Diagnostic Accuracy of Conjunctival Rt-Pcr in Sars-Cov-2: A Systematic Review and Diagnostic Accuracy Meta-Analysis

PURPOSE

To study the positivity rate of conjunctival realtime polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

DESIGN

Systematic review and diagnostic accuracy meta-analysis.

METHODS

MEDLINE and EMBASE were queried using medical subject headings terms. Diagnostic accuracy meta-analyses and forest plots were obtained using the RevMan software.

RESULTS

After deduplication, appraisal of abstract titles and full-text analysis of 1441 articles, 42 articles with 3351 COVID-19 patients were included in this review. Of these, 412 conjunctival swabs/Schirmer paper strips tested positive for SARS-CoV-2 by RT-PCR. The pooled sensitivity of the RT-PCR tests across the 24 studies with laboratory-confirmed COVID-19 patients was 10.3%.

CONCLUSIONS

Only 1 in 10 RT-PCR tests performed on conjunctival swabs were positive for SARS-CoV-2. Although this suggests that SARS-CoV-2 is likely present and detectable in the conjunctiva, this detection method has low diagnostic potential.

[The role of the urology nurse in prehabilitation and same-day discharge robot-assited radical prostatectomy programs]

INTRODUCTION

The purpose of this article is to explain the role of urology nurse in prehabilitation and same-day discharge programs for robotic radical prostatectomy.

METHODS

This article is based on the analysis of the literature and the experience of our center.

RESULTS

In order to prepare patients for outpatient surgery, urology nurse plays a key role during prehabilitation journeys. Two weeks before the operation, the healthcare teams (nurses, anesthetists, physiotherapists, etc.) organize workshops to explain to patients the operation course and post-operative care in order to allay any anxieties. Individual and group interviews, in specific workshops (compression stockings, urinary catheter, sexology) are organized in particular with urology nurse to answer all patients' questions. In association with enhanced recovery after surgery pathway, these programs improve the patient experience and satisfaction as well as peri-operative outcomes, and allows the development of an outpatient surgery program which currently represents approximately one third of surgeries.

CONCLUSION

The implementation of perioperative protocols including prehabilitation improves the early results of robotic total prostatectomy, but also the patient experience. The urology nurse has a key role to play during these patient education days and in the preparation, information, support and follow-up of the patient, since the prehabilitation journey until the patient leaves the outpatient clinic.

0777 Variations in Vigilance and Sleep Among Underground Mine Workers During 14 Consecutive Night Shifts

Introduction

Adverse effects of night shift work are well known but there is scarce data on how vigilance and sleep vary across a large number of consecutive night shifts.

Methods

In summer, 38 underground miners (mean age (SD): 36.8 (13.9) years) wore an actigraph, filled out the Morningness-Eveningness questionnaire, and completed a Visual Analog Scale capturing subjective vigilance (very sleepy to very alert) 4 times per shift (19:00, 22:00, 02:00, and 05:30) for 14 consecutive night shifts. Mixed effects linear regression models were used to account for repeated measures.

Results

Mean vigilance level is lower at 22:00, 02:00 and 05:30 than at the beginning of the shift at 19:00 (p<0.001). Also, a more pronounced decrease in vigilance during the night was observed among older workers compared to younger workers (p<0.05). Moreover, workers with greater eveningness have higher vigilance at the beginning of the first night shift at 19:00 (p<0.001), but their decline in vigilance level during the night is faster than that observed in workers with greater morningness (p<0.01). Interestingly, the mean vigilance decline observed at 02:00 and 05:30 (compared to 19:00) is slowed down for each additional night shift (p<0.001). Furthermore, mean sleep efficiency is negatively associated with morningness and gradually decreases across consecutive night shifts (p<0.05). In addition, mean sleep duration is shorter in older workers and is positively associated with morningness (p<0.05).

Conclusion

Results show a progressive improvement in vigilance of mine workers assigned to a large number of consecutive 12-hour night shifts from 2 am onwards. This may probably be ascribed to an adjustment in homeostatic sleep propensity consecutive to the partial sleep deprivation associated with time spent traveling to the remote site before the first shift. However, circadian adjustment is unlikely considering the strong morning light exposure experienced daily after the night shift.

