bluuebunny/crossref_metadata_2025 huggingface dataset:
Let the EHR Talk Loudly: An EHR-Connected Verbal Surgical Safety Checklist for Medical Procedures in the Intensive Care Unit
Authors: Uppot Raul N. , Yu Alvin Yiu Chun , Samadi Katayoun , Pino Richard M. , Lee Jarone
Published: June 2020

Objectives

The purpose of this study was to test the accuracy and user acceptance of an electronic health records (EHR)-connected verbal surgical safety checklist in the intensive care unit (ICU).

Methods

An EHR-connected verbal checklist software was deployed in our ICU between January 2019 and June 2019. The software, loaded on a mobile tablet, loudly verbalized clinical information from the EHR in the form of a time-out checklist. The accuracy of the information delivered was compared with up-to-date clinical data in the EHR in 300 patients. User acceptance was assessed using survey instruments.

Results

The software accurately verbalized patient demographics in 100% (300/300) of tested cases. Concordance rates with real-time values in the EHR for the following variables were calculated: allergies 98.6% (296/300), international normalized ratio 97.6% (293/300), and platelets 91.6% (275/300). Surveys showed that 41.2% (7/17) of users preferred current standard EHR time-outs, 17.6% (3/17) preferred verbalization software, 35.3% (6/17) preferred neither, and 5.9% (1/17) wanted both. When asked if EHR-connected verbalization software should officially replace the current standard EHR checklists, 76.5% (13/17) supported the idea.

Conclusions

An EHR-connected verbal surgical safety checklist software can leverage information in the EHR to help with workflow and patient safety. This study shows that the software can verbally deliver clinical information with great accuracy and that most ICU staff would support replacing current time-out processes.
The Effect of Padded Adhesive Dressing and Static Body Position on Sacral Interface Pressure
Authors: Seu Michelle , Bhat Deepa , Wong Alison , Wong Michael , Nojoomi Matthew , Padula William , Sacks Justin M.
Published: June 2020

Objectives

Padded adhesive bandages are frequently used in the inpatient setting for sacral pressure injury prevention, but it is unclear whether they truly decrease interface pressure. We hypothesized such devices reduce sacral peak interface pressure in the supine position, which would be further reduced in 30-degree reclined and upright seated positions.

Methods

Study participants rested with their sacrum on a pressure-sensing mat, in 3 positions, for 30 seconds each: (1) sitting upright; (2) supine; and (3) supine against 30-degree wedge. Measurements were made with and without a padded adhesive bandage overlying the sacrum. Age, sex, and body mass index (BMI) were collected. These variables were entered sequentially, in an a priori order to construct a linear mixed-effects model.

Results

Forty healthy adults participated. After controlling for by-subject variation, age, and sex, BMI did not influence peak sacral pressure (P = 0.22), although the effect of body position was significant (P < 0.01). Subsequent addition of padded adhesive dressing was nonsignificant (P = 0.17); sacral peak pressure was similar with a padded adhesive dressing (247.8 ± 147.3 mm Hg) or without (mean ± standard deviation = 229.8 ± 127.7 mm Hg). Lastly, there was no significant interaction between BMI and body position (P = 0.11).

Conclusions

Padded adhesive bandages did not reduce interface pressure in any position. Sacral pressure was highest in the supine position and was not specifically affected by BMI. If padded bandages provide clinically significant reduction in pressure injury incidence, it is not simply through the reduction of interface pressure.
Pharmacokinetic and Pharmacodynamic Impacts of Depot Medroxyprogesterone Acetate Use on HIV Pre-exposure Prophylaxis in Women
Authors: Tarleton Jessica , Chen Beatrice A. , Meyn Leslie A. , Hendrix Craig W. , Marzinke Mark A. , Achilles Sharon L.
Published: June 2020

Background:

Depot medroxyprogesterone acetate (DMPA) is a commonly used contraceptive in areas where use of tenofovir disoproxil fumarate and emtricitabine for HIV pre-exposure prophylaxis (PrEP) is increasing.

Objectives:

We aimed to investigate the impact of DMPA on PrEP drug pharmacokinetics and pharmacodynamics in women using PrEP before and after DMPA administration.

Methods:

In this pilot study, 12 HIV-negative women ages 18–45 underwent biological sample collection at 3 time points: before study drug, after 2 weeks of daily PrEP use alone, and after 2 weeks of daily PrEP and concomitant DMPA use. We measured drug and drug metabolites in plasma, peripheral blood mononuclear cells, cervicovaginal fluid, cervical tissue, and rectal fluid after each 2-week course of PrEP. We measured HIV replication ex vivo in genital tissue biopsies and innate anti-HIV activity in cervicovaginal fluid before PrEP and after both courses. We compared drug concentrations after PrEP alone to after PrEP and DMPA in the same participant using Wilcoxon signed-rank tests. We used mixed effects linear regression models to compare pharmacodynamic measures for each participant at predrug baseline, after PrEP alone, and after PrEP and DMPA.

Results:

We found no significant differences in PrEP drug and drug metabolite concentrations in any compartment during concomitant DMPA use compared with use of PrEP alone, except for a reduction in emtricitabine concentration in cervical tissue. We found no difference in HIV replication in cervical tissue or anti-HIV activity in cervicovaginal fluid during concomitant DMPA and PrEP use compared with during PrEP use alone.

