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Contact tracing is an important tool in managing infectious disease outbreaks and Ireland used a comprehensive contact tracing program to slow the spread of COVID-19. Although the benefits of contact tracing seem obvious, it is difficult to estimate the actual impact contact tracing has on an outbreak because it is hard to separate the effects of contact tracing from other behavioural changes or interventions. To understand the impact contact tracing had in Ireland, we used an agent-based model that is designed to simulate the spread of COVID-19 through Ireland. The model uses real contact tracing data from the first year of the COVID-19 pandemic. We found that without contact tracing, and everything else held constant, a larger number of cases, hospital admissions, ICU admissions and deaths would have occurred. The model suggests that without contact tracing deaths from COVID-19 in Ireland during the first year of the pandemic could have increased by 80% (this equates to approximately 5,768 agents in the model). This modelling study is an important step in highlighting the impact that contact tracing had on the course of the COVID-19 pandemic. Although we use a model for Ireland, this method is applicable to any country or region.

Background: The aetiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods: Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n= 439) and UKIVAS (n= 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine the relapse risk using only the RKD dataset. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse risk, phenotype and serotype. Results: Residential latitude was positively correlated (OR 1.41, 95% CI 1.14–1.74, p= 0.002) and average vitD-UVB negatively correlated (0.82, 0.70–0.99, p= 0.04) with relapse risk, with a stronger effect when restricting to winter measurements (0.71, 0.57–0.89, p= 0.002). However, these associations were not restricted to granulomatous phenotypes. We observed no clear relationship between latitude, vitD-UVB or CW-D-UVB and AAV phenotype or serotype. Conclusion: Our findings suggest that low winter ambient UVB and prolonged vitD status contribute to AAV relapse risk across all phenotypes. However, the development of a granulomatous phenotype does not appear to be directly vitD-mediated. Further research is needed to determine whether sufficient vitD status would reduce relapse propensity in AAV.

Equation-based and agent-based models are popular methods in understanding disease dynamics. Although there are many types of equation-based models, the most common is the SIR compartmental model that assumes homogeneous mixing and populations. One way to understand the effects of these assumptions is by agentization. Equation-based models can be agentized by creating a simple agent-based model that replicates the results of the equation-based model, then by adding complexity to these agentized models it is possible to break the assumptions of homogeneous mixing and populations and test how breaking these assumptions results in different outputs. We report a set of experiments comparing the outputs of an SEIR model and a set of agent-based models of varying levels of complexity, using as a case study a measles outbreak in a town in Ireland. We define and use a six level complexity hierarchy for agent-based models to create a set of progressively more complex variants of an agentized SEIR model for the spread of infectious disease. We then compare the results of the agent-based model at each level of complexity with results of the SEIR model to determine when the agentization breaks. Our analysis shows this occurs on the fourth step of complexity, when scheduled movements are added into the model. When agents networks and behaviours are complex the peak of the outbreak is shifted to the right and is lower than in the SEIR model suggesting that heterogeneous populations and mixing patterns lead to slower outbreaks compared homogeneous populations and mixing patterns.

Wiping of the mouth and nose at birth is an alternative method to oronasopharyngeal suction in delivery-room management of neonates, but whether these methods have equivalent effectiveness is unclear.

The article discusses the introduction of assessment of technology in the syllabus of General Certificate of Secondary Education (GCSE) live performance and A-Level examinations in music including composing, listening, and appraising.

The Children's Cancer Group (CCG) 1952 clinical trial for children with standard-risk acute lymphoblastic leukemia (SR-ALL) compared intrathecal (IT) methotrexate (MTX) with IT triples (ITT) (MTX, cytarabine, and hydrocortisone sodium succinate [HSS]) as presymptomatic central nervous system (CNS) treatment. Following remission induction, 1018 patients were randomized to receive IT MTX and 1009 ITT. Multivariate analysis identified male sex, hepatomegaly, CNS-2 status, and age younger than 2 or older than 6 years as significant predictors of isolated CNS (iCNS) relapse. The 6-year cumulative incidence estimates of iCNS relapse are 3.4% ± 1.0% for ITT and 5.9% ± 1.2% for IT MTX; P = .004. Significantly more relapses occurred in bone marrow (BM) and testicles with ITT than IT MTX, particularly among patients with T-cell phenotype or day 14 BM aspirate containing 5% to 25% blasts. Thus, the estimated 6-year event-free survivals (EFS) with ITT or IT MTX are equivalent at 80.7% ± 1.9% and 82.5% ± 1.8%, respectively (P = .3). Because the salvage rate after BM relapse is inferior to that after CNS relapse, the 6-year overall survival (OS) for ITT is 90.3% ± 1.5% versus 94.4% ± 1.1% for IT MTX (P = .01). It appears that ITT improves presymptomatic CNS treatment but does not improve overall outcome.