Support

College and Community Innovation Program of the Natural Sciences and Engineering Research Council of Canada (NSERC) (CUI2I 472201-14)

Associations among oxytocin receptor gene (OXTR) DNA methylation in adulthood, exposure to early life adversity, and childhood trajectories of anxiousness

Recent models propose deoxyribonucleic acid methylation of key neuro-regulatory genes as a molecular mechanism underlying the increased risk of mental disorder associated with early life adversity (ELA). The goal of this study was to examine the association of ELA with oxytocin receptor gene (OXTR) methylation among young adults. Drawing from a 21-year longitudinal cohort, we compared adulthood OXTR methylation frequency of 46 adults (23 males and 23 females) selected for high or low ELA exposure based on childhood socioeconomic status and exposure to physical and sexual abuse during childhood and adolescence. Associations between OXTR methylation and teacher-rated childhood trajectories of anxiousness were also assessed. ELA exposure was associated with one significant CpG site in the first intron among females, but not among males. Similarly, childhood trajectories of anxiousness were related to one significant CpG site within the promoter region among females, but not among males. This study suggests that females might be more sensitive to the impact of ELA on OXTR methylation than males.

Self-Blame and Avoidance Coping as Predictors of Post-Traumatic Stress Symptoms Among Sexually Abused Children

BACKGROUND: Child sexual abuse is clearly associated with posttrau-matic stress symptoms (PTSS). Prior studies have identified self-blame and coping as important predictors of PTSS among adult survivors of sexual assault. However, few studies have explored the potential impact of self-blame and avoidance coping in influencing PTSS in children who have disclosed sexual abuse.

OBJECTIVES: This study attempted to test the contribution of self-blame and avoidance coping to the prediction of PTSS among sexually abused children. The severity of the abuse and child’s gender were also examined.

DESIGN/METHODS: The sample consisted of 477 sexually abused children (319 girls and 128 boys), aged 6 to 12. Self-blame and PTSS were evaluated by the Children’s Impact of Traumatic Events Scale II. A brief version of the Self-Report Coping Scale was used to assess children’s coping avoidance. These questionnaires were child self-report measures. The severity of the abuse was categorized as (1) less severe (physical contact over clothing), (2) severe (physical contact under clothing without penetration or force) and (3) more severe (physical contact with penetration or attempted penetration). Linear regression analysis was used to test the contribution of self-blame and avoidance coping to the prediction of PTSS. First, the child’s gender and the severity of the abuse were entered, and secondly, self-blame and avoidance coping.

RESULTS: A total of 10.7% of the sample reported less severe sexual abuse, 27.7% reported severe sexual abuse and 61.6% reported more severe abuse. The model which only included child’s gender and severity of the abuse explained 3.8% of the variance (F=9.04, p<0.001) in PTSS. Adding self-blame and avoidance coping, the proportion of explained variance increased to 35.1% (F=56.62%, p<0.001). Being a girl (beta=0.15, p<0.001), reporting high levels of self-blame (beta=0.26, p<0.001) and using avoidance coping (beta=0.43, p<0.001) were predictors of PTSS. The severity of the abuse was significant into the first model (beta=0.14, p=0.004), but not into the final one (beta=0.08, p=0.057).

CONCLUSION: Results suggest that sense of self-blame and using avoidance coping are important targets for clinical intervention with sexually abused children, because these factors contribute to the prediction of PTSS among this vulnerable population.

Health Impact of Adverse Childhood Experiences Among Youths in Custody: The Significant Contribution of Sexual Abuse

BACKGROUND: Growing evidence suggests a graded relationship between adverse childhood experiences (ACE) and unfavorable health outcomes as early as in the teenage years. Youths under the welfare protection system represent an especially vulnerable group - presenting traumatic personal trajectory while cumulating family related-risk factors. Among early life adversities, specific experience might have a greatest contribution on the long-term health-risk.

OBJECTIVES: The objective of this analysis is to evaluate the contribution of sexual abuse as compare to other ACEs on different health issues in adolescent under court custody.

DESIGN/METHODS: This is a secondary analysis from a cross-sectional health evaluation study of youths in custodial facilities (2011-13). A total of 315 teenagers 14-17 y.o. (134 girls, 181 boys) completed a self-reported questionnaire about their health status and were then evaluated by a nurse/ doctor using a comprehensive standardized data collection checklist. We identified 8 ACEs: (1) single family; (2) violent death of family member; family history of (3) incarceration, (4) mental health issues, (5) substance abuse; personal history of (6) intrafamilial or (7) extrafamilial physical abuse; personal history of (8) sexual abuse. Multiple and logistic regression were performed between the ACEs and a number of relevant variables.

