Spread, circulation, and evolution of the Middle East respiratory syndrome coronavirus

The Middle East respiratory syndrome coronavirus (MERS-CoV) was first documented in the Kingdom of Saudi Arabia (KSA) in 2012 and, to date, has been identified in 180 cases with 43% mortality. In this study, we have determined the MERS-CoV evolutionary rate, documented genetic variants of the virus and their distribution throughout the Arabian peninsula, and identified the genome positions under positive selection, important features for monitoring adaptation of MERS-CoV to human transmission and for identifying the source of infections. Respiratory samples from confirmed KSA MERS cases from May to September 2013 were subjected to whole-genome deep sequencing, and 32 complete or partial sequences (20 were ≥99% complete, 7 were 50 to 94% complete, and 5 were 27 to 50% complete) were obtained, bringing the total available MERS-CoV genomic sequences to 65. An evolutionary rate of 1.12 × 10−3 substitutions per site per year (95% credible interval [95% CI], 8.76 × 10−4; 1.37 × 10−3) was estimated, bringing the time to most recent common ancestor to March 2012 (95% CI, December 2011; June 2012). Only one MERS-CoV codon, spike 1020, located in a domain required for cell entry, is under strong positive selection. Four KSA MERS-CoV phylogenetic clades were found, with 3 clades apparently no longer contributing to current cases. The size of the population infected with MERS-CoV showed a gradual increase to June 2013, followed by a decline, possibly due to increased surveillance and infection control measures combined with a basic reproduction number (R0) for the virus that is less than 1

Viral shedding and antibody response in 37 patients with MERS-coronavirus infection

Background. The Middle East respiratory syndrome (MERS) coronavirus causes isolated cases and outbreaks of severe respiratory disease. Essential features of the natural history of disease are poorly understood. Methods. We studied 37 adult patients infected with MERS coronavirus for viral load in the lower and upper respiratory tracts (LRT and URT, respectively), blood, stool, and urine. Antibodies and serum neutralizing activities were determined over the course of disease. Results. One hundred ninety-nine LRT samples collected during the 3 weeks following diagnosis yielded virus RNA in 93% of tests. Average (maximum) viral loads were 5 × 106 (6 × 1010) copies/mL. Viral loads (positive detection frequencies) in 84 URT samples were 1.9 × 104 copies/mL (47.6%). Thirty-three percent of all 108 serum samples tested yielded viral RNA. Only 14.6% of stool and 2.4% of urine samples yielded viral RNA. All seroconversions occurred during the first 2 weeks after diagnosis, which corresponds to the second and third week after symptom onset. Immunoglobulin M detection provided no advantage in sensitivity over immunoglobulin G (IgG) detection. All surviving patients, but only slightly more than half of all fatal cases, produced IgG and neutralizing antibodies. The levels of IgG and neutralizing antibodies were weakly and inversely correlated with LRT viral loads. Presence of antibodies did not lead to the elimination of virus from LRT. Conclusions. The timing and intensity of respiratory viral shedding in patients with MERS closely matches that of those with severe acute respiratory syndrome. Blood viral RNA does not seem to be infectious. Extrapulmonary loci of virus replication seem possible. Neutralizing antibodies do not suffice to clear the infection

Estimating potential incidence of MERS-CoV associated with Hajj pilgrims to Saudi Arabia, 2014

Between March and June 2014 the Kingdom of Saudi Arabia (KSA) had a large outbreak of MERS-CoV, renewing fears of a major outbreak during the Hajj this October. Using KSA Ministry of Health data, the MERS-CoV Scenario and Modeling Working Group forecast incidence under three scenarios. In the expected incidence scenario, we estimate 6.2 (95% Prediction Interval [PI]: 1-17) pilgrims will develop MERS-CoV symptoms during the Hajj, and 4.0 (95% PI: 0-12) foreign pilgrims will be infected but return home before developing symptoms. In the most pessimistic scenario, 47.6 (95% PI: 32-66) cases will develop symptoms during the Hajj, and 29.0 (95% PI: 17-43) will be infected but return home asymptomatic. Large numbers of MERS-CoV cases are unlikely to occur during the 2014 Hajj even under pessimistic assumptions, but careful monitoring is still needed to detect possible mass infection events and minimize introductions into other countries

The Effect of Twitter Dissemination on Cost of Equity: Evidence from Financial and Carbon Information

Ph. D. ThesisThe recent development of communication technology through social media, more particularly Twitter, has changed the way that firms communicate with investors. This channel has created an opportunity for firms to disseminate their information to investors on a real-time basis directly. This thesis aims to investigate whether firms can influence their cost of equity (COE) by broadly disseminating their information over Twitter. Employing a sample of non-financial firms with a Twitter account, listed on the US NASDAQ stock exchange over the period 2009-2015, the thesis comprises several objectives. The first objective investigates the effect of firms’ dissemination of financial information (iDisc) over Twitter on the cost of equity. The results find evidence that firms’ dissemination of financial information over Twitter (iDisc) significantly reduces the cost of equity. These results are pronounced for less visible firms that are relatively small in size, have a low analyst following and a small number of investors. Highly visible firms are less likely to benefit from iDisc influencing their cost of equity as other communication channels may have widely disseminated their financial information. Additionally, further tests are employed to investigate the influence of news magnitude on the examined relationship. The findings of the additional tests show a significant negative association between iDisc and cost of equity. The second objective is to investigate whether firms’ dissemination of carbon-related information over Twitter, referred to as iCarbon, influences their cost of equity. The study finds that iCarbon is significantly and negatively associated with COE. Also, additional tests are applied to investigate whether Bloomberg's environmental (ENV) and environmental, social and governance (ESG) disclosure scores influence the relationship between iCarbon and cost of equity. The findings show a consistent negative association between iCarbon and cost of equity after determining the effect of ENV and ESG score. The findings of the thesis encourage managers to consider the benefits of directly disseminating financial and carbon information to stakeholders and potential investors over Twitter to reduce firm equity financing.Saudi Cultural Bureau and King Faisal Universit

