bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of a Medical Scribe Program on Outpatient Pediatric Gastroenterology Clinic
Authors: Rahhal Riad , Goad Lindsay , Bishop Warren
Published: September 2020

Objectives:

Medical scribes may offer a route to improve physician productivity and workflow efficiency with reduced physician time for documentation. To our knowledge, there is no prior literature on medical scribe impact on outpatient pediatric gastroenterology clinic operations. The primary aim of our study was to address this knowledge gap.

Methods:

Data were collected on encounters conducted by pediatric gastroenterology physicians at a tertiary center, during a summer scribe program. Scribes were trained and attended clinics in a nonrandomized fashion. Clinic efficiency was assessed by patient flow, tracked via the electronic medical record system. Medical note complexity codes, associated work relative value units (wRVUs), and note delinquency were compared between encounters with and without scribes. Patient satisfaction survey scores were compared between groups.

Results:

One thousand nine hundred seventy encounters were included. Documented medical note complexity (and wRVUs), note delinquency, patient satisfaction, and perceived overall quality of service were similar between groups. Clinic time for established encounters was statistically shorter with scribes (median 18 vs 21 minutes, P = 0.01), a 14% reduction. No significant difference was noted in new encounter clinic time. The time to note completion was shorter for new encounters with scribes (2 vs 3 days, P = 0.048). More notes were finalized by the third day postencounter when a scribe was present (63% vs 57%, P = 0.02).

Conclusions:

The presence of medical scribes was associated with significantly more efficient clinic flow for established encounters and modest improvements in note completion rate. There were no measurable negative effects on documented medical note complexity or patient satisfaction scores.
Syndrome of the Trephined Related to Inflation of a Scalp Tissue Expander
Authors: Stewart Christopher M. , Deibert Christopher P. , Thompson Peter W.
Published: September 2020

Syndrome of the Trephined (SoT) is a severe complication following decompressive craniectomy. Urgent cranioplasty fully reverses the neurologic symptoms of SoT. This article presents a recent case of SoT following inflation of a scalp tissue expander.

A review of the literature was performed and case details obtained from the electronic medical record. Our patient had a large craniectomy defect following traumatic brain injury. A scalp tissue expander was used before secondary cranioplasty. The patient suffered severe neurologic decline temporally related to tissue expander inflation, which was fully reversed following expander removal and urgent cranioplasty.

SoT can be a neurologically devastating complication which can resolve following urgent cranioplasty. To our knowledge, this is the first description of SoT resulting from inflation of a scalp tissue expander. Familiarity with this syndrome is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.
Evaluation of Velopharyngeal Closure Ratio by a New Semi-Automatic Detection Method Based on Nasopharyngoscopy With Image Processing Method
Authors: Mao Bochun , Fu Fangling , Chen Shengkai , Cheng Xu , Guo Chunli , Ma Huangshui , He Ling , Yin Heng
Published: September 2020

The goal of this study is to develop and validate a novel semi-automatic detection method (SADM) under nasopharyngoscopy based on the image processing technique, which can assist the evaluation of the velar closure ratio (VCR). After the development of the SADM, 72 patients were enrolled. The reliability of SADM was evaluated by repeated measurements. Velar closure ratio are given by conventional nasopharyngoscopy method and SADM were compared. Velar closure ratios given by SADM were further translated into a trichotomous classification for velopharyngeal function diagnosis, that is, velopharyngeal closure (VPC), marginal VPC (MVPC), and velopharyngeal incomplete. The 2 VCR-thresholds used for the translation were explored and validated. As results shown, SADM was proved to be reliable with an intraclass correlation coefficient of 0.996 (95% confidence interval: 0.993–0.997, P < 0.001). Intraclass correlation coefficient between conventional nasopharyngoscopy method and SADM was 0.954 (95% confidence interval: 0.927– 0.971, P < 0.001). Velar closure ratio-thresholds were set at 0.82 and 0.92 according to the ROC curve. Diagnostic sensitivity and specificity for velopharyngeal incomplete were 1.00 and 1.00. MVPC had 0.58 sensitivity and 0.96 specificities while VPC had 0.92 and 0.79, respectively. No statistically significant difference was found between the diagnosis of SADM and speech pathologists (P > 0.1). In conclusion, this study successfully developed an accurate and reliable semi-automatic method to evaluate VCR, which could help improve the efficacy of VCR evaluation and velopharyngeal function diagnosis.
Navigating the Maze of Dietary Supplements
Authors: O'Dwyer Darla Daniel
Published: September 2020

Over half of the adult population consumes dietary supplements, according to one estimate. Choosing the right form of supplements based on the physiology of the patient, genetic variability (if possible), and lifestyle factors are important. Some supplements have poor bioavailability based on the chemical nature of an ingredient. These products should either be combined with ingredients or processed in a way to enhance bioavailability. The supplement should be able to disintegrate and dissolve in a specific amount of time. Knowledge of inactive ingredients is recommended to avoid unintended side effects. Suggestions to assist in the supplement evaluation process are provided.
Culinary Medicine
Authors: Vanderpool Lauren E. , Trilk Jennifer L. , Griffin Sarah F. , Condrasky Margaret D.
Published: September 2020

