bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Computed Tomography Angiography in the Clinical Workflow of Athletes With Anomalous Origin of Coronary Arteries From the Contralateral Valsalva Sinus
Authors: Marano Riccardo , Merlino Biagio , Savino Giancarlo , Natale Luigi , Rovere Giuseppe , Paciolla Fabiano , Muciaccia Massimo , Flammia Francesco C. , Larici Anna R. , Palmieri Vincenzo , Zeppilli Paolo , Manfredi Riccardo
Published: May 2020

Purpose:

This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management.

Materials and Methods:

Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO).

Results:

CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3±11.0 y) and 22 AORCA (18 males; 29.1±16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6±39.5 months.

Conclusion:

CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.
Four-Corner Arthrodesis Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse
Authors: Amer Kamil M. , Thomson Jennifer E. , Vosbikian Michael M. , Ahmed Irfan
Published: May 2020

Background

Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for individuals with symptomatic SLAC and degenerative disease that affects the radioscaphoid joint. The most popular options for motion-preserving reconstruction and treatment of this disease include 4-corner arthrodesis and proximal row carpectomy. The purpose of this article was to conduct a systematic literature review and meta-analysis to identify any differences in the clinical outcomes of 4-corner arthrodesis and proximal row carpectomy for the treatment of SLAC.

Methods

An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies evaluating the clinical outcomes of 4-corner arthrodesis versus proximal row carpectomy for the treatment of SLAC. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain.

Results

Eight studies encompassing 311 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4-corner arthrodesis, patients who underwent proximal row carpectomy had statistically significantly increased flexion/extension range of motion by 6.2 degrees, significantly increased grip strength by 1.52%, and reduced level of pain by 0.3.

Conclusions

This study demonstrated that in comparative studies, there was a statistical difference favoring proximal row carpectomy to 4-corner arthrodesis for the treatment of SLAC. Although these differences were statistically significant, they remain very small and lack clinical relevance. This study further supports that both of these treatment options are equivalent for the treatment of this disease. Although not clinically significant, compared with 4-corner arthrodesis, patients treated with proximal row carpectomy had increased range of motion, increased grip strength, and decreased pain. Limitations to these findings are the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.
Inaccuracies in Postoperative Inpatient Stays Assumed in the Valuation of Surgical RVUs
Authors: Childers Christopher P. , Maggard-Gibbons Melinda
Published: May 2020

Objective:

The aim of this study was to assess the accuracy of inpatient postoperative visits assumed in the valuation of surgical relative value units (RVUs).

Summary Background Data:

Medicare reimburses physicians based on the number of RVUs assigned to a service. For surgical procedures with a 10- or 90-day global period, the RVU valuation is based, in part, on a presumed number of inpatient postoperative visits whether or not those visits occur. The Centers for Medicare and Medicaid Services (CMS) have recently proposed changing all surgical procedures to a 0-day global period.

Methods:

We combined 2017 National Surgical Quality Improvement (NSQIP) data with physician time and RVU files from CMS. We then compared the number of inpatient postoperative visits assumed in the valuation to actual length of stay (LOS) information from the surgical registry.

Results:

The analysis included 10 specialties and 601 distinct current procedural terminology codes. The number of patient observations underlying NSQIP LOS estimates ranged from 50 to 57,904. Eighty-three percent of procedures had median NSQIP LOS values that were shorter than the values assumed in the global period. These differences varied by specialty, with the largest discrepancy in neurosurgery. Procedures in this sample were last reviewed, on average, in 2000, with procedures reviewed more recently having more accurate valuations with respect to LOS.

Conclusions:

The number of postoperative visits assumed in the valuation of surgical RVUs is grossly inaccurate. Holding all else equal, removing global periods from surgical RVUs would dramatically reduce surgeon compensation.
Interhospital Variations in Resource Use Intensity for In-hospital Injury Deaths
Authors: Farhat Imen , Moore Lynne , Porgo Teegwendé Valérie , Assy Coralie , Belcaid Amina , Berthelot Simon , Stelfox Henry T. , Gabbe Belinda J. , Lauzier François , Clément Julien , Turgeon Alexis F.
Published: May 2020

Objective:

Evaluate interhospital variation in resource use for in-hospital injury deaths.

Background:

Significant variation in resource use for end-of-life care has been observed in the US for chronic diseases. However, there is an important knowledge gap on end-of-life resource use for trauma patients.

Methods:

We conducted a multicenter, retrospective cohort study of injury deaths following hospitalization in any of the 57 trauma centers in a Canadian trauma system (2013–2016). Resource use intensity was measured using activity-based costing (2016 $CAN) according to time of death (72 h, 3–14 d, ≥14 d). We used multilevel log-linear regression to model resource use and estimated interhospital variation using intraclass correlation coefficients (ICC).

