bluuebunny/crossref_metadata_2025 huggingface dataset:
INDOOR RADON CONCENTRATION AND ANNUAL EFFECTIVE DOSE IN 56 RADIATION AREAS AT 34 MEDICAL INSTITUTIONS IN SOUTH KOREA
Authors: Ji YoungSeok , Kim DongJin , Shin EunYoung , Dae ChanMin , Lee BaeWon
Published: January 2021

This study aims to measure the indoor radon concentration (IRC) of 56 radiation areas at 34 medical institutions to assess their adequacy as required by the South Korean Ministry of Environment and international standards, and calculate the annual effective dose (AED) of individuals in radiation-related professions at each medical institution. The study was conducted for 9 months and the AED was calculated according to the South Korean Nuclear Safety and Security Commission’s equation. The environmental factors that can affect IRC were analyzed by medical institution, floor level, province and ventilation system. The IRC of eight radiation areas exceeded the recommendation of the International Commission on Radiological Protection, with max-AED and min-AED showing a difference of 1.42 mSv/y. Therefore, all radiation areas that exceed the recommended limits must set up preventative measures to minimize exposure. Furthermore, a systematic management plan involving the issuance of radon test reports is required.
Does the Helical Blade Lead to Higher Rates of Fixation Failure as Compared to Lag Screw in the Cephalomedullary Nailing Treatment of Hip Fractures? A Systematic Review and Meta-Analysis
Authors: Kim Chul-Ho , Kim Han Soul , Kim Yong-Chan , Moon Dou Hyun
Published: January 2021

Objectives:

Recently, several studies have suggested that blade-type cephalomedullary nails (CMNs) have a higher risk of fixation failure than that of lag screws, but no clinical consensus exists. This study compared fixation failure between helical blade-type and lag screw-type CMNs with cut-out and cut-through rates as primary outcomes and degree of sliding length, time to union, and nonunion rate as secondary outcomes.

Data Sources:

MEDLINE, Embase, and Cochrane Library were systematically searched for studies published before March 4, 2020, using the PRISMA guidelines.

Study Selection:

Studies were included if they directly compared helical blade and lag screw for treating hip fractures. Data could be extracted for CMN alone to avoid mixing CMN and extramedullary plate devices, such as the dynamic hip screw.

Data Extraction:

Two board-certified orthopaedic surgeons specializing in hip surgery independently extracted data from the selected studies, and the data collected were compared to verify agreement.

Data Synthesis:

All data were pooled using a random-effects model. For all comparisons, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, whereas continuous data were analyzed using mean differences with 95% CIs.

Conclusions:

Fixation failure (OR = 1.88, 95% CI: 1.09–3.23, P = 0.02), especially cut-through (OR = 5.33; 95% CI, 2.09–13.56; P < 0.01), was more common with helical blades than with lag screws, although the cut-out rate was not significantly different between both the 2 groups (OR = 0.87, 95% CI: 0.38–1.96, P = 0.73). Surgeons should carefully select a blade-type CMN when treating hip fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Defining the Mean Angle of Diaphyseal Long Bone Nonunions—Does Shear Prevail?
Authors: Houston James , Armitage Leanne , Sedgwick Philip M. , McGovern Madeline , Smith Raymond M. , Trompeter Alex J.
Published: January 2021

Objectives:

To define the mean angle of a series of diaphyseal nonunions based on radiographic analysis.

Design:

A retrospective cohort study.

Setting:

Two level-1 trauma centers.

Patients:

One hundred twenty patients presenting with nonunion.

Intervention:

A mean nonunion angle was calculated from a series of AP and lateral X-rays using a standardized technique. The nonunion angle was then estimated in a single plane by considering the greater of the 2 measured angles. Additional data collected included patient age, sex, nonunion site, initial fracture angle, and original fracture pattern.

Main Outcome Measurement:

Single plane nonunion angle.

Results:

The mean angles of all nonunion in coronal plane was 42 degrees (SD 17 degrees) and 42 degrees in sagittal plane (SD 18 degrees) and 48 degrees (SD 15 degrees) in single plane. The single plane nonunion angle in fractures which were originally multiplanar was steeper to those occurring in originally single plane fractures (P 0.002) although both were close to 45 degrees. There was no significant difference in the nonunion angles on subgroup analysis of cohort location, sex, or anatomic location.

Conclusions:

This study demonstrates the mean angle of diaphyseal nonunions from long bones of the lower limb approaches 45 degrees. This is noted in all types of fractures and is irrespective of anatomic location or sex. This confirms the hypothesis that shear is likely to play a role in the development of a nonunion. This study provides further evidence that nonunions occur primarily because of mechanical instability.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Variable Presentation of COVID-19 in Pediatric Patients
Authors: Crawford Richard L. , Bolin Elijah H. , Prodhan Parthak , Renno Markus S. , Knecht Kenneth R.
Published: January 2021

