bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating the COVID-19 Infection Rate: Anatomy of an Inference Problem
Authors: Manski Charles F. , Molinari Francesca
Published: May 2020

As a consequence of missing data on tests for infection and imperfect accuracy of tests, reported rates of cumulative population infection by the SARS CoV-2 virus are lower than actual rates of infection. Hence, reported rates of severe illness conditional on infection are higher than actual rates. Understanding the time path of the COVID-19 pandemic has been hampered by the absence of bounds on infection rates that are credible and informative. This paper explains the logical problem of bounding these rates and reports illustrative findings, using data from Illinois, New York, and Italy. We combine the data with assumptions on the infection rate in the untested population and on the accuracy of the tests that appear credible in the current context. We find that the infection rate might be substantially higher than reported. We also find that the infection fatality rate in Illinois, New York, and Italy is substantially lower than reported.
Catechol-O-methyltransferase (COMT) Val158Met Polymorphism and susceptibility to alcohol dependence
Authors: Chaudhary Amrita , Kumar Pradeep , Rai Vandana
Published: May 2020

Catechol-O-methyl transferase (COMT) enzyme catalyzes the metabolism of dopamine and other catechols in the brain. Several articles investigated catechol-O-methyltransferase (COMT) Val158Met polymorphism as risk factor for alcohol dependence (AD) but the results were inconclusive. The aim of present meta-analysis was to evaluate the association of Val158Met (COMT) polymorphism with AD. Authors performed keyword search of the four electronic databases- Pubmed, Google Scholar, Springer Link and Science Direct databases up to December 31,2019 . Total eighteen studies that investigated the association of Val158Met polymorphism with AD were retrieved. The pooled results from the meta-analysis (2,278 AD cases and 3717 healthy controls) did not show association with AD using all five genetic models (allele contrast model: OR = 1.02, 95% CI= 0.90-1.14, p= 0.03; homozygote model: OR = 1.06, 95% CI= 0.81-1.38, p= 0.69; dominant model: OR = 0.99, 95% CI= 0.85-1.14, p= 0.87; co-dominant model: OR = 0.97, 95% CI= 0.86-1.11, p= 0.71; recessive model: OR = 1.05;95% CI= 0.85-1.29, p=0.61). Results of subgroup analysis showed that Val158Met is not risk for AD in Asian and Caucasian population. In conclusion, COMT Val158Met is not a risk factor for alcohol dependence.
Performance verification of detecting COVID-19 specific antibody by using four chemiluminescence immunoassay systems
Authors: Wan Yafang , Li Zhijie , Wang Kun , Li Tian , Liao Pu
Published: May 2020

Background

The purpose of current study is to evaluate the analytical performance of seven kits for detecting IgM/IgG antibody of corona virus (2019-nCoV) by using four chemiluminescence immunoassay systems.

Methods

50 patients diagnosed with 2019-nCoV infection and 130 controls without corona virus infection from the General Hospital of Chongqing were enrolled in current retrospective study. Four chemiluminescence immunoassay systems including seven IgM/IgG antibody detection Kits for 2019-nCoV (A_IgM, A_IgG, B_IgM, B_IgG, C_IgM, C_IgG, D_Ab) were employed to detecting antibody concentration. Chi-square test, receiver operating characteristic (ROC) curve and Youden’s index were demonstrated to verify the cutoff value of each detection system.

Results

The repeatability verification results of the A, B, C, and D system are all qualified. D-Ab performances best (92% sensitivity and 99.23% specificity), and B_IgM worse than other systems. Except for the system of A_IgM and C_IgG, the optimal diagnostic thresholds and cutoff value of other kits from recommendations are inconsistent with each other. B_IgM got the worst AUC and C_IgG had the best diagnostic accuracy. More importantly, B_IgG system have the highest false positive rate for testing patients with AIDS, tumor and pregnant. A_IgM system test showed highest false positive rates among elder over 90 years old.

Conclusions

Systems for CoVID-2019 IgM/IgG antibody test performance difference. Serum diagnosis kit of D-Ab is the most reliable detecting system for 2019-nCoV antibody, which can be used as an alternative method for nucleic acid testing.
Genome-wide variations of SARS-CoV-2 infer evolution relationship and transmission route
Authors: Zhang Lehai , Wang Shifu , Ren Qian , Yang Junjie , Lu Yanqin , Zhang Lei , Gai Zhongtao
Published: May 2020

The authors have withdrawn this manuscript (Genome-wide variations of SARS-CoV-2 infer evolution relationship and transmission route) from medRxiv, because it was found that the statistical and analytical methods used in the manuscript had certain controversies after further discussion, so the authors of the manuscipt disclaimed that this conclusion cannot be used as the basis for the origin and evolution of SARS-COV-2, also as information to guide clinical practice and health-related behaviors, it should not be reported as established facts in the news media and “We-Media”. No one should do too much extended interpretation of the content of this manuscript. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
How 3D Printing and Social Media Tackles the PPE Shortage during Covid – 19 Pandemic
Authors: Vordos Nick , Gkika Despoina A. , Maliaris George , Tilkeridis Konstantinos E. , Antoniou Anastasia , Bandekas Dimitrios V. , Mitropoulos Athanasios Ch.
Published: May 2020

During the recent Covid-19 pandemic, additive Technology and Social Media were used to tackle the shortage of Personal Protective Equipment. A literature review and a social media listening software were employed to explore the number of the users referring to specific keywords related to 3D printing and PPE. Additionally, the QALY model was recruited to highlight the importance of the PPE usage. More than 7 billion users used the keyword covid or similar in the web while mainly Twitter and Facebook were used as a world platform for PPE designs distribution through individuals and more than 100 different 3D printable PPE designs were developed.
Global academic response to COVID-19: Cross-sectional study
Authors: Helliwell Jack A , Bolton William S , Burke Joshua R , Tiernan Jim P , Jayne David G , Chapman Stephen J
Published: May 2020

Objective

To describe the global academic response to COVID-19 during its early stages. The responsiveness of investigators, editorial teams, and publishers was explored.

