Breakthrough Covid-19 infections during periods of circulating Beta, Delta and Omicron variants of concern, among health care workers in the Sisonke Ad26.COV2.S vaccine trial, South Africa

Background: We report breakthrough infections (BTIs) during periods of circulating Beta, Delta and Omicron variants of concern, among health care workers (HCW) participating in the Sisonke phase 3B Ad26.COV2.S vaccine trial (ClinicalTrials.gov number, NCT04838795). Data were gathered between 17 February and 15 December 2021. Duration of each period in this study was 89 days for Beta, 180 days or Delta and 30 days for Omicron. Results: A total of 40 538 BTIs were observed, with 609 during Beta, 22 279 during Delta and 17 650 during Omicron. By 15 December, daily infections during Omicron were three times that seen during the peak observed during Delta. However, unlike the Delta period, with Omicron there was a clear and early de-coupling of hospitalisation from cases as a percentage of the Delta peak curves. Omicron significantly infected a greater proportion of HCW in the 18-30 year age-group, compared with the 55+ age group. There were 1 914 BTI-related hospitalisations - 77, 1 429 and 408 in the Beta (89 days), Delta (180 days) and Omicron (30 days) periods, respectively. During Omicron, 91% hospitalized HCWs required general ward care, 6% high care and 3% intensive care, compared with 89% general ward care, 4% high care and 7% intensive care, during Delta and 78% general care, 7% high care and 16% intensive care during Beta (p<0.001). During Beta and Beta 43% of hospitalized HCW needed supplementary oxygen and 7-8% needed ventilation, compared with 16% and 0.2% respectively during the Omicron period (p<0.001). Median length of hospitalization was significantly lower with Omicron compared with Beta and Delta (3 days compared with 5-6 days, p<0.001). Conclusions: We illustrate more BTIs but reassuringly less severe Covid-19 with Omicron. Re-infections and Omicron-driven primary infections were likely driven by high population SARS-CoV-2 seroprevalence, waning vaccine effectiveness over time, increased Omicron infectivity, Omicron immune evasion or a combination of these and need further investigation. Follow-up of this cohort will continue and reports will be updated, as time and infections accrue.

Economics of implementing an early deterioration detection solution for general care patients at a US hospital

Aim: This study estimates the costs and outcomes pre- versus post-implementation of an early deterioration detection solution (EDDS), which assists in identifying patients at risk of clinical decline. Materials & methods: A retrospective database analysis was conducted to assess average costs per discharge, length of stay (LOS), complications, in-hospital mortality and 30-day all-cause re-admissions pre- versus post-implementation of an EDDS. Results: Average costs per discharge were significantly reduced by 18% (US$16,201 vs $13,304; p = 0.007). Average LOS was also significantly reduced (6 vs 5 days; p = 0.033), driven by a reduction in general care LOS of 1 day (p = 0.042). Complications, in-hospital mortality and 30-day all-cause re-admissions were similar. Conclusion: Costs and LOS were lower after implementation of an EDDS for general care patients.

Cuidados especiais com o politraumatizado

A review about general care, clonical examinations, laboratories test and transportation care of wounded platients with poly traumatism.

Who cares for the eggs? Analysis of egg attendance behaviour in Ranitomeya imitator, a poison frog with biparental care

Dendrobatid poison frogs are known for their diverse parental care behaviours, including terrestrial egg attendance. While usually this behaviour is conducted by males, this study compared the pre-hatching investment of males and females in Ranitomeya imitator, a species with biparental care. Although males tended to spend more time with their eggs overall, there was no difference between sexes when comparing different types of care behaviour. Furthermore, both sexes increased general care behaviour when caring for more than one clutch. The finding that the sexes are relatively equal in their contribution to basic parental care forms provides a basis to understand why biparental care is stable in this species.

Pet Parenting in the United States: Investigating an Evolutionary Puzzle

Fertility rates continue to decline globally amidst the second demographic transition, marked by urbanization, increased educational attainment, and most importantly, a new flexibility in life-course organization. As a result, some individuals are choosing to bring companion animals in the home rather than raising children. Purpose The purpose of this study is to explore whether these transitions result in differential companion animal attachment and caregiving behavior in the homes of parents (or those who desire to become parents) and nonparents or childfree “pet parents.” Methods A total of 917 respondents completed an online survey via Qualtrics that included demographic questions, the Lexington Attachment to Pets Scale (LAPS), and Likert-scale questions designed to probe direct and indirect caretaking behaviors. Results Nonparents reported more Generalized Attachment and more Affective Responsiveness to their companion animals, as well as increased investment in General Care. They also reported more People Substituting on the LAPS. Parents and nonparents reported similar agreement regarding Animal Rights/Welfare and Training and Play. Conclusion I conclude that nonparents' investment in companion animals much like parents invest in children, but in ways that meet species-specific needs. This supports the notion that nonparents may be nurturing companion animals as a trade-off to raising children, but not as a substitute. This is an evolutionarily novel application of parenting strategies in a new, flexible environment.

Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods

Objectives Isolated dizziness is a challenging stroke presentation in the emergency department, but little is known about this problem in other clinical settings. We sought to compare stroke hospitalizations after treat-and-release clinic visits for purportedly “benign dizziness” between general and specialty care settings. Methods This was a population-based retrospective cohort study from a national database. We included clinic patients with a first incident treat-and-release visit diagnosis of non-specific dizziness/vertigo or a peripheral vestibular disorder (ICD-9-CM 780.4 or 386.x [not 386.2]). We compared general care (internal medicine, family medicine) vs. specialty care (neurology, otolaryngology) providers. We used propensity scores to control for baseline stroke risk differences unrelated to dizziness diagnosis. We measured excess (observed>expected) stroke hospitalizations in the first 30 d (i.e., missed strokes associated with an adverse event). Results We analyzed 144,355 patients discharged with “benign dizziness” (n=117,117 diagnosed in general care; n=27,238 in specialty care). After propensity score matching, patients in both groups were at higher risk of stroke in the first 30 d (rate difference per 10,000 treat-and-release visits for “benign dizziness” 24.9 [95% CI 18.6–31.2] in general care and 10.6 [95% CI 6.3–14.9] in specialty care). Short-term stroke risk was higher in general care than specialty care (relative risk, RR 2.2, 95% CI 1.5–3.2) while the long-term risk was not significantly different (RR 1.3, 95% CI 0.9–1.9), indicating higher misdiagnosis-related harms among dizzy patients who initially presented to generalists after adequate propensity matching. Conclusions Missed stroke-related harms in general care were roughly twice that in specialty care. Solutions are needed to address this care gap.