COVID-19 Vaccination Coverage, and Rates of SARS-CoV-2 Infection and COVID-19-Associated Hospitalization Among Residents in Nursing Homes - National Healthcare Safety Network, United States, October 2023-February 2024

Nursing home residents are at increased risk for developing severe COVID-19. Nursing homes report weekly facility-level data on SARS-CoV-2 infections, COVID-19-associated hospitalizations, and COVID-19 vaccination coverage among residents to CDC's National Healthcare Safety Network. This analysis describes rates of incident SARS-CoV-2 infection, rates of incident COVID-19-associated hospitalization, and COVID-19 vaccination coverage during October 16, 2023-February 11, 2024. Weekly rates of SARS-CoV-2 infection ranged from 61.4 to 133.8 per 10,000 nursing home residents. The weekly percentage of facilities reporting one or more incident SARS-CoV-2 infections ranged from 14.9% to 26.1%. Weekly rates of COVID-19-associated hospitalization ranged from 3.8 to 7.1 per 10,000 residents, and the weekly percentage of facilities reporting one or more COVID-19-associated hospitalizations ranged from 2.6% to 4.7%. By February 11, 2024, 40.5% of nursing home residents had received a dose of the updated 2023-2024 COVID-19 vaccine that was first recommended in September 2023. Although the peak rate of SARS-CoV-2 infection among nursing home residents was lower during the 2023-24 respiratory virus season than during the three previous respiratory virus seasons, nursing home residents continued to be disproportionately affected by SARS-CoV-2 infection and related severe outcomes. Vaccination coverage remains suboptimal in this population. Ongoing surveillance for SARS-CoV-2 infections and COVID-19-associated hospitalizations in this population is necessary to develop and evaluate evidence-based interventions for protecting nursing home residents.

Influenza and Up-to-Date COVID-19 Vaccination Coverage Among Health Care Personnel - National Healthcare Safety Network, United States, 2022-23 Influenza Season

The Advisory Committee on Immunization Practices recommends that health care personnel (HCP) receive an annual influenza vaccine and that everyone aged ≥6 months stay up to date with recommended COVID-19 vaccination. Health care facilities report vaccination of HCP against influenza and COVID-19 to CDC's National Healthcare Safety Network (NHSN). During January-June 2023, NHSN defined up-to-date COVID-19 vaccination as receipt of a bivalent COVID-19 mRNA vaccine dose or completion of a primary series within the preceding 2 months. This analysis describes influenza and up-to-date COVID-19 vaccination coverage among HCP working in acute care hospitals and nursing homes during the 2022-23 influenza season (October 1, 2022-March 31, 2023). Influenza vaccination coverage was 81.0% among HCP at acute care hospitals and 47.1% among those working at nursing homes. Up-to-date COVID-19 vaccination coverage was 17.2% among HCP working at acute care hospitals and 22.8% among those working at nursing homes. There is a need to promote evidence-based strategies to improve vaccination coverage among HCP. Tailored strategies might also be useful to reach all HCP with recommended vaccines and protect them and their patients from vaccine-preventable respiratory diseases.

Progress in reducing cancer mortality in the United States by congressional district, 1996-2003 to 2012-2020

BACKGROUND

United States cancer death rates have been steadily declining since the early 1990s, but information on disparities in progress against cancer mortality across congressional districts is lacking. This study examined trends in cancer death rates, overall and for lung, colorectal, female breast, and prostate cancer by congressional district.

METHODS

County level cancer death counts and population data from the National Center for Health Statistics were used to estimate relative change in age-standardized cancer death rates from 1996-2003 to 2012-2020 by sex and congressional district.

RESULTS

From 1996-2003 to 2012-2020, overall cancer death rates declined in every congressional district, with most congressional districts showing a 20%-45% decline among males and a 10%-40% decline among females. In general, the smallest percent of relative declines were found in the Midwest and Appalachia, whereas the largest declines were found in the South along the East Coast and the southern border. As a result, the highest cancer death rates generally shifted from congressional districts across the South in 1996-2003 to districts in the Midwest and central divisions of the South (including Appalachia) in 2012-2020. Death rates for lung, colorectal, female breast, and prostate cancers also declined in almost all congressional districts, although with some variation in relative changes and geographical patterns.

CONCLUSIONS

Progress in reducing cancer death rates during the past 25 years considerably vary by congressional district, underscoring the need for strengthening existing and implementing new public health policies for broad and equitable application of proven interventions such as raising tax on tobacco and Medicaid expansion.

