bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Measures of Trunk Recovery 5 to 10 Weeks Postpartum and Pelvic Floor Support and Symptoms 1 Year Postpartum in Primiparas Delivered Vaginally
Authors: Hitchcock Robert , Shaw Janet M. , Niederauer Stefan , Zhou Jing , Sheng Xiaoming , Yang Meng , Nygaard Ingrid E.
Published: September 2020

Objective

To determine whether 2 aspects of trunk recovery after childbirth, intraabdominal pressure (IAP) generation and trunk flexor endurance (TFE), predict measures of pelvic floor health 1 year postpartum.

Methods

In this prospective cohort study, we enrolled nulliparas in their third trimester and followed up those delivered vaginally for 1 year. We measured IAP while lifting a weighted car seat (IAPLIFT), IAP during TFE testing (IAPTFE), and TFE duration 5 to 10 weeks postpartum and assessed pelvic floor support and symptoms 1 year postpartum.

Results

Mean age of the 624 participants was 28.7 years. At 5 to 10 weeks postpartum, mean (SD) maximal IAPLIFT and IAPTFE were 47.67 (11.13) and 51.57 (12.34) cm H2O, respectively. Median TFE duration was 126 seconds (Interquartile range, 74–211). At 1 year postpartum, 9.3% demonstrated worse support (maximal vaginal descent at or below hymen) and 54% met criteria for symptom burden (bothersome symptoms in ≥2 domains of Epidemiology of Prolapse and Incontinence Questionnaire). In multivariable models, neither IAPLIFT nor IAPTFE were associated with worse support or symptom burden (P = 0.54–1.00). Trunk flexor endurance duration increased prevalence of worse support (prevalence ratio, 1.05; 95% confidence interval, 1.01–1.08) per 60-second increase, P = 0.005) but not symptom burden (prevalence ratio, 1.00; 95% confidence interval, 0.98–1.03; P = 0.92).

Conclusions

These results provide some reassurance to early postpartum women, who are unlikely to perform routine activities that generate IAP far outside the range tested. Further research is needed to understand why women with long TFE durations have increased prevalence of worse support.
Put PEP in your step with a Podiatric Enhanced Recovery After Surgery Protocol in the outpatient adult population: a best practice implementation project
Authors: Noble Kim A.
Published: September 2020

Objective:

The goal of this implementation project was to improve postoperative outcomes in the Day Surgery Podiatric patient population with the implementation of an enhanced recovery after surgery (ERAS) protocol at a large urban health system in the northeastern United States. We aimed to improve postoperative patient pain scores and reduce patient length of stay (LOS) with the implementation of the podiatric ERAS protocol (PEP).

Introduction:

ERAS provides an evidence-based interdisciplinary approach to the preparation and care of surgical patients. The core goals of ERAS promote accelerated patient recovery after surgery by incorporating broad patient education with strategies to reduce the physiologic stress associated with surgery and anesthesia. This strategy has been applied to many major surgical specialties but has not been established in podiatric patients.

Methods:

The PEP evidence implementation initiative integrates two Joanna Briggs Institute tools: the Getting Research into Practice audit and feedback tool, and Practical Application of Clinical Evidence System, by incorporating proactive planning and data analyses. Baseline electronic health record data were collected in July 2019, followed by interdisciplinary PEP review, revision, implementation, and three data collection cycles. Strategic education was provided to stakeholders throughout data collection cycles.

Results:

This use of ERAS in the outpatient podiatric surgery population demonstrated excellence in compliance with best practice recommendations. The proactive multimodal approach of PEP revealed improvement in four measures of patient pain, with improvement from 83 to 100% of patients having a pain goal higher than their admission postoperative pain score. Patient pain goal greater than discharge pain score was also found but not sustained. Baseline data collection established that 29% of podiatric patients had a LOS less than 90 min, which improved to 42% with PEP. This finding was also not sustained in the third cycle of audit data. Missing data may have influenced these results, reinforcing the need for further study.

Conclusion:

The use of ERAS in orthopedic patients has an established empirical basis for use, demonstrating a reduction in both postoperative pain and LOS. This novel use of ERAS in a podiatric surgery outpatient population has similar findings but was not sustained in all audit criteria. PEP demonstrated promising reductions in postoperative pain and LOS; however, further implementation replication is needed to confirm this expansion of ERAS and the promising results.
Successful Emergency Treatment of Refractory Neuroleptic Malignant Syndrome With Electroconvulsive Therapy and a Novel Use of Dexmedetomidine
Authors: Rajan Rajani , Sage Mary
Published: September 2020

