The Evolution of Genetic Testing from Focused Testing to Panel Testing and from Patient Focused to Population Testing: Are We There Yet?

The field of cancer genetics has evolved significantly over the past 30 years. Genetic testing has become less expensive and more comprehensive which has changed practice patterns. It is no longer necessary to restrict testing to those with the highest likelihood of testing positive. In addition, we have learned that the criteria developed to determine who has the highest likelihood of testing positive are neither sensitive nor specific. As a result, the field is moving from testing only the highest risk patients identified based on testing criteria to testing all cancer patients. This requires new service delivery models where testing can be mainstreamed into oncology clinics and posttest genetic counseling can be provided to individuals who test positive and those with concerning personal or family histories who test negative. The use of videos, testing kiosks, chatbots, and genetic counseling assistants have been employed to help facilitate testing at a larger scale and have good patient uptake and satisfaction. While testing is important for cancer patients as it may impact their treatment, future cancer risks, and family member's cancer risks, it is unfortunate that their cancer could not be prevented in the first place. Population testing for all adults would be a strategy to identify individuals with adult-onset diseases before they develop cancer in an attempt to prevent it entirely. A few research studies (Healthy Nevada and MyCode) have offered population testing for the three Centers for Disease Control and Prevention Tier 1 conditions: hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia finding a prevalence of 1 in 70 individuals in the general population. We anticipate that testing for all cancer patients and the general population will continue to increase over the next 20 years and the genetics community needs to help lead the way to ensure this happens in a responsible manner.

Advances in testing for human papillomavirus -mediated head and neck cancer

PURPOSE OF REVIEW

New evidence has recently emerged regarding the utility and benefits of dual p16 INKa (p16) and Human papillomavirus (HPV) status testing when determining the diagnosis and prognosis of patients with oropharyngeal cancer.

RECENT FINDINGS

HPV RNA polymerase chain reaction (PCR) is the most accurate diagnostic test. The other assays (HPV DNA PCR, HPV DNA/RNA in-situ hybridization (ISH) and p16) applied to formalin fixed tumour tissue have varying but high sensitivities and specificities. Dual p16 and HPV testing identifies discordant (p16+/HPV- or p16-/HPV+) results in 9.2% of cases, who have significantly poorer prognoses than p16+/HPV+, particularly in smokers. The proportion of discordant cases varies by region, and appears to be highest in regions with lowest attributable (p16+/HPV+) fractions. Dual testing improves prognostication for oropharyngeal cancer cases by identifying discordant cases and improving the prognostic power of the Tumour Node Metastasis (TNM) classification, especially in regions with high discordant rates.

SUMMARY

Dual testing is essential when considering patients for clinical trials of treatment de-escalation, and may be important when counselling patients on prognosis, especially in regions with high discordant rates and in smokers.

A template for creating and sharing ground truth data in digital forensics

Ground truth data (GTD) is used by those in the field of digital forensics (DF) for a variety of purposes including to evaluate the functionality of undocumented, new, or emerging technology and services and the digital traces left behind following their usage. Most accepted and reliable trace interpretations must be derived from an examination of relevant GTD, yet despite the importance of it to the DF community, there is little formal guidance available for supporting those who create it, to do so in a way that ensures any data is of good quality, reliable, and therefore usable. In an attempt to address this issue, this work proposes a minimum standard of documentation that must accompany the production of any GTD, particularly when it is intended for use in the process of discovering new knowledge, proposing original interpretations of a digital trace, or determining the functionality of any technology or service. A template structure is discussed and provided in Appendix S1 which sets out a minimum standard for metadata describing any GTD's production process and content. It is suggested that such an approach can support the maintenance of trust in any GTD and improve the shareability of it.

Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis

BACKGROUND

Healthy Davis Together was a program launched in September 2020 in the city of Davis, California, to mitigate the spread of COVID-19 and facilitate the return to normalcy. The program involved multiple interventions, including free saliva-based asymptomatic testing, targeted communication campaigns, education efforts, and distribution of personal protective equipment, community partnerships, and investments in the local economy.

OBJECTIVE

This study identified demographic characteristics of individuals that underwent testing and assessed adherence to testing over time in a community pandemic-response program launched in a college town in California, United States.

METHODS

This study outlines overall testing engagement, identifies demographic characteristics of participants, and evaluates testing participation changes over 4 periods of the COVID-19 pandemic, distinguished by the dominant variants Delta and Omicron. Additionally, a recurrent model is employed to explore testing patterns based on the participants' frequency, timing, and demographic characteristics.

RESULTS

A total of 770,165 tests were performed between November 18, 2020, and June 30, 2022, among 89,924 (41.1% of total population) residents of Yolo County, with significant participation from racially or ethnically diverse participants and across age groups. Most positive cases (6351 of total) and highest daily participation (895 per 100,000 population) were during the Omicron period. There were some gender and age-related differences in the pattern of recurrent COVID-19 testing. Men were slightly less likely (hazard ratio [HR] 0.969, 95% CI 0.943-0.996) to be retested and more likely (HR 1.104, 95% CI 1.075-1.134) to stop testing altogether than women. People aged between 20 and 34 years were less likely to be retested (HR 0.861, 95% CI 0.828-0.895) and more likely to stop testing altogether (HR 2.617, 95% CI 2.538-2.699). However, older age groups were less likely to stop testing, especially those aged between 65-74 years and 75-84 years, than those aged between 0 and 19 years. The likelihood of stopping testing was lower (HR 0.93, 95% CI 0.889-0.976) for the Asian group and higher for the Hispanic or Latino (HR 1.185, 95% CI 1.148-1.223) and Black or African American (HR 1.198, 95% CI 1.054-1.350) groups than the White group.

CONCLUSIONS

The unique features of a pandemic response program that supported community-wide access to free asymptomatic testing provide a unique opportunity to evaluate adherence to testing recommendations and testing trends over time. Identification of individual and group-level factors associated with testing behaviors can provide insights for identifying potential areas of improvement in future testing initiatives.

The association between memory, COVID-19 testing, and COVID-19 incidence in middle-aged and older adults: a prospective analysis of the CLSA

We investigated the association between pre-COVID-19 memory function and (a) receipt of a COVID-19 test and (b) incidence of COVID-19 using the COVID-19 Questionnaire Study (CQS) of the Canadian Longitudinal Study on Aging (CLSA). The CQS included 28,565 middle-aged and older adults. We regressed receipt of a COVID-19 test on participants' immediate and delayed recall memory scores and re-ran the regression models with COVID-19 incidence as the outcome. All regression models were adjusted for sociodemographic, lifestyle, and health covariates. In the analytical sample (n = 21,930), higher delayed recall memory (better memory) was significantly associated with lower COVID-19 incidence. However, this association was not significant for immediate recall memory. Immediate and delayed recall memory were not associated with receipt of a COVID-19 test. Health policymakers and practitioners may viewmemory status as a potential risk for COVID-19. Memory status may not be a barrier to COVID-19 testing.

Using SCENTinel® to predict SARS-CoV-2 infection: insights from a community sample during dominance of Delta and Omicron variants

Introduction

Based on a large body of previous research suggesting that smell loss was a predictor of COVID-19, we investigated the ability of SCENTinel®, a newly validated rapid olfactory test that assesses odor detection, intensity, and identification, to predict SARS-CoV-2 infection in a community sample.

Methods

Between April 5, 2021, and July 5, 2022, 1,979 individuals took one SCENTinel® test, completed at least one physician-ordered SARS-CoV-2 PCR test, and endorsed a list of self-reported symptoms.

Results

Among the of SCENTinel® subtests, the self-rated odor intensity score, especially when dichotomized using a previously established threshold, was the strongest predictor of SARS-CoV-2 infection. SCENTinel® had high specificity and negative predictive value, indicating that those who passed SCENTinel® likely did not have a SARS-CoV-2 infection. Predictability of the SCENTinel® performance was stronger when the SARS-CoV-2 Delta variant was dominant rather than when the SARS-CoV-2 Omicron variant was dominant. Additionally, SCENTinel® predicted SARS-CoV-2 positivity better than using a self-reported symptom checklist alone.

Discussion

These results indicate that SCENTinel® is a rapid assessment tool that can be used for population-level screening to monitor abrupt changes in olfactory function, and to evaluate spread of viral infections like SARS-CoV-2 that often have smell loss as a symptom.

