bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep, screen time, and family meal frequency in preschool children
Authors: Hayes Katey , Williams Susan G. , Fruh Sharon , Graves Rebecca J. , Minchew Leigh A. , Hall Heather R.
Published: July 2020

This exploratory pilot study identified the prevalence and perceptions of three healthy habits in preschool-age children by surveying their parents/caregivers. Researchers examined children's hours of sleep, screen time, and number of family meals per week.
How to determine the type of femoral osteotomy in the management of developmental dysplasia of the hip: a prospective case series
Authors: Aly Ahmad Saeed
Published: July 2020

Background:

Developmental dysplasia of the hip (DDH) is a disease that presents with multiple abnormalities, varying from mild dysplasia to frank dislocation. Management of DDH is determined by the patient’s age, and the best results are gained if treatment is initiated at an early age.

Methods:

This prospective case series study included 40 hips (37 patients) with primary DDH, that had open reduction and capsulorrhaphy. According to the measured caput-collum-diaphyseal (CCD) angle, the patients were classified into two groups. Group 1 was assigned femoral derotation osteotomy (FDO) and included 20 hips (19 patients) with normal CCD angle ≤140 degrees. Group 2 was assigned femoral varus derotation osteotomy (VDO) and included 20 hips (18 patients) with coxa valga and increased CCD angle >140 degrees. All patients were followed a minimum of 2 yr with a mean of 3.96±1.45 yr (range 2 to 7 yr).

Results:

The mean postoperative Sharp’s acetabular index was 17.65±3.69 degrees in group 1 as compared to 20.85±6.64 degrees in group 2. There was a significant difference between both groups in limb-length discrepancy, persistent Trendelenburg sign, and residual coxa vara.

Conclusions:

Femoral shortening should be performed in cases where tight reduction is achieved to avoid pressure on the femoral head and development of avascular necrosis (AVN). Femoral derotational osteotomy was usually required with femoral shortening because most of the cases had excessive femoral neck anteversion. Evaluation of the CCD angle was done preoperatively and intraoperatively to determine the need for adding varus. If the CCD angle was less than 140 degrees, additional varization was deemed unnecessary.

Level of Evidence:

Level III
Considerations in the use of slit lamp shields to reduce the risk of respiratory virus transmission in coronavirus disease 2019
Authors: Ong Sze C. , Yap Jun X. , Tay Terrence Y.F. , Mo Yin , Loon Seng C. , Koh Victor
Published: July 2020

Purpose of review

The use of slit lamp shields has been recommended by the American Academy of Ophthalmology as an infection control measure during the coronavirus disease 2019 pandemic. However, there is limited evidence regarding its efficacy to reduce viral transmission risks. We aim to provide an evidence-based approach to optimize the use of slit lamp shields during clinical examination.

Recent findings

Respiratory droplets from coughing and sneezing can travel up to 50 m/s and over a distance of 2 m, with a potential area of spread of 616 cm2. Slit lamp shields confer added protection against large droplets but are limited against smaller particles. A larger shield curved toward the ophthalmologist and positioned closer to the patient increases protection against large droplets. A potential improvement to the design of such shields is the use of hydrophilic materials with antiviral properties which may help to minimize splashing of infectious droplets, reducing transmission risks. These include gold or silver nanoparticles and graphene oxide.

Slit lamp shields serve as a barrier for large droplets, but its protection against smaller droplets is undetermined. It should be large, positioned close to the patient, and used in tandem with routine basic disinfection practices.
Fetal Intervention During the COVID-19 Pandemic
Authors: Wilpers Abigail , Eichhorn Barbara , Vermeersch Leslie , Gosnell Kristen
Published: July 2020

Two case studies are presented that illustrate the challenges of fetal diagnosis and intervention during the COVID-19 pandemic. Clinical recommendations from the North American Fetal Therapy Network and the International Fetal Medicine and Surgery Society are reviewed. Finally, the experiences and actions of nurses practicing in fetal intervention during the COVID-19 pandemic are illustrated through a discussion of the ongoing Fetal Therapy COVID-19 Survey.
Waist circumference a clinical criterion for prediction of cardio-vascular complications in children and adolescences with overweight and obesity
Authors: Trandafir Laura Mihaela , Russu Georgiana , Moscalu Mihaela , Miron Ingrith , Lupu Vasile Valeriu , Leon Constantin Maria Magdalena , Cojocaru Elena , Lupu Ancuta , Frasinariu Otilia Elena
Published: July 2020

Overweight and obesity in childhood are associated with early cardiovascular dysfunction and promote heightened risk of cardiovascular morbidity and mortality in adulthood. Waist circumference (WC) correlates with visceral obesity, which is why obese children with elevated WC need to be carefully monitored to prevent long-term cardio-metabolic complications. The purpose of our study was to establish if WC could be a predictor of cardiovascular complications in children.

The authors conducted a retrospective study that included 160 overweight and obese children and adolescents, aged 6 to 18 years. Patients were evaluated completely anthropometrically, biologically, and imagistic. The anthropometric data tracked were height, weight, WC, and body mass index. Echocardiography evaluated the following parameters: the interventricular septum, left ventricular mass, the relative thickness of the ventricular wall, the pathological epicardial fat.

