bluuebunny/crossref_metadata_2025 huggingface dataset:
Peer-Review and Rejection Causes in Submitting Original Medical Manuscripts
Authors: Mendiola Pastrana Indira Rocío , Hernández Adriana Vargas , Pérez Manjarrez Francia Estefanía , López Eduardo Ortiz , Romero-Henríquez Luisa Fernanda , López-Ortiz Geovani
Published: May 2020

The purpose of specialized medical journals is to accurately disseminate the results of new research. The peer-review process is crucial for journals to be able to fulfill this purpose. Although the peer-review determines whether scientific papers are accepted or rejected for publication, for many authors is a not well known process in its entirety. Many journals have focused on educating their audience about how and what is assessed during peer-review, nevertheless, the rate of manuscripts rejected because of easily-avoidable causes related to this, remains high. In this paper, we describe the process that specialized journals use to assess original medical manuscripts and list the main causes of paper rejection. Practicing physicians and medical students who wish to report their research results stand to benefit if they can identify and early avoid on the issues that most often arise during the peer-review process.
A Case for Early Screening: Prenatal Alcohol Risk Exposure Predicts Risk for Early Childhood Communication Delays
Authors: Netelenbos Nicole , Sanders James Ladell , Ofori Dei Samuel , McDonald Sheila
Published: May 2020

Objective:

Studies have confirmed the detrimental effects of prenatal alcohol exposure on language development in children. Little is known about the ability of prenatal alcohol risk (PAR) screening measures to predict language or other neurodevelopmental delays in young children, however. The intent of this study is to identify whether PAR predicts communication development in children at 12, 24, and 36 months of age.

Method:

Data from 772 women and their children who participated in the All Our Families pregnancy cohort were analyzed. Respondents completed the T-ACE, a validated screening tool for detecting PAR. Communication development in children was measured through the Ages and Stages Questionnaire, Third Edition. Logistic regression was used to generate odds ratios and 95% confidence intervals.

Results:

A positive screen for PAR places a child at risk for communication delay (≤1 SD below mean) by approximately 1.5-fold at 12, 24, and 36 months of age, even after adjustment for demographic variables. Follow-up analysis revealed a significant difference in the prevalence of risk for communication delays between 12 and 24 months and between 24 and 36 months in both low- and high-risk drinking groups, with 24-month-old children showing the greatest risk for delay.

Conclusion:

The results of this study suggest that screening for PAR in expectant mothers may identify a group of young children at increased risk for communication delays. This research carries clinical implications and provides support for PAR screening in informing early childhood developmental screening efforts.
Noninvasive respiratory support in the hypoxaemic peri-operative/periprocedural patient
Authors: Leone Marc , Einav Sharon , Chiumello Davide , Constantin Jean-Michel , De Robertis Edoardo , Abreu Marcelo Gama De , Gregoretti Cesare , Jaber Samir , Maggiore Salvatore Maurizio , Pelosi Paolo , Sorbello Massimiliano , Afshari Arash
Published: May 2020

Hypoxaemia is a potential life-threatening yet common complication in the peri-operative and periprocedural patient (e.g. during an invasive procedure with risk of deterioration of gas exchange, such as bronchoscopy). The European Society of Anaesthesiology (ESA) and the European Society of Intensive Care Medicine (ESICM) have developed guidelines for the use of noninvasive respiratory support techniques in the hypoxaemic patient in the peri-operative and periprocedural period. The panel outlined five clinical questions regarding treatment with noninvasive respiratory support techniques [conventional oxygen therapy (COT), high flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV) and continuous positive airway pressure (CPAP)] for hypoxaemic patients with acute peri-operative/periprocedural respiratory failure. The goal was to assess the available literature on the various noninvasive respiratory support techniques, specifically studies that included adult participants with hypoxaemia in the peri-operative/periprocedural period. The literature search strategy was developed by a Cochrane Anaesthesia and Intensive Care trial search specialist in close collaboration with the panel members and the ESA group methodologist. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the level of evidence and to grade recommendations. The final process was then validated by both ESA and ESICM scientific committees. Among 19 recommendations, the two grade 1B recommendations state that in the peri-operative/periprocedural hypoxaemic patient, the use of either NIPPV or CPAP (based on local expertise) is preferred to COT for improvement of oxygenation; and that the panel suggests using NIPPV or CPAP immediately postextubation for hypoxaemic patients at risk of developing acute respiratory failure after abdominal surgery.
Subarachnoid block and ultrasound-guided transversalis fascia plane block for caesarean section
Authors: Aydin Muhammed E. , Bedir Zehra , Yayik Ahmet M. , Celik Erkan C. , Ates İrem , Ahiskalioglu Elif O. , Ahiskalioglu Ali
Published: May 2020

BACKGROUND

After caesarean section, maternal postoperative comfort is critical to allow the new mother to care for her baby. Insufficient pain relief during the postoperative period may delay maternal/infant bonding and, in addition, such pain has been linked to subsequent depression and chronic pain. Caesarean section is commonly performed with a Pfannenstiel incision, and a transversalis fascia plane (TFP) block provides postoperative analgesia in the T12 and L1 dermatomes.