We describe the case of a patient, hospitalized in a California community medical ICU for over a month, with severe neuroleptic malignant syndrome (NMS), unresponsive to medical management, but responsive to electroconvulsive therapy (ECT). We discuss the medical, logistical, and legal challenges in providing ECT in this setting. We also describe a previously unpublished use of dexmedetomidine, which aided in the safe and rapid reduction of benzodiazepines and permitted a successful ECT course. The rapid delivery and efficacy of ECT were essential because of the burgeoning coronavirus pandemic. The patient's treatment required exemplary efforts by providers across multiple disciplines, ongoing medicolegal consultation with the county mental health medical director, as well as consultation with expert members of the International Society for ECT and Neurostimulation. We conclude with a discussion of the unique challenges of providing emergency ECT to patients in California, including during a serious pandemic, when courts are closed. This case illustrates the importance of cultivating and maintaining high-quality ECT expertise in community hospitals and keeping ECT services available even during pandemics. Also, this case demonstrates that ECT is not “merely an elective procedure” but a vital, life-saving treatment, even during the era of COVID-19. To our knowledge, this is the first such published case of emergency ECT performed in California.
Travel-time, bikes, and HIV elimination in Malawi: a geospatial modeling analysis
Authors: Palk Laurence , Okano Justin T. , Dullie Luckson , Blower Sally
Published: September 2020

Background

UNAIDS has prioritized Malawi and 21 other countries in sub-Saharan Africa (SSA) for “fast-tracking” the end of their HIV epidemics. To achieve elimination requires treating 90% of people living with HIV (PLHIV); coverage is already fairly high (70–75%). However, many individuals in SSA have to walk to access healthcare. We use data-based geospatial modeling to determine whether the need to travel long distances to access treatment and limited transportation in rural areas are barriers to HIV elimination in Malawi. Additionally, we evaluate the effect on treatment coverage of increasing the availability of bicycles in rural areas.

Methods

We build a geospatial model that we use to estimate, for every PLHIV, their travel-time to access HIV treatment if driving, bicycling, or walking. We estimate the travel-times needed to achieve 70% or 90% coverage. Our model includes a spatial map of healthcare facilities (HCFs), the geographic coordinates of residencies for all PLHIV, and an “impedance” map. We quantify impedance using data on road/river networks, land cover, and topography.

Findings

To cross an area of one km2in Malawi takes from ~60 seconds (driving on main roads) to ~60 minutes (walking in mountainous areas); ~80% of PLHIV live in rural areas. At ~70% coverage, HCFs can be reached within: ~45 minutes if driving, ~65 minutes if bicycling, and ~85 minutes if walking. Increasing coverage above ~70% will become progressively more difficult. To achieve 90% coverage, the travel-time for many PLHIV (who have yet to initiate treatment) will be almost twice as long as those currently on treatment. Increasing bicycle availability in rural areas reduces round-trip travel-times by almost one hour (in comparison with walking), and could substantially increase coverage levels.

Interpretation

Geographic inaccessibility to treatment coupled with limited transportation in rural areas are substantial barriers to reaching 90% coverage in Malawi. Increased bicycle availability could help eliminate HIV.

Funding

National Institute of Allergy and Infectious Diseases
Mortality and risk factors among US Black, Hispanic, and White patients with COVID-19
Authors: Jun Tomi , Nirenberg Sharon , Kovatch Patricia , Huang Kuan-lin
Published: September 2020

Background

Little is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States.

Methods

In this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-hospital mortality. The analysis was stratified by self-reported race and ethnicity.

Findings

A total of 3,086 COVID-19 patients were hospitalized, of whom 680 were excluded (78 due to missing race or ethnicity data, 144 were Asian, and 458 were of other unspecified race/ethnicity). Of the 2,406 patients included, 892 (37.1%) were Hispanic, 825 (34.3%) were black, and 689 (28.6%) were white. Black and Hispanic patients were younger than White patients (median age 67 and 63 vs. 73, p<0.001 for both), and they had different comorbidity profiles. Older age and baseline hypoxia were associated with increased mortality across all races. There were suggestive but non-significant interactions between Black race and diabetes (p=0.09), and obesity (p=0.10). Among inflammatory markers associated with COVID-19 mortality, there was a significant interaction between Black race and interleukin-1-beta (p=0.04), and a suggestive interactions between Hispanic ethnicity and procalcitonin (p=0.07) and interleukin-8 (p=0.09).

Interpretation

In this large, racially and ethnically diverse cohort of COVID-19 patients in New York City, we identified similarities and important differences across racial and ethnic groups in risk factors for in-hospital mortality.

Funding

Icahn School of Medicine at Mount Sinai, New York, NY.
Estimating the Risk of Outbreaks of COVID-19 Associated with Shore Leave by Merchant Ship Crews: Simulation Studies for a Case Country
Authors: Wilson Nick , Blakely Tony , Baker Michael , Eichner Martin
Published: September 2020

Aim

We aimed to estimate the risk of COVID-19 outbreaks in a case study COVID-free destination country, associated with shore leave for merchant ship crews.

Methods

A stochastic version of the SEIR model CovidSIM v1.1, designed specifically for COVID-19 was utilised. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics, and plausible control measures.

Results

When no control interventions were in place, an outbreak of COVID-19 in our case study destination country (New Zealand; NZ) was estimated to occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1000 population per week, a crew of 20, a voyage length of 10 days, 1 day of shore leave both in NZ and abroad, and 108 port visits by international merchant ships per week). For this example the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combined use of a PCR test on arrival, self-reporting of symptoms with contact tracing, and mask use during shore leave, increased this median time to 1.0 year (14 days to 5.4 years). Scenario analyses found that onboard infection chains could persist for well over 4 weeks even with crews of only 5 members.

