bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes of drinking behavior in Korean pregnant women for the last 20 year
Authors: Seo Bi-A , Kim Sung-Gon , Huh Sung-Young , Lee Dong-Hyeong , An Hyun-Sook , Lee So-Young , Kim Hyeon Kyeong , Choi Ji-Min
Published: September 2020

Background

The purpose of this study is to investigate the drinking behavior of Korean pregnant women in 2017 and to compare the changes of drinking status with the results of the research conducted in 1997 and 2008.

Methods

Pregnant women at one obstetrics and gynecology hospital and one university hospital were the subjects of the study. They were filled out questionnaire.

Results

The rate of positive responses to CAGE increased 16.0% in 2008 and 16.3% in 2017 compared to 11.8% in 1997 (P = 0.046). Blackout history rate was keep increasing from 1997 to 2017 (8.8% versus 27.7% versus 36.3%, P < 0.001). The rate of family history of alcohol was nearly doubled in 2017 (30.3%) compared to 1997 (17.6%) and 2008 (16.3) (P < 0.001). The rate of pregnant women who drink alcohol during pregnancy decreased from 57.5% in 1997 to 39.5% in 2008 and decreased to 25.6% in 2017 (P < 0.001). The rate of pregnant women who drink alcohol after knowing the pregnancy was decreased in 2017 (6.9%) compared to 2008 (23.5%) (P < 0.001).

Conclusion

According to the results of the study in 2017, the rate of pregnant women who drink alcohol after pregnancy was decreased compared to 1997 and 2008. However drinking behavior severity has increased in 2017.
Threat of policy alienation: Exploring the implementation of Open Science policy in research practice
Authors: Lilja Erika
Published: September 2020

Many European countries have introduced Open Science (OS) policies to improve the quality and efficiency of science and to increase economic and societal growth. Researchers’ perceptions and experiences of OS policies remain relatively under-investigated. This explorative study applies the policy alienation perspective to understand researchers’ perceptions of OS policy implementation. Analysis of survey responses indicates that researchers have difficulties in coping with OS policy and that they feel policy alienation from OS policy. Hence, researchers may be less willing to try to support OS policy implementation despite the fact that OS policies are motivated by the desire to enhance the excellence and quality of research. The findings address how the incentive problems lie not only in the research evaluation and academic credit systems but also in the policy–practice divide. These problems need to be solved in terms of participation in policymaking and in the knowledge production of ‘openness’ itself.
‘My Husband … is an Authentic Psychopath’: Spanish Civil War Veterans, Mental Illness and the Francoist Regime
Authors: Wright Stephanie
Published: September 2020

This article seeks to broaden current understandings of war psychiatry, particularly within authoritarian contexts, through its focus on mental illness in the Francoist army during and after the Spanish Civil war of 1936–39. More specifically, this research points to the coexistence of multiple discourses of psychological disturbance in Francoist Spain. Francoist psychiatrists were reluctant to acknowledge the psychological fallout of the Spanish Civil War on those soldiers who had helped to ensure the Nationalist victory, and the regime’s legislation disenfranchised those who did not boast lengthy military careers. Yet in the absence of an official language of war trauma, veterans and their families found other ways to express themselves, often appropriating the regime’s own political and psychiatric discourse. Such popular understandings of Civil War trauma served an important function for Spaniards seeking to negotiate the many contradictions of life under the Francoist regime.
Moving Toward Standardized Pediatric Performance Improvement Measures in Child Physical Abuse: A Modified Delphi Approach
Authors: Nickoles Todd , Greenberg Jodie , Young LeAnne , Randall Amy , Herndon Michele , Bautista Durand Maria , McMahon Maria , Roney Linda
Published: September 2020

Background:

Limited guidance exists for pediatric trauma centers (PTCs) regarding best practice for measuring and reviewing performance improvement (PI) in the child physical abuse population. To move PTC programs toward standardized guidelines and PI practices, current practice and points of consensus among level 1 and 2 PTCs across the United States were assessed.

Methods:

Utilizing a two-round, modified Delphi methodology, electronic surveys were distributed to pediatric trauma program managers and coordinators representing 125 PTCs. Survey data included demographics, coding practices, definitions, current PI measures, prevention programs, and opinions regarding key components of child physical abuse guidelines.

Results:

In Round 1, responses were received from 90 (72%) PTCs [47 (84%) ACS-verified level 1 PTCs; 29 (73%) ACS-verified level 2 PTCs; and 14 (48%) state PTCs]. Of the respondents, 87% agreed that establishing a national consensus for child physical abuse PI is important, and 92% agreed that their institution would benefit from standardized guidelines. Although PI process varied among PTCs in terms of measures, review, and coding practices, several points of consensus were achieved.

