bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study
Authors: Zuniga-Moya Julio C , Romero-Reyes Luis Enrique , Saavedra Emilio Barrueto , Montoya Sandra , Varela Diana , Borjas Mitchel , Cerna Alicia , Bejarano Suyapa , Martinez Paola , Lujan Karen , Erazo Karen , Lainez Isis , Pineda Luisamaria , Yanes David , O’Halloran Jane A , Spec Andrej
Published: November 2020

Background

Cryptococcal meningitis is a major cause of death among people with human immunodeficiency virus (PWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high-incidence areas. However, limited data exist on CrAg prevalence in Central America.

Methods

We conducted a prospective cohort study at the 2 largest human immunodeficiency virus (HIV) clinics and hospitals in Honduras. Cryptococcal antigen in serum and cerebrospinal fluid was performed in individuals with HIV who had CD4 ≤100 cells/mm3 between 2017 and 2018. After CrAg testing, individuals were observed for 12 months to assess mortality using adjusted Cox proportional hazard models.

Results

A total of 220 PWH were tested for CrAg, 12.7% (n = 28) of which tested positive. Cryptococcal antigen prevalence was higher among hospitalized individuals in 40% (n = 10 of 25) of the cases. The proportion (35.8%) of individuals taking antiretroviral therapy was significantly (P < .01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n = 25 of 220) by 12 months. Cryptococcal antigen-positive cases were at a significantly higher risk of death (adjusted hazard ratio, 2.69; 95% confidence interval, 1.07–6.84) compared with CrAg-negative participants.

Conclusions

Cryptococcal antigen prevalence in Honduras was high among PWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PWH with a CD4 ≤100 cells/mm3 should be routinely performed in Central America.
The Rice Plastidial Phosphorylase Participates Directly in Both Sink and Source Processes
Authors: Koper Kaan , Hwang Seon-Kap , Wood Magnus , Singh Salvinder , Cousins Asaph , Kirchhoff Helmut , Okita Thomas W
Published: November 2020

The plastidial starch phosphorylase (Pho1) functions in starch metabolism. A distinctive structural feature of the higher Pho1 is a 50–82-amino-acid long peptide (L50–L82), which is absent in phosphorylases from non-plant organisms. To study the function of the rice Pho1 L80 peptide, we complemented a pho1− rice mutant (BMF136) with the wild-type Pho1 gene or with a Pho1 gene lacking the L80 region (Pho1ΔL80). While expression of Pho1 in BMF136 restored normal wild-type phenotype, the introduction of Pho1ΔL80 enhanced the growth rate and plant productivity above wild-type levels. Mass spectrometry analysis of proteins captured by anti-Pho1 showed the surprising presence of PsaC, the terminal electron acceptor/donor subunit of photosystem I (PSI). This unexpected interaction was substantiated by reciprocal immobilized protein pull-down assays of seedling extracts and supported by the presence of Pho1 on isolated PSI complexes resolved by blue-native gels. Spectrophotometric studies showed that Pho1ΔL80 plants exhibited modified PSI and enhanced CO2 assimilation properties. Collectively, these findings indicate that the higher plant Pho1 has dual roles as a potential modulator of source and sink processes.
Altered retinal oxygen metabolism in patients with combined ocular and central nervous system sarcoidosis
Authors: Kindt Astrid , Byg Keld-Erik , Wied Jimmi , Ellingsen Torkell , Davidsen Jesper Rømhild , Grauslund Jakob
Published: November 2020

Objective

To evaluate retinal oxygen metabolism by retinal oximetry for ocular and CNS diseases in a cross-sectional study of sarcoidosis.

Methods

Overall 201 eyes from 103 biopsy-verified sarcoidosis patients were included and divided into four groups depending on the organ affection: (i) sarcoidosis without ocular or CNS affection, (ii) ocular sarcoidosis, (iii) CNS sarcoidosis, and (iv) combined ocular and CNS sarcoidosis. Retinal oximetry was obtained and analysed, with the mean retinal arteriolar and venular saturation as well as arteriovenous difference as principal outcomes. Comparison between groups was done in a multi linear regression model adjusted for age, sex, duration of sarcoidosis, best corrected visual acuity and retinal oximetry quality.

Results

Mean (s.d.) age was 50.5 (13.4) (95% CI: 47.9, 53.1) years and 52.2% were males. Eyes of the combined Ocular/CNS group had a higher retinal arteriovenous difference than eyes of the Non-ocular/no-CNS group (42.1% vs 37.7%, P = 0.012) but did not differ between other groups. Eyes in the four groups (Non-ocular/no-CNS, Ocular, CNS and Ocular/CNS) did not differ according to retinal arterial (94.5%, 93.5%, 93.5% and 94.5%, respectively) or venular (57.5%, 56.4%, 55.0% and 52.5%, respectively) oxygen saturation.