Steady improvement of infection control services in six community hospitals in Makkah following annual audits during Hajj for four consecutive years

BACKGROUND: the objective of this study was to evaluate the impact of annual review of the infection control practice in all Ministry of Health hospitals in the holy city of Makkah, Saudi Arabia, during the Hajj period of four lunar Islamic years, 1423 to 1426 corresponding to 2003 to 2006. METHODS: audit of infection control service was conducted annually over a 10-day period in six community hospitals with bed capacities ranging from 140 to 557 beds. Data were collected on standardized checklists on various infection control service items during surprise visits to the medical, pediatric, surgical, and critical care units, and the kitchens. Percentage scores were calculated for audited items. The results of the audit for hospitals were confidentially sent to them within four weeks after the end of Hajj. RESULTS: deficiencies observed in the first audit included lack of infection control committees, infection control units, infection control educational activities, and surveillance system and shortage of staff. These deficiencies were resolved in the subsequent audits. The average (range) scores of hospitals in 11 infection control items increased from 43% (20–67%) in the first audit to 78% (61–93%) in the fourth audit. CONCLUSION: regular hospital infection control audits lead to significant improvement of infection control practice. There is a need to build a rigorous infection control audit into hospitals' ongoing monitoring and reporting to the Ministry of Health and to provide these hospitals with feed back on such audits to continuously strengthen the safety standards for patients, visitors, and employees

Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review

Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts

Reforming energy subsidy in Kuwait: maximizing net benefits and equity compliance

The net benefits and public acceptance for a proposed reform to the current subsidization of energy in the State of Kuwait was investigated in this study. The proposal claims to reduce the consumption of utilities (electricity and water) and gasoline. This is expected to improve the ambient air quality and reduce the cost of subsidization. The public health will result in less mortality and morbidity rates. The proposed subsidization suggests that the government pays the consumers the subsidization cost in advance and in exchange for raising the subsidized tariffs to full price. The consumption will likely be reduced by a rate equals the over consumption due to the current subsidized tariffs in relative to the income. The net benefits is expected to be maximized and shifted to a pseudo-equilibrium point where both the governments and the consumers will be better off financially. There is no loser in this scenario, all are winners. The public acceptance toward the proposed strategy was examined using 293 voluntarily one-to-one interviews and utilities meter reading program conducted on 90 houses. The interviews for gasoline and utilities indicated 57% and 66% of the respondents see no equity in the current subsidization, 55% and 80% admitted to overuse, 11% and 20% averages of the over consumptions, and 67% and 66% of the respondents were willing to adopt the new strategy. The consumer is expected to save 762 USD/year from gasoline, and 7,940 USD/year from utilities. The estimated net benefits is 2,845.3 million USD annually with 58% attributed to cost saving and 42% to health benefits. The expected avoided premature deaths from gasoline and utilities are 21 and 62 lives annually. Also, it was estimated that utilities benefits contribute to the net benefits by 68%. The annual concentration of PM2.5 is expected to drop by 2.6 µg/m3

Biomimetic Whitening Effect of Polyphosphate-Bleaching Agents on Dental Enamel.

This in vitro study investigated the extrinsic tooth-whitening effect of bleaching products containing polyphosphates on the dental enamel surface compared to 10% carbamide peroxide (CP). Eighty human molars were randomly allocated into four whitening-products groups. Group A (control) was treated with 10% CP (Opalescence). The other groups with non-CP over-the-counter (OTC) products were group B = polyphosphates (iWhiteWhitening-Kit); group C = polyphosphates+fluoride (iWhite-toothpaste); and group D = sodium bicarbonate (24K-Whitening-Pen). L*, a*, b* color-parameters were spectrophotometer-recorded at baseline (T0), one day (T1), and one month (T2) post-treatment. Changes in teeth color (ΔEab) were calculated. Data were analyzed using ANOVA and the Bonferroni test (α = 0.05). Groups A, B, and D showed significant differences in ΔL*&Δa* parameters at T1, but not in Δb* at T0. Group C showed no difference for ΔL*, Δa*, Δb* at T0 and T1. Group A showed differences for ΔL*, Δa*, Δb*, at T2, while groups B, C, and D had no difference in any parameters at T0. At T1, ΔEab values = A > D> B > C (ΔEab = 13.4 > 2.4 > 2.1 > 1.2). At T2, ΔEab values increased = A > B > C > D (ΔEab = 12.2 > 10.6 > 9.2 > 2.4). In conclusion, the 10% CP and Biomimetic polyphosphate extrinsic whitening kit demonstrated the highest color change, while simulated brushing with dark stain toothpaste and a whitening pen demonstrated the lowest color change at both measurement intervals