bluuebunny/crossref_metadata_2025 huggingface dataset:
Socioeconomic and demographic risk factors in COVID-19 hospitalization among immigrants and ethnic minorities
Authors: Islamoska Sabrina , Petersen Jørgen Holm , Benfield Thomas , Norredam Marie
Published: October 2021

Background

Immigrants and ethnic minorities have been shown to be at increased risk of hospitalization from COVID-19. Our aim was to analyse the contribution of socioeconomic and demographic risk factors on hospital admissions for COVID-19 among immigrants and ethnic minorities compared to the majority population.

Methods

We used nationwide register data on all hospitalized COVID-19 cases between February and June 2020 (N = 2232) and random controls from the general population (N = 498 117). We performed logistic regression analyses and adjusted for age, sex, comorbidity, and socioeconomic and demographic factors. The main outcome measure was hospitalization with COVID-19 and was estimated using odds ratios (OR) and 95% confidence intervals (95% CI).

Results

Among 2232 COVID-19 cases, the OR of hospitalization with COVID-19 among immigrants and descendants of non-Western origin was 2.5 times higher (95% CI: 2.23–2.89) compared with individuals of Danish origin with most pronounced results among individuals from Iraq, Morocco, Pakistan and Somalia. The OR was largely attributed to comorbidity and socioeconomic factors, especially household size, occupation, and population density.

Conclusion

There is a significantly higher OR of hospitalization with COVID-19 among non-Western immigrants and ethnic minorities compared with ethnic Danes. This knowledge is crucial for health policymakers and practitioners in both the current and future pandemics to identify more vulnerable groups and target prevention initiatives.
Accuracies of genomic predictions for disease resistance of striped catfish to Edwardsiella ictaluri using artificial intelligence algorithms
Authors: Vu Nguyen Thanh , Phuc Tran Huu , Oanh Kim Thi Phuong , Sang Nguyen Van , Trang Trinh Thi , Nguyen Nguyen Hong
Published: October 2021

Assessments of genomic prediction accuracies using artificial intelligent (AI) algorithms (i.e., machine and deep learning methods) are currently not available or very limited in aquaculture species. The principal aim of this study was to examine the predictive performance of these new methods for disease resistance to Edwardsiella ictaluri in a population of striped catfish Pangasianodon hypophthalmus and to make comparisons with four common methods, i.e., pedigree-based best linear unbiased prediction (PBLUP), genomic-based best linear unbiased prediction (GBLUP), single-step GBLUP (ssGBLUP) and a nonlinear Bayesian approach (notably BayesR). Our analyses using machine learning (i.e., ML-KAML) and deep learning (i.e., DL-MLP and DL-CNN) together with the four common methods (PBLUP, GBLUP, ssGBLUP, and BayesR) were conducted for two main disease resistance traits (i.e., survival status coded as 0 and 1 and survival time, i.e., days that the animals were still alive after the challenge test) in a pedigree consisting of 560 individual animals (490 offspring and 70 parents) genotyped for 14,154 single nucleotide polymorphism (SNPs). The results using 6,470 SNPs after quality control showed that machine learning methods outperformed PBLUP, GBLUP, and ssGBLUP, with the increases in the prediction accuracies for both traits by 9.1–15.4%. However, the prediction accuracies obtained from machine learning methods were comparable to those estimated using BayesR. Imputation of missing genotypes using AlphaFamImpute increased the prediction accuracies by 5.3–19.2% in all the methods and data used. On the other hand, there were insignificant decreases (0.3–5.6%) in the prediction accuracies for both survival status and survival time when multivariate models were used in comparison to univariate analyses. Interestingly, the genomic prediction accuracies based on only highly significant SNPs (P < 0.00001, 318–400 SNPs for survival status and 1,362–1,589 SNPs for survival time) were somewhat lower (0.3–15.6%) than those obtained from the whole set of 6,470 SNPs. In most of our analyses, the accuracies of genomic prediction were somewhat higher for survival time than survival status (0/1 data). It is concluded that although there are prospects for the application of genomic selection to increase disease resistance to E. ictaluri in striped catfish breeding programs, further evaluation of these methods should be made in independent families/populations when more data are accumulated in future generations to avoid possible biases in the genetic parameters estimates and prediction accuracies for the disease-resistant traits studied in this population of striped catfish P. hypophthalmus.
The Gerontological Case Against Fossil Fuels
Authors: Sykes Kathy
Published: October 2021

Climate change is a threat to persons of all ages, but the older population is especially susceptible to the harms of extreme heat, growing air toxics, increasingly prevalent extreme weather events, and related environmental hazards. These changes reflect our continuing dependence on fossil fuels. The effects range from increased risk of chronic conditions to disruption of essential medical and social supports. We need the expertise of gerontologists to craft practical and evidence-based mitigation and adaptation interventions for climate change if we are to meet the needs of aging populations. We cannot wait for others to raise their voices. Gerontologists must address the challenge of climate change and support energy policies that terminate the fossil fuel supply chain.
Understanding the performance of county health service delivery in Kenya: a mixed-method analysis
Authors: Zeng Wu , Musiega Anita , Oyasi Joyce , Di Giorgio Laura , Chuma Jane , Lu Ruoyan , Ahn Haksoon
Published: October 2021