Conclusions

The results of this study suggest that eyes of sarcoidosis patients with combined ocular and CNS affection have an altered oxygen metabolism indicating a subclinical eye affection that is not recognized by conventional screening methods.
Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise
Authors: Rossi-Semerano Linda , Breton Sylvain , Semerano Luca , Boubaya Marouane , Ohanyan Haykanush , Bossert Marie , Boiu Sorina , Chatelus Emmanuel , Durand Géraldine , Jean Sylvie , Goumy Laurence , Mathiot Anne , Mouterde Gaël , Nugues Frédérique , Ould Hennia Ahmed , Rey Bénédicte , Von Scheven Annette , Sparsa Laetitia , Devauchelle-Pensec Valérie , Jousse-Joulin Sandrine
Published: November 2020

Objectives

To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA.

Methods

Thirteen sonographers analysed 75 images for the presence/absence of elementary lesions (binary scoring) and for grading synovitis, synovial hypertrophy, effusion and Doppler signals. Static US images of the second metacarpophalangeal joint (MCP-II), wrist, elbow, knee and ankle in JIA patients at different ages and different disease stages were collected with standardized scanning by two experienced sonographers. Intra- and inter-reader reliability were analysed with kappa coefficients.

Results

Intra-reader reliability was good for binary scoring (Cohen’s kappa 0.62, range 0.47–0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66–0.86; 0.76, 0.61–0.84; and 0.87, 0.77–0.94, respectively); and moderate for effusion (0.55, 0.24–0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light’s kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54–0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40–0.60, respectively). We obtained the best scores for the knee (0.71, 0.54–0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children.

Conclusions

This is the first study establishing the reliability of the OMERACT paediatric US synovitis definitions and scoring system in the five most commonly affected joints in JIA. The reliability was good among a large group of sonographers. These results support the applicability of these definitions and scoring system in clinical practice and multicentre studies.
Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis
Authors: Zhao Sizheng Steven , Pittam Bradley , Harrison Nicholas L , Ahmed Ashar E , Goodson Nicola J , Hughes David M
Published: November 2020

Background

Delay to diagnosis in axial SpA (axSpA) is longer than in many other rheumatic diseases. Prolonged delay is associate with poorer outcomes, including functional impairment and quality of life. Our aims were to describe global variation in delay to diagnosis, factors associated with delay, and delay compared with PsA.

Methods

We searched MEDLINE, PubMed, Embase and Web of Science using a predefined protocol. Diagnostic delay was defined as years between the age at symptom onset and at diagnosis. We pooled the mean delay using random effects inverse variance meta-analysis. We examined variations in pooled estimates using prespecified subgroup analyses and sources of heterogeneity using meta-regression.

Results

A total of 64 studies reported the mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% CI 6.2, 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delays than those from middle-income countries. Factors consistently reported to be associated with longer delays were lower education levels, younger age at symptom onset and absence of extra-articular manifestations (EAMs). The pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95% CI 1.6, 3.6).

Conclusion

For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world. Patient factors (e.g. education) and disease presentation (onset age and EAMs) should inform campaigns to improve delay.
Personality Across the Psychosis Continuum: A Fine-Grained Perspective
Authors: Begemann Marieke J H , Boyette Lindy-Lou , Kwast Aimo K , Sommer Iris E C
Published: November 2020

Background

Personality is associated with the etiology, course, and outcome of psychosis. Yet, more specific knowledge on this association, beyond the global domains of the Five-Factor Model, is scarce. One way to investigate this is to study the personality profile of individuals having frequent psychosis-like experiences (PE), but without clinical psychosis or Cluster A personality disorder and compare them to patients with such symptoms.

Methods

We included 134 individuals with nonclinical PE, 40 psychotic disorder patients, and 126 healthy controls. Participants completed the NEO-PI-R. Domain and facet-level data were compared across groups.

Result

As expected, group differences were significant for Neuroticism, Openness, and Conscientiousness. Facet-level analyses showed intermediate levels of Depression and Anxiety (N) in individuals with nonclinical PE, together with high Fantasy, Aesthetics and Ideas (O) compared to controls. Notably, they displayed high Angry Hostility (N) and Feelings (O), along with low Trust (A) and Gregariousness (E). Patients showed high Vulnerability and Self-Consciousness (N), and low Competence and Self-discipline (C), while both nonclinical groups showed similar levels.

