bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphologic remission status is limited compared to ΔN flow cytometry: a Children’s Oncology Group AAML0531 report
Authors: Brodersen Lisa Eidenschink , Gerbing Robert B. , Pardo M. Laura , Alonzo Todd A. , Paine Dana , Fritschle Wayne , Hsu Fan-Chi , Pollard Jessica A. , Aplenc Richard , Kahwash Samir B. , Hirsch Betsy , Ramondi Susana , Wells Denise , Kolb E. Anders , Gamis Alan S. , Meshinchi Soheil , Loken Michael R.
Published: October 2020

Risk stratification for acute myeloid leukemia (AML) uses molecular and cytogenetic abnormalities identified at diagnosis. Response to therapy informs risk, and morphology continues to be used more frequently than flow cytometry. Herein, the largest cohort of pediatric patients prospectively assessed for measurable residual disease (MRD) by flow cytometry (N = 784) is reported. The “difference from normal” (ΔN) technique was applied: 31% of all patients tested positive (AML range, 0.02% to 91%) after the first course of treatment on Children’s Oncology Group study AAML0531. Detection of MRD following initial chemotherapy proved the strongest predicator of overall survival (OS) in univariable and multivariable analyses, and was predictive of relapse risk, disease-free survival, and treatment-related mortality. Clearance of MRD after a second round of chemotherapy did not improve survival. The morphologic definition of persistent disease (>15% AML) failed 27% of the time; those identified as MRD− had superior outcomes. Similarly, for patients not achieving morphologic remission (>5% blasts), 36% of patients were MRD− and had favorable outcomes compared with those who were MRD+ (P < .001); hence an increase in myeloid progenitor cells can be favorable when ΔN classifies them as phenotypically normal. Furthermore, ΔN reclassified 20% of patients in morphologic remission as having detectable MRD with comparable poor outcomes. Retrospective analysis using the relapse phenotype as a template demonstrated that 96% of MRD− patients had <0.02% of the relapse immunophenotype in their end of induction 1 marrow. Thus, the detection of abnormal myeloid progenitor cells by ΔN is both specific and sensitive, with a high predictive signal identifiable early in treatment. This trial was registered at www.clinicaltrials.gov as #NCT00372593.
Allogeneic transplantation for Ph+ acute lymphoblastic leukemia with posttransplantation cyclophosphamide
Authors: Webster Jonathan A. , Luznik Leo , Tsai Hua-Ling , Imus Philip H. , DeZern Amy E. , Pratz Keith W. , Levis Mark J. , Gojo Ivana , Showel Margaret M. , Prince Gabrielle , Bolaños-Meade Javier , Gondek Lukasz P. , Ghiaur Gabriel , Dalton W. Brian , Jain Tania , Fuchs Ephraim J. , Gladstone Douglas E. , Gocke Christian B. , Ali Syed Abbas , Huff Carol Ann , Borrello Ivan M. , Swinnen Lode , Wagner-Johnston Nina , Ambinder Richard F. , Jones Richard J. , Smith B. Douglas
Published: October 2020

Allogeneic blood or marrow transplantation (alloBMT) is standard of care for adults with Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ ALL) in first complete remission (CR1). The routine pretransplant and posttransplant use of tyrosine kinase inhibitors (TKIs) has dramatically improved outcomes, but the optimal conditioning regimen, donor type, and TKI remain undefined. The bone marrow transplant database at Johns Hopkins was queried for adult patients with de novo Ph+ ALL who received alloBMT using posttransplantation cyclophosphamide (PTCy) as a component of graft-versus-host disease (GVHD) prophylaxis from 2008 to 2018. Among transplants for Ph+ ALL, 69 (85%) were performed in CR1, and 12 (15%) were performed in second or greater remission (CR2+). The majority of transplants (58%) were HLA haploidentical. Nearly all patients (91.4%) initiated TKI posttransplant. For patients in CR1, the 5-year relapse-free survival (RFS) was 66%. The use of nonmyeloablative conditioning, absence of measurable residual disease (MRD) according to flow cytometry at transplant, and the use of dasatinib vs imatinib at diagnosis were associated with improved overall survival (OS) and RFS. Neither donor type nor recipient age ≥60 years affected RFS. When analyzing all transplants, alloBMT in CR1 (vs CR2+) and the absence of pretransplant MRD were associated with improved RFS. Most relapses were associated with the emergence of kinase domain mutations. The cumulative incidence of grade 3 to 4 acute GVHD at 1 year was 9%, and moderate to severe chronic GVHD at 2 years was 8%. Nonmyeloablative alloBMT with PTCy for Ph+ ALL in an MRD-negative CR1 after initial treatment with dasatinib yields favorable outcomes.
Design-based learning for a sustainable future: student outcomes resulting from a biomimicry curriculum in an evolution course
Authors: Fried Erin , Martin Andrew , Esler Alexa , Tran Antoine , Corwin Lisa
Published: October 2020

