Healthcare staff perceptions towards influenza and potential COVID-19 vaccination in the 2020 pandemic context

The COVID-19 pandemic generated renewed focus on infectious disease transmission in healthcare settings. This study aimed to evaluate staff perceptions towards influenza vaccination in the COVID-19 context. All healthcare workers within a major UK tertiary referral hospital were invited to answer a survey conducted from September 2^nd to 13^th, 2020. In all, 593 responses were received across a spectrum of roles; 44% reported they were more likely to get an influenza vaccine this year due to COVID-19; however, 10% felt that an influenza vaccine was less important due to social distancing. Additional questions evaluated intention to receive COVID-19 vaccination. There were substantial differences of opinion between staff groups.

Healthcare staff perceptions and misconceptions regarding antibody testing in the United Kingdom: implications for the next steps for antibody screening

BACKGROUND

Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. A number of comment and editorial articles have been published that raise concerns about antibody testing in this context. We present perceptions of National Health Service (NHS) healthcare workers in relation to SARS-CoV-2 antibody testing.

METHODS

An electronic survey regarding perceptions towards SARS-CoV-2 antibody testing was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing.

RESULTS

In total, 560 healthcare workers completed the survey (80% female; 25% of Black and Minority Ethnic background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean "social distancing is less important", with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives.

CONCLUSIONS

NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients.

Serotonergic modulation of cognition; An acute challenge

Serotonin is well known to affect the multifaceted construct of impulsivity. Lowering brain serotonin levels is shown to increase impulsive choice in delay-discounting tasks (1) but improves response inhibition in stop-signal paradigms. (2) Administration of the antidepressant citalopram in healthy people increases tendency to perform go choices in a Go/No-Go task independent of outcome valence (3). It is rather unclear thought how serotonergic neurotransmission affects several aspects of cognition. We administered a single dose of 20 mg escitalopram, a selective serotonin reuptake inhibitor, to 66 healthy participants, aged 18–45 years old, in a double-blind, randomized, placebo-controlled, parallel-groups study. Acute escitalopram administration had a beneficial effect on inhibitory control with reduced stop-signal reaction time observed in the treatment group. Participants made significantly more errors in a probabilistic learning task and had lower accuracy during the discrimination stage in an instrumental learning task thus indicating a learning impairment. More errors in the CANTAB intra-extra dimensional set shift task were also observed in the escitalopram-treated group. Our findings following acute administration of a clinically relevant dose of escitalopram show a dissociate role for serotonin in modulating cognition mediated by a potentially differential modulation of fronto-striatal loops.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Genomic architecture of human neuroanatomical diversity

Human brain anatomy is strikingly diverse and highly inheritable: genetic factors may explain up to 80% of its variability. Prior studies have tried to detect genetic variants with a large effect on neuroanatomical diversity, but those currently identified account for <5% of the variance. Here, based on our analyses of neuroimaging and whole-genome genotyping data from 1765 subjects, we show that up to 54% of this heritability is captured by large numbers of single-nucleotide polymorphisms of small-effect spread throughout the genome, especially within genes and close regulatory regions. The genetic bases of neuroanatomical diversity appear to be relatively independent of those of body size (height), but shared with those of verbal intelligence scores. The study of this genomic architecture should help us better understand brain evolution and disease.

Access to and utilization of neurologists by people with multiple sclerosis

OBJECTIVE

This study examined access to and use of neurologists among a broad, national sample of people with multiple sclerosis (MS); identified demographic, economic, and clinical factors associated with access and use; and examined differences in treatment and management of MS.

METHODS

We used computer-assisted telephone interviews to collect data from 2,156 people with MS on demographics, disease characteristics, and use of neurologists, other specialists, and disease-modifying agents (DMAs). We used chi(2) tests and logistic regressions to compare patients of neurologists and other providers and identify predictor variables and treatment factors associated with seeing neurologists.

RESULTS

For their usual MS care, 72.2% of participants saw a neurologist. The probability of seeing a neurologist was significantly lower for people who lacked health insurance, were poor, lived in rural areas, or were African American; had been ill for more than 15 years; had difficulty walking but did not use an assistive device; or required a wheelchair/scooter or were confined to bed. People who reported one to two relapses in the preceding year and women were significantly more likely to see neurologists. Patients of neurologists were significantly more likely to take a DMA, attend an outpatient rehabilitation program, or see an occupational therapist, urologist, or physical therapist.

