bluuebunny/crossref_metadata_2025 huggingface dataset:
Burn Patient Insurance Status Influences Hospital Discharge Disposition and Utilization of Postdischarge Outpatient Care
Authors: Hulsebos Ian F , Collier Zachary J , Spera Leigh J , Johnson Maxwell B , Hulsebos Elise M , Yenikomshian Haig A , Gillenwater Justin
Published: August 2021

Postdischarge services, such as outpatient wound care, may affect long-term health outcomes and postrecovery quality-of-life. Access to these services may vary according to insurance status and ability to cover out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, and privately insured at the time of their burn unit admissions. A retrospective review from July 1, 2015 to November 1, 2019 was performed at an American Burn Association-verified burn center. All admitted burn patients 18 years and older were identified and categorized according to insurance payer type. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. In total, 284 uninsured, 565 publicly insured, and 293 privately insured patients were identified. There were no significant differences in TBSA (P = .3), inhalation injury (P = .3), intensive care unit days (P = .09), or need for skin grafting (P = .1) between the three groups. For primary outcome, uninsured patients were more likely to be discharged without ancillary services (P < .0001) compared to both publicly and privately insured. Publicly insured patients were more likely to receive skilled nursing care (P = .0007). Privately insured patients were more likely to receive homecare (P = .0005) or transfer for ongoing inpatient care (P < .0001). There was no difference in burn unit readmission rates (P = .5). The uninsured were more likely to follow up with outpatient burn clinic after discharge (P = .004). Uninsured patients were less likely to receive postdischarge resources. Uninsured patients received fewer postdischarge wound care resources which could result in suboptimal long-term results, and diminished return to preinjury functional status. Given the impact of insurance status on discharge location and resources, efforts to increase access for uninsured patients to postdischarge resources will ensure greater healthcare equity and improve quality of comprehensive care regardless of insurance status.
Fireworks Injuries to the Head and Neck: A Retrospective Analysis Between 2008 and 2017
Authors: Tanenbaum Zachary , Prasad Navin , Bhardwaj Priya , Welschmeyer Alexandra , Harley Earl H
Published: August 2021

This study examines firework-associated head and neck injuries in the United States from 2008 to 2017 obtained from a single epidemiology source. The National Electronic Injury Surveillance System (NEISS) was used to collect epidemiologic data and retrospectively analyze firework-associated injuries from 2008 to 2017. Injury types included burns, concussions, contusions, foreign bodies, hematomas, internal organ injury, lacerations, and puncture wounds. Four hundred and thirty-one individuals were originally included; however, 14 participants were excluded due to inadequate injury information. Chi-squared analyses were performed between the following categorical variables: gender vs body part injured, patient age vs injury type, and patient age vs body part injured. About 417 injuries to the head and neck (67.4% male, 32.6% female) were treated in NEISS-reporting emergency departments during the 10-year period. Sixty-nine percent of the injuries occurred in July. Body parts injured included the ear (10.6%), face (61.6%), head (13.0%), mouth (4.8%), and neck (10.0%). Chi-squared analysis demonstrated an association between gender and body part injured (P = .0001). Patient age (P = .066) was independent of injury type. Children aged 0 to 12 years had the highest probability of being injured (40.2%), then adults 22 and older (33.1%) and adolescents 13 to 21 years (26.9%). Given that the preponderance of injuries caused by fireworks occurred primarily in minors, pediatricians should screen for any household firework use during the anticipatory guidance portion of well-child checks, which we believe would improve patient safety and decrease injury rates.
Targeting Microglial Disturbances to Protect the Brain From Neurodevelopmental Disorders Associated With Prematurity
Authors: Delahaye-Duriez Andrée , Dufour Adrien , Bokobza Cindy , Gressens Pierre , Van Steenwinckel Juliette
Published: August 2021

Microglial activation during critical phases of brain development can result in short- and long-term consequences for neurological and psychiatric health. Several studies in humans and rodents have shown that microglial activation, leading to a transition from the homeostatic state toward a proinflammatory phenotype, has adverse effects on the developing brain and neurodevelopmental disorders. Targeting proinflammatory microglia may be an effective strategy for protecting the brain and attenuating neurodevelopmental disorders induced by inflammation. In this review we focus on the role of inflammation and the activation of immature microglia (pre-microglia) soon after birth in prematurity-associated neurodevelopmental disorders, and the specific features of pre-microglia during development. We also highlight the relevance of immunomodulatory strategies for regulating activated microglia in a rodent model of perinatal brain injury. An original neuroprotective approach involving a nanoparticle-based therapy and targeting microglia, with the aim of improving myelination and protecting the developing brain, is also addressed.
Analyses of DNA Methylation Profiling in the Diagnosis of Intramedullary Astrocytomas
Authors: Lebrun Laetitia , Bizet Martin , Melendez Barbara , Alexiou Barbara , Absil Lara , Van Campenhout Claude , D’Haene Nicky , Rorive Sandrine , Fuks François , Decaestecker Christine , Salmon Isabelle
Published: August 2021

