ABSTRACT
Background. Respiratory syncytial virus (RSV) is an important cause of disease in older adults and is associated with high morbidity and mortality, especially in those with high-risk conditions. Illness can vary from mild upper respiratory tract symptoms to more severe lower respiratory tract disease. After over 50 years of research, there is now hope for an RSV vaccine for any population, including older adults. An investigational bivalent RSV A and B, stabilized RSV prefusion F subunit vaccine (RSVpreF) was assessed successfully in a pivotal phase 3 efficacy study in older adults. (NCT05035212). Methods. The primary efficacy objective of this Phase 3, global, multicenter, randomized, double-blinded, placebo-controlled study was to evaluate the prevention of RSV associated lower respiratory tract illness (LRTI-RSV) in up to 40,000 adults >=60 years of age during the first winter season (September 2021-June 2022). Two primary endpoints were tested sequentially - LRTI-RSV with >=2 and >=3 symptoms. A pre-planned efficacy interim analysis (IA) was to be conducted by an external Data Monitoring Committee (DMC) upon accrual of at least 29 cases of LRTI-RSV with >=2 symptoms. With efficacy demonstrated for cases with >=2 symptoms and sufficient cases with >= 3 symptoms accrued, an efficacy analysis of cases with >= 3 symptoms was to be conducted. The ongoing study is collecting additional safety and descriptive efficacy data. Results. At the time of the IA, approximately 34,000 participants received either RSVpreF 120 mug (60 mug each of RSVpreF from RSV A and RSV B) or placebo (1:1 randomization). Forty-four LRTI-RSV cases with >=2 symptoms were accrued with 11 cases in the RSVpreF group and 33 cases in the placebo group corresponding to a VE of 66.7% (96.66% CI: 28.8%, 85.8%). Sixteen LRTI-RSV cases with >=3 symptoms were accrued with 2 cases in the RSVpreF group and 14 cases in the placebo group corresponding to a VE of 85.7% (96.66% CI: 32.0%, 98.7%). The investigational vaccine was well-tolerated with no safety concerns. Conclusion. Despite unpredictable RSV activity due to the COVID-19 pandemic, the primary objective of the study was met demonstrating that RSVpreF had a favorable safety profile and was highly efficacious in preventing LRTI-RSV with >=2 symptoms and >=3 symptoms in older adults 60 years and older.
ABSTRACT
The rapidly growing market of eSports has become a lucrative industry. Sim racing is one of the traditional sports that gain increasing popularity in eSports. With raising profits, lucrative sponsoring contracts, and competitive price money, incentives for fraud are also on the upraise. This is further facilitated by the COVID-19 pandemic, which led to the substitution of live eSport events by virtual formats. Particularly, in sim racing it becomes increasingly challenging to verify the contestants identity in virtual events. Here, we propose and evaluate a generic workflow to identify personal driving style by transforming raw racing data (including measurements extracted from the simulation software and connected simulator hardware) into a comparable representation (fingerprint). As data base we used an extensive collection of telemetry data recorded from the racing simulation Assetto Corsa on 3 immersive motion simulators. The set contains over 2,000 laps of seven player recorded in weekly sessions. The experiments demonstrate the feasibility to distinguish players using the proposed method on different tracks, car models, and motion simulators. Due to the extensive experiments, we could achieve a driver separation score of up to 89%. The raw data and the raw results are made publicly available on Github. © 2022 IEEE.