Results:

Our study population comprised 2044 injury deaths. Variation in resource use between hospitals was observed for all 3 time frames (ICC = 6.5%, 6.6%, and 5.9% for < 72 h, 3–14 d, and ≥14 d, respectively). Interhospital variation was stronger for allied health services (ICC = 18 to 26%), medical imaging (ICC = 4 to 10%), and the ICU (ICC = 5 to 6%) than other activity centers. We observed stronger interhospital variation for patients < 65 years of age (ICC = 11 to 34%) than those ≥65 (ICC = 5 to 6%) and for traumatic brain injury (ICC = 5 to 13%) than other injuries (ICC = 1 to 8%).

Conclusions:

We observed variation in resource use intensity for injury deaths across trauma centers. Strongest variation was observed for younger patients and those with traumatic brain injury. Results may reflect variation in level of care decisions and the incidence of withdrawal of life-sustaining therapies.
Real-Word Effectiveness and Safety of Dimethyl Fumarate in a Multiple Sclerosis Portuguese Population
Authors: Barros Ariana , Sequeira João , de Sousa Ary , Parra Joana , Brum Marisa , Pedrosa Rui , Capela Carlos
Published: May 2020

Objectives

The aim of this study was to evaluate postmarketing dimethyl fumarate (DMF) safety and effectiveness in a real-world population with relapsing-remitting multiple sclerosis (RRMS).

Methods

This was a retrospective, single-center study with RRMS patients treated with DMF. Demographic, clinical, and imagiological characteristics were analyzed, including annualized relapse rate (ARR), Expanded Disability Status Scale, “No Evidence of Disease Activity 3,” previous treatment, adverse events, treatment duration, and reason for discontinuation. We investigated which baseline variables were associated with clinical and radiological outcomes.

Results

We included 176 patients (70.4% females) with a median on-treatment follow-up time of 25.5 months. In total, 139 patients received prior disease-modifying therapies, and 37 were treatment-naive. Annualized relapse rate decreased by 77.1% in the total population (P < 0.001) and also decreased in the naive, tolerability switch, and efficacy switch groups by 95.8%, 56.7%, and 76.6% (P < 0.001). No Evidence of Disease Activity 3 status after 12 months of DMF treatment was maintained in 69.2% patients. Thirty patients (17%) discontinued treatment because of adverse drug reactions, and 21 (11.9%) because of lack of effectiveness. The occurrence of first relapse during follow-up was associated with higher ARR in the year before DMF start (hazard ratio, 4.833; P < 0.001) and prior exposure to multiple sclerosis treatments (tolerability and efficacy switchers).

Conclusions

In this real-world audit, DMF appeared to be effective and safe for RRMS. Additionally, the study suggested that naive patients strongly benefit from DMF, and DMF also improves ARR in patients who switched from injectable therapies due to tolerability and efficacy issues.
Avoidable and Unavoidable Pressure Injuries Among Residents Living in Nursing Homes
Authors: Palese Alvisa , Zammattio Erica , Zuttion Ranieri , Ferrario Barbara , Ponta Sandra , Gonella Silvia , Comoretto Rosanna
Published: May 2020

PURPOSE:

The aim of this study was to describe the prevalence of unavoidable pressure injuries (UPIs) in residents of nursing homes (NHs) and characteristics associated with UPIs.

DESIGN:

A retrospective study.

SUBJECTS AND SETTING:

Residents 65 years or older residing in any of 105 NHs in the Friuli Venezia Giulia region of Italy between January and December 2013.

METHODS:

Database search comprised of a multidimensional assessment of NH residents.

RESULTS:

Data from 7950 residents were reviewed, 925 (11.6%) of whom had 1 or more documented pressure injuries (PIs). Among these, 221 (23.9%) residents met criteria for avoidable PIs (APIs) and 704 (76.1%) for UPIs. Residents with UPIs were more frequently hemodynamically unstable, terminally ill, and had medical devices (all Ps < .001) than residents with APIs. Moreover, residents with UPIs showed higher functional, cognitive, and mood impairments compared to residents with APIs (all Ps < .001).

CONCLUSIONS:

Our findings suggest a high prevalence of UPIs compared to APIs among residents residing in NHs in one region of Italy. Additional research is needed to establish the prevalence of UPIs among NH residents country-wide, as well as determine specific criteria that identify UPIs in long-term care settings and increase consistency in prevalence and incidence measurement models.
Stigma and Its Influence on Patients With Temporary Ostomy
Authors: Qin Fang , Zhen Li , Ye Xinmei , Wei Huiqiang , Zhu Mulan , Chen Jiali , Shi Lei
Published: May 2020

PURPOSE:

The purpose of this study was to explore stigma and its influencing factors in Chinese patients with a temporary ostomy.

DESIGN:

Cross-sectional, descriptive.

SUBJECTS AND SETTING:

Convenience sampling was used to recruit 170 patients living with a temporary ostomy for at least 2 weeks. Participants were recruited from 3 general hospitals in Guangdong province, located in southeastern China.