OBJECTIVE

The aim of this study was to investigate the effect of the TFP block on postoperative opioid consumption and pain scores in patients undergoing caesarean section under spinal anaesthesia.

DESIGN

A randomised controlled, double-blind study.

SETTINGS

Single-centre, academic hospital.

PARTICIPANTS

Sixty patients undergoing caesarean section.

INTERVENTIONS

The TFP group (n = 30) received an ultrasound-guided bilateral TFP block with 20 ml of 0.25% bupivacaine. The control group (n = 30) received 20 ml of saline bilaterally. Postoperative analgesia was given every 6 h with intravenous paracetamol 1 g and patient-controlled analgesia (PCA) with morphine.

MAIN OUTCOME MEASURES

Postoperative visual analogue pain scores, morphine consumption, rescue analgesia and opioid-related side effects were evaluated.

RESULTS

In the TFP group, the visual analogue pain scores were significantly lower at rest for 2 h after the operation (P = 0.011) and during active movement at 2, 4 and 8 h postoperatively (P = 0.014, <0.001 and 0.032, respectively). Morphine consumption in the first 24 h after surgery was significantly higher in the control group compared with the TFP group (38.5 ± 11.63 and 19.5 ± 8.33 mg, respectively; P < 0.001). The incidence of postoperative nausea and constipation were statistically higher in the control group than in the TFP group (P < 0.05). Patient satisfaction was significantly higher in the TFP group (P = 0.027).

CONCLUSION

A postoperative TFP block can reduce opioid consumption and relieve acute pain after a caesarean section under spinal anaesthesia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04172727.
Omega-3 fatty acid therapy for cardiovascular disease: justified or not?
Authors: Maki Kevin C. , Dicklin Mary R.
Published: May 2020

Purpose of review

To discuss the current evidence regarding the relationship between omega-3 fatty acid intake and atherosclerotic cardiovascular disease (ASCVD) risk.

Recent findings

Combined results from randomized controlled trials using low-dosage (≤1.8 g/day of ethyl esters) eicosapentaenoic acid (EPA) or EPA + docosahexaenoic acid (DHA) suggest a small benefit for reducing coronary heart disease risk. The Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) that administered 4 g/day icosapent ethyl (IPE) to individuals on statin at high or very high ASCVD risk with elevated triglycerides demonstrated a 25% relative risk reduction in the composite primary endpoint (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization and unstable angina) for IPE vs. placebo, and a lower hazard for all prespecified individual endpoints other than total mortality. Several national organizations have recommended IPE for ASCVD risk reduction in populations aligning with REDUCE-IT; the Food and Drug Administration has approved IPE for ASCVD risk reduction. However, the Outcomes Study to Assess Statin Residual Risk Reduction with Epanova (EPA + DHA carboxylic acids) in High Cardiovascular Risk Patients with Hypertriglyceridemia was recently stopped for futility.

At present, the best available evidence for a role of omega-3 fatty acids in ASCVD risk reduction is for 4 g/day of IPE, as an adjunct to statin therapy, for patients with ASCVD or diabetes mellitus and elevated triglycerides.
Blood pressure measurements on a bare arm, over a sleeve or below a rolled-up sleeve: a systematic review and meta-analysis
Authors: Seguret David , Gamelon Danaé , Dourmap Caroline , Steichen Olivier
Published: May 2020

Objective:

Several guidelines call for blood pressure (BP) measurement on a bare arm, which is not always easy. This systematic review aims to synthesize existing evidence concerning the effect of a sleeve on BP measurement.

Methods:

Pubmed and Embase were searched for cross-sectional studies comparing BP values measured on a bare arm, over a sleeve or below a rolled-up sleeve. A meta-analysis was conducted on available data.

Results:

Thirteen articles were selected from 720 references. All studies reported office BP values, 12 compared measurements on a bare arm and on a sleeve, and four also performed measurements below a rolled-up sleeve, with heterogeneous sleeve types and thicknesses. Most studies had a high risk of bias. Three studies showed a small overestimation of BP measured over a sleeve, but the remaining 10 studies did not find statistically significant differences between measurements. Meta-analysis showed a nonsignificant 0.59 mmHg [95% confidence interval (CI) −0.11 to +1.30; P = 0.10] overestimation of SBP measured over a sleeve when the thinnest sleeve was considered for studies that investigated various thicknesses, a nonsignificant 1.10 mmHg (95% CI −0.21 to +2.40; P = 0.10) overestimation of SBP when the thickest sleeve was considered, and a nonsignificant 2.76 mmHg (95% CI −0.96 to +6.47; P = 0.15) overestimation of SBP measured below a rolled-up sleeve.