ABSTRACT
Case Report Pediatric Systemic Lupus Erythematous (pSLE) is a multi-system autoimmune disease with varied clinical presentations. Although rare, it can be associated with significant morbidity and mortality. We report a case of a newly diagnosed pSLE patient who's presenting symptoms were concerning for viral pericarditis. Our 17-year-old African American female presented with non-radiating substernal chest pain and shortness of breath for three days. Pain was described as a constant pressure, exacerbated by lying down, and improved with leaning forward. Shortness of breath was most notable with ambulation. Other associated symptoms included subjective fever, chills, fatigue, two-week history of mild cough, intermittent headaches, nausea, emesis, pedal edema, myalgias, arthralgias, and a 10-pound weight loss. Detailed enquiry revealed a long-standing history of lymphadenopathy, neutropenia, microcytic anemia, and migraine headaches. Previous evaluation included normal thyroid studies, Hemoglobin A1c, complete metabolic panel, HIV testing, monospot, and a reassuring peripheral blood smear. Initial evaluation for her chest pain revealed normal EKG and chest x-ray. On physical exam at our facility, she was afebrile with normal vital signs. Soft, mobile, non-tender, <2 cm posterior cervical lymph nodes were palpated. Cardiac exam was unrevealing and no arthritis or rashes were noted. Her lungs were clear, but she had conversational dyspnea. Initial differential diagnoses included systemic processes such as rheumatologic, oncologic, and infectious. Testing revealed elevated troponin, proteinuria, pancytopenia, and elevated inflammatory markers. Coombs test and ACE were negative. D-dimer and creatinine kinase to evaluate for deep vein thrombosis and myositis were normal. EKG was concerning for ST elevation in anterolateral leads, and an echocardiogram revealed a small, globally distributed pericardial effusion. COVID PCR was positive concerning for pericarditis secondary to multisystem inflammatory syndrome in children (MIS-C). Though she met diagnostic criteria for MIS-C with her history of fever, elevated inflammatory markers, and multisystem involvement (cardiac and abdominal), the presence of her symptoms over several months was more concerning for a chronic process. Further evaluation into an underlying etiology revealed low C3/C4, positive ANA, positive ds-DNA, and positive SS-A, SS-B, chromatin, Anti-Smith, and RNP antibodies. The immunologic profile along with her clinical presentation was consistent with pSLE. Treatment with high-dose intravenous steroids resulted in complete resolution of her chest pain and she was discharged on oral hydroxychloroquine. pSLE is a multi-faceted and diagnostically challenging disease. Our case highlights the importance of obtaining a thorough history and a low threshold of suspicion for this complex autoimmune condition.
ABSTRACT
Background: The SARS-CoV-2 pandemic has created unprecedented challenges for society and healthcare systems worldwide. Switzerland is one of the more affected countries in Europe. We examined the association between socioeconomic position (SEP) and SARS-CoV-2 tests, SARS-CoV-2-positive cases, COVID-19 hospitalisations and COVID-19 deaths in Switzerland. Methods: We used surveillance data reported to the Federal Office of Public Health from March to October, 2020. We geocoded patients' residential addresses to determine the Swiss neighbourhood index of SEP, based on education and occupation of household heads, rent per square meter, and crowding. We used negative binomial regression models adjusted for sex, age, canton of residence and wave of the epidemic (first, March to June;second, July to October) to investigate the association between deciles of the SEP index (1st=lowest, 10th=highest) and four outcomes. We used different denominators: the 2018 Swiss population for tests and deaths, the number of tests for positive cases, and the number of positive cases for hospitalisations. Results: Analyses were based on 1,130,405 SARS-CoV-2 tests, 143,101 positive cases, 6,367 hospitalisations and 1,749 deaths up to 31 October 2020. Figure 1 shows the distribution across deciles of neighbourhood SEP of (A) tests per population, (B) positive cases per test, (C) hospitalisations per case and (D) deaths per population (the black lines and shaded areas show the corresponding model prediction adjusted for sex, age, canton of residence and wave of the epidemic -- median posterior and 95% credible interval). The adjusted change in proportion per 1 decile increase in neighbourhood SEP was +2.4% (95% credible interval: 1.0 to 3.9) for tests per population, -2.4% (-3.6 to -1.1) for positive cases per test, -4.6% (-5.9 to -3.3) for hospitalisations per case and -4.5% (-7.7 to -1.4) for deaths per population. Conclusion: This nation-wide study provides a comprehensive analysis of the association between SEP and SARS-CoV-2 testing, reported infections, and COVID-19-related hospitalisations and deaths. People living in neighbourhoods with higher SEP are more likely to be tested, but less likely to test positive, to be hospitalised or to die, a manifestation of the inverse care law where availability of care varies inversely with the need for it.