Conclusion:

Survey results demonstrate areas of consistency and a foundation for consensus among PTCs. Results also identify areas of practice diversity that may benefit from an attempt to standardize PI across centers.
Effects of an intervention on internalized HIV-related stigma for individuals newly entering HIV care
Authors: Yigit Ibrahim , Modi Riddhi A. , Weiser Sheri D. , Johnson Mallory O. , Mugavero Michael J. , Turan Janet M. , Turan Bulent
Published: September 2020

Objective:

Considering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The ‘integrating ENGagement and Adherence Goals upon Entry’ (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles.

Design:

The iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm.

Methods:

Baseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined.

Results:

The decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame.

Conclusion:

The multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.
What shapes resilience among people living with HIV? A multi-country analysis of data from the PLHIV Stigma Index 2.0
Authors: Gottert Ann , McClair Tracy L. , Pulerwitz Julie , Friedland Barbara A.
Published: September 2020

Objective:

To inform efforts to promote greater resilience among people living with HIV (PLHIV), we examined associations between resilience and factors at the individual, interpersonal and structural/policy levels in three countries.

Design:

Data come from the PLHIV Stigma Index 2.0, a cross-sectional survey with PLHIV, implemented from 2017 to 2019 in Cambodia (n = 1207), the Dominican Republic (n = 891), and Uganda (n = 391).

Methods:

Hierarchical multiple regression was used to assess associations between resilience and factors at the individual/interpersonal/structural-policy levels, controlling for potential confounders. Resilience was measured by the previously tested PLHIV Resilience Scale.

Results:

About 60% of respondents were women; mean time since HIV diagnosis was 11 years in Cambodia and seven in the Dominican Republic /Uganda. Resilience varied substantially across the six province/districts per country (all p < 0.001). In multivariable analyses, higher resilience was associated with lower internalized stigma (all three countries), no experience of human rights abuses (Dominican Republic), no food/housing insecurity (Uganda), and greater community awareness of legal protections for PLHIV (Cambodia and Dominican Republic). HIV-related enacted stigma (i.e., discrimination) in the community was associated with lower resilience in Cambodia, but higher resilience in the Dominican Republic. The set of structural/policy-level factors in Cambodia and the Dominican Republic, and individual-level in Uganda, explained the most variance in resilience.

Conclusion:

Factors at multiple levels affect whether PLHIV in Cambodia, the Dominican Republic, and Uganda report resilience. Multilevel interventions are required to promote resilience among PLHIV, and should incorporate efforts to reduce internalized stigma and promote supportive structural/legal environments including broader awareness of legal protections for PLHIV.
A multilevel intervention to reduce stigma among alcohol consuming men living with HIV receiving antiretroviral therapy: findings from a randomized control trial in India
Authors: Singh Roopal J. , Sarna Avina , Schensul Jean J. , Mahapatra Bidhubhushan , Ha Toan , Schensul Stephen L.
Published: September 2020

Objective:

To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India.

Design:

A crossover randomized controlled trial in four sites.

Setting:

Government ART centres (ARTCs) offering core services in the greater Mumbai area.

Participants:

Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited.

Intervention:

Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each.

Main outcome measure:

HIV stigma, measured using the 16-item Berger Stigma scale.

Methods:

The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression.

Results:

At baseline, 57% of participants had moderate-high levels of stigma (scores >40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: β
coeff = −9.71; p < 0.001; group intervention: β
coeff = −5.22; p < 0.001; individual counselling: β
coeff = −4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (β
coeff = −10.29; p < 0.001), followed by GI+CA+IC (β
coeff = −8.23, p < 0.001).

Conclusion:

Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program
A Unique Approach to Building a Learner-Guided Ultrasound Simulator for Central Venous Access Training
Authors: Harrington Douglas , Damon Aaron , Clifton William , Simon Leslie
Published: September 2020

Commercial central line vascular access trainers are available but have significant limitations including cost, size, and limited durability when used for the complete procedure. A unique central venous access trainer was constructed using silicone loaf pan, ballistic gel, copper pipe and aluminum rods as vessels conduits, with varying inserts including latex and silicone to simulate different vascular structures, and the use of camouflage. This trainer is inexpensive, portable, reusable, allows the complete procedure to be simulated, and may be customized to the specific needs of the learner. The assembled simulator demonstrated excellent ultrasound visualization, including varying size and vessel character, allowed modification to specific learner needs, while at the same time being light-weight, portable, inexpensive, and reusable. A moderate-fidelity central venous access simulator can be constructed in a cost-effective manner, which can be optimized to the learner skill level and allows the entire procedure to be completed on the simulator.
Guidelines for Ultrasound in the Radiology Department During the COVID-19 Pandemic
Authors: Sheth Sheila , Fetzer David , Frates Mary , Needleman Laurence , Middleton William , Jones Jill , Podrasky Ann , Mankowski Gettle Lori
Published: September 2020

The coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2. The virus can be spread by close person-to-person contact primarily by respiratory droplets. Given the close proximity of the sonographer or sonologist with the patient during ultrasound examinations, special precautions should be taken to limit the exposure of radiology personnel to patients with coronavirus disease 2019 while still providing optimal patient care. Methods covered in this article include modified workflow, close scrutiny and prioritization of imaging orders, and design of targeted ultrasound protocols. These guidelines summarize the personal experience and insight of multiple colleagues who lead ultrasound sections or are experts in the field.
When and How to Treat Status Epilepticus: The Tortoise or the Hare?
Authors: Fong Michael W. K. , Hirsch Lawrence J.
Published: September 2020

Status epilepticus (SE) is a collective term that is used to describe a variety of subtypes. Forgetting this point can be perilous, even resulting in exposing patients to unnecessary harms. This review revisits the foundations of many of our current treatment guidelines, providing context to the ever-growing options in the treatment of SE. It aims to highlight the uncertainties that clinicians and EEGers face when treating SE. Several promising future approaches are raised. These bring hope of transitioning to therapies that are based on correcting maladaptive neuronal responses that are personally tailored using real time measures. All types of SE should be diagnosed as soon as possible, and treatment should be started expeditiously. For convulsive SE, treatment should be aggressive with full doses and cessation of seizures should be confirmed with EEG if patients are not returning to normal rapidly. For most other types of SE, the perennial debate about the tortoise or the hare continues: When should we be more measured and conservative and when should we rapidly escalate therapies to a combination of highly sedating agents?
Mycobacterium mucogenicum meningitis due to external ventricular drain
Authors: Moiz Salwa , Rahman Omar , Morcos Mark , Siddiqui Asma , Hameed Usman Bin
Published: September 2020

Introduction.

Mycobacterium mucogenicum

is a rare non-tuberculous organism associated with catheter-related infections when pathogenic in humans. We present the first case of an external ventricular drain (EVD)-associated

M. mucogenicum

meningitis.

Case presentation. A 55-year-old woman had EVD placement for obstructive hydrocephalus following traumatic subarachnoid haemorrhage. Cerebrospinal fluid (CSF) was obtained 5 days later for fever and neurological changes.

M. mucogenicum

was ultimately isolated from the CSF and the patient was placed on appropriate antibiotics. Her management included replacement of the EVD and a prolonged course of anti-mycobacterial antibiotics. CSF findings showed her response to therapy and neurological exam improved after 6 weeks.

Conclusion.

M. mucogenicum

infections are very rare and existing reports indicate that it may be a device- or catheter-related pathogen. This microorganism has not been previously associated with an EVD. Ours may be the first documented report of EVD-related

M. mucogenicum

infection.
Aeromicrobium piscarium sp. nov., isolated from the intestine of Collichthys lucidus
Authors: Zhao Li-Hua , Xing Xiang , Liu Ying-Ying , Sha Sha , Song Cui , Sun Yuan-Hao , Xianyu Dai-Wei , Zhu Qian
Published: September 2020

A Gram-stain-positive, rod-shaped, whitesmoke-coloured and aerobic bacterium, designated strain Co35T, was isolated from the intestine of Collichthys lucidus collected from the Jiangmen Guangdong Chinese White Dolphin Provincial Nature Reserve. Strain Co35T was able to grow at 15–35 °C (optimal 28 °C), at pH 7.0–8.5 (optimal 8.0) and with 0–9 % (w/v) NaCl (optimal 0.5–1 %). Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain Co35T was a member of the genus

Aeromicrobium

within the family

Nocardioidaceae

. The genomic DNA G+C content of strain Co35T was 68.4 mol%. Chemotaxonomic analysis showed that the sole respiratory quinone was menaquinone 9 (MK-9), and the major fatty acids included 10-methyl C18 : 0. The polar lipids were found to consist of phosphatidylglycerol (PG), diphosphatidylglycerol (DPG), phosphatidylethanolamine (PE), phosphatidylinositol (PI), two unidentified phospholipids (PL1–2) and two unidentified glycolipids (GL1–2). On the basis of its phylogenetic, phenotypic, chemotaxonomic, genotypic and genomic characteristics presented in this study, strain Co35T represents a novel species in the genus

Aeromicrobium

, for which the name Aeromicrobium piscarium sp. nov. is proposed. The type strain is Co35T (=KCTC 49280T=MCCC 1K03754T).
Drifting Assemblies for Persistent Memory
Authors: Kalle Kossio Yaroslav Felipe , Goedeke Sven , Klos Christian , Memmesheimer Raoul-Martin
Published: September 2020

Change is ubiquitous in living beings. In particular, the connectome and neural representations can change. Nevertheless behaviors and memories often persist over long times. In a standard model, memories are represented by assemblies of strongly interconnected neurons. For faithful storage these assemblies are assumed to consist of the same neurons over time. Here we propose a contrasting memory model with complete temporal remodeling of assemblies, based on experimentally observed changes of connections and neural representations. The assemblies drift freely as spontaneous synaptic turnover or random activity induce neuron exchange. The gradual exchange allows activity dependent and homeostatic plasticity to conserve the representational structure and keep inputs, outputs and assemblies consistent. This leads to persistent memory. Our findings explain recent experimental results on the temporal evolution of fear memory representations and suggest that memory systems need to be understood in their completeness as individual parts may constantly change.
Exploring options for reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) amidst COVID-19 pandemic: a systematic review
Authors: Paul Diptanu , Gupta Ayush , Maurya Anand Kumar
Published: September 2020

Background

There is global shortage of Personal Protective Equipment due to COVID-19 pandemic. N95 Filtering Facepiece Respirators (N95-FFRs) provide respiratory protection against respiratory pathogens including SARS-COV-2. There is scant literature on reprocessing methods which can enable reuse of N95-FFRs.

