Simultaneous detection of SARS-CoV-2, influenza A, respiratory syncytial virus, and measles in wastewater by multiplex RT-qPCR.

A multiplex quantitative reverse transcription polymerase chain reaction (RT-qPCR)-based method was designed for the simultaneous detection of influenza A, SARS-CoV-2, respiratory syncytial virus, and measles virus. The performance of the multiplex assay was compared to four monoplex assays for relative quantification using standard quantification curves. Results showed that the multiplex assay had comparable linearity and analytical sensitivity to the monoplex assays, and the quantification parameters of both assays demonstrated minimal differences. Viral reporting recommendations for the multiplex method were estimated based on the corresponding limit of quantification (LOQ) and the limit of detection at 95 % confidence interval (LOD) values for each viral target. The LOQ was determined by the lowest nominal RNA concentrations where %CV values were ≤35 %. Corresponding LOD values for each viral target were between 15 and 25 gene copies per reaction (GC/rxn), and LOQ values were within 10 to 15 GC/rxn. The detection performance of a new multiplex assay was validated in the field by collecting composite wastewater samples from a local treatment facility and passive samples from three sewer shed locations. Results indicated that the assay could accurately estimate viral loads from various sample types, with samples collected from passive samplers showing a greater range of detectable viral concentrations than composite wastewater samples. This suggests that the sensitivity of the multiplex method may be improved when paired with more sensitive sampling methods. Laboratory and field results demonstrate the robustness and sensitivity of the multiplex assay and its applicability to detect the relative abundance of four viral targets among wastewater samples. Conventional monoplex RT-qPCR assays are suitable for diagnosing viral infections. However, multiplex analysis using wastewater provides a fast and cost-effective way to monitor viral diseases in a population or environment.

Assessing carrying capacity using demographics, visitor experience and field studies: the case of Hanauma Bay Nature Preserve

The Hanauma Bay Nature Preserve (HBNP) was designated the first Marine Life Conservation District in Hawai'i in 1967. It is the most popular visitor snorkelling experience on the island of O'ahu. A social carrying capacity study was conducted upon reopening, following a nine-month COVID-19 closure due to travel restrictions. Surveys were compared to three prior surveys conducted between 1990 and 2002 to provide a larger historical context of social dynamics and perceived human impacts over time. Demographics, recreational activities, crowding perceptions, and educational availability were assessed. Visitor activity photos and counts were evaluated in context with survey responses. Perceived visitor contact on the reef was compared to in situ snorkelling impact. These quantitative observations reported an average of one reef disturbance for every two individuals. Photographic analysis of breakage of selected baseline corals prior to closure were compared to corals following reopening of the preserve in 2021. Partial mortality occurred in 60% of coral colonies. Successful management policies that include social carrying capacities should align with biological carrying capacities to balance the health of the ecosystem with a positive experience for visitors. These management strategies provide a holistic approach to advance conservation and meet visitor satisfaction goals. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Locked, Stocked, and Charmin: Sources of White Americans' Responses to the COVID-19 Pandemic

In March 2020, the COVID-19 pandemic resulted in an unprecedented number of people purchasing firearms/ammunition. However, this was not the only way Americans responded to the pandemic: large swaths of the public also stayed at home and stockpiled goods. Twelve months later, as the pandemic raged, these coping mechanisms were still present as Americans continued to buy guns/ammunition, limit social interactions, and hoard supplies. Using two nationwide surveys conducted one year apart, we examine the extent and sources of gun/ammunition purchasing compared to staying home and panic buying during this unique moment in American history. Results from both surveys indicate that the factors that led to these divergent coping mechanisms vary. Both at the beginning of the pandemic and one year later, the likelihood of purchasing a firearm/ammunition was associated low self-control and White nationalism. Conversely, fear of the virus was associated with people staying home and amassing supplies. © 2023 Taylor & Francis Group, LLC.

Visual fields in glaucoma: Where are we now?