The Children's Cancer Group (CCG) 1952 clinical trial for children with standard-risk acute lymphoblastic leukemia (SR-ALL) compared intrathecal (IT) methotrexate (MTX) with IT triples (ITT) (MTX, cytarabine, and hydrocortisone sodium succinate [HSS]) as presymptomatic central nervous system (CNS) treatment. Following remission induction, 1018 patients were randomized to receive IT MTX and 1009 ITT. Multivariate analysis identified male sex, hepatomegaly, CNS-2 status, and age younger than 2 or older than 6 years as significant predictors of isolated CNS (iCNS) relapse. The 6-year cumulative incidence estimates of iCNS relapse are 3.4% ± 1.0% for ITT and 5.9% ± 1.2% for IT MTX; P= .004. Significantly more relapses occurred in bone marrow (BM) and testicles with ITT than IT MTX, particularly among patients with T-cell phenotype or day 14 BM aspirate containing 5% to 25% blasts. Thus, the estimated 6-year event-free survivals (EFS) with ITT or IT MTX are equivalent at 80.7% ± 1.9% and 82.5% ± 1.8%, respectively (P= .3). Because the salvage rate after BM relapse is inferior to that after CNS relapse, the 6-year overall survival (OS) for ITT is 90.3% ± 1.5% versus 94.4% ± 1.1% for IT MTX (P= .01). It appears that ITT improves presymptomatic CNS treatment but does not improve overall outcome.

Discusses issues on business forecasting. Need for chief executive officers to have a unified view of company performance; Factors that make forecasting difficult; Importance of an integrated approach to financial visibility. INSETS: CIOs Eye Visibility Gains;THE 90-DAY PLAN.

We present the case of an 11.5-year-old girl with M1 acute myelogenous leukemia (AML) who had isolated extramedullary relapse develop in both breasts 12 months after diagnosis and 7 months off chemotherapy. She received further chemotherapy, focal radiation therapy, then underwent a matched, unrelated bone marrow transplant and continues in remission 37 months later. Review of the literature revealed 10 cases in other children younger than 21-years-old with AML and breast involvement. These cases are summarized, and potential pathophysiologic mechanisms of spread are discussed. Breast involvement in AML is rare in children. However, regular breast examinations should be performed as part of routine follow-up in all girls with AML.

Hepatic dysfunction is a rare presentation of leukemia in children. Because most chemotherapy agents are metabolized by the liver, this complication may have major adverse consequences and effective treatment could be compromised.

The article presents distance learning model for teaching music. It discusses options for music teachers to teach instrument online using apps such as Skype, FaceTime and Google Hangouts, investment in gear that will transmit and receive quality sound, and payment arrangement for lessons. It also discusses requirements for teaching music theory and General Certificate of Secondary Education and A levels in Music.

Hemoglobin SD-Los Angeles is an uncommon sickle hemoglobinopathy. We describe a boy with dccumented Hb SD-Los Angeles who had experienced acute splenic sequestration, pnelrmococcal sepsis, aplastic crisis and functional asplenia during his first two years of life. We suggest that children with Hb SD-Los Angeles are at similar risks for the 1 if e- t hreatening complications which characterize sickle cell anemia and should receive the same comprehensive medical care currently recommended for children with Hb SS disease.

We have developed a rapid and simple method for the isolation of relatively young cells from ordinary fresh or previously frozen blood units, using the IBM-2991 Blood Cell Processor. Based on in vitro measurements of red cell pyruvate kinase activity, the resolution of the method is excellent, comparable to that of the stractan discontinuous gradient system. In splenectomized patients with thalassemia major, the administration of the “youngest” 50% of blood units yielded 51Cr survival times of 40 and 42 days for fresh packed red cells and 41 and 43 days for previously frozen red cells.

Histiocytosis X of the female genital tract is unusual. Thirty-two cases have been reported to date in the world literature. An additional case is reported herein, presenting as a vulvar ulcer in a 2.5-year-old child with osteolytic lesions of the skull, splenomegaly, and otitis media. The diagnosis of histiocytosis X may be established by identifying the Langerhans histiocyte, characterized by nuclear grooves, immunoreactivity for S-100 protein, and pentalamellar cytoplasmic structures seen by electron microscopy. Prognosis is difficult to determine with certainty. However, age of less than 2 years at presentation, multi-organ involvement, and/ or organ dysfunction appear to be associated with a less favorable prognosis. The patient presented herein is currently receiving vinblastine chemotherapy for recurrence of disease, manifested as an osteolytic lesion in the skull.