The Association Between Census Tract Healthy Food Accessibility and Life Expectancy in the United States

Accessibility of healthy food is an important predictor for several health outcomes, but its association with life expectancy is unclear. We evaluated the association between U.S. Department of Agriculture's Food Research Atlas measures of healthy food accessibility and life expectancy at birth across contiguous U.S. census tracts using spatial modeling analysis. Both income and healthy food accessibility were associated with life expectancy at birth, as indicated by shorter life expectancy in low-income census tracts when comparing tracts with similar healthy food accessibility level, and in low-access tracts when comparing tracts with similar income level. Compared to high-income/high-access census tracts, life expectancy at birth was lower in high-income/low-access (- 0.33 years; 95% confidence interval - 0.42, - 0.28), low-income/high-access (- 1.45 years; - 1.52, - 1.38), and low-income/low-access (- 2.29 years; - 2.38, - 2.21) tracts after adjusting for socio-demographic characteristics and incorporating vehicle availability. Effective interventions to increase healthy food accessibility may improve life expectancy.

Contemporaneity of Australopithecus, Paranthropus, and early Homo erectus in South Africa

Understanding the extinction of Australopithecus and origins of Paranthropus and Homo in South Africa has been hampered by the perceived complex geological context of hominin fossils, poor chronological resolution, and a lack of well-preserved early Homo specimens. We describe, date, and contextualize the discovery of two hominin crania from Drimolen Main Quarry in South Africa. At ~2.04 million to 1.95 million years old, DNH 152 represents the earliest definitive occurrence of Paranthropus robustus, and DNH 134 represents the earliest occurrence of a cranium with clear affinities to Homo erectus These crania also show that Homo, Paranthropus, and Australopithecus were contemporaneous at ~2 million years ago. This high taxonomic diversity is also reflected in non-hominin species and provides evidence of endemic evolution and dispersal during a period of climatic variability.

Feasibility and acceptability of a web-based HIV/STD prevention program for adolescent girls targeting sexual communication skills

Adolescent girls are at substantial risk of sexually transmitted diseases including HIV. To reduce these risks, we developed Health Education And Relationship Training (HEART), a web-based intervention focused on developing sexual assertiveness skills and enhancing sexual decision-making. This study assessed the feasibility and acceptability of this new program and examined if perceived acceptability varied according to participant ethnicity, sexual orientation or sexual activity status. Participants were part of a randomized controlled trial of 222 10th-grade girls (Mage = 15.26). The current analyses included those in the intervention condition (n = 107; 36% white, 27% black and 29% Hispanic). HEART took approximately 45 min to complete and was feasible to administer in a school-based setting. Participants found the program highly acceptable: 95% liked the program and learned from the program, 88% would recommend the program to a friend and 94% plan to use what they learned in the future. The primary acceptability results did not vary by the ethnicity, sexual orientation or sexual activity status of participants, suggesting broad appeal. Results indicate that this new online program is a promising method to reach and engage adolescents in sexual health education.

Audit of the job satisfaction levels of the UK radiography and physics workforce in UK radiotherapy centres 2012

OBJECTIVE

Workforce planning reports identify a staff shortfall that jeopardizes the ability of UK radiotherapy centres to meet future demands. Obtaining an understanding of the work experiences of radiotherapy professionals will support the development of strategies to increase job satisfaction, productivity and effectiveness.

METHODS

A quantitative survey assessed job satisfaction, attitudes to incident reporting, stress and burnout, opportunities for professional development, workload, retention and turnover. Clinical oncologists were not included, as the Royal College of Radiologists, London, UK, had recently assessed their members' satisfaction. All questions were taken from validated instruments or adapted from the "UK National Health Service Staff Survey".

RESULTS

The survey yielded 658 completed responses (approximately 16% response rate), from public and private sectors. Over a third (36%) of respondents were classified as satisfied for job satisfaction with 11% dissatisfied and the remaining 53% ambivalent. A significant proportion of clinical staff (37.5%) report high emotional exhaustion. Presenteeism was an issue with 42.4% attending work despite feeling unable to fulfil their role.

CONCLUSION

Radiotherapy professionals are prone to the effects of compassion fatigue and burnout. Attention must be paid to workload and its impact on practitioners' job satisfaction. Professional development that is supported and informed by a performance development review is a simple and effective means of enhancing satisfaction. Individuals have a responsibility to themselves and their colleagues as their behaviours and attitudes influence job satisfaction.

ADVANCES IN KNOWLEDGE

This work identifies areas for future research to enhance the professional resilience of practitioners, in order to provide high-quality treatments.

