Considerable advances in the global ocean observing system over the last two decades offers an opportunity to provide more quantitative information on changes in heat and freshwater storage. ...Variations in these storage terms can arise through internal variability and also the response of the ocean to anthropogenic climate change. Disentangling these competing influences on the regional patterns of change and elucidating their governing processes remains an outstanding scientific challenge. This challenge is compounded by instrumental and sampling uncertainties. The combined use of ocean observations and model simulations is the most viable method to assess the forced signal from noise and ascertain the primary drivers of variability and change. Moreover, this approach offers the potential for improved seasonal-to-decadal predictions and the possibility to develop powerful multi-variate constraints on climate model future projections. Regional heat storage changes dominate the steric contribution to sea level rise over most of the ocean and are vital to understanding both global and regional heat budgets. Variations in regional freshwater storage are particularly relevant to our understanding of changes in the hydrological cycle and can potentially be used to verify local ocean mass addition from terrestrial and cryospheric systems associated with contemporary sea level rise. This White Paper will examine the ability of the current ocean observing system to quantify changes in regional heat and freshwater storage. In particular we will seek to answer the question: What time and space scales are currently resolved in different regions of the global oceans? In light of some of the key scientific questions, we will discuss the requirements for measurement accuracy, sampling, and coverage as well as the synergies that can be leveraged by more comprehensively analysing the multi-variable arrays provided by the integrated observing system.
Understanding the nanoscale structure and dynamics of supramolecular hydrogels is essential for exploiting their self-healing mechanisms. We describe here nanostructural evolution and self-healing ...mechanism of hydrogels formed from in situ generated hydrophobically modified hydrophilic polymers and wormlike sodium dodecyl sulfate (SDS) micelles. We observe a conformational transition in wormlike SDS micelles upon addition of hydrophobic as well as hydrophilic monomers. Several hundred nanometer long SDS micelles completely disappear after the monomer addition, in favor of spherical micelles with a radius of 2.4 nm. After conversion of the monomers to hydrophobically modified polymer chains via micellar copolymerization, the spherical shape of the micelles remains intact but the radius increases to 2.8 nm. The interconnected spherical mixed micelles consisting of SDS and hydrophobic blocks of the polymer self-assemble to form a layered hydrogel structure. Self-healing response of the damaged hydrogel samples begins by reshaping the injured area into circular holes and ends by complete healing due to the intra- and interlayer mobility of the mixed micelles, respectively.
Background
In response to the spread of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and the impact of coronavirus disease 2019 (COVID‐19), governments have implemented a variety of ...measures to control the spread of the virus and the associated disease. Among these, have been measures to control the pandemic in primary and secondary school settings.
Objectives
To assess the effectiveness of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID‐19 pandemic, with particular focus on the different types of measures implemented in school settings and the outcomes used to measure their impacts on transmission‐related outcomes, healthcare utilisation outcomes, other health outcomes as well as societal, economic, and ecological outcomes.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the Educational Resources Information Center, as well as COVID‐19‐specific databases, including the Cochrane COVID‐19 Study Register and the WHO COVID‐19 Global literature on coronavirus disease (indexing preprints) on 9 December 2020. We conducted backward‐citation searches with existing reviews.
Selection criteria
We considered experimental (i.e. randomised controlled trials; RCTs), quasi‐experimental, observational and modelling studies assessing the effects of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID‐19 pandemic. Outcome categories were (i) transmission‐related outcomes (e.g. number or proportion of cases); (ii) healthcare utilisation outcomes (e.g. number or proportion of hospitalisations); (iii) other health outcomes (e.g. physical, social and mental health); and (iv) societal, economic and ecological outcomes (e.g. costs, human resources and education). We considered studies that included any population at risk of becoming infected with SARS‐CoV‐2 and/or developing COVID‐19 disease including students, teachers, other school staff, or members of the wider community.