This pilot study evaluated the feasibility, efficacy, and efficiency of a culinary medicine course for medical students at the University of South Carolina School of Medicine Greenville. The “Cooking With a Chef” survey was administered pre- and postculinary medicine training to assess cooking knowledge, attitudes, behaviors, confidence, and self-efficacy. Five medical students participated in 10 project modules. Students demonstrated significant improvements (P < .05) in all assessment measures. Student feedback revealed increased awareness of nutrition-based care as a result of culinary medicine training. Implementing culinary medicine in medical curricula may improve nutrition education and counseling skills of health care providers.
The relationship between plasma vitamin D level and heart valves calcification in acute coronary syndrome and non acute coronary syndrome patients
Authors: Feldman Viktor , Laish-Farkash Avishag , Yosefy Chaim
Published: September 2020

Background

There is conflicting data regarding the association between low levels of plasma vitamin D and ischemic heart disease. We aimed to investigate the relationship between plasma vitamin D levels and heart valve calcification in hospitalized patients with ischemic heart disease versus non-ischemic heart disease controls.

Methods

A prospective case-control study comprising two age and gender-matched groups. The study group included consecutive patients hospitalized due to acute coronary syndrome; the control group included consecutive non-ischemic heart disease patients hospitalized for noncardiac causes. Blood samples for 25-hydroxyvitamin D level were drawn. An echocardiogram was performed during the first 3 days of hospitalization and reviewed for presence and degree of valvular calcification.

Results

Forty patients with acute coronary syndrome and 40 controls (age 58 ± 11 years, 64% male in both groups) were included. Mean plasma 25-hydroxyvitamin D vitamin level in the entire cohort was 24.5 ± 8 ng/ml. Valve calcification rates were similar in acute coronary syndrome versus non-acute coronary syndrome group (28 vs. 21 had valvular calcification; 18 vs. 12 had aortic valve calcification; 21 vs. 14 had mitral valve calcification, respectively; P = NS for all). We found no significant relationship between vitamin D level and valvular calcification, aortic valve calcification, or mitral valve calcification rate or degree in the entire cohort and in each group alone (P = NS for all). There was a negative correlation between 25-hydroxyvitamin D levels and age in the acute coronary syndrome group (r = −0.399, P = 0.012).

Conclusions

We did not find a significant relationship between plasma vitamin D levels and the rate or degree of calcification of either aortic/mitral/both valves in hospitalized patients with or without ischemic heart disease.
Does unfairness sound wrong? A cross-domain investigation of expectations in music and social decision-making
Authors: Civai Claudia , Teodorini Rachel , Carrus Elisa
Published: September 2020

This study was interested in investigating the existence of a shared psychological mechanism for the processing of expectations across domains. The literature on music and language shows that violations of expectations produce similar neural responses and violating the expectation in one domain may influence the processing of stimuli in the other domain. Like music and language, our social world is governed by a system of inherent rules or norms, such as fairness. The study therefore aimed to draw a parallel to the social domain and investigate whether a manipulation of melodic expectation can influence the processing of higher-level expectations of fairness. Specifically, we aimed to investigate whether the presence of an unexpected melody enhances or reduces participants' sensitivity to the violations of fairness and the behavioural reactions associated with these. We embedded a manipulation of melodic expectation within a social decision-making paradigm, whereby musically expected and unexpected stimuli will be simultaneously presented with fair and unfair divisions in a third-party altruistic punishment game. Behavioural and electroencephalographic responses were recorded. Results from the pre-planned analyses show that participants are less likely to punish when melodies are more unexpected and that violations of fairness norms elicit medial frontal negativity (MFN)-life effects. Because no significant interactions between melodic expectancy and fairness of the division were found, results fail to provide evidence of a shared mechanism for the processing of expectations. Exploratory analyses show two additional effects: (i) unfair divisions elicit an early attentional component (P2), probably associated with stimulus saliency, and (ii) mid-value divisions elicit a late MFN-like component, probably reflecting stimulus ambiguity. Future studies could build on these results to further investigate the effect of the cross-domain influence of music on the processing of social stimuli on these early and late components.
Navigating cross-cultural research: methodological and ethical considerations
Authors: Broesch Tanya , Crittenden Alyssa N. , Beheim Bret A. , Blackwell Aaron D. , Bunce John A. , Colleran Heidi , Hagel Kristin , Kline Michelle , McElreath Richard , Nelson Robin G. , Pisor Anne C. , Prall Sean , Pretelli Ilaria , Purzycki Benjamin , Quinn Elizabeth A. , Ross Cody , Scelza Brooke , Starkweather Kathrine , Stieglitz Jonathan , Mulder Monique Borgerhoff
Published: September 2020

The intensifying pace of research based on cross-cultural studies in the social sciences necessitates a discussion of the unique challenges of multi-sited research. Given an increasing demand for social scientists to expand their data collection beyond WEIRD (Western, educated, industrialized, rich and democratic) populations, there is an urgent need for transdisciplinary conversations on the logistical, scientific and ethical considerations inherent to this type of scholarship. As a group of social scientists engaged in cross-cultural research in psychology and anthropology, we hope to guide prospective cross-cultural researchers through some of the complex scientific and ethical challenges involved in such work: (a) study site selection, (b) community involvement and (c) culturally appropriate research methods. We aim to shed light on some of the difficult ethical quandaries of this type of research. Our recommendation emphasizes a community-centred approach, in which the desires of the community regarding research approach and methodology, community involvement, results communication and distribution, and data sharing are held in the highest regard by the researchers. We argue that such considerations are central to scientific rigour and the foundation of the study of human behaviour.
Brevibacterium profundi sp. nov., isolated from deep-sea sediment of the Western Pacific Ocean
Authors: Pei Shengxiang , Xie Fuquan , Niu Siwen , Ma Lingqi , Zhang Rui , Zhang Gaiyun
Published: September 2020

