COVID-19 Stroke Apical Lung Examination Study 2: a national prospective CTA biomarker study of the lung apices, in patients presenting with suspected acute stroke (COVID SALES 2)

BACKGROUND: Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19. OBJECTIVE: To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients. METHODS: In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed. RESULTS: CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality. CONCLUSION: Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage

Search for dark matter candidates and large extra dimensions in events with a jet and missing transverse momentum with the ATLAS detector

A search for new phenomena in events with a high-energy jet and large missing transverse momentum is performed using data from proton-proton collisions at s√=7TeV with the ATLAS experiment at the Large Hadron Collider. Four kinematic regions are explored using a dataset corresponding to an integrated luminosity of 4.7 fb−1. No excess of events beyond expectations from Standard Model processes is observed, and limits are set on large extra dimensions and the pair production of dark matter particles

Pathways of care and resource utilization in a national cohort of patients with transfusion-acquired hepatitis C.

The Hepatitis C Strategy and Action Plan for England recommend that all individuals testing positive for hepatitis C virus (HCV) should be referred to a specialist centre for assessment and care. One key aim is to reduce the number of people progressing to liver disease and therefore reduce the associated costs. The aims of this paper are to describe the care pathways and evaluate resource utilization in a cohort of 826 patients with transfusion-acquired hepatitis C enrolled in the HCV national register. We reviewed data extracted from patient notes to establish pathways of care since HCV-positive diagnosis through to May 2002, and to document all treatment, liver biopsy and hospital usage for each patient. Type of care was classified into specialist-interest in HCV-related care, other-hospital care or general practitioner (GP)-led care. Over 70% of patients were referred to specialist care following HCV diagnosis. Patients who were older or who had normal liver function were less likely to be referred to specialist-care. Between first diagnosis and May 2002, no patients were referred from GP to specialist-care. Less than half of this cohort had undergone liver biopsy and only 18% had been treated. Younger patients and those with abnormal liver function were more likely to have undergone liver biopsy and to have received treatment. Analysis of care histories of patients with transfusion-acquired hepatitis C suggest that changes are needed in the care and management of patients with HCV infection, if the recommendations of the HCV strategy and action plan are to be fully implemented