RESULTS: A personal history of sexual abuse was the most consistant ACE predicting negative health outcomes including perceived health status (R2=0.04; p=0.05), number of health problems identified / acute or chronic (p=0.00), psychosomatic complaints (R2=0.12; p=0.00), sleeping problems (OR=2.8; p=0.005), medication (OR=3.5; p=0.01). This trauma was also the most important factor for high-risk sexuality items evaluated: number of sexuality-related problems in girls (R2=0.15; p=0.00), vaginal sex before 13 y.o. (OR=1.8; p=0.48), number of partners (R2=0.04; p=0.03), sex work (OR=9.6; p=0.00), fear of STI (OR=3.2; p=0.001), as it was for mental health issues: mental health disorders (OR=4.3; p=0.00), suicidal ideation (OR=4.0; p=0.00), suicidal attempt (OR=3.6; p=0.00), self-inflicting injuries (R2=0.12 ; p = 0.01), depression (R2=0.08 ; p=0.00), low self-esteem (R2=0.07; p=0.00) and overdose (OR=2.1; p=0.02).

CONCLUSION: Among ACEs, a personal history of sexual abuse seems to be the most contributing factor for significant health outcomes. Some traumatic or adverse childhood events have a greater burden on subsequent health-risk. A simple question could help identified those at higher risk and higher needs for health services in teens under custody.

Multilayer four-flux matrix model accounting for directional-diffuse light transfers

The four-flux model is a method to solve light radiative-transfer problems in planar, possibly multilayer structures. The light fluxes are modeled as two collimated and two diffuse beams propagating forward and backward perpendicularly to the layer stack. In the present contribution, we develop a four-flux model relying on a matrix formalism to determine the reflectance and transmittance factors of stacks of components by knowing those of each individual component. This model is also extended to generate the bidirectional scattering distribution function of the stack by considering an incoming collimated flux in any direction and by taking into account the directionality of the diffuse fluxes exiting from the material at the border components of the stack. The model is applied to opaque Lambertian backgrounds with flat or rough interfaces for which analytical expressions of the BSDF are obtained.

The story of an exceptional serine protease, tissue-type plasminogen activator (tPA)

The only acute treatment of ischemic stroke approved by the health authorities is tissue recombinant plasminogen activator (tPA)-induced thrombolysis. Under physiological conditions, tPA, belonging to the serine protease family, is secreted by endothelial and brain cells (neurons, astrocytes, microglia, oligodendrocytes). Although revascularisation induced by tPA is beneficial during a stroke, research over the past 20 years shows that tPA can also be deleterious for the brain parenchyma. Thus, in this review of the literature, after a brief history on the discovery of tPA, we reviewed current knowledge of mechanisms by which tPA can influence brain function in physiological and pathological conditions.

The molecular legacy of apoptosis in transplantation

Transplanted organs have to cope with diverse immunologic and metabolic stressors that augment the percentage of stressed and dying cells. Cell death, whether apoptotic or necrotic, is crucial in various transplantation-associated conditions. Necrosis, a proinflammatory type of cell death classically considered as accidental, is increasingly recognized as a highly controlled death program. Apoptosis, the classical programmed cell death mode program, is tightly orchestrated and culminates in the activation of caspases. Apoptosis was classically regarded as a silent form of cell death, but mounting evidence indicates that apoptotic cells "don't go silently" and leave a heritage to the local microenvironment. This apoptotic legacy, embedded within the effector phase of apoptosis, is aimed, at least in part, at controlling leukocyte trafficking and fostering tissue remodeling at sites of apoptotic cell deletion and can promote maladaptive remodeling pathways of importance for obliterative vascular remodeling. Moreover, apoptotic cells can transfer bioactive molecules by the release of apoptotic membrane vesicles that, in turn, shapes the phenotype and functions of immune cells. In this review, we summarize recent data highlighting the importance of apoptosis-associated intercellular communication networks in the regulation of allograft remodeling and immune responses in transplantation.