Visual fields are an integral part of glaucoma diagnosis and management. COVID has heightened the awareness of the potential for viral spread with the practice of visual fields modified. Mask artefacts can occur due to fogging of the inferior rim of the trail lens. Fortunately, the risk of airborne transmission when field testing is low. The 24-2c may be useful to detect early disease and the 10-2 more sensitive to detect advanced loss. The SITA faster test algorithm is able to reduce testing time thereby improving clinic efficiency, however, may show milder results for moderate or severe glaucoma. The technician has an important role of supervising the visual field performance to achieve reliable output. Home monitoring can provide earlier detection of progression and thus improve monitoring of glaucoma as well as reduce the burden of in-clinic assessments. Artificial Intelligence has been found to have high sensitivity and specificity compared to expert observers in detecting field abnormalities and progression as well as integrating structure with function. Although these advances will improve efficiency and guide accuracy, there will remain a need for clinicians to interpret the results and instigate management.

Low Prevalence of Late Myocardial Injury on Cardiac MRI Following COVID-19 Infection.

BACKGROUND: The prevalence of abnormal cardiac magnetic resonance imaging (MRI) findings indicative of myocardial injury in patients who recovered from coronavirus disease 2019 (COVID-19) is currently unclear, with a high variability in the reported prevalence. PURPOSE: To assess the prevalence of myocardial injury after a COVID-19 infection. STUDY TYPE: Prospective, bicentric study. SUBJECTS: Seventy consecutive patients who recovered from COVID-19 and were previously hospitalized. Mean age was 57 years and 39% of the patients were female. Ten healthy controls and a comparator group of 75 nonischemic cardiomyopathy (NICM) patients were employed. FIELD STRENGTH/SEQUENCE: 1.5-T, steady-state free precession (SSFP) gradient-echo sequence, modified Look-Locker inversion recovery sequence with balanced SSFP readout, T2-prepared spiral readout sequence and a T1-weighted inversion recovery fast gradient-echo sequence was acquired ~4-5 months after recovery from COVID-19. ASSESSMENT: The SSFP sequence was utilized for the calculation of left and right ventricular volumes and ejection fractions (LVEF and RVEF) following manual endocardial contouring. T1 and T2 mapping was performed by pixel-wise exponential fitting, and T1 and T2 values were computed by manual contouring of the left ventricular endocardial and epicardial walls. Late gadolinium enhancement (LGE) images were graded qualitatively as LGE present or absent. STATISTICAL TESTS: T-tests and the χ2 or Fisher's exact tests were used to compare continuous and categorical variables respectively between the COVID-19 and NICM groups. Inter-rater agreement was evaluated by the intraclass correlation coefficient for continuous variables and Cohen's kappa test for LGE. RESULTS: Reduced RVEF occurred in 10%, LGE and elevated native T1 in 9%, reduced LVEF in 4%, and elevated T2 in 3% of COVID-19 patients, respectively. Patients with NICM had lower mean LVEF (41.6% ± 6% vs. 60% ± 7%), RVEF (46% ± 5% vs. 61% ± 9%), and a significantly higher prevalence of LGE (27% vs. 9%) when compared to those post-COVID-19. DATA CONCLUSION: Abnormal cardiac MRI findings may show a low prevalence in patients who recovered from COVID-19 and were previously hospitalized. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

Impact of the COVID-19 pandemic on breast, colorectal, lung, and prostate cancer stage at diagnosis according to race.

