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There is a lack of data on the safety of providing oxygen at home to stable patients recovering from COVID-19. A retrospective analysis of patients discharged to a COVID-19 virtual ward (CVW) between January 2021 and March 2021 at a UK district general hospital was performed. Patients with improving clinical trajectories and oxygen requirements up to 4 L/minute were eligible. Outcomes measured were 30-day mortality and readmission rate. From 02 January 2021 to 16 March 2021 (74 days), 147 patients discharged to the CVW were included: 71 received continuous or ambulatory oxygen, and 76 received pulse oximetry monitoring only. Five patients were readmitted within 30 days and two patients died. There were no significant differences between readmission and mortality rates between those discharged with or without oxygen. Provision of oxygen at home for selected patients recovering from COVID-19 is safe with low risk of readmission and death.

Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O 2peak in COPD. The included 59 studies involving 2191 participants demonstrated that V̇O 2peak increased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms=86) and the addition of non-invasive ventilation (SMD 0.55 95% CI 0.04;1.06, intervention arms=4) appeared to offer additional benefit but there was limited evidence for effectiveness of other exercise and non-exercise components.

Pulmonary rehabilitation programmes including aerobic training improve cardiorespiratory fitness in patients with COPD, but the optimal programme design is unclear. We used random effects additive component network meta-analysis to investigate the relative effectiveness of different programme components on fitness measured by V̇O2peak in COPD. The included 59 studies involving 2191 participants demonstrated that V̇O2peak increased after aerobic training of at least moderate intensity with the greatest improvement seen following high intensity training. Lower limb aerobic training (SMD 0.56 95% CI 0.32;0.81, intervention arms=86) and the addition of non-invasive ventilation (SMD 0.55 95% CI 0.04;1.06, intervention arms=4) appeared to offer additional benefit but there was limited evidence for effectiveness of other exercise and non-exercise components.

Stephen Rich and colleagues report the discovery and fine mapping of type 1 diabetes susceptibility loci using the Immunochip. They also perform comparative analyses with 15 other immune disorders and find evidence of colocalization of causal variants with lymphoid gene enhancers. Genetic studies of type 1 diabetes (T1D) have identified 50 susceptibility regions 1 , 2 , finding major pathways contributing to risk 3 , with some loci shared across immune disorders 4 , 5 , 6 . To make genetic comparisons across autoimmune disorders as informative as possible, a dense genotyping array, the Immunochip, was developed, from which we identified four new T1D-associated regions ( P < 5 × 10 −8 ). A comparative analysis with 15 immune diseases showed that T1D is more similar genetically to other autoantibody-positive diseases, significantly most similar to juvenile idiopathic arthritis and significantly least similar to ulcerative colitis, and provided support for three additional new T1D risk loci. Using a Bayesian approach, we defined credible sets for the T1D-associated SNPs. The associated SNPs localized to enhancer sequences active in thymus, T and B cells, and CD34 + stem cells. Enhancer-promoter interactions can now be analyzed in these cell types to identify which particular genes and regulatory sequences are causal.

Alternative models of genetic counseling are needed to meet the rising demand for genomic sequencing. Digital tools have been proposed as a method to augment traditional counseling and reduce burden on professionals; however, their role in delivery of genetic counseling is not established. This study explored the role of the Genomics ADvISER, a digital decision aid, in delivery of genomic counseling. We performed secondary analysis of 52 pretest genetic counseling sessions that were conducted over the course of a randomized controlled trial evaluating the effectiveness of the Genomics ADvISER. As part of the trial, participants were randomized to receive standard counseling or use the tool and then speak with a counselor. A qualitative interpretive description approach using thematic analysis and constant comparison was used for analysis. In the delivery of genomic counseling, the Genomics ADvISER contributed to enhancing counseling by (1) promoting informed dialogue, (2) facilitating preference-sensitive deliberation, and (3) deepening personalization of decisions, all of which represent fundamental principles of patient-centered care: providing clear high-quality information, respecting patients’ values, preferences, and expressed needs, and providing emotional support. This study demonstrates that our digital tool contributed to enhancing patient-centered care in the delivery of genomic counseling.

