The Microbiome Project: Hospitals
Bacteria may actually be beneficial to hospitals.
59 BASIC BIOLOGICAL SCIENCES↗
SEARCH · Engineering Papers
Results for “HOSPITALS”
Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.
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Hospital Lighting Controls: Lighting Energy Efficiency in Parking Campaign
This case study describes how NorthBay VacaValley Hospital completed lighting retrofits to its 150,000-square-foot parking lot with help from the California Lighting Technology Center at UC Davis, resulting in 65% energy savings.
Lighting, Parking, Retrofits, LED, Lighting Contro↗
Management of Low-Level Radioactive Waste from Research, Hospitals and Nuclear Medical Centers in Egypt - 13469
The application of radioisotopes and radiation sources in medical diagnosis and therapy is an important issue. Physicians can use radioisotopes to diagnose and treat diseases. Methods of treatment, conditioning and management of low level radioactive wastes from the use of radiation sources and radioisotopes in hospitals and nuclear medicine application, are described. Solid Radioactive waste with low-level activity after accumulation, minimization, segregation and measurement, are burned or compressed in a compactor according to the international standards. Conditioned drums are transported to the interim storage site at the Egyptian Atomic Energy Authority (EAEA) represented in Hot Labs and Waste Management Center (HLWMC) for storage and monitoring. (authors)
12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
Optimizing design and dispatch of a resilient renewable energy microgrid for a South African hospital
Lack of access to reliable energy is a major concern for countries in sub-Saharan Africa. The national grids are unable to consistently satisfy demand. Therefore, users turn to distributed generation systems in the form of back-up generators. However, such systems are usually designed based on a rule of thumb. We employ a mixed-integer linear programming model that considers several options such as renewable energy, combined heat and power, and storage technologies, in addition to those on-site, to provide optimal design and dispatch decisions that minimize total cost. We apply this model to a case study for a hospital in South Africa, considering its need for reliable electricity in light of multiple outages that might occur over the course of a year, as well as its high heating and cooling loads. Our results show that optimal design and dispatch decisions for the distributed generation system address reliability challenges, regardless of the time at which they occur. And, these solutions yield millions of dollars in savings, suggesting that technologies such as the absorption chiller may be overlooked in typical designs; its integration can reduce demand charges even in the absence of combined heat and power. We show that total cost is most sensitive to changes in site electrical demand, followed by capital cost, fuel cost, photovoltaic production, and monthly demand charges; changes in fuel cost primarily affect system sizes of combined heat and power and the absorption chiller, while photovoltaic system size is more sensitive to the changes in capital and fuel costs, photovoltaic resource availability, and hourly electrical demand. Finally, an outage simulator demonstrates the ability of our optimized system to sustain with no interruptions in power five-hour outages with probability 1.0 and ten-hour outages with probability 0.65, significant improvements over 0.5 and 0.0, respectively, under a business-as-usual case.
24 POWER TRANSMISSION AND DISTRIBUTION↗
Environmental surveillance and in vitro activity of antimicrobial agents against Legionella pneumophila isolated from hospital water systems in Campania, South Italy: a 5-year study
Highlights: • None of the Legionella strains isolated showed resistance to the antibiotics tested. • Rifampicin was the most active antibiotic against all Legionella strains isolated. • All Legionella strains inhibited by low concentrations of macrolides and fluoroquinolones. Legionellosis’ treatment failures have been recently reported showing the possibility of resistance development to traditional therapy, especially in healthcare related disease cases. Environmental impact of antibiotic residues, especially in hospital waters, may act on the resistome of Legionella resulting in developing resistance mechanisms.
54 ENVIRONMENTAL SCIENCES↗
Unconventional natural gas development and pediatric asthma hospitalizations in Pennsylvania
Highlights: • Unconventional natural gas development may be linked to pediatric asthma. • Specific air pollutants from drilling emissions may be driving these associations. • Associations remain for up to eight years after drilling begins in a community. Pediatric asthma is a common chronic condition that can be exacerbated by environmental exposures, and unconventional natural gas development (UNGD) has been associated with decreased community air quality. This study aims to quantify the association between UNGD and pediatric asthma hospitalizations.
