Machine learning application for the prediction of SARS-CoV-2 infection using blood tests and chest radiograph.

Triaging and prioritising patients for RT-PCR test had been essential in the management of COVID-19 in resource-scarce countries. In this study, we applied machine learning (ML) to the task of detection of SARS-CoV-2 infection using basic laboratory markers. We performed the statistical analysis and trained an ML model on a retrospective cohort of 5148 patients from 24 hospitals in Hong Kong to classify COVID-19 and other aetiology of pneumonia. We validated the model on three temporal validation sets from different waves of infection in Hong Kong. For predicting SARS-CoV-2 infection, the ML model achieved high AUCs and specificity but low sensitivity in all three validation sets (AUC: 89.9-95.8%; Sensitivity: 55.5-77.8%; Specificity: 91.5-98.3%). When used in adjunction with radiologist interpretations of chest radiographs, the sensitivity was over 90% while keeping moderate specificity. Our study showed that machine learning model based on readily available laboratory markers could achieve high accuracy in predicting SARS-CoV-2 infection.

Preventing secondary exposure to women from men applying a novel nestorone/testosterone contraceptive gel.

BACKGROUND: Testosterone (T)/Nestorone (NES) combination gel is a potential transdermal male contraceptive that suppresses gonadotropins and spermatogenesis. Transfer of transdermal T from men to women can be prevented by washing or covering application sites with clothing. OBJECTIVES: We hypothesized that showering or wearing a shirt over gel application sites would prevent secondary exposure of T and NES to a woman after close skin contact. MATERIALS AND METHODS: Twelve healthy male and 12 healthy female participants were recruited. Men applied T/NES 62 mg/8 mg gel to their shoulders and upper arms. Two hours after application, female partners rubbed the application site for 15 min. Exposure in the female partner was assessed under three conditions: a shirt covered the application site; the man showered prior to skin contact; or without intervention to reduce transfer. Serum T and NES concentrations were measured by LC-MS/MS in serial blood samples for 24 h after gel exposure. MAIN OUTCOMES: Change in female serum T and NES levels as measured by average concentration over 24 h (Cavg ). RESULTS: Median female serum T Cavg was 23.9 ng/dL (interquartile range, 19.3, 33.9) with the shirt barrier and 26.7 ng/dL (20.7, 33.9) after showering, which was higher than baseline 20.9 ng/dL (16.7, 25.0), both p < 0.03) but lower than without intervention (58.2 ng/dL [30.9, 89.1], both p < 0.01). Female serum NES Cavg and maximum concentration were below the lower limit of quantification with the shirt barrier and after showering, but increased without intervention in six of 12 women (maximum concentration <60 pg/mL). Men had lower average serum NES levels after showering (47 pg/ml [20, 94] compared to no intervention (153.3 pg/mL [51, 241], p < 0.02). CONCLUSION: Secondary transfer of T and NES occurs after intensive skin contact with the gel application site. Secondary transfer is decreased by a shirt barrier or showering before contact.

Renal allograft C4d deposition in Chinese: Hong Kong perspective.

BACKGROUND: Acute rejection constitutes a significant proportion of renal allograft loss. Peritubular capillary deposition of C4d has been recognized as the footprint of humoral alloimmunity and proven to be a sensitive and specific marker for humoral rejection in the appropriate clinical context. Its presence in indication biopsies is the most important independent risk factor for graft failure. Data are, however, scarce among Chinese subjects. METHODS: We retrospectively reviewed all renal graft biopsies performed from 1 April 2002 to 31 March 2006 for unexplained acute renal dysfunction or delayed graft function. Renal outcomes were assessed at the time of renal biopsy and at 1 month, 3 months, 6 months and 1 year afterwards. Survival was assessed by Kaplan-Meier analysis. Multivariate analysis was used to determine if C4d positivity is an independent risk factor for poor renal outcome. RESULTS: Fifty-two biopsies were included, of which 16 were positive for peritubular capillary C4d. Peritubular capillary C4d was associated with lower glomerular filtration rate and higher serum creatinine at 6 and 12 months after renal biopsies. The C4d-positive group fares worse in terms of death-censored graft failure, doubling of serum creatinine and reaching 50% of glomerular filtration rate at the end of the study. Peritubular capillary C4d deposition was the only significant risk factor that predicts graft failure in multivariate analysis. CONCLUSION: Our findings confirmed the independent prognostic value of peritubular capillary C4d staining on renal allograft survival in Chinese.

Vincristine treatment of nephrotic syndrome complicated by Kimura disease.

Kimura disease is a rare inflammatory condition of unknown aetiology. It typically presents in young Asian males with the triad of non-tender subcutaneous swellings in the head and neck region, peripheral eosinophilia and raised serum IgE. About 16% of cases have associated renal disease. We present the case of a 10-year-old boy with a past history of steroid responsive, frequently relapsing nephrotic syndrome who developed a right submandibular swelling and eosinophilia. Kimura disease was diagnosed on the basis of clinical and histological findings. The condition recurred during relapses of nephrotic syndrome. Because of poor adherence with oral medication, our patient was treated with intravenous vincristine with synchronous remissions of his nephrotic syndrome and Kimura swellings on each occasion.