An Investigation into the Prevalence of Methamphetamine Related Enquiries to Local Government Environmental Health Officers

Methamphetamine contamination of residential properties remains a serious public health concern for members of the public. External stakeholders including Environmental Health Officers (EHOs) and testing and remediation technicians are engaged on investigating whether contamination has occurred from manufacturing or smoking processes. More specifically, local council EHOs are responsible for managing clandestine drug laboratories when notified by police and also for responding to public enquiries. However, the full scope of these contaminated properties is not seen by any single stakeholder, making it very challenging to quantify these situations. To evaluate the prevalence of methamphetamine related enquiries from the general public to EHOs, this study surveyed and interviewed officers from around Australia. It was found that public enquiries were infrequent with only 6% of respondents having received enquiries in the last month, which indicates that people are seeking information from other sources. Interestingly, there were case study scenarios that also mentioned issues with awareness and the flow of information. Concerns regarding difficult cases, police notifications, and site visits were also highlighted. The results of this study provide a benchmark of how methamphetamine related cases are managed and highlight the need for trustworthy information that is available to EHOs, governments, industry members, and the public in a unified location.

Impact of systematic variations in hematocrit and platelet count on thrombelastometry tissue factor activated assay parameters

BACKGROUND

Thromboelastogram testing is increasingly being used to manage patients with massive bleeding. An earlier study found that the test results were influenced by the hematocrit (Hct) and platelet (PLT) concentrations. This study sought to determine if these factors confounded the results of a different manufacturer's thromboelastography testing.

METHODS

Using freshly collected whole blood from volunteers and stored red blood cells (RBC) and plasma, the whole blood was manipulated to achieve different Hct values and PLT concentrations. Each reconstituted whole blood sample was tested in triplicate on the ROTEM Delta device and the ExTEM results were recorded.

RESULTS

Many of the ExTEM results varied according to the Hct and PLT concentration. In particular, the ExTEM clot formation time (CFT) was abnormally long when the Hct was 45% and the PLT concentration was ≤75 × 109/L, normalizing only when the PLT count was ≥100 × 109/L. CFT samples with Hct 25% and 35% were also abnormal with low PLT concentrations but normalized at lower PLT concentrations compared to the Hct 45% samples. The ExTEM angle also demonstrated abnormal results when the Hct was 45% and the PLT concentration was ≤50 × 109/L. The ExTEM A10 and maximum clot firmness (MCF) tests tended to also be abnormal when the Hct was between 25% and 45% and the platelet concentrations were below 75 × 109/L.

CONCLUSION

While thromboelastogram testing is gaining popularity for managing bleeding patients, clinicians should be aware of these confounding factors when making transfusion decisions based on their results.

Nurse Practitioner Certification Examination Development: From Reflecting Clinical Practice to Ensuring Lifelong Learning

OBJECTIVE

Certifications in psychiatric-mental health nursing promote safe practice by psychiatric-mental health nurse practitioners (PMHNPs) and nurses (PMHNs) and help protect the public from harm. This protection begins with the development of an examination that meets rigorous national education, practice, and accreditation standards and reflects PMHNPs' or PMHNs' clinical practice. Achievement and maintenance of a certification is a journey that involves a commitment to lifelong learning and the improvement of the field of psychiatric-mental health nursing through involvement in the examination process.

METHODS

This discussion paper outlines the role nurses can play in the development of certification examinations. It describes the process of developing an effective certification examination, including the role of standards, accrediting bodies, and content experts; determining necessary tasks, knowledge, and skills; surveying practitioners to validate information; writing test questions; and ongoing analysis of examination content. The Psychiatric-Mental Health Nurse Practitioner (across the lifespan) Certification (PMHNP-BC) is presented as an example of the process.

RESULTS

This discussion paper raises awareness of how certification exams are developed, PMHNPs participate in certification development, and volunteering promotes career development.

CONCLUSION

The PMHNP-BC examination is based on education, practice, and certification accreditation standards and reflects current clinical practice. PMHNPs can (a) point to the rigor of certification as an indication of the quality of care they deliver, (b) volunteer to participate in the examination process to ensure examination rigor, and (c) advance their careers through the development and application of a valuable skill set.

Validity and reliability of the My Jump 2 app for detecting interlimb asymmetry in young female basketball players

Introduction

The aim of this study was to examine the validity and reliability of the My Jump 2 app for the assessment of interlimb jump asymmetry in young female basketball players.

Methods

Nine athletes (age 15 ± 0.9 years; weight 62.9 ± 5.8 kg; height 173.6 ± 6.1 cm) performed single-leg drop jumps (DJs) and both-leg drop jumps on a force plate (Kistler Quattro jump) and were simultaneously recorded on two smartphones using the My Jump 2 app. Jump height from flight time and contact time data were statistically analyzed to evaluate the validity of two different camera settings, drop jump performance, and interlimb jump asymmetry in basketball players. The testing was repeated after 1 week for test retest reliability.

Results

High test-retest reliability [intraclass correlation coefficient (ICC) > 0.88] was observed in DJ height. High correlation between the force plate and the My Jump 2 app was observed in DJ height (r = 0.99) and DJ contact time (r = 0.98). For the interlimb jump height asymmetries, mean differences were 0.6 percentages for the My Jump 2 app and the force plate, respectively (p = 0.77). Inter-device reliability revealed almost perfect correlation for the DJ height (ICC = 0.99, r = 0.98).

Conclusion

The My Jump 2 app is a valid and reliable tool to assess drop jump performance and interlimb asymmetry in young female basketball players.

Wastewater Surveillance of US Coast Guard Installations and Seagoing Military Vessels to Mitigate the Risk of COVID-19 Outbreaks, March 2021-August 2022

OBJECTIVES

Military training centers and seagoing vessels are often environments at high risk for the spread of COVID-19 and other contagious diseases, because military trainees and personnel arrive after traveling from many parts of the country and live in congregate settings. We examined whether levels of SARS-CoV-2 genetic material in wastewater correlated with SARS-CoV-2 infections among military personnel living in communal barracks and vessels at US Coast Guard training centers in the United States.

METHODS

The Coast Guard developed and established 3 laboratories with wastewater testing capability at Coast Guard training centers from March 2021 through August 2022. We analyzed wastewater from barracks housing trainees and from 4 Coast Guard vessels for the presence of SARS-CoV-2 genes N and E and quantified the results relative to levels of a fecal indicator virus, pepper mild mottle virus. We compared quantified data with the timing of medically diagnosed COVID-19 infection among (1) military personnel who had presented with symptoms or had been discovered through contact tracing and had medical tests and (2) military personnel who had been discovered through routine surveillance by positive SARS-CoV-2 antigen or polymerase chain reaction test results.

RESULTS

Levels of viral genes in wastewater at Coast Guard locations were best correlated with diagnosed COVID-19 cases when wastewater testing was performed twice weekly with passive samplers deployed for the entire week; such testing detected ≥1 COVID-19 case 69.8% of the time and ≥3 cases 88.3% of the time. Wastewater assessment in vessels did not continue because of logistical constraints.

CONCLUSION

Wastewater testing is an effective tool for measuring the presence and patterns of SARS-CoV-2 infections among military populations. Success with wastewater testing for SARS-CoV-2 infections suggests that other diseases may be assessed with similar approaches.

Program Factors Associated With Improved American Board of Surgery Examination Pass Rates

INTRODUCTION

The American Board of Surgery awards board certification after successful completion of both the Qualifying Exam and Certifying Exam. Although multiple studies have evaluated board performance at the resident level, fewer studies have evaluated board performance at the program level.

METHODS

Program pass rates, available through the American Board of Surgery, for 2019-2021 were compared to program information through the American Medical Association Fellowship and Residency Electronic Interactive Database Access (FREIDA).

RESULTS

A significant positive correlation of Certifying Exam performance to residency length, resident class size, and number of total physician faculty within the program was seen. Greater average hours of didactics per week had a significant positive correlation to improved Qualifying Exam performance but not Certifying Exam. Programs with higher percentages of residents graduating from a United States MD program, compared to international or DO schools, were associated with improved performances. It also appears that more established programs performed better than younger programs <20 years old. Programs in the West and Midwest performed significantly better on the Qualifying Exam than programs in the South and Northeast.

CONCLUSION

Board certification serves as the capstone for surgeons after completing general surgery residency. Multiple program factors demonstrate a significant correlation to board performance.

Rapid diagnostic testing for onchocerciasis in Maridi (South Sudan) before and after improving elimination strategies: a repeated cross-sectional survey

Background

Maridi County is an onchocerciasis-endemic area in South Sudan. Annual community-directed treatment with ivermectin (CDTi) was instituted in Maridi since the early 2000s, but with low coverage. In 2021, the CDTi programme was strengthened to a six-monthly programme. Additionally, the community-based vector control strategy "Slash and Clear" has been implemented since 2019 at the Maridi Dam, the only blackfly breeding site in the area. This study assessed the effect of these reinforced onchocerciasis elimination interventions on the Onchocerca volvulus seroprevalence among young children, an indicator of ongoing transmission.

