National population prevalence of antibodies to SARS-CoV-2 among pregnant women in Scotland during the second wave of the COVID-19 pandemic: a prospective national serosurvey

OBJECTIVES

This study aimed to determine SARS-CoV-2 seroprevalence among pregnant women in the Scottish population during the second wave of the COVID-19 pandemic.

STUDY DESIGN

Prospective national serosurvey.

METHODS

We tested 13,428 residual samples retrieved from pregnant women participating in the first trimester combined ultrasound and biochemical screening for fetal trisomy across Scotland for SARS-CoV-2 antibodies over a 6-month period from November 2020 to April 2021. Seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations.

RESULTS

Seroprevalence rates in the antenatal samples significantly increased from 5.5% (95% confidence interval [CI] 4.7%-6.5%) in the 5-week period up to and including International Organization for Standardization (ISO) Week 51 (w/b Monday 14 December 2020) to 11.3% (95% CI 10.1%-12.6%) in the 5-week period up to and including ISO Week 14 (w/b Monday 5 April 2021). Increasing seroprevalence trends across the second wave were observed among all age groups.

CONCLUSIONS

By the end of the second wave of the COVID-19 pandemic, approximately one in 10 women tested around the end of the first trimester of pregnancy had antibodies to SARS-CoV-2, suggesting that the vast majority were still susceptible to COVID-19 as they progressed to the later stages of pregnancy, when risks from infection are elevated for both mother and baby.

Translating Research into Agile Development (TRIAD): Development of Electronic Health Record Tools for Primary Care Settings

OBJECTIVES

This article describes a method for developing electronic health record (EHR) tools for use in primary care settings.

METHODS

The "Translating Research into Agile Development" (TRIAD) method relies on the close collaboration of researchers, end users, and development teams. This five-step method for designing a tailored EHR tool includes (1) assessment, observation, and documentation; (2) structured engagement for collaboration and iterative data collection; (3) data distillation; (4) developmental feedback from clinical team members on high-priority EHR needs and input on design prototypes and EHR functionality; and (5) agile scrum sprint cycles for prototype development.

RESULTS

The TRIAD method was used to modify an existing EHR for behavioral health clinicians (BHCs) embedded with primary care teams, called the BH e-Suite. The structured engagement processes stimulated discussions on how best to automate BHC screening tools and provide goal tracking functionality over time. Data distillation procedures rendered technical documents, with information on workflow steps, tasks, and associated challenges. In the developmental feedback phase, BHCs gave input on screening assessments, scoring needs, and other functionality to inform prototype feature development. Six 2-week sprint cycles were conducted to address three domains of prototype development: assessment and documentation needs, information retrieval, and monitoring and tracking. The BH e-Suite tool resulted with eight new EHR features to accommodate BHCs' needs.

CONCLUSION

The TRIAD method can be used to develop EHR functionality to address the evolving needs of health professionals in primary care and other settings. The BH e-Suite was developed through TRIAD and was found to be acceptable, easy to use, and improved care delivery during pilot testing. The BH e-Suite was later adopted by OCHIN Inc., which provided the tool to its 640 community health centers. This suggests that the TRIAD method is a promising research and development approach.

A guide to manufacturing CAR T cell therapies

In recent years, chimeric antigen receptor (CAR) modified T cells have been used as a treatment for haematological malignancies in several phase I and II trials and with Kymriah of Novartis and Yescarta of KITE Pharma, the first CAR T cell therapy products have been approved. Promising clinical outcomes have yet been tempered by the fact that many therapies may be prohibitively expensive to manufacture. The process is not yet defined, far from being standardised and often requires extensive manual handling steps. For academia, big pharma and contract manufacturers it is difficult to obtain an overview over the process strategies and their respective advantages and disadvantages. This review details current production processes being used for CAR T cells with a particular focus on efficacy, reproducibility, manufacturing costs and release testing. By undertaking a systematic analysis of the manufacture of CAR T cells from reported clinical trial data to date, we have been able to quantify recent trends and track the uptake of new process technology. Delivering new processing options will be key to the success of the CAR-T cells ensuring that excessive manufacturing costs do not disrupt the delivery of exciting new therapies to the wide possible patient cohort.

