A ferrofluid-based homogeneous assay for highly sensitive and selective detection of single-nucleotide polymorphisms

10.1039/C3CC43281EChemical Communications49738114-811

Admission to hospital in the UK at a weekend does not influence the prognosis of adults with community-acquired pneumonia

Outcomes for adults with community-acquired pneumonia (CAP) admitted to hospital at the weekend were compared with those admitted during weekdays using data from the British Thoracic Society national CAP audits. Of 31 400 cases, 40.7% were weekend admissions; these patients were older (mean age 72 vs 71.3 years, p=0.001) and more likely to have high severity CAP (28.9% vs 27.1%, p trend 0.003) but had slightly lower adjusted 30-day inpatient mortality (aOR 0.94 95% CI 0.88 to 1.01) compared with those admitted during weekdays. More patients in the weekend group received antibiotics within 4 hours of admission (70.3% vs 68.7%, aOR 1.07 95% CI 1.01 to 1.12). We did not observe increased mortality for adults admitted at the weekend with CAP

Improving readiness for recruitment through simulated trial activation: the Adjuvant Steroids in Adults with Pandemic influenza (ASAP) trial

Background: Research in public health emergencies requires trials to be set up in readiness for activation at short notice and in anticipation of limited timelines for patient recruitment. We conducted a simulated activation of a hibernating pandemic influenza clinical trial in order to test trial processes and to determine the value of such simulation in maintaining trial readiness. Methods: The simulation involved the Nottingham Clinical Trials Unit, one participating hospital, one manufacturing unit and the Investigational Medicinal Product (IMP) supplier. During the exercise, from 15 September 2015 to 2 December 2015, clinical staff at the participating site completed the trial training package, a volunteer acting as a patient was recruited to the study, ‘dummy’ IMP was prescribed and follow-up completed. Results: Successful activation of the hibernating trial with patient recruitment within 4 weeks of ‘arousal’ as planned was demonstrated. A need for greater resilience in anticipation of staff absenteeism was identified, particularly in relation to key trial procedures where the potential for delay is high. A specific issue relating to the IMP Stock Control System was highlighted as a potential source of error that could compromise the randomisation sequence. The simulation exercise was well received by site investigators and increased their confidence in being able to meet the likely demands of the trial when activated. The estimated cost of the exercise was £1995; 90% of this being staff costs. Conclusions: Simulated activation is useful as a means to test, and prepare for, the rapid activation of ‘hibernating’ research studies. Whether simulation exercises can also help reduce waste in complex clinical trial research deserves further exploration

Co-infections in people with COVID-19: a systematic review and meta-analysis

Objectives: In previous influenza pandemics, bacterial co-infections have been a major cause of mortality. We aimed to evaluate the burden of co-infections in patients with COVID-19. Methods: We systematically searched Embase, Medline, Cochrane Library, LILACS and CINAHL for eligible studies published from 1 January 2020 to 17 April 2020. We included patients of all ages, in all settings. The main outcome was the proportion of patients with a bacterial, fungal or viral co-infection. .Results: Thirty studies including 3834 patients were included. Overall, 7% of hospitalised COVID-19 patients had a bacterial co-infection (95% CI 3-12%, n=2183, I2=92∙2%). A higher proportion of ICU patients had bacterial co-infections than patients in mixed ward/ICU settings (14%, 95% CI 5-26, I2=74∙7% versus 4%, 95% CI 1-9, I2= 91∙7%). The commonest bacteria were Mycoplasma pneumonia, Pseudomonas aeruginosa and Haemophilus influenzae. The pooled proportion with a viral co-infection was 3% (95% CI 1-6, n=1014, I2=62∙3%), with Respiratory Syncytial Virus and influenza A the commonest. Three studies reported fungal co-infections.Conclusions: A low proportion of COVID-19 patients have a bacterial co-infection; less than in previous influenza pandemics. These findings do not support the routine use of antibiotics in the management of confirmed COVID-19 infection

Patient reported outcome measures in the recovery of adults hospitalised with community-acquired pneumonia: a systematic review

Symptomatic and functional recovery are important patient-reported outcome measures (PROMs) in community-acquired pneumonia (CAP) that are increasingly used as trial endpoints. This systematic review summarises the literature on PROMs in CAP.Comprehensive searches in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement were conducted to March 2017. Eligible studies included adults discharged from hospital following confirmed CAP and reporting PROMs.Fifteen studies (n=5644 patients) were included; most of moderate quality. Studies used a wide range of PROMs and assessment tools. At 4-6 weeks’ post-discharge, the commonest symptom reported was fatigue (45% to 72.6% of patients, 3 studies), followed by cough (35.3% to 69.7%) and dyspnoea (34.2% to 67.1%), corresponding values from studies restricted by ag