CONCLUSIONS

People with multiple sclerosis who see neurologists are more likely than people who see other providers to receive treatment with disease-modifying agents and see rehabilitation specialists and urologists. While some people may choose other providers, economic, insurance, racial, and geographic factors appear to limit access to neurologists.

Decision making and neuropsychiatry

Abnormal decision making is a central feature of neuropsychiatric disorders. Recent investigations of the neural substrates underlying decision making have involved qualitative assessment of the cognition of decision making in clinical lesion studies (in patients with frontal lobe dementia) and neuropsychiatric disorders such as mania, substance abuse and personality disorders. A neural network involving the orbitofrontal cortex, ventral striatum and modulatory ascending neurotransmitter systems has been identified as having a fundamental role in decision making and in the neural basis of neuropsychiatric diseases. This network accounts for the dissociations among decision-making deficits in different clinical populations. Ultimately, a more refined and sophisticated characterization of such deficits might guide the early diagnosis and cognitive and therapeutic rehabilitation of these patients.

The effects of diffusible creosote-derived compounds on development in Pacific herring (Clupea pallasi)

The effects of diffusible creosote-derived compounds from weathered creosote-treated pilings on embryonic development in the Pacific herring were investigated. Parameters used to evaluate toxicity included embryonic development, cardiac function, embryo/larval activity (movement of developing embryos), hatching success, and larval morphology at hatch. For acute exposures, embryos were incubated in seawater containing either creosote-treated wood (creosote) or untreated wood (wood control), or seawater alone (control). All embryos adhering directly to creosote-treated wood and 40-50% of embryos not adhering to the creosote-treated wood failed to develop beyond the first few days of incubation. For surviving embryos, a 93% reduction in heart rate, and moderate to marked arrhythmia was observed. Surviving embryos also exhibited both an increase in frequency and an alteration in pattern of embryo/larval movement, with most embryos exhibiting tremors as compared with the vigorous movements of the control embryos. Cardiac function and embryo/larval movements of embryos exposed to untreated wood were not significantly different from controls. The hatching rate of embryos exposed to creosote was 90% lower than control embryos and 72.4% lower than embryos exposed to untreated wood, and the LC(50) for hatching success was 0.05 mg/l. Partial hatching (incomplete hatch) was observed in 15-20% of embryos exposed to creosote. All of the hatched larvae exposed as embryos to creosote exhibited morphological deformities, including scoliosis, pericardial edema and/or ascites. Similar effects were observed in embryos collected from creosoted pilings in San Francisco Bay, with a 72% decrease in hatching success compared with embryos collected from the Bay and severely deformed larvae. To investigate the combined effects of creosote and salinity on hatching success, larval morphology, and cardiac function, embryos were exposed to a sublethal concentration of creosote (0.003 mg/l) at three salinities; sub-optimal (8 parts per thousand (ppt)), optimal (16 ppt), and high salinity (28 ppt). The presence of creosote decreased hatching success at all three salinities, but the effect was greatest at 8 ppt (34% reduction) and the least in 28 ppt (14% reduction). The increased incidence of morphological abnormalities was also smallest at the high salinity (10% compared with 24 and 33% in 8 and 16 ppt). While exposure to creosote resulted in reduced heart rates at all three salinities, no additive effect of creosote and salinity was observed.

External fixation of subglottic tracheal stents

Bronchoscopically placed silicone stents are used increasingly for treating patients with tracheal stenosis due to benign or malignant airway disease. When stenosis occurs in the immediate subglottic region, however, complications of stent insertion, especially migration, are troublesome. The purpose of this report is to describe a technique of external fixation of subglottic stents that may be used when tracheotomy, Montgomery T-tubes, or other therapeutic measures are undesirable or have failed. This technique may also be considered in carefully selected patients with severe malacia and subglottic stenosis who have failed indwelling stent placement because of stent migration.

