False-negative SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is an Important Consideration for Patient Management and Infection Prevention: A Case Report from The Louisville COVID-19 Epidemiology Study

We report a case of false negative SARS-CoV-2 RT-PCR on nasopharyngeal swab. Treating clinicians and infection preventionists should maintain a high suspicion for COVID-19 in the appropriate clinical setting despite negative test results. Utilization of chest CT should be strongly considered in the diagnostic work-up for suspected COVID-19, particularly in areas with limited RT-PCR availability

Why Every Hospital Needs a COVID-19 Clinical Case Review Team

A hospital’s response to a global pandemic requires a coordinated effort to provide consistent guidance as information rapidly changes. In the early months of the COVID-19 pandemic, diagnosis and subsequent containment was challenging due to unfamiliarity with disease presentation, unknown reverse transcription-polymerase chain reaction sensitivity and inconsistent access to testing supplies. A centralized COVID-19 clinical case review team can provide guidance on test interpretation, isolation, resource coordination and more

A Patient with Escherichia coli Bacteremia and COVID-19 Co-Infection: A Case Report for the Louisville COVID-19 Epidemiology Study

Patients with COVID-19 may have co-infections with other microorganisms. Here we report a case of a patient with an E. coli bacteremia secondary to a urinary tract infection, who experienced fevers while on active antimicrobial therapy. The patient was eventually tested for COVID-19 and found to be positive. This case emphasizes the need to suspect COVID-19 even in patients with documented bacterial infection

Ultra-high accuracy optical testing: creating diffraction-limitedshort-wavelength optical systems

Since 1993, research in the fabrication of extreme ultraviolet (EUV) optical imaging systems, conducted at Lawrence Berkeley National Laboratory (LBNL) and Lawrence Livermore National Laboratory (LLNL), has produced the highest resolution optical systems ever made. We have pioneered the development of ultra-high-accuracy optical testing and alignment methods, working at extreme ultraviolet wavelengths, and pushing wavefront-measuring interferometry into the 2-20-nm wavelength range (60-600 eV). These coherent measurement techniques, including lateral shearing interferometry and phase-shifting point-diffraction interferometry (PS/PDI) have achieved RMS wavefront measurement accuracies of 0.5-1-{angstrom} and better for primary aberration terms, enabling the creation of diffraction-limited EUV optics. The measurement accuracy is established using careful null-testing procedures, and has been verified repeatedly through high-resolution imaging. We believe these methods are broadly applicable to the advancement of short-wavelength optical systems including space telescopes, microscope objectives, projection lenses, synchrotron beamline optics, diffractive and holographic optics, and more. Measurements have been performed on a tunable undulator beamline at LBNL's Advanced Light Source (ALS), optimized for high coherent flux; although many of these techniques should be adaptable to alternative ultraviolet, EUV, and soft x-ray light sources. To date, we have measured nine prototype all-reflective EUV optical systems with NA values between 0.08 and 0.30 (f/6.25 to f/1.67). These projection-imaging lenses were created for the semiconductor industry's advanced research in EUV photolithography, a technology slated for introduction in 2009-13. This paper reviews the methods used and our program's accomplishments to date

At-wavelength characterization of the extreme ultraviolet Engineering Test Stand Set-2 optic

At-wavelength interferometric characterization of a new 4x-reduction lithographic-quality extreme ultraviolet (EUV) optical system is described. This state-of-the-art projection optic was fabricated for installation in the EUV lithography Engineering Test Stand (ETS) and is referred to as the ETS Set-2 optic. EUV characterization of the Set-2 optic is performed using the EUV phase-shifting point diffraction interferometer (PS/PDI) installed on an undulator beamline at Lawrence Berkeley National Laboratory's Advanced Light Source. This is the same interferometer previously used for the at-wavelength characterization and alignment of the ETS Set-1 optic. In addition to the PS/PDI-based full-field wavefront characterization, we also present wavefront measurements performed with lateral shearing interferometry, the chromatic dependence of the wavefront error, and the system-level pupil-dependent spectral-bandpass characteristics of the optic; the latter two properties are only measurable using at-wavelength interferometry

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Guidelines for Designing Social Robots as Second Language Tutors

In recent years, it has been suggested that social robots have potential as tutors and educators for both children and adults. While robots have been shown to be effective in teaching knowledge and skill-based topics, we wish to explore how social robots can be used to tutor a second language to young children. As language learning relies on situated, grounded and social learning, in which interaction and repeated practice are central, social robots hold promise as educational tools for supporting second language learning. This paper surveys the developmental psychology of second language learning and suggests an agenda to study how core concepts of second language learning can be taught by a social robot. It suggests guidelines for designing robot tutors based on observations of second language learning in human–human scenarios, various technical aspects and early studies regarding the effectiveness of social robots as second language tutors

Enhancing rare variant interpretation in inherited arrhythmias through quantitative analysis of consortium disease cohorts and population controls.