PURPOSE: To determine if the COVID-19 pandemic has further exacerbated racial disparities in late-stage presentation of breast, colorectal, lung, and prostate cancers. METHODS: We conducted a registry-based retrospective study of patients with newly reported diagnoses of breast, colorectal, lung, and prostate cancers between March 2019-June 2019 (pre-COVID-19) and March 2020-June 2020 (early-COVID-19). We compared the volume of new diagnoses and stage at presentation according to race between both periods. RESULTS: During the study period, a total of 3528 patients had newly diagnosed cancer; 3304 of which had known disease stages and were included in the formal analyses. 467 (14.1%) were Blacks, and 2743 were (83%) Whites. 1216 (36.8%) had breast, 415 (12.6%) had colorectal, 827 (25%) had lung, and 846 (25.6%) had prostate cancers, respectively. The pre-COVID-19 period included 2120 (64.2%), and the early-COVID-19 period included 1184 (35.8%), representing a proportional 44.2% decline in the volume of new cases of breast, colorectal, lung, and prostate cancers, p < 0.0001. Pre-COVID-19, 16.8% were diagnosed with metastatic disease, versus 20.4% early-COVID-19, representing a proportional increase of 21.4% in the numbers of new cases with metastatic disease, p = 0.01. There was a non-significant proportional decline of 1.9% in Black patients diagnosed with non-metastatic breast, colorectal, lung, and prostate cancers early-COVID-19 (p = 0.71) and a non-significant proportional increase of 7% in Black patients diagnosed with metastatic disease (p = 0.71). Difference-in-difference analyses showed no statistically significant differences in metastatic presentation comparing Black to White patients. CONCLUSION: While we identified substantial reductions in the volume of new cancer diagnoses and increases in metastatic presentations due to the COVID-19 pandemic, the impact was similar for White and Black patients.

Blinded by the White (Nationalism): Separatist Ideology and Discounting the Threat of COVID-19 to Society

After more than one million COVID-19 deaths and ninety-one million cases in the United States, it is clear that COVID-19 has and will continue to pose a threat to the health of the United States' population and economy. However, despite the clear and early warnings from the CDC, many have continued to downplay the impact of the pandemic, which has arguably inflamed the perniciousness of the virus. Using data from national surveys conducted a year apart, in March 2020 and March 2021, we examine the perceived national and personal threat of COVID-19 in the United States. We argue that collective narcissism-in the form of White nationalism-has blinded some Americans to this national threat, leading to an inadequate collective response that was further exacerbated by the political leadership of former President Donald Trump. We demonstrate that White nationalism is associated with discounting the national but not personal threat of the virus. This was true both early in the pandemic (2020) and later (2021), after the virus had ravaged the country.

Clinical Features of the UK FSHD Patient Registry

The UK Facioscapulohumeral Muscular Dystrophy (FSHD) Patient Registry is a patient self-enrolling online database collecting clinical and genetic information about FSHD type 1 (FSHD1) and type 2 (FSHD2). The registry was established in May 2013 with support from Muscular Dystrophy UK and is coordinated by Newcastle University. The registry aims to facilitate academic and clinical research, better characterise and understand FSHD, and disseminate information relating to upcoming studies and research advancements. The registry is used to capture longitudinal, selfreported data through an online portal available to patients and clinicians. Where specialised clinical or genetic information is required, the neuromuscular specialist involved in the patient's care can be invited to provide some additional information and the patient can select them from a pre-populated list at the registration stage. The registry is a Core Member of the TREAT-NMD Global Registries Network for FSHD. Between May 2013 and January 2022, there were 1,074 patient registrations, with 84% based in the UK. On average, there are 9 new registrations per month. For those reporting a clinical diagnosis, 97% have FSHD or FSHD1, and 3% have FSHD2. Overall, 46% of patients have had genetic confirmation of FSHD1 provided. The registry has previously supported almost 30 registry enquiries to date. Since 2020, the registry has facilitated 12 enquiries including, three COVID-19 surveys, and various surveys capturing information on dysphagia, pregnancy, sleep and the patient/caregiver experience. The registry is currently one of the largest national FSHD patient registries and is an example of a versatile, cost-effective research tool, helping facilitate and advance a wide range of FSHD research. Additional work continues to be done to improve reporting of genetic information on the registry and there are future data linkage plans between the registry and the Newcastle Research Biobank for Rare and Neuromuscular Diseases.

Immersive ultraviolet disinfection of E. coli and MS2 phage on woven cotton textiles.