Conclusions:

Concomitant use of DMPA does not clinically alter pharmacokinetics or pharmacodynamics of PrEP in women. These data support the safety of DMPA use in women using PrEP.
Surgical Complications of Skin-Sparing Mastectomy and Immediate Implant-Based Breast Reconstruction in Women Concurrently Treated With Adjuvant Chemotherapy for Breast Cancer
Authors: Kooijman Merel M. L. , Hage J. Joris , Oldenburg Hester S. A. , Stouthard Jacqueline M. , Woerdeman Leonie A. E.
Published: June 2020

Background and Aim

To date, studies on adjuvant chemotherapy as a risk factor for the surgical outcome of combined mastectomy and breast reconstruction were hampered by the inclusion of mixed reconstructive cohorts of both delayed and immediate timing and of both autologous and implant-based techniques. Consequently, there is a paucity of data on the impact of adjuvant chemotherapy on surgical complication rates after combined skin-sparing mastectomy and immediate implant-based breast reconstruction.

Methodology

We compared the postoperative complications that occurred within 16 weeks after this combined procedure in 131 women (139 breasts) treated with adjuvant chemotherapy with those in a control group of 491 women (517 breasts) not receiving any adjuvant therapy within 16 weeks.

Results

In line with the clinically indicated selection of women to undergo adjuvant chemotherapy, the interventional group differed significantly from the control group in 7 of the 12 patient- and procedure-related characteristics. The prevalence of minor complications (13.7% and 12.4%, respectively, P = 0.68) and major complications (31.7% and 29.4%, respectively, P = 0.60) did not differ significantly between the interventional group and the controls. The fraction of breasts that needed unscheduled surgery (0.29 and 0.24, respectively, P = 0.20), the fraction of total number of interventions (0.34 and 0.33, respectively, P = 0.24), and the fraction of implants lost (0.72 and 0.67, respectively, P = 0.86) did not differ significantly between both groups. The onset of chemotherapy, furthermore, seemed not to influence the occurrence or severity of complications.

Conclusions

Like other women who have to undergo mastectomy, women who need to undergo adjuvant chemotherapy can potentially benefit from combined skin-sparing mastectomy and immediate implant-based breast reconstruction.
Custom Alloplastic Temporomandibular Joint Reconstruction: Expanding Reconstructive Horizons
Authors: Humphries Laura S. , Shakir Afaaf , Figueroa Alvaro A. , Mercuri Louis G. , Dianiskova Simona , Reid Russell R. , Tragos Christina
Published: June 2020

Custom alloplastic temporomandibular joint (TMJ) reconstruction has been well established for the management of end-stage TMJ disease. However, its use in congenital TMJ deformities is limited. Here, the authors present initial outcomes of skeletally mature patients who underwent custom alloplastic TMJ reconstruction and simultaneous orthognathic surgery.

A retrospective case series of patients who underwent custom alloplastic TMJ reconstruction concurrent with orthognathic surgery between 2014 and 2019 was completed. Functional, aesthetic and orthodontic outcomes as well as complications were recorded.

Seven TMJs in 5 skeletally mature patients (4 female, 1 male, ages 16–30) (2 bilateral, 3 unilateral) were replaced. All but 1 patient had previous attempts at reconstructive surgery with poor results. All cases were prepared using virtual surgical planning and underwent concomitant maxillomandibular orthognathic surgery. All patients demonstrated improved post-operative occlusions. Four of 5 patients achieved >30 millimeters of post-operative MIO. Complications included ear canal perforation and facial nerve dysfunction.

There were no infections or other implant-related complications. Mean follow up was 2 years and 15 days. Alloplastic TMJ reconstruction at the time of skeletal maturity for patients with congenital mandibular TMJ defects is an alternative to existing management options. Further long-term prospective outcomes studies are ongoing.
Validation of the Hubli Grading System for Assessing Unilateral and Bilateral Cleft Lip Outcomes
Authors: Davis Matthew J. , Volk Angela S. , Desai Priya K. , Rumprecht Ewa , Hubli Eric
Published: June 2020

Background:

When determining whether a cleft lip repair outcome is acceptable, the severity of a patient's cleft at initial presentation must be considered. Currently, there is not a widely agreed upon scale for grading the pre-operative severity or post-operative surgical outcome for patients with unilateral and/or bilateral cleft lip. The aim of this study is to validate the Hubli grading system as a reliable and reproducible system for characterizing cleft lip repair outcomes.

Methods:

Craniofacial surgeon graders independently evaluated 2489 patients from 56 different countries undergoing both unilateral and bilateral cleft lip repair from April 2004 to December 2018. Preoperative severity and postoperative surgical results were assessed, and these grades were combined to determine surgical outcome acceptability based on initial cleft severity. Intrarater and interrater reliability were calculated as percentages of agreement.

Results:

Intrarater and interrater acceptability scores had an agreement of 94.50% and 87.04%, respectively. These results indicate that using the Hubli grading system, independent raters are able to reliably and reproducibly measure the acceptability of a cleft lip repair.

Conclusions:

This study validates the use of the Hubli grading system to evaluate the acceptability of unilateral and bilateral cleft lip repairs. This is the largest study to date to evaluate cleft lip severity and repair outcomes, and the Hubli grading system is the only scale to determine the acceptability of surgical outcomes based on initial cleft severity. This system is designed to identify surgeons with sub-optimal outcomes in order to implement timely, individualized training on a global scale.
Breast Implant-associated Anaplastic Large Cell Lymphoma
Authors: Tevis Sarah E. , Hunt Kelly K. , Miranda Roberto N. , Lange Caitlin , Pinnix Chelsea C. , Iyer Swaminathan , Butler Charles E. , Clemens Mark W.
Published: June 2020

Objective:

We sought to evaluate patients at a single academic institution in a prospective manner to report patient presentation, clinical course, treatment, and outcomes in breast implant ALCL patients.