Our results confirm that the presence of visceral obesity was significantly associated (χ2 = 11.72, P = .0006) with pathological epicardial fat. In children, visceral obesity is not a risk factor for vascular or cardiac impairment, but in adolescents, the results showed that visceral obesity is an important predictive factor for the occurrence of vascular (AUC = 0.669, P = .021) and cardiac (AUC = 0.697, P = .037) impairment. Concentric left ventricular (LV) hypertrophy is significantly influenced by the presence of visceral obesity (AUC = 0.664, P = .013 children; AUC = 0.716, P = .026 adolescents).

WC above the 90th percentile is a predictive factor for increased LVM index and concentric hypertrophy in both children and adolescents.
Effectiveness of direct-acting antivirals for hepatitis C virus infection in hepatitis C/HIV coinfected individuals
Authors: Machado Soraia M. , Vigani Aline G. , Leite Andrea G. , Diaz Ana Claudia M. , Ferreira Paulo Roberto A. , Carnaúba-Júnior Dimas , Tenore Simone B. , Brandão-Mello Carlos Eduardo , Gonzalez Mario P. , Siroma Fabiana , Prado Kleber D. , Nunes Delzi V. , Lisboa-Neto Gaspar , Pinho João Renato R. , Malta Fernanda M. , Azevedo Raymundo S. , Witkin Steven S. , Mendes-Correa Maria Cássia
Published: July 2020

In a hepatitis C virus (HCV)/HIV-positive Brazilian cohort, evaluate the safety and efficacy of HCV DAAs, the frequency of resistance substitutions in the HCV NS5A and NS5B genes and identify predictors of treatment failure.

Retrospective multicenter study of HCV/HIV patients treated with sofosbuvir (SOF)-based regimens at 10 reference centers in Brazil.

Clinical and virological data were collected. Genetic diversity in the NS5A and NS5B genes was assessed by direct nucleotide sequencing. The primary outcome was sustained virological response (SVR) 12 weeks after DAA completion.

Of 643 HCV/HIV patients analyzed, 74.7% were male, median CD4+ T cell count was 617 cells/mm3, 90% had an undetectable HIV viral load. HCV genotype 1 was detected in 80.2%, and 60% were taking at least 1 medication other than antiretroviral drugs during their DAA therapy. Cirrhosis was present in 42%. An SOF/daclatasvir (DCV) regimen was used in most patients (98%). The frequency of NS5A polymorphisms associated with clinically relevant resistance to DCV was 2%; no relevant NS5B variants were identified. The SVR12 rate was 92.8% in an intention to treat (ITT) analysis and 96% in a modified ITT (m-ITT) analysis. AE occurred in 1.6% of patients. By multivariate analysis, therapeutic failure was associated, in the m-ITT analysis, with concomitant use of anticonvulsant drugs (P = .001), age (P = .04), and female gender (P = .04).

SOF/DCV regimens were associated with a high SVR rate in an HCV/HIV population. The use of concurrent anticonvulsant drugs and DAAs decreases the chances of achieving an SVR.
Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic
Authors: Kajdy Anna , Feduniw Stepan , Ajdacka Urszula , Modzelewski Jan , Baranowska Barbara , Sys Dorota , Pokropek Artur , Pawlicka Paulina , Kaźmierczak Maria , Rabijewski Michał , Jasiak Hanna , Lewandowska Roksana , Borowski Dariusz , Kwiatkowski Sebastian , Poon Liona C.
Published: July 2020

Introduction:

The article presents a protocol of a cross-sectional study of mental health of pregnant women in relation to the coronavirus disease 19 (COVID-19) pandemic. The primary aim is to compare differences in anxiety and depression scores of pregnant women between countries affected by the COVID-19 pandemic. The secondary aim is to assess demographic, economic, and social aspects affecting maternal anxiety and depression scores among pregnant women worldwide in the time of the COVID-19 pandemic. Finally, we will be able to compare differences in perception of the different aspects of the COVID-19 pandemic (social distancing, restrictions related to delivery) between countries and according to the epidemic status (number of infected patients, number of reported deaths). The comparisons will also be done according to the COVID-19 status of the participants.

Methods and analysis:

It is a web-based anonymous survey of pregnant women living in countries affected by the COVID-19 pandemic. The survey is comprised of 3 sections:

Web-based recruitment for health research has proven to be cost-effective and efficient. At current times with the COVID-19 pandemic, limited resources and social distancing restrictions, performing a mental health study involving pregnant women on a large international scale cannot be safely conducted without involving social-media.

The fears of pregnant women fall into 3 categories: the medical condition, the economic status and the organization of daily activity.

The study has received approval of the medical ethics committee and has been registered on Clinicaltrials.gov. Results will be published in peer-reviewed journals and made public through all available media.
Traditional Chinese medicine for symptoms of upper respiratory tract of COVID-19
Authors: Liang Fangqi , Dong Lei , Zhou Li , Shi Yu , Tian Li
Published: July 2020

Background:

Assessing the effectiveness and safety of traditional Chinese medicine (TCM) for symptoms of upper respiratory tract of coronavirus disease 2019 is the main purpose of this systematic review protocol.