Effect of thymectomy on human peripheral blood T cell pools in myasthenia gravis

The human thymus is required for establishment of the T cell pool in fetal life, but postnatal thymectomy does not lead to immunodeficiency in humans. Because thymectomy in humans is performed for treatment of myasthenia gravis (MG), we have studied patients with MG for effects of thymectomy on peripheral blood (PB) naive (CD45RA(+), CD62L(+)) and memory (CD45RO(+)) T cells. We have also determined the effect of thymectomy on levels of PB cells containing signal joint TCR delta excision circles (TRECs), a molecular marker of thymus emigrants that have divided few times after leaving the thymus. In 17 nonthymectomized and 26 thymectomized MG patients studied at varying times after thymectomy (1 day to 41 years), we found no significant mean difference in PB T cell TREC levels between ages 40 and 80 years. However, both thymectomized and nonthymectomized MG patients had lower PB T cell TREC levels than did age-matched normal subjects (p < 0.0001 for both). These data demonstrated that MG itself or treatment for MG decreased thymopoiesis independent of thymectomy. Next, to control for disease activity and treatment, we prospectively studied 10 MG patients before and from 27 to 517 days after thymectomy. We found that thymectomy decreased CD4 or CD8 T cell TREC concentrations most when thymopoiesis was active before thymectomy (six of six patients), but had little effect in patients when thymopoiesis was minimal (four of four patients). In contrast, there was no significant effect of thymectomy on absolute numbers of naive PB T cells. Thus, in MG, removal of a thymus with active thymopoiesis resulted in a significant fall in PB TREC(+) T cells postthymectomy.

Adaptation to metastatic cancer pain, regional/local cancer pain and non-cancer pain: role of psychological and behavioral factors

The present study compared the adaptation of cancer pain patients and chronic non-cancer pain patients. Differences between samples of cancer pain patients with and without metastatic disease were also examined. Cancer pain patients reported comparable levels of pain severity to non-cancer chronic pain patients; however, pain due to cancer was associated with higher levels of perceived disability (t(250) = 2.97, P < 0.004) and lower degree of activity (t(286) = 2.45, P < 0.04). The patients with cancer pain, particularly those with metastatic disease, reported significantly higher levels of support and solicitous behaviors from significant others, compared to non-cancer chronic pain patients. The majority of the cancer patients, both with (81%) and without (84%) metastatic disease as well as non-cancer chronic pain patients (85%), could be classified into one of three psychosocial subgroups that had been previously identified with non-cancer chronic pain patients: 'dysfunctional' (high levels of pain, perceived interference, affective distress and low levels of perceived control and activity), 'interpersonally distressed' (high levels of affective distress, negative responses from significant others and low levels of perceived support) and 'adaptive copers' (low levels of interference and affective distress, high levels of perceived control and activity). The distribution of the profiles was significantly different across groups (chi2(4) = 12.79, P < 0.02). However, within each profile. the response patterns were highly comparable across groups. Thus, contrary to the suggestions of some authors, cancer pain and non-cancer chronic pain patients share many features in common. Furthermore, the heterogeneity of psychosocial adaptation to pain within each patient group suggests the importance of psychological assessment in determining the pain management plan.

A validation study using the case-control method of the nursing diagnosis high risk for aspiration

PURPOSE

To develop further the nursing diagnosis risk for aspiration by determining risk factors present in patients who aspirated.

METHODS

The case-control design was used to compare cases (n = 131) and controls (n = 206) on past and present exposures thought to be risk factors for aspiration. Data were analyzed using univariate and multiple logistic regression.

FINDINGS

The following risk factors were statistically significant and comprise the final model: altered level of consciousness, metoclopramide (known to accelerate gastric emptying), vomiting, seizures, and unable to change own position.

CONCLUSIONS

The risk factors of altered level of consciousness and delayed gastric emptying are currently included in the NANDA taxonomy for the nursing diagnosis risk for aspiration. These risk factors are not included in the taxonomy: vomiting, seizures, and unable to change own position. Results of the study have been submitted to the Diagnosis Review Committee for consideration to further develop this diagnosis.

Developmental changes in the dendritic architecture of salt-sensitive neurons in the nucleus of the solitary tract