Conclusions

This is the first study to analyze both domain and facet-level data across the psychosis continuum. Our findings show how the facets Hostility and Feelings, low Trust and Gregariousness may be related to general PE proneness, both in nonclinical and clinical individuals alike, while Vulnerability and Self-Consciousness, low Competence, and low Self-discipline may differentiate patients from individuals with nonclinical PE. Current results encourage intervention strategies targeting coping and social skills for youth at risk for psychosis.
Public Nutrition Policies and their Influence on School Feeding: The Spanish Experience in the Twentieth Century
Authors: Trescastro-López Eva María
Published: November 2020

This article analyses the influence that public nutrition policies had had on school feeding and their contribution to improving nutritional status and health in Spain in the twentieth century. The study demonstrates the importance of providing continuity to nutrition policies. The problem of undernutrition in the child population in Spain had been overcome by the 1970s; however, in the final decades of the twentieth century and coinciding with the abandonment of food and nutrition education policies and programmes, the current problems of overweight and obesity appeared. Despite initiatives such as the NAOS strategy (nutrition, physical activity and obesity prevention) launched by the Spanish Ministry of Health in 2005, further efforts should be made to revive and adapt nutrition policies such as those that once enabled the Spanish population to achieve an optimal nutritional balance.
Altered circadian activity and sleep/wake rhythms in the stable tubule only polypeptide (STOP) null mouse model of schizophrenia
Authors: Deurveilher Samuel , Ko Kristin Robin , Saumure Brock St C , Robertson George S , Rusak Benjamin , Semba Kazue
Published: November 2020

Sleep and circadian rhythm disruptions commonly occur in individuals with schizophrenia. Stable tubule only polypeptide (STOP) knockout (KO) mice show behavioral impairments resembling symptoms of schizophrenia. We previously reported that STOP KO mice slept less and had more fragmented sleep and waking than wild-type littermates under a light/dark (LD) cycle. Here, we assessed the circadian phenotype of male STOP KO mice by examining wheel-running activity rhythms and EEG/EMG-defined sleep/wake states under both LD and constant darkness (DD) conditions. Wheel-running activity rhythms in KO and wild-type mice were similarly entrained in LD, and had similar free-running periods in DD. The phase delay shift in response to a light pulse given early in the active phase under DD was preserved in KO mice. KO mice had markedly lower activity levels, lower amplitude activity rhythms, less stable activity onsets, and more fragmented activity than wild-type mice in both lighting conditions. KO mice also spent more time awake and less time in rapid eye movement sleep (REMS) and non-REMS (NREMS) in both LD and DD conditions, with the decrease in NREMS concentrated in the active phase. KO mice also showed altered EEG features and higher amplitude rhythms in wake and NREMS (but not REMS) amounts in both lighting conditions, with a longer free-running period in DD, compared to wild-type mice. These results indicate that the STOP null mutation in mice altered the regulation of sleep/wake physiology and activity rhythm expression, but did not grossly disrupt circadian mechanisms.
MicroRNA profiling in BEAS-2B cells exposed to alpha radiation reveals potential biomarkers for malignant cellular transformation
Authors: Dang Xuhong , Lin Haipeng , Li Youchen , Guo Xiuli , Yuan Yayi , Zhang Ruifeng , Li Xiaozhen , Chai Dongliang , Zuo Yahui
Published: November 2020

The carcinogenicity of radon has been convincingly documented through epidemiological studies of underground miners. The risk of lung cancer from radon exposure is due to the continuous radioactive decay of this gas and subsequent emission of high-energy alpha decay particles. And the bronchial epithelial cells are the main targets of radon exposure. However, there is a lack of early warning indicators of lung cancer caused by radon in the physical examination of populations involved in occupations with higher exposure to radon. To assess the potential of a molecular-based marker approach for the early detection of human lung cancer induced by radon, human bronchial epithelial cell injury models induced by alpha-particle irradiation were constructed. The results of transwell migration assay, transwell invasion assay, and the expression of the epithelial–mesenchymal transition-related proteins showed that malignant cell transformation could be triggered by alpha irradiation. Potential microRNAs (miRNAs) (hsa-miR-3907, hsa-miR-6732-3p, hsa-miR-4788, hsa-miR-5001-5p, and hsa-miR-4257) were screened using miRNA chips in cell models. The pathway analyses of miRNAs selected using DIANA-miRPath v3.0 showed that miRNAs involved in malignant cell transformation were associated with cell adhesion molecules, extracellular matrix receptor interaction, and proteoglycans in cancer, among others, which are closely related to the occurrence and development of carcinogenesis. Reverse Transcription Quantitative Real-Time PCR (RT-qPCR) assay showed that five screened miRNAs were up-regulated in five lung cancer tissue samples. In conclusion, the results indicated that hsa-miR-3907, hsa-miR-6732-3p, hsa-miR-4788, hsa-miR-5001-5p, and hsa-miR-4257 may be potential early markers of the malignant transformation of bronchial epithelial cells induced by alpha-particle irradiation.
Identification of early and late flowering time candidate genes in endodormant and ecodormant almond flower buds
Authors: Prudencio Ángela S , Hoeberichts Frank A , Dicenta Federico , Martínez-Gómez Pedro , Sánchez-Pérez Raquel
Published: November 2020