Design

Cross-sectional bibliometric review of COVID-19 literature. A parallel search of Middle East Respiratory Syndrome (MERS) literature was performed for comparison of outcomes.

Data sources

MEDLINE and EMBASE databases. The search for COVID-19 studies was performed between 1st November 2019 and 24th March 2020. The search for MERS studies was performed one year earlier between 1st November 2018 and 24th March 2019.

Main outcome measures

Investigator-responsiveness was assessed by measuring the volume and type of published research. Editorial-responsiveness was assessed by measuring the time from manuscript submission to acceptance and the availability of original data to support the study results. Publisher-responsiveness was assessed by measuring the time from manuscript acceptance to first publication and the provision of open access.

Results

In total, 398 of 2835 COVID-19 and 55 of 1513 MERS search results were eligible. Most COVID-19 studies were clinical reports (n=242; 60.8%) and the majority of these were case series (n=105; 43.4%) and single cases (n=65; 26.9%). The times from manuscript submission to acceptance (median: 5 days (IQR: 3–11) vs 71.5 days (38–106); P<0.001) and acceptance to publication (median: 5 days (IQR: 2–8) vs. 22.5 days (4–48.5-; P<0.001) were strikingly shorter for COVID-19. Almost all COVID-19 (n=396; 99.5%) and MERS (n=55; 100%) studies were available with open-access. Data sharing was infrequent, with original data available for 104 (26.1%) COVID-19 and 10 (18.2%) MERS studies (P=0.203).

Conclusions

The early academic response to COVID-19 was characterised by investigators aiming to define the disease. These studies were made rapidly and openly available by editorial and publishing teams. Data sharing practises are an essential target for improvement as the pandemic progresses.
Simulating a community mental health service during the COVID-19 pandemic: effects of clinician–clinician encounters, clinician–patient–family encounters, symptom-triggered protective behaviour, and household clustering
Authors: Cardinal Rudolf N. , Meiser-Stedman Caroline E. , Christmas David M. , Price Annabel C. , Denman Chess , Underwood Benjamin R. , Chen Shanquan , Banerjee Soumya , White Simon R. , Su Li , Ford Tamsin J. , Chamberlain Samuel R. , Walsh Catherine M.
Published: May 2020

Background

Face-to-face healthcare, including psychiatric provision, must continue despite reduced interpersonal contact during the COVID-19 (SARS-CoV-2 coronavirus) pandemic. Community-based services might use domiciliary visits, consultations in healthcare settings, or remote consultations. Services might also alter direct contact between clinicians.

Aims

We examined the effects of appointment types and clinician–clinician encounters upon infection rates.

Methods

We modelled a COVID-19-like disease in a hypothetical community healthcare team, their patients, and patients’ household contacts (family). In one condition, clinicians met patients and briefly met family (e.g. home visit or collateral history). In another, patients attended alone (e.g. clinic visit), segregated from each other. In another, face-to-face contact was eliminated (e.g. videoconferencing). We also varied clinician–clinician contact; baseline and ongoing “external” infection rates; whether overt symptoms reduced transmission risk behaviourally (e.g. via personal protective equipment, PPE); and household clustering.

Results

Service organization had minimal effects on whole-population infection under our assumptions but materially affected clinician infection. Appointment type and inter-clinician contact had greater effects at low external infection rates and without a behavioural symptom response. Clustering magnified the effect of appointment type. We discuss infection control and other factors affecting appointment choice and team organization.

Conclusions

Distancing between clinicians can have significant effects on team infection. Loss of clinicians to infection likely has an adverse impact on care, not modelled here. Appointments must account for clinical necessity as well as infection control. Interventions to reduce transmission risk can synergize, arguing for maximal distancing and behavioural measures (e.g. PPE) consistent with safe care.
Effect of delays in concordant antibiotic treatment on mortality in patients with hospital-acquired Acinetobacter spp. bacteremia: a 13-year retrospective cohort
Authors: Lim Cherry , Yin Mo , Teparrukkul Prapit , Hongsuwan Maliwan , Day Nicholas P.J. , Limmathurotsakul Direk , Cooper Ben S
Published: May 2020

Background

Therapeutic options for multidrug-resistant Acinetobacter spp. are limited, and resistance to last resort antibiotics in hospitals is increasing globally. Quantifying the impact of delays in concordant antibiotic treatment on patient mortality is important for designing hospital antibiotic policies.

Methods

We included patients with Acinetobacter spp. hospital-acquired bacteremia (HAB) in a hospital in Thailand over a 13-year period. For each day of stay following the first positive blood culture we considered antibiotic treatment to be concordant if the isolated organism was susceptible to at least one antibiotic given. We used marginal structural models with inverse-probability weightings to determine the association between delays in concordant treatment and 30-day mortality.