Conclusion:

Measuring BP over a thick sleeve in the office may result in a small overestimation of recorded values but measuring over a thin sleeve does not appear to have a significant impact and, in any case, should be preferred to rolling it up.
Refractive surgery for the patient with autoimmune diseases
Authors: Chen Tony Y. , Chu David S.
Published: May 2020

Purpose of review

Autoimmune and immune-mediated diseases are considered contraindications for laser refractive surgeries according to the US Food and Drug Administration's guideline. This guideline, however, is based on limited case reports or complications reported during other intraocular procedures. There have been only a handful of new clinical studies that evaluate the efficacy and safety of refractive surgery in this specific patient population. The aim of this article is to review currently available research and offer updated recommendations for the evaluation and management of laser refractive surgery (LRS) in patients with autoimmune diseases.

Recent findings

More recent retrospective studies have reported good refractive outcomes in patients with well controlled autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, seronegative spondyloarthropathy, among others. No severe sight-threatening complications have been reported in these reports. Although postoperative complications occur, the risk of refractive surgery is comparable with those without autoimmune diseases.

With the exception of primary Sjogren's syndrome, patients with autoimmune diseases may be good candidates for LRS if diseases are well controlled and have minimal ophthalmic manifestation. Patients should be made aware of the potential surgical complications and be informed of the currently available data. More multicenter and larger prospective studies are needed to compare the refractive outcomes and surgical complications in patients with and without autoimmune diseases. This will help patients make better informed medical decisions.
Preoperative carbohydrates: what is new?
Authors: Gianotti Luca , Sandini Marta , Hackert Thilo
Published: May 2020

Purpose of review

The aim of this review is to give an overview of recently published articles covering preoperative carbohydrate loading in surgical patients.

Recent findings

Between January 1, 2017, and December 31, 2019, 26 publications addressing the effect of carbohydrate load were retrieved through a systematic search. Seventeen were randomized clinical trials, three prospective observational studies and six retrospective series with case-control comparison. Most of the studies were underpowered, addressed surrogate endpoints, and variability among dose and timing of carbohydrate (CHO) treatment was high. The most recent literature endorses preoperative carbohydrate loading up to 2 h before operations as a safe treatment. The new evidence confirm that this strategy is effective in reducing perioperative insulin resistance and the proportion of hyperglycemia episodes, and improving patient well-being and comfort but without affecting surgery-related morbidity.

Further properly designed randomized clinical trials, addressing more clinically relevant endpoints such as length of hospitalization and morbidity rate, are warrant.
Network Engagement in Action
Authors: Poger Jennifer M. , Mayer Victoria , Duru Obidiugwu Kenrik , Nauman Beth , Holderness Heather , Warren Nate , Vasquez Carolina , Bibi Salma , Rasmussen-Torvik Laura J. , Hosseinian Zahra , Shi Lizheng , Wallace Jamie , Goytia Crispin N. , Horowitz Carol R. , Kraschnewski Jennifer L.
Published: May 2020

Background:

Stakeholders (ie, patients, policymakers, clinicians, advocacy groups, health system leaders, payers, and others) offer critical input at various stages in the research continuum, and their contributions are increasingly recognized as an important component of effective translational research. Natural experiments, in particular, may benefit from stakeholder feedback in addressing real-world issues and providing insight into future policy decisions, though best practices for the engagement of stakeholders in observational studies are limited in the literature.

Methods:

The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) network utilizes rigorous methods to evaluate natural experiments in health policy and program delivery with a focus on diabetes-related outcomes. Each of the 8 partnering institutions incorporates stakeholder engagement throughout multiple study phases to enhance the patient-centeredness of results. NEXT-D2 dedicates a committee to Engagement for resource sharing, enhancing engagement approaches, and advancing network-wide engagement activities. Key stakeholder engagement activities include Study Meetings, Proposal Development, Trainings & Educational Opportunities, Data Analysis, and Results Dissemination. Network-wide patient-centered resources and multimedia have also been developed through the broad expertise of each site’s stakeholder group.

Conclusions:

This collaboration has created a continuous feedback loop wherein site-level engagement approaches are informed via the network and network-level engagement efforts are shaped by individual sites. Emerging best practices include: incorporating stakeholders in multiple ways throughout the research, building on previous relationships with stakeholders, enhancing capacity through stakeholder and investigator training, involving stakeholders in refining outcome choices and understanding the meaning of variables, and recognizing the power of stakeholders in maximizing dissemination.
Detection of Amblyogenic Refractive Error Using the Spot Vision Screener in Children
Authors: Gaiser Hilary , Moore Bruce , Srinivasan Gayathri , Solaka Nadine , He Ran
Published: May 2020

SIGNIFICANCE

Vision screenings are conducted to detect significant refractive errors, amblyopia, and ocular diseases. Vision screening devices are desired to have high testability, sensitivity, and specificity. Spot has demonstrated high testability, but previous reports suggest that the Spot has low sensitivity for detecting amblyogenic hyperopia and moderate sensitivity for amblyogenic astigmatism.

PURPOSE

This study assessed the concurrent validity of detecting amblyogenic refractive errors by the Spot (v.1.1.50; Welch Allyn Inc., Skaneateles Falls, NY) compared with cycloplegic retinoscopy.

