bluuebunny/crossref_metadata_2025 huggingface dataset:
Gallium-67 Single-Photon Emission Computed Tomography Affects Management of Infections of Left Ventricular Assist Devices
Authors: Puius Yoram A. , Parkar Fauziya , Tlamsa Aileen P. , Nistico Justin A. , Muggia Victoria A. , Minamoto Grace Y. , Jorde Ulrich P. , Goldstein Daniel J. , Moadel Renée M.
Published: November 2020

Our institution employs gallium-67 single-photon emission computed tomography low-dose CT (Ga-SPECT-CT) to determine the presence and extent of left ventricular assist device (LVAD) infections. We present a retrospective single-center study of 41 LVAD recipients who underwent Ga-SPECT-CT from January 2011 to June 2018 to determine whether Ga-SPECT-CT led to changes in antimicrobial therapy, LVAD revision or exchange, or application for 1A exception. The average age was 56.6 years, predominantly male (80.5%) and diabetic (68.3%), divided between ischemic (48.8%) and nonischemic (51.2%) cardiomyopathy. The majority had HeartMate II devices (82.9%). Device-related infections were classified as possible (12.2%), probable (36.6%), proven (36.6%), or rejected (14.6%). Sensitivity was 68.6% and specificity was 100%. Most VAD-specific infections were percutaneous deep driveline infections (DRIs) (34.1%), and VAD-related infections were primarily bloodstream infections (31.7%). Staphylococcus aureus was the major pathogen isolated. Gallium-67 single-photon emission computed tomography low-dose CT resulted in changes in management in more than half (53.7%) of patients: starting (24.4%) or stopping (17.1%) antimicrobial therapy, LVAD revision (22.0%) or exchange (12.2%), and the application for 1A exception for transplant listing (17.1%). We conclude that Ga-SPECT-CT is an effective modality for determining the presence and extent of LVAD DRIs, and contributed to a change in management in more than half of cases.
Factors associated with deep venous thrombosis in patients infected with coronavirus disease 2019: a meta-analysis
Authors: Loomba Rohit S. , Aggarwal Gaurav , Villarreal Enrique G. , Farias Juan S. , Flores Saul , Lavie Carl J. , Aggarwal Saurabh
Published: November 2020

Coronavirus disease 2019 (COVID-19) has affected more than 6 million patients worldwide. Deep venous thrombosis (DVT) has been increasingly recognized complication in these patients and is associated with increased morbidity and mortality. However, the factors associated with development of DVT in patients with COVID-19 have not been elucidated due to the novelty of the virus. We performed a meta-analysis of published studies comparing laboratory results in COVID-19 patients with and without DVT with the aim of identifying risk factors. We searched major databases for studies evaluating DVT in COVID-positive patients and performed a meta-analysis of baseline laboratory markers associated with development of DVT. A total of six studies with 678 patients were included in the pooled analyses. Of the 678 patients, 205 of patients had a DVT. Patients diagnosed with DVT were more likely to be older [mean difference 4.59 years, 95% confidence interval (CI) 1.25–7.92], and needing admission to ICU (relative risk 1.96, 95% CI 1.09–3.51). Patients with DVT had significantly higher white cell count (mean difference 1.36 × 109/l, 95% CI 0.33–2.40) and d-dimer levels (mean difference 3229.8, 95% CI 1501.5–4958.1). Lymphocyte count was lower in patients with DVT (mean difference −0.19 × 109/l, 95% CI −0.37 to −0.02). Patients with COVID-19 who develop DVT are more likely to be older and have leukocytosis with lymphopenia. Moreover, d-dimer is statistically higher and patients that are admitted to the ICU are at great risk to develop DVT.
Prediction factors of tolvaptan effectiveness in patients with refractory ascites complicated with hepatocellular carcinoma
Authors: Imai Michitaka , Ishikawa Toru , Kojima Yuichi , Azumi Motoi , Nozawa Yujiro , Sano Tomoe , Iwanaga Akito , Honma Terasu , Yoshida Toshiaki
Published: November 2020

Objective

Tolvaptan (TVP) is an effective treatment for patients with cirrhotic ascites; however, studies have indicated that a sufficient effect is difficult to obtain in patients with hepatocellular carcinoma (HCC). This study evaluates the efficacy of TVP in patients with HCC with refractory ascites.

Methods

We retrospectively enrolled 32 patients with liver cirrhosis and refractory ascites [mean age: 74 years (range, 47–86 years), men: 78.1% (25/32)]. All patients had HCC and were treated with TVP at our hospital. A TVP responder was defined as a patient who experienced decrease in body weight by ≥1.5 kg within 1 week of treatment. Univariate and multivariate analyses were performed to evaluate clinical and laboratory predictive factors of TVP response.

Results

The TVP response rate was 46.9% (15/32 patients) after 1 week of treatment. HCC treatment (transcatheter arterial chemoembolization and/or radiofrequency ablation) was administered to 11/15 (73.3%) responders. In the multivariate analysis, the reduction of urine osmolality was higher in responders than nonresponders (202 mOsm/l vs. 65 mOsm/l, P = 0.040), and the tumor stage (P = 0.043) was worse in nonresponders. Multivariate Cox proportional hazards regression analysis indicated a significantly better prognosis among responders than among nonresponders (P < 0.01).

