bluuebunny/crossref_metadata_2025 huggingface dataset:
S88. THE EFFECT OF SLEEP QUALITY ON ATTENUATED PSYCHOTIC SYMPTOMS IN A NON-CLINICAL SAMPLE OF YOUNG ADULTS
Authors: Hanna Donncha , James Shannon Ciaran , Clarke Stephen , Davidson Sarah , Mulholland Ciaran
Published: May 2020

Background

Background: One factor known to be associated with attenuated psychotic symptoms is poor sleep but it is not known if poor sleep increases the likelihood of experiencing multiple attenuated psychotic symptoms, which research suggests may be suggestive of an At-Risk Mental State (ARMS). The study aimed to determine if poor sleep quality makes a unique contribution to predicting the number of attenuated psychotic symptoms endorsed in a prodromal questionnaire and the level of distress associated with the symptoms, when accounting for demographics, depression and drug/alcohol use variables.

Methods

Method: An online survey was conducted using Amazon’s online crowdsourcing service Mechanical Turk (MTurk). The sample was 1,013 adults (18 to 36 years) from the general population in the USA. The survey consisted of the Prodromal Questionnaire 16 (PQ-16), the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire 9 (PHQ-9), the DAST-10 and the AUDIT. Regression analyses were performed with the PQ-16 as the dependent variable, and sleep quality as the predictor variable, while controlling for sociodemographic variables, depression, and alcohol/drug abuse.

Results

Results: 37% of the sample endorsed six or more PQ-16 items, which may be suggestive of an at-risk mental state, with sleep disturbance significantly increasing the likelihood (Odds ratio 2.09 <.001) of endorsing six or more PQ-16 items. After controlling for socio-demographic variables, depression and drug/alcohol abuse, poor sleep quality made a unique contribution of 5.8% of the variance accounted for in level of distress experienced by attenuated psychotic symptoms.

Discussion

Conclusion: A significant proportion of young adults in the general population may have an at-risk mental state. The results add to the evidence that sleep disturbance is a contributory factor in attenuated psychotic symptoms. Further research is required to investigate the possible mechanisms (e.g. impaired cognitive processes) through which poor sleep influences attenuated psychotic symptoms and if effective treatment of sleep disturbance can influence the likelihood of developing an at-risk mental state.
S97. IS EARLY DEBUT OF SUBSTANCE USE ASSOCIATED WITH VIOLENT OFFENDING IN SCHIZOPHRENIA?
Authors: Breivik Storvestre Guttorm , Jensen Arvid , Bjerke Espen , Tesli Natalia , Rosaeg Cato , Lagerberg Trine , Friestad Christine , Andreassen Ole A , Melle Ingrid , Haukvik Unn K
Published: May 2020

Background

Substance use is one of many risk factors for schizophrenia, and substance use is also associated with violent offending.

This study compared a group of individuals suffering from schizophrenia with a history of violent offending (SCZ-V) to a group of schizophrenia patients without any history of violent offending (SCZ-NV). We investigated whether there is a difference between the SCZ-V and SCZ-NV groups when it comes to lifetime use, and debut age for use, of alcohol, cannabis, and amphetamines.

Methods

This study examined the overall lifetime substance-use and the debut age of use of alcohol, cannabis and amphetamine among a selected group of patients with schizophrenia and a history of violent offending (SCZ-V n=25) recruited from psychiatric security wards in South-Eastern Norway, compared to a matched group of schizophrenia patients without violent offending (SCZ-NV n=34). Participants completed interviews and questionnaires to confirm diagnoses and to map the history of substance use.

Results

While we found no significant difference in lifetime use of alcohol and cannabis between the groups (alcohol: SCZ-V: 88%, SCZ-NV: 97%, cannabis: SCZ-V: 76%, SCZ-NV: 71%), the SCZ-V group reported significantly more lifetime use of amphetamines compared to the SCZ-NV group (SCZ-V: 76% vs SCZ-NV: 18%, p<0.001). When comparing debut ages for substance use, the SCZ-V group was significantly younger than the SCZ-NV group at debut of alcohol (Mean age SCZ-V: 13.8 vs. SCZ-NV: 16.4, p=.004), cannabis (Mean age SCZ-V: 14.0 vs. SCZ-NV: 18.3, p<.001), and amphetamines (Mean age SCZ-V: 15.6 vs. SCZ-NV: 21.2, p=.001).

Discussion

The SCZ-V group reported significantly more lifetime use of amphetamine and a significantly lower debut age for use of alcohol, cannabis, and amphetamines than the SCZ-NV group.

According to the Norwegian Institute of Public Health, the average lifetime uses of cannabis for the general Norwegian population between 16 and 64 years old is 20.6%, while the average for the population between 16 and 34 years old when it comes to ever have used amphetamines is 4.7%. The numbers for both the SCZ-V and the SCZ-NV groups were noticeably higher than the population averages. What separates the groups are the significantly lower debut age of drug use in the SCZ-V group, and especially the higher number of lifetime amphetamines use.