Background:

Breast implant-associated anaplastic large cell lymphoma (breast implant ALCL) is an uncommon T cell lymphoma, which is associated with textured surface breast implants. The disease has received increasing attention over the last 20 years. Previous retrospective studies have begun to outline the clinical course of breast implant ALCL.

Methods:

We prospectively followed women with cytologically proven breast implant ALCL from 2014 to 2019. Demographic, clinical, treatment, and outcome data were collected and descriptive statistics were performed on variables of interest.

Results:

We identified 52 women with pathologically confirmed breast implant ALCL. Implants were placed for augmentation in 61.5% of women and reconstruction in 36.5% of women. All of the 41 patients with known implant information had implants with textured surface. The majority of patients presented with delayed seroma (69.2%) and without systemic symptoms (86.5%). Most patients with staging information presented with Stage IA disease. Patient outcomes were excellent with 2 disease recurrence (3.8%) and all patients ultimately achieved complete remission.

Conclusions:

Further evaluation of the prospective and growing database of patients with breast implant ALCL will further improve our understanding of the disease and its clinical course. Robust participation in the breast implant ALCL PROFILE registry will improve our knowledge of long-term outcomes after implant placement. Finally, increasing awareness for patients and providers will lead to earlier diagnosis and improved outcomes for patients.
A Checklist to Assess Adequacy of Vitamin D Intake
Authors: Drummond James E. , Kraft Diane
Published: June 2020

Few foods are natural sources of vitamin D in the American diet. A Vitamin D Checklist (VDC) containing 11 food groupings that represent the major sources of the vitamin was developed to estimate vitamin D intake adequacy. Undergraduate students (N = 82, 25 males and 57 females) completed a 3-day food record (FR) and analyzed them with the USDA Supertracker nutrition analysis program, which generated their daily average vitamin D intake as a % of their vitamin D RDA (%D-RDA). Subjects also completed a VDC for the same 3-day FR period. FR %D-RDA correlated with higher VDC recall of consuming either milk (P ≤ .001), vitamin D–fortified cereal (P ≤ .001), or American cheese (P = .02). The greater the number of VDC food groupings consumed, the higher the estimated FR %D-RDA. We concluded that the VDC may have applications for use as a tool for a quick assessment of vitamin D intake in patient settings.
The Association Between Cancer and Spousal Rate of Memory Decline
Authors: Ospina-Romero Monica , Brenowitz Willa D. , Glymour M. Maria , Mayeda Elizabeth R. , Graff Rebecca E. , Witte John S. , Ackley Sarah F. , Lu Kun Ping , Kobayashi Lindsay C.
Published: June 2020

Cancer diagnoses are associated with better long-term memory in older adults, possibly reflecting a range of social confounders that increase cancer risk but improve memory. We used spouse’s memory as a negative control outcome to evaluate this possible confounding, since spouses share social characteristics and environments, and individuals’ cancers are unlikely to cause better memory among their spouses. We estimated the association of an individual’s incident cancer diagnosis (exposure) with their own (primary outcome) and their spouse’s (negative control outcome) memory decline in 3601 couples from 1998 to 2014 in the Health and Retirement Study, using linear mixed-effects models. Incident cancer predicted better long-term memory for the diagnosed individual. We observed no association between an individual’s cancer diagnosis and rate of spousal memory decline. This negative control study suggests that the inverse association between incident cancer and rate of memory decline is unlikely to be attributable to social/behavioral factors shared between spouses.
Flavobacterium salilacus sp. nov., isolated from surface water of a hypersaline lake, and descriptions of Flavobacterium salilacus subsp. altitudinum subsp. nov. and Flavobacterium salilacus subsp. salilacus subsp. nov.
Authors: Debnath Sanjit Chandra , Chen Can , Khan Ishrat , Wang Wen-Jie , Zheng Dao-Qiong , Xu Jin-Zhong , Wang Pin-Mei
Published: June 2020

Two yellow-pigmented, Gram-stain-negative, aerobic, rod-shaped bacteria were isolated from the water of the hypersaline Chaka Salt Lake (strain SaA2.12T) and sediment of Qinghai Lake (strain LaA7.5T), PR China. According to the 16S rRNA phylogeny, the isolates belong to the genus