Flower bud dormancy in temperate fruit tree species, such as almond [Prunus dulcis (Mill.) D.A. Webb], is a survival mechanism that ensures that flowering will occur under suitable weather conditions for successful flower development, pollination and fruit set. Dormancy is divided into three sequential phases: paradormancy, endodormancy and ecodormancy. During the winter, buds need cultivar-specific chilling requirements (CRs) to overcome endodormancy and heat requirements to activate the machinery to flower in the ecodormancy phase. One of the main factors that enables the transition from endodormancy to ecodormancy is transcriptome reprogramming. In this work, we therefore monitored three almond cultivars with different CRs and flowering times by RNA sequencing during the endodormancy release of flower buds and validated the data by quantitative real-time PCR in two consecutive seasons. We were thus able to identify early and late flowering time candidate genes in endodormant and ecodormant almond flower buds associated with metabolic switches, transmembrane transport, cell wall remodeling, phytohormone signaling and pollen development. These candidate genes were indeed involved in the overcoming of the endodormancy in almond. This information may be used for the development of dormancy molecular markers, increasing the efficiency of temperate fruit tree breeding programs in a climate-change context.
Intraspecific plasticity in hydraulic and stomatal regulation under drought is linked to aridity at the seed source in a wild pear species
Authors: Paudel Indira , Gerbi Hadas , Zisovich Annat , Sapir Gal , Klein Tamir
Published: November 2020

Adaptations of fruit trees to future climate are a current research priority due to the rapid increase in air temperature and changes in precipitation patterns. This is aimed at securing sustainable food production for our growing populations. Key physiological traits in trees conferring drought tolerance are resistance to embolism and stomatal control over water loss. Recently, we have shown in the field that a native wild pear species performs better under drought than two cultivated pear species. A comparative greenhouse study was conducted to investigate traits associated with drought tolerance in four ecotypes of a wild pear species (Pyrus syriaca Boiss), compared with a wild pear species (Pyrus betulifolia Bunge) commonly used as a pear rootstock. Seed sources were collected from semi-arid, sub-humid and humid sites across northern Israel. Measurements of water relations, leaf physiology, hydraulic conductivity and percent loss of hydraulic conductivity (PLC) were conducted under standard irrigation, drought and recovery from drought. The four P. syriaca ecotypes maintained significantly higher leaf gas exchange values and water-use efficiency and had lower PLC than the rootstock species under prolonged drought as well as during recovery. Across the four ecotypes, stomatal closure occurred at stem water potential (Ψ) around −3.5 MPa; however, Ψ at 50% PLC ranged from −4.1 MPa in the humid ecotype to −5.2 MPa in one of the semi-arid ecotypes, rendering the latter with a higher hydraulic safety margin (the Ψ difference between stomatal closure and 50% PLC). Divergence of the ecotypes in xylem vulnerability to embolism closely matched the mean annual precipitation at their seed sources. Thus, selection of pear ecotypes from populations in semi-arid sites may be better than the currently used plant material for preparing our cultivated species for hotter and drier future climate.
Highlight of severe acute respiratory syndrome coronavirus-2 vaccine development against COVID-19 pandemic
Authors: Liu Cheng-Hsuan , Huang Hsuan-Yang , Tu Yung-Fang , Lai Wei-Yi , Wang Chia-Lin , Sun Jun-Ren , Chien Yueh , Lin Tzu-Wei , Lin Yi-Ying , Chien Chian-Shiu , Huang Chih-Heng , Chen Yuh-Min , Huang Pin-I , Wang Fu-Der , Yang Yi-Ping
Published: November 2020

The pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has brought an unprecedented impact upon the global economy and public health. Although the SARS-CoV-2 virology has been gradually investigated, measures to combat this new threat in public health are still absent. To date, no certificated drug or vaccine has been developed for the treatment or prevention of coronavirus disease Extensive researches and international coordination has been conducted to rapidly develop novel vaccines against SARS-CoV-2 pandemic. Several major breakthroughs have been made through the identification of the genetic sequence and structural/non-structural proteins of SARS-CoV-2, which enabled the development of RNA-, DNA-based vaccines, subunit vaccines, and attenuated viral vaccines. In this review article, we present an overview of the recent advances of SARS-CoV-2 vaccines and the challenges that may be encountered in the development process, highlighting the advantages and disadvantages of these approaches that may help in effectively countering COVID-19.
The Utility of a Screening Neck Computed Tomographic Angiogram in Blunt Trauma Patients Presenting With a Seat Belt Sign in the Absence of Associated Risk Factors
Authors: Jordan Roger Wayne , Breland David M. , Zhang Xu , Friedman Elliott
Published: November 2020

Objective

Blunt cerebrovascular injuries (BCVI) of the neck are a common cause for concern after blunt trauma. The purpose of this article is to demonstrate whether patients with a cervical seat belt sign in the absence of associated high-risk injuries or neurological symptoms are at an increased risk for developing a clinically significant vascular injury and therefore require a screening neck computed tomographic angiography (CTA).

Methods

A retrospective review was performed of patients who presented after motor vehicle collision and received a neck CTA for an indication of “seat belt sign.” Imaging was reviewed to determine the vascular injury grade, associated injuries, and, if available, follow-up imaging was reviewed to assess for interval change or resolution. The patients were split into 2 groups. Group 1 included patients without high-risk injuries, and group 2 included patients with high-risk injuries.