METHODS

A total of 475 subjects (24 to 96 months) were screened by Spot and then received a masked comprehensive examination. Sensitivity and specificity, Bland-Altman plot, receiver operating characteristic area under the curve, and paired t test were evaluated by comparing the results of the Spot (v1.1.50) using the manufacturer referral criteria with the results of the comprehensive examination using the 2013 American Association for Pediatric Ophthalmology and Strabismus criteria.

RESULTS

The Spot (v.1.1.50) referred 107 subjects (22.53%) for the following: 18.73% (89/475) astigmatism, 4.63% (22/475) myopia, 0.42% (2/475) hyperopia, and 2.11% (10/475) anisometropia. The sensitivity and specificity of the Spot vision screener for detecting amblyogenic risk factors were 86.08% (95% confidence interval [CI], 76.45 to 92.84%) and 90.15% (95% CI, 86.78 to 92.90%). Areas under the curve were 0.906 (95% CI, 0.836 to 0.976) for hyperopia, 0.887 (95% CI, 0.803 to 0.972) for spherical equivalent, and 0.914 (95% CI, 0.866 to 0.962) for astigmatism. A modified hyperopia criteria cutoff of greater than +1.06 D improved the sensitivity from 25 to 80% with 90% specificity. The current cutoff criterion, greater than −1.75 D, for astigmatism seemed optimal.

CONCLUSIONS

This study shows that the Spot vision screener accurately detects low spherical refractive errors and astigmatism. Lowering the hyperopia cutoff criteria from the current Spot screener referral criteria improves the sensitivity with desired (high) specificity.
Contributing Factors for Pediatric Ambulatory Diagnostic Process Errors: Project RedDE
Authors: Dadlez Nina M. , Adelman Jason , Bundy David G. , Singh Hardeep , Applebaum Jo R. , Rinke Michael L.
Published: May 2020

Background:

Pediatric ambulatory diagnostic errors (DEs) occur frequently. We used root cause analyses (RCAs) to identify their failure points and contributing factors.

Methods:

Thirty-one practices were enrolled in a national QI collaborative to reduce 3 DEs occurring at different stages of the diagnostic process: missed adolescent depression, missed elevated blood pressure (BP), and missed actionable laboratory values. Practices were encouraged to perform monthly “mini-RCAs” to identify failure points and prioritize interventions. Information related to process steps involved, specific contributing factors, and recommended interventions were reported monthly. Data were analyzed using descriptive statistics and Pareto charts.

Results:

Twenty-eight (90%) practices submitted 184 mini-RCAs. The median number of mini-RCAs submitted was 6 (interquartile range, 2–9). For missed adolescent depression, the process step most commonly identified was the failure to screen (68%). For missed elevated BP, it was the failure to recognize (36%) and act on (28%) abnormal BP. For missed actionable laboratories, failure to notify families (23%) and document actions on (19%) abnormal results were the process steps most commonly identified. Top contributing factors to missed adolescent depression included patient volume (16%) and inadequate staffing (13%). Top contributing factors to missed elevated BP included patient volume (12%), clinic milieu (9%), and electronic health records (EHRs) (8%). Top contributing factors to missed actionable laboratories included written communication (13%), EHR (9%), and provider knowledge (8%). Recommended interventions were similar across errors.

Conclusions:

EHR-based interventions, standardization of processes, and cross-training may help decrease DEs in the pediatric ambulatory setting. Mini-RCAs are useful tools to identify their contributing factors and interventions.
Weissella muntiaci sp. nov., isolated from faeces of Formosan barking deer (Muntiacus reevesi)
Authors: Lin Shih-Ting , Wang Li-Ting , Wu Yen-Chi , Guu Jia-Rong Jeremy , Tamura Tomohiko , Mori Koji , Huang Lina , Watanabe Koichi
Published: May 2020

A Gram-stain-positive strain, 8 H-2T, was isolated from faeces of Reeves’ muntjac (Muntiacus reevesi) barking deer in Taiwan. Cells of the strain were short rod-shaped, non-motile, non-haemolytic, asporogenous, facultatively anaerobic, heterofermentative and did not exhibit catalase and oxidase activities. Comparative analyses of 16S rRNA, pheS and dnaA gene sequences demonstrated that the novel strain was a member of the genus

Weissella

. On the basis of 16S rRNA gene sequence similarities, the type strains of

Weissella oryzae

(99.2 %),

Weissella confusa

(97.8 %),

Weissella cibaria

(97.6 %) and

Weissella soli

(97.3 %) were the closest neighbours to strain 8 H-2T. The concatenated housekeeping gene sequence (pheS and dnaA) similarities of 8 H-2T to closely related type strains were 72.5–84.9 %, respectively. The genomic DNA G+C content was 40.5 mol%. The average nucleotide identity and digital DNA–DNA hybridization values with these type strains were 70.2–75.4% and 25.1–30.1 %, respectively. Phenotypic and genotypic test results demonstrated that strain 8 H-2T represents a novel species belonging to the genus

