Evaluating the Ability to ID (COVID-19) NOW: a Large Real-World Prospective Evaluation of the Abbott ID NOW COVID-19 Assay.

The Abbott ID NOW COVID-19 assay is a rapid point-of-care molecular test for SARS-CoV-2 detection. In theory, it has the potential to decrease turnaround times (TATs) and rapidly facilitate patient flow and triage. Reports for its performance have been mixed, likely due to variations in patient cohorts, preanalytical considerations, and study design. We prospectively evaluated the ID NOW performance against reference reverse transcriptase PCR (RT-PCR) tests, using dual swabs. Patients presented at a large multisite academic hospital with the highest volumes of COVID-19 admissions in Canada. From 1,968 valid swabs, 186 were true positive, 1,760 were true negative, 21 were false negatives, and 1 was false positive. At 10.5% positivity rate, the positive and negative predictive values were 99.5% and 98.8%, respectively. This led to a modest increase in the pretest probability in this cohort of individuals presenting <7 days of symptom onset. The mean times from collection to laboratory receipt and receipt to reporting were 31 and 23 min, respectively. This reduced TAT observed in our study may assist with triage of admitted patients and breaking the chain of transmission through immediate notification of status. We also observed how test performance changed with prevalence, and thus, how the test is used to "rule in" or "rule out" disease must be considered. Although the ID NOW is regarded as a rapid test, it is not high throughput and requires rapid transportation times (<1 h) that may not be plausible in large centers. The utility of this test should be considered with the observed TAT and interpreted in the context of limitations discussed. IMPORTANCE Rapid testing for COVID-19 has been recognized as one potentially important measure in managing the pandemic. However, these rapid tests vary grossly in their performance and their applicability. There have been many studies evaluating the performance of rapid tests for SARS-CoV-2 detection. However, they are frequently not prospective, and patients are not simultaneously swabbed to compare the reference standard RT-PCR. Previous ID NOW study findings are mixed, which may be due to various factors, including patient, epidemiological, and preanalytical considerations. It is critical to consider how the pretest and posttest probabilities and epidemiological factors may affect the performance as the community prevalence of disease fluctuates during this highly dynamic pandemic. We consider how the ID NOW may be utilized in different settings, with considerations of public health and infection control and prevention risk tolerance.

Bilateral vision loss as the initial presentation for central nervous system involvement of mantle cell lymphoma: A case series.

PURPOSE: Mantle cell lymphoma is a rare aggressive subtype of non-Hodgkins B cell lymphoma. It typically presents with asymptomatic monoclonal lymphocytosis, lymphadenopathy or bulky extranodal disease. Mantle cell lymphoma rarely affects the central nervous system. We present two cases in which vision loss was the initial symptom of central nervous system involvement by the malignancy. OBSERVATIONS: Both patients initially received high dose intravenous steroids with notable improvement in their vision. CONCLUSIONS AND IMPORTANCE: Early detection and management of optic nerve infiltration by mantle cell lymphoma is essential as it improves visual outcomes and enables prompt management of the patient's systemic disease.

The role of clinical history in the interpretation of chest radiographs.

OBJECTIVE: This review will appraise the literature pertaining to the influences that clinical history has on the action of assessing the chest radiograph. KEY FINDINGS: There remains conflicting evidence on the impact of clinical history on chest radiography. Some research suggests that clinical history has the potential to influence the reporter in a negative way by limiting their search strategy to a more focussed search. Image interpretation is more accurate when reporters are allowed to conduct a free search of the chest image, untainted by preconceived concepts. CONCLUSION: Clinical history needs to be accessed appropriately to aid and not stifle accurate image interpretation. Reporters need to be aware of the potential bias clinical history can introduce to their reporting and develop strategies to alleviate this as much as possible. IMPLICATIONS FOR PRACTICE: A greater understanding of the potential bias of clinical history on the process of image interpretation is required by all reporters. Reporters need to develop an approach and strategy when accessing clinical history. Novice reporters need to be educated regarding the impact of clinical history on their reporting.

Distribution of hepatitis B virus infection in Namibia.