03 NATURAL GAS↗
Reassessment of the Necessity of the Proton Gantry: Analysis of Beam Orientations From 4332 Treatments at the Massachusetts General Hospital Proton Center Over the Past 10 Years
Purpose: To retrospectively analyze the beam approaches used in gantry-based proton treatments, and to reassess the practical advantages of the gantry, compared with beam approaches that are achievable without a gantry, in the context of present-day technology. Methods and Materials: We reviewed the proton therapy plans of 4332 patients treated on gantries at our hospital, delivered by the double scattering technique (n=4228) and, more recently, pencil beam scanning (PBS) (n=104). Beam approaches, relative to the patient frame, were analyzed individually to identify cases that could be treated without a gantry. Three treatment configurations were considered, with the patient in lying position, sitting position, or both. The FIXED geometry includes a fixed horizontal portal. The BEND geometry enables a limited vertical inflection of the beam by up to 20°. The MOVE geometry allows for flexibility of the patient head and body setup. Results: The percentage of patients with head and neck tumors that could be treated without a gantry using double scattering was 44% in FIXED, 70% in 20° BEND, and 100% in 90° MOVE. For torso regions, 99% of patients could be treated in 20° BEND. Of 104 PBS treatments, all but 1 could be reproduced with FIXED geometry. The only exception would require a 10° BEND capability. Note here that the PBS treatments were applied to select anatomic sites, including only 2 patients with skull-base tumors. Conclusions: The majority of practical beam approaches can be realized with gantry-less delivery, aided by limited beam bending and patient movements. Practical limitations of the MOVE geometry, and treatments requiring a combination of lying and sitting positions, may lower the percentage of head and neck patients who could be treated without a gantry. Further investigation into planning, immobilization, and imaging is needed to remove the practical limitations and to facilitate proton treatment without a gantry.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
A Machine Learning Model Approach to Risk-Stratify Patients With Gastrointestinal Cancer for Hospitalization and Mortality Outcomes
Patients with gastrointestinal (GI) cancer frequently experience unplanned hospitalizations, but predictive tools to identify high-risk patients are lacking. We developed a machine learning model to identify high-risk patients.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
Evaluation of FluSight influenza forecasting in the 2021–22 and 2022–23 seasons with a new target laboratory-confirmed influenza hospitalizations
Accurate forecasts can enable more effective public health responses during seasonal influenza epidemics. For the 2021–22 and 2022–23 influenza seasons, 26 forecasting teams provided national and jurisdiction-specific probabilistic predictions of weekly confirmed influenza hospital admissions for one-to-four weeks ahead. Forecast skill is evaluated using the Weighted Interval Score (WIS), relative WIS, and coverage. Six out of 23 models outperform the baseline model across forecast weeks and locations in 2021–22 and 12 out of 18 models in 2022–23. Averaging across all forecast targets, the FluSight ensemble is the 2nd most accurate model measured by WIS in 2021–22 and the 5th most accurate in the 2022–23 season. Forecast skill and 95% coverage for the FluSight ensemble and most component models degrade over longer forecast horizons. In this work we demonstrate that while the FluSight ensemble was a robust predictor, even ensembles face challenges during periods of rapid change.
59 BASIC BIOLOGICAL SCIENCES↗
Sociomarkers and biomarkers: predictive modeling in identifying pediatric asthma patients at risk of hospital revisits
The importance of social components of health has been emphasized both in epidemiology and public health. This paper highlights the significant impact of social components on health outcomes in a novel way. Introducing the concept of sociomarkers, which are measurable indicators of social conditions in which a patient is embedded, we employed a machine learning approach that uses both biomarkers and sociomarkers to identify asthma patients at risk of a hospital revisit after an initial visit with an accuracy of 66%. The analysis has been performed over an integrated dataset consisting of individual-level patient information such as gender, race, insurance type, and age, along with ZIP code-level sociomarkers such as poverty level, blight prevalence, and housing quality. Using this uniquely integrated database, we then compare the traditional biomarker-based risk model and the sociomarker-based risk model. A biomarker-based predictive model yields an accuracy of 65% and the sociomarkerbased model predicts with an accuracy of 61%. Without knowing specific symptom-related features, the sociomarker-based model can correctly predict two out of three patients at risk. We systematically show that sociomarkers play an important role in predicting health outcomes at the individual level in pediatric asthma cases. Additionally, by merging multiple data sources with detailed neighborhood-level data, we directly measure the importance of residential conditions for predicting individual health outcomes.
