scholarly journals Implementing Building-Level SARS-CoV-2 Wastewater Surveillance on a University Campus

2021 ◽  
Author(s):  
Cynthia Gibas ◽  
Kevin Lambirth ◽  
Neha Mittal ◽  
Md Ariful Islam Juel ◽  
Visva Bharati Barua ◽  
...  
Keyword(s):  
Monitoring Program ◽  
Group Living ◽  
Cost Effective ◽  
Contact Tracing ◽  
Weekly Schedule ◽  
Term Care ◽  
Increased Risk ◽  
Asymptomatic Individuals ◽  
The University ◽  
Building Level

AbstractThe COVID-19 pandemic has been a source of ongoing challenges and presents an increased risk of illness in group environments, including jails, long term care facilities, schools, and, of course, residential college campuses. Early reports that the SARS-CoV-2 virus was detectable in wastewater in advance of confirmed cases sparked widespread interest in wastewater based epidemiology (WBE) as a tool for mitigation of COVID-19 outbreaks. One hypothesis was that wastewater surveillance might provide a cost-effective alternative to other more expensive approaches such as pooled and random testing of groups. In this paper, we report the outcomes of a wastewater surveillance pilot program at the University of North Carolina at Charlotte, a large urban university with a substantial population of students living in on-campus dormitories. Surveillance was conducted at the building level on a thrice-weekly schedule throughout the university’s fall residential semester. In multiple cases, wastewater surveillance enabled identification of asymptomatic COVID-19 cases that were not detected by other components of the campus monitoring program, which also included in-house contact tracing, symptomatic testing, scheduled testing of student athletes, and daily symptom reporting. In the context of all cluster events reported to the University community during the fall semester, wastewater-based testing events resulted in identification of smaller clusters than were reported in other types of cluster events. Wastewater surveillance was able to detect single asymptomatic individuals in dorms with total resident populations of 150-200. While the strategy described was developed for COVID-19, it is likely to be applicable to mitigation of future pandemics in universities and other group-living environments.

scholarly journals When Should Asymptomatic Persons Be Tested for COVID-19?

2020 ◽  
Vol 59 (1) ◽  
pp. e02563-20
Author(s):  
Audrey N. Schuetz ◽  
Peera Hemarajata ◽  
Ninad Mehta ◽  
Sheldon Campbell ◽  
Stephanie Mitchell ◽  
...  
Keyword(s):  
Medical Knowledge ◽  
Mitigation Measures ◽  
Contact Tracing ◽  
Severe Illness ◽  
Routine Surveillance ◽  
Increased Risk ◽  
Control And Prevention ◽  
American Society ◽  
Asymptomatic Individuals ◽  
American Society For Microbiology

ABSTRACTOn 24 August 2020, the Centers for Disease Control and Prevention (CDC) updated its website to highlight that asymptomatic individuals, even those with exposure to a COVID-19-positive contact, do not necessarily need to be tested unless they have medical conditions associated with increased risk of severe illness from COVID-19. The CDC subsequently updated its guidance on 19 September 2020 to support testing of asymptomatic persons, including close contacts of persons with documented SARS-CoV-2 infection. In this editorial, the American Society for Microbiology Clinical and Public Health Microbiology Committee’s Subcommittee on Laboratory Practices comments on testing of asymptomatic individuals relative to current medical knowledge of the virus and mitigation measures. Specific points are provided concerning such testing when undertaking contact tracing and routine surveillance. Limitations to consider when testing asymptomatic persons are covered, including the need to prioritize testing of contacts of positive COVID-19 cases. We urge the CDC to consult with primary stakeholders of COVID-19 testing when making such impactful changes in testing guidance.

scholarly journals Using Non-Pharmaceutical Interventions and High Isolation of Asymptomatic Carriers to Contain the Spread of SARS-CoV-2 in Nursing Homes