Methods

Baseline and follow-up serosurveys were conducted in Maridi in 2019 (prior to strengthening onchocerciasis elimination efforts) and 2023, respectively. During both surveys, children aged three to nine years were recruited from five study sites situated at different distances from the Maridi Dam. Ov16 antibodies were detected via rapid diagnostic tests (RDTs) using whole blood obtained by finger-pricking the participants. Baseline and follow-up Ov16 prevalence rates were calculated and compared.

Results

In 2019, the Ov16 seroprevalence among children aged three to nine years was 24.5% compared to 30.6% in 2023 (p=0.22). Both surveys found a particularly high Ov16 seroprevalence in the study site closest to the Maridi Dam (35.0% in 2019 and 44.0% in 2023, p=0.52). The Ov16 seroprevalence had a non-significant decreasing trend in the three-year-old children, from 12.5% (3/24) in 2019 to 8.8% (3/34) in 2023 (p=0.65).

Conclusion

The persistent Ov16 RDT seropositivity among three-year-old children in 2023 indicates ongoing O. volvulus transmission. Therefore, further strengthening of the onchocerciasis elimination programme is required. The study highlights the utility of RDTs in monitoring onchocerciasis transmission in highly endemic settings.

Behavioral Intention of Receiving Monkeypox Vaccination and Undergoing Monkeypox Testing and the Associated Factors Among Young Men Who Have Sex With Men in China: Large Cross-Sectional Study

BACKGROUND

The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022.

OBJECTIVE

This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM.

METHODS

An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention.

RESULTS

A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001).

CONCLUSIONS

Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM's mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.

An Escape Game on University Students' Mental Health During the COVID-19 Pandemic: Cocreation Study

BACKGROUND

The COVID-19 pandemic has had a severe impact on students' mental health. Interventions are needed to promote their psychological well-being and prevent mental illnesses in the aftermath of this unprecedented situation. Digital escape games can be an effective tool to support students' mental health. A cocreation approach can improve the acceptability of these interventions by involving different stakeholders (eg, end users, game designers, and health professionals) to obtain audience-specific games.

OBJECTIVE

This study aims to describe the process of testing and optimizing the game "EscapeCovid" on students' mental health, to serve as a model for the cocreation of future similar interventions.

METHODS

The PRODUCES (Problem, Objective, Design, End Users, Cocreators, Evaluation, Scalability) framework was used. Cocreation steps (test and optimization) were detailed for replicability. A total of 45 students tested a pilot version of the game, with 10 undergoing a semistructured interview. Meetings with a group of stakeholders and brainwriting were organized to optimize the game.

RESULTS

We produced a new version of the game incorporating the suggestions provided by student testers and following the stakeholders' guidelines. Improvements were made to both the content and the form of the new version of the pilot game. The storyline, including the protagonist and the scenes, was adapted to the student population.

CONCLUSIONS

Our results suggested that cocreation can contribute to the design of more widely accepted interventions aimed at promoting mental health and preventing psychological disorders. Results also suggest that an end user-centered approach can facilitate intervention tailoring. When conceiving a health-related escape game for students, we recommend using the cocreation approach to enhance players' experience, thus positively influencing their learning process and overall well-being.

Rapid, high-throughput, cost-effective whole-genome sequencing of SARS-CoV-2 using a condensed library preparation of the Illumina DNA Prep kit

The ongoing COVID-19 pandemic necessitates cost-effective, high-throughput, and timely whole-genome sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses for outbreak investigations, identifying variants of concern (VoC), characterizing vaccine breakthrough infections, and public health surveillance. In addition, the enormous demand for WGS on supply chains and the resulting shortages of laboratory supplies necessitated the use of low-reagent and low-consumable methods. Here, we report an optimized library preparation method (the BCCDC cutdown method) that can be used in a high-throughput scenario, where one technologist can perform 576 library preparations (6 plates of 96 samples) over the course of one 8-hour shift. The same protocol can also be used in a rapid turnaround time scenario, from primary samples (up to 96 samples) to loading on a sequencer in an 8-hour shift. This new method uses Freed et al.'s 1,200 bp primer sets (Biol Methods Protoc 5:bpaa014, 2020, https://doi.org/10.1093/biomethods/bpaa014) and a modified and condensed Illumina DNA Prep workflow (Illumina, CA, USA). Compared to the original protocol, the application of this new method using hundreds of clinical specimens demonstrated equivalent results to the full-length DNA Prep workflow at 45% of the cost, 15% of consumables required (such as pipet tips), 25% of manual hands-on time, and 15% of on-instrument time if performing on a liquid handler, with no compromise in sequence quality. Results demonstrate that this new method is a rapid, simple, cost-effective, and high-quality SARS-CoV-2 WGS protocol.

IMPORTANCE

Sequencing has played an invaluable role in the response to the COVID-19 pandemic. Ongoing work in this area, however, demands optimization of laboratory workflow to increase sequencing capacity, improve turnaround time, and reduce cost without compromising sequence quality. This report describes an optimized DNA library preparation method for improved whole-genome sequencing of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen. The workflow advantages summarized here include significant time, cost, and consumable savings, which suggest that this new method is an efficient, scalable, and pragmatic alternative for SARS-CoV-2 whole-genome sequencing.

The Digital Therapeutics Real-World Evidence Framework: An Approach for Guiding Evidence-Based Digital Therapeutics Design, Development, Testing, and Monitoring

Digital therapeutics (DTx) are a promising way to provide safe, effective, accessible, sustainable, scalable, and equitable approaches to advance individual and population health. However, developing and deploying DTx is inherently complex in that DTx includes multiple interacting components, such as tools to support activities like medication adherence, health behavior goal-setting or self-monitoring, and algorithms that adapt the provision of these according to individual needs that may change over time. While myriad frameworks exist for different phases of DTx development, no single framework exists to guide evidence production for DTx across its full life cycle, from initial DTx development to long-term use. To fill this gap, we propose the DTx real-world evidence (RWE) framework as a pragmatic, iterative, milestone-driven approach for developing DTx. The DTx RWE framework is derived from the 4-phase development model used for behavioral interventions, but it includes key adaptations that are specific to the unique characteristics of DTx. To ensure the highest level of fidelity to the needs of users, the framework also incorporates real-world data (RWD) across the entire life cycle of DTx development and use. The DTx RWE framework is intended for any group interested in developing and deploying DTx in real-world contexts, including those in industry, health care, public health, and academia. Moreover, entities that fund research that supports the development of DTx and agencies that regulate DTx might find the DTx RWE framework useful as they endeavor to improve how DTxcan advance individual and population health.

Boundary Integrity Testing of Containment Level 3 (Biological Safety Level 3) Laboratories

Background

Containment Level 3 (CL3) laboratories may require boundary integrity testing. Existing guidelines for CL3 room leakage are often subjective, lacking a definitive standard for what constitutes a "sealed" room.

Methods

This study reviews global biocontainment guidelines and standards, and it compares multiple test results from global CL3 facilities by standardizing test data to an equivalent test pressure of 250 Pa.

Results

Our analysis revealed that 55% of rooms constructed using typical CL3 methodologies met the proposed testing criteria. The United States Department of Agriculture (USDA) Agricultural Research Service (ARS) greenhouse leakage rate acceptance criterion of 0.139 L/s per square meter (0.027 cfm per square foot) at a room differential pressure of 250 Pa was found to be a challenging, yet achievable standard.

Conclusions

A two-step process is recommended for boundary integrity testing: (1) Initial leaks are identified using smoke pencil or soap bubble tests, followed by necessary repairs; (2) The room is then subjected to quantifiable leakage rate testing to verify it meets minimum requirements. In the absence of definitive local guidelines, we recommend the published ARS greenhouse leakage rate at a room differential pressure of 300 Pa of 0.152 L/s per square meter of surface area as an acceptable criterion for testing construction boundaries of CL3 laboratories built using current CL3 construction practices. For primary containment CL3 rooms, a more stringent criterion following the German Verein Deutscher Ingenieure guidelines at a room pressure differential of 250 Pa is noted as 0.03620 L/s per square meter of room surface area is more appropriate.

