scholarly journals Comparison of Saliva and Mid-Turbinate Swabs for Detection of COVID-19

2021 ◽  
Author(s):  
Jianyu Lai ◽  
Jennifer German ◽  
Filbert Hong ◽  
S.-H. Sheldon Tai ◽  
Kathleen M. McPhaul ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Screening Tool ◽  
Cost Effective ◽  
Probability Of Detection ◽  
List Type ◽  
Viral Detection ◽  
Suitable Alternative ◽  
High Agreement ◽  
Key Points ◽  
Nasal Swabs

AbstractBackgroundSaliva is an attractive sample for detecting SARS-CoV-2 because it is easy to collect and minimally invasive. However, contradictory reports exist concerning the sensitivity of saliva versus nasal swabs.MethodsWe recruited and followed close contacts of COVID-19 cases for up to 14 days from their last exposure and collected self-reported symptoms, mid-turbinate swabs (MTS) and saliva every two or three days. Ct values and frequency of viral detection by MTS and saliva were compared. Logistic regression was used to estimate the probability of detection by days since symptom onset for the two sample types.ResultsWe enrolled 58 contacts who provided a total of 200 saliva and MTS sample pairs; 14 contacts (13 with symptoms) had one or more positive samples. Overall, saliva and MTS had similar rates of viral detection (p=0.78). Although Ct values for saliva were significantly greater than for MTS (p=0.014), Cohen’s Kappa demonstrated substantial agreement (κ=0.83). However, sensitivity varied significantly with time relative to symptom onset. Early in the course of infection (days -3 to 2), saliva had 12 times (95%CI: 1.2, 130) greater likelihood of detecting viral RNA compared to MTS. After day 2, there was a non-significant trend to greater sensitivity using MTS samples.ConclusionSaliva and MTS specimens demonstrated high agreement, making saliva a suitable alternative to MTS nasal swabs for COVID-19 detection. Furthermore, saliva was more sensitive than MTS early in the course of infection, suggesting that it may be a superior and cost-effective screening tool for COVID-19.Key PointsSaliva is more sensitive in detecting symptomatic cases of COVID-19 than MTS early in the course of infection.Saliva performs best in the pre-symptomatic period.Saliva and MTS demonstrated high agreement making saliva a suitable and cost-effective COVID-19 screening tool.

scholarly journals Dysfunctional breathing and reaching one’s physiological limit as causes of exercise-induced dyspnoea

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 120-129 ◽  
Author(s):  
Julie Depiazzi ◽  
Mark L. Everard
Keyword(s):  
Drug Therapy ◽  
Cardiopulmonary Exercise Testing ◽  
Cost Effective ◽  
List Type ◽  
Accurate Assessment ◽  
Key Points ◽  
Physiological Limit ◽  
Young Subjects ◽  
Dysfunctional Breathing ◽  
Exercise Induced

Key pointsExcessive exercise-induced shortness of breath is a common complaint. For some, exercise-induced bronchoconstriction is the primary cause and for a small minority there may be an alternative organic pathology. However for many, the cause will be simply reaching their physiological limit or be due to a functional form of dysfunctional breathing, neither of which require drug therapy.The physiological limit category includes deconditioned individuals, such as those who have been through intensive care and require rehabilitation, as well as the unfit and the fit competitive athlete who has reached their limit with both of these latter groups requiring explanation and advice.Dysfunctional breathing is an umbrella term for an alteration in the normal biomechanical patterns of breathing that result in intermittent or chronic symptoms, which may be respiratory and/or nonrespiratory. This alteration may be due to structural causes or, much more commonly, be functional as exemplified by thoracic pattern disordered breathing (PDB) and extrathoracic paradoxical vocal fold motion disorder (pVFMD).Careful history and examination together with spirometry may identify those likely to have PDB and/or pVFMD. Where there is doubt about aetiology, cardiopulmonary exercise testing may be required to identify the deconditioned, unfit or fit individual reaching their physiological limit and PDB, while continuous laryngoscopy during exercise is increasingly becoming the benchmark for assessing extrathoracic causes.Accurate assessment and diagnosis can prevent excessive use of drug therapy and result in effective management of the cause of the individual’s complaint through cost-effective approaches such as reassurance, advice, breathing retraining and vocal exercises.This review provides an overview of the spectrum of conditions that can present as exercise-­induced breathlessness experienced by young subjects participating in sport and aims to promote understanding of the need for accurate assessment of an individual’s symptoms. We will highlight the high incidence of nonasthmatic causes, which simply require reassurance or simple interventions from respiratory physiotherapists or speech pathologists.