Anaplastic large cell lymphoma of the pancreas: a pediatric case and literature review.

A 13-year-old boy presented with acute abdominal pain and later became jaundiced. Medical imaging subsequently demonstrated a 7 x 8 cm pancreatic mass. Examination of a biopsy specimen obtained by open laparotomy revealed malignant lymphoma. Histology, immunohistochemistry, and cytogenetics confirmed the diagnosis of ALK1-positive anaplastic large cell lymphoma. He was treated with multiagent chemotherapy and remains in complete remission 12 months off treatment. This is the first case of primary pancreatic ALK1-positive anaplastic large cell lymphoma described in a child and shows that aggressive surgical resection of pancreatic tumors is not always necessary to achieve a cure.

Pulmonary embolization by chorionic villi causing maternal death after a car crash.

Throughout the last century, there has been a marked decline in obstetric maternal deaths, resulting in an increase in the proportion of nonobstetric deaths among pregnant women. Trauma, in particular, has become a leading cause of maternal death. We report the case of a 20-year-old primigravid woman who was involved in a motor vehicle crash at 36 weeks gestation. The woman developed abruptio placentae, followed by disseminated intravascular coagulation, adult respiratory distress syndrome, and shock, and died the day after the crash. Widespread pulmonary embolization by chorionic villi was identified at autopsy. This report discusses traumatic maternal deaths, with emphasis on the differences in injury pattern observed in pregnant trauma victims in comparison with other adults. It is important that the pathologist be aware of these problems so that an accurate cause of death can be identified in cases of maternal death after trauma. Also discussed is the relationship between trauma and placental abruption and the mechanism of death in the patient. To the authors' knowledge, this is the first reported case of extensive embolism of chorionic villi to the lungs after trauma.

Massive ovarian edema causing early puberty.

Massive ovarian edema is a rare tumor-like condition found predominantly in young women. Patients usually present with abdominal pain and/or abdominal mass. Pre-operative diagnosis is often difficult. Awareness of this rare and benign lesion in young women may allow conservative management and prevention of oophorectomy in some patients.

Family health: an emerging paradigm for social workers.

The profession of social work has, since its inception, stressed the importance of the family system in social treatment. Even though the family has always been central to effective social work intervention, the framing of the family system from a family health perspective is new to the field. The goal of this paper is to present the empirical grounding of family health and the implications of this emerging paradigm for social policy. Family health is built on the biopsychosocial model and emphasizes the importance of the role of the family system in the social functioning of individuals. Family health is defined (Pardeck and Yuen, 1999, p. 1) "as a state of holistic well-being of the family system. Family health is manifested by the development of, and continuous interaction among, the physical, mental, emotional, social, economic, cultural and spiritual dimensions of the family which results in the holistic well-being of the family and its members."

Power in partnership.

This paper focuses on the meaning and process of collaboration, particularly in the area of research and clinical practice. Much has been written about the existing gaps between research and the practice of nursing; however, action research is one mechanism that allows these elements to be drawn together. Research developed through collaborative participation has the potential to harness the energy, enthusiasm and talents of nurses at different levels and practice into a cohesive group motivated to achieve professional development and quality practice goals. Action research that is built on the philosophy of a quality within the process and significance of the group can lead to effective practice in nursing. Power can be found in partnership.

Scholarly/research activities in nursing administration: some issues.

Despite an increasing commitment to expanding scholarly/research activities within the discipline of nursing and the overwhelming agreement on its value, scholarship progress has been relatively slow within the subdiscipline of nursing administration. The vast majority of nurse administrators are preoccupied with strategic and operational management and give limited attention to nursing scholarly/research activities. Nurse administrators appear to have embraced the idea of research and scholarship but perhaps have yet to become widely involved. This paper explores some of the issues related to scholarship/research activities in nursing administration.

Evaluations in mental health services: some methodological considerations.

Most health organizations evaluate policies and programmes periodically. Mental health services, without exception, also need to examine their established practices with particular concern about their propriety and effectiveness. As mental health services are coming under increasing pressure to function as self-evaluating organizations that carefully link planning, service delivery and assessment, choices must be made regarding which evaluative strategies are most relevant to the development of mental health services. This paper examines some of the methodological issues in the outcome evaluations in mental health services.

Case study of learning milieux: the modifying effect of the workplace.

In examining the clinical environment that may influence the first-year college graduate's attitudes toward continuing learning, four case studies were conducted in hospitals within the Illawarra Area Health Service, New South Wales. The exploratory research attempts to determine the extent to which desired educational changes occur and where improvements could be made to the educational process. This paper reports the research findings.