Background

National institutes and education initiatives emphasize the need to prepare future biologists to apply discoveries in science towards solving problems that are both social and scientific in nature. Research from socio-scientific, design-based, and problem-based learning demonstrates that contextualized, real-world tasks can improve students’ ability to apply their scientific knowledge in practical ways to navigate social problems. Biomimicry Design is an interdisciplinary field requiring biology and design skills; it informs the creation of sustainable designs through emulation of biological structures and functions that arise as a result of natural selection. Notably, engaging in biomimicry design targets an important biology and engineering learning outcome: understanding of how structure influences function. This study leveraged the practices of biomimicry along with those of design-based learning (DBL) to improve student outcomes in an evolutionary biology undergraduate course. Through DBL, the authors aimed to (1) ignite deeper understanding of how structure determines function in nature (a cross-disciplinary concept) and (2) help students to consider new ways this concept can benefit society (a science process skill).

Results

We randomly assigned two sections of an upper-division evolutionary biology course to either a biomimicry DBL (DBL group) or species comparison (comparison group) curricular design. Students in the course were exposed to a 1-day lesson, then 1-weeklong case study, and then a final project focused on either biomimicry species-to-human design comparisons (DBL condition) or species-to-species comparisons (comparison condition). To assess the targeted outcomes, we analyzed students’ responses from a pre-post assessment. Students in the biomimicry section were more likely to apply their biological structure–function knowledge to societal benefits when leaving the course. Students in both sections showed comparable gains in structure–function understanding, but there was no change in the number of students who used misconception language in their post-course compared to pre-course responses.

Conclusions

We conclude that our DBL curriculum, above and beyond the comparison curriculum, may support students’ ability to apply biological concepts to societal benefits without compromising structure–function understanding. Overall, these results provide rationale for incorporating tasks situated in DBL to address socio-scientific issues in biology courses.
Transition towards sustainable pharmacy? The influence of public debates on policy responses to pharmaceutical contaminants in water
Authors: Schaub Simon , Braunbeck Thomas
Published: October 2020

Background

Despite clear-cut scientific evidence for pharmaceutical contaminants causing adverse effects in aquatic life, the regulatory response in Germany has been weak. In principle, there are different policy approaches to address pharmaceutical contaminants: German water protection policies mostly follows a control approach, complemented by end-of-pipe solutions in some German states. The approach leaves the activities of key target groups, such as the pharmaceutical industry, largely unaffected. A stakeholder consultation initiated in 2016 by the German Federal Ministry of the Environment did not lead to significant changes in regulation. Empirical research in political science has shown that analysing the public debate can be helpful in explaining policy responses and, in particular, policy change. This study follows this approach and investigates whether the German policy response to pharmaceutical contaminants can be explained by characteristics of the public debate on the issue.

Results

A discourse network analysis based on newspaper reporting in Germany was conducted between 2013 and 2017 to investigate the public debate on pharmaceutical contaminants. German newspapers actually paid considerable attention to the issue. In fact, the debate was not controversial, and participating organisations expressed similar views with regard to the risk of the contaminants, the causes of contamination and the approaches to be taken to mitigate the release of contaminants to the environment. The main narrative in the debate was supportive to the current policy approach applied in Germany. There were no concerted efforts by organisations such as environmental organisations or ecological parties to mobilise for an alternative policy approach.

Conclusions

The low level of polarisation in the policy subsystem and the absence of a strong narrative mobilising a major policy change may explain the persistence of the policy approach to pharmaceutical contaminants applied in Germany. A significant change to the current approach in the near future seems unlikely. Nevertheless, literature in political science shows that a polarised public debate and a strong pro-change actor coalition often preceded policy change. Actors with an interest in stricter regulation might want to reconsider their mobilisation strategies.
Evaluation of the Autof MS1000 mass spectrometer in the identification of clinical isolates
Authors: Ma Qiong , Zhang Qi , Yuan Youhua , Yan Wenjuan , Wang Shanmei , Xu Junhong , Zhang Jiangfeng , Wang Yuming , Li Yi
Published: October 2020

Background

To evaluate the accuracy and performance of the Autof MS1000 mass spectrometer in bacteria and yeast identification, 2342 isolates were obtained from microbial cultures of clinical specimens (e.g. blood, cerebrospinal fluid, respiratory tract samples, lumbar puncture fluid, wound samples, stool, and urine) collected in 2019 in Henan Provincial People’s Hospital. Repetitive strains from the same patient were excluded. We tested the Autof MS1000 and Bruker Biotyper mass spectrometry systems and the classical biochemical identification system VITEK 2/API 20C AUX. Inconsistencies in strain identification among the three systems were identified by 16S rDNA and gene sequencing.