Conclusion

Introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. The risk can be substantially mitigated by control measures such as PCR testing and mask use.
Identification of Blood Glucose Patterns through Continuous Glucose Monitoring Sensors and Decision Trees
Authors: Lozano F. José , Hidalgo J. Ignacio , Botella Marta , Contador Sergio , Lanchares Juan , Velasco J. Manuel , Garnica Oscar
Published: September 2020

The demand for Continuous Glucose Monitoring systems is increasing among type 1 diabetic patients. Some companies are trying to improve the monitoring and the usability of these systems. One example is Abbott FreeStyle Libre, which provides a new concept of glucose monitoring called Flash Glucose Monitoring which is more affordable and does not need calibration. The increasing demand for these devices means an opportunity for data and computer scientists, who can contribute to the development of decision-making support systems based on the data collected from the devices. Type 1 diabetic patients that use FreeStyle Libre may enter the number of insulin and carbohydrates units that they are going to take before a meal. Using both the entered data and the blood glucose values collected by the device automatically, the application presented in this paper generates a report of the patient’s glucose patterns. In addition, it provides a web application that allows the user to upload the data obtained from the device and download the report on his computer or smartphone. The application uses decision trees to detect the patterns and entails a starting point in the creation of ensemble models with more predictive power, also based on decision trees. Furthermore, the methodology makes a segmentation of the data set in blocks, determined by the different meals done throughout the day, adding more information to the set of variables used to train the model. As a result, the application can discover repetitive patterns in the daily life of the patient, which can help to take early preventive measures for risk situations in a period close to the next meal.
How to Make COVID-19 Contact Tracing Apps work: Insights From Behavioral Economics
Authors: Ayres Ian , Romano Alessandro , Sotis Chiara
Published: September 2020

Due to network effects, Contact Tracing Apps (CTAs) are only effective if many people download them. However, the response to CTAs has been tepid. For example, in France less than 2 million people (roughly 3% of the population) downloaded the CTA. Against this background, we carry out an online experiment to show that CTAs can still play a key role in containing the spread of COVID-19, provided that they are re-conceptualized to account for insights from behavioral science. We start by showing that carefully devised in-app notifications are effective in inducing prudent behavior like wearing a mask or staying home. In particular, people that are notified that they are taking too much risk and could become a superspreader engage in more prudent behavior. Building on this result, we suggest that CTAs should be re-framed as Behavioral Feedback Apps (BFAs). The main function of BFAs would be providing users with information on how to minimize the risk of contracting COVID-19, like how crowded a store is likely to be. Moreover, the BFA could have a rating system that allows users to flag stores that do not respect safety norms like wearing masks. These functions can inform the behavior of app users, thus playing a key role in containing the spread of the virus even if a small percentage of people download the BFA. While effective contact tracing is impossible when only 3% of the population downloads the app, less risk taking by small portions of the population can produce large benefits. BFAs can be programmed so that users can also activate a tracing function akin to the one currently carried out by CTAs. Making contact tracing an ancillary, opt-in function might facilitate a wider acceptance of BFAs.
Self-reported sleep duration and timing: A methodological review of event definitions, context, and timeframe of related questions
Authors: Robbins Rebecca , Quan Stuart F. , Barger Laura K. , Czeisler Charles A. , Frazy-Witzer Maya , Weaver Matthew D. , Zhang Ying , Redline Susan , Klerman Elizabeth B.
Published: September 2020

Background

Clinical practice guidelines and population health recommendations are derived from studies that include self-reported data. Small semantic differences in question wording and response scales, may significantly affect the response. We conducted a methodological review to assess the variation in event definition(s), context (i.e., work-versus free-day), and timeframe of sleep timing and duration questions.

Methods

We queried multiple databases of sleep, medicine, public health, and psychology for survey-based studies and/or publications with sleep duration and/or timing questions. The text of these questions was extracted and thematically analyzed by two trained coders.

Results

We identified 49 surveys that included sleep duration and/or timing questions. Sample sizes of participants in the reviewed publications using these surveys ranged from 93 to 1,185,106. For sleep duration questions, participants were asked to report nocturnal sleep (22/43), sleep in the past 24-hours (15/43), their major sleep episode (3/43), or no event definition was given (3/43). Among bedtime questions, participants were asked to report the time into bed (17/40), fall asleep time (10/40), or first attempt to sleep (13/40). For wake time questions, participants were asked to report their out of bed time (3/36), the time they get up (6/36), or their wake up time (27/36). Context (e.g., work versus free day) guidance was provided in 18/43 major sleep duration questions, 31/40 bedtime questions, and 30/36 wake time questions. Timeframe (e.g., the past 4 weeks) was provided in 6/43 major sleep episode duration questions, 9/40 bedtime questions, and 3/36 wake time questions. Among the surveys analyzed, only one question asked about the method of awakening (e.g., spontaneously or by alarm clock), 15 questions assessed sleep latency, and eight measured napping.

