bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview
Authors: Seron Pamela , Oliveros María-Jose , Gutierrez-Arias Ruvistay , Fuentes-Aspe Rocío , Torres-Castro Rodrigo C , Merino-Osorio Catalina , Nahuelhual Paula , Inostroza Jacqueline , Jalil Yorschua , Solano Ricardo , Marzuca-Nassr Gabriel N , Aguilera-Eguía Raul , Lavados-Romo Pamela , Soto-Rodríguez Francisco J , Sabelle Cecilia , Villarroel-Silva Gregory , Gomolán Patricio , Huaiquilaf Sayen , Sanchez Paulina
Published: February 2021

Objective

The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy.

Methods

We searched Medline/PubMed, EMBASE, and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations, and contexts—where the intervention to be evaluated is telerehabilitation by physical therapy—were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence, and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively in the tables and figures.

Results

Fifty-three systematic reviews were included, of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions, and 13 on neurorehabilitation. The other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results.

Conclusions

Despite the contradictory results, telerehabilitation in physical therapy could be comparable with in-person rehabilitation or better than no rehabilitation for conditions such as osteoarthritis, low-back pain, hip and knee replacement, and multiple sclerosis and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews.

Impact

Providing the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore yield better clinical outcomes for patients, both in these times of the COVID-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.
Ban Bedcentricity: A Multifaceted Innovation to Reduce Sedentary Behavior of Patients During the Hospital Stay
Authors: Koenders Niek , Potkamp-Kloppers Sandra , Geurts Yvonne , Akkermans Reinier , Nijhuis-van der Sanden Maria W G , Hoogeboom Thomas J
Published: February 2021

Objective

The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward level.

Methods

The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses.

Results

Behavioral observations showed that in 52% of the observations, patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards, respectively. The mean length of hospital stay after implementation (compared with implementation before) was 5.1 days at the cardiothoracic surgery (n = 1923; mean = +0.13 days, 95% CI = −0.32 to 0.60), 2.6 days at the cardiology (n = 2646; mean = −0.22 days, 95% CI = −0.29 to −0.14), and 2.4 days at the orthopedics-traumatology wards (n = 1598; mean = +0.28 days, 95% CI = 0.06 to 0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23], 95% CI = 1.07 to 1.37) and cardiology wards (OR = 1.37, 95% CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09, 95% CI = 0.88 to 1.27).

Conclusion

The results indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home compared with before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity; therefore, outcomes should be interpreted with caution.

Impact

This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation.

Lay Summary

We introduced Ban Bedcentricity, an intervention to reduce the amount of time patients lie in the hospital bed during their hospitalization. This study shows that after the introduction of Ban Bedcentricity, patients lie in bed less and are more often discharged home.
Female hormonal exposures and risk of rheumatoid arthritis in the French E3N-EPIC cohort study
Authors: Salliot Carine , Nguyen Yann , Gusto Gaëlle , Gelot Amandine , Gambaretti Juliette , Mariette Xavier , Boutron-Ruault Marie-Christine , Seror Raphaèle
Published: February 2021

Objective

To assess the relationships between female hormonal exposures and risk of RA in a prospective cohort of French women.

Methods

E3N (Etude Epidémiologique auprès des femmes de la Mutuelle générale de l’Education Nationale) is an on-going French prospective cohort that included 98 995 women aged 40–65 years in 1990. Every 2–3 years, women completed mailed questionnaires on their lifestyles, reproductive factors and health conditions. Cox proportional hazards regression models were used to determine factors associated with risk of incident RA, with age as the time scale, adjusted for known risk factors of RA, and considering endogenous and exogenous hormonal factors. Hazard ratios (HRs) and 95% CIs were estimated. Effect modification by smoking history was investigated.

Results

A total of 698 incident cases of RA were ascertained among 78 452 women. In multivariable-adjusted Cox regression models, risk of RA was increased with early age at first pregnancy (<22 vs ≥27 years; HR = 1.34; 95% CI 1.0, 1.7) and menopause (≤45 vs ≥53 years; HR = 1.40; 95% CI 1.0, 1.9). For early menopause, the association was of similar magnitude in ever and never smokers, although the association was statistically significant only in ever smokers (HR = 1.54; 95% CI 1.0, 2.3). We found a decreased risk in nulliparous women never exposed to smoking (HR = 0.44; 95% CI 0.2, 0.8). Risk of RA was inversely associated with exposure to progestogen only in perimenopause (>24 vs 0 months; multi-adjusted HR = 0.77; 95% CI 0.6, 0.9).