Sharp increase in gonorrhoea notifications among young people, EU/EEA, July 2022 to June 2023

Gonorrhoea cases increased steeply in women aged 20 to 24 years across 15 EU/EEA countries in July to December 2022 and January to June 2023 with, respectively, 73% and 89% more cases reported than expected, based on historical data from 2015 to 2019. Smaller increases among men due to heterosexual transmission were observed in nine EU/EEA countries. Interventions to raise awareness among young people about sexually transmitted infection risks are needed, emphasising the benefit of safe sexual practices and testing.

Reliability, Variability and Minimal Detectable Change of the Isometric Mid-Thigh Pull in Adolescent Dancers

INTRODUCTION

The importance and potential benefits of muscular strength in the adolescent's development for health and fitness has been demonstrated in the literature. Maximal muscular strength and its assessment, however, is not a primary assessment criterium in the selection of young talented dancers.

METHODS

The present study evaluated the within- and between session reliability, variability, and minimal detectable change (MDC) of the isometric mid-thigh pull (IMTP). Thirty-five participants (female n = 17) participated in 2 identical assessments on the same day with 4-hour break in between. Three 3-second IMTP were performed, and the mean peak force value was used for the analyses.

RESULTS

Within-session the ICC indicated excellent reliability (ICC = .99, 95% CI: 0.98-0.99). Between-session reliability was excellent (ICC = .98, 95% CI: 0.95-0.99). The standard error of measurement was 4% (48 N), the minimum detectable change was 12% (134 N) and the CV was 3%. There were no within-session statistically significant differences, but statistically significant differences between-session were observed (P < .001). Limits of agreement ranged from -121 N (95% CI -186 to -56 N) to 307 N (95% CI 243-372 N).

CONCLUSION

The observed results demonstrated excellent within- and between sessions reliability, low variability, and an MDC of 12%. The consistency of the within-session scores suggest that peak force data may be obtained with single try efforts. The statistically significant difference in the means of the retest session, however, suggests that the time of the day or the time since entrained awakening may be affecting performance in adolescent dancers. The results of the current study indicate that the IMTP is a reliable assessment tool for maximal muscular strength in adolescent dancers.

Estimation of maximum sprinting speed with timing gates: greater accuracy of 5-m split times compared to 10-m splits

This study assessed the validity of 5-m (TG5) and 10-m (TG10) split times measured with timing gates to estimate maximum sprint speed (MSS) against a criterion measure radar gun (RG) during the maximum velocity phase of a 30-m sprint. Nineteen amateur rugby players performed two 30-m sprints. The timing gates were placed at the starting line and at 5-, 10-, 20-, 25- and 30-m. In addition, a RG was used to measure instantaneous velocity. Both trials per participant were used selected as references. MSS obtained from TG10, TG5 and RG showed high intraclass correlation coefficients (0.971-0.978), low coefficients of variation (1.14-1.70%) and smallest detectable changes (<0.02 m/s). Pairwise comparison revealed differences (p = 0.002) in MSS when comparing TG10 to RG, but not TG5 and RG (p = 0.957). Almost perfect correlations were found between RG, TG5 and TG10 (r > 0.926, p < 0.001). In conclusion, MSS obtained from TG5, TG10 and RG presented good intra-session reliability. However, practitioners should be aware that substantial differences exist between TG10 and RG. For the assessment of MSS in team-sport athletes, it is recommended the use of TG5 for more accurate estimations when a gold standard criterion is not available.

Testing Care and Morality: Everyday Testing During COVID-19 in Denmark

COVID-testing was central to control the spread of infection in Denmark. Drawing on ethnographic fieldwork, we show that testing was not just a diagnostic sign; it was also a biosocial practice that enacted a public health morality, centered on responsibility, care, and belonging. We argue that testing led to a public healthicization of everyday life, as it moralized individual and collective behavior and created a moral divide between the tested and the untested. By attending to COVID-19 testing as a material-semiotic sign, we show how testing is embedded within a particular cultural and moral framework of the Danish welfare state.

State of the Art in Pediatric Anesthesia: A Narrative Review about the Use of Preoperative Time

This review delves into the challenge of pediatric anesthesia, underscoring the necessity for tailored perioperative approaches due to children's distinctive anatomical and physiological characteristics. Because of the vulnerability of pediatric patients to critical incidents during anesthesia, provider skills are of primary importance. Yet, almost equal importance must be granted to the adoption of a careful preanesthetic mindset toward patients and their families that recognizes the interwoven relationship between children and parents. In this paper, the preoperative evaluation process is thoroughly examined, from the first interaction with the child to the operating day. This evaluation process includes a detailed exploration of the medical history of the patient, physical examination, optimization of preoperative therapy, and adherence to updated fasting management guidelines. This process extends to considering pharmacological or drug-free premedication, focusing on the importance of preanesthesia re-evaluation. Structural resources play a critical role in pediatric anesthesia; components of this role include emphasizing the creation of child-friendly environments and ensuring appropriate support facilities. The results of this paper support the need for standardized protocols and guidelines and encourage the centralization of practices to enhance clinical efficacy.

Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol

(1) Background: Extracorporeal membrane oxygenation (ECMO) is a complex procedure affecting both the risk of thrombosis and bleeding. High-quality data to personalize anticoagulation management in ECMO are lacking, resulting in a high variability in practice among centers. For this reason, we review coagulation methods and monitoring and share a pragmatic proposal of coagulation management, as performed in our high-volume ECMO Referral Centre; (2) Methods: We revised the anticoagulation options and monitoring methods available for coagulation management in ECMO through PubMed search based on words including "anticoagulation," "coagulation assays," "ECMO," "ELSO," and "ISTH"; (3) Results: Actual revision of the literature was described as our routine practice regarding ECMO anticoagulation and monitoring; (4) Conclusions: No coagulation test is exclusively predictive of bleeding or thrombotic risk in patients undergoing ECMO support. An approach that allows for a tailored regimen of anticoagulation (regardless of agent used) and monitoring is mandatory. To accomplish this, we propose that the titration of anticoagulation therapies should include multiple laboratory tests, including anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. Anticoagulation regimens should be tailored to a specific patient and personalized based on this complex array of essays.

Community-Engaged Research: COVID-19 Testing, Infection, and Vaccination among Underserved Minority Communities in Miami, Florida

Community collaboration is a cornerstone of modern public health efforts. This work aimed to use community-engaged research to explore COVID-19 vaccination, testing, and infection in a minoritized community. This study was conducted in Miami, Florida, from March 2021 to February 2022 in community partner sites and the Miami Adult Studies on HIV (MASH) cohort. Sociodemographic characteristics, vaccination and testing beliefs, and COVID-19 challenges were self-reported. COVID-19 vaccinations were verified with medical records, testing history was self-reported, and severe acute respiratory syndrome coronavirus 2 positivity was determined via real-time reverse transcription-polymerase chain reaction (rt-PCR). Of 1689 participants, the median age was 57, 51% were male, 49% were non-Hispanic Black, 66% reported an income < USD 15,000/year, and 75.9% received at least one dose of a COVID-19 vaccine. Belief that COVID-19 vaccination is effective was associated with lower odds of COVID-19 positivity and was the strongest predictor of vaccination. Challenges accessing health care, housing, food, and transportation were associated with lower odds of vaccination. Employment, health insurance, higher education, and greater perceived test accuracy were associated with greater odds of COVID-19 testing. Social determinants of health and the belief that vaccines are effective and tests are accurate predicted behaviors and thus should be considered during public health crises in vulnerable communities.

Performance of ChatGPT on Ophthalmology-Related Questions Across Various Examination Levels: Observational Study

BACKGROUND

ChatGPT and language learning models have gained attention recently for their ability to answer questions on various examinations across various disciplines. The question of whether ChatGPT could be used to aid in medical education is yet to be answered, particularly in the field of ophthalmology.

OBJECTIVE

The aim of this study is to assess the ability of ChatGPT-3.5 (GPT-3.5) and ChatGPT-4.0 (GPT-4.0) to answer ophthalmology-related questions across different levels of ophthalmology training.

METHODS

Questions from the United States Medical Licensing Examination (USMLE) steps 1 (n=44), 2 (n=60), and 3 (n=28) were extracted from AMBOSS, and 248 questions (64 easy, 122 medium, and 62 difficult questions) were extracted from the book, Ophthalmology Board Review Q&A, for the Ophthalmic Knowledge Assessment Program and the Board of Ophthalmology (OB) Written Qualifying Examination (WQE). Questions were prompted identically and inputted to GPT-3.5 and GPT-4.0.

