Search

Background:The scale of the 2022 global mpox (formerly known as monkeypox) outbreak has been unprecedented. In less than 6 months, non-endemic countries have reported more than 67 000 cases of a disease that had previously been rare outside of Africa. Mortality has been reported as rare but hospital admission has been relatively common. We aimed to describe the clinical and laboratory characteristics and outcomes of individuals admitted to hospital with mpox and associated complications, including tecovirimat recipients. Methods:In this cohort study, we undertook retrospective review of electronic clinical records and pathology data for all individuals admitted between May 6, and Aug 3, 2022, to 16 hospitals from the Specialist and High Consequence Infectious Diseases Network for Monkeypox. The hospitals were located in ten cities in England and Northern Ireland. Inclusion criteria were clinical signs consistent with mpox and MPXV DNA detected from at least one clinical sample by PCR testing. Patients admitted solely for isolation purposes were excluded from the study. Key outcomes included admission indication, complications (including pain, secondary infection, and mortality) and use of antibiotic and anti-viral treatments. Routine biochemistry, haematology, microbiology, and virology data were also collected. Outcomes were assessed in all patients with available data. Findings:156 individuals were admitted to hospital with complicated mpox during the study period. 153 (98%) were male and three (2%) were female, with a median age of 35 years (IQR 30–44). Gender data were collected from electronic patient records, which encompassed full formal review of clincian notes. The prespecified options for data collection for gender were male, female, trans, non-binary, or unknown. 105 (71%) of 148 participants with available ethnicity data were of White ethnicity and 47 (30%) of 155 were living with HIV with a median CD4 count of 510 cells per mm3(IQR 349–828). Rectal or perianal pain (including proctitis) was the most common indication for hospital admission (44 [28%] of 156). Severe pain was reported in 89 (57%) of 156, and secondary bacterial infection in 82 (58%) of 142 individuals with available data. Median admission duration was 5 days (IQR 2–9). Ten individuals required surgery and two cases of encephalitis were reported. 38 (24%) of the 156 individuals received tecovirimat with early cessation in four cases (two owing to hepatic transaminitis, one to rapid treatment response, and one to patient choice). No deaths occurred during the study period. Interpretation:Although life-threatening mpox appears rare in hospitalised populations during the current outbreak, severe mpox and associated complications can occur in immunocompetent individuals. Analgesia and management of superimposed bacterial infection are priorities for patients admitted to hospital.

Between December 2021 and June 2022, 10 cases of ceftriaxone-resistant

Objective Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients. Methods The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?" Results The search yielded an initial 16,686 references, 19 of which met the inclusion criteria. Baseline rates of language service utilization were extremely low and remained at low levels postintervention in multiple studies. Most studies focused on language service utilization, patient communication, metric tracking, and access to care, whereas few studies evaluated quality of care or health outcomes of LEP patients. Multifaceted interventions that include elements of administrative emphasis, process evaluation, and education appear to improve language service use and communication. Conclusion This review revealed large gaps in the evidence to guide hospital and health system improvement strategies for LEP patient care. Given the large and persistent performance gaps in the provision of language assistance for LEP patients, hospitals, health systems, and granting agencies should invest in implementation and dissemination research focused on language service use.

In the first study measuring sexual harassment experiences of academic library employees at a single institution, we conducted a census of 1,610 non-student employees at the 10-campus University of California Libraries system. This anonymous online survey measured how sexual harassment was experienced and observed in terms of behaviors, exhibitors, reporting and disclosure, institutional support and betrayal, and recommendations for future actions. Out of 579 respondents, 54% experienced and/or observed sexual harassment at work. Respondents recommended training, workplace culture change, support from leadership, and clear reporting processes in order to address sexual harassment at University of California Libraries.

WI+RE (Writing Instruction + Research Education) is a learner-led team of undergraduate and graduate student employees at UCLA Library who apply values-driven design principles and grassroots instructional media production techniques to foster breakthroughs in research, reading, and writing for their fellow learners. The WI+RE Way (UCLA Library WI+RE, 2019c) is a collaboratively authored manifesto for learner-led design co-authored by WI+RE's learner-designers in collaboration with library staff.