Infection by SARS-CoV-2 has led to disease referred to as coronavirus disease 2019 which, in children has been described as of multisystem inflammatory syndrome in children. Our experience demonstrates 2 distinct presentations of this syndrome which have different clinical courses and may have differing long-term outcomes.
Safety and Efficacy of Oral and/or Intravenous Tedizolid Phosphate From a Randomized Phase 3 Trial in Adolescents With Acute Bacterial Skin and Skin Structure Infections
Authors: Bradley John S. , Antadze Tinatin , Ninov Borislav , Tayob Mohammed S. , Broyde Natasha , Butterton Joan R. , Chou Margaret Z. , De Anda Carisa S. , Kim Jason Y. , Sears Pamela S.
Published: January 2021

Background:

Tedizolid phosphate is an oxazolidinone prodrug approved in 2014 for treatment of adults with acute bacterial skin and skin structure infections (ABSSSIs); however, efficacy has not previously been evaluated in children. This study compared the safety and efficacy of tedizolid (administered as tedizolid phosphate) with active antibacterial comparators for the treatment of ABSSSIs in adolescents.

Methods:

This was a randomized, assessor-blind, global phase 3 study of tedizolid versus active comparators for the treatment of Gram-positive ABSSSIs in adolescents (12 to <18 years of age; NCT02276482). Enrolled participants were stratified by region and randomized 3:1 to receive tedizolid phosphate 200 mg (oral and/or intravenous) once daily for 6 days or active comparator, selected by investigator from an allowed list per local standard of care, for 10 days. The primary endpoint was safety; blinded investigator’s assessment of clinical success at the test-of-cure visit (18–25 days after the first dose) was a secondary efficacy endpoint. Statistical comparisons between treatment groups were not performed.

Results:

Of the 121 participants enrolled, 120 were treated (tedizolid, n = 91; comparator, n = 29). Treatment-emergent adverse events were balanced between treatment groups (tedizolid, 14.3%; comparator, 10.3%). Overall, 3 participants (3.3%) in the tedizolid group and 1 (3.4%) in the comparator group experienced a single drug-related TEAE. Clinical success rates were high in both treatment groups: 96.7% and 93.1% at the test-of-cure visit for the tedizolid and comparator groups, respectively.

Conclusions:

Tedizolid demonstrated safety and efficacy similar to comparators for the treatment of ABSSSIs in adolescents.
Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema
Authors: Forster Johannes , Piazza Giuseppina , Goettler David , Kemmling Daniel , Schoen Christoph , Rose Markus , Streng Andrea , Liese Johannes G.
Published: January 2021

Background:

Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection.

Methods:

Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included.

Results:

A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263).

Conclusions:

In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
Vitamin D Supplement for Prevention of Alzheimer's Disease: A Systematic Review and Meta-Analysis
Authors: Du Yage , Liang Fangfang , Zhang Liping , Liu Jie , Dou Haoying
Published: January 2021

Background:

Prevention of Alzheimer's disease (AD) with Vitamin D (VD) supplementation has been studied widely, but the results in the literature are very conflicting.

The Study Question:

Can VD supplementation really prevent AD?

Study Design:

The literature was searched from PubMed, Cochrane library, Web of Science, and EMBASE to identify relevant randomized clinical trials (RCTs). The titles and abstracts were evaluated independently by 2 of the authors.

Results:

Nine RCTs with 2345 participants were included. In the meta-analysis, we found no significant difference in the Mini-Mental State Examination, verbal fluency, verbal memory, visual ability, and attention scores between the VD intervention group and comparison group [standardized mean difference (SMD) = −0.05, 95% confidence interval (CI) = −0.51 to 0.41; SMD = −0.01, 95% CI = −0.13 to 0.11; SMD = 0.12, 95% CI = −0.45 to 0.69; SMD = 0.42, 95% CI = −0.15 to 1.00; and SMD = 0.01, 95% CI = −0.24 to 0.27, respectively]. In subgroup analysis, we found that the intervention with only VD or plus calcium, follow-up duration, and baseline 25(OH)D levels did not explain the cause for high heterogeneity.

Conclusions:

Overall, the current evidence did not support the beneficial effect of VD supplement to prevent AD. High quality RCTs and further studies are needed to clarify the effects of VD supplementation on preventing AD.
High-density electromyography biofeedback during robotic wrist exercises for reducing co-activation of antagonist muscles: a case report
Authors: Cikajlo Imre , Zadravec Matjaž , Matjačič Zlatko , Urh Filip , Šavc Martin , Kranjec Jernej , Divjak Matjaž , Frančič Aljaž , Potočnik Božidar , Holobar Aleš
Published: January 2021

High-density (HD) electrodes have been introduced in research and diagnostic electromyography. Recent advances in technology offer an opportunity for using the HDEMG signal as biofeedback in stroke rehabilitation. The purpose of this case study was to test the feasibility of using two 5 × 13 electrode arrays for providing real-time HDEMG biofeedback and the preliminary outcome of combining HDEMG biofeedback with robotic wrist exercises over 4 weeks in a person who suffered a stroke 26 months earlier. The isometric wrist flexion/extension task required to keep the paretic agonist activity within variable preset limits with minimal activation of the antagonists. The participant was able to utilize the provided biofeedback interface and after eight sessions significantly decreased co-activation in the antagonist wrist extensor muscles during isometric wrist flexion. The HDEMG biofeedback seems feasible and may be used alone or in combination with robotic therapy for increasing the selectivity of muscle activation after stroke.
A fixed-point approach for decaying solutions of difference equations
Authors: Došlá Zuzana , Marini Mauro , Matucci Serena
Published: January 2021