Conclusion

The HCC tumor stage and the reduction in urine osmolality can predict the efficacy of TVP in patients with refractory ascites complicated with HCC. TVP may allow therapeutic intervention for HCC and improve prognosis, even in patients with Child–Pugh class C.
Identifying Symptom Information in Clinical Notes Using Natural Language Processing
Authors: Koleck Theresa A. , Tatonetti Nicholas P. , Bakken Suzanne , Mitha Shazia , Henderson Morgan M. , George Maureen , Miaskowski Christine , Smaldone Arlene , Topaz Maxim
Published: November 2020

Background

Symptoms are a core concept of nursing interest. Large-scale secondary data reuse of notes in electronic health records (EHRs) has the potential to increase the quantity and quality of symptom research. However, the symptom language used in clinical notes is complex. A need exists for methods designed specifically to identify and study symptom information from EHR notes.

Objectives

We aim to describe a method that combines standardized vocabularies, clinical expertise, and natural language processing to generate comprehensive symptom vocabularies and identify symptom information in EHR notes. We piloted this method with five diverse symptom concepts: constipation, depressed mood, disturbed sleep, fatigue, and palpitations.

Methods

First, we obtained synonym lists for each pilot symptom concept from the Unified Medical Language System. Then, we used two large bodies of text (clinical notes from Columbia University Irving Medical Center and PubMed abstracts containing Medical Subject Headings or key words related to the pilot symptoms) to further expand our initial vocabulary of synonyms for each pilot symptom concept. We used NimbleMiner, an open-source natural language processing tool, to accomplish these tasks and evaluated NimbleMiner symptom identification performance by comparison to a manually annotated set of nurse- and physician-authored common EHR note types.

Results

Compared to the baseline Unified Medical Language System synonym lists, we identified up to 11 times more additional synonym words or expressions, including abbreviations, misspellings, and unique multiword combinations, for each symptom concept. Natural language processing system symptom identification performance was excellent.

Discussion

Using our comprehensive symptom vocabularies and NimbleMiner to label symptoms in clinical notes produced excellent performance metrics. The ability to extract symptom information from EHR notes in an accurate and scalable manner has the potential to greatly facilitate symptom science research.
Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors
Authors: Casale Marisa , Cluver Lucie , Boyes Mark , Toska Elona , Gulaid Laurie , Armstrong Alice , Shenderovich Yulia , Rudgard William E. , Zhou Siyanai , Langwenya Nontokozo
Published: November 2020

Background:

Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART nonadherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent nonadherence or risk and protective factors that could moderate this relationship.

Setting:

This study investigates (1) the direct longitudinal relationship between bullying exposure and ART nonadherence, and the indirect relationship via psychological distress, and (2) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public health care facilities in a South African health district.

Methods:

Survey data were collected at 2 time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach.

Results:

A significant longitudinal relationship was found between bullying victimization and nonadherence, operating indirectly through psychological distress [B = 0.07; 95% confidence interval (CI): (0.03 to 0.13)]. Moderation analyses indicated that older adolescents exposed to bullying are more at risk of nonadherence [B = 0.52; 95% CI: (0.07 to 0.97) P < 0.05], and parental monitoring is a potential protective factor buffering indirect effects of bullying on nonadherence [B = −0.22; 95% CI: (−0.42 to −0.02) P < 0.05].

Conclusions:

These findings underscore the importance of interventions that address bullying and psychological distress, and strengthen parental monitoring, particularly among older ALHIV.
The Calcium Phosphate Modified Titanium Implant Combined With Platelet-Rich Plasma Treatment Promotes Implant Stabilization in an Osteoporotic Model
Authors: Sun Peng , Wang Yan , Xu Dapeng , Gong Kun
Published: November 2020

Osteoporosis as a kind of systemic bone metabolic disease has become one of the most prevalent diseases among the middle- and old-age, characterized with low bone mass and disruptive osseous microenvironment. The poor bone condition both in quantity and quality makes it daunting for osteoporotic patients who are submitted to dental implantation, joint replacement therapy, or orthopedic surgery. Since calcium phosphate (CaP) and platelet-rich plasma (PRP) treatment, all have improving the effect on bone regeneration. Inspired by this fact, the authors introduced a kind of novel implant with CaP modified surface by HPT (hydrothermal & pressure) treatment in this study. After producing, the authors tested its physicochemical properties through scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscope (XPS) and contact-angle measurement. Then the authors desired to investigate the effect of this CaP-modified implant on bone regeneration and stabilization maintenance combined with PRP treatment by establishing an osteoporotic rat model. After 3 months of surgery, the authors collected all the specimens and evaluated new bone formation by micro-computed tomography (micro-CT) analysis, biomechanical test, and histologic assessment. All the results in vivo experiment showed the CaP modified implant combined with PRP treatment could improve the osteoinductive effect under osteoporotic condition, leading to better maintenance for stabilization between bone and implant interface, which might be rendered as a promising clinical method for osteoporotic patients when they receive orthopedic surgeries.
The Use of Crowdsourcing Technology to Evaluate Preoperative Severity in Patients With Unilateral Cleft Lip in a Multiethnic Population
Authors: McCullough Meghan , Auslander Allyn , Nagengast Eric S. , Yao Caroline A. , Swanson Jordan W. , Magee William P.
Published: November 2020