Conclusions

These results suggest an effect of both endogenous and exogenous hormonal exposures on RA risk and phenotype that deserves further investigation.
Association of particulate matter with autoimmune rheumatic diseases among adults in South Korea
Authors: Park Jun Seok , Choi Seulggie , Kim Kyuwoong , Chang Jooyoung , Kim Sung Min , Kim Seong Rae , Lee Gyeongsil , Son Joung Sik , Kim Kyae Hyung , Lee Eun Young , Park Sang Min
Published: February 2021

Objective

The primary objective of this study was to investigate adverse effects of ambient particulate matter of various sizes on the incidence of the prevalent autoimmune rheumatic diseases (AIRDs): RA, AS and SLE.

Methods

We investigated 230 034 participants in three metropolitan cities of South Korea from the National Health Insurance Service–National Sample Cohort (NHIS-NSC). Starting from January 2010, subjects were followed up until the first event of prevalent AIRDs, death, or December 2013. The 2008–2009 respective averages of particulate matter2.5 (<2.5 μm) and particulate mattercoarse (2.5 μm to 10 μm) were linked with participants’ administrative district codes. Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox regression analysis in one- and two-pollutant models.

Results

Adjusted for age, sex, region, and household income, in the two-pollutant model, RA incidence was positively associated with the 10 μg/m³ increment of particulate matter2.5 (aHR = 1.74, 95% CI: 1.06, 2.86), but not with particulate mattercoarse (aHR = 1.27, 95% CI: 0.87, 1.85). In the one-pollutant model, the elevated incidence rate of RA was slightly attenuated (particulate matter2.5 aHR = 1.61, 95% CI: 0.99, 2.61; particulate mattercoarse aHR = 1.13, 95% CI: 0.80, 1.61), with marginal statistical significance for particulate matter2.5. The RA incidence was also higher in the 4th quartile group of particulate matter2.5 compared with the first quartile group (aHR = 1.83, 95% CI: 1.07, 3.11). Adverse effects from particulate matter were not found for AS or SLE in either the one- or two-pollutant models.

Conclusion

The important components of particulate matter10 associated with RA incidence were the fine fractions (particulate matter2.5); no positive association was found between particulate matter and AS or SLE.
Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study
Authors: Roodenrijs Nadia M T , van der Goes Marlies C , Welsing Paco M J , van Oorschot Eline P C , Nikiphorou Elena , Nijhof Nienke C , Tekstra Janneke , Lafeber Floris P J G , Jacobs Johannes W G , van Laar Jacob M , Geenen Rinie
Published: February 2021

Objectives

Treatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients’ and rheumatologists’ perspectives.

Methods

Patients’ perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists.

Results

Nine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators.

Conclusions

D2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.
Segmental Series and Size: Clade-Wide Investigation of Molar Proportions Reveals a Major Evolutionary Allometry in the Dentition of Placental Mammals
Authors: Billet Guillaume , Bardin Jérémie
Published: February 2021

Iterative segments such as teeth or limbs are a widespread characteristic of living organisms. While their proportions may be governed by similar developmental rules in vertebrates, there is no emerging pattern as regards their relation to size. Placental mammals span eight orders of magnitude in body size and show a wide spectrum of dietary habits associated with size and reflected in their dentitions, especially molars. Although variation in size constitutes an important determinant for variation in biological traits, few major allometric trends have been documented on placental molars so far. Molar proportions have been intensively explored in placentals in relation to developmental models, but often at a small phylogenetic scale. Here, we analyzed the diversity of upper molar proportions in relation to absolute size in a large sample of placental species ($n = 299$) encompassing most of the group’s dental diversity. Our phylogenetically informed analyses revealed a 2-fold pattern of evolutionary integration among upper molars: while molars covary in size with each other, their proportions covary with the absolute size of the entire molar field. With increasing absolute size, posterior molars increase in size relative to anterior ones, meaning that large-sized species have relatively large rear molars while the opposite is true for small-sized species. The directionality of proportional increase in the molar row exhibits a previously unsuspected allometric patterning among placentals, showing how large-scale variations in size may have influenced variation in dental morphology. This finding provides new evidence that processes regulating the size of individual molars are integrated with overall patterns of growth and calls for further testing of allometric variation in the dentition and in other segmental series of the vertebrate body. [Dentition; evolution; model; phylogeny; segmentation; size.]
Heparin Resistance Is Common in Patients Undergoing Extracorporeal Membrane Oxygenation but Is Not Associated with Worse Clinical Outcomes
Authors: Raghunathan Vikram , Liu Patricia , Kohs Tia C. L. , Amirsoltani Ramin , Oakes Michael , McCarty Owen J. T. , Olson Sven R. , Zonies David , Shatzel Joseph J.
Published: February 2021