A boundary value problem associated with the difference equation with advanced argument

*

Δ
(

a

n

Φ

(
Δ

x

n

)
)
+

b

n

Φ

(

x

n
+
p

)
=
0
,

n
≥
1

is presented, where
Φ
(
u
) = |
u
|

α

sgn
u
,
α
 > 0,
p
is a positive integer and the sequences
a
,
b
, are positive. We deal with a particular type of decaying solution of (*), that is the so-called intermediate solution (see below for the definition). In particular, we prove the existence of this type of solution for (*) by reducing it to a suitable boundary value problem associated with a difference equation without deviating argument. Our approach is based on a fixed-point result for difference equations, which originates from existing ones stated in the continuous case. Some examples and suggestions for future research complete the paper.

This article is part of the theme issue ‘Topological degree and fixed point theories in differential and difference equations’.
Positive solutions of systems of perturbed Hammerstein integral equations with arbitrary order dependence
Authors: Infante Gennaro
Published: January 2021

Motivated by the study of systems of higher-order boundary value problems with functional boundary conditions, we discuss, by topological methods, the solvability of a fairly general class of systems of perturbed Hammerstein integral equations, where the nonlinearities and the functionals involved depend on some derivatives. We improve and complement earlier results in the literature. We also provide some examples in order to illustrate the applicability of the theoretical results.

This article is part of the theme issue ‘Topological degree and fixed point theories in differential and difference equations’.
On solvability of the impulsive Cauchy problem for integro-differential inclusions with non-densely defined operators
Authors: Benedetti Irene , Obukhovskii Valeri , Taddei Valentina
Published: January 2021

We prove the existence of at least one integrated solution to an impulsive Cauchy problem for an integro-differential inclusion in a Banach space with a non-densely defined operator. Since we look for integrated solution we do not need to assume that
A
is a Hille Yosida operator. We exploit a technique based on the measure of weak non-compactness which allows us to avoid any hypotheses of compactness both on the semigroup generated by the linear part and on the nonlinear term. As the main tool in the proof of our existence result, we are using the Glicksberg–Ky Fan theorem on a fixed point for a multivalued map on a compact convex subset of a locally convex topological vector space.

This article is part of the theme issue ‘Topological degree and fixed point theories in differential and difference equations’.
Fixed points for planar maps with multiple twists, with application to nonlinear equations with indefinite weight
Authors: Margheri Alessandro , Rebelo Carlota , Zanolin Fabio
Published: January 2021

In this paper, we investigate the dynamical properties associated with planar maps which can be represented as a composition of twist maps together with expansive–contractive homeomorphisms. The class of maps we consider present some common features both with those arising in the context of the Poincaré–Birkhoff theorem and those studied in the theory of topological horseshoes. In our main theorems, we show that the multiplicity results of fixed points and periodic points typical of the Poincaré–Birkhoff theorem can be recovered and improved in our setting. In particular, we can avoid assuming area-preserving conditions and we also obtain higher multiplicity results in the case of multiple twists. Applications are given to periodic solutions for planar systems of non-autonomous ODEs with sign-indefinite weights, including the non-Hamiltonian case. The presence of complex dynamics is also discussed.

This article is part of the theme issue ‘Topological degree and fixed point theories in differential and difference equations’.
Direct detection of SARS-CoV-2 RNA using high-contrast pH-sensitive dyes
Authors: Brown Timothy A. , Schaefer Katherine S. , Tsang Arthur , Yi Hyun Ah , Grimm Jonathan B. , Lemire Andrew L. , Jradi Fadi M. , Kim Charles , McGowan Kevin , Ritola Kimberly , Armstrong Derek T. , Mostafa Heba H. , Korff Wyatt , Vale Ronald D. , Lavis Luke D.
Published: January 2021

The worldwide COVID-19 pandemic has had devastating effects on health, healthcare infrastructure, social structure, and economics. One of the limiting factors in containing the spread of this virus has been the lack of widespread availability of fast, inexpensive, and reliable methods for testing of individuals. Frequent screening for infected and often asymptomatic people is a cornerstone of pandemic management plans. Here, we introduce two pH sensitive ‘LAMPshade’ dyes as novel readouts in an isothermal RT-LAMP amplification assay for SARS-CoV-2 RNA. The resulting JaneliaLAMP (jLAMP) assay is robust, simple, inexpensive, has low technical requirements and we describe its use and performance in direct testing of contrived and clinical samples without RNA extraction.
Severe bandemia is not associated with increased risk for adverse events in general pediatric emergency department patients
Authors: Najafali Daniel , Berman Emilie , Cao Tiffany T , Karwoski Allison , Kaur Norvir , Afridi Ikram , Abdalla Norhan , Afridi Leenah , Sahadzic Iana , Solomon Juliana , Yardi Isha , Tran Quincy K
Published: January 2021

Background

The presence of band cells >10% of the total white blood cell (WBC) count (“bandemia”) is often used as an indicator of serious bacterial illness (SBI). Results from studies of bandemia as a predictor of SBI were conflicting and little is known about the relationship between severe bandemia (SB) and clinical outcomes from SBI in children.