Aim

We conducted this study to evaluate research done, prior to COVID-19 pandemic, on various decontamination methods for reprocessing of N95-FFRs.

Methods

We searched 5 electronic databases (Pubmed, Google Scholar, Crossref, Ovid, ScienceDirect) and 1 Grey literature database (OpenGrey). We included original studies, published prior to year 2020, which had evaluated any decontamination method on FFRs. Studies had evaluated a reprocessing method against parameters namely physical changes, user acceptability, respirator fit, filter efficiency, microbicidal efficacy and presence of chemical residues post-reprocessing.

Findings and Conclusions

Overall, we found 7887 records amongst which 17 original research articles were finally included for qualitative analysis. Overall, 21 different types of decontamination or reprocessing methods for N95-FFRs were evaluated. Most commonly evaluated method for reprocessing of FFRs was Ultraviolet (Type-C) irradiation (UVGI) which was evaluated in 13/17 (76%) studies.

We found published literature is scant on this topic despite warning signs of pandemic of a respiratory illness over the years. Promising technologies requiring expeditious evaluation are UVGI, Microwave generated steam (MGS) and Hydrogen peroxide vapor (HPV). Global presence of technologies, which have been given Emergency use authorisation for N95-FFR reprocessing, is extremely limited. Reprocessing of N95-FFRs by MGS should be considered for emergency implementation in resource limited settings to tackle shortage of N95-FFRs.

Systematic Review Identifier

PROSPERO, PROSPERO ID: CRD42020189684, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020189684)
Insights into the practical effectiveness of RT-PCR testing for SARS-CoV-2 from serologic data, a cohort study
Authors: Zhang Zhen , Bi Qifang , Fang Shisong , Wei Lan , Wang Xin , He Jianfan , Wu Yongsheng , Liu Xiaojian , Gao Wei , Zhang Renli , Gong Wenfeng , Su Qiru , Azman Andrew S , Lessler Justin , Zou Xuan
Published: September 2020

Background

Virologic detection of SARS-CoV-2 through Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) has limitations for surveillance. Serologic tests can be an important complementary approach.

Objective

Assess the practical performance of RT-PCR based surveillance protocols, and the extent of undetected SARS-CoV-2 transmission in Shenzhen, China.

Design

Cohort study nested in a public health response.

Setting

Shenzhen, China; January-May 2020.

Participants

880 PCR-negative close-contacts of confirmed COVID-19 cases and 400 residents without known exposure (main analysis). Fifty-seven PCR-positive case contacts (timing analysis).

Measurements

Virological testing by RT-PCR. Measurement of anti-SARS-CoV-2 antibodies in PCR-negative contacts 2-15 weeks after initial testing using total Ab ELISA. Rates of undetected infection, performance of RT-PCR over the course of infection, and characteristics of seropositive but PCR-negative individuals were assessed.

Results

The adjusted seropositivity rate for total Ab among 880 PCR-negative close-contacts was 4.1% (95%CI, 2.9% to 5.7%), significantly higher than among residents without known exposure to cases (0.0%, 95%CI, 0.0% to 1.0%). PCR-positive cases were 8.0 times (RR; 95% CI, 5.3 to 12.7) more likely to report symptoms than the PCR-negative individuals who were seropositive, but otherwise similar. RT-PCR missed 36% (95%CI, 28% to 44%) of infected close-contacts, and false negative rates appear to be highly dependent on stage of infection.

Limitations

No serological data were available on PCR-positive cases. Sample size was limited, and only 20% of PCR-negative contacts met inclusion criteria.

Conclusion

Even rigorous RT-PCR testing protocols may miss a significant proportion of infections, perhaps in part due to difficulties timing testing of asymptomatics for optimal sensitivity. Surveillance and control protocols relying on RT-PCR were, nevertheless, able to contain community spread in Shenzhen.

