Concordance between SARS-CoV-2 index individuals and their household contacts on index individual COVID-19 transmission cofactors: a comparison of self-reported and contact-reported information.

BACKGROUND: Following the outbreak of the COVID-19 pandemic, several clinical trials have evaluated postexposure prophylaxis (PEP) among close contacts of an index individual with a confirmed SARS-CoV-2 infection. Because index individuals do not directly inform the efficacy of prevention interventions, they are seldom enrolled in COVID-19 PEP studies. However, adjusting for prognostic covariates such as an index individual's COVID-19 illness and risk behaviors can increase precision in PEP efficacy estimates, so approaches to accurately collecting this information about the index individual are needed. This analysis aimed to assess whether surveying household contacts captures the same information as surveying the index individual directly. METHODS: REGN 2069/CoVPN 3502, a randomized controlled trial of COVID-19 PEP, enrolled household contacts of SARS-CoV-2 index individuals. CoVPN 3502-01 retrospectively enrolled and surveyed the index individuals. We compared responses to seven similar questions about the index individuals' transmission cofactors that were asked in both studies. We estimated the percent concordance between index individuals and their household contacts on each question, with 50% concordance considered equivalent to random chance. RESULTS: Concordance between index individuals and contacts was high on the most objective questions, approximately 97% (95% CI: 90-99%) for index individual age group and 96% (88-98%) for hospitalization. Concordance was moderate for symptoms, approximately 85% (75-91%). Concordance on questions related to the index individual's behavior was only slightly better or no better than random: approximately 62% (51-72%) for whether they received COVID-19 treatment, 68% (57-77%) for sharing a bedroom, 70% (59-79%) for sharing a common room, and 49% (39-60%) for mask wearing at home. However, while contacts were surveyed within 96 h of the index individual testing positive for SARS-CoV-2, the median time to enrollment in CoVPN 3502-01 was 240 days, which may have caused recall bias in our results. CONCLUSIONS: Our results suggest a need to survey index individuals directly in order to accurately capture their transmission cofactors, rather than relying on their household contacts to report on their behavior. The lag in enrolling participants into CoVPN 3502-01 also highlights the importance of timely enrollment to minimize recall bias.

Transfer patient imaging: secondary interpretation reimbursement.

INTRODUCTION: Trauma center radiologists vary widely in the degree to which they provide secondary interpretations for transferred patients' advanced imaging. A general perception of uncertainty over reimbursement for these exams often results in reluctance to provide routine overreads. The purpose of this study is to assess the difference in reimbursement rates between primary interpretations and secondary interpretations in the emergency department (ED) setting. MATERIALS AND METHODS: Billing records for the three CT procedures most commonly performed in a single, major level 1 trauma center ED from January 1, 2021, to December 31, 2021, constituted the dataset. Gross charges, total receipts, and payer status were recorded for each exam, and reimbursement rates calculated. RESULTS: In total, 19,754 exams met the inclusion criteria. Primary interpretation was performed on 16,507 (83.6%) exams and secondary interpretation on 3247 (16.4%). For the three CPT codes examined, the average reimbursement percentage was 32.9% for primary interpretation and 43.5% for secondary interpretation. The average reimbursement percentage for commercial payers was 56.5% for primary interpretation and 65.9% for secondary interpretation. The average reimbursement percentage for Health Insurance Exchange payers was 58.5% for primary interpretation and 59.5% for secondary interpretation. The average reimbursement percentage for Medicaid was 24.7% for primary interpretation and 39.9% for secondary interpretation. The average reimbursement percentage for Medicare was 31.1% for primary interpretation and 30.2% for secondary interpretation. The average reimbursement percentage for self-paying patients was 2.3% for primary interpretation and 3.5% for secondary interpretation. CONCLUSION: Regardless of payer status, reimbursement for secondary interpretation of the three most common transfer patients' CT exams is near or greater than that of primary interpretations.

Self-Assessed Severity as a Determinant of Coronavirus Disease 2019 Symptom Specificity: A Longitudinal Cohort Study.

