Performance of Screening for SARS-CoV-2 using Rapid Antigen Tests to Detect Incidence of Symptomatic and Asymptomatic SARS-CoV-2 Infection: findings from the Test Us at Home prospective cohort study

BackgroundPerformance of Rapid Antigen Tests for SARS-CoV-2 (Ag-RDT) varies over the course of an infection, and their performance is not well established among asymptomatic individuals. ObjectiveEvaluate performance of Ag-RDT for detection of SARS-CoV-2 in relation to onset of infection for symptomatic and asymptomatic participants. Design, Setting, and ParticipantsProspective cohort study conducted from October 2021 to February 2022 among participants > 2 years-old from across the US who enrolled using a smartphone app. During each testing encounter, participants self-collected one nasal swab and performed Ag-RDT at home; at-least fifteen minutes later, a second nasal swab was self-collected and shipped for SARS-CoV-2 RT-PCR at a central lab. Both nasal swabs were collected 7 times at 48-hour intervals (over approximately 14 days) followed by an extra nasal swab collection with home Ag-RDT test 48-hours after their last PCR sample. Each participant was assigned to one of the three emergency use authorized (EUA) Ag-RDT tests used in this study. This analysis was limited to participants who were asymptomatic and tested negative by antigen and molecular test on their first day of study participation. ExposureSARS-CoV-2 positivity was determined by testing a single home-collected anterior nasal sample with three FDA EUA molecular tests, where 2 out 3 positive test results were needed to determine a SARS-CoV-2 positive result. Onset of infection was defined as day on which the molecular PCR comparator result was positive for the first time. Main Outcomes and MeasuresSensitivity of Ag-RDT was measured based on testing once (same-day), twice (at 48-hours) and thrice (at 96 hours). Analysis was repeated for different Days Post Index PCR Positivity (DPIPP) and stratified based on symptom-status on a given DPIPP. ResultsA total of 7,361 participants enrolled in the study and 5,609 were eligible for this analysis. Among 154 eligible participants who tested positive for SARS-CoV-2 infection based on RT-PCR, 97 were asymptomatic and 57 had symptoms at onset of infection (DPIPP 0). Serial testing with Ag-RDT twice over 48-hours resulted in an aggregated sensitivity of 93.4% (95% CI: 89.1-96.1%) among symptomatic participants on DPIPP 0-6. Among the 97 people who were asymptomatic at the onset of infection, 19 were singleton RT-PCR positive, i.e., their positive test was preceded and followed by a negative RT-PCR test within 48-hours. Excluding these singleton positives, aggregated sensitivity on DPIPP 0-6 for two-time serial-testing among asymptomatic participants was lower 62.7% (54.7-70.0%) but improved to 79.0% (71.0-85.3%) with serial testing three times at 48-hour interval. DiscussionPerformance of Ag-RDT within first week of infection was optimized when asymptomatic participants tested three-times at 48-hour intervals and when symptomatic participants tested two-times separated by 48-hours. Key pointsO_ST_ABSQuestionC_ST_ABSWhat is the performance of serial rapid antigen testing (Ag-RDT) in the first week of infection among symptomatic and asymptomatic SARS-CoV-2 infections? FindingsSerial testing with Ag-RDT two-times separated by 48-hours resulted in detection of more than 90% of SARS-CoV-2 infections when symptomatic participants began testing within first week from onset of molecular positivity; participants who were asymptomatic when they began testing within the first-week of molecular positivity observed a sensitivity of 79.0% when they performed three rapid antigen-tests, 48 hours apart. MeaningTo optimize detection of SARS-CoV-2 infection with home antigen tests, people suspected to be infected with SARS-CoV-2 virus should test twice at least 48-hours apart if they are symptomatic and three times at 48-hour intervals if they do not have symptoms (asymptomatic). Key definitionsO_ST_ABSComparator positiveC_ST_ABScomposite definition of molecular positivity if majority of molecular assays were positive Days Past Index Comparator Positive (DPIPP)Number of calendar-days past the day when first Comparator positive was observed Onset of InfectionDPIPP 0, when first Comparator positive was observed Symptomatic and Asymptomatic CasesBased on presence or absence of self-reported symptoms on the day of testing. Sensitivity was measured for Symptomatic and Asymptomatic cases on DPIPP 0-10 First week of InfectionDPIPP 0 - 6

Planned initiation of extracorporeal membrane oxygenation prior to liver transplantation: a report of 3 cases / 中华器官移植杂志