Extracorporeal membrane oxygenation (ECMO) protocols generally require systemic anticoagulation with heparin to prevent circuit thrombosis. The prevalence, risk factors, and outcomes of heparin resistance in this setting are ill-defined. To better understand the prevalence and clinical consequences of heparin resistance in this population, we conducted a retrospective analysis of all patients treated with ECMO at a single academic medical center between 2016 and 2019. Univariate and multivariate analyses were used to evaluate predictors and outcomes of heparin resistance. Of 67 patients in our study, 50.7% met the threshold for heparin resistance for at least 1 day, which was managed in all cases with increases in heparin dose. Patients with heparin resistance were more likely to be male (82.4% vs. 48.5%, p = 0.005) and to have a higher mean platelet count (132 vs. 104 × 103/mL, p = 0.027) compared with those without heparin resistance. Multivariate logistic regression found no significant association between the development of heparin resistance and rates of thrombosis, hemorrhage, or overall survival. Additional prospective studies are required to clarify the clinical implications of heparin resistance in this population.
Heparin-Free Lung Transplantation on Venovenous Extracorporeal Membrane Oxygenation Bridge
Authors: Scaravilli Vittorio , Fumagalli Jacopo , Rosso Lorenzo , Polli Federico , Panigada Mauro , Abbruzzese Chiara , Crotti Stefania , Lissoni Alfredo , Nosotti Mario , Pesenti Antonio , Zanella Alberto , Grasselli Giacomo
Published: February 2021

Extracorporeal membrane oxygenation (ECMO) bridge to lung transplantation (LuTX) exposes the patients to a high risk of perioperative bleeding secondary to systemic anticoagulation and coagulation factors deficiency. With this case series, we propose innovative “no-heparin” management of ECMO-bridge support during LuTX, based upon 1) control heparin resistance with antithrombin III in the preoperative period; 2) relying upon a fully functional, brand new heparinized ECMO circuit; 3) completely avoiding perioperative heparin; 4) hampering fibrinolysis with tranexamic acid; and 5) limiting venoarterial (VA) ECMO escalation, and the following need for full anticoagulation. Following the application of this new approach, we carried out three challenging clinical cases of bilateral ECMO-bridged LuTX effectively, with limited intraoperative blood requirement and no major postoperative bleeding or thromboembolic events. Of note, two of them had an extremely high risk for hemorrhage due to complete right lung anatomic derangement in case number 2 and surgical adhesion following first LuTX in case number 3, while for the case number 1, no blood products were administered during surgery. Despite the limited patient population, such an approach relies on a strong rationale and may be beneficial for managing ECMO bridging to LuTX. Prospective studies are necessary to confirm the validity of our strategy.
HYDROXYCHLOROQUINE FOR THE TREATMENT OF SEVERE RESPIRATORY INFECTION BY COVID-19: A RANDOMIZED CONTROLLED TRIAL
Authors: Hernandez-Cardenas Carmen , Thirion-Romero Ireri , Rivera-Martinez Norma E. , Meza-Meneses Patricia , Remigio-Luna Arantxa , Perez-Padilla Rogelio
Published: February 2021

The novel coronavirus pandemic (COVID–19) represents a major public health problem due to its rapid spread and its ability to generate severe pneumonia. Thus, it is essential to find a treatment that reduces mortality. Our objective was to estimate whether treatment with 400 mg/day of Hydroxychloroquine for 10 days reduces in-hospital mortality in subjects with severe respiratory disease due to COVID-19 compared with placebo.

Material and methods

A double-blind, randomized, placebo-controlled trial to evaluate the safety and efficacy of Hydroxychloroquine for the treatment of severe disease by COVID-19 through an intention-to-treat analysis. Eligible for the study were adults aged more than 18 years with COVID-19 confirmed by RT-PCR and lung injury requiring hospitalization with or without mechanical ventilation. Primary outcome was 30-day mortality. Secondary outcomes: days of mechanical ventilation, days of hospitalization and cumulative incidence of serious adverse events.

Results

A total of 214 patients with COVID-19 were recruited, randomized and analyzed. They were hypoxemic with a mean SpO2 of 65% ± 20, tachycardic (pulse rate 108±17 min-1) and tachypneic (32 ±10 min-1); 162 were under mechanical ventilation at randomization. Thirty-day mortality was similar in both groups (38% in Hydroxychloroquine vs. 41% in placebo, hazard ratio [HR] 0.88, 95% Confidence Interval [95%CI] 0.51-1.53). In the surviving participants, no significant difference was found in secondary outcomes.