Methods:

The following electronic databases will be searched from inception to Sep 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, Web of Science, TCM, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Search dates: from inception dates to June 2020. Language: English. Publication period: from inception dates to June 2020. The primary outcome is the time and rate of appearance of main symptoms (including coughing, pharyngalgia, and nasal obstruction). The secondary outcome is the length of hospital stay. Two independent reviewers will conduct the study selection, data extraction and assessment. RevMan V.5.3 will be used for the assessment of risk of bias and data synthesis.

Results:

The results will provide a high-quality synthesis of current evidence for researchers in this subject area.

Conclusion:

The conclusion of our study will provide an evidence to judge whether TCM is effective and safe for the patients with symptoms of upper respiratory tract of coronavirus disease 2019.

Ethics and dissemination:

This protocol will not evaluate individual patient information or affect patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports.

PROSPERO registration number:

CRD42020187422.
Acute monocular nasal hemianopia following a mild traumatic brain injury
Authors: Lin Hsin-Le , Yen Ju-Chuan
Published: July 2020

Introduction:

Monocular hemianopia is a visual field defect with an uncommon pattern. The etiology of monocular temporal hemianopia has been well-evaluated and has been suggested to result from an optic nerve or chiasmal lesion. However, the etiology of monocular nasal hemianopia remains unclear.

Patient concerns:

Here, we present the case of a 41-year-old male who was punched on the head with fists during a fight and then suffered from painless blurred vision in the left eye after mild traumatic brain injury. An ophthalmic examination revealed a conjunctival chemosis, periorbital hematoma, and a relative afferent pupillary defect in the left eye. Automated perimetry indicated there was a left side nasal hemianopia along the vertical meridian.

Diagnosis:

Examination of the fundus showed there was a normal appearing retina and disc bilaterally. Fluorescein angiography revealed no delayed filling of the vessels. Computed tomography and magnetic resonance imaging showed unremarkable findings of the visual pathways, orbit, and brain. A diagnosis of left traumatic optic neuropathy was made.

Interventions:

Systemic steroid pulse therapy (1 gram of intravenous methylprednisolone per day) was given to the patient for 3 days.

Outcomes:

An ophthalmologic examination after treatment indicated there was no obvious improvement in the relative afferent pupillary defect, best corrected visual acuity, and color sense. A second set of automated perimetry results showedno changes after 3 months.

Conclusion:

Monocular nasal hemianopia caused by traumatic optic neuropathy is uncommon. In this case, monocular nasal hemianopia was likely due to ischemic changes from impairment of the prechiasmal arterial anastomotic network or indirect injury to the lateral prechiasmal nerve fiber.
Association between Vitamin B12 levels and cognitive function in the elderly Korean population
Authors: Soh Yunsoo , Lee Do Hun , Won Chang Won
Published: July 2020

Vitamin B12 (B12), also known as cobalamin, is a water-soluble vitamin. It is a cofactor in DNA synthesis and is involved in the metabolism of every cell of the human body, including the central nervous system. Those with a deficiency of B12 can present with peripheral neuropathy, pernicious anemia, or a cognitive disorder. Previous studies have revealed that a deficiency of B12 is associated with cognitive decline or Alzheimer disease.

The data of 2991 people were evaluated from 2 years of the Korean Frailty and Aging Cohort Study, a nationwide multicenter survey. To assess cognitive function, a short form of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) was used. Of the CERAD-K tests, we included the Mini-Mental State Examination in the Korean version of the CERAD assessment packet (MMSE-KC), the word list: memory/recall/recognition, digit span (forward, backward), trail making test-A, and the frontal assessment battery. B12 concentrations were classified into clinically relevant categories, insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). A linear regression analysis was used to evaluate the relationship between cognitive function and B12 levels.

The mean age of the 2991 participants was 76.4 ± 3.9 years old. Overall, 414 (13.8%) were classified as B12 insufficient, and 2577 (86.2%) as B12 sufficient. The sufficient B12 group performed better in the MMSE-KC, Wordlist: memory, Wordlist: recognition, TMT-A test, digit span, and FAB tests. This was statistically significant (P < .05). However, in the multivariable linear regression analysis, after adjusting for age, sex, education period, marriage, smoking and drinking habits, and comorbidities, the association between the B12 group and cognitive function was not statistically significant.

Although our study does not show that B12 insufficiency is a direct risk factor to cognitive decline, B12 levels could be a contributing factor to cognitive function. Our results suggest that cognition was affected by the B12 levels, along with demographic and sociological variables.
Factors associated with delayed diagnosis of infective endocarditis
Authors: Nishiguchi Sho , Nishino Koichi , Kitagawa Izumi , Tokuda Yasuharu
Published: July 2020

Patients with infective endocarditis (IE), have high mortality and morbidity, however, its early diagnosis is difficult. Few studies have examined the delayed diagnosis of IE. We aimed to investigate the factors associated with the diagnostic delay of IE.

A retrospective cohort study was conducted for consecutive patients diagnosed with IE in an acute care teaching hospital in Japan from April 2006 to March 2018. Time-to-diagnosis was analyzed using a multivariate Cox hazard model for determining factors associated with days required for IE diagnosis. Factors analyzed in the model included age, gender, activities of daily living, Charlson comorbidity index, presence of internal device, chief complaint, inappropriate antibiotics use, shaking chill, fever >38°C, hypoxemia, serum C-reactive protein (CRP) < 10 mg/dL, Staphylococcus aureus as causative pathogen, findings on first echocardiography, resident as a first contact physician, primary care physician as a first contact doctor, and transport measures to the clinic/hospital.