Results

In group 1, 6 (2.9%) of 208 patients had BCVI. In group 2, 7 (18.9%) of 37 patients had BCVI. Patients in group 2 were 6.5 times more likely to suffer BCVI compared with group 1 (P < 0.001). No patient in group 1 was ever symptomatic, and only 1 (0.5%) patient underwent interventional treatment.

Conclusions

Patients presenting after blunt trauma with a seat belt sign and no other high-risk injuries as laid out by screening criteria demonstrate a low probability of BCVI and an even lower likelihood of adverse outcome.
Use of Cryopreserved Human Umbilical Cord and Amniotic Membrane Allograft and Portable Negative Pressure Therapy in Dehisced Giant Omphalocele Repair
Authors: Boyar Vita
Published: November 2020

BACKGROUND:

A giant omphalocele is a rare congenital abdominal wall defect that measures more than 6 to 8 cm in any dimension. The child's abdominal visceral contents as well as the liver which are both covered by the amniotic sac protrude outside the abdomen through the umbilicus. Consequently, closing this defect is extremely challenging due to the risk for wound dehiscence.

CASE:

Baby C, a 1-year-old male infant, developed a dehisced abdominal wound after secondary repair of a giant omphalocele. Escharification of the amniotic sac was achieved with silver products, followed by intra-abdominal tissue expansion and skin closure. A conservative approach was undertaken with the use of cryopreserved human umbilical cord and amniotic membrane allograft in conjunction with portable negative pressure therapy.

CONCLUSIONS:

To the best of our knowledge, this is the first case study to evaluate the effect of cryopreserved human umbilical cord and amniotic membrane allograft in a dehisced neonatal abdominal wound due to a giant omphalocele or, in fact, neonatal wounds in general. Our experience with this case suggests that cryopreserved human umbilical cord and amniotic membrane allograft may create a superior healing trajectory and regeneration, avoidance of surgical intervention, and an early hospital discharge. Wound-supporting properties of amniotic allograft, in addition to lack of immunologic reactivity, offer an attractive option for a variety of pediatric and neonatal wounds.
Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus
Authors: Pacis Michelle , Azor-Ocampo Annielyn , Burnett Emily , Tanasapphaisal Chutiwan , Coleman Bernice
Published: November 2020

PURPOSE:

Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.

PARTICIPANTS AND SETTING:

This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.

APPROACH:

We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.

OUTCOMES:

We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).

CONCLUSION:

Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.
Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture
Authors: Gazineo Domenica , Chiarabelli Matteo , Cirone Rosanna , Chiari Paolo , Ambrosi Elisa
Published: November 2020

PURPOSE:

The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures.

DESIGN:

Open-label, parallel-group, 2-arm, superiority trial.

SUBJECTS AND SETTING:

The sample comprised older patients aged 69 to 97 years admitted to a 1500-bed university hospital in Bologna, Italy, for hip fracture surgery.

METHODS:

Patients were randomly allocated to an intervention or control group. Both groups received standard evidence-based PI preventive care in accordance with National Pressure Ulcer Advisory Panel guidelines. In addition, patients in the intervention group received a single 12.9 × 12.9-cm2 multilayered polyurethane foam dressing shaped for the sacrum area applied within 24 hours of hospital admission. Bivariate analysis on primary and secondary outcomes and baseline characteristics was performed to compare group differences, and a survival analysis was used to determine the difference in PI incidence rates per group.

RESULTS:

Sixty-eight patients completed the trial; 34 patients were allocated to the intervention group and 34 patients to the control group. A trend toward significance was observed for sacral PI occurrence in the intervention group (intervention: 20.6%; control: 2.9%; P = .054). The foam dressing allowed significantly longer time (days) to PI occurrence (intervention: 5.9 ± 1.60; control: 2.7 ± 0.96; P = .003).

CONCLUSIONS:

These findings suggest that multilayered polyurethane foam dressings are not superior to the standard preventive PI care alone and should be used with caution, especially when multiple dressing changes may occur. Further exploration of the role of multilayered polyurethane foam dressings in preventing PI development is warranted.
Mathematical analysis of Córdoba calcifediol trial suggests strong role for Vitamin D in reducing ICU admissions of hospitalized COVID-19 patients
Authors: Jungreis Irwin , Kellis Manolis
Published: November 2020