2021 ◽  
Author(s):  
Alec J. Schmidt ◽  
Yury García ◽  
Diego Pinheiro ◽  
Tom Reichert ◽  
Miriam A. Nuño
Keyword(s):  
Attack Rate ◽  
Group Living ◽  
Daily Basis ◽  
Contact Tracing ◽  
Term Care ◽  
Care Facilities ◽  
Degree Of Control ◽  
Antigen Tests ◽  
Pharmaceutical Interventions

ABSTRACTObjectiveUsing a pandemic influenza model modified for COVID-19, this study investigated the degree of control over pre-symptomatic transmission that common non-pharmaceutical interventions (NPIs) would require to reduce the spread in long-term care facilities.MethodsWe created a stochastic compartmental SEIR model with Poisson-distributed transition states that compared the effect of R0, common NPIs, and isolation rates of pre-symptomatic carriers primarily on attack rate, peak cases, and timing in a 200-resident nursing home. Model sensitivity was assessed with 1st order Sobol’ indices.ResultsThe most rigorous NPIs decreased the peak number of infections by 4.3 and delayed the peak by 9.7 days in the absence of pre-symptomatic controls. Reductions in attack rate were not likely, even with rigorous application of all defined NPIs, unless pre-symptomatic carriers were identified and isolated at rates exceeding 76%. Attack rate was most sensitive to the pre-symptomatic isolation rate (Sobol’ index > 0.7) and secondarily to R0.ConclusionsCommon NPIs delayed and reduced epidemic peaks. Reducing attack rates ultimately required efficient isolation of pre-symptomatic cases, including rapid antigen tests on a nearly daily basis. This must be accounted for in testing and contact tracing plans for group living settings.

Thrombophilia Screening

2014 ◽  
Vol 27 (3) ◽  
pp. 253-259 ◽  
Author(s):  
Lori B. Hornsby ◽  
Emily M. Armstrong ◽  
Jessica M. Bellone ◽  
Sarah Treadway ◽  
Haley M. Phillippe
Keyword(s):  
Anticoagulation Therapy ◽  
Factor V Leiden ◽  
Cost Effective ◽  
Factor V ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Unwanted Pregnancies ◽  
Thrombophilia Screening ◽  
Asymptomatic Individuals ◽  
The Individual

Although controversial, screening for thrombophilia has become common. Testing for antiphospholipid antibodies is indicated in order to guide treatment decisions if there is clinical suspicion for antiphospholipid syndrome. The utility of identifying other thrombophilias in symptomatic venous thromboembolism (VTE) is questionable, as the risk of recurrence does not appear to be increased by an appreciable degree with the most common disorders (heterozygosity for factor V Leiden or prothrombin mutation). Although recurrence appears to be increased in those with homozygous or multiple abnormalities and potentially deficiencies in natural anticoagulants, screening to detect these conditions is difficult to justify based on their rarity. The American College of Chest Physicians’ current guidelines note the increased risk of recurrence with idiopathic, proximal events regardless of thrombophilia status. They suggest duration of anticoagulation therapy be based on location and provoking factors rather than whether or not the individual has a thrombophilia. Because routine prophylaxis in asymptomatic individuals with thrombophilia is not recommended, screening of asymptomatic family members is difficult to justify. Screening prior to prescribing combination oral contraceptives is not cost effective, may result in unwanted pregnancies, and may have little effect on the overall rate of VTE.

ASSESSMENT OF THE PLATELET COUNT IN THE PREGNANT WOMEN IN IGIMS, PATNA, BIHAR

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Tanwi Singh ◽  
Anshuman Sinha
Keyword(s):  
Platelet Count ◽  
Pregnant Women ◽  
Screening Test ◽  
Low Cost ◽  
Medical Science ◽  
Cost Effective ◽  
Platelet Indices ◽  
Increased Risk ◽  
Low Platelet Count ◽  
Severity Of The Disease