There were 145 IE patients with a mean age of 70 years and 90 were male (62.1%). The median time to the diagnosis of definite IE was 13 days and median time to consider the diagnosis of IE from first clinic/hospital visit was 6 days. The time to consider IE diagnosis was significantly delayed in patients who had inappropriate prior antibiotic use (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.01 to 2.57; P = .045), in patients without fever >38°C (HR, 1.80; 95% CI, 1.11 to 2.90; P = .016), in patients with serum CRP level < 10 mg/dL (HR, 1.53; 95% CI, 1.01 to 2.33; P = .046), and in patients who did not use an ambulance for hospital arrival (HR, 3.18; 95% CI, 1.72 to 5.85; P < .001).

Delay in considering IE diagnosis is associated with inappropriate prior antibiotics use, absence of high fever, absence of high CRP level, and use of a hospital arrival vehicle other than an ambulance. For earlier IE diagnosis, inappropriate use of antibiotics should be avoided and IE should not be excluded by relatively low level of temperature or serum CRP.
Orthopaedic Nurses' Perceptions of Preoperative Education for Total Knee Replacement
Authors: Causey-Upton Renee , Howell Dana M. , Kitzman Patrick H. , Custer Melba G. , Dressler Emily V.
Published: July 2020

BACKGROUND:

Limited descriptions of preoperative education programs for total knee replacement (TKR) surgery are provided in the literature, and the most effective program design is currently unknown.

PURPOSE:

The purpose of this qualitative study is to describe orthopaedic nurses' perceptions of preoperative education prior to TKR surgery.

METHODS:

Ten participants completed phone interviews and transcripts were analyzed qualitatively for themes among participants.

RESULTS:

Participants believed that preoperative education was a significant component impacting patient outcomes following surgery. Interprofessional preoperative education was valued, but pragmatic factors were identified as barriers to the inclusion of other disciplines within these programs. Education programs were constantly evolving on the basis of evidence-based practice and changes to orthopaedic protocols. Pragmatic factors influenced all aspects of program design, such as the timing and length of education sessions.

CONCLUSIONS:

Results from this study provide descriptions of factors that influence program design and can be used to restructure education programs for improved patient outcomes.
Clinical and Psychosocial Factors Over Time Following an Acute Low Back Pain Episode
Authors: Salt Elizabeth , Wiggins Amanda T. , Hooker Quenten , Rayens Mary Kay
Published: July 2020

BACKGROUND:

Low back pain (LBP) is a prevalent condition with overwhelming healthcare costs and high disability rates. Characterization of clinical and psychosocial variables over time in patients experiencing an episode of acute LBP and the identification of factors that differ between those who develop chronic LBP and those who do not could aid in the development of improved targeted treatment.

PURPOSE:

The purpose of this study was to evaluate the trajectory of depression, pain catastrophizing, life purpose, pain sensitivity, and disability in persons presenting with an acute/subacute episode of LBP, evaluating whether there are changes over time and differences in these variables between those who developed chronic LBP and those who did not.

METHODS:

Prospective analysis (baseline, 2.5 months, 6 months, and weekly diaries) of 42 patients experiencing an acute LBP episode was performed. Descriptive statistics, repeated-measures mixed modeling, and Fisher's least significant differences method were used during data analysis.

RESULTS:

Depressive symptoms vary over time. There was no difference over time in pain catastrophizing, life purpose, pain sensitivity, or disability. Those who met the criteria for chronic LBP at 6 months had increased pain catastrophizing scores and higher disability scores compared with those who do not meet the criteria for chronic LBP. Depressive symptoms, life purpose, and pain sensitivity were not different between those who met the criteria for chronic LBP and those who did not.

CONCLUSION:

Findings from this study characterize factors potentially contributory to the development of chronic LBP over time. Those participants who developed chronic LBP had higher pain catastrophizing scores averaged across all time points in this study, suggesting it could be an interesting factor to target to improve LBP chronicity.
Angiomyolipoma of the Hard Palate
Authors: Akçay Hüseyin , Adak Berat Metin
Published: July 2020

Angiomyolipoma (AML) is a tumor which commonly affects the kidney. Few authors have been reported AML in the oral cavity. In this clinical report, an AML of the hard palate will be presented in a 48-year-old patient. The AML contains mature adipose tissue, thick-walled blood vessels, and irregular bundle of smooth muscle. The AML is sometimes associated with tuberous sclerosis. Although the renal AMLs are often invasive, they involve regional nodes and may recur, extrarenal AMLs are commonly well demarcated, show no recurrence and may simply be removed. The AML usually behaves in a benign fashion.
Good Platelets Gone Bad: The Effects of Trauma Patient Plasma on Healthy Platelet Aggregation
Authors: Fields Alexander T. , Matthay Zachary A. , Nunez-Garcia Brenda , Matthay Ellicott C. , Bainton Roland J. , Callcut Rachael A. , Kornblith Lucy Z.
Published: July 2020

Background:

Altered postinjury platelet behavior is recognized in the pathophysiology of trauma-induced coagulopathy (TIC), but the mechanisms remain largely undefined. Studies suggest that soluble factors released by injury may inhibit signaling pathways and induce structural changes in circulating platelets. Given this, we sought to examine the impact of treating healthy platelets with plasma from injured patients. We hypothesized that healthy platelets treated ex-vivo with plasma from injured patients with shock would impair platelet aggregation, while treatment with plasma from injured patients with significant injury burden, but without shock, would enhance platelet aggregation.