Results

Between January 2003 and December 2015, 1,203 patients had HAB with Acinetobacter spp., of which 682 patients (56.7%) had one or more days of delay in concordant treatment. These delays were associated with an absolute increase in 30-day mortality of 6.6% (95% CI 0.2%-13.0%), from 33.8% to 40.4%. Crude 30-day mortality was substantially lower in patients with three or more days of delays in concordant treatment compared to those with one to two days of delays. Accounting for confounders and immortal time bias resolved this paradox, and showed similar 30-day mortality for one, two and three or more days of delays.

Conclusions

Delays in concordant antibiotic treatment were associated with a 6.6% absolute increase in mortality among patients with hospital-acquired Acinetobacter spp. bacteremia. If this association is causal, switching fifteen patients from discordant to concordant initial treatment would be expected to prevent one death.

Funding

The Mahidol Oxford Tropical Medicine Research Unit (MORU) is funded by the Wellcome Trust [grant number 106698/Z14/Z]. CL is funded by a Wellcome Trust Research Training Fellowship [grant number 206736/Z/17/Z]. MY is supported by a Singapore National Medical Research Council Research Fellowship [grant number NMRC/Fellowship/0051/2017]. BSC is funded by the UK Medical Research Council and Department for International Development [grant number MR/K006924/1]. DL is funded by a Wellcome Trust Intermediate Training Fellowship [grant number 101103]. The funder has no role in the design and conduct of the study, data collection, or in the analysis and interpretation of the data.
An ARIMA Model to Forecast the Spread and the Final Size of COVID-2019 Epidemic in Italy
Authors: Perone Gaetano
Published: May 2020

Coronavirus disease (COVID-2019) is a severe ongoing novel pandemic that is spreading quickly across the world. Italy, that is widely considered one of the main epicenters of the pandemic, has registered the highest COVID-2019 death rates and death toll in the world, to the present day. In this article I estimate an autoregressive integrated moving average (ARIMA) model to forecast the epidemic trend over the period after April 4, 2020, by using the Italian epidemiological data at national and regional level. The data refer to the number of daily confirmed cases officially registered by the Italian Ministry of Health (www.salute.gov.it) for the period February 20 to April 4, 2020. The main advantage of this model is that it is easy to manage and fit. Moreover, it may give a first understanding of the basic trends, by suggesting the hypothetic epidemic’s inflection point and final size.

Highlights

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ARIMA models allow in an easy way to investigate COVID-2019 trends, which are nowadays of huge economic and social impact.

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These data may be used by the health authority to continuously monitor the epidemic and to better allocate the available resources.

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The results suggest that the epidemic spread inflection point, in term of cumulative cases, will be reached at the end of May.

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Further useful and more precise forecasting may be provided by updating these data or applying the model to other regions and countries.
Dietary diversity practice and associated factors among pregnant women attending ANC in Kolfe Keranyo sub city health centers, Addis Ababa, Ethiopia
Authors: Tefera Walelgn , Brhanie Tsegahun Worku , Dereje Mamo
Published: May 2020

Background

Adequate and healthy diet during pregnancy is essential for the health of both mother and newborn. Dietary diversity is a proxy indicator of maternal nutrient adequacy. However, little is documented on dietary diversity among pregnant women.

Objectives

This study was designed to assess the dietary diversity practice and associated factors among pregnant women attending ANC in health centers of the coffee keranyo sub city, Addis Ababa, Ethiopia, 2018

Methods

Institution based cross-sectional study was conducted on 406 randomly selected pregnant women attending ANC in health centers of the coffee keranyo sub city, Addis Ababa from March 2-April 2/ 2018. Data were collected by using interviewer and 24 H dietary recall method. Data had entered and analyzed using SPSS version 21. Multiple logistic regression was run to assess factors associated with the dependent variable at P<0.05.

Result

The mean DDS was 5.45± 1.83. About 60.9% of pregnant women had good dietary diversity practice. Pregnant women learned collage and above had more dietary diversity practice than the illiterate one [AOR=2.26., 95% CI: (1.066, 4.808)]. Pregnant women with monthly income more than 5,000 ETB had more dietary diversity than income less than 2,000 ETB [AOR=2.33, 95% CI: (1.234, 4.416)]. Pregnant women at second ANC visit had more dietary diversity than at first visit [AOR=2.42, 95% CI: (1.183, 4.952)]. Having nutrition information during pregnancy increases 2 times dietary diversity practice than none informed ones [AOR=2.10, 95% CI: (1.294, 3.422)].