Flavobacterium

, showing the highest 16S rRNA sequence similarities to

Flavobacterium arcticum

SM1502T(97.6–97.7 %) and

Flavobacterium suzhouense

XIN-1T(96.5–96.6 %). Moreover, strains SaA2.12T and LaA7.5T showed 99.73 % 16S rRNA sequence similarity to each other. Major fatty acids, respiratory quinones and polar lipids detected in these isolates were iso-C15 : 0, menaquinone-6 and phosphatidylethanolamine, respectively. Strains SaA2.12T and LaA7.5T showed significant unique characteristics between them as well as between the closest phylogenetic members. The highest digital DNA–DNA hybridization (dDDH) and average nucleotide identity (ANI) values between SaA2.12T and its closest neighbours were 25.3 and 82.8 %, respectively; whereas these values (highest) between LaA7.5T and its closest members were 25.2 and 82.8 %, respectively. The dDDH and ANI values between strains SaA2.12T and LaA7.5T were calculated as 75.9 and 97.2 %, respectively. Therefore, based on polyphasic data, we propose that strain SaA2.12T represents a novel species with the name Flavobacterium salilacus sp. nov., with the type strain SaA2.12T (=KCTC 72220T=MCCC 1K03618T) and strain LaA7.5T as a subspecies within novel Flavobacterium salilacus with the name Flavobacterium salilacus subsp. altitudinum subsp. nov., with the type strain LaA7.5T (=KCTC 72806T=MCCC 1K04372T). These propositions automatically create Flavobacterium salilacus subsp. salilacus subsp. nov. with SaA2.12T (=KCTC 72220T=MCCC 1K03618T) as the type strain.
SARS-coronavirus-2 replication in Vero E6 cells: replication kinetics, rapid adaptation and cytopathology
Authors: Ogando Natacha S. , Dalebout Tim J. , Zevenhoven-Dobbe Jessika C. , Limpens Ronald W.A.L. , van der Meer Yvonne , Caly Leon , Druce Julian , de Vries Jutte J. C. , Kikkert Marjolein , Bárcena Montserrat , Sidorov Igor , Snijder Eric J.
Published: June 2020

The sudden emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of 2019 from the Chinese province of Hubei and its subsequent pandemic spread highlight the importance of understanding the full molecular details of coronavirus infection and pathogenesis. Here, we compared a variety of replication features of SARS-CoV-2 and SARS-CoV and analysed the cytopathology caused by the two closely related viruses in the commonly used Vero E6 cell line. Compared to SARS-CoV, SARS-CoV-2 generated higher levels of intracellular viral RNA, but strikingly about 50-fold less infectious viral progeny was recovered from the culture medium. Immunofluorescence microscopy of SARS-CoV-2-infected cells established extensive cross-reactivity of antisera previously raised against a variety of non-structural proteins, membrane and nucleocapsid protein of SARS-CoV. Electron microscopy revealed that the ultrastructural changes induced by the two SARS viruses are very similar and occur within comparable time frames after infection. Furthermore, we determined that the sensitivity of the two viruses to three established inhibitors of coronavirus replication (remdesivir, alisporivir and chloroquine) is very similar, but that SARS-CoV-2 infection was substantially more sensitive to pre-treatment of cells with pegylated interferon alpha. An important difference between the two viruses is the fact that – upon passaging in Vero E6 cells – SARS-CoV-2 apparently is under strong selection pressure to acquire adaptive mutations in its spike protein gene. These mutations change or delete a putative furin-like cleavage site in the region connecting the S1 and S2 domains and result in a very prominent phenotypic change in plaque assays.
Methylenetetrahydrofolate reductase gene C677T polymorphism and risk of alcohol dependence
Authors: Rai Vandana , Kumar Pradeep
Published: June 2020

Alcohol dependence is a complex neuropsychiatric disorder. Numerous studies investigated association between MTHFR gene C677T polymorphism and alcohol dependence (AD), but the results of this association remain conflicting. Accordingly, authors conducted a meta-analysis to further investigate such an association. PubMed, Elsevier Science Direct and Springer Link databases were searched for studies on the association between the MTHFR C677T polymorphism and AD. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using the fixed- or random-effects model. Statistical analysis was performed with the software program MetaAnayst and MIX.

A total of 11 articles were identified through a search of electronic databases, up to February 28, 2020. The results of the present meta-analysis did not show any association between MTHFR C677T polymorphisms and AD risk (for T vs. C: OR = 1.04, 95% CI = 0.88-1.24; CT vs. CC: OR=1.02, 95%CI= 0.62-1.68; for TT + CT vs. CC: OR = 1.10, 95% CI = 0.94-1.29; for TT vs. CC: OR = 1.01, 95% CI = 0.66-1.51; for TT vs. CT + CC: OR = 0.97, 95% CI = 0.66-1.40). Results of subgroup analysis showed no significant association between MTHFR C677T polymorphism with AD in Asian as well as in Caucasian population. In conclusion, C677T polymorphism is not a risk factor for alcohol dependence.
Are Suboptimal in utero Conditions Associated with Obesity and Cardiometabolic Risk Factors in Caucasian children?
Authors: Saidj Soraya , Henderson Melanie , Ruchat Stephanie-May , Paradis Gilles , Hulst Andraea Van , Zappitelli Michael , Mathieu Marie-Eve
Published: June 2020

Objective

To explore the association between in utero exposure to suboptimal gestational factors (SGFS; gestational diabetes mellitus, hypertensive disorders during pregnancy, maternal smoking during pregnancy), childhood obesity, and cardiometabolic risk factors.

Methods

Data were obtained from the “QUebec Adiposity and Lifestyle InvesTigation in Youth” longitudinal study (QUALITY) composed of 630 Caucasian children recruited at age 8–10 (first visit V1; n=619) and followed-up 2 years later (second visit V2; n=557). Multivariate logistic regression models were used.

Results

In the cohort, maternal smoking during pregnancy was associated with higher odds of obesity (OR1=2.00, 95% CI 1.25-3.20, OR2=2.29, 95% CI 1.26-4.16) at both visit and with higher odds of high waist circumference (OR1=1.96, 95% CI 1.24-3.1) at V1. Hypertensive disorders during pregnancy were associated with higher odds of obesity (OR1=2.37, 95% CI 1.17-4.80) at visit 1. Joint exposure to SGFS was associated with higher odds of: high waist circumference (OR1=1.42, 95% CI 1.06-1.91) at V1, obesity (OR2= 1.63, 95% CI 1.153-2.32) at V2 and low levels of HDL cholesterol (OR2=1.45, 95% CI 1.04-2.03) at V2. Analysis stratification by sex revealed that boys were more adversely affected by exposure to combined SGFS while girls were more affected by exposure to maternal smoking during pregnancy.