A new Gram-stain-positive, aerobic, non-motile and rod-shaped actinobacterium, designated O1T, was isolated from a deep-sea sediment of the Western Pacific Ocean. Strain O1T showed optimal growth at 30 °C, between pH 6.0 and 8.0, and in the presence of 1–5 % (w/v) NaCl. The predominant menaquinone was MK-8 (H2), and anteiso-C15 : 0 and anteiso-C17 : 0 were the major fatty acids. The diagnostic diamino acid in the cell-wall peptidoglycan was meso-diaminopimelic acid. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol and one unknown glycolipid. The DNA G+C content of strain O1T was 64.9 mol% and the genome size was 4.17 Mb. Based on a similarity search and phylogenetic analysis of the 16S rRNA gene sequence, strain O1T belonged to the genus

Brevibacterium

. The values of average nucleotide identity and in silico DNA–DNA hybridization between strain O1T and its close relatives were well below the thresholds used for the delineation of a new species. On the basis of the morphological and chemotaxonomic characteristics, as well as the genotypic data, it is proposed that strain O1T represents a novel species of the genus

Brevibacterium

, for which the name Brevibacterium profundi sp. nov. is proposed. The type strain is O1T (=JCM 33845T=MCCC 1A16744T).
Ramlibacter pinisoli sp. nov., a novel bacterial species isolated from pine garden soil
Authors: Akter Shahina , N. A. M. Kihong , Lee Sun-Young , Moon Sung-Kwon , Choi Changsun , Balusamy Sri Renukadevi , Siddiqi Muhammad Zubair , Ashrafudoulla Md. , Rahman Md. Shahedur , Huq Md. Amdadul
Published: September 2020

A Gram-stain-negative, aerobic, non-motile and rod- or coccoid-shaped novel bacterial strain, designated MAH-25T, was isolated from soil sampled in a pine garden. The colonies were observed to be light pink-coloured, smooth, spherical and 1–2 mm in diameter when grown on nutrient agar for 2 days. Strain MAH-25T was found to be able to grow at 15–35 °C, at pH 5.0–8.0 and at 0–2.0 % NaCl. Cell growth occurred on Reasoner's 2A agar and nutrient agar. The strain was found to be positive in both oxidase and catalase tests. According to 16S rRNA gene sequence comparisons, the isolate was identified as a member of the genus

Ramlibacter

and closely related to

Ramlibacter solisilvae

5-10T (98.0 % similarity),

Ramlibacter henchirensis

TMB834T (97.7 %),

Ramlibacter tataouinensis

TTB310T (97.6 %) and

Ramlibacter rhizophilus

YS3.2.7T (97.3 %). The average nucleotide identity and digital DNA–DNA hybridization values between strain MAH-25T and the four closely related type strains were in the range of 78.8–81.3 % and 22.3–24.1 %, respectively. The novel strain MAH-25T has a draft genome size of 5 505 957 bp (11 contigs), annotated with 5210 protein-coding genes, 46 tRNA and three rRNA genes. The genomic DNA G+C content was determined to be 70.3 mol%. The predominant isoprenoid quinone was ubiquinone 8 (Q-8). The major fatty acids were identified as C16 : 0, summed feature 3 (C16 : 1
 ω7c and/or C16 : 1
 ω6c) and summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c). The main polar lipids were phosphatidylethanolamine, phosphatidylglycerol and diphosphatidylglycerol. On the basis of DNA–DNA hybridization, genotypic analysis, chemotaxonomic and physiological data, strain MAH-25T represents a novel species within the genus

Ramlibacter

, for which the name Ramlibacter pinisoli sp. nov. is proposed, with MAH-25T (=KACC 19839T=CGMCC1.13660T) as the type strain.
Use of causal claims in observational studies: a research on research study
Authors: Parra Camila Olarte , Bertizzolo Lorenzo , Schroter Sara , Dechartres Agnès , Goetghebeur Els
Published: September 2020

Objective

To evaluate the consistency of causal statements in the abstracts of observational studies published in The BMJ.

Design

Research on research study.

Data source

All cohort or longitudinal studies describing an exposure-outcome relationship published in The BMJ during 2018. We also had access to the submitted papers and reviewer reports.

Main outcome measures:

Proportion of published research papers with ‘inconsistent’ use of causal language in the abstract. Papers where language was consistently causal or non-causal were classified as ‘consistently causal’ or ‘consistently not causal’, respectively; those where causality may be inferred were classified as ‘suggests causal’. For the ‘inconsistent’ papers, we then compared the published and submitted version.

