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Presents a collection of unconventional essays by leading writers to challenge how students think about essays using imaginative, rule-breaking, and unconventional examples.

Background The mechanism for spread of SARS-CoV-2 has been attributed to large particles produced by coughing and sneezing. There is controversy whether smaller airborne particles may transport SARS-CoV-2. Smaller particles, particularly fine particulate matter (≤ 2.5 µm in diameter), can remain airborne for longer periods than larger particles and after inhalation will penetrate deeply into the lungs. Little is known about the size distribution and location of airborne SARS-CoV-2 RNA. Methods As a measure of hospital-related exposure, air samples of three particle sizes (> 10.0 µm, 10.0–2.5 µm, and ≤ 2.5 µm) were collected in a Boston, Massachusetts (USA) hospital from April to May 2020 ( N  = 90 size-fractionated samples). Locations included outside negative-pressure COVID-19 wards, a hospital ward not directly involved in COVID-19 patient care, and the emergency department. Results SARS-CoV-2 RNA was present in 9% of samples and in all size fractions at concentrations of 5 to 51 copies m −3 . Locations outside COVID-19 wards had the fewest positive samples. A non-COVID-19 ward had the highest number of positive samples, likely reflecting staff congregation. The probability of a positive sample was positively associated ( r  = 0.95, p  < 0.01) with the number of COVID-19 patients in the hospital. The number of COVID-19 patients in the hospital was positively associated ( r  = 0.99, p  < 0.01) with the number of new daily cases in Massachusetts. Conclusions More frequent detection of positive samples in non-COVID-19 than COVID-19 hospital areas indicates effectiveness of COVID-ward hospital controls in controlling air concentrations and suggests the potential for disease spread in areas without the strictest precautions. The positive associations regarding the probability of a positive sample, COVID-19 cases in the hospital, and cases in Massachusetts suggests that hospital air sample positivity was related to community burden. SARS-CoV-2 RNA with fine particulate matter supports the possibility of airborne transmission over distances greater than six feet. The findings support guidelines that limit exposure to airborne particles including fine particles capable of longer distance transport and greater lung penetration.

The founders of \"National Novel Writing Month\" offer practical advice on how to organize and commit to writing stories and novels, and includes motivating essays from such popular authors as John Green and Scott Westerfeld.

Academic hospital nurses were surveyed to assess adherence barriers to a universal povidone-iodine nasal decolonization protocol to prevent Staphylococcus aureus infection. Low training rates, inadequate supplies, documentation and tracking challenges, patient refusal, and burnout contributed to suboptimal adherence. Prioritizing education is essential but alone is insufficient for successful protocol adoption.

This special issue deals with temporalities in migration law with particular emphasis on the European context. At the crossroads of several legal fields, including public law, human rights law, EU law and public international law, the topic is cutting-edge in migration law. The articles collected were originally presented at a conference organized at Vrije Universiteit in Amsterdam in June 2023 and another organized at Uppsala University in September 2024, both dealing with time and temporalities in migration law from a variety of perspectives. The aim of these conferences was to further develop the study of the roles of time in European migration law by unpacking the diversity of ways in which time works as an instrument of migration control in Europe. While temporal governance is far from limited to the European context – the US ‘remain in Mexico’ policy7 and the Australian temporary protection visa8 being only two examples – Europe is an interesting site of analysis. It is a forerunner in creating ‘innovative’ migration control policies9; it combines opposites, such as unhindered international movement within Europe for some, e.g., European citizens, alongside fierce immobility and stuckedness for others; it is characterized by a multilevel interplay marking the complexities of interaction between a multitude of different legal regimes and jurisdictions – domestic, EU and international (including the ECHR) – with strong human rights institutions and frameworks. This combination makes Europe a privileged site of inquiry. Drawing on this ‘forerunner quality’ and characterizing elements, this Introduction poses the question whether it is possible to distinguish a form of time one could call ‘European time’ to describe a specifically European approach to implementing temporal governance techniques in the field of migration.