The major risk associated with low platelet count in pregnancy is the increased risk of bleeding during the childbirth or post that. There is an increased blood supply to the uterus during pregnancy and the surgical procedure requires cutting of major blood vessels. Women with thrombocytopenia are at increased risk of losing excessive blood. The risk is more in case of caesarean delivery as compared to vaginal delivery. Hence based on above findings the present study was planned for Assessment of the Platelet Count in the Pregnant Women in IGIMS, Patna, Bihar. The present study was planned in Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India. The present study was planned from duration of January 2019 to June 2019. In the present study 200 pregnant females samples received for the platelet estimation were enrolled in the present study. Clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease. Platelet count is a simple, low cost, and rapid routine screening test. Hence the data generated from the present study concludes that platelet count can be used as a simple and cost effective tool to monitor the progression of preeclampsia, thereby preventing complications to develop during the gestational period. Keywords: Platelet Count, Pregnant Women, IGIMS, Patna, Bihar, etc.

scholarly journals Risk of Nursing Home Use Among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function

2021 ◽  
Author(s):  
Maria T Brown ◽  
Miriam Mutambudzi
Keyword(s):  
Nursing Home ◽  
Cognitive Function ◽  
Latent Class ◽  
Study Data ◽  
Psychiatric Training ◽  
Psychiatric History ◽  
Term Care ◽  
Increased Risk ◽  
Course Variables ◽  
The Impact

Abstract Objectives Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, 8-year cognitive function trajectories, and prospective incidence of nursing home use over a 10-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional, or nervous problems would be associated with a greater risk of nursing home use and that cognition trajectories with the greatest decline would be associated with a subsequent higher risk of nursing home use. Methods We used 8 waves (1998–2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified 4 distinct cognitive function trajectory classes (1998–2006): low-declining, medium-declining, medium-stable, and high-declining. Participants from the 1998 wave (N = 5,628) were classified into these 4 classes. Competing risks regression analysis modeled the subhazard ratio of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. Results Psychiatric history was independently associated with greater risk of nursing home use (subhazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06–1.51, p < .01), net the effects of life course variables. Furthermore, “low-declining” (SHR 2.255, 95% CI 1.70–2.99, p < .001) and “medium-declining” (2.103, 95% CI 1.69–2.61, p < .001) trajectories predicted increased risk of nursing home use. Discussion Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.

scholarly journals Sample-Pooling Strategy for SARS-CoV-2 Detection among Students and Staff of the University of Sannio

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1166
Author(s):  
Immacolata Polvere ◽  
Elena Silvestri ◽  
Lina Sabatino ◽  
Antonia Giacco ◽  
Stefania Iervolino ◽  
...  
Keyword(s):  
Quantitative Polymerase Chain Reaction ◽  
Virus Detection ◽  
Testing Procedures ◽  
Stem Infection ◽  
In Vitro Diagnostic ◽  
Sample Pooling ◽  
Pooling Strategy ◽  
Asymptomatic Individuals ◽  
The University

Since the beginning of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, it has been clear that testing large groups of the population was the key to stem infection and prevent the effects of the coronavirus disease of 2019, mostly among sensitive patients. On the other hand, time and cost-sustainability of virus detection by molecular analysis such as reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) may be a major issue if testing is extended to large communities, mainly asymptomatic large communities. In this context, sample-pooling and test grouping could offer an effective solution. Here we report the screening on 1195 oral-nasopharyngeal swabs collected from students and staff of the Università degli Studi del Sannio (University of Sannio, Benevento, Campania, Italy) and analyzed by an in-house developed multiplex RT-qPCR for SARS-CoV-2 detection through a simple monodimensional sample pooling strategy. Overall, 400 distinct pools were generated and, within 24 h after swab collection, five positive samples were identified. Out of them, four were confirmed by using a commercially available kit suitable for in vitro diagnostic use (IVD). High accuracy, sensitivity and specificity were also determined by comparing our results with a reference IVD assay for all deconvoluted samples. Overall, we conducted 463 analyses instead of 1195, reducing testing resources by more than 60% without lengthening diagnosis time and without significant losses in sensitivity, suggesting that our strategy was successful in recognizing positive cases in a community of asymptomatic individuals with minor requirements of reagents and time when compared to normal testing procedures.

