Integrative modelling of reported case numbers and seroprevalence reveals time-dependent test efficiency and infection rates

Mathematical models have been widely used during the ongoing SARS-CoV-2 pandemic for data interpretation, forecasting, and policy making. However, most models are based on officially reported case numbers, which depend on test availability and test strategies. The time dependence of these factors renders interpretation difficult and might even result in estimation biases. Here, we present a computational modelling framework that allows for the integration of reported case numbers with seroprevalence estimates obtained from representative population cohorts. To account for the time dependence of infection and testing rates, we embed flexible splines in an epidemiological model. The parameters of these splines are estimated, along with the other parameters, from the available data using a Bayesian approach. The application of this approach to the official case numbers reported for Munich (Germany) and the seroprevalence reported by the prospective COVID-19 Cohort Munich (KoCo19) provides first estimates for the time dependence of the under-reporting factor. Furthermore, we estimate how the effectiveness of non-pharmaceutical interventions and of the testing strategy evolves over time. Overall, our results show that the integration of temporally highly resolved and representative data is beneficial for accurate epidemiological analyses.

Evaluation of point-of-care algorithms to detect diabetes during screening for latent TB infection

BACKGROUND: Individuals with both diabetes mellitus (DM) and TB infection are at higher risk of progressing to TB disease.OBJECTIVE: To determine DM prevalence in populations at high risk for latent TB infection (LTBI) and to identify the most accurate point-of-care (POC) method for DM screening.METHODS: Adults aged ≥25 years were recruited at health department clinics in Hawaii and Arizona, USA, and screened for LTBI and DM. Screening methods for DM included self-report, random blood glucose (RBG), and POC hemoglobin A1c (HbA1c). Using HbA1c ≥6.5% or self-reported history as the gold standard for DM, we compared test strategies to determine the most accurate method while keeping test costs low.RESULTS: Of 472 participants, 13% had DM and half were unaware of their diagnosis. Limiting HbA1c testing to ages ≥30 years with a RBG level of 120–180 mg/dL helped identify most participants with DM (sensitivity 85%, specificity 99%) at an average test cost of US$2.56 per person compared to US$9.56 per person using HbA1c for all patients.CONCLUSION: Self-report was insufficient to determine DM status because many participants were previously undiagnosed. Using a combination of POC RBG and HbA1c provided an inexpensive option to assess DM status in persons at high risk for LTBI.

Regional Resource Urbanism, Envisioning an Adaptive Transition for the Urbanising Periphery of Kathmandu

Despite a strong tradition of harmony between the landscape and its settlements, Kathmandu's periphery now stands altered due to the contemporary challenges of modernisation. It has become the contested territory where rapid urbanisation and infrastructure projects conflict with the valley's last remaining resources. i.e., fertile soil, floodplains, water sources, forests and agricultural land. The periphery is essential in preserving the remaining agricultural landscape, which is the mainstay of the numerous traditional communities of Kathmandu. Both the occupants and the productive landscape are threatened due to haphazard urbanisation and future mobility projects, resulting in speculative and uncontrolled sprawl. A detailed investigation was conducted on a site 15km south of Kathmandu to address the city's landscape challenges. The chosen investigation frame presented the suitable conditions to study and test strategies posed by the research objectives. The research utilises landscape urbanism and cartography to reveal the landscape's latent capacities, identify the spatial qualities, stakeholders and typologies involved in the production and consumption of resources. The study identifies existing resource flows and their ability to generate future scenarios. Systematic design strategies were applied in resource recovery projects by optimising enterprising capacity building within communities after the earthquake. The research recognises the merit in existing practices, community networks, the ongoing post-earthquake rebuilding efforts in offering an alternative design strategy in which landscape becomes the carrying structure for the sustainable reorganisation of Kathmandu's periphery.

Close Gap Test Strategies for Students with Severe Speech Impairment

Introduction. The level of formedness of text competence at secondary school in the aspect of understanding the text’s factual information ensures the successful grasping of the learning content. The purpose of the research was to identify the specifics of the functioning of linear deployment mechanisms and probabilistic forecasting among learners of 5–10th grade (form) with specific language impairment. Материалы и методы. The modified close gap test method was used as the main research method at the level of the ascertaining experiment. The results of the close gap tests, filled by learners, were exposed to quantitative and qualitative analysis. The research was conducted by applying theoretical (interpretive) and empirical (ascertaining experiment based on author’s method) methods. The analytical stage involved the use of the method of correlation analysis, the mathematical processing was carried out with the help of one-way analysis of variance (ANOVA). Results. Analysis of experimental data helped determine the close gap test strategies in adolescent students with specific language impairment. The qualitative and quantitative analysis of studentsʼ work was applied to determine three main groups of strategies for linear deployment and probabilistic forecasting: strategies for establishing semantic links at the level of the lexical component, a strategy for establishing links at the level of associations, and no strategy. Furthermore, the analysis of substitutes with regard to their compliance with grammatical requirements revealed the following typology of manifestations of agrammatism: the use of an inadequate part of speech, deficiencies of grammatical presentation in phrases, non-compliance of the grammatical form of the substitute with the requirements for the grammatical design of the sentence. Correlation analysis was applied to establish links between different types of close gap test strategies used by adolescents with specific language impairment, as well as their relationship with the levels of understanding the factual content of the text. Discussion and Conclusion. The results obtained contribute to the development of developmental psycholinguistics, special pedagogy, speech therapy and school methods of speech development.