Shin, Eun Kyong↗
True beam commissioning experience at Nordland Hospital Trust, Norway
To evaluate the measured of all photon beam data of first Varian True Beam version 2.0 slim model, recently commissioned at Nordland Hospital Trust, Bodø. To compare and evaluate the possibility of beam matching with the Clinac2300, for the energies of 6MV and 15 MV. Materials/Methods: Measurements of PDD, OAR, and Output factors were realized with the IBA Blue-phantom with different detectors and evaluated between them for all photon energies: 6MV, 15MV, 6MV FFF and 10MV FFF. The ionization chambers used were Pin Point CC01, CC04, Semiflex CC13 and photon diode by Iba dosimetry. The data were processed using Beizer algorithm with a resolution of 1 mm. The measured depth dose curves, diagonals, OAR, and output factors were imported into Eclipse in order to calculate beam data for the anisotropic analytical algorithm (AAA version 10.0.28) for both the dataset measured with CC04 and CC13 and compared. The model head of 23EX was selected as the most near model to True Beam as a restriction of our version of Aria. It was seen that better results were achieved with the CC04 measured data as a result of better resolution. For the biggest field after 10 cm depth a larger difference is seen between measured and calculated for both dataset, but it is within the criteria for acceptance. Results: The Beam analysis criteria of 2 mm at 50% dose is achieved for all the fields accept for 40x40 that is within 3%. Depth difference at maximum dose is within 1 mm for all the fields and dose difference at 100 mm and 200 mm is lower than 1% for or all the fields. The PDD between two machines for all the fields differ after Dmax with less than 1%. For profiles in the field zone and outside field the difference is within 1% for all the fields. In the penumbra region the difference is from 2% up to 12% for big fields. As for diagonals they differ as a result of the head construction at the edge of the field and the penumbra region. The output factors differ for big fields within 5% and for the small fields within 3%. MU and dose distribution does not change for plans recalculated with the new modeled machine.
71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
Exploration of a Potential DOOR Endpoint for Hospital-acquired Bacterial Pneumonia and Ventilator-associated Bacterial Pneumonia Using Six Registrational Trials for Antibacterial Drugs
Abstract Background Desirability of outcome ranking (DOOR) is an innovative approach to clinical trial design and analysis that uses an ordinal ranking system to incorporate the overall risks and benefits of a therapeutic intervention into a single measurement. Here we derived and evaluated a disease-specific DOOR endpoint for registrational trials for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP). Methods Through comprehensive examination of data from nearly 4000 participants enrolled in six registrational trials for HABP/VABP submitted to the Food and Drug Administration (FDA) between 2005 and 2022, we derived and applied a HABP/VABP specific endpoint. We estimated the probability that a participant assigned to the study treatment arm would have a more favorable overall DOOR or component outcome than a participant assigned to comparator. Results DOOR distributions between treatment arms were similar in all trials. DOOR probability estimates ranged from 48.3% to 52.9% and were not statistically different. There were no significant differences between treatment arms in the component analyses. Although infectious complications and serious adverse events occurred more frequently in ventilated participants compared to non-ventilated participants, the types of events were similar. Conclusions Through a data-driven approach, we constructed and applied a potential DOOR endpoint for HABP/VABP trials. The inclusion of syndrome-specific events may help to better delineate and evaluate participant experiences and outcomes in future HABP/VABP trials and could help inform data collection and trial design.
Immunology↗
Viral Load Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospitalized Individuals With Coronavirus Disease 2019
Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) kinetics remain understudied, including the impact of remdesivir. In hospitalized individuals, peak sputum viral load occurred in week 2 of symptoms, whereas viremia peaked within 1 week of symptom-onset, suggesting early systemic seeding of SARS-CoV-2. Remdesivir treatment was associated with faster viral decay.
60 APPLIED LIFE SCIENCES↗
TH-E-209-01: Fluoroscopic Dose Monitoring and Patient Follow-Up Program at Massachusetts General Hospital
Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilities over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.
60 APPLIED LIFE SCIENCES↗
Bacterial colonization and succession in a newly opened hospital
Patients share their microbiota with their rooms and with nursing staff, and this shapes the microbial ecology of the hospital environment.
Lax, Simon↗
A MUC 5 B Gene Polymorphism, rs35705950-T, Confers Protective Effects Against COVID-19 Hospitalization but Not Severe Disease or Mortality
A common MUC5B gene polymorphism, rs35705950-T, is associated with idiopathic pulmonary fibrosis (IPF), but its role in severe acute respiratory syndrome coronavirus 2 infection and disease severity is unclear. To assess whether rs35705950-T confers differential risk for clinical outcomes associated with coronavirus disease (COVID-19) infection among participants in the Million Veteran Program (MVP). The MUC5B rs35705950-T allele was directly genotyped among MVP participants; clinical events and comorbidities were extracted from the electronic health records. Associations between the incidence or severity of COVID-19 and rs35705950-T were analyzed within each ancestry group in the MVP followed by transancestry meta-analysis. Replication and joint meta-analysis were conducted using summary statistics from the COVID-19 Host Genetics Initiative (HGI). Sensitivity analyses with adjustment for additional covariates (body mass index, Charlson comorbidity index, smoking, asbestosis, rheumatoid arthritis with interstitial lung disease, and IPF) and associations with post–COVID-19 pneumonia were performed in MVP subjects. The MUC5B variant rs35705950-T may confer protection in COVID-19 hospitalizations.