RESULTS

GPT-3.5 achieved a total of 55% (n=210) of correct answers, while GPT-4.0 achieved a total of 70% (n=270) of correct answers. GPT-3.5 answered 75% (n=33) of questions correctly in USMLE step 1, 73.33% (n=44) in USMLE step 2, 60.71% (n=17) in USMLE step 3, and 46.77% (n=116) in the OB-WQE. GPT-4.0 answered 70.45% (n=31) of questions correctly in USMLE step 1, 90.32% (n=56) in USMLE step 2, 96.43% (n=27) in USMLE step 3, and 62.90% (n=156) in the OB-WQE. GPT-3.5 performed poorer as examination levels advanced (P<.001), while GPT-4.0 performed better on USMLE steps 2 and 3 and worse on USMLE step 1 and the OB-WQE (P<.001). The coefficient of correlation (r) between ChatGPT answering correctly and human users answering correctly was 0.21 (P=.01) for GPT-3.5 as compared to -0.31 (P<.001) for GPT-4.0. GPT-3.5 performed similarly across difficulty levels, while GPT-4.0 performed more poorly with an increase in the difficulty level. Both GPT models performed significantly better on certain topics than on others.

CONCLUSIONS

ChatGPT is far from being considered a part of mainstream medical education. Future models with higher accuracy are needed for the platform to be effective in medical education.

Influence of Body Mass Index, Physical Fitness, and Physical Activity on Energy Expenditure during Recess

This study aims to investigate the potential relationship between energy expenditure, physical fitness level, physical activity, and body mass index among children taking part in a 30 min school recess. A total of 259 participants from three schools were included in this study. Data on energy expenditure during recess, age, gender, anthropometric measurements, global physical fitness, and physical activity index were recorded. The evaluation sessions occurred twice a week on alternate days over two weeks. A significant gender difference was observed in energy expenditure during recess, favoring boys (p < 0.01). The participants classified as very active exhibited significantly higher scores compared to those categorized as sedentary and moderately active, respectively (p < 0.01), with a poor but significant correlation (rho: 0.208; p < 0.001). There were significant differences between energy expenditure and cardiorespiratory fitness and energy expenditure and global physical fitness (p < 0.01) with fair (rho: 0.289; p < 0.001) and poor (rho: 0.196, p = 0.001) correlation, respectively. In contrast, there were no significant differences by body mass index categories (p = 0.571). These results suggest that gender, physical activity index, and global physical fitness were found to influence energy expenditure during a 30 min recess. However, no significant relationships were found with the body mass index.

Evaluating bottoming-out of bariatric sized wheelchair cushions

In the United States, wheelchair cushions are classified using HCPCS codes. Cushions classified as Skin Protection cushions are provided for wheelchair users who are at risk of tissue damage. Cushions designed for bariatric users fall into a category of cushions with width of 22 inches or greater. Current coding procedures require tests that are designed for 41-43-cm-wide cushion so cannot evaluate wider cushions. The objective of this study was to evaluate the performance of heavy-duty or bariatric wheelchair cushions using an anthropometrically appropriate buttock model and loading profile. A rigid buttock model, designed to reflect the anthropometry of persons using cushions over 55 cm in width was loaded onto six bariatric-sized wheelchair cushions. Two applied loads, 75 and 88 kg, represented the 50th and 80th percentile of persons who would be expected to use a 55-cm-wide cushion. None of the cushions indicated a bottomed-out state at the 88 kg load, suggesting that they could adequately support users weighing 135 kg. However, when evaluating cushions at their maximum rated loads, two of the six cushions were approaching or had bottomed-out. This study indicates that a more valid approach to classify Skin Protection bariatric cushions is needed.

Multiple Confidence Intervals and Surprisal Intervals to Avoid Significance Fallacy

Overconfidence in statistical results in medicine is fueled by improper practices and historical biases afflicting the concept of statistical significance. In particular, the dichotomization of significance (i.e., significant vs. not significant), blending of Fisherian and Neyman-Pearson approaches, magnitude and nullification fallacies, and other fundamental misunderstandings distort the purpose of statistical investigations entirely, impacting their ability to inform public health decisions or other fields of science in general. For these reasons, the international statistical community has attempted to propose various alternatives or different interpretative modes. However, as of today, such misuses still prevail. In this regard, the present paper discusses the use of multiple confidence (or, more aptly, compatibility) intervals to address these issues at their core. Additionally, an extension of the concept of confidence interval, called surprisal interval (S-interval), is proposed in the realm of statistical surprisal. The aforementioned is based on comparing the statistical surprise to an easily interpretable phenomenon, such as obtaining S consecutive heads when flipping a fair coin. This allows for a complete departure from the notions of statistical significance and confidence, which carry with them longstanding misconceptions.

Stroke-Specific Swimming Critical Speed Testing: Balancing Feasibility and Scientific Rigour

This study aimed to assess the reliability of a two-distance critical speed protocol in the specialist strokes of national-level swimmers and understand the practical feasibility of extending the protocol to increase its validity. Thirty-two national-level swimmers (butterfly n = 7; backstroke n = 8; breaststroke n = 7; front crawl n = 10) swum three 200-m and three 400-m performance trials over a three-week period. Critical speed and supra-critical speed distance capacity were computed from the linear modelling of the distance-time relationship. Swimmers were subsequently asked whether they felt they could or would want to complete an 800-m trial as part of a three-distance critical speed protocol to enhance validity. Both 200-m and 400-m performances (coefficient of variation of < 2%) and derived critical speed (typical error of ≤ 0.04 m·s-1; coefficient of variation of < 4%) were reliable for all strokes, while supra-critical speed distance capacity (typical error from 4 to 9 m; coefficient of variation from 13 to 45%) was not reliable. Response rates to the follow-up questions were 100%. Few butterfly swimmers said they felt they could complete an 800-m performance trial (39%), with more positive responses for breaststroke (71%), backstroke (100%), and front crawl swimmers (100%). Butterfly swimmers were significantly less likely to say they could or would want to complete an 800-m trial than backstroke and front crawl swimmers (p < 0.05). Including a third distance 800-m trial to increase critical speed validity would not be acceptable to butterfly swimmers, would be challenging to breaststroke swimmers, but would be acceptable to front crawl and backstroke swimmers.

The use and impact of European Testing Week regional awareness campaigns to increase HIV and viral hepatitis testing coverage

INTRODUCTION

Since 2013, the European Testing Week (ETW) awareness campaign has become a key regional event influencing testing efforts for HIV, viral hepatitis, and sexually transmitted infections (STIs) through participation of 720 organizations. Here, we report on a survey from May to June 2022 aimed at assessing the participant-reported impact of the campaign.

METHODS

All past and current participating organizations were asked to complete an online questionnaire between 12 May and 17 June 2022. Multiple choice and open-text questions included organization information, usage of ETW to engage in local testing-related activities, and the effect of a regional campaign to reach a wider audience and generate impact.

RESULTS

Of the 52 respondents, 34 (65%) stated first participating in ETW 5-10 years ago. ETW was used for awareness raising by 40 respondents (83%), new testing activities by 37 (77%), advocacy initiatives by 15 (31%), and training/capacity building by 18 (38%). For awareness raising, 95% used ETW to highlight the importance of and to encourage testing; for new testing activities, 74% used ETW to reach new groups. In total, 44 (85%) reported added benefits of a Europe-wide campaign compared with national/local campaigns, particularly the increased visibility and collaboration opportunities. Impact at the local level was observed by 24 (51%), and impact at a national level was observed by 20 (43%). A total of 28 (79%) reported increases in the number of tests performed and 25 (75%) reported increases in clients accessing services.

CONCLUSIONS

Regional awareness campaigns reach wider audiences, boost local and national efforts to increase testing, and sensitize key populations about the critical value of testing compared with local/national campaigns.

Prevalence and sociodemographic determinants of public stigma towards people with HIV and its impact on HIV testing uptake: A cross-sectional study in 64 low- and middle-income countries

BACKGROUND

HIV stigma and discrimination are drivers of adverse HIV outcomes because they deter individuals from engaging in the HIV care continuum. We estimate the prevalence of public stigma towards people with HIV, investigate individuals' sociodemographic determinants for reporting stigmatizing attitudes, and test the impact of HIV stigma on HIV testing uptake.

METHODS

This was an observational study based on an analysis of cross-sectional surveys from 64 low- and middle-income countries. We used nationally representative survey data for the population aged 15-49 years from 2015 to 2021, which was the latest available data. HIV public stigma was measured using an index of two questions about attitudes towards people with HIV. First, prevalence estimates of HIV stigma were calculated by country, across countries, and by sociodemographic characteristics. Second, country fixed-effects multivariable logistic regression models were fit to assess sociodemographic determinants of holding stigmatizing attitudes towards people with HIV. Additional logistic regression models assessed country-level income and HIV prevalence as determinants of stigma and assessed the role of HIV public stigma as a driver of testing uptake.

