bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomical and Histological Study of the Conjoint Fascial Sheath of the Levator and Superior Rectus for Ptosis Surgery
Authors: Li Bei , Yang Jianwei , Wu Wencan , Chai Chang , Gu Zhuo , He Zaiqing , Tan Zhiwei , Cheng Shuanghua , Lu Ping , Zeng Liuzhi
Published: April 2020

Purpose:

An anatomical and histological study of the conjoint fascial sheath of the levator and superior rectus (CFS) was carried out by using the cadavers for teaching.

Methods:

Three adult Asian cadaver heads fixed in formalin were used. The CFS was exposed by the same surgeon in each case. Then the CFS was observed and measured in vivo and ex vivo. And the CFS, the levator and the frontal muscle were removed from the same eye for histological study.

Results:

The CFS was located 2.1 ± 0.4 mm posterior to the fornix. A special muscle sheath of the levator was observed. The special muscle sheath and the tendon of the superior rectus were fused to the CFS through loose connective tissue. Hematoxylin-Eosin (HE) staining showed a large amount of connective tissue on examination of the CFS by microscopy. Double staining with Victoria-blue and Masson trichrome staining confirmed elastic fibers and collagen fibers in the CFS tissues.

Conclusions:

If ptosis correction surgery is performed by looking for the CFS from the upper edge of the conjunctiva, in fact, only a special part of the muscle sheath of the levator in the CFS, but not the integral CFS, is used in the surgery. The histological results confirm that the CFS is a fibrous tissue membrane with both elasticity and toughness. Perhaps the best choice is to recombine the special muscle sheath of the levator in the CFS with the levator muscle tissue during ptosis correction surgery to suspend the eyelids.
A Prediction Model of Rehabilitation Motivation in Middle-Aged Survivors of Stroke in Rehabilitation Facilities in Korea
Authors: Oh Soo Yong , Hwang Seon Young , Chung Misook L. , Lennie Terry A.
Published: April 2020

Background

To improve the health outcomes of survivors of stroke, it is critical that they are highly motivated to engage in rehabilitation activities. Despite the increasing prevalence of strokes among middle-aged adults, there is limited knowledge regarding factors that may affect survivors' motivation to engage in rehabilitation.

Objective

The aim of this study was to examine the relationship among factors that predict the rehabilitation motivation of middle-aged survivors after a stroke through structural equation modeling.

Methods

A total of 200 middle-aged (40–64 years) survivors of stroke from 9 rehabilitation hospitals in Korea completed questionnaires on depressive symptoms, self-efficacy, social support, and rehabilitation motivation. Information on clinical characteristics, including physical function (activities performed during daily life), was collected through the review of medical records. Structural equation modeling was used to construct a prediction model of rehabilitation motivation.

Results

The average subject's age was 56.2 ± 6.6 years, and the mean time since the event of their stroke was 15.02 ± 8.95 months. Subjects' self-efficacy (being able to live everyday life) after their stroke (β = .500, P < .001) and the social support provided by family and medical personnel (β = .284, P < .010) directly affected their rehabilitation motivation. The bootstrapping method showed that depressive symptoms indirectly affected rehabilitation motivation through self-efficacy, as did physical function.

Conclusions

In middle-aged survivors of stroke, self-efficacy and social support play a critical role in maintaining intrinsic motivation to engage in rehabilitation activities. Self-efficacy should be evaluated periodically and improved by encouraging individuals to achieve goals, emphasizing their self-regulation, especially among those who reported depressive symptoms and low physical function.
Help or hindrance: Exploring nurse practitioners' perceptions of transition to practice legislation
Authors: Speight Chandra , Scott Elaine S.
Published: April 2020

Background:

Fourteen states have adopted transition to practice (TP) legislation, which requires newly certified nurse practitioners (NPs) to practice under a senior clinician. States have adopted such legislation despite vast evidence indicating NPs provide safe care.

Purpose:

The purpose of this study is to explore NPs' perceptions of the effects of this legislation and to describe communication between NPs and senior clinicians working in TP states.

Methods:

Using a cross-sectional, descriptive design, we surveyed a convenience sample of NPs working in TP states. Descriptive statistical analysis and qualitative content analysis were conducted.

Results:

Most respondents believed TP legislation posed unnecessary regulatory barriers but also believed it promoted professional development. No statistically significant relationships between professional characteristics, regulatory variations, and these perceptions were identified.

Implications for practice:

Given the increasing number of states considering TP legislation, and the vast variability in TP models, additional research into the effects of this regulation is needed.
High-specific-activity iodine 131 metaiodobenzylguanidine for the treatment of metastatic pheochromocytoma or paraganglioma: a novel therapy for an orphan disease
Authors: Jimenez Camilo , Núñez Rodolfo , Wendt Richard
Published: April 2020

Purpose of review

Pheochromocytomas and paragangliomas represent less than 1% of all endocrine tumors. Approximately 15–20% of these tumors are malignant. The definition of malignancy relies on the presence of metastasis. Metastatic pheochromocytomas and paragangliomas are usually advanced, incurable tumors with limited therapeutic options. About 50–60% of these tumors express the noradrenaline transporter in their cell membranes. Recently, the United States Food and Drug Administration approved high-specific-activity iodine 131 metaiodobenzylguanidine (HSA-I-131-MIBG) for the treatment of metastatic pheochromocytomas and paragangliomas that express the noradrenaline transporter. This review reports the benefits and toxicity of HSA-I-131-MIBG, its physical and dosimetric aspects, and radiation safety precautions, as well as its potential therapeutic value for other malignancies (neuroblastoma, gastroenteropancreatic neuroendocrine tumors, and medullary thyroid carcinoma).