Conclusion and Recommendation

The mean DDS among the pregnant mothers was 5.45. 60.9% of pregnant women had good dietary diversity score and 39.1 % had poor dietary diversity. Mothers education, monthly income, second and third ANC visit and nutrition information had a positive significant with pregnant mothers’ dietary diversity (P<0.05. Early initiation of ANC visit and incorporation of nutrition education in each visit should be practice. Health extension workers should provide nutritional education to every pregnant woman.
Quantitative Estimation of Disruption in Social Contact Structure and its Effect in COVID-19 Spread in India
Authors: Dhanwant Jay Naresh , Ramanathan V.
Published: May 2020

In this paper we use the well-known SIR (Susceptible-Infected-recovered) epidemiology model for quantitatively estimating the impact of this disruption in the social contact structure of India and retrospectively estimate the number of COVID-19 cases in India by neglecting the single source event. Model predicts that around 32% of COVID-19 cases (as on April 14, 2020) are contributed by the single source event. Given this disruption of the social contact structure, the model shows that the country wide lockdown has been effective in bringing down the number of cases in India.
COVID-19 spreading in Rio de Janeiro, Brazil: do the policies of social isolation really work?
Authors: Crokidakis Nuno
Published: May 2020

The recent Coronavirus (COVID-19) has been spreading through all the world fastly. In this work we focus on the evolution of the COVID-19 in one of the most populous Brazilian states, namely the Rio de Janeiro state. The first case was reported in March 5, 2020, thus we have a considerable amount of available data to make a good analysis. First we study the early evolution of the disease, considering a Susceptible-Infectious-Quarantined-Recovered (SIQR) model. This initial phase shows the usual exponential growth of the number of confirmed cases. In this case, we estimate the parameters of the model based on the data, as well as the epidemic doubling time. After, we analyze all the available data, from March 5, 2020 through April 26, 2020. In this case, we observe a distinct behavior: a sub-exponential growth. In order to capture this change in the behavior of the evolution of the confirmed cases, we consider the implementation of isolation policies. The modified model agrees well with data. Finally, we consider the relaxation of such policies, and discuss about the ideal period of time to release people to return to their activities.
Clinical classifiers of COVID-19 infection from novel ultra-high-throughput proteomics
Authors: Messner Christoph B. , Demichev Vadim , Wendisch Daniel , Michalick Laura , White Matthew , Freiwald Anja , Textoris-Taube Kathrin , Vernardis Spyros I. , Egger Anna-Sophia , Kreidl Marco , Ludwig Daniela , Kilian Christiane , Agostini Federica , Zelezniak Aleksej , Thibeault Charlotte , Pfeiffer Moritz , Hippenstiel Stefan , Hocke Andreas , von Kalle Christof , Campbell Archie , Hayward Caroline , Porteous David J. , Marioni Riccardo E. , Langenberg Claudia , Lilley Kathryn S. , Kuebler Wolfgang M. , Mülleder Michael , Drosten Christian , Witzenrath Martin , Kurth Florian , Sander Leif Erik , Ralser Markus
Published: May 2020

The COVID-19 pandemic is an unprecedented global challenge. Highly variable in its presentation, spread and clinical outcome, novel point-of-care diagnostic classifiers are urgently required. Here, we describe a set of COVID-19 clinical classifiers discovered using a newly designed low-cost high-throughput mass spectrometry-based platform. Introducing a new sample preparation pipeline coupled with short-gradient high-flow liquid chromatography and mass spectrometry, our methodology facilitates clinical implementation and increases sample throughput and quantification precision. Providing a rapid assessment of serum or plasma samples at scale, we report 27 biomarkers that distinguish mild and severe forms of COVID-19, of which some may have potential as therapeutic targets. These proteins highlight the role of complement factors, the coagulation system, inflammation modulators as well as pro-inflammatory signalling upstream and downstream of Interleukin 6. Application of novel methodologies hence transforms proteomics from a research tool into a rapid-response, clinically actionable technology adaptable to infectious outbreaks.

Highlights

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A completely redesigned clinical proteomics platform increases throughput and precision while reducing costs.

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27 biomarkers are differentially expressed between WHO severity grades for COVID-19.

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The study highlights potential therapeutic targets that include complement factors, the coagulation system, inflammation modulators as well as pro-inflammatory signalling both upstream and downstream of interleukin 6.
Distinguishing L and H phenotypes of COVID-19 using a single x-ray image
Authors: Islam Mohammad Tariqul , Fleischer Jason W.
Published: May 2020

Recent observations have shown that there are two types of COVID-19 response: an H phenotype with high lung elastance and weight, and an L phenotype with low measures1. H-type patients have pneumonia-like thickening of the lungs and require ventilation to survive; L-type patients have clearer lungs that may be injured by mechanical assistance2,3. As treatment protocols differ between the two types, and the number of ventilators is limited, it is vital to classify patients appropriately. To date, the only way to confirm phenotypes is through high-resolution computed tomography2. Here, we identify L- and H-type patients from their frontal chest x-rays using feature-embedded machine learning. We then apply the categorization to multiple images from the same patient, extending it to detect and monitor disease progression and recovery. The results give an immediate criterion for coronavirus triage and provide a methodology for respiratory diseases beyond COVID-19.
Direct observation of repeated infections with endemic coronaviruses
Authors: Galanti Marta , Shaman Jeffrey
Published: May 2020

Background

While the mechanisms of adaptive immunity to pandemic coronavirus SARS-CoV-2 are still unknown, the immune response to the widespread endemic coronaviruses HKU1, 229E, NL63 and OC43 provide a useful reference for understanding repeat infection risk.

Methods

Here we used data from proactive sampling carried out in New York City from fall 2016 to spring 2018. We combined weekly nasal swab collection with self-reports of respiratory symptoms from 191 participants to investigate the profile of recurring infections with endemic coronaviruses.

Results

During the study, 12 individuals tested positive multiple times for the same coronavirus. We found no significant difference between the probability of testing positive at least once and the probability of a recurrence for the beta-coronaviruses HKU1 and OC43 at 34 weeks after enrollment/first infection. We also found no significant association between repeat infections and symptom severity but strong association between symptom severity and belonging to the same family.