Funding source

Bill & Melinda Gates Foundation, Special Foundation of Science and Technology Innovation Strategy of Guangdong Province of China, and Key Project of Shenzhen Science and Technology Innovation Commission, Shenzhen, China
Validating and modeling the impact of high-frequency rapid antigen screening on COVID-19 spread and outcomes
Authors: Nash Beatrice , Badea Anthony , Reddy Ankita , Bosch Miguel , Salcedo Nol , Gomez Adam R. , Versiani Alice , Silva Gislaine Celestino Dutra , dos Santos Thayza Maria Izabel Lopes , Milhim Bruno H. G. A. , Moraes Marilia M , Campos Guilherme Rodrigues Fernandes , Quieroz Flávia , Reis Andreia Francesli Negri , Nogueira Mauricio L. , Naumova Elena N. , Bosch Irene , Herrera Bobby Brooke
Published: September 2020

High frequency screening of populations has been proposed as a strategy in facilitating control of the COVID-19 pandemic. We use computational modeling, coupled with clinical data from rapid antigen tests, to predict the impact of frequent viral antigen rapid testing on COVID-19 spread and outcomes. Using patient nasal or nasopharyngeal swab specimens, we demonstrate that the sensitivity/specificity of two rapid antigen tests compared to quantitative real-time polymerase chain reaction (qRT-PCR) are 82.0%/100% and 84.7%/85.7%, respectively; moreover, sensitivity correlates directly with viral load. Based on COVID-19 data from three regions in the United States and São José do Rio Preto, Brazil, we show that high frequency, strategic population-wide rapid testing, even at varied accuracy levels, diminishes COVID-19 infections, hospitalizations, and deaths at a fraction of the cost of nucleic acid detection via qRT-PCR. We propose large-scale antigen-based surveillance as a viable strategy to control SARS-CoV-2 spread and to enable societal re-opening.
Erythrocyte sedimentation rate as a new diagnostic biomarker for neuroacanthocytosis syndromes
Authors: Darras Alexis , Peikert Kevin , Rabe Antonia , Yaya François , Simionato Greta , John Thomas , Dasanna Anil Kumar , Buvalyy Semen , Geisel Jürgen , Hermann Andreas , Fedosov Dmitry A. , Danek Adrian , Wagner Christian , Kaestner Lars
Published: September 2020

Chorea-acanthocytosis (ChAc) and McLeod syndrome (MLS) are the core diseases among the group of rare neurodegenerative disorders that comprise neuroacanthocytosis syndrome (NAS). Both ChAc and MLS patients present with an increased number of irregularly spiky erythrocytes, so-called acanthocytes. The detection of acanthocytes is often a crucial parameter in the diagnosis of NAS. However, this approach is error-prone and not very reliable, typically explaining the misdiagnosis of NAS patients. Based on the standard Westergren method, we show that compared with that in healthy controls, the erythrocyte sedimentation rate (ESR) with a two-hour read-out is significantly prolonged in ChAc and MLS with no overlap. Thus, the ESR is a clear, robust and easily obtained diagnostic marker. Mechanistically, by applying modern colloidal physics, we show that acanthocyte aggregation and plasma fibrinogen levels slow the sedimentation process. Apart from its diagnostic value, ESR may also be the first biomarker for monitoring treatments for NAS patients. Further studies are required to test whether the ESR may also detect other NASs. In addition to medical progress, this study is also a hallmark of the physical view of the erythrocyte sedimentation process by describing anticoagulated blood in stasis as a percolating gel, allowing the application of colloidal physics theory.
Advanced neurological recovery translates into greater long-term functional independence after acute spinal cord injury
Authors: Khosravi-Hashemi Navid , Abel Rainer , Grassner Lukas , Kalke Yorck-Bernhard , Maier Doris , Rupp Rüdiger , Weidner Norbert , Curt Armin , Kramer John K.
Published: September 2020

The absence of effective pharmacological interventions in acute traumatic spinal cord injury is a major problem in its management. A critical barrier in identifying such interventions lies in the vast heterogeneity of recovery profiles, which masks the potential efficacy of treatments in clinical trials. To determine the impact of temporal recovery profiles on long-term functional independence, we used EMSCI (European Multicenter Study about Spinal Cord Injury) data. Total motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM) were used to assess neurological and functional outcomes, respectively. We developed a classification method consisting of thresholding and unsupervised machine learning clustering and applied it to the total motor score profiles. Comparing SCIM scores between classes revealed that functional independence is significantly higher among patients displaying advanced neurological recovery profile. Our study suggests that the evaluation of temporal recovery profiles can provide novel insights in spinal cord injury clinical trials.
Integrative Genetics Analysis of Juvenile Idiopathic Arthritis Identifies Novel Loci
Authors: Li Yun R. , Li Jin , Glessner Joseph T. , Yang Jie , March Michael E. , Kao Charlly , Bradfield Jonathan P. , Li Junyi , Mentch Frank D. , Qu Huiqi , Qi Xiaohui , Chang Xiao , Hou Cuiping , Abrams Debra J. , Qiu Haijun , Wei Zhi , Connolly John J. , Wang Fengxiang , Snyder James , Limou Sophie , Flatø Berit , Førr Øystein , Thompson Susan D. , Langefeld Carl D , Glass David N , Becker Mara L. , Perez Elena , Lie Benedicte A. , Punaro Marilynn , Shivers Debra K , Ellis Justine A. , Munro Jane E. , Wise Carol , Sleiman Patrick M.A. , Hakonarson Hakon
Published: September 2020

Juvenile Idiopathic Arthritis (JIA) is the most common type of arthritis among children, encompassing a highly heterogeneous group of immune-mediated joint disorders, being classified into seven subtypes based on clinical presentation.