PURPOSE: Stringent variant interpretation guidelines can lead to high rates of variants of uncertain significance (VUS) for genetically heterogeneous disease like long QT syndrome (LQTS) and Brugada syndrome (BrS). Quantitative and disease-specific customization of American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines can address this false negative rate. METHODS: We compared rare variant frequencies from 1847 LQTS (KCNQ1/KCNH2/SCN5A) and 3335 BrS (SCN5A) cases from the International LQTS/BrS Genetics Consortia to population-specific gnomAD data and developed disease-specific criteria for ACMG/AMP evidence classes-rarity (PM2/BS1 rules) and case enrichment of individual (PS4) and domain-specific (PM1) variants. RESULTS: Rare SCN5A variant prevalence differed between European (20.8%) and Japanese (8.9%) BrS patients (p = 5.7 × 10-18) and diagnosis with spontaneous (28.7%) versus induced (15.8%) Brugada type 1 electrocardiogram (ECG) (p = 1.3 × 10-13). Ion channel transmembrane regions and specific N-terminus (KCNH2) and C-terminus (KCNQ1/KCNH2) domains were characterized by high enrichment of case variants and >95% probability of pathogenicity. Applying the customized rules, 17.4% of European BrS and 74.8% of European LQTS cases had (likely) pathogenic variants, compared with estimated diagnostic yields (case excess over gnomAD) of 19.2%/82.1%, reducing VUS prevalence to close to background rare variant frequency. CONCLUSION: Large case-control data sets enable quantitative implementation of ACMG/AMP guidelines and increased sensitivity for inherited arrhythmia genetic testing

Vitamin D insufficiency in COVID-19 and influenza A, and critical illness survivors: a cross-sectional study

Objectives: The steroid hormone vitamin D has roles in immunomodulation and bone health. Insufficiency is associated with susceptibility to respiratory infections. We report 25-hydroxy vitamin D (25(OH)D) measurements in hospitalised people with COVID-19 and influenza A and in survivors of critical illness to test the hypotheses that vitamin D insufficiency scales with illness severity and persists in survivors. Design: Cross-sectional study. Setting and participants: Plasma was obtained from 295 hospitalised people with COVID-19 (International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)/WHO Clinical Characterization Protocol for Severe Emerging Infections UK study), 93 with influenza A (Mechanisms of Severe Acute Influenza Consortium (MOSAIC) study, during the 2009–2010 H1N1 pandemic) and 139 survivors of non-selected critical illness (prior to the COVID-19 pandemic). Total 25(OH)D was measured by liquid chromatography-tandem mass spectrometry. Free 25(OH)D was measured by ELISA in COVID-19 samples. Outcome measures: Receipt of invasive mechanical ventilation (IMV) and in-hospital mortality. Results: Vitamin D insufficiency (total 25(OH)D 25–50 nmol/L) and deficiency (<25 nmol/L) were prevalent in COVID-19 (29.3% and 44.4%, respectively), influenza A (47.3% and 37.6%) and critical illness survivors (30.2% and 56.8%). In COVID-19 and influenza A, total 25(OH)D measured early in illness was lower in patients who received IMV (19.6 vs 31.9 nmol/L (p<0.0001) and 22.9 vs 31.1 nmol/L (p=0.0009), respectively). In COVID-19, biologically active free 25(OH)D correlated with total 25(OH)D and was lower in patients who received IMV, but was not associated with selected circulating inflammatory mediators. Conclusions: Vitamin D deficiency/insufficiency was present in majority of hospitalised patients with COVID-19 or influenza A and correlated with severity and persisted in critical illness survivors at concentrations expected to disrupt bone metabolism. These findings support early supplementation trials to determine if insufficiency is causal in progression to severe disease, and investigation of longer-term bone health outcomes

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)