Objectives

In this retrospective patient-centered study, we hypothesized that SB (band level >20%) is not associated with adverse outcomes in an emergency department (ED) pediatric population.

Methods

Medical records from children between the ages of 2 months and 18 years with SB who presented to a tertiary referral regional hospital were studied. Outcomes were categorized as severe adverse events (SAEs) or moderate adverse events (MAEs). Multivariate logistic regressions were used to assess the association between SB and outcomes.

Results

We analyzed 102 patients. Mean age (standard deviation [SD]) was 5.25(0.5) years, 18 (18%) had MAE, 21 (21%) had SAE, and no patients died. Mean band levels were similar between groups: no adverse events [28 (10)] vs. SAE [31 (9)] vs. MAE [27(8)], p=0.64. Multivariate logistic regressions showed SB was not associated with any adverse events (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.9-1.1, p=0.27). Non-normal X-ray (XR) (OR 17, 95% CI 3.3-90, p<0.001) was associated with MAE, while non-normal computerized tomography (CT) scan (OR 15.4, 95% CI 2.2-100+, p=0.002) was associated with SAE.

Conclusion

Severe bandemia was not associated with higher odds of adverse events among the general ED pediatric population. Clinicians should base their clinical judgment on the overall context of history, physical examinations, and other laboratory and imaging data.
Continuous pain report demonstrates time delay of pain ratings in Fibromyalgia
Authors: Kharko Anna Y , Hall Stephen D , Furlong Paul L , Roser Matthew E
Published: January 2021

Background

Enhanced temporal summation (TS), measured through self-reported pain ratings, has been interpreted as indicative of central sensitisation in fibromyalgia. Greater TS in patients, however, has not been universally observed. It is also unclear whether increased pain report maintains beyond the TS period.

Methods

In this study, we measured TS through continuously reported pain ratings. Fibromyalgia-diagnosed patients (n = 17) and matched pain-free controls (n = 13) rated painful transcutaneous electrical stimulation of various intensity levels in 18 one-minute-long blocks. Pain was rated on a 101-point visual analogue scale. The resulting continuous response was divided into TS (< 15s) and adaptation (15 – 60s) periods. Average pain values were extracted for each period alongside the timing of key events such as maximal pain ratings. The difference in temporal summation and adaptation measures between fibromyalgia and control participants was analysed using mixed-effects modelling.

Results

The average pain ratings for TS and adaptation periods were not significantly associated with fibromyalgia diagnosis but were with stimulation intensity. The same was true for the magnitude of the maximal rating during TS and the slope leading to that peak rating. The presence of fibromyalgia, however, did predict the time of the maximal TS rating, as well as the value and the time of the maximal adaptation rating.

Conclusions

Our study did not find homogeneously increased TS pain ratings. Instead, by utilising continuous pain data we demonstrate for the first time that the time of TS peak rating, as well as the magnitude and time of adaptation peak rating are linked to fibromyalgia diagnosis.
SARS-CoV-2 Variant of Concern 202012/01 has about twofold replicative advantage and acquires concerning mutations
Authors: Grabowski Frederic , Preibisch Grzegorz , Giziński Stanisław , Kochańczyk Marek , Lipniacki Tomasz
Published: January 2021

The novel SARS-CoV-2 Variant of Concern (VOC)-202012/01 (also known as B.1.1.7), first collected in United Kingdom on September 20, 2020, is a rapidly growing lineage that in January 2021 constituted 86% of all SARS-CoV-2 genomes sequenced in England. The VOC has been detected in 40 out of 46 countries that reported at least 50 genomes in January 2021. We have estimated that the replicative advantage of the VOC is in the range 1.83–2.18 [95% CI: 1.71–2.40] with respect to the 20A.EU1 variant that dominated in England in November 2020, and in range 1.65–1.72 [95% CI: 1.46–2.04] in Wales, Scotland, Denmark, and USA. As the VOC strain will likely spread globally towards fixation, it is important to monitor its molecular evolution. We have estimated growth rates of expanding mutations acquired by the VOC lineage to find that the L18F substitution in spike has initiated a substrain of high replicative advantage in relation to the remaining VOC substrains. The L18F substitution is of significance because it has been found to compromise binding of neutralizing antibodies. Of concern are immune escape mutations acquired by the VOC: E484K, F490S, S494P (in the receptor binding motif of spike) and Q677H, Q675H (in the proximity of the polybasic cleavage site at the S1/S2 boundary). These mutants may hinder efficiency of existing vaccines and expand in response to the increasing after-infection or vaccine-induced seroprevalence.
The Experience of Care Partners of Patients with Parkinsonism and Psychosis
Authors: Mantri Sneha , Klawson Emily , Albert Steven , Rapoport Robyn , Precht Chelle , Glancey Sarah , Daeschler Margaret , Mamikonyan Eugenia , Kopil Catherine M. , Marras Connie , Chahine Lana M.
Published: January 2021

Background

Parkinson’s disease psychosis (PDP) has a major impact on quality of life and care partner burden; however, little is known about the lived experiences of care partners in managing PDP.