Results

At the species level, the Autof MS1000 and Bruker Biotyper systems had isolate identification accuracies of 98.9 and 98.5%, respectively. At the genus level, the Autof MS1000 and Bruker Biotyper systems were 99.7 and 99.4% accurate, respectively. The instruments did not significantly differ in identification accuracy at either taxonomic level. The frequencies of unreliable identification were 1.1% (26/2342) for the Autof MS1000 and 1.5% (34/2342) for the Bruker Biotyper. In vitro experiments demonstrated that the coincidence rate of the Autof MS1000 mass spectrometer in the identification of five types of bacteria was > 93%, the identification error rate was < 3%, and the no identification rate was 0. This indicates that the Autof MS1000 system is acceptable for identification.

Conclusions

The Autof MS1000 mass spectrometer can be utilised to identify clinical isolates. However, an upgradation of the database is recommended to correctly identify rare strains.
Towards unravelling Wolbachia global exchange: a contribution from the Bicyclus and Mylothris butterflies in the Afrotropics
Authors: Duplouy Anne , Pranter Robin , Warren-Gash Haydon , Tropek Robert , Wahlberg Niklas
Published: October 2020

Background

Phylogenetically closely related strains of maternally inherited endosymbiotic bacteria are often found in phylogenetically divergent, and geographically distant insect host species. The interspecies transfer of the symbiont Wolbachia has been thought to have occurred repeatedly, facilitating its observed global pandemic. Few ecological interactions have been proposed as potential routes for the horizontal transfer of Wolbachia within natural insect communities. These routes are however likely to act only at the local scale, but how they may support the global distribution of some Wolbachia strains remains unclear.

Results

Here, we characterize the Wolbachia diversity in butterflies from the tropical forest regions of central Africa to discuss transfer at both local and global scales. We show that numerous species from both the Mylothris (family Pieridae) and Bicyclus (family Nymphalidae) butterfly genera are infected with similar Wolbachia strains, despite only minor interclade contacts across the life cycles of the species within their partially overlapping ecological niches. The phylogenetic distance and differences in resource use between these genera rule out the role of ancestry, hybridization, and shared host-plants in the interspecies transfer of the symbiont. Furthermore, we could not identify any shared ecological factors to explain the presence of the strains in other arthropod species from other habitats, or even ecoregions.

Conclusion

Only the systematic surveys of the Wolbachia strains from entire species communities may offer the material currently lacking for understanding how Wolbachia may transfer between highly different and unrelated hosts, as well as across environmental scales.
Increased osteoprotegerin level is associated with impaired cardiovagal modulation in type-2 diabetic patients treated with oral antidiabetic drugs
Authors: Jasmine M. R. , Nanda Nivedita , Sahoo Jayaprakash , Velkumary S. , Pal G. K.
Published: October 2020

Background

An increased osteoprotegerin (OPG) level has been reported in both type-2 diabetes mellitus (T2DM) and cardiovascular diease (CVD) that are linked to sympathovagal imbalance (SVI). We explored the link of osteoprotegerin with cardiovagal modulation in T2DM.

Methods

We assessed fasting serum OPG, high-sensitive C-reactive protein (hsCRP), glucose, insulin and lipid profile in patients having T2DM receiving oral antidiabetic drugs (OAD) (n = 42) compared with age, gender and body composition-matched healthy participants without diabetes (n = 42). Rate pressure product (RPP), spectral indices of heart rate variability (HRV) and body composition were recorded in both the groups. Association of HOMA-IR and OPG with various parameters were assessed.

Results

Osteoprotegerin, HOMA-IR, hsCRP, coronary lipid risk factor were significantly increased, markers of cardiovagal modulation (TP, SDNN, RMSSD) were considerably decreased, ratio of low-frequency to high-frequency (LH-HF ratio), the indicator of SVI, and RPP, the marker of myocardial work stress were significantly higher in patients with diabetes, suggesting an overall elevated CVD risks in them. HOMA-IR was correlated with RMSSD, lipid risk factors and OPG. Rise in OPG was correlated with decreased cardiovagal modulation in patients with diabetes. There was significant contribution of OPG in decreasing TP, suggesting impaired cardiovagal modulation.

Conclusion

T2DM patients receiving OAD had higher cardiometabolic risks compared to age, gender and body composition-matched healthy individuals. Increased level of OPG is linked to decreased cardiovagal modulation in T2DM patients.
A hypocaloric high-protein diet supplemented with β-cryptoxanthin improves non-alcoholic fatty liver disease: a randomized controlled trial
Authors: Haidari Fatemeh , Hojhabrimanesh Abdollah , Helli Bizhan , Seyedian Seyed-Saeed , Ahmadi-Angali Kambiz , Abiri Behnaz
Published: October 2020

Background

Despite promising animal data, there is no randomized controlled trial (RCT) on the effects of high protein (HP)-diet and/or β-cryptoxanthin in non-alcoholic fatty liver disease (NAFLD). Aims: Safety and efficacy assessment of a hypocaloric HP-diet supplemented with β-cryptoxanthin in NAFLD.