Crowd sourcing has been used in multiple disciplines to quickly generate large amounts of diverse data. The objective of this study was to use crowdsourcing to grade preoperative severity of unilateral cleft lip phenotype in a multiethnic cohort with the hypothesis that crowdsourcing could efficiently achieve similar rankings compared to expert surgeons. Deidentified preoperative photos were collected for patients with primary, unilateral cleft lip with or without cleft palate (CL ± P). A platform was developed with C-SATS for pairwise comparisons utilizing Elo rankings by crowdsource workers through Amazon Mechanical Turk. Images were independently ranked by 2 senior surgeons for comparison. Seventy-six patients with varying severity of unilateral (CL ± P) phenotype were chosen from Operation Smile missions in Bolivia, Madagascar, Vietnam, and Morocco. Patients were an average of 1.2 years’ old, ranging from 3 months to 3.3 years. Each image was compared with 10 others, for a total of 380 unique pairwise comparisons. A total of 4627 total raters participated with a median of 12 raters per pair. Data collection was completed in <20 hours. The crowdsourcing ranking and expert surgeon rankings were highly correlated with Pearson correlation coefficient of R = 0.77 (P = 0.0001). Crowdsourcing provides a rapid and convenient method of obtaining preoperative severity ratings, comparable to expert surgeon assessment, across multiple ethnicities. The method serves as a potential solution to the current lack of rating systems for preoperative severity and overcomes the difficulty of acquiring large-scale assessment from expert surgeons.
Slice Functional Condylectomy and Piezosurgery: A Proposal in Unilateral Condylar Hyperplasia Treatment
Authors: Cascone Piero , Runci Anastasi Michele , Maffia Francesco , Vellone Valentino
Published: November 2020

Condylar hyperplasia is a temporomandibular joint progressive disease characterized by an excessive growth of the mandibular condyle. Condylar overgrowth represents one of the most common causes of facial asymmetry in early adulthood. To date, there is not a clearly established origin of the disease: genetic, traumatic, infective, vascular, and functional factors are involved hypotheses. Clinically, condylar hyperplasia presentation is characterized by an asymmetry of the lower third of the face, deviation of the chin, inclination of the labial line and malocclusion. Several treatments have been proposed over the years in the treatment of mandibular condyle hyperplasia, but to date a gold standard has not been defined. Two are the main approaches: condylectomy and orthognathic surgery, isolated or in a combination. Many condylectomy technique differentiations have been developed: high, low, and proportional, are the most performed. In this technical note, the Slice Functional Condylectomy (SFC), a modification of the proportional condylectomy is presented.
Alloplastic Total Temporomandibular Joint Reconstruction: A 10-Year Experience of the University of the Witwatersrand, Johannesburg
Authors: Rikhotso Risimati E. , Sekhoto Mmathabo G.
Published: November 2020

Aim:

This study aimed to retrospectively analyze our 10-year experience with total alloplastic reconstruction of the temporomandibular joint prostheses. Indications and clinical outcomes were also evaluated.

Methodology: This was a cross-sectional study in which 31 patients who had alloplastic total Temporomandibular Joint prosthesis implanted between 2007 and 2017 were reviewed.

Objective:

Outcomes (maximum mouth opening distance and occlusion), subjective outcomes (pain, diet consistency and chewing, quality of life), and complications were evaluated.

Results:

There were 16 females and 15 males with a mean age of 36.94 years (range 11–72 years). In total, 51 prostheses (20 bilateral, 11 unilateral) were implanted. The stock prostheses were used in 28 patients (90.32%) and only 3 (9.68%) were of custom-made type. Fifty-eight percent of patients were diagnosed with temporomandibular joint ankylosis, 22.58% had degenerative conditions, 9.68% had pathology (hemifacial microsomia, synovial chondromatosis, and osteochondroma), and 9.68% had malocclusion.

The results showed that there was a significant improvement in maximum mouth opening distance (P-value < 0.0001), particularly in patients who had ankylosis.

There was improvement in diet consistency (P-value < 0.0001) and quality of life (P-value 0.013). Postoperative complications ranged from facial nerve injuries (n = 4), keloids (n = 2), and heterotopic bone formation (n = 2).

Conclusion:

TMJ alloplasts provide satisfactory clinical and functional outcomes for patients with end-stage TMJ diseases, evidenced by overall improvement in maximum mouth opening, chewing ability and quality of life and reduction in pain. Previously operated joints and a preoperative diagnosis of ankylosis increase the risk of occurrence of complications postimplantation of total alloplastic joints.
An Anatomical Landmark for Retromandibular Transparotid Approach to Treat Subcondylar Fractures
Authors: Liu Pan , Li Fujun , Peng Liwei
Published: November 2020

