Development and operation of the defence COVID-19 lab as a SARS-CoV-2 diagnostic screening capability for UK military personnel

BACKGROUND

In the face of the COVID-19 pandemic, the Defence Science and Technology Laboratory (Dstl) and Defence Pathology combined to form the Defence Clinical Lab (DCL), an accredited (ISO/IEC 17025:2017) high-throughput SARS-CoV-2 PCR screening capability for military personnel.

LABORATORY STRUCTURE AND RESOURCE

The DCL was modular in organisation, with laboratory modules and supporting functions combining to provide the accredited SARS-CoV-2 (envelope (E)-gene) PCR assay. The DCL was resourced by Dstl scientists and military clinicians and biomedical scientists.

LABORATORY RESULTS

Over 12 months of operation, the DCL was open on 289 days and tested over 72 000 samples. Six hundred military SARS-CoV-2-positive results were reported with a median E-gene quantitation cycle (Cq) value of 30.44. The lowest Cq value for a positive result observed was 11.20. Only 64 samples (0.09%) were voided due to assay inhibition after processing started.

CONCLUSIONS

Through a sustained effort and despite various operational issues, the collaboration between Dstl scientific expertise and Defence Pathology clinical expertise provided the UK military with an accredited high-throughput SARS-CoV-2 PCR test capability at the height of the COVID-19 pandemic. The DCL helped facilitate military training and operational deployments contributing to the maintenance of UK military capability. In offering a bespoke capability, including features such as testing samples in unit batches and oversight by military consultant microbiologists, the DCL provided additional benefits to the UK Ministry of Defence that were potentially not available from other SARS-CoV-2 PCR laboratories. The links between Dstl and Defence Pathology have also been strengthened, benefitting future research activities and operational responses.

A Long-Term Outcome Assessment of the Effects on Subsequent Reoffense Rates of a Prison-Based CBT/RNR Sex Offender Treatment Program With Strength-Based Elements

This article describes an evaluation of the effects of an early version (1991-2001) of Rockwood's prison-based Cognitive Behavioral Therapy/Risk-Needs-Responsivity (CBT/RNR) sex offender program that had emerging elements of a strength-based approach. This program was implemented under contract to Correctional Service of Canada (CSC) and continued to evolve in response to emerging evidence until it closed in 2013. Thus, the program as evaluated here did not involve a fixed approach as did the comparison CSC program (hereafter referred to as SOTP). Long-term reoffense data, from Rockwood's program (n = 579), were compared with SOTP (n = 625) and with a group of untreated men (n = 107) sentenced for sex offenses. A modified brief actuarial risk scale (BARS-M) was used to control for baseline risk among the three groups, along with additional controls for age at release, victim type, and individual differences in the length of long-term follow-up period. Both treatment groups displayed lower rates of both sexual and violent reoffending when compared with the no-treatment offenders. Overall, the Rockwood program generated the lowest recidivism rates. The results demonstrate that prison-based sex offense-specific treatment can be effective. We discuss the strengths and limitations of the current design through the Collaborative Outcome Data Committee's guidelines.

The Rockwood Preparatory Program for sexual offenders: description and preliminary appraisal

This article describes the Rockwood Preparatory Program for sexual offenders. This program operates in the Millhaven induction center of the Correctional Service of Canada. Clients remain in the program for 6 to 8 weeks, depending on when they are placed in their home prison, where they will receive a full treatment program. The preparatory program takes a motivational approach, integrating several theoretical views and employing the therapeutic approaches that have been shown to maximize effectiveness with sexual offenders. The content and approach of the program are described and the observed benefits are outlined.

The utility of the random controlled trial for evaluating sexual offender treatment: the gold standard or an inappropriate strategy?