The findings point towards an association between the early debut of use of alcohol, cannabis, and amphetamines, and later violent offending in patients suffering from schizophrenia.
S112. ELUCIDATING THE CHRONOLOGY OF FLUCTUATIONS IN BASIC SYMPTOMS, EARLY SIGNS AND PSYCHOTIC SYMPTOMS IN ESTABLISHED PSYCHOSIS USING REPEATED MEASURES DATA GATHERED USING A SMARTPHONE APP
Authors: Eisner Emily , Drake Richard , Emsley Richard , Barrowclough Christine , Bucci Sandra
Published: May 2020

Background

Psychosis relapses are common, have profound adverse consequences for patients, and are costly to health services. ‘Early signs’ (e.g. anxiety; insomnia) have been used to predict relapse, in the hope of prevention or mitigation, with moderate sensitivity and specificity. Recent studies have provided preliminary prospective evidence that assessing ‘basic symptoms’ (e.g. vivid colour vision; disturbances in expressive speech) in addition to conventional early signs improves relapse prediction.

Basic symptoms are assumed to be one of the earliest, most basic subjective expressions of the underlying neurobiological disruption preceding the development of psychosis. There is some empirical evidence from ultra-high risk groups suggesting that basic symptoms do indeed emerge prior to other risk indicators during the prodromal period. However, no studies to date have examined the relative timing of increases in basic symptoms, conventional early signs and psychotic symptoms in individuals with established psychosis.

In the current study, we used time-lagged, repeated measures, prospective data to test whether increased basic symptoms would precede increased conventional early signs, and in turn increased psychotic symptoms.

Methods

Individuals who had experienced a relapse of psychosis within the past year (n=18) were asked to use a smartphone app (‘ExPRESS’) weekly for six months to report early signs, basic symptoms and psychotic symptoms. Participants completed 65% of app assessments over the 6 month follow-up period, providing >200 observations in total. These data were analyzed using mixed effects models to account for clustering within individuals and to allow for missing data.

Results

App items showed high concurrent validity with researcher-rated psychotic symptoms (ρ range 0.80 to 0.87, p<0.001) and basic symptoms (ICC=0.76, p<0.001) over six months. The results of the mixed effects analyses described above will be presented in full, and their theoretical and clinical implications will be discussed.

Discussion

We anticipate that the findings of this study will be of theoretical interest. Within the socio-developmental-cognitive model (Howes & Murray, 2014), it would be logical to equate basic symptoms with the initial ‘anomalous experiences’ that are proposed to occur as a result of a disrupted dopamine system. Conventional early signs may then either occur later in the deterioration process laid out in the model or, as a heterogeneous group, may relate to more than one stage of the process. The results of the current study may help to elucidate the place of basic symptoms and conventional early signs within the socio-developmental-cognitive model. The findings may also lend support to the idea that basic symptoms are dopaminergic in origin.
S243. RACIAL AND ETHNIC DIFFERENCES IN PATHWAY TO CARE AND BASELINE CHARACTERISTICS IN EARLY INTERVENTION SERVICES FOR PSYCHOSIS IN NEW YORK STATE
Authors: van der Ven Els , Smith Stephen , Rawlins Yasmin , Nossel Ilana , Basaraba Cale , Wall Melanie , Scodes Jennifer , Veling Wim , Marino Leslie , Dixon Lisa
Published: May 2020

Background

The racial and ethnic background of individuals with psychosis may shape their pathway to early intervention services and clinical presentation at admission. Studies from Europe and Canada demonstrate that black minority patients with first-episode psychosis experience a more adverse and coercive pathway to care. The extent to which these findings can be extrapolated to the US context is unknown. The aims of this study are (1) to compare baseline contextual and clinical characteristics, and (2) to examine care pathways by race and ethnicity among young people with psychosis in early intervention services.

Methods

This study included individuals with a recent-onset (<2 years) psychosis aged 16 to 30 years enrolled at 19 early intervention programs across New York State. Clinicians collected data on pathway to care, demographic, social and clinical variables at program entry. Level of functioning was assessed using the social, occupational and symptomatic functioning subscales of the MIRECC GAF.

Results

The sample included 767 individuals with a non-Hispanic white (n=209, 27.2%), non-Hispanic black (277, 36.1%), Hispanic (218, 28.4%), or Asian (63, 8.2%) racial/ethnic background. Compared to non-Hispanic white, minority individuals were more likely to have public or no insurance and, overall, had a lower level of completed education. In terms of pathway to care, a lower proportion of non-Hispanic black (65.7%) and Asian (58.7%) participants had previously used mental health services compared to the non-Hispanic white group (78.0%). In contrast, psychiatric hospital or emergency department admissions in the 90 days prior to program enrollment were more frequent among all minority groups in comparison to the non-Hispanic white group. There were no significant differences by race and ethnicity in the level of symptoms or social functioning at baseline.