Conclusion

There is large variability in the event definition(s), context, and timeframe of questions relating to duration, bed/wake times, latency, and napping. This work may inform future efforts at data harmonization for meta-analyses, provide options for question wording for researchers and clinicians, and be used to identify candidate questions for future surveys.
Increased prolonged sitting in rheumatoid arthritis patients during the COVID-19 pandemic: a within-subjects, accelerometer-based study
Authors: Pinto Ana J. , Rezende Diego , Sieczkowska Sofia M. , Meireles Kamila , Bonfiglioli Karina , Ribeiro Ana C. M. , Bonfá Eloisa , Owen Neville , Dunstan David W. , Roschel Hamilton , Gualano Bruno
Published: September 2020

Background

Social distancing measures designed to contain the COVID-19 pandemic can explicitly and implicitly restrict physical activity, a particular concern for high-risk patient groups. Using a within-subjects design with objective measurement (via validated accelerometers), we assessed rheumatoid arthritis patients’ physical activity and sedentary behavior levels prior to and during the social distancing measures implemented in Sao Paulo, Brazil.

Methods

Post-menopausal women diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24th May to 7th July 2020) social distancing measures to contain COVID-19 pandemic, using a within-subjects, repeated-measure design. Physical activity and sedentary behavior were assessed using postural-based accelerometry (ActivPAL micro™).

Findings

Mean age was 60.9 years (95%CI: 58.0, 63.7) and BMI was 29.5 Kg/m2 (95%CI: 27.2, 31.9). Disease activity ranged from remission to moderate activity. Most of the patients were using disease-modifying anti-rheumatic drugs and prednisone. Hypertension and dyslipidemia were the most frequent comorbidities During social distancing, there were reductions in total stepping time (15.7% [−0.3 h/day, 95%CI: −0.4, −0.1; p = 0.004]), in light-intensity activity (13.0% [−0.2 h/day, 95%CI: −0.4, −0.04; p = 0.016]) and in moderate-to-vigorous physical activity (38.8% [−4.5 min/day, 95%CI: −8.1, −0.9; p = 0.015]), but no changes in total standing time or total sedentary time. However, time spent in prolonged bouts of sitting ≥ 30 min increased by 34% 1.0 h/day, 95%CI: 0.3, 1.7; p=0.006) and sitting bouts ≥60 min increased by 85% (1.0 h/day, 95%CI: 0.5, 1.6) Sit-stand transitions were reduced by 10% (−5.1/day, 95%CI: −10.3, 0.0; p = 0.051)

Conclusion

Imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sitting among rheumatoid arthritis patients. Since this has the potential to increase the burden of cardiovascular disease in such high-risk patients, attention to maintaining physical activity is an urgent consideration during the pandemic.
Quantitative Evaluation of apparent diffusion coefficient in a large multi-unit institution using the QIBA diffusion phantom
Authors: Yung Joshua P , Ding Yao , Hwang Ken-Pin , Cardenas Carlos E. , Ai Hua , Fuller Clifton David , Stafford R. Jason
Published: September 2020

Purpose

The purpose of this study was to determine the quantitative variability of diffusion weighted imaging and apparent diffusion coefficient values across a large fleet of MR systems. Using a NIST traceable magnetic resonance imaging diffusion phantom, imaging was reproducible and the measurements were quantitatively compared to known values.

Methods

A fleet of 23 clinical MRI scanners was investigated in this study. A NIST/QIBA DWI phantom was imaged with protocols provided with the phantom. The resulting images were analyzed and ADC maps were generated. User-directed region-of-interests on each of the different vials provided ADC measurements among a wide range of known ADC values.

Results

Three diffusion phantoms were used in this study and compared to one another. From the one-way analysis of the variance, the mean and standard deviation of the percent errors from each phantom were not significantly different from one another. The low ADC vials showed larger errors and variation and appear directly related to SNR. Across all the MR systems and data, the coefficient of variation was calculated and Bland-Altman analysis was performed. ADC measurements were similar to one another except for the vials with the lower ADC values, which had a higher coefficient of variation.

Conclusion

ADC values among the three phantoms showed good agreement and were not significantly different from one another. The large percent errors seen primarily at the low ADC values were shown to be a consequence of the SNR dependence and very little bias was observed between magnetic strengths and manufacturers. ADC values between diffusion phantoms were not statistically significant. Future investigations will be performed to study differences in magnetic field strength, vendor, MR system models, gradients, and bore size. More data across different MR platforms would facilitate quantitative measurements for multi-platform and multi-site imaging studies. With the increasing usage of diffusion weighted imaging in the clinic, the characterization of ADC variability for MR systems provides an improved quality control over the MR systems.
Higher Native Peruvian ancestry proportion is associated with tuberculosis progression risk
Authors: Asgari Samira , Luo Yang , Slowikowski Kamil , Huang Chuan-Chin , Calderon Roger , Jimenez Judith , Yataco Rosa , Contreras Carmen , Galea Jerome T. , Lecca Leonid , Jones David , Moody D. Branch , Murray Megan B. , Raychaudhuri Soumya
Published: September 2020