Conclusion

No beneficial effect or significant harm could be demonstrated in our randomized controlled trial including 214 patients, using relatively low doses of Hydroxychloroquine compared with placebo in hospitalized patients with severe COVID-19.

CONSORT GUIDELINES
Concentrations and immunostimulatory potential of circulating cell-free membrane-bound and membrane-unbound mitochondrial DNA in preeclampsia
Authors: Cushen Spencer C. , Ricci Contessa A. , Bradshaw Jessica L. , Silzer Talisa , Blessing Alexandra , Sun Jie , Scroggins Sabrina M. , Santillan Mark K. , Santillan Donna A. , Phillips Nicole R. , Goulopoulou Styliani
Published: February 2021

Cell-free circulating mitochondrial DNA (CFCmtDNA) is a damage-associated molecular pattern (DAMP) that can activate Toll-like receptor 9 (TLR-9). The main objectives of this case-control study were 1) to determine absolute concentrations and immunostimulatory capacity of CFCmtDNA, in membrane-bound and -unbound states, in cases with preeclampsia and healthy controls and 2) to implement a bootstrapped penalized regression analysis to establish the contribution of CFCmtDNA to preeclampsia diagnosis and its interaction with commonly collected patient characteristics. To determine the contribution of membrane-bound and -unbound CFCmtDNA in preeclampsia, DNA from plasma samples was exctracted with lysis buffer (membrane-unbound) and without lysis buffer (membrane-bound). CFCmtDNA, quantified using absolute PCR quantification protocol, was reduced in preeclampsia compared to healthy controls (P≤0.02). While the pattern of reduced CFCmtDNA in preeclampsia was similar between methods of DNA extraction, DNA isolation with membrane lysis buffer resulted in 1,000-fold higher CFCmtDNA quantification in the preeclampsia group (P=0.0014) and 430-fold higher CFCmtDNA quantification in the control group (P<0.0001). Even though CFCmtDNA concentrations were reduced, plasma from women with preeclampsia induced greater TLR-9 activation than plasma from gestational age matched controls (P≤0.01) as monitored using SEAP reporter 293 cells expressing humanTLR-9. Penalized regression analysis showed that women with preeclampsia are strongly likely to have high concentrations of nDNA and DNase I along with a prior history of preeclampsia. Low concentrations of CFCmtDNA and mode of delivery were also associated with preeclampsia. In conclusion, our data demonstrate increases in the immunostimulatory potential of CFCmtDNA and upregulation of DNA degradation mechanisms in women with preeclampsia at the third trimester.
COVID19-related and all-cause mortality among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection in the region of Tarragona, Spain: results from the COVID19 TARRACO Cohort Study, March-June 2020
Authors: Vila-Corcoles Angel , Satue-Gracia Eva , Vila-Rovira Angel , de Diego-Cabanes Cinta , Forcadell-Peris Maria Jose , Ochoa-Gondar Olga
Published: February 2021

Background

Direct and indirect COVID19-related mortality is uncertain. This study investigated COVID19-related and all-cause deaths among middle-aged and older adults during the first wave of COVID19 epidemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions.

Methods

Population-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (occurred in patients diagnosed with the disease) and all-cause deaths occurred among cohort members between 01/03/2020-30/06/2020. Mortality risks were assessed by Cox regression analyses.

Results

Cohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related). All-cause mortality rate was 42.5 deaths per 100,000 persons-week, being 22.8 in healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. In multivariable analyses, increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years, sex male and nursing-home residence were strong predictors for COVID19-related mortality, but none comorbidity appeared significantly associated with an increased risk.

Conclusion

Apart from direct COVID19-related deaths (which represented almost 22% of all-cause mortality), theoretically COVID19-excluded patients (PCR-negative) suffered considerable greater all-cause mortality than healthy/unrelated-COVID19 subjects, which could explain, in part, the large excess deaths observed across the COVID19 pandemic.
DermoExpert: Skin lesion classification using a hybrid convolutional neural network through segmentation, transfer learning, and augmentation
Authors: Hasan Md. Kamrul , Elahi Md. Toufick E , Alam Md. Ashraful , Jawad Md. Tasnim
Published: February 2021

Background and Objective

Although automated Skin Lesion Classification (SLC) is a crucial integral step in computeraided diagnosis, it remains challenging due to inconsistency in textures, colors, indistinguishable boundaries, and shapes.