To better understand the wide variation of performance among county health systems in Kenya, this study investigated their performance determinants. We selected five counties with varied performance and examined their performance across five domains containing 10 thematic areas. We conducted a stakeholder analysis, consisting of focus group discussions and key informant interviews, and administered a quantitative survey to quantify the magnitude of inefficiency. The study found that a shortage of funding was one of the most common complaints from counties, leading to inefficiency in the health system. Another major reason for inefficiencies was the delay in disbursing funding to health facilities, which affected the procurement of medical supplies and commodities essential for delivering healthcare to the population. In addition, lack of autonomy in procuring commodities and equipment was repeatedly mentioned as a barrier to delivering quality health services. Other reported common concerns contributing to the performance of county health systems were the lack of lab tests and equipment, low willingness to join health insurance, rigid procurement policies and lengthy procurement process, lack of motivation and incentives for service delivery, and poor economic status. Despite the common concerns among the five counties, they differed in some schematic areas, such as the county’s commitment to health and community mobilization. In summary, this study suggests various factors that determine county health system performance. Given the multifaceted nature of inefficiency drivers, it is necessary to adopt a holistic approach to address the causes of inefficiencies and improve the county health systems
Revealing the relationship between feeding and growth of larval redfish (Sebastes sp.) in the Gulf of St. Lawrence
Authors: Burns Corinne M , Pepin Pierre , Plourde Stéphane , Veillet Guillaume , Sirois Pascal , Robert Dominique
Published: October 2021

Year-class strength of fish stocks is often set during the larval stage, with fast growth being a favourable factor leading to strong recruitment. Following 30 years of poor recruitment, redfish (Sebastes sp.) in the Gulf of St. Lawrence (GSL) produced unprecedentedly strong year classes in 2011–2013. The relationship between larval diet and growth that potentially drove these successful recruitment events is unknown. Gut content and otolith microstructure of redfish larvae collected from the GSL in 1999 and 2000 were analysed in order to understand the relationship between recent feeding success and growth in larval redfish, and identify feeding behaviours that are associated with fast growth. Growth was positively correlated with larval body depth (BD), which was used as a morphological proxy for growth. Prey type and size were the best explanatory variables of larval BD after obligatory first-feeding. Larvae that consumed large naupliar stages of frequently consumed copepod taxa were deeper-bodied and grew more quickly than larvae that consumed redfish's preferred prey, Calanus finmarchicus eggs. Warming GSL waters have shifted the phenology of commonly consumed prey taxa earlier in the season, which may increase the overlap between redfish and naupliar prey that drive fast growth, survival, and potentially recruitment success.
Re-dosing of del Nido cardioplegia in adult cardiac surgery requiring prolonged aortic cross-clamp
Authors: D’Angelo Alex M , Nemeth Samantha , Wang Catherine , Kossar Alexander P , Takeda Koji , Takayama Hiroo , Bapat Vinayak , Naka Yoshifumi , Argenziano Michael , Smith Craig R , Beck James , Spellman Jessica , Kurlansky Paul , George Isaac
Published: October 2021

OBJECTIVES

Few data exist on the use of del Nido cardioplegia in adults, specifically during operations requiring prolonged aortic cross-clamp. In this pilot study, we evaluate outcomes of patients undergoing surgery with cross-clamp time >3 h based on re-dosing strategy, using either full dose (FD; 1:4 blood to crystalloid ratio) or dilute (4:1 blood to crystalloid ratio) solution.

METHODS

Consecutive adult patients (>18 years) undergoing cardiac surgery from 2012 to 2018 with cross-clamp time >3 h were reviewed. Patients were excluded if del Nido cardioplegia was not used. Patients were categorized into FD or dilute groups based on re-dosing solution. Propensity score matching was used to control for baseline differences between groups. The primary endpoint was in-hospital mortality. Other outcomes examined included: postoperative mechanical support, arrhythmia, stroke, dialysis and cardiac function.

RESULTS

Included for analysis were 173 patients (115 male) with median age of 63.8 (interquartile range 53.9–73.1). Major comorbidities included diabetes (45), cerebrovascular disease (34), hypertension (131), atrial fibrillation (52) and previous cardiac surgery (83). There were 108 patients (62%) who received FD re-dosing, while 65 (38%) received dilute. A greater proportion of patients in the dilute group received retrograde delivery, for both induction (32/108 vs 39/65, P < 0.001) and re-dose (50/108 vs 53/65, P < 0.001). After propensity score matching, in-hospital mortality was not different between groups (6/48 vs 1/48, P = 0.131). There were no differences in rates of postoperative mechanical circulatory support, stroke, left ventricular ejection fraction or right ventricle dysfunction.

