BackgroundHealth care and public health professionals rely on accurate, real-time monitoring of infectious diseases for outbreak preparedness and response. Early detection of outbreaks is improved by systems that are comprehensive and specific with respect to the pathogen but are rapid in reporting the data. It has proven difficult to implement these requirements on a large scale while maintaining patient privacy.ObjectiveThe aim of this study was to demonstrate the automated export, aggregation, and analysis of infectious disease diagnostic test results from clinical laboratories across the United States in a manner that protects patient confidentiality. We hypothesized that such a system could aid in monitoring the seasonal occurrence of respiratory pathogens and may have advantages with regard to scope and ease of reporting compared with existing surveillance systems.MethodsWe describe a system, BioFire Syndromic Trends, for rapid disease reporting that is syndrome-based but pathogen-specific. Deidentified patient test results from the BioFire FilmArray multiplex molecular diagnostic system are sent directly to a cloud database. Summaries of these data are displayed in near real time on the Syndromic Trends public website. We studied this dataset for the prevalence, seasonality, and coinfections of the 20 respiratory pathogens detected in over 362,000 patient samples acquired as a standard-of-care testing over the last 4 years from 20 clinical laboratories in the United States.ResultsThe majority of pathogens show influenza-like seasonality, rhinovirus has fall and spring peaks, and adenovirus and the bacterial pathogens show constant detection over the year. The dataset can also be considered in an ecological framework; the viruses and bacteria detected by this test are parasites of a host (the human patient). Interestingly, the rate of pathogen codetections, on average 7.94% (28,741/362,101), matches predictions based on the relative abundance of organisms present.ConclusionsSyndromic Trends preserves patient privacy by removing or obfuscating patient identifiers while still collecting much useful information about the bacterial and viral pathogens that they harbor. Test results are uploaded to the database within a few hours of completion compared with delays of up to 10 days for other diagnostic-based reporting systems. This work shows that the barriers to establishing epidemiology systems are no longer scientific and technical but rather administrative, involving questions of patient privacy and data ownership. We have demonstrated here that these barriers can be overcome. This first look at the resulting data stream suggests that Syndromic Trends will be able to provide high-resolution analysis of circulating respiratory pathogens and may aid in the detection of new outbreaks.
Background. Vaccine-preventable diseases and multi-drug-resistant organisms (MDROs) are common outside of the US, and multiple infectious outbreaks have been linked to travelers. Boston Children's Hospital cared for 2796 international patients in 2016 but lacked an infection risk screening process for these patients, placing patients and staff at risk. We developed the Assessing Infection Risks for Safe Healthcare of International Patients (AIRSHIP) protocol to identify risks to guide infection prevention and control (IPC) measures.Methods. A multidisciplinary team of IPC, infectious diseases, and International Health Services (IHS) experts assessed current IHS intake procedures and stakeholder engagement. We then developed AIRSHIP, devising standardized processes and forms to (1) assess underimmunization, MDRO and tuberculosis history, recent exposures, and current symptoms and (2) triage cases for catch-up immunization, urgent healthcare evaluation, and/or IPC intervention (Figure 1). We piloted incorporation of AIRSHIP into existing intake procedures. We tracked process, outcome, and balancing measures to evaluate feasibility, effectiveness, and acceptability to families (Figure 2) and made iterative improvements through Plan-Do-Study-Act (PDSA) cycles.Results. For our first 13 cases, we completed pre-arrival family and referring provider interviews in 5 cases and on-arrival family interviews in 8 cases (in no cases were both pre-arrival and on-arrival interviews feasible). We were able to assign a risk category in all cases, identifying 5 patients with infection risks (38%) and 4 who were undervaccinated (30%). In 7 of 8 cases (88%) in which on-arrival interviews were performed, the interview and referring provider records yielded complete and reliable data. The average duration of family interviews was 18 minutes. All 13 families reported being "very satisfied" with AIRSHIP.Conclusion. International patients often present with active infections and are commonly undervaccinated. A feasible and effective strategy for infection risk screening of international patients is review of records pre-arrival, together with on-arrival family interview to gather additional data and identify acute symptoms and exposures.
Flow around a rigid, truncated, wall-mounted cylinder with an aspect ratio of 5 is examined computationally at various Reynolds numbers Re to determine how the end effects impact the vortex shedding frequency. The existence of the wall and free end cause a dampening of the classical shedding frequency found for a semi-infinite, two-dimensional cylinder, as horseshoe vortices along the wall and flow over the tip entrain into the shedding region. This effect was observed for Reynolds numbers in the range of 50 to 2000, and quantified by comparing the modified Strouhal numbers to the classical (two-dimensional) solution for Strouhal number as a function of Reynolds number. The range of transition was found to be 220 < Re < 300, versus 150 < Re < 300 for the classical case. Vortex shedding started at Re ≈ 100, significantly above Re = 50, where shedding starts for the two-dimensional case.
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