Long-term care facilities are high-risk settings for severe outcomes from outbreaks of Covid-19, owing to both the advanced age and frequent chronic underlying health conditions of the residents and ...the movement of health care personnel among facilities in a region.
After identification on February 28, 2020, of a confirmed case of Covid-19 in a skilled nursing facility in King County, Washington, Public Health-Seattle and King County, aided by the Centers for Disease Control and Prevention, launched a case investigation, contact tracing, quarantine of exposed persons, isolation of confirmed and suspected cases, and on-site enhancement of infection prevention and control.
As of March 18, a total of 167 confirmed cases of Covid-19 affecting 101 residents, 50 health care personnel, and 16 visitors were found to be epidemiologically linked to the facility. Most cases among residents included respiratory illness consistent with Covid-19; however, in 7 residents no symptoms were documented. Hospitalization rates for facility residents, visitors, and staff were 54.5%, 50.0%, and 6.0%, respectively. The case fatality rate for residents was 33.7% (34 of 101). As of March 18, a total of 30 long-term care facilities with at least one confirmed case of Covid-19 had been identified in King County.
In the context of rapidly escalating Covid-19 outbreaks, proactive steps by long-term care facilities to identify and exclude potentially infected staff and visitors, actively monitor for potentially infected patients, and implement appropriate infection prevention and control measures are needed to prevent the introduction of Covid-19.
This guideline updates the 2008 American College of Physicians (ACP) recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is ...endorsed by the American Academy of Family Physicians.
The ACP Clinical Guidelines Committee based these recommendations on a systematic review of randomized controlled trials; systematic reviews; large observational studies (for adverse events); and case reports (for rare events) that were published between 2 January 2005 and 3 June 2011. The review was updated to July 2016 by using a machine-learning method, and a limited update to October 2016 was done. Clinical outcomes evaluated were fractures and adverse events. This guideline focuses on the comparative benefits and risks of short- and long-term pharmacologic treatments for low bone density, including pharmaceutical prescriptions, calcium, vitamin D, and estrogen. Evidence was graded according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
The target audience for this guideline includes all clinicians. The target patient population includes men and women with low bone density and osteoporosis.
ACP recommends that clinicians offer pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce the risk for hip and vertebral fractures in women who have known osteoporosis. (Grade: strong recommendation; high-quality evidence).
ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years. (Grade: weak recommendation; low-quality evidence).
ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis. (Grade: weak recommendation; low-quality evidence).
ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women. (Grade: weak recommendation; low-quality evidence).
ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women. (Grade: strong recommendation; moderate-quality evidence).
ACP recommends that clinicians should make the decision whether to treat osteopenic women 65 years of age or older who are at a high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications. (Grade: weak recommendation; low-quality evidence).
Isoprene emission from plants plays a dominant role in atmospheric chemistry. Predicting how isoprene emission may change in the future will help predict changes in atmospheric oxidant, greenhouse ...gas and secondary organic aerosol concentrations in the future atmosphere. At the leaf‐scale, an increase in isoprene emission with increasing temperature is offset by a reduction in isoprene emission rate caused by increased CO2. At the canopy scale, increased leaf area index in elevated CO2 can offset the reduction in leaf‐scale isoprene emission caused by elevated CO2. At the landscape scale, a reduction in forest coverage may decrease, while forest fertilization and community composition dynamics are likely to cause an increase in the global isoprene emission rate. Here we review the potential for changes in the isoprene emission rate at all of these scales. When considered together, it is likely that these interacting effects will result in an increase in the emission of the most abundant plant volatile, isoprene, from the biosphere to the atmosphere in the future.
About the same amount of isoprene is emitted from vegetation to the atmosphere as all other non‐methane hydrocarbons combined. Isoprene emission is very sensitive to environmental variables, especially variables likely to change in the future such as temperature and carbon dioxide concentration. These will affect isoprene emission both directly because of changes at the leaf level and indirectly as a result of landscape level effects of global change. We review what is known about how isoprene emission will change in the future and conclude that, on balance, isoprene emission is likely to be greater in the future than it is today.
Isoprene emission is a major component of biosphere–atmosphere interactions. It is the single largest source of non‐methane hydrocarbon in the atmosphere. The first report of isoprene emission from ...plants was published in 1957 by Professor Guivi Sanadze. While humans have smelled the monoterpene hydrocarbons made by coniferous trees since their earliest migrations, only in 1957 did the world became aware that other trees make a type of hydrocarbon in even greater amounts but one to which the human nose is much less sensitive. For this 60th anniversary of the first report of isoprene emission from leaves, we trace the discovery and development of the research field, highlighting some of the most seminal observations and theoretical interpretations. This is not an exhaustive review, and many important papers are not cited, but we hope it will be of general interest to read how research in this field developed, how new observations forced us to reevaluate our theories about the significance of isoprene biosynthesis to plant physiology and adaptation and how scientific serendipity can sometimes drive a topic forward.
