Measurement of the major ignored burden of multiple myeloma, pernicious anaemia and of other haematological conditions on partners and family members: A cross-sectional study.

BACKGROUND: Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. OBJECTIVE: To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure-16 (FROM-16). METHODS: A cross-sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM-16. RESULTS: 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM-16. The FROM-16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM-16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non-malignant conditions (mean = 11, SD = 7.4, n = 56, p < .01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM-16 score>16) on their quality of life. CONCLUSIONS: Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM-16, identify those most affected and should consider how to provide appropriate holistic support within routine practice.

Quantitative assessment of olfactory dysfunction accurately detects asymptomatic COVID-19 carriers.

BACKGROUND: COVID-19 threatens the global community because a large fraction of infected people are asymptomatic, yet can effectively transmit SARS-CoV-2. Finding and isolating these silent carriers is a crucial step in confining the spread of the disease. A sudden loss of the sense of smell has been self-reported by COVID-19 patients across different countries, consistent with expression of the molecular factors mediating SARS-CoV-2 uptake into human olfactory epithelial supporting cells. However, precise quantification of olfactory loss in asymptomatic COVID-19 carriers is missing to date. METHODS: To quantify olfactory functions in asymptomatic COVID-19 patients, we designed an olfactory-action meter that determines detectability indices at different odor concentrations and an olfactory matching accuracy score using monomolecular odors. The optimization of test parameters allowed us to reliably and accurately assess olfactory deficits in a patient within 20 minutes. FINDINGS: Measurement of detection indices at low concentrations revealed a 50% reduction in asymptomatic COVID-19 carriers. Further, patients with better detection scores showed significantly reduced olfactory matching accuracies compared to normal healthy subjects. Our quantification of olfactory loss, considering all parameters, identified 82% of the asymptomatic SARS-CoV-2 carriers with olfactory deficits. However, on subjective evaluation, only 15% of the patients noticed a compromised ability to smell. INTERPRETATION: Compromised olfactory fitness can serve as a strong basis for identifying asymptomatic COVID-19 patients. Detailed design specifications and protocols provided here should enable the development of a sensitive, fast, and economical screening strategy that can be administered to large populations to prevent the rapid spread of COVID-19. FUNDING: This work was supported by the DBT - Wellcome Trust India Alliance intermediate grant (IA/I/14/1/501,306 to N.A.) and UGC NET Fellowship (A.B.). All the funding sources played no roles in the study.

Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control.

We examined the rates of infection and colonisation by methicillin-resistant Staphylococcus aureus (MRSA) between January 2003 and May 2004 in order to assess the impact of the introduction of an MRSA policy in October 2003, which required all admissions to be screened. Emergency admissions were treated prophylactically and elective beds ring-fenced. A total of 5,594 admissions were cross-referenced with 22,810 microbiology results. The morbidity, mortality and cost of managing MRSA-carrying patients, with a proximal fracture of the femur were compared, in relation to age, gender, American Society of Anaesthesiologists grade and residential status, with a group of matched controls who were MRSA-negative. In 2004, we screened 1795 of 1,796 elective admissions and MRSA was found in 23 (1.3%). We also screened 1,122 of 1,447 trauma admissions and 43 (3.8%) were carrying MRSA. All ten ward transfers were screened and four (40%) were carriers (all p < 0.001). The incidence of MRSA in trauma patients increased by 2.6% per week of inpatient stay (r = 0.97, p < 0.001). MRSA developed in 2.9% of trauma and 0.2% of elective patients during that admission (p < 0.001). The implementation of the MRSA policy reduced the incidence of MRSA infection by 56% in trauma patients (1.57% in 2003 (17 of 1,084) to 0.69% in 2004 (10 of 1,447), p = 0.035). Infection with MRSA in elective patients was reduced by 70% (0.56% in 2003 (7 of 1,257) to 0.17% in 2004 (3 of 1,806), p = 0.06). The cost of preventing one MRSA infection was 3,200 pounds. Although colonisation by MRSA did not affect the mortality rate, infection by MRSA more than doubled it. Patients with proximal fractures of the femur infected with MRSA remained in hospital for 50 extra days, had 19 more days of vancomycin treatment and 26 more days of vacuum-assisted closure therapy than the matched controls. These additional costs equated to 13,972 pounds per patient. From this experience we have been able to describe the epidemiology of MRSA, assess the impact of infection-control measures on MRSA infection rates and determine the morbidity, mortality and economic cost of MRSA carriage on trauma and elective orthopaedic wards.