Weissella

, for which the name Weissella muntiaci sp. nov. is proposed. The type strain is 8 H-2T (=BCRC 81133T=NBRC 113537T).
Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission
Authors: Rivett Lucy , Sridhar Sushmita , Sparkes Dominic , Routledge Matthew , Jones Nicholas K. , Forrest Sally , Young Jamie , Pereira-Dias Joana , Hamilton William L , Ferris Mark , Torok Estee , Meredith Luke , Bioresource Collaboration The CITIID-NIHR COVI , Curran Martin , Fuller Stewart , Chaudhry Afzal , Shaw Ashley , Samsworth Richard J. , Bradley John R. , Dougan Gordon , Smith Kenneth G. C. , Lehner Paul J. , Matheson Nicholas J. , Wright Giles , Goodfellow Ian , Baker Stephen , Weekes Michael P.
Published: May 2020

Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3-week period (April 2020), 1,032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab.

3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19) >7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B·1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.
Depression and anxiety during the COVID-19 pandemic in Saudi Arabia: a cross-sectional study
Authors: Alyami Hamad S. , Naser Abdallah Y , Dahmash Eman Zmaily , Alyami Mohammed H. , Alyami Musfer S
Published: May 2020

Aims

The emergence of the COVID-19 global pandemic, with a high transmission and mortality rate, has created an extraordinary crisis worldwide. Such an unusual situation may have an undesirable impact on the mental health of individuals which, in turn, may influence their outcomes. This study aimed to explore the influence of the COVID-19 pandemic on the psychological disposition of residents of the Kingdom of Saudi Arabia.

Methods

A cross-sectional study using an online survey was conducted in Saudi Arabia between 27 March and 27 April 2020. The Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. Logistic regression analysis was used to identify predictors of these.

Results

A total of 2,081 individuals participated in the study. The prevalence of depression and anxiety among the study participants was 9.4% and 7.3%, respectively. Non-Saudi residents, individuals aged 50 years and above, divorced people, retired people, university students, and those with an income between 2,000 and 10,000 SR were at higher risk of developing depression. Saudi individuals, married people, the unemployed, and those with a high income (> 10,000 RS) were at higher risk of developing anxiety.

Conclusion

We found that there is a wide range of Saudi residents who are at higher risk of developing mental illness during the current COVID-19 pandemic. Policymakers and mental healthcare providers are advised to provide continuous monitoring of the psychological consequences during this pandemic and provide the required health support.

What is already known about this subject?

–

The emergence of the COVID-19 global pandemic, with a high transmission and mortality rate, has created an extraordinary crisis worldwide.

–

The COVID-19 pandemic might have an undesirable impact on the mental health of individuals.

What does this article add?

–

Depression and anxiety are common among the Saudi population.

–

A considerable proportion of the Saudi population is concerned about contracting COVID-19 or transmitting it to family members.

–

Unemployed individuals and university students are at higher risk of depression and anxiety.
Feasibility and Acceptability of the Multicontext Approach for Individuals with Acquired Brain Injury in Acute Inpatient Rehabilitation
Authors: Jaywant Abhishek , Steinberg Chelsea , Lee Alyson , Toglia Joan
Published: May 2020

The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility, acceptability, and patient perceived benefit of the MC approach. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach— involving guided questioning and patient self-generation of strategies within everyday functional cognitive tasks—was implemented within routine occupational therapy. Outcome measures were self-report of treatment satisfaction, the Self-Regulation Skills Interview, and the Weekly Calendar Planning Activity. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial structured intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted.
Comorbidities and Disparities in Outcomes of COVID-19 Among African American and White Patients
Authors: Khan Ahmad , Chatterjee Arka , Singh Shailendra
Published: May 2020

Initial surveillance data suggests a disproportionately high number of deaths among Black patients with COVID-19. However, high-risk comorbidities are often over-represented in the Black population, and understanding whether the disparity is entirely secondary to them is essential. We performed a retrospective cohort study using real-time analysis of electronic medical records (EMR) of patients from multiple healthcare organizations in the United States. Our results showed that Black patients with COVID-19 have a significantly higher risk of mortality, hospitalization, and invasive mechanical ventilation compared to White patients. The incremental risk of poor outcomes in Blacks persists despite accounting for a higher prevalence of comorbidities. This may point to the disparities in socioeconomic determinants of health affecting Blacks and the need for an improvement in the care of this vulnerable population.
Causes of variation in epigenetic aging across the lifespan
Authors: Li Shuai , Nguyen Tuong , Wong Ee Ming , Dugué Pierre-Antoine , Dite Gillian S , Armstrong Nicola J , Craig Jeffrey M , Mather Karen A , Sachdev Perminder S , Saffery Richard , Sung Joohon , Tan Qihua , Thalamuthu Anbupalam , Milne Roger L , Giles Graham G , Southey Melissa C , Hopper John L
Published: May 2020

Background
DNA methylation-based biological age (DNAm age) is potentially an important biomarker for adult health. Studies in specific age ranges have found widely varying results about its causes of variation. We investigated these causes across the lifespan.