Decreased hippocampal translocator protein (18 kDa) expression in alcohol dependence: a [11C]PBR28 PET study

Repeated withdrawal from alcohol is clinically associated with progressive cognitive impairment. Microglial activation occurring during pre-clinical models of alcohol withdrawal is associated with learning deficits. We investigated whether there was microglial activation in recently detoxified alcohol-dependent patients (ADP), using [¹¹C]PBR28 positron emission tomography (PET), selective for the 18kDa translocator protein (TSPO) highly expressed in activated microglia and astrocytes. We investigated the relationship between microglial activation and cognitive performance. Twenty healthy control (HC) subjects (45±13; M:F 14:6) and nine ADP (45±6, M:F 9:0) were evaluated. Dynamic PET data were acquired for 90 min following an injection of 331±15 MBq [¹¹C]PBR28. Regional volumes of distribution (V_T) for regions of interest (ROIs) identified a priori were estimated using a two-tissue compartmental model with metabolite-corrected arterial plasma input function. ADP had an ~20% lower [¹¹C]PBR28 V_T, in the hippocampus (F(1,24) 5.694; P=0.025), but no difference in V_T in other ROIs. Hippocampal [¹¹C]PBR28 V_T was positively correlated with verbal memory performance in a combined group of HC and ADP (r=0.720, P<0.001), an effect seen in HC alone (r=0.738; P=0.001) but not in ADP. We did not find evidence for increased microglial activation in ADP, as seen pre-clinically. Instead, our findings suggest lower glial density or an altered activation state with lower TSPO expression. The correlation between verbal memory and [¹¹C]PBR28 V_T, raises the possibility that abnormalities of glial function may contribute to cognitive impairment in ADP.

MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial

BACKGROUND

Worldwide, depression is rated as the fourth leading cause of disease burden and is projected to be the second leading cause of disability by 2020. Annual depression-related costs in the United States are estimated at US $210.5 billion, with employers bearing over 50% of these costs in productivity loss, absenteeism, and disability. Because most adults with depression never receive treatment, there is a need to develop effective interventions that can be more widely disseminated through new channels, such as employee assistance programs (EAPs), and directly to individuals who will not seek face-to-face care.

OBJECTIVE

This study evaluated a self-guided intervention, using the MoodHacker mobile Web app to activate the use of cognitive behavioral therapy (CBT) skills in working adults with mild-to-moderate depression. It was hypothesized that MoodHacker users would experience reduced depression symptoms and negative cognitions, and increased behavioral activation, knowledge of depression, and functioning in the workplace.

METHODS

A parallel two-group randomized controlled trial was conducted with 300 employed adults exhibiting mild-to-moderate depression. Participants were recruited from August 2012 through April 2013 in partnership with an EAP and with outreach through a variety of additional non-EAP organizations. Participants were blocked on race/ethnicity and then randomly assigned within each block to receive, without clinical support, either the MoodHacker intervention (n=150) or alternative care consisting of links to vetted websites on depression (n=150). Participants in both groups completed online self-assessment surveys at baseline, 6 weeks after baseline, and 10 weeks after baseline. Surveys assessed (1) depression symptoms, (2) behavioral activation, (3) negative thoughts, (4) worksite outcomes, (5) depression knowledge, and (6) user satisfaction and usability. After randomization, all interactions with subjects were automated with the exception of safety-related follow-up calls to subjects reporting current suicidal ideation and/or severe depression symptoms.

