Daily Screening Research Articles

Feasibility and effectiveness of daily temperature screening to detect COVID-19 in a prospective cohort at a large public university

BackgroundMany persons with active SARS-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention. Regular temperature screening is nonetheless used in some settings, including university campuses, to reduce transmission potential. We evaluated the potential impact of this strategy using a prospective university-affiliated cohort.MethodsBetween June and August 2020, 2912 participants were enrolled and tested for SARS-CoV-2 by PCR at least once (median: 3, range: 1–9). Participants reported temperature and symptoms daily via electronic survey using a previously owned or study-provided thermometer. We assessed feasibility and acceptability of daily temperature monitoring, calculated sensitivity and specificity of various fever-based strategies for restricting campus access to reduce transmission, and estimated the association between measured temperature and SARS-CoV-2 test positivity using a longitudinal binomial mixed model.ResultsMost participants (70.2%) did not initially have a thermometer for taking their temperature daily. Across 5481 total person months, the average daily completion rate of temperature values was 61.6% (median: 67.6%, IQR: 41.8–86.2%). Sensitivity for SARS-CoV-2 ranged from 0% (95% CI 0–9.7%) to 40.5% (95% CI 25.6–56.7%) across all strategies for self-report of possible COVID-19 symptoms on day of specimen collection, with corresponding specificity of 99.9% (95% CI 99.8–100%) to 95.3% (95% CI 94.7–95.9%). An increase of 0.1 °F in individual mean body temperature on the same day as specimen collection was associated with 1.11 increased odds of SARS-CoV-2 positivity (95% CI 1.06–1.17).ConclusionsOur study is the first, to our knowledge, that examines the feasibility, acceptability, and effectiveness of daily temperature screening in a prospective cohort during an infectious disease outbreak, and the only study to assess these strategies in a university population. Daily temperature monitoring was feasible and acceptable; however, the majority of potentially infectious individuals were not detected by temperature monitoring, suggesting that temperature screening is insufficient as a primary means of detection to reduce transmission of SARS-CoV-2.

An educational strategy for the implementation of a delirium assessment tool

Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient. Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff. Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals. Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff. Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.

High Frequency Occult Hepatitis B Virus Infection Detected in Non-Resolved Donations Suggests the Requirement of Anti-HBc Test in Blood Donors in Southern China.

BackgroundMost Chinese Blood Centers adopted mini pool (MP) nucleic acid testing (NAT) for HBV screening due to high cost of Individual donation (ID) NAT, and different proportions of MP-reactive but ID-non-reactive donations (MP+/ID−, defined as non-resolved donations) have been observed during daily donor screening process. Some of these non-resolved donations are occult HBV infections (OBIs), which pose potential risk of HBV transmission if they are not deferred. This study is aimed to further analyze these non-resolved donations.MethodsThe non-resolved plasma samples were further analyzed by serological tests and various HBV DNA amplification assays including quantitative PCR (qPCR) and nested PCR amplifying the basic core and pre-core promoter regions (BCP/PC; 295 base pairs) and HBsAg (S) region (496 base pairs). Molecular characterizations of HBV DNA+ non-resolved samples were determined by sequencing analysis.ResultsOf 17,226 MPs from 103,356 seronegative blood donations, 98 MPs were detected reactive for HBV. Fifty-six out of these 98 (57.1%) reactive MPs were resolved as HBV DNA+, but the remaining 42 pools (42.9%, 252 donations) were left non-resolved with a high rate (53.2%) of anti-HBc+. Surprisingly, among 42 non-resolved MPs, 17 contained one donation identified as OBIs by alternative NAT assays. Sequence analysis on HBV DNAs extracted from these OBI donations showed some key mutations in the S region that may lead to failure in HBsAg detection and vaccine escape.ConclusionA total of 53.2% of the non-resolved donations were anti-HBc+, and OBIs were identified in 40.5% of these non-resolved pools. Therefore, non-resolved donations with anti-HBc+ might pose potential risk for HBV transmission. Our present analysis indicates that anti-HBc testing in non-resolved donations should be used to identify OBIs in order to further increase blood safety in China.

