Distributions of reported attack rates and predicted infection risk and HCWs routine round patterns.

<p>(A) Reported attack rates distribution [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0181558#pone.0181558.ref020" target="_blank">20</a>]. (B) Predicted average infection risk distribution (for 1,000 simulations) via the long-range airborne route at 24:00 on March 12, the end of the exposure period. (C) HCWs routine round Pattern 1. (D) Predicted average infection risk distribution via the fomite route (Pattern 1). (E) HCWs routine round Pattern 3. (F) Predicted average infection risk distribution via the fomite route (Pattern 3). (G) HCWs routine round Pattern 5. (H) Predicted average infection risk distribution via the fomite route (Pattern 5). The largest virus-containing droplet size <i>d</i>_<i>g</i> = 100 μm, dose–response parameters in respiratory tracts <i>η</i>_<i>r</i> = 3.2/mRNA copy and on mucous membranes <i>η</i>_<i>m</i> = 3.2 × 10⁻³/mRNA copy and the viral load coefficient <i>c</i>_<i>L</i> = 10. Bed numbers are marked in black in (C), (E) and (G). Reported attack rates and predicted average infection risks for every inpatient are marked in blue in (A), (B), (D), (F) and (H). The intensity of red shading represents levels of attack rate or infection risk.</p

Role of fomites in SARS transmission during the largest hospital outbreak in Hong Kong

<div><p>The epidemic of severe acute respiratory syndrome (SARS) had a significant effect on global society in the early 2000s and the potential of its resurgence exists. Studies on the modes of transmission of SARS are limited though a number of outbreak studies have revealed the possible airborne route. To develop more specific and effective control strategies, we conducted a detailed mechanism-based investigation that explored the role of fomite transmission in the well-known Ward 8A outbreak. We considered three hypothetical transmission routes, i.e., the long-range airborne, fomite and combined routes, in 1,744 scenarios with combinations of some important parameters. A multi-agent model was used to predict the infection risk distributions of the three hypothetical routes. Model selection was carried out for different scenarios to compare the distributions of infection risk with that of the reported attack rates and select the hypotheses with the best fitness. Our results reveal that under the assumed conditions, the SARS coronavirus was most possible to have spread via the combined long-range airborne and fomite routes, and that the fomite route played a non-negligible role in the transmission.</p></div

Important parameters for scenarios with the minimum RSS for Hypothesis 3 [Long air + Fomite (including six patterns)].

<p>Important parameters for scenarios with the minimum RSS for Hypothesis 3 [Long air + Fomite (including six patterns)].</p

System architecture of the multi-agent model.

<p>System architecture of the multi-agent model.</p

Illustration of the hypotheses with the minimum RSS in 1,744 scenarios.

<p><i>d</i>_<i>g</i> denotes the largest virus-containing droplet size (4 values: 50, 100, 150 and 200 μm); <i>η</i>_<i>r</i><i>c</i>_<i>L</i> and <i>η</i>_<i>m</i><i>c</i>_<i>L</i> denote products of viral load coefficient and dose–response parameters in respiratory tracts (26 values, 10⁻¹–10⁴/mRNA copy) and on mucous membranes (26 values, 10⁻⁴–10¹/mRNA copy). (A) <i>d</i>_<i>g</i> = 50 μm; (B) <i>d</i>_<i>g</i> = 100 μm; (C) <i>d</i>_<i>g</i> = 150 μm; (D) <i>d</i>_<i>g</i> = 200 μm. Dots of different colours represent different hypotheses as shown in the legend. Dot diameter is inversely proportion to the value of RSS. The smallest RSS in all scenarios (the biggest dot) was 0.5505, and the small black dots represent scenarios with the minimum RSS at least five times as much as 0.5505.</p

Indacaterol for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

<div><p>Background</p><p>Inhaled bronchodilators are the first-line therapy for COPD. Indacaterol is a novel addition to existing long-acting bronchodilators.</p><p>Objectives</p><p>Systematic review of randomized controlled trials (RCT) on efficacy and safety of indacaterol as compared: 1) with placebo at different dosages, 2) with existing bronchodilators; (3) as add-on treatment to tiotropium.</p><p>Methods</p><p>We searched 13 electronic databases, including MEDLINE, EMBASE and CENTRAL, and contacted the manufacturer for unpublished data. Primary outcome was mean FEV1 change at 12^th week, secondary outcomes included changes in SGRQ, TDI and BODE index at 6 months, exacerbation at 1 year, and worsening of symptoms.</p><p>Results</p><p>Twelve eligible RCTs of moderate risk of bias included data from 10,977 patients. Compared to placebo, indacaterol improved FEV1 by a weighted mean difference (WMD) of 0.16 L (95%CI: 0.15, 0.18 L, p<0.001), homogeneously above the minimally important difference of 0.10 L. It offered clinically relevant improvement in all secondary outcomes except exacerbation. Magnitude of benefit did not differ significantly by dosage, but one treatment related death was reported at 300 ug. Efficacy of Indacaterol was similar to formoterol and salmeterol (FEV1 WMD = 0.04L, 95%CI: 0.01L, 0.07 L, p = 0.02); and tiotropium (FEV1 WMD = 0.01L, 95%CI: −0.01, 0.03L, p = 0.61). The use of indacaterol on top of tiotropium yielded additional improvement on FEV1 (WMD = 0.07 L, 95%CI: 0.05L, 0.10 L, p<0.001).</p><p>Conclusion</p><p>Indacaterol is safe and beneficial for patients with COPD at dosage ≤150 ug. It may serve as a good alternative to existing bronchodilators, or as an add-on to tiotropium for unresponsive patients. Use of higher dosage requires further justification.</p></div

Indacaterol versus Placebo on FEV1 at 12 weeks.

<p>Indacaterol versus Placebo on FEV1 at 12 weeks.</p

The flow of literature search.

<p>The flow of literature search.</p

Indacaterol plus Tiotropium versus Tiotropium plus placebo on FEV1 at 12 weeks.

<p>Indacaterol plus Tiotropium versus Tiotropium plus placebo on FEV1 at 12 weeks.</p

Risk of bias amongst included studies.

<p>#Assessed based in the primary outcome of this review, FEV1 measurement. We assumed that the impact of assessor blinding on FEV1 measurement to be minimal.</p