RESULTS

At 6-week follow-up, significant effects were found on depression, behavioral activation, negative thoughts, knowledge, work productivity, work absence, and workplace distress. MoodHacker yielded significant effects on depression symptoms, work productivity, work absence, and workplace distress for those who reported access to an EAP, but no significant effects on these outcome measures for those without EAP access. Participants in the treatment arm used the MoodHacker app an average of 16.0 times (SD 13.3), totaling an average of 1.3 hours (SD 1.3) of use between pretest and 6-week follow-up. Significant effects on work absence in those with EAP access persisted at 10-week follow-up.

CONCLUSIONS

This randomized effectiveness trial found that the MoodHacker app produced significant effects on depression symptoms (partial eta(2) = .021) among employed adults at 6-week follow-up when compared to subjects with access to relevant depression Internet sites. The app had stronger effects for individuals with access to an EAP (partial eta(2) = .093). For all users, the MoodHacker program also yielded greater improvement on work absence, as well as the mediating factors of behavioral activation, negative thoughts, and knowledge of depression self-care. Significant effects were maintained at 10-week follow-up for work absence. General attenuation of effects at 10-week follow-up underscores the importance of extending program contacts to maintain user engagement. This study suggests that light-touch, CBT-based mobile interventions like MoodHacker may be appropriate for implementation within EAPs and similar environments. In addition, it seems likely that supporting MoodHacker users with guidance from counselors may improve effectiveness for those who seek in-person support.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02335554; https://clinicaltrials.gov/ct2/show/NCT02335554 (Archived by WebCite at http://www.webcitation.org/6dGXKWjWE).

A Value Chain Analysis of ghost nets in the Arafura Sea: identifying trans-boundary stakeholders, intervention points and livelihood trade-offs

Lost or discarded fishing nets are a significant component of marine debris which has trans-boundary impacts in large marine ecosystems. Such 'ghost nets' cause the by-catch of marine fauna and require retrieval from coastlines where they wash up. Identifying the causes of discarded nets and feasible intervention points requires analysis of a complex value chain and the stakeholders within it, yet no studies have attempted this. In this paper we combine Value Chain Analysis, commonly applied to understand value-adding for a commodity, with elements of Life Cycle Assessment and social network analysis to examine the drivers, stakeholders, economic, environmental and social costs and benefits in the life of a trawl net. We use the Arafura Sea as a case study, which is shared by Indonesia, Papua New Guinea and Australia, and is the focus of a Trans-boundary Diagnostic Assessment (TDA) within the Arafura-Timor Seas Ecosystem Action program (ATSEA). We follow a trawl net through four sub-systems: manufacture of webbing in South Korea, fishing and loss by an Indonesian vessel, retrieval as ghost net on the northern Australian coastline by Indigenous rangers, and disposal or re-cycling as 'GhostNet Art' by Indigenous artists. Primary stakeholders along the value chain incur economic and social benefits, and economic and environmental costs. There is an anomaly in the chain between Indonesian fishermen and Indigenous rangers, artists and communities due to the lack of market linkages between these primary stakeholders. The first 'nexus of influence' where reductions in net losses and environmental costs can be achieved is through interactions between GhostNets Australia, the World Wide Fund for Nature and the Australian Government, which can influence Indonesian fishery management institutions and fishing crews. The second nexus is via the international art market which by publicising GhostNet Art can raise awareness amongst fish consumers about the impacts of ghost nets, and hence influence Indonesian fishing companies. GhostNets Australia is a key bridging organisation in the network, linking stakeholders across scales and sub-systems. Feasible preventative interventions are discussed to rectify the anomaly in the value chain. The importance of GhostNets Australia and ATSEA in the evolving adaptive co-management and trans-boundary governance of fisheries is highlighted. However, the prevention of ghost nets will result in trade-offs in benefits for the livelihoods of primary stakeholders. The utility of the method for analysing marine debris in TDAs, and ATSEA in particular, is discussed.

Thunderstorm electrification of hail and graupel by polar dribble

Hail and graupel falling through rain collect water that selectively dribbles upward from the upper surface of a hailstone. When the hailstones are polarized by nearly vertical electrostatic field these vertically discharged water drops carry away free charge of the same sign as that induced on the upper surfaces. The hail thereby accumulates an equilibrium charge of opposite sign, corresponding to the charges induced on the bottom surfaces. The equilibrium charges are large enough to be important in thunderstorms.