BACKGROUND: Namibia regards hepatitis B virus (HBV) infection as a public health problem and introduced hepatitis B vaccinations for infants during 2009. However, information on HBV infection in the country remains limited, and effective public health interventions may be compromised in the absence of adequate evidence-based data. Available data from the World Health Organization (WHO) estimate that 15 - 60% of the normal population in many African countries may be positive for one or more of the HBV serological markers. OBJECTIVE: To investigate the distribution of HBV infection in Namibia, using available laboratory data for 2013. METHODS: A cross-sectional descriptive study was conducted using pre-existing electronic laboratory data on HBV infection. The data were retrieved from the central Namibia Institute of Pathology laboratory in Windhoek during January - December 2013. Tests were done on the following three main groups: (i) pregnant women during routine antenatal care (ANC) visits; (ii) patients with HIV/AIDS during antiretroviral therapy clinic visits; and (iii) any other individual suspected of having HBV infection. RESULTS: Of a total of 77 238 hepatitis B surface antigen test results retrieved countrywide, 9 087 (11.8%) were positive. Of the positive results, 246/9 087 (2.7%) were in children aged 0 - 14 years, with the sexes equally affected. HBV infections increased markedly, particularly among females, in the age group 15 - 39 years, reaching a peak in the age group 30 - 34 years. Routine screening of pregnant women for HBV during ANC visits was found to be systematically conducted in only two regions, Ohangwena and Khomas. CONCLUSIONS: This study showed high proportions of positive results in pregnant women, patients with HIV/AIDS and individuals suspected of having HBV infection. The Ministry of Health and Social Services and stakeholders may wish to consider improving the routine and surveillance reporting systems for viral hepatitis and uptake of screening for pregnant women in all regions, and expanding HBV screening to other population groups. Population-based or similar studies are therefore required to determine the HBV prevalence and risk factors. This will assist Namibia in developing appropriate national viral hepatitis strategies as per WHO recommendations.

Distribution of hepatitis B virus infection in Namibia

Background. Namibia regards hepatitis B virus (HBV) infection as a public health problem and introduced hepatitis B vaccinations for infants during 2009. However, information on HBV infection in the country remains limited, and effective public health interventions may be compromised in the absence of adequate evidence-based data. Available data from the World Health Organization (WHO) estimate that 15 - 60% of the normal population in many African countries may be positive for one or more of the HBV serological markers.Objective. To investigate the distribution of HBV infection in Namibia, using available laboratory data for 2013.Methods. A cross-sectional descriptive study was conducted using pre-existing electronic laboratory data on HBV infection. The data were retrieved from the central Namibia Institute of Pathology laboratory in Windhoek during January - December 2013. Tests were done on the following three main groups: (i) pregnant women during routine antenatal care (ANC) visits; (ii) patients with HIV/AIDS during antiretroviral therapy clinic visits; and (iii) any other individual suspected of having HBV infection.Results. Of a total of 77 238 hepatitis B surface antigen test results retrieved countrywide, 9 087 (11.8%) were positive. Of the positive results, 246/9 087 (2.7%) were in children aged 0 - 14 years, with the sexes equally affected. HBV infections increased markedly, particularly among females, in the age group 15 - 39 years, reaching a peak in the age group 30 - 34 years. Routine screening of pregnant women for HBV during ANC visits was found to be systematically conducted in only two regions, Ohangwena and Khomas.Conclusions. This study showed high proportions of positive results in pregnant women, patients with HIV/AIDS and individuals suspected of having HBV infection. The Ministry of Health and Social Services and stakeholders may wish to consider improving the routine and surveillance reporting systems for viral hepatitis and uptake of screening for pregnant women in all regions, and expanding HBV screening to other population groups. Population-based or similar studies are therefore required to determine the HBV prevalence and risk factors. This will assist Namibia in developing appropriate national viral hepatitis strategies as per WHO recommendations

Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes.