To systematically understand the distinct and shared genetic underpinnings of JIA subtypes, we conducted a heterogeneity-sensitive GWAS encompassing a total of 1245 JIA cases classified into 7 subtypes and 9250 controls. In addition to the MHC locus, we uncovered 16 genome-wide significant loci, among which 15 were shared between at least two JIA subtypes, including 11 novel loci. Functional annotation indicates that candidate genes at these loci are expressed in diverse immune cell types. Further, based on the association results, the 7 JIA subtypes were classified into two groups, reflecting their autoimmune vs autoinflammatory nature.

Our results suggest a common genetic mechanism underlying these subtypes in spite of their different clinical disease phenotypes, and that there may be drug repositioning opportunities for rare JIA subtypes.
Examination of Isolation Rate in SIQR model for COVID-19 Epidemic
Authors: Hashiguchi Koichi
Published: September 2020

Newly proposed SIQR model defines exponent λ of exponential function expressing daily number of isolated persons as linear equation of isolation rate q and social distancing ratio x. In order to dynamically analyze the process of COVID-19 epidemic in seven countries by means of regression analyses of λ, increasing rate of cumulative isolated persons(cases), IRCC, is proposed as practical index for the isolation rate q. IRCC is correlated with q in the form of q=C · IRCC, where C is a normalizing coefficient. At first, C is formulated in two modes, one is simple and the other complex, under the constraint conditions by definition 0≤x, q≤1, which give allowable narrow path of C between upper and lower boundaries. Then, the dynamic locus of q-x relation is analyzed for each of seven countries including Japan and the United States using formulated isolation rate q, and characteristic q-x behavior for each country is derived. At the same time, it is shown that specific path selection of C gives almost same linear loci of q-x relation derived by mathematical sequential method imitating a bipedal walk. In addition, increasing rates of cumulative PCR tests, IRCT, for six countries are discussed in relation with IRCC, and are shown that IRCT contributes to the promotion of the isolation rate via IRCC.
Prognostic accuracy of emergency department triage tools for children with suspected COVID-19: The PRIEST observational cohort study
Authors:   The PRIEST Research Group, Biggs Katie , Thomas Ben , Goodacre Steve , Lee Ellen , Sutton Laura , Bursnall Matthew , Loban Amanda , Waterhouse Simon , Simmonds Richard , Marincowitz Carl , Schutter Jose , Connelly Sarah , Sheldon Elena , Hall Jamie , Young Emma , Bentley Andrew , Challen Kirsty , Fitzimmons Chris , Harris Tim , Lecky Fiona , Lee Andrew , Maconochie Ian , Walter Darren
Published: September 2020

Objectives

Emergency department clinicians can use triage tools to predict adverse outcome and support management decisions for children presenting with suspected COVID-19. We aimed to estimate the accuracy of triage tools for predicting severe illness in children presenting to the emergency department (ED) with suspected COVID-19 infection.

Methods

We undertook a mixed prospective and retrospective observational cohort study in 44 EDs across the United Kingdom (UK). We collected data from children attending with suspected COVID-19 between 26 March 2020 and 28 May 2020, and used presenting data to determine the results of assessment using the WHO algorithm, swine flu hospital pathway for children (SFHPC), Paediatric Observation Priority Score (POPS) and Children’s Observation and Severity Tool (COAST). We recorded 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome.

Results

We collected data from 1530 children, including 26 (1.7%) with an adverse outcome. C-statistics were 0.80 (95% confidence interval 0.73-0.87) for the WHO algorithm, 0.80 (0.71-0.90) for POPS, 0.76 (0.67-0.85) for COAST, and 0.71 (0.59-0.82) for SFHPC. Using pre-specified thresholds, the WHO algorithm had the highest sensitivity (0.85) and lowest specificity (0.75), but POPS and COAST could optimise sensitivity (0.96 and 0.92 respectively) at the expense of specificity (0.25 and 0.38 respectively) by using a threshold of any score above zero instead of the pre-specified threshold.

Conclusion

Existing triage tools have good but not excellent prediction for adverse outcome in children with suspected COVID-19. POPS and COAST could achieve an appropriate balance of sensitivity and specificity for supporting decisions to discharge home by considering any score above zero to be positive.