Pindolol occupancy of 5-HT(1A) receptors measured in vivo using small animal positron emission tomography with carbon-11 labeled WAY 100635

Positron emission tomography (PET), following an intravenous injection of [carbonyl-(11)C]WAY 100635, was used to image central 5-HT(1A) receptors in rat following pretreatment with graded doses of (-)-pindolol (0.001-3 mg/kg, i.v.). The use of PET had advantages over ex vivo radioligand binding methods in that it produced parametric image volumes and reduced errors due to inter-rat variability. Time-radioactivity curves from regions of interest (ROI) acquired from individual rats enabled the estimation of specific binding of the radioligand using a compartmental model with reference tissue input. Binding potential (BP) of [(11)C]WAY 100635 was estimated for frontal cortex and hippocampus (postsynaptic), and midbrain raphe nuclei (presynaptic). In the latter ROI, pindolol dose-dependently decreased BP. The saturation curve could be fitted to a single-site model up to the lowest dose of pindolol used, giving an ED(50) (dose to cause 50% occupancy) value of 0.26 +/- 0. 05 mg/kg, and inclusion of control (nonpindolol-treated) rats did not affect the fit. In contrast, in cortex and hippocampus ROI, low doses of pindolol caused an increase in BP compared with controls. Pindolol doses greater than approximately 0.1 mg/kg, resulted in a dose-dependent decrease in BP, and ED(50) values in cortex and hippocampus were estimated as 0.44 +/- 0.13 and 0.48 +/- 0.12 mg/kg, respectively. The increase in [(11)C]WAY 100635 binding at low pindolol doses is feasibly related to a decrease in basal receptor occupancy following reduced release of endogenous 5-HT. Considering the apparently greater potency of pindolol at the midbrain raphe ROI, this effect could be mediated via agonist activity at the autoreceptor.

Nontuberculous mycobacterial otomastoiditis in children: four cases and a literature review

Otomastoiditis due to nontuberculous mycobacteria (NTM) is rare but increasingly being recognised. We present four cases and discuss the clinical presentation, pathogenesis, diagnosis, and treatment, with a review of previous case reports in the literature.

Phosphoinositol glycan derived mediators and insulin resistance. Prospects for diagnosis and therapy

While much work remains, the evidence has become strong that IPG generation following insulin action is a significant signaling mechanism. A considerable body of data has established IPG release by insulin and other growth factors from cell membranes, cells and in human blood and muscle biopsies in vivo. Two separate IPG species containing D-chiro-inositol and myo-inositol have been separated by ion exchange. These IPGs have separate actions in vitro and are both active as insulin surrogates in vivo. A deficiency of the chiro-inositol system has been demonstrated in urine and tissues in humans and directly related to insulin resistance. Accordingly, D-chiro-inositol was administered to STZ diabetic rats and rhesus monkeys and shown to decrease hyperglycemia and enhance glucose disposal. Two trials in humans with impaired glucose tolerance and women with PCOS have now also proven successful. Thus, the pathophysiology in the chiro-inositol system related to insulin resistance and its reversal by chiro-inositol administration, in addition to the basic work, argues strongly for the physiological significance of this novel signaling system in the control of glucose metabolism.

Timolol hemihydrate vs timolol maleate to treat ocular hypertension and open-angle glaucoma

PURPOSE

We compared the therapeutic efficacy and safety of timolol hemihydrate to timolol maleate in patients with ocular hypertension and chronic open-angle glaucoma.

METHODS

We conducted this three-month study as a multicentered, masked, parallel group comparison. Both the 0.25% and 0.5% concentrations were evaluated against similar concentrations of timolol maleate. Dosing was twice daily. An open-label, nine-month study followed the masked portion of the protocol, in which all patients received either 0.25% or 0.5% timolol hemihydrate. A total of 371 patients were included in both the 0.25% and 0.5% studies.

