Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

The State of Patient-Reported Outcomes in Atrial Fibrillation: A Review of Current Measures

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately 2.2 million people in the US. The presentation of AF ranges from asymptomatic to severely symptomatic. When symptomatic, AF has been shown to have an adverse impact on health-related quality of life (HR-QOL) and to result in increased healthcare costs. The objective of this analysis was to review the current AF literature on patient-reported outcomes (PROs) in order to evaluate the impact of AF on PROs and the applicability of current PRO measures in assessing AF outcomes. HR-QOL and symptoms were the most frequently assessed PROs; however, the sensitivity of the majority of the questionnaires for detecting subtle change is not known. For highly symptomatic patients, interventional procedures reduce symptoms and improve HR-QOL; however, this is a small cohort of patients with AF. For the most part, PROs are equivalent between pharmacological treatments or are not known for the large percentage of patients treated pharmacologically with antiarrhythmic or rate-controlling drugs. PRO assessment in AF patients is an area that needs continued development. AF-specific PRO measures are needed to assess the full range of patient symptoms and treatment outcomes. The impact of paroxysmal AF versus permanent AF is not well delineated, and sex and nationality differences are not known. In addition, the impact of AF on daily activities and HR-QOL is not clearly described.Antiarrhythmics, Atrial-fibrillation, Quality-of-life-rating-scales

Upper Gastrointestinal Symptoms Experienced by Users of Low-Dose Aspirin (Acetylsalicylic Acid) &lsqb;75-325 mg/day&rsqb; for Primary and Secondary Coronary Artery Disease Prevention: Perspectives from Patient Focus Groups

Background and objective: As upper gastrointestinal (GI) symptoms are common with the use of low-dose aspirin (low-dose acetylsalicylic acid &lsqb;LDASA&rsqb;; 75-325 mg/day), this exploratory qualitative study evaluated the upper GI symptom experience and attribution of symptoms among patients taking LDASA for coronary artery disease (CAD) or known CAD risk factors. Abstract: Methods: Focus groups were conducted among patients aged ≥40 years with CAD or known CAD risk factors currently taking daily LDASA. Patients were recruited from primary-care clinical sites, and all had experienced upper GI symptoms the week before inclusion (including heartburn, acid reflux, and stomach or abdominal pain). The focus group discussions were designed to explore the participants' experience with upper GI symptoms, LDASA use, potential adverse effects of treatment, and physician interactions. Content analysis and descriptive statistics were used to analyze the data. Abstract: Results: Thirty-three men and women participated in four focus group sessions in France and in the US. All participants recognized the cardioprotective benefits of LDASA and reported a high level of compliance with therapy. Although participants regarded LDASA as a necessary and valuable treatment, many participants had concerns about LDASA use, primarily because of the bleeding risk. Many participants were aware that LDASA may cause GI symptoms. Participants experienced a range of upper GI symptoms, including heartburn, regurgitation, and nausea. Almost half of the participants believed that their GI symptoms were solely due to lifestyle issues such as stress and eating spicy food rather than being caused by medication, where others reported that they were directly related to LDASA use. The GI symptoms experienced by LDASA users were cited as troublesome, causing the participants to change eating habits, avoid stress or employ stress-reduction techniques, change physical activities, and take more medication to treat the symptoms. Abstract: Conclusion: Participants were well aware of the potential adverse effects of LDASA use and reported that GI symptoms had a high impact on several areas of their lives. To maintain the cardioprotective benefits of LDASA, participants used several strategies to deal with their upper GI symptoms, including changing their eating habits, avoiding stress, changing their physical activities, and taking medication.