Methods

This article proposes an automated dermoscopic SLC framework named Dermoscopic Expert (DermoExpert). The DermoExpert consists of preprocessing and hybrid Convolutional Neural Network (hybrid-CNN), leveraging a transfer learning strategy. The proposed hybrid-CNN classifier has three different feature extractor modules taking the same input images, which are fused to achieve better-depth feature maps of the corresponding lesion. Those unique and fused feature maps are classified using different fully connected layers, which are then ensembled to predict the lesion class. We apply lesion segmentation, augmentation, and class rebalancing in the proposed preprocessing. We have also employed geometry- and intensity-based augmentations and class rebalancing by penalizing the majority class’s loss and combining additional images to the minority classes to enhance lesion recognition outcomes. Moreover, we leverage the knowledge from a pre-trained model to build a generic classifier, although small datasets are being used. In the end, we design and implement a web application by deploying the weights of our DermoExpert for automatic lesion recognition.

Results

We evaluate our DermoExpert on the ISIC-2016, ISIC-2017, and ISIC-2018 datasets, where the DermoExpert has achieved the area under the receiver operating characteristic curve (AUC) of 0.96, 0.95, and 0.97, respectively. The experimental results defeat the recent state-of-the-art by the margins of 10.0 % and 2.0 % respectively for the ISIC-2016 and ISIC-2017 datasets in terms of AUC. The DermoExpert also outperforms by a border of 3.0 % for the ISIC-2018 dataset concerning a balanced accuracy.

Conclusion

Since our framework can provide better-classification outcomes on three different test datasets, it can lead to better-recognition of melanoma to assist dermatologists. Our source code and segmented masks for the ISIC-2018 dataset will be publicly available for further improvements.
Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study
Authors: Wengenroth Laura , Berglund Fanny , Blaak Hetty , Chifiriuc Mariana Carmen , Flach Carl-Fredrik , Pircalabioru Gratiela Gradisteanu , Larsson D. G. Joakim , Marutescu Luminita , van Passel Mark , Popa Marcela , Radon Katja , de Roda Husman Ana Maria , Rodríguez-Molina Daloha , Weinmann Tobias , Wieser Andreas , Schmitt Heike
Published: February 2021

Background

Antibiotic resistance has become a serious global health threat. Wastewater treatment plants (WWTPs) may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to WWTP workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Waste Water Treatment Plants) study.

Methods/Design

Within the AWARE study, we gather data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E.coli (ESBL-EC) and carbapenemase-producing Enterobacteriaceae (CPE) as well as on their corresponding antibiotic resistance genes (ARGs) isolated from air, water, and sewage samples taken from inside and outside of different WWTPs in Germany, Netherlands and Romania. Additionally, we analyse stool samples of WWTP workers, nearby residents and members of a comparison group living ≥1,000 m away from the closest WWTP.

Discussion

The study results will enable the assessment of the potential health impact of exposure to ESBL-EC, CPE and ARGs in and around WWTPs. Quantifying the contribution of different wastewater treatment processes to the ESBL-EC, CPE and ARGs removal efficiency will provide us with evidence-based support for possible mitigation strategies.
Intention to receive a COVID-19 vaccine: Results from a population-based survey in Canada
Authors: Ogilvie Gina S. , Gordon Shanlea , Smith Laurie W. , Albert Arianne , Racey C. Sarai , Booth Amy , Gottschlich Anna , Goldfarb David , Murray Melanie C.M. , Galea Liisa A.M. , Kaida Angela , Brotto Lori A. , Sadarangani Manish
Published: February 2021

Background

The success of any COVID-19 vaccine program ultimately depends on high vaccine uptake. This study determined overall intention to receive a COVID-19 vaccine and identified factors that predict intentions to be vaccinated against COVID-19 in Canada, specifically in key priority groups identified by the American Committee on Immunization Practice (ACIP) and the National Advisory Committee on Immunization (NACI) for early immunization.

Methods

Individuals from research cohorts from the general population of British Columbia aged 25-69 were invited complete an online survey based on validated scales and theoretical frameworks to explore intention to receive a COVID-19 vaccine. Two multivariable logistic regression models were conducted to determine factors associated with intention to receive the COVID-19 vaccine.