Methods

Ninety-two Iranian NAFLD outpatients were recruited for this 12-week, single-center, parallel-group, double-blind RCT and randomized into 4 arms (n = 23): HP-diet and β-cryptoxanthin (hypocaloric HP-diet + β-cryptoxanthin), HP-diet (hypocaloric HP-diet + placebo), β-cryptoxanthin (standard hypocaloric diet + β-cryptoxanthin), and control (standard hypocaloric diet + placebo). Serum levels of liver enzymes and grade of hepatic steatosis were assessed at baseline and study endpoint as outcome measures.

Results

In the intention-to-treat population (N = 92), HP-diet and β-cryptoxanthin group experienced greater 12-week reductions in serum levels of liver enzymes than control group (mean difference for alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase: − 27.2, − 7.2, − 39.2, and − 16.3 IU/L, respectively; all p < 0.010). Clinical remission rate (achieving grade 0 hepatic steatosis) in HP-diet and β-cryptoxanthin group (82.6%) was also higher than other groups (13.0%, 17.4%, and 0.0% in HP-diet, β-cryptoxanthin, and control groups, respectively; p < 0.001). Sixteen patients reported minor adverse events.

Conclusion

A hypocaloric HP-diet supplemented with β-cryptoxanthin safely and efficaciously improves NAFLD.

Trial registration number

This trial was registered at https://www.irct.ir as IRCT2017060210181N10.
Subtotal (segment II–VIII) hepatectomy for bilateral diffuse hepatolithiasis with compensatory caudate lobe hypertrophy: a report of two cases
Authors: Wang Wei , Zhang ZiJie , Wang Jian
Published: October 2020

Background

Hepatolithiasis often leads to atrophy–hypertrophy complex due to bile duct obstruction, inflammation or infection in the affected liver segments and compensatory response in the normal segments. In severe bilateral diffuse cases, main liver can all be atrophic, leaving the caudate lobe to be extremely hypertrophic. Subtotal (segment II–VIII) hepatectomy can be an option in selected patients under such circumstances. Since rare cases have been reported, our study aims to highlight the preoperative evaluation and key points of this procedure.

Case presentation

Two patients with primary and secondary bilateral diffuse hepatolithiasis, respectively, were enrolled in this case series. The atrophy of the left and right liver with an exceeding hypertrophy of the caudate lobe were observed. Since the liver anatomy had completely been changed, contrast computed tomography, magnetic resonance imaging combined with 3D liver reconstruction were employed for comprehensive evaluation and pre-operational planning. The patients underwent standard subtotal (segment II–VIII) hepatectomy. During operation, the hepatoduodenal ligament around porta hepatis was dissected firstly to expose the hepatic artery, portal vein, bile duct and their branches successively. And then the vessels and bile duct to caudate lobe were preserved safely through cutting off the left and right hepatic artery, portal vein and bile duct at a safe point distal to the origin of the branches to caudate lobe. Operation time was 300 min and 360 min, respectively. Blood loss was 200 ml and 300 ml. No evidence of liver dysfunction, hepatolithiasis relapse or cholangitis was observed during the follow-up of 12 and 26 months.

Conclusions

Subtotal (segment II–VIII) hepatectomy may be one of several treatments possible in selected patients with compensatory caudate lobe hypertrophy caused by bilateral diffuse hepatolithiasis.
Detecting SARS-CoV-2 at point of care: preliminary data comparing loop-mediated isothermal amplification (LAMP) to polymerase chain reaction (PCR)
Authors: Österdahl Marc F. , Lee Karla A. , Lochlainn Mary Ni , Wilson Stuart , Douthwaite Sam , Horsfall Rachel , Sheedy Alyce , Goldenberg Simon D. , Stanley Christopher J. , Spector Tim D. , Steves Claire J.
Published: October 2020

Background

A cost effective and efficient diagnostic tool for COVID-19 as near to the point of care (PoC) as possible would be a game changer in the current pandemic. We tested reverse transcription loop mediated isothermal amplification (RT-LAMP), a method which can produce results in under 30 min, alongside standard methods in a real-life clinical setting.

Methods

This prospective service improvement project piloted an RT-LAMP method on nasal and pharyngeal swabs on 21 residents of a high dependency care home, with two index COVID-19 cases, and compared it to multiplex tandem reverse transcription polymerase chain reaction (RT-PCR). We recorded vital signs of patients to correlate clinical and laboratory information and calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a single swab using RT-LAMP compared with the current standard, RT-PCR, as per Standards for Reporting Diagnostic Accuracy Studies (STARD) guidelines.

Results

The novel method accurately detected 8/10 RT-PCR positive cases and identified a further 3 positive cases. Eight further cases were negative using both methods. Using repeated RT-PCR as a “gold standard”, the sensitivity and specificity of a single novel test were 80 and 73% respectively. PPV was 73% and NPV was 83%. Incorporating retesting of low signal RT-LAMP positives improved the specificity to 100%. We also speculate that hypothermia may be a significant early clinical sign of COVID-19.