The global burden of pulmonary tuberculosis (TB) remains a major public health problem that is particularly severe among and disproportionately affects indigenous populations. We aimed to investigate whether genetic factors related to indigeneity affect TB progression risk in a cohort of admixed Peruvians with active TB and their latently infected household contacts. Our results show that Native Peruvian ancestry is positively associated with TB progression risk: a 10% increase in native ancestry tracks with a 25% increased risk of TB progression. This risk is independent of the potentially confounding socio-demographic and environmental factors that we tested here. Our results demonstrate that the genetic contribution to TB risk varies among populations and brings new insight to the long-standing debate on the role of genetic ancestry in susceptibility to TB. Additionally, our study highlights the value of including diverse populations in genetic studies of infectious diseases and other complex phenotypes, and provides a road map for future similar studies where it is important to account for confounding non-genetic risk factors to identify genetic risk factors.
Estimation and Removal of spurious echo Artifacts in single-voxel MRS using Sensitivity Encoding
Authors: Berrington Adam , Považan Michal , Barker Peter B
Published: September 2020

Purpose

In localized MR spectroscopy, spurious echo artifacts commonly occur when unsuppressed signal outside the volume-of-interest is exicted and refocused. In the spectral domain, these signals often overlap with metabolite resonances and hinder accurate quantification. Since the artifacts orginate from regions separate from the target MRS voxel, this work proposes that sensitivity encoding based on receive coil sensitivity profiles may be used to separate these signal contributions.

Methods

Numerical simulations were performed to explore the effect of sensitivity encoded separation for unknown artifact regions. An imaging-based approach was developed to identify regions that may contribute to spurious echo artifacts, and tested for sensitivity-based unfolding of signal contribution on 6 datasets from 3 brain regions. Spectral data reconstructed using the proposed method (‘ERASE’) were compared to standard coil combination.

Results

The method was able to fully separate metabolite and artifact signals if regions were known a priori. Mismatch between estimated and actual artifact locations reduced the efficiency of artifact removal. Water suppression imaging (WSI) was able to identify unsuppressed signal remote from the MRS voxel in all cases, and ERASE reconstruction (of up to 8 distinct locations) led to improvements in spectral quality and reduced fitting errors for the major metabolites compared to standard reconstruction, without significant degradation of spectral SNR.

Conclusion

The ERASE reconstruction tool was demonstrated to reduce spurious echo artifacts in single voxel MRS. ERASE may be incorporated into standard MRS workflows to improve spectral quality when scanner hardware limitations or other factors result in out-of-voxel signal contamination.
Lewis Blood Group Antigens are Associated with Altered Susceptibility to Shigellosis
Authors: Leslie Jhansi L. , Weddle Erin , Yum Lauren K. , Lin Ye , Jenior Matthew L. , Lee Benjamin , Ma Jennie Z. , Kirkpatrick Beth D. , Nayak Uma , Platts-Mills James A. , Agaisse Herve F. , Haque Rashidul , Petri William A.
Published: September 2020

In a cohort of infants, we found that lack of the Lewis histo-blood group antigen was associated with increased susceptibility to shigellosis. Broadly inhibiting fucosylation in epithelial cells in vitro decreased invasion by Shigella flexneri. These results support a role for fucosylated glycans in susceptibility to shigellosis.
Analysis of twenty-week time-series of confirmed cases of New Coronavirus COVID-19 and their simple short-term prediction for Georgia and Neighboring Countries (Armenia, Azerbaijan, Turkey, Russia) in amid of a global pandemic
Authors: Amiranashvili Avtandil G. , Khazaradze Ketevan R. , Japaridze Nino D.
Published: September 2020

Results of a comparative statistical analysis of the daily data associated with New coronavirus COVID-19 infection of confirmed cases (Č) of the population in Georgia (GEO), Armenia (ARM), Azerbaijan (AZE), Turkey (TUR) and Russia (RUS) amid a global pandemic (WLD) in the period from March 14 to July 31, 2020 are presented.

The analysis of data is carried out with the use of the standard statistical analysis methods of random events and methods of mathematical statistics for the non-accidental time-series of observations.

In particular, a correlation and autocorrelation analysis of the observational data was carried out, the periodicity in the time- series of Č were revealed, the calculation of the interval prediction values of Č taking into account the periodicity in the time-series of observations from August 1 to 31, 2020 (ARM, AZE) and from August 1 to September 11, 2020 (WLD, GEO, TUR, RUS) were carried out.

Comparison of real and calculated predictions data on Č in the study sites from August 1 to August 31, 2020 is carried out. It was found that daily, monthly and mean weekly real values of Č for all the studied locations practically fall into the 99% confidence interval of the predicted values of Č for the specified time period.