Results

Of 4,948 respondents, 79.8% intended to receive a COVID-19 vaccine. In multivariable modeling, respondents who intended to receive the vaccine had higher vaccine attitudinal scores (p <0.001), reported greater influence of direct social norms (p = 0.001), and indirect social norms, including their family physician (p = 0.024), and Provincial Health Officer (p = 0.011). Older individuals (>60 years) were more likely to intend to receive the vaccine, while females (95%CI 0.57,0.93), those with less than high school education (95%CI 0.5,0.76), those who self-identified as non-white (95%CI 0.60,0.92), self-identified as Indigenous (95%CI 0.36,0.84) and essential non-health care workers (95%CI 0.59,0.86) had lower adjusted odds of intending to receive a COVID-19 vaccine.

Conclusions

To optimize vaccine coverage, public health should focus on key messages around vaccine safety and benefit, and leverage trusted practitioners for messaging. As certain key populations identified by NACI and ACIP for early immunization report a lower intention to vaccinate, there is a need for in-depth education and support for these communities to ensure optimal uptake.
Impact of personal protective equipment use on health care workers’ physical health during the COVID-19 pandemic: a systematic review and meta-analysis
Authors: Galanis Petros , Vraka Irene , Fragkou Despoina , Bilali Angeliki , Kaitelidou Daphne
Published: February 2021

Background

During the COVID-19 pandemic, health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) in high-risk clinical settings have been obliged to wear personal protective equipment (PPE).

Aim

To assess the impact of PPE use on HCWs’ physical health during the COVID-19 pandemic. Also, we examined factors related with a greater risk of adverse events among HCWs due to PPE use.

Methods

We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane criteria for this systematic review and meta-analysis. We searched PubMed, Medline, Scopus, ProQuest, CINAHL and pre-print services (medRxiv) from January 1, 2020 to December 27, 2020.

Findings

Our review included 14 studies with 11,746 HCWs from 16 countries. The estimated overall prevalence of adverse events among HCWs was 78% (95% CI: 66.7-87.5%) with a range from 42.8% to 95.1% among studies. The prevalence of adverse events was higher for the studies with poor quality compared to those with moderate quality (83.5% vs. 67.1%), while increased sample size was related with decreased prevalence (p<0.001). The most frequent adverse events were headache (55.9%), dry skin (54.4%), dyspnoea (53.4%), pressure injuries (40.4%), itching (39.8%), hyperhidrosis (38.5%), and dermatitis (31.0%). Among others, the following factors were related with the risk of adverse events among HCWs due to PPE use: female gender, younger age, obesity, diabetes mellitus, smoking pre-existing headache, longer duration of shifts wearing PPE, increased consecutive days with PPE, and increased exposure to confirmed or suspected COVID-19 patients.

Conclusion

The frequency of adverse events amongst HCWs due to PPE use is very high. Further studies should be conducted since the limitations of this review do not allow us to infer conclusive results especially in case of risk factors for the occurrence of adverse events. Healthcare facilities should take the necessary precautions and change the working conditions during the COVID-19 pandemic to prevent adverse events associated with PPE use and minimize harm to HCWs.
“Breaking the silence”: Sexual victimisation in an old age psychiatry patient population in Flanders
Authors: Nobels Anne , Keygnaert Ines , Robert Egon , Vandeviver Christophe , Haekens An , Lemey Lieve , Strobbe Marieke , Noortgate Nele Van Den , Lemmens Gilbert M.D.
Published: February 2021

Background

Sexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging.

Methods

Between July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape.

Outcomes

In 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before.

Interpretation

Sexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures.
Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank
Authors: Mutz Julian , Lewis Cathryn M.
Published: February 2021

Individuals with depression, on average, die prematurely, have high levels of physical comorbidities and may experience accelerated biological ageing. A greater understanding of age-related changes in physiology could provide novel biological insights that may help inform strategies to mitigate excess mortality in depression. We used generalised additive models to examine age-related changes in 15 cardiovascular, body composition, grip strength and lung function measures, comparing males and females with a lifetime history of depression to healthy controls. The main dataset included 342,393 adults (mean age = 55.87 years, SD = 8.09; 52.61% females). We found statistically significant case-control differences for most physiological measures. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in depression. These differences did not uniformly narrow or widen with age and differed by sex. For example, BMI in female cases was 1.1 kg/m2higher at age 40 and this difference narrowed to 0.4 kg/m2at age 70. In males, systolic blood pressure was 1 mmHg lower in depression cases at age 45 and this difference widened to 2.5 mmHg at age 65. These findings suggest that targeted screening for physiological function in middle-aged and older adults with depression is warranted to potentially mitigate excess mortality.
Antibody responses boosted in seropositive healthcare workers after single dose of SARS-CoV-2 mRNA vaccine
Authors: Bradley Todd , Grundberg Elin ,   CODIEFY study team, Selvarangan Rangaraj
Published: February 2021

