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Many reverse transcription polymerase chain reaction (RT-PCR) methods exist that can detect SARS-CoV-2 RNA in different matrices. RT-PCR is highly sensitive, although viral RNA may be detected long after active infection has taken place. SARS-CoV-2 proteins have shorter detection windows hence their detection might be more meaningful. Given salivary droplets represent a main source of transmission, we explored the detection of viral RNA and protein using four different detection platforms including SISCAPA peptide immunoaffinity liquid chromatography-mass spectrometry (SISCAPA-LC-MS) using polyclonal capture antibodies. The SISCAPA-LC MS method was compared to RT-PCR, RT-loop-mediated isothermal amplification (RT-LAMP), and a lateral flow rapid antigen test (RAT) for the detection of virus material in the drool saliva of 102 patients hospitalised after infection with SARS-CoV-2. Cycle thresholds (Ct) of RT-PCR (E gene) were compared to RT-LAMP time-to-positive (TTP) (NE and Orf1a genes), RAT optical densitometry measurements (test line/control line ratio) and to SISCAPA-LC-MS for measurements of viral protein. SISCAPA-LC-MS showed low sensitivity (37.7 %) but high specificity (89.8 %). RAT showed lower sensitivity (24.5 %) and high specificity (100 %). RT-LAMP had high sensitivity (83.0 %) and specificity (100.0 %). At high initial viral RNA loads (<20 Ct), results obtained using SISCAPA-LC-MS correlated with RT-PCR (R2 0.57, p-value 0.002). Detection of SARS-CoV-2 nucleoprotein in saliva was less frequent than the detection of viral RNA. The SISCAPA-LC-MS method allowed processing of multiple samples in <150 min and was scalable, enabling high throughput. [ABSTRACT FROM AUTHOR]

During 2020, the UK's Department of Health and Social Care (DHSC) established the Moonshot programme to fund various diagnostic approaches for the detection of SARS-CoV-2, the pathogen behind the COVID-19 pandemic. Mass spectrometry was one of the technologies proposed to increase testing capacity. Moonshot funded a multi-phase development programme, bringing together experts from academia, industry and the NHS to develop a state-of-the-art targeted protein assay utilising enrichment and liquid chromatography tandem mass spectrometry (LC-MS/MS) to capture and detect low levels of tryptic peptides derived from SARS-CoV-2 virus. The assay relies on detection of target peptides, ADETQALPQRK (ADE) and AYNVTQAFGR (AYN), derived from the nucleocapsid protein of SARS-CoV-2, measurement of which allowed the specific, sensitive, and robust detection of the virus from nasopharyngeal (NP) swabs. The diagnostic sensitivity and specificity of LC-MS/MS was compared with reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) via a prospective study. Analysis of NP swabs (n=361) with a median RT-qPCR quantification cycle (Cq) of 27 (range 16.7–39.1) demonstrated diagnostic sensitivity of 92.4% (87.4–95.5), specificity of 97.4% (94.0–98.9) and near total concordance with RT-qPCR (Cohen's Kappa 0.90). Excluding Cq>32 samples, sensitivity was 97.9% (94.1–99.3), specificity 97.4% (94.0–98.9) and Cohen's Kappa 0.95. This unique collaboration between academia, industry and the NHS enabled development, translation, and validation of a SARS-CoV-2 method in NP swabs to be achieved in 5 months. This pilot provides a model and pipeline for future accelerated development and implementation of LC-MS/MS protein/peptide assays into the routine clinical laboratory. [ABSTRACT FROM AUTHOR]