This is a longterm retrospective study of eight patients who had undergone little finger to thumb transposition after traumatic thumb loss in order to evaluate the presence of longterm changes in the transposed digit. The transposed little finger, contralateral nontransposed little finger, and contralateral thumb were compared using standardized measurements of size, comparison photographs, xrays, and volume determination using silicone mold impressions of these digits. Significant and marked hypertrophy of the transposed digit was demonstrated in all these patients. Comparison radiographs demonstrated that this enlargement was due to hypertrophy of both softtissue and osseous components. This study demonstrates that the little finger transposed to the thumb position undergoes an adaptive hypertrophy to become more thumblike in appearance as well as function.

Hb Santa Ana (β88 Leu→Pro) was found at a level of 30% of total hemoglobin in red cells from a patient with congenital hemolytic anemia. Since no detailed functional studies of this hemoglobin have been done previously, we determined oxygen equilibrium curves of red cell suspensions, hemolysates, and isolated Hb Santa Ana. The P50 values obtained were 22.5 mm Hg (37°C, pH 7.4) for red cell suspensions (normal mean = 27.0 mm Hg), 10.0 mm Hg (25°C, pH 7.0) for hemolysate (normal = 13.5 mm Hg), and 1.3 mm Hg (25°C, pH 7.0) for isolated Hb Santa Ana. Measurements of mechanical stability of Hb Santa Ana showed that the oxy-form of this hemoglobin was 10 times more unstable than that of Hb S and 100 times more unstable than that of Hb A. The deoxy-form of Hb Santa Ana was as unstable as its oxy-form, indicating that no stabilization (R→T conversion) takes place upon the deoxygenation of Hb Santa Ana.

Chronic thrombocytopenia was noted in two siblings and a first cousin. The initial impression was of immune thrombocytopenic purpura (ITP) with decreased megakaryocytes. One patient had splenectomy for presumed chronic ITP but showed no improvement. Bone marrow buffy coat slides were examined in the three children with thrombocytopenia, four normal controls, and five children with “classic” acute ITP. Megakaryocyte size, maturation, and ploidy were determined with Wright-Giemsa and Feulgen-stained material. Mean megakaryocyte diameters were 23.1 μm in the three related patients, 30.8 H-m in normal controls, and 63.1 p-m in children with “classic” acute ITP. Many “micromegakaryocytes” were noted in the three related children with chronic thrombocytopenia. An exhaustive family history was obtained, which showed multiple points of consanguinity. These patients represent an apparently new autosomal recessive disorder of megakaryocytopoiesis, characterized by disturbed megakaryocyte ploidization and maturation. More sensitive recognition of micromegakaryocytes should be attempted in children with atypical chronic thrombocytopenia, familial history of thrombocytopenia, or patients who have ITP and who have not responded to initial therapy.

The definition, clinical manifestations, and causes of anemia in childhood are age-related and reflect the dynamic processes of growth and development during this period. Although the possible causes of anemia in children are extensive, the etiology is usually unifactorial. Thus, systematic evaluation of the anemia will usually result in the diagnosis of a specific anemia, which can then be effectively treated in a gratifying number of children.

• Previous studies have indicated a high incidence of nonanemic iron deficiency in high school runners, but little is known regarding participants in other sports. The hematologic and iron status of 30 high school swimmers was assessed at the beginning and end of a competitive swim season. Iron depletion (serum ferritin level 12 μg/L) was initially present in 46.7% of the girls and none of the boys, yet among those subjects with hypoferritinemia there was no evidence of impaired red blood cell production. Serum haptoglobin levels were normal and did not correlate with serum ferritin levels. No significant change was observed in ferritin, hemoglobin, or haptoglobin concentrations during the course of the season. Dietary intake of iron was poor, particularly in the girls, in whom it averaged 43% of the recommended dietary allowance. Menstrual histories suggested an inverse relationship between the amount of menstrual flow and the serum ferritin level. These findings indicate a high prevalence of nonanemic iron deficiency in female high school swimmers that bears no relationship to swim training. Dietary inadequacies and menstrual blood flow appear to be important contributors to the hypoferritinemia observed in these athletes.(AJDC 1989;143:197-200)

The importance of personality characteristics in the processing of displays is examined. Forty-six people, screened for specific information processing and decision making preferences using the MBTI, learned to classify instances of system data into one of four state categories. System data were presented in one of three types of display formats: a polygon; a bargraph; and a digital display. The experiment involved two sessions: a training session where each person learned the classification task; and an extended practice session with no feedback. The ability of people to accurately classify instances was found to be influenced by both the type of display and their personality type. The importance of individual differences in display research is discussed, with emphasis placed on the implications for training, and selection of display formats.