A randomized controlled trial of calcifediol (25-hydroxyvitamin D3) as a treatment for hospitalized COVID-19 patients in Córdoba, Spain, found that the treatment was associated with reduced ICU admissions with very large effect size and high statistical significance, but the study has had limited impact because it had only 76 patients and imperfect blinding, and did not measure vitamin D levels pre- and post-treatment or adjust for several comorbidities. Here we reanalyze the reported results of the study using rigorous and well established statistical techniques, and find that the randomization, large effect size, and high statistical significance address many of these concerns. We show that random assignment of patients to treatment and control groups is highly unlikely to distribute comorbidities or other prognostic indicators sufficiently unevenly to account for the large effect size. We also show that imperfect blinding would need to have had an implausibly large effect to account for the reported results. Finally, comparison with two additional randomized clinical trials of vitamin D supplementation for COVID-19 in India and Brazil indicates that early intervention and rapid absorption may be crucial for the observed benefits of vitamin D. We conclude that the Córdoba study provides sufficient evidence to warrant immediate, well-designed pivotal clinical trials of early calcifediol administration in a broader cohort of inpatients and outpatients with COVID-19.
State- and County-Level COVID-19 Public Health Orders in California: Constructing a Dataset and Describing Their Timing, Content, and Stricture
Authors: Goldhaber-Fiebert Jeremy D. , Holsinger Alexander F. , Holsinger Erin , Long Elizabeth
Published: November 2020

Without vaccines, non-pharmaceutical interventions have been the most widely used approach to controlling the spread of COVID-19 epidemics. Various jurisdictions have implemented public health orders as a means of reducing effective contacts and controlling their local epidemics. Multiple studies have examined the effectiveness of various orders (e.g. use of face masks) for epidemic control. However, orders occur at different timings across jurisdictions and some orders on the same topic are stricter than others. We constructed a county-level longitudinal data set of more than 2,400 public health orders issues by California and its 58 counties pertaining to its 40 million residents. First, we describe methods used to construct the dataset that enables the characterization of the evolution over time of California state- and county-level public health orders dealing with COVID-19 from January 1, 2020 through June 30, 2021. Public health orders are both an interesting and important outcome in their own right and also a key input into analyses looking at how such orders may impact COVID-19 epidemics. To construct the dataset, we developed and executed a search strategy to identify COVID-19 public health orders over this time period for all relevant jurisdictions. We characterized each identified public health order in terms of the timing of when it was announced, went into effect and (potentially) expired. We also adapted an existing schema to describe the topic(s) each public health order dealt with and the level of stricture each imposed, applying it to all identified orders. Finally, as an initial assessment, we examined the patterns of public health orders within and across counties, focusing on the timing of orders, the rate of increase and decrease in stricture, and on variation and convergence of orders within regions.
Development of a highly sensitive point-of-care test to detect SARS-CoV-2 from saliva combining a simple RNA extraction method with colorimetric reverse transcription loop-mediated isothermal amplification detection
Authors: Yamazaki Wataru , Matsumura Yasufumi , Thongchankaew-Seo Uraiwan , Yamazaki Yasuko , Nagao Miki
Published: November 2020

To diagnose COVID-19 patients in the field, a sensitive point-of-care test using saliva was developed. Using a heat block without centrifuge, the test took 45 minutes. Naked eye judgement with color change dye outperformed the reference standard, with a diagnostic sensitivity of 82.6% (19/23) and diagnostic specificity of 100% (21/21).
Two-way remote monitoring allows effective and realistic provision of home-NIV to COPD patients with persistent hypercapnia.
Authors: McDowell Grace , Sumowski Maksymilian , Toellner Hannah , Karok Sophia , O'Dwyer Ciara , Hornsby James , Lowe David , Carlin Chris
Published: November 2020

Background Outcomes for chronic obstructive pulmonary disease (COPD) patients with persistent hypercapnic respiratory failure are improved by long-term home non-invasive ventilation (NIV). Provision of home-NIV presents clinical and service challenges. The aim of this study was to assess outcomes of home-NIV in hypercapnic COPD patients managed remotely.
Methods Retrospective analysis of a dataset of 46 COPD patients with persistent hypercapnic respiratory failure who commenced home-NIV managed by two-way remote monitoring (Lumis, AirView, ResMed) between February 2017 and January 2018. The primary outcome of this study was time to readmission or death at 12 months in patients receiving home-NIV versus a retrospectively identified control cohort of 27 patients with hypercapnic COPD who had not been referred for home-NIV.
Results The median time to readmission or death was significantly prolonged in patients who commenced home-NIV (median 160 days, 95% CI 69.38-250.63) versus the control cohort (66 days, 95% CI 21.9-110.1; p<0.01). Average time to hospital readmission was 221 days (95% CI, 47.77-394.23) and 70 days (95% CI, 55.31-84.69; p<0.05), respectively. Median decrease in bicarbonate level of 4.9mmol/L (p<0.0151) and daytime PCO2 2.2kPa (p<0.032) demonstrate efficacy of home-NIV. A median reduction of 14 occupied bed days per annum versus previous year prior to NIV was observed per patient who continued home-NIV throughout the study period (N=32).
Conclusion These findings confirm the benefits of home-NIV in clinical practice and support the use of two-way remote monitoring as a feasible solution to managing the delivery of home-NIV for COPD patients with persistent hypercapnia.
The Individual and Social Determinants of COVID-19 Diagnosis in Ontario, Canada: A Population-Wide Study
Authors: Sundaram Maria E. , Calzavara Andrew , Mishra Sharmistha , Kustra Rafal , Chan Adrienne K. , Hamilton Mackenzie A. , Djebli Mohamed , Rosella Laura C. , Watson Tristan , Chen Hong , Chen Branson , Baral Stefan D. , Kwong Jeffrey C.
Published: November 2020

Background

Optimizing the public health response to reduce coronavirus disease 2019 (COVID-19) burden necessitates characterizing population-level heterogeneity of COVID-19 risks. However, heterogeneity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing may introduce biased estimates depending on analytic design.