Results

Of 151 published research papers, 60 described eligible studies. Of these 60, we classified the causal language used as ‘consistently causal’ (13%), ‘suggests causal’ (35%), ‘inconsistent’ (20%) and ‘consistently not causal’(32%). The majority of the ‘Inconsistent’ papers (92%) were already inconsistent on submission. The inconsistencies found in both submitted and published versions was mainly due to mismatches between objectives and conclusions. One section might be carefully phrased in terms of association while the other presented causal language. When identifying only an association, some authors jumped to recommending acting on the findings as if motivated by the evidence presented.

Conclusion

Further guidance is necessary for authors on what constitutes a causal statement and how to justify or discuss assumptions involved. Based on screening these abstracts, we provide a list of expressions beyond the obvious ‘cause’ word which may inspire a useful more comprehensive compendium on causal language.

Strengths and limitations of this study

We present examples of ambiguous causal statements in published abstracts of observational studies in a high impact journal

We focused on the abstract where clear messages are especially important, as many readers just read the abstract of a study

The focus on the abstract may miss further discussion on the validity of underlying assumptions justifying causal inference in the setting studied.

The prevalence and nature of the problems found is a call for better instruction on and consideration of causal language throughout the editorial process in clinical and epidemiological research.

We provide a list of words and study elements that could point in the direction of causality or otherwise, which may inspire a more comprehensive compendium.
Craniofacial features of 3q29 deletion syndrome: application of next generation phenotyping technology
Authors: Mak Bryan , Russo Rossana Sanchez , Gambello Michael J. , Black Emily , Leslie Elizabeth , Murphy Melissa M. ,   The Emory 3q29 Project, Mulle Jennifer
Published: September 2020

Introduction

3q29 deletion syndrome (3q29del) is a recurrent deletion syndrome associated with neuropsychiatric disorders and congenital anomalies. Dysmorphic facial features have been described but not systematically characterized. This study aims to detail the 3q29del craniofacial phenotype and use a machine learning approach to categorize individuals with 3q29del through analysis of 2D photos.

Methods

Detailed dysmorphology exam and 2D facial photos were ascertained from 31 individuals with 3q29del. Photos were used to train the next generation phenotyping platform Face2Gene (FDNA, Inc, Boston, MA) to distinguish 3q29del cases from controls, using a proprietary algorithm. Area under the curve of receiver operating characteristic curves (AUC-ROC) were used to determine the capacity of Face2Gene to identify 3q29del cases against controls.

Results

In this cohort, the most common observed craniofacial features were prominent forehead (48.4%), prominent nose tip (35.5%), and thin upper lip vermillion (25.8%). The FDNA technology showed an ability to distinguish cases from controls with an AUC-ROC value of 0.873 (p = 0.006).

Conclusion

This study found a recognizable facial pattern in 3q29del, as observed by trained clinical geneticists and next generation phenotyping technology. These results expand the potential application of automated technology such as FDNA in identifying rare genetic syndromes, even when facial dysmorphology is subtle.
Clinical efficacy of external beam radiotherapy complementing incomplete transarterial chemoembolization for hepatocellular carcinoma
Authors: Park Sunmin , Yoon Won Sup , Jang Mi Hee , Rim Chai Hong
Published: September 2020

Purpose

External beam radiotherapy (EBRT) has been commonly applied as salvage or a combination locoregional modality after transarterial chemoembolization (TACE) for hepatocellular carcinomas (HCCs). This study reports oncologic outcomes and feasibility after application of the two modalities in our center.

Methods

Forty consecutive patients who underwent EBRT due to incomplete responses of TACE were evaluated. Fourteen patients (35.0%) received stereotactic body radiotherapy (SBRT) and the remaining patients received conventionally fractionated radiotherapy (RT). A majority of patients who underwent SBRT received doses of 27 to 48 Gy in 3–4 fractions (median *EQD2: 57.0 Gy). Conventionally fractionated RT was performed with a median EQD2 of 47.8 Gy.

Results

The median follow-up duration was 14.4 months (range: 2.6–83.0 months). A majority (77.5%) of patients were regarded as having Child-Pugh grade A. The median tumor size was 3.4 cm (range: 0.8–20.1 cm). Ten patients (25.0%) had thrombosis at a main portal branch. The 1- and 2-year overall survival (OS) and progression-free survival (PFS) rates were 82.2% and 42.1% and 55.8% and 32.1%, respectively. The local control rates were 89.1% and 89.1% at 1 and 2 years, respectively. The albumin level was a significant factor affecting OS (p = 0.002), and the BCLC stage significantly affected PFS (p = 0.001). Intrahepatic, out-of-field recurrence was the main cause of disease progression (60.0%), and distant metastasis developed in 12 patients (30.0%) during follow-up. Non-classic radiation-induced liver disease was seen in five (12.5%) patients, and two (5%) patients experienced grade ≥ 3 hepatic toxicities.

Conclusions

EBRT after incomplete TACE was feasible and yielded favorable oncologic outcomes. However, disease progression related to intrahepatic failure remained a hindrance.

*EQD2: Equivalent dose in 2 Gy per fraction radiotherapy
Exponential distribution of large excess death rates in Europe during the COVID-19 outbreak in the spring of 2020
Authors: Martín-Olalla José María
Published: September 2020

Excess death rates E during the spring of 2020 are computed in N = 540 level 3 European territorial units for statistics —NUTS3 in Belgium (40), France (96), Italy (110), Netherlands (44), Spain (50), Sweden(21) and United Kingdom (179)— from 2020 provisional week deaths, the population numbers for 2020, and observations in previous years (reference or baseline), all of them obtained from Eurostat web page.