Targeting neonatal ischemic brain injury with a pentapeptide-based irreversible caspase inhibitor

Brain protection of the newborn remains a challenging priority and represents a totally unmet medical need. Pharmacological inhibition of caspases appears as a promising strategy for neuroprotection. In a translational perspective, we have developed a pentapeptide-based group II caspase inhibitor, TRP601/ORPHA133563, which reaches the brain, and inhibits caspases activation, mitochondrial release of cytochrome c, and apoptosis in vivo. Single administration of TRP601 protects newborn rodent brain against excitotoxicity, hypoxia-ischemia, and perinatal arterial stroke with a 6-h therapeutic time window, and has no adverse effects on physiological parameters. Safety pharmacology investigations, and toxicology studies in rodent and canine neonates, suggest that TRP601 is a lead compound for further drug development to treat ischemic brain damage in human newborns.

Differences and similarities in the serotonergic diathesis for suicide attempts and mood disorders: a 22-year longitudinal gene-environment study

To investigate similarities and differences in the serotonergic diathesis for mood disorders and suicide attempts, we conducted a study in a cohort followed longitudinally for 22 years. A total of 1255 members of this cohort, which is representative of the French-speaking population of Quebec, were investigated. Main outcome measures included (1) mood disorders (bipolar disorder and major depression) and suicide attempts by early adulthood; (2) odds ratios and probabilities associated with 143 single nucleotide polymorphisms in 11 serotonergic genes, acting directly or as moderators in gene-environment interactions with childhood sexual or childhood physical abuse (CPA), and in gene-gene interactions; (3) regression coefficients for putative endophenotypes for mood disorders (childhood anxiousness) and suicide attempts (childhood disruptiveness). Five genes showed significant adjusted effects (HTR2A, TPH1, HTR5A, SLC6A4 and HTR1A). Of these, HTR2A variation influenced both suicide attempts and mood disorders, although through different mechanisms. In suicide attempts, HTR2A variants (rs6561333, rs7997012 and rs1885884) were involved through interactions with histories of sexual and physical abuse whereas in mood disorders through one main effect (rs9316235). In terms of phenotype-specific contributions, TPH1 variation (rs10488683) was relevant only in the diathesis for suicide attempts. Three genes contributed exclusively to mood disorders, one through a main effect (HTR5A (rs1657268)) and two through gene-environment interactions with CPA (HTR1A (rs878567) and SLC6A4 (rs3794808)). Childhood anxiousness did not mediate the effects of HTR2A and HTR5A on mood disorders, nor did childhood disruptiveness mediate the effects of TPH1 on suicide attempts. Of the serotonergic genes implicated in mood disorders and suicidal behaviors, four exhibited phenotype-specific effects, suggesting that despite their high concordance and common genetic determinants, suicide attempts and mood disorders may also have partially independent etiological pathways. To identify where these pathways diverge, we need to understand the differential, phenotype-specific gene-environment interactions such as the ones observed in the present study, using suitably powered samples.

[The evaluation of the program "Prejudices...I did not know!" by high school students]

This paper presents an evaluation of the impact of a program designed to reduce negative attitudes in adolescents towards individuals suffering from mental illness and their relatives. In a quasi-experimental design involving 16 senior high school classes, a group of 214 students participating in the prevention program "Les préjugés ... j'connais pas!" completed a knowledge questionnaire, a questionnaire focusing on attitudes towards persons with mental illness and a social distance instrument, and were compared to a control group of 159 adolescents. Results indicate that high school students participating in the prevention program show greater knowledge and report more favourable attitudes towards individuals with mental illness than control students. Moreover, data suggest that those students who took part in the program are less negative about social relationships with people who have mental illness problems.

Proximate effects of a child sexual abuse prevention program in elementary school children

OBJECTIVE

The effects of the sexual child abuse prevention program ESPACE were evaluated by means of a Solomon-type design with first and third grade children. ESPACE is an adaptation of the American Child Assault Prevention Program (CAP). Possible side effects of the program were also examined.

METHOD

A total of 133 children (64 first-graders and 69 third-graders) participated in the study. Children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills towards abusive and potentially abusive situations. A follow-up measure (2 months) was administered to verify whether knowledge and skills were maintained.

RESULTS

Results indicated that children participating in the prevention program showed greater preventive knowledge and skills relative to children not participating. Follow-up data showed that knowledge gains were maintained while the preventive skill gains may attenuate. However, while global skill scores decreased between post-test and follow-up, children still showed greater preventive skills at follow-up than before the program. In terms of unanticipated side effects, results revealed that almost half of the parents noted positive reactions following children's participation in the ESPACE program. Furthermore, the majority of parents did not identify negative reactions in their children following their participation in the workshop.

