Large-scale implementation of pooled RNA extraction and RT-PCR for SARS-CoV-2 detection.

INTRODUCTION: Testing for active SARS-CoV-2 infection is a fundamental tool in the public health measures taken to control the COVID-19 pandemic. Because of the overwhelming use of SARS-CoV-2 reverse transcription (RT)-PCR tests worldwide, the availability of test kits has become a major bottleneck and the need to increase testing throughput is rising. We aim to overcome these challenges by pooling samples together, and performing RNA extraction and RT-PCR in pools. METHODS: We tested the efficiency and sensitivity of pooling strategies for RNA extraction and RT-PCR detection of SARS-CoV-2. We tested 184 samples both individually and in pools to estimate the effects of pooling. We further implemented Dorfman pooling with a pool size of eight samples in large-scale clinical tests. RESULTS: We demonstrated pooling strategies that increase testing throughput while maintaining high sensitivity. A comparison of 184 samples tested individually and in pools of eight samples showed that test results were not significantly affected. Implementing the eight-sample Dorfman pooling to test 26 576 samples from asymptomatic individuals, we identified 31 (0.12%) SARS-CoV-2 positive samples, achieving a 7.3-fold increase in throughput. DISCUSSION: Pooling approaches for SARS-CoV-2 testing allow a drastic increase in throughput while maintaining clinical sensitivity. We report the successful large-scale pooled screening of asymptomatic populations.

A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services.

The number of discharges (63,303) from a university-affiliated medical center in Israel were reviewed. Eight percent of cases in three departments rcceivcd social work services. Patients experiencing inappropriate hospital stay (discharge delay) and who received social work services were characterized and compared with social work clients not experiencing delay. Discharge delay patients differed from other social work clients on key sociodemographic variables. Patients admitted because of "injury" were significantly more likely to experience delay than patients admitted because of "illness." "Waiting for community/institutional resources" was the most common reason for delay and discharge to an institutional setting increased the likelihood of delayed discharge. High risk factors were department-specific and should be studied in context. Results suggested the limited but positive impact of hospital-community collaborative strategies in reducing the incidence of delay over time.

Does the coronary care unit improve prognosis of patients with acute myocardial infarction? A thrombolytic era study.

AIMS: The purpose of our study was to examine and compare the prognosis of acute myocardial infarction patients hospitalized in an intensive coronary care unit and in an internal medicine ward, in the era of reperfusion therapy, and to identify factors associated with the observed outcomes. METHODS AND RESULTS: Patients hospitalized for acute myocardial infarction during the period 1994-1997 at the Sheba Medical Center, Tel Hashomer, Israel (n=2114), were grouped according to the hospital department in which they were treated: the intensive coronary care unit (n=1443, 68.3%) or an internal medicine ward (n=671, 31.7%). Baseline characteristics, comorbidity, hospital course, use of procedures and 30-day mortality were compared between the groups. Stepwise logistic regression was used to identify the factors associated with 30-day mortality. Crude 30-day mortality rates were 5.4% among all patients hospitalized in the intensive coronary care unit compared with 15.9% for all patients in an internal medicine ward (P<0.001); in a subgroup of patients aged 70 years and above these rates were 11.0% and 21.0%, respectively (P<0. 001). Among the independent predictors of the 30-day mortality identified in multivariate analysis was treatment only in an internal medicine ward (odds ratio: 1.48; 95% confidence interval: 1. 00-2.18). Reperfusion therapy was independently associated with a 53% reduction in 30-day mortality. CONCLUSIONS: Our findings emphasize the importance of the treatment of acute myocardial infarction in the setting of intensive coronary care units in the thrombolytic era, in order to ensure early access to advanced diagnostic and therapeutic options for all patients, including the elderly.

A reduction in the number of unwanted pregnancies among female army draftees through a controlled intervention.

OBJECTIVE: To assess the possibility of reducing the risk of unwanted pregnancy through a controlled intervention program that was based on a sex education workshop. DESIGN: Educational intervention study. SETTING: Newly drafted women in a central absorption army base in Israel. PATIENT(S): One thousand seven hundred ninety-three female draftees in the Israeli Defence Force. INTERVENTION(S): A 2-day workshop on sex education at the beginning of army service. MAIN OUTCOME MEASURE(S): Rate of unwanted pregnancy. RESULT(S): After 2 years of follow-up, there were approximately 40% fewer unwanted pregnancies among women with a lower socioeconomic and intellectual profile. CONCLUSION(S): Structured intervention programs may reduce significantly the rate of unwanted pregnancy in young women.

PIP: This study evaluates the success of sex education workshops in preventing unwanted pregnancy among 1793 newly drafted women in 1987 in the central absorption army base in Israel. The sex education workshops were held over a 2-day period at the beginning of army service. The study sample included 968 women in the intervention group and 825 controls. The sex education program included information on sexuality, the anatomy and physiology of the reproductive system, contraceptive methods, pregnancy and childbirth, decision making processes, interpersonal relations, pregnancy prevention, sexually transmitted diseases, and personal hygiene. Each of the 4 daily sessions aimed to involve young women in verbal participation on sex-related topics and to correct myths and prejudices. Questionnaires were administered pre and post army service among cases and controls. The extent of unwanted pregnancy was assessed at a point 2 years after induction. During the 2-year study period, 58 women became pregnant. 2.6% in the intervention group and 4% in the control group had unwanted pregnancies. Unwanted pregnancy was significantly higher among controls and among lower socioeconomic groups. The rates of contraceptive use at first intercourse and visiting a gynecologist were higher in the case group than in the control group after the workshops. Logistic models confirmed the statistical significance of the relationship between unwanted pregnancy and the low Caba subscale (education, Hebrew language proficiency, and language and scholastic fluency), low level of language skill, and controls.

The dynamics of patient visits to a public hospital ED: a statistical model.

Using a public hospital's computerized database, we formulated a statistical model to explain emergency department (ED) patient volume for better staffing and resource allocation. All patients visiting the ED over a 3-year period were included in this retrospective study. Each observation described the total daily number of referrals and was defined by the following variables: day of the week, month of the year, holiday/ weekday, relative order in a 3-year sequence, and number of visits to the ED on that day. The statistical method used to build the model was analysis of covariance. Periodicity in average number of daily visits existed for each of the seasonal factors that were examined, repeating every year during the study period. Based on a graphic analysis, the model was defined and explained 65% of the variance during the 3-year study, with a relatively low standard deviation of error. A statistically significant correlation existed between time-related factors and the number of visits to the ED. This statistical model may prove to be of value for planning emergency services, which operate under stressful, unpredictable situations.

Principal components analysis of therapeutic orientations of doctoral programs in clinical psychology.

A principal components analysis was conducted on a data set that consisted of ratings of therapeutic orientations reported by directors of clinical psychology training programs in 96 clinical psychology programs in the U.S. Two principal components emerged, which contrasted (1) behavioral vs. psychoanalytic approaches and (2) humanistic vs. conditioning approaches. A plotting of factor scores revealed relatively clear separation among programs primarily identified with either behavioral or psychoanalytic/humanistic approaches. The majority of training programs, however, clustered around the midpoint on both underlying factor dimensions, an indication of the adoption of multiple approaches in training.