Recent findings

A phase 2 clinical trial with HSA-I-131-MIBG reported an impressive clinical benefit rate, acceptable toxicity and long-term benefits.

HSA-I-131-MIBG is an effective medication for metastatic pheochromocytomas and paragangliomas that express the noradrenaline transporter.
Length of Clinical Shift on Quality of Care, Learning Outcomes, and Satisfaction in Prelicensure Nursing Programs
Authors: Hamilton Diane J. , Benson Julie A. , Callahan Rebecca
Published: April 2020

Background

Some schools and nursing care organizations have implemented 12-hour shifts for students' clinical experiences.

Purpose

The aim of this review was to identify how student 12-hour shifts compared to shifts of less than 12 hours influence patient safety, care quality, learning outcomes, and student, faculty, and staff satisfaction.

Methods

Searches for academic literature using electronic databases resulted in 13 primary research articles covering the period between 1982 and 2018.

Results

During longer clinical shifts, no change in patient safety events occurred. Students and clinical staff perceived care quality was maintained or influenced positively. Faculty were undecided or minimally did not believe care quality improved. While students perceived meeting learning outcomes, faculty perceptions were divided. Students were satisfied with longer shifts; however, the satisfaction of faculty and clinical staff was mixed.

Conclusions

Within realms of patient safety, care quality, learning outcomes, and student, faculty, and clinical staff satisfaction, research has been insufficient and inconclusive regarding 12-hour student shifts.
Transforming the Experience of Mirror Viewing for Individuals Faced With Disfiguring Injuries
Authors: Thayer Virginia (Becky) , Freysteinson Wyona , Thomas Lisa W.
Published: April 2020

Purpose/Aims

This study explored the feasibility of educating nurses on an emotionally sensitive topic using video. The aim was to educate nurses on how to assist individuals who have had an amputation of a limb in viewing themselves in the mirror.

Design

One-group repeated-measures design with 2 time points (pretest and posttest at 1 month).

Methods

Nurses viewed a video in which 8 amputee actors described how and why nurses should support individuals' viewing of self in the mirror following amputation.

Results

This video-based education was feasible, and recommendations were made for future research. Participants were engaged and shared insight into how this knowledge would change their nursing practice.

Conclusions

A larger educational research study to test the effect of this education on improving nursing confidence and offering the mirror is recommended.
Subcutaneous Tocilizumab in Monotherapy or in Combination With Nonbiologic Disease-Modifying Antirheumatic Drugs in Latin American Patients With Moderate to Severe Active Rheumatoid Arthritis
Authors: Mysler Eduardo , Cardiel Mario H. , Xavier Ricardo M. , López Alejandra , Ramos-Esquivel Allan
Published: April 2020

Objective

To assess the efficacy and safety of subcutaneous tocilizumab (TCZ) in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in Latin American patients with rheumatoid arthritis (RA) and inadequate response to previous csDMARDs.

Methods

ML28700 was a multicenter, open-label, single-arm trial. Previously treated RA patients who had not received treatment with TCZ or any biological agent (n = 284) and with a baseline Disease Activity Score in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) of 3.2 or greater were assigned to receive subcutaneous TCZ (162 mg/wk) in association with csDMARD for 24 weeks. Patients who achieved remission (DAS28-ESR <2.6) at week 24 continued with TCZ as monotherapy until week 52; otherwise, they continued with their assigned treatment. The primary efficacy end point was remission rate (DAS28-ESR <2.6) at weeks 24 and 52. Secondary objectives included disease activity scores, safety, and quality of life.

Results

At week 24, a total of 169 patients (59.5%; 95% confidence interval, 53.5%–65.3%) achieved remission, 91 patients (32.0%) had low disease activity, and 46 patients (8.4%) were not responders. Sustained remission at week 52 was achieved by 80.8% (n = 126) of patients who continued with TCZ monotherapy versus 44.6% (n = 37) of those on combination therapy. A total of 241 patients (84.9%; 95% confidence interval, 80.2%–88.8%) had at least 1 adverse event during follow-up. Adverse events led to drug modification in 32 patients (11.3%) or discontinuation in 21 patients (7.4%).

Conclusions

Subcutaneous TCZ is an efficacious therapy with long-lasting results and tolerable adverse events in Latin American patients with RA.