Although the retromandibular transparotid approach (RTA) has been widely used to treat mandibular subcondyle fractures, the transient facial nerve injury (FNI) caused by this approach is not uncommon. The purpose of this paper was to present an anatomical landmark for RTA to treat subcondylar fractures, aiming to minimize FNI caused by the surgery. A total of 25 patients with subcondylar fractures but no FNI underwent RTA surgery. Intraoperatively, the plane of angulus oris was utilized as a reference to open the parotid and masseter tissues for exposing the fracture site. Postoperatively, FNI and other surgical complications were counted. The results showed that except for 2 cases of hematoma, no FNI or other complications occur. As a conclusion, utilization of plane of angulus oris as a reference for RTA to treat subcondylar fractures might make the surgery safer and less invasive.
The Effects of Alar Base Augmentation in Secondary Unilateral Cleft Lip Nasal Deformity
Authors: Kim Yong Bae , Nam Seung Min , Park Eun Soo , Choi Chang Yong , Kang Moon Seok , Cha Han Gyu
Published: November 2020

In unilateral cleft lip and palate patients, the alar base is displaced inferoposterolaterally due to the depression of the pyriform aperture in the cleft side, and the drooping of the nostril rim is provoked by displacement of the alar base. This study was conducted between May 1998 and December 2012. In total, 82 patients with secondary unilateral cleft lip nasal deformities were treated using alar base augmentation. The patients were divided into two groups according to the degree of their preoperative alar base asymmetry. Patients with alar base asymmetry <3 mm were treated with a soft tissue augmentation procedure. Those with alar base asymmetry >3 and <6 mm were treated with a bony augmentation procedure. Soft tissue augmentation was conducted in 42 patients, and bony augmentation was conducted in 40 patients. In the soft tissue augmentation group, the degree of alar base asymmetry was improved from 2.42 ± 0.38 mm preoperatively to 0.45 ± 0.21 mm postoperatively (P 
< 0.05). In the bony augmentation group, the degree of alar base asymmetry was improved from 4.33 ± 0.50 mm preoperatively to 0.81 ± 0.20 mm postoperatively (P 
< 0.05). In the amount of alar base augmentation, there were statistically significant differences between the soft tissue augmentation group and the bony augmentation group (P 
< 0.05). This clinical study shows that secondary cleft lip nasal deformities can be corrected with alar base augmentation using soft tissue and bony augmentation and that these procedures can provide reliable, satisfactory, and safe clinical outcomes.
Effect of Gum Chewing on Recovery After Surgery for Colorectal Surgery Patients
Authors: Duluklu Burcu , Senol Celik Sevilay
Published: November 2020

The aim of this study was to determine the role of chewing gum in bowel functions after left colon and/or rectal surgery. In this randomized controlled study, the sample consisted of adult patients who had undergone elective open left colon and/or rectal surgical interventions under general anesthesia. The sample comprised 17 patients in the experimental group and control group. The patients in the experimental group chewed a sugar-free gum after removal of their nasogastric tubes, 3 times a day for 45 minutes, from the first postoperative morning until they had first flatus. Routine care was maintained for the patients in the control group until their first flatus. The effects of chewing gum on the length of time until first flatus, the first defecation in the postoperative period, and the discharge of patients were investigated. The patients in the experimental group had flatus and defecation earlier, and the duration of their hospital stay was shorter than those of patients in the control group. It was found that gum chewing as a physiological method promotes the early initiation of bowel functions and, consequently, shortens the hospital stay after elective left colon and/or rectal surgery.
Sublobar Resection Versus Lobectomy for Early-Stage Pulmonary Carcinoid Tumors ≤3 cm in Size
Authors: Xu Song , Li Xiongfei , Ren Fan , He Jinling , Zhao Shikang , Wang Yanye , Ren Dian , Zhu Shuai , Lei Xi , Chen Gang , Chen Jun
Published: November 2020

Objective:

This study aimed to determine the optimal surgical procedure for early-stage pulmonary carcinoids (PCs).

Background:

PCs, comprising typical carcinoids (TCs) and atypical carcinoids (ACs), are rare low-grade malignant tumors. We determine the optimal surgical management for early-stage PCs using data from the Surveillance, Epidemiology, and End Results registry.

Methods:

Clinical and survival data of patients with early-stage PC tumors with a diameter ≤3 cm were retrieved. The Kaplan-Meier method and logrank tests were used to assess the differences in overall survival (OS). Subgroup analyses were also performed. To reduce the inherent bias of retrospective studies, two propensity score matching (PSM) analysis with (PSM2) or without (PSM1) consideration of lymph node assessment were performed.

Results:

In total, 2934 patients with PCs, including 2741 (93.42%) with TCs and 193 (6.58%) with ACs, were recruited. After PSM1 analysis, TC patients in the lobectomy group had a significantly better OS than those in the sublobar resection group (P = 0.0067), which is more remarkable for patients with a tumor diameter of 2 cm <T ≤ 3 cm (P = 0.0345) and those aged <70 years (P = 0.0032). However, survival benefits were not found after PSM2 analysis which balanced lymph node assessment. In multivariate cox analysis, age <70 years, female, TC histology and adequate lymph node assessment were associated with better OS.

