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IntroductionDynamic contrast-enhanced CT (DCE-CT) and positron emission tomography/CT (PET/CT) have a high reported accuracy for the diagnosis of malignancy in solitary pulmonary nodules (SPNs). The aim of this study was to compare the accuracy and cost-effectiveness of these.MethodsIn this prospective multicentre trial, 380 participants with an SPN (8–30 mm) and no recent history of malignancy underwent DCE-CT and PET/CT. All patients underwent either biopsy with histological diagnosis or completed CT follow-up. Primary outcome measures were sensitivity, specificity and overall diagnostic accuracy for PET/CT and DCE-CT. Costs and cost-effectiveness were estimated from a healthcare provider perspective using a decision-model.Results312 participants (47% female, 68.1±9.0 years) completed the study, with 61% rate of malignancy at 2 years. The sensitivity, specificity, positive predictive value and negative predictive values for DCE-CT were 95.3% (95% CI 91.3 to 97.5), 29.8% (95% CI 22.3 to 38.4), 68.2% (95% CI 62.4% to 73.5%) and 80.0% (95% CI 66.2 to 89.1), respectively, and for PET/CT were 79.1% (95% CI 72.7 to 84.2), 81.8% (95% CI 74.0 to 87.7), 87.3% (95% CI 81.5 to 91.5) and 71.2% (95% CI 63.2 to 78.1). The area under the receiver operator characteristic curve (AUROC) for DCE-CT and PET/CT was 0.62 (95% CI 0.58 to 0.67) and 0.80 (95% CI 0.76 to 0.85), respectively (p<0.001). Combined results significantly increased diagnostic accuracy over PET/CT alone (AUROC=0.90 (95% CI 0.86 to 0.93), p<0.001). DCE-CT was preferred when the willingness to pay per incremental cost per correctly treated malignancy was below £9000. Above £15 500 a combined approach was preferred.ConclusionsPET/CT has a superior diagnostic accuracy to DCE-CT for the diagnosis of SPNs. Combining both techniques improves the diagnostic accuracy over either test alone and could be cost-effective.Trial registration number NCT02013063

Introduction Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with increasing prevalence worldwide. The disease is, however, underdiagnosed in many resource-limited countries, especially in sub-Saharan Africa with unknown prevalence. Study aim The aim of this study was to determine the demographic and clinical characteristics, as well as measured sleep study parameters of suspected OSA patients. Methods The study was a retrospective review of the clinical characteristics and home sleep study reports of patients seen at the respiratory and sleep clinic from January 2020 to June 2022. Descriptive statistics such as means, medians, and percentages were employed to summarize the data using tables and graphs. Spearman correlation coefficient and Fisher's exact test were used to determine associations between the variables. Findings The study participants were predominantly male, and 64.7% were ≥50 years of age. Approximately 76% of the cases had moderate-to-severe OSA based on the apnea-hypopnea index (AHI) scores with a mean BMI of 38.4kg/m and 43.1kg/m , respectively (p=0.013), and a mean STOP-BANG score of 5.2 and 6.2, respectively (p <0.001). There was a positive correlation between AHI scores and BMI of the patients (r=0.252, p=0.003), as well as with their STOP-BANG scores ( =0.436, p< 0.001). Oxygen desaturation index (ODI) parameters of participants also positively correlated with the AHI scores ( =0.872, p<0.001). Conclusion The proportion of patients with moderate-to-severe OSA was high. Obesity was significantly associated with AHI scores, which also positively correlated with the STOP-BANG and ODI scores. These results suggest that the burden of OSA, which is closely linked with obesity, could be underestimated in Ghana and requires epidemiological studies in the very near future to clearly define and anticipate its impact on the health economy of Ghana.