Data collection and analysis
Two review authors independently screened titles, s and full texts. One review author extracted data and critically appraised each study. One additional review author validated the extracted data. To critically appraise included studies, we used the ROBINS‐I tool for quasi‐experimental and observational studies, the QUADAS‐2 tool for observational screening studies, and a bespoke tool for modelling studies. We synthesised findings narratively. Three review authors made an initial assessment of the certainty of evidence with GRADE, and several review authors discussed and agreed on the ratings.
Main results
We included 38 unique studies in the analysis, comprising 33 modelling studies, three observational studies, one quasi‐experimental and one experimental study with modelling components.
Measures fell into four broad categories: (i) measures reducing the opportunity for contacts; (ii) measures making contacts safer; (iii) surveillance and response measures; and (iv) multicomponent measures. As comparators, we encountered the operation of schools with no measures in place, less intense measures in place, single versus multicomponent measures in place, or closure of schools.
Across all intervention categories and all study designs, very low‐ to low‐certainty evidence ratings limit our confidence in the findings. Concerns with the quality of modelling studies related to potentially inappropriate assumptions about the model structure and input parameters, and an inadequate assessment of model uncertainty. Concerns with risk of bias in observational studies related to deviations from intended interventions or missing data. Across all categories, few studies reported on implementation or described how measures were implemented. Where we describe effects as 'positive', the direction of the point estimate of the effect favours the intervention(s); 'negative' effects do not favour the intervention.
We found 23 modelling studies assessing measures reducing the opportunity for contacts (i.e. alternating attendance, reduced class size). Most of these studies assessed transmission and healthcare utilisation outcomes, and all of these studies showed a reduction in transmission (e.g. a reduction in the number or proportion of cases, reproduction number) and healthcare utilisation (i.e. fewer hospitalisations) and mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school).
We identified 11 modelling studies and two observational studies assessing measures making contacts safer (i.e. mask wearing, cleaning, handwashing, ventilation). Five studies assessed the impact of combined measures to make contacts safer. They assessed transmission‐related, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed a reduction in transmission, and a reduction in hospitalisations; however, studies showed mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school).
We identified 13 modelling studies and one observational study assessing surveillance and response measures, including testing and isolation, and symptomatic screening and isolation. Twelve studies focused on mass testing and isolation measures, while two looked specifically at symptom‐based screening and isolation. Outcomes included transmission, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed effects in favour of the intervention in terms of reductions in transmission and hospitalisations, however some showed mixed or negative effects on societal, economic and ecological outcomes (e.g. fewer number of days spent in school).
We found three studies that reported outcomes relating to multicomponent measures, where it was not possible to disaggregate the effects of each individual intervention, including one modelling, one observational and one quasi‐experimental study. These studies employed interventions, such as physical distancing, modification of school activities, testing, and exemption of high‐risk students, using measures such as hand hygiene and mask wearing. Most of these studies showed a reduction in transmission, however some showed mixed or no effects.
As the majority of studies included in the review were modelling studies, there was a lack of empirical, real‐world data, which meant that there were very little data on the actual implementation of interventions.
Authors' conclusions
Our review suggests that a broad range of measures implemented in the school setting can have positive impacts on the transmission of SARS‐CoV‐2, and on healthcare utilisation outcomes related to COVID‐19. The certainty of the evidence for most intervention‐outcome combinations is very low, and the true effects of these measures are likely to be substantially different from those reported here. Measures implemented in the school setting may limit the number or proportion of cases and deaths, and may delay the progression of the pandemic. However, they may also lead to negative unintended consequences, such as fewer days spent in school (beyond those intended by the intervention). Further, most studies assessed the effects of a combination of interventions, which could not be disentangled to estimate their specific effects. Studies assessing measures to reduce contacts and to make contacts safer consistently predicted positive effects on transmission and healthcare utilisation, but may reduce the number of days students spent at school. Studies assessing surveillance and response measures predicted reductions in hospitalisations and school days missed due to infection or quarantine, however, there was mixed evidence on resources needed for surveillance. Evidence on multicomponent measures was mixed, mostly due to comparators. The magnitude of effects depends on multiple factors. New studies published since the original search date might heavily influence the overall conclusions and interpretation of findings for this review.