RESULTS

A total of 1 172 841 participants were included in the study. HIV stigma was prevalent in all countries, ranging from 12.87% in Rwanda to 90.58% in Samoa. There was an inverse dose-response association between HIV stigma and educational level, wealth quintile, and age group, whereby higher levels of each were associated with lower odds of holding stigmatized attitudes towards people with HIV. The odds of stigmatized attitudes were lower among men and individuals with adequate knowledge of HIV. HIV stigma was lower in countries with greater gross domestic product per capita and HIV prevalence. Holding stigmatized attitudes towards people with HIV was associated with lower testing uptake, including having ever tested or having tested in the last year.

CONCLUSION

HIV stigma is present to a highly varying degree in all countries studied, so different approaches to reducing stigma towards people with HIV are required across settings. Action to eliminate HIV stigma is crucial if we are to progress towards ending HIV because holding stigmatized attitudes towards people with HIV was associated with reduced testing.

The Relationship Between Isometric and Dynamic Strength Following Resistance Training: A Systematic Review, Meta-Analysis, and Level of Agreement

BACKGROUND

Maximal lower-body strength can be assessed both dynamically and isometrically; however, the relationship between the changes in these 2 forms of strength following resistance training is not well understood.

PURPOSE

To systematically review and analyze the effects of resistance training on changes in maximal dynamic (1-repetition-maximum back squat, deadlift, and power clean) and position-matched isometric strength (isometric midthigh pull and the isometric squat). In addition, individual-level data were used to quantify the agreement and relationship between changes in dynamic and isometric strength.

METHODS

Databases were systematically searched to identify eligible articles, and meta-analysis procedures were performed on the extracted data. The raw results from 4 studies were acquired, enabling bias and absolute reliability measures to be calculated using Bland-Altman test of agreement.

RESULTS

Eleven studies met the inclusion criteria, which resulted in 29 isometric-dynamic change comparisons. The overall pooled effect was 0.13 in favor of dynamic testing; however, the prediction interval ranged from g = -0.49 to 0.75. There was no evidence of bias (P = .825) between isometric and dynamic tests; however, the reliability coefficient was estimated to be 16%, and the coefficient of variation (%) was 109.27.

CONCLUSIONS

As a range of future effects can be expected when comparing isometric to dynamic strength changes following resistance training, and limited proportionality exists between changes in these 2 strength qualities, there is strong evidence that isometric and dynamic strength represent separate neuromuscular domains. These findings can be used to inform strength-assessment models in athlete populations.

The Bilingual Is Not Two Monolinguals of Same Age: Normative Testing Implications for Multilinguals

A fundamental concept in psychological and intelligence testing involves the assumption of comparability in which performance on a test is compared to a normative standard derived from prior testing on individuals who are comparable to the examinee. When evaluating cognitive abilities, the primary variable used for establishing comparability and, in turn, validity is age, given that intellectual abilities develop largely as a function of general physical growth and neuromaturation. When an individual has been raised only in the language of the test, language development is effectively controlled by age. For example, when measuring vocabulary, a 12-year-old will be compared only to other 12-year-olds, all of whom have been learning the language of the test for approximately 12 years-hence, they remain comparable. The same cannot be said when measuring the same or other abilities in a 12-year-old who has been raised only in a different language or raised partly with a different language and partly with the language of the test. In such cases, a 12-year-old may have been learning the language of the test at some point shortly after birth, or they might have just begun learning the language a week ago. Their respective development in the language of the test thus varies considerably, and it can no longer be assumed that they are comparable in this respect to others simply because they are of the same age. Psychologists noted early on that language differences could affect test performance, but it was viewed mostly as an issue regarding basic comprehension. Early efforts were made to address this issue, which typically involved simplification of the instructions or reliance on mostly nonverbal methods of administration and measurement. Other procedures that followed included working around language via test modifications or alterations (e.g., use of an interpreter), testing in the dominant language, or use of tests translated into other languages. None of these approaches, however, have succeeded in establishing validity and fairness in the testing of multilinguals, primarily because they fail to recognize that language difference is not the same as language development, much like cultural difference is not the same as acquisition of acculturative knowledge. Current research demonstrates that the test performance of multilinguals is moderated primarily by the amount of exposure to and development in the language of the test. Moreover, language development, specifically receptive vocabulary, accounts for more variance in test performance than age or any other variable. There is further evidence that when the influence of differential language development is examined and controlled, historical attributions to race-based performance disappear. Advances in fairness in the testing of multilinguals rest on true peer comparisons that control for differences in language development within and among multilinguals. The BESA and the Ortiz PVAT are the only two examples where norms have been created that control for both age and degree of development in the language(s) of the test. Together, they provide a blueprint for future tests and test construction wherein the creation of true peer norms is possible and, when done correctly, exhibits significant influence in equalizing test performance across diverse groups, irrespective of racial/ethnic background or language development. Current research demonstrates convincingly that with deliberate and careful attention to differences that exist, not only between monolinguals and multilinguals of the same age but also among multilinguals themselves, tests can be developed to support claims of validity and fairness for use with individuals who were in fact not raised exclusively in the language or the culture of the test.

Generating Edge Cases for Testing Autonomous Vehicles Using Real-World Data

In the past decade, automotive companies have invested significantly in autonomous vehicles (AV), but achieving widespread deployment remains a challenge in part due to the complexities of safety evaluation. Traditional distance-based testing has been shown to be expensive and time-consuming. To address this, experts have proposed scenario-based testing (SBT), which simulates detailed real-world driving scenarios to assess vehicle responses efficiently. This paper introduces a method that builds a parametric representation of a driving scenario using collected driving data. By adopting a data-driven approach, we are then able to generate realistic, concrete scenarios that correspond to high-risk situations. A reinforcement learning technique is used to identify the combination of parameter values that result in the failure of a system under test (SUT). The proposed method generates novel, simulated high-risk scenarios, thereby offering a meaningful and focused assessment of AV systems.

Speed Effects on the Accuracy of Heart Rate as Oxygen-Uptake Indicator in Short-Distance Shuttle Running

Purpose: Despite the accuracy of heart rate (HR) as an indicator of the aerobic engagement has been evaluated in several intermittent on-court activities, its validity as an oxygen uptake (V ˙ O 2 ) indicator during shuttle running over short paths remains uncertain. Moreover, it is unclear whether speed may affect such validity. This study evaluated the HR ability in estimating the V ˙ O 2 during 5-m shuttle running at different speeds. Methods: V ˙ O 2 and HR of 12 physically active young men were recorded during an incremental forward running (FW) protocol and a 5-m shuttle test at 50%, 60%, and 75% of maximal aerobic speed (MAS). Slope and intercept of the relationship between HR and V ˙ O 2 (HR/V ˙ O 2 ) were individually determined, in both protocols. The HR measured during the shuttle test was used in the FW HR/V ˙ O 2 to estimate V ˙ O 2 at each shuttle speed. A paired Student's t-test compared slopes and intercepts of the two HR/V ˙ O 2 . A two-way RM-ANOVA and an equality test examined, respectively, the differences and the equality between measured and estimated V ˙ O 2 . Lastly, a Bland-Altman plot described the accuracy and precision of the estimated V ˙ O 2 at each shuttle intensity. Results: Slopes and intercepts of the HR/V ˙ O 2 appeared not different between FW and shuttle running. At 50%MAS, HR underestimated the V ˙ O 2 (~7%), whereas returned accurate values at the two higher velocities, although with high variability (±18%). Conclusions: When using HR as V ˙ O 2 indicator during shuttle running over short paths, a separated analysis of the HR validity as V ˙ O 2 indicator is recommended especially when administering different exercise intensities.

Hepatitis C Knowledge and Self-Reported Testing Behavior in the General Population in China: Online Cross-Sectional Survey

BACKGROUND

The World Health Organization has proposed a worldwide target of eliminating hepatitis C virus (HCV) by 2030. A better understanding of HCV, testing behaviors, and associated factors in the general population is essential.

OBJECTIVE

This study aimed to assess HCV knowledge, self-reported HCV testing behavior, and willingness to undergo HCV screening in the general Chinese population.