METHODS:

Respondents completed a questionnaire that included ostomy-related sociodemographic questionnaire, the Social Impact Scale, and the Stoma Self-Efficacy Scale. Multivariate linear regression was used to identify factors influencing stigma.

RESULTS:

Of the 170 questionnaires distributed, 159 (93.5%) respondents who sufficiently completed responses were included in the final analysis. The average score of the Social Impact Scale was 61.63 (SD = 8.39), reflecting a moderate level of stigma, and 27 (17%) experienced high levels of stigma. Multivariate regression analysis revealed that stigma was associated with family relationships (B = 6.139, P = .000), age when ostomy was created (B = −4.038, P = .000), and self-efficacy (B = −0.080, P = .002).

CONCLUSIONS:

The level of stigma in Chinese patients with temporary ostomies is moderate. Multivariate regression analysis identified family relationship, age, and self-efficacy as the main factors that influenced stigma in patients with temporary ostomy.
Pathogenesis and remission of type 2 diabetes: what has the twin cycle hypothesis taught us?
Authors: Al-Mrabeh Ahmad
Published: May 2020

Type 2 diabetes has been regarded a complex multifactorial disease that lead to serious health complications including high cardiovascular risks. The twin cycle hypothesis postulated that both hepatic insulin resistance and dysfunction rather than death of beta (β) cell determine diabetes onset. Several studies were carried out to test this hypothesis, and all demonstrated that chronic excess calorie intake and ectopic fat accumulation within the liver and pancreas are fundamental to the development of this disease. However, these recent research advances cannot determine the exact cause of this disease. In this review, the major factors that contribute to the pathogenesis and remission of type 2 diabetes will be outlined. Importantly, the effect of disordered lipid metabolism, characterized by altered hepatic triglyceride export will be discussed. Additionally, the observed changes in pancreas morphology in type 2 diabetes will be highlighted and discussed in relation to β cell function.
Estimation of Transmission Potential and Severity of COVID–19 in Romania and Pakistan
Authors: Ozair Muhammad , Hussain Takasar , Hussain Mureed , Awan Aziz Ullah , Baleanu Dumitru
Published: May 2020

During the outbreak of an epidemic, it is of immense interest to monitor the effects of containment measures and forecast of outbreak including epidemic peak. To confront the epidemic, a simple SIR model is used to simulate the number of affected patients of Coronavirus disease in Romania and Pakistan. The model captures the growth in case onsets and the estimated results are almost compatible with the actual reported cases. Through the calibration of parameters, forecast for the appearance of new cases in Romania and Pakistan is reported till the end of this year by analysing the current situation. The constant level of number of patients and time-to-reach this level is also reported through the simulations. The drastic condition is also discussed which may occur if all the preventive restraints are removed.
Predictions of Covid-19 Related Unemployment On Suicide and All-cause Mortality
Authors: Bhatia Rajiv
Published: May 2020

Importance

The Covid-19 pandemic has driven behavioral and governmental responses with large impacts on economic activity. Estimates of indirect health effects of economic impacts may inform societal action.

Objective

To estimate the size of the impact of Covid-19 unemployment on suicides and deaths from all causes.

Design

Risk assessment applying of pooled effects hazard ratios from published meta-analyses of observational epidemiological studies, post-Covid-19 unemployment, current labor force composition data, and current age-adjusted mortality rates.

Results

This risk assessment estimates approximately 9,700 excess annual deaths from suicide and 66,000 annual deaths from all causes among those recently unemployed due to Covid-19.

Conclusions and Relevance

Indirect health impacts of societal responses to Covid-19 are identifiable, multiple and quantifiable. Adverse health impacts, such as those from unemployment, may endure longer than those of the Covid-19 pandemic itself. Decision-makers can include indirect health impacts in policy-making calculi for Covid-19 mitigation and suppression strategies.

Key Points

Question

What are the expected impacts of post Covid-19 unemployment on excess suicide and premature death.

Findings

A risk assessment applying pooled summary risk estimates from meta-analyses of observational studies predicts approximately 9,700 excess annual deaths from suicide and 66,000 annual deaths from all causes among those recently unemployed due to Covid-19.

Meaning

Indirect health impacts of societal responses to Covid-19 are identifiable, multiple and quantifiable.
Impact of hospitalised patients with COVID-19 taking Renin-Angiotensin-Aldosterone System inhibitors: a systematic review and meta-analysis
Authors: Baral Ranu , White Maddie , Vassiliou Vassilios S
Published: May 2020

Inhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) have been scrutinised in hypertensive patients hospitalised with coronavirus disease 2019 (COVID-19) following some initial data they might adversely affect prognosis. With an increasing number of COVID-19 cases worldwide and the likelihood of a “second wave” of infection it is imperative to better understand the impact RAAS inhibitor use in antihypertensive covid positive hospitalised patients.