Current guidelines recommend that individuals who have had COVID-19 should receive the identical vaccine regimen as those who have not had the infection. This includes two doses of the mRNA platform vaccines (BNT162b2/Pfizer; mRNA-1273/Moderna) that are approved for use in the United States. In this brief report, we show that after a single dose of the Pfizer SARS-CoV-2 vaccine, individuals that had prior SARS-CoV-2 infection had significantly higher antibody levels than individuals that had no history of infection. This provides the rationale for changing vaccination policy to deliver only a single dose to individuals with recent SARS-CoV-2 infection that may free up additional doses for individuals that have no preexisting immunity to the virus. Future study of other immune parameters such as T cell response and durability of immune response should be rapidly undertaken in individuals that had COVID-19 prior to vaccination.
A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients with COVID-19
Authors: Ko Justine J. , Wu Clay , Mehta Neha , Wald-Dickler Noah , Yang Wei , Qiao Renli
Published: February 2021

OBJECTIVES

This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring ICU care.

DESIGN

This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit admission. Patients admitted and requiring oxygen supplementation were treated with either methylprednisolone or dexamethasone.

SETTING

This study takes place in the intensive care units at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles.

PATIENTS

All eligible patients admitted to the intensive care unit for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study.

INTERVENTIONS

A total of 262 patients were grouped as receiving usual care (n=75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n=104), or dexamethasone dosed at least at 6 mg for ≥ 7 days (n=83).

MEASUREMENTS and MAIN RESULTS

All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient.

In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days (p <0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, p=0.0385).

CONCLUSIONS

In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.
High-throughput miRNA-sequencing of the human placenta: expression throughout gestation
Authors: Gonzalez Tania L , Eisman Laura E , Joshi Nikhil V , Flowers Amy E , Wu Di , Wang Yizhou , Santiskulvong Chintda , Tang Jie , Buttle Rae A , Sauro Erica , Clark Ekaterina L , DiPentino Rosemarie , Jefferies Caroline A , Chan Jessica L , Lin Yayu , Zhu Yazhen , Afshar Yalda , Tseng Hsian-Rong , Taylor Kent , Williams John , Pisarska Margareta D
Published: February 2021

Background

Altered placenta miRNA abundance may impact the maternal-fetal interface and pregnancy outcomes. Understanding miRNA changes across gestation is essential before miRNAs can be used as biomarkers or prognostic indicators during pregnancy.

Materials & Methods

Using next-generation sequencing, we characterize the normative human placenta miRNA transcriptome in first (N=113) and third trimester (N=47).

Results

There are 801 miRNAs expressed in both first and third trimester, including 182 with similar expression across gestation (P≥0.05) and 182 significantly different (FDR<0.05). Of placenta-specific miRNA clusters, C14MC is more upregulated in first trimester and C19MC is more highly expressed overall.

Conclusion

This work provides a rich atlas of healthy pregnancies to direct functional studies investigating the epigenetic differences in first and third trimester placentae.

Lay Abstract

The human body produces microRNAs which affect the expression of genes and proteins. This study uses next generation sequencing to identify the microRNA profile of first and third trimester human placentae using a large cohort (N=113 first, N=47 third trimester). All pregnancies resulted in healthy babies. We identify microRNAs with significantly different expression between first and third trimester, as well as stably expressed microRNAs. This work provides a baseline for future studies which may use microRNAs to monitor maternal-fetal health throughout pregnancy.
Population genetics as a tool to elucidate pathogen reservoirs: Lessons fromPseudogymnoascus destructans, the causative agent of white-nose disease in bats
Authors: Fischer Nicola M. , Altewischer Andrea , Ranpal Surendra , Dool Serena , Kerth Gerald , Puechmaille Sébastien J.
Published: February 2021