Discussion

Our findings suggest a pattern of mental health service use among minority groups with psychosis characterized by less mental health contacts but more inpatient and emergency care prior to the initiation of early intervention services. This trend could be partly explained by racial and ethnic patterning at the contextual level, including financial barriers to care, less so by racial/ethnic differences in illness severity. Our findings are consistent with evidence demonstrating an overrepresentation of minority individuals, especially African-Americans, in psychiatric emergency services suggesting a gap in unmet mental health need among minority populations in the US.
Longitudinal Assessment and Functional Neuroimaging of Movement Variability Reveal Novel Insights Into Motor Dysfunction in Clinical High Risk for Psychosis
Authors: Dean Derek J , Bernard Jessica A , Damme Katherine S F , O’Reilly Randall , Orr Joseph M , Mittal Vijay A
Published: May 2020

Motor dysfunction in youth at clinical high risk (CHR) for psychosis is thought to reflect abnormal neurodevelopment within cortical-subcortical motor circuits and may be important for understanding clinical trajectories of CHR individuals. However, to date, our perspective of brain-behavior relationships has been informed solely by cross-sectional correlational studies linking behavior in the lab to brain structure or respective resting-state network connectivity. Here, we assess movement dysfunction from 2 perspectives: study 1 investigates the longitudinal progression of handwriting variability and positive symptoms in a sample of 91 CHR and healthy controls during a 12-month follow-up and study 2 involves a multiband functional magnetic resonance imaging task exploring the relationship between power grip force stability and motor network brain activation in a subset of participants. In study 1, we found that greater handwriting variability was a stable feature of CHR participants who experienced worse symptom progression. Study 2 results showed that CHR individuals had greater variability in their grip force and greater variability was related to decreased activation in the associative cortico-striatal network compared to controls. Motor variability may be a stable marker of vulnerability for psychosis risk and possible indicator of a vulnerable cortico-striatal brain network functioning in CHR participants, although the effects of antipsychotic medication should be considered.
When to be temperate: on the fitness benefits of lysis vs. lysogeny
Authors: Li Guanlin , Cortez Michael H , Dushoff Jonathan , Weitz Joshua S
Published: May 2020

Bacterial viruses, that is ‘bacteriophage’ or ‘phage’, can infect and lyse their bacterial hosts, releasing new viral progeny. In addition to the lytic pathway, certain bacteriophage (i.e. ‘temperate’ bacteriophage) can also initiate lysogeny, a latent mode of infection in which the viral genome is integrated into and replicated with the bacterial chromosome. Subsequently, the integrated viral genome, that is the ‘prophage’, can induce and restart the lytic pathway. Here, we explore the relationship among infection mode, ecological context, and viral fitness, in essence asking: when should viruses be temperate? To do so, we use network loop analysis to quantify fitness in terms of network paths through the life history of an infectious pathogen that start and end with infected cells. This analysis reveals that temperate strategies, particularly those with direct benefits to cellular fitness, should be favored at low host abundances. This finding applies to a spectrum of mechanistic models of phage–bacteria dynamics spanning both explicit and implicit representations of intra-cellular infection dynamics. However, the same analysis reveals that temperate strategies, in and of themselves, do not provide an advantage when infection imposes a cost to cellular fitness. Hence, we use evolutionary invasion analysis to explore when temperate phage can invade microbial communities with circulating lytic phage. We find that lytic phage can drive down niche competition amongst microbial cells, facilitating the subsequent invasion of latent strategies that increase cellular resistance and/or immunity to infection by lytic viruses—notably this finding holds even when the prophage comes at a direct fitness cost to cellular reproduction. Altogether, our analysis identifies broad ecological conditions that favor latency and provide a principled framework for exploring the impacts of ecological context on both the short- and long-term benefits of being temperate.
Extinct and extant Pacific Trogossitidae and the evolution of Cleroidea (Coleoptera) after the Late Triassic biotic crisis
Authors: Kolibáč Jiří , Bocakova Milada , Liebherr James K , Ramage Thiboult , Porch Nick
Published: May 2020

A new subgenus of Tenebroides, Polynesibroides subgen. nov., is established for six potentially extinct beetles, Tenebroides atiu, T. moorea, T. raivavae, T. rimatara, T. tubuai and T. mihiura spp. nov., described from the Cook, Austral and Society Islands based on subfossil fragments, and the extant T. tahiti sp. nov. from the island of Tahiti, Society Islands. Here we present the first detailed time-scaled phylogeny of the superfamily Cleroidea inferred from our four-gene dataset, including T. tahiti. Bayesian tip-dating, incorporating 17 fossils, estimated that Cleroidea appeared at the end of the Triassic (~210 Mya). The split of Biphyllidae + Byturidae + Phloiophilidae was reconstructed at ~204 Mya, followed by Early Jurassic separation of Trogossitidae (~200 Mya), Acanthocnemidae (~197 Mya), stem Cleridae–Thanerocleridae–Chaetosomatidae (~194 Mya), Peltidae, Lophocateridae, Decamerinae and the melyrid lineage (~191 Mya). Trogossitidae diversified by separation of Kolibacia (~136 Mya) in the Cretaceous, followed by parting Temnoscheila + Nemozoma and Airora + Tenebroides lineages (~113 Mya). Tenebroides radiated ~75 Mya and T. tahiti diverged from Panamanian taxa in the Middle Eocene (~40 Mya). Fourteen morphological characters of Pacific trogossitids were analysed. Parallelodera, including the Panamanian species, is nested within Tenebroides being sister to Polynesibroides. Therefore, Parallelodera is classified as a subgenus of Tenebroides. Tenebroides fairmairei is placed in the subgenus Parallelodera. A Neotropical origin for Parallelodera and Polynesibroides is inferred.
Sensory bias and signal detection trade-offs maintain intersexual floral mimicry
Authors: Russell Avery L. , Kikuchi David W. , Giebink Noah W. , Papaj Daniel R.
Published: May 2020

