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BackgroundIn early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting. ObjectiveThis study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore. MethodsOver a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers. ResultsOf 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%). ConclusionsRTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary.

We conducted latent class analyses to identify women with homogeneous combinations of lifestyle and behavioral variables and tested whether latent classes were prospectively associated with diabetes incidence for women with or without baseline obesity. A total of 64,710 postmenopausal women aged 50-79 years without prevalent diabetes at baseline (years 1993-1998) were followed until 2018 with a mean follow-up of 14.6 years (sd = 6.4). Lifestyle variables included smoking, diet quality, physical activity, and sleep quality. Psychosocial variables included social support, depression, and optimism. Multivariable Cox proportional hazards regression models tested associations between latent classes and diabetes incidence controlling for age, race/ethnicity, and education. During follow-up, 8076 (12.4%) women developed diabetes. For women without baseline obesity, five latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.45; 95% CI 1.28, 1.64), poor diet and exercise (HR = 1.23; 95% CI 1.13, 1.33), and psychosocial risks alone (HR = 1.20; 95% CI 1.12, 1.29). For women with baseline obesity, four latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher for women with obesity in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.48; 95% CI 1.32, 1.66), poor diet and exercise (HR = 1.32; 95% CI 1.19, 1.47), and intermediate probabilities of multiple risks (HR = 1.17; 95% CI 1.05, 1.30). Diabetes prevention efforts that focus on diet and exercise may benefit from attention to how lifestyle behaviors interact with psychosocial variables to increase diabetes risks, and conversely, how psychological or social resources may be leveraged with lifestyle changes to reduce the risk for women with and without obesity.

Students' motivational beliefs about learning physical science are critical for achieving positive educational outcomes. In this study, we incorporated expectancy-value theory to capture the heterogeneity of adolescents' motivational trajectories in physics and chemistry from seventh to twelfth grade and linked these trajectories to science-related outcomes. We used a cross-sequential design based on three different cohorts of adolescents (N = 699; 51.5 % female; 95 % European American; M ages for youngest, middle, and oldest cohorts at the first wave = 13.2, 14.1, and 15.3 years) coming from ten public secondary schools. Although many studies claim that physical science motivation declines on average over time, we identified seven differential motivational trajectories of ability self-concept and task values, and found associations of these trajectories with science achievement, advanced science course taking, and science career aspirations. Adolescents' ability self-concept and task values in physics and chemistry were also positively related and interlinked over time. Examining how students' motivational beliefs about physical science develop in secondary school offers insight into the capacity of different groups of students to successfully adapt to their changing educational environments.

OBJECTIVE: Antibiotic computerized decision support systems (CDSSs) were developed to guide antibiotic decisions, yet prescriptions of CDSS-recommended antibiotics have remained low. Our aim was to identify predictors of patients receipt of empiric antibiotic therapies recommended by a CDSS when the prescribing physician had an initial preference for using broad-spectrum antibiotics. METHODS: We conducted a prospective cohort study in a 1 500-bed tertiary-care hospital in Singapore. We included all patients admitted from October 1, 2011 through September 30, 2012, who were prescribed piperacillin-tazobactam or carbapenem for empiric therapy and auto-triggered to receive antibiotic recommendations by the in-house antibiotic CDSS. Relevant data on the patient, prescribing and attending physicians were collected via electronic linkages of medical records and administrative databases. To account for clustering, we used multilevel logistic regression models to explore factors associated with receipt of CDSS-recommended antibiotic therapy. RESULTS: One-quarter of the 1 886 patients received CDSS-recommended antibiotics. More patients treated for pneumonia (33.2%) than sepsis (12.1%) and urinary tract infections (7.1%) received CDSS-recommended antibiotic therapies. The prescribing physician - but not the attending physician or clinical specialty - accounted for some (13.3%) of the variation. Prior hospitalization (odds ratio [OR] 1.32, 95% CI, 1.01-1.71), presumed pneumonia (OR 6.77, 95% CI, 3.28-13.99), intensive care unit (ICU) admission (OR 0.38, 95% CI, 0.21-0.66), and renal impairment (OR 0.70, 95% CI, 0.52-0.93) were factors associated with patients receipt of CDSS-recommended antibiotic therapies. CONCLUSIONS: We observed that ICU admission and renal impairment were negative predictors of patients receipt of CDSS-recommended antibiotic therapies. Patients admitted to ICU and those with renal impairment might have more complex clinical conditions that require a physicians assessment in addition to antibiotic CDSS.