Conclusions

RT-LAMP testing for SARS-CoV-2 was found to be promising, fast and to work equivalently to RT-PCR methods. RT-LAMP has the potential to transform COVID-19 detection, bringing rapid and accurate testing to the PoC. RT-LAMP could be deployed in mobile community testing units, care homes and hospitals to detect disease early and prevent spread.
Epidemiological and clinical characteristics of 161 discharged cases with coronavirus disease 2019 in Shanghai, China
Authors: Lin Sheng , Pan Hao , Wu Huanyu , Yu Xiao , Cui Peng , Han Ruobing , Jiang Chenyan , Kong Dechuan , Zheng Yaxu , Gong Xiaohuan , Xiao Wenjia , Mao Shenghua , Jin Bihong , Zhu Yiyi , Sun Xiaodong
Published: October 2020

Background

In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) began in Wuhan, China, and rapidly spread to other regions. We aimed to further describe the epidemiological and clinical characteristics of discharged COVID-19 cases and evaluate the public health interventions.

Methods

We collected epidemiological and clinical data of all discharged COVID-19 cases as of 17 February 2020 in Shanghai. The key epidemiological distributions were estimated and outcomes were also compared between patients whose illness were before 24 January and those whose illness were after 24 January.

Results

Of 161 discharged COVID-19 cases, the median age was 45 years, and 80 (49.7%) cases were male. All of the cases were categorized as clinical moderate type. The most common initial symptoms were fever (85.7%), cough (41.0%), fatigue (19.3%), muscle ache (17.4%), sputum production (14.9%), and there were six asymptomatic cases. 39 (24.2%) cases got infected in Shanghai, and three of them were second-generation cases of Shanghai native cases. The estimated median of the time from onset to first medical visit, admission, disease confirmation, and discharge for 161 cases was 1.0 day (95% CI, 0.6–1.2), 2.0 days (95% CI, 1.5–2.6), 5.2 days (95% CI, 4.6–5.7), 18.1 days (95% CI, 17.4–18.8), respectively. The estimated median of the time from admission to discharge was 14.0 days (95% CI, 13.3–14.6). The time from onset to first medical visit, admission and disease confirmation were all shortened after the Shanghai’s first-level public health emergency response. In Cox regression model, the significant independent covariates for the duration of hospitalization were age, the time from onset to admission and the first-level public health emergency response.

Conclusions

Local transmission had occurred in Shanghai in late January 2020. The estimated median of the time from onset to discharge of moderate COVID-19 was 18.1 days in Shanghai. Time intervals from onset to first medical visit, admission and disease confirmation were all shortened after the Shanghai’s first-level public health emergency response. Age, the first-level public health emergency response and the time from onset to admission were the impact factors for the duration of hospitalization.
Evaluation of liver function using liver parenchyma, spleen and portal vein signal intensities during the hepatobiliary phase in Gd-EOB-D TPA-enhanced MRI
Authors: Yang Ming , Zhang Yue , Zhao Wenlu , Cheng Wen , Wang Han , Guo Shengren
Published: October 2020

Background

Previous studies have used signal intensity (SI) to reflect liver function. However, few studies have evaluated liver function via the portal vein. Regarding the SI of the liver, spleen, and portal vein, no study has indicated which can best reflect liver function. Therefore, the aim of this study is to investigate whether these parameters can evaluate liver function in patients with cirrhosis and determine which is the best parameter.

Methods

120 patients with normal livers (n = 41) or Child–Pugh class A (n = 50), B (n = 21) or C (n = 8) disease who had undergone Gd-EOB-DTPA-enhanced MRI were retrospectively reviewed. Comparisons of the MRI data (liver parenchyma SI, portal vein SI, and spleen SI and liver-to-portal vein contrast ratio (LPC), liver-to-spleen contrast ratio (LSC), and portal vein-to-spleen contrast ratio (PSC)) in the 15-min hepatobiliary phase images were performed among the groups, and the correlations among the liver function parameters (total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, albumin, creatinine, platelet count, prothrombin time and international normalized ratio), liver function scores and MRI data were also quantitatively analysed.

Results

Significant differences were observed in the liver parenchyma SI, LPC and LSC among the groups. These values all decreased gradually from normal livers to Child–Pugh class C cirrhotic livers (P < 0.001). The portal vein SI constantly and slightly increased from normal livers to Child–Pugh class C cirrhotic livers, but no differences were found among the groups in the portal vein SI and PSC (P > 0.05). LPC showed a stronger correlation with the Child–Pugh score and MELD score than LSC and the liver parenchyma SI. The order of the AUCs of these parameters, from largest to smallest, was as follows: LPC, LSC, and liver parenchyma SI (P > 0.05).

