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.

Coping with AIDS. An approach to training and education in a therapeutic community--the Samaritan Village Program.

The emerging demographics of AIDS related disease and disorders suggests a redistribution toward the population of intravenous drug users (IVDU) and the sexual partners of IVDU's. Risk reduction strategies employing education and disease prevention appear to have had significant success within the gay community as borne out by changing epidemiologic data. This paper focuses upon one such approach that has been used in a residential therapeutic environment. It offers a practical working model that might be applicable in a variety of settings. It should be emphasized that this is not a one-step presentation of AIDS information, but rather that it is an ongoing program of AIDS education.

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.

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.

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.

Aftercare residential facility for ex-psychiatric patients--the Australian and American perspectives.

The decline in the number of inpatients in psychiatric hospitals over the last decade has resulted in a strong demand for community based mental health services, and a search for alternative accommodation for ex-psychiatric patients. However, for any comprehensive planning for residential services for ex-psychiatric patients to be effective, there must be a recognition of the variety of patient needs and resources and the range of service models available. This paper attempts to review aftercare residential facilities in America and Australia, to identify the underlying care philosophy and to propose various supervision approaches.

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.

Continuing nursing education: some issues.

In nursing, a commitment to continuing education appears to be a relatively new concept. There have always been nurses who are continuing learners throughout their professional lives. Too often, this is incidental, rather than planned. There appears to be a need to re-examine current approach in continuing nursing education.

Multi-dimensional approach: a task for curriculum development.

Curriculum development is an issue of continuing concern to nurse educators. For the planning model to be effective, it must be compatible with, and actually facilitate, the implementation of the particular programme or practice that is to be used. In nursing, the process of curriculum construction is predominantly influenced by the linear approach. This planning model which has taken over nursing education at all levels and in all content areas seems neutral, but it is not. It carries with it a particular value position on human nature. This paper examines the value position of the linear model and its limitation, and proposes a multi-dimensional model as a possible alternative.

The nurse-client relationship: a mutual learning experience.

The nurse-client relationship is a mutual learning experience and a corrective emotional experience for the client. The terms 'learning' and 'corrective' imply a change in the participants' behaviour. Because the prospect of change is threatening, the skillful nurse provides a climate for the client that is conducive to expressing feelings at every step in the course of the nurse-client relationship. Both positive and negative feelings are appreciated; both are put into the service of the problem-solving venture other than being allowed to impede it. To the extent that this occurs, the nurse-client collaborative efforts further the experience of each participant.

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.