Objective

To understand how care partners of individuals with PDP experience their role and articulate their needs related to psychosis.

Methods

This was a qualitative study of semi-structured telephone interviews. Recruitment was conducted online via the clinical study matching tool, Fox Trial Finder; study activities took place remotely via telephone interviews. Transcripts of the phone interviews were analyzed by grounded theory methods, and a codebook of key themes that emerged from the analysis was developed.

Results

Nine care partners (all female) were interviewed. Discussion topics in the codebook included (1) care partner burden and guilt; (2) communication with medical professionals; (3) coping strategies; (4) emotional reactions of the care partner to psychosis; (5) sources of knowledge about PD psychosis; (6) attitudes towards medications for PDP; (7) strategies to care for loved ones with psychosis; (8) psychosis triggers.

Conclusions

This qualitative analysis uncovers important aspects of the care partner experience, including challenges in navigating the medical system and communicating with professionals. Providers treating patients with PDP should be aware of these constraints and provide added support for strained care partners.
OASIS+: leveraging machine learning to improve the prognostic accuracy of OASIS severity score for predicting in-hospital mortality
Authors: EL-Manzalawy Yasser , Abbas Mostafa , Hoaglund Ian , Cerna Alvaro Ulloa , Morland Thomas B. , Haggerty Christopher M. , Hall Eric S. , Fornwalt Brandon K.
Published: January 2021

Severity scores assess the acuity of critical illness by penalizing for the deviation of physiologic measurements from normal and aggregating these penalties (also called “weights” or “subscores”) into a final score (or probability) for quantifying the severity of critical illness (or the likelihood of in-hospital mortality). Although these simple additive models are human readable and interpretable, their predictive performance needs to be further improved. To address this need, we argue for replacing these simple additive models with models based on state-of-the-art non-linear supervised learning algorithms (e.g., Random Forest (RF) and eXtreme Gradient Boosting (XGB)). Specifically, we present OASIS+, a variant of the Oxford Acute Severity of Illness Score (OASIS) in which an ensemble of 200 decision trees is used to predict in-hospital mortality based on the 10 same clinical variables in OASIS. Using a test set of 9566 admissions extracted from MIMIC-III database, we show that the performance of OASIS can be substantially improved from AUC score of 0.77 to 0.83 using OASIS+. Moreover, we show that OASIS+ has superior performance compared to eight other commonly used severity scoring methods. Our results underscore the potential of improving existing severity scores by using more sophisticated machine learning algorithms (e.g., ensemble of non-linear decision tress) not just via including additional physiologic measurements.
Histopathological Profile of Cervical Biopsies in Northern Malawi: A Retrospective Study
Authors: Kaseka Paul Uchizi , Kayira Alfred , Chimbatata Chikondi Sharon , Chisale Master , Kamudumuli Pocha , Wu Tsung-Shu Joseph , Mbakaya BalwaniChingatichifwe , Sinyiza Frank Watson
Published: January 2021

Objectives

This study was carried out to determine the histopathological profile of cervical biopsies in a public tertiary hospital in Mzuzu, northern region of Malawi.

Setting

A public tertiary hospital in Mzuzu, northern region of Malawi

Participants

This was a retrospective study of all cervical biopsy specimen reports received in a public tertiary hospital in northern Malawi over a period of 5 years from July 2013-June 2018. Eleven reports which had missing demographic and clinical data or had inconclusive results were excluded. Demographic, clinical and histopathological data was obtained from original histology reports.

Results

A total of 500 cervical biopsy reports were reviewed during the study period. The mean age of the patients was 41.99±12.5. Age ranged from 15 to 80 years. Cervicitis accounted for 46.0% (n=162) of the total nonmalignant lesions seen, followed by cervical intraepithelial neoplasm (CIN), at 24.4% (n=86) and endocervical polyp, at 20.5% (n=72). Squamous cell carcinoma (SCC) accounted for 15.6% (n=78) of the total cervical biopsies studied and 85.7% of all total malignant lesions. All malignant tumours had HIV.

Conclusion

Our study shows that cervicitis and squamous cell carcinoma were most common among nonmalignant and malignant cervical biopsies respectively. Since the frequency of cervical cancer is high, there is need to have well detailed national policies to be put in place to increase detection of pre-invasive lesions in order to reduce the prevalence of cervical cancer.

Strengths and limitation of this study Strengths

This paper has shown

The need for well detailed national policies to be put in place to increase detection of pre-invasive lesions, which in turn will decrease the frequency of cervical cancer in the country.

The importance of intensifying cervical cancer screening programmes among women and provision of long term ART to the HIV infected which may offer an opportunity for appropriate interventions to reduce morbidity, mortality and reduce complications among these women.

Limitations

This study used available programme health facility data and histopathological reports on cervical cancer which has its own limitations, such as incompleteness and bias in the sense that information is obtained only from people who came to the facility and underwent biopsy, leaving out those that did not seek medical care and or were not biopsied and therefore cannot be generalized to the general population.