CONCLUSIONS

Del Nido cardioplegia has been used in complex cardiac surgery requiring prolonged cross-clamp. Re-dosing can be performed with either FD or dilute del Nido solution with no statistical difference in outcomes.
The International Consensus on ANA Patterns (ICAP) in 2021—The 6th Workshop and Current Perspectives
Authors: Chan Edward K L , von Mühlen Carlos A , Fritzler Marvin J , Damoiseaux Jan , Infantino Maria , Klotz Werner , Satoh Minoru , Musset Lucile , García-De La Torre Ignacio , Carballo Orlando Gabriel , Herold Manfred , de Melo Cruvinel Wilson , Mimori Tsuneyo , Conrad Karsten , Andrade Luis E C
Published: October 2021

The establishment of the International Consensus on ANA Patterns (ICAP) in 2014–2015 was welcomed by members of the medical community as a significant improvement in guiding harmonization of ANA test interpretation and reporting. In the subsequent years, several itinerant meetings and continuous interaction with the community contributed to disseminate the ICAP harmonization on the immunofluorescence patterns observed in the indirect immunofluorescence assay on HEp-2 cells (HEp-2 IFA) and to promote progressive improvement in the classification of HEp-2 IFA patterns. The 6th ICAP Workshop was held in person on September 6, 2021 as a satellite meeting of the 15th Dresden Symposium on Autoantibodies. This article summarizes the major discussions at the meeting as well as outlining the current plans for the ICAP committee.
Preoperative chemoradiotherapy for locally advanced low rectal cancer using intensity-modulated radiotherapy to spare the intestines: a single-institutional pilot trial
Authors: Sakanaka Katsuyuki , Fujii Kota , Ishida Yuichi , Mukumoto Nobutaka , Hida Koya , Inoo Hiroyuki , Sakai Yoshiharu , Mizowaki Takashi
Published: October 2021

The irradiated volume of intestines is associated with gastrointestinal toxicity in preoperative chemoradiotherapy for rectal cancer. The current trial prospectively explored how much of the irradiated volume of intestines was reduced by intensity-modulated radiotherapy (IMRT) compared with 3-dimensional conformal radiotherapy (3DCRT) and whether IMRT might alleviate the acute gastrointestinal toxicity in this population. The treatment protocol encompassed preoperative chemoradiotherapy using IMRT plus surgery for patients with clinical T3–4, N0–2 low rectal cancer. IMRT delivered 45 Gy per 25 fractions for gross tumors, mesorectal and lateral lymph nodal regions, and tried to reduce the volume of intestines receiving 15 Gy (V15 Gy) < 120 cc and V45 Gy ≤ 0 cc, respectively, while keeping target coverage. S-1 and irinotecan were concurrently administered. Acute gastrointestinal toxicity, rates of clinical downstaging, sphincter preservation, local regional control (LRC) and overall survival (OS) were evaluated. Twelve enrolled patients completed the chemoradiotherapy protocol. The volumes of intestines receiving medium to high doses were reduced by the current IMRT protocol compared to 3DCRT; however, the predefined constraint of V15 Gy was met only in three patients. The rate of ≥ grade 2 gastrointestinal toxicity excluding anorectal symptoms was 17%. The rates of clinical downstaging, sphincter preservation, three-year LRC and OS were 75%, 92%, 92% and 92%, respectively. In conclusion, preoperative chemoradiotherapy using IMRT for this population might alleviate acute gastrointestinal toxicity, achieving high LRC and sphincter preservation; although further advancement is required to reduce the irradiated volume of intestines, especially those receiving low doses.
Surgical radiofrequency ablation of atrial flutter: which operation should we choose?
Authors: Chen Fengjie , Gao Jin , Song Chen , Wang Zhiwei , Xiong Hui , Ding Ligang , Gao Ge , Fan Hongguang
Published: October 2021

The treatment of atrial flutter (AFL) in patients without structural heart disease (SHD) by transcatheter radiofrequency ablation of the cavotricuspid isthmus (CTI) and bilateral pulmonary veins has achieved good results. We report three cases of typical AFL treated by surgical radiofrequency ablation. One patient, without SHD, successfully underwent CTI ablation and cardioversion. The other two patients, with SHD, underwent CTI ablation, partial right atrial ablation and pulmonary vein isolation, but a normal sinus rhythm was not achieved. Therefore, standard maze IV surgery may be the best choice in patients with AFL and SHD.
An unusual association of adenocarcinoma and isolated tuberculosis of prostate gland
Authors: Tapsoba Abdoul Kader , Rahoui Moez , Bibi Mokhtar , Chelly Beya , Ouanes Yassine , Chaker Kays , Dali Kheireddine Mrad , Sellami Ahmed , Rhouma Sami Ben , Nouira Yassine
Published: October 2021

Adenocarcinoma of prostate is the most common primary prostatic malignancy in the world. Isolated prostate tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. We report two cases of adenocarcinoma and tuberculosis of the prostate. The patients were 83 and 74 years old, respectively. They presented obstructive and irritative symptoms of the lower urinary tract. The prostatic finding and prostate-specific antigen were abnormals. The diagnosis of prostatic tuberculosis and adenocarcinoma was made by histologic analysis after transurethral resection of prostate. The treatment is based on chemotherapy anti-tuberculosis and hormonotherapy. Tuberculosis and malignancy may co-exist in some cases and clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.
Abscisic acid activation of oleosin geneHvOle3expression prevents the coalescence of protein storage vacuoles in barley aleurone cells
Authors: Lee Sung-eun , Yoon In Sun , Hwang Yong-sic
Published: October 2021