Ultrasound guided biopsy of nonpalpable and difficult to palpate thyroid masses

We reviewed our experience with ultrasound-guided biopsies of masses of the thyroid gland that were either nonpalpable or difficult to localize by palpation to evaluate the technique and correlate the results. Thirty-two biopsies were performed upon 25 patients whose clinical presentations were palpable nodule (six patients), throat discomfort (two patients), postpartial thyroidectomy follow-up evaluation (two patients), incidental discovery of a mass--by ultrasound of the neck (two patients), roentgenogram of the chest (two patients), computed tomography of the chest (one patient) and during tracheostomy placement (one patient). Other presentations were eliminate infection (one patient), odynophagia (one patient), hoarseness (one patient), cold nodule on a nuclear medicine study (one patient), hyperparathyroidism (one patient), rule out metastasis from carcinoma of the colon (one patient), persistent cough (one patient), enlarged thyroid gland (one patient) or family history of carcinoma of the thyroid gland (one patient). Fifteen patients had nuclear medicine studies showing either a cold nodule (ten patients), multinodular goiter (one patient), normal examination (two patients), hot nodule (one patient) or no thyroid gland activity (one patient). The ultrasound examinations showed either a hypoechoic nodule (25 patients), inhomogeneous or mixed echogenic nodule (six patients) or a hyperechoic nodule with hypoechoic rim (one patient). The nodules ranged in size from 3 milliliters to 7 centimeters. Twenty-six lesions were less than 3 centimeters in diameter; of the other six, four were substernal goiters. Six patients had a previous nondiagnostic biopsy directed by palpation only. Biopsy was performed using real-time ultrasound guidance with various needles. One patient had a small hematoma, which was the only complication in the study. The results of the biopsies were diagnostic in 26 of 32 patients. The final diagnosis was benign follicular cells (ten patients), adenomatous nodule (seven patients), follicular neoplasm (three patients), colloid cyst (two patients), aspergillus (two patients), fibrosis (one patient) and papillary carcinoma (one patient). Six of the biopsies yielded unsatisfactory specimens. One of the patients with a diagnosis of benign follicular cells on biopsy had a follicular carcinoma after surgical pathologic factors were obtained; that was the only false-negative result. We conclude that ultrasound-guided biopsy of the thyroid is a safe and useful method of evaluating nonpalpable and difficult to palpate thyroid masses.

Tagging and Cloning of a Petunia Flower Color Gene with the Maize Transposable Element Activator

We report here the use of the maize transposable element Activator (Ac) to isolate a dicot gene. Ac was introduced into petunia, where it transposed into Ph6, one of several genes that modify anthocyanin pigmentation in flowers by affecting the pH of the corolla. Like other Ac-mutable alleles, the new mutation is unstable and reverts to a functional form in somatic and germinal tissues. The mutant gene was cloned using Ac as a probe, demonstrating the feasibility of heterologous transposon tagging in higher plants. Confirmation that the cloned DNA fragment corresponded to the mutated gene was obtained from an analysis of revertants. In every case examined, reversion to the wild-type phenotype was correlated with restoration of a wild-type-sized DNA fragment. New transposed Acs were detected in many of the revertants. As in maize, the frequency of somatic and germinal excision of Ac from the mutable allele appears to be dependent on genetic background.

Bulk flow of the medium and cutaneous sodium uptake in frogs: potential significance of sodium and oxygen boundary layers

To examine the potential impact of fluid dynamic boundary layers on cutaneous ion exchange, we investigated how bulk flow of dilute Na+ solutions (&lt; or = 1.0 mmol l-1) over the skin of intact frogs (Rana catesbeiana and Rana pipiens) affects cutaneous Na+ uptake (JNa(in)) and transepithelial potential (TEP). Cessation of stirring resulted in a 14-35% decrease in TEP and a 14-65% decrease in JNa(in). Two weeks' acclimation to an unstirred bath increased JNa(in) to levels 70% greater than in frogs acclimated to a continuously stirred bath and to levels comparable to those of frogs acclimated to deionized water. These effects are consistent with depletion of Na+ in the boundary layer, but are also consistent with depletion of O2 in the boundary layer, which might limit generation of ATP consumed by ATPases responsible for cutaneous Na+ uptake. To investigate this latter possibility, we measured TEP and JNa(in) while manipulating the PO2 of well-stirred external media at constant [Na+]. Hyperoxia (PO2 &gt; or = 97 kPa) increased JNa(in) by 28% and had little or no effect on TEP. Hypoxia (PO2 &lt; or = 1.5 kPa) reduced JNa(in) by 48% and decreased TEP by 22%. These results suggest that ionic and gaseous boundary layers may interact to affect cutaneous ion transport.

