Rostered Routine Testing: A Necessary Evil?

We report our institution's experience of detecting a staff member who was infected with severe acute respiratory syndrome coronavirus 2 while he was asymptomatic, as part of a rostered routine testing program, and how the institution was able to undertake measures to curb the spread, hence reducing the impact on the daily operations of our institution.

Thermal strain and fluid balance during a 72-km military route march in a field setting.

Introduction: A physiological profiling study was conducted to evaluate thermal strain as well as fluid and electrolyte balances on heat-acclimatised men performing a 72-km route march in a field setting. Methods: 38 male soldiers (age range 18-23 years) participated in the study, as part of a cohort that marched for 72 km, with loads for about 26 hours. Core temperature and heart rate sensors were used for the duration of the march. Fluid and food intake and output were monitored for the duration of the march. Blood samples were taken one day before the march (pre-march), immediately after the march (Post 1) and on the 15th day after the march to ascertain recovery (Post 2) to assess fluid and electrolyte profiles. Results: Mean core temperature was within safe limits, ranging from 37.1 to 38.1°C throughout the march. There was an overall decrease in serum sodium levels, a decline in serum sodium concentration in 28 participants and three instances of hyponatraemia (serum sodium concentration <135 mmol/L). Conclusion: Our study found low thermal strain heat-acclimatised individuals during a 72-km route march. However, there was an overall decrease in serum sodium levels, even when the participants were allowed to drink ad libitum. Challenges of exercise-associated hyponatraemia during prolonged activities remain to be addressed.

Relationship between weather parameters and risk of exertional heat injuries during military training.

Introduction: The Singapore Armed Forces (SAF) collaborated with the Meteorological Service Singapore (MSS) to study the relationship between weather parameters and the incidents of exertional heat injury (EHI) to mitigate the risk of EHI in a practical manner. Methods: Data from the SAF's heat injury registry and MSS' meteorological data from 2012 to 2018 were used to establish a consolidated dataset of EHI incidents and same-day weather parameters rank-ordered in deciles. Poisson regression modelling was used to determine the incidence rate ratios (IRRs) of the EHI, referencing the first decile of weather parameters. Two frames of analysis were performed - the first described the relationship between the weather parameters and the adjusted IRR for the same day (D), and the second described the relationship between the weather parameters and the adjusted IRR on the following day (D + 1). Results: For wet-bulb temperature, the IRR on D + 1 approximated unity for the first nine deciles but rose to 3.09 at the tenth decile. For dew-point temperature, the IRR on D + 1 approximated unity for the first nine deciles but rose to 3.48 at the tenth decile. By designating a single dew-point temperature cut-off at ≥25.1°C (transition between the ninth and tenth decile), the adjusted IRR on D + 1 was 2.26 on days with dew-point temperature ≥25.1°C. Conclusion: Integrating the data from the SAF and MSS demonstrated that a dew-point temperature ≥25.1°C on D correlates statistically with the risk of EHI on D + 1 and could be used to supplement the risk mitigation system.

Innovative use of health informatics to augment contact tracing during the COVID-19 pandemic in an acute hospital.

This case report describes the innovative design and build of an algorithm that integrates available data from separate hospital-based informatics systems, which perform different daily functions to augment the contact-tracing process of COVID-19 patients by identifying exposed neighboring patients and healthcare workers and assessing their risk. Prior to the establishment of the algorithm, contact-tracing teams comprising 6 members would spend up to 10 hours each to complete contact tracing for 5 new COVID-19 patients. With the augmentation by the algorithm, we observed ≥ 60% savings in overall man-hours needed for contact tracing when there were 5 or more daily new cases through a time-motion study and Monte Carlo simulation. This improvement to the hospital's contact-tracing process supported more expeditious and comprehensive downstream contact-tracing activities as well as improved manpower utilization in contact tracing.