Conclusion

This study provides evidence that re-infections with the same endemic coronavirus are not atypical in a time window shorter than 1 year and that the genetic basis of innate immune response may be a greater determinant of infection severity than immune memory acquired after a previous infection.
Data management in substance use disorder treatment research: Implications from data harmonization of National Institute on Drug Abuse-funded randomized controlled trials
Authors: Susukida Ryoko , Aminesmaeili Masoumeh , Mojtabai Ramin
Published: May 2020

Background

Secondary analysis of data from completed randomized controlled trials (RCTs) is a critical and efficient way to maximize the potential benefit from past research. De-identified primary data from completed RCTs have been increasingly available in recent years; however, the lack of standardized data products is a major barrier to further use of these valuable data. Pre-statistical harmonization of data structure, variables and codebooks across RCTs would facilitate secondary data analysis including meta-analysis and comparative effectiveness studies. We describe a data harmonization initiative to harmonize de-identified primary data from substance use disorder (SUD) treatment RCTs funded by the National Institute on Drug Abuse (NIDA) available on the NIDA Data Share website.

Methods

Harmonized datasets with standardized data structures, variable names, labels, and definitions and harmonized codebooks were developed for 36 completed RCTs. Common data domains were identified to bundle data files from individual RCTs according to relevant subject areas. Variables within the same instrument were harmonized if at least two RCTs used the same instrument. The structures of the harmonized data were determined based on the feedback from clinical trialists and SUD research experts.

Results

We have created a harmonized database of variables across 36 RCTs with a build-in label, and a brief definition for each variable. Data files from the RCTs have been consistently categorized into eight domains (enrollment, demographics, adherence, adverse events, physical health measures, mental-behavioral-cognitive health measures, self-reported substance use measures, and biologic substance use measures). Harmonized codebooks and instrument/variable concordance tables have also been developed to help identify instruments and variables of interest more easily.

Conclusions

The harmonized data of RCTs of SUD treatments can potentially promote future secondary data analysis of completed RCTs, allowing combining data from multiple RCTs and provide guidance for future RCTs in SUD treatment research.
Mental Health of Clinical Staff Working in High-Risk Epidemic and Pandemic Health Emergencies: A Rapid Review of the Evidence and Meta-Analysis
Authors: Bell Vaughan , Wade Dorothy
Published: May 2020

The global pandemic of SARS-CoV-2 / COVID-19 has raised concerns about the potential mental health impact on frontline clinical staff. However, given that poor mental health is common in staff working in acute medicine, we aimed to estimate the additional burden of working directly with infected patients during epidemic and pandemic health emergencies. We completed a rapid review of the evidence and identified 74 relevant studies from outbreaks of COVID-19, Ebola, H1N1 influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS). Due to varying caseness criteria, a meta-analysis of prevalence was not possible. However, it was clear that levels of self-reported depression, anxiety and posttraumatic stress disorder (PTSD) related symptoms were high, and somewhat higher in clinical staff working in high exposure roles. To assess the impact of high- versus low-exposure healthcare work more formally, we estimated the standardised mean difference (SMD) of scale means using a random effects meta-analysis. High exposure work was associated with only a small additional burden of acute mental health problems compared to low exposure work (anxiety: SMD=0.22, 95% CI 0.06 – 0.38; PTSD symptoms: SMD=0.21, 95% CI 0.01 – 0.4; depression: SMD=0.20, -0.07 – 0.47). This effect was potentially inflated by publication bias and there was a moderate risk of bias in the studies in the meta-analysis. A narrative review of candidate risk factors identified being a nurse, seeing colleagues infected, experiencing quarantine, non-voluntary role assignment, and experiencing stigma, as associated with particularly poor mental health outcomes. Protective factors included team and institutional support, use and faith in infection prevention measures, and a sense of professional duty and altruistic acceptance of risk. Notably, formal psychological support services were valued by frontline staff, although those with the highest burden of mental health difficulties were the least likely to request or receive support.
Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Preference and Satisfaction in Chinese Patients with Parkinson’s Disease
Authors: Qiu Xian , Peng Tingting , Lin Zhengyu , Zhu Kaiwen , Wang Yuhan , Sun Bomin , Ashkan Keyoumars , Zhang Chencheng , Li Dianyou
Published: May 2020

Objective

To evaluate the preference and satisfaction in the Chinese Parkinson’s disease (PD) patients treated with deep brain stimulation (DBS).

Background

DBS is a widely used therapy for PD. There is now a choice between fixed-life implantable pulse generators (IPGs) and rechargeable IPGs, each having their advantages and disadvantages.

Methods

Two hundred and twenty PD patients treated with DBS completed a self-designed questionnaire to assess long-term satisfaction and experience with the type of battery they had chosen, and the key factors affecting their choices. The survey was performed online and double-checked for completeness and accuracy.