Isoprene emission from plants is a major component of biosphere–atmosphere interactions but is relatively unrecognized. The first report of isoprene emission from plants was 60 years ago, and a number of attributes of isoprene emission from plants were quickly discovered. In the ensuing years, a number of people have devoted much effort to understanding the biology, biochemistry and role in atmospheric chemistry that has occurred. Publications describing significant advances are highlighted.
Plasmodium parasites undergo several major developmental transitions during their complex lifecycle, which are enabled by precisely ordered gene expression programs. Transcriptomes from the 48-h ...blood stages of the major human malaria parasite Plasmodium falciparum have been described using cDNA microarrays and RNA-seq, but these assays have not always performed well within non-coding regions, where the AT-content is often 90-95%.
We developed a directional, amplification-free RNA-seq protocol (DAFT-seq) to reduce bias against AT-rich cDNA, which we have applied to three strains of P. falciparum (3D7, HB3 and IT). While strain-specific differences were detected, overall there is strong conservation between the transcriptional profiles. For the 3D7 reference strain, transcription was detected from 89% of the genome, with over 78% of the genome transcribed into mRNAs. We also find that transcription from bidirectional promoters frequently results in non-coding, antisense transcripts. These datasets allowed us to refine the 5' and 3' untranslated regions (UTRs), which can be variable, long (> 1000 nt), and often overlap those of adjacent transcripts.
The approaches applied in this study allow a refined description of the transcriptional landscape of P. falciparum and demonstrate that very little of the densely packed P. falciparum genome is inactive or redundant. By capturing the 5' and 3' ends of mRNAs, we reveal both constant and dynamic use of transcriptional start sites across the intraerythrocytic developmental cycle that will be useful in guiding the definition of regulatory regions for use in future experimental gene expression studies.
We assessed the emissions response of a fleet of seven light-duty gasoline vehicles for gasoline fuel aromatic content while operating over the LA92 driving cycle. The test fleet consisted of model ...year 2012 vehicles equipped with spark-ignition (SI) and either port fuel injection (PFI) or direct injection (DI) technology. Three gasoline fuels were blended to meet a range of total aromatics targets (15%, 25%, and 35% by volume) while holding other fuel properties relatively constant within specified ranges, and a fourth fuel was formulated to meet a 35% by volume total aromatics target but with a higher octane number. Our results showed statistically significant increases in carbon monoxide, nonmethane hydrocarbon, particulate matter (PM) mass, particle number, and black carbon emissions with increasing aromatics content for all seven vehicles tested. Only one vehicle showed a statistically significant increase in total hydrocarbon emissions. The monoaromatic hydrocarbon species that were evaluated showed increases with increasing aromatic content in the fuel. Changes in fuel composition had no statistically significant effect on the emissions of nitrogen oxides (NOx), formaldehyde, or acetaldehyde. A good correlation was also found between the PM index and PM mass and number emissions for all vehicle/fuel combinations with the total aromatics group being a significant contributor to the total PM index followed by naphthalenes and indenes.
The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout.
Using the ACP grading system, the committee ...based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms.
The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout.
ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence).
ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence).
ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence).
ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence).
ABSTRACT The fourth-DR3 version (4FGL-DR3) of the Fermi-LAT catalogue of γ-ray sources contains ∼1000 objects at a galactic latitude |b| > 10° that are not identified with an optical counterpart. We ...performed a systematic study of these sources, focusing on 190 objects that have a unique X-ray counterpart in the available Swift/XRT observations. Optical counterparts were then selected, and optical spectra were found in the literature for 33 sources. We found that 21 could be classified as BL Lac objects. Among these, we were able to provide the redshift for eight of them, while for two others we established a lower limit to the redshift by detecting intervening absorption. The other 12 objects display optical spectra with prominent emission lines (0.036 < z < 1.65). These spectra are characterized by both broad and narrow emission lines, with the exception of three sources. One of these displays only broad emission lines, while the other two exclusively exhibit narrow lines. On the basis of the radio/optical flux ratio, all BL Lac objects in this study are radio-loud. Four sources out of the 12 with prominent emission lines can be classified as radio-loud, while at least five of the 12 sources with prominent lines are radio-quiet. This is somewhat unexpected, given the radio-loudness distribution of 4FGL-associated blazars.
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