Effectiveness of Personal Protective Equipment for Healthcare Workers Caring for Patients with Filovirus Disease: A Rapid Review.

BACKGROUND A rapid review, guided by a protocol, was conducted to inform development of the World Health Organization's guideline on personal protective equipment in the context of the ongoing (2013-present) Western African filovirus disease outbreak, with a focus on health care workers directly caring for patients with Ebola or Marburg virus diseases. METHODS Electronic databases and grey literature sources were searched. Eligibility criteria initially included comparative studies on Ebola and Marburg virus diseases reported in English or French, but criteria were expanded to studies on other viral hemorrhagic fevers and non-comparative designs due to the paucity of studies. After title and abstract screening (two people to exclude), full-text reports of potentially relevant articles were assessed in duplicate. Fifty-seven percent of extraction information was verified. The Grading of Recommendations Assessment, Development and Evaluation framework was used to inform the quality of evidence assessments. RESULTS Thirty non-comparative studies (8 related to Ebola virus disease) were located, and 27 provided data on viral transmission. Reporting of personal protective equipment components and infection prevention and control protocols was generally poor. CONCLUSIONS Insufficient evidence exists to draw conclusions regarding the comparative effectiveness of various types of personal protective equipment. Additional research is urgently needed to determine optimal PPE for health care workers caring for patients with filovirus.

Multiple causes of the Younger Dryas cold period

The Younger Dryas cooling event disrupted the overall warming trend in the North Atlantic region during the last deglaciation. Climate change during the Younger Dryas was abrupt and thus provides insights into the sensitivity of the climate system to perturbations. The sudden Younger Dryas cooling has traditionally been attributed to a shutdown of the Atlantic Meridional Overturning Circulation by meltwater discharges. However, alternative explanations such as strong negative radiative forcing14 and a shift in atmospheric circulation have also been offered. Here we investigate the importance of these different forcings in coupled climate model experiments constrained by data assimilation. We find that the Younger Dryas climate signal as registered in proxy evidence is best simulated using a combination of processes: a weakened Atlantic Meridional Overturning Circulation, moderate negative radiative forcing and an altered atmospheric circulation. We conclude that none of the individual mechanisms alone provide a plausible explanation for the Younger Dryas cold period. We suggest that the triggers for abrupt climate changes such as the Younger Dryas are more complex than suggested so far, and that studies on the response of the climate system to perturbations should account for this complexity.

Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study

BACKGROUND: Crossing a street can be a very difficult task for older pedestrians. With increased age and potential cognitive decline, older people take the decision to cross a street primarily based on vehicles' distance, and not on their speed. Furthermore, older pedestrians tend to overestimate their own walking speed, and could not adapt it according to the traffic conditions. Pedestrians' behavior is often tested using virtual reality. Virtual reality presents the advantage of being safe, cost-effective, and allows using standardized test conditions. METHODS: This paper describes an observational study with older and younger adults. Street crossing behavior was investigated in 18 healthy, younger and 18 older subjects by using a virtual reality setting. The aim of the study was to measure behavioral data (such as eye and head movements) and to assess how the two age groups differ in terms of number of safe street crossings, virtual crashes, and missed street crossing opportunities. Street crossing behavior, eye and head movements, in older and younger subjects, were compared with non-parametric tests. RESULTS: The results showed that younger pedestrians behaved in a more secure manner while crossing a street, as compared to older people. The eye and head movements analysis revealed that older people looked more at the ground and less at the other side of the street to cross. CONCLUSIONS: The less secure behavior in street crossing found in older pedestrians could be explained by their reduced cognitive and visual abilities, which, in turn, resulted in difficulties in the decision-making process, especially under time pressure. Decisions to cross a street are based on the distance of the oncoming cars, rather than their speed, for both groups. Older pedestrians look more at their feet, probably because of their need of more time to plan precise stepping movement and, in turn, pay less attention to the traffic. This might help to set up guidelines for improving senior pedestrians' safety, in terms of speed limits, road design, and mixed physical-cognitive trainings.

Younger Dryas and Allerød summer temperatures at Gerzensee (Switzerland) inferred from fossil pollen and cladoceran assemblages

Linear- and unimodal-based inference models for mean summer temperatures (partial least squares, weighted averaging, and weighted averaging partial least squares models) were applied to a high-resolution pollen and cladoceran stratigraphy from Gerzensee, Switzerland. The time-window of investigation included the Allerød, the Younger Dryas, and the Preboreal. Characteristic major and minor oscillations in the oxygen-isotope stratigraphy, such as the Gerzensee oscillation, the onset and end of the Younger Dryas stadial, and the Preboreal oscillation, were identified by isotope analysis of bulk-sediment carbonates of the same core and were used as independent indicators for hemispheric or global scale climatic change. In general, the pollen-inferred mean summer temperature reconstruction using all three inference models follows the oxygen-isotope curve more closely than the cladoceran curve. The cladoceran-inferred reconstruction suggests generally warmer summers than the pollen-based reconstructions, which may be an effect of terrestrial vegetation not being in equilibrium with climate due to migrational lags during the Late Glacial and early Holocene. Allerød summer temperatures range between 11 and 12°C based on pollen, whereas the cladoceran-inferred temperatures lie between 11 and 13°C. Pollen and cladocera-inferred reconstructions both suggest a drop to 9–10°C at the beginning of the Younger Dryas. Although the Allerød–Younger Dryas transition lasted 150–160 years in the oxygen-isotope stratigraphy, the pollen-inferred cooling took 180–190 years and the cladoceran-inferred cooling lasted 250–260 years. The pollen-inferred summer temperature rise to 11.5–12°C at the transition from the Younger Dryas to the Preboreal preceded the oxygen-isotope signal by several decades, whereas the cladoceran-inferred warming lagged. Major discrepancies between the pollen- and cladoceran-inference models are observed for the Preboreal, where the cladoceran-inference model suggests mean summer temperatures of up to 14–15°C. Both pollen- and cladoceran-inferred reconstructions suggest a cooling that may be related to the Gerzensee oscillation, but there is no evidence for a cooling synchronous with the Preboreal oscillation as recorded in the oxygen-isotope record. For the Gerzensee oscillation the inferred cooling was ca. 1 and 0.5°C based on pollen and cladocera, respectively, which lies well within the inherent prediction errors of the inference models.