THE BENEFITS OF ENHANCED CONTACT TRACING AND QUARANTINE TO RESUME AND MAINTAIN COLLEGE‐CAMPUS OPERATIONS: AN AGENT‐BASED PROABLISTIC SIMULATION ANALYSIS

AbstractUniversities, K‐12 schools, sports programs, and businesses are operating (and generating revenue) during the COVID‐19 pandemic. The key to operating safely is to manage the risk of infectious events that lead to an outbreak and require excess costs and/or lead to a complete shutdown of the enterprise. To operate through a pandemic, organizations must plan to accommodate the quarantine of exposed individuals and isolation of infected individuals (e.g. accommodations and food). To prevent or slow infections, organizations can implement mitigation options to: (1) reduce peer‐to‐peer transmission in operations (e.g. social distancing and protective equipment), (2) identify and quarantine individuals who have been exposed (e.g. daily symptom and exposure screening, randomized surveillance testing, timely contact tracing), and (3) test and/or isolate individuals who are infected (asymptomatic as well as symptomatic). Mitigation option #1 prevents individuals from becoming infected. Mitigation options #2 and #3 remove people who are infected from circulation, preventing them from infecting others. The efficacy of mitigations #2 and #3 have a non‐linear impact due to the amplifying effect of circulating asymptomatic/symptomatic individuals.An agent‐based, probabilistic model measured the efficacy of contact tracing and quarantine on infection counts and lost productivity (i.e. total days in quarantine and isolation). Two modes of operations were evaluated: Cohort with no interaction with the community (i.e. hermetically sealed “bubble” with one undetected infection at start), Cohort with limited interaction with community (e.g. attending classes, take‐out food court). For the No Community Interaction cohort, a contact tracing and quarantine with only 25% efficacy and compliance reduced the infection count from 60% to 6%. This yielded a reduction in total lost productivity days of 94%. In contrast, the Limited Community Interaction cohort required more than 75% efficacy and compliance in contact tracing and quarantine to reduce the infection count from 80% to 30%. This yielded a reduction in total lost productivity days of 30%.These results highlight the role interaction with the general community has on a cohort's health. Further, the results emphasize the utility of contact tracing and quarantine within a cohort to mitigate community‐wide practices that are not under jurisdiction of managers of the enterprise. The implications of these results and limitations of the model are discussed.

Longitudinal Assessment of Diagnostic Test Performance Over the Course of Acute SARS-CoV-2 Infection.

Serial screening is critical for restricting spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by facilitating timely identification of infected individuals to interrupt transmission. Variation in sensitivity of different diagnostic tests at different stages of infection has not been well documented. In a longitudinal study of 43 adults newly infected with SARS-CoV-2, all provided daily saliva and nasal swabs for quantitative reverse transcription polymerase chain reaction (RT-qPCR), Quidel SARS Sofia antigen fluorescent immunoassay (FIA), and live virus culture. Both RT-qPCR and Quidel SARS Sofia antigen FIA peaked in sensitivity during the period in which live virus was detected in nasal swabs, but sensitivity of RT-qPCR tests rose more rapidly prior to this period. We also found that serial testing multiple times per week increases the sensitivity of antigen tests. RT-qPCR tests are more effective than antigen tests at identifying infected individuals prior to or early during the infectious period and thus for minimizing forward transmission (given timely results reporting). All tests showed >98% sensitivity for identifying infected individuals if used at least every 3 days. Daily screening using antigen tests can achieve approximately 90% sensitivity for identifying infected individuals while they are viral culture positive.

True Accuracy of Fast Scoring Functions to Predict High-Throughput Screening Data from Docking Poses: The Simpler the Better.