ABSTRACT
Introduction: The World Health Organization (WHO) declared COVID-19 virus as pandemic on March 12, 2020.Now it has infected more than 5 million people in 188 countries and caused more than 340,000 deaths. The purposeof this paper is to share the experience of our radiation oncology department in a moderate-sized regional cancercenter (1,600 new consults for radiation per year) in the battle against COVID-19, including the safety measurestaken and the lessons learned. Methods: Our institution is located in the neighbor city of one of the largest COVID-19 epicenters in the USA. Wehave taken precautionary measures gradually to continue our practice in radiation oncology in order to reduceimpact on vulnerable cancer patients. These include reducing the number of entrance doors for both staff andpatients;restricted visitor policy;mandatory screening questionnaires;social distancing in waiting rooms;self-quarantine of staff with travel history or symptoms similar to COVID-19;most responsible physicians reviewingevery case to prioritize or defer consultation, investigation, or treatment;telemedicine for most consultation andfollow-up visits;universal COVID-19 swabbing test for all symptomatic and asymptomatic cancer patients beforestarting treatment planning or radiotherapy;full personal protective equipment (PPE) for staff doing CT simulation ordelivering treatment;mandatory face mask for everyone in the building;keeping 2/3 of all radiation oncologists (RO) and dosimetrists working from home on a roster schedule;and discouraging handling physical paper charts anddocuments in a completely paperless working environment. Results: We saw 267 new consults in the 10 weeks between March 16 and May 24, 2020, vs. 274 in the sameperiod last year. There is no significant difference in average consults per RO, 44.5 (30-60) vs. 45.7 (24-67), p=0.799 (Student's t-test), or wait time within provincial target of 2 weeks, 93.5% vs 97%, p=0.074. We performed193 swabbing tests for 183 patients, with 10 patients bein.g swabbed twice. Most were asymptomatic (144), with 49symptomatic. Only 0.52% tested positive (1 asymptomatic case), lower than many other cancer institutions reportedin the literature, and there were no cases among staff. During the same 10 weeks, confirmed cases in ourcommunity and the province increased from 0 to 912 (6.05% positive tests) and from 142 to 25,904 (4.18% positivetests), with 63 and 2,102 deaths, respectively. Conclusions: Due to restrictions to test asymptomatic patients and to use PPE, the COVID-19 testing rate is farfrom reaching the provincial target and the new cases and deaths are more than originally predicted. However, ourdepartment was not heavily affected due to the diligent team effort ahead of policy changes in the province. It ispossible for frontline health care teams to minimize the risk of cancer patients getting COVID-19 and avoidtreatment interruptions by planning safety measures early, even before the first case in the community and beforeformal provincial guidelines become available.
ABSTRACT
BACKGROUND: With the novel coronavirus-induced disease (COVID-19), there is the fear of nosocomial infections and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissions to healthcare workers (HCW). We report the case of a 64-year-old male patient who underwent explantation of a shoulder prosthesis due to a periprosthetic infection. He was tested SARS-CoV-2 positive 7 days after admission to the orthopaedic department following strict infection control measures, routinely including screening all patients for multi-drug-resistant organism (MDRO) colonization upon admission. Aim of our study is to report on the spreading potential of SARS-CoV-2 in a healthcare setting if standard contact precautions and infection control measures have been established. METHODS: All HCW with exposure to the patient from day of admission until confirmed diagnosis of COVID-19 were identified and underwent oropharyngeal swab testing for SARS-CoV-2 by real-time RT-PCR. RESULTS: Sixty-six HCW were identified: nine orthopaedic surgeons, four anaesthesiologists, 25 orthopaedic nurses, five nurse anesthetists, eight scrub nurses, five nursing students, two medical assistants and seven service employees. Fourteen HCW (21%) showed clinical symptoms compatible with a SARS-CoV-2 infection: cough (n = 4), sore throat (n = 3), nasal congestion (n = 3), dyspnea (n = 2), fever (n = 1), headache and myalgia (n = 1). SARS-CoV-2 was not detected in any of the 66 HCW. CONCLUSION: Hygienic measures and contact precautions, aimed at preventing the spread of MRDO, may have helped to prevent a SARS-CoV-2 transmission to HCW-despite high-risk exposure during intubation, surgical treatment and general care. LEVEL OF EVIDENCE: IV, case series.