This paper examines the scientific, practical, and ethical issues surrounding the employment of the Random Controlled Trial (RCT) in the evaluation of sexual offender treatment. Consideration of these issues leads us to conclude that the RCT design is not suitable for determining the effectiveness of sexual offender treatment. We also examine the RCT study by Marques et al. (Sexual Abuse: A Journal of Research and Treatment and Evaluation 17:79-107, 2005) that is often held up as the model for the evaluation of sexual offender treatment. We found several problems with this study that, in our opinion, reduce its relevance for deciding whether treatment is effective with these clients. Finally, we examine two alternative strategies for evaluating treatment that may allow treatment providers to more readily examine, and report, the results of their programs.

Recovering memories of the offense in "amnesic" sexual offenders

This paper describes a technique designed to assist sexual offenders to recover memories of their offense. We have consistently observed that some sexual offenders present as having no recall of their offense although they are able to remember other events of the day of the offense. This failure to recall offense details prevents the offenders from making an appropriate disclosure which, in turn, blocks attempts to identify their offense pathways and develop relapse prevention plans. The memory recovery technique we describe is based on experimental literature on memory and we outline its use with 22 clients, 20 of whom showed satisfactory recovery of their memories.

Distorted attitudes and perceptions, and their relationship with self-esteem and coping in child molesters

Two studies were conducted to compare various aspects of child molesters, non-sexual offenders, and community-based nonoffenders. These studies were aimed at examining some implications of our general model of sexual offending. Study 1 compared the responses of these 3 groups on measures of self-esteem, attitudes toward women and children, and social desirability tendencies. The only observed difference was that child molesters had significantly lower self-esteem than did the other 2 groups. In Study 2, child molesters displayed more cognitive distortions about sex between adults and children than did nonsexual offenders or nonoffenders. However in this study child molesters scored in the same range as the other participants on self-esteem and the tendency to use sex as a way of coping with problems. The results are discussed in terms of the differences between the present findings and earlier studies, and their implications for future research.

Treatment of sexual offenders who are in categorical denial: a pilot project

This paper describes an approach to treatment for sexual offenders who are in categorical denial. Other efforts to have them, at least partially, admit responsibility had failed and they were to be released from prison without any treatment. Evidence that suggests denial is not predictive of risk and that treatment may reduce the risk of these offenders is reviewed. Essentially, this paper offers a possible approach to dealing with these intractable deniers which, it is suggested, is better than not trying to modify their risk, and that may prove to be effective.

False-positive legionella titres in routine clinical serology testing detected by absorption with campylobacter: implications for the serological diagnosis of legionnaires' disease

A simple absorption step using blocking fluid prepared from a selected campylobacter strain was introduced in parallel with routine legionella serology tests. Over 12 months, 2716 patients were tested for legionella antibodies by the Indirect Fluorescent Antibody Test of whom 58 (2.1%) had a positive titre (> or = 16) in one or more sera. Campylobacter blocking fluid significantly reduced the legionella titres in 17 of these patients (29%) including four patients with diagnostic serology results (two of whom had pneumonia) and 13 patients with non-diagnostic titres. Absorption with campylobacter however had no effect on the legionella titres in 10 patients with positive serology, in whom legionnaires' disease had been confirmed by culture of Legionella pneumophila from sputum or detection of legionella urinary antigen by ELISA. These results indicate that the serological cross-reaction between legionella and campylobacter is encountered in routine legionella serology tests. The important implications for the diagnosis of legionnaires' disease are discussed.

The localizing value of asymmetry in pupillary size in severe head injury: relation to lesion type and location