Methods:

Plasma samples were isolated from injured patients (pretransfusion) and healthy donors at a Level I trauma center and stored at −80°C. Plasma samples from four separate patients in each of the following stratified clinical groups were used: mild injury/no shock (injury severity score [ISS] 2–15, base excess [BE]>−6), mild injury/with shock (ISS 2–15, BE≤−6), severe injury/no shock (ISS>25, BE>−6), severe injury/with shock (ISS>25, BE≤−6), minimal injury (ISS 0/1, BE>−6), and healthy. Platelets were isolated from three healthy adult males and were treated with plasma for 30 min. Aggregation was stimulated with a thrombin receptor agonist and measured via multiple-electrode platelet aggregometry. Data were normalized to HEPES Tyrode's (HT) buffer-only treated platelets. Associations of plasma treatment groups with platelet aggregation measures were tested with Mann–Whitney U tests.

Results:

Platelets treated with plasma from patients with shock (regardless of degree of injury) had significantly impaired thrombin-stimulated aggregation compared with platelets treated with plasma from patients without shock (P = 0.002). Conversely, platelets treated with plasma from patients with severe injury, but without shock, had amplified thrombin-stimulated aggregation (P = 0.030).

Conclusion:

Shock-mediated soluble factors impair platelet aggregation, and tissue injury-mediated soluble factors amplify platelet aggregation. Future characterization of these soluble factors will support development of novel treatments of TIC.
Reducing bruising and pain through enhancement of subcutaneous anticoagulant injection techniques: a best practice implementation project
Authors: Neo Nicholas W.S. , Seow Paola Y.Q. , Tho Poh Chi
Published: July 2020

Introduction:

Subcutaneous delivery of anticoagulant therapy is a common treatment modality across multiple medical disciplines. However, postinjection complications of bruising and pain continues to be a problem that has the propensity to affect patients physically and psychologically. A review of literature revealed a set of recommended injection techniques that have shown to improve these clinical outcomes.

Objectives:

The project aims to utilize an evidence implementation framework to introduce evidence-based injection technique, for the reduction of postinjection complications.

Methods:

A best practice implementation project was administered across three adult- cardiology and cardio-thoracic general wards in Singapore from March 2018 to February 2019. The Joanna Briggs Institute (JBI)'s framework of evidence implementation was utilized to enable change. A baseline audit was carried out to ascertain existing injection practices. Guided by the latest evidence, a new subcutaneous injection workflow was created and disseminated. Follow-up audits were held at 1 and 8-month postimplementation to assess compliance to the new subcutaneous injection workflow and the sustainment of change. Data were consolidated and analysed with the aid of JBI Practical Application of Clinical Evidence System. Barriers to change were also identified and addressed with the aid of JBI's Getting Research into Practice tool.

Results:

A large variation of subcutaneous injection techniques was observed at the baseline audit. At 1-month postimplementation, overall compliance with the new subcutaneous injection workflow was assessed to be 73.3%. Criteria 2 and 3 of the JBI Practical Application of Clinical Evidence System audit criteria improved from the baseline values (9.1–80%; 0–93.3%). At 8-month postimplementation, compliance rate remained high (83%) following strategies to reinforce and sustain change. Participants complied to Criteria 1 at all stages of the project. Correspondingly, the incidence of bruising reduced from baseline, with a relative risk reduction of 52% (1 month) and 29% (8 months). Median pain also decreased from the baseline, with an improvement from 2.0 (1.0–3.0) to 0.0 (0.0–1.0).

Conclusion:

Introduction and sustainment of change requires careful planning and execution. JBI's framework of evidence implementation is an effective model to guide this process. This project also highlighted the value of continuous learning, clinical update and practice standardization. This is especially important in the current climate of nursing mobility worldwide and the associated practice variations based on nursing education and experience.
Assessing the quality of the evidence underlying recommendations in type 2 diabetes’ commonly used clinical practice guidelines
Authors: Enchev-Hristov Enrik , Esteve-Serra Mariona , Reyes-Céspedes Luz Maria , Barahona-San Millán Rebeca , Recasens-Sala Mònica , Sojo-Vega Lidia , Costa-Lima Elisabet , Fernández-Real José Manuel , Ricart-Engel Wifredo , Fernández-Balsells Mercè
Published: July 2020

Aim:

In a world of data overload, clinical practice recommendations are needed to help practitioners and patients to take evidence-based decisions. However, in the field of type 2 diabetes mellitus (T2DM) recommendations on glycemic goals and treatment choice are controversial in spite of being supported by a common body of evidence. We hypothesize that internal and external validity of this body of evidence might not be as sound as expected. The aim of the current study is to appraise the studies supporting recommendations developed by influential medical societies dealing with glycemic goals and the choice of pharmacological treatment in adults with T2DM.

Methods:

Clinical practice recommendations and their references were extracted out of eight documents developed by influential scientific societies between 2016 and 2019. Internal and external validity of each study was then appraised with standard tools and in duplicate.