Conclusion

In utero exposure to an independent or combined SGFS is associated with adverse adipose and cardiometabolic profiles in children, with sex specificities.
Epidemiological and clinical characteristics in patients with SARS-CoV-2 antibody negative probable COVID-19 in Wuhan
Authors: Duan Limin , Zhang Shuai , Guo Mengfei , Zhou E , Fan Jinshuo , Wang Xuan , Wang Ling , Wu Feng , Jin Yang
Published: June 2020

Background

Patients with suspected COVID-19 might be admitted to hospital. We aimed to describe the characteristic of SARS-CoV-2 antibody negative probable COVID-19 patients and give some suggestions to manage suspected COVID-19 patients.

Methods

We analyzed 616 confirmed COVID-19 patients and 35 SARS-CoV-2 antibody negative probable COVID-19 patients who were admitted in Wuhan Union Hospital from February 13, 2020 to February 16, 2020. Telephone interviews were conducted and medical records were reviewed for epidemiological, clinical, laboratory and radiographic data.

Results

Of the 35 SARS-CoV-2 antibody negative probable COVID-19 patients, all of them had tested at least 3 times of nucleic acid, 3 were believed to be non-SARS-CoV-2 infection. Compared with confirmed patients, antibody negative probable patients were younger (P=0.017), exhibited similar symptoms and chest CT images, had higher lymphocyte count (P=0.004) and albumin level (P<0.001), showed lower lactate dehydrogenase level (P=0.011) and erythrocyte sedimentation rate (P<0.001). During hospitalization, all the 35 patients had contacted with confirmed COVID-19 patients, but all used general face mask for protection and maintained a social distance of more than one meter from each other. All the isolation wards were kept ventilation and disinfected once a day. After discharged from hospital, all of them had negative nucleic acid tests and no one developed symptoms again.

Conclusions

The conditions of patients with AbN probable COVID-19 were less critical than those of patients with confirmed COVID-19. Room ventilation and daily disinfection, wearing face masks, and maintaining social distance might be helpful to prevent patients from hospital acquired COVID-19 infection.
Clinical characteristics and outcomes of critically ill patients with COVID-19 in a tertiary community hospital in upstate New York
Authors: Lenka Jyotirmayee , Chhabria Mamta S. , Sharma Naman , Tan Bryan E-Xin , Teja Boppana Leela Krishna , Venugopal Sharini , Sondhi Damanpaul S.
Published: June 2020

Background

There are limited reports describing critically ill COVID-19 patients in New York.

Methods

We conducted a retrospective analysis of 32 adult critically ill patients admitted to a tertiary community hospital in upstate NY, between March 14th and April 12th, 2020. We collected demographic, laboratory, ventilator, and treatment data, which were analyzed and clinical outcomes tabulated.

Results

32 patients admitted to the ICU were included, with mean (±SD) follow-up duration 21 ± 7 days. Mean (±SD) age was 62.2 ± 11.2 years, and 62.5% were men. 27 (84.4%) of patients had one or more medical co-morbidities and 50% of the patients were current or former smokers. The mean (±SD) duration of symptoms was 6.6 (±4.4) days before presentation, with cough (81.3%), dyspnea (68.7%), and fever (65.6%) being most common. 23 (71.9%) patients received invasive mechanical ventilation. 5 (15.6%) had died, 11 (34.4%) had been discharged home, and 16 (50%) remained hospitalized, 8 (25%) of which were still in ICU. Mean (±SD) length of ICU stay was 10.2 (±7.7) days, and mean (±SD) length of hospital stay was 14.8 (±7.7) days.

Conclusion

Majority of patients were of older age and with medical co-morbidities. With adequate resource utilization, mortality of critically ill COVID-19 patients may not be as high as previously suggested.
Aging, Care and Dependency in Multimorbidity: How Relationships Affect Older Bangladeshi Women’s Use of Homecare and Health Services
Authors: Hamiduzzaman Mohammad , Torres Stacy , Fletcher Amber , Islam Md. Rezaul , Greenhill Jennene
Published: June 2020

Relationships are multidimensional, and we know little about how different facets of relationships affect how older patients’ with multimorbidity use homecare and health services. Social gerontology literature emphasizes the importance of care settings, gender inequalities, availability of health services, and affordability. However, the diversity of relationships and associated dependency in elder care remains underassessed. This qualitative study combining a demographic survey with interviews explores the relationship experiences of older women (age 60 years and over) with multimorbidity in homecare and health services utilization. Researchers contacted the Civil Surgeon of Sylhet District in Bangladesh to recruit study participants and conducted 33 interviews [11 staff members and 22 older women with multimorbidity]. Three domains of Axel Honneth’s theory of recognition and misrecognition [i.e. intimate, community, and legal relationships] underpin study findings. Data were analysed using critical thematic discourse analysis. Four themes, including seven relationship dimensions, emerged: the nature of caregiving; intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in peer-relationships and neighbourhood [siblings’ overlooking of women’s rights and needs, neighbourhood challenges such as ageism, and gender inequality in interactions]; and legal connections [ignorance of rights and missed communication]. Marginalization in family relationships, together with poor peer supports and a misrecognition of care needs from service providers, resulted in a lack of quality care for older women with multimorbidity. Understanding the complexities of older women’s relationships may assist in policy making with better attention to their health needs and deepen understanding of how gender inequality intersects with the cultural devaluation of older adults to reduce their well-being. Staff training on relationship building and counselling services for family caregivers and kin are essential to improve the quality of care for these women.
COVID-19 severity is associated with immunopathology and multi-organ damage
Authors: Chen Yan-Mei , Zheng Yuanting , Yu Ying , Wang Yunzhi , Huang Qingxia , Qian Feng , Sun Lei , Song Zhi-Gang , Chen Ziyin , Feng Jinwen , An Yanpeng , Yang Jingcheng , Su Zhenqiang , Sun Shanyue , Dai Fahui , Chen Qinsheng , Lu Qinwei , Li Pengcheng , Ling Yun , Yang Zhong , Tang Huiru , Shi Leming , Jin Li , Holmes Edward C. , Ding Chen , Zhu Tong-Yu , Zhang Yong-Zhen
Published: June 2020