A systematic review and meta-analysis of ACEi or ARB in patients admitted with COVID-19 was conducted. PubMed and Embase were searched and six studies were included in the meta-analysis. Pooled analysis demonstrated that 18.3% of the patients admitted with COVID-19 were prescribed ACEi/ARBs (0.183, CI 0.129 to 0.238, p<0.001). The use of RAAS inhibitors did not show any association with ‘critical’ events (Pooled OR 0.833 CI 0.605 to 1.148, p=0.264) or death (Pooled OR 0.650, CI 0.356 to 1.187, p=0.161). In conclusion, our meta-analysis including ‘critical’ events and mortality data on patients prescribed ACEi/ARB and hospitalised with COVID-19, found no evidence to associate ACEi/ARB with death or adverse events.
Sensitivity Optimisation of Tuberculosis Bioaerosol Sampling
Authors: Patterson Benjamin , Dinkele Ryan , Gessner Sophia , Morrow Carl , Kamariza Mireille , Bertozzi Carolyn R. , Kamholz Andrew , Bryden Wayne , Call Charles , Warner Digby F. , Wood Robin
Published: May 2020

Introduction

Detection of Mycobacterium tuberculosis (Mtb) in patient-derived bioaerosol is a potential tool to measure source case infectiousness. However, current bioaerosol sampling approaches have reported low detection yields in sputum-positive TB cases. To increase the utility of bioaerosol sampling, we present advances in bioaerosol collection and Mtb identification that improve detection yields.

Methods

A previously described Respiratory Aerosol Sampling Chamber (RASC) protocol, or “RASC-1”, was modified to incorporate liquid collection of bioaerosol using a high-flow wet-walled cyclone (RASC-2). Individuals with GeneXpert-positive pulmonary TB were sampled pre-treatment over 60-minutes. Putative Mtb bacilli were detected in collected fluid by fluorescence microscopy utilising DMN-Trehalose. Exhaled air and bioaerosol volumes were estimated using continuous CO2 monitoring and airborne particle counting, respectively. Mtb capture was calculated per exhaled air volume sampled and bioaerosol volume for RASC-1 (n=35) and for RASC-2 (n=21). Empty chamber samples were collected between patients as controls.

Results

The optimised RASC-2 protocol sampled a median of 258.4L (IQR: 226.9-273.6) of exhaled air per patient compared with 27.5L (IQR: 23.6-30.3) for RASC-1 (p<0.0001). Bioaerosol volume collection was estimated at 2.3nL (IQR: 1.1-3.6) for RASC-2 compared with 0.08nL (IQR: 0.05-0.10) for RASC-1 (p<0.0001). The detection yield of viable Mtb improved from 43% (median 2 CFU, range: 1-14) to 95% (median 20.5 DMN-Trehalose positive bacilli, range: 2-155). These improvements represent a lowering of the limit of detection in the RASC-2 platform to 0.9 Mtb bacilli per 100L of exhaled air from 3.3 Mtb bacilli per 100L (RASC-1).

Conclusion

This study demonstrates that technical improvements in particle collection together with sensitive detection enable rapid quantitation of viable Mtb in bioaerosols of sputum positive TB cases. Increased sampling sensitivity may allow future TB transmission studies to be extended to sputum-negative and subclinical individuals, and suggests the potential utility of bioaerosol measurement for rapid intervention in other airborne infectious diseases.
Association between gait speed decline and EEG abnormalities in a cohort of active older adults living in the community
Authors: García-Agustin Daysi , Morgade-Fonte Rosa Ma. , Bobes María A , Galán-García Lídice , Rodríguez-Rodríguez Valia
Published: May 2020

Background

Age-related gait speed decline is associated with pathological brain changes. Despite EEG sensitivity for detecting alteration in the brain function, its clinical use to evaluate walking disorders is rare. In this study, we examined the association of subclinical gait speed deterioration in older individuals with changes in the EEG frequency composition as a marker of mild cerebral dysfunction.

Methods

We studied the gait speed of 90 physically active, community-dwelling older adults in two different appointments separated by an interval of 6 years. In the last assessment, resting-state EEG was acquired in all participants. After a visual clinical report, the EEG was transformed to the frequency domain, and the energy of each frequency band was compared against normative data.

Results

63 of 90 older individuals had gait speed deterioration, 87% of which also had an abnormal EEG frequency composition. EEG abnormalities were characterised by an increase in delta and theta bands power, higher than that expected for their age. We found some participants with gait speed decline that also had a decrease in alpha band power. EEG sensitivity for classifying participants with a deterioration in gait speed was 0.86, with a likelihood ratio of 2.9.

Conclusions

The subclinical gait speed decline found in this cohort was associated with significant changes in resting-state EEG frequency composition. The sensitivity of EEG frequency abnormalities for identifying older individuals with deterioration in gait speed supports its inclusion in the assessment pathway of older individuals at risk of developing gait disorders.

Key Points

-

Independent and physically active older individuals had a sub-clinical gait speed deterioration.

-

Gait speed decline was associated with abnormalities in the EEG frequency composition not expected for their age.

-

EEG frequency changes had a high sensitivity for classifying older adults with gait speed decline.