METHODS

A cross-sectional online survey of the general Chinese population aged ≥15 years was conducted from November 2021 to May 2023. Participant characteristics were assessed based on their knowledge level and uptake of HCV testing. Participants ever having heard of HCV were recognized as being aware of HCV and asked additional HCV knowledge questions using a brief, validated 9-item scale. Participants with 0-3 points and who were unaware of HCV were categorized as having poor knowledge, and those with 4-6 points and 7 points were categorized as having fair and good knowledge, respectively. Participant uptake of HCV testing, testing results, reasons for undergoing or not undergoing HCV testing, and willingness to undergo HCV screening were collected through self-reports. Ordinal and binary logistic regression analyses were used to assess factors associated with the HCV knowledge level and the uptake of HCV testing, respectively.

RESULTS

A total of 1491 valid participants' questionnaires were included. Of these, 714 (47.6%) participants were aware of HCV. The proportion of participants with poor, fair, and good HCV knowledge was 63.4% (945/1491), 9.3% (139/1491), and 27.3% (407/1491), respectively. A total of 465 (31.2%) participants reported ever undergoing HCV testing, and 4 (0.9%) were anti-HCV antibody positive. Most participants were tested for HCV following blood donation (353/465, 75.9%). The most common reasons for not undergoing HCV screening were a lack of HCV awareness (665/1026, 64.8%), followed by a low self-perceived risk of infection (176/1026, 17.2%). Of 1026 participants who had never undergone HCV testing, 937 (91.3%) were willing to undergo HCV screening if universal screening was provided at no cost. The HCV knowledge level was positively associated with the HCV testing rate. Participants who were less educated, lived in rural areas, resided in West China, and were currently alcohol drinkers had lower HCV knowledge and reduced odds of having undergone HCV testing. In contrast, participants with a blood donation history and a family history of hepatitis B virus or HCV infection had higher HCV knowledge and increased odds of prior testing. Participants aged ≥60 years had lower knowledge, and women had reduced odds of having undergone previous HCV testing.

CONCLUSIONS

The general population of China has low HCV knowledge and testing rate. There is an urgent need for enhanced HCV awareness and scaled-up HCV screening and treatment. Individuals who are less well educated, reside in less-developed areas, currently drink alcohol, and are female should be prioritized for health education and interventions.

Pollution and Heritage Metals-Effectiveness of Oddy Testing and Mitigation

Metals are particularly sensitive to some pollutant gases. Many museum showcases and store rooms present atmospheres that can corrode cultural heritage artefacts containing metals. Whilst numerous strategies have been reported to mitigate such situations, avoiding them is preferable. Several approaches to testing materials used in construction, fitting out or dressing are used. The relative merits and drawbacks are discussed. Several parameters of the most widely used, accelerated corrosion 'Oddy' test are investigated. The influence of abrasive on subsequent corrosion of lead and copper coupons are assessed. Quantification methods for tested coupons are reviewed. The influence of test duration and temperature are assessed through comparison with real-life, long-term experience of material behaviour. Direct contact tests with touching the test material are investigated. Several materials present in artefacts are known to potentially cause corrosion when enclosed with metals in other artefacts. A number of situations are investigated with pollution and RH and some corrosion rate measurements. Ways to isolate artefacts or mitigate are explored and a decision support model is further developed.

Demographic Characteristics of Unvaccinated Asymptomatic and Symptomatic SARS-CoV-2 Cases in Barwon South West, Victoria, Australia

We investigated 328 SARS-CoV-2 cases in Barwon South West, Victoria, Australia, in the 2020 pre-vaccination period, comparing infections with symptoms to those that remained asymptomatic. De-identified self-reported data on case characteristics and symptom progression from three sequential questionnaires were examined. Multivariable logistic regression was used to model associations between demographic profiles and symptoms. Asymptomatic infections were more than three times as likely to be seen in ethnic minority groups than the Caucasian population after adjusting for gender and age [OR 3.2, 95% CI 1.5-6.7, p < 0.01] and were more common among cases of Asian background [OR 2.8, 95%CI 1.2-6.4]. Asymptomatic infections were also more common in youth and younger adults, but cases were approximately seven times more likely to be in seniors (≥65 years) compared with those 24 years of age or younger after adjusting for sex and ethnicity [OR 6.9, 95% CI 1.3-35.8]. The overrepresentation of ethnic minority groups among asymptomatic infections is suggestive of genetic haplotype variability by ethnic group, conferring greater cross-protection from other coronaviruses in the initial phase of the COVID-19 pandemic. Replication of this analysis in the post-vaccination era and reassessment of symptom expression according to ethnicity in a community with established vaccine and infection-induced immunity would determine whether this is a sustained association or one confined to the early stages of a pandemic in an immunologically naive population. These findings may, in part, reflect differences in testing patterns by ethnicity and true differences in disease expression, both of which are important to understand in order to inform transmission prevention strategies and tailored risk messaging according to ethnic background.

Vertical Jump Neuromuscular Performance Characteristics Determining On-Court Contribution in Male and Female NCAA Division 1 Basketball Players

While various quantifiable physical attributes have been found to contribute to athletes' performance, there is a lack of scientific literature focused on examining how they relate to success during competition performance. The aim of this study was to investigate different countermovement jump (CMJ)-derived force-time characteristics and their utility in distinguishing high from low performers within a measure of on-court contribution (i.e., minutes per game played). Twenty-nine collegiate athletes (n = 15 males and n = 14 females) volunteered to participate in this investigation and performed CMJs on dual force plates sampling at 1000 Hz, weekly over the course of their basketball season. The athletes' average of their three best test-days across the season was used for further analysis. To identify their on-court contribution, athletes were divided into groups with high and low minutes per game, based on a median-split analysis. The findings suggest that at the overall group level (i.e., both genders), the modified reactive strength index (mRSI) and braking rate of force development (RFD) revealed the greatest between-group magnitudes of difference, with athletes playing more minutes per game showing greater performance. At the team-specific level, the braking RFD, average braking velocity, and mRSI were shown to be the greatest differentiators between groups for the men's team. The women's high-minutes group displayed greater magnitudes of mRSI and jump height. By identifying the neuromuscular qualities seen in top performers within their respective populations, the attributed physical performance underpinning these qualities may be identified, providing practitioners with insights into physical performance qualities and training methodologies that have the potential to influence basketball performance.

Heterogeneity in practitioner-reported barriers to use, cost considerations and priorities for point of care sexually transmitted infection tests on surveys across seven years

BACKGROUND

Point of care diagnostic tests (POCTs) for sexually transmitted infections (STIs) have the potential to improve STI care worldwide. However, barriers to adoption, cost considerations and practitioner priorities may not be uniform globally and over time. We conducted two surveys, 7 years apart, among members of the International Union Against Sexually Transmitted Infections (IUSTI), and compare results here.

METHODS

Surveys were given to members attending two IUSTI conferences in 2012 (Australia) and 2019 (Estonia). Descriptive analyses were performed and chi-square or Fisher's exact tests conducted.

RESULTS

Amongst N = 190 participants in 2012 and N = 166 in 2019, 61% in 2012 and 77% in 2019 were from high-income countries (HICs). In 2012, 84% of respondents from low- and middle-income countries (LMICs) and 70% from HICs thought cost of test was more important than amount of reimbursement. Trends were similar in 2019. In 2012, unreliability was considered the most important barrier to POCT use by all groups, followed by being laboratory-driven and complexity. In 2019, time frame was considered most important, followed by unreliability and being laboratory-driven. In 2012, the top priority for POCT development among LMIC respondents was early HIV seroconversion (31%), versus chlamydia (57%) for HICs. In 2019, chlamydia remained top priority for HICs (40%), followed by early HIV seroconversion (19%) and gonorrhea (17%); top priorities for LMICs were chlamydia (26%), HPV (24%), and early HIV seroconversion (21%).

CONCLUSIONS

Practitioner priorities for STI POCTs may be shifting. Cost may be critical to adoption in all settings. Larger studies are needed to verify findings.

Decreasing the Risk for Transmission of SARS-CoV-2 During In-Person Visitation Within a State Prison System

To decrease the introduction of COVID-19, in-person visitation programs were temporarily limited at California Department of Corrections and Rehabilitation facilities. After consultation with the California Department of Public Health, and in accordance with Centers for Disease Control and Prevention guidelines, in-person visitation was reintroduced on April 10, 2021, with COVID-19 mitigation strategies. To assess the risk of visitation as a mode of entry for COVID-19 into a prison setting, data were gathered demonstrating the number of visitors who were not allowed into the prison due to a positive COVID-19 test prior to visitation. The number of patients who tested positive for COVID-19 after interaction with visitors was also assessed. Between April 10 and June 27, 2021, 33,212 visitors participated in the in-person visiting program. Eight visitors received positive test results prior to entry. Between January 1 and October 1, 2021, 19,025 patients received a total of 93,135 visitations. Of these, 66 patients received positive test results from post-visit testing. These data suggest that when appropriate mitigation strategies are implemented, the visitation process is not a significant contributor to COVID-19 entry into the prison facility when compared with the total number of COVID-19 cases among patients.