Background
With the emergence of SARS‐CoV‐2 in late 2019, governments worldwide implemented a multitude of non‐pharmaceutical interventions in order to control the spread of the virus. Most countries ...have implemented measures within the school setting in order to reopen schools or keep them open whilst aiming to contain the spread of SARS‐CoV‐2. For informed decision‐making on implementation, adaptation, or suspension of such measures, it is not only crucial to evaluate their effectiveness with regard to SARS‐CoV‐2 transmission, but also to assess their unintended consequences.
Objectives
To comprehensively identify and map the evidence on the unintended health and societal consequences of school‐based measures to prevent and control the spread of SARS‐CoV‐2. We aimed to generate a descriptive overview of the range of unintended (beneficial or harmful) consequences reported as well as the study designs that were employed to assess these outcomes. This review was designed to complement an existing Cochrane Review on the effectiveness of these measures by synthesising evidence on the implications of the broader system‐level implications of school measures beyond their effects on SARS‐CoV‐2 transmission.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, four non‐health databases, and two COVID‐19 reference collections on 26 March 2021, together with reference checking, citation searching, and Google searches.
Selection criteria
We included quantitative (including mathematical modelling), qualitative, and mixed‐methods studies of any design that provided evidence on any unintended consequences of measures implemented in the school setting to contain the SARS‐CoV‐2 pandemic. Studies had to report on at least one unintended consequence, whether beneficial or harmful, of one or more relevant measures, as conceptualised in a logic model.
Data collection and analysis
We screened the titles/s and subsequently full texts in duplicate, with any discrepancies between review authors resolved through discussion. One review author extracted data for all included studies, with a second review author reviewing the data extraction for accuracy. The evidence was summarised narratively and graphically across four prespecified intervention categories and six prespecified categories of unintended consequences; findings were described as deriving from quantitative, qualitative, or mixed‐method studies.
Main results
Eighteen studies met our inclusion criteria. Of these, 13 used quantitative methods (3 experimental/quasi‐experimental; 5 observational; 5 modelling); four used qualitative methods; and one used mixed methods. Studies looked at effects in different population groups, mainly in children and teachers. The identified interventions were assigned to four broad categories: 14 studies assessed measures to make contacts safer; four studies looked at measures to reduce contacts; six studies assessed surveillance and response measures; and one study examined multiple measures combined. Studies addressed a wide range of unintended consequences, most of them considered harmful. Eleven studies investigated educational consequences. Seven studies reported on psychosocial outcomes. Three studies each provided information on physical health and health behaviour outcomes beyond COVID‐19 and environmental consequences. Two studies reported on socio‐economic consequences, and no studies reported on equity and equality consequences.
Authors' conclusions
We identified a heterogeneous evidence base on unintended consequences of measures implemented in the school setting to prevent and control the spread of SARS‐CoV‐2, and summarised the available study data narratively and graphically. Primary research better focused on specific measures and various unintended outcomes is needed to fill knowledge gaps and give a broader picture of the diverse unintended consequences of school‐based measures before a more thorough evidence synthesis is warranted. The most notable lack of evidence we found was regarding psychosocial, equity, and equality outcomes. We also found a lack of research on interventions that aim to reduce the opportunity for contacts. Additionally, study investigators should provide sufficient data on contextual factors and demographics in order to ensure analyses of such are feasible, thus assisting stakeholders in making appropriate, informed decisions for their specific circumstances.
Abstract
Background/Objective
International travel measures to contain the coronavirus disease of 2019 (COVID-19) pandemic represent a relatively intrusive form of non-pharmaceutical intervention. To ...inform decision-making on the (re)implementation, adaptation, relaxation or suspension of such measures, it is essential to not only assess their effectiveness but also their unintended effects.