Trial registration no.: NCT02011334 Tozura Study Program.
18F-PSMA 1007 in Suspected Renal Cell Carcinoma
Authors: Marafi Fahad , Sasikumar Arun , Al-Terki Abdullatif , Alfeeli Mahmoud
Published: April 2020

A 60-year-old man with suspected right renal cell carcinoma underwent 18F-FDG PET/CT and 18F prostate-specific membrane antigen (PSMA) 1007 PET/CT scan. Compared with the 18F-FDG PET/CT scan, 18F-PSMA 1007 PET/CT showed intense tracer concentration in the primary tumor in the right kidney and intense tracer concentration consistently in all lung nodules. Unlike noted in previous pilot studies with 68Ga-PSMA, we observed that the primary renal tumor also showed intense tracer avidity with 18F-PSMA 1007. 18F-PSMA 1007 PET/CT may provide preoperative insight into possible etiology, histopathological probability of tumor type, staging information, and theranostic potentials in evaluation of suspected renal cell carcinoma.
Mediastinal Epithelioid Hemangioendothelioma Revealed on 68Ga-DOTATATE PET/CT
Authors: Long Yu , Shao Fuqiang , Lan Xiaoli
Published: April 2020

Epithelioid hemangioendothelioma is a rare vascular sarcoma, and it rarely leads abnormal serum calcium. Here we presented a 61-year-old woman with suspected tumor-induced osteomalacia who underwent68Ga-DOTATATE PET/CT to detect possible culprit tumor. The images showed a hypermetabolic paraspinal soft nodule in the right upper posterior mediastinum, which suggested a somatostatin receptor–positive tumor. The tumor was resected and pathologically confirmed as epithelioid hemangioendothelioma.
Parents’ Perception of Self-Management Behaviors for Their Children With Spina Bifida in South Korea: A Qualitative Study
Authors: Yun Hyun Jung , Choi Eun Kyoung , Han Sang Won
Published: April 2020

Purpose

This study aimed to explore parents’ perceptions of self-management behaviors for their children with spina bifida (SB).

Design

Qualitative method.

Methods

In-depth interviews were conducted with nine Korean parents of children with SB. The data were analyzed using the content analysis method.

Findings

Parental perceptions of the experiences of self-management behaviors in children with SB were classified into risk factors that hinder self-management behaviors and protective factors that accelerate them. Each category of factors was then further classified into child-, parent-, and school-related factors.

Conclusions

To promote self-management behaviors in children with SB, reducing risk factors and promoting protective factors considering child, family, and school dimensions based on cultural differences are necessary.

Clinical Relevance

Rehabilitation nurses should be considered essential healthcare providers who can offer stepwise guidance to achieve self-management behaviors in children with SB according to their stage of development.
No news is good news? Three-year postdischarge mortality of octogenarian and nonagenarian patients following emergency general surgery
Authors: Narueponjirakul Natawat , Hwabejire John , Kongwibulwut Manasnun , Lee Jae Moo , Kongkaewpaisan Napaporn , Velmahos George , King David , Fagenholz Peter , Saillant Noelle , Mendoza April , Rosenthal Martin , Kaafarani Haytham M.A.
Published: April 2020

BACKGROUND

Outcome data on the very elderly patients undergoing emergency general surgery (EGS) are sparse. We sought to examine short- and long-term mortality in the 80 plus years population following EGS.

METHODS

Using our institutional 2008–2018 EGS Database, all the 80 plus years patients undergoing EGS were identified. The data were linked to the Social Security Death Index to determine cumulative mortality rates up to 3 years after discharge. Univariate and multivariable logistic regression analyses were used to determine predictors of in-hospital and 1-year cumulative mortality.

RESULTS

A total of 385 patients were included with a mean age of 84 years; 54% were female. The two most common comorbidities were hypertension (76.1%) and cardiovascular disease (40.5%). The most common procedures performed were colectomy (20.0%), small bowel resection (18.2%), and exploratory laparotomy for other procedures (15.3%; e.g., internal hernia, perforated peptic ulcer). The overall in-hospital mortality was 18.7%. Cumulative mortality rates at 1, 2, and 3 years after discharge were 34.3%, 40.5%, and 43.4%, respectively. The EGS procedure associated with the highest 1-year mortality was colectomy (49.4%). Although hypertension, renal failure, hypoalbuminemia, hyperbilirubinemia, and elevated liver enzymes predicted in-hospital mortality, the only independent predictors of cumulative 1-year mortality were hypoalbuminemia (odds ratio, 2.17; 95% confidence interval, 1.10–4.27; p = 0.025) and elevated serum glutamic pyruvic transaminase (SGOT) level (odds ratio, 2.56; 95% confidence interval, 1.09–4.70; p = 0.029) at initial presentation. Patients with both factors had a cumulative 1-year mortality rate of 75.0%.

CONCLUSION

More than half of the very elderly patients undergoing major EGS were still alive at 3 years postdischarge. The combination of hypoalbuminemia and elevated liver enzymes predicted the highest 1-year mortality. Such information can prove useful for patient and family counseling preoperatively.

LEVEL OF EVIDENCE

Prognostic, Level III.
Blood-based biomarkers for prediction of intracranial hemorrhage and outcome in patients with moderate or severe traumatic brain injury
Authors: Anderson Taylor N. , Hwang Jun , Munar Myrna , Papa Linda , Hinson Holly E. , Vaughan Allison , Rowell Susan E.
Published: April 2020

BACKGROUND

Early identification of traumatic intracranial hemorrhage (ICH) has implications for triage and intervention. Blood-based biomarkers were recently approved by the Food and Drug Administration (FDA) for prediction of ICH in patients with mild traumatic brain injury (TBI). We sought to determine if biomarkers measured early after injury improve prediction of mortality and clinical/radiologic outcomes compared with Glasgow Coma Scale (GCS) alone in patients with moderate or severe TBI (MS-TBI).