-

Inclusion of quantitative EEG in the assessment pathway of older adults at risk of mobility disorders could serve in the identification of associated mild brain dysfunction and help in decisions related to appropriate clinical management.
Impact of complete lock-down on total infection and death rates: A hierarchical cluster analysis
Authors: Ghosal Samit , Bhattacharyya Rahul , Majumder Milan
Published: May 2020

Introduction and Aims

Retarding the spread of SARS-CoV-2 infection by preventive strategies is the first line of management. Several countries have declared a stringent lock-down in order to enforce social distancing and prevent the spread of infection. This analysis was conducted in an attempt to understand the impact of lock-down on infection and death rates over a period of time.

Material and Methods

A validated database was used to generate data related to countries with declared lock-down. Simple regression analysis was conducted to assess the rate of change in infection and death rates. Subsequently, a k-means and hierarchical cluster analysis was done to identify the countries that performed similarly. Sweden and South Korea were included as counties without lock-down in a second-phase cluster analysis.

Results

There was a significant 61% and 43% reduction in infection rates 1-week post lock-down in the overall and India cohorts, respectively, supporting its effectiveness. Countries with higher baseline infections and deaths fared poorly compared to those who declared lock-down early on. Sweden and South Korea fared equally well, as most lock-down countries stemmed the growth of infection and death.

Conclusion

Lock-down has proven to be an effective strategy is slowing down the SARS-CoV-2 disease progression exponentially. However, lessons need to be learned from Sweden and South Korea on arresting the disease progression without imposing such stringent measures.
Intensive care risk estimation in COVID-19 pneumonia based on clinical and imaging parameters: experiences from the Munich cohort
Authors: Burian Egon , Jungmann Friederike , Kaissis Georgios A. , Lohöfer Fabian K. , Spinner Christoph D. , Lahmer Tobias , Treiber Matthias , Dommasch Michael , Schneider Gerhard , Geisler Fabian , Huber Wolfgang , Protzer Ulrike , Schmid Roland M. , Schwaiger Markus , Makowski Marcus R. , Braren Rickmer F.
Published: May 2020

The evolving dynamics of coronavirus disease 2019 (COVID-19) and the increasing infection numbers require diagnostic tools to identify patients at high risk for a severe disease course. Here we evaluate clinical and imaging parameters for estimating the need of intensive care unit (ICU) treatment. We collected clinical, laboratory and imaging data from 65 patients with confirmed COVID-19 infection based on PCR testing. Two radiologists evaluated the severity of findings in computed tomography (CT) images on a scale from 1 (no characteristic signs of COVID-19) to 5 (confluent ground glass opacities in over 50% of the lung parenchyma). The volume of affected lung was quantified using commercially available software. Machine learning modelling was performed to estimate the risk for ICU treatment. Patients with a severe course of COVID-19 had significantly increased IL-6, CRP and leukocyte counts and significantly decreased lymphocyte counts. The radiological severity grading was significantly increased in ICU patients. Multivariate random forest modelling showed a mean ± standard deviation sensitivity, specificity and accuracy of 0.72 ± 0.1, 0.86 ± 0.16 and 0.80 ± 0.1 and a ROC-AUC of 0.79 ± 0.1.

The need for ICU treatment is independently associated with affected lung volume, radiological severity score, CRP and IL-6.
Shared Antigen-specific CD8+ T cell Responses Against the SARS-COV-2 Spike Protein in HLA A*02:01 COVID-19 Participants
Authors: Chour William , Xu Alex M , Ng Alphonsus H.C. , Choi Jongchan , Xie Jingyi , Yuan Dan , Lee John K. , Delucia Diane C. , Edmark Rick , Jones Lesley , Schmitt Thomas M. , Chaffee Mary E. , Duvvuri Venkata , Greenberg Philip D. , Murray Kim , Wallick Julie , Algren Heather A. , Berrington William R. , O'Mahoney D. Shane , Goldman Jason D. , Heath James R
Published: May 2020

We report here on antigens from the SARS-CoV-2 virus spike protein, that when presented by Class I MHC, can lead to cytotoxic CD8+ T cell anti-viral responses in COVID-19 patients. We present a method in which the SARS-CoV-2 spike protein is converted into a library of peptide antigen-Major Histocompatibility Complexes (pMHCs) as single chain trimers that contain the peptide antigen, the MHC HLA allele, and the β-2 microglobulin sub-unit. That library is used to detect the evolution of virus-specific T cell populations from two COVID-19 patients, at two time points over the course of infection. Both patients exhibit similar virus-specific T cell populations, but very different time-trajectories of those populations. These results can be used to track those virus-specific T cell populations over the course of an infection, thus providing deep insight into the variations in immune system trajectories observed in different COVID-19 patients.
The Impact of Neurofeedback on Effective Connectivity Networks in Chronic Stroke Patients
Authors: Giulia Lioi , Adolfo Veliz , Julie Coloigner , Quentin Duché , Simon Butet , Fleury Mathis , Leveque-Le Bars Emilie , Bannier Elise , Lécuyer Anatole , Barillot Christian , Bonan Isabelle
Published: May 2020