scholarly journals An Artificial-Intelligence-Discovered Functional Ingredient, NRT_N0G5IJ, Derived from Pisum sativum, Decreases HbA1c in a Prediabetic Population

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1635
Author(s):  
Sweeny Chauhan ◽  
Alish Kerr ◽  
Brian Keogh ◽  
Stephanie Nolan ◽  
Rory Casey ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Pisum Sativum ◽  
Cost Effective ◽  
Glycated Haemoglobin ◽  
Glucose Regulation ◽  
Functional Ingredient ◽  
Effective Manner ◽  
Human Skeletal Muscle Cells ◽  
Increased Risk

The prevalence of prediabetes is rapidly increasing, and this can lead to an increased risk for individuals to develop type 2 diabetes and associated diseases. Therefore, it is necessary to develop nutritional strategies to maintain healthy glucose levels and prevent glucose metabolism dysregulation in the general population. Functional ingredients offer great potential for the prevention of various health conditions, including blood glucose regulation, in a cost-effective manner. Using an artificial intelligence (AI) approach, a functional ingredient, NRT_N0G5IJ, was predicted and produced from Pisum sativum (pea) protein by hydrolysis and then validated. Treatment of human skeletal muscle cells with NRT_N0G5IJ significantly increased glucose uptake, indicating efficacy of this ingredient in vitro. When db/db diabetic mice were treated with NRT_N0G5IJ, we observed a significant reduction in glycated haemoglobin (HbA1c) levels and a concomitant benefit on fasting glucose. A pilot double-blinded, placebo controlled human trial in a population of healthy individuals with elevated HbA1c (5.6% to 6.4%) showed that HbA1c percentage was significantly reduced when NRT_N0G5IJ was supplemented in the diet over a 12-week period. Here, we provide evidence of an AI approach to discovery and demonstrate that a functional ingredient identified using this technology could be used as a supplement to maintain healthy glucose regulation.

scholarly journals Online Opioid Stewardship Training for Long-Term Care Staff

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 533-533
Author(s):  
Linda Edelman ◽  
Troy Andersen ◽  
Cherie Brunker ◽  
Nicholas Cox ◽  
Jorie Butler ◽  
...  
Keyword(s):  
Staff Training ◽  
Long Term Care ◽  
Treatment Strategies ◽  
Care Staff ◽  
Video Content ◽  
Opioid Use ◽  
Term Care ◽  
Increased Risk ◽  
Pain Management Strategy

Abstract Opioids are often the first-line chronic pain management strategy for long-term care (LTC) residents who are also at increased risk for opioid-related adverse events. Therefore, there is a need to train LTC providers and staff about appropriate opioid use and alternative treatment strategies. Our interdisciplinary team worked with LTC partners to identify staff educational needs around opioid stewardship. Based on this need’s assessment, we developed eight modules about opioid use and risks for older adults, including those with dementia, recommendations for de-prescribing including other pharmacological and non-pharmacological alternatives, SBIRT, and motivational interviewing to determine “what matters”. Each 20-minute module contains didactic and video content that is appropriate for group staff training or individuals and provides rural LTC facilities access to needed training in their home communities. Within the first month of launching online, the program received over 1100 hits and LTC partners are incorporating modules into clinical staff training schedules.

scholarly journals 368. Clinical Characteristics of Hospitalized COVID-19 American Indian Patients in Rural Arizona

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S253-S254
Author(s):  
Amy Nham ◽  
Ryan M Close
Keyword(s):  
American Indians ◽  
Median Number ◽  
Clinic Visit ◽  
Contact Tracing ◽  
Shortness Of Breath ◽  
Early Referral ◽  
Increased Risk ◽  
Wbc Count ◽  
The Impact ◽  
D Dimer