CONCLUSION

The findings suggest that the Quebec adaptation of the CAP program was effective in training children in abuse prevention concepts and skills.

The attitude of Canadian nurses towards advance directives

This article seeks to shed light on the beliefs that influence nurses' intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses' beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients' wishes, nurses should be aware that they do not systematically guarantee respect of a patient's autonomy, nor do they replace a relationship based on trust between patients and health care professionals.

[Contribution of individual characteristics to learning by children with first exposure to a prevention of abuse program]

This study explores the contribution of personal characteristics in the knowledge and skills gains of children taking part in the child abuse prevention program ESPACE. The program is an adaptation of the widely implemented American Child Assault Prevention Program (CAP). A group of 107 fourth-grade children completed a knowledge questionnaire and a video vignette measure designed to evaluate preventive skills in abusive and potentially abusive situations. Children were also invited to complete questionnaires evaluating individual characteristics such as self-esteem, locus of control and self-efficacy. The results highlight the importance of certain individual variables such as the child's gender, self-efficacy and perception of athletic competence in the acquisition of sexual abuse preventive skills.

Introducing an evaluation of community based occupational therapy services: a client-centred practice

The results of a study conducted in 1996 by the "Groupe de recherche en ergothérapie communautaire" (GREC), indicate that the quality of occupational therapy services in community settings is infrequently evaluated. A conceptual framework supporting such a process is presented in the context of client-centered services with a focus on continuous health care improvement. Both the research process leading to the design of an assessment tool, and its congruence with the beliefs and values of the profession, are explored. Finally, some issues relating to the implementation of a formal evaluation process are discussed.

Nocturnal melatonin secretion is not suppressed by light exposure behind the knee in humans

Ocular light exposure can phase shift circadian rhythms and suppress nocturnal melatonin production. A recent finding suggests that extraocular light can also produce phase shifts in humans. We investigated whether extraocular light could also suppress melatonin secretion in humans. We assayed the salivary melatonin of 16 subjects during a baseline night and an experimental night in dim light (10-20 lux). The experimental night included either: (1) 3-h ocular light exposure (1000 lux, n = 6); (2) 3-h extraocular light exposure behind the knee (13,000 lux, n = 7) or (3) constant dim light exposure (10-20 lux, n = 3). Melatonin suppression occurred with ocular light but not with extraocular light or constant dim light.

Coping strategies and social support as mediators of consequences in child sexual abuse victims

OBJECTIVE

The main objective of this study was to evaluate the mediator role of coping strategies and social support on the adaptation of children following CSA. Empirical studies indicate that short-term consequences of child sexual abuse (CSA) are multiple and varied (Kendall-Tackett, Williams, & Finkelhor, 1993; Wolfe & Birt, 1995). While abuse-related characteristics were first studied to explain the variability of CSA outcome, more recently, the influence of other variables such as coping strategies and social support have been considered.

METHOD

Fifty sexually abused children aged between 7 and 12 participated in this study. The Child Behavior Checklist (Achenbach, 1991) and the Perceived Competence Scale for Children (Harter, 1985) were used to measure victims' adjustment. Coping strategies were evaluated by the Self-Report Coping Scale (Causey & Dubow, 1992) and the children completed the Perceived Social Support (Harter, 1985). A French version of the History of Victimization (Wolfe, Gentile, & Bourdeau, 1987) was used to gather abuse-related characteristics from medical records.

RESULTS

Results indicate that sexually abused children exhibit internalizing and externalizing behavior problems following CSA. Coping strategies and social support exert direct effects on victims' adjustment instead of the mediator influences originally expected. Among abuse-related variables, only the perpetrator's identity is directly related to internalizing symptoms.

CONCLUSIONS

The absence of mediational effects of coping and social support is discussed in light of the measures used and the cross-sectional nature of the study. Results highlight the importance of parental implication and the consideration of coping strategies in designing therapeutic interventions with this population.

Reproducibility of ERG responses obtained with the DTL electrode

Previous investigators have suggested that the DTL fibre electrode might not be suitable for the recording of replicable electroretinograms. We present experimental evidence that when used adequately, this electrode does permit the recording of highly reproducible retinal potentials.