SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes

OBJECTIVES

To understand SARS-Co-V-2 infection and transmission in UK nursing homes in order to develop preventive strategies for protecting the frail elderly residents.

METHODS

An outbreak investigation involving 394 residents and 70 staff, was carried out in 4 nursing homes affected by COVID-19 outbreaks in central London. Two point-prevalence surveys were performed one week apart where residents underwent SARS-CoV-2 testing and had relevant symptoms documented. Asymptomatic staff from three of the four homes were also offered SARS-CoV-2 testing.

RESULTS

Overall, 26% (95% CI 22-31) of residents died over the two-month period. All-cause mortality increased by 203% (95% CI 70-336) compared with previous years. Systematic testing identified 40% (95% CI 35-46) of residents as positive for SARS-CoV-2, and of these 43% (95% CI 34-52) were asymptomatic and 18% (95% CI 11-24) had only atypical symptoms; 4% (95% CI -1 to 9) of asymptomatic staff also tested positive.

CONCLUSIONS

The SARS-CoV-2 outbreak in four UK nursing homes was associated with very high infection and mortality rates. Many residents developed either atypical or had no discernible symptoms. A number of asymptomatic staff members also tested positive, suggesting a role for regular screening of both residents and staff in mitigating future outbreaks.

Establishing a research network in Scotland more than doubles trial recruitment

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Background: Scotland has a population of 5.4 million people with 26, 000 new cases of cancer per annum. In 2002 the Scottish Executive established a research network covering all of the country with the objective of doubling recruitment to cancer trials within 3 years. Methods: A grant of £1million (circa $2 million) was provided to establish a network covering all of Scotland. The network was centred on 3 of the main cancer centres. Support staff consisting mainly of data managers and research nurses were employed in each region. Clinical trials were selected by interested clinicians from the existing NCRI portfolio in the UK. These trials were then opened in centres and regional units with the intention of recruiting patients locally. Each trial was approved by appropriate local university and NHS ethics, research and development boards. Recruitment numbers were collated by trials co-ordinators and compared with baseline figures derived from 2001–2 Results: 31 members of staff were recruited and trained. These were a mix of data managers and research nurses. In 2001, 927 patients were entered in trials which is 3.5% of all cases. In 2005 this had risen to 3557 (13.7% of all cases). These ranged across all the major common solid and haematological malignancies. In portfolio includes therapy studies in phase 1–3 including large scale RCTs, screening and prevention studies. The breakdown of patients treated within the cancer centres versus those in regional units indicated that the biggest impact on recruitment was in the latter. The network has introduced streamlined procedures for multiple ethics and R+D submissions which has facilitated recruitment in cancer units. Web based tools have been piloted to allow patient screening to be performed remote from the cancer centres. A breakdown of recruitment by trial and tumour type will be presented. Conclusions: Investment in infrastructure support in a targeted manner can very significantly improve trial recruitment.

No significant financial relationships to disclose.

Immunization information systems progress - United States, 2005

Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2005 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. These data indicated that approximately 56% of U.S. children aged <6 years participated in an IIS, an increase from 48% in 2004. Moreover, 75% percent of public vaccination provider sites and 44% of private vaccination provider sites submitted vaccination data to an IIS during July-December 2005. These findings underscore the need to increase the number of participating children, from the current 13 million to approximately 21 million, to assure 95% participation of children aged <6 years and improve the effectiveness of U.S. immunization programs.

Does intrathecal morphine alter the stress response following coronary artery bypass grafting surgery?

PURPOSE

Intrathecal morphine administered prior to coronary artery revascularization (CABG) surgery was studied to determine its effects on the stress response.

METHODS

In a single centre, open, randomized clinical trial, first time elective CABG surgery patients, < 75 yr, were studied. Control subjects (n=12) received a standardized anesthetic consisting of fentanyl (maximum cumulative dose of 35 microg x kg(-1)), propofol, and pancuronium. In addition, spinal subjects (n=13) received 1.0 mg (age > 60 yr) or 1.5 mg (age < or = 59 yr) intrathecal morphine prior to induction of anesthesia. Control subjects received continuous i.v. morphine at 2 mg x hr(-1) on arrival in the ICU with i.v. bolus morphine supplementation as required while spinal subjects received bolus i.v. morphine as required. Changes in plasma cortisol and catecholamine concentrations were measured preoperatively, poststernotomy, on admission to ICU, following tracheal extubation, at 0800 hr on the first postoperative day, and 24 and 48 hr after ICU admission.