The study is a single-hospital-based review and as such inadequate to draw conclusions, but it does shed some light on pathological pattern of cervical cancer in Malawi.
Identical trends of SARS-Cov-2 transmission and retail and transit mobility during non-lockdown periods
Authors: Cazelles Bernard , Comiskey Catherine , Van Yen Benjamin Nguyen , Champagne Clara , Roche Benjamin
Published: January 2021

Recent literature strongly supports the idea that mobility reduction and social distancing play a crucial role in transmission of SARS-Cov-2 infections. It was shown during the first wave that mobility restrictions reduce significantly infection transmission. Here we document the reverse relationship by showing, between the first two Covid-19 waves, a high positive correlation between the trends of SARS-Cov-2 transmission and mobility. These two trends oscillate simultaneously and increased mobility following lockdown relaxation has a significant positive relationship with increased transmission. From a public health perspective, these results highlight the importance of following the evolution of mobility when relaxing mitigation measures to anticipate the future evolution of the spread of the SARS-Cov-2.
Race and ethnicity do not impact eligibility for remdesivir- a single-center experience
Authors: Pischel Lauren , Walelo Makeda , Benson Jemma , Osborn Rebecca , Schrier Rachel , Tuan Jessica , Barakat Lydia , Ogbuagu Onyema
Published: January 2021

As the Coronavirus-2019 (COVID-19) pandemic continues, multiple therapies are rapidly being tested for efficacy in clinical trials. Clinical trials should be racially and ethnically representative of the population that will eventually benefit from these medications. There are multiple potential barriers to racial and ethnic minority enrollment in clinical trials, one of which could be that inclusion and exclusion criteria select for certain racial or ethnic groups disproportionately. In this observational cohort study at a single health care system, we examined if there were differences in eligibility for treatment with remdesivir based on clinical trial criteria for racial and ethnic minorities compared to non-Hispanic Whites. 201 electronic medical record charts were reviewed manually. Self-identified Whites were older than other racial or ethnic groups. At the time of presentation, Black, Latinx, and White participants met inclusion criteria for remdesivir at similar rates (72%, 80%, and 73% respectively), exclusion criteria at similar rates (43%, 38% and 49% for Black, Latinx and White participants respectively). In this study, there was no difference in eligibility for remdesivir based on race or ethnicity alone.
Use of Diagnosis Codes to Find Blood Transfusion Adverse Events in Electronic Health Records
Authors: Bright Roselie A. , Bright-Ponte Susan J. , Palmer Lee Anne , Rankin Summer K. , Blok Sergey
Published: January 2021

Background

Electronic health records (EHRs) and big data tools offer the opportunity for surveillance of adverse events (patient harm associated with medical care). We chose the case of transfusion adverse events (TAEs) and potential TAEs (PTAEs) because 1.) real dates were obscured in the study data, and 2.) there was emerging recognition of new types during the study data period.

Objective

We aimed to use the structured data in electronic health records (EHRs) to find TAEs and PTAEs among adults.

Methods

We used 49,331 adult admissions involving critical care at a major teaching hospital, 2001-2012, in the MIMIC-III EHRs database. We formed a T (defined as packed red blood cells, platelets, or plasma) group of 21,443 admissions vs. 25,468 comparison (C) admissions. The ICD-9-CM diagnosis codes were compared for T vs. C, described, and tested with statistical tools.

Results

TAEs such as transfusion associated circulatory overload (TACO; 12 T cases; rate ratio (RR) 15.61; 95% CI 2.49 to 98) were found. There were also PTAEs similar to TAEs, such as fluid overload disorder (361 T admissions; RR 2.24; 95% CI 1.88 to 2.65), similar to TACO. Some diagnoses could have been sequelae of TAEs, including nontraumatic compartment syndrome of abdomen (52 T cases; RR 6.76; 95% CI 3.40 to 14.9) possibly being a consequence of TACO.

Conclusions

Surveillance for diagnosis codes that could be TAE sequelae or unrecognized TAE might be useful supplements to existing medical product adverse event programs.
Detection of SARS-CoV-2 in the air from hospitals and closed rooms occupied by COVID-19 patients
Authors: Moharir Shivranjani C , Chandra T. Sharath , Goel Arushi , Thakur Bhuwaneshwar , Bhalla Gurpreet Singh , Kumar Dinesh , Naruka Digvijay Singh , Kumar Ashwani , Tuli Amit , Suravaram Swathi , Bingi Thrilok Chander , Srinivas M , Mesipogu Rajarao , Reddy Krishna , Khosla Sanjeev , Tallapaka Karthik Bharadwaj , Mishra Rakesh K
Published: January 2021