A 63-year-old male, with no significant past history and not on any regular medications previously, had mild respiratory symptoms post the first dose of the AstraZeneca (Cambridge, England) coronavirus disease 2019 (COVID-19) vaccine, which were self-limiting. Following the second dose of the vaccine, he arrived at the emergency department (ED) with worsening shortness of breath. During this admission, he was assumed to have interstitial lung disease due to a possible past history of occupational exposure. He responded to a short-term course of corticosteroids and antibiotics and was discharged home. However, he reported again to the emergency department three weeks later, with persistent dyspnoea along with myalgia. His blood tests and imaging from scans suggested myositis, pneumonitis, and myopericarditis. Since he recently had the COVID-19 AstraZeneca vaccine, it was postulated as the most likely cause of the symptoms. He was managed with intravenous (IV) corticosteroids followed by oral corticosteroids with symptom resolution.

Background TDP‐43 is a multifunctional heterogeneous nuclear ribonucleoprotein and is the major pathological protein in motor neuron disease. Previously, TDP‐43 pathology has been described in up to 50% of those with Alzheimer’s disease. Recent evaluation of this cohort revealed a distinct pathological staging of TDP‐43 proteinopathy in an aged population, called Limbic predominant age‐related TDP‐43 encephalopathy (LATE). Hippocampal sclerosis of aging (HS‐A) is an age‐related neuropathology characterized by severe neuronal loss and gliosis, also seen as a co‐pathology in AD and LATE. HS‐A is evident in ∼80% of cases in the hippocampal region of cases that are positive for phosphorylated TDP‐43. Method We examined aged mice that selectively express human TDP‐43 and TDP‐43 with a defective nuclear localization signal (ΔNLS) in the hippocampus in an APP/PSEN1 background, six genotypes of interest were evaluated; WT, APP/PS1, Camk2a/TDP‐43, Camk2a/TDP‐43ΔNLS, Camk2a/TDP‐43/APP/PS1, and Camk2a/TDP‐43ΔNLS/APP/PS1 in 24 month old mice. A sample size of n = 3 was used for each genotype. Protein lysates as well as fixed tissues were prepared and analyzed. Result These 24‐ month‐ old mice display severe neuronal loss in the hippocampus, a decrease in beta‐amyloid plaque deposition, an increase in neuroinflammation, and reduced survival. Conclusion This aged hippocampal sclerosis‐like model may provide a greater understanding of the pathogenesis of neurodegeneration seen in TDP‐43 proteinopathies.

TDP-43 is a multifunctional heterogeneous nuclear ribonucleoprotein and is the major pathological protein in motor neuron disease. Previously, TDP-43 pathology has been described in up to 50% of those with Alzheimer's disease. Recent evaluation of this cohort revealed a distinct pathological staging of TDP-43 proteinopathy in an aged population, called Limbic predominant age-related TDP-43 encephalopathy (LATE). Hippocampal sclerosis of aging (HS-A) is an age-related neuropathology characterized by severe neuronal loss and gliosis, also seen as a co-pathology in AD and LATE. HS-A is evident in ∼80% of cases in the hippocampal region of cases that are positive for phosphorylated TDP-43. We examined aged mice that selectively express human TDP-43 and TDP-43 with a defective nuclear localization signal (ΔNLS) in the hippocampus in an APP/PSEN1 background, six genotypes of interest were evaluated; WT, APP/PS1, Camk2a/TDP-43, Camk2a/TDP-43ΔNLS, Camk2a/TDP-43/APP/PS1, and Camk2a/TDP-43ΔNLS/APP/PS1 in 24 month old mice. A sample size of n = 3 was used for each genotype. Protein lysates as well as fixed tissues were prepared and analyzed. These 24- month- old mice display severe neuronal loss in the hippocampus, a decrease in beta-amyloid plaque deposition, an increase in neuroinflammation, and reduced survival. This aged hippocampal sclerosis-like model may provide a greater understanding of the pathogenesis of neurodegeneration seen in TDP-43 proteinopathies.