59 BASIC BIOLOGICAL SCIENCES↗
Virologic outcome among patients receiving antiretroviral therapy at five hospitals in Haiti
Introduction Viral load (VL) assessment is the preferred method for diagnosing and confirming virologic failure for patients on antiretroviral therapy (ART). We conducted a retrospective cross-sectional study to evaluate the virologic suppression rate among patients on ART for 6 months in five hospitals around Port-au-Prince, Haiti. Methods Plasma VL was measured and patients with VL <1,000 copies/mL were defined as virologically suppressed. A second VL test was performed within at least six months of the first test. Factors associated with virologic suppression were analyzed using logistic regression models accounting for site-level clustering using complex survey procedures. Results Data were analyzed for 2,313 patients on ART for six months or longer between July 2013 and February 2015. Among them, 1,563 (67.6%) achieved virologic suppression at the first VL test. A second VL test was performed within at least six months for 718 (31.0%) of the patients. Of the 459 patients with an initial HIV-1 RNA <1,000 copies/mL who had a second VL performed, 394 (85.8%) maintained virologic suppression. Virologic suppression was negatively associated with male gender (adjusted odds ratio [aOR]: 0.80, 95% CI: 0.74– 0.0.86), 23 to 35 months on ART (aOR:0.72[0.54–0.96]), baseline CD4 counts of 201–500 cells/mm 3 and 200 cells/mm 3 or lower (aORs: 0.77 [0.62–0.95] and 0.80 [0.66–0.98], respectively), poor adherence (aOR: 0.69 [0.59–0.81]), and TB co-infection (aOR: 0.73 [0.55–0.97]). Conclusions This study showed that over two-thirds of the patients in this evaluation achieved virologic suppression after six months on ART and the majority of them remained suppressed. These results reinforce the importance of expanding access to HIV-1 viral load testing in Haiti for monitoring ART outcomes.
59 BASIC BIOLOGICAL SCIENCES↗
Willingness to Receive mHealth Services Among Patients with Diabetes on Chronic Follow-up in Public Hospitals in Eastern Ethiopia: Multicenter Mixed-Method Study
Background: Management of diabetes requires a long-term care strategy, including support for adherence to a healthy lifestyle and treatment. Exploring the willingness of patients with diabetes to receive mHealth services is essential for designing efficient and effective services. This study aimedto determine willingness to receive mHealth services and associated factors, as well as explore the barriers to receive mHealth services among patients with diabetes. Methods: A multicenter mixed-method study was employed from September 1 to November 30, 2022. For the quantitative part, a total of 365 patients with diabetes receiving chronic follow-up at three public hospitals were enrolled. Data were gathered using structured questionnaires administered by interviewers, entered into Epi-data version 4.6, and analyzed using Stata version 17. A binary and multivariable logistic regression model was computed to identify the associated factors. For qualitative, eight key informants and seven in-depth interviews were conducted. After verbatim transcription and translation, the data were thematically analyzed using ATLAS.ti V. 7.5. Results: Overall, 77.3% had access to a mobile phone, and 74.5% of them were willing to receive mHealth services. Higher odds of willingness to receive mHealth services were reported among patients with an age below 35 years [AOR = 4.11 (1.15– 14.71)], attended formal education [AOR = 2.63 (1.19– 5.77)], without comorbidity [AOR = 3.6 (1.54– 8.41)], < 1-hour travel to reach a health facility [AOR = 3.57 (1.03– 12.36)], answered unknown calls [AOR = 2.3 (1.04– 5.13)], and were satisfied with health-care provider service [AOR = 2.44 (1.04– 5.72)]. In the qualitative part, infrastructure, health facilities, socioeconomic factors, and patients’ behavioral factors were major identified barriers to receiving mHealth services. Conclusion: In this study, the willingness to receive mHealth services for those who have access to mobile phones increased. Additionally, the study highlighted common barriers to receiving mHealth services.
60 APPLIED LIFE SCIENCES↗