To understand air transmission characteristics of SARS-CoV-2 and risks for health care personnel and visitors to hospitals, we analyzed air samples collected from various enclosures in hospitals at Hyderabad and Mohali and performed closed room experiments with COVID-19 positive individuals. We collected 64 air samples from COVID and non-COVID areas of various hospitals and 17 samples from closed rooms occupied by COVID patients. 4 samples from COVID care areas were positive for SARS-CoV-2 with no obvious predilection towards ICU/non-ICU areas in the hospital samples. In the closed room experiments, where one or more COVID-19 patients spent a short duration of time, one sample - collected immediately after the departure of three symptomatic patients from the room - was positive. Our results indicate that the chance of picking up SARS-CoV-2 in the air is directly related to a number of COVID positive cases in the room, their symptomatic status, and the duration of exposure and that the demarcation of hospital areas into COVID and non-COVID areas is a successful strategy to prevent cross infections. In neutral environmental conditions, the virus does not seem to spread farther away from the patients, especially if they are asymptomatic, giving an objective evidence for the effectiveness of physical distancing in curbing the spread of the epidemic.
Unsupervised Discovery of Risk Profiles on Negative and Positive COVID-19 Hospitalized Patients
Authors: Nezhadmoghadam Fahimeh , Tamez-Peña Jose
Published: January 2021

COVID-19 is a viral disease that affects people in different ways: Most people will develop mild symptoms; others will require hospitalization, and a few others will die. Hence identifying risk factors is vital to assist physicians in the treatment decision. The objective of this paper is to determine whether unsupervised analysis of risk factors of positive and negative COVID-19 subjects may be useful for the discovery of a small set of reliable and clinically relevant risk-profiles. We selected 13367 positive and 19958 negative hospitalized patients from the Mexican Open Registry. Registry patients were described by 13 risk factors, three different outcomes, and COVID-19 test results. Hence, the dataset could be described by 6144 different risk-profiles per age group. To discover the most common risk-profiles, we propose the use of unsupervised learning. The data was split into discovery (70%) and validation (30%) sets. The discovery set was analyzed using the partition around medoids (PAM) method and robust consensus clustering was used to estimate the stable set of risk-profiles. We validated the reliability of the PAM models by predicting the risk-profile of the validation set subjects. The clinical relevance of the risk-profiles was evaluated on the validation set by characterizing the prevalence of the three patient outcomes: pneumonia diagnosis, ICU, or death. The analysis discovered six positives and five negative COVID-19 risk-profiles with strong statistical differences among them. Henceforth PAM clustering with consensus mapping is a viable method for unsupervised risk-profile discovery among subjects with critical respiratory health issues.
Cost-utility of two minimally-invasive surgical techniques for operable oropharyngeal cancer: Transoral robotic surgery versus transoral laser microsurgery
Authors: Parimbelli Enea , Soldati Federico , Duchoud Lorry , Armas Gian Luca , de Almeida John R. , Broglie Martina , Quaglini Silvana , Simon Christian
Published: January 2021

Importance

Transoral robotic surgery (TORS) and transoral laser micro-surgery (TLM) are two different but competing minimally invasive techniques to surgically remove operable oropharyngeal squamous cell cancers (OPSCC). As of now, no comparative analysis as to the cost-utility of these techniques exists.

Objective

Recent population-level data suggest for TORS and TLM equivalent tumor control, but different total costs, need for adjuvant chemoradiation, and learning curves. Therefore, the objective of this study was to compare TORS and TLM from the cost-utility (C/U) point of view using a decision-analytical model from a Swiss hospital perspective.

Design

Our decision-analytical model combines decision trees and a Markov model to compare TORS and TLM strategies. Model parameters were quantified using available literature, original cost data from two Swiss university tertiary referral centers, and utilities elicited directly from a Swiss population sample using standard gamble. C/U and sensitivity analyses were used to generate results and gauge model robustness.

Setting

Swiss hospital perspective

Intervention

Cost-utility analysis

Main outcome measure

Comparative cost-utility data from TLM and TORS

Results

In the base case analysis TLM dominates TORS. This advantage remains robust, even if the costs for TORS would reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment (pTorsAlone>0.407), whereby in an interval between 55%-62% (pTorsAlone 0.38-0.45) cost effectiveness of TORS is sensitive to the prescription of adjuvant CRT. Also, exceeding 29% of TLM patients requiring a re-operation for inadequate margins renders TORS more cost-effective.

Conclusion

TLM is more cost-effective than TORS. However, this advantage is sensitive to various parameters i.e. the number of re-operations and adjuvant treatment.

Key points

Question

Compare cost-utility of TORS versus TLM

Findings

In the base case analysis TLM dominates TORS, even if the costs for TORS would reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment, whereby in an interval between 55%-62% cost effectiveness of TORS is sensitive to the prescription of adjuvant CRT. Exceeding 29% of TLM patients requiring a re-operation for inadequate margins renders TORS more cost-effective.