Intramedullary astrocytomas (IMAs) consist of a heterogeneous group of rare central nervous system (CNS) tumors associated with variable outcomes. A DNA methylation-based classification approach has recently emerged as a powerful tool to further classify CNS tumors. However, no DNA methylation-related studies specifically addressing to IMAs have been performed yet. In the present study, we analyzed 16 IMA samples subjected to morphological and molecular analyses, including DNA methylation profiling. Among the 16 samples, only 3 cases were classified in a reference methylation class (MC) with the recommended calibrated score (≥0.9). The remaining cases were either considered “no-match” cases (calibrated score <0.3, n = 7) or were classified with low calibrated scores (ranging from 0.32 to 0.53, n = 6), including inconsistent classification. To obtain a more comprehensive tool for pathologists, we used different unsupervised analyses of DNA methylation profiles, including our data and those from the Heidelberg reference cohort. Even though our cohort included only 16 cases, hypotheses regarding IMA-specific classification were underlined; a potential specific MC of PA_SPINE was identified and high-grade IMAs, probably consisting of H3K27M wild-type IMAs, were mainly associated with ANA_PA MC. These hypotheses strongly suggest that a specific classification for IMAs has to be investigated.
MERG1A Protein Abundance Increases in the Atrophied Skeletal Muscle of Denervated Mice, But Does Not Affect NFκB Activity
Authors: Anderson Luke B , Ravara Barbara , Hameed Sohaib , Latour Chase D , Latour Sawyer M , Graham Valerie M , Hashmi Mariam N , Cobb Brittan , Dethrow Nicole , Urazaev Albert K , Davie Judy K , Albertin Giovanna , Carraro Ugo , Zampieri Sandra , Pond Amber L
Published: August 2021

Skeletal muscle atrophy may occur with disease, injury, decreased muscle use, starvation, and normal aging. No reliably effective treatments for atrophy are available, thus research into the mechanisms contributing to muscle loss is essential. The ERG1A K+ channel contributes to muscle loss by increasing ubiquitin proteasome proteolysis (UPP) in the skeletal muscle of both unweighted and cachectic mice. Because the mechanisms which produce atrophy vary based upon the initiating factor, here we investigate atrophy produced by denervation. Using immunohistochemistry and immunoblots, we demonstrate that ERG1A protein abundance increases significantly in the Gastrocnemius muscle of rodents 7 days after both sciatic nerve transection and hind limb unweighting. Further, we reveal that ectopic expression of a Merg1a encoded plasmid in normal mouse Gastrocnemius muscle has no effect on activity of the NFκB transcription factor family, a group of proteins which contribute to muscle atrophy by modulation of the UPP. Further, although NFκB activity increases significantly after denervation, we show that expression of a plasmid encoding a dominant negative Merg1a mutant in Gastrocnemius muscle prior to denervation, has no effect on NFκB activity. Thus, although the ERG1A K+ channel increases UPP, it does not do so through modulation of NFκB transcription factors.
Tau Isoform Profile in Essential Tremor Diverges From Other Tauopathies
Authors: Kim Soong Ho , Farrell Kurt , Cosentino Stephanie , Vonsattel Jean-Paul G , Faust Phyllis L , Cortes Etty P , Bennet David A , Louis Elan D , Crary John F
Published: August 2021

Patients with essential tremor (ET) frequently develop concurrent dementia, which is often assumed to represent co-morbid Alzheimer disease (AD). Autopsy studies have identified a spectrum of tau pathologies in ET and tau isoforms have not been examined in ET. We performed immunoblotting using autopsy cerebral cortical tissue from patients with ET (n = 13), progressive supranuclear palsy ([PSP], n = 10), Pick disease ([PiD], n = 2), and AD (n = 7). Total tau in ET samples was similar to that in PSP and PiD but was significantly lower than that in AD. Abnormal tau levels measured using the AT8 phospho-tau specific (S202/T205/S208) monoclonal antibody in ET were similar to those in PSP but were lower than in PiD and AD. In aggregates, tau with 3 microtubule-binding domain repeats (3R) was significantly higher in AD than ET, while tau with 4 repeats (4R) was significantly higher in PSP. Strikingly, the total tau without N-terminal inserts in ET was significantly lower than in PSP, PiD, and AD, but total tau with other N-terminal inserts was not. Monomeric tau with one insert in ET was similar to that in PSP and PiD was lower than in AD. Thus, ET brains exhibit an expression profile of tau protein isoforms that diverges from that of other tauopathies.
Elevated Oxidative Stress and DNA Damage in Cortical Neurons of Chemotherapy Patients
Authors: Torre Matthew , Dey Adwitia , Woods Jared K , Feany Mel B
Published: August 2021

The unintended neurologic sequelae of chemotherapy contribute to significant patient morbidity. Chemotherapy-related cognitive impairment (CRCI) is observed in up to 80% of cancer patients treated with chemotherapy and involves multiple cognitive domains including executive functioning. The pathophysiology underlying CRCI and the neurotoxicity of chemotherapy is incompletely understood, but oxidative stress and DNA damage are highly plausible mechanisms based on preclinical data. Unfortunately, validating pathways relevant to CRCI in humans is limited by an absence of relevant neuropathologic studies of patient brain tissue. In the present study, we stained sections of frontal lobe autopsy tissue from cancer patients treated with chemotherapy (n = 15), cancer patients not treated with chemotherapy (n = 10), and patients without history of cancer (n = 10) for markers of oxidative stress (nitrotyrosine, 4-hydroxynonenal) and DNA damage (pH2AX, pATM). Cancer patients treated with chemotherapy had increased staining for markers of oxidative stress and DNA damage in frontal lobe cortical neurons compared to controls. We detected no statistically significant difference in oxidative stress and DNA damage by the duration between last administration of chemotherapy and death. The study highlights the potential relevance of oxidative stress and DNA damage in the pathophysiology of CRCI and the neurotoxicity of chemotherapy.
Epidemiology, Diagnosis, and Treatment of Clostridioides difficile Infection in Immunocompromised Children
Authors: Cross Shane J , Morton Theodore H , Wolf Joshua
Published: August 2021