Cardiometabolic diseases are among the most prevalent and harmful conditions worldwide. They are complex, comorbid conditions that require polypharmacy - a known contributor to non-adherence in cardiovascular disease (CVD) and diabetes mellitus (DM). Suboptimal adherence is associated with poor disease control, which increases the risk of hospitalizations, mortality, and preventable financial implications. However, until recently, the lack of a gold standard for non-adherence testing in cardiometabolic diseases has been the major barrier for understanding true prevalence and mortality consequences. Recent European guidelines have endorsed biochemical testing as the preferred measure for non-adherence in CVD, with urinary screening methods being the most clinically widespread. The diagnostic and therapeutic benefits incurred to health service resources by use of biochemical non-adherence testing are vast, as hospitalizations and associated economic burdens are reduced, and tailored therapies are increased. However, biochemical testing can only signify a snap shot of adherence behavior, and true adherence may be skewed by pharmacokinetic factors. This review summarizes current literature regarding the prevalence, impact, and reasons of non-adherence in cardiometabolic disease. The benefits of current adherence diagnostic tools have been appraised, where urine in biochemical testing has been focused upon and evaluated against other matrices. [ABSTRACT FROM AUTHOR]

Previous research has offered conflicting findings regarding the influence of help appeals that feature an individual victim compared to a group of victims. Studies examining emotional responses and donation behavior have generally found that help appeals focusing on a single victim elicit more prosocial responses, while studies examining policy support have found the opposite. The present studies investigate these effects while addressing potential confounds that may have arisen in previous research. Study 1 (N = 924) compares the effects of help appeals that focus on either a) an identified individual, b) an identified group, c) statistics describing many individuals, or d) statistics paired with an individual. Study 1 also examines how the location of the individual(s) in need moderates observed effects. Study 2 (N = 1,085) compares the effects of help appeals that describe either an identified individual or statistics about many individuals, while fully crossing the text manipulation with either a) no imagery, b) an image of an individual, or c) a map indicating areas of poverty. In both Study 1 and Study 2 no significant differences were found between the individual and the group conditions. [ABSTRACT FROM AUTHOR]

Background: We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care.Methods: We searched Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Data were extracted on the article type, study details for research articles, patient population, phase of care during discharge, and dimensions of health-care quality.Results: From 8,154 unique publications we included 224 articles. Of these, 131 articles (58%) were original research, predominantly case series (23%) and cohort (16%) studies; 12% were narrative reviews; and 11% were guidelines/policies. Common themes included patient and family needs/experiences (29% of articles) and the importance of complete and accurate information (26%). Facilitators of high-quality care included provider-patient communication (30%), provider-provider communication (25%), and the use of guidelines/policies (29%). Patient and family anxiety (21%) and limited availability of ICU and ward resources (26%) were reported barriers to high-quality care. A total of 47 tools to facilitate patient discharge from the ICU were identified and focused on patient evaluation for discharge (29%), discharge planning and teaching (47%), and optimized discharge summaries (23%).Conclusions: Common themes, facilitators and barriers related to patient and family needs/experiences, communication, and the use of guidelines/policies to standardize patient discharge from ICU transcend the literature. Candidate tools to improve care are available; comparative evaluation is needed prior to broad implementation and could be tested through local quality-improvement programs. [ABSTRACT FROM AUTHOR]

The article reports on a scoping review of literature concerning patient discharge from intensive care units (ICU). Topics discussed include the factors that influence the quality of care provided during ICU discharge, the tools that help facilitate ICU discharge and the steps involved in the process of patient discharge from ICU, including the evaluation of the patient's readiness, the planning and execution of discharge and the post-discharge follow-up.

Aims: Liquid chromatography‐mass spectrometry (LC‐MS/MS) is an objective new technique to assess non‐adherence to medications. We used this method to study the prevalence, predictors and outcomes of non‐adherence in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Methods and results: This study included 1296 patients with HFrEF from BIOSTAT‐CHF, a study that aimed to optimise guideline‐recommended therapies. Angiotensin‐converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, β‐blockers and loop diuretics were measured in a single spot urine sample at 9 months using LC‐MS/MS. The relationship between medication non‐adherence and the composite endpoint of all‐cause death or heart failure hospitalisation, over a median follow‐up of 21 months, was evaluated. Non‐adherence to at least one prescribed medication was observed in 45.9% of patients. The strongest predictor of non‐adherence was non‐adherence to any of the other medication classes (P < 0.0005). Regional differences within Europe were observed. On multivariable analyses, non‐adherence to ACEi/ARBs and β‐blockers was associated with an increased risk of the composite endpoint [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.09–1.95, P = 0.008 and HR 1.48, 95% CI 1.12–1.96, P = 0.006, respectively). Non‐adherence to β‐blockers was also associated with an increased risk of death (HR 2.48, 95% CI 1.67–3.68, P < 0.0005). Patients who were non‐adherent to loop diuretics were healthier and had a decreased risk of the composite endpoint (HR 0.69, 95% CI 0.51–0.93, P = 0.014). Non‐adherence to mineralocorticoid receptor antagonists was not related to any clinical outcome. Conclusion: Non‐adherence to medications, assessed by a single urine test, is common and predicts clinical outcomes in patients with HFrEF. [ABSTRACT FROM AUTHOR]