Protein storage vacuoles (PSVs) in aleurone cells coalesce during germination, and this process is highly coupled with mobilization of PSV reserves, allowing de novo synthesis of various hydrolases in aleurone cells for endosperm degradation. Here we show that in barley (Hordeum vulgare L.) oleosins, the major integral proteins of oleosomes are encoded by four genes (HvOle1 to 4), and the expression of HvOle1 and HvOle3 is strongly up-regulated by abscisic acid (ABA), which shows antagonism to gibberellic acid. In aleurone cells, all HvOLEs were subcellularly targeted to the tonoplast of PSVs. Gain-of-function analyses revealed that HvOLE3 effectively delayed PSV coalescence, whereas HvOLE1 only had a moderate effect, with no notable effect of HvOLE2 and 4. With regard to longevity, HvOLE3 chiefly outperformed other HvOLEs, followed by HvOLE1. Experiments swapping the N- and C-terminal domain between HvOLE3 and other HvOLEs showed that the N-terminal region of HvOLE3 is mainly responsible, with some positive effect by the C-terminal region, for mediating the specific preventive effect of HvOLE3 on PSV coalescence. Three ACGT-core elements and the RY-motif were responsible for ABA induction of HvOle3 promoter activity. Transient expression assays using aleurone protoplasts demonstrated that transcriptional activation of the HvOle3 promoter was mediated by transcription factors HvABI3 and HvABI5, which acted downstream of protein kinase HvPKABA1.
Intravenous Fluid Bag as a Substitute for Gel Standoff Pad in Musculoskeletal Point-of-care Ultrasound
Authors: Mount Cristin , Taylor David , Skinner Carl , Grogan Scott
Published: October 2021

Introduction

Point-of-care ultrasound (POCUS) is a tool undergoing expanding use in military medicine, including routine inpatient, outpatient, and operational environments. Specific musculoskeletal POCUS examinations require additional equipment in the form of a standoff assist device to maximize image acquisition. These devices may not be readily available to POCUS users in more austere or resource-constrained environments. We devised a study to determine if intravenous fluid bags of various volumes could be substituted for standard standoff devices in musculoskeletal POCUS.

Materials and Methods

Sequential images of a soft tissue foreign body model, an interphalangeal joint, and a chest wall were taken using a gel standoff pad or water bath and compared to images acquired using three different sizes of intravenous fluid bags after removing excess air from the bags. Images were de-identified and scored for quality using a visual analog scale. We used a two-factor analysis of variance without replication to analyze the differences in image quality between standoff devices, with a P-value less than.05 considered statistically significant.

Results

We performed 13 POCUS studies and had a group of eight POCUS-trained physicians and physician assistants score these studies, resulting in 104 total quality scores. There was no significant difference in image quality between standoff devices for chest (P-value.280) and hand (P-value 0.947) images. We found a significant difference in image quality between standoff devices for the soft tissue foreign body model (P-value 0.039), favoring larger intravenous fluid bag standoff over standard devices.

Conclusions

In the absence of a standard commercial gel standoff device or water bath, intravenous fluid bags of 50, 100, and 250 mL can facilitate quality image acquisition for musculoskeletal POCUS.
Cosmopsychism, Coherence, and World-Affirming Monism
Authors: Shani Itay
Published: October 2021

This paper explores cosmopsychism’s explanatory aspirations from a programmatic perspective. The bulk of the text consists of an argument in favor of the conclusion that cosmopsychism suffers from no insurmountable individuation problem (IND). I argue that the widespread tendency to view IND as a mirror-image of micropsychism’s combination problem (CP) is mistaken. In particular, what renders CP insolvable, namely, the commitment to the coupling of phenomenal constitution with phenomenal inclusion, is, from the standpoint of cosmopsychism, an entirely nonmandatory assumption. I proceed to show that severing this unhappy coupling is the key for defending cosmopsychism against the charge of theoretical incoherence. Moreover, I argue that successful defense against such accusation could be mounted regardless of whether or not we assume cosmic consciousness to be perspectival in nature. In addition, the paper touches upon another foundational issue: cautioning against the popular tendency to identify cosmopsychism’s monism with a mereological unity-in-diversity, and motivating an alternative conception which I call generative monism. Finally, as befitting this volume, I pause to reflect upon the question of which schools of Hindu philosophy might tally best, and connect most fruitfully, with cosmopsychism as I understand it.
From genotype to phenotype inArabidopsis thaliana:in-silicogenome interpretation predicts 288 phenotypes from sequencing data
Authors: Raimondi Daniele , Corso Massimiliano , Fariselli Piero , Moreau Yves
Published: October 2021

In many cases, the unprecedented availability of data provided by high-throughput sequencing has shifted the bottleneck from a data availability issue to a data interpretation issue, thus delaying the promised breakthroughs in genetics and precision medicine, for what concerns Human genetics, and phenotype prediction to improve plant adaptation to climate change and resistance to bioagressors, for what concerns plant sciences. In this paper, we propose a novel Genome Interpretation paradigm, which aims at directly modeling the genotype-to-phenotype relationship, and we focus on A. thaliana since it is the best studied model organism in plant genetics. Our model, called Galiana, is the first end-to-end Neural Network (NN) approach following the genomes in/phenotypes out paradigm and it is trained to predict 288 real-valued Arabidopsis thaliana phenotypes from Whole Genome sequencing data. We show that 75 of these phenotypes are predicted with a Pearson correlation ≥0.4, and are mostly related to flowering traits. We show that our end-to-end NN approach achieves better performances and larger phenotype coverage than models predicting single phenotypes from the GWAS-derived known associated genes. Galiana is also fully interpretable, thanks to the Saliency Maps gradient-based approaches. We followed this interpretation approach to identify 36 novel genes that are likely to be associated with flowering traits, finding evidence for 6 of them in the existing literature.
Observation of 1D Fermi arc states in Weyl semimetal TaAs
Authors: Zheng Xiaohu , Gu Qiangqiang , Liu Yiyuan , Tong Bingbing , Zhang Jian-Feng , Zhang Chi , Jia Shuang , Feng Ji , Du Rui-Rui
Published: October 2021