Methods
We pooled genome-wide DNA methylation data for 4,217 people aged 0-92 years from 1,871 families. DNAm age was calculated using the Horvath epigenetic clock. We estimated familial correlations in DNAm age for monozygotic (MZ) twin, dizygotic (DZ) twin, sibling, parent-offspring, and spouse pairs by cohabitation status. Genetic and environmental variance component models were fitted and compared.

Results
Twin pair correlations were -0.12 to 0.18 around birth, not different from zero (all P>0.29). For all pairs of relatives, their correlations increased with time spent living together (all P<0.02) at different rates (MZ>DZ and siblings>parent-offspring; P<0.001) and decreased with time spent living apart (P=0.02) at similar rates. These correlation patterns were best explained by cohabitation-dependent shared environmental factors, the effects of which were 1.41 (95% confidence interval [CI], 1.16 to 1.66) times greater for MZ pairs than for DZ and sibling pairs, and the latter were 2.03 (95% CI, 1.13 to 9.47) times greater than for parent-offspring pairs. Genetic factors explained 13% (95% CI, -10% to 35%) of variation (P=0.27).

Conclusion
Variation in DNAm age is mostly caused by environmental factors, including those shared to different extents by relatives while living together and whose effects persist into old age. The equal environment assumption of the classic twin study might not hold for epigenetic aging.
Virtual health care for community management of patients with COVID-19.
Authors: Hutchings Owen , Dearing Cassandra , Jagers Dianna , Shaw Miranda , Raffan Freya , Jones Aaron , Taggart Richard , Sinclair Tim , Anderson Teresa , Ritchie Angus G
Published: May 2020

Objectives: To describe the implementation and early experience of virtual health care for community management of patients with COVID-19.
Design: observational cohort study.
Setting: large Australian metropolitan health service with established virtual health care program and remote patient monitoring capability.
Participants: patients with COVID-19 living within the health service who can self-isolate safely, do not require immediate admission to an inpatient setting, have no major active comorbid illness and can be managed at home or other suitable accommodation.
Main outcome measures: care escalation rates, including hospital admission.
Results: between 11-29 March 2020, 162/173 (93.6%) locally diagnosed patients with COVID-19 were accepted to the virtual health care program, median age 38y (range 11-79). For the 62 patients discharged during this period the median length of stay was 8 days (range 1-17). The peak of 100 prevalent patients equated to approximately 25 patients per Registered Nurse per shift. Patients were contacted a median of 16 times (range 1-30) during this period, with video consultations used 66.3% of the time; 132/162 (81.5%) patients were monitored remotely. Care escalation rates were low: ambulance attendance, 5 (3%); ED attendance, 4 (2.5%); hospital admission, 3 (1.9%). There were no deaths.
Conclusions: community-based virtual health care is feasible for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian context for pandemic management. Health services implementing virtual health care should anticipate challenges with rapid technology deployments and provide adequate support to resolve them including strategies supporting consumer use of health information technologies.
The impact of goggle-associated harms to health and working status of nurses during management of COVID-19
Authors: Xiao-huan He , Yan-ru Feng , Gao-ming Li , Xiao-jiao Pang , Ting Chen , Ya-li Zhou , Hao Zhang , Jing Lang , Li-min Li , Li Feng , Xin He , Wei Zheng , Hong-ming Miao , Yong-hua Wang , Xia Kang
Published: May 2020

Background

To investigate the impact of goggles on their health and clinical practice during management of patients with COVID-19.

Methods

231 nurse practitioners were enrolled who worked in isolation region in designated hospitals to admit patients with COVID-19 in China. Demographic data, goggle-associated symptoms and underlying reasons, incidence of medical errors or exposures, the effects of fog in goggles on practice were all collected. Data were stratified and analyzed by age or working experience. Risk factors of goggle-associated medical errors were analyzed by multivariable logistical regression analysis.

Findings

Goggle-associated symptoms and foggy goggles widely presented in nurses. The most common symptoms were headache, skin pressure injury and dizziness. Headache, vomit and nausea were significantly fewer reported in nurses with longer working experience while rash occurred higher in this group. The underlying reasons included tightness of goggles, unsuitable design and uncomfortable materials. The working status of nurses with more working experience was less impacted by goggles. 11.3% nurses occurred medical exposures in clinical practice while 19.5% nurses made medical errors on patients. The risk factors for medical errors were time interval before adapting to goggle-associated discomforts, adjusting goggles and headache.