Objective:To explore the feasibility and advantages of planned initiation of extracorporeal membrane oxygenation(ECMO)prior to liver transplantation.Methods:From November 2017 to July 2021, clinical data were retrospectively reviewed for 3 liver transplantation recipients assisted by ECMO.There were such preoperative symptoms of right ventricular dysfunction as fatigue, chest tightness and palpitations.In the first case, right heart catheterization was not performed due to patient refusal; another two patients were screened by transthoracic Doppler echocardiography(TDE)and diagnosed through right heart catheterization as portopulmonary hypertension(POPH)and pulmonary hypertension.Results:Three recipients with pulmonary hypertension received catheterization in right femoral artery and vein.After freeing of diseased liver and before blocking inferior vena cava, V-A ECMO support was performed.The dose of heparin was adjusted according to activated clotting time(ACT)and perioperative vital signs remained stable.They were ventilated for 54, 12 and 62 hours and supported by ECMO for 27, 61 and 14 hours.All were smoothly discharged.During a mean follow-up period of 26(9-22)months, liver functions were normal.Conclusions:Patients with end-stage liver disease with pulmonary hypertension should undergo routine TDE examinations during waiting period before liver transplantation.Those with pulmonary hypertension should undergo further right heart catheterization to confirm the diagnosis and severity of the disease.Planned application of ECMO through multidisciplinary consultations can expand surgical indications for liver transplantation, maintain intraoperative hemodynamic stability and facilitate smooth liver transplantation and postoperative patient recovery.

A multiplex protein panel assay determines disease severity and is prognostic about outcome in COVID-19 patients

Global healthcare systems continue to be challenged by the COVID-19 pandemic, and there is a need for clinical assays that can both help to optimize resource allocation and accelerate the development and evaluation of new therapies. Here, we present a multiplex proteomic panel assay for the assessment of disease severity and outcome prediction in COVID-19. The assay quantifies 50 peptides derived from 30 COVID-19 severity markers in a single measurement using analytical flow rate liquid chromatography and multiple reaction monitoring (LC-MRM), on equipment that is broadly available in routine and regulated analytical laboratories. We demonstrate accurate classification of COVID-19 severity in patients from two cohorts. Furthermore, the assay outperforms established risk assessments such as SOFA and APACHE II in predicting survival in a longitudinal COVID-19 cohort. The prognostic value implies its use for support of clinical decisions in settings with overstrained healthcare resources e.g. to optimally allocate resources to severely ill individuals with high chance of survival. It can furthermore be helpful for monitoring of novel therapies in clinical trials.

Effect of painting intervention based on Mandala-self theory on mood and physiological state in patients in preoperative waiting room / 中南大学学报(医学版)

OBJECTIVES@#The waiting room for surgery is an area set up to improve the surgical turnover rate, but the waiting time for surgery is uncertain. Patients are prone to negative emotions that affect their physiological state during waiting time. This study aims to explore the effect of Mandala painting intervention based on Mandala-self theory on the emotion and physiological state of patients waiting before operation.@*METHODS@#The patients in the control group (@*RESULTS@#Diastolic pressure, heart rate, and happiness and excitement showed no statistical significance in the time effect, intervention effect, and interaction between the 2 factors (all @*CONCLUSIONS@#The application of Mandala painting in the operation waiting room is feasible and can effectively regulate the patients' negative mood and systolic pressure, as well as shorten the waiting time of perception.

ThevalueofMRIindifferentiatingbetweenmass-formingchronicpancreatitisandpancreaticcarcinoma / 实用放射学杂志

Objective ToexplorethevalueofMRIindifferentiatingbetweenmass-formingchronicpancreatitis(MFCP)andpancreatic carcinoma(PC).Methods MRIdataof19caseswith MFCP,36caseswithPCand30normalcontrolcasesconfirmedbypathology orfollow-upwereanalyzedretrospectively.AllofthesubjectsunderwentroutineMRIandDWIscan.MRIcharacteristicsofdiseases andnormalpancreaswereanalyzed,andADCvalueswerecomparedamongthethreegroups.Results TheaverageADCvalueofthe MFCPgroupwas(1.41±0.25)×10-3 mm2/s,higherthanthatofthePCgroup (1.13±0.11)×10-3 mm2/s(P<0.05),andlower thanthatofthenormalcontrolgroup(1.50±0.27)×10-3 mm2/s(P<0.05).IntheT2WI,enhancedscanningarterialphase,andenhanced scanningportalphase,thesignalcharacteristicsofthelesionswerestatisticallydifferentbetweentheMFCPandPCgroup (P<0.05).The sensitivityandspecificityofthecombinationT2WI,enhancedarterialimagingandADCvaluewere86.9%and88.9%indifferentiatingMFCPand PC,whichwasbetterthananysinglemethod.Conclusion MRImulti-sequencecombinationisoneoftheeffectivemethodsforidentifyingPCand MFCP,andhasreferencevalueforclinicaldiagnosis.