Clostridioides difficile infection is very common in immunocompromised children. Management is confounded by frequent asymptomatic colonization, multiple alternative etiologies for gastrointestinal symptoms, and high rates of relapse. Important considerations include indications for testing, appropriate choice of diagnostic tests, antibiotic therapy for initial and subsequent episodes, and primary and secondary prevention.
Persistent brainstem abscess requiring repeat microsurgical drainage: case report
Authors: Shoap Wesley , Hayden Ellery A , Crabill George A
Published: August 2021

In this paper, we present a patient who was treated for a pontine abscess at our institution. This patient underwent sub-occipital craniotomy for microscopic abscess drainage after which cultures grew Streptococcus intermedius. She was treated with antibiotics but failed to show clinical improvement and was taken back to the operating room for repeat abscess drainage. Clinical improvement was seen after the second operation. This case report describes open surgical technique as a safe and effective way of treating brainstem abscess.
The museum and the border: the Merseyside Maritime Museum and the construction of the migrant and refugee
Authors: Neylon Anne
Published: August 2021

This article examines how the state imagines and represents migration. Using the Merseyside Maritime Museum as a frame, it provides key insights into how perspectives of time and particular constructions of colonial history have contributed to a system of immigration law that is characterised by a policy of institutional forgetting.
Medical School Clinical Knowledge Exam Scores, Not Demographic or Other Factors, Associated With Residency In-Training Exam Performance
Authors: Patzkowski Michael S , Hauser Joshua M , Liu Mark , Herrera Germaine F , Highland Krista B , Capener Dale C
Published: August 2021

Background

The anesthesiology in-training exam (ITE) is a 200-item multiple-choice assessment completed annually by physician residents. Because all matriculated U.S. Department of Defense (DoD) anesthesiology residents are “hired” by the DoD after residency graduation, it is important to ensure that ITE performance, as a proxy for core competencies achievement, is maximized.

Methods

Graduated resident program files from 2013 to 2020 were queried for age, sex, matriculant status (medical student vs. other), medical school (Uniformed Services University vs. other), military service (Army vs. Air Force), preresidency military service (yes vs. no), U.S. Medical Licensing Exam (USMLE) Step 2 Clinical Knowledge (CK) score, and the American Board of Anesthesiologists ITE Score from the third clinical anesthesia year (CA-3 year).

Results

For every 1-point increase in USMLE Step 2 CK true z-score, the CA-3 ITE z-score increased by 0.59 points. Age was not associated with CA-3 ITE z-score in any dataset regression. Categorical covariates of sex, application status, medical school, service, and preresidency military service were not significantly associated with CA-3 ITE z-score (all P >.05), as shown by estimated adjusted marginal means. The estimated adjusted grand mean of CA-3 ITE z-scores was 0.48 (standard error ± 0.14).

Conclusion

Resident physicians enter residency with varying degrees of past academic success, and it is important to develop early strategies to support them in acquiring the requisite knowledge base.
Different DNA repair pathways are involved in single-strand break-induced genomic changes in plants
Authors: Wolter Felix , Schindele Patrick , Beying Natalja , Scheben Armin , Puchta Holger
Published: August 2021

In nature, single-strand breaks (SSBs) in DNA occur more frequently (by orders of magnitude) than double-strand breaks (DSBs). SSBs induced by the CRISPR/Cas9 nickase at a distance of 50–100 bp on opposite strands are highly mutagenic, leading to insertions/deletions (InDels), with insertions mainly occurring as direct tandem duplications. As short tandem repeats are overrepresented in plant genomes, this mechanism seems to be important for genome evolution. We investigated the distance at which paired 5′-overhanging SSBs are mutagenic and which DNA repair pathways are essential for insertion formation in Arabidopsis thaliana. We were able to detect InDel formation up to a distance of 250 bp, although with much reduced efficiency. Surprisingly, the loss of the classical nonhomologous end joining (NHEJ) pathway factors KU70 or DNA ligase 4 completely abolished tandem repeat formation. The microhomology-mediated NHEJ factor POLQ was required only for patch-like insertions, which are well-known from DSB repair as templated insertions from ectopic sites. As SSBs can also be repaired using homology, we furthermore asked whether the classical homologous recombination (HR) pathway is involved in this process in plants. The fact that RAD54 is not required for homology-mediated SSB repair demonstrates that the mechanisms for DSB- and SSB-induced HR differ in plants.
The risk, predictors and outcomes of amyloidosis in ankylosing spondylitis: a longitudinal population-based cohort study
Authors: Kridin Mouhammad , Kridin Khalaf , Cohen Arnon D , Amital Howard , Watad Abdulla
Published: August 2021

Objectives

The risk of amyloidosis during the course of AS is yet to be firmly established. We aimed to evaluate the risks, predictors and prognostic outcomes of amyloidosis among patients with AS.

Methods

A population-based cohort study was conducted comparing AS patients (n = 5911) with age-, sex- and ethnicity-matched control subjects (n = 29 007) with regard to incident cases of amyloidosis. Hazard ratios (HRs) and odds ratios (ORs) were estimated by Cox regression and logistic regression analyses, respectively.

Results

The incidence rate of amyloidosis was 2.15 (95% CI 1.09, 2.82) and 0.35 (95% CI 0.16, 0.66) per 10 000 person-years among patients with AS and controls, respectively. The risk of incident amyloidosis was >6-fold higher among patients with AS relative to control subjects [adjusted HR 6.16 (95% CI 2.43, 15.62); P < 0.001]. A higher comorbidity burden [OR 1.36 (95% CI 1.08, 1.73); P = 0.010] was found to predict an increased susceptibility to amyloidosis in AS patients. Compared with other patients with AS, those with AS and comorbid amyloidosis had a 14-fold increased risk of end-stage renal disease necessitating dialysis [adjusted HR 14.7 (95% CI 2.0, 107.2); P = 0.008], but comparable risk of all-cause mortality [adjusted HR 2.16 (95% CI 0.69, 6.71); P = 0.174].