Immersive ultraviolet disinfection provides a chemical-free technology for safer textiles, surfaces, and public spaces by inactivating communicable pathogens. This study examined immersive UV disinfection, using a disinfection cabinet, of E. coli and MS2 that was inoculated on white cotton T-shirts. The impact that porous materials have on UV disinfection is poorly understood with the majority of previous surface disinfection research focusing on hard, smooth surfaces. Several approaches were used in this study to characterize the light dynamics within the disinfection cabinet including colorimetric dosimetry coupons, biodosimetry, and spectroradiometry. Micro and macro geometry of porous surfaces are important factors to consider when using immersive UV technologies. The geometry of the cabinet impacted the distribution of emitted UV light within the disinfection cabinet and the physical properties of a porous material, such as the woven pattern of cotton, both contribute to UV disinfection efficiency. This work identified that light distribution is crucial for immersive UV technologies as the delivered fluence was highly variable within the disinfection cabinet and resulted in a difference of several logs of reduction for adjacent areas of T-shirt samples. Other inoculated areas achieved upwards of 1-log reductions values for MS2 and upwards of 2-log reductions for E. coli.

Adsorption of SARS-CoV-2 onto granular activated carbon (GAC) in wastewater: Implications for improvements in passive sampling.

Based on recent studies, passive sampling is a promising method for detecting SARS-CoV-2 in wastewater surveillance (WWS) applications. Passive sampling has many advantages over conventional sampling approaches. However, the potential benefits of passive sampling are also coupled with apparent limitations. We established a passive sampling technique for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in wastewater using electronegative filters. Though, it was evident that the adsorption capacity of the filters constrained their use. This work intends to demonstrate an optimized passive sampling technique for SARS-CoV-2 in wastewater using granular activated carbon (GAC). Through bench-scale batch-adsorption studies and sewershed deployments, we established the adsorption characteristics of SARS-CoV-2 and two human feacal viruses (PMMoV and CrAssphage) onto GAC. A pseudo-second-order model best-described adsorption kinetics for SARS-CoV-2 in either deionized (DI) water and SARS-CoV-2, CrAssphage, and PMMoV in wastewater. In both laboratory batch-adsorption experiments and in-situ sewershed deployments, the maximum amount of SARS-CoV-2 adsorbed by GAC occurred at ~60 h in wastewater. In wastewater, the maximum adsorption of PMMoV and CrAssphage by GAC occurred at ~60 h. In contrast, the adsorption capacity was reached in DI water seeded with SARS-CoV-2 after ~35 h. The equilibrium assay modeled the maximum adsorption quantity (qmax) in wastewater with spiked SARS-CoV-2 concentrations using a Hybrid Langmuir-Freundlich equation, a qmax of 2.5 × 109 GU/g was calculated. In paired sewershed deployments, it was found that GAC adsorbs SARS-CoV-2 in wastewater more effectively than electronegative filters. Based on the anticipated viral loading in wastewater, bi-weekly sampling intervals with deployments up to ~96 h are highly feasible without reaching adsorption capacity with GAC. GAC offers improved sensitivity and reproducibility to capture SARS-CoV-2 RNA in wastewater, promoting a scalable and convenient alternative for capturing viral pathogens in wastewater.

BACK TO THE FUTURE-IS DIVERSION WITHOUT RESECTION A SAFE OPTION FOR COMPLICATED DIVERTICULITIS?