Fermi arcs on Weyl semimetals exhibit many exotic quantum phenomena. Usually found on atomically flat surfaces with approximate translation symmetry, Fermi arcs are rooted in the peculiar topology of bulk Bloch bands of 3D crystals. The fundamental question of whether a 1D Fermi arc can be probed remains unanswered. Such an answer could significantly broaden potential applications of Weyl semimetals. Here, we report a direct observation of robust edge states on atomic-scale ledges in TaAs using low-temperature scanning tunneling microscopy/spectroscopy. Spectroscopic signatures and theoretical calculations reveal that the 1D Fermi arcs arise from the chiral Weyl points of bulk crystals. The crossover from 2D Fermi arcs to eventual complete localization on 1D edges was arrested experimentally on a sequence of surfaces. Our results demonstrate extreme robustness of the bulk-boundary correspondence, which offers topological protection for Fermi arcs, even in cases in which the boundaries are at the atomic-scale. The persistent 1D Fermi arcs can be profitably exploited in miniaturized quantum devices.
Optimal Cutoff Concentration of Urinary Cyanoethyl Mercapturic Acid for Differentiating Cigarette Smokers From Nonsmokers
Authors: Bhandari Deepak , Zhang Luyu , Zhu Wanzhe , De Jesús Víctor R , Blount Benjamin C
Published: October 2021

Introduction

Cotinine is a widely used biomarker for classifying cigarette smoking status. However, cotinine does not differentiate between the use of combustible and noncombustible tobacco products. The increasing use of noncombustible tobacco drives the need for a complementary biomarker for distinguishing cigarette smokers from users of noncombustible tobacco products.

Aims and Methods

We evaluated the urinary acrylonitrile metabolite, 2CyEMA, as a biomarker of exposure to cigarette smoke in the US population-representative data from the National Health and Nutritional Examination Survey (NHANES). Smoking status was categorized based on the recent tobacco use questionnaire. The receiver operating characteristic (ROC) curve analysis was performed to identify optimal cutoff concentrations by maximizing Youden’s J index. The area under the curve (AUC) was used to compare 2CyEMA effectiveness with respect to serum cotinine.

Results

The overall cutoff concentration for the classification of cigarette smokers from nonsmokers was 7.32 ng/ml with high sensitivity and specificity (≥0.925). When stratified by demographic variables, the cutoff concentrations varied among subgroups based on age, sex, and race/Hispanic origin. Non-Hispanic Blacks had the highest cutoff concentration (15.3 ng/ml), and Hispanics had the lowest (4.63 ng/ml). Females had higher cutoff concentrations (8.80 ng/ml) compared to males (6.10 ng/ml). Among different age groups, the cutoff concentrations varied between 4.63 ng/ml (21–39 years old) and 10.6 ng/ml (for ≥60 years old). We also explored the creatinine adjusted cutoff values.

Conclusions

2CyEMA is an effective biomarker for distinguishing cigarette smokers from nonsmokers (users of noncombustible tobacco products or nonusers).

Implications

Distinguishes smokers from noncombustible tobacco product users.
Finite-N superconformal index via the AdS/CFT correspondence
Authors: Imamura Yosuke
Published: October 2021

We propose a prescription to calculate the superconformal index of the ${\cal N}=4$U(N) supersymmetric Yang–Mills theory with finite N on the anti-de Sitter side. The finite-N corrections are included as contributions of D3-branes wrapped around three-cycles in ${\boldsymbol S}^5$, which are calculated as the index of the gauge theories realized on the wrapped branes. The single-wrapping contribution has been studied in a previous work, and we further confirm that the inclusion of multiple-wrapping contributions correctly reproduces the higher-order terms as far as we have checked numerically.
Patient Preferences for Antipsychotic Drug Side Effects: A Discrete Choice Experiment
Authors: McCrone Paul , Mosweu Iris , Yi Deokhee , Ruffell Tamatha , Dalton Bethan , Wykes Til
Published: October 2021

Background

Development of pharmaceutical interventions for schizophrenia emphasizes clinical efficacy and subsequent effectiveness and cost-effectiveness. However, given the many side effects of antipsychotic medication, it is important to consider the importance of different side effects on the preferences that people with schizophrenia have for different drugs. This study aims to use a discrete choice experiment to elicit patient preferences for antipsychotic medication with different side effects profiles.

Method

Preferences for antipsychotic side effects were investigated using a discrete choice experiment conducted in south London. 297 participants with a schizophrenia diagnosis who had been in receipt of anti-psychotic medication for a minimum of one month were included. Participants were presented with a sequence of choices involving five antipsychotic side effects (attributes) each with four levels. Conditional logit models were used to determine the side effects most (and least) likely to be preferred by people prescribed antipsychotics. Subgroup analyses explored the impact of side effects by gender, ethnicity, age, and symptoms.

Results

As expected, participants tended to value antipsychotic medications offering the least side effects, and the model coefficients were in the expected direction. For the whole sample and subgroups, memory and fatigue were the most important side effects, whereas palpations and mobility were the least important.