Excess death rates are classified in three tiers. Largest 27 excess death rates (tier 1, E > 1721× 10−6) were distributed exponentially with empirical complementary cumulative distribution function (empirical survival function) S following S ∝ 2−E/ε with ε1 = 958(42) × 10−6. Tier 2 (the next 52 largest excess death rates, E < 1142 × 10−6 also distributed exponentially with ε2 = 379.5(89) ×10−6. Tier 3 (smallest 460 excess death rates) were distributed normally.

The results suggests that when, within some regions, the outbreak is above a threshold, interaction with neighbouring region become less relevant and the outcomes —excess death rates— become exponentially distributed as it happens with independent events.
Role of treatments for diabetes and hyperlipidaemia in risk and mortality of primary and secondary brain tumours
Authors: Robinson Jamie W , Martin Richard M , Ozawa Mio , Elwenspoek Martha M C , Redaniel Maria Theresa , Kurian Kathreena M , Ben-Shlomo Yoav
Published: September 2020

Background

In vivo and observational studies suggest anti-hyperlipidaemic and -diabetic medications (fibrates and glitazones respectively) may have a role in primary prevention and progression of brain tumours by targeting PPAR-α and -γ, respectively.

Methods

We conducted a case-control and clinical cohort study within the UK Clinical Practice Research Datalink. We identified adults (aged 18 years+) with primary or secondary brain tumours diagnosed between 2000-2016 prescribed either fibrates or glitazones and identified four controls based on age, sex and drug exposure duration. Multivariable logistic regression analysis estimated an association between drug exposure and brain tumour status. Cox’s survival models were used to look at risk of mortality.

Results

1,916 cases were prescribed a fibrate and 445 cases a glitazone. Our analyses showed little evidence of an association between fibrates and either risk or mortality of brain tumours (adjusted odds ratio for ever exposed PPAR-α 0.98, 95% CI: 0.77, 1.23; adjusted hazard ratio for ever exposed 0.91; 95% CI: 0.76, 1.09). We observed a reduced risk with a per-year increase in exposure duration for glitazones (adjusted odds ratio 0.88, 95% CI: 0.81, 0.96, P=0.002) but no major mortality benefit (adjusted hazard ratio 0.99, 95% CI: 0.80, 1.23).

Conclusions

Our results suggest longer duration exposure to glitazones is associated with a reduced risk of primary and secondary brain tumours but no large effect on mortality. We failed to find any strong evidence of a protective effect on risk or mortality for fibrate exposure. Further studies are required for replication and to provide more precise effect estimates.

Key Points

Repurposing existing drugs that target PPAR-α and -γ receptors may have a role in prevention and progression of brain tumours.

We observed a reduced risk between duration of glitazones and both primary and secondary brain tumours but no major reduction on mortality

We observed no major reduction of risk or mortality with fibrates

Future studies need to be undertaken to ensure replication and obtain more precise estimates

Importance of Study

The incidence of brain tumours appears to be increasing with a growing impact on years of life lost. Therapeutic options are limited, either for primary prevention or to prevent mortality of disease once developed. We investigated whether two commonly prescribed families of drugs (fibrates and glitazones) could offer potential drug-repurposing options in reducing brain tumour incidence or progression as informed by previous in vivo and observational studies. Our analyses suggest that glitazones are associated with a decreased brain tumour risk. These results can help guide future research into drug re-repurposing for brain tumour treatment.
Efficacy and Safety of Guduchi Ghan Vati in the Management of Asymptomatic COVID-19 Infection: An Open Label Feasibility Study
Authors: Kumar Abhimanyu , Prasad Govind , Srivastav Sanjay , Gautam Vinod Kumar , Sharma Neha
Published: September 2020

Background

Guduchi Ghan Vati (aqueous extract of Tinospora cordifolia) is an essential herbal plant in Indian traditional medicine (Ayurveda) that is well documented as an immunomodulator and antimicrobial agent. A recent in silico study found the therapeutic efficacy of Guduchi against SARS-CoV-2. Based on available evidence, we conducted a feasibility study of the safety and efficacy of Guduchi Ghan Vati in asymptomatic patients with covid-19.

Patients and methods

An open label, feasibility trial was conducted on 46 patients in the hospital setting. A single-arm study with no control group and blinding was executed in Jodhpur, Rajasthan, India. All patients orally received 2 tablets (1000 mg) twice daily for 2 weeks. Clinical parameters were collected at baseline, day 3, day 7 and day 14. Patients were continuously monitored for side effects and adverse reactions during the study period..

Results

Out of 46 asymptomatic patients included in the study, 40 completed the 14-day follow-up period. None developed any Covid-19 symptoms after admission to the hospital. On day 3 post-treatment, viral clearance was reported in 16 (32.5%) patients. By the end of D-7, 38 (95%) patients had viral load disappearance. Follow-up at D-14 showed that all participants tested negative.