A dangerous situation with the spread of coronavirus infection may arise when the mean weekly values of Č of the 99% upper level of the forecast confidence interval are exceeded within 1–2 weeks. Favorable – when the mean weekly values of Č decrease below 99% of the lower level of the forecast confidence interval.
Where has democracy helped the poor? Democratic transitions and early-life mortality at the country level
Authors: Pedro Ramos Antonio , Jose Flores Martiniano , Ross Michael L.
Published: September 2020

The effects of democracy on living conditions among the poor are disputed. Previous studies have addressed this question by estimating the average effect of democracy on early-life mortality across all countries. We revisit this debate using a research design that distinguishes between the aggregated effects of democracy across all countries and their individual effects within countries. Using Interrupted Time Series methodology and estimating model parameters in a Bayesian framework, we find the average effect of democracy on early-life mortality to be close to zero, but with considerable variation at the country-level. Democratization was followed by fewer child deaths in 21 countries, an increase in deaths in eight, and no measurable changes in the remaining 32 cases. Transitions were usually beneficial in Europe, neutral or beneficial in Africa and Asia, and neutral or harmful in Latin America. The distribution of country-level effects is not consistent with common arguments about the conditional effects of democratic transitions. Our results open a new line of research into the sources of theses heterogeneous effects.
Use of Unofficial Newspaper Data for COVID-19 Death Surveillance
Authors: Ahamad Mazbahul G. , Ahmed Monir U. , Talukder Byomkesh , Tanin Fahian
Published: September 2020

Objective

To highlight the critical importance of unofficially reported newspaper-based deaths from coronavirus disease 2019 (COVID-19)–like illness (CLI) together with officially confirmed death counts to support improvements in COVID-19 death surveillance.

Methods

Both hospital-based official COVID-19 and unofficial CLI death counts were collected from daily newspapers between March 8 and August 22, 2020. We performed both exploratory and time-series analyses to understand the influence of combining newspaper-based CLI death counts with confirmed hospital death counts on the trends and forecasting of COVID-19 death counts. An autoregressive integrated moving average–based approach was used to forecast the number of weekly death counts for six weeks ahead.

Results

Between March 8 and August 22, 2020, 2,156 CLI deaths were recorded based on newspaper reporting for a count that was 55% of the officially confirmed death count (n = 3,907). This shows that newspaper reports tend to cover a significant number of COVID-19 related deaths. Our forecast also indicates an approximate total of 406 CLI expected for the six weeks ahead, which could contribute to a total of 2,413 deaths including 2,007 confirmed deaths expected from August 23 to October 3, 2020.

Conclusions

Analyzing existing trends in and forecasting the expected number of newspaper-based CLI deaths indicates yet-unreported COVID-19 death counts, which could be a critical source to estimate provisional COVID-19 death counts and mortality surveillance.

Public Health Implications

Considering unofficial newspaper-based CLI death counts is essential to identify COVID-19 death severity and surveillance needs to advance public health research efforts to prepare appropriate response strategies for low- and middle-income countries.
The influence of pH on SARS-CoV-2 infection and COVID-19 severity
Authors: Jimenez Leandro , Codo Ana Campos , de Souza Sampaio Vanderson , Oliveira Antonio E.R. , Ferreira Lucas Kaoru Kobo , Davanzo Gustavo Gastão , de Brito Monteiro Lauar , Virgilio-da-Silva João Victor , Borba Mayla Gabriela Silva , de Souza Gabriela Fabiano , Zini Nathalia , de Andrade Gandolfi Flora , Murano Stéfanie Primon , Proença-Modena José Luiz , Val Fernando Almeida , Melo Gisely Cardoso , Monteiro Wuelton Marcelo , Nogueira Maurício Lacerda , Lacerda Marcus Vinícius Guimarães , Moraes-Vieira Pedro M. , Nakaya Helder I
Published: September 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect a broad range of human tissues by using the host receptor angiotensin-converting enzyme 2 (ACE2). Individuals with comorbidities associated with severe COVID-19 display higher levels ofACE2in the lungs compared to those without comorbidities, and conditions such as cell stress, elevated glucose levels and hypoxia may also increase the expression ofACE2. Here we showed that patients with Barrett’s esophagus (BE) have a higher expression ofACE2in BE tissues compared to normal squamous esophagus, and that the lower pH associated with BE may drive this increase in expression. Human primary monocytes cultured in reduced pH displayed increasedACE2expression and viral load upon SARS-CoV-2 infection. We also showed in two independent cohorts of COVID-19 patients that previous use of proton pump inhibitors is associated with 2- to 3-fold higher risk of death compared to those not using the drugs. Our work suggests that pH has a great influence on SARS-CoV-2 Infection and COVID-19 severity.
High COVID-19 transmission potential associated with re-opening universities can be mitigated with layered interventions
Authors: Brooks-Pollock Ellen , Christensen Hannah , Trickey Adam , Hemani Gibran , Nixon Emily , Thomas Amy , Turner Katy , Finn Adam , Hickman Matt , Relton Caroline , Danon Leon
Published: September 2020

Background

Re-opening universities while controlling COVID-19 transmission poses unique challenges. UK universities typically host 20,000 to 40,000 undergraduate students, with the majority moving away from home to attend. In the absence of realistic mixing patterns, previous models suggest that outbreaks associated with universities re-opening are an eventuality.

Methods

We developed a stochastic transmission model based on realistic mixing patterns between students. We evaluated alternative mitigation interventions for a representative university.