Results:

A total of 114 recommendations and their underlying 233 citations were extracted. Out of these 233 citations 81 (35%) corresponded to randomized controlled trials (RCT) and 45 (20%) to systematic reviews. After systematical appraisal only four RCT (5%) and eight systematic reviews (17%) were considered to be unflawed. Indirectness (lack of generalizability) was the most common caveat identified in RCTs. Out of the 114 recommendations analyzed (32 dealing with glycemic goals and 82 with treatment choice), only 21 (18.4%) were supported by at least one high-quality study.

Conclusion:

Only one in five recommendations regarding glycemic goals or pharmacological treatment choice in T2DM is based on at least one high-quality study. Clinical practice recommendations dealing with areas of uncertainty should be formulated more transparently to enable real evidence-based decisions.
Earthquake observations in the age before Lisbon: eyewitness observation and earthquake philosophy in the Royal Society, 1665–1755
Authors: Blanken Kerrewin van
Published: July 2020

Between 1665 and 1755 several members of the Royal Society collected eyewitness accounts of earthquakes, some of which were published in the
Philosophical Transactions
. While such observations have been recognized as crucial to early seismology in the nineteenth century, their impact on the seventeenth- and eighteenth-century natural philosophy of earthquakes has received limited attention. This article suggests that growing inclusion of observations considerably challenged existing theories and epistemologies and was indispensable to the emergence of seismology in the second half of the eighteenth century. Initially, observations of earthquakes served two uses: the provision of particulars and the verification of other observations. By the eighteenth century, a new approach to empiricism was beginning to influence the collection of observations, focusing on information that could be compared and synthesized to chart the extent and varying intensities of earthquakes. This practice promoted a conception of subterranean, travelling earthquakes that could be measured by their intensity, and which were hypothesized to have some form of centre or origin. While seismology could develop on the basis of sound theoretical assumptions, these assumptions were heavily indebted to the methodological practice of eyewitness observation.
Time between Symptom Onset, Hospitalisation and Recovery or Death: a Statistical Analysis of Different Time-Delay Distributions in Belgian COVID-19 Patients
Authors: Faes C. , Abrams S. , Van Beckhoven D. , Meyfroidt G. , Vlieghe E. , Hens N.
Published: July 2020

Background

There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. Different age-groups are also impacted differently. However, it remains unclear whether the time from symptom onset to diagnosis and hospitalization or the length of stay in the hospital is different for different age groups, gender, residence place or whether it is time dependent.

Methods

Sciensano, the Belgian Scientific Institute of Public Health, collected information on hospitalized patients with COVID-19 hospital admissions from 114 participating hospitals in Belgium. Between March 14, 2020 and June 12, 2020, a total of 14,618 COVID-19 patients were registered. The time of symptom onset, time of COVID-19 diagnosis, time of hospitalization, time of recovery or death, and length of stay in intensive care are recorded. The distributions of these different event times for different age groups are estimated accounting for interval censoring and right truncation in the observed data.

Results

The truncated and interval-censored Weibull regression model is the best model for the time between symptom onset and diagnosis/hospitalization best, whereas the length of stay in hospital is best described by a truncated and interval-censored lognormal regression model.

Conclusions

The time between symptom onset and hospitalization and between symptom onset and diagnosis are very similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient and whether or not the patient lives in a nursing home. Patients coming from a nursing home facility have a slightly prolonged time between symptom onset and hospitalization (i.e., 2 days). The longest delay time is observed in the age group 20-60 years old. The time from symptom onset to diagnosis follows the same trend, but on average is one day longer as compared to the time to hospitalization. The median length of stay in hospital varies between 3 and 10.4 days, with the length of stay increasing with age. However, a difference is observed between patients that recover and patients that die. While the hospital length of stay for patients that recover increases with age, we observe the longest time between hospitalization and death in the age group 20-60. And, while the hospital length of stay for patients that recover is shorter for patients living in a nursing home, the time from hospitalization to death is longer for these patients. But, over the course of the first wave, the length of stay has decreased, with a decrease in median length of stay of around 2 days.
Statistical analysis of national & municipal corporation level database of COVID-19 cases In India
Authors: Bajaj Naman S. , Pardeshi Sujit S. , Patange Abhishek D. , Kotecha Disha , Mate K. K.
Published: July 2020

Since its origin in December 2019, Novel Coronavirus or COVID-19 has caused massive panic in the word by infecting millions of people with a varying fatality rate. The main objective of Governments worldwide is to control the extent of the outbreak until a vaccine or cure has been devised. Machine learning has been an efficient mechanism to train, map, analyze, and predict datasets. This paper aims to utilize regression, a supervised machine learning algorithm to assess time-series datasets of COVID-19 pandemic by performing comparative analysis on datasets of India and two Municipal Corporations of Maharashtra, namely, Mira-Bhayander and Akola. Current study is an attempt towards drawing attention to the dynamics and nature of the pandemic in a controlled locality such as Municipal Corporation; which differs from the exponential nature observed nationally. However, for limited area like the one considered the nature of curve is observed to be cubic for total cases and multi-peak Gaussian for active cases. In conclusion, Government should empower district/ corporations/local authorities to adopt their own methodology and decision-making policy to contain the pandemic at regional-level like the case study discussed herein.
Transparency Assessment of COVID-19 Models
Authors: Jalali Mohammad S. , DiGennaro Catherine , Sridhar Devi
Published: July 2020

