A scoping review of the experience of implementing population testing for SARS-CoV-2.

OBJECTIVES: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - also known as the coronavirus disease (COVID-19) - pandemic has led to the swift introduction of population testing programmes in many countries across the world, using testing modalities such as drive-through, walk-through, mobile and home visiting programmes. Here, we provide an overview of the literature describing the experience of implementing population testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). STUDY DESIGN: Scoping review. METHODS: We conducted a scoping review using Embase, Medline and the Cochrane library in addition to a grey literature search. We identified indicators relevant to process, quality and resource outcomes related to each testing modality. RESULTS: In total, 2999 titles were identified from the academic literature and the grey literature search, of which 22 were relevant. Most studies were from the USA and the Republic of Korea. Drive-through testing centres were the most common testing modality evaluated and these provided a rapid method of testing whilst minimising resource use. CONCLUSIONS: The evidence base for population testing lacks high quality studies, however, the literature provides evaluations of the advantages and limitations of different testing modalities. There is a need for robust evidence in this area to ensure that testing is deployed in a safe and effective manner in response to the COVID-19 pandemic.

The transmission of Mycobacterium bovis infection to cattle.

The prevalence of Mycobacterium bovis infection in cattle is increasing rapidly in some countries, including the UK and Ireland. The organism infects a wide range of mammalian hosts, and eradication of the disease is difficult if there is an extensive reservoir in the wildlife population. Existing evidence suggests that wildlife vectors include the European badger in the UK and Ireland, the brush-tailed possum and ferret in New Zealand and ungulates in some other countries. Cattle grazing field boundaries or short swards are at particularly high risk, since the chance of contact with the intermediate host or their excreta is increased. There is evidence that the transmission of the disease between cattle following movement accounts for 10-15% of outbreaks in the British Isles and that transmission can occur across farm boundaries. The prevalence the prevalence of single reactors in herds suggested that within-herd transmission was not common. In herds with infected cattle, spreading slurry is a risk factor, which can be minimised by prolonged storage of the slurry, by spreading it on fields not used for grazing or by soil injection. M. bovis also survives in water and may enter the respiratory tract during drinking. It is concluded that M. bovis infection in cattle can be transmitted by a number of routes, some of which can be controlled by appropriate husbandry, but that circumstantial evidence suggests that the existence of a widespread intermediate host is the greatest contributor to infection in cattle.

Battlefield use of depleted uranium and the health of veterans.

Depleted uranium munitions have been used in recent military operations in both the Gulf and the Balkans and there have been concerns that exposure to depleted uranium may be a cause of 'Gulf War Syndrome' and cancer clusters. We recount the properties of depleted uranium, its military uses and the situations in which personnel may be exposed. Following a review of scientific literature, the health effects of depleted and natural uranium exposure are described and the major outcomes of research into Gulf Veterans' Illnesses are summarised. We conclude that, although there is the potential for uranium exposures to cause renal damage or lung cancer, the risk of harm following depleted uranium exposure in military settings seems to be low. We advise on the management of casualties exposed to depleted uranium and suggest control measures that may be appropriate to protect personnel who provide casualty care.

Usefulness of SPECT in the early detection of avascular necrosis of the knees.

Single photon emission computerized tomography (SPECT), was performed on a female with an acutely painful knee. She had been on corticosteroids just before the onset of symptoms. Radiographs and planar scintigraphic views of the knees were unremarkable. SPECT images of the knees were instrumental in the diagnosis of avascular necrosis of the knee. The cases illustrates the usefulness of SPECT in the early detection of avascular necrosis of the knees.

A program to help asthmatic students reach their potential.

Asthma is the most common chronic disease of childhood, affecting 15 percent of Americans under the age of 15. It ranks first among the chronic disease in causing school absenteeism, and it has been linked to lowered academic performance. An educational program for elementary school teachers has been developed to assist the asthmatic student in reaching his or her potential. The program addresses needs expressed by members of the Montgomery, Ala., chapter of Parents of Asthmatic Kids (PAK). These parents voiced concern regarding the inadequate preparation of teachers for dealing with the needs of the asthmatic student. Results of a survey of teachers in local elementary schools confirmed their need for asthma education. The program, consisting of an audiovisual presentation, an informative brochure, and an instructional packet to use with first to sixth graders, is designed to be presented in faculty meetings throughout the school system. To evaluate the effectiveness of the module, a simple test is administered before and after the program. The program has been accepted by the American Lung Association of Alabama and is under consideration by the American Lung Association at the national level.

Multidirectional instability of the shoulder in the athlete.

Laxity of the inferior glenohumeral ligament is the essential lesion in involuntary multidirectional instability of the shoulder. Most important in the diagnosis, which is difficult to make, is the physical examination. Treatment consists of strengthening the muscles in the direction of the greatest instability. If this fails after a year, surgery is indicated.

Late hematogenous infection of total joint replacement.

Late deep wound infection secondary to hematogenous spread of bacteria from a distant focus is an infrequent but devastating complication of total joint replacement. Nine patients (ten implants) with documented late hematogenous infection are reported, all of whom demonstrated several characteristic features. The initial operation was free of clinical evidence of infection and a long asymptomatic interval ensued, followed by a definite febrile illness and acute joint pain. The source of the infection often was not recognized until late and prophylactic antibiotics were not given when it was identified. Seven of the ten implants had to be removed. The primary responsibility for the prevention of this devastating complication lies with the surgeon, who must inform each patient of the risk of late hematogenous seeding from infection elsewhere in the body. It is also important to pay special attention to patients who are at particularly high risk, such as those with rheumatoid arthritis or other systemic diseases. A knowledge of the bacterial flora of the various areas of the human body is essential in choosing the appropriate prophylactic antibiotic.

Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report.

In thirty-six patients (forty shoulders) with involuntary inferior and multidirectional subluxation and dislocation, there had been failure of standard operations or uncertainty regarding diagnosis or treatment. Clinical evaluation of these patients stressed meticulous psychiatric appraisal, conservative treatment, and repeated examination of the shoulder. All patients were treated by an inferior capsular shift, a procedure in which a flap of the capsule reinforced by overlying tendon is shifted to reduce capsular and ligamentous redundancy on all three sides. This technique offers the advantage of correcting multidirectional instability through one incision without damage to the articular surface. One shoulder began subluxating again within seven months after operation, but there have been no other unsatisfactory results to date. Seventeen shoulders were followed for more than two years.