METHODS

We measured glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and microtubule-associated protein-2 (MAP-2) on arrival to the emergency department (ED) in patients with blunt TBI enrolled in the placebo arm of the Prehospital TXA for TBI Trial (prehospital GCS score, 3–12; SPB, > 90). Biomarkers were modeled individually and together with prehospital predictor variables [PH] (GCS score, age, sex). Data were divided into a training data set and test data set for model derivation and evaluation. Models were evaluated for prediction of ICH, mass lesion, 48-hour and 28-day mortality, and 6-month Glasgow Outcome Scale-Extended (GOS-E) and Disability Rating Scale (DRS). Area under the curve (AUC) was evaluated in test data for PH alone, PH + individual biomarkers, and PH + three biomarkers.

RESULTS

Of 243 patients with baseline samples (obtained a median of 84 minutes after injury), prehospital GCS score was 8 (interquartile range, 5–10), 55% had ICH, and 48-hour and 28-day mortality were 7% and 13%, respectively. Poor neurologic outcome at 6 months was observed in 34% based on GOS-E of 4 or less, and 24% based on DRS greater than or equal to7. Addition of each biomarker to PH improved AUC in the majority of predictive models. GFAP+PH compared with PH alone significantly improved AUC in all models (ICH, 0.82 vs. 0.64; 48-hour mortality, 0.84 vs. 0.71; 28-day mortality, 0.84 vs. 0.66; GOS-E, 0.78 vs. 0.69; DRS, 0.84 vs. 0.81, all p < 0.001).

CONCLUSION

Circulating blood-based biomarkers may improve prediction of neurological outcomes and mortality in patients with MS-TBI over prehospital characteristics alone. Glial fibrillary acidic protein appears to be the most promising. Future evaluation in the prehospital setting is warranted.

LEVEL OF EVIDENCE

Prospective, Prognostic and Epidemiological, level II.
KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation
Authors: Chadban Steven J. , Ahn Curie , Axelrod David A. , Foster Bethany J. , Kasiske Bertram L. , Kher Vijah , Kumar Deepali , Oberbauer Rainer , Pascual Julio , Pilmore Helen L. , Rodrigue James R. , Segev Dorry L. , Sheerin Neil S. , Tinckam Kathryn J. , Wong Germaine , Knoll Gregory A.
Published: April 2020

The 2020 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation is intended to assist health care professionals worldwide who evaluate and manage potential candidates for deceased or living donor kidney transplantation. This guideline addresses general candidacy issues such as access to transplantation, patient demographic and health status factors, and immunological and psychosocial assessment. The roles of various risk factors and comorbid conditions governing an individual’s suitability for transplantation such as adherence, tobacco use, diabetes, obesity, perioperative issues, causes of kidney failure, infections, malignancy, pulmonary disease, cardiac and peripheral arterial disease, neurologic disease, gastrointestinal and liver disease, hematologic disease, and bone and mineral disorder are also addressed. This guideline provides recommendations for evaluation of individual aspects of a candidate’s profile such that each risk factor and comorbidity are considered separately. The goal is to assist the clinical team to assimilate all data relevant to an individual, consider this within their local health context, and make an overall judgment on candidacy for transplantation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Guideline recommendations are primarily based on systematic reviews of relevant studies and our assessment of the quality of that evidence, and the strengths of recommendations are provided. Limitations of the evidence are discussed with differences from previous guidelines noted and suggestions for future research are also provided.
Chronic inflammation mediates brain injury in HIV infection: relevance for cure strategies
Authors: McArthur Justin C. , Johnson Tory P.
Published: April 2020

Purpose of review

Chronic inflammation is a major component of HIV infection, the effects of which can be devastating in the central nervous system (CNS). Protecting the brain is, therefore, critical as efforts proceed to cure HIV infection by reactivating latent viral reservoirs and driving immune responses. We review the clinical presentation and pathology findings of inflammatory processes in the CNS in patients managed with ART and the drivers of these processes.

Recent findings

Chronic inflammation is associated with increased mortality and morbidity and HIV infection increases the risk for chronic diseases, especially cognitive impairment. Latent viral reservoirs, including microglia and tissue macrophages, contribute to inflammation in the CNS. Inflammation is generated and maintained through residual viral replication, dysregulation of infected cells, continuously produced viral proteins and positive feedback loops of chronic inflammation. Novel therapeutics and lifestyle changes may help to protect the CNS from immune-mediated damage.

As therapies are developed to cure HIV, it is important to protect the CNS from additional immune-mediated damage. Adjunctive therapies to restore glial function, reduce neuroinflammation and systemic inflammation, and inhibit expression of viral proteins are needed.
Cortical complexity and gyrification patterns in Parkinson’s disease
Authors: Li Dan , Wang Erlei , Jia Yujing , Xu Jin , Zhang Zhongshuai , Jiang Zhen , Luo Weifeng
Published: April 2020