Conclusions:

Sublobar resection may not significantly compromise the longterm oncological outcomes in early-stage PCs ≤3 cm in size if lymph node assessment is performed adequately. Further validation in large randomized clinical trials is warranted.
SARS-CoV-2: Proof of recombination between strains and emergence of possibly more virulent ones
Authors: Haddad Dania , John Sumi Elsa , Mohammad Anwar , Hammad Maha M , Hebbar Prashantha , Channanath Arshad , Nizam Rasheeba , Al-Qabandi Sarah , Madhoun Ashraf Al , Alshukry Abdullah , Ali Hamad , Thanaraj Thangavel Alphonse , Al-Mulla Fahd
Published: November 2020

COVID-19 is challenging healthcare preparedness, world economies, and livelihoods. The infection and death rates associated with this pandemic are strikingly variable in different countries. To elucidate this discrepancy, we analyzed 2431 early spread SARS-CoV-2 sequences from GISAID. We estimated continental-wise admixture proportions, assessed haplotype block estimation, and tested for the presence or absence of strains recombination. Herein, we identified 1010 unique missense mutations and seven different SARS-CoV-2 clusters. In samples from Asia, a small haplotype block was identified; whereas, samples from Europe and North America harbored large and different haplotype blocks with nonsynonymous variants. Variant frequency and linkage disequilibrium varied among continents, especially in North America. Recombination between different strains was only observed in North American and European sequences. Additionally, we structurally modeled the two most common mutations D614G and P314L which suggested that these linked mutations may enhance viral entry and stability. Overall, we propose that COVID-19 virulence may be more severe in Europe and North America due to coinfection with different SARS-CoV-2 strains leading to genomic recombination which might be challenging for current treatment regimens and vaccine development. Furthermore, our study provides a possible explanation for the more severe second wave of COVID-19 that many countries are currently experiencing presented as higher rates of infection and death.
Automatic Head and Neck Tumor Segmentation in PET/CT with Scale Attention Network
Authors: Yuan Yading
Published: November 2020

Automatic segmentation is an essential but challenging step for extracting quantitative imaging bio-markers for characterizing head and neck tumor in tumor detection, diagnosis, prognosis, treatment planning and assessment. The HEad and neCK TumOR Segmentation Challenge 2020 (HECKTOR 2020) provides a common platform for comparing different automatic algorithms for segmentation the primary gross target volume (GTV) in the oropharynx region on FDG-PET and CT images. We participated in the image segmentation challenge by developing a fully automatic segmentation network based on encoder-decoder architecture. In order to better integrate information across different scales, we proposed a dynamic scale attention mechanism that incorporates low-level details with high-level semantics from feature maps at different scales. Our framework was trained using the 201 challenge training cases provided by HECKTOR 2020, and achieved an average Dice Similarity Coefficient (DSC) of 0.7505 with cross validation. By testing on the 53 testing cases, our model achieved an average DSC, precision and recall of 0.7318, 0.7851, and 0.7319 respectively, which ranked our method in the fourth place in the challenge (id: deepX).
Modelling the positive testing rate of COVID-19 in South Africa Using A Semi-Parametric Smoother for Binomial Data
Authors: Owokotomo Olajumoke Evangelina , Manda Samuel , Kasim Adetayo , Claesen Jurgen , Shkedy Ziv , Reddy Tarylee
Published: November 2020

The current outbreak of COVID-19 is a major pandemic that has shaken up the entire world in a short time. South Africa has the highest number of COVID-19 cases in Africa and understanding the country’s disease trajectory is important for government policy makers to plan the optimal COVID-19 intervention strategy. The number of cases is highly correlated with the number of COVID-19 tests undertaking. Thus, current methods of understanding the COVID-19 transmission process in the country based only on the number of cases can be misleading. In light of this, we propose to estimate both the probability of positive cases per tests conducted (the positive testing rate) and the rate in which the positive testing rate changes over time (its derivative) using a flexible semi-parametric model.

We applied the method to the observed positive testing rate in South Africa with data obtained from March 5th to September 2nd 2020. We found that the positive testing rate was declining from early March when the disease was first observed until early May where it kept on increasing. In the month of July 2020, the infection reached its peak then its started to decrease again indicating that the intervention strategy is effective. From mid August, 2020, the rate of change of the positive testing rate indicates that decline in the positive testing rate is slowing down, suggesting that a less effective intervention is currently implemented.
Neurobiological Underpinnings of Social-Emotional Impairments in Adolescents with Non-Suicidal Self-Injury
Authors: Lutz Nina , Villa Luca , Jassim Nazia , Goodyer Ian , Suckling John , Wilkinson Paul
Published: November 2020

Objective

Few studies have investigated the neurological underpinnings of social-emotional processing among individuals with non-suicidal self-injury (NSSI), despite the range of interpersonal impairments associated with the behavior. This study aims to identify NSSI-specific patterns of resting state functional connectivity (RSFC) and neural activation during an emotional facial expression task.

Methods

Participants were currently depressed, antidepressant-free adolescents with and without lifetime history of NSSI. Left and right amygdala were specified as seed regions for RSFC analysis (n=43 NSSI, n=9 clinical controls). The emotional faces task presented participants with neutral, happy, and sad faces. Whole-brain analyses examined neural activation during the task, and groups were compared on post-scan ratings of facial emotional intensity (n=39 NSSI, n=9 clinical controls).

Results

Groups did not differ in RSFC analyses. Adolescents with NSSI showed attenuated neural activation to happy (versus neutral) faces in areas of the occipital lobe and cerebellum, and rated neutral and sad faces as more negative than clinical controls.