Stroke is a complex motor disease that not only affects perilesional areas but also global brain networks in both hemispheres. Neurofeedback (NF) is a promising technique to enhance neural plasticity and support functional improvement after stroke by means of brain self-regulation. Most of the studies using NF or brain computer interfaces for stroke rehabilitation have assessed treatment effects focusing on motor outcomes and successful activation of targeted cortical regions. However, given the crucial role of large-scale networks reorganization for stroke recovery, it is now believed that assessment of brain connectivity is central to predict treatment response and to individualize rehabilitation therapies. In this study, we assessed the impact of EEG-fMRI NF training on connectivity strength and direction using a Dynamic Causal Modeling approach. We considered a motor network including both ipsilesional and contralesional premotor, supplementary and primary motor areas. Our results in nine chronic stroke patients indicate that NF upregulation of targeted areas (ipsilesional SMA and M1) not only modulated activation patterns, but also had a more widespread impact on fMRI bilateral motor networks. In particular, inter-hemispheric connectivity between premotor and primary motor regions decreased, and ipsilesional self-inhibitory connections were reduced in strength, indicating an increase in activation during the NF motor task. To the best of our knowledge, this is the first work that investigates fMRI connectivity changes elicited by training of localized motor targets in stroke. Our results open new perspectives in the understanding of large-scale effects of NF training and the design of more effective NF strategies, based on the pathophysiology underlying stroke-induced deficits.
Variation in SARS-CoV-2 free-living survival and environmental transmission can modulate the intensity of emerging outbreaks
Authors: Ogbunugafor C. Brandon , Miller-Dickson Miles D. , Meszaros Victor A. , Gomez Lourdes M. , Murillo Anarina L. , Scarpino Samuel V.
Published: May 2020

Variation in free-living, microparasite survival can have a meaningful impact on the ecological dynamics of established and emerging infectious diseases. Nevertheless, resolving the importance of environmental transmission in the ecology of epidemics remains a persistent challenge, requires accurate measuring the free-living survival of pathogens across reservoirs of various kinds, and quantifying the extent to which interaction between hosts and reservoirs generates new infections. These questions are especially salient for emerging pathogens, where sparse and noisy data can obfuscate the relative contribution of different infection routes. In this study, we develop a mechanistic, mathematical model that permits both direct (host-to-host) and indirect (environmental) transmission and then fit this model to empirical data from 17 countries affected by an emerging virus (SARS-CoV-2). From an ecological perspective, our model highlights the potential for environmental transmission to drive complex, non-linear dynamics during infectious disease outbreaks. Summarizing, we propose that fitting such models with environmental transmission to real outbreak data from SARS-CoV-2 transmission highlights that variation in environmental transmission is an underappreciated aspect of the ecology of infectious disease, and an incomplete understanding of its role has consequences for public health interventions.
Detection of Cytomegalovirus infection in infants with biliary atresia: A meta-analysis
Authors: Mohamed Sagad Omer Obeid , Ali Almigdad H. M. , Elbathani Mohamed Elata Hassan , Abdallah Osman Omer Ali , Ahmed Assad Ahmed Mohammed , Ibrahim Abazr A. H. , Elhassan Almutasim B. E. , Salman Mohammed Suliman Tawer , Elnil Mahmoud , Elkhidir Ibrahim H. E. , Elhassan Mazin A.M. , Abuzied Abdulhamid Ibrahim Hassan
Published: May 2020

Background

Biliary atresia (BA) is a leading cause of end-stage liver disease and the most common indication of liver transplantation in children. Several reports attributed BA to both prenatal and perinatal aetiologies, including a viral infection-induced auto-immune response that targets the bile ducts. Cytomegalovirus (CMV) remains the most common virus being linked to BA. This meta-analysis estimates to what extent CMV infection is detected in patients with BA.

Methods

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), ScienceDirect, and Google Scholar were used for the systematic search. Random effects model was used to estimate the pooled prevalence estimate with the corresponding 95% confidence interval (CI) using StatsDirect statistical software. Heterogeneity among the included studies was estimated using the I2 statistics. Publication bias was determined based on Begg’s test, Egger’s test, and examination of the funnel plot. Subgroup analyses and meta-regression were used to explore the moderators of heterogeneity between studies.

Results

A total of 13 studies that fulfilled the eligibility criteria were included in the meta-analysis. The pooled overall prevalence of CMV infection in patients with BA was 24.5% (95% CI 11.9 %– 33.9%). In subgroup and meta-regression analyses, the prevalence of CMV infection in patients with BA was correlated with the geographical areas (p = .001) but not with the study year (p = .153).

Conclusions

The available data demonstrate that the detection of CMV infection is common in infants with BA. There is still a need for large studies with appropriate controls to examine various aspects of the association between CMV infection and BA.