Conclusion

The liver parenchyma SI, LSC and LPC may be used as alternative imaging biomarkers to assess liver function, while the portal vein SI and PSC do not reflect liver function. Furthermore, LPC values can more effectively distinguish severity among patients with cirrhosis than the liver parenchyma SI and LSC.
A model based on CT radiomic features for predicting RT-PCR becoming negative in coronavirus disease 2019 (COVID-19) patients
Authors: Cai Quan , Du Si-Yao , Gao Si , Huang Guo-Liang , Zhang Zheng , Li Shu , Wang Xin , Li Pei-Ling , Lv Peng , Hou Gang , Zhang Li-Na
Published: October 2020

Background

Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic. According to the diagnosis and treatment guidelines of China, negative reverse transcription-polymerase chain reaction (RT-PCR) is the key criterion for discharging COVID-19 patients. However, repeated RT-PCR tests lead to medical waste and prolonged hospital stays for COVID-19 patients during the recovery period. Our purpose is to assess a model based on chest computed tomography (CT) radiomic features and clinical characteristics to predict RT-PCR negativity during clinical treatment.

Methods

From February 10 to March 10, 2020, 203 mild COVID-19 patients in Fangcang Shelter Hospital were retrospectively included (training: n = 141; testing: n = 62), and clinical characteristics were collected. Lung abnormalities on chest CT images were segmented with a deep learning algorithm. CT quantitative features and radiomic features were automatically extracted. Clinical characteristics and CT quantitative features were compared between RT-PCR-negative and RT-PCR-positive groups. Univariate logistic regression and Spearman correlation analyses identified the strongest features associated with RT-PCR negativity, and a multivariate logistic regression model was established. The diagnostic performance was evaluated for both cohorts.

Results

The RT-PCR-negative group had a longer time interval from symptom onset to CT exams than the RT-PCR-positive group (median 23 vs. 16 days, p < 0.001). There was no significant difference in the other clinical characteristics or CT quantitative features. In addition to the time interval from symptom onset to CT exams, nine CT radiomic features were selected for the model. ROC curve analysis revealed AUCs of 0.811 and 0.812 for differentiating the RT-PCR-negative group, with sensitivity/specificity of 0.765/0.625 and 0.784/0.600 in the training and testing datasets, respectively.

Conclusion

The model combining CT radiomic features and clinical data helped predict RT-PCR negativity during clinical treatment, indicating the proper time for RT-PCR retesting.
Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography
Authors: Liu Yu , Zhang Ning , He Yanni , Shi Jiayao , Zhou Meijun , Xu Jingjiao , Liu Hongmei
Published: October 2020

Background

Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. However, Few studies have evaluated the influencing factors of spontaneous conception in 4D-HyCoSy and suggested ways to choose treatment options after 4D-HyCoSy. The study was to evaluate the correlation between spontaneous conception outcome and the patients’ clinical characteristics as well as tubal patency in infertile women to provide reference on ways to manage the patient after 4D-HyCoSy.

Methods

This was a retrospective study and analysis of two hundred and eighty three (283) infertile patients who underwent a 4D-HyCoSy between December 2014 and October 2017 in our center. Eligible patients were those whose partners semen parameters were normal when based on World Health Organization (WHO) criteria, and had spontaneous conception without clinical interventions after 4D-HyCoSy.

Result(s)

One hundred and sixteen patients (40.9%) conceived spontaneously and the mean conception time was (8.8 ± 0.3) months. Within a year after 4D-HyCoSy, the spontaneous conception rate was highest in type VI(62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%). With Cox regression analysis, two factors associated with spontaneous conception outcome appeared to increase spontaneous conception rate: patients with type IV or type VI tubes and duration of infertility less than 2 years. The age, type of infertility, multiparas, history of pelvic surgery, history of uterine cavity operation, uterine fibromyomata and polycystic ovary were unrelated to spontaneous conception outcome after 4D-HyCoSy.

Conclusion(s)

This study showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy. Hence, We recommend the usage of 4D-HyCoSy as first line for tubal patency test and infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible. Expectant treatment of about 8–9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed one tube patency or poor patency. Alternatively, an immediate clinical intervention is recommended for those with bilateral obstructed tubes .
Glaucomatous visual fields and neurocognitive function are independently associated with poor lane maintenance during driving simulation
Authors: Anderson David E. , Bader John P. , Boes Emily A. , Gagrani Meghal , Smith Lynette M. , Ndulue Jideofor K. , Kedar Sachin , Gulati Vikas , Ghate Deepta A. , Rizzo Matthew
Published: October 2020

Background

Driving simulators are a safe alternative to on-road vehicles for studying driving behavior in glaucoma drivers. Visual field (VF) loss severity is associated with higher driving simulator crash risk, though mechanisms explaining this relationship remain unknown. Furthermore, associations between driving behavior and neurocognitive performance in glaucoma are unexplored. Here, we evaluated the hypothesis that VF loss severity and neurocognitive performance interact to influence simulated vehicle control in glaucoma drivers.

