We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Patients presenting to hospital with suspected coronavirus disease 2019 (COVID-19), based on clinical symptoms, are routinely placed in a cohort together until polymerase chain reaction (PCR) test results are available. This procedure leads to delays in transfers to definitive areas and high nosocomial transmission rates. FebriDx is a finger-prick point-of-care test (PoCT) that detects an antiviral host response and has a high negative predictive value for COVID-19. We sought to determine the clinical impact of using FebriDx for COVID-19 triage in the emergency department (ED).
Design:
We undertook a retrospective observational study evaluating the real-world clinical impact of FebriDx as part of an ED COVID-19 triage algorithm.
Setting:
Emergency department of a university teaching hospital.
Patients:
Patients presenting with symptoms suggestive of COVID-19, placed in a cohort in a ‘high-risk’ area, were tested using FebriDx. Patients without a detectable antiviral host response were then moved to a lower-risk area.
Results:
Between September 22, 2020, and January 7, 2021, 1,321 patients were tested using FebriDx, and 1,104 (84%) did not have a detectable antiviral host response. Among 1,104 patients, 865 (78%) were moved to a lower-risk area within the ED. The median times spent in a high-risk area were 52 minutes (interquartile range [IQR], 34–92) for FebriDx-negative patients and 203 minutes (IQR, 142–255) for FebriDx-positive patients (difference of −134 minutes; 95% CI, −144 to −122; P < .0001). The negative predictive value of FebriDx for the identification of COVID-19 was 96% (661 of 690; 95% CI, 94%–97%).
Conclusions:
FebriDx improved the triage of patients with suspected COVID-19 and reduced the time that severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR-negative patients spent in a high-risk area alongside SARS-CoV-2–positive patients.
Registry-based trials have emerged as a potentially cost-saving study methodology. Early estimates of cost savings, however, conflated the benefits associated with registry utilisation and those associated with other aspects of pragmatic trial designs, which might not all be as broadly applicable. In this study, we sought to build a practical tool that investigators could use across disciplines to estimate the ranges of potential cost differences associated with implementing registry-based trials versus standard clinical trials.
Methods:
We built simulation Markov models to compare unique costs associated with data acquisition, cleaning, and linkage under a registry-based trial design versus a standard clinical trial. We conducted one-way, two-way, and probabilistic sensitivity analyses, varying study characteristics over broad ranges, to determine thresholds at which investigators might optimally select each trial design.
Results:
Registry-based trials were more cost effective than standard clinical trials 98.6% of the time. Data-related cost savings ranged from $4300 to $600,000 with variation in study characteristics. Cost differences were most reactive to the number of patients in a study, the number of data elements per patient available in a registry, and the speed with which research coordinators could manually abstract data. Registry incorporation resulted in cost savings when as few as 3768 independent data elements were available and when manual data abstraction took as little as 3.4 seconds per data field.
Conclusions:
Registries offer important resources for investigators. When available, their broad incorporation may help the scientific community reduce the costs of clinical investigation. We offer here a practical tool for investigators to assess potential costs savings.
§77. Chinese enters history as the language written onto cattle or sheep scapulae and turtle plastrons by the diviners of an archaeological culture centred at 小屯 Xiǎotún (c.1200–1050 bce). The decipherment of these oracle bone inscriptions permits the identification of this culture with the 商 Shāng dynasty of traditional Chinese historiography (K. Chang 1980). Bone inscriptions record questions concerning weather, crops, warfare, and the regulation of the Shāng’s complex ritual life. Although they serve historians as invaluable sources (Keightley 1978), these short formulaic texts are difficult to profitably use in historical linguistics. Linguistic research on the language of the oracle bone inscriptions focuses primarily on syntax (Takashima 2000).
§1. Tibetan originated as the language spoken in the Yarlung valley, the cradle of the Tibetan empire (Takeuchi 2012a: 4). Together with the troops of this empire the Old Tibetan language colonized the entire Tibetan plateau, extinguishing almost all of the languages formerly spoken across that territory (Takeuchi 2012a: 6). Evidence is available for three such languages. Most famous is Źaṅ-źuṅ, the language of a pre-existing polity in West Tibet and the sacred tongue of the Bon faith. Źaṅ-źuṅ is preserved in one bilingual cosmological text, the Mdzod phug, and a number of short passages in Bon texts (cf. Martin 2010). The closest living relative of Źaṅ-źuṅ is the Darma language of Uttarakhand state in India (Martin 2010: 17–21, 2013). Aside from Źaṅ-źuṅ, samples of two Trans-Himalayan languages are preserved among the collection of documents found at Dunhuang. F. W. Thomas, who first published the manuscripts containing these two languages, confusingly dubs them ‘Źaṅ-źuṅ’ (Thomas 2011) and ‘Nam’ (Thomas 1948); there is no evidence to accept these identifications (Martin 2010: 10, 2013).
§44. Prior to the appearance of Burmese the Pyu and Mon languages had already been spoken and written in what is now Burma for several centuries (Krech 2012: 120–3, Bauer 1990). Burmese emerged as the language spoken by the Burman population in Pagan at the time of the Pagan dynasty (1113–1287 ce). The Burmese-speaking population entered Burma from the north; this is clear from the distribution of the Burmish languages, namely that they are all in the north, and further the Burmese word toṅ ‘mountain’ means also ‘south’, which suggests that at one point the Burmans lived to the north of the mountains. The oldest document in Burmese is the Myazedi inscription of 1113 ce (cf. Nishida 1955, Yabu 2006). Essentially all documents in Old Burmese are stone inscriptions recording land grants to Bu ddhist establishments (cf. Frasch 1996: 1–16).
§205. The preceding chapters trace the attested forms of Tibetan, Burmese, and Chinese backwards in time to the greatest extent that currently appears possible. This final chapter compares the results of these three exercises. If all developments in the three languages followed exceptionless phonological patterns with no interference from analogy and lost morphology a few scant remarks would suffice to point out that the backward projection of each of the three languages leads to the self-same result. The true situation is far less elegant. The Trans-Himalayan family is an ancient and ramified one; the three languages studied here offer only fragmentary glimpses of the proto-language.
The goal of this work is to present the sound laws relating Tibetan, Burmese, and Chinese, and to reconstruct the linguistic unity from which these three languages descend, so far as current knowledge permits. Tracing the development of etyma from their primitive origins into the living tongues of today would bring the narrative satisfaction of accompanying a hero through his struggles, but it is dishonest to present historical phonology as the trials of reconstructed forms progressing through sound changes towards an ultimate destiny in history. The end of this journey, the attested corpus of related languages, is fixed, but the original linguistic unity is the protean and mercurial product of research. Rather than presenting reconstructions picked out of the air and discussing their development, I present sound changes in reverse chronological order. I subsequently reiterate these sound changes in chronological order, so that, after seeing how the reconstructions are arrived at, one can see how it is that the reconstructed forms become the attested forms.