As the COVID-19 pandemic has caused major societal unrest, modelers have worked to project future trends of COVID-19 and predict upcoming challenges and impacts of policy action. These models, alone or in aggregate, are influential for decision-makers at every level. Therefore, the method and documentation of COVID-19 models must be highly transparent to ensure that projections and consequential policies put forth have sound epistemological grounds. We evaluated 29 COVID-19 models receiving high attention levels within the scientific community and/or informing government responses. We evaluated these models against 27 transparency criteria. We found high levels of transparency in model documentation aspects such as reporting uncertainty analysis; however, about half of the models do not share code and a quarter do not report equations. These discrepancies underscore the need for transparency and reproducibility to be at the forefront of researchers’ priorities, especially during a global health crisis when stakes are critically high.

Evaluation of 29 impactful COVID-19 models reveals inconsistent adherence to best transparency practices; higher transparency is needed to inform policy.
Do low TB prevalence and lack of BCG Vaccinations Contribute to Emergence of Multisystem Inflammatory Syndrome in Children?
Authors: Raham Tareef Fadhil
Published: July 2020

Background

Emergence of new multisystem inflammatory syndrome in children (MIS-C) is thought to be associated with COVID-19 pandemic. Covid-19 morbidity and mortality variances among countries have been suggested by previous works to be influenced by BCG and previous latent TB infection (which is reflected by TB prevalence) possibly through inducing heterogeneous immunity against SARS-CoV-2.

Aim

To examine influence of BCG status and TB prevalence on variances among countries which report new multisystem inflammatory syndrome in children (MIS-C).

Methods

We choose all countries which report MIS-C till 23/6/2020, number of cases for each 10 million inhabitants was examined among 3 categories of countries classified according to BCG program status. TB prevalence, MIS-C no. / 10 million (M) population and Covid-19 deaths/M are taken as markers. Receiver operation characteristic - (ROC) curve, with some relative indicators such as (sensitivity and specificity rates), estimation area of trade - off between sensitivity and specificity, and cutoff points are used with different studied markers for discriminating different three pairs of countries (which have different BCG practices).

Results

BCG vaccinations and high TB prevalence are found to be associated with decrease MIS-C no. and COVID-19 deaths

Conclusions

Findings might explain variances in MIS-C incidence and in COVID-19 mortality among countries worldwide. Further studies to confirm this relation and to confirm possible similar relations in Kawasaki disease(KD) in previous epidemics is recommended.

What is Known

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Although the etiology for KD remains unknown, available evidence supports the hypothesis that the pathogenesis is closely associated with dysregulation of immune responses to an infectious agent.

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BCG and / or Latent TB have heterogeneous beneficial effects.

What is New

Our study shows that TB prevalence and implementing BCG vaccination have negative statistical association with MIS-C cases and COVID-19 mortality.
Cryo-electron Microscopy and Exploratory Antisense Targeting of the 28-kDa Frameshift Stimulation Element from the SARS-CoV-2 RNA Genome
Authors: Zhang Kaiming , Zheludev Ivan N. , Hagey Rachel J. , Wu Marie Teng-Pei , Haslecker Raphael , Hou Yixuan J. , Kretsch Rachael , Pintilie Grigore D. , Rangan Ramya , Kladwang Wipapat , Li Shanshan , Pham Edward A. , Bernardin-Souibgui Claire , Baric Ralph S. , Sheahan Timothy P. , D′Souza Victoria , Glenn Jeffrey S. , Chiu Wah , Das Rhiju
Published: July 2020

Drug discovery campaigns against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are beginning to target the viral RNA genome1, 2. The frameshift stimulation element (FSE) of the SARS-CoV-2 genome is required for balanced expression of essential viral proteins and is highly conserved, making it a potential candidate for antiviral targeting by small molecules and oligonucleotides3–6. To aid global efforts focusing on SARS-CoV-2 frameshifting, we report exploratory results from frameshifting and cellular replication experiments with locked nucleic acid (LNA) antisense oligonucleotides (ASOs), which support the FSE as a therapeutic target but highlight difficulties in achieving strong inactivation. To understand current limitations, we applied cryogenic electron microscopy (cryo-EM) and the Ribosolve7 pipeline to determine a three-dimensional structure of the SARS-CoV-2 FSE, validated through an RNA nanostructure tagging method. This is the smallest macromolecule (88 nt; 28 kDa) resolved by single-particle cryo-EM at subnanometer resolution to date. The tertiary structure model, defined to an estimated accuracy of 5.9 Å, presents a topologically complex fold in which the 5′ end threads through a ring formed inside a three-stem pseudoknot. Our results suggest an updated model for SARS-CoV-2 frameshifting as well as binding sites that may be targeted by next generation ASOs and small molecules.
Calibration and Evaluation of a Force Measurement Glove for Field-Based Monitoring of Manual Wheelchair Users
Authors: Anderson Anthony , Hooke Alexander W. , Jayaraman Chandrasekaran , Burns Adam , Fortune Emma , Sosnoff Jacob J. , Morrow Melissa M.
Published: July 2020