Results

The median value of follow-up length was 18 months. 87.3% of the DBS used rechargeable IPGs (r-IPG). The choice between rechargeable and non-rechargeable IPGs was significantly associated with the patient’s affordability (, p < 0.001). Interestingly, the feature of remote programming significantly affected patients’ choices between domestic and imported brands (, p < 0.001). 87.7% of the patients were satisfied with the stimulating effects as well as the implanted device. 40.6% of the patients with r-IPGs felt confident handling their devices within one week after discharge. More than half of the patients checked their batteries every week. The mean interval for battery recharge was 4.3 days. 57.8% of the patients spent around one-hour recharging and 71.4% of them recharged the battery independently. The most popular way for patients to learn about DBS surgery was through media (79/220, 35.9%), including the Internet and television programs. The rehabilitation (40.6%, 78/192), and programming (36.5%, 70/192) were two main courses that most patients wanted to learn after surgery.

Conclusion

Most patients were satisfied with their choices of IPGs. The patients’ financial status and remote programming function were the two most critical factors in their decision. The skill of using rechargeable IPG was easy to master by most patients.
Protocol of a population-based prospective COVID-19 cohort study Munich, Germany (KoCo19)
Authors: Radon Katja , Saathoff Elmar , Pritsch Michael , Noller Jessica Michelle Guggenbühl , Kroidl Inge , Olbrich Laura , Thiel Verena , Diefenbach Max , Riess Friedrich , Forster Felix , Theis Fabian , Wieser Andreas , Hoelscher Michael ,   the KoCo19 collaboration group#
Published: May 2020

Background

The SARS-CoV-2 pandemic is leading to the global introduction of public health interventions to prevent the spread of the virus and avoid the overload of health care systems, especially for the most severely affected patients. Scientific studies to date have focused primarily on describing the clinical course of patients, identifying treatment options and developing vaccines. In Germany, as in many other regions, current tests for SARS-CoV2 are not being conducted on a representative basis and in a longitudinal design. Furthermore, knowledge about the immune status of the population is lacking. Yet these data are needed to understand the dynamics of the pandemic and to thus appropriately design and evaluate interventions. For this purpose, we recently started a prospective population-based cohort in Munich, Germany, with the aim to better understand the state and dynamics of the pandemic.

Methods

In 100, randomly selected constituencies out of 755, 3,000 Munich households are identified via random route and offered enrollment into the study. All household members are asked to complete a baseline questionnaire and subjects ≥14 years of age are asked to provide a venous blood sample of ≤3 ml for the determination of SARS-CoV-2 IgG/IgA status. The residual plasma and the blood pellet are preserved for later genetic and molecular biological investigations. For twelve months, each household member is asked to keep a diary of daily symptoms, whereabouts and contacts via WebApp. If symptoms suggestive for COVID-19 are reported, family members, including children <14 years, are offered a pharyngeal swab taken at the Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, for molecular testing for SARS-CoV-2. In case of severe symptoms, participants will be transferred to a Munich hospital. For one year, the study teams re-visits the households for blood sampling every six weeks.

Discussion

With the planned study we will establish a reliable epidemiological tool to improve the understanding of the spread of SARS-CoV-2 and to better assess the effectiveness of public health measures as well as their socio-economic effects. This will support policy makers in managing the epidemic based on scientific evidence.
Obesity paradox in patients with cancer: A systematic review and meta-analysis of 6,320,365 patients
Authors: Petrelli Fausto , Cortellini Alessio , Indini Alice , Tomasello Gianluca , Ghidini Michele , Nigro Olga , Salati Massimiliano , Dottorini Lorenzo , Iaculli Alessandro , Varricchio Antonio , Rampulla Valentina , Barni Sandro , Cabiddu Mary , Bossi Antonio , Ghidini Antonio , Zaniboni Alberto
Published: May 2020

BACKGROUND

Obesity, defined as a body mass index (BMI) > 30 kg/m2, is associated with a significant increase in risk of many cancers. In last years, various studies suggested that obese cancer patients have better outcomes than non-obese patients. This phenomenon, also known as “the obesity paradox”, is not well understood and presents controversial explanations. We performed a systematic review and meta-analysis to assess the association between obesity and outcome after a diagnosis of cancer.

PATIENTS AND METHODS

PubMed, the Cochrane Library, and EMBASE were searched from inception to January 2020, for studies reporting prognosis of patients with obesity and cancer. Risk of death, cancer-specific survival (CSS) and progression were pooled to provide an adjusted hazard ratio with a 95% confidence interval (HR 95%CI). The primary outcome of the study refers to overall survival (OS) in obese vs non-obese patients with malignancies. Secondary endpoints were CSS and progression- or disease-free survival (PFS or RFS).

RESULTS

Mortality and relapse associated with obesity in patients with cancer were evaluated among n=6,320,365 participants (n=203 studies). Overall, association of obesity and cancer was associated with a reduced OS (HR =1.14, 95% CI: 1.09-1.19; P<.01) and CSS (HR=1.17, 95%CI 1.12-1.23; P<.01). Patients were also at increased risk for relapse (HR=1.13, 95%CI 1.07-1.19; P<.01). Patients with breast, colorectal and uterine tumors were at increased risk of death. Conversely, obese with lung cancer, renal cell carcinoma and melanoma survived longer that non-obese.