Maintaining accuracy at the expense of speed: stimulus similarity defines odor discrimination time in mice.

Odor discrimination times and their dependence on stimulus similarity were evaluated to test temporal and spatial models of odor representation in mice. In a go/no-go operant conditioning paradigm, discrimination accuracy and time were determined for simple monomolecular odors and binary mixtures of odors. Mice discriminated simple odors with an accuracy exceeding 95%. Binary mixtures evoking highly overlapping spatiotemporal patterns of activity in the olfactory bulb were discriminated equally well. However, while discriminating simple odors in less than 200 ms, mice required 70-100 ms more time to discriminate highly similar binary mixtures. We conclude that odor discrimination in mice is fast and stimulus dependent. Thus, the underlying neuronal mechanisms act on a fast timescale, requiring only a brief epoch of odor-specific spatiotemporal representations to achieve rapid discrimination of dissimilar odors. The fine discrimination of highly similar stimuli, however, requires temporal integration of activity, suggesting a tradeoff between accuracy and speed.

Use of hand-held laser scanning in the assessment of facial swelling: a preliminary study.

A new generation lightweight, hand-held, laser surface scanner (FastSCAN) was validated and clinically evaluated for the assessment of postoperative facial swelling. The potential sources of error-scanner error, registration error, and repositioning and movement error were established for laser scans of a mannequin head and seven volunteers. For the mannequin head the mean (S.D.) volume of the simulated swelling was 12.5 (0.5) cm3. The measurement error was therefore about 4%, and reflected the error in scanned data and in surface registration. Among the volunteers, repositioning of the head introduced additional errors of up to 7.6 cm3 (mean 1.8 cm3), illustrating the additional influence of variable positions. We then scanned 20 patients (9 women and 11 men, age range 18-26) before and 2 days after, third molar removal. The external, facial soft tissue volume changes were calculated for both left and right sides (range 0.2-64.3 cm3). The main source of inaccuracy was again variability of position. Despite this, the FastSCAN proved to be a simple, accurate, and non-invasive method of measuring postoperative changes in volume in the external, soft tissues of the face. Minimising variability in position by using more precise positioning techniques will increase the accuracy of this technique and is a focus for future work.

How many gated lymphocytes are needed for accurate assessment of T-subset percentages by flow cytometry?

Current regulatory agencies specify the use of 2,500 gated lymphocytes for accurate lymphocyte immunophenotyping by flow cytometry. However, acquisition of 2,500 gated lymphocytes is often technically infeasible when testing whole blood from lymphopenic patients. Our laboratory thus compared CD3, CD4, and CD8 percentages obtained from a lymphocyte acquisition gate of 2,500 events with those obtained, respectively, from 1,000 and 500 event acquisition gates. The study group consisted of 59 specimens with CD4 values ranging from 1% to 66%; for data analysis purposes, the group was considered as a whole and was then subdivided according to CD4 percentage (> 25%, < 25%, < 5%). For all groupings analyzed, percentages of CD3+, CD4+, and CD8+ lymphocytes were not significantly different for either 1,000-event or 500-event gates when compared to the standard 2,500 gate (paired t-test). Replicate parallel analyses of some samples indicated that comparable precision is obtained by using the alternative gates. These findings indicate that the use of smaller numbers of acquired lymphocytes is a reasonable alternative in situations where 2,500 lymphocytes cannot be attained.

A study of the use of a transdermal fentanyl patch in cats.

A transdermal therapeutic system (TTS) has been developed for the continuous delivery of fentanyl citrate to provide ongoing analgesia in human patients with chronic pain. Several researchers believe that fentanyl transdermal patches have a place in postoperative pain control. The purpose of this study was to determine whether transdermal technology is an effective way of administering fentanyl to feline patients. Fentanyl patches were applied to the skin of six cats, and blood samples for fentanyl analysis were collected over 104 hours. This study establishes that the transdermal patch technology is an effective, long-lasting, cost-effective, noninvasive, and well-tolerated mode of deliverying fentanyl to cats.