Methods
This scoping review maps existing empirical studies on the unintended consequences, both predicted and unforeseen, and beneficial or harmful, of international travel measures. We searched multiple health, non-health and COVID-19-specific databases. The evidence was charted in a map in relation to the study design, intervention and outcome categories identified and discussed narratively.
Results
Twenty-three studies met our inclusion criteria—nine quasi-experimental, two observational, two mathematical modelling, six qualitative and four mixed-methods studies. Studies addressed different population groups across various countries worldwide. Seven studies provided information on unintended consequences of the closure of national borders, six looked at international travel restrictions and three investigated mandatory quarantine of international travellers. No studies looked at entry and/or exit screening at national borders exclusively, however six studies considered this intervention in combination with other international travel measures. In total, 11 studies assessed various combinations of the aforementioned interventions. The outcomes were mostly referred to by the authors as harmful. Fifteen studies identified a variety of economic consequences, six reported on aspects related to quality of life, well-being, and mental health and five on social consequences. One study each provided information on equity, equality, and the fair distribution of benefits and burdens, environmental consequences and health system consequences.
Conclusion
This scoping review represents the first step towards a systematic assessment of the unintended benefits and harms of international travel measures during COVID-19. The key research gaps identified might be filled with targeted primary research, as well as the additional consideration of gray literature and non-empirical studies.
Background EUS-guided FNA is currently advocated in lung cancer staging guidelines as an alternative for surgical staging to prove mediastinal metastases. To date, training requirements for chest ...physicians to obtain competency in EUS for lung cancer staging are unknown. Objective To test a training and implementation strategy for EUS for the diagnosis and staging of lung cancer. Design Prospective national multicenter implementation trial. Nine (chest) physicians from 5 hospitals participated in a dedicated EUS educational program (investigation of 50 patients) for the diagnosis and staging of lung cancer. EUS outcomes of trainees were compared with those of the training center. Setting Four general hospitals, the national cancer center (implementation centers), and a tertiary referral center (expert center). Patients This study involved 551 consecutive patients with (suspected) lung cancer, all candidates for surgical staging, who underwent EUS in 1 of the 5 implementation centers (n = 346) or the single expert center (n = 205). Surgical-pathological staging was the reference standard in case no mediastinal metastases were found. Results EUS had a sensitivity of 83% versus 82% and accuracy of 89% versus 88% for mediastinal nodal staging (implementation center vs expert center). Surgery was spared because of EUS findings in 51% versus 54% of patients. A single complication occurred in each group. Limitation Surgical-pathological verification of mediastinal nodes was not available in all patients staged negative at EUS. Conclusion Chest physicians who participate in a dedicated training and implementation program for EUS in lung cancer staging can obtain results similar to those of experts for mediastinal nodal staging.
CDC has updated the interim guidance for U.S. health care providers caring for pregnant women with possible Zika virus exposure in response to 1) declining prevalence of Zika virus disease in the ...World Health Organization's Region of the Americas (Americas) and 2) emerging evidence indicating prolonged detection of Zika virus immunoglobulin M (IgM) antibodies. Zika virus cases were first reported in the Americas during 2015-2016; however, the incidence of Zika virus disease has since declined. As the prevalence of Zika virus disease declines, the likelihood of false-positive test results increases. In addition, emerging epidemiologic and laboratory data indicate that, as is the case with other flaviviruses, Zika virus IgM antibodies can persist beyond 12 weeks after infection. Therefore, IgM test results cannot always reliably distinguish between an infection that occurred during the current pregnancy and one that occurred before the current pregnancy, particularly for women with possible Zika virus exposure before the current pregnancy. These limitations should be considered when counseling pregnant women about the risks and benefits of testing for Zika virus infection during pregnancy. This updated guidance emphasizes a shared decision-making model for testing and screening pregnant women, one in which patients and providers work together to make decisions about testing and care plans based on patient preferences and values, clinical judgment, and a balanced assessment of risks and expected outcomes.