Reliable Assessment of the probability that a head injury patient harbors a surgical intracranial lesion is critical to both triage and treatment. The authors analyzed data from 608 patients with severe head injuries (Glasgow Coma Scale score, < or = 8) in the Traumatic Coma Data Bank to assess the reliability of pupillary asymmetry in predicting the presence and location of an intracranial mass lesion. Of 210 patients with pupillary asymmetry of > or = 1 mm, 63 (30%) had intracranial mass lesions, 52 (25%) of which were extra-axial in location, 38 (73%) of these located ipsilateral to the larger pupil. Of 51 patients with asymmetry of > or = 3 mm, 22 (43%) had intracranial mass lesions, 18 (35%) of which were extra-axial in location, 14 (64%) of these located ipsilateral to the larger pupil. For both asymmetry categories, strong interactions were found with age and mechanism of injury, the highest incidence of extra-axial lesions occurring in older patients injured other than as occupants of motor vehicles. The authors developed regression equations that provide a graphic means to predict the presence of an intracranial hematoma using data on pupillary asymmetry, age, and mechanism of injury. This predictive model, interpreted in a hospital- and patient-specific fashion, should be of significant use in directing triage, activating diagnostic and therapeutic resources, and evaluating the utility of exploratory trephination.

False positive legionella serology in campylobacter infection: campylobacter serotypes, duration of antibody response and elimination of cross-reactions in the indirect fluorescent antibody test

Sera from 83 patients with campylobacter gastroenteritis were examined for the presence of legionella antibodies by indirect immunofluorescence. Twenty-one patients (25%) had positive titres (> or = 16) including 11 patients with titres of > or = 128. Legionella seropositivity persisted in 5 of 9 patients (55%) studied for 6-9 months. Campylobacter isolates were serotyped by the Penner scheme. Isolates associated with legionella seropositivity included Penner types 1, 2 and 4, the common endemic serotypes in England. Campylobacter blocking fluids were prepared from a range of Penner reference strains. The blocking fluid prepared from Penner type 11 was the most efficient at inhibiting the false-positive legionella titres. Using this absorption step legionella titres were inhibited from 24 of 26 patients (92%) with campylobacter but not from 8 patients with culture-proven legionnaires' disease. We recommend that this method is incorporated into routine diagnostic legionella serology in order to eliminate false-positive reactions due to campylobacter.

Variability of TRH test responses in depressed and normal elderly subjects

Thyrotropin releasing hormone (TRH) tests were conducted in 33 elderly patients with Major Depressive Disorder and 99 normal elderly volunteers. A wide range of thyrotropin-stimulating hormone (TSH) responses to TRH injection was revealed. A gender effect was found such that men had significantly diminished TSH responses to TRH relative to women (p = 0.008). However, there were no significant differences noted between depressed patients and normal elderly subjects of either gender. It appears that the wide range of TSH responses to TRH found in normal elderly men and women blurs any measurable differentiation between depressed patients and normal subjects and thereby limits the usefulness of the TRH test in the study of depressive disorder in elderly patients.

Measurement of cortisol and lymphocyte subpopulations in depressed and conduct-disordered adolescents

Lymphocyte subpopulations were analyzed in 11 adolescents with major depressive disorder, 11 with conduct disorder, and eight normal age-matched subjects. No significant differences were noted on any T or B cell measure between the groups. Further, no significant correlations were found between any cortisol measure (baseline cortisol, post-dexamethasone cortisol, urinary free cortisol) and any lymphocyte measure in either depressed or conduct-disordered adolescents. The negative findings in this small sample contrast with those reported in adult patients and suggest that an aging effect may be associated with the immunological changes reported in older depressed patients.

Lymphocyte subpopulations in depressed elderly women

Dexamethasone Suppression Tests (DST) and measurement of lymphocyte subpopulations were conducted in 21 medically healthy elderly women with major depressive disorder and 77 healthy elderly women volunteers. Depressed women revealed significantly reduced absolute lymphocytes (p less than 0.01), T cells (p less than 0.01), and T helper cells (p less than 0.02) compared to normal elderly women. Of the depressed women, 50% had positive DSTs (postdexamethasone cortisols greater than 5 micrograms/dl) compared to 5.4% of the normal women (p less than 0.0001). Within the depressed group, patients with positive DSTs had significantly reduced absolute lymphocytes (p less than 0.05) and T helper cells (p less than 0.025) compared with depressed women who had normal DSTs. Further, a significant negative correlation was found between postdexamethasone cortisols (at both 4:00 and 11:00 PM) and absolute lymphocyte count and T helper cells. These data suggest that the hypercortisolemia seen in some patients with major depressive disorder is sufficient to alter leukocyte distribution in the peripheral circulation, particularly that of the T helper cell subset. The association between cortisol and lymphopenia appears to be more pronounced in an elderly population than in younger depressed patients.