RESULTS

No differences between groups were detected for demographic variables. The percent change in cortisol concentration relative to preoperative values (control vs spinal; (38 (87) vs -41 (46)%: P < 0.05)) was lower in the spinal group on admission to ICU. The percent change in plasma epinephrine levels (control vs spinal) on admission to ICU (285 (337) vs -10 (37)%) and 0800 hr after surgery (314 (341) vs -4 (37)%) was also significantly different.

CONCLUSION

Intrathecal morphine only partially attenuated the postsurgical stress response in CABG surgical patients.

The relationship of p53 immunostaining to survival in carcinoma of the lung

In this study 125 primary lung tumours have been immunostained with a panel of 5 anti-p53 antibodies (PAb240, PAb421, PAb1801, CM-1 and C19). These antibodies recognise different epitopes over the full extent of the p53 gene. It is generally believed that immunolabelling identifies only mutant p53 proteins due to the short half life of the wild type protein. The aims of this study were to confirm earlier studies of p53 positivity in human lung tumours and to establish whether or not this bore any relationship to survival. Immunostaining was demonstrated within the nuclei of affected cells in 54% of the 125 lung tumours (59% of 78 squamous cell carcinomas, 52% of 42 adenocarcinomas and 20% of five small cell carcinomas). This confirms previous smaller studies of p53 protein expression in human lung tumours. Survival curves have been drawn for all of the cases considered together and for squamous and adenocarcinomas separately. No differences in survival between p53 positive and negative cases were seen for any group of tumours. This indicates that although p53 may be of considerable importance in the initiation of malignancy it is probably of little significance once a tumour has developed.

Computer-assisted analysis of fetal heart rate patterns at 20-41 weeks' gestation

Fetal heart rate (FHR) monitoring and computer-assisted analysis of FHR patterns were used to study 190 normal pregnancies on one occasion at 20-41 weeks' gestation. The mean baseline FHR decreased, while the overall FHR variation, number of accelerations and time spent in high variation increased with gestation. The time spent in low variation did not change significantly with gestation. These data indicate that, in the interpretation of FHR patterns from high-risk pregnancies, it is necessary to make adjustments for gestational age.

Recognition of fused dichotic words: an examination of the effects of head-turn and perceived spatial position

Ear advantages for verbal stimuli were determined for male and female right-handed subjects using a fused dichotic words test. Subjects performed the word recognition task with their heads turned 90 degrees to the left, 90 degrees to the right, and straight ahead. In addition, subjects provided subjective judgements with regard to the perceived spatial position of the sound. A significant right ear advantage was evidenced under all three head turn conditions, although the magnitude of the REA was reduced in the right head turn condition. There was no significant effect of sex. Judgements of perceived spatial position indicated that subjects perceived the fused sound as coming from the centre of the head, regardless of the head's orientation with respect to the body. These findings suggest that ear of entry rather than the perceived position of a sound source is the major factor in determining the perceptual asymmetries observed with dichotic stimuli.

Early detection of genital chlamydial infection in women: an economic evaluation

A decision analysis model was constructed for comparison of early detection of asymptomatic genital chlamydial infection in women by the direct immunofluorescence antibody (DFA) test and the enzyme-linked immunosorbent assay (ELISA) with no intervention. Early-detection programs using the DFA test and ELISA were shown to be cost-effective in female populations where the prevalences of chlamydial infection exceeded 6% and 7%, respectively. Sensitivity analysis showed that the two most important factors were the probability of developing pelvic inflammatory disease and the cost of the test. The DFA method was more appropriate for an early-detection program because of its higher sensitivity.

The σ* molecular orbitals of perfluoroalkanes as studied by inner-shell electron energy loss and electron transmission spectroscopies

Absolute oscillator strength spectra in the C 1s (280–340 eV) and F 1s (680–740 eV) regions of the perfluoro-n-alkanes from C2 to C6 and perfluorocycloalkanes from C3 to C6 have been determined from inner-shell electron energy loss spectra recorded under electric-dipole scattering conditions. The spectral features are interpreted in terms of spatially localized transitions terminating at orbitals of predominantly σ*(C—F) and σ*(C—C) character. When compared to the spectra of the perfluoro-n-alkanes, both the C 1s and F 1s spectra of the perfluorocycloalkanes exhibit additional low-lying bands which are assigned to transitions terminating at σ*(C—C) orbitals which are shifted to low energy by the combination of the strain of cyclization and the inductive effect of the fluorination. The electron transmission spectra of selected perfluorocycloalkanes (which provide information on their anion states) show as well that the electron affinities of the cyclic systems are substantially lower than those of the corresponding perfluoro-n-alkanes, again as a result of a low-lying σ* orbital in the cyclic species. Quantum chemical calculations of the alkane and perfluoroalkane ground-state orbital structures support the experimental results. The localized character of the inner-shell excitations, indicated by the constancy of both term values and oscillator strengths with increasing chain length, contrasts with the more delocalized character of the states accessed in ultraviolet excitation or negative ion formation.