Emerging infectious diseases pose a major threat to human, animal, and plant health. The risk of species-extinctions increases when pathogens can survive in the absence of the host, for example in environmental reservoirs. However, identifying such reservoirs and modes of infection is often highly challenging. In this study, we investigated the presence and nature of an environmental reservoir for the ascomycete fungusPseudogymnoascus destructans, the causative agent of white-nose disease. We also characterised the modes and timing of transmission of the pathogen; key elements to better understand the disease dynamics. Using 18 microsatellite markers, we determined the genotypic and genic (based on allele frequencies) differentiation between 1,497P. destructansisolates collected from nine closely situated hibernacula in North-Eastern Germany. One hibernaculum was the focus of intensive sampling in which both the bats and walls of the site were sampled at regular intervals over five consecutive winter seasons (1,062 isolates). We found significant genic differentiation between sites and few multi-locus genotypes shared across hibernacula (genotypic differentiation). This demonstrates that each hibernaculum has an essentially unique population of the fungus. This would be expected if bats purge viableP. destructansover the summer, preventing the mixing and exchange of the pathogen in maternity colonies, where bats from all of the studied hibernacula meet. Results from the intensively sampled site show higher measures of genotypic richness on walls compared to bats, the absence of genic differentiation between bats and walls, and stable relative abundance of multi-locus genotypes over multiple winter seasons. This clearly implicates hibernacula walls as the main environmental reservoir of the pathogen, from which bats become re-infected annually.
Expanding the SiMPl plasmid toolbox for use with spectinomycin/streptomycin
Authors: Palanisamy Navaneethan , Ballestin Ballestin Jara , Di Ventura Barbara
Published: February 2021

We recently developed the SiMPl plasmid toolbox, which is constituted by pairs of plasmids, generically indicated as pSiMPlx_N and pSiMPlx_C, which can be stably maintained inEscherichia coliwith a single antibiotic x. The method exploits the split intein gp41-1 to reconstitute the enzyme conferring resistance towards the antibiotic x, whereby each enzyme fragment is expressed from one of the plasmids in the pair. pSiMPl plasmids are currently available for use with ampicillin, kanamycin, chloramphenicol, hygromycin and puromycin. Here we introduce another pair for use with spectinomycin/streptomycin broadening the application spectrum of the SiMPl toolbox. To find functional splice sites in aminoglycoside adenylyltransferase we apply a streamlined strategy looking exclusively at the flexibility of native cysteine and serine residues, which we first validated splitting the enzymes conferring resistance towards ampicillin, kanamycin, chloramphenicol and hygromycin. This strategy could be used in the future to split other enzymes conferring resistance towards antibiotics.
Sensitive visualization of SARS-CoV-2 RNA with CoronaFISH
Authors: Rensen Elena , Pietropaoli Stefano , Mueller Florian , Weber Christian , Souquere Sylvie , Isnard Pierre , Rabant Marion , Gibier Jean-Baptiste , Simon-Loriere Etienne , Rameix-Welti Marie-Anne , Pierron Gérard , Barba-Spaeth Giovanna , Zimmer Christophe
Published: February 2021

The current COVID-19 pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The positive-sense single-stranded RNA virus contains a single linear RNA segment that serves as a template for transcription and replication, leading to the synthesis of positive and negative-stranded viral RNA (vRNA) in infected cells. Tools to visualize viral RNA directly in infected cells are critical to analyze its replication cycle, screen for therapeutic molecules or study infections in human tissue. Here, we report the design, validation and initial application of fluorescencein situhybridization (FISH) probes to visualize positive or negative RNA of SARS-CoV-2 (CoronaFISH). We demonstrate sensitive visualization of vRNA in African green monkey and several human cell lines, in patient samples and human tissue. We further demonstrate the adaptation of CoronaFISH probes to electron microscopy (EM). We provide all required oligonucleotide sequences, source code to design the probes, and a detailed protocol. We hope that CoronaFISH will complement existing techniques for research on SARS-CoV-2 biology and COVID-19 pathophysiology, drug screening and diagnostics.
Does Food Insecurity exist among Farm Households? Evidence from Ghana
Authors: Acheampong Patricia Pinamang , Obeng Elvis Agyei , Opoku Monica , Brobbey Lydia , Sakyiamah Bernard
Published: February 2021

Household food security exists when households have physical, social and economic access to sufficient, safe and nutritious food at all times that meets their dietary needs and food preferences for an active and healthy life. Food security remains a serious challenge for many households in Ghana and the situation is even more prevalent among smallholder farmers. Using data collected from 2,603 farm households across Ghana and employing an ordered probit model the determinants of food security among farm households were assessed. The food security indicator-Food Consumption Score (FCS) which combines diet diversity, frequency of consumption and relative nutritional importance of different food groups was used for the analysis. Results indicated that farm households (76%) across Ghana were within the acceptable household food consumption groups. Nonetheless, 19% and 6% of farm households respectively were within the borderline and poor food consumption groups respectively. Further analysis revealed the determinants of food security to include experience, gender, improved variety adoption, access to credit and location. The suggestion is that government and private institutions should create an enabling environment to enhancing production capacities, economic and social resilience to improve on food security and nutrition.