Conclusions

While groups did not differ in baseline limbic connectivity, neurological and behavioral findings revealed NSSI-specific alterations in processing of social-emotional stimuli. Depressed adolescents with NSSI interpreted ambiguous or negative social stimuli more negatively than depressed controls, and had an attenuated neural response to positive social stimuli. This negative bias likely contributes to the myriad interpersonal difficulties associated with NSSI. Adolescents with NSSI may benefit from treatments which combat these negative social interpretations and improve control over emotional responses to interpersonal stress.
The iHealth-T2D study: Statistical analysis plan for a cluster randomised controlled trial with intensive family-based lifestyle modification programme to reduce type 2 diabetes risk amongst South Asians
Authors: Muilwijk Mirthe , Loh Marie , Mahmood Sara , Palaniswamy Saranya , Siddiqui Samreen , Silva Wnurinham , Frost Gary S. , Gage Heather M. , Jarvelin Marjo-Riitta , Rannan-Eliya Ravindra P. , Ahmed Sajjad , Jha Sujeet , Kasturiratne Anuradhani , Katulanda Prasad , Khawaja Khadija I. , Kooner Jaspal S. , Wickremasinghe Ananda R. , van Valkengoed Irene G.M. , Chambers John C.
Published: November 2020

Background

South Asians are at high risk of type 2 diabetes (T2D). Lifestyle modification is effective at preventing T2D amongst South Asians, but the approaches to screening and intervention are limited by high-costs, poor scalability and thus low impact on T2D burden. An intensive family-based lifestyle modification programme for prevention of T2D was developed. The aim of the iHealth-T2D trial is to compare the effectiveness of this programme with usual care.

Methods

The iHealth-T2D trial is designed as a cluster randomised controlled trial (RCT) conducted at 120 locations across India, Pakistan, Sri Lanka and the UK. A total of 3,682 South Asian men and women with age between 40-70 years without T2D but at elevated risk for T2D [defined by central obesity (waist circumference ≥95cm in Sri Lanka, or ≥100cm in India, Pakistan and UK) and/or prediabetes (HbA1c ≥6.0%)] were included in the trial. Here we describe in detail the statistical analysis plan (SAP), which was finalised before outcomes were available to the investigators. The primary outcome will be evaluated after three years of follow-up after enrolment to the study, and is defined as T2D incidence in the intervention arm compared to usual care. Secondary outcomes are evaluated both after one and three years of follow-up and include biochemical measurements, anthropometric measurements, behavioural components and treatment compliance.

Discussion

The iHealth-T2D trial will provide evidence whether an intensive family-based lifestyle modification programme in South Asians who are at high risk for T2D is effective in the prevention of T2D. The data from the trial will be analysed according to this pre-specified SAP.

Ethics and dissemination

The trial was approved by the international review board of each participating study site. Study findings will be disseminated through peer-reviewed publications and in conference presentations.

Trial registration

EudraCT 2016-001350-18. Registered 14 April 2016https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/ihealth-t2d/;ClinicalTrials.govNCT02949739. Registered 31 October 2016,https://clinicaltrials.gov/ct2/show/NCT02949739, First posted 31/10/2016.
Mobile consulting (mConsulting) as an option for accessing healthcare services for communities in remote rural areas and urban slums in low- and middle- income countries: A mixed methods study
Authors: Harris Bronwyn , Ajisola Motunrayo , Alam Raisa , Watkins Jocelyn Antsley , Arvanitis Theodoros N , Bakibinga Pauline , Chipwaza Beatrice , Choudhury Nazratun , Fayhun Olufunke , Kibe Peter , Omigbodun Akinyinka , Owoaje Eme , Pemba Senga , Potter Rachel , Rizvi Narjis , Sturt Jackie , Cave Jonathan , Iqbal Romaina , Kabaria Caroline , Kalolo Albino , Kyobutungi Catherine , Lilford Richard , Mashanya Titus , Ndegese Sylvester , Rahman Omar , Sayani Saleem , Yusuf Rita , Griffiths Frances
Published: November 2020

Objective

Remote or mobile consulting (mConsulting) is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during COVID-19 and beyond. We explored whether mConsulting is a viable option for communities with minimal resources in low- and middle-income countries (LMICs).

Methods

We reviewed evidence published since 2018 about mConsulting in LMICs and undertook a scoping study (pre-COVID) in two rural settings (Pakistan, Tanzania) and five urban slums (Kenya, Nigeria, Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites), and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mConsulting providers, local and national decision-makers. Project advisory groups guided the study in each country.

Results

We reviewed five empirical studies and seven reviews, analysed data from 5,219 urban slum households and engaged with 419 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. mConsulting services are operating through provider platforms (n=5-17) and, at community-level, some direct experience of mConsulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. mConsulting can reduce affordability barriers and facilitate care-seeking practices.