Conclusions

Participants had a strong preference for medications with the least side effects on memory and fatigue. These findings should inform drug development by pharmaceutical companies and prescribing practice by clinicians.
Longitudinal association of actigraphy-assessed sleep with physical growth in the first 6 months of life
Authors: Li Xiaoyu , Haneuse Sebastien , Rueschman Michael , Kaplan Emily R , Yu Xinting , Davison Kirsten K , Redline Susan , Taveras Elsie M
Published: October 2021

Study Objectives

Suboptimal sleep is associated with obesity and its sequelae in children and adults. However, few studies have examined the association between sleep and physical growth in infants who experience rapid changes in sleep/wake patterns. We examined the longitudinal association of changes in objectively assessed sleep/wake patterns with changes in growth between ages 1 and 6 months.

Methods

We studied 298 full-term infants in the longitudinal Rise & SHINE cohort study. Changes from 1 and 6 months in nighttime sleep duration, wake after sleep onset (WASO), and number of waking bouts ≥5 min were assessed using ankle actigraphy. Overweight was defined as age- and sex-specific weight for length ≥95th percentile. Generalized estimating equation analyses adjusted for infants′ and mothers′ characteristics.

Results

The mean (SD) birth weight was 3.4 (0.4) kg; 48.7% were boys. In multivariable adjusted models, each 1-h increase in nighttime sleep duration between months 1 and 6 was associated with a 26% decrease in the odds of overweight from 1 to 6 months (odds ratio [OR] = 0.74; 95% confidence interval [CI, 0.56, 0.98]). Each 1-unit decrease in number of waking bouts was associated with a 16% decrease in the odds of overweight (OR = 0.84; 95% CI [0.72, 0.98]). Changes in WASO were not associated with the odds of overweight.

Conclusions

Greater increases in nighttime sleep duration and more consolidation of nighttime sleep were associated with lower odds of overweight from 1 to 6 months. Adverse sleep patterns as early as infancy may contribute to excess adiposity.
Predictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil
Authors: Frata Bruna , Souza Janaina M , Montemezzo Dayane , Henning Elisa , Menegol Natalia A , Okubo Rodrigo , Sonza Anelise , Sanada Luciana S
Published: October 2021

Background

The use of technology is an increasingly common practice among preschoolers. Little is known about the relationship between screen time exposure (STE) and aspects related to family and the environment.

Aim

The aim is to characterize STE in Brazilian children aged between 3 and 5 years. Furthermore, the objective of this study is to associate the STE of children and of their parents with sociodemographic variables.

Methods

Children aged between 3 and 5 years from southern Brazil and their parents participated in this study. To investigate STE, the researchers developed a specific questionnaire. To compare STE between age groups, the Kruskal–Wallis test was performed, followed by Dunn’s post hoc test. Spearman’s correlation and linear regression were used to correlate the variables.

Results

Children (n = 237) spend an average of 3.7 ± 0.8 h/day in front of screens. The STE of children had a moderately positive correlation with the STE of their parents (r = 0.4; p-value < 0.001). Only the variables of the children’s and parents’ STE had a significant and positive association. The model is significant (F = 6164, p-value < 0.001) and the residuals of the model met the necessary assumptions, with normal distribution, constant variance and without the presence of outliers.

Conclusion

Children in southern Brazil remain in front of screens four times longer than the recommended amount of time. It was also found that the STE of parents directly influences that of their children.
Belatacept Conversion in Kidney After Liver Transplantation
Authors: Cristea Octav , Karadkhele Geeta , Kitchens William H. , Vasanth Payaswini , Larsen Christian P. , Badell Idelberto R.
Published: October 2021

Background.

Costimulatory blockade with belatacept has demonstrated long-term benefits in renal transplantation, but de novo use in liver transplant recipients has resulted in increased rejection, graft loss, and death. However, belatacept conversion as a calcineurin inhibitor (CNI) avoidance strategy has not been studied and may be of benefit in liver transplantation where CNI-induced renal dysfunction and toxicity are barriers to improved outcomes.

Methods.

Using clinical data extracted from our institutional medical record, we report on 8 patients who underwent kidney after liver transplantation and were treated with belatacept-based immunosuppression and transient CNI therapy.

Results.

All patients tolerated belatacept therapy without any patient deaths or graft losses. No episodes of rejection, de novo donor-specific antibody formation, or major systemic infections were observed, and all patients demonstrated preserved liver and excellent renal allograft function. Patients received belatacept for a median duration of 13.2 mo, and at a median follow-up of 15.9 mo post–kidney transplant, 6 of 8 patients continued on belatacept with 3 completely off and 3 poised to transition off CNI.

Conclusions.