Conclusions

Patients with AS are at an increased risk of amyloidosis. AS-associated amyloidosis is associated with an elevated risk of dialysis dependence. Awareness of the burden and consequences of this complication may be of help for rheumatologists managing patients with AS.
Has the incidence of total joint arthroplasty in rheumatoid arthritis decreased in the era of biologics use? A population-based cohort study
Authors: Zhou Vivienne Y , Lacaille Diane , Lu Na , Kopec Jacek A , Garbuz Donald S , Qian Yi , Aviña-Zubieta J Antonio , Esdaile John M , Xie Hui
Published: August 2021

Objectives

To determine whether the introduction of biological DMARDs (bDMARDs) was associated with reduced incidences of total hip and knee arthroplasty (THA/TKA) among patients with RA compared with OA.

Methods

Using a population-based cohort in British Columbia, Canada, RA and OA patients diagnosed between 1995 and 2007 were divided into semi-annual cohorts according to diagnosis date. For each cohort, we calculated 8-year incidence rates of THA and TKA. We compared levels and trends of THA/TKA incidence in RA/OA patients diagnosed during pre-bDMARDs (1995–2001) and post-bDMARDs (2003–2007) periods using interrupted time-series analysis, adjusting for baseline characteristics. Adjusted 8-year total joint arthroplasty incidence estimated for RA/OA cohorts diagnosed five years after bDMARDs introduction were compared with expected rates assuming no bDMARDs introduction, based on extrapolation of pre-bDMARDs trends.

Results

We identified 60 227 RA and 288 260 OA incident cases. For cohorts diagnosed pre-bDMARDs, 8-year THA/TKA incidence rates increased over time in both RA and OA. For cohorts diagnosed post-bDMARDs, these rates decreased over time in RA but continued to increase for OA. For RA, differences between the post- and pre-bDMARDs secular trends in incidence rates were −0.49 (P = 0.002) for THA and −0.36 (P = 0.003) for TKA, compared with +0.40 (P = 0.006) and +0.54 (P < 0.001), respectively, for OA. For RA cohorts diagnosed five years after bDMARDs introduction, 8-year incidences were 26.9% and 12.6% lower for THA and TKA, respectively, than expected rates. In contrast, corresponding rates in OA were higher by 11.7% and 16.6%, respectively.

Conclusion

Arthritis onset after bDMARDs introduction is associated with a significant reduction in THA/TKA incidence in RA, but not in OA. The reduction reflects a significant improvement in RA treatment during the biological era.
Clinical Reasoning, Judgment, and Safe Medication Administration Practices in Senior Nursing Students
Authors: Lee Kristin C. , Wessol Jennifer L.
Published: August 2021

Background and Purpose

Medication errors occur at alarming rates. Safe medication administration practices require more than observing patient safety rights and psychomotor skills. The purpose of this study was to explore the relationships between clinical judgment skills and reasoning processes and safe medication practices in senior nursing students.

Methods

Using a cross-sectional design, 29 students from 3 schools of nursing watched a video simulation of a nurse administering medications in a clinical setting. At predetermined times, reflections on the medication administration practices were journaled. Journals were scored for clinical reasoning processes and clinical judgment using the Clinical Judgment Rubric–Reflective Journal (CJR-RJ) and for medication administration best practices.

Results

Students scored low on the CJR-RJ (mean [SD], 5.2 [1.7]). We found a positive relationship between clinical judgment skills and safe medication practices (r = 0.39, t
27 = 2.94, P = .018). The clinical reasoning process of Interpreting was a significant indicator of best practices (b = 1.4, t
28 = 2.81, P = .010).

Conclusion

Our findings suggest that students struggle to connect theory to practice, emphasizing the need to plan experiential learning opportunities for students to develop clinical reasoning, particularly in Interpreting, and judgment skills to prevent medication errors upon entry to practice.
Assessment of Quadriceps Muscle Weakness in Association with Symptomatic and Radiological Osteoarthritis of the Knee
Authors: Hegde Siddhi , Ranganath N
Published: August 2021

Background

Primary knee osteoarthritis is a significant cause of impairment of the lower limb’s mobility, making effective rehabilitation particularly important. This study aimed to identify the association of quadriceps strength with pain and disability in comparison to its association with increasing severity of radiological grades of knee osteoarthritis.

Methods

50 subjects above the age of 40 years with different grades of knee osteoarthritis were evaluated for their radiological grade of osteoarthritis using Kellgren-Lawrence grading criteria for the knee radiographs, isometric quadriceps muscle strength using a modified hand-held dynamometer, pain, and disability using WOMAC questionnaire, all on the same day in this cross-sectional study.

Results

There is a significant negative correlation between K/L grade and maximum strength of the quadriceps muscle, r(50) = -0.28(p<0.05). We found a highly significant negative correlation between WOMAC score and strength of the quadriceps muscle,r (50) = -0.41(p<0.05).