This study aimed to investigate the cortical complexity and gyrification patterns in Parkinson’s disease (PD) using local fractional dimension (LFD) and local gyrification index (LGI), respectively. In a cross-sectional study, LFD and LGI in 60 PD patients without dementia and 56 healthy controls (HC) were investigated using brain structural MRI data. LFD and LGI were estimated using the Computational Anatomy Toolbox (CAT12) and statistically analyzed between groups on a vertex level using statistical parametric mapping 12 (SPM12). Additionally, correlations between structural changes and clinical indices were further examined. PD patients showed widespread LFD reductions mainly in the left pre- and postcentral cortex, the left superior frontal cortex, the left caudal middle frontal cortex, the bilaterally superior parietal cortex and the right superior temporal cortex compared to HC. For LGI, there was no significant difference between PD and HC. In PD patients group, a significant negative correlation was found between LFD of the left postcentral cortex and duration of illness (DOI). Our results of widespread LFD reductions, but not LGI, indicate that LFD may provide a more sensitive diagnostic biomarker and encode specific information of PD. The significant negative correlation between LFD of the left postcentral cortex and DOI suggests that LFD may be a biomarker to monitor disease progression in PD.
Widespread use of face masks in public may slow the spread of SARS CoV-2: an ecological study
Authors: Kenyon Chris
Published: April 2020

Background

The reasons for the large differences between countries in the sizes of their SARS CoV-2 epidemics is unknown. Individual level studies have found that the use of face masks was protective for the acquisition and transmission of a range of respiratory viruses including SARS CoV-1. We hypothesized that population level usage of face masks may be negatively associated SARS CoV-2 spread.

Methods

At a country level, linear regression was used to assess the association between COVID-19 diagnoses per inhabitant and the national promotion of face masks in public (coded as a binary variable), controlling for the age of the COVID-19 epidemic and testing intensity.

Results

Eight of the 49 countries with available data advocated wearing face masks in public – China, Czechia, Hong Kong, Japan, Singapore, South Korea, Thailand and Malaysia. In multivariate analysis face mask use was negatively associated with number of COVID-19 cases/inhabitant (coef. −326, 95% CI −601- −51, P=0.021). Testing intensity was positively associated with COVID-19 cases (coef. 0.07, 95% CI 0.05-0.08, P<0.001).

Conclusion

Whilst these results are susceptible to residual confounding, they do provide ecological level support to the individual level studies that found face mask usage to reduce the transmission and acquisition of respiratory viral infections.
Association Between moleculars and Osteoporotic Fracture Risk:A systematical review
Authors: Liu Jie-Yu , Wang Jia-Xiang , Xu Li , Lei Shu-Feng , Deng Fei-Yan
Published: April 2020

Osteoporosis is a systemic chronic skeletal disease, which is characterized by low bone mineral density (BMD) and increased risk to osteoporotic fractures (OFs). OFs are associated with high mortality and morbidity, and seriously affect the life quality of patients. Osteoporosis is prevalent in the middle-aged and elderly population, especially the postmenopausal women. With population aging, osteoporosis becomes a world-wide serious public health problem. Early recognition of the high-risk population followed by timely and efficient intervention and/or treatment is important for preventing OFs. In light of the high heritability and complex pathogenesis of OP, comprehensive consideration of significant biological/biochemical factors is necessary for accurate risk evaluation. For this purpose, we reviewed recent research progress on moleculars which are diagnostic and/or predictive of OFs risk. Future integrative analyses and systematic evaluation of these moleculars may facilitate developing novel methodologies and/or test strategies, i.e., biochips, for early recognition of osteoporosis, hence to contribute to preventing OFs in the world.

Graphical Abstract

Osteoporosis, which is characterized by low bone mineral density (BMD) and increased risk to osteoporotic fractures (OFs), is prevalent in the middle-aged and elderly population, especially in the postmenopausal women. We focused on several types of important molecules, including proteins/peptides, RNAs, lipids, to gain comprehensive understanding and to generate novel perspectives in predicting and diagnosing OFs.
Frequency of testing for COVID 19 infection and the presence of higher number of available beds per country predict outcomes with the infection, not GDP of the country – A descriptive statistical analysis
Authors: Sinha Binayak , Sengupta Sumit , Ghosal Samit
Published: April 2020

Introduction

The novel coronavirus epidemic which originated in late 2019 from China has wreaked havoc on millions across the world with illness, death and socioeconomic recession. As of now no valid treatment or preventative strategy has evolved worldwide and governments across the world have been forced to take the draconian step of social isolation in communities by enforcing “lockdowns”.

Aim of this Study

This study aims to correlate the rates of infection with the novel coronavirus and total deaths as the primary output variable. In addition the strength of association between infection rates and total death in comparison to GDP share of the respective countries, physicians, hospital beds and rates of testing for COVID 19 infection per thousand patients, is being assessed, in a bid to develop a model which would help to develop tools to reduce the impact of this disease.

Material & Methods

Data relating to number of cases, severity, cases recovered and deaths worldwide and specifically for the top six countries affected was collected from the WHO COVID-19 situation report which is being updated on a daily basis till 22nd March 2020, the date of analysis. Additional data related to GDP, physician and hospital bed per 1000 patients were procured from the World Bank database. All data were collected in a file in CSV format. Analysis was conducted in Jupyter notebook with Python 3.8.2 software and also with XL-Stat statistical software for excel. The analytical strategy was descriptive with no inferential overtones.

Results

COVID 19 infection strongly correlates with total deaths (r : 0.89), with a predicted death rate of 25 patients per 1000 affected. There was no correlation between the GDP growth of the country and number of treating physicians/1000 patient population with any COVID 19 related outcome. However there was a negative correlation between COVID 19-related deaths and the number of beds available per 1000 population [r=-0.34]. Importantly there is an inverse correlation between the number of tests conducted per million population with the rates of active infections [r=-0.12], new cases [r=-0.38] and new deaths [r=-0.28] in COVID 19.