Occupational mental health and job satisfaction in university teachers in Shenyang, China / 中华劳动卫生职业病杂志

Objective@#To investigate the current status of occupational mental health and job satisfaction in university teachers in Shenyang, China and related influencing factors.@*Methods@#A total of 1500 teachers from 6 universities in Shenyang were randomly selected as study subjects from November 2013 to January 2014. Self-administered questionnaires were used to investigate mental health, including effort-reward imbalance questionnaire, Minnesota Satisfaction Questionnaire, Center for Epidemiological Survey-Depression Scale, and Psychological Capital Questionnaire.@*Results@#Of all teachers, 58.9% had depressive symptoms. Depressive symptoms in university teachers were negatively correlated with the scores of psychological capital, supervisory commitment, and perceived organizational support (r=-0.461, -0.306, and -0.366, all P<0.01) and were positively correlated with the score of occupational stress (r=0.414, P<0.01) . Job satisfaction was positively correlated with psychological capital, perceived organizational support, and supervisory commitment (r=0.650, 0.715, and 0.636, all P<0.01) and negatively correlated with occupational stress (r=-0.475, P<0.01) . The direct effects of occupational stress, perceived organizational support, and supervisory commitment on job satisfaction were -0.30, 0.26, and 0.14, respectively, and their indirect effects were -0.0176, 0.0656, and 0.0368, respectively. The direct effects of occupational stress, perceived organizational support, and supervisory commitment on depressive symptoms were 0.20, -0.08, and -0.05, respectively, and their indirect effects was 0.033, -0.123, and -0.069, respectively.@*Conclusion@#Occupational mental health is closely associated with job satisfaction in university teachers in Shenyang, and psychological capital has a mediating effect on perceived organizational support, supervisory commitment, occupational stress, job satisfaction, and depressive symptoms.

Time related receiver operation characteristic curves and its application in clinical trials and diagnostic analysis / 中华流行病学杂志

By using R language to deal with practical problems,we introduce two methods of obtaining time related receiver operation characteristic [ROC(t)] curves from survival data:1) nearestneighbor estimator of bivariate distribution (NNE) estimation:to obtain cumulative/dynamic ROCC/D(t) curves;2) Cox estimation:to obtain incident/dynamic ROCI/D (t) curves.The areas under the ROC(t) curves (AUC) obtained from the two methods fluctuate over time.The one obtained through NNE has bigger fluctuation than that obtained through Cox,while the mean of AUC of the two methods are similar.Time related ROC (t) can be effectively used to evaluate the diagnostic capacity of the marker in clinical trials,and help to select the best diagnostic time of the marker.According to the different scientific interests,researchers should select relevant methods for more accurate evaluation.

Time related receiver operation characteristic curves and its application in clinical trials and diagnostic analysis / 中华流行病学杂志

By using R language to deal with practical problems,we introduce two methods of obtaining time related receiver operation characteristic [ROC(t)] curves from survival data:1) nearestneighbor estimator of bivariate distribution (NNE) estimation:to obtain cumulative/dynamic ROCC/D(t) curves;2) Cox estimation:to obtain incident/dynamic ROCI/D (t) curves.The areas under the ROC(t) curves (AUC) obtained from the two methods fluctuate over time.The one obtained through NNE has bigger fluctuation than that obtained through Cox,while the mean of AUC of the two methods are similar.Time related ROC (t) can be effectively used to evaluate the diagnostic capacity of the marker in clinical trials,and help to select the best diagnostic time of the marker.According to the different scientific interests,researchers should select relevant methods for more accurate evaluation.

The Moderating and Mediating Roles of Psychological Capital in the Associations of Effort-reward Imbalance and Overcommitment with Job Burnout among Iron-steel Workers / 中国医科大学学报

Objective To explore the moderating and mediating roles of psychological capital in the associations of effort?reward imbalance and overcommitment with job burnout among iron?steel workers. Methods Totally 1 700 male iron?steel workers from an iron and steel company were enrolled for the study. A set of questionnaires that included demographic and working factors,the Maslach Burnout Inventory?General Survey,the Ef?fort?reward Imbalance Scale and the Psychological Capital Questionnaire,as well as perceived work environment was distributed to the subjects. A to?tal of 1 254 effective respondents(73.76%)were collected. Hierarchical linear regression analysis was performed to explore moderating role,and as?ymptotic and resampling strategies were used to detect mediating role. Results There was no moderating role of psychological capital on the associa?tion between effort?reward imbalance and job burnout. Psychological capital had significant and positive moderating roles on the associations of over?commitment with emotional exhaustion and cynicism. Psychological capital showed significant mediating role in the associations of effort?reward im?balance with emotional exhaustion and cynicism,and the proportion of mediating role was 5.84%and 18.75%,respectively. Conclusion In work?ers with high level of psychological capital,emotional exhaustion and cynicism would be significantly increased with overcommitment,and there is a weak increasing trend of emotional exhaustion and cynicism in workers with low level of psychological capital. Effort?reward imbalance could lead to emotional exhaustion and cynicism through the reduction of psychological capital of iron?steel workers.