Discussion

Quadriceps strength reduced progressively in subjects with more significant radiographic changes, questioning whether quadriceps muscle weakness precedes the onset of osteoarthritis and progressively results in further damage or osteoarthritis itself reduces the quadriceps strength. Though patients may have greater joint destruction on knee radiographs, increasing the strength of quadriceps might reduce the pain and functional disability.
Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index
Authors: Carter Lucy M , Gordon Caroline , Yee Chee Seng , Bruce Ian , Isenberg David , Skeoch Sarah , Vital Edward M
Published: August 2021

Objective

BILAG-2004 index is a comprehensive disease activity instrument for SLE but administrative burden and frequency of errors limits its use in routine practice. We aimed to develop a tool for more accurate, time-efficient scoring of BILAG-2004 index with full fidelity to the existing instrument.

Methods

Frequency of BILAG-2004 items was collated from a BILAG-biologics registry (BILAG-BR) dataset. Easy-BILAG prototypes were drafted to address known issues affecting speed and accuracy. After expert-verification, accuracy and usability of the finalised Easy-BILAG was validated against standard format BILAG-2004 index in a workbook exercise of 10 case vignettes. 33 professionals with a range of expertise from 14 UK centres completed the validation exercise.

Results

Easy-BILAG incorporates all items present in ≥5% BILAG-BR records, plus full constitutional and renal domains into a rapid single-page assessment. An embedded glossary and colour-coding assists scoring each domain. A second page captures rarer manifestations when needed. In the validation exercise, Easy-BILAG yielded higher median scoring accuracy (96.7%) than standard BILAG-2004 documentation (87.8%, p=0.001), with better inter-rater agreement. Easy-BILAG was completed faster (59.5min) than the standard format (80.0min, p=0.04) for 10 cases. An advantage in accuracy was observed with Easy-BILAG use among general hospital rheumatologists (91.3 vs 75.0, p=0.02), leading to equivalent accuracy as tertiary centre rheumatologists. Clinicians rated Easy-BILAG as intuitive, convenient, and well adapted for routine practice.

Conclusion

Easy-BILAG facilitates more rapid and accurate scoring of BILAG-2004 across all clinical settings which could improve patient care and biologics prescribing. Easy-BILAG should be adopted wherever BILAG-2004 assessment is required.
Characterising COVID-19 empirical research production in Latin America and the Caribbean: a scoping review
Authors: Mansilla Cristián , Herrera Cristian A. , Boeira Laura , Yearwood Andrea , Lopez Analia S. , Colunga-Lozano Luis E. , Brocard Eva , Villacres Tatiana , Vélez Marcela , Di Paolantonio Gabriel , Reveiz Ludovic
Published: August 2021

Introduction

The Coronavirus Disease 2019 (COVID19) pandemic has struck Latin America and the Caribbean (LAC) particularly hard. One of the crucial areas in the international community’s response relates to accelerating research and knowledge sharing. The aim of this article is to map and characterise the existing empirical research related to COVID-19 in LAC countries and contribute to identify opportunities for strengthening future research.

Methods

In this scoping review, articles published between December 2019 and 11 November 2020 were selected if they included an empirical component (explicit scientific methods to collect and analyse primary data), LAC population was researched, and the research was about the COVID-19 pandemic, regardless of publication status or language. MEDLINE, EMBASE, LILACS, Scielo, CENTRAL and Epistemonikos were searched. All titles and abstracts, and full texts were screened by two independent reviewers. Data from included studies was extracted by one reviewer and checked by a second independent reviewer.

Results

14,406 records were found. After removing duplicates, 5,458 titles and abstracts were screened, of which 2,323 full texts were revised to finally include 1,626 empirical studies. The largest portion of research came from people/population of Brazil (54.6%), Mexico (19.1%), Colombia (11.2%), Argentina (10.4%), Peru (10.3%) and Chile (10%), while Caribbean countries concentrated 15.3%. The methodologies most used were cross-sectional studies (34.7%), simulation models (17.5%) and randomized controlled trials (RCTs) (13.6%). Using a modified version of WHO’s COVID-19 Coordinated Global Research Roadmap classification, 54.2% were epidemiological studies, followed by clinical management (22.3%) and candidate therapeutics (12.2%). Government and public funds support were reported in 19.2% of studies, followed by universities or research centres (9%), but 47.5% did not include any funding statement.

Conclusion

During the first part of the COVID-19 pandemic, LAC countries have contributed to the global research effort primarily with epidemiological studies, with little participation on vaccines research, meaning that this type of knowledge would be imported from elsewhere. Research agendas could be further coordinated aiming to enhance shared self-sufficiency regarding knowledge needs in the region.
Multiple-time measurements of multidimensional psychiatric states from immediately before the COVID-19 pandemic to one year later: A longitudinal online survey of the Japanese population
Authors: Oka Taiki , Kubo Takatomi , Kobayashi Nao , Nakai Fumiya , Miyake Yuka , Hamamura Toshitaka , Honjo Masaru , Toda Hiroyuki , Boku Shuken , Kanazawa Tetsufumi , Nagamine Masanori , Cortese Aurelio , Takebayashi Minoru , Kawato Mitsuo , Chiba Toshinori
Published: August 2021