Knowledge and intentions regarding the Pap smear test among Saudi Arabian women

Background The knowledge of Pap smear and uptake of preventive behaviors to prevent cervical cancer are the most important contributors to the advanced stage of the disease. Knowledge is one of the most leading factors to predict the health behaviors and a helpful factor in performing screening procedures. This study aimed to investigate Saudi Arabian women knowledge of Pap testing in relation to their intention to undergo the test. Methods An online survey including demographic characteristics (3 questions), knowledge (13 questions), and intentions (3 questions) towards Pap smear was completed by 467 Saudi Arabian women. Data were analyzed through SPSS version 22, using descriptive statistics and correlation to measure the relationship between knowledge, demographic factors, and intention. Results The study found that average level of knowledge was 1.3 which is between high and moderate knowledge, and the average score for the intention was 2.88, to indicate that the intentions to uptake Pap smear among the participants were above the average. The study revealed a significant correlation between demographic factors and intention (p<0.01). Conclusion Findings from the current study can inform health care providers about Saudi Arabian women knowledge of Pap smear and the intention to uptake the test. Strategies to motivate women to undergo Pap screening should be introduced.

High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation

Background Early diagnosis of acute myocardial infarction is important, but only 20% of emergency admissions for chest pain will actually have an acute myocardial infarction. High-sensitivity cardiac troponin assays may allow rapid rule out of myocardial infarction and avoid unnecessary hospital admissions. Objectives To assess the clinical effectiveness and cost-effectiveness of high-sensitivity cardiac troponin assays for the management of adults presenting with acute chest pain, in particular for the early rule-out of acute myocardial infarction. Methods Sixteen databases were searched up to September 2019. Review methods followed published guidelines. Studies were assessed for quality using appropriate risk-of-bias tools. The bivariate model was used to estimate summary sensitivity and specificity for meta-analyses involving four or more studies; otherwise, random-effects logistic regression was used. The health economic analysis considered the long-term costs and quality-adjusted life-years associated with different troponin testing methods. The de novo model consisted of a decision tree and a state–transition cohort model. A lifetime time horizon (of 60 years) was used. Results Thirty-seven studies (123 publications) were included in the review. The high-sensitivity cardiac troponin test strategies evaluated are defined by the combination of four factors (i.e. assay, number and timing of tests, and threshold concentration), resulting in a large number of possible combinations. Clinical opinion indicated a minimum clinically acceptable sensitivity of 97%. When considering single test strategies, only those using a threshold at or near to the limit of detection for the assay, in a sample taken at presentation, met the minimum clinically acceptable sensitivity criterion. The majority of the multiple test strategies that met this criterion comprised an initial rule-out step, based on high-sensitivity cardiac troponin levels in a sample taken on presentation and a minimum symptom duration, and a second stage for patients not meeting the initial rule-out criteria, based on presentation levels of high-sensitivity cardiac troponin and absolute change after 1, 2 or 3 hours. Two large cluster randomised controlled trials found that implementation of an early rule-out pathway for myocardial infarction reduced length of stay and rate of hospital admission without increasing cardiac events. In the base-case analysis, standard troponin testing was both the most effective and the most costly. Other testing strategies with a sensitivity of 100% (subject to uncertainty) were almost equally effective, resulting in the same life-year and quality-adjusted life-year gain at up to four decimal places. Comparisons based on the next best alternative showed that for willingness-to-pay values below £8455 per quality-adjusted life-year, the Access High Sensitivity Troponin I (Beckman Coulter, Brea, CA, USA) [(symptoms > 3 hours AND < 4 ng/l at 0 hours) OR (< 5 ng/l AND Δ < 5 ng/l at 0 to 2 hours)] would be cost-effective. For thresholds between £8455 and £20,190 per quality-adjusted life-year, the Elecsys® Troponin-T high sensitive (Roche, Basel, Switzerland) (< 12 ng/l at 0 hours AND Δ < 3 ng/l at 0 to 1 hours) would be cost-effective. For a threshold > £20,190 per quality-adjusted life-year, the Dimension Vista® High-Sensitivity Troponin I (Siemens Healthcare, Erlangen, Germany) (< 5 ng/l at 0 hours AND Δ < 2 ng/l at 0 to 1 hours) would be cost-effective. Conclusions High-sensitivity cardiac troponin testing may be cost-effective compared with standard troponin testing. Study registration This study is registered as PROSPERO CRD42019154716. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 33. See the NIHR Journals Library website for further project information.

Diagnose it yourself: will there be a home test kit for Alzheimer’s disease?

Alzheimer’s disease is the most common neurodegenerative process leading to dementia. To date, there is no curative approach; thus, establishing a diagnosis as early as possible is necessary to implement preventive measures. However, today’s gold standard for diagnosing Alzheimer’s disease is high in both cost and effort and is not readily available. This defines the need for low-effort and economic alternatives that give patients low-threshold access to testing systems at their general practitioners or even at home for an independent retrieval of a biologic specimen. This perspective gives an overview of established and novel approaches in the field and speculates on the future of test strategies eventually technically implementable at home.