Determinants of SARS-CoV-2 nasopharyngeal testing in a rural community sample susceptible of first infection: the CHRIS COVID-19 study

To characterize COVID-19 epidemiology, numerous population-based studies have been undertaken to model the risk of SARS-CoV-2 infection. Less is known about what may drive the probability to undergo testing. Understanding how much testing is driven by contextual or individual conditions is important to delineate the role of individual behavior and to shape public health interventions and resource allocation. In the Val Venosta/Vinschgau district (South Tyrol, Italy), we conducted a population-representative longitudinal study on 697 individuals susceptible to first infection who completed 4,512 repeated online questionnaires at four-week intervals between September 2020 and May 2021. Mixed-effects logistic regression models were fitted to investigate associations of self-reported SARS-CoV-2 testing with individual characteristics (social, demographic, and biological) and contextual determinants. Testing was associated with month of reporting, reflecting the timing of both the pandemic intensity and public health interventions, COVID-19-related symptoms (odds ratio, OR:8.26; 95% confidence interval, CI:6.04-11.31), contacts with infected individuals within home (OR:7.47, 95%CI:3.81-14.62) or outside home (OR:9.87, 95%CI:5.78-16.85), and being retired (OR:0.50, 95%CI:0.34-0.73). Symptoms and next within- and outside-home contacts were the leading determinants of swab testing predisposition in the most acute phase of the pandemics. Testing was not associated with age, sex, education, comorbidities, or lifestyle factors. In the study area, contextual determinants reflecting the course of the pandemic were predominant compared to individual sociodemographic characteristics in explaining the SARS-CoV-2 probability of testing. Decision makers should evaluate whether the intended target groups were correctly prioritized by the testing campaign.

Analysis of alternate material Onyx™ for total knee arthroplasty instrumentation sets

CONTEXT

A 25-pound weight limit is currently set on containerized instrumentation sets by the Association of periOperative Registered Nurses (AORN) and the Association for the Advancement of Medical Instrumentation (AAMI), in order to reduce strain on the staff and ensure that the sets are not too crowded in order to preserve sterilization and drying of the instruments. This is pushing companies to reduce the weight and number of instrumentation sets for the operating room. One solution has been to explore the viability of new, lighter materials such as Onyx.

OBJECTIVES

The goal of this study is to evaluate the novel material Onyx as a viable material utilized in reusable total knee arthroplasty (TKA) instrumentation sets utilizing traditional steam sterilization as the sterilization method.

METHODS

Mechanical and biocompatibility tests according to the American Society for Testing Materials (ASTM) and International Organization for Standardization (ISO) 10,993 were run to evaluate the Onyx Material to see if it would be a viable alternative to the stainless and martensitic steel that is currently being utilized.

RESULTS

Gross warping and cracking after 10 rounds of sterilization was observed. This was qualitatively worse in the Onyx without a carbon fiber component. The Onyx material did not meet biocompatibility standards for its application.

CONCLUSIONS

Onyx was determined to not be a viable material for TKA instruments regarding multiple high-pressure and -temperature sterilizations and cytotoxic cell testing.

Pharmacy-based screening program to detect hepatitis C in 'baby-boomer' cohorts in western Canada

Background

The estimated prevalence of hepatitis C virus (HCV) in Canada is approximately 1.0%. However, the number of individuals living with HCV but unaware of it is estimated to be 30%-44%. Increased screening programs that are accessible, effective, and feasible are important to ensure treatment and meet WHO elimination goals. We implemented an HCV point of care test (POCT) program in community pharmacies to examine the effectiveness and feasibility in screening.

Methods

Twenty two London Drugs pharmacies in British Columbia and Alberta implemented an HCV POC screening program using OraQuick rapid antibody tests. Consenting patients filled out a 10-question screening questionnaire to examine risk factors. The participants then were tested using the POCT. While waiting for the test (20 minutes), patients were educated on HCV and treatment options.

Results

Three hundred seventy-one participants underwent HCV screening. The most common HCV risk factor was being born between 1945 and 1975 (baby boomer) (93% of cohort), while the second most common was having a tattoo or body piercing (22%). Seven people (2%) tested positive; four were HCV-RNA PCR-positive and were treated, whereas the PCR status of three was unknown as they were lost to follow-up or not tested.

Conclusions

Pharmacy-based POCT was shown to be effective and feasible in the western Canadian context, especially for baby boomers. Sustainable funding for pharmacy screening programs may be considered nationwide to identify HCV-infected persons and help meet elimination goals.

Cognitive Performance changes during a 20-day Winter Military Training Course and the Following 10-day Recovery Period

Introduction: The purpose of the present study was to investigate the effects of a winter military field training course consisting of strenuous physical stressors (e.g. physical activity, sleep deprivation and cold weather) on cognitive performance among Finnish soldiers.Methods: Fifty-eight (age 19 ± 1 years, height 182 ± 6 cm, body mass 78.5 ± 7.2 kg) male soldiers took part in a 20-day military field training course in northern Finland. Cognitive performance was assessed before, during, and after the course four times on a tablet computer. Sustained Attention to Response Task (SART) was used to assess soldier's executive and inhibitory function. Baddeley's 3-min reasoning task (BRT) was used to assess grammatical reasoning, and Change Blindness (CB) task was used to assess visual perception.Results: Strenuous winter field training had detrimental effects in all performance tests compared to baseline. SART response rate decreased 27.3% (p < 0.001), and BRT and CB task scores decreased 20.6% (p < 0.01) and 14.1% (p < .05), respectively.Conclusion: The present study showed a decline in soldier's cognitive performance after 20-days of physically demanding winter military field training. To be able to optimise field training, it is important to be aware of how cognitive performance changes during military exercises and missions.

Remote Determination of Critical Speed and Critical Power in Recreational Runners

PURPOSE

This study aimed to compare estimations of critical speed (CS) and work completed above CS (D'), and their analogies for running power (critical power [CP] and W'), derived from raw data obtained from habitual training (HAB) and intentional maximal efforts in the form of time trials (TTs) and 3-minute all-out tests (3MTs) in recreational runners. The test-retest reliability of the 3MT was further analyzed.

METHODS

Twenty-three recreational runners (4 female) used a foot pod to record speed, altitude, and power output for 8 consecutive weeks. CS and D', and CP and W', were calculated from the best 3-, 7-, and 12-minute segments recorded in the first 6 weeks of their HAB and in random order in weeks 7 and 8 from 3 TTs (3, 7, and 12 min) and three 3MTs (to assess test-retest reliability).

RESULTS

There was no difference between estimations of CS or CP derived from HAB, TT, and 3MT (3.44 [0.63], 3.42 [0.53], and 3.76 [0.57] m · s-1 and 281 [41], 290 [45], and 305 [54] W, respectively), and strong agreement between HAB and TT for CS (r = .669) and CP (r = .916). Limited agreement existed between estimates of D'/W'. Moderate reliability of D'/W' was demonstrated between the first and second 3MTs, whereas excellent reliability was demonstrated for CS/CP.

CONCLUSION

These data suggest that estimations of CS/CP can be derived remotely, from either HAB, TT, or 3MT, although the lower agreement between D'/W' warrants caution when using these measures interchangeably.

The role of the biomechanics analyst in swimming training and competition analysis

Swimming analysts aid coaches and athletes in the decision-making by providing evidence-based recommendations. The aim of this narrative review was to report the best practices of swimming analysts that have been supporting high-performance athletes. It also aims to share how swimming analysts can translate applied research into practice. The role of the swimming analyst, as part of a holistic team supporting high-performance athletes, has been expanding and is needed to be distinguished from the job scope of a swimming researcher. As testing can be time-consuming, analysts must decide what to test and when to conduct the evaluation sessions. Swimming analysts engage in the modelling and forecast of the performance, that in short- and mid-term can help set races target-times, and in the long-term provide insights on talent and career development. Races can be analysed by manual, semi-automatic or fully automatic video analysis with single or multi-cameras set-ups. The qualitative and quantitative analyses of the swim strokes, start, turns, and finish are also part of the analyst job scope and associated with race performance goals. Land-based training is another task that can be assigned to analysts and aims to enhance the performance, prevent musculoskeletal injuries and monitor its risk factors.