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected the mental health of both infected and uninfected people. Although most psychiatric disorders have highly overlapping genetic and pathogenic backgrounds, most studies investigating the impact of the pandemic have examined only single psychiatric disorders. It is necessary to examine longitudinal trajectories of factors that modulate psychiatric states across multiple dimensions. 2274 Japanese citizens participated in online surveys presented in December 2019 (before the pandemic), August 2020, Dec 2020, and April 2021. These surveys included nine questionnaires on psychiatric symptoms, such as depression and anxiety. Multi-dimensional psychiatric time series data were then decomposed into four principal components. We used generalized linear models to identify modulating factors for effects of the pandemic on these components. The four principal components can be interpreted as general psychiatric burden, social withdrawal, alcohol-related problems, and depression/anxiety. Principal components associated with general psychiatric burden and depression/anxiety peaked during the initial phase of the pandemic. They were further exacerbated by the economic burden of the pandemic. In contrast, principal components associated with social withdrawal showed a delayed peak, with human relationships as an important risk modulating factor. In addition, being elderly and female were risk factors shared across all components. Our results show that COVID-19 has imposed a large and varied burden on the Japanese population since the commencement of the pandemic. Although components related to the general psychiatric burden remained elevated, peak intensities differed between components related to depression/anxiety and those related to social anxiety. These results underline the importance of using flexible monitoring and mitigation strategies for mental problems, according to the phase of the pandemic.
The 3p21.31 genetic locus promotes progression to type 1 diabetes through the CCR2/CCL2 pathway
Authors: Tran Paul , Purohit Sharad , Kim Eileen , Satter Khaled bin , Hopkins Diane , Waugh Kathleen , Dong Fran , Onengut-Gumuscu Suna , Rich Stephen S. , Rewers Marian , She Jin-Xiong
Published: August 2021

Objective

Multiple cross-sectional and longitudinal studies have shown that serum levels of the chemokine ligand 2 (CCL-2) are associated with type 1 diabetes (T1D), although the direction of effect differs. We assessed CCL-2 serum levels in a longitudinal cohort to clarify this association, combined with genetic data to elucidate the regulatory role of CCL-2 in T1D pathogenesis.

Research design and methods

The Diabetes Autoimmunity Study in the Young (DAISY) followed 310 subjects with high risk of developing T1D. Of these, 42 became persistently seropositive for islet autoantibodies but did not develop T1D (non-progressors); 48 did develop T1D (progressors). CCL-2 serum levels among the three study groups were compared using linear mixed models adjusting for age, sex, HLA genotype, and family history of T1D. Summary statistics were obtained from the CCL-2 protein quantitative trait loci (pQTL) and CCR2 expression QTL (eQTL) studies. The T1D fine mapping association data were provided by the Type 1 Diabetes Genetics Consortium (T1DGC).

Results

Serum CCL-2 levels were significantly lower in both progressors (p=0.004) and non-progressors (p=0.005), compared to controls. Two SNPs (rs1799988 and rs746492) in the 3p21.31 genetic locus, which includes the CCL-2 receptor, CCR2, were associated with increased CCR2 expression (p = 8.2e-5 and 5.2e-5, respectively), decreased CCL-2 serum level (p = 2.41e-9 and 6.21e-9, respectively), and increased risk of T1D (p = 7.9e-5 and 7.9e-5, respectively).

Conclusions

The 3p21.31 genetic region is associated with developing T1D through regulatory control of the CCR2/CCL2 immune pathway.
Low SARS-CoV-2 infection rate and high vaccine-induced immunity among German healthcare workers at the end of the third wave of the COVID-19 pandemic
Authors: Brehm Thomas Theo , Thompson Michelle , Ullrich Felix , Schwinge Dorothee , Addo Marylyn M , Spier Anthea , Knobloch Johannes K , Aepfelbacher Martin , Lohse Ansgar W , Lütgehetmann Marc , zur Wiesch Julian Schulze
Published: August 2021

In this longitudinal cohort study, we assessed the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) seroconversion rates and analyzed the coronavirus disease 2019 (COVID-19) vaccine-induced immunity of 872 hospital workers at the University Medical Center Hamburg-Eppendorf between May 11 and May 31, 2021. The overall seroprevalence of anti-NC-SARS-CoV-2 antibodies was 4.7% (n=41), indicating low SARS-CoV-2 infection rates and persistent effectiveness of hospital-wide infection control interventions during the second and third wave of the pandemic. In total, 92.7% (n=808) out of the entire study cohort, 98.2% (n=325) of those who had been vaccinated once and all 393 individuals who had been vaccinated twice had detectable anti-S1-RBD-SARS-CoV-2 antibody titers and no significant differences in vaccine-induced immune response were detected between male and female individuals and between different age groups. Vaccinated study participants with detectable anti-NC-SARS-CoV-2 antibody titers (n=30) developed generally higher anti-S1-RBD-SARS-CoV-2 antibody titers compared to anti-NC-SARS-CoV-2 negative individuals (n=694) (median titer: 7812 vs. 345 BAU/ml, p<0.0001). Furthermore, study participants who received heterologous vaccination with AZD1222 followed by an mRNA vaccine showed markedly higher anti-S1-RBD-SARS-CoV-2 antibody titers than individuals who received two doses of an mRNA vaccine or two doses of AZD1222 (median titer: AZD1222 / AZD1222: 1069 BAU/ml, mRNA / mRNA: 1388 BAU/ml, AZD1222/mRNA: 9450 BAU/ml; p<0.0001). Our results demonstrate that infection control interventions were generally effective in preventing nosocomial transmission of SARS-CoV-2 and that COVID-19 vaccines can elicit strong humoral responses in the majority of a real-world cohort of hospital workers.
A qualitative exploration of the perspectives of international medical students residing in university hostels amid COVID-19 pandemic lockdown
Authors: Khadka Sitaram , Usman Muhammad , Saleem Mohammad , Ali Moshin , Rasheed Huma , Giri Santoshi , Saeed Hafiz Asad , Gupta Ravi Prasad , Bajgain Yogesh , Shahi Janak
Published: August 2021

Background

COVID-19 pandemic has portentously frightened the existence of life all over the world. The lockdown approach was adopted as a containment strategy as the disease itself has manifested severe social, economic, and psychiatric implications.

Objectives

To explore the perception and preparedness of international medical students residing in university hostels amid the COVID-19 pandemic lockdown.