Conclusion

In adult patients with asymptomatic Covid-19, Gudhuchi Ghan Vati could be effective. Randomized controlled trials with larger sample sizes in patients with Covid-19 are urgently needed to confirm the definite benefit with Ayurveda.
Validation and clinical evaluation of a SARS-CoV-2 Surrogate Virus Neutralization Test (sVNT)
Authors: Meyer Benjamin , Reimerink Johan , Torriani Giulia , Brouwer Fion , Godeke Gert-Jan , Yerly Sabine , Hoogerwerf Marieke , Vuilleumier Nicolas , Kaiser Laurent , Eckerle Isabella , Reusken Chantal
Published: September 2020

To understand SARS-CoV-2 immunity after natural infection or vaccination, functional assays such as virus neutralizing assays are needed. So far, assays to determine SARS-CoV-2 neutralizing antibodies rely on cell-culture based infection assays either using wild type SARS-CoV-2 or pseudotyped viruses. Such assays are labour-intensive, require appropriate biosafety facilities and are difficult to standardize.

Recently, a new surrogate virus neutralisation assay (sVNT) was described that uses the principle of an ELISA to measure the neutralization capacity of anti-SARS-CoV-2 antibodies directed against the receptor binding domain.

Here, we performed an independent evaluation of the robustness, specificity and sensitivity on an extensive panel of sera from 269 PCR-confirmed COVID-19 cases and 259 unmatched samples collected before 2020 and compared it to cell-based neutralization assays. We found a high specificity of 99.2 (95%CI: 96.9-99.9) and overall sensitivity of 80.3 (95%CI: 74.9-84.8) for the sVNT. Clinical sensitivity increased between early (< 14 days post symptom onset or post diagnosis, dpos/dpd) and late sera (>14 dpos/dpd) from 75.0 (64.7-83.2) to 83.1 (76.5-88.1). Also, higher severity was associated with an increase in clinical sensitivity. Upon comparison with cell-based neutralisation assays we determined an analytical sensitivity of 74.3 (56.4-86.9) and 98.2 (89.4-99.9) for titres ≥10 to < 40 and ≥40 to < 160, respectively. Only samples with a titre ≥160 were always positive in the sVNT.

In conclusion, the sVNT can be used as an additional assay to determine the immune status of COVID-19 infected of vaccinated individuals but its value needs to be assessed for the specific context of use.
Effect of calcium intake on iron absorption and hematologic status: A systematic review and dose-response meta-analysis of randomized trials and case-cross-over studies
Authors: Abioye Ajibola Ibraheem , Okuneye Taofik A , Odesanya Abdul-Majeed O , Adisa Olufunmilola , Abioye Asanat I , Soipe Ayorinde I , Ismail Kamal A , Yang JaeWon F , Fasehun Luther-King , Omotayo Moshood O.
Published: September 2020

Background

The interaction between dietary (and supplementary) divalent ions has been a long- standing issue in human nutrition research. Developing optimal calcium and iron supplementation recommendation needs detailed knowledge of the potential trade-offs between: a) the clinical effects of concurrent intake on iron absorption and hematological indices, and b) the potentially negative effects of separated ingestion on adherence to either or both iron and calcium supplements. Human clinical studies have examined the effects of calcium intake on iron status, but there are no meta-analyses or recent reviews summarizing the findings.

Objective

We aimed to summarize the literature on the effect of calcium consumption from meals and supplements on iron indices in humans, and quantify the pooled effects.

Design

Peer-reviewed randomized and case-cross-over studies were included in this review.

Result

The negative effect of calcium intake was statistically significant in short-term iron absorption studies but the effect magnitude was low (weighted mean difference (WMD) = -5.57%, (95% CI: -7.09, -4.04)). The effect of calcium on iron status was mixed. There was a quadratic dose-response relationship between calcium intake and serum ferritin concentration. Higher daily calcium intake was associated with a modest reduction in serum ferritin concentration. There was, however, no reduction in hemoglobin concentration (WMD = 1.22g/L, 95% CI: 0.37, 2.07).

Conclusion

The existing body of studies is insufficient to make recommendations with high confidence due to heterogeneity in design, limitations of ferritin as an iron biomarker and lack of intake studies in pregnant women. Prescribing separation of prenatal calcium and iron supplements in free living individuals is unlikely to affect the anemia burden. There is a need for effectiveness trials comparing the effects of prescribing separated intake to concurrent intake, with functional end-points as primary outcomes, and adherence to each supplement as intermediate outcomes.
An Interpretable Deep Learning Model for Early Prediction of Sepsis in the Emergency Department
Authors: Zhang Dongdong , Yin Changchang , Hunold Katherine M. , Jiang Xiaoqian , Caterino Jeffrey M. , Zhang Ping
Published: September 2020

Background

Sepsis, a life-threatening illness caused by the body’s response to an infection, is the leading cause of death worldwide and has become a global epidemiological burden. Early prediction of sepsis increases the likelihood of survival for septic patients.

Methods

The 2019 DII National Data Science Challenge enabled participating teams to develop models for early prediction of sepsis onset with de-identified electronic health records of over 100,000 unique patients. Our task is to predict sepsis onset 4 hours before its diagnosis using basic administrative and demographics, time-series vital, lab, nutrition as features. An LSTM-based model with event embedding and time encoding is proposed to model time-series prediction. We utilized the attention mechanism and global max pooling techniques to enable interpretation for the proposed deep learning model.