Mimicry is common in interspecies interactions, yet conditions maintaining Batesian mimicry have been primarily tested in predator–prey interactions. In pollination mutualisms, floral mimetic signals thought to dupe animals into pollinating unrewarding flowers are widespread (greater than 32 plant families). Yet whether animals learn to both correctly identify floral models and reject floral mimics and whether these responses are frequency-dependent is not well understood. We tested how learning affected the effectiveness and frequency-dependence of imperfect Batesian mimicry among flowers using the generalist bumblebee,
Bombus impatiens
, visiting
Begonia odorata
, a plant species exhibiting intersexual floral mimicry. Unrewarding female flowers are mimics of pollen-rewarding male flowers (models), though mimicry to the human eye is imperfect. Flower-naive bees exhibited a perceptual bias for mimics over models, but rapidly learned to avoid mimics. Surprisingly, altering the frequency of models and mimics only marginally shaped responses by naive bees and by bees experienced with the distribution and frequency of models and mimics. Our results provide evidence both of exploitation by the plant of signal detection trade-offs in bees and of resistance by the bees, via learning, to this exploitation. Critically, we provide experimental evidence that imperfect Batesian mimicry can be adaptive and, in contrast with expectations of signal detection theory, functions largely independently of the model and mimic frequency.

This article is part of the theme issue ‘Signal detection theory in recognition systems: from evolving models to experimental tests’.
Decision making in the face of a deadly predator: high-amplitude behavioural thresholds can be adaptive for rainforest crickets under high background noise levels
Authors: Römer Heiner , Holderied Marc
Published: May 2020

Many insect families have evolved ears that are adapted to detect ultrasonic calls of bats. The acoustic sensory cues indicating the presence of a bat are then used to initiate bat avoidance behaviours. Background noise, in particular at ultrasonic frequencies, complicates these decisions, since a response to the background may result in costly false alarms. Here, we quantify bat avoidance responses of small rainforest crickets (Gryllidae, Trigoniinae), which live under conditions of high levels of ultrasonic background noise. Their bat avoidance behaviour exhibits markedly higher thresholds than most other studied eared insects. Their responses do not qualitatively differ at suprathreshold amplitudes up to sound pressure levels of 105 dB. Moreover, they also exhibit evasive responses to single, high-frequency events and do not require the repetitive sequence of ultrasonic calls typical for the search phase of bat echolocation calls. Analysis of bat and katydid sound amplitudes and peak frequencies in the crickets' rainforest habitat revealed that the cricket's behavioural threshold would successfully reject the katydid background noise. Using measurements of the crickets' echo target strength for bat predators, we calculated the detection distances for both predators and prey. Despite their high behavioural threshold, the cricket prey still has a significant detection advantage at frequencies between 20 and 40 kHz. The low-amplitude bat calls they ignore are no predation threat because even much louder calls would be detected before the bat would hear the cricket echo. This leaves ample time for evasive actions. Thus, a simple decision criterion based on a high-amplitude behavioural threshold can be adaptive under the high background noise levels in nocturnal rainforests, in avoiding false alarms and only missing detection for bat calls too far away to pose a risk.

This article is part of the theme issue ‘Signal detection theory in recognition systems: from evolving models to experimental tests’.
Signal detection: applying analysis methods from psychology to animal behaviour
Authors: Sumner Christian J. , Sumner Seirian
Published: May 2020

Conspecific acceptance thresholds (Reeve 1989
Am. Nat.
133
, 407–435), which have been widely applied to explain ecological behaviour in animals, proposed how sensory information, prior information and the costs of decisions determine actions. Signal detection theory (Green & Swets 1966
Signal detection theory and psychophysics
; SDT), which forms the basis of CAT models, has been widely used in psychological studies to partition the ability to discriminate sensory information from the action made as a result of it. In this article, we will review the application of SDT in interpreting the behaviour of laboratory animals trained in operant conditioning tasks and then consider its potential in ecological studies of animal behaviour in natural environments. Focusing on the nest-mate recognition systems exhibited by social insects, we show how the quantitative application of SDT has the potential to transform acceptance rate data into independent indices of cue sensitivity and decision criterion (also known as the acceptance threshold). However, further tests of the assumptions underlying SDT analysis are required. Overall, we argue that SDT, as conventionally applied in psychological studies, may provide clearer insights into the mechanistic basis of decision making and information processing in behavioural ecology.

This article is part of the theme issue ‘Signal detection theory in recognition systems: from evolving models to experimental tests’.
To accept or reject heterospecific mates: behavioural decisions underlying premating isolation
Authors: Shizuka Daizaburo , Hudson Emily J.
Published: May 2020

Premating isolation in animals involves decision-making processes that affect whether individuals accept or reject heterospecific mates. An integrative understanding of the behavioural processes underlying heterospecific acceptance can clarify the conditions under which premating isolation evolves. As an illustration, we review how Reeve's (Reeve 1989Am. Nat.133, 407–435. (doi:10.1086/284926)) acceptance threshold model can help make sense of patterns of premating isolation in nature. This model derives a threshold trait value for acceptance for rejection of recipients of an action (e.g. mating) based on the fitness consequences of these decisions. We show that the maintenance of partial reproductive isolation can be an outcome of optimal acceptance thresholds, even in the face of reinforcement. We also use this model to clarify how the composition of multispecies communities can shape premating isolation. The acceptance threshold model can also be viewed as the behavioural underpinning of reproductive character displacement and cascading reinforcement. Finally, we highlight potential limitations of the acceptance threshold model with respect to investigating the role of sexual selection in speciation, and we propose that integration of behavioural models in speciation research will help us gain a full picture of the mechanisms underlying premating isolation.