Abstract Background American Indians have an increased risk of serious complications from COVID-19 due to the high prevalence of comorbidities such as diabetes, heart disease, obesity, and asthma. To date, there has been limited analysis of COVID-19 in the AI population. This study describes the characteristics of hospitalized COVID-19 patients from a well-defined AI population in eastern Arizona. Additionally, we explored the impact of early referral via contact tracing versus those who self-presented. Methods Retrospective chart reviews were completed for patients hospitalized for COVID from March 29 to May 16, 2020. Summary statistics were used to describe demographics, symptoms, pre-existing conditions, and hospitalization data. Results We observed 447 laboratory-confirmed cases of COVID-19, resulting in 71 (15.9%) hospitalizations over a 7-week period and a hospitalization rate of 159 per 1,000 persons. Of the 50 hospitalizations reviewed sequentially, 56% were female, median age of 55 (IQR 44–65). Median number of days hospitalized was 4 (2–6), with 16% requiring intensive care unit support, 15% intubated, 12% readmitted, and 10% deceased. 67% had an epidemiological link, and 32% had an emergency department or outpatient clinic visit within 7 days of hospitalization. All patients were symptomatic; the most common symptoms were cough (90%), shortness of breath (78%), and subjective fever (66%). 86% of patients had a pre-existing condition; the most common pre-existing conditions were diabetes (66%), obesity (58%), and hypertension (52%, Figure 1). All patients had elevated LDH, 94% had elevated CRP, 86% had elevated d-dimer, and 40% had lymphopenia; only 10% had an elevated WBC count and 26% had thrombocytopenia (Table 1). 26% of the patients were referred in by the tracing team (Table 2). Analysis of 500 hospitalizations will be available in October 2020. Conclusion Most AI patients hospitalized had a pre-existing condition, symptoms of cough or shortness of breath, and elevated LDH, CRP, and d-dimer. More research is needed to understand the patterns of COVID-19 related disease in vulnerable populations, like AI/AN, and to examine the utility of early referral by contact tracing teams in rural settings which may guide future tracing strategies. Disclosures All Authors: No reported disclosures

scholarly journals Relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals: a rapid scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042354
Author(s):  
David McEvoy ◽  
Conor McAloon ◽  
Aine Collins ◽  
Kevin Hunt ◽  
Francis Butler ◽  
...  
Keyword(s):  
Scoping Review ◽  
Quantitative Measure ◽  
Contact Tracing ◽  
Cochrane Library ◽  
International Studies ◽  
Screening Process ◽  
Modelling Studies ◽  
Asymptomatic Individuals ◽  
Definition Of ◽  
The Cochrane Library

ObjectivesThe aim of this study was to determine the relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals based on a scoping review of available literature.DesignRapid scoping review of peer-reviewed literature from 1 January to 5 December 2020 using the LitCovid database and the Cochrane library.SettingInternational studies on the infectiousness of individuals infected with SARS-CoV-2.ParticipantsStudies were selected for inclusion if they defined asymptomatics as a separate cohort distinct from presymptomatics and if they provided a quantitative measure of the infectiousness of asymptomatics relative to symptomatics.Primary outcome measuresPCR result (PCR studies), the rate of infection (mathematical modelling studies) and secondary attack rate (contact tracing studies) - in each case from asymptomatic in comparison with symptomatic individuals.ResultsThere are only a limited number of published studies that report estimates of relative infectiousness of asymptomatic compared with symptomatic individuals. 12 studies were included after the screening process. Significant differences exist in the definition of infectiousness. PCR studies in general show no difference in shedding levels between symptomatic and asymptomatic individuals; however, the number of study subjects is generally limited. Two modelling studies estimate relative infectiousness to be 0.43 and 0.57, but both of these were more reflective of the infectiousness of undocumented rather than asymptomatic cases. The results from contact tracing studies include estimates of relative infectiousness of 0, but with insufficient evidence to conclude that it is significantly different from 1.ConclusionsThere is considerable heterogeneity in estimates of relative infectiousness highlighting the need for further investigation of this important parameter. It is not possible to provide any conclusive estimate of relative infectiousness, as the estimates from the reviewed studies varied between 0 and 1.

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