CONCLUSIONS

In many cancer patients, obesity reduces survival and increases the risk of relapse. In lung cancer, renal cell carcinoma and melanoma obesity was protective in terms of outcome. More intensive follow up, adequate dosing of oncological treatments, calories intake restrictions, physical activity and monitoring of obesity-related complications are effective measures for reducing mortality in these subjects.
A possible role of immunopathogenesis in COVID-19 progression
Authors: Anft Moritz , Paniskaki Krystallenia , Blazquez-Navarro Arturo , Doevelaar Adrian , Seibert Felix S. , Hoelzer Bodo , Skrzypczyk Sarah , Kohut Eva , Kurek Julia , Zapka Jan , Wehler Patrizia , Kaliszczyk Sviatlana , Bajda Sharon , Thieme Constantin J. , Roch Toralf , Justine Konik Margarethe , Brenner Thorsten , Tempfer Clemens , Watzl Carsten , Dolff Sebastian , Dittmer Ulf , Westhoff Timm H. , Witzke Oliver , Stervbo Ulrik , Babel Nina
Published: May 2020

Background

The efficacy of the humoral and cellular immunity determines the outcome of viral infections. An appropriate immune response mediates protection, whereas an overwhelming immune response has been associated with immune-mediated pathogenesis in viral infections. The current study explored the general and SARS-CoV-2 specific cellular and humoral immune status in patients with different COVID-19 severities.

Methods

In this prospective study, we included 53 patients with moderate, severe, and critical COVID-19 manifestations comparing their quantitative, phenotypic, and functional characteristics of circulating immune cells, SARS-CoV-2 antigen specific T-cells, and humoral immunity.

Results

Significantly diminished frequencies of CD8+T-cells, CD4+ and CD8+T-cell subsets with activated differentiated memory/effector phenotype and migratory capacity were found in circulation in patients with severe and/or critical COVID-19 as compared to patients with moderate disease. Importantly, the improvement of the clinical courses from severe to moderate was accompanied by an improvement in the T-cell subset alterations. Furthermore, we surprisingly observed a detectable SARS-CoV-2-reactive T-cell response in all three groups after stimulation with SARS-CoV-2 S-protein overlapping peptide pool already at the first visit. Of note, patients with a critical COVID-19 demonstrated a stronger response of SARS-CoV-2-reactive T-cells producing Th1 associated inflammatory cytokines. Furthermore, clear correlation between antibody titers and SARS-CoV-2-reactive CD4+ frequencies underscore the role of specific immunity in disease progression.

Conclusion

Our data demonstrate that depletion of activated memory phenotype circulating T-cells and a strong SARS-CoV-2-specific cellular and humoral immunity are associated with COVID-19 disease severity. This counter-intuitive finding may have important implications for diagnostic, therapeutic and prophylactic COVID-19 management.
Early viral clearance and antibody kinetics of COVID-19 among asymptomatic carriers
Authors: Xiao Tongyang , Wang Yanrong , Yuan Jing , Ye Haocheng , Wei Lanlan , Liao Xuejiao , Wang Haiyan , Qian Shen , Wang Zhaoqin , Liu Lei , Zhang Zheng
Published: May 2020

Background

Asymptomatic carriers contribute to the spread of Coronavirus Disease 2019 (COVID-19), but their clinical characteristics, viral kinetics, and antibody responses remain unclear.

Methods

A total of 56 COVID-19 patients without symptoms at admission and 19 age-matched symptomatic patients were enrolled. RNA of SARS-CoV-2 was tested using transcriptase quantitative PCR, and the total antibodies (Ab), IgG, IgA and IgM against the SARS-CoV-2 were tested using Chemiluminescence Microparticle Immuno Assay.

Results

Among 56 patients without symptoms at admission, 33 cases displayed symptoms and 23 remained asymptomatic throughout the follow-up period. 43.8% of the asymptomatic carriers were children and none of the asymptomatic cases had recognizable changes in C-reactive protein or interleukin-6, except one 64-year-old patient. The initial threshold cycle value of nasopharyngeal SARS-CoV-2 in asymptomatic carriers was similar to that in pre-symptomatic and symptomatic patients, but the communicable period of asymptomatic carriers (9.63 days) was shorter than pre-symptomatic patients (13.6 days). There was no obvious differences of the seropositive conversion rate of total Ab, IgG, and IgA among the three groups, though the rates of IgM varied largely. The average peak IgG and IgM COI of asymptomatic cases was 3.5 and 0.8, respectively, which is also lower than those in symptomatic patients with peaked IgG and IgM COI of 4.5 and 2.4 (p <0.05).

Conclusion

Young COVID-19 patients seem to be asymptomatic cases with early clearance of SARS-CoV-2 and low levels of IgM generation but high total Ab, IgG and IgA. Our findings provide empirical information for viral clearance and antibody kinetics of asymptomatic COVID-19 patients.
CovidCounties - an interactive, real-time tracker of the COVID-19 pandemic at the level of US counties
Authors: Arneson Douglas , Elliott Matthew , Mosenia Arman , Oskotsky Boris , Vashisht Rohit , Zack Travis , Bleicher Paul , Butte Atul J. , Rudrapatna Vivek A.
Published: May 2020

Management of the COVID-19 pandemic has proven to be a significant challenge to policy makers. This is in large part due to uneven reporting and the absence of open-access visualization tools to present local trends and infer healthcare needs. Here we report the development of CovidCounties.org, an interactive web application that depicts daily disease trends at the level of US counties using time series plots and maps. This application is accompanied by a manually curated dataset that catalogs all major public policy actions made at the state-level, as well as technical validation of the primary data. Finally, the underlying code for the site is also provided as open source, enabling others to validate and learn from this work.
Modifiable and non-modifiable risk factors for COVID-19: results from UK Biobank
Authors: Ho Frederick K , Celis-Morales Carlos A , Gray Stuart R , Katikireddi S Vittal , Niedzwiedz Claire L , Hastie Claire , Lyall Donald M , Ferguson Lyn D , Berry Colin , Mackay Daniel F , Gill Jason MR , Pell Jill P , Sattar Naveed , Welsh Paul
Published: May 2020

Background

Information on risk factors for COVID-19 is sub-optimal. We investigated demographic, lifestyle, socioeconomic, and clinical risk factors, and compared them to risk factors for pneumonia and influenza in UK Biobank.