Purpose/Background: Historically, diversion was performed prior to resection of complex diverticular disease. This fell out of favor, but with the advent of laparoscopy, we investigated whether fecal diversion as a first step is a safe alternative in select patients who would otherwise undergo a Hartmann's procedure. Hypothesis/Aim: For select patients with acute medically-refractory diverticulitis, diversion without resection controls sepsis and is a safe option. Methods/Interventions: Single institution retrospective chart review of all patients presenting with acute complicated diverticulitis from July 2016- June 2021 was performed. The subset of patients who underwent diverting loop ileostomy or colostomy without initial resection were analyzed for demographics, reason for diversion alone and clinical course. Results/Outcome(s): Nineteen patients who underwent loop diverting ostomy (17 ileostomies, 2 colostomies) were identified. Seventeen of 19 were performed laparoscopically. The average patient age was 52.8 years old (SD 18.1) and 47% were men. Six patients had preoperative abscesses, one of which was amenable to percutaneous drainage. Several patients were initially admitted for another diagnosis and subsequently developed diverticulitis. Comorbidities included cases of severe COVID, recent bone marrow transplantation, and current chemotherapy for lymphoma. The average time from admission to operation was 3.3 days (SD 2.9), and the average postoperative length of stay was 10.1 days (SD 10.7). None of the 19 patients required resection for failure to improve during that hospitalization. Two patients (10.5%) required placement of a percutaneous drain post-operatively. Seventeen patients were discharged home (89.5%) and 2 were discharged to a rehabilitation facility. Six patients required emergency department visits or readmission, most often for dehydration. Since their diversion, 16 patients have subsequently undergone sigmoid resection (84.2%), 15 with primary anastomosis and subsequent diverting ostomy takedown, and one with conversion from loop colostomy to descending colostomy and Hartmann's pouch. Five of the 16 sigmoid resections were performed laparoscopically (31.3%). Limitations: This study is a single institution retrospective review with a small sample size. Conclusions/Discussion: Fecal diversion appears to be a safe initial surgical strategy, providing adequate control of local sepsis in patients who are felt to be poor candidates for sigmoid resection with primary anastomosis and diversion, and allows patients to avoid an initial Hartmann's procedure. All 19 patients were discharged without requiring additional surgery. For patients with severe acute confounding medical comorbidities, initial diversion may allow the patient to recover from their acute process, permit optimization of their health status, and allow an elective sigmoid resection at a more opportune time. (Table Presented).

Case Report of Donor Transmitted SARS-CoV-2 Infection During Lung Transplantation

Avoiding SARS-CoV-2 infection in the peri-operative period is a challenge for lung transplantation during the COVID19 pandemic. Testing donor lung BAL samples for SARS-CoV-2 as part of pre-transplant workup may avoid donor-derived infections. A 36-year-old woman with interstitial lung disease secondary to desquamatous interstitial pneumonia during infancy underwent bilateral lung transplant. She was highly allosensitized (cPRA >89%, ccPRA 97%) prompting intra-operative plasmapheresis (PLEX) and rabbit thymoglobulin induction immunosuppression. Post-operatively, her immunosuppression consisted of institution-standard tacrolimus, mycophenolate, and methylprednisolone. For HLA desensitization belatacept, rituximab, intravenous immunoglobulin (IVIG), and carfilzomib regimens were added. She was extubated post-op day 2. Her course was complicated by worsening hypercarbia, hypoxia and respiratory secretions. Post-op day 11, she was reintubated with tracheostomy placement. Chest imaging showed bilateral heterogeneous pulmonary opacities. BAL sampling was positive for SARS-CoV-2 with concern for donor transmission given adherent hospital precautions. Pre-transplant donor and recipient nasopharyngeal (NP) SARS-CoV-2 screenings were negative. Donor transmission was confirmed by positive PCR testing of banked pre-operative donor lung BAL samples. Dexamethasone and remdesivir were started. Tacrolimus and mycophenolate were continued for immunosuppression. She developed acute antibody-mediated rejection (AMR) with new donor specific antigens (DSA) likely related to her SARS-CoV-2 infection. Her AMR was managed with IVIG and PLEX x 10 with PLEX followed by SARS-CoV-2 convalescent plasma. Her DSA's resolved and ventilatory support was weaned. She was discharged home post-op day 56 and was doing well on room air 6 months out. This case emphasizes a potential to miss donor SARS-CoV-2 infection in standard pre-operative evaluation. Despite absence from the NP mucosa viable SARS-CoV-2 virions may be present in donor lung tissue, increasing risk of infection to recipients. Peri-transplant SARS-CoV-2 infection carries a high risk of morbidity. Of note, our case occurred prior to the UNOS mandate for donor lung SARS-CoV-2 screening by lower respiratory sampling. This mandate will decrease risk for similar cases in the future. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Digital sexual and reproductive health resources for women living in a migrant camp in Serbia