Morphine-augmented cholescintigraphy: its efficacy in detecting acute cholecystitis

Cholescintigrams were performed in 158 patients suspected of having acute cholecystitis after administration of 185 Mbq (5 mCi) of 99mTc-mebrofenin or disofenin. Morphine sulfate, 0.04 mg/kg was given intravenously if there was nonvisualization of the gallbladder at 40-60 min provided that radiotracer was seen within the small bowel. Acute cholecystitis was deemed present if there was nonvisualization of the gallbladder 30 min post-morphine administration; no cystic duct obstruction was present if the gallbladder was demonstrated pre- or post-morphine administration. A final diagnosis was estimated in 51 postoperative patients histologically, the remainder having their final diagnosis gleaned from their medical records. The sensitivity, specificity, positive and negative predictive value of morphine-augmented cholescintigraphy in detecting acute cholecystitis was 94.6, 99.1, 97.2, and 98.3%, respectively. These findings indicate that morphine-augmented cholescintigraphy detects acute cholecystitis with as high a degree of accuracy as conventional hepatobiliary scintigraphy, yet requires only 1.5 hr to establish the diagnosis.

Cytogenetic studies of human brain tumors and their clinical significance. II. Meningioma

Cytogenetic study of 45 meningiomas from 31 female and 14 male patients are reported. No chromosomal abnormalities were found in nine (20%). These were predominantly meningotheliomatous, and were from younger patients (average age, 46 years). Monosomy 22 was noted in only 20% and in 12 patients (27%) with other losses and rearrangements. Among the latter, 50% were either recurrent or recurrent and invasive, the majority were fibromatous and occurred in older patients. Nonrandom loss was observed of the Y and abnormalities of chromosomes #1, #7, and #14 and, to a lesser extent, chromosomes #18, #19, and #20. Meningiomas may begin with no chromosomal abnormalities, having meningotheliomatous histopathologic appearance, occur in younger patients, and are less aggressive. Karyotypic evolution following loss of a chromosome #22 continues with losses and rearrangements of other chromosomes with apparent nonrandom involvement of chromosomes #1, #7, #14 and Y. This karyotypic change is associated with aggressive tumor behavior and fibromatous morphology.

Diagnosis and treatment of chalazia

A patient with recurrent chalazia is described. This patient also had acne rosacea. The clinical and histologic characteristics of chalazia are described. In addition, therapy for chalazia is presented, with emphasis being given to conservative therapy.

Linkage analysis of Von Recklinghausen neurofibromatosis: chromosomes 4 and 19

This report describes a study that examines the hypotheses of genetic linkage between the autosomal dominant disorder neurofibromatosis (NF) and loci on human chromosomes 4 and 19. Twelve Utah families were evaluated for evidence of possible linkage of NF to six known markers on chromosome 4 and five markers on chromosome 19. Due to previous reports suggesting tight linkage of NF to the GC locus on chromosome 4 and the C3 (linked to myotonic dystrophy) locus on chromosome 19, these two markers were of particular interest. For the Utah families the cumulative LOD score for GC was -4.81 (r = 0.05). Cumulative LOD scores were -0.90 (r = 0.05) and -1.01 (r = 0.05) for C3 serum determinations and a C3 DNA polymorphism respectively. Linkage data is also included on all individual informative families for the GC and C3 loci to specifically address the question of heterogeneity. Linkage data is consistent with, but does not strongly support, the existence of heterogeneity implicating both the GC locus on chromosome 4 and the C3 locus on chromosome 19. A compilation of cumulative LOD scores from this and other current linkage studies produces values that in the absence of heterogeneity refute previous reports for tight linkage of NF to GC and to C3.