Coronavirus disease 2019 symptom definitions rarely include symptom severity. We collected daily nasal swab samples and symptom diaries from contacts of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) case patients. Requiring ≥1 moderate or severe symptom reduced sensitivity to predict SARS-CoV-2 shedding from 60.0% (95% confidence interval [CI], 52.9%-66.7%) to 31.5% (95% CI, 25.7%- 38.0%) but increased specificity from 77.5% (95% CI, 75.3%-79.5%) to 93.8% (95% CI, 92.7%-94.8%).

A new implementation of a semi-continuous method for DNA mixture interpretation.

A new calculation module within the PopStats module of the CODIS software package, based on the underlying mathematics presented in the MixKin software package, has been developed for assigning the Likelihood Ratio (LR) of DNA mixture profiles. This module uses a semi-continuous model that allows for population structure and allelic drop-out and drop-in but does not require allelic peak heights or other laboratory-specific parameters. This new implementation (named SC Mixture), like MixKin, does not specify or estimate a probability of drop-out. Instead, each contributor to a mixture has an independent drop-out rate, and the probability of the mixture profile for a specified proposition concerning the contributors is integrated over the range of possible drop-out rates. The allelic drop-in rate and the population structure parameter, theta, used by the software are specified by the user. The user can examine up to five contributors to a mixture, however, conditioning on assumed contributors and limiting the number of unknowns in both numerator and denominator hypotheses greatly improves performance. We report results from an extensive validation study performed for ten mixtures with each of one (single source), two, three, four, or five contributors, with four combinations of drop-in rate and a population structure parameter. Each mixture was run as a complete profile or with the random removal of alleles to simulate drop-out. All 1620 combinations were evaluated with PopStats, MixKin, and LRmix and considerable consistency was found among the results with all three packages.

Ankle Spatting Compared to Bracing or Taping during Maximal-Effort Sprint Drills.

The purpose of this study was to compare the influences of 4 ankle conditions (no support, bracing, taping, taping + spatting; all in football cleats) during 2 maximal-effort field drills (40-yd dash and 34-yd cutting drill) on perceptions of comfort and stability and performance outcomes. Fourteen young adult males participated. Subjects' perceptions of comfort and stability were assessed by visual analogue scales after each drill for each ankle condition. Time-to-completion and post-completion heart rate were recorded. For both drills, significant differences in comfort perception were found such that subjects perceived no support as equivocal to bracing but more comfortable than either taping or spatting + taping. Stability results differed by drill. For the dash, significant differences in stability perception were found such that subjects perceived no support as equivocal to bracing but less stable than either taping or spatting + taping. By contrast, for the cutting drill significant differences in stability perception were found such that subjects perceived their ankles as less stable during the no support condition as compared to all 3 other conditions. Generally, bracing was perceived as equivocal to all 3 other conditions for comfort and stability. There were no significant differences in time-to-completion or heart rate for any comparison. Compared to bracing or taping, spatting + taping (a) did not influence performance time in explosive/sprint-type drills, (b) was perceived as equivalent to taping alone in terms of ankle comfort and stability, and

Anatomy of the ward round: the time spent in different activities.

BACKGROUND: The ward round, central to inpatient care, has not been well studied. One recent trend is for hospitals to run at capacity by placing 'overflow' patients into 'outlying' beds. Bed occupancy rates are increased and ward rounds may require visits to many wards. The present study aims to identify the time spent in different activities on general surgical ward rounds, with particular reference to the impact of outlying patients. METHODS: For 4 days, the morning ward round was observed. Activity was timed to the second. The resulting data were analysed to compare outlying wards, acute wards and home ward patients. RESULTS: Seven hours and 7 min of ward rounds were documented. One hundred ten consultations were observed. Four hours and 4 min were spent at the bedside (58%). Sixty-six minutes were spent in transit between wards. The average times spent at the bedside and in patient discussion were similar for the different ward types. The mean average time per patient was nearly doubled for outlying patients compared with home wards (5:40 min versus 2:57 min, respectively). Although patient discussion and consultation were longer for outlying patients, most of the increased time was related to time travelling between wards (2:16 min average per patient consultation). CONCLUSION: Most of the time spent on surgical ward rounds is in patient contact. Travel time to outlying patients for morning ward rounds is more than an hour per week.