Modern devices for treatment of the surgeon’s hands and the surgical field (literature review)

2020 ◽  
pp. 41-50
Author(s):  
Artem Mikhailovich Morozov ◽  
◽  
Alexey Nikolaevich Sergeev ◽  
Gennady Alexandrovich Dubatolov ◽  
Nikolay Alexandrovich Sergeev ◽  
...  
Keyword(s):  
Cost Effective ◽  
Surgical Infection ◽  
Operating Field ◽  
Functional Additives ◽  
Literary Sources ◽  
Film Forming ◽  
Key Points ◽  
Surgical Field ◽  
Ammonium Compounds ◽  
Active Substances

The aim – analyze modern Russian and foreign literary sources in order to determine modern means for treating the hands of the surgeon and the operating field. Results. One of the key points in the prevention of surgical infection is the treatment of the surgeon’s hands and the operating field with effective skin antiseptics in order to destroy pathogenic and opportunistic microorganisms that colonize intact skin. In modern practice, skin antiseptics are predominantly used containing alcohols as active substances, in particular ethyl, propyl and isopropyl, halogenated substances such as iodine and iodophores, guanidines, which include chlorhexidine digluconate, as well as quaternary ammonium compounds. Moreover, the most widespread are combined preparations containing several active substances and functional additives, which makes it possible to neutralize the negative properties of various active substances. Also, an interesting and promising direction is the use of polymer operating films or film-forming antiseptics. Currently, research is being actively carried out aimed at finding and developing modern highly effective antiseptic agents and their rational combinations that meet the necessary requirements, are optimal in their properties, cost-effective and comfortable to use.

scholarly journals PSVII-3 Correlations between L-lactate concentrations obtained using a handheld lactate analyser and a lactate assay colorimetric kit in beef cattle transported by road

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 296-297
Author(s):  
Daniela M Meléndez ◽  
Sonia Marti ◽  
Luigi Faucitano ◽  
Derek B Haley ◽  
Timothy D Schwinghamer ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Cost Effective ◽  
Road Transportation ◽  
Long Distance ◽  
Suitable Alternative ◽  
Blood Samples ◽  
Handheld Device ◽  
Time Points ◽  
Relationship Of ◽  
The Relationship

Abstract Blood metabolites are used to assess a variety of animal conditions for veterinary diagnosis and research. Concentration of metabolites in blood can be measured using a commercially-available lab-based assay or in real-time using a handheld device developed to be more time- and cost-effective than the lab-based method. Lactate is a product of anaerobic glycolysis, used in animal research as an indicator of muscle fatigue. Therefore, it has been used as an indicator of cattle response to long distance transportation. The aim of this study was to assess the relationship of L-lactate concentrations measured using a Lactate Scout+ analyzer (Lactate Scout, EFK Diagnostics, Barleben, Germany) and a lactate assay colorimetric kit (Lactate Assay Kit, Cell Biolabs Inc., San Diego, CA). Blood samples were collected by venipuncture from 96 steers (245 ± 35.7 kg BW) prior to (L1) and after 36 h, and prior to and after an additional 4 h of road transportation, and on d 1, 2, 3, 5, 14, and 28 after transport. The Lactate Scout+ analyzer strip was dipped in blood at the time of sampling, while blood samples were collected into sodium fluoride tubes for use in colorimetric analysis. Pearson correlations were calculated to determine the relationship between the experimental methods for the quantification of L-lactate concentrations. The strengths and levels of statistical significance of the correlation varied over the observed time points, r = -0.03, P = 0.75 (L1) to r = 0.75, P = < 0.0001 (d 3). The correlation for the pooled data was weak but statistically significant (r = 0.33, P < 0.001). Based on the experimental results, the Lactate Scout+ analyzer is not a suitable alternative to a lab-based assay for measuring L-lactate in transported cattle, due to variability across sampling time points and weak correlation with the traditional enzymatic method.

scholarly journals NESTROFT—A Cost-Effective Mass Screening Tool for the Detection of β-Thalassemia Carrier Status in Anemic Pregnant Women: A Step Toward Reducing the National Disease Burden