Registration

ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533
Analysis of presence and short-term persistence of SARS-CoV-2 neutralizing antibodies in COVID-19 convalescent plasma donors
Authors: Annen Kyle , Morrison Thomas E. , DomBourian Melkon G. , McCarthy Mary K. , Huey Leah , Merkel Patricia , Andersen Gillian , Schwartz Eileen , Knight Vijaya
Published: September 2020

In March 2020, the FDA approved the use of COVID-19 convalescent plasma (CCP) as an investigational new drug for treatment of COVID-19. Since then, collection of CCP from COVID-19 recovered patients has been implemented in several donor centers across the country. Children’s Hospital Colorado rapidly put into practice a CCP collection protocol, necessitating the development and implementation of assays to evaluate SARS-CoV-2 antibodies in CCP units. We evaluated 87 separate units of CCP collected from 36 donors over two to four sequential donations using both antigen- binding assays for SARS-CoV-2 nucleoprotein and spike antigens, and a live virus focus reduction neutralization test (FRNT50). Our data shows that the majority of donors (83%) had a FRNT50 titer of 1:80 or greater, and 61% had a titer ≥ 1:160, which meet the FDA’s criteria for acceptable CCP units. Additionally, our data indicates that analysis of antibodies to a single SARS-CoV-2 antigen is likely to miss a percentage of seroconverters; however, these individuals tend to have neutralizing antibody titers of <1:80. Of note, there was considerable variability in the short term, sustained antibody response, measured by neutralizing antibody titers, among our donor population.
Trends and Patterns of Opioid Epidemic: A Large-Scale Retrospective Study of Hospital Visits with Opioid Poisoning in New York State, 2010-2016
Authors: Chen Xin , Hou Wei , Rashidian Sina , Wang Yu , Zhao Xia , Rosenthal Richard N , Saltz Mary , Saltz Joel H , Schoenfeld Elinor Randi , Leibowitz George Stuart , Wang Fusheng
Published: September 2020

Introduction

To discover trends and patterns of opioid poisoning and the demographic and regional disparities by analyzing large scale patient visits data in New York State (NYS).

Methods

Demographic, spatial, temporal and correlation analyses were performed for all OP patients extracted from the New York Statewide Planning and Research Cooperative System (SPARCS) from 2010 to 2016, along with Decennial US Census and American Community Survey zip code level data. The study is based on claims data. 58,481 patients with at least one OP diagnosis and a valid NYS zip code address were included. OP patient counts and rates per 100,000 population; patient level factors (gender, age, race and ethnicity, residential zip code); zip code level social demographic factors. Analyses were completed between 2017 and 2019.

Results

In this study of 58,481 patients with opioid poisoning (OP) in New York State from 2010 to 2016, the OP rate increased by 364.6%, and by 741.5% for the age group > 65 years. There were wide disparities among groups by race and ethnicity on rates and age distributions of OP. Heroin and non-Heroin based OP rates show distinct temporal trends as well as major geospatial variation.

Conclusions

The findings highlight strong demographic disparity of OP patients, evolving patterns and substantial geospatial variation.
Early elevation of FIB-4 liver fibrosis score is associated with adverse outcomes among patients with COVID-19
Authors: Xiang Fangfei , Sun Jing , Chen Po-Hung , Han Peijin , Zheng Haipeng , Cai Shuijiang , Kirk Gregory D.
Published: September 2020

Background

Limited prior data suggest that pre-existing liver disease was associated with adverse outcomes among patients with COVID-19. FIB-4 is a noninvasive index of readily available laboratory measurements that represents hepatic fibrosis. The association of FIB-4 with COVID-19 outcomes has not been previously evaluated.

Methods

FIB-4 was evaluated at admission in a cohort of 267 patients admitted with early-stage COVID-19 confirmed through RT-PCR. Hazard of ventilator use and of high-flow oxygen was estimated using Cox regression models controlled for covariates. Risk of progress to severe cases and of death/prolonged hospitalization (>30 days) were estimated using logistic regression models controlled for same covariates.

Results

Forty-one (15%) patients progressed to severe cases, 36 (14%) required high-flow oxygen support, 10 (4%) required mechanical ventilator support, and 1 died. Patients with high FIB-4 score (>3.25) were more likely to be older with pre-existing conditions. FIB-4 between 1.45-3.25 was associated with over 5-fold (95% CI: 1.2-28) increased hazard of high-flow oxygen use, over 4-fold (95% CI: 1.5-14.6) increased odds of progress to severe stage, and over 3-fold (95% CI: 1.4-7.7) increased odds of death or prolonged hospitalization. FIB-4>3.25 was associated with over 12-fold (95% CI: 2.3-68. 7) increased hazard of high-flow oxygen use and over 11-fold (95% CI: 3.1-45) increased risk of progress to severe disease. All associations were independent of sex, number of comorbidities, and inflammatory markers (D-dimer, C-reactive protein).