Carbon fiber reinforced plastic (CFRP) plates versus stainless steel dynamic compression plates in the treatment of fractures of the tibiae in dogs

In a series of 14 dogs, fractures of both tibiae were caused by a "bone-breaker" designed in the authors' department and observed to produce a consistent and realistic canine fracture. One tibia was plated with a carbon fiber reinforced plastic (CFRP) plate and the other with a dynamic compression (DC) plate. Roentgenographic examination demonstrated healing of the CFRP-plated tibiae with abundant callus, and almost total remodeling of the fracture callus between ten and 20 weeks. Biomechanical testing by three-point bending revealed little difference between the strength of union of the fractures at 12-16 weeks. At 20 weeks, although the numbers were too small for statistical confirmation, the CFRP-plated tibiae were consistently stronger than the DC-plated tibiae.

Winding one's ps and qs: mental rotation and mirror-image discrimination

Subjects were timed as they made judgments about ps and qs (also interpretable as ds and bs) in different angular orientations. Whether these judgments were left-right mirror-image discriminations (b vs. d or p vs. q) or up-down mirror-image discriminations (b vs. p or d vs. q), the subjects' reaction times increased sharply with the angular departure of each letter from its designated normal upright orientation, a fact implying mental rotation. This was so whether the subjects responded with the letter labels themselves (e.g., b vs. d) or with the labels left versus right or top versus bottom. It was again the case when the letters were replaced by nonletter forms, in which event there was also a left visual-field advantage in reaction time. This study is therefore the first to demonstrate a mental-rotation strategy when the canonical forms to be discriminated are up-down mirror images as well as when they are left-right mirror images. In both cases, however, the task requires the ability to tell left from right, and we suggest that this is the critical ingredient that induces mental rotation.

Interaction between perceived and imagined rotation

In Experiment 1, subjects performed a mental-rotation task in which they were timed as they decided whether rotated letters were normal or backwards. Between presentations of the letters, they watched a rotating textured disk that induced an aftereffect of rotary movement on the letters. The function relating reaction times to orientation was influenced asymmetrically by the aftereffect, suggesting that perceived movement interacts with imagined movement. Experiment 2 showed that the aftereffect produced a negligible influence on perceived orientation, suggesting that the influence of the aftereffect on mental rotation was not caused by changes in the perceived orientations of the letters. Detailed analysis of the mental-rotation functions suggested that the aftereffect may sometimes have induced subjects to rotate letters through the larger rather than the smaller angle back to the upright where the aftereffect was in the appropriate direction.

Interaction between perceived and imagined rotation

In Experiment 1, subjects performed a mental-rotation task in which they were timed as they decided whether rotated letters were normal or backwards. Between presentations of the letters, they watched a rotating textured disk that induced an aftereffect of rotary movement on the letters. The function relating reaction times to orientation was influenced asymmetrically by the aftereffect, suggesting that perceived movement interacts with imagined movement. Experiment 2 showed that the aftereffect produced a negligible influence on perceived orientation, suggesting that the influence of the aftereffect on mental rotation was not caused by changes in the perceived orientations of the letters. Detailed analysis of the mental-rotation functions suggested that the aftereffect may sometimes have induced subjects to rotate letters through the larger rather than the smaller angle back to the upright where the aftereffect was in the appropriate direction.

Extradural analgesia in obstetrics: a controlled trial of carbonated lignocaine and bupivacaine hydrochloride with or without adrenaline

Four local anaesthetic solutions (2% carbonated lignocaine with or without adrenaline and 0.5% bupivacaine HCl with or without adrenaline) were used randomly for 335 continuous lumbar extradural blocks in labour. Carbonated lignocaine caused a more rapid onset of analgesia than bupivacaine HCl. The addition of adrenaline made little difference to the onset times, prolonged markedly the duration of analgesia with carbonated lignocaine and had little effect on the duration of analgesia with bupivacaine HCl. Tachyphylaxis was a feature with carbonated lignocaine and adrenaline, but not with the other solutions. The incidence of unblocked segments was 7-9% in the four groups. The incidence of unilateral analgesia was 6% with plain lignocaine and 13% in the other groups. Complete pain relief occurred more frequently with bupivacaine HCl than with carbonated lignocaine and the use of adrenaline had little effect on the degree of analgesia.

Preventing pressure sores in hospital: controlled trial of a large-celled ripple mattress

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