Abbreviations

BA = biliary atresia, CMV = cytomegalovirus.
Estimation of the Potential Impact of COVID-19 Responses on the HIV Epidemic: Analysis using the Goals Model
Authors: Stover John , Chagoma Newton , Taramusi Isaac , Teng Yu , Glaubius Rob , Mahiane Guy
Published: May 2020

We applied a simulation model of HIV to analyze the effects of 3 and 6-month disruptions in health services as a result of COVID-19. We found that disruptions to primary prevention programs (male circumcision, behavior change programs, condom distribution) would have small but transitory effects on new infections that might be more than offset by reductions in commercial and multi-partner sex due to lock downs. However, if COVID-19 leads to disruptions in ART services the impacts on mortality could be severe, doubling or tripling the estimated number of HIV deaths in 2020.
Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: Insight from the “ECLB-COVID19” multi countries survey
Authors: Ammar Achraf , Trabelsi Khaled , Brach Michael , Chtourou Hamdi , Boukhris Omar , Masmoudi Liwa , Bouaziz Bassem , Bentlage Ellen , How Daniella , Ahmed Mona , Mueller Patrick , Mueller Notger , Aloui Asma , Hammouda Omar , Paineiras-Domingos Laisa Liane , Braakman-jansen Annemarie , Wrede Christian , Bastoni Sophia , Pernambuco Carlos Soares , Mataruna Leonardo , Taheri Morteza , Irandoust Khadijeh , Khacharem Aïmen , Bragazzi Nicola L , Chamari Karim , Glenn Jordan M , Bott Nicholas T , Gargouri Faiez , Chaari Lotfi , Batatia Hadj , Ali Gamal Mohamed , Abdelkarim Osama , Jarraya Mohamed , Abed Kais El , Souissi Nizar , Van Gemert-Pijnen Lisette , Riemann Bryan L , Riemann Laurel , Moalla Wassim , Gómez-Raja Jonathan , Epstein Monique , Sanderman Robbert , Schulz Sebastian , Jerg Achim , Al-Horani Ramzi , Mansi Taysir , Jmail Mohamed , Barbosa Fernando , Santos Fernando , Šimunič Boštjan , Pišot Rado , Cowan Donald , Gaggioli Andrea , Bailey Stephen J , Steinacker Jürgen , Driss Tarak , Hoekelmann Anita
Published: May 2020

Background

Although recognised as effective measures to curb the spread of the COVID-19 outbreak, social distancing and self-isolation, have been suggested to generate burden throughout the population. To provide scientific data to help identify risk-factors for the psychosocial strain during the COVID-19 outbreak, an international cross-disciplinary online survey was circulated in April 2020. This report outlines the mental, emotional and behavioural consequences of COVID-19 home confinement.

Method

Thirty-five research organisations from four continents promoted the survey through their networks to the general society, in Ten different languages. Questions were presented in a differential format with questions related to responses “before” and “during” confinement period.

Results

1047 replies (54% women) from Western-Asia (36%), North-Africa (40%), Europe (21%) and other countries (3%) were analysed. The COVID-19 home confinement evoked a negative effect on mental wellbeing and emotional status (P < 0.001; 0.43 ≤ d ≤ 0.65) with a greater proportion of individuals experiencing psychosocial and emotional disorders (10% to 16.5%). These psychosocial tolls were associated with unhealthy lifestyle behaviours with a greater proportion of individuals experiencing (i) physical (+15.2%) and social (71.2%) inactivity, (ii) poor sleep quality (12.8%), (iii) unhealthy diet behaviours (10%), and (iv) unemployment (6%). Conversely, participants demonstrated a greater use (15%) of technology solutions during the confinement period.

Conclusion

These findings elucidate the risk of psychosocial strain during the current home confinement period and provide a clear remit for the urgent implementation of technology-based intervention to foster an Active and Healthy Confinement Lifestyle (AHCL).
Long-term individual and population functional outcomes in older adults with atrial fibrillation
Authors: Parks Anna L. , Jeon Sun Y. , Boscardin W. John , Steinman Michael A. , Smith Alexander K. , Fang Margaret C. , Shah Sachin J.
Published: May 2020

Background

Older adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability has not been previously characterized.

Methods

We performed a longitudinal, observational study in the nationally representative Health and Retirement Study (1992-2014). We included participants ≥65 years with Medicare claims who met incident AF diagnosis claims criteria. We examined the association of incident stroke with three functional outcomes: independence with activities of daily living (ADL) and instrumental activities of daily living (IADL) and community-dwelling. We fit separate logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimate the contribution of strokes to the overall population burden of functional impairment using the method of recycled predictions.

Results

Among 3530 participants (median age 79 years, 53% women, median CHA2DS2-VASc 5), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for population comorbidities, annually, ADL dependence increased by 4.4%, IADL dependence increased by 3.9%, and nursing home residence increased by 1.2% (p<0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p<0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4years.