Manual wheelchair users exhibit pain related to repetitive and demanding shoulder activities of daily living. Wearable sensing systems like force measurement gloves can provide insights about upper extremity loading in the community and home environments. We calibrated and evaluated the accuracy of a novel force measurement glove with a body-worn data logger. The device was calibrated with loads of 0-800 N applied to the palmar surface of the glove. Calibration conditions were tested that varied the stiffness of the material in the glove, the temperature, and the curvature of the force applicator. Calibration equations from each condition were evaluated by comparing the glove’s force prediction with the output of an instrumented wheelchair rim during propulsion and weight relief exercises. The force measurement glove detected 72.7% of 355 propulsion peaks and had a strong linear correlation with the instrumented rim force measurements (r=0.80). The most accurate calibration equation was constructed using data from all conditions, with an RMS force measurement error of 64.7 N and 31.7 N for weight relief exercise and propulsion, respectively. The force measurement glove design described here may serve as a useful tool for detection of loading events and relative magnitude changes.
Interferons and viruses induce a novel primate-specific isoform dACE2 and not the SARS-CoV-2 receptor ACE2
Authors: Onabajo Olusegun O. , Banday A. Rouf , Yan Wusheng , Obajemu Adeola , Stanifer Megan L. , Santer Deanna M. , Florez-Vargas Oscar , Piontkivska Helen , Vargas Joselin , Kee Carmon , Tyrrell D. Lorne J. , Mendoza Juan L. , Boulant Steeve , Prokunina-Olsson Ludmila
Published: July 2020

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes COVID-19, utilizes angiotensin-converting enzyme 2 (ACE2) for entry into target cells.ACE2has been proposed as an interferon-stimulated gene (ISG). Thus, interferon-induced variability inACE2expression levels could be important for susceptibility to COVID-19 or its outcomes. Here, we report the discovery of a novel, primate-specific isoform ofACE2, which we designate asdeltaACE2 (dACE2). We demonstrate thatdACE2, but notACE2, is an ISG.In vitro, dACE2, which lacks 356 N-terminal amino acids, was non-functional in binding the SARS-CoV-2 spike protein and as a carboxypeptidase. Our results reconcile current knowledge onACE2expression and suggest that the ISG-type induction ofdACE2in IFN-high conditions created by treatments, inflammatory tumor microenvironment, or viral co-infections is unlikely to affect the cellular entry of SARS-CoV-2 and promote infection.
The short- and long-range RNA-RNA Interactome of SARS-CoV-2
Authors: Ziv Omer , Price Jonathan , Shalamova Lyudmila , Kamenova Tsveta , Goodfellow Ian , Weber Friedemann , Miska Eric A.
Published: July 2020

TheCoronaviridaeis a family of positive-strand RNA viruses that includes SARS-CoV-2, the etiologic agent of the COVID-19 pandemic. Bearing the largest single-stranded RNA genomes in nature, coronaviruses are critically dependent on long-distance RNA-RNA interactions to regulate the viral transcription and replication pathways. Here we experimentally mapped thein vivoRNA-RNA interactome of the full-length SARS-CoV-2 genome and subgenomic mRNAs. We uncovered a network of RNA-RNA interactions spanning tens of thousands of nucleotides. These interactions reveal that the viral genome and subgenomes adopt alternative topologies inside cells, and engage in different interactions with host RNAs. Notably, we discovered a long-range RNA-RNA interaction - the FSE-arch - that encircles the programmed ribosomal frameshifting element. The FSE-arch is conserved in the related MERS-CoV and is under purifying selection. Our findings illuminate RNA structure based mechanisms governing replication, discontinuous transcription, and translation of coronaviruses, and will aid future efforts to develop antiviral strategies.
Association of gut microbiota with cerebral cortex and cerebrovascular abnormality in human mild traumatic brain injury
Authors: Bai Lijun , Li Tianhui , Zhang Ming , Wang Shan , Gan Shuoqiu , Jia Xiaoyan , Yang Xuefei , Sun Yinxiang , Xiong Feng , Yin Bo , Ren Yi , Bai Guanghui , Yan Zhihan , Mu Xin , Zhu Feng
Published: July 2020

Key roles of the gut–brain axis in brain injury development have been suggested in various mouse models; however, little is known about its functional significance in human mild traumatic brain injury (TBI). Here, we decipher this axis by profiling the gut microbiota in 98 acute mild TBI patients and 62 matched controls, and subgroup of them also measured circulating mediators and applied neuroimaging. Mild TBI patients had increased α-diversity and different overall microbial compositions compared with controls. 25-microbial genus classifiers distinguish patients from controls with an area under the receiver operating characteristic curve (AUC) of 0.889, while adding serum mediators and neuroimaging features further improved performance even in a small sample size (AUC = 0.969). Numerous correlations existed between gut bacteria, aberrant cortical thickness and cerebrovascular injury. Co-occurrence network analysis revealed two unique gut–brain axes in patients: 1) altered intestinalLachnospiraceae_NK4A136_groupandEubacterium_ruminantium_group-increased serum GDNF-subcallosal hypertrophy and cerebrovascular injury; 2) decreased intestinalEubacterium_xylanophilum_group–upregulated IL-6–thinned anterior insula. Our findings provide a new integrated mechanistic understanding and diagnostic model of mild TBI.