This article is part of the theme issue ‘Signal detection theory in recognition systems: from evolving models to experimental tests’.
Contribution of HDAC3 to transcriptional repression by the human papillomavirus 31 E8^E2 protein
Authors: Dreer Marcel , Blondzik Saskia , Straub Elke , Iftner Thomas , Stubenrauch Frank
Published: May 2020

Human papillomaviruses (HPV) such as HPV16 and HPV31 encode an E8^E2 protein that acts as a repressor of viral replication and transcription. E8^E2′s repression activities are mediated via the interaction with host-cell NCoR (nuclear receptor corepressor)/SMRT (silencing mediator of retinoid and thyroid receptors) corepressor complexes, which consist of NCoR, its homologue SMRT, GPS2 (G-protein pathway suppressor 2), HDAC3 (histone deacetylase 3), TBL1 (transducin b-like protein 1) and its homologue TBLR1 (TBL1-related protein 1). We now provide evidence that transcriptional repression by HPV31 E8^E2 is NCoR/SMRT-dependent but surprisingly always HDAC3-independent when analysing different HPV promoters. This is in contrast to the majority of several cellular transcription factors using NCoR/SMRT complexes whose transcriptional repression activities are both NCoR/SMRT- and HDAC3-dependent. However, NCoR/SMRT-dependent but HDAC3-independent repression has been described for specific cellular genes, suggesting that this may not be specific for HPV promoters but could be a feature of a subset of NCoR/SMRT-HDAC3 regulated genes.
Mycoplasma pneumoniae biofilms grown in vitro: traits associated with persistence and cytotoxicity
Authors: Feng Monica , Schaff Andrew C. , Balish Mitchell F.
Published: May 2020

The atypical bacterial pathogen

Mycoplasma pneumoniae

is a leading etiological agent of community-acquired pneumonia in humans; infections are often recalcitrant, recurrent and resistant to antibiotic treatment. These characteristics suggest a mechanism that facilitates long-term colonization in hosts. In an in vitro setting,

M. pneumoniae

forms biofilms that are unusual in that motility plays no more than a very limited role in their formation and development. Given the unusual nature of

M. pneumoniae

biofilms, open questions remain concerning phenotypes associated with persistence, such as what properties might favour the bacteria while minimizing host damage.

M. pneumoniae

also produces several cytotoxic molecules including community-acquired respiratory distress syndrome (CARDS) toxin, H2S and H2O2, but how it deploys these agents during growth is unknown. Whereas several biochemical techniques for biofilm disruption were ineffective, sonication was required for disruption of

M. pneumoniae

biofilms to generate individual cells for comparative studies, suggesting unusual physical properties likely related to the atypical cell envelope. Nonetheless, like for other bacteria, biofilms were less susceptible to antibiotic inhibition and complement killing than dispersed cells, with resistance increasing as the biofilms matured. CARDS toxin levels and enzymatic activities associated with H2S and H2O2 production were highest during early biofilm formation and decreased over time, suggesting attenuation of virulence in connection with chronic infection. Collectively, these findings result in a model of how

M. pneumoniae

biofilms contribute to both the establishment and propagation of

M. pneumoniae

infections, and how both biofilm towers and individual cells participate in persistence and chronic disease.
Coronavirus protective immunity is short-lasting
Authors: Edridge Arthur W. D. , Kaczorowska Joanna , Hoste Alexis C. R. , Bakker Margreet , Klein Michelle , Jebbink Maarten F. , Matser Amy , Kinsella Cormac M. , Rueda Paloma , Prins Maria , Sastre Patricia , Deijs Martin , van der Hoek Lia
Published: May 2020

In the current COVID-19 pandemic a key unsolved question is the duration of acquired immunity in recovered individuals. The recent emergence of SARS-CoV-2 precludes a direct study on this virus, but the four seasonal human coronaviruses may reveal common characteristics applicable to all human coronaviruses. We monitored healthy subjects over a time span of 35 years (1985-2020), providing a total of 2473 follow up person-months, and determined a) the time to reinfection by the same seasonal coronavirus and b) the dynamics of coronavirus antibody depletion post-infection. An alarmingly short duration of protective immunity to coronaviruses was found. Reinfections occurred frequently at 12 months post-infection and there was for each virus a substantial reduction in antibody levels as soon as 6 months post-infection.
Basic emergency Obstetric and Neonatal Care Knowledge retention and Skills of Health Professionals in Burundi following an ALARM International Program Training: A pilot study
Authors: Kalay Anifa Luyinga , Mareschal Veronique , Ndereye Juma , Cook Jocelynn
Published: May 2020

Background

This study describes the immediate and short-term improvement in basic emergency obstetric and neonatal care (BEmONC) knowledge and skills after ALARM International Programme (AIP) training in Burundi.