TRH tests in a healthy elderly population. Demonstration of gender differences

Thyrotropin releasing hormone (TRH) tests were conducted in 99 healthy elderly men and women between the ages of 65 and 89. The TRH test identified elderly patients with subclinical thyroid dysfunction not recognized by basal TSH values alone. Men revealed significantly diminished TSH responses to TRH injection relative to women. Mean delta max TSH was 9.0 +/- 8.3 microIU/mL in men vs 15.7 +/- 14.8 microIU/mL in women (P less than .01) reflecting the need to consider gender effect in the interpretation of TRH test responses.

Fenfluramine provocation of anxiety in patients with panic disorder

Fenfluramine, and indirect serotonergic agonist, was administered to nine women with panic disorder, nine women with major depressive disorder, and nine women controls. Panic disorder patients revealed significantly greater anxiogenic responses to fenfluramine administration at all 5 hourly measurement points than either depressed patients or control subjects. Prolactin and cortisol responses to fenfluramine were also significantly greater in panic disorder patients than in either depressed patients or control subjects. Placebo administration did not elicit robust or significantly different anxiety or hormonal responses in panic disorder patients or control subjects. These data offer evidence that serotonergic hyperresponsivity must be considered as an important factor in the mechanism of events provoking overt panic attacks.

Hepatitis B vaccination. Response of alcoholic with and without liver injury

Alcoholics are at risk to develop hepatitis B infections, chronic active hepatitis, and even hepatoma. Hence, immunization with hepatitis B vaccine is recommended. However, immune abnormalities may coexist which alter their responsiveness to vaccination. This study compares the immune response to this vaccine in controls (group I), alcoholics without overt liver disease (group II), and alcoholics with clinical liver disease (group III). By the seventh month after the initial vaccination, 89% in group I, 70% in group II, and 18% in group III had a response greater than 36 RIA units. The magnitude of the response was significantly different in groups I, II, and III (19,456 vs 8,326 vs 153 RIA units, respectively; P less than 0.05, group I vs III). In those who did not respond, a significant (P less than 0.02) lower helper/inducer (T4) class of lymphocytes was observed as compared to patients who exhibited an adequate response. These observations suggest: (1) that the response to hepatitis B vaccine is a T-cell-dependent event and (2) that in this population, using the existing vaccine, postvaccination evaluations of antibody concentrations are needed before protection against hepatitis B infection can be assumed.

Review of intermittent dobutamine infusions for congestive cardiomyopathy

Dobutamine is a potent inotropic agent traditionally used for treatment of acute cardiac decompensation of congestive heart failure (CHF). It acts primarily by increasing myocardial contractility and cardiac output. It has a rapid onset of action, a half-life of 2 minutes, and a duration of action of 10 minutes. Recently, the therapeutic effect of dobutamine was noted to be prolonged beyond the discontinuation of an infusion, persisting for 4-10 weeks after infusion of 48-72 hours. Because of this prolonged effect, dobutamine infusions were evaluated in outpatients with intractable CHF and were effective in improving their functional status. No effect on survival rates may be expected, but this form of therapy may improve the patient's lifestyle. Although several factors may limit the application of dobutamine infusion to outpatients, it offers an effective alternative to traditional therapy for select patients.

Rotenone inhibition of tubulin self-assembly

Rotenone effectively inhibits the in vitro formation of microtubules from tubulin containing or lacking microtubule-associated proteins. In both cases a concentration of rotenone equal to that of tubulin present completely blocks assembly. The inhibition can be reversed by the addition of dimethylsulfoxide or by removing rotenone with charcoal.