Results

Our model predicts, for a set of plausible parameter values, that if asymptomatic cases are half as infectious as symptomatic cases then 5,760 (3,940 – 7,430) out of 28,000 students, 20% (14% – 26%), could be infected during the first term, with 950 (656 – 1,209) cases infectious on the last day of term. If asymptomatic cases are as infectious as symptomatic cases then three times as many cases could occur, with 94% (93% – 94%) of the student population getting infected during the first term. We predict that one third of infected students are likely to be in their first year, and first year students are the main drivers of transmission due to high numbers of contacts in communal residences. We find that reducing face-to-face teaching is likely to be the single most effective intervention, and this conclusion is robust to varying assumptions about asymptomatic transmission. Supplementing reduced face-to-face testing with COVID-secure interactions and reduced living circles could reduce the percentage of infected students by 75%. Mass testing of students would need to occur at least fortnightly, is not the most effective option considered, and comes at a cost of high numbers of students requiring self-isolation. When transmission is controlled in the student population, limiting imported infection from the community is important.

Conclusions

Priority should be given to understanding the role of asymptomatic transmission in the spread of COVID-19. Irrespective of assumptions about asymptomatic transmission, our findings suggest that additional outbreak control measures should be considered for the university setting. These might include reduced face-to-face teaching, management of student mixing and enhanced testing. Onward transmission to family members at the end of term is likely without interventions.
High efficacy of face masks explained by characteristic regimes of airborne SARS-CoV-2 virus abundance
Authors: Cheng Yafang , Ma Nan , Witt Christian , Rapp Steffen , Wild Philipp , Andreae Meinrat O. , Pöschl Ulrich , Su Hang
Published: September 2020

Airborne transmission by droplets and aerosols is important for the spread of viruses and face masks are a well-established preventive measure, but their effectiveness for mitigating COVID-19 is still under debate. We show that variations in mask efficacy can be explained by different regimes of virus abundance. For SARS-CoV-2, the virus load of infectious individuals can vary by orders of magnitude, but we find that most environments and contacts are in a virus-limited regime where simple surgical masks are highly effective on individual and population-average levels, whereas more advanced masks and other protective equipment are required in potentially virus-rich indoor environments such as medical centers and hospitals. Due to synergistic effects, masks are particularly effective in combination with other preventive measures like ventilation and distancing.

One Sentence Summary

Face masks are highly effective due to prevailing virus-limited environments in airborne transmission of COVID-19.
Profiling Genome-Wide DNA Methylation Patterns in Human Aortic and Mitral Valves
Authors: Halawa Sarah , Latif Najma , Tseng Yuan-Tsan , Ibrahim Ayman M. , Chester Adrian H. , Moustafa Ahmed , Aguib Yasmine , Yacoub Magdi
Published: September 2020

Cardiac valves exhibit highly complex structures and specialized functions that include dynamic interactions between cells, extracellular matrix (ECM) and their hemodynamic environment. Valvular gene expression is tightly regulated by a variety of mechanisms including epigenetic factors such as histone modifications, RNA-based mechanisms and DNA methylation. To date, methylation fingerprints of non-diseased human aortic and mitral valves have not been studied. In this work we analyzed the differential methylation profiles of 12 non-diseased aortic and mitral valve tissue samples (in matched pairs). Analysis of methylation data (reduced representation bisulfite sequencing (RRBS)) of 1601 promoters genome-wide revealed 584 differentially methylated (DM) promoters, of which 13 were reported in endothelial mesenchymal trans-differentiation (EMT), 37 in aortic and mitral valve disease and 7 in ECM remodeling. Both functional classification as well as network analysis showed that the genes associated with the DM promoters were enriched for WNT-, Cadherin-, Endothelin-, PDGF- and VEGF-signaling implicated in valvular physiology and pathophysiology. Additional enrichment was detected for TGFB-, NOTCH- and Integrin-signaling involved in EMT as well as ECM remodeling. This data provides the first insight into differential regulation of human aortic and mitral valve tissue and identifies candidate genes linked to DM promoters. Our work will improve the understanding of valve biology, valve tissue engineering approaches and contributes to the identification of relevant drug targets.
The impact of asthma on mental health & wellbeing during COVID-19 lockdown
Authors: Higbee Daniel H , Nava George , Kwong Alex S F , Dodd James W , Granell Raquel
Published: September 2020

Introduction

The global SARS CoV2 pandemic resulted in social isolation measures with unintended negative impacts, particularly on mental health. We hypothesised that people with asthma are likely to be more vulnerable to worse mental health during lockdown.

Methods

We examined COVID-19 surveys (completed April/May 2020), nested within two generations of the Avon Longitudinal Study of Parents and Children (ALSPAC): index-generation ALSPAC-G1 (n= 2942, mean age=28) and the parent’s generation ALSPAC-G0 (n=3737, mean age=59). We used Poisson and logistic regression models to estimate the effect of asthma on wellbeing, anxiety and depression, and factors related to COVID-19 and lockdown. Models were adjusted for validated pre-pandemic measures of mental health and socio-economic factors.

Results

Asthma was associated with a 13% increase in depression score in ALSPAC-G1 (p=0.005) and 15% increase in ALSPAC-G0 (p=0.05) compared to participants without asthma, anxiety scores increased by 14% in ALSPAC-G1 (p=0.005) and by 16% in ALSPAC-G0 (p=0.02). Asthma was associated with a similar increase of anxiety and depression scores during COVID-19 in both generations (Z test p values >0.80).