Recent studies have provided evidence that brainstem gustatory neurons undergo substantial dendritic growth during a period of postnatal development that coincides with the maturation of their response to salts, suggesting a relationship (perhaps causal) between the physiology and morphology of developing salt-sensitive neurons. In an initial effort to explore this issue, we used extracellular and intracellular recording and intracellular labeling techniques to examine the structure and function of individual gustatory neurons in the rostral nucleus of the solitary tract (rNST) of young (postnatal day [P] 22-28) and adult rats. We found that P22-28 cells that responded to all three of the salts in our taste array had a greater dendritic length, a greater cell volume, and more dendritic branches than the cells that responded to one salt. As a group, taste-sensitive neurons in P22-28 animals had a higher maximum dendritic branch order and a trend toward more dendritic branch points than gustatory neurons in adult animals. The dendritic arbors of P22-28 taste neurons that responded to all three salts were larger (greater surface area and volume), more extensive in the rostrocaudal axis and exhibited a higher maximum branch order, more branch points and higher swelling density than adult cells that responded to all three salts. These results demonstrate that the morphology of salt-sensitive gustatory neurons in developing animals is closely related to the number of salts that evoke a response. The data also support the postulate that gustatory neurons in the rat brainstem undergo substantial dendritic remodeling between the fourth week of life and adulthood. Dendritic remodeling may play an important role in the maturation of the rNST response to NaCl.

Ultrasound Devulcanization of SBR: Molecular Mobility of Gel and Sol

In an effort to support the recycling of rubbery polymers and composites, 1H NMR relaxation and pulsedgradient spin echo diffusion measurements have been performed on virgin and unfilled vulcanized strene-butadiene rubber (SBR), and networks after various extents of devulcanization using an ultrasound technique. The NMR methods recognize unentangled light molecules (e.g. sol), but do not distinguish between unattached entangled large molecules and chemical network segments. Devulcanization generates additional sol with a wide mass distribution, thus increasing both sol and gel mobility, but decreasing sol mean diffusivity. The latter effect is accounted for by the increasing mean sol molecular mass but also by the increasing glass transition temperature, which is related to main-chain stiffening seen in our earlier 13C NMR experiments. In addition to improving the molecular-level understanding of devulcanization, this study provides guidance for the optimization of the devulcanization parameters.

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is now the technique of choice for patients requiring long-term enteral feeding. It is a good method for feeding patients with neurological dysphagia and can safely be kept in situ for long periods. PEG feeding requires a multidisciplinary approach, involving doctors, nurses, pharmacists, speech therapists, dieticians and carers. The insertion of a PEG, which requires two operators and two endoscopy nurses, is described in full. Feeding can commence after a few hours. Various types of feed and feed-ing patterns are described and their relative merits discussed. Although psychological problems may occur following PEG insertion, the procedure is usually well accepted by patients.

Preliminary experience with human oocyte cryopreservation using 1,2-propanediol and sucrose

Feasibility of cryopreservation of mature human oocytes using 1, 2-propanediol and sucrose was studied initially utilizing 1 and 2 day old unfertilized oocytes. Of these 285 aged oocytes 55% survived thawing, and 41% of 128 oocytes inseminated by single sperm intracytoplasmic injection (ICSI) fertilized normally. Limited embryonic development occurred in 51% of these embryos (n = 27) observed for the next 4 days. Cryosurvival of fresh donated oocytes (n = 81) was poorer (n = 20; 24.7%), while fertilization (n = 13; 65%) and embryo development (100%) was good prior to uterine transfer on day 3. Eight oocyte recipient cycles were undertaken, in which cryopreserved donated oocytes were thawed and inseminated by ICSI. Five of these cycles reached embryo transfer, and three pregnancies were initiated though none went successfully to term. Oocyte cryopreservation will ultimately facilitate oocyte donation procedures; however, cryosurvival of fresh frozen oocytes must be improved to at least the degree observed with aged unfertilized oocytes.

Ultrasound Devulcanization of Sulfur Vulcanized SBR: Crosslink Density and Molecular Mobility

Sulfur-cured SBR vulcanizates are devulcanized by high power ultrasonic irradiation in a continuous process under various processing conditions. Crosslink density and gel fraction of devulcanized rubber are measured. The unique dependence of crosslink density on gel fraction of devulcanized samples obtained at various processing conditions is established. DSC studies indicate a significant increase in the glass transition temperature of the devulcanized rubber having crosslink density lower than that of the original vulcanizates. Solid state NMR studies confirm that these changes in Tg are due to a decrease of molecular mobility as measured by a decrease in spin-spin relaxation time. Ultrasonic devulcanization is accompanied by a significant increase in xcis-trans isomerization. Chemical changes explaining the observed phenomena are discussed.

The team approach to percutaneous endoscopic gastrostomy feeding

The importance of early recognition and treatment of patients who are at risk of developing malnutrition is becoming increasingly recognised. Percutaneous endoscopic gastrostomy has become increasingly popular as a method of feeding, since its description in 1980, because of its ease of insertion and low morbidity and mortality. Its success, however, depends upon the use of a multidisciplinary approach.

Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients

BACKGROUND

We prospectively studied surgical cancer patients who received epidural bupivacaine-morphine to determine perioperative morphine use, side effects, and complications.