These findings are the first evidence that in liver transplant recipients requiring subsequent kidney transplantation, belatacept-based therapy can potentially facilitate CNI-free maintenance immunosuppression. This supports the possibility of belatacept conversion in stand-alone liver transplant recipients as a viable method of CNI avoidance.
Attitudes towards glaucoma genetic risk assessment in unaffected individuals
Authors: Hollitt Georgina L , Siggs Owen M , Ridge Bronwyn , Keane Miriam C , Mackey David A , MacGregor Stuart , Hewitt Alex W , Craig Jamie E , Souzeau Emmanuelle
Published: October 2021

Integrating polygenic risk scores (PRS) into healthcare has the potential to stratify an individual’s risk of glaucoma across a broad population. Glaucoma is the most common cause of irreversible blindness worldwide, therefore effective screening for glaucoma endorsed by the population is highly important. This study assessed the attitude of unaffected individuals towards PRS testing for glaucoma, and sought to identify factors associated with interest in testing. We surveyed 418 unaffected individuals including those with a first-degree relative with glaucoma (n=193), those who had a recent eye examination (n=117), and general members of the community (n=108). Overall, 71.3% indicated an interest in taking a polygenic risk test for glaucoma. Interest was more likely in those who believed glaucoma to be a severe medical condition (OR 14.58, 95%CI (1.15-185.50), p=0.039), those concerned about developing glaucoma (OR 4.37, 95%CI (2.32-8.25), p<0.001), those with an intention to take appropriate measures regarding eye health (OR 2.39, 95%CI (1.16-4.95), p=0.019), and those preferring to know if considered to be at-risk or not (OR 4.52, 95%CI (2.32-8.83), p<0.001). These findings represent a valuable assessment of general public interest in glaucoma polygenic risk testing, which will be integral to the implementation and uptake of novel PRS based tests into clinical practice.
COVID-19: Knowledge, Perception of Risk, Preparedness and Vaccine Acceptability among Healthcare Workers in Kenya
Authors: Abdulle Hafso Mohamed , Masika Moses Muia , Oyugi Julius Otieno
Published: October 2021

Background

Coronaviruses are highly contagious and healthcare workers are at a higher risk of contracting the disease. The objective of this study was to assess the level of knowledge, risk perception, preparedness for coronavirus disease 2019 and vaccine acceptability among healthcare workers in Kenya.

Methods

A cross-sectional study was conducted from December 2020 to January 2021. A link to an online self-administered questionnaire was disseminated to health workers across the country. SPSS version 20 was used for data analysis. Bivariate correlation analyses were used to determine associations between variables. P-value of <0.05 was considered statistically significant.

Results

A total of 997 participants were enrolled in the study. About half (53%) of the participants were female. The mean age was 36.54 years (SD = 8.31) and 46% of the participants were aged between 31-40years. The overall knowledge score of health workers for COVID-19 was 80%. Most of the health workers (89%) perceived that they were at high risk of infection. Seventy-two percent of the participants felt that they were either partially or fully prepared to handle patients with COVID-19. Overall, 71% of all health workers would take a vaccine if provided free by the government.

Conclusion

Health workers’ knowledge on transmission, clinical manifestations and risk factors for development of severe COVID-19 was good. Majority of the health workers perceived the risk of infection with COVID-19 as high and a significant number felt that they were not fully prepared to handle the pandemic. Majority of health workers would take a COVID-19 vaccine.
Small Airway Disease as long-term Sequela of COVID-19: Use of Expiratory CT despite Improvement in Pulmonary Function test
Authors: Garg Alpana , Nagpal Prashant , Goyal Sachin , Comellas Alejandro P.
Published: October 2021

Background

It is important to understand the spectrum of pulmonary diseases that patients are presenting after recovery from initial SARS-CoV-2 infection. We aim to study small airway disease and changes in Computed Tomography (CT)and pulmonary function tests (PFTs) with time.

Methods

This is retrospective observation study including adult patients with confirmed SARS-CoV-2 infection with at-least two CT scans either during acute (defined as <1 month) or subacute (1-3 months) or chronic (>3months) phase after positive test. Radiological features and follow up PFTs were obtained.

Results

22 patients met the inclusion criteria with mean age 57.6 years (range 36-83). Out of these,18 (81.81%) were hospitalized. Mean duration of diagnosis to CT and PFT was 192.68(112-385) days and 161.54(31-259) days respectively. On PFTs, restrictive pulmonary physiology was predominant finding during subacute 56.25% (9/16) and chronic phases 47% (7/15). PFTs improved significantly with time {FEV1((p=0.0361), FVC (p=0.0341), FEF 25%-75% (p=0.0259) and DLCO (p=0.0019)}, but there was persistent air trapping in the expiratory chronic phase CT. There was resolution of ground glass opacity, consolidation, and bronchiectasis however air trapping increased with time in 41.61% (10/21) of subacute CTs compared to 81.25% (13/16) in chronic CTs.

Conclusion

Our study shows evidence of airway as well as parenchymal disease as relatively long-term sequel of SARS-CoV-2 infection. It also highlights the natural course and spontaneous recovery of some radiological and pulmonary function test abnormalities over time with evidence of persistent small airway disease (air trapping) on expiratory CT imaging months after infection.