Meaning

TLM is more cost-effective than TORS. However, this advantage is sensitive to the number of re-operations and adjuvant treatment
Imprecise assessment of mask use may obscure associations with SARS-CoV-2 positivity
Authors: Bérubé Sophie , Clipman Steven J. , Mehta Shruti H. , Solomon Sunil S. , Wesolowski Amy
Published: January 2021

Masks are effective measures to prevent the transmission of SARS-CoV-2, however, lack of a national mandate coupled with poor adherence has led to suboptimal levels of transmission reduction. Although data has suggested that mask adherence is high, few studies have captured details on how mask wearing changes with activities and how these behaviors are associated with SARS-CoV-2 positivity. We recruited an online sample of 3,058 respondents from three US states (MD, FL, IL; n∼1000/state) between September 16 - October 15, 2020. The median age of the sample was 47; 53% were female, 56% were white and 22% were working outside the home. Seventy three percent of the sample reported always wearing a mask indoors and outdoors based on local guidelines, however, 78% of participants who reported always wearing a mask reported taking their mask off when outside the home. While overall masking according to guidelines was not significantly associated with SARS-CoV-2 positivity, sometimes, often or always removing a mask during activities were significantly associated with SARS-CoV-2 positivity (adjusted odds ratio for always vs never removing mask: 9.92; 95% CI: 1.16 – 85.1). These findings suggest that masks were most effective when worn without removal reflecting the need for consistent use.
Percentage of reported Covid-19 cases in Colombia: Estimating the true scale of the pandemic
Authors: Parra-A Nicolás , Vargas-Calderón Vladimir , Sebastián Flórez Juan , Ardila Leonel , Viviescas Carlos
Published: January 2021

At the outbreak of a virus, data on cases is sparse and commonly severe cases, with a higher probability of a fatal resolution, are detected at a larger rate than mild cases. In addition, in an under-sampling situation, the number of total cases is under-estimated leading to a biased case fatality rate estimation, most likely inflating the virus mortality. In this communication, we present a method to estimate the sub-report in a country that accounts for both the delay time between symptoms onset to death and the country’s demographics. The method is based on the comparison of the corrected case fatality rate (CFR) of the target country with the one of a benchmark country. Using reported data from Instituto Nacional de Salud up to December 28, we utilize our method to provide a comprehensive estimate of the Covid-19 sub-report in Colombia, its regions and some of its cities during 2020.
De novogermline mutation in the Dual Specificity Phosphatase 10 gene accelerates autoimmune diabetes in Non-Obese Diabetic (NOD) mice
Authors: Foray Anne-Perrine , Candon Sophie , Hildebrand Sara , Marquet Cindy , Valette Fabrice , Pecquet Coralie , Lemoine Sebastien , Langa-Vives Francina , Dumas Michael , Hu Peipei , Santamaria Père , Lyon Stephen , Scott Lindsay , Bu Chun Hui , Wang Tao , Xu Darui , Moresco Eva Marie Y. , Scazzocchio Claudio , Bach Jean-François , Beutler Bruce , Chatenoud Lucienne
Published: January 2021

Here we report the isolation by selective breeding of two sublines of Non-Obese Diabetic (NOD) mice exhibiting a significant difference in the incidence of autoimmune type 1 diabetes (T1D). Whole genome sequencing of the NOD/NckH(high T1D incidence) and NOD/NckL(low T1D incidence) revealed the presence of a limited number of variants specific to each subline. Treating the age of T1D onset as a quantitative trait and using automated meiotic mapping (AMM), enhanced susceptibility in the NOD/NckHsubline was unambiguously attributed to a recessive allele ofDusp10which encodes a dual specificity phosphatase. The causative effect of the mutation was verified with a high level of confidence by targetingDusp10with CRISPR/Cas9 in NOD/NckLmice: in these animals a higher incidence of diabetes was observed. Expression of wild-typeDusp10correlated with higher levels of surface PD-L1 in the islets of NOD/NckLmice.
Implementing Building-Level SARS-CoV-2 Wastewater Surveillance on a University Campus
Authors: Gibas Cynthia , Lambirth Kevin , Mittal Neha , Juel Md Ariful Islam , Barua Visva Bharati , Brazell Lauren Roppolo , Hinton Keshawn , Lontai Jordan , Stark Nicholas , Young Isaiah , Quach Cristine , Russ Morgan , Kauer Jacob , Nicolosi Bridgette , Akella Srinivas , Tang Wenwu , Chen Don , Schlueter Jessica , Munir Mariya
Published: January 2021

The COVID-19 pandemic has been a source of ongoing challenges and presents an increased risk of illness in group environments, including jails, long term care facilities, schools, and, of course, residential college campuses. Early reports that the SARS-CoV-2 virus was detectable in wastewater in advance of confirmed cases sparked widespread interest in wastewater based epidemiology (WBE) as a tool for mitigation of COVID-19 outbreaks. One hypothesis was that wastewater surveillance might provide a cost-effective alternative to other more expensive approaches such as pooled and random testing of groups. In this paper, we report the outcomes of a wastewater surveillance pilot program at the University of North Carolina at Charlotte, a large urban university with a substantial population of students living in on-campus dormitories. Surveillance was conducted at the building level on a thrice-weekly schedule throughout the university’s fall residential semester. In multiple cases, wastewater surveillance enabled identification of asymptomatic COVID-19 cases that were not detected by other components of the campus monitoring program, which also included in-house contact tracing, symptomatic testing, scheduled testing of student athletes, and daily symptom reporting. In the context of all cluster events reported to the University community during the fall semester, wastewater-based testing events resulted in identification of smaller clusters than were reported in other types of cluster events. Wastewater surveillance was able to detect single asymptomatic individuals in dorms with total resident populations of 150-200. While the strategy described was developed for COVID-19, it is likely to be applicable to mitigation of future pandemics in universities and other group-living environments.