RESULTS

We found statistically similar intraocular pressures with both the 0.25% (18.3 and 18.6 mm Hg for the hemihydrate and maleate groups, respectively) and 0.5% (19.9 and 19.5 mm Hg for the hemihydrate and maleate groups, respectively) concentrations of timolol hemihydrate and timolol maleate after three months of masked treatment. Likewise, peak intraocular effect at two hours after taking the medication was statistically similar between medicines at both concentrations. Likewise, both ocular and systemic safety were similar between the maleate and hemihydrate preparations at both concentrations. In the nine-month open-label protocol, therapeutic efficacy (19.9 and 19.1 mm Hg for the 0.25% and 0.5% concentrations, respectively) and safety of timolol hemihydrate were similar to effect and safety of the three-month protocol.

CONCLUSIONS

This study suggests that timolol hemihydrate had an ocular hypotensive efficacy and safety profile statistically equivalent to that of timolol maleate for up to three months of therapy. Timolol hemihydrate showed efficacy and safety similar to that observed within the first three months, for up to one year of therapy.

A new human (psycho)pharmacology tool: the multiple organs coincidences counter (MOCC)

We describe a novel instrument which is capable of measuring the uptake of radioligand in human organs in vivo with the administration of very small doses of positron-emitting radioligands. This technique readily detects the displacement or reduced uptake of radioligand when a competitive agonist or antagonist is administered. This system provides no tomographic information, but the small radioactive doses involved mean that investigations can be repeated at regular intervals and that female volunteers can also participate. We administered [(11) C]flumazenil, [(11)C]diprenorphine, [(11)C]meta -hydroxyephedrine (MHED) and [(11)C]RTI 55 to healthy male volunteers and performed control, pre-loading and displacement experiments. These demonstrate the feasibility of using this technique to investigate benzodiazepine and opiate receptor occupancy, as well as occupancy at dopamine, noradrenaline and serotonin (5-HT) re-uptake sites. This method is likely to be useful in pharmacokinetic/pharmacodynamic experiments, in drug development and discovery and in the development of novel imaging radioligands.

High prevalence of syphilis detected through a jail screening program. A potential public health measure to address the syphilis epidemic

BACKGROUND

In June 1990, a syphilis initiative was undertaken to help control New York's most extensive syphilis epidemic since the 1940s.

METHODS

To evaluate the usefulness of syphilis screening in local jails, were reviewed demographic and syphilis screening data from a county jail in an area with a high prevalence of syphilis that has routinely tested incoming inmates.

RESULTS

Of 12,685 inmates, 9797 (77%) were screened for syphilis, and 321 (3.3%) had a positive test result; 258 (80%) of the positive results were confirmed. Data were available for 244 of the inmates with a confirmed positive result: 162 (67%) had newly diagnosed syphilis (overall rate, 1.6%), 112 of whom had early syphilis; 50 (20%) had been previously treated for syphilis; and 32 (13%) were unavailable for follow-up. Of 162 inmates with newly diagnosed syphilis, 122 (75%) were treated in jail, and 40 were treated after their release from jail. The median time from screening to treatment was 17 days. The median jail stay was 45 days for inmates who were evaluated for treatment vs 5 days for those who were unavailable for follow-up.

CONCLUSIONS

Screening inmates for syphilis was a productive public health measure, as inmates accounted for 20% of the county's syphilis morbidity. Given the high prevalence of syphilis among inmates and the inability to reach them for treatment after release, strategies are needed to rapidly screen and treat inmates before their release from jail.