Hundreds of fast scoring functions have been developed over the last 20 years to predict binding free energies from three-dimensional structures of protein-ligand complexes. Despite numerous statistical promises, we believe that none of them has been properly validated for daily prospective high-throughput virtual screening studies, mostly because in silico screening challenges usually employ artificially built and biased datasets. We here carry out a fully unbiased evaluation of four scoring functions (Pafnucy, ΔvinaRF20, IFP, and GRIM) on an in-house developed data collection of experimental high-confidence screening data (LIT-PCBA) covering about 3 million data points on 15 diverse pharmaceutical targets. All four scoring functions were applied to rescore the docking poses of LIT-PCBA compounds in conditions mimicking exactly standard drug discovery scenarios and were compared in terms of propensity to enrich true binders in the top 1%-ranked hit lists. Interestingly, rescoring based on simple interaction fingerprints or interaction graphs outperforms state-of-the-art machine learning and deep learning scoring functions in most of the cases. The current study notably highlights the strong tendency of deep learning methods to predict affinity values within a very narrow range centered on the mean value of samples used for training. Moreover, it suggests that knowledge of pre-existing binding modes is the key to detecting the most potent binders.

Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

BackgroundCOVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.MethodsWe developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing.ResultsThe proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0 = 1.5), moderate-risk (R0 = 2.9), and high-risk (R0 = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community.ConclusionsIn high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.

Personal protective equipment for Health care workers donning for COVID-19 areas: Walking a tight rope between safety and comfort!

Dear Editor, Coronavirus disease-2019 (COVID-19) pandemic has infected more than 180 million cases worldwide. The frontline healthcare workers (HCWs) battling the disease need to don into personal protective equipment (PPE) to protect themselves from the infection.[1] An N95 respirator is a protective mask designed to achieve an efficient filtration (block at least 95% of particles >0.3 μm in size). Its incorrect use could compromise its protective effect and may even increase the risk of infection.[23] This is especially important for anesthesiologists who are frequently involved in aerosol-generating procedures like noninvasive ventilation, tracheal intubation or extubation. The most important consideration for the effectiveness of a mask is its fit on the HCWs face and its filtration efficacy. A tightly fit mask may lead to discomfort, claustrophobia, pressure on the face and difficulty in breathing.[1] Previous studies have observed that the HCW's compliance with use of N95 mask and the recommended PPE is generally poor because the respirators reduce the maximal physical work capacity by increasing the inspiratory resistance, expiratory resistance, and dead space. COVID areas have limited air conditioning and the non-valved masks may become wet with usage earlier due to inability to dissipate humidity. The resistance offered by the non-valved masks during expiration may lead to headache, inability to concentrate, shortness of breath, dizziness, rise in blood pressure, and fatigue due to accumulation of carbon dioxide.[4] This may increase mask handling and increase the risk of infection to the HCW. In addition, non-valved N95 masks may increase the fogging of goggles and face shield and that makes procedures like intubation difficult for HCW especially with a prolonged donning (6–8 h period usually), in the already cumbersome conditions (PPE and aerosol box).[5] The valved variety allows unimpeded exhalation through one-way valve. An exhalation valve in the N95 masks may help to dissipate humidity, heat, and carbon dioxide from the dead space and decrease exhalation resistance. However, an infected person wearing a valved mask may spread the virus to others around him. No previous study has identified the impact of mask type on COVID-19 transmission. A valved N95 mask may be more acceptable for the HCW, but there is a distinct possibility of transmition of the infection to others. This can be minimized by daily screening of the HCWs before coming for duty, maintaining a safe distance from each other and wearing a surgical mask over it. The stress of working in COVID areas with PPE during the present pandemic has already dented the morale of HCWs. We should ensure comfort of the HCWs along with the safety for others. Based on logical thinking a valved mask should be avoided when working in non-COVID or COVID suspect areas. However, in COVID positive areas where prolonged continuous donning in full PPE is required and risk of infection from HCW to others is negligible, valved mask would offer the best balance of breathing comfort and safety to the provider. Centers for disease control and prevention (CDC) also mentions that valve in N95 masks reduces the exhalation resistance and makes it more comfortable to wear without reducing their efficacy in prevention of infection to the HCWs caring for COVID positive patients.[6] Further research could give invaluable insights for clarifying the risks and level of safety associated with the use of either type of devices and in framing appropriate policies regarding the appropriate type of PPE in various circumstances. We would urge the manufacturers to deliberate into mask designs with appropriate certification like 'SITARA' and are universally acceptable to all HCWs in tackling the pandemic of COVID-19. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

WHO'S IN AND WHO'S OUT UNDER WORKPLACE COVID SYMPTOM SCREENING?