2021 ◽  
Author(s):  
Manasi Gosavi ◽  
Ramesh Chavan ◽  
M. B. Bellad
Keyword(s):  
Pregnant Women ◽  
Effective Mass ◽  
Mass Screening ◽  
Predictive Value ◽  
Screening Tool ◽  
Hematological Parameters ◽  
False Negative ◽  
Cost Effective ◽  
Mean Corpuscular Hemoglobin ◽  
Carrier Status

Abstract Introduction β-Thalassemias are inherited hemoglobinopathies commonly encountered in practice. With chances of a promising cure being rare, the prevention of births with this disorder should assume priority, especially in low-resource countries. This can be achieved by the implementation of a mass screening program that is reliable and, at the same time, cost-effective. Objectives This study focuses on the utility of Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) as a mass screening tool to detect thalassemia carriers. Hematological parameters that may predict carrier status were also evaluated. Materials and Methods Hemoglobin estimation was performed on all consented pregnant women. If the patient was found to have hemoglobin < 11 g/dL, the blood sample was subjected to other routine hematological tests along with peripheral smear examination. NESTROFT was performed using 0.36% saline solution. Confirmation was done using high-performance liquid chromatography (HPLC). Statistical Analysis Data obtained were tabulated using version 21 of the Statistical Package for Social Sciences. Means, standard deviations, and percentages were used to describe the sample. Chi-square test and Students’ “t” test were used to identify differences between the groups. Results Of 441 pregnant women enrolled, 206 were found to be anemic. Nineteen (9.2%) of the anemic pregnant women were detected to be carriers of hemoglobinopathies. Among the hematological parameters, mean red blood cell count and reticulocyte count were higher, while mean corpuscular hemoglobin concentration was lower in carriers. Also, carriers were more likely to present with microcytic hypochromic anemia. NESTROFT showed a sensitivity of 84.21%, specificity of 96.25%, a positive predictive value of 69.56%, and a negative predictive value of 98.36%. A false-positive result was seen in 3.74% of the tests, while a false negative result was seen in 15.78% of the tests. Conclusions NESTROFT (0.36%) can be used as a simple and cost-effective mass screening tool for the detection of carrier status. This should be followed by confirmation using HPLC or hemoglobin electrophoresis.

scholarly journals Sporulation in solventogenic and acetogenic clostridia

2021 ◽  
Author(s):  
Mamou Diallo ◽  
Servé W. M. Kengen ◽  
Ana M. López-Contreras
Keyword(s):  
Current Knowledge ◽  
Carbon Sources ◽  
Cost Effective ◽  
Biotechnological Production ◽  
Key Points ◽  
Wide Range ◽  
Potential Applications ◽  
A Cell ◽  
Sporulation Initiation ◽  
Solventogenic Clostridia

AbstractThe Clostridium genus harbors compelling organisms for biotechnological production processes; while acetogenic clostridia can fix C1-compounds to produce acetate and ethanol, solventogenic clostridia can utilize a wide range of carbon sources to produce commercially valuable carboxylic acids, alcohols, and ketones by fermentation. Despite their potential, the conversion by these bacteria of carbohydrates or C1 compounds to alcohols is not cost-effective enough to result in economically viable processes. Engineering solventogenic clostridia by impairing sporulation is one of the investigated approaches to improve solvent productivity. Sporulation is a cell differentiation process triggered in bacteria in response to exposure to environmental stressors. The generated spores are metabolically inactive but resistant to harsh conditions (UV, chemicals, heat, oxygen). In Firmicutes, sporulation has been mainly studied in bacilli and pathogenic clostridia, and our knowledge of sporulation in solvent-producing or acetogenic clostridia is limited. Still, sporulation is an integral part of the cellular physiology of clostridia; thus, understanding the regulation of sporulation and its connection to solvent production may give clues to improve the performance of solventogenic clostridia. This review aims to provide an overview of the triggers, characteristics, and regulatory mechanism of sporulation in solventogenic clostridia. Those are further compared to the current knowledge on sporulation in the industrially relevant acetogenic clostridia. Finally, the potential applications of spores for process improvement are discussed.Key Points• The regulatory network governing sporulation initiation varies in solventogenic clostridia.• Media composition and cell density are the main triggers of sporulation.• Spores can be used to improve the fermentation process.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

A virtual multi-disciplinary meeting is a cost-effective method of triaging referrals to a regional musculoskeletal oncology service