Psychosocial factors, alcohol use, and hangover signs among social drinkers: a reappraisal

To reappraise a prior study of hangover signs and psychosocial factors among a sample of current drinkers, we excluded a subgroup termed Sobers, who report "never" being "tipsy, high or drunk." The non-sober current drinkers then formed the sample for this report (N = 1104). About 23% of this group reported no hangover signs regardless of their intake level or gender, and the rest showed no sex differences for any of 8 hangover signs reported. Using multiple regression, including ethanol, age and weight, it was found that psychosocial variables contributed independently in predicting to hangover for both men and women in this order: (1) guilt about drinking; (2) neuroticism; (3) angry or (4) depressed when high/drunk and (5) negative life events. For men only, ethanol intake was also significant; for women only, being younger and reporting first being high/drunk at a relatively earlier age were also predictors of the Hangover Sign Index (HSI). These multiple predictors accounted for 5-10 times more of the hangover variance than alcohol use alone: for men, R = 0.43, R2 = 19%; and for women, R = 0.46, R2 = 21%. The findings suggest that hangover signs are a function of age, sex, ethanol level and psychosocial factors.

Using the Short Michigan Alcoholism Screening Test to study social drinkers: Tecumseh, Michigan

The Short Michigan Alcoholism Screening Test (SMAST), often given to clinical samples to detect alcoholics, was used in a survey of a randomly selected sample (N = 1,266) in a small midwestern town, with a population of about 10,000. The specific aims were: (1) to test if scores on the SMAST would be related to these normal subject's levels of drinking; (2) to test if the SMAST could identify a drinking group who had never sought treatment for alcohol-related problems, thus defining a potential subset for help; and (3) to appraise the SMAST as a research tool for use in a general population. Results show that the number of SMAST items endorsed is significantly but modestly correlated to drinking levels, with higher volume drinkers having higher scores. This prediction was improved by removing two items reporting "not normal" drinking that had caused SMAST scores to be spuriously high. Factor analysis of test items allowed construction of five rank-ordered groups: those (1) reporting no alcohol-related SMAST problems; (2) described by two items, self-reported "not normal" drinking; (3) with one problem: "can't stop" drinking; (4) reporting problems but had not received treatment for them (the predicted group); and (5) reporting both problems and attempts at help with them (e.g., Alcoholics Anonymous). These latter two groups had significantly higher scores on several other measures of alcohol-related behavior, as well as tests measuring emotional adjustment, notably Eysenck's Neuroticism Scale and Buss and Plomin's measure of Impulsivity. The SMAST demonstrates potential usefulness in selecting problem, no-problem and patterns of use in drinkers from a normal drinking population when clusters of items are constructed to be exclusive in a Guttman-like rank order, rather than by sheer number of items endorsed or use of simple factor scores.

Non-O group 1 Vibrio cholerae gastroenteritis associated with eating raw oysters

A cluster of five cases of non-O group 1 (non-O1) V. cholerae gastroenteritis occurred in one Florida locality during November 1979. Clinical findings included nausea, vomiting, and abdominal cramping in all affected persons; two had bloody diarrhea. All five persons gave a history of eating raw oysters within four days of onset of illness. A case-control study statistically associated the eating of raw oysters with development of illness (p = 0.0008); this finding was confirmed by a retrospective cohort study of patients hospitalized for diarrhea (p = 0.0001). Non-O1 V. cholerae organisms were isolated from oysters and water samples taken from areas where ill persons had obtained their oysters. In at least one instance the same serotype was isolated from a patient's stool specimen and from the water where the patient had obtained oysters. Non-O1 V. cholerae infection must be considered in the differential diagnosis of shellfish-associated gastroenteritis.

Impedance of membrane and myoplasm during the action potential of frog muscle

The transient imbalance of a Wheatstone bridge was used to estimate the changes in both membrane and myoplasmic impedance that occurred as an action potential propagated over a 1 mm length of a frog muscle fiber. It was also used to estimate the changes in the membrane impedance alone. Alterations in myoplasmic impedance that might have been predicted were not found.

Thunderstorm Electrification and Raindrop Collisions and Disjection in an Electric Field

Raindrop collisions in an electric field selectively transfer charges of one sign to the larger disjected drops. The disjected drops, falling away from the smaller drops, separate free charge to establish electric fields as large as those observed in thunderstorms.