Subjects and Method

In 2017, sixteen health professionals participated in a 5-day AIP training. They completed pre and post course tests. At the end of the training, they did objective structured clinical examinations (OSCE) on postpartum hemorrhage (PPH), shoulder dystocia and neonatal resuscitation. In 2018, a refresher course was offered to participants who scored the highest in the 2017 post-training test. Pre and post tests were administered. Mean pre- and post-test scores and t-paired test was performed to determine the knowledge change and retention between 2017 and 2018. Mean OSCE scores were calculated to describe acquired clinical skills at the 2017 training. A one-way ANOVA test was performed to assess the differences between cadres’ scores in the tests and the OSCEs.

Results

In 2017, pre and post scores were significantly different within cadres except imidwives: physicians t(5)=8.77(p<0.05), midwives t(1)=5,29 (p=0,11) and nurses t(7)=7,91(p<0.05) In 2018, the mean score was 67% (± 10.31) on the pre-test and was 82% (± 5.78) in 2017 post-test. The difference was significant (t(7)=4.80, p<0.05). Scores were significantly different between cadres in PPH [F=(2,13)=6.17, p <0.05)] and dystocia [F=(2,13)=3.92, p <0.05)].

Conclusion

An immediate gain in knowledge and acquisition of critical skills was observed in all cadres. Knowledge significantly decreased eight months following AIP training. Supervision, mentoring of trainees and continuing medical education are needed following the initial training.
Feasibility of using alternative swabs and storage solutions for paired SARS-CoV-2 detection and microbiome analysis in the hospital environment
Authors: Minich Jeremiah J. , Ali Farhana , Marotz Clarisse , Belda-Ferre Pedro , Chiang Leslie , Shaffer Justin P. , Carpenter Carolina S. , McDonald Daniel , Gilbert Jack , Allard Sarah M. , Allen Eric E , Knight Rob , Sweeney Daniel A. , Swafford Austin D.
Published: May 2020

Background

Determining the role of fomites in the transmission of SARS-CoV-2 is essential in the hospital setting and will likely be important outside of medical facilities as governments around the world make plans to ease COVID-19 public health restrictions and attempt to safely reopen economies. Expanding COVID-19 testing to include environmental surfaces would ideally be performed with inexpensive swabs that could be transported safely without concern of being a source of new infections. However, CDC-approved clinical-grade sampling supplies and techniques using a polyester swab are expensive, potentially expose laboratory workers to viable virus and prohibit analysis of the microbiome due to the presence of antibiotics in viral transport media (VTM). To this end, we performed a series of experiments comparing the diagnostic yield using five consumer-grade swabs (including plastic and wood shafts and various head materials including cotton, polyester, and foam) and one clinical grade swab for inhibition to RNA. For three of these swabs, we evaluated performance to detect SARS-CoV-2 in twenty intensive care unit (ICU) hospital rooms of patients with 16 COVID-19+. All swabs were placed in 95% ethanol and further evaluated in terms of RNase activity. SARS-CoV-2 was measured both directly from the swab and from the swab eluent.

Results

Compared to samples collected in VTM, 95% ethanol demonstrated significant inhibition properties against RNases. When extracting directly from the swab head as opposed to the eluent, RNA recovery was approximately 2-4x higher from all six swab types tested as compared to the clinical standard of testing the eluent from a CDC-approved polyester swab. The limit of detection (LoD) of SARs-CoV-2 from floor samples collected using the CGp or TMI swabs was similar or better than the CDC standard, further suggesting that swab type does not impact RNA recovery as measured by SARs-CoV-2. The LoD for TMI was between 0-362.5 viral particles while PE and CGp were both between 725-1450 particles. Lastly microbiome analyses (16S rRNA) of paired samples (e.g., environment to host) collected using different swab types in triplicate indicated that microbial communities were not impacted by swab type but instead driven by the patient and sample type (floor or nasal).

Conclusions

Compared to using a clinical-grade polyester swab, detection of SARS-CoV-2 from environmental samples collected from ICU rooms of patients with COVID was similar using consumer grade swabs, stored in 95% ethanol. The yield was best from the swab head rather than the eluent and the low level of RNase activity in these samples makes it possible to perform concomitant microbiome analysis.
Use of Computerized Neurocognitive Assessment Software for the Detection of Alcohol Intoxication
Authors: Janarthanan Sanjeev , Phi Huy , Flores Benjamin , Katz Yael , Eagleman David M. , Huang Bin , Hosseini Ghomi Reza
Published: May 2020

Background: Acute ingestion of alcohol impairs cognitive function and poses significant threat to public health and safety with impaired operation of motor vehicles. However, there is a lack of access to tools to assess one's cognitive impairment due to alcohol. The purpose of this study was to explore the use of a neuropsychological assessment software, BrainCheck, to assess levels of alcohol impairment based on performance on the neuropsychological assessments.

Methods: We administered the BrainCheck battery to 91 volunteer participants. Participants were required to take a baseline battery prior to any alcohol ingestion, and another testing battery after a voluntary drinking period. Blood alcohol concentration (BAC) for the participant was obtained using a breathalyzer. We performed statistical analysis comparing alcohol vs. non-alcohol performance on the BrainCheck battery, and used significant metrics of these assessments to generate predictive models.