Effect of corticosteroid therapy on influenza-related mortality: a systematic review and meta-analysis

Background: Most studies have reported that corticosteroid therapy adversely influences influenza-related outcomes. Methods: Electronic databases were searched from inception to March 2013 for experimental and observational studies investigating systemic corticosteroid therapy for presumed influenza-associated complications. Meta-analysis of Observational Studies in Epidemiology guidelines were adopted. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects models, and heterogeneity was assessed using the I2 statistic. Quality of evidence was assessed using the Grading Assessment, Development, and Evaluation system. Results: We identified 16 eligible studies (3039 individuals), all of which were observational; 10 (1497 individuals) were included in the meta-analysis of mortality, of which 9 studied patients with 2009 pandemic influenza A virus subtype H1N1. Risk of bias was greatest in the comparability domain of the Newcastle–Ottawa scale, consistent with potential confounding by indication, and data specific to mortality were of low quality. Meta-analysis found an increased odds of mortality (OR, 2.12; 95% CI, 1.36–3.29) associated with corticosteroid therapy. Subgroup analysis of adjusted estimates from 4 studies with very low statistical heterogeneity found a similar association (OR, 2.58; 95% CI, 1.39–4.79). Conclusions: No completed clinical trials were identified. Evidence from observational studies, with important limitations, suggests that corticosteroid therapy for presumed influenza-associated complications is associated with increased mortality

Pseudo-solidification of dredged marine soils with cement - fly ash for reuse in coastal development

The dislodged and removed sediments from the seabed, termed dredged marine soils, are generally classified as a waste material requiring special disposal procedures. This is due to the potential contamination risks of transporting and disposing the dredged soils, and the fact that the material is of poor engineering quality, unsuitable for usage as a conventional good soil in construction. Also, taking into account the incurred costs and risk exposure in transferring the material to the dump site, whether on land or offshore, it is intuitive to examine the possibilities of reusing the dredged soils, especially in coastal development where the transportation route would be of shorter distance between the dredged site and the construction location. Pseudo-solidification of soils is not a novel idea though, where hydraulic binders are injected and mixed with soils to improve the inherent engineering properties for better load bearing capacity. It is commonly used on land in areas with vast and deep deposits of soft, weak soils. However, to implement the technique on the displaced then replaced dredged soil would require careful study, as the material is far more poorly than their land counterparts, and that the deployment of equipment and workforce in a coastal environment is understandably more challenging. The paper illustrates the laboratory investigation of the improved engineering performance of dredged marine soil sample with cement and fly ash blend. Some key findings include optimum dosage of cement and fly ash mix to produce up to 30 times of small strain stiffness improvement, pre-yield settlement reduction of the treated soil unaffected by prolonged curing period, and damage of the cementitious bonds formed by the rather small dosage of admixtures in the soil post-yield. In short, the test results show a promising reuse potential of the otherwise discarded dredged marine soils

Towards Green Metaverse Networking Technologies, Advancements and Future Directions

As the Metaverse is iteratively being defined, its potential to unleash the next wave of digital disruption and create real-life value becomes increasingly clear. With distinctive features of immersive experience, simultaneous interactivity, and user agency, the Metaverse has the capability to transform all walks of life. However, the enabling technologies of the Metaverse, i.e., digital twin, artificial intelligence, blockchain, and extended reality, are known to be energy-hungry, therefore raising concerns about the sustainability of its large-scale deployment and development. This article proposes Green Metaverse Networking for the first time to optimize energy efficiencies of all network components for Metaverse sustainable development. We first analyze energy consumption, efficiency, and sustainability of energy-intensive technologies in the Metaverse. Next, focusing on computation and networking, we present major advancements related to energy efficiency and their integration into the Metaverse. A case study of energy conservation by incorporating semantic communication and stochastic resource allocation in the Metaverse is presented. Finally, we outline the critical challenges of Metaverse sustainable development, thereby indicating potential directions of future research towards the green Metaverse

Effects of tobacco smoking on recurrent hospitalisation with pneumonia: a population-based cohort study

The incidence of and risk factors for recurrent hospitalisation for pneumonia were investigated using data from Hospital Episode Statistics, linked to a UK primary care database. Within 90 days and 1 year of follow-up, 1733 (3.1%) and 5064 (9.0%), developed recurrent pneumonia respectively. Smoking status at the time of hospitalisation with index pneumonia was associated with the risk of readmission with recurrent pneumonia within a year of discharge: current versus never smokers: adjusted subhazard ratio (sHR) 1.42, 95% CI 1.32 to 1.53, p≤0.001, and ex smokers versus never smokers: adjusted sHR 1.24, 95% CI 1.15 to 1.34, p≤0.001. Other independent risk factors associated with recurrent pneumonia were age, gender, deprivation and underlying comorbidities