2021 ◽  
pp. 003693302110085
Author(s):  
Omer MHF Alanie ◽  
Ashish Mahendra ◽  
Mairi Mackinnon ◽  
Mark McCleery ◽  
Christopher Nicholas ◽  
...  
Keyword(s):  
Screening Tool ◽  
Discharge Rate ◽  
Cost Effective ◽  
Risk Environment ◽  
Potential Cost ◽  
Patient Journey ◽  
Cost Effective Method ◽  
Diagnosis Of Cancer ◽  
Musculoskeletal Oncology ◽  
Prospective Database

Background and aims In 2010, a virtual sarcoma referral model was implemented, which aims to provide a centralised multidisciplinary team (MDT) to provide rapid advice, avoiding unnecessary appointments and providing a streamlined service. The aim of this study is to examine the feasibility of this screening tool in reducing the service burden and expediting patient journey. Methods and results All referrals made to a single tertiary referral sarcoma unit from January 2010 to December 2018 were extracted from a prospective database. Only 26.0% events discussed required review directly. 30.3% were discharged back to referrer. 16.5% required further investigations. 22.5% required a biopsy prior to review. There was a reduction in the rate of patients reviewed at the sarcoma clinic, and a higher discharge rate from the MDT in 2018 versus 2010 (p < 0.001). This gives a potential cost saving of 670,700 GBP over the 9 year period. Conclusion An MDT meeting which triages referrals is cost-effective at reducing unnecessary referrals. This can limit unnecessary exposure of patients who may have an underlying diagnosis of cancer to a high-risk environment, and reduces burden on services as it copes with increasing demands during the COVID-19 pandemic.

scholarly journals Empowering conservation practice with efficient and economical genotyping from poor quality samples

2018 ◽  
Author(s):  
Meghana Natesh ◽  
Ryan W. Taylor ◽  
Nathan Truelove ◽  
Elizabeth A. Hadly ◽  
Stephen Palumbi ◽  
...  
Keyword(s):  
Population Structure ◽  
Genetic Material ◽  
Cost Effective ◽  
Poor Quality ◽  
Wildlife Trade ◽  
List Type ◽  
High Quality ◽  
Conservation Practice ◽  
Queen Conch ◽  
Close Relatives

AbstractModerate to high density genotyping (100+ SNPs) is widely used to determine and measure individual identity, relatedness, fitness, population structure and migration in wild populations.However, these important tools are difficult to apply when high-quality genetic material is unavailable. Most genomic tools are developed for high quality DNA sources from labor medical settings. As a result, most genetic data from market or field settings is limited to easily amplified mitochondrial DNA or a few microsatellites.To enable genotyping in conservation contexts, we used next-generation sequencing of multiplex PCR products from very low-quality DNA extracted from feces, hair, and cooked samples. We demonstrated utility and wide-ranging potential application in endangered wild tigers and tracking commercial trade in Caribbean queen conch.We genotyped 100 SNPs from degraded tiger samples to identify individuals, discern close relatives, and detect population differentiation. Co-occurring carnivores do not amplify (e.g. Indian wild dog/Dhole) or are monomorphic (e.g. leopard). 62 SNPs from conch fritters and field-collected samples were used to test relatedness and detect population structure.We provide proof-of-concept for a rapid, simple, cost-effective, and scalable method (for both samples and number of loci), a framework that can be applied to other conservation scenarios previously limited by low quality DNA samples. These approaches provide a critical advance for wildlife monitoring and forensics, open the door to field-ready testing, and will strengthen the use of science in policy decisions and wildlife trade.

scholarly journals Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: a simulation and economic modelling study

2020 ◽  
Author(s):  
Peter Griffiths ◽  
Christina Saville ◽  
Jane E Ball ◽  
Jeremy Jones ◽  
Thomas Monks
Keyword(s):  
Cost Effectiveness ◽  
Significant Proportion ◽  
Nurse Staffing ◽  
Cost Savings ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
List Type ◽  
Economic Modelling ◽  
The Face ◽  
Hospital Wards