METHODS

All study patients received general-epidural anesthesia followed by epidural analgesia with 0.05% or 0.1% bupivacaine and 0.01% morphine at a rate of 5-10 ml.h-1 to keep the dynamic pain score at less than 5 (of 10). Patients were evaluated daily for pain relief, side effects, catheter migration, accidental removal, hypotension, respiratory rate, mental status changes, nausea and vomiting, and pruritus.

RESULTS

Over 4 yr, 4,227 patients (61% women, aged 68 +/- 24 yr) were studied. Lumbar epidural catheters (n = 2,248 or 53.18%) were used more frequently than thoracic catheters (n = 1,979 or 46.82%) (P < 0.00001). Most of the patients were discharged to the surgical wards after the procedures (n = 3,001, 71%). Those patients (n = 1,226, 29%) admitted to the surgical intensive care unit, spent 1.2 +/- 0.8 days. Epidural catheter failure occurred in 283 (6.3%) patients. Length of epidural analgesia therapy was 6.3 +/- 2.6 days. There were three cases (0.07%) of respiratory depression which were treated with oxygen, intravenous naloxone, and by stopping the epidural infusion for 6 h. Hypotension occurred in 126 patients (3%). There were no apparent cases of catheter migration to either the subdural or subarachnoid space. Nausea or vomiting occurred in 929 patients (22%). Pruritus occurred in 930 patients (22%).

CONCLUSIONS

Continuous epidural analgesia with 0.05-0.1% bupivacaine and 0.01% morphine is an effective method of postoperative analgesia with a low incidence of side effects, that can be safely administered on the surgical wards with no special monitoring equipment.

Self-management of recovery: implications for nursing practice

This article describes and discusses differences in responses to a 60-item survey instrument, the Carolina Self-Regulation Inventory (CSRI) from a selected sample of university faculty and staff. The CSRI was designed to measure the types of self-regulation strategies (SRS) individuals use to facilitate their recovery from illness episodes. When the CSRI was developed, 1,306 university employees participated in the survey. Four hundred eighty (36%) employees classified themselves as faculty; 346 (26%), staff; 418 (32%), midlevel administrators; and 62 (6%), blue-collar workers. This report focuses on the differences between the faculty and staff groups in the survey. Analysis revealed that the staff used a variety of strategies and had higher statistically significant means on the following CSRI subscales: visualization (t = 2.53, P less than .01), self-talk (t = 6.801, P less than .001), and external attention deployment strategies (t = 4.08, P less than .001). No significant differences were found between faculty and staff in the use of exercise and physical activity or interactive self-regulation strategies. Higher-educated faculty women tended to use fewer SRS when compared with female staff (F = 4.70; df = 8.819; P = .0009). Faculty women were similar to faculty men in their use of SRS. Female staff used significantly more SRS when compared with faculty of both genders and male staff (t = 2.81, P = .05). Nursing implications of self-regulation nursing assessments are discussed in terms of nursing interventions and need for more research.

Poor implantation of cryopreserved reinsemination-fertilized human embryos

OBJECTIVE

To investigate whether a poor rate of implantation after in vitro fertilization (IVF) was due to poor embryonic/endometrial synchrony during the original IVF cycle, we have cryopreserved reinseminated-fertilized embryos for later more synchronous replacement after thawing. The chance of implantation of fresh reinseminated fertilized human oocytes is approximately one tenth that of timely fertilized embryos. STUDY DESIGN AND DATA: Retrospective study of 35 original oocyte collections in which initial normal fertilization was 47.3% (129/273 oocytes), with 49.6% fertilization (67/135) upon reinsemination. Of these, 70 initially fertilized and 67 reinsemination-fertilized embryos were cryopreserved, and 50 initially fertilized and all 67 reinsemination-fertilized embryos were subsequently thawed with 72% and 63% cryosurvival, respectively, (not significant).

SETTING

Private infertility clinic.

RESULTS

In 11 cycles, 23 thawed initially fertilized embryos (group A) were replaced with a 21.7% implantation rate per embryo; in 10 cycles, 13 initially fertilized and 12 reinsemination-fertilized embryos (group B) were replaced together with an 8% implantation rate; finally, in 16 cycles, 30 reinsemination-fertilized embryos (group C) were replaced with a 3.3% implantation rate (group A versus group C: P = 0.076). Comparison of clinical pregnancies between these groups was significantly different (6/11 versus 1/16; P = 0.0427).

CONCLUSION

Reinsemination-fertilized embryos survive freezing as well as initially fertilized embryos, but better embryonic/endometrial synchrony does not improve chances of their implantation.