BACKGROUND: Athletic groin pain (AGP) is an encompassing term for the multitude of chronic conditions presenting as pain in the inguinal region. The purpose of this review was to compare the return to play rates (RTPrate) and return to play times (RTPtime) between surgical and rehabilitation interventions in the treatment of AGP. METHODS: A systematic review of English language peer review journals was carried out between 1980 to June 2013 using PubMed, Embase, CINHAL and Google Scholar searching for all papers relating to AGP (and its various pseudonyms) and all surgical and rehabilitative interventions which reported RTPrate and/or RTPtime. AGP literature has been subdivided by many eponymous diagnoses but anatomical diagnostic groupings of (1) abdominal wall, (2) adductor and (3) pubic related pain were used in this review. Meta-analysis was then carried out on the data to compare results between the surgical and rehabilitation groups. RESULTS: Fifty-six papers out of the 561 discovered in the initial search were included in the review with 3332 athletes included. Evidence was mostly level IV. Using the Black and Downs checklist we found poor study quality overall with a high risk of bias especially among surgical studies. The results showed comparable RTPrate between surgical and rehabilitative interventions within the three diagnostic groups. Rehabilitation had significantly quicker RTPtime for pubic related groin pain compared to surgery (10.5 weeks and 23.1 weeks respectively). The abdominal group had the fastest return of the three groups for the rehabilitation and surgery. CONCLUSIONS: The review suggested better outcomes with rehabilitation for pubic-related groin pain with no difference between the adductor and abdominal groups. The review highlighted the poor quality and risk of bias in the literature making accurate comparison difficult.

High-throughput measurement of ionic conductivity in composition-spread thin films.

This paper demonstrates the feasibility of high-throughput investigation of ionic conductivity in oxygen-ion conductors. Yttria stabilized zirconia (YSZ) composition-spread thin films with nanometer-size grains were prepared by 90° off-axis reactive RF cosputtering. We compare results for two electrode configurations, namely, out-of-plane (parallel plate) and in-plane (planar interdigitated electrode) and find that the contribution from the intragrain conductivity in YSZ thin films (150 nm) is more explicit in the latter configuration because it greatly diminishes electrode effects. The intragrain oxygen ion conductivity of thin film YSZ was systematically measured as a function of yttria concentration over the range 2 mol % to 12 mol %. The results show that the measured conductivity of the YSZ thin films is close to that of corresponding bulk materials with a peak value around 3 × 10⁻4 S cm⁻¹ at 440 °C at the optimum Y2O3 concentration of 8 mol %. Validation of this technique means that it can be applied to novel chemical systems for which systematic bulk measurements have not been attempted.

Quality-of-Life Experiences From the Perspective of Patients Receiving Haemodialysis for Chronic Renal Failure

This study describes the experiences of patients receiving haemodialysis for chronic renal failure at the only dialysis centre in Windhoek; Namibia. A qualitative; explorative and descriptive design was used. Data were collected by means of in-depth interviews and analysed using Tesch's process. Four themes emerged from the data; relating to (1) financial constraints; (2) loss of independence and spontaneous activities; (3) strain on relationships and (4) feelings of significant physiological changes and weakness. Based on the results; recommendations were submitted for psychosocial support and the establishment of support groups

Foreign Nursing Students: Their Profile and Perceptions Ofnursing Care in Namibia

A survey was conducted using open and close-ended questions to determine how visiting nursing students in Namibia could be assisted during their visits (cultural encounters). Many students decide to complete their clinical exposure in a foreign country; either for personal reasons or in order to meet the course requirements for transcultural nursing. Since 1998; Namibia has received a number of these students. In discussion and from passing remarks from the students themselves; the question has arisen as to how an optimum placement for each student might be achieved. Aspects of the Campina-Bacote model and The Process of Cultural Competence in the Delivery of Health Care Services were used to answer this question. It was decided to gather both biographical (profile) information and information on perceptions of nursing care in Namibia from such foreign nursing students. The biographical (profile) information collected indicates a prevalence of certain shared biographical characteristics among international students. Such students tend to be adventurous; caring and sensitive to human rights issues. This finding correlates with the constructs of cultural desire and cultural awareness as described in the model of Campina-Bacote. Based on this finding; specific recommendations were made for clinical allocations. From the data gathered from the open-ended questions; three themes emerged: firstly; nursing in Namibia has identifiable characteristics; secondly; there is a paternalistic and one-sided communication style among nursing caregivers in Namibia; and finally; nursing care delivery in this country is often characterised by a detached attitude. It was concluded that these themes correlated with a cultural awareness and cultural knowledge among the nursing students. The discovery of these themes was useful for making recommendations for clinical guidelines to help these students adapt; as well as for providing a foundation and substantiation for clinical placement

MR imaging and quantification of the movement of the lamina terminalis depending on the CSF dynamics.