Prior to Covid-19 (C19), I delivered sexual and reproductive health (SRH) educational workshops to refugee/migrant women in a migrant camp in Belgrade, Serbia. SRH education and access are key to the public health for all but specifically this vulnerable population. C19 and a national lockdown meant an alternative, none face to face delivery method was required. Migrant camps exist throughout Europe, and restrictions due to C19 continue across the world increasing the applicability of this practice in many settings. My previous experience informed my knowledge for course content, however not suitable delivery methods. Most women had mobile phones, however barriers to accessing online content included intermittent internet access, low computer literacy, inadequate privacy, and need for translation. Following research into alternative formats, over a number of months we piloted;texts +/- attachments, voice messages, video streaming, online videos to download. The questions posed were 1. Which format was the most accessible/acceptable to the women? 2. When the format was decided, how many women would access the content and was this number comparable to the workshops? The feedback showed texts with links to unlisted YouTube videos with burned subtitles were best, enabling download when internet access/privacy allowed and requiring minimal computer skills. We created an SRH programme of 5-minute videos with feedback obtained via text. Each video has 4-21 views (averaging 8 and continuing to increase) at time of submission, comparable or more than the workshops. This innovative practice delivers SRH information to women in this migrant camp. It doesn't replace workshops but when access is restricted it can be used independently, or ordinarily as a supplementary tool to workshops. It is applicable in any setting when access is restricted. Benefits include;choice of when/where/how to access;repeat views;potential for wider reach/scaling to reach larger populations. Key messages These carefully designed digital resources have allowed non-English speaking migrant women in a migrant camp to continue accessing sexual and reproductive health education during Covid-19 lockdowns. This innovative practice of delivering information to vulnerable, hard to reach groups is applicable in many settings when face to face access is restricted.

Survival analysis of factors affecting the timing of COVID-19 non-pharmaceutical interventions by U.S. universities.

BACKGROUND: During March of 2020 the Centers for Disease Control and Prevention (CDC) announced non-pharmaceutical intervention (NPI) guidance as the primary mitigation strategy against growing COVID-19 community spread due to the absence of a vaccine or effective treatment at that time. CDC guidance states that NPIs are most effective when instituted in an early, targeted, and layered fashion. NPIs are effective in slowing spread, and measures should be custom-tailored to each population. This study examines factors associated with implementation and timing of NPI interventions across large public and private U.S. universities at the onset of the COVID-19 pandemic. METHODS: NPI decisions of interest include when U.S. universities canceled international travel, shifted to online learning, moved faculty/staff to remote work, limited campus housing, and closed campus for all non-essential personnel. Cox proportional hazard analyses of retrospective data were conducted to assess the time to NPI events. Hazard ratios were calculated for university governance, campus setting, religious affiliation, health infrastructure, faculty diversity, and student demographics. The methods control for variance inflation factors, COVID case prevalence, and time varying covariates of spring break and states' state of emergency (SOE) orders. This study captures NPI decisions at 575 U.S. universities during spring of 2020 which affected the movement of seven million students and two million employees. RESULTS: Universities located in districts represented by Democratic party congressional members reported earlier NPI implementation than Republican (Cox proportional hazard ratio (HR) range 0.61-0.80). University religious affiliation was not associated with the timing any of the NPI decisions. Universities with more diverse faculty showed an association with earlier NPI implementation (HR range 0.65-0.76). The existence of university-affiliated health infrastructure was not associated with NPI timing. CONCLUSION: University NPI implementation was largely driven by local COVID-19 epidemiology, culture and political concerns. The timing of university NPI decisions varied by regional politics, faculty demographics, university governance, campus setting, and foreign student prevalence adjusting for COVID-19 state case prevalence and spring break timing. Religious affiliation and presence of university health infrastructure were not associated with timing.

Accuracy of the Veterans Health Administration COVID-19 (VACO) Index for predicting short-term mortality among 1307 US academic medical centre inpatients and 427 224 US Medicare patients.