Conclusion

This is the first study to assess parameters other than age and sex and sets out a robust dataset which indicates an increased risk of worsening outcomes with lesser number of beds and testing, suggesting that the need of the hour is to increase available bed numbers and to increase rates of testing.
Facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid systematic review
Authors: Brainard Julii , Jones Natalia , Lake Iain , Hooper Lee , Hunter Paul R
Published: April 2020

The current pandemic of COVID-19 has lead to conflicting opinions on whether wearing facemasks outside of health care facilities protects against the infection. To better understand the value of wearing facemasks we undertook a rapid systematic review of existing scientific evidence about development of respiratory illness, linked to use of facemasks in community settings.

Methods

We included all study designs. There were 31 eligible studies (including 12 RCTs). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention in 28 studies were performed. Results were reported by design, setting and type of face barrier in primary prevention, and by who wore the facemask (index patient or well contacts) in secondary prevention trials. The preferred outcome was influenza-like illness (ILI) but similar outcomes were pooled with ILI when ILI was unavailable. GRADE quality assessment was based on RCTs with support from observational studies.

Results

Where specific information was available, most studies reported about use of medical grade (surgical paper masks). In 3 RCTs, wearing a facemask may very slightly reduce the odds of developing ILI/respiratory symptoms, by around 6% (OR 0.94, 95% CI 0.75 to 1.19, I 29%, low-certainty evidence). Greater effectiveness was suggested by observational studies. When both house-mates and an infected household member wore facemasks the odds of further household members becoming ill may be modestly reduced by around 19% (OR 0.81, 95%CI 0.48 to 1.37, I 45%, 5 RCTs, low certainty evidence). The protective effect was very small if only the well person (OR 0.93, 95% CI 0.68 to 1.28, I 11%, 2 RCTs, low uncertainty evidence) or the infected person wore the facemask (very low certainty evidence).

Discussion

Based on the RCTs we would conclude that wearing facemasks can be very slightly protective against primary infection from casual community contact, and modestly protective against household infections when both infected and uninfected members wear facemasks. However, the RCTs often suffered from poor compliance and controls using facemasks. Across observational studies the evidence in favour of wearing facemasks was stronger. We expect RCTs to under-estimate the protective effect and observational studies to exaggerate it. The evidence is not sufficiently strong to support widespread use of facemasks as a protective measure against COVID-19. However, there is enough evidence to support the use of facemasks for short periods of time by particularly vulnerable individuals when in transient higher risk situations. Further high quality trials are needed to assess when wearing a facemask in the community is most likely to be protective.
A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication
Authors: Pymer Sean , Ibeggazene Said , Palmer Joanne , Smith George E. , Harwood Amy E. , Carroll Sean , Ingle Lee , Chetter Ian C.
Published: April 2020

Background

Uptake and completion rates for supervised exercise programmes (SEP) for patients with intermittent claudication (IC) are low. Current exercise prescription is aone size fits all approach, based on claudication pain thresholds, potentially limiting individual benefits. High-intensity interval training (HIIT) has the potential to overcome these barriers as it is a more time-efficient, objectively prescribed exercise programme. This study aimed to assess a novel HIIT programme for patients with IC in terms of safety, feasibility, tolerability and indicators of efficacy.

Design/Methods

Patients referred to a usual-care SEP were invited to undertake an alternative HIIT programme. All recruited patients performed a baseline cardiopulmonary exercise test (CPET), to inform their exercise prescription. HIIT involved ten, one-minute high-intensity intervals on a stationary cycle ergometer interspersed with one-minute recovery intervals, performed three times per week for six-weeks. Outcomes included safety, feasibility, tolerability, walking distance and quality of life (QoL).

Results

144 patients with IC were referred, 95 met initial eligibility criteria (66%) and 30 (32%) were recruited for HIIT, of which 15 (50%) completed. Of the recruited patients, 90% were on optimal medical therapy and 40% had concomitant cardiac, cerebrovascular and/or respiratory disease.

One serious adverse event was recorded and patients who completed the programme attended 100% of the sessions. Improvements in walking distances and quality of life were observed. Following recruitment of the first 20 patients, the inclusion criteria was refined on the basis of CPET, leading to improved completion rates.

Conclusion

The study provides preliminary findings indicating that patients with IC can complete a short-term HIIT programme. HIIT also appears safe, well-tolerated and although not formally powered, walking distances and QoL appear to improve following HIIT. Further research to evaluate the role of HIIT in patients with IC seems warranted.
Mapping insecticide resistance in mosquitoes to aid malaria control
Authors: Moyes Catherine L. , Athinya Duncan Kobia , Seethaler Tara , Battle Katherine , Sinka Marianne , Hadi Melinda P. , Hemingway Janet , Coleman Michael , Hancock Penelope A.
Published: April 2020

Malaria vector control may be compromised by resistance to insecticides in vector populations. Actions to mitigate against resistance rely on surveillance using standard susceptibility tests, but there are large gaps in the monitoring data. Using a published geostatistical ensemble model, we have generated maps that bridge these gaps and consider the likelihood that resistance exceeds recommended thresholds. Our results show that this model provides more accurate next-year predictions than two simpler approaches. We have used the model to generate district-level maps for the probability that pyrethroid resistance in Anopheles gambiae s.l. exceeds the World Health Organization (WHO) thresholds for susceptibility and confirmed resistance. In addition, we have mapped the three criteria for the deployment of piperonyl butoxide-treated nets that mitigate against the effects of metabolic resistance to pyrethroids. This includes a critical review of the evidence for presence of cytochrome P450-mediated metabolic resistance mechanisms across Africa. The maps for pyrethroid resistance are available on the IR Mapper website where they can be viewed alongside the latest survey data.