COVID-19 is characterised by dysregulated immune responses, metabolic dysfunction and adverse effects on the function of multiple organs. To understand how host responses contribute to COVID-19 pathophysiology, we used a multi-omics approach to identify molecular markers in peripheral blood and plasma samples that distinguish COVID-19 patients experiencing a range of disease severities. A large number of expressed genes, proteins, metabolites and extracellular RNAs (exRNAs) were identified that exhibited strong associations with various clinical parameters. Multiple sets of tissue-specific proteins and exRNAs varied significantly in both mild and severe patients, indicative of multi-organ damage. The continuous activation of IFN-I signalling and neutrophils, as well as a high level of inflammatory cytokines, were observed in severe disease patients. In contrast, COVID-19 in mild patients was characterised by robust T cell responses. Finally, we show that some of expressed genes, proteins and exRNAs can be used as biomarkers to predict the clinical outcomes of SARS-CoV-2 infection. These data refine our understanding of the pathophysiology and clinical progress of COVID-19 and will help guide future studies in this area.
How does the brain navigate knowledge of social relations? Testing for shared neural mechanisms for shifting attention in space and social knowledge
Authors: Du Meng , Basyouni Ruby , Parkinson Carolyn
Published: June 2020

How does the human brain support reasoning about social relations (e.g., social status, friendships)? Converging theories suggest that navigating knowledge of social relations may co-opt neural circuitry with evolutionarily older functions (e.g., shifting attention in space). Here, we analyzed multivoxel response patterns of fMRI data to examine the neural mechanisms for shifting attention in knowledge of a social hierarchy. The “directions” in which participants mentally navigated social knowledge were encoded in multivoxel patterns in superior parietal cortex, which also encoded directions of attentional shifts in space. Exploratory analyses implicated additional regions of posterior parietal and occipital cortex in encoding analogous mental operations in space and social knowledge. However, cross-domain analyses suggested that attentional shifts in space and social knowledge may be encoded in functionally independent response patterns. These results elucidate the neural basis for navigating abstract knowledge of social relations, and its connection to more basic mental operations.
Structural modeling and thermostability of a serine protease inhibitor belonging to the Kunitz family from the tick Rhipicephalus microplus
Authors: Bomediano Camillo Lívia de Moraes , Ferreira Graziele Cristina , Alves Duran Adriana Feliciano , da Silva Flavia Ribeiro Santos , Garcia Wanius , Scott Ana Lígia , Sasaki Sergio Daishi
Published: June 2020

rBmTI-A is a recombinant serine protease inhibitor that belongs to the Kunitz-BPTI family and that was cloned from Rhipicephalus microplus tick. rBmTI-A has inhibitory activities on bovine trypsin, human plasma kallikrein, human neutrophil elastase and plasmin with dissociation constants in nM range. It is characterized by two inhibitory domains and each domain presents six cysteines that form three disulfide bonds, which contribute to the high stability of its structure. Previous studies suggest that serine protease inhibitor rBmTI-A has a protective potential against pulmonary emphysema in mice and anti-inflammatory potential, besides rBmTI-A presented a potent inhibitory activity againstin vitrovessel formation. In this study, the tertiary structure of BmTI-A was modeled based on the structure of itsSabellastarte magnificahomologue. The structure stabilization was evaluated by molecular dynamics analysis. Circular dichroism data corroborated the secondary structure found by the homology modeling. Thermostability analysis confirmed the thermostability and the relation between the effects of the temperature in the inhibitor activity. The loss of activity observed was gradual, and, after 60 minutes of incubation at 90°C the inhibitor lost it completely.
Mapping infectious disease mortality onto the within-host dynamics of pathogen growth
Authors: O’Sullivan Tim , Waldetoft Kristofer Wollein , Brown Sam P.
Published: June 2020