BACKGROUND: The Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans-we now assess its accuracy in an academic medical centre and a nationwide US Medicare cohort. METHODS: With measures and weights previously derived and validated in US national Veterans Health Administration (VA) inpatients and outpatients (n=13 323), we evaluated the accuracy of the VACO Index for estimating 30-day all-cause mortality using area under the receiver operating characteristic curve (AUC) and calibration plots of predicted versus observed mortality in inpatients at a single US academic medical centre (n=1307) and in Medicare inpatients and outpatients aged 65+ (n=427 224). RESULTS: 30-day mortality varied by data source: VA 8.5%, academic medical centre 17.5%, Medicare 16.0%. The VACO Index demonstrated similar discrimination in VA (AUC=0.82) and academic medical centre inpatient population (AUC=0.80), and when restricted to patients aged 65+ in VA (AUC=0.69) and Medicare inpatient and outpatient data (AUC=0.67). The Index modestly overestimated risk in VA and Medicare data and underestimated risk in Yale New Haven Hospital data. CONCLUSIONS: The VACO Index estimates risk of short-term mortality across a wide variety of patients with COVID-19 using data available prior to or at the time of diagnosis. The VACO Index could help inform primary and booster vaccination prioritisation, and indicate who among outpatients testing positive for SARS-CoV-2 should receive greater clinical attention or scarce treatments.

Specificity of UV-C LED disinfection efficacy for three N95 respirators.

The recent surge in the use of UV technology for personal protective equipment (PPE) has created a unique learning opportunity for the UV industry to deepen surface disinfection knowledge, especially on surfaces with complex geometries, such as the N95 filter facepiece respirators (FFR). The work outlined in this study addresses the interconnectedness of independent variables (e.g., UV Fluence, respirator material) that require consideration when assessing UV light efficacy for disinfecting respirators. Through electron microscopy and Fourier-transform infrared (FTIR) spectroscopy, we characterized respirator filter layers and revealed that polymer type affects disinfection efficacy. Specifically, FFR layers made from polypropylene (PP) (hydrophobic in nature) resulted in higher disinfection efficiency than layers composed of polyethylene terephthalate (PET-P) (hygroscopic in nature). An analysis of elastic band materials on the respirators indicated that silicone rubber-based bands achieved higher disinfection efficiency than PET-P bands and have a woven, fabric-like texture. While there is a strong desire to repurpose respirators, through this work we demonstrated that the design of an appropriate UV system is essential and that only respirators meeting specific design criteria may be reasonable for repurposing via UV disinfection.

Assessing the impact of multiple ultraviolet disinfection cycles on N95 filtering facepiece respirator integrity.

During the COVID-19 pandemic, N95 filtering facepiece respirators (FFRs) were recommended to protect healthcare workers when providing care to infected patients. Despite their single-use disposable nature, the need to disinfect and repurpose FFRs is paramount during this global emergency. The objectives of this study were to (1) determine if UV treatment has an observable impact on respirator integrity; (2) test the impact of UV treatment on N95 FFR user fit; and (3) test the impact of UV treatment on FFR integrity. Ultraviolet (UV) disinfection was assessed in maintaining N95 FFR integrity. Two models of FFRs were exposed to UV fluences ranging from 0 to 10,000 mJ cm-2 per side and subsequently tested for fit, respirator integrity, and airflow. Inspection of N95 FFRs before and after UV treatment via microscopy methods showed no observable or tactile abnormalities in the integrity of respirator material or straps. Tensile loading tests on UV-treated and untreated respirator straps also demonstrated no impact on breaking strength. Standardized fit test methods showed no compromise in user fit following UV treatment. Evaluation of particle penetration and airflow through N95 FFRs showed no impact on integrity, and average filtration efficiency did not fall below 95% for any of the respirator types or fluence levels. This work provides evidence that UV disinfection does not compromise N95 FFR integrity at UV fluences up to 10,000 mJ cm-2. UV disinfection is a viable treatment option to support healthcare professionals in their strategy against the spread of COVID-19.