Interpretation

Goggle-associated symptoms and fog can highly impact the working status and contribute to medical errors during management of COVID-19. Increased the experience with working in PPE through adequate training and psychological education may benefit for relieving some symptoms and improving working status. Improvement of goggle design during productive process was strongly suggested to reduce incidence of discomforts and medical errors.
A Systems Approach to Assess Transport and Diffusion of Hazardous Airborne Particles in a Large Surgical Suite: Potential Impacts on Viral Airborne Transmission
Authors: Garbey Marc , Joerger Guillaume , Furr Shannon
Published: May 2020

Airborne transmission of viruses, such as the coronavirus 2 (SARS-CoV-2), in hospital systems are under debate: it has been shown that transmission of SARS-CoV-2 virus goes beyond droplet dynamics that is limited to 3-6 feet, but it is unclear if the airborne viral load is significant enough to ensure transmission of the disease. Surgical smoke can act as a carrier for tissue particles, viruses, and bacteria. To quantify airborne transmission from a physical point of view, we consider surgical smoke produced by thermal destruction of tissue during the use of electrosurgical instruments as a marker of airborne particle diffusion-transportation. Surgical smoke plumes are also known to be dangerous for human health, especially to surgical staff who receive long-term exposure over the years. There are limited quantified metrics reported on long-term effects of surgical smoke on staff's health. The purpose of this paper is to provide a mathematical framework and experimental protocol to assess the transport and diffusion of hazardous airborne particles in every large operating room suite. Measurements from a network of air quality sensors gathered during a clinical study provide validation for the main part of the model. Overall, the model estimates staff exposure to airborne contamination from surgical smoke and biological material. To address the clinical implication over a long period of time, the systems approach is built upon previous work on multi-scale modeling of surgical flow in a large operating room suite and takes into account human behavior factors.
COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease
Authors: Brill Simon E , Jarvis Hannah , Ozcan Ezgi , Burns Thomas , Warraich Rabia , Amani Lisa , Jaffer Amina , Paget Stephanie , Sivaramakrishnan Anand , Creer Dean
Published: May 2020

Abstract:

Objectives:

To describe the presenting features and outcomes of patients with COVID-19 in a UK hospital, with a focus on those patients over 80 years and patients with hospital onset infection.

Design:

Retrospective cohort study with data extracted from the electronic records of patients with PCR-confirmed COVID-19 admitted to our institution.

Setting:

Suburban general hospital serving the most populous London borough.

Participants:

The first 450 inpatients admitted to our hospital with swab-confirmed COVID-19 infection.

Primary outcome:

The primary outcome measure was death during the index hospital admission.

Results:

The median (IQR) age was 72 (56, 83), with 150 (33%) over 80 years old and 60% male. Presenting clinical and biochemical features were consistent with those reported elsewhere. The ethnic breakdown of patients admitted was similar to that of our underlying local population with no excess of BAME deaths. Inpatient mortality was high at 38%.

Patients over 80 presented earlier in their disease course and were significantly less likely to present with the typical features of cough, breathlessness and fever. Cardiac co-morbidity and markers of cardiac dysfunction were more common, but not those of bacterial infection. Mortality was significantly higher in this group (60% vs 28%, p <0.001).

31 (7%) of patients were classified as having hospital-onset COVID-19 infection. The peak of hospital-onset infections occurred at the same time as the overall peak of admitted infections. Despite being older and more frail, the outcomes for this cohort were no worse.

Conclusions:

Inpatient mortality was high, especially among the over-80s, who were more likely to present atypically. The ethnic composition of our caseload was similar to the underlying population. While a significant number of patients presented with COVID-19 while already in hospital, their outcomes were no worse.
In vivo PET imaging of neuroinflammation in familial frontotemporal dementia
Authors: Malpetti Maura , Rittman Timothy , Jones P. Simon , Cope Thomas E. , Passamonti Luca , Bevan-Jones W. Richard , Patterson Karalyn , Fryer Tim D. , Hong Young T. , Aigbirhio Franklin I. , O’Brien John T. , Rowe James B.
Published: May 2020

INTRODUCTION

We report in vivo patterns of neuroinflammation and abnormal protein aggregation in seven cases of familial frontotemporal dementia with mutations in MAPT, GRN and C9orf72 genes.

METHODS

Using positron emission tomography (PET), we explored the association of the distribution of activated microglia, as measured by the radioligand [11C]PK11195, and the regional distribution of tau- or TDP-43 pathology, indexed using the radioligand [18F]AV-1451. The familial FTD PET data were compared to healthy controls.

RESULTS

Familial FTD patients across all mutation groups showed increased [11C]PK11195 binding predominantly in frontotemporal regions, with additional regions showing abnormalities in individuals. Patients with MAPT mutations had a consistent distribution of [18F]AV-1451 binding across the brain, with heterogeneous distributions among carriers of GRN and C9orf72 mutations.

DISCUSSION

This case series suggests a consistent role for neuroinflammation in the pathophysiology of familial FTD, warranting further consideration of immunomodulatory therapies for disease modification and prevention.
Health literacy of inland population in the mitigation phase 3.2. of COVID-19's pandemic in Portugal - a descriptive cohort study
Authors: Gomes da Silva Joana , Sofia Silva Carla , Alexandre Barbara , Morgado Pedro
Published: May 2020