COVID symptom screening, a new workplace practice, is already affecting many millions of American workers. As of this writing, 34 states already require, and federal guidance recommends, frequent screening of at least some employees for fever or other symptoms. This paper provides the first empirical work identifying major features of symptom screening in a broad population and exploring the trade‐offs employers face in using daily symptom screening. First, we find that common symptom checkers could screen out up to 7 percent of workers each day, depending on the measure used. Second, we find that the measures used will matter for three reasons: Many respondents report any given symptom, survey design affects responses, and demographic groups report symptoms at different rates, even absent fluctuations in likely COVID exposure. This last pattern can potentially lead to disparate impacts and is important from an equity standpoint.

Severe Acute Respiratory Infections (SARI) surveillance in over-65-years-old patients: the experience of a University hospital (seasons 2017-2018 and 2018-2019).

Influenza is a relevant public health problem, also due to the risk of complications. The most effective measure to prevent influenza is vaccination; therefore, at present, there is consensus among European countries, regarding the need for routine seasonal influenza vaccination of elderly and individuals at increased risk of severe influenza. At the same time, influenza surveillance is necessary to understand the viruses circulating and effectiveness of vaccination strategies. The present study reports the results of two seasons influenza surveillance (2017/2018 and 2018/2019) conduced in an University Hospital in Rome among hospitalized patients aged ≥65 years. A prospective cohort study. The study consisted of systematic daily screening of all admissions among patients aged ≥65 years meeting a syndromic SARI case definition during two consecutive influenza seasons: 2017/2018 and 2018/2019. Characteristics of patients and their risk factors were collected by a standardized questionnaire and nose-pharyngeal swabs were performed to each patient. Influenza vaccine effectiveness (IVE), rates of vaccinated subjects and case fatality rate were also evaluated. Influenza was laboratory confirmed in 11 (9.9%) of the 111 and 11 (9.6%) of the 115 enrolled patients in seasons 2017/18 and 2018/19, respectively. Adjusted IVE against all influenza type, calculated for each season, was 88.5% (95% CI: 38.9 to 97.8) and 61.7% (95% CI: -59.9 to 90.9) for 2017/2018 and 2018/2019 seasons, respectively. Our analysis shows a Case Fatality Rate of 2.7% and 4.3% for the 2017/18 and 2018/19 seasons, respectively. The surveillance of SARI conduced in one hospital in Rome confirmed that influenza is an important cause of hospital admissions. Routine monitoring of infectious diseases and related aetiology associated with SARI, also at the local-level, is useful for targeting the right preventive measures.

Blood transfusion rates in Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action)-a single-center experience.

Previous studies in non-critically ill hospitalized pediatric patients have shown that daily serum creatinine monitoring for the development of nephrotoxic medication-associated acute kidney injury decreases both the rate of high nephrotoxic medication exposure and associated acute kidney injury. Attempts to spread this successful screening program have been met with concerns that daily serum creatinine monitoring in critically ill neonates with high-risk nephrotoxic medication exposure would lead to iatrogenic anemia and an increase in blood transfusion requirements. We measured blood transfusion rates while implementing a system of daily serum creatinine monitoring in critically ill neonates at risk for high nephrotoxic medication-associated acute kidney injury. There was no correlation between blood transfusion rates and serum creatinine monitoring rates. We recommend that critically ill neonates identified as having high-risk nephrotoxic medication exposure undergo daily screening for the development of nephrotoxic medication-associated acute kidney injury.

