TASK DEFINITION: In this task, you're given a paragraph from the research paper and your task is to generate a suitable title for the research paper based on the given paper. Under 100 words is a good title length.
PROBLEM: Background. In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Methods. Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti-MERS-CoV antibodies. Results. Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti-MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Conclusions. Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed casefatality rate was lower than has been reported from outbreaks elsewhere.

SOLUTION: Eastern Mediterranean Public Health Network, and 6 Field Epidemiology Training Program

PROBLEM: Both antiseptic hand rubbing (AHR) using ethanol-based disinfectants (EBDs) and antiseptic hand washing (AHW) are important means of infection control to prevent seasonal influenza A virus (IAV) outbreaks. However, previous reports suggest a reduced efficacy of ethanol disinfection against pathogens in mucus. We aimed to elucidate the situations and mechanisms underlying the reduced efficacy of EBDs against IAV in infectious mucus. We evaluated IAV inactivation and ethanol concentration change using IAV-infected patients' mucus (sputum). Additionally, AHR and AHW effectiveness against infectious mucus adhering to the hands and fingers was evaluated in 10 volunteers. Our clinical study showed that EBD effectiveness against IAV in mucus was extremely reduced compared to IAV in saline. IAV in mucus remained active despite 120 s of AHR; however, IAV in saline was completely inactivated within 30 s. Due to the low rate of diffusion/convection because of the physical properties of mucus as a hydrogel, the time required for the ethanol concentration to reach an IAV inactivation level and thus for EBDs to completely inactivate IAV was approximately eight times longer in mucus than in saline. On the other hand, AHR inactivated IAV in mucus within 30 s when the mucus dried completely because the hydrogel characteristics were lost. Additionally, AHW rapidly inactivated IAV. Until infectious mucus has completely dried, infectious IAV can remain on the hands and fingers, even after appropriate AHR using EBD, thereby increasing the risk of IAV transmission. We clarified the ineffectiveness of EBD use against IAV in infectious mucus. IMPORTANCE Antiseptic hand rubbing (AHR) and antiseptic hand washing (AHW) are important to prevent the spread of influenza A virus (IAV). This study elucidated the situations/mechanisms underlying the reduced efficacy of AHR against infectious mucus derived from IAV-infected individuals and indicated the weaknesses of the current hand hygiene regimens. Due to the low rate of diffusion/convection because of the physical properties of mucus as a hydrogel, the efficacy of AHR using ethanolbased disinfectant against mucus is greatly reduced until infectious mucus adhering to the hands/fingers has completely dried. If there is insufficient time before treating the next patient (i.e., if the infectious mucus is not completely dry), medical staff should be aware that effectiveness of AHR is reduced. Since AHW is effective against both dry and nondry infectious mucus, AHW should be adopted to compensate for these weaknesses of AHR. FIG 1 Analysis of the physical properties of mucus from 19 influenza A virus-infected patients. (A) Rheological analysis: mean, maximum, and minimum viscosities of mucus (sputum) samples at different shear rates (left panel). Shown is a comparison of mucus and saline viscosities at different shear rates (right panel). (B) Average parameters measured for saline and mucus samples: contact angles, surface tension, and densities at different temperatures. (C) Time required for saline and mucus to completely dry (complete drying time). (D) Ethanol diffusion coefficients of saline and mucus exposed to an 80% ethanol concentration. Situations of Reduced Hand Hygiene Effectiveness September/October 2019 Volume 4 Issue 5 e00474-19 msphere.asm.org 3 FIG 6 Additional fluid simulation of changes in the ethanol concentrations in mucus. (A) Addition of 95 l of 80% ethanol to 5 l saline was modeled in OpenFOAM, demonstrating the disappearance over time of the region with Ͻ31% ethanol (shown in red). See also Movie S1. (B) Addition of 95 l of 80% ethanol to 5 l mucus was modeled. The simulation was performed under conditions of reduced viscosity (16.7% of the actual measurement value) because of the long time required for disappearance of the concentration region of Ͻ31%. See also Movie S2.

SOLUTION: Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus- Infected Patients

PROBLEM: selection of patients and acquisition of samples: The etiology of acute exacerbation of idiopathic pulmonary fibrosis remains unknown. Occult viral infection has been proposed as one possible cause of acute exacerbation of idiopathic pulmonary fibrosis. This study uses the most current genomics-based technologies to investigate the possible infectious etiology of acute exacerbations of idiopathic pulmonary fibrosis. Most cases demonstrate no evidence of viral infection. Torque teno virus was present in a significant minority of cases, and cases of acute lung injury.

SOLUTION:
Viral Infection in Acute Exacerbation of Idiopathic Pulmonary Fibrosis