Background: COVID-19 is a respiratory disease transmitted through respiratory droplets with a high transmission rate. There's still no effective and approved antiretroviral treatment or vaccine, thus, preventive measures are the main key to contain this pandemic. Portugal is now in phase 3.2 of the mitigation of COVID-19, being imperative to understand the health literacy of our country and how to prevent the lack of information, through community empowerment.
Material and methods: A cross-sectional study with a cohort from a primary care facility was conducted. We collected demographic and epidemiological data and carried out a questionnaire by phone call. Descriptive statistics and nonparametric tests were used to assess associations between the independent variables and the level of health literacy. The level of significance was set at p<0.05.
Results: Our cohort includes 222 subjects (median age: 62 years old), mostly females (131), undergraduate (193) and with at least one risk factor for COVID-19 (144). Globally, younger individuals, females, graduates and the Non-Risk Group appear to have higher levels of health literacy, with some exceptions to this pattern.
Conclusions: We observe a well-informed population. However, being a pandemic situation, we intend to identify and correct outliers/misconceptions. This work allows a perspective of the current state/pattern of health literacy as well as its possible predictors. Furthermore, this study makes aware of how relevant the specific communication approaches are. Further studies to understand the predictors of health literacy are necessary.
Key-Words: COVID-19, pandemic, SARS-CoV2, Portugal, Health literacy.
PathoSPOT genomic epidemiology reveals under-the-radar nosocomial outbreaks
Authors: Caban Ana Berbel , Pak Theodore R. , Obla Ajay , Dupper Amy C. , Chacko Kieran I. , Fox Lindsey , Mills Alexandra , Ciferri Brianne , Oussenko Irina , Beckford Colleen , Chung Marilyn , Sebra Robert , Smith Melissa , Conolly Sarah , Patel Gopi , Kasarskis Andrew , Sullivan Mitchell J. , Altman Deena R. , van Bakel Harm
Published: May 2020

Whole genome sequencing (WGS) is increasingly used to map the spread of bacterial and viral pathogens in nosocomial settings. A limiting factor for more widespread adoption of WGS for hospital infection prevention practices is the availability of standardized tools for genomic epidemiology. Here we present the Pathogen Sequencing Phylogenomic Outbreak Toolkit (PathoSPOT), which automates integration of genomic and medical record data for rapid detection and tracing of nosocomial outbreaks. To demonstrate its capabilities we applied PathoSPOT to complete genome surveillance data of 197 MRSA bacteremia cases from two hospitals during a two-year period. PathoSPOT identified 8 clonal clusters encompassing 33 patients (16.8% of cases); none of which had been recognized by standard practices. The largest cluster corresponded to a prolonged outbreak of a hospital-associated MRSA clone among 16 adults, spanning 9 wards over a period of 21 months. Analysis of precise timeline and location data with our toolkit suggested that an initial exposure event in a single ward led to infection and long-term colonization of multiple patients, followed by transmissions to other patients during recurrent hospitalizations. Overall, we demonstrate that PathoSPOT genomic surveillance enables detection of complex transmission chains that are not readily apparent from epidemiological data and that contribute significantly to morbidity and mortality, enabling more effective intervention strategies.
Testosterone enhances GLP-1 efficacy at the plasma membrane and endosomes to augment insulin secretion in male pancreatic β cells
Authors: Xu Weiwei , Ashford Fiona B. , Bitsi Stavroula , Schiffer Lina , Qadir M.M. Fahd , Arlt Wiebke , Tomas Alejandra , Hodson David J. , Mauvais-Jarvis Franck
Published: May 2020

Male mice with elimination of the androgen receptor (AR) in islet β cells (βARKO) exhibit blunted glucose-stimulated insulin secretion (GSIS), leading to hypoinsulinemia and hyperglycemia when challenged with a Western diet. Testosterone activation of an extranuclear AR in β cells potentiates GSIS by amplifying the insulinotropic action of glucagon-like peptide-1 (GLP-1). Here, using a combination of βARKO and β cell-selective GLP-1 receptor knockout mice and their islets, we show that AR activation in β cells amplifies the insulinotropic effect of islet-derived GLP-1. In β cell models expressing cAMP sensors, testosterone enhances the ability of GLP-1, but not that of glucose-dependent insulinotropic polypeptide or glucagon, to produce cAMP. Accordingly, testosterone selectively enhances the ability of GLP-1 to potentiate GSIS. Notably, testosterone enhances GLP-1 production of cAMP at the plasma membrane and endosomes. In male mouse and human islets, the insulinotropic effect of testosterone is abolished following inhibition of the membrane and endosomal cAMP-dependent protein kinase A and exchange protein activated by cAMP islet 2 pathways. Thus, membrane localization of AR enhances the ability of the GLP-1 receptor to produce cAMP, thus increasing glucose-stimulated insulin exocytosis.

Significance Statement

This study reveals that testosterone, acting on the androgen receptor (AR) in insulin-producing β cells amplifies the insulinotropic action of glucagon-like peptide-1 (GLP-1) by increasing GLP-1-mediated production of cAMP at the plasma membrane and endosomal compartments, to promote insulin vesicles exocytosis in human β cells. This study establishes a novel biological paradigm in which membrane location of a steroid nuclear receptor enhances the ability of a G protein-coupled receptor to produce cAMP. It has exceptional clinical significance for targeted delivery of testosterone to β cells in the large population of aging and androgen-deficient men who are at increased risk of diabetes.