Methods

We explored the potential for collider bias and characterized individual, environmental, and social determinants of testing and diagnosis using cross-sectional analyses among 14.7 million community-dwelling people in Ontario, Canada. Among those diagnosed, we used separate analytic designs to compare predictors of: 1) individuals testing positive versus negative; 2) symptomatic individuals only testing positive versus testing negative; and 3) individuals testing positive versus individuals not testing positive (i.e., testing negative or not being tested). Analyses included tests conducted between March 1 and June 20, 2020.

Results

Of a total of 14,695,579 individuals, 758,691 were tested for SARS-CoV-2, of whom 25,030 (3.3%) tested positive. The further the odds of testing from the null, the more variability observed in the odds of diagnosis across analytic design, particularly among individual factors. There was less variability in testing by social determinants across analytic designs. Residing in areas with highest household density (adjusted odds ratio [aOR]: 1.86; 95%CI: 1.75-1.98), highest proportion of essential workers (aOR: 1.58; 95%CI: 1.48-1.69), lowest educational attainment (aOR: 1.33; 95%CI: 1.26-1.41), and highest proportion of recent immigrants (aOR: 1.10; 95%CI: 1.05-1.15) were consistently related to increased odds of SARS-CoV-2 diagnosis regardless of analytic design.

Interpretation

Where testing is limited, risk factors may be better estimated using population comparators rather than test-negative comparators. Optimizing COVID-19 responses necessitates investment and sufficient coverage of structural interventions tailored to heterogeneity in social determinants of risk, including household crowding, occupation, and structural racism.
Identifying Neuroanatomical and Behavioral Features for Autism Spectrum Disorder Diagnosis in Children using Machine Learning
Authors: Han Yu , Rizzo Donna M. , Hanley John P. , Coderre Emily L. , Prelock Patricia A.
Published: November 2020

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause significant social, communication, and behavioral challenges. Diagnosis of ASD is complicated and there is an urgent need to identify ASD-associated biomarkers and features to help automate diagnostics and develop predictive ASD models. The present study adopts a novel evolutionary algorithm, the conjunctive clause evolutionary algorithm (CCEA), to select features most significant for distinguishing individuals with and without ASD, and is able to accommodate datasets having a small number of samples with a large number of feature measurements. The dataset is unique and comprises both behavioral and neuroimaging measurements from a total of 28 children from 7 to 14 years old. Potential biomarker candidates identified include brain volume, area, cortical thickness, and mean curvature in specific regions around the cingulate cortex, frontal cortex, and temporal-parietal junction, as well as behavioral features associated with theory of mind. A separate machine learning classifier (i.e., k-nearest neighbors algorithm) was used to validate the CCEA feature selection and for ASD prediction. Study findings demonstrate how machine learning tools might help move the needle on improving diagnostic and predictive models of ASD.
The metabolic fingerprint of COVID-19 severity
Authors: Dierckx Tim , van Elslande Jan , Salmela Heli , Decru Bram , Wauters Els , Gunst Jan , Van Herck Yannick ,   the CONTAGIOUS-consortium, Wauters Joost , Stessel Björn , Vermeersch Pieter
Published: November 2020

Corona virus disease 2019 (COVID-19) has been associated with a wide range of divergent pathologies, and risk of severe disease is reported to be increased by a similarly broad range of co-morbidities. The present study investigated blood metabolites in order to elucidate how infection with severe acute respiratory syndrome coronavirus 2 can lead to such a variety of pathologies and what common ground they share. COVID-19 patient blood samples were taken at hospital admission in two Belgian patient cohorts, and a third cohort that included longitudinal samples was used for additional validation (total n=581). A total of 251 blood metabolite measures and ratios were assessed using nuclear magnetic resonance spectroscopy and tested for association to disease severity. In line with the varied effects of severe COVID-19, the range of severity-associated biomarkers was equally broad and included increased inflammatory markers (glycoprotein acetylation), amino acid concentrations (increased leucine and phenylalanine), increased lipoprotein particle concentrations (except those of very low density lipoprotein, VLDL), decreased cholesterol levels (except in large HDL and VLDL), increased triglyceride levels (only in IDL and LDL), fatty acid levels (decreased poly-unsaturated fatty acid, increased mono-unsaturated fatty acid) and decreased choline concentration, with association sizes comparable to those of routine clinical chemistry metrics of acute inflammation. Our results point to systemic metabolic biomarkers for COVID-19 severity that make strong targets for further fundamental research into its pathology (e.g. phenylalanine and omega-6 fatty acids).
Correlation of SARS-CoV-2 nucleocapsid antigen and RNA concentrations in nasopharyngeal samples from children and adults using an ultrasensitive and quantitative antigen assay
Authors: Pollock Nira R. , Savage Timothy J. , Wardell Hanna , Lee Rose , Mathew Anu , Stengelin Martin , Sigal George B.
Published: November 2020