Algorithms such as Kleinberg's HITS algorithm, the PageRank algorithm of Brin and Page, and the SALSA algorithm of Lempel and Moran use the link structure of a network of web pages to assign weights to each page in the network. The weights can then be used to rank the pages as authoritative sources. These algorithms share a common underpinning; they find a dominant eigenvector of a nonnegative matrix that describes the link structure of the given network and use the entries of this eigenvector as the page weights. We use this commonality to give a unified treatment, proving the existence of the required eigenvector for the PageRank, HITS, and SALSA algorithms, the uniqueness of the PageRank eigenvector, and the convergence of the algorithms to these eigenvectors. However, we show that the HITS and SALSA eigenvectors need not be unique. We examine how the initialization of the algorithms affects the final weightings produced. We give examples of networks that lead the HITS and SALSA algorithms to returnnonunique or nonintuitive rankings. We characterize all such networks in terms of the connectivity of the related HITS authority graph. We propose a modification, Exponentiated Input to HITS, to the adjacency matrix input to the HITS algorithm. We prove that Exponentiated Input to HITS returns a unique ranking, provided that the network is weakly connected. Our examples also show that SALSA can give inconsistent hub and authority weights, due to nonuniqueness. We also mention a small modification to the SALSA initialization which makes the hub and authority weights consistent.

BackgroundThe goal of treatment of a valgus deformity of the knee that is secondary to osteoarthritis of the lateral compartment is to obtain axial correction of the malalignment of the extremity. Osteosynthesis of the osteotomized femur with use of internal fixation and a stiff implant has not been as successful as expected. We evaluated the accuracy and maintenance of correction and the stability of fixation with a malleable plate after a supracondylar osteotomy of the distal aspect of the femur that was performed to correct a valgus deformity of the knee.MethodsWe performed an incomplete oblique osteotomy of the distal aspect of the femur in nineteen patients (twenty-one knees) and stabilized the osteotomy site with a malleable semitubular plate, which was bent to form an angled plate, and lag-screws. Postoperatively, the patients were immediately encouraged to walk, with partial weight-bearing on the affected extremity. The mean age of the patients was fifty-seven years (range, thirty-nine to seventy-one years), and the mean duration of follow-up was five years (range, two to twelve years).ResultsIn seventeen knees, the osteosynthesis withstood the mechanical loading that occurred during the postoperative functional rehabilitation program. Prolonged use of crutches or immobilization, or both, was necessary after the operation in three knees. The osteosynthesis failed in one knee. The loss of correction in eighteen knees, after bone-healing, averaged 1.7 degrees (range, 0 to 4 degrees).ConclusionsOur method of achieving osteosynthesis is based on the concept that inherent endogenous stability mechanisms can be mobilized by circumferentially compressing the two cortical tubes with the cut ends congruently apposed to each other. We believe that our technique provides an alternative to osteosynthesis with use of a stiff implant such as a fixed-angle blade-plate device.

We report two children who presented with symptoms suggestive of biotinidase deficiency. Rather than deficiency, markedly elevated serum biotinidase activities were found. Based upon literature reports of elevated biotinidase activities in children with glycogen storage disease (GSD) type Ia, we considered the latter in our differential diagnosis and subsequently confirmed GSD type Ia in both patients by enzymatic testing. GSD type Ia should be considered in children with markedly elevated serum biotinidase activity.

This study used both exploratory (EFA) and confirmatory factor analyses (CFA) to examine the factor structure of the WISC-III among White and Black students from the WISC-III standardization sample and a sample of 348 Black students referred for psychological evaluation. Results of the EFA provided evidence of a large first principal factor as well as the expected Verbal and Performance components across all three groups. Empirical support for the Freedom from Distractibility dimension was provided only from the confirmatory factor analyses. Although the four factor confirmatory model exhibited the best overall statistical fit, inspection of specific factor loadings revealed anomalies with the third and fourth factors, especially for the Referred Black sample. Implications for school psychologists are presented and recommendations for future research are provided.

Sequence analysis of cDNA from an asymptomatic patient belonging to a high-risk breast cancer family carrying the genetic variant BRCA1 IVS10-2A → C revealed that functional BRCA1 mRNA was derived from only one of the patient's chromosomes. The other chromosome produced an aberrant RNA splicing transcript that deleted exon 11. Analysis of the patient's genomic DNA demonstrated that the chromosome producing the non-functional mRNA carried the genotype BRCA1 IVS10-2A → C. This transversion disrupts a highly conserved base in the consensus splice acceptor motif. These results support the conclusion that BRCA1 IVS10-2A → C is a mutation that confers predisposition to breast and ovarian cancer.