Results

We evaluated the performance of the proposed model on 2 use cases of sepsis onset prediction which achieved AUC scores of 0.940 and 0.845, respectively. Our team, BuckeyeAI achieved an average AUC of 0.892 and the official rank is #2 out of 30 participants.

Conclusions

Our model outperformed collapsed models (i.e., logistic regression, random forest, and LightGBM). The proposed LSTM-based model handles irregular time intervals by incorporating time encoding and is interpretable thanks to the attention mechanism and global max pooling techniques.

Availability

The code for this paper is available at: https://github.com/yinchangchang/DII-Challenge.
Environmental impact of Personal Protective Equipment supplied to health and social care services in England in the first six months of the COVID-19 pandemic
Authors: Rizan Chantelle , Reed Malcolm , Bhutta Mahmood F
Published: September 2020

Objectives

Use of Personal Protective Equipment (PPE) has been central to controlling spread of SARS-CoV2. This study aims to quantify the environmental impact of this, and to model strategies for its reduction.

Methods

Life cycle assessment was used to determine environmental impacts of PPE supplied to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use, air freighted, and disposed via clinical waste. Scenario modelling was used to determine the effect of 1) switching mode of, or eliminating, international travel during supply, 2) reducing glove use 3) using reusable alternatives, 4) maximal recycling.

Results

The carbon footprint of PPE supplied during the study period totalled 158,838 tonnes CO2e, with greatest contributions from gloves, aprons, face shields, and Type IIR surgical masks. The estimated damage to human health was 314 DALYs (disability adjusted life years), impact on ecosystems was 0.67 species.year (loss of local species per year), and impact on resource depletion costing US $ 20.4 million.

Scenario modelling indicated one-third of the carbon footprint could be avoided through switching to shipping, and by 41% through manufacturing PPE in the UK. The carbon footprint was reduced by 83% compared with the base scenario through a combination of UK manufacturing, reducing glove use, using reusable gowns and reuse of face shields, and maximal recycling, estimated to save 259 DALYS, 0.54 species.year, and US $ 15 million due to resource depletion.

Conclusions

The environmental impact of PPE could be reduced through shipping supplies or domestic manufacture, rationalising glove use, using reusables where possible, and optimising waste management.

SUMMARY BOX

What is already known on this topic

The current COVID-19 pandemic has seen a massive global increase in the use and manufacture of PPE which has contributed, with other measures, to the reduction in transmission of the virus in many countries.

What this study adds

The carbon footprint of PPE supplied to health and social care in England in the first six months of the COVD-19 pandemic was 158,848 tonnes CO2e, equivalent to around 65,500 return flights from London to New York.

The environmental impact of PPE could be reduced through shipping supplies or domestic manufacture, rationalising glove use, using reusables where possible, and optimising waste processing.
Multivariate GWAS elucidates the genetic architecture of alcohol consumption and misuse, corrects biases, and reveals novel associations with disease
Authors: Mallard Travis T , Savage Jeanne E , Johnson Emma C , Huang Yuye , Edwards Alexis C , Hottenga Jouke J , Grotzinger Andrew D , Gustavson Daniel E , Jennings Mariela V , Anokhin Andrey , Dick Danielle M , Edenberg Howard J , Kramer John R , Lai Dongbing , Meyers Jacquelyn L , Pandey Ashwini K , Harden Kathryn Paige , Nivard Michel G , de Geus Eco JC , Boomsma Dorret I , Agrawal Arpana , Davis Lea K , Clarke Toni-Kim , Palmer Abraham A , Sanchez-Roige Sandra
Published: September 2020

Genome-wide association studies (GWASs) of the Alcohol Use Disorder Identification Test (AUDIT), a ten-item screener for alcohol use disorder (AUD), have elucidated novel loci for alcohol consumption and misuse. However, these studies also revealed that GWASs can be influenced by numerous biases (e.g., measurement error, selection bias), which have led to inconsistent genetic correlations between alcohol involvement and AUD, as well as paradoxically negative genetic correlations between alcohol involvement and psychiatric disorders/medical conditions. To explore these unexpected differences in genetic correlations, we conducted the first item-level and largest GWAS of AUDIT items (N=160,824), and applied a multivariate framework to mitigate previous biases. In doing so, we identified novel patterns of similarity (and dissimilarity) among the AUDIT items, and found evidence of a correlated two-factor structure at the genetic level (Consumption and Problems, rg=.80). Moreover, by applying empirically-derived weights to each of the AUDIT items, we constructed an aggregate measure of alcohol consumption that is strongly associated with alcohol dependence (rg=.67) and several other psychiatric disorders, and no longer positively associated with health and positive socioeconomic outcomes. Lastly, by performing polygenic analyses in three independent cohorts that differed in their ascertainment and prevalence of AUD, we identified novel genetic associations between alcohol consumption, alcohol misuse, and human health. Our work further emphasizes the value of AUDIT for both clinical and genetic studies of AUD, and the importance of using multivariate methods to study genetic associations that are more closely related to AUD.
Insufficient Eye Tracking Data Leads to Errors in Evaluating Typical and Atypical Fixation Preferences
Authors: Reimann Gabrielle E. , Walsh Catherine , Csumitta Kelsey D. , McClure Patrick , Pereira Francisco , Martin Alex , Ramot Michal
Published: September 2020