Infectious diseases remain a major cause of global mortality, yet basic questions concerning the relationship between within-host processes governing pathogen burden (pathogen replication, immune responses) and epidemiological patterns of mortality remain obscure. In standard epidemiological models of bacterial and viral infections (‘compartmental models’), pathogen-induced mortality is described as a constant risk factor, unchanging with time since infection or the dynamics of the pathogen population inside the host. Here we review experimental data illustrating the failure of this assumption, with multiple infection models highlighting an accelerating risk of death with time since infection. Next, we show that the dynamics of infection-mediated death are phenomenologically similar to the dynamics of all-causes death, captured by an exponentially increasing instantaneous mortality or ‘hazard’ (a Gompertz function). We then sketch a series of within-host pathogen models and highlight that multiple models are consistent with existing Gompertz-like infection mortality data, including: (1) exponential pathogen growth and a linear mapping between pathogen density and host hazard, and (2) linear pathogen growth and an exponential mapping between pathogen density and host hazard. We review critical experimental questions that our work highlights, requiring additional non-invasive data on pathogen burden throughout the course of infection, and end with a discussion on the unpicking of the mechanistic and dynamical basis of accelerating mortality risk during the course of human infections.
Type and frequency of ocular and other known symptoms experienced by people who self–diagnosed as suffering from COVID-19 in the UK
Authors: Pardhan Shahina , Vaughan Megan , Zhang Jufen , Smith Lee , Chichger Havovi
Published: June 2020

Background

Recent literature suggests that ocular manifestations present in people suffering from COVID-19. However, the prevalence and the type of ocular symptoms varies substantially, and most studies report retrospective data from patients suffering from more serious versions of the disease. Little is known of exactly which ocular symptoms manifest in people with milder forms of COVID-19.

Methods

An online questionnaire obtained self-report data from people in the community, who reported to be inflicted with COVID-19. The type and frequency of different symptoms suffered during COVID-19 were obtained. Details of any pre-existing ocular conditions and the duration of symptoms of COVID-19 were ascertained.

Results

Data from 132 participants showed that the four most reported COVID-19 symptoms were Dry Cough (63%), Fever (67%), Fatigue (83%), and loss of Smell/Taste (63%). 56% of the participants reported to having experienced an eye symptom, 46% reported to having a new or different eye symptom compared to pre-COVID-19 state. Three ocular symptoms (watery eyes, sore eyes, sensitivity to light) were significantly different from Pre-COVID-19 state (p<0.05). Logistic regression showed a significant association of eye symptoms with Fever (p=0.035).

Conclusion

Nearly half of the sample of people studied experienced ocular symptoms. The significant ocular symptoms, indicative of viral conjunctivitis, might have been missed in patients with more serious manifestations of the disease. It is also important to differentiate between the types of ocular manifestation, as symptoms of bacterial conjunctivitis (i.e. mucous discharge, gritty eyes) were not significant. Possible mechanisms for SARS-CoV-2 infection within the eye are discussed.

Key message

To date, there are no studies on ocular symptoms experienced by people who self-reported as suffering from mild case of COVID-19. In the absence of population –wide testing in the UK, our study shows that nearly half of the population reported to having experienced an eye symptom. It is likely that the significant ocular symptoms, indicative of viral conjunctivitis, might have been overlooked in the light of other more serious and critical manifestations of COVID-19. The data are important, especially in countries that rely on self –report of COVID-19 symptoms when confirmative tests for COVID-19 are not available.
An Age-Specific Atlas for Delineation of White Matter Pathways in Children Aged 6-8 Years
Authors: Spencer Arthur P.C. , Byrne Hollie , Lee-Kelland Richard , Jary Sally , Thoresen Marianne , Cowan Frances M. , Chakkarapani Ela , Brooks Jonathan C.W.
Published: June 2020

Diffusion MRI allows non-invasive assessment of white matter maturation in typical development and of white matter damage due to brain injury or pathology. Probabilistic white matter atlases provide delineation of white matter tracts, allowing diffusion metrics to be measured in specific white matter pathways. However, given the known age-dependency of developmental change in white matter it may not be optimal to use an adult template when assessing data acquired from children. This study develops an age-specific probabilistic white matter atlas for delineation of 12 major white matter tracts in children aged 6-8 years. By comparing to subject-specific tract tracing in two validation cohorts, we demonstrate that this age-specific atlas gives better overall performance than simply registering to the Johns Hopkins University adult white matter template. Specifically, when normalising diffusion data acquired from children to an adult template, estimates of fractional anisotropy (FA) values for corticospinal tract, uncinate fasciculus, forceps minor, cingulate gyrus part of the cingulum and anterior thalamic radiation were all less accurate than those obtained when using an age-specific atlas, potentially leading to false negatives when performing group comparisons. We then applied the newly developed atlas to compare FA between children treated with therapeutic hypothermia for neonatal encephalopathy and age-matched controls, which revealed significant reductions in the fornix, the left superior longitudinal fasciculus, and both the hippocampal and cingulum parts of the left cingulate gyrus. To our knowledge, this is the first publicly available probabilistic atlas of white matter tracts for this age group.
Mapping cell structure across scales by fusing protein images and interactions
Authors: Qin Yue , Winsnes Casper F. , Huttlin Edward L. , Zheng Fan , Ouyang Wei , Park Jisoo , Pitea Adriana , Kreisberg Jason F. , Gygi Steven P. , Harper J. Wade , Ma Jianzhu , Lundberg Emma , Ideker Trey
Published: June 2020