Conclusion

Older adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant decline in function and an increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of functional loss, stroke was not the dominant determinant of population-level disability in older adults with AF.

Impact statement

We certify that this work is novel. Little is known about long-term function (ADL, IADL, community-dwelling) among older adults with AF and the association with stroke. This nationally representative study finds a high rate of function loss independent of stroke, and among those who suffer a stroke, a dramatic and immediate decline in function. Because of the high rate of function loss independent of stroke and the relatively low rate of stroke, on a population level, stroke is not the dominant determinant of disability in older adults with AF.
Phenomenological Modelling of COVID-19 epidemics in Sri Lanka, Italy and Hebei Province of China
Authors: Attanayake A.M.C.H. , Perera S.S.N. , Jayasinghe S.
Published: May 2020

The COVID-19 pandemic has resulted in increasing number of infections and deaths on a daily basis. There is no specific treatment or vaccine identified and the focus has been preventive measures based on statistical and mathematical models. These have relied on analyzing the behavior of populations and characteristics of the infection and applying modelling techniques. The analysis of epidemiological curve fitting on number of daily infections across affected countries could give useful insights on the characteristics of the epidemic. A variety of phenomenological models are available to capture dynamics of disease spread and growth. Data for this study used the number of daily new infections and cumulative number of infections in COVID-19 in three selected countries, Sri Lanka, Italy and Hebei province of China, from the first day of appearance of cases to 20th April 2020. In this study Gompertz, Logistic and Exponential growth curves were fitted on cumulative number of infections across countries. Akaike’s information criteria (AIC) was used in determining the best fitting curve for each country. Results revealed that the most appropriate growth curves for Sri Lanka, Italy and China-Hebei are Exponential, Gompertz and Logistic curves respectively. The overall growth rate and final epidemic size evaluated from best models for the three countries and short-term forecasts were also generated. Log incidences over time in each country were regressed before and after the identified peak time of the respective outbreaks of countries. Hence, doubling time/halving time together with daily growth rates and predictions were estimated. Findings altogether demonstrate that outbreak seems extinct in Hebei-China whereas further transmissions are possible in Sri Lanka. In Italy, current outbreak transmits in a decreasing rate.
Prediction of 7-year’s Conversion from Subjective Cognitive Decline to Mild Cognitive Impairment
Authors: Yue Ling , Hu Dan , Zhang Han , Wen Junhao , Wu Ye , Li Wei , Sun Lin , Li Xia , Wang Jinghua , Li Guanjun , Wang Tao , Shen Dinggang , Xiao Shifu
Published: May 2020

Subjective cognitive decline (SCD) is a high-risk yet less understood status years before Alzheimer’s disease (AD). This work included 76 SCD individuals with two (baseline and seven years later) neuropsychological evaluations and a baseline T1-MRI. A machine learning-based model was trained based on 198 baseline neuroimage features and a battery of 25 clinical measurements to discriminate 24 progressive SCDs from 52 stable SCDs. The SCD progression was satisfactorily predicted with combined features. A history of stroke, a low education level, a low baseline MoCA score, a shrunk left amygdala, and enlarged white matter at the banks of the right superior temporal sulcus favor the progression. This is to date the largest retrospective study of SCD-to-MCI conversion with the longest follow-up, suggesting predictable far-future cognitive decline for the risky populations with baseline measures only. These findings provide valuable knowledge to the future neuropathological studies of AD in its prodromal phase.
COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic
Authors: Seale H , Heywood AE , Leask J , Sheel M , Thomas S , Durrheim D.N , Bolsewicz K , Kaur R
Published: May 2020

Background

Since the emergence of SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) in late 2019, communities have been required to rapidly adopt community mitigation strategies rarely used before, or only in limited settings. This study aimed to examine the attitudes and beliefs of Australian adults towards the COVID-19 pandemic, and willingness and capacity to engage with these mitigation measures. In addition, we aimed to explore the psychosocial and demographic factors that are associated with adoption of recommended hygiene-related and avoidance-related behaviors.

Methods

A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between the 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis.

Findings

The survey of 1420 respondents found 50% (710) of respondents felt COVID-19 would ‘somewhat’ affect their health if infected and 19% perceived their level of risk as high or very high. 84·9% had performed ≥1 of the three recommended hygiene-related behaviors and 93·4% performed ≥1 of six avoidance-related behaviors over the last one month. Adopting avoidance behaviors was associated with trust in government/authorities (aOR: 5·5, 95% CI 3-9·0), higher perceived rating of effectiveness of behaviors (aOR: 4·3, 95% CI: 2·8-6·9) and higher levels of perceived ability to adopt social distancing strategies (aOR: 1·8, 95% CI 1·1-3·0).

Interpretation

In the last two months, members of the public have been inundated with messages about hygiene and social (physical) distancing. However, our results indicate that a continued focus on supporting community understanding of the rationale for these strategies, as well as instilling community confidence in their ability to adopt or sustain the recommendations is needed.

Funding

None