Results: Statistical analyses were performed comparing participants performance on the BrainCheck battery before and after alcohol consumption. Comparison was also done comparing performance between an intoxicated group with a BAC > 0.05, and a sober group with a BAC ≤ 0.05. Two assessment metrics were found to be significant among comparison groups after P-value correction, and four test metrics were observed to moderately correlate (|r| > 0.40) with BAC levels. Three linear regression models (least-squares, ridge and LASSO) were built to predict participant BAC levels, with the best performing model being the least-squares model with a RMSE of 0.027. We also built a predictive logistic regression model to detect whether the participant is intoxicated or not, with 80.6% accuracy, 73.3% sensitivity, and 75.0% specificity.

Discussion: The BrainCheck battery has potential to predict alcohol impairment, including participant BAC levels and if the participant is intoxicated or not. BrainCheck provides another option to assess an individual's cognitive impairment due to alcohol, with the utility of being portable and available on one's smartphone.
Video Consultation in Lung Transplant Recipients during the COVID-19 Pandemic
Authors: Kayser Moritz Z. , Valtin Christina , Greer Mark , Karow Bernd , Fuge Jan , Gottlieb Jens
Published: May 2020

Background: The COVID-19 pandemic has disrupted health care systems worldwide. This is due to the demand for medical resources in other areas as well as concern for the risk of nosocomial SARS-CoV-2 exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant recipients. New methods like telemedicine are needed to provide care to these patients.

Methods: A retrospective analysis of video consultations (VC) in comparison to on-site visits (OSV) was performed during a six-week period in a lung transplant center in Germany. VC included a structured work-up questionnaire and vital sign documentation.

Results: During the 6-week study period, 75 VC were performed for 53 patients and 75 OSV by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred via VC. Overall, physician-patient consultations were reduced by 47% in comparison to an equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. For two VC patients, the indication for inpatient admission was established during the consultation. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high.

Conclusions: By transitioning to VC, OSV for lung transplant patients during the COVID-19 pandemic was reduced. VC was well received by the majority of patients. This technology can be adopted to provide care for a wide range of chronic illnesses.
The impact of testing and infection prevention and control strategies on within-hospital transmission dynamics of COVID-19 in English hospitals
Authors: Evans Stephanie , Agnew Emily , Vynnycky Emilia , Robotham Julie
Published: May 2020

Nosocomial transmission of SARS-CoV-2 is a key concern and evaluating the effect of testing and infection prevention control strategies is essential for guiding policy in this area. Using a within-hospital SEIR transition model of SARS-CoV-2 in a typical UK hospital, we predict that approximately 20% of infections in inpatients, and 89% of infections in HCWs were due to nosocomial transmission. Placing suspected COVID-19 patients in single rooms or bays has the potential to reduce hospital-acquired infections in patients by up to 80%. Periodic testing of HCWs has a smaller effect on the patient-burden of COVID-19 but would considerably reduce infection in HCWs by as much as 64% and result in only a small proportion of staff absences (approximately 1% per day). This is considerably fewer than currently observed due to suspected COVID-19 and self-isolation.
Community-based surveys for Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions in selected regions of mainland Tanzania
Authors: Bakari Catherine , Jones Sophie , Subramaniam Gireesh , Mandara Celine Isaack , Chiduo Mercy G , Rumisha Susan , Chacky Frank , Molteni Fabrizio , Mandike Renata , Mkude Sigsbert , Njau Ritha , Herman Camelia , Nace Douglas P , Mohamed Ally , Udhayakumar Venkatachalam , Kibet Caleb K , Nyanjom Steven G , Rogier Eric , Ishengoma Deus Simon
Published: May 2020

Background: Despite recent reports of false negative results among histidine-rich protein 2 (HRP2) based-malaria rapid diagnostic tests (mRDTs) caused by pfhrp2/3 gene deletions in different countries, there is paucity of data in Tanzania.
Methods: This study assessed the status of pfhrp2/3 deletions in 7,543 blood sample using laboratory multiplex antigen detection (Plasmodium lactate dehydrogenase - pLDH, aldolase, and HRP2). Samples showing mRDT false negativity or aberrant relationship of HRP2 to pan-Plasmodium antigens were genotyped for pfhrp2/3 genes.
Results: Of all samples, 2,417 (32.0%) were positive for any Plasmodium antigens while 5,126 (68.0%) were negative. About 99.8% (n=2,411) of antigen positive samples had HRP2, but 6 (0.2%) had only pLDH and/or pAldolase. Thirteen samples had atypical relationships between pan-Plasmodium antigens and HRP2, but were positive by PCR. An additional 16 samples with negative HRP2 mRDTs but positive by microscopy were also chosen; all giving 35 samples genotyped for pfhrp2/3. Of 35 samples, 4 (11.4%) failed to consistently amplify positive control genes (pfmsp1 and pfmsp2), and pfhrp2 and pfhrp3 genes were successfully amplified in 31 (88.6%) samples.
Conclusions: Lack of pfhrp2 and/or pfhrp3 genes deletions in Plasmodium falciparum parasites supports continued use of HRP2-based mRDTs for routine malaria diagnosis in Tanzania.
Predicting inpatient flow at a major hospital using interpretable analytics
Authors: Bertsimas Dimitris , Pauphilet Jean , Stevens Jennifer , Tandon Manu
Published: May 2020

Problem definition

Turn raw data from Electronic Health Records into accurate predictions on patient flows and inform daily decision-making at a major hospital.

Practical Relevance

In a hospital environment under increasing financial and operational stress, forecasts on patient demand patterns could help match capacity and demand and improve hospital operations.