The eukaryotic cell is a multi-scale structure with modular organization across at least four orders of magnitude1,2. Two central approaches for mapping this structure – protein fluorescent imaging and protein biophysical association – each generate extensive datasets but of distinct qualities and resolutions that are typically treated separately3,4. Here, we integrate immunofluorescent images in the Human Protein Atlas5with ongoing affinity purification experiments from the BioPlex resource6to create a unified hierarchical map of eukaryotic cell architecture. Integration involves configuring each approach to produce a general measure of protein distance, then calibrating the two measures using machine learning. The evolving map, called the Multi-Scale Integrated Cell (MuSIC 1.0), currently resolves 69 subcellular systems of which approximately half are undocumented. Based on these findings we perform 134 additional affinity purifications, validating close subunit associations for the majority of systems. The map elucidates roles for poorly characterized proteins, such as the appearance of FAM120C in chromatin; identifies new protein assemblies in ribosomal biogenesis, RNA splicing, nuclear speckles, and ion transport; and reveals crosstalk between cytoplasmic and mitochondrial ribosomal proteins. By integration across scales, MuSIC substantially increases the mapping resolution obtained from imaging while giving protein interactions a spatial dimension, paving the way to incorporate many molecular data types in proteome-wide maps of cells.
Exercise mitigates sleep-loss-induced changes in glucose tolerance, mitochondrial function, sarcoplasmic protein synthesis, and circadian rhythms
Authors: Saner Nicholas J , Lee Matthew J-C , Kuang Jujiao , Pitchford Nathan W , Roach Gregory D , Garnham Andrew , Genders Amanda J , Stokes Tanner , Schroder Elizabeth A , Esser Karyn A , Phillips Stuart M , Bishop David J , Bartlett Jonathan D
Published: June 2020

Sleep loss has emerged as a risk factor for the development of impaired glucose tolerance. The mechanisms underpinning this observation are unknown; however, both mitochondrial dysfunction and circadian misalignment have been proposed. Given that exercise improves glucose tolerance, mitochondrial function, and alters circadian rhythms, we investigated whether exercise may counteract the effects induced by inadequate sleep. We report that sleeping 4 hours per night, for five nights, reduced glucose tolerance, with novel observations of associated reductions in mitochondrial function, sarcoplasmic protein synthesis, and measures of circadian rhythmicity; however, incorporating three sessions of high-intensity interval exercise (HIIE) during this period mitigates these effects. These data demonstrate, for the first time, a sleep loss-induced concomitant reduction in a range of physiological processes linked to metabolic function. These same effects are not observed when exercise is performed during a period of inadequate sleep, supporting the use of HIIE as an intervention to mitigate the detrimental physiological effects of sleep loss.
Predicting Gene Expression from DNA Sequence using Residual Neural Network
Authors: Zhang Yilun , Zhou Xin , Cai Xiaodong
Published: June 2020

It is known thatcis-acting DNA motifs play an important role in regulating gene expression. The genome in a cell thus contains the information that not only encodes for the synthesis of proteins but also is necessary for regulating expression of genes. Therefore, the mRNA level of a gene may be predictable from the DNA sequence. Indeed, three deep neural network models were developed recently to predict the mRNA level of a gene directly or indirectly from the DNA sequence around the transcription start side of the gene. In this work, we develop a deep residual network model, named ExpResNet, to predict gene expression directly from DNA sequence. Applying ExpResNet to the GTEx data, we demonstrate that ExpResNet outperforms the three existing models across four tissues tested. Our model may be useful in the investigation of gene regulation.
Implementing health-promoting schools to prevent obesity
Authors: Bennett Lindsay , Burns Sharyn
Published: June 2020

Purpose

Obesity in children and adolescents is a significant public health concern. The World Health Organization Health Promoting Schools (HPS) framework promotes good nutrition and physical activity in school settings. While HPS is embraced globally, effective implementation and sustainable programmes are a continued challenge. This paper aims to report on the characteristics of current school interventions based on HPS and implementation barriers and enablers.

Design/methodology/approach

A literature search identified peer-reviewed studies of school health interventions reflective of the HPS framework focusing on obesity prevention. Studies from all countries were included, if conducted in primary and/or secondary schools; included a sufficient amount of qualitative implementation or process evaluation data to draw conclusions regarding key barriers and enablers to implementation; and were published in English.

Findings

Nine interventions (n = 9) from seven countries were included. Most were implemented in primary schools and focused on specific grade levels. Engaging parents, the home environment, teacher time constraints, fun interventions, student participation, teacher training, integration with the curriculum and stakeholder engagement all emerged as strong implementation themes. Teachers as role models, establishing community partnerships and policy support also emerged as common themes.

Originality/value

Future interventions may benefit from enhancing teacher and parent health promotion. Partnerships with initiatives focusing on environmental sustainability may simultaneously benefit human and planetary health while strengthening stakeholder engagement opportunities and consistent messaging throughout the community. More comprehensive evaluation data are needed, in particular, for long-term HPS initiatives.
Constructing secure and memorable passwords
Authors: Kävrestad Joakim , Lennartsson Markus , Birath Marcus , Nohlberg Marcus
Published: June 2020

Purpose

Using authentication to secure data and accounts has grown to be a natural part of computing. Even if several authentication methods are in existence, using passwords remain the most common type of authentication. As long and complex passwords are encouraged by research studies and practitioners alike, computer users design passwords using strategies that enable them to remember their passwords. This paper aims to find strategies that allow for the generation of passwords that are both memorable and computationally secure.

Design/methodology/approach

The study began with a literature review that was used to identify cognitive password creation strategies that facilitate the creation of passwords that are easy to remember. Using an action-based approach, attack models were created for the resulting creation strategies. The attack models were then used to calculate the entropy for passwords created with different strategies and related to a theoretical cracking time.

Findings

The result of this study suggests that using phrases with four or more words as passwords will generate passwords that are easy to remember and hard to attack.

Originality/value

This paper considers passwords from a socio-technical approach and provides insight into how passwords that are easy to remember and hard to crack can be generated. The results can be directly used to create password guidelines and training material that enables users to create usable and secure passwords.