Importance The COVID-19 pandemic has resulted in a persistent shortage of personal protective equipment; therefore, a need exists for hospitals to reprocess filtering facepiece respirators (FFRs), such as N95 respirators. Objective To perform a systematic review to evaluate the evidence on effectiveness and feasibility of different processes used for decontaminating N95 respirators. Evidence review A search of PubMed and EMBASE (through January 31, 2021) was completed for 5 types of respirator-decontaminating processes including UV irradiation, vaporized hydrogen peroxide, moist-heat incubation, microwave-generated steam, and ethylene oxide. Data were abstracted on process method, pathogen removal, mask filtration efficiency, facial fit, user safety, and processing capability. Findings Forty-two studies were included that examined 65 total types of masks. All were laboratory studies (no clinical trials), and 2 evaluated respirator performance and fit with actual clinical use of N95 respirators. Twenty-seven evaluated UV germicidal irradiation, 19 vaporized hydrogen peroxide, 9 moist-heat incubation, 10 microwave-generated steam, and 7 ethylene oxide. Forty-three types of N95 respirators were treated with UV irradiation. Doses of 1 to 2 J/cm2 effectively sterilized most pathogens on N95 respirators (>103 reduction in influenza virus [4 studies], MS2 bacteriophage [3 studies], Bacillus spores [2 studies], Escherichia virus MS2 [1 study], vesicular stomatitis virus [1 study], and Middle East respiratory syndrome virus/SARS-CoV-1 [1 study]) without degrading respirator components. Doses higher than 1.5 to 2 J/cm2 may be needed based on 2 studies demonstrating greater than 103 reduction in SARS-CoV-2. Vaporized hydrogen peroxide eradicated the pathogen in all 7 efficacy studies (>104 reduction in SARS-CoV-2 [3 studies] and >106 reduction of Bacillus and Geobacillus stearothermophilus spores [4 studies]). Pressurized chamber systems with higher concentrations of hydrogen peroxide caused FFR damage (6 studies), while open-room systems did not degrade respirator components. Moist heat effectively reduced SARS-CoV-2 (2 studies), influenza virus by greater than 104 (2 studies), vesicular stomatitis virus (1 study), and Escherichia coli (1 study) and preserved filtration efficiency and facial fit for 11 N95 respirators using preheated containers/chambers at 60 °C to 85 °C (5 studies); however, diminished filtration performance was seen for the Caron incubator. Microwave-generated steam (1100-W to 1800-W devices; 40 seconds to 3 minutes) effectively reduced pathogens by greater than 103 (influenza virus [2 studies], MS2 bacteriophage [3 studies], and Staphylococcus aureus [1 study]) and maintained filtration performance in 10 N95 respirators; however, damage was noted in least 1 respirator type in 4 studies. In 6 studies, ethylene oxide preserved respirator components in 16 N95 respirator types but left residual carcinogenic by-product (1 study). Conclusions and relevance Ultraviolet germicidal irradiation, vaporized hydrogen peroxide, moist heat, and microwave-generated steam processing effectively sterilized N95 respirators and retained filtration performance. Ultraviolet irradiation and vaporized hydrogen peroxide damaged respirators the least. More research is needed on decontamination effectiveness for SARS-CoV-2 because few studies specifically examined this pathogen.

The cascade of events following the global outbreak of COVID-19 produced exceptional examples of camaraderie, collaboration, and resourcefulness. In this article, we share two ways UCLA Library public services staff came together to rapidly re-envision learner-centered library services and support in response to the COVID-19 campus shutdown. In both cases, library staff adapted existing services (e.g., workshop delivery and tutorial design) to embrace remote technologies and scale to meet the needs of a greater number of learners.

The current pathway into genitourinary medicine (GUM) training involves the completion of foundation training followed by core medical training, during which time the MRCP must be achieved. Once in a GUM training programme, the curriculum is broadly divided to focus on GUM and HIV competences with assessment of these including a range of work-place-based assessments and formal examination with DipGUM, DipHIV and the DFSRH for contraception.1 All competencies must be achieved within the 4 years of GUM training culminating in the Certificate of Completion of Training (CCT). In recent years, however, several factors have impacted both directly and indirectly on GUM training. From differences in the commissioning structure of GUM and HIV services to proposed changes in the structure of medical training as well as the changing needs of HIV patients in the post highly active antiretroviral therapy (HAART) era, we will be addressing the factors that are changing the shape of GUM training. The commissioning of HIV and GUM services varies across the United Kingdom. In Scotland and Wales, regional Health Boards fund …

Background/introduction Adult safeguarding is the process of protecting vulnerable adults from harm or exploitation. In 2014 our sexual health clinic introduced an adult safeguarding proforma and a regular adult safeguarding meeting. Aim(s)/objectives To evaluate the impact of a new safeguarding pathway. Methods Retrospective case note review of patients entered onto the safeguarding database from April-December 2015. Results Of 14833 adult attendances, 148 patients were identified as vulnerable (1.0% vs 0.3% in 2013, p Discussion/conclusion A large number of vulnerable adults attend our service, highlighting the importance of robust safeguarding procedures. Greater numbers were identified following introduction of a new safeguarding pathway.

We performed an audit to review rates of HIV testing in Homerton University Hospital's acute care unit (ACU), following its participation as one of the HINTS1 study sites and its subsequent introduction of an opt-out HIV testing policy. Local diagnosed HIV prevalence is 8.25/1000. Electronic patient records were searched for all ACU admissions, January to April 2014, inclusive. Data collected included demographics, admitting specialty, presenting complaint, HIV tests and results. For …