Design

A semi-structured interview guide was developed in this qualitative study design. All the interviews were audio-taped, transcribed verbatim, and then analyzed for thematic contents by standard content analysis framework.

Setting

Interviews were conducted in university hostels in Punjab, Pakistan.

Participants

A total of 11 international medical students were interviewed face-to-face through the purposive sampling technique to obtain in-depth individual viewpoints.

Results

The thematic content analysis yielded five major themes: Familiarity with COVID-19, Perceptions and attitudes towards COVID-19, Preparedness for safety against COVID-19, Barriers to lifestyle, and Psychological perspectives. A better general perception and preparedness among international medical students regarding COVID-19 was found. Good knowledge regarding the overview of COVID-19; adequate preventive approaches such as social distancing, use of masks, gloves, and sanitizers; and compliance with the lockdown measures were reported by the respondents. The pertinent issue raised by the respondents is the disturbance in normal routine due to distortion in social life and isolation that may cause psychological stress.

Conclusions

The findings from this study lighten the people’s perspectives that help the government to prepare public health strategies based on population-focused approaches. The present study demonstrates the respondents’ opinion on COVID-19 management by personal hygiene, social distancing, and complying with the lockdown measures. Furthermore, it demands that timely and evidence-based teaching-learning techniques should be adopted for students’ engagement which ensures mental health and self-motivation as well. Therefore, they can utilize their time productively which could have a long-term effect on their careers and healthcare services.
Outbreak of SARS-CoV-2 in a prison: Low effectiveness of a single dose of the adenovirus vector ChAdOx1 vaccine in recently vaccinated inmates
Authors: Marco A , Teixidó N , Guerrero RA , Puig L , Rué X , Cobo A , Barnés I , Turu E
Published: August 2021

Introduction

To analyse the effectiveness of a dose of adenovirus vector ChAdOx1 vaccine (AVChOx1) in an outbreak of SARS-CoV-2 detected in a prison.

Methods

Observational study carried out at Brians-1 Prison, Barcelona. After detecting a case of infection, rt-PCR was administered to all prisoners (some of whom had been vaccinated 21-23 days previously with a dose of AVChOx1) and to staff. Infection rates in vaccinated and unvaccinated populations were calculated, as was vaccine effectiveness.

Results

One hundred and eighty-four asymptomatic prisoners (50.3% vaccinated) and 33 staff were screened. Forty-eight (25.9%) infections by the SCV-B.1.17 variant were recorded in prisoners and none in staff. Infection rates were higher in younger prisoners, immigrants, and those admitted ≥7 days previously. In all, 22.6% of vaccinated subjects were infected vs. 29.3% of unvaccinated. Vaccine effectiveness was 23%. Only 6.2 cases would have been prevented by vaccinating the unvaccinated individuals. At seven days, the rt-PCR was negative in 46.2% of vaccinated subjects vs. 13.6% of unvaccinated (p = 0.02).

Discussion

In a prison outbreak, a dose of AVChAdOx1 administered 21-23 days earlier did not significantly prevent the occurrence of infections, but did reduce the duration of rt-PCR positivity. Maintaining post-vaccination preventive measures is essential.
Temporal considerations in the 2021 COVID-19 lockdown of Ho Chi Minh City
Authors: Plan Emmanuel L. C. VI M. , Thi Huong Le , Le Duy Manh , Phan Haidang
Published: August 2021

The success of Vietnam in controlling the spread of COVID-19 hinges on a timely implementation of its coherent strategy of containment and rapid tracing and testing efforts. The Vietnamese living in Mekong Delta are currently being besieged by the SARS-Cov-2 Delta variant as they undergo several and extended levels of lockdown. In this work we examine the temporal aspects of the lockdown in Ho Chi Minh City and predict the progress of the outbreak in terms of the total number of confirmed cases.

A compartmental model with containment is fit to data to estimate the rate of transmission in Ho Chi Minh City. The severity of the lockdown is estimated from publicly-available data on mobility and coupled to the rate of infection. Various scenarios on when to begin a lockdown and its duration are assessed. This report, dated 27 July 2021, supports a lockdown of at least 3 weeks and predicts that there could be half as many cases had the inevitable lockdown started a week earlier.
Epidemiological characteristics of the B.1.526 SARS-CoV-2 variant
Authors: Yang Wan , Greene Sharon K. , Peterson Eric R. , Li Wenhui , Mathes Robert , Graf Laura , Lall Ramona , Hughes Scott , Wang Jade , Fine Anne
Published: August 2021

To characterize the epidemiological properties of the B.1.526 SARS-CoV-2 variant of interest, here we utilized nine epidemiological and population datasets and model-inference methods to reconstruct SARS-CoV-2 transmission dynamics in New York City, where B.1.526 emerged. We estimated that B.1.526 had a moderate increase (15-25%) in transmissibility and could escape immunity in 0-10% of previously infected individuals. In addition, B.1.526 substantially increased the infection-fatality risk (IFR) among adults 65 or older by >60% during Nov 2020 – Apr 2021, compared to baseline risk estimated for preexisting variants. Overall, findings suggest that new variants like B.1.526 likely spread in the population weeks prior to detection and that partial immune escape (e.g., resistance to therapeutic antibodies) could offset prior medical advances and increase IFR. Early preparedness for and close monitoring of SARS-CoV-2 variants, their epidemiological characteristics, and disease severity are thus crucial to COVID-19 response as it remains a global public health threat.
On the persistence of mental health deterioration during the COVID-19 pandemic by sex and ethnicity in the UK: evidence from Understanding Society
Authors: Proto Eugenio , Quintana-Domeque Climent
Published: August 2021