Discussion

People with asthma have worse mental health & wellbeing during lockdown compared to people without asthma. Although the effect of asthma on mental health is of similar magnitude between the generations, younger participants with asthma declined to lower levels of mental health despite reporting less symptoms, COVID-19 infection and self-isolation. This has important implications given repeated lockdowns. Young people with asthma should be closely monitored and supported to mitigate the impact of lockdown on their mental health.

Key Messages

What is the question?

What is the impact of asthma on mental health & wellbeing during COVID-19 pandemic?

What is the bottom line?

People living with asthma report worse wellbeing, anxiety and depression in lockdown compared to those without asthma, the effect is not entirely explained by pre-existing mental health problems, physical symptoms or COVID-19 infections.

Why read on?

Young people living with asthma are more likely to report concerns about susceptibility to COVID 19 and job security. The negative impact of asthma on length of self-isolation, suspected COVID and symptoms appears greater in older people with asthma.
SARS-CoV-2 detection by extraction-free qRT-PCR for massive and rapid COVID-19 diagnosis during a pandemic
Authors: Avetyan Diana , Chavushyan Andranik , Ghazaryan Hovsep , Melkonyan Ani , Stepanyan Ani , Zakharyan Roksana , Hayrapetyan Varduhi , Atshemyan Sofi , Martirosyan Gevorg , Melik-Andreasyan Gayane , Sargsyan Shushan , Ghazazyan Armine , Aleksanyan Naira , Yin Xiushan , Arakelyan Arsen
Published: September 2020

COVID-19 pandemic severely impacted the healthcare and economy on a global scale. It is widely recognized that mass testing is an efficient way to contain the infection spread as well as the development of informed policies for disease management. However, the current COVID-19 worldwide infection rates increased demand in the rapid and reliable screening of SARS-CoV-2 infection.

We compared the performance of qRT-PCR in direct heat-inactivated, heat-inactivated/pelleted samples against RNA in a group of 74 subjects (44 positive and 30 negative). In addition, we compared the sensitivity of heat-inactivated/pelleted in another group of 196 COVID-19 positive samples.

Our study suggests that swab sample heat-inactivation and pelleting show higher accuracy for SARS-CoV-2 detection PCR assay compared to heat-inactivation only (89% vs 83% of the detection in RNA). The accuracy of detection using direct samples varied depending on the sample transport and storage media as well as the concentration of viral particles.

Our study suggests that purified RNA provides more accurate results, however, direct qRT-PCR may help to significantly increase testing capacity. Switching to the direct sample testing is justified if the number of tests is doubled at least.
Mental health as a mediator of the association between educational inequality and cardiovascular disease: A Mendelian randomisation study
Authors: Jones Daniel P , Wootton Robyn E , Gill Dipender , Carter Alice R , Gunnell David , Munafò Marcus R , Sallis Hannah M
Published: September 2020

Background

Education is inversely associated with cardiovascular disease. Several mediators for this association have been established but a significant proportion of the protective effect remains unaccounted for. Mental health is a proposed mediator, but current evidence is mixed and subject to bias from confounding factors and reverse causation. Mendelian randomisation (MR) is an instrumental variable technique that uses genetic proxies for exposures and mediators to reduce such bias.

Methods and Results

We used logistic regression and two-step MR analyses to investigate whether educational attainment affects risk of mental health disorders. We then performed observational and MR mediation analyses to explore whether mental health disorders mediate the association between educational attainment and risk of cardiovascular disease. Higher levels of educational attainment were associated with reduced depression, anxiety and cardiovascular disease in observational analyses [Odds Ratio (95% Confidence interval) 0.79 (0.77-0.81), 0.76 (0.73-0.79) and 0.79 (0.78-0.81) respectively], and MR analyses provided support for these reflecting causal effects [OR (95% CI) 0.72 (0.67-0.77), 0.50 (0.42-0.59) and 0.62 (0.58-0.66) respectively]. Both anxiety and depression were associated with cardiovascular disease in observational analyses [OR (95% CI) 1.63 (1.49-1.79) and OR (95% CI) 1.70 (1.59-1.82) respectively] but only depression was associated in the MR analyses [OR (95% CI) 1.09 (1.03-1.15)]. Roughly 6% of the total protective effect of education on cardiovascular disease was mediated by depression.

Conclusions

Higher levels of educational attainment protect against mental health disorders and reduced depression accounts for a small proportion of the total protective effect of education on cardiovascular disease.
The King’s College London Coronavirus Health and Experiences of Colleagues at King’s Study: SARS-CoV-2 antibody response in an occupational sample
Authors: Leightley Daniel , Vitiello Valentina , Bergin-Cartwright Gabriella , Wickersham Alice , Davis Katrina A.S. , Stevelink Sharon A.M , Hotopf Matthew , Razavi Reza
Published: September 2020

We report test results for SARS-CoV-2 antibodies in an occupational group of postgraduate research students and current members of staff at King’s College London. Between June and July 2020, antibody testing kits were sent to n = 2296 participants; n = 2004 (86.3%) responded, of whom n = 1882 (93.9%) returned valid test results. Of those that returned valid results, n = 124 (6.6%) tested positive for SARS-CoV-2 antibodies, with initial comparisons showing variation by age group and clinical exposure.