Background

Diagnosis of COVID-19 by PCR offers high sensitivity, but the utility of detecting samples with high cycle threshold (Ct) values remains controversial. Currently available rapid diagnostic tests (RDTs) for SARS-CoV-2 nucleocapsid antigens (Ag) have sensitivity well below PCR. The correlation of Ag and RNA quantities in clinical nasopharyngeal (NP) samples is unknown.

Methods

An ultrasensitive, quantitative electrochemiluminescence immunoassay for SARS-CoV-2 nucleocapsid (the MSD® S-PLEX® CoV-2 N assay) was used to measure Ag in clinical NP samples from adults and children previously tested by PCR.

Results

The S-PLEX Ag assay had a limit of detection (LOD) of 0.16 pg/mL and a cutoff of 0.32 pg/mL. Ag concentrations measured in clinical NP samples (collected in 3.0 mL media) ranged from less than 160 fg/mL to 2.7 ug/mL. Log-transformed Ag concentrations correlated tightly with Ct values. In 35 adult and 101 pediatric PCR-positive samples, sensitivity was 91% (95% CI, 77-98%) and 79% (70-87%), respectively. In samples with Ct ≤ 35, sensitivity was 100% (88-100%) and 96% (88-99%), respectively. In 50 adult and 40 pediatric PCR-negative specimens, specificity was 100% (93-100%) and 98% (87-100%), respectively.

Conclusions

Nucleocapsid concentrations in clinical NP samples span 8 orders of magnitude and correlate closely with RNA concentrations (Ct values). The S-PLEX Ag assay had 96-100% sensitivity in samples from children and adults with Ct values ≤ 35, and 98-100% specificity. These results clarify Ag concentration distributions in clinical samples, providing insight into the performance of Ag RDTs and offering a new approach to diagnosis of COVID-19.

Key points

SARS-CoV-2 nucleocapsid concentrations in clinical nasopharyngeal samples, measured with an ultrasensitive assay, spanned an 8-log range and correlated closely with PCR Ct values. The assay was 96-100% sensitive in pediatric/adult samples with Ct values ≤ 35, and 98-100% specific.
A room, a bar and a classroom: how the coronavirus is spread through the air depends on heavily mask filtration efficiency
Authors: Srikrishna Devabhaktuni
Published: November 2020

Background

Recently the US CDC acknowledged by that the COVID-19 crisis is facilitated at least in part by aerosolized virus exhaled by symptomatic, asymptomatic, or pre-symptomatic infected individuals. Disposable N95 masks remain in short supply due to their use in healthcare settings during the Coronavirus pandemic, whereas NIOSH-approved elastomeric N95 (eN95) masks remain immediately available for use by essential workers and the general public. New reusable N95 mask options with symmetric filtration efficiency can be anticipated to be NIOSH approved in the coming months, today’s eN95 masks have asymmetric filtration efficiency upon inhalation (95%) and exhalation (well under 95%) but are available now during the Fall and Winter when Coronavirus cases are expected to peak.

Methods

Based on the Wells-Riley model of infection risk, we examine how the rate of transmission of the virus from one infected person in a closed, congested room with poor ventilation to several other susceptible individuals is impacted by the filtration efficiency of the masks they are wearing. Three scenarios are modeled – a room (6 people, 12’ × 20’ × 10’), a bar (18 people, 20’ × 40’ × 10’), and a classroom (26 people, 20’ × 30’ × 10’) with one infectious individual and remaining susceptibles. By dynamically estimating the accumulation of virus in aerosols exhaled by the infected person in these congested spaces for four hours using a “box model,” we compare the transmission risk (probability) when susceptible people based on a realistic hypothesis of face mask protection during inhaling and exhaling e.g. using cloth masks or N95 respirators.

Results

Across all three scenarios, cloth masks modeled with 30% symmetric filtration efficiency alone were insufficient to stop the spread (18% to 40% infection risk), whereas eN95 masks (modeled as 95% filtration efficiency on inhalation, 30% on exhalation) reduced the infection risk to 1.5% to 3.6%. Symmetric filtration of 80% reduces the risk to 1.7% to 4.1% and symmetric filtration of 95% would further reduce the risk to 0.11% to 0.26%.

Conclusion

This modeling of mask filtration efficiency suggests that the pandemic could be readily controlled within several weeks if (in conjunction with sensible hygiene) a sufficiently large majority of people wear asymmetric but higher-filtration masks (e.g. eN95) that also block aerosols whenever exposed to anyone else outside their household in order to completely stop inter-household spread.