Preparing for a \u201cdirty bomb\u201d attack: the optimum mix of medical countermeasure resources

BackgroundIn radiological emergencies with radionuclide incorporation, decorporation treatment is particularly effective if started early. Treating all people potentially contaminated (“urgent treatment”) may require large antidote stockpiles. An efficacious way to reduce antidote requirements is by using radioactivity screening equipment. We analyzed the suitability of such equipment for triage purposes and determined the most efficient mix of screening units and antidote daily doses.MethodsThe committed effective doses corresponding to activities within the detection limits of monitoring portals and mobile whole-body counters were used to assess their usefulness as triage tools. To determine the optimal resource mix, we departed from a large-scale scenario (60,000 victims) and based on purchase prices of antidotes and screening equipment in Germany, we calculated efficiencies of different combinations of medical countermeasure resources by data envelopment analysis. Cost-effectiveness was expressed as the costs per life year saved and compared to risk reduction opportunities in other sectors of society as well as the values of a statistical life.ResultsMonitoring portals are adequate instruments for a sensitive triage after cesium-137 exposure with a high screening throughput. For the detection of americium-241 whole-body counters with a lower daily screening capacity per unit are needed. Assuming that 1% of the potentially contaminated patients actually need decorporation treatment, an efficient resource mix includes 6 monitoring portals and 25 mobile whole-body counters. The optimum mix depends on price discounts and in particular the fraction of victims actually needing treatment. The cost-effectiveness of preparedness for a “dirty bomb” attack is less than for common health care, but costs for a life year saved are less than for many risk-reduction interventions in the environmental sector.ConclusionTo achieve economic efficiency a high daily screening capacity is of major importance to substantially decrease the required amount of antidote doses. Among the determinants of the number of equipment units needed, the fraction of the potentially contaminated victims that actually needs treatment is the most difficult to assess. Judging cost-effectiveness of the preparedness for “dirty bomb” attacks is an issue of principle that must be dealt with by political leaders.

Corporate Communications Are Key to Success During a Pandemic.

Corporate Communications Are Key to Success During a Pandemic.

Translating daily COVID-19 screening into a simple glucose test: a proof of concept study.

Home testing is an attractive emerging strategy to combat the COVID-19 pandemic and prevent overloading of healthcare resources through at-home isolation, screening and monitoring of symptoms. However, current diagnostic technologies of SARS-CoV-2 still suffer from some drawbacks because of the tradeoffs between sensitivity, usability and costs, making the test unaffordable to most users at home. To address these limitations, taking advantage of clustered regularly interspaced short palindromic repeats (CRISPRs) and a portable glucose meter (PGM), we present a proof-of-concept demonstration of a target-responsive CRISPR-PGM system for translating SARS-CoV-2 detection into a glucose test. Using this system, a specific N gene, N protein, and pseudo-viruses of SARS-CoV-2 have been detected quantitatively with a PGM. Given the facile integration of various bioreceptors into the CRISPR-PGM system, the proposed method provides a starting point to provide patients with a single-device solution that can quantitatively monitor multiple COVID-19 biomarkers at home.

Improving “Fast” Indicators of TB Infection Control through Targeted Health Workers Training; Findings from Facility Based Studies in Abia State, Nigeria

Aim: The aim of this study was to assess the effect of health workers training and implementation of the FAST strategy on the “FAST” indicators at Abia State University Teaching Hospital (ABSUTH); a tertiary referral facility. ”FAST” strategy; a focused approach to stopping TB spread in congregate settings developed by TB Care1 stands for Finding TB cases Actively, Separating safely, and Treating effectively.
 Study Design: This was a facility based interventional study using control group design methods with ABSUTH as the intervention facility while Federal Medical Centre Umuahia (FMCU) was the control.
 Methodology: Health workers (74 across cadres; doctors, nurses, laboratory scientist and medical record staff) selected through stratified random sampling were trained to ensure daily cough surveillance and screening for TB among patients at the General outpatient, medical wards and HIV clinic of ABSUTH under supervision of a “FAST” focal person.Baseline “Fast Indicators” in the facility TB records of newly diagnosed TB patients 3 months before and 3 months after the training intervention were obtained.
 Results: At baseline the “FAST” strategy indicators recorded in the study facility include time to diagnosis > 1 week, time to treatment 3.5 days, presumptive TB cases 92, number of cases commenced on treatment were 22 while presumptive DRTB cases was 0.33. This study observed a significant positive difference in all the “FAST” indicators following the intervention. Time to diagnosis decreased by 52%, time to treatment decreased by 17% while the number of presumptive TB cases increased by over 100%. Number of TB cases diagnosed also increased by 100% as well as the cases commenced on treatment by 91%, while number of diagnosed DRTB cases increased by over 100%.These were all statistically significant ( P=.013,.03, .032, and .049 except time to treatment P= 0.053).
 Conclusion: The training intervention on ‘FAST” strategy of TB infection Control significantly improved FAST Indicators in the intervention facility with attendant reduction in diagnostic delays and increased case notification.

Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic

Approximately 356 000 people stay in homeless shelters nightly in the United States. They have high risk of contracting coronavirus disease 2019 (COVID-19). To assess the estimated clinical outcomes, costs, and cost-effectiveness associated with strategies for COVID-19 management among adults experiencing sheltered homelessness. This decision analytic model used a simulated cohort of 2258 adults residing in homeless shelters in Boston, Massachusetts. Cohort characteristics and costs were adapted from Boston Health Care for the Homeless Program. Disease progression, transmission, and outcomes data were taken from published literature and national databases. Surging, growing, and slowing epidemics (effective reproduction numbers [Re], 2.6, 1.3, and 0.9, respectively) were examined. Costs were from a health care sector perspective, and the time horizon was 4 months, from April to August 2020. Daily symptom screening with polymerase chain reaction (PCR) testing of individuals with positive symptom screening results, universal PCR testing every 2 weeks, hospital-based COVID-19 care, alternative care sites (ACSs) for mild or moderate COVID-19, and temporary housing were each compared with no intervention. Cumulative infections and hospital-days, costs to the health care sector (US dollars), and cost-effectiveness, as incremental cost per case of COVID-19 prevented. The simulated population of 2258 sheltered homeless adults had a mean (SD) age of 42.6 (9.04) years. Compared with no intervention, daily symptom screening with ACSs for pending tests or confirmed COVID-19 and mild or moderate disease was associated with 37% fewer infections (1954 vs 1239) and 46% lower costs ($6.10 million vs $3.27 million) at an Re of 2.6, 75% fewer infections (538 vs 137) and 72% lower costs ($1.46 million vs $0.41 million) at an Re of 1.3, and 51% fewer infections (174 vs 85) and 51% lower costs ($0.54 million vs $0.26 million) at an Re of 0.9. Adding PCR testing every 2 weeks was associated with a further decrease in infections; incremental cost per case prevented was $1000 at an Re of 2.6, $27 000 at an Re of 1.3, and $71 000 at an Re of 0.9. Temporary housing with PCR every 2 weeks was most effective but substantially more expensive than other options. Compared with no intervention, temporary housing with PCR every 2 weeks was associated with 81% fewer infections (376) and 542% higher costs ($39.12 million) at an Re of 2.6, 82% fewer infections (95) and 2568% higher costs ($38.97 million) at an Re of 1.3, and 59% fewer infections (71) and 7114% higher costs ($38.94 million) at an Re of 0.9. Results were sensitive to cost and sensitivity of PCR and ACS efficacy in preventing transmission. In this modeling study of simulated adults living in homeless shelters, daily symptom screening and ACSs were associated with fewer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and decreased costs compared with no intervention. In a modeled surging epidemic, adding universal PCR testing every 2 weeks was associated with further decrease in SARS-CoV-2 infections at modest incremental cost and should be considered during future surges.

An open source reservoir and sediment simulation framework for identifying and evaluating siting, design, and operation alternatives

This paper introduces PySedSim, an open-source, object-oriented, Python-based, daily time step river basin simulation screening model for flow, sediment, and hydropower in networks of reservoirs and river channels. The model enables users to explore representations of four key concerns relevant to the selection and evaluation of alternative reservoir configurations: 1) management approaches to improve the passage of sediment through and around reservoirs to avoid storage capacity loss and downstream ecological impacts; 2) search for flexible and adaptive reservoir operating policies designed to achieve multiple objectives; 3) alternative design features such as dam gates, which are necessary to enable ecologically-focused reservoir features; and 4) uncertainties associated with hydroclimatic drivers and sediment processes. PySedSim is intended to support deliberative decision-making and design processes. We highlight PySedSim's functionality by demonstrating its use in a real decision context focused on identifying siting, design, and operation alternatives for the proposed Sambor mega Dam in Cambodia.