• Iron-deficiency anemia impairs exercise capacity, but whether nonanemic iron depletion decreases endurance performance is unclear. In 14 iron-deficient (serum ferritin level, <20 μg/L [<20 ng/mL]) nonanemic runners, hematologic and treadmill running values were followed up during a competitive season. Following a four-week control period, runners were treated for one month in a double-blind protocol with ferrous sulfate (975 mg/d) or placebo. During treatment, the mean ferritin level rose from 8.7 to 26.6 μg/L (8.7 to 26.6 ng/mL) in those patients taking iron and fell from 10.6 to 8.6 μg/L (10.7 to 8.6 ng/mL) in the placebo group. Treadmill endurance times improved significantly in the iron-treated runners compared with controls. Endurance time declined in all seven controls (range, 0.07 to 1.30 minutes), while six of seven iron-treated subjects improved their performance (range, 0.03 to 1.92 minutes). No significant differences in maximal or submaximal oxygen consumption, ventilation, or heart rate were observed between the groups except for a 4% increase in maximum oxygen consumption during placebo treatment. These data indicate that nonanemic iron deficiency impairs exercise performance but does not influence gas exchange or cardiac measures.(AJDC 1988;142:165-169)

We have presented our thoughts regarding the use of abdominal pedicle flaps to the hand as they have evolved and changed over the past 20 years.

This section offers advice on chemicals and spotting. Do not leave wet spotting brushes face up. Keep them face down on the board when they are not in use, so the water drains out of the bristles. If brushes are left bristle-side-up, water will seep into the wood, making it swell until the wood begins to split and the bristles fall out. Meanwhile, if you are struggling with the last traces of a food or beverage stain on a silk garment and want to use a bleach, remember that sodium perborate is alkaline and can yellow white silk and wool. Try using hydrogen peroxide instead. Do not forget to test for colorfastness before using any type of bleach. Furthermore, if you need to work in small areas or around intricate trimming, use the end of a Q-tip or cotton swab to apply the chemical agent.

An infant who experienced disseminated relapse of medulloblastoma while receiving chemotherapy is described. He was subsequently treated with radiation therapy. Seven and one-half years from diagnosis, he is currently disease-free and enjoys a relatively normal life. We emphasize the importance of considering radiation as one of the treatment modalities for young children with relapsed medulloblastoma.

Although delayed menarche and alterations in reproductive hormones are well documented in competitive female runners, little is known regarding the effects of endurance training in male athletes. Serum levels of total and free testosterone were determined in 15 adolescent male cross-country runners during the course of a competitive season. Thirteen demonstrated postpubertal Values at the onset of the season. No significant changes were observed in either total or free testosterone levels during the eight-week period of training and racing. The data indicate that running training does not disturb normal function of the hypothalamic-pituitary-gonadal axis in high school male athletes.The growing participation of children and adolescents in competitive sports has been viewed by the medical profession with a mixture of supportive enthusiasm and cautious concern.1 While regular exercise may be promoted for a variety of health benefits, the risks to the immature, developing athlete involved in highly intense training

• An infectious agent has long been suspected as the cause of aplastic crisis in sickle cell disease, but no specific organism has been implicated. We studied six children with sickle cell disease in whom an aplastic crisis developed, looking for evidence of parvoviruslike virus (SPLV) infection using a new radioimmunoassay. All six patients had conclusive evidence of acute infection with SPLV. We postulated that SPLV is the predominant cause of aplastic crises in patients with hemolytic anemia.(AJDC 1984;138:401-403)

• Two children with acute lymphoblastic leukemia in complete and partial remission, respectively, had severe respiratory disease that subsequently proved to be massive pulmonary infiltrates of leukemic cells. Diffuse pneumonitis may be a symptom of leukemic relapse. The diagnosis of pulmonary leukemia should be considered in all episodes of pneumonitis in children with leukemia.(Am J Dis Child 1981;135:716-718)

This article features three music teachers, namely Jane Werry, director of music at Hayes School, Rachel Barnes, head of music at the Hackney New School, and Emma Goddard, head of music at Coopers School, and their efforts in ensuring that their pupils' education remains positive.

The article offers information on the Soundtrap browser-based super sequencer from Soundtrap.

The article offers the author's insights on the non-inclusion of the music education performance measure for Key Stage 4 (KS4) under the General Certificate of Secondary Education (GCSE) draft specifications in Great Britain. Topics include choosing between GCSE and vocational qualification, the Music Practitioner qualification improvement made by music publisher Rockschool, and music performance measure certification offered by educational charity Northern Council for Further Education (NCFE).

The article offers information on several online teaching resources for music in Great Britain. Topics discussed include A Day in the Snow resource for Christmas including carols, Making the Most from Christmas Carols which provides suggestions and ideas for singing carols and Christmas songs, and a music resource for Key Stage 5 music students.