Aim Our study aimed to find a correlation between low absolute lymphocyte count and COVID-19-related mortality. Methods This study followed a retrospective observational cohort design to analyze the data of patients who presented with symptoms and signs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the Conquest Hospital and Eastbourne District General Hospital in East Sussex, United Kingdom, between February 10, 2020 and May 1, 2020, retrospectively. Survival and mortality for the first 30 days and comorbidities were analyzed for all patients who were tested for COVID-19 irrespective of swab results and had blood lymphocyte levels taken at the time of their visit to the ED and their data were analyzed for statistical significance. Results A total of 1226 patients had SARS-CoV-2 RNA identification swabs taken between February 10, 2020 and May 1, 2020. A cohort of 742 patients of these patients tested for COVID-19 also had blood lymphocyte levels measured. Overall, the lymphocyte count did not differ significantly between patients suspected to have COVID-19 infection with either positive or negative COVID-19 swab results. The lymphocyte count, however, was significantly lower in those who died from COVID-19 (p < 0.001) but when comorbidities were analyzed, we found an association between an increased number of comorbidities and a significantly decreased lymphocyte count. Conclusion Once adjusted for comorbidities, the lymphocyte count had no association with COVID-19 infection and mortality.Aim Our study aimed to find a correlation between low absolute lymphocyte count and COVID-19-related mortality. Methods This study followed a retrospective observational cohort design to analyze the data of patients who presented with symptoms and signs of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the Conquest Hospital and Eastbourne District General Hospital in East Sussex, United Kingdom, between February 10, 2020 and May 1, 2020, retrospectively. Survival and mortality for the first 30 days and comorbidities were analyzed for all patients who were tested for COVID-19 irrespective of swab results and had blood lymphocyte levels taken at the time of their visit to the ED and their data were analyzed for statistical significance. Results A total of 1226 patients had SARS-CoV-2 RNA identification swabs taken between February 10, 2020 and May 1, 2020. A cohort of 742 patients of these patients tested for COVID-19 also had blood lymphocyte levels measured. Overall, the lymphocyte count did not differ significantly between patients suspected to have COVID-19 infection with either positive or negative COVID-19 swab results. The lymphocyte count, however, was significantly lower in those who died from COVID-19 (p < 0.001) but when comorbidities were analyzed, we found an association between an increased number of comorbidities and a significantly decreased lymphocyte count. Conclusion Once adjusted for comorbidities, the lymphocyte count had no association with COVID-19 infection and mortality.

The aim of this paper is to explore the mediating role of corporate image between corporate social responsibility and marketing performance in the financial sector. Data were collected from 220 Ghanaian financial houses. Questionnaire for the data collection was based on measurement scale. Statistical values were derived to test the relationship between the three variables understudy. The effect of corporate image on marketing performance was found to be positive. Corporate image was also found to positively mediate the relationship between corporate social responsibility and marketing performance. Fostering corporate social responsibility and maintaining high corporate image will have a direct positive effect on marketing performance of financial houses. The paper thus contributes to marketing performance studies by extending the predictors of firm performance to test the mediating role of corporate image.

The purpose of the study was to ascertain the effects of innovation types and environmental antecedents on performance outcomes of Metropolitan, Municipal and District Assemblies in Ashanti region, Ghana. Specifically, the study measures the mediating effects of environmental antecedents on the performance outcomes of the MMDAs. A total of 280 responses received from interested workers of the MMDAs were used for the study. As a result of the Covid-19 and its related restrictions, the questionnaire was developed using Google forms. Data were collected through social media and the responses received were screened and used for the analysis. The questionnaire was based on measurement scales for the key variables (innovation types, environmental antecedent, performance outcomes) understudy. SPSS and Sobel Test were used to estimate the mediation effect. The study results revealed that there is a significant but negative relationship between innovation types and performance outcomes at the MMDAs. Similarly, a significant and positive relationship was found between environmental antecedent and performance outcomes of the MMDs. Again, the results showed that there is a relationship between innovation types and performance outcomes of the MMDAs. Finally, the results showed that environmental antecedents mediate the relationship between innovation types and performance outcomes of the MMDAs. Based on the findings, the study recommends that managers of the MMDAs should continue to monitor and control the various environmental (public demands, political demand, regulatory frameworks, competition) forces within the public sector in order to realize the full potential of innovation and its role in facilitating performance outcome. Also, the MMDAs should embrace the innovation types (process innovation, process innovation, governance innovation, and conceptual innovation) in order to achieve higher performance outcomes (effectiveness, efficiency, citizen involvement and participation and customer satisfaction).