Conclusions

There are indications of readiness for mConsulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply-chains to fully realise the continuity of care and responsiveness that mConsulting services offer, particularly during/beyond COVID-19.
Sociodemographic inequalities in cardiovascular risk factors among adolescents from indigenous areas of Chiapas, Mexico
Authors: Flores-Guillen Elena , Castro-Quezada Itandehui , Ochoa Hector , Garcia-Miranda Rosario , Cruz Miguel , Irecta-Najera Cesar Antonio , Cruz-Cruz Paola , Solis-Hernandez Roberto
Published: November 2020

Objectives: The objective of this study was to determine the prevalence of cardiovascular risk factors among different sociodemographic and geographic areas of adolescents from indigenous areas of Chiapas, Mexico.
Design: A cross-sectional study.
Setting: Communities in the Totzil - Tseltal and Selva region of Chiapas, Mexico, were studied. Urban and rural areas of high marginalization according to the Human Development Index.

Participants: 253 adolescents were studied, of which 48.2% were girls and 51.8% were boys.

Primary and secondary outcome measures: a descriptive analysis of the quantitative variables was performed through central tendency and dispersion measures. Prevalence of cardiovascular risk factors and 95% confidence intervals (95% CI), stratified by sex, geographic area (rural/urban), schooling and ethnicity of mothers were estimated.
Results: the predominant risk factor in the study population was low HDL-c (51%). Higher prevalences of abdominal obesity and high triglycerides in girls were found and abnormal diastolic blood pressure in boys was identified. In urban areas were found greater prevalences of overweight/obesity and of insulin resistance while abnormal blood pressure levels were more prevalent in rural areas. Differences were found in the educational levels and ethnicity of the adolescents' mothers. Prevalence of metabolic syndrome was 10% according to NCEP-ATPIII.
Conclusions: In this study, sociodemographic and geographical disparities were found in cardiovascular risk factors. Prevalence of risk factors was high, affecting mostly girls and urban population. Thus, there is a great need to promote healthy lifestyles and health, social and economic interventions to prevent chronic diseases in adulthood.
Protective behaviours and secondary harms from non-pharmaceutical interventions during the COVID-19 epidemic in South Africa: a multisite prospective longitudinal study
Authors: Harling Guy , Gómez-Olivé Francesc Xavier , Tlouyamma Joseph , Mutevedzi Tinofa , Kabudula Chodziwadziwa Whiteson , Mahlako Ruth , Singh Urisha , Ohene-Kwofie Daniel , Buckland Rose , Ndagurwa Pedzisai , Gareta Dickman , Gunda Resign , Mngomezulu Thobeka , Nxumalo Siyabonga , Wong Emily B. , Kahn Kathleen , Siedner Mark J. , Maimela Eric , Tollman Stephen , Collinson Mark , Herbst Kobus
Published: November 2020

Background

In March 2020 South Africa implemented strict non-pharmaceutical interventions (NPIs) to contain Covid-19. Over the subsequent five months NPIs were eased in stages according to national strategy. Covid-19 spread throughout the country heterogeneously, reaching rural areas by July and peaking in July-August. Data on the impact of NPI policies on social and economic wellbeing and access to healthcare is limited. We therefore analysed how rural residents of three South African provinces changed their behaviour during the first epidemic wave.

Methods

The South African Population Research Infrastructure Network (SAPRIN) nodes in Mpumalanga (Agincourt), KwaZulu-Natal (AHRI) and Limpopo (DIMAMO) provinces conducted longitudinal telephone surveys among randomly sampled households from rural and peri-urban surveillance populations every 2-3 weeks. Interviews included questions on: Covid-19 knowledge and behaviours; health and economic impact of NPIs; and mental health.

Results

2262 households completed 10,966 interviews between April and August 2020. By August, self-reported satisfaction with Covid-19 knowledge had risen from 48% to 85% and facemask use to over 95%. As selected NPIs were eased mobility increased, and economic losses and anxiety and depression symptoms fell. When Covid-19 cases spiked at one node in July, movement dropped rapidly, and missed daily medication rates doubled. Economic concerns and mental health symptoms were lower in households receiving a greater number of government-funded old-age pensions.

Conclusions

South Africans reported complying with stringent Covid-19 NPIs despite the threat of substantial social, economic and health repercussions. Government-supported social welfare programmes appeared to buffer interruptions in income and healthcare access during local outbreaks. Epidemic control policies must be balanced against impacts on wellbeing in resource-limited settings and designed with parallel support systems where they threaten income and basic service access.
What is the Status of Elderly Abuse in India: A Systematic Review Protocol
Authors: Nagi Raunaq Singh , Sembiah Sembagamuthu , Chatterjee Anirban , Negi Rudresh
Published: November 2020

Elder abuse has been identified as one of the major problems of public health globally. Many types of mistreatment practices contribute to elder abuse. Also, the event has been known to occur in community as well as institutional settings such as hospitals and nursing homes. Elder abuse has been shown to affect the quality of life of individuals and increase premature mortality of the elderly. However, majority of elder abuse remains undocumented due to reasons such as fear and lack of awareness of one’s rights among others. Furthermore, the social construct of Indian societies makes the identification and acknowledgement of elder abuse challenging. Although, there have been studies and reports regarding the prevalence of elder abuse in India from various geographical regions, the strength of this evidence is unknown and a general view of prevalence of elder abuse in India is missing.