Methods

UK Biobank recruited 37–70 year olds in 2006–2010 from the general population. The outcome of confirmed COVID-19 infection (positive SARS-CoV-2 test) was linked to baseline UK Biobank data. Incident influenza and pneumonia were obtained from primary care data. Poisson regression was used to study the association of exposure variables with outcomes.

Findings

Among 428,225 participants, 340 had confirmed COVID-19. After multivariable adjustment, modifiable risk factors were higher body mass index (RR 1.24 per SD increase), smoking (RR 1.38), slow walking pace as a proxy for physical fitness (RR 1.66) and use of blood pressure medications as a proxy for hypertension (RR 1.40). Non-modifiable risk factors included older age (RR 1.10 per 5 years), male sex (RR 1.64), black ethnicity (RR 1.86), socioeconomic deprivation (RR 1.26 per SD increase in Townsend Index), longstanding illness (RR 1.38) and high cystatin C (RR 1.24 per 1 SD increase). The risk factors overlapped with pneumonia somewhat; less so for influenza. The associations with modifiable risk factors were generally stronger for COVID-19, than pneumonia or influenza.

Interpretation

These findings suggest that modification of lifestyle may help to reduce the risk of COVID-19 and could be a useful adjunct to other interventions, such as social distancing and shielding of high risk.

Funding

British Heart Foundation, Medical Research Council, Chief Scientist Office.
Anosmia in COVID-19 patients
Authors: Hornuss Daniel , Lange Berit , Schröter Nils , Rieg Siegbert , Kern Winfried V. , Wagner Dirk
Published: May 2020

Objectives

Coronaviruses (CoVs) have a neuroinvasive propensity, and the frequently reported symptoms of smelling and taste dysfunction in many COVID-19 patients may be related to the respective capability of SARS-CoV2, the cause of the current pandemic. In this study we objectified and quantified the magnitude and underreporting of the smelling dysfunction caused by COVID-19 using a standardized test.

Methods

We conducted a prospective cross-sectional study comparing the proportion of anosmia using Sniffin-sticks in those reporting a loss of smell, in those who did not as well as in uninfected controls. The outcome of anosmic versus not anosmic patients were recorded during hospital stay and at day 15 on a six-category ordinal scale. The study was approved by the institutional review board, all participants consented to the study.

Results

40% of 45 consecutive hospitalized COVID-19 patients and 0% of 45 uninfected controls consenting were diagnosed with anosmia. 44% of anosmic and 50% of hyposmic patients did not report having smelling problems. Anosmia or hyposmia was not predictive of a severe COVID-19 manifestation.

Conclusions

The majority of COVID-19 patients have an objective anosmia and hyposmia, which often occurs unnoticed. These symptoms may be related to the neuroinvasive propensity of SARS-COV-2 and the unusual presentation of COVID-19 disease manifestations.
Releasing the lockdown in the UK Covid-19 epidemic: a stochastic model
Authors: Lander Anthony
Published: May 2020

Background

In a classic epidemic, the infected population has an early exponential phase, before slowing and fading to its peak. Mitigating interventions may change the exponent during the rising phase and a plateau can replace a peak. With interventions comes the risk that relaxation causes a second-wave. In the UK Covid-19 epidemic, infections cannot be counted, but their influence is seen in the curve of the mortality data. This work simulated social distancing and the lockdown in the UK Covid-19 epidemic to explore strategies for relaxation.

Methods

Cumulative mortality data was transposed 20 days earlier to identify three doubling periods separated by the 17th March—social distancing, and 23rd March—lockdown. A set of stochastic processes simulated viral transmission between interacting individuals using Covid-19 incubation and illness durations. Social distancing and restrictions on interactions were imposed and later relaxed.

Principal Findings

Daily mortality data, consistent with that seen in the UK Covid-19 epidemic to 24th April 2020 was simulated. This output predicts that under a lockdown maintained till early July 2020, UK deaths will exceed 31,000, but leave a large susceptible population and a requirement for vaccination or quarantine. An earlier staged relaxation carries a risk of a second-wave. The model allows exploration of strategies for lifting the lockdown.

Interpretation

Social distancing and the lockdown have had an impressive impact on the UK Covid-19 epidemic and saved lives, caution is now needed in planning its relaxation.

Funding

Unfunded research.

Research in context

Evidence before this study

The classical Susceptible, Infected, Recovered, (SIR) epidemiological model with additional compartments and sophistications have been widely used to make forecasts in the Covid-19 pandemic but are not easily accessible.

Added value of this study

This study adds reassurance that the interventions of social distancing introduced on the 17th March and the lockdown of the 23rd March 2020 have reduced mortality. The risks of a second-wave on their relaxation are real and illustrated graphically.

Implications of all the available evidence

Together with other models, credence is given to the risks of a second-wave in the UK Covid-19 epidemic on the relaxation of restrictions.