Accuracy of Smoking Status Reporting Stevens, Maria A.; Rabe, Kari G.; Boursi, Ben ...
Mayo Clinic proceedings. Innovations, quality & outcomes,
December 2020, 2020-12-00, 2020-12-01, Letnik:
4, Številka:
6
Journal Article
Recenzirano
Odprti dostop
To assess whether patients and relatives can serve as reliable proxy reporters of other family members’ cigarette-smoking history.
Two samples (325 patients, 707 relatives) were identified from the ...Mayo Clinic Biospecimen Resource for Pancreas Research, enrolled from November, 6, 2000, to March 15, 2018. Smoking-history data, including categorical (ever/never) and quantitative (packs per day and years smoked) smoking measures, were obtained from self-completed questionnaires by patients and relatives. Relative reports were compared with patient reports on self; patient reports were compared with relative reports on self.
Overall, spouses and first-degree relatives (FDRs) were accurate (94.5%) when reporting patient ever smoking; spouse reports were 98.6% sensitive and 97.7% accurate. Accuracy of patient reports was 97.8% for spouse smoking and 85.5% for FDR smoking; accuracy varied by relationship of FDR. When not concordant, patients generally over-reported daily packs smoked by relatives and under-reported years smoked. Within a 25% agreement range, spouse reports about patients’ daily packs smoked was 46.7%, and years smoked was 69.6%, whereas FDRs were 50% and 64.6%, respectively. When not concordant, relatives generally over-reported daily packs smoked by patients, but no consistent pattern was observed of over- or under-reporting years smoked by patients.
Patients and relatives can be reliable proxies for smoking history (ever/never) in their family members, especially spouses. An accurate reporting of smoking status will help physicians to better gauge performance status and family smoking exposures to inform disease management.
To assess whether patients and relatives can serve as reliable proxy reporters of other family members' cigarette-smoking history.
Two samples (325 patients, 707 relatives) were identified from the ...Mayo Clinic Biospecimen Resource for Pancreas Research, enrolled from November, 6, 2000, to March 15, 2018. Smoking-history data, including categorical (ever/never) and quantitative (packs per day and years smoked) smoking measures, were obtained from self-completed questionnaires by patients and relatives. Relative reports were compared with patient reports on self; patient reports were compared with relative reports on self.
Overall, spouses and first-degree relatives (FDRs) were accurate (94.5%) when reporting patient ever smoking; spouse reports were 98.6% sensitive and 97.7% accurate. Accuracy of patient reports was 97.8% for spouse smoking and 85.5% for FDR smoking; accuracy varied by relationship of FDR. When not concordant, patients generally over-reported daily packs smoked by relatives and under-reported years smoked. Within a 25% agreement range, spouse reports about patients' daily packs smoked was 46.7%, and years smoked was 69.6%, whereas FDRs were 50% and 64.6%, respectively. When not concordant, relatives generally over-reported daily packs smoked by patients, but no consistent pattern was observed of over- or under-reporting years smoked by patients.
Patients and relatives can be reliable proxies for smoking history (ever/never) in their family members, especially spouses. An accurate reporting of smoking status will help physicians to better gauge performance status and family smoking exposures to inform disease management.
A number of observational arrays, together with the main circulation features, have been established across the Atlantic and in the Arctic Oceans to improve our understanding of and to monitor ...changes in the Atlantic Meridional Overturning Circulation (AMOC), as well as large-scale changes in water mass properties and ocean transports (how much heat or salt is transported by currents). These observational arrays contribute to the Global Ocean Observing System (GOOS) via the Observing Coordination Groups (OCG) networks. The global community has been obtaining critical environmental information by measuring ocean transports at different locations in the Atlantic and at the Arctic Ocean gateways. Continued efforts based on these observational arrays are paramount to understanding and adapting to the impacts of climate and weather on humans and Earth's natural resources on land and in the ocean.
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