Methodology

We use data from 63, 432 admissions at a large academic hospital (50.0% female, median age 64 years old, median length-of-stay 3.12 days). We construct an expertise-driven patient representation on top of their EHR data and apply a broad class of machine learning methods to predict several aspects of patient flows.

Results

With a unique patient representation, we estimate short-term discharges, identify long-stay patients, predict discharge destination and anticipate flows in and out of intensive care units with accuracy in the 80%+ range. More importantly, we implement this machine learning pipeline into the EHR system of the hospital and construct prediction-informed dashboards to support daily bed placement decisions.

Managerial Implications

Our study demonstrates that interpretable machine learning techniques combined with EHR data can be used to provide visibility on patient flows. Our approach provides an alternative to deep learning techniques which is equally accurate, interpretable, frugal in data and computational power, and production-ready.
A pitfall in estimating the effective reproductive numberRtfor COVID-19
Authors: Petermann Markus , Wyler Daniel
Published: May 2020

The effective reproductive numberRtof COVID-19 is determined indirectly from data that are only incompletely known. Approaches based on reconstructing these data by sampling time lags from suitable distributions introduce noise effects that can result in distorted estimates ofRt. This, in turn, may lead to misleading interpretations of the efficacy of the various measures taken to limit COVID-19 transmission. We discuss in some detail a study used for real time monitoring of the reproductive number in Switzerland; seehttps://ncs-tf.ch/en/situation-report.

We argue that the method used to derive the above curve is systematically flawed and leads to an underestimation of the efficacy of the lockdown. The method adopted by the Robert Koch Institute suffers from similar deficiencies, their impact is however smaller.
Novel Autosegmentation Spatial Similarity Metrics Capture the Time Required to Correct Segmentations Better than Traditional Metrics in a Thoracic Cavity Segmentation Workflow
Authors: Kiser Kendall , Barman Arko , Stieb Sonja , Fuller Clifton D , Giancardo Luca
Published: May 2020

Introduction
Automated segmentation templates can save clinicians time compared to de novo segmentation but may still take substantial time to review and correct. It has not been thoroughly investigated which automated segmentation-corrected segmentation similarity metrics best predict clinician correction time.

Materials and Methods
Bilateral thoracic cavity volumes in 329 CT scans were segmented by a UNet-inspired deep learning segmentation tool and subsequently corrected by a fourth-year medical student. Eight spatial similarity metrics were calculated between the automated and corrected segmentations and associated with correction times using Spearman′s rank correlation coefficients. Nine clinical variables were also associated with metrics and correction times using Spearman′s rank correlation coefficients or Mann-Whitney U tests.

Results
The added path length, false negative path length, and surface Dice similarity coefficient correlated better with correction time than traditional metrics, including the popular volumetric Dice similarity coefficient (respectively ρ = 0.69, ρ = 0.65, ρ = −0.48 versus ρ = −0.25; correlation p values < 0.001). Clinical variables poorly represented in the autosegmentation tool′s training data were often associated with decreased accuracy but not necessarily with prolonged correction time.

Discussion
Metrics used to develop and evaluate autosegmentation tools should correlate with clinical time saved. To our knowledge, this is only the second investigation of which metrics correlate with time saved. Validation of our findings is indicated in other anatomic sites and clinical workflows.

Conclusion
Novel spatial similarity metrics may be preferable to traditional metrics for developing and evaluating autosegmentation tools that are intended to save clinicians time.
Public attitudes towards COVID-19 contact tracing apps: A UK-based focus group study
Authors: Williams Simon N , Armitage Christopher J , Tampe Tova , Dienes Kimberly
Published: May 2020

OBJECTIVE: To explore public attitudes to the proposed COVID-19 contact tracing app in the United Kingdom.

DESIGN: Qualitative study consisting of five focus groups carried out between 1st-4th May 2020 (39-42 days after the official start of the UK lockdown).

SETTING: Online video-conferencing

PARTICIPANTS: 22 participants, all UK residents aged 18 years and older, representing a range of different genders, ages, ethnicities and locations.

RESULTS: Participants were split roughly equally in number across three groups: will use the app; will not be using the app; and undecided as to whether they will use the app. Analysis revealed five main themes: (1) Lack of information and misconceptions surrounding COVID-19 contact tracing apps; (2) concerns over privacy; (3) concerns over stigma; (4) concerns over uptake; and (5) contact tracing as the 'greater good'. These themes were found across the sample and the three groups. However, concerns over privacy, uptake and stigma were particularly significant amongst those state they will not be using the app and the view that the app is for the 'greater good' was particularly significant amongst those who stated they will be using the app. One of the most common misconceptions about the app was that it could allow users to specifically identify and map COVID-19 cases amongst their contacts and in their vicinity.

CONCLUSIONS: We offer four recommendations: (1) To offset the fact that many people may not be accessing, or might be avoiding, news coverage on COVID-19, authorities must communicate to the public via a range of methods including but not limited to: social media ads, postal information, text messaging and other emergency alert systems. (2) Communications should emphasise that the app cannot enable the user to identify which of their contacts has reported COVID-19 symptoms or tested positive. (3) Communication should emphasise collective responsibility ('the greater good') to promote social norms around use of the app (4) Communication should provide a slogan that maximises clarity of message, for example: 'Download the app, protect the NHS, save lives'.