In 1993 Carey and Smith conjectured that the most promising way to boost students' understanding of the nature of science is a "theory-building approach to teaching about inquiry." The research reported here tested this conjecture by comparing results from two Grade 4 classrooms that differed in their emphasis on and technological support for creating and improving theories. One class followed a Knowledge Building approach and used Knowledge Forum[R], which together emphasize theory improvement and sustained creative work with ideas. The other class followed an inquiry approach mediated through collaborative project-based activities. Apart from this, the two classes were demographically similar and both fell within the broad category of constructivist, inquiry-based approaches and employed a range of modes and media for investigative research and reports. An augmented version of Carey and Smith's Nature of Science Interview showed that the Knowledge Building approach resulted in deeper understanding of the nature of theoretical progress, the connections between theories and facts, and the role of ideas in scientific inquiry. (Contains 1 table and 2 footnotes.)

Antibiotic computerised decision support systems (CDSSs) are shown to improve antibiotic prescribing, but evidence of beneficial patient outcomes is limited. We conducted a prospective cohort study in a 1500-bed tertiary-care hospital in Singapore, to evaluate the effectiveness of the hospital's antibiotic CDSS on patients' clinical outcomes, and the modification of these effects by patient factors. To account for clustering, we used multilevel logistic regression models. One-quarter of 1886 eligible inpatients received CDSS-recommended antibiotics. Receipt of antibiotics according to CDSS's recommendations seemed to halve mortality risk of patients (OR 0.54, 95% CI 0.26-1.10, P = 0.09). Patients aged ≤65 years had greater mortality benefit (OR 0.45, 95% CI 0.20-1.00, P = 0.05) than patients that were older than 65 (OR 1.28, 95% CI 0.91-1.82, P = 0.16). No effect was observed on incidence of Clostridium difficile (OR 1.02, 95% CI 0.34-3.01), and multidrug-resistant organism (OR 1.06, 95% CI 0.42-2.71) infections. No increase in infection-related readmission (OR 1.16, 95% CI 0.48-2.79) was found in survivors. Receipt of CDSS-recommended antibiotics reduced mortality risk in patients aged 65 years or younger and did not increase the risk in older patients. Physicians should be informed of the benefits to increase their acceptance of CDSS recommendations.

Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly important pathogen in obstetrics. MRSA infections can result in morbidity for both mothers and their infants. Over the past decade, MRSA infection has increased in pregnant women and neonates [1]. Indeed, there is increasing evidence that horizontal transmission from MRSA colonized mothers to their neonates plays a role in increasing neonatal MRSA colonization and, sometimes, infection [2]. Additionally, obstetric patients are frequently exposed to antibiotics, a known risk factor for infection by drug resistant organisms including MRSA.[3] Infection in the postpartum period is still common, even in developed countries [4]. Nonetheless, there is inadequate information in the published literature about the epidemiology of MRSA infections in postpartum women and no consensus on how to reduce the burden and consequences of such infections. This is worrisome given the urgency of the double threat of (multi-)drug resistance and stagnating antibiotic development.

In June 2009, during Singapore's pandemic influenza plan containment phase, pandemic (H1N1) 2009 was introduced into the country through imported cases. To understand how travel patterns affected the initial outbreak, we examined epidemiologic and travel data for the first 116 case-patients admitted to Tan Tock Seng Hospital, Singapore, with travel-associated infection. Sixty-one percent and 54% of patients, respectively, met US Centers for Disease Control and Prevention and World Health Organization temperature criteria for influenza-like illness. One fourth of the case-patients traveled after illness onset, and 15% became ill while traveling. Regions of exposure for imported infections changed rapidly; case-patients initially arrived from North America, followed by Australasia and Southeast Asia. Case-patients on longer flights were more likely to become ill before arrival; those with shorter flights tended to become ill after arrival. Thermal scanners detected fevers in 12% of the arriving case-patients, resulting in a shorter time to isolation.

Zika virus and dengue virus (DENV) are arboviral infections transmitted by the Aedes mosquito. Dengue is endemic in Singapore with >10,000 case notifications annually (1). Although Zika virus was known [...]

Group B Streptococcus (GBS) disease is caused by S. agalactiae, a commensal bacterium that can be isolated from genitourinary and gastrointestinal tracts of up to 30% of healthy adults. GBS [...]