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55家企业新入围中国企业500强榜单

Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 节水洁具标准实施 北京补贴更换高效节水洁具 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

Read our latest coverage of the coronavirus outbreak

  1. Shamil Haroon, clinical lecturer in primary care1,
  2. Joht Singh Chandan, academic clinical fellow in public health12,
  3. John Middleton, president3,
  4. Kar Keung Cheng, professor of public health and primary care1
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2Warwick Medical School, University of Warwick, Coventry, UK
  3. 3Association of Schools of Public Health in the European Region (ASPHER)
  1. Correspondence to: S Haroon s.haroon{at}bham.ac.uk

开发商频放大幅优惠促销信号 是时候入市了吗?

The UK is one of the countries most severely affected by covid-19. Recent outbreaks in English towns such as Oldham, probably involving transmission within large multigenerational households, show the importance of getting the right public health measures in place now to prevent more widespread surges in infections.1

Current test and trace policies have mainly focused on preventing spread in care homes, hospitals, and in the community.2 However, contact within households is thought to be responsible for roughly 70% of SARS-CoV-2 transmission when widespread community control measures are in place.3 In Wuhan, the reproduction number (R) dropped from 3.54 to 1.18 after lockdown and cordon sanitaire. But the epidemic was only brought under complete control when Fangcang (field) hospitals were introduced to isolate cases outside the home, with R dropping to 0.51 after two weeks.4

Current UK guidance advises household contacts to isolate within the same home as the index case for 14 days.5 They make up the majority of contacts for infected individuals and are likely to remain exposed to the infected household member during this period of isolation.6 Despite guidance advising household members to socially distance, contacts are likely to interact repeatedly—during mealtimes, for example—and to share facilities such as bathrooms.

We know that transmission is more likely to occur indoors than outdoors.7 The cumulative risk to household contacts from an infected person is likely to be substantial during peak viral shedding. In one study in New York State, 38% of household contacts tested positive for SARS-Cov-2, and similar secondary infection rates have been reported in China.89 Transmission may be even higher among household contacts of essential workers, who are at greater risk of being infected than the general population.10

Household members who are older, have underlying medical conditions, or share a bed or vehicle with the index case are the most susceptible.91112 Children seem to be at lower risk of being infected.13 However, their stool samples and nasopharyngeal swabs can remain positive for SARS-CoV-2 for more than two weeks after symptom resolution,14 although their role in transmission remains to be established.

Governments should consider new public health measures to prevent household transmission as we prepare for a potential second wave. Household quarantine is likely to remain an important pandemic control measure, and government support for people quarantined at home is conspicuously absent in the UK: this position has been challenged by independent experts.15

Effective isolation

Effective isolation of index cases from household members could reduce secondary infections.12 Wearing masks within quarantined households may help, particularly if used by the index case as soon as infection is suspected.16 The World Health Organization recommends that infected people and unavoidable close contacts, particularly those in vulnerable groups, should wear medical masks, but Public Health England does not currently recommend this. Other measures that should be considered (and evaluated) include clear advice on enhanced personal hygiene; cleaning and disinfecting shared toilets and other common spaces, door handles, and touch points; and staggering mealtimes.

People who are unable to self-isolate safely at home could be accommodated in special isolation facilities such as hotels and hostels, an approach adopted by some other countries, including Italy, Finland, and Lithuania.17 In China, field hospitals were created to manage and strictly isolate patients with mild-to-moderate covid-19.18 Nightingale hospitals in the UK could be similarly repurposed to support isolation of infected people with mild-to-moderate disease. As medical and nursing care needs are mostly modest, the cost would be relatively low. However, such a system depends on access to rapid testing for anyone with symptoms or possible exposure so that infection can be confirmed and isolation started before transmission occurs. It would also require public trust that isolation in these facilities would be voluntary, safe, and supportive.

节目11 歌曲《我心永恒》,席琳-迪翁
The tightening drove some enterprises seek other financing options such as bonds or listing on the National Equities Exchange and Quotations (NEEQ).
“有1400人出境去参加圣战,加入叙利亚和伊拉克境内的恐怖主义组织。” Valls告诉BFMTV。
Dachis: JetBlue started the year with some tough moments (a pilot’s panic attack gave them a rough start), but customer satisfaction and excellent social service during the busy holiday travel season carried the brand to success in 2012.
"Overall this ranking of Asia's best 300 universities proves what a dynamic, diverse and competitive higher education region the continent is becoming -- and China is a key part of that development," said Baty.
该调查发现,211和985重点建设高校毕业生的薪酬水平大幅度领先普通高校毕业生。
2.人工眼睛

It was the lesson of the UK general election and it's the big 'takeaway' from Cannes too: prediction is a mug's game. All week the chatter was that Todd Haynes' lesbian love story Carol was set to collect the Palme d'Or – or that Holocaust drama Son of Saul from first-time director László Nemes would triumph. In the last few days a consensus began to form around The Assassin from Taiwanese director Hou Hsiao-Hsien; according to British bookmakers, The Lobster was the one to beat. But when Jacques Audiard's Dheepan was announced as the winner, the response was a collective “really?” For all the pundits, critics' panels, insider gossip, statistics and God knows what else, few had picked it. Oh well: c'est la vie.
It was also the "most liked" tweet of the year, with 4.59 million likes.
胡润在接受路透社采访时表示:“这是一种新型的财富创造方式。”他还表示,中国经济正在缓慢下行,中国必须适应这种方式。
But the UK courts may land a heavy blow on ride-hailing app Uber. In 2017, the California-based company failed to persuade an appeal judge that two of its London drivers are independent contractors. In 2018, the test case will go to the Court of Appeal and possibly to the Supreme Court. If Uber loses the case and is told to assume the responsibilities of an employer, the implications will ripple far and wide.
Local-level work experience will advantageous for applicants, with personnel with more than two years of experience at this level given some advantage.

Footnotes

  • “归心城市”战略:融创东南面对时代新里程的答案
  • 1896年,美国首任总统的夫人玛莎·华盛顿的画像印在一美元银圆券上,此后美元纸币上再没有出现过女性画像。

威廉姆斯指出,据凯投宏观估计,全球经济增长率将从2016年的2.5%上升至今年的2.8%,“新兴世界的大宗商品净出口国的出口额(以美元计算)同比增长应会达到20%左右。”
迁移工程也是京津冀一体化计划的一部分,其目的在于缓解首都交通拥挤,为地区提供更加均衡的发展。
Adding a plant is beneficial, as nature is a subconscious link to energy. An orchid or bamboo plant is easy to maintain, while providing a refreshing element to your space.
然而,澳大利亚和西班牙学校表现不错。这两个国家分别有3所学校上榜,且排名均有上升。悉尼的麦考瑞大学管理学院(Macquarie Graduate School of Management)是澳大利亚排名最高的学府,排在第49位,而西班牙IE商学院(IE Business School)的排名上升4个位次,排在第8位,这是这所位于马德里的学校自2012年以来首次回到前10名。
9. The brain literally starts eating itself when it doesn't get enough sleep. Chronic sleep deprivation causes the 'clearing' process that usually happens when we sleep to kick into hyperdrive, prompting the brain to clear a huge amount of neurons and synaptic connections away.
8.轮滑

致焦虑的卫浴企业:左右徘徊才是痛苦的根源

References

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