We use longitudinal data from a representative sample of the UK and compare self-reported mental health, as measured by the GHQ-12 score, at three timepoints (2017-2019, April 2020 and March 2021), for the whole sample and by sex and ethnicity. Out of the 14,382 individuals interviewed in 2017-2019 and April 2020, 10,445 were interviewed again in March 2021. The mean GHQ-12 in April 2020 is 12.37 [95% CI: 12.22, 12.52] and in March 2021 is 12.36 [95% CI: 12.21, 12.51], above that in 2017-2019, 11.13 [95% CI: 10.99, 11.26]. We do not find evidence that the level of mental health goes back to pre-pandemic levels. In terms of inequalities, while the gender gap (mean difference between women and men) in mental health deterioration among White British is closing, there is no clear evidence that the ethnic gap (mean difference between ethnic minorities and White British) among men is changing.
Preliminary Analysis of Excess Mortality in India During the Covid-19 Pandemic (Update September 26, 2021)
Authors: Leffler Christopher T. , Lykins V Joseph D. , Yang Edward
Published: August 2021

As both testing for SARS Cov-2 and death registrations are incomplete or not yet available in many countries, the full impact of the Covid-19 pandemic is currently unknown in many world regions.

We studied the Covid-19 and all-cause mortality in 19 Indian states (combined population of 1.27 billion) with available all-cause mortality data during the pandemic for the entire state or for large cities. Excess mortality was calculated by comparison with available data from years 2015-2019. The known Covid-19 deaths reported by the Johns Hopkins University Center for Systems Science and Engineering for a state were assumed to be accurate, unless excess mortality data suggested a higher toll during the pandemic. Data from one state were not included in the final model due to anomalies.

In several regions, fewer deaths were reported in 2020 than expected. The excess mortality in Mumbai (in Maharashtra) in 2020 was 137.0 / 100K. Areas in Andhra Pradesh, Delhi, Haryana, Karnataka, Madhya Pradesh, Tamil Nadu, and Kolkata (in West Bengal), saw spikes in mortality in the spring of 2021.

The pandemic-related mortality through August 31, 2021 in 18 Indian states was estimated to be 198.7 per 100,000 population (range 146.1 to 263.8 per 100K). If these rates apply to India as a whole, then 2.69 million people (range 1.98 to 3.57 million) may have perished in India as a result of the Covid-19 pandemic by August 31, 2021.
Diagnostic Efficacy of Rapid Antigen Testing for SARS-CoV-2: The COVid-19 AntiGen (COVAG) study
Authors: Wertenauer Christoph , Michael Geovana Brenner , Dressel Alexander , Pfeifer Caroline , Hauser Ulrike , Wieland Eberhard , Mayer Christian , Mutschmann Caren , Roskos Martin , Wertenauer Hans-Jörg , März Winfried
Published: August 2021

Background

Widely available rapid testing is pivotal to the fight against COVID-19. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) remains the gold standard. We compared two frequently used commercial rapid diagnostic tests (RDTs) for SARS-CoV-2-antigens, the SD Biosensor SARS-CoV-2 Rapid Antigen Test (Roche Diagnostics) and the Panbio COVID-19 Ag Rapid Test (Abbott Diagnostics), against rRT-PCR for SARS-CoV-2 detection.

Methods

We compared the tests in 2215 all-comers at a diagnostic centre between February 1 and March 31, 2021. rRT-PCR-positive samples were examined for SARS-CoV-2 variants.

Findings

338 participants (15%) were rRT-PCR-positive for SARS-CoV-2. The sensitivities of Roche-RDT and Abbott-RDT were 60.4% and 56.8% (P<0·0001) and specificities 99.7% and 99.8% (P=0·076), respectively. Sensitivity inversely correlated with rRT-PCR-derived Ct values. Unadjusted, the RDTs had higher sensitivities in individuals referred by treating physicians and health departments than those tested for other reasons, in persons without comorbidities compared to those with comorbidities, in individuals with symptoms suggesting COVID-19, and in the absence of SARS-CoV-2 variants compared to Alpha variant carriers. The associations of sensitivity with clinical symptoms and the SARS-CoV-2 genotype were robust against adjustment for Ct values. Assuming that 10 000 symptomatic individuals are tested, 500 of which are truly positive, the RDTs would generate 38 false-positive and 124 false-negative results. Assuming that 10 000 asymptomatic individuals are tested, including 50 true positives, 18 false-positives and 34 false-negatives would be generated.

Interpretation

The sensitivities of the two RDTs are unsatisfactory. This calls into question whether their widespread use is effective in the ongoing SARS-CoV-2 pandemic.

Funding

SYNLAB Holding Deutschland GmbH

Research in context

Evidence before this study

Small studies and a meta-analysis from the Cochrance collaboration indicate vastly different diagnostic efficacies of commercial rapid diagnostic tests (RDTs) for SARS-CoV-2 antigen. The impact of SARS-CoV-2 variants has not been known.

Added value of this study

This is one of the largest real-world studies of the diagnostic efficacy of two widely recommended RDTs SARS-CoV-2 antigen in comparison to rRT-PCR. The sensitivities of the two RDTs are unsatisfactory, mainly in asymptomatic persons. Presence of the SARS-CoV-2 Alpha Variant decreased both tests’ sensitivities significantly.

Implications of all the available evidence

Policy and health care providers should account for substantial limitations of RDTs for SARS-CoV-2 particular in asymptomatic persons. Research into alternative approaches to the screening for SARS-CoV-2 should be intensified.