Conclusions

FIB-4 at early-stage of COVID-19 disease had an independent and dose-dependent association with adverse outcomes during hospitalization. FIB-4 provided significant prognostic value to adverse outcomes among COVID-19 patients.
Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners
Authors: Brown Allison , Kassam Aliya , Paget Mike , Blades Kenneth , Mercia Megan , Kachra Rahim
Published: September 2020

To broadly explore the extent that COVID-19 has initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training, a cross-sectional survey of medical learners was conducted between March 25-June 14th, 2020, shortly after the World Health Organization declared concurrent COVID-19 a pandemic. 6492 medical learners completed the survey from 140 countries, Students were concerned about the quality of their learning, training progression, and milestone fulfillment. Most trainees felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some trainees felt that contributing to healthcare during a pandemic was beyond the scope of a medical learner. Statistically significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses, the impact of COVID-19 on wellness, and state-trait anxiety. Overall, the initial disruption to medical training has been perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial insights into the areas that warrant future research as well as consideration for current and future policy planning, such as the policies for clinical utilization of medical learners during public health emergencies.
Neuropsychiatric symptoms are associated with dementia in Parkinson’s disease but not predictive of it
Authors: Horne Kyla-Louise , MacAskill Michael R. , Myall Daniel J. , Livingston Leslie , Grenfell Sophie , Pascoe Maddie J. , Young Bob , Shoorangiz Reza , Melzer Tracy R. , Pitcher Toni L. , Anderson Tim J. , Dalrymple-Alford John C.
Published: September 2020

Background

Neuropsychiatric symptoms in Parkinson’s disease (PD) may increase dementia (PDD) risk. The predictive value of these symptoms, however, has not been compared to clinical and demographic predictors of future PDD.

Methods

325 PD participants completed baseline neuropsychiatric and MDS-Task Force Level II assessments. Of these, 195 non-demented individuals were followed-up over a four-year period to detect conversion to PDD; 51 developed PDD. ROC analysis tested associations between baseline neuropsychiatric symptoms and conversion to PDD. The probability of developing PDD was also modelled as a function of neuropsychiatric inventory (NPI) total score, PD Questionnaire (PDQ) hallucinations, PDQ anxiety and contrasted to cognitive ability, age and motor function. Leave-one-out information criterion was used to evaluate which models provided useful information when predicting future PDD.

Results

The PDD group experienced greater levels of neuropsychiatric symptoms compared to the PD-MCI and PD-N groups at baseline. Few differences were found between the PD-MCI and PD-N groups. Five neuropsychiatric measures were significantly, but weakly, associated with future PDD. The strongest was NPI total score: AUC=0.66 [0.55-0.76]. There was, however, no evidence that it contained useful out-of-sample predictive information of future PDD (delta ELPD=1.6 (SD 2.4)); Similar results held for PDQ hallucinations and PDQ anxiety. In contrast, cognitive ability (delta ELPD=35 (SD 8)) and age (delta ELPD=11 (SD 5)) provided useful predictive information of future PDD.

Conclusions

Cognitive ability and age strongly out-performed neuropsychiatric measures as markers of developing PDD within four years. Therefore, neuropsychiatric symptoms do not appear to be useful markers of PDD risk.
Systematic evaluation of SARS-CoV-2 spike protein derived peptides for diagnosis of COVID-19 patients
Authors: Li Yang , Lai Dan-yun , Lei Qing , Xu Zhao-wei , Hou Hongyan , Chen Lingyun , Wu Jiaoxiang , Ren Yan , Ma Ming-liang , Zhang Bo , Chen Hong , Yu Caizheng , Xue Jun-biao , Zheng Yun-xiao , Wang Xue-ning , Jiang He-wei , Zhang Hai-nan , Qi Huan , Guo Shu-juan , Zhang Yandi , Lin Xiaosong , Yao Zongjie , Pang Pengfei , Shi Dawei , Wang Wei , Yang Xiao , Zhou Jie , Sheng Huiming , Sun Ziyong , Shan Hong , Wang Feng , Fan Xionglin , Tao Sheng-ce
Published: September 2020

Serological test plays an essential role in monitoring and combating COVID-19 pandemic. Recombinant spike protein (S protein), especially S1 protein is one of the major reagents for serological tests. However, the high cost in production of S protein, and the possible cross-reactivity with other human coronaviruses poses unneglectable challenges. Taking advantage of a peptide microarray of full spike protein coverage, we analyzed 2,434 sera from 858 COVID-19 patients, sera from 63 asymptomatic patients and 610 controls collected from multiple clinical centers. Based on the results of the peptide microarray, we identified several S protein derived 12-mer peptides that have high diagnosis performance. Particularly, for monitoring IgG response, one peptide (aa 1148-1159 or S2-78) has a comparable sensitivity (95.5%, 95% CI 93.7-96.9%) and specificity (96.7%, 95% CI 94.8-98.0%) to that of S1 protein for detection of both COVID-19 patients and asymptomatic infections. Furthermore, the performance of S2-78 IgG for diagnosis was successfully validated by ELISA with an independent sample cohort. By combining S2-78/ S1 with other peptides, a two-step strategy was proposed to ensure both the sensitivity and specificity of S protein based serological assay. The peptide/s identified in this study could be applied independently or in combination with S1 protein for accurate, affordable, and accessible COVID-19 diagnosis.

One Sentence Summary

Eight S protein-derived peptides, particularly S2-78 (aa 1148-1159), are of high performance for diagnosis of COVID-19 as well as discrimination of other coronaviruses.