BACKGROUND AND PURPOSE: Brain pulsation is a well-known observation in neurosurgery, but methods for its visualization on MR imaging, like phase imaging, do not provide a detailed structural view. We prospectively investigated electrocardiographic (ECG)-gated cine true fast imaging with steady-state precession (FISP) sequence on volunteers to test a sequence for demonstrating brain pulsation and movements of intracranial structures related to CSF dynamics. MATERIALS AND METHODS: Eleven healthy volunteers were investigated with prospectively ECG-gated cine true-FISP in the midsagittal plane. A total of 50 phases were recorded per cardiac cycle and per volunteer. The lamina terminalis was chosen to study the pulsatility of the brain, and the optic recess diameter was chosen for means of objective quantification of the degree of pulsatility. RESULTS: Pulsatile motion of the lamina terminalis was apparent in all volunteers on the cine mode. The mean diameter of the optic recess was 2.5 mm. The greatest change in diameter in 1 volunteer was 1.5 mm. The mean change in diameter was 40% during 1 cardiac cycle. CONCLUSIONS: Cine true-FISP sequence is a well-suited method for investigations of passive movements of the ventricular system. It shows pulsations of the brain as well as passive changes caused by CSF dynamics with high temporal and spatial resolution.

Exposure to Domestic Violence during Pregnancy : Perceptions and Coping Mechanisms of a Vulnerable Group

The purpose of this study was to explore and describe the perceptions of maternity clients' relating to domestic violence. A quantitative; exploratory and descriptive design was utilised. The population consisted of maternity patients admitted to a referral hospital in Windhoek; Namibia. The findings indicate that some perceptions reflect biographical differences such as education; age and economic status. In some instances; perceptions of maternity clients were in line with findings published in existing literature that reported socio-economic circumstances and familial obligations which forced women to endure abuse. It was recommended that these differences in perceptions be taken into account during the counselling of maternity clients or while health education is being given

Molecular evolution of the Li/li chemical defence polymorphism in white clover (Trifolium repens L.).

White clover (Trifolium repens) is naturally polymorphic for cyanogenesis (hydrogen cyanide release following tissue damage). The ecological factors favouring cyanogenic and acyanogenic plants have been examined in numerous studies over the last half century, making this one of the best-documented examples of an adaptive polymorphism in plants. White clover cyanogenesis is controlled by two, independently segregating Mendelian genes: Ac/ac controls the presence/absence of cyanogenic glucosides; and Li/li controls the presence/absence of their hydrolysing enzyme, linamarase. In this study, we examine the molecular evolution and population genetics of Li as it relates to the cyanogenesis polymorphism. We report here that Li exists as a single-copy gene in plants possessing linamarase activity, and that the absence of enzyme activity in li/li plants is correlated with the absence of much or all of the gene from the white clover genome. Consistent with this finding, we confirm by reverse transcription-polymerase chain reaction that Li gene expression is absent in plants lacking enzyme activity. In a molecular population genetic analysis of Li and three unlinked genes using a worldwide sample of clover plants, we find an absence of nucleotide variation and statistically significant deviations from neutrality at Li; these findings are consistent with recent positive directional selection at this cyanogenesis locus.

Trans-Cultural Nursing : Exploring the Experiences of International Students Visiting Namibia

