gram intra-wound vancomycin powder In patients undergoing total hip arthroplasty, lead to reduced rates of postoperative surgical site infections or not? From April 2013, 125 patients had consent prior to their hip surgery. These 125 patients had total hip arthtoplasty by three different surgeons at Imam Hossein hospital. All patients received either 2 grams of IV Cefazolin one hour prior to the incision or 1 gram of IV Vancomycin one hour prior to the incision in patient with a Penicillin allergy. Near the end of the procedure, the wound was thoroughly irrigated with normal saline. for All patients befor surgical wound closure 2 gram of Vancomycin powder was poured into the wound. Postoperatively, patients continued on intravenous antibiotics for twenty-four hours. All patients underwent routine postoperative surgical care including physical therapy, routine radiographs, and routine managment of pain medications. Laboratory tests include Hb , BUN, Cr and electrolits were done before surgery and postoperatively after 48 hours and 7 days. All patients were discharged within the first 3 days after surgery and follow-up at weeks 2 and 4 and one year after surgery was performed. During the course of follow up that has ranged from one months to one year, sixteen of patients experienced surgical site infection. 10 patients were lost to follow up. No allergic reactions or adverse outcomes were reported from the use of 2 gram of Vancomycin powder prior to closure. Although intra-wound application of Vancomycin is known to minimize infections in spinal surgery little previous studies reported if Vancomycin application will reduce surgical site infection in hip surgeries. This study demonstrates that intra-wound application of Vancomycin reduces surgical site infection in total hip arthroplasty without any adverse complications

Stochastic analysis of the impact of freestream conditions on the aerodynamics of a rectangular 5:1 cylinder

Uncertainty plays a significant role in the Benchmark on the Aerodynamics of a Rectangular Cylinder (BARC) with a chord-to-depth ratio of 5. In particular, besides modeling and numerical errors, in numerical simulations it is difficult to exactly reproduce the experimental conditions due to uncertainties in the set-up parameters, which sometimes cannot be exactly controlled or characterized. In this study, the impact of the uncertainties in the inflow conditions of the BARC configuration is investigated by using probabilistic methods and two-dimensional URANS simulations. The following uncertain set-up parameters are investigated: the angle of incidence, the freestream longitudinal turbulence intensity and the freestream turbulence length scale. The stochastic collocation method is employed to perform the probabilistic propagation of the uncertainty in the three set-up parameters. This results in 25 URANS simulations based on the Smolyak sparse grid extension of the level-2 Clenshaw-Curtis quadrature points. The discretization error is estimated by repeating the same analysis on different grid sizes. Similarly, the effect of turbulence modeling is appraised by carrying out the uncertainty quantification for the Reynolds stress and the SST k-. ω models. Finally, the results obtained for different assumed probability density functions of the set-up parameters are compared. The propagation of the considered uncertainties does not explain alone the dispersion of the BARC experimental data. For certain quantities of interest, the effect of turbulence modeling is more important than the impact of the uncertainties in inflow conditions. The sensitivity to the considered uncertainties also varies with the turbulence model, with a larger variability of the results obtained with the Reynolds stress model. The inflow turbulence length scale is in all cases the least important parameter