We propose to undertake a systematic review and metanalysis of the published literature from India regarding the prevalence of elder abuse in any setting. For the purpose we will scan various indexing databases for identification of relevant studies and follow standard protocols and guidelines for formulation of evidence. The results of this study will give an entrusted overview of the status of elder abuse in India and aid policy-making initiatives and interventions to be directed accordingly.
Correlation of Body Mass Index (BMI), initial neutralizing antibodies (nAb), ABO group and kinetics of nAb and anti-nucleocapsid (NP) SARS-CoV-2 antibodies in convalescent plasma (CCP) donors – A longitudinal study with proposals for better quality of CCP collections
Authors: Wendel S , Fontão-Wendel R , Fachini R , Candelaria G , Scuracchio P , Achkar R , Brito MA , Reis LFL , Camargo A , Amano M , Machado RRG , Araujo D , Soares CP , Durigon E
Published: November 2020

Introduction

A cohort of COVID-19 convalescent volunteers allowed the study of neutralizing (nAb) and ligand antibodies kinetics by providing sequential samples during a median of 100 days after onset of disease.

Material and Methods

A cohort of previously RT-PCR+ve (detected by nasopharyngeal swab during the acute phase), male convalescent patients, all with mild symptoms, were enrolled on serial blood sample collection for evaluation of longitudinal nAb titers and anti-nucleocapsid (NP) antibodies (IgM, IgG and IgA). Nabs were detected by a cytopathic effect-based virus neutralization test (CPE-based VNT), carried out with SARS-CoV-2 (GenBank: MT350282)

Results

A total of 78 male volunteers provided 316 samples, spanning a total of 4820 days of study. Although only 25% of donors kept nAb titers ≥160, after a median of 100 days after the onset of disease, there was a high probability of sustaining nAB titers ≥160 in volunteers whose initial nAb titer was ≥1280, weight ≥ 90kg or BMI classified as overweight or obese, evidenced by Kaplan-Meier estimates and Cox hazard regression. There was no correlation between ABO group, ABO antibody titers and persistent high nAb titers. High IgG anti-NP (S/CO ≥5.0) is a good surrogate for detecting nAB ≥160, defined by ROC curve (sensitivity = 90.5%; CI95% 84.5-94.7%)

Conclusion

Selection of CCP donors for multiple collections based on initial high nAb titers (≥1280) or overweight/obese (BMI) provides a simple strategy to achieve higher quality in CCP programs. High IgG anti-NP levels can also be used as surrogate markers for high nAb screening.
Early Prediction of Hemodynamic Shock in the Intensive Care Units with Deep Learning on Thermal Videos
Authors: Vats Vanshika , Nagori Aditya , Singh Pradeep , Dutt Raman , Bandhey Harsh , Wason Mahika , Lodha Rakesh , Sethi Tavpritesh
Published: November 2020

Shock is one of the major killers in Intensive Care Units and early interventions can potentially reverse it. In this study, we advance a non-contact thermal imaging modality to continuous monitoring of hemodynamic shock working on 103,936 frames from 406 videos recorded longitudinally upon 22 patients. Deep learning was used to preprocess and extract the Center-to-Peripheral Difference (CPD) in temperature values from the videos. This time-series data along with heart rate was finally analyzed using Long-Short Term Memory models to predict the shock status up to the next 6 hours. Our models achieved the best area under the receiver operating characteristics curve of 0.81 ± 0.06 and area under the precision-recall curve of 0.78 ± 0.05 at 5 hours, providing sufficient time to stabilize the patient. Our approach, thus, provides a reliable shock prediction using an automated decision pipeline, that can provide better care and save lives.
Estimating the cumulative incidence of SARS-CoV-2 infection and the infection fatality ratio in light of waning antibodies
Authors: Shioda Kayoko , Lau Max SY , Kraay Alicia NM , Nelson Kristin N , Siegler Aaron J , Sullivan Patrick S , Collins Matthew H , Weitz Joshua S , Lopman Benjamin A
Published: November 2020

Background

Serology tests can identify previous infections and facilitate estimation of the number of total infections. However, immunoglobulins targeting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to wane below the detectable level of serological assays. We estimate the cumulative incidence of SARS-CoV-2 infection from serology studies, accounting for expected levels of antibody acquisition (seroconversion) and waning (seroreversion), and apply this framework using data from New York City (NYC) and Connecticut.

Methods

We estimated time from seroconversion to seroreversion and infection fatality ratio (IFR) using mortality data from March-October 2020 and population-level cross-sectional seroprevalence data from April-August 2020 in NYC and Connecticut. We then estimated the daily seroprevalence and cumulative incidence of SARS-CoV-2 infection.

Findings

The estimated average time from seroconversion to seroreversion was 3-4 months. The estimated IFR was 1.1% (95% credible interval: 1.0-1.2%) in NYC and 1.4% (1.1-1.7%) in Connecticut. The estimated daily seroprevalence declined after a peak in the spring. The estimated cumulative incidence reached 26.8% (24.2-29.7%) and 8.8% (7.1-11.3%) at the end of September in NYC and Connecticut, higher than maximum seroprevalence measures (22.1% and 6.1%), respectively.

Interpretation

The cumulative incidence of SARS-CoV-2 infection is underestimated using cross-sectional serology data without adjustment for waning antibodies. Our approach can help quantify the magnitude of underestimation and adjust estimates for waning antibodies.

Funding

This study was supported by the US National Science Foundation and the National Institute of Allergy and Infectious Diseases.