"In a rapidly changing world; where people from diverse cultures move about more readily; nurses may find themselves faced with patients and clients with a totally different world perspective and health belief system. Because this aspect has long been recognised by nurse educators; many educational institutions; in a proactive fashion; have incorporated trans-cultural nursing content in their nursing curricula. As possible options for students to gain clinical exposure in caring for a culturally diverse population; educational visits by student nurses to foreign countries have been increasingly accepted and credited. Namibia is amongst the countries that are visited by foreign nursing students; who are usually well-prepared with regard to what is required during their clinical exposure; as their educational institutions provide them with instructions and objectives. However; they are not as well-prepared in respect of ""acclimatising"" to the country per se and the world view of Namibians. In fact; it appears that there is a huge gap between their expectations and reality. Consequently; it becomes necessary to provide them with basic guidelines to bridge this discrepancy and to make their visit more meaningful. A qualitative; explorative; descriptive and contextual study was conducted to determine the nature of their experiences. Data were collected over a period of four years by means of narratives that were written by students who had spent at least 12 weeks within the Namibian health care services as visiting nurses. Three themes emerged; namely (1) experiences relating to recognition of differences in care delivery; (2) experiences relating to feelings of culture shock; and (3) appreciation for experiencing a cultural encounter. Based on these themes; guidelines were constructed. These guidelines addressed aspects such as the health structure of the country; health belief systems; legal aspects; and the philosophy of nursing care in Namibia."

The Contribution of the Clinical Nurse Instructor to the Development of Critical Thinking Skills of the Student Nurse in Namibia

A quantitative; non-experimental and exploratory study was undertaken to determine the contribution by the clinical nurse instructor to develop critical thinking skills of student nurses in Namibia. The study was conducted at the training hospitals of Namibia; namely Windhoek; Oshakati and Onandjokwe State hospitals. Clinical nurse instructors from all disciplines were included in the study; as well as student nurses in their second; third and fourth year of undergraduate nursing study. The findings of the study revealed that; although the clinical instructors in the training hospitals of Namibia are aware of their responsibility; they do not focus on the development of critical thinking of student nurses in Namibia. A need for in-service programmes to emphasise the development of critical thinking skills of both clinical nurse instructors and student nurses was identified

The quality of nursing care regarding personal hygiene of patients admitted to a selected hospital in the Kavango region.

The aim of the study was to determine the quality of nursing care regarding personal hygiene of patients admitted to a hospital in the Kavango region of Namibia. The study was prompted by repeated media reports over the radio. Commentators and listeners expressed concern over the seeming lack of adequate hygienic measures, specifically with regard to patient care. To objectively quantify and describe the extent of this problem, a single objective was stated, namely to measure the quality of nursing care with regard to patient hygiene. A descriptive survey design was chosen to explore and describe the problem. A check-list was developed to observe thirty patients (the total population) over a period of one week. The results indicated that certain aspects of hygienic care needed improvement. These aspects (parts) were the care of male patient's beards; perineal care; and mouth care. Other aspects of care were indirectly negatively influenced due to incomplete record keeping. On completion of the study recommendations were made with regard to in-service education, management and research.

Survey for hydatidosis in cattle bred in the northern region of the Northern Territory of Australia.

OBJECTIVE: To determine whether hydatidosis occurs in cattle bred in the northern region of the Northern Territory. DESIGN: A survey utilising two stage sampling was designed to provide 95% confidence of detecting hydatids in cattle with a herd prevalence of 10% and animal prevalence of 10%. PROCEDURE: For a 1 year abattoir killing season, lesions from the liver and/or lung were collected from 4348 cattle being slaughtered at a Northern Territory abattoir and examined for hydatid cysts. The origin of cattle was established through identification of the brand. RESULTS: Sample sizes of 41 or more Northern Territory bred cattle were achieved for each of 29 properties. No hydatid cysts were found in cattle bred in the northern region of the Northern Territory. CONCLUSION: This study provides evidence that a cycle of hydatid transmission does not occur in the northern region of the Northern Territory.

Role of porphyrin sequestration in the biogenesis of iron-laden astrocytic inclusions in primary culture.