Significance Statement

Malaria control in Africa largely relies on the use of insecticides to prevent mosquitoes from transmitting the malaria parasite to humans, however, these mosquitoes have evolved resistance to these insecticides. To manage this threat to malaria control, it is vital that we map locations where the prevalence of resistance exceeds thresholds defined by insecticide resistance management plans. A geospatial model and data from Africa are used to predict locations where thresholds of resistance linked to specific recommended actions are exceeded. This model is shown to provide more accurate next-year predictions than two simpler approaches. The model is used to generate maps that aid insecticide resistance management planning and that allow targeted deployment of interventions that counter specific mechanisms of resistance.
Modeling risk of infectious diseases: a case of Coronavirus outbreak in four countries
Authors: Islam Md. Mazharul , Islam Md. Monirul , Hossain Md. Jamal , Ahmed Faroque
Published: April 2020

Background

The novel coronavirus (2019-nCOV) outbreak has been a serious concern around the globe. Since people are in tremor due to the massive spread of Coronavirus in the major parts of the world, it requires to predict the risk of this infectious disease. In this situation, we develop a model to measure the risk of infectious disease and predict the risk of 2019-nCOV transmission by using data of four countries—US, Australia, Canada and China.

Methods

The model underlies that higher the population density, higher the risk of transmission of infectious disease from human to human. Besides, population size, case identification rate and travel of infected passengers in different regions are also incorporated in this model.

Results

According to the calculated risk index, our study identifies New York State in United States (US) to be the most vulnerable area affected by the novel Coronavirus. Besides, other areas (province/state/territory) such as Hubei (China, 2nd), Massachusetts (US, 3rd), District of Columbia (US, 4th), New Jersey (US, 5th), Quebec (Canada, 20th), Australian Capital Territory (Australia, 29th) are also found as the most risky areas in US, China, Australia and Canada.

Conclusion

The study suggests avoiding any kind of mass gathering, maintaining recommended physical distances and restricting inbound and outbound flights of highly risk prone areas for tackling 2019-nCOV transmission.
Patient-collected tongue, nasal, and mid-turbinate swabs for SARS-CoV-2 yield equivalent sensitivity to health care worker collected nasopharyngeal swabs
Authors: Tu YP , Jennings R , Hart B , Cangelosi GA , Wood RC , Wehber K , Verma P , Vojta D , Berke EM
Published: April 2020

Background

Current testing for SARS-CoV-2 requires health care workers to collect a nasopharyngeal (NP) sample from a patient. NP sampling requires the use of personal protective equipment that are in limited supply, is uncomfortable for the patient, and reduces clinical efficiency. This study explored the equivalency of patient-collected tongue, anterior nares (nasal), and mid-turbinate (MT) samples to health care worker-collected NP samples for detecting SARS-CoV-2.

Methods

Patients presenting to five urgent care facilities with symptoms indicative of an upper respiratory infection provided self-collected samples from three anatomic sites along with a health care worker-collected NP sample. Using NP as the comparator, sensitivities and one-sided 95% confidence intervals for the tongue, nasal, and MT samples for detection of SARS-CoV-2 were calculated.

Results

The sensitivity for detecting SARS-CoV-2 in patient-collected tongue, nasal, and mid-turbinate samples was 89.8% (95% CI: 80.2 -100.0), 94.0 (95% CI: 84.6-100.0) and 96.2 (95% CI: 87.7-100.0), respectively. Among samples yielding positive results, cycle threshold (Ct) values (a measure of viral load) had correlation coefficients of 0.48, 0.78, and 0.86 between the NP samples and the tongue, nasal, and MT samples, respectively.

Conclusions

Patient-collected nasal and MT samples demonstrated high sensitivity for SARS-CoV-2 detection using health care worker-collected NP samples as the comparator. Among patients testing positive with NP samples, nasal and MT Ct values demonstrated high correlations with those Ct values of the NP samples. Patient-collected nasal or MT sampling may improve efficiency for COVID-19 testing while reducing the risk of exposure of the health workforce.
Estimation of the Final Size of the COVID-19 Epidemic in Pakistan
Authors: Syed F. , Sibgatullah S.
Published: April 2020

The COVID-19 infections in Pakistan are spreading at an exponential rate and a point may soon be reached where rigorous prevention measures would need to be adopted. Mathematical models can help define the scale of an epidemic and the rate at which an infection can spread in a community. We used an SIR model to predict the magnitude of the COVID-19 epidemic in Pakistan and compared the numbers with the reported cases on the national database. Our results indicate that Pakistan could hit peak number of infectious cases on May 26th, 2020 and by June 24th, 2020, 90% of the population will have become infected with the virus if policy interventions seeking to curb this infection are not adopted aggressively.
Predicting Whom to Test is More Important Than More Tests - Modeling the Impact of Testing on the Spread of COVID-19 Virus By True Positive Rate Estimation
Authors: Rodriguez Paul
Published: April 2020