Methods

Glaucoma patients (n = 25) and suspects (n = 18) were recruited into the study. All had > 20/40 corrected visual acuity in each eye and were experienced field takers with at least three stable (reliability > 20%) fields over the last 2 years. Diagnosis of neurological disorder or cognitive impairment were exclusion criteria. Binocular VFs were derived from monocular Humphrey VFs to estimate a binocular VF index (OU-VFI). Montreal Cognitive Assessment (MoCA) was administered to assess global and sub-domain neurocognitive performance. National Eye Institute Visual Function Questionnaire (NEI-VFQ) was administered to assess peripheral vision and driving difficulties sub-scores. Driving performance was evaluated using a driving simulator with a 290° panoramic field of view constructed around a full-sized automotive cab. Vehicle control metrics, such as lateral acceleration variability and steering wheel variability, were calculated from vehicle sensor data while patients drove on a straight two-lane rural road. Linear mixed models were constructed to evaluate associations between driving performance and clinical characteristics.

Results

Patients were 9.5 years older than suspects (p = 0.015). OU-VFI in the glaucoma group ranged from 24 to 98% (85.6 ± 18.3; M ± SD). OU-VFI (p = .0066) was associated with MoCA total (p = .0066) and visuo-spatial and executive function sub-domain scores (p = .012). During driving simulation, patients showed greater steering wheel variability (p = 0.0001) and lateral acceleration variability (p < .0001) relative to suspects. Greater steering wheel variability was independently associated with OU-VFI (p = .0069), MoCA total scores (p = 0.028), and VFQ driving sub-scores (p = 0.0087), but not age (p = 0.61).

Conclusions

Poor vehicle control was independently associated with greater VF loss and worse neurocognitive performance, suggesting both factors contribute to information processing models of driving performance in glaucoma. Future research must demonstrate the external validity of current findings to on-road performance in glaucoma.
Giving syphilis and gonorrhea to friends: using in-person friendship networks to find additional cases of gonorrhea and syphilis
Authors: Rosenbaum Janet E. , Jennings Jacky , Ellen Jonathan M. , Borkovic Laurel M. , Scott Jo-Ann , Wylie Charleen , Rompalo Anne
Published: October 2020

Background

Syphilis and gonorrhea reached an all-time high in 2018. The resurgence of syphilis and gonorrhea requires innovative methods of sexual contact tracing that encourage disclosure of same-sex sexual contacts that might otherwise be suppressed. Over 75% of Grindr mobile phone application users report seeking “friendship,” so this study asked people diagnosed with syphilis and gonorrhea to identify their friends.

Methods

Patients at the two Baltimore sexually transmitted infection (STI) clinics and the Baltimore City Health Department were asked 12 questions to elicit members of their friendship networks before eliciting sexual networks. The study included 353 index cases and 172 friendship contacts, yielding a friendship network of 331 non-isolates (n = 331) and sexual-only network of 140 non-isolates. The data were plotted and analyzed using exponential family random graph analysis.

Results

Eliciting respondents’ in-person social contacts yielded 12 syphilis cases and 6 gonorrhea cases in addition to the 16 syphilis cases and 4 gonorrhea cases that would have been found with sexual contacts alone. Syphilis is clustered within sexual (odds ratio = 2.2, 95% confidence interval (1.36, 3.66)) and social contacts (OR = 1.31, 95% CI (1.02, 1.68)). Gonorrhea is clustered within reported social (OR = 1.56, 95% CI (1.22, 2.00)) but not sexual contacts (OR = 0.98, 95% CI (0.62, 1.53)).

Conclusions

Eliciting friendship networks of people diagnosed with syphilis and gonorrhea may find members of their sexual networks, drug use networks, or people of similar STI risk. Friendship networks include more diagnosed cases of syphilis and gonorrhea than sexual networks alone, especially among populations with many non-disclosing men who have sex with men (MSM) and women who have sex with women (WSW). Future research should evaluate whether this friendship network method of contact tracing can be implemented by adapting automated mobile phone COVID-19 contact tracing protocols, if these COVID-19 contact tracing methods are able to maintain anonymity and public trust.
Parental concerns and uptake of childhood vaccines in rural Tanzania – a mixed methods study
Authors: Vasudevan Lavanya , Baumgartner Joy Noel , Moses Sara , Ngadaya Esther , Mfinanga Sayoki Godfrey , Ostermann Jan
Published: October 2020

Background

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

Methods

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards.

Results

In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage.

Conclusions

Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies.
Tickborne disease awareness and protective practices among U.S. Forest Service employees from the upper Midwest, USA
Authors: Schotthoefer Anna , Stinebaugh Kathryn , Martin Michael , Munoz-Zanzi Claudia
Published: October 2020

Background

People with occupations that require them to spend time working outdoors in suitable tick habitats are predicted to be at an increased risk for tick-borne diseases (TBDs). However, few studies have assessed the risks of outdoor employees in the United States.