Vision-Specific Instruments for the Assessment of Health-Related Quality of Life and Visual Functioning: A Literature Review

Clinically objective measures such as visual acuity or visual field provide an assessment of a patient's visual status. However such measures may not reflect the degree of visual impairment the patient experiences in his or her daily activities. Visual impairment has been shown to have negative effects on health-related quality of life (HR-QOL) and a significant impact on daily functioning, including social activities. As such, there is a growing recognition of the importance of patient-reported outcomes of visual functioning. This review examines the development and psychometric properties of 22 vision-specific instruments assessing visual functioning and/or the impact of visual impairment on HR-QOL or daily activities. Issues relevant to assessing vision-specific subjective outcomes are reviewed, with specific application of the reviewed instruments. Three instruments, the Activities of Daily Vision Scale, National Eye Institute Visual Function Questionnaire, and Visual Function Index have been well validated and widely used, but others also show promise. To fully capture the benefits of a new ophthalmology treatment (or new treatment for eye disease) a valid and reliable visual instrument, in which the psychometric performance has been demonstrated in the particular ocular condition being treated, should be utilised.Eye disorders, Pharmacoeconomics, Quality of life

Further Validation of the Uterine Fibroid Symptom and Quality-of-Life Questionnaire

AbstractObjectiveTo further examine the reliability, validity and responsiveness of the uterine fibroid symptom and quality-of-life (UFS-QOL) questionnaire among women with and without uterine fibroids.MethodsA multicenter, non-randomized, prospective study was conducted with women undergoing treatment for uterine fibroids (fibroid treatment group [FTG]) and normal controls (normal control group [NCG]). Women in the FTG were recruited when they were scheduled for treatment; women in the NCG were recruited during their annual exam. Participants completed the UFS-QOL and a short form 36 health survey (SF-36) at enrollment and at 6 and 12 months. Descriptive statistics, Cronbach's alpha, Spearman's correlations, t tests, and general linear models were used to analyze the internal consistency and test–retest reliability, concurrent and discriminant validity, and responsiveness of the UFS-QOL.ResultsThere were 89 NCG and 234 FTG women who completed the study. Mean age was 43.1 years for FTG and 40.8 for NCG (P < 0.001). The FTG reported significantly greater symptom severity and worse health-related quality of life (HRQL) than the NCG (all UFS-QOL subscales P < 0.001). The UFS-QOL subscales were significantly correlated in the expected direction and magnitude with each SF-36 subscale in the FTG, indicating acceptable concurrent validity. Cronbach's alphas were 0.73 to 0.97, reflecting adequate internal consistency. Each UFS-QOL subscale was responsive to changes after treatment in the FTG with effect sizes ranging between 1.1 and −2.35. The UFS-QOL remained stable in the NCG during the 1 year follow-up.ConclusionThe UFS-QOL is a valid and reliable measure to assess symptoms and HRQL in women with uterine fibroids and is highly responsive to treatment-related changes

New insights into the specificity and plasticity of reward and aversion encoding in the mesolimbic system.

The mesocorticolimbic system, consisting, at its core, of the ventral tegmental area, the nucleus accumbens, and medial prefrontal cortex, has historically been investigated primarily for its role in positively motivated behaviors and reinforcement learning, and its dysfunction in addiction, schizophrenia, depression, and other mood disorders. Recently, researchers have undertaken a more comprehensive analysis of this system, including its role in not only reward but also punishment, as well as in both positive and negative reinforcement. This focus has been facilitated by new anatomical, physiological, and behavioral approaches to delineate functional circuits underlying behaviors and to determine how this system flexibly encodes and responds to positive and negative states and events, beyond simple associative learning. This review is a summary of topics covered in a mini-symposium at the 2013 Society for Neuroscience annual meeting

New insights into the specificity and plasticity of reward and aversion encoding in the mesolimbic system.

The mesocorticolimbic system, consisting, at its core, of the ventral tegmental area, the nucleus accumbens, and medial prefrontal cortex, has historically been investigated primarily for its role in positively motivated behaviors and reinforcement learning, and its dysfunction in addiction, schizophrenia, depression, and other mood disorders. Recently, researchers have undertaken a more comprehensive analysis of this system, including its role in not only reward but also punishment, as well as in both positive and negative reinforcement. This focus has been facilitated by new anatomical, physiological, and behavioral approaches to delineate functional circuits underlying behaviors and to determine how this system flexibly encodes and responds to positive and negative states and events, beyond simple associative learning. This review is a summary of topics covered in a mini-symposium at the 2013 Society for Neuroscience annual meeting