Highlights

Long term pulmonary complication of SARS-CoV-2 infection include small airway disease

There is role of inspiratory and expiratory Computed tomography (CT) scan to identify air trapping in patients with persistent respiratory symptoms after SARS-CoV-2 infection

Normal spirometry and normal routine CT may not be sufficient to characterize and identify cause of persistent respiratory complains in patients after COVID-19

This study highlights persistent parenchymal and physiological airway abnormalities more than six months after recovery from initial SARS-CoV-2 infection
Metagenomic analysis of the abundance and composition of antibiotic resistance genes in hospital wastewater in Benin, Burkina Faso, and Finland
Authors: Markkanen Melina A. , Haukka Kaisa , Pärnänen Katariina M. M. , Dougnon Victorien Tamegnon , Bonkoungou Isidore Juste O. , Garba Zakaria , Tinto Halidou , Sarekoski Anniina , Karkman Antti , Kantele Anu , Virta Marko P. J.
Published: October 2021

Antibiotic resistance is one of the greatest global threats to human health, but substantial gaps in antibiotic resistance data exist in West African countries. We explored the presence of antibiotic resistance genes (ARGs) in the hospital wastewater (HWW) of nine hospitals in Benin and Burkina Faso and, for comparison, four hospitals in Finland using shotgun metagenomic sequencing. The highest sum of the relative abundance of ARGs in the 68 HWW samples was detected in Benin and the lowest in Finland. HWW resistomes and mobilomes in Benin and Burkina Faso resembled more of each other than those in Finland. Different carbapenemases were detected in varying abundances, especially in HWW from Burkina Faso and Finland. TheblaGES genes, the most widespread carbapenemase genes in the Beninese HWW, were also found in water intended for hand-washing and in a puddle at the hospital yard in Benin.mcrwere detected in the HWW of all three countries, withmcr-5being the most commonmcrgene. These and othermcrgenes were observed in very high relative abundances, even in treated wastewater in Burkina Faso and in a street gutter in Benin. The results provide evidence for public health decision-makers for the dire need to increase wastewater treatment capacity, with particular attention to HWW.

Importance

The global emergence and increased spread of antibiotic resistance threaten the effectiveness of antibiotics and, thus, the health of the entire population. Therefore, understanding the resistomes in different geographical locations is crucial in the global fight against the antibiotic crisis. However, this information is scarce in many low- and middle-income countries (LMICs), such as those in West Africa. In this study, we describe the resistomes of hospital wastewater in Benin and Burkina Faso and, as a comparison, in Finland. Our results help to understand the hitherto unrevealed resistance in Beninese and Burkinabe hospitals. Furthermore, the results emphasize the importance of wastewater management infrastructure design to minimize exposure events between humans, HWW, and the environment, preventing the circulation of resistant bacteria and ARGs between humans (hospitals and community) and the environment.
Escherichia colistrains from patients with inflammatory bowel diseases have disease-specific genomic adaptations
Authors: Dubinsky Vadim , Reshef Leah , Rabinowitz Keren , Wasserberg Nir , Dotan Iris , Gophna Uri
Published: October 2021

Objective

Escherichia coliis over-abundant in the gut microbiome of patients with IBD, yet most studies have focused on the adherent-invasiveE. colipathotype. Here, we aimed to identify IBD-specific or phenotype-specific genomic functions of diverseE. colilineages.

Design

We investigatedE. colifrom patients with UC, CD and a pouch and healthy subjects. The majority ofE. coligenomes were reconstructed directly from metagenomic samples, including publicly available and newly sequenced fecal metagenomes. Clinical metadata and biomarkers were collected. Functional analysis at the gene and mutation level and genome replication rates ofE. coli strainswere performed, and correlated with IBD phenotypes and biomarkers.

Results

Overall, 530E. coligenomes were analysed. A specificE. colilineage (B2) was more prevalent in UC compared to other IBD phenotypes. Genomic metabolic capacities varied acrossE. colilineages and IBD phenotypes. Specifically,sialidases involved in host mucin utilization, were exclusively present in a single lineage and were depleted in patients with a pouch. In contrast, enzymes that hydrolyze inulin were enriched in patients with a pouch.E. colifrom patients with UC were twice as likely to encode the genotoxic molecule colibactin than strains from patients with CD or pouch. Strikingly, patients with a pouch showed the highestE. coligrowth rates, even in the presence of antibiotics. Fecal calprotectin did not correlate with the relative abundance ofE. coli. Finally, we identified multiple IBD-specific loss-of function mutations inE. coligenes encoding for bacterial cell envelope and secretion components.

Conclusion

This study presentsE. colias a commensal species better adapted to the overly-active mucosal immune milieu in IBD, that may benefit from intestinal inflammation, rather than causing it. The evidence given here suggests adaptive evolution toward attenuated virulence in someE. colistrains, coupled with a rapid growth despite the presence of antibiotics.
Intracerebral Hemorrhage Detection in Computed Tomography Scans Through Cost-Sensitive Machine Learning
Authors: Goyal Rushank
Published: October 2021

Abstract

Purpose

Intracerebral hemorrhage is the most severe form of stroke, with a greater than 75% likelihood of death or severe disability, and half of its mortality occurs in the first 24 hours. The grave nature of intracerebral hemorrhage and the high cost of false negatives in its diagnosis are representative of many medical tasks.

Approach

Cost-sensitive machine learning has shown promise in various studies as a method of minimizing unwanted results. In this study, 6 machine learning models were trained on 160 computed tomography brain scans both with and without utility matrices based on penalization, an implementation of cost-sensitive learning.

Results

The highest-performing model was the support vector machine, which obtained an accuracy of 97.5%, sensitivity of 95% and specificity of 100% without penalization, and an accuracy of 92.5%, sensitivity of 100% and specificity of 85% with penalization, on a dataset of 40 scans. In both cases, the model outperforms a range of previous work using other techniques despite the small size of, and high heterogeneity in, the dataset.

Conclusion

Utility matrices demonstrate strong potential for sensitive yet accurate artificial intelligence techniques in medical contexts and workflows where a reduction of false negatives is crucial.