Astrocytes in subcortical regions of the mammalian brain progressively accumulate iron-rich, autofluorecent cytoplasmic inclusions as a function of aging. Cysteamine (CSH) accelerates the appearance of this senescent glial phenotype in situ and in primary rat astroglial cultures. Porphyrins have been implicated as the source of orange-red autofluorescence in these glial inclusions. Yet, CSH has been shown to suppress porphyrin-heme biosynthesis in cultured astroglia. To determine whether porphyrin biosynthesis or sequestration participates in the biogenesis of these glial inclusions, the porphyrin precursor, (3)H-delta-aminolevulinic acid ((3)H-ALA) was administered to CSH-exposed and control rat astroglial cultures followed by light and electron microscopic autoradiography. Control cultures exhibited faint orange-red autofluorescence, intense (3)H-ALA labeling, numerous normal mitochondria and few cytoplasmic inclusions. In these cells, (3)H-ALA labeling largely occurred over normal mitochondria. The CSH-treated astroglia exhibited diminished (3)H-ALA labeling and contained numerous orange-red autofluorescent inclusions. The latter manifested internal compartments delimited by double membranes characteristic of damaged mitochondria. The complement of normal mitochondria in the CSH-exposed cells was markedly reduced. In the CSH-treated cells, (3)H-ALA labeling predominated over the large multi-compartmental inclusions. CSH attenuates de novo porphyrin-heme biosynthesis in astroglia but may induce punctate orange-red autofluorescence in the cytoplasm of these cells by promoting large numbers of damaged, porphyrin-containing mitochondria to form tight aggregates within the nascent gliosomes.

Improving cognitive development of low-birth-weight premature infants with the COPE program: a pilot study of the benefit of early NICU intervention with mothers.

The purpose of this pilot study was to evaluate the effectiveness of a parent-focused intervention program (COPE) on infant cognitive development and maternal coping. A randomized clinical trial was conducted with 42 mothers of low-birth-weight (LBW) premature infants hospitalized in a neonatal intensive care unit (NICU), with follow-up at 3 months' and 6 months' corrected ages. COPE mothers received the four-phase educational-behavioral program that began 2-4 days postbirth and continued through 1 week following discharge from the NICU. Comparison mothers received audiotaped information during the same four time frames. Results indicated that COPE infants had significantly higher mental development scores at a 3 months' corrected age (M = 100.3) than did the comparison infants (M = 93.9), and this difference widened at 6 months' corrected age, with COPE infants scoring 14 points higher. COPE mothers were significantly less stressed by the NICU sights and sounds and had significantly stronger beliefs about what behaviors and characteristics to expect from their premature infants. Findings from this study support the need for further testing of early NICU interventions with parents to determine their effectiveness on parental coping and infant developmental outcomes.

Assessing exposure to disinfection by-products in women of reproductive age living in Corpus Christi, Texas, and Cobb county, Georgia: descriptive results and methods.

We conducted a field study in Corpus Christi, Texas, and Cobb County, Georgia, to evaluate exposure measures for disinfection by-products, with special emphasis on trihalomethanes (THMs). Participants were mothers living in either geographic area who had given birth to healthy infants from June 1998 through May 1999. We assessed exposure by sampling blood and water and obtaining information about water use habits and tap water characteristics. Two 10-mL whole blood samples were collected from each participant before and immediately after her shower. Levels of individual THM species (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) were measured in whole blood [parts per trillion (pptr)] and in water samples (parts per billion). In the Corpus Christi water samples, brominated compounds accounted for 71% of the total THM concentration by weight; in Cobb County, chloroform accounted for 88%. Significant differences in blood THM levels were observed between study locations. For example, the median baseline blood level of bromoform was 0.3 pptr and 3.5 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). Differences were most striking in blood obtained after showering. For bromoform, the median blood levels were 0.5 pptr and 17 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). These results suggest that blood levels of THM species vary substantially across populations, depending on both water quality characteristics and water use activities. Such variation has important implications for epidemiologic studies of the potential health effects of disinfection by-products.

Effect of literacy on breast-feeding outcomes.

BACKGROUND: We studied the effect of functional health literacy on the initiation and continuance of breast-feeding in women at a public health clinic. METHODS: Subjects were 61 first-time mothers aged 18 years or older who spoke English as their first language. They were divided into two groups, one who exclusively breast-fed for at least the first 2 months and one who never initiated breast-feeding or did not exclusively breast-feed for at least 2 months. The Rapid Estimate of Adult Literacy in Medicine (REALM) was administered, providing reading grade-level estimates for each subject. RESULTS: An association between functional health literacy and breast-feeding was seen, with only 23% of the women in the lower literacy group exclusively breast-feeding during the first 2 months compared with 54% of women in the higher literacy group. CONCLUSION: Many patients need simpler health education materials encouraging breastfeeding. These materials are needed both before and during pregnancy.