I estimate plausible true positive (TP) rates for the number of COVID-19 tests per day, most relevant when the number of test is on the same order of magnitude as number of infected persons. I then modify a standard SEIR model to model current growth patterns and detection rates in South Korea and New York state. Although reducing transmission rates have the largest impact, increasing TP rates by ∼10% in New York can have an impact equal to adding tens of thousands of new tests per day. Increasing both TP rates and tests per day together can have significant impacts and likely be more easily sustained than social distancing restrictions. Systematic and standardized data collection, even beyond contact tracking, should be ongoing and quickly made available for research teams to maximize the efficacy of testing.
Potent Antiviral Activities of Type I Interferons to SARS-CoV-2 Infection
Authors: Mantlo Emily , Bukreyeva Natalya , Maruyama Junki , Paessler Slobodan , Huang Cheng
Published: April 2020

The ongoing historic outbreak of COVID-19 not only constitutes a global public health crisis, but also carries a devastating social and economic impact. The disease is caused by a newly identified coronavirus, Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). There is an urgent need to identify antivirals to curtail the COVID-19 pandemic. Herein, we report the remarkable sensitivity of SARS-CoV-2 to recombinant human interferons α and β (IFNα/β). Treatment with IFN-α at a concentration of 50 international units (IU) per milliliter drastically reduces viral titers by 3.4 log or over 4 log, respectively, in Vero cells. The EC50of IFN-α and IFN-β treatment is 1.35 IU/ml and 0.76 IU/ml, respectively, in Vero cells. These results suggest that SARS-CoV-2 is more sensitive than many other human pathogenic viruses, including SARS-CoV. Overall, our results demonstrate the potent efficacy of human Type I IFN in suppressing SARS-CoV-2 infection, a finding which could inform future treatment options for COVID-19.
Reduction of lymphocyte at early stage elevates severity and death risk of COVID-19 patients: a hospital-based case-cohort study
Authors: Fei Jun , Fu Lin , Li Ying , Xiang Hui-Xian , Xiang Ying , Li Meng-Die , Liu Fang-Fang , Xu De-Xiang , Zhao Hui
Published: April 2020

Background and objective

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) has been pandemic worldwide. Several reports observed a reduction of lymphocytes among COVID-19 patients. However, clinical significance of lymphocyte reduction in COVID-19 patients remains unclear. The objective of this study was to analyze the association between lymphocyte reduction at early stage and the prognosis of COVID-19 patients.

Methods

All 192 hospitalized patients with COVID-19 were enrolled. Electronic medical records, including demographic data, clinical characteristics, comorbidities and exposure history, were collected. Biochemical indexes on admission and chest computed tomography (CT) were detected. Patient’s prognosis was followed up.

Results

On admission, 84 (43.8%) patients suffered from lymphocyte reduction among COVID-19 patients. The count and percentage of lymphocytes on admission were lower among more than seventy-year-old patients than those of younger patients. Multivariate logistic regression revealed that older age was a risk factor of lymphocyte reduction. Of interest, chest CT score, a key marker of lung injury, was increased among COVID-19 patients with lymphocyte reduction. By contrast, PaCO2, SpO2 and oxygenation index, several respiratory function markers, were decreased in COVID-19 patients with lymphocyte reduction. Moreover, TBIL and DBIL, two markers of hepatic injury, creatinine and urea nitrogen, two indices of renal function, and creatine kinase, AST and LDH, three myocardial enzymes, were elevated in COVID-19 patients with lymphocyte reduction. Among 84 COVID-19 patients with lymphocyte reduction, 32.1% died. Fatality rate was obviously higher in COVID-19 patients with lymphocyte reduction than those with normal lymphocyte (RR=5.789, P<0.001).

Conclusion

Older COVID-19 patients are more susceptible to lymphocyte reduction. Lymphocyte reduction at early stage aggravates the severity of multiple organ injuries and elevates death risk of COVID-19 patients.
A Model of Supply-Chain Decisions for Resource Sharing with an Application to Ventilator Allocation to Combat COVID-19
Authors: Mehrotra Sanjay , Rahimian Hamed , Barah Masoud , Luo Fengqiao , Schantz Karolina
Published: April 2020

We present a stochastic optimization model for allocating and sharing a critical resource in the case of a pandemic. The demand for different entities peaks at different times, and an initial inventory for a central agency is to be allocated. The entities (states) may share the critical resource with a different state under a risk-averse condition. The model is applied to study the allocation of ventilator inventory in the COVID-19 pandemic by FEMA to different US states. Findings suggest that if less than 60% of the ventilator inventory is available for non-COVID-19 patients, FEMA’s stockpile of 20,000 ventilators (as of 03/23/2020) would be nearly adequate to meet the projected needs in slightly above average demand scenarios. However, when more than 75% of the available ventilator inventory must be reserved for non-COVID-19 patients, various degrees of shortfall are expected. In a severe case, where the demand is concentrated in the top-most quartile of the forecast confidence interval and states are not willing to share their stockpile of ventilators, the total shortfall over the planning horizon (till 05/31/20) is about 232,000 ventilator days, with a peak shortfall of 17,200 ventilators on 04/19/2020. Results are also reported for a worst-case where the demand is at the upper limit of the 95% confidence interval.