Background: Implementation of transmission-based precautions has predominantly been performed in inpatient acute care settings. Limited guidance is available on applying these precautions in ambulatory clinics, especially for patients with suspected or confirmed COVID-19. This timed analysis of empiric isolation precautions for COVID-19 in walk-in clinics (WIC) aimed to identify unintended impacts that are underappreciated with inpatient use. Methods: An observational analysis at four WIC sites in an academic hospital network was conducted in July-October 2024. Patients who screened positive at check-in with cough, sore throat, congestion, or recent COVID-19 positive testing triggered an electronic notification on the need for airborne and contact isolation precautions with eye protection. A timed evaluation of healthcare personnel (HCP) to don and doff personal protective equipment (PPE) upon patient room entry and exit was performed by two observers using a standardized process with a stopwatch. HCP were surveyed regarding attitudes and barriers using a 5-point Likert scale on REDCap. Results: Sixty patient encounters requiring COVID-19 isolation were observed, representing 30.4% of the total WIC patients seen during the observation periods (N=197 over 36.5 hours). Cough and sore throat were the most common symptoms triggering isolation (both 55%). The mean time to don and doff PPE per room entry and exit was 1.58 and 0.57 minutes, respectively (2.16 minutes per don and doff cycle; Table 1). HCP performed donning and doffing an average of 1.8 times (range 1-4) per patient. Extrapolated to a 12-hour shift, this adds 1.3 hours to daily activities and encompasses 35 sets of PPE (e.g. gowns, gloves, eye protection, respirators), contributing to WIC waste volumes (Table 2). HCP survey respondents (N=26/49) indicated a majority strong agreement that PPE increased the time required, burden to HCP, and waste. Conclusions: Multiple workflow, resource, and HCP burdens of using full COVID-19 isolation precautions for WIC patients suggest that refining isolation criteria for ambulatory settings may help preserve clinic efficiency and limit waste. This pilot occurred during a period with low COVID-19 and influenza-like illness incidence, underscoring the challenges of scaling empiric transmission-based precautions to high-volume clinics during surges of respiratory virus season. Further studies are needed to evaluate the impacts of eliminating the gown and gloves components of PPE for COVID-19 in ambulatory settings, which may be unnecessary given the lower likelihood of transmission by non-airborne routes, short duration of outpatient clinic encounters which limits environmental contamination with SARS-CoV-2 virus, and lack of aerosol-generating procedures.

A cluster of Rhizobium radiobacter isolates isolated from six unique surgical tissue cultures prompted an investigation ultimately identifying a pseudo-outbreak linked to errant laboratory tissue processing with contaminated, nonsterile saline. Timely response and multidisciplinary collaboration led to tangible system-level interventions and avoidance of unnecessary antibiotic exposures.

The limestone bluff cedar–pine forest is a rare upland natural community that is threatened by development and invasion by exotic species. Furthermore, the sensitivity of this forest-type to changes in climate and pollution exposure is unknown. We collected xylem increment cores from 4 conifer species (Thuja occidentalis [Northern White Cedar], Juniperus virginiana [Eastern Red Cedar], Pinus strobus [Eastern White Pine], and Tsuga canadensis [Eastern Hemlock]) and 4 hardwood species (Quercus rubrum [Northern Red Oak], Quercus alba [White Oak], Fagus grandifolia [American Beech], and Fraxinus americana [White Ash]) within and close to a cedar–pine forest along the eastern shore of Lake Champlain in Vermont and correlated radial tree growth to precipitation, snow, temperature, and pollution data to assess which factors influenced growth during the time period 1937–2016. We examined growth and possible environmental drivers of it for a variety of species to evaluate how unique these may be for the cedar and pine trees emblematic of the limestone-bluff community. For both conifers and hardwoods, precipitation exhibited the strongest positive correlations with growth and occurred with greater frequency compared to other climate and pollution parameters. Snow was positively associated and temperature was negatively associated with growth for all species. Despite growing over calcium-rich bedrock, and especially for the conifers, pollution seemed to limit growth in years prior to pollution reductions enacted following the 1990 Amendments to the Clean Air Act.

Aerosol-borne SARS-CoV-2 has not been linked specifically to nosocomial outbreaks. To explore the genomic concordance of SARS-CoV-2 from aerosol particles of various sizes and infected nurses and patients during a nosocomial outbreak of COVID-19. This cohort study included patients and nursing staff in a US Department of Veterans Affairs inpatient hospital unit and long-term-care facility during a COVID-19 outbreak between December 27, 2020, and January 8, 2021. Outbreak contact tracing was conducted using exposure histories and screening with reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2. Size-selective particle samplers were deployed in diverse clinical areas of a multicampus health care system from November 2020 to March 2021. Viral genomic sequences from infected nurses and patients were sequenced and compared with ward nurses station aerosol samples. SARS-CoV-2. The primary outcome was positive RT-PCR results and genomic similarity between SARS-CoV-2 RNA in aerosols and human samples. Air samplers were used to detect SARS-CoV-2 RNA in aerosols on hospital units where health care personnel were or were not under routine surveillance for SARS-CoV-2 infection. A total of 510 size-fractionated air particle samples were collected. Samples representing 3 size fractions (>10 μm, 2.5-10 μm, and <2.5 μm) obtained at the nurses station were positive for SARS-CoV-2 during the outbreak (3 of 30 samples [10%]) and negative during 9 other collection periods. SARS-CoV-2 partial genome sequences for the smallest particle fraction were 100% identical with all 3 human samples; the remaining size fractions shared >99.9% sequence identity with the human samples. Fragments of SARS-CoV-2 RNA were detected by RT-PCR in 24 of 300 samples (8.0%) in units where health care personnel were not under surveillance and 7 of 210 samples (3.3%; P = .03) where they were under surveillance. In this cohort study, the finding of genetically identical SARS-CoV-2 RNA fragments in aerosols obtained from a nurses station and in human samples during a nosocomial outbreak suggests that aerosols may have contributed to hospital transmission. Surveillance, along with ventilation, masking, and distancing, may reduce the introduction of community-acquired SARS-CoV-2 into aerosols on hospital wards, thereby reducing the risk of hospital transmission.