Eye tracking provides insights into social processing and its deficits in disorders such as autism spectrum disorder (ASD), especially in conjunction with dynamic, naturalistic stimuli. However, reliance on manual stimuli segmentation severely limits scalability. We assessed how the amount of available data impacts individual reliability of fixation preference for different facial features, and the effect of this reliability on between-group differences. We trained an artificial neural network to segment 22 Hollywood movie clips (7410 frames). We then analyzed fixation preferences in typically developing participants and participants with ASD as we incrementally introduced movie data for analysis. Although fixations were initially variable, results stabilized as more data was added. Additionally, while those with ASD displayed significantly fewer face-centered fixations (p<.001), they did not differ in eye or mouth fixations. Our results highlight the validity of treating fixation preferences as a stable individual trait, and the risk of misinterpretation with insufficient data.
ANNAVP, using neural networks to predict neutralization efficiency of antibodies against viral strains and to cluster strains by protein sequence
Authors: Cristian Ghiță Iulian
Published: September 2020

Studying viral antibody neutralization data is a complex task and knowledge relating to the effectiveness of a particular antibody to particular strains of viruses cannot easily be extrapolated to other new, related strains. We have developed ANNAVP, a software that uses neural networks to model viral protein data. ANNAVP uses supervised or unsupervised learning and viral protein sequence data to form correlations between different strains and to predict the effectiveness of neutralizing agents against them.
Temporal dynamics of functional networks in long-term infant scalp EEG
Authors: Smith Rachel J. , Alipourjeddi Ehsan , Garner Cristal , Maser Amy L. , Shrey Daniel W. , Lopour Beth A.
Published: September 2020

Human functional connectivity networks are modulated on time scales ranging from milliseconds to days. Rapid changes in connectivity over short time scales are a feature of healthy cognitive function, and variability over long time scales can impact the likelihood of seizure occurrence. However, relatively little is known about modulation of healthy functional networks over long time scales. To address this, we analyzed functional connectivity networks calculated from long-term EEG recordings from 19 healthy infants. Networks were subject-specific, as inter-subject correlations between weighted adjacency matrices were low. However, within individual subjects, both sleep and wake networks were stable over time, with stronger functional connectivity during sleep than wakefulness. This enabled automatic separation of wakefulness and sleep states via principle components analysis of the functional network time series, with median classification accuracy of 91%. Lastly, we found that network strength, degree, clustering coefficient, and path length significantly varied with time of day, when measured in both wakefulness and sleep. Together, these results suggest that modulation of healthy functional networks occurs over long timescales and is robust and repeatable. Accounting for such temporal periodicities may improve the physiological interpretation and use of functional connectivity analysis to investigate brain function in health and disease.
Commercial fishery disturbance of the global open-ocean carbon sink
Authors: Cavan E. L. , Hill S. L.
Published: September 2020

Primary production in the global oceans fuels multiple ecosystem services including fisheries, and the open-ocean biological carbon sink, which support food security and livelihoods1, and the regulation of atmospheric CO2levels2respectively. The spatial distributions of these two services are driven by primary production and it is likely that ecosystem disturbance from fishing impacts both the carbon sink and atmospheric CO2. Yet the extent of these impacts from past, present and future fishing is unknown. Here we show that 23% of global export and 40% of fishing effort are concentrated in zones of intensive overlap representing 7% of the global ocean area. This overlap is particularly evident in the Northeast Atlantic and Northwest Pacific. Small pelagic fish dominate catches in these regions and globally, and their exploitation will reduce faecal pellet carbon sinks and may cause tropic cascades affecting plankton communities important in sinking carbon. There is an urgent need to address how fisheries affect carbon cycling, and for policy objectives to include protecting the carbon sink, particularly in areas where fishing intensity and carbon export and storage are high.
College Openings in the United States Increased Mobility and COVID-19 Incidence
Authors: Andersen Martin S. , Bento Ana I. , Basu Anirban , Marsicano Christopher R. , Simon Kosali I.
Published: September 2020

School and college reopening-closure policies are considered one of the most promising non-pharmaceutical interventions for mitigating infectious diseases. Nonetheless, the effectiveness of these policies is still debated, largely due to the lack of empirical evidence on behavior during implementation. We examined U.S. college reopenings’ association with changes in human mobility within campuses and in COVID-19 incidence in the counties of the campuses over a twenty-week period around college reopenings in the Fall of 2020. We used an integrative framework, with a difference-in-differences design comparing areas with a college campus, before and after reopening, to areas without a campus and a Bayesian approach to estimate the daily reproductive number (Rt). We found that college reopenings were associated with increased campus mobility, and increased COVID-19 incidence by 3.4 cases per 100,000 (95% confidence interval [CI]: 1.5 – 5.4), or a 25% increase relative to the pre-period mean. This reflected our estimate of increased transmission locally after reopening. A greater increase in county COVID-19 incidence resulted from campuses that drew students from counties with high COVID-19 incidence in the weeks before reopening (χ2(2) = 10.19, p = 0.006). Even by Fall of 2021, large shares of populations remained unvaccinated, increasing the relevance of understanding non-pharmaceutical decisions over an extended period of a pandemic. Our study sheds light on movement and social mixing patterns during the closure-reopening of colleges during a public health threat, and offers strategic instruments for benefit-cost analyses of school reopening/closure policies.