Methods

We conducted a cross-sectional survey to collect data on exposure to ticks and TBD infections among U.S. Forest Service employees in a high TBD incidence region of northern Wisconsin, and to examine employee knowledge, attitudes, and practices (KAPs) regarding TBDs to help guide future education and prevention programs. Chi-square contingency tables, calculations of odds ratios, and logistic regression models were used to identify associations among self-reported employee factors, the proportion of correctly answered knowledge questions, their ranked concern for TBDs, adherence to practicing preventive behaviors, and willingness to pay for protective measures.

Results

Ninety-five employees completed the survey. Nearly all respondents (97%) reported recent tick exposure, with 27% reporting encountering 10 or more ticks per week during peak tick season. Employee knowledge of TBD was high (median score: 80% correct). Fifty-nine percent of respondents had high concern for TBDs, and there was high adherence to conducting body checks for ticks (83% reported always doing them), but only moderate use of tick repellents (24% reported always and 60% reported occasionally using). High concern for TBD (adjusted odds ratio (aOR) = 6.32 [95% confidence intervals, 1.97–20.28]), a history of TBD diagnosis (aOR = 5.88 [1.41–24.55]), and older age (≥ 46 years) (aOR = 3.29 [1.00–10.84]) were positively associated with high practice adherence. Respondents suggested they would be willing to pay for personal protective methods and get a hypothetical vaccine for Lyme disease, but not community-wide efforts to control ticks.

Conclusions

Our study provides evidence that U.S. Forest Service employees in Wisconsin represent a high risk group for TBD, and despite relatively high TBD knowledge and engagement in tick protection activities, efforts are needed to reduce their risks for tick bites. More generally, our findings suggest that studies to better understand the factors related to the adoption and effectiveness of public health interventions are needed.
Pensions, consumption and health: evidence from rural South Africa
Authors: Lloyd-Sherlock Peter , Agrawal Sutapa , Gómez-Olivé Francesc Xavier
Published: October 2020

Background

Increasing numbers of older people in sub-Saharan Africa are gaining access to pension benefits and it is often claimed that these benefits promote healthy forms of consumption, which contribute to significant improvements in their health status. However, evidence to support these claims is limited.

Methods

The paper uses data for 2701 people aged 60 or over who participated in a population-based study in rural north-eastern South Africa. It analyses effects of receiving a pension on reported food scarcity, body mass index and patterns of consumption.

Results

The paper finds that living in a pension household is associated with a reduced risk of reported food scarcity and with higher levels of consumption of food and drink. The paper does not find that living in a pension household is associated with a higher prevalence of current smoking nor current alcohol consumption. However, the paper still finds that tobacco and alcohol make up over 40% of reported food and drink consumption, and that the correlation between reported food scarcity and body mass index status is imperfect.

Conclusions

The paper does not show significant associations between pension receipt and the selected risk factors. However, the context of prevalent obesity and high shares of household spending allocated to tobacco and alcohol call into question widely-made claims that pensions enhance healthy consumption among older people in low and middle-income countries.
Implementation outcomes of a culturally adapted diabetes self-management education intervention for Native Hawaiians and Pacific islanders
Authors: Sinclair Kaʻimi A. , Zamora-Kapoor Anna , Townsend-Ing Claire , McElfish Pearl A. , Kaholokula Joseph Keaweʻaimoku
Published: October 2020

Background

Native Hawaiians and Pacific Islanders (NHPIs) experience a disproportionate burden of type 2 diabetes and related complications. Although diabetes self-management education and support (DSMES) interventions have generally yielded positive results, few NHPIs have been included in these studies, and even fewer studies have been evaluated using a randomized controlled trial design and/or implementation research methods. The purpose of this pilot study was to evaluate implementation outcomes of a culturally adapted diabetes self-management education intervention delivered by peer educators to Native Hawaiians and Pacific Islanders residing in Honolulu, Hawai’i.

Methods

In three study sites, the peer educators and 48 participants randomized to the intervention were invited to participate in the mixed methods implementation research. We used a convergent parallel design to collect implementation data including fidelity, feasibility, acceptability, appropriateness, adoption, and sustainability. Data were collected from class observations, participants’ class feedback, and post-intervention focus groups with participants and peer educators.

Results

In 314 end-of-class feedback surveys, 97% of respondents expressed that they were satisfied or highly satisfied with the class content and activities, 98% reported that the classes and materials were very useful, 94% reported very applicable, and 93% reported materials were culturally appropriate. Respondents identified several aspects of the program as especially enjoyable: interactions with peer educators, meeting in groups, learning about other participants’ experiences with diabetes, and the information presented in each class. Major themes that emerged from the end-of-intervention focus groups were the relevance of the educational materials, strategies to manage blood glucose, hands-on activities, cultural aspects of the program, including the stories and analogies used to convey information, and appreciation of the group format and peer educators.

Conclusions

Results from this research support a culturally tailored, peer educator approach to DSMES among NHPIs. Delivery of the Partners in Care program is feasible in health care and community settings and is a reimbursable DSMES program.

Trial registration

Clinicaltrials.gov Identifier: NCT01093924 prospectively registered 01.20.09.