Quantification of biotic responses to rapid climatic changes around the Younger Dryas — a synthesis

To assess the presence or absence of lags in biotic responses to rapid climatic changes, we: (1) assume that the δ18O in biogenically precipitated carbonates record global or hemispheric climatic change at the beginning and at the end of the Younger Dryas without any lag at our two study sites of Gerzensee and Leysin, Switzerland; (2) derive a time scale by correlating the δ18O record from these two sites with the δ18O record of the GRIP ice core; (3) measure δ18O records in ostracods and molluscs to check the record in the bulk samples and to detect possible hydrological changes; (4) analyse at Gerzensee and Leysin as well as at two additional sites (that lack carbonates and hence a δ18O record) pollen, plant macrofossils, chironomids, beetles and other insects, and Cladocera; (5) estimate our sampling resolution using the GRIP time scale for the isotope stratigraphies and the biostratigraphies; and (6) summarise the major patterns of compositional change in the biostratigraphies by principal component analysis or correspondence analysis. We conclude that, at the major climatic shifts at the beginning and end of the Younger Dryas, hardly any biotic lags occur (within the sampling resolution of 8–30 years) and that upland vegetation responded as fast as aquatic invertebrates. We suggest that the minor climatic changes associated with the Gerzensee and Preboreal oscillations were weakly recorded in the biostratigraphies at the lowland site, but were more distinct at higher altitudes. Individualistic responses of plant and animal species to climatic change may reflect processes in individuals (e.g. productivity and phenology), in populations (e.g. population dynamics), in spatial distributions (e.g. migrations), and in ecosystems (e.g. trophic state). We suggest that biotic responses may be telescoped together into relatively short periods (50 to 150 years), perhaps disrupting functional interactions among species and thus destabilising ecosystems.

Oxygen isotopes of lake marl at Gerzensee and Leysin (Switzerland), covering the Younger Dryas and two minor oscillations, and their correlation to the GRIP ice core

The ratio of oxygen isotopes is a temperature proxy both in precipitation and in the calcite of lacustrine sediments. The very similar oxygen-isotope records from Greenland ice cores and European lake sediments during the Last Glacial Termination suggest that the drastic climatic changes occurred quasi-simultaneously on an extra-regional, probably hemispheric scale. In order to study temporal relations of the different parameters recorded in lake sediments, for example biotic response times to rapid climatic changes, a precise chronology is required. In unlaminated lake sediments there is not yet available a method to provide a high-resolution chronology, especially for periods with radiocarbon plateaux. Alternatively, an indirect time scale can be constructed by linking the lake stratigraphy with other well-dated climate records. New oxygen-isotope records from Gerzensee and Leysin, with an estimated sampling resolution of between 15 and 40 years, match the Greenlandic isotope record in many details. Under the assumption that the main variations in temperature and thus in oxygen isotopes occurred about simultaneously in Greenland and Switzerland, we have assigned a time scale to the lake sediments of Gerzensee and Leysin by wiggle-matching their stable-isotope records with those of Greenland ice cores, which are among the best dated climatic archives. We estimate a precision of 20 to 100 years during the Last Glacial Termination.

Isotope signature of the Younger Dryas and two minor oscillations at Gerzensee (Switzerland): palaeoclimatic and palaeolimnologic interpretation based on bulk and biogenic carbonates

Oxygen- and carbon-isotope ratios in the carbonate of benthic ostracodes (Pseudocandona marchica) and molluscs (Pisidium ssp.) were measured across the transitions bordering the Younger Dryas chronozone in littoral lacustrine cores from Gerzensee (Switzerland). The specific biogenic carbonate records confirm the major shifts already visible in the continuous bulk-carbonate oxygen-isotope record (δ18OCc). If corrected for their vital offsets, oxygen-isotope ratios of Pisidium and juvenile P. marchica, both formed in summer, are almost identical to δ18OCc. This bulk carbonate is mainly composed of encrustations of benthic macrophythes (Chara ssp.), also mainly produced during summer. Adult P. marchica, which calcify in winter, show consistently higher δ18O, larger shifts across both transitions, and short positive excursions compared with the summer forms, especially during early Preboreal. Despite such complexity, the δ18O of adult P. marchica probably reflects more accurately the variations of the δ18O of former lake water because, during winter, calcification temperatures are less variable and the water column isotopically uniform. The difference between normalised δ18O of calcite precipitated in winter to that formed in summer can be used to estimate the minimum difference between summer and winter water temperatures. In general, the results indicate warmer summers during the late Allerød and early Preboreal compared with the Younger Dryas. Altogether, the isotopic composition of lake water (δ18OL) and of the dissolved inorganic carbonate (δ13CDIC) reconstructed from adult Pseudocandona marchica, as well as the seasonal water temperature contrasts, indicate that the major shifts in the δ18O of local precipitation at Gerzensee were augmented by changes of the lake's water balance, with relatively higher evaporative loss occurring during the Allerød compared with the Younger Dryas. It is possible that during the early Preboreal the lake might even have been hydrologically closed for a short period. We speculate that such hydrologic changes reflect a combination of varying evapotranspiration and a rearrangement of groundwater recharge during those climatic shifts.