bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequent Stools Were Related to Reduced Quality of Life and Capacity in Daily Activities
Authors: Enblom Anna , Steineck Gunnar , Börjeson Sussanne
Published: May 2020

Background

Greater knowledge regarding stool frequency and infrequency during pelvic and abdominal irradiation is needed to accurately identify patients at risk of either.

Objective

To describe occurrence of frequent and infrequent stools during pelvic-abdominal radiotherapy, and to compare quality of life (QoL) and activities of