Objective: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a new method to objectively and robustly detect nonadherence. We applied this technique to study nonadherence to cardiovascular medications in people with type 2 diabetes (T2DM).Research Design and Methods: Routine urine samples, received at the time of the annual diabetes review from 228 people with T2DM in primary care, were assessed for adherence by LC-MS/MS.Results: A total of 28.1% patients (N = 64) were nonadherent to antidiabetic, antihypertensive, and/or lipid-lowering medications. Nonadherence to statins was the highest at 23.7%, and nonadherence to oral hypoglycemic agents was 9.3%. HbA1c, albumin-to-creatinine ratio, and lipid profiles were significantly higher in the patients who were nonadherent compared with those who were adherent to treatment.Conclusions: This unique study shows that routine urine samples can be used for adherence testing screening by LC-MS/MS and has demonstrated high nonadherence rates especially to statins in people with T2DM. Future intervention studies using LC-MS/MS as a diagnostic/therapeutic tool may help to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

An interdisciplinary team of academics and representatives of fishing fleets and government collaborated to study the emerging requirements for sustainability in Canada's fisheries. Fisheries assessment and management has focused on biological productivity with insufficient consideration of social (including cultural), economic, and institutional (governance) aspects. Further, there has been little discussion or formal evaluation of the effectiveness of fisheries management. The team of over 50 people (i) identified a comprehensive set of management objectives for a sustainable fishery system based on Canadian policy statements, (ii) combined objectives into an operational framework with relevant performance indicators for use in management planning, and (iii) undertook case studies that investigated some social, economic, and governance aspects in greater detail. The resulting framework extends the suite of widely accepted ecological aspects (productivity and trophic structure, biodiversity, and habitat–ecosystem integrity) to include comparable economic (viability and prosperity, sustainable livelihoods, distribution of access and benefits, regional–community benefits), social (health and well-being, sustainable communities, ethical fisheries), and institutional (legal obligations, good governance structure, effective decision-making) aspects of sustainability. This work provides a practical framework for implementation of a comprehensive approach to sustainability in Canadian fisheries. The project also demonstrates the value of co-construction of collaborative research and co-production of knowledge that combines and builds on the strengths of academics, industry, and government. [ABSTRACT FROM AUTHOR]

Abstract: Fisheries sustainability is recognized to have four pillars: ecological, economic, social (including cultural) and institutional (or governance). Although international agreements, and legislation in many jurisdictions, call for implementation of all four pillars of sustainability, the social, economic and institutional aspects (i.e., the “human dimensions”) have not been comprehensively and collectively addressed to date. This study describes a framework for comprehensive fisheries evaluation developed by the Canadian Fisheries Research Network (CFRN) that articulates the full spectrum of ecological, economic, social and institutional objectives required under international agreements, together with candidate performance indicators for sustainable fisheries. The CFRN framework is aimed at practical fisheries evaluation and management and has a relatively balanced distribution of elements across the four pillars of sustainability relative to 10 alternative management decision support tools and indicator scorecards, which are heavily focused on ecological and economic aspects. The CFRN framework has five immediate uses: (a) It can serve as a logic frame for defining management objectives; (b) it can be used to define alternate management options to achieve given objectives; (c) it can serve as a tool for comparing management scenarios/options in decision support frameworks; (d) it can be employed to create a report card for comprehensive fisheries management evaluation; and (e) it is a tool for practical implementation of an integrated social–ecological system approach. [ABSTRACT FROM AUTHOR]