Обменные нефропатии у детей раннего возраста при пневмонии

В ходе исследования было осмотрено 121 пациент раннего возраста с дизметаболической нефропатией на фоне пневмонии, а также 20 детей с пневмонией и мочевым синдромом. Функция клубочкового аппарата оценивалась по клиренсу эндогенного образования, аммиака, титруемой кислотности, осмолярность мочи, метаболиты (оксалаты, ураты, мочевая кислота). У больных детей с пневмонией и дизметаболической нефропатией отмечалось изменение парциальных функций почек, структурно-функциональных состояний цитомембран эритроцитов, а также усиления перекисного окисления липидов. В связи с чем, данным пациентам была рекомендована метаболическая коррегирующая терапия.

Automated Classification of Glaucoma Stages Using Flexible Analytic Wavelet Transform From Retinal Fundus Images

Glaucoma is one of the leading causes of irreversible vision loss, it progresses gradually without easily noticeable symptoms. The detection of glaucoma in the early stage is crucial as it may help to decelerate the progress. The traditional instrument methods are manual, time-consuming and less accurate. Hence, the automated diagnosis of glaucoma is needed for detection of glaucoma in the early stage with high accuracy. The flexible analytic wavelet transform (FAWT) based novel method has been proposed for the classification of glaucoma stages. In the proposed method, FAWT has been used to decompose the preprocessed images into various sub-band images. Then, ReliefF and sequential box-counting (SBC) algorithms are applied to extract the various entropies and fractal dimension (FD) based features, respectively. Further, the extracted feature values are ranked using Fisher's linear discriminant analysis (LDA) dimensionally reduction. Finally, the higher rank features have been used for the classification of glaucoma stages using least squares-support vector machine (LS-SVM) classifier. The proposed method has been evaluated on publicly available large and diverse glaucoma database. The classification accuracy of the proposed method is 93.40% using tenfold cross-validation. The proposed method has demonstrated better performance for glaucoma classification as compared to the existing methods. The proposed method is ready to help the ophthalmologist in their daily screening for glaucoma detection.

Accuracy of qualitative and quantitative cranial ultrasonographic markers in first-trimester screening for open spina bifida and other posterior brain defects: a systematic review and meta-analysis.

The significant number of qualitative and quantitative ultrasound markers described for first-trimester screening of open spina bifida (OSB) and other posterior brain defects (oPBD) has resulted in their complex implementation and interpretation for a widespread screening and in a lack of consensus regarding diagnostic accuracy. To assess and compare the accuracy of qualitative and quantitative cranial sonographic markers at 11-14weeks of gestation for the detection of OSB and oPBD. A systematic literature search was performed in MEDLINE and COCHRANE from 2009 to April 2020. Studies assessing the diagnostic accuracy of quantitative and/or qualitative ultrasound signs to predict OSB and oPBD were included. Cohort studies and case-control studies were also considered. Two reviewers independently extracted data and assessed the risk of bias. The overall pooled estimate and a summary receiver operating characteristic curve was estimated for each subgroup (qualitative and quantitative assessment). Twenty-three studies were included in our meta-analysis. The pooled sensitivity and specificity for qualitative assessment were 76.5% and 99.6%, and for quantitative assessment were 84.5% and 96.3%, respectively; specificity for the qualitative ultrasound signs was significantly higher (P=0.001). The overall sensitivity of cranial sonographic markers for the screening of oPBD was 76.7% and specificity was 97.5%. The qualitative approach demonstrated greater specificity, so this would appear to be more appropriate for daily screening, as a first-line tool, whereas the quantitative approach should be reserved for expert ultrasound. This study highlights the relevance of first-trimester qualitative ultrasound signs in the screening of open spina bifida.