AbstractBackgroundIn the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals.ObjectivesWe modelled the cost-effectiveness of different approaches to planning baseline numbers of nurses to roster on general medical/surgical units while using flexible staff to respond to fluctuating demand.Design and SettingWe developed an agent-based simulation model, where units move between being understaffed, adequately staffed or overstaffed as staff supply and demand, measured by the Safer Nursing Care Tool, varies. Staffing shortfalls are addressed firstly by floating staff from overstaffed units, secondly by hiring temporary staff. We compared a standard staffing plan (baseline rosters set to match average demand) with a ‘resilient’ plan set to match higher demand, and a ‘flexible’ plan, set at a lower level. We varied assumptions about temporary staff availability. We estimated the effect of unresolved low staffing on length of stay and death, calculating cost per life saved.ResultsStaffing plans with higher baseline rosters led to higher costs but improved outcomes. Cost savings from low baseline staff largely arose because shifts were left under staffed. Cost effectiveness for higher baseline staff was improved with high temporary staff availability. With limited temporary staff available, the resilient staffing plan (higher baseline staff) cost £9,506 per life saved compared to the standard plan. The standard plan cost £13,967 per life saved compared to the flexible (low baseline) plan. With unlimited temporary staff, the resilient staffing plan cost £5,524 per life saved compared to the standard plan and the standard plan cost £946 per life saved compared with the flexible plan. Cost-effectiveness of higher baseline staffing was more favourable when negative effects of high temporary staffing were modelled.ConclusionFlexible staffing can be guided by shift-by-shift measurement of patient demand, but proper attention must be given to ensure that the baseline number of staff rostered is sufficient.In the face of staff shortages, low baseline staff rosters with high use of flexible staff on hospital wards is not an efficient or effective use of nurses whereas high baseline rosters may be cost-effective. Flexible staffing plans that minimise the number of nurses routinely rostered are likely to harm patients because temporary staff may not be available at short notice.Study registration: ISRCTN 12307968Tweetable abstractEconomic model of hospital wards shows low baseline staff levels with high use of flexible staff are not cost-effective and don’t solve nursing shortages].What is already known?Because nursing is the largest staff group, accounting for a significant proportion of hospital’s variable costs, ward nurse staffing is frequently the target of cost containment measuresStaffing decisions need to address both the baseline staff establishment to roster, and how best to respond to fluctuating demand as patient census and care needs varyFlexible deployment of staff, including floating staff and using temporary hires, has the potential to minimise expenditure while meeting varying patient need, but high use of temporary staff may be associated with adverse outcomes.What this paper addsOur simulation shows that low baseline staff rosters that rely heavily on flexible staff increase the risk of patient death and provide cost savings largely because wards are often left short staffed under real world availability of temporary staff.A staffing plan set to meet average demand appears to be cost effective compared to a plan with a lower baseline but is still associated with frequent short staffing despite the use of flexible deployments.A staffing plan with a higher baseline, set to meet demand 90% of the time, is more resilient in the face of variation and may be highly cost effective

scholarly journals Enhanced production of taxadiene in Saccharomyces cerevisiae

2020 ◽  
Author(s):  
Behnaz Nowrouzi ◽  
Rachel Li ◽  
Laura E. Walls ◽  
Leopold d’Espaux ◽  
Koray Malci ◽  
...  
Keyword(s):  
Saccharomyces Cerevisiae ◽  
Shake Flask ◽  
Scale Up ◽  
Cost Effective ◽  
Cancer Drug ◽  
List Type ◽  
Taxadiene Synthase ◽  
Enhanced Production ◽  
Anti Cancer ◽  
Positive Effect

AbstractCost-effective production of the highly effective anti-cancer drug, paclitaxel (Taxol®), remains limited despite growing global demands. Low yields of the critical taxadiene precursor remains a key bottleneck in microbial production. In this study, the key challenge of poor taxadiene synthase (TASY) solubility in S. cerevisiae was revealed, and the strains were strategically engineered to relieve this bottleneck. Multi-copy chromosomal integration of TASY harbouring a selection of fusion solubility tags improved taxadiene titres 22-fold, up to 57 ± 3 mg/L at 30 °C at shake flask scale. The scalability of the process was highlighted through achieving similar titres during scale up to 25 mL and 250 mL in shake flask and bioreactor cultivations, respectively. Maximum taxadiene titres of 129 ± 15 mg/L and 119 mg/L were achieved through shake flask and bioreactor cultivation, respectively, of the optimal strain at a reduced temperature of 20 °C. The results highlight the positive effect of coupling molecular biology tools with bioprocess variable optimisation on synthetic pathway development.HighlightsMaximum taxadiene titre of 129 ± 15 mg/L in Saccharomyces cerevisiae at 20 °CIntegrating fusion protein tagged-taxadiene synthase improved taxadiene titre.Consistent taxadiene titres were achieved at the micro-and mini-bioreactor scales.

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