Resistance of cerclage to knot failure

The comparative ability of loop-knotted and twist-knotted cerclage to withstand tensile forces was tested. Two twist-knot devices and one loop-knot device were used to apply cerclage wires to a 5-cm diameter split circular jaw mounted on a tensile testing machine. Twist-knot devices were tested with 0.8-, 1.0-, or 1.2-mm wire, and the loop-knot device was tested with 0.8-, 1.0-, or 1.25-mm wire. For all wire sizes, the twisted knot provided greater resistance to knot failure than did the loop-knot. Of the 2 twist-knot devices, the Rhinelander wire tightener-twister produced the greatest resistance to knot failure. Knot resistance increased with increase in wire size for all devices tested.

Linkage studies between polymorphic markers on chromosome 4 and cystic fibrosis

It has been suggested that a protein factor causing ciliary dyskinesis is a marker for the basic defect causing cystic fibrosis (CF), and that the structural gene for this protein may be (amongst others) on human chromosome 4. We have isolated two DNA sequences mapping to chromosome 4 which show restriction fragment length polymorphisms (RFLPs), and have followed their segregation in families in which cystic fibrosis occurs. Eleven families with a total of 30 children with CF and ten unaffected sibs were studied. We have also followed the inheritance of RFLPs revealed by two probes mapping to chromosome 4 and obtained from another laboratory, polymorphisms revealed by cloned coding sequences for albumin and fibrinogen, and the inheritance of the MNS blood group. Although the level of albumin is altered in children with CF, the gene does not segregate with CF, and therefore albumin can be excluded as the site of the basic defect. Tight linkage with CF was not found with any of the seven markers investigated, and therefore, assuming that the markers (excepting MNS and fibrinogen) are unlinked to one another, approximately half of the total genetic length of chromosome 4 may be excluded.

The positions of three restriction fragment length polymorphisms on chromosome 4 relative to known genetic markers

A library of DNA sequences cloned in lambda phage has been prepared from DNA of chromosomes sorted by cytofluorimetry to give enrichment for chromosome 4. Five sequences have been assigned to chromosome 4 using a panel of hybrid cells, and each has been localised relative to a translocation breakpoint at 4q26. Each of the probes gives a Southern blot pattern which indicates that it does not cross-hybridize with sequences found on other human chromosomes. Three of the probes reveal frequent restriction fragment length polymorphisms (RFLPs) and are useful for linkage analysis.

Brainwashing and the persecution of "cults"

While the presence of authoritarian "cults" in our midst raises a number of social control and "law and order" issues, current controversies over cults contain substantial elements of mystification. "Brainwashing" is an inherently subjective metaphor that is used as a rationale for persecuting unpopular movements and defining religious converts as nonautonomous zombies who can be coerced for therapeutic purposes. While "coercive persuasion" models do have some heuristic value for the analysis of indoctrination in some authoritarian groups, assumptions regarding the alleged destruction of the "free will" of converts and the status of authoritarian religiosity as a medical pathology are not warranted.

Patients and pilgrims. Changing attitudes toward psychotherapy of converts to eastern mysticism

The eastern mystical tradition's movement into American life is depicted in this paper, which reports on the intriguing pattern of changing attitudes toward the use of psychotherapy among many members of the two major groups studied and also suggests a new rationale to justify psychotherapy.

Plasma concentrations of L-dopa and 3-methoxydopa and improvement in clinical ratings and motor performance in patients with Parkinsonism treated with L-dopa alone or in combination with amantadine

Six patients with idiopathic Parkinsonism were treated with a combination of amantadine and L-dopa and after 12 to 24 weeks amantadine was replaced by placebo for a six week period in a double-blind trial. Although there was a tendency for clinical disability ratings and scores on objective ratings of motor skills to deteriorate initially after amantadine removal, there was no significant deterioration in clinical improvement or motor performance during the period of amantadine withdrawal. Amantadine withdrawal also failed to cause any significant change in plasma concentrations of L-dopa or its metabolite 3-methoxy-dopa in these patients. In a group of 27 patients seen regularly as outpatients measurements of plasma L-dopa failed to correlate significantly with either oral dose or with clinical improvement scores. The plasma concentration of 3-methoxy-dopa, however, was on average 2.8 times higher than that of L-dopa, and there was a significant correlation between plasma levels of this metabolite and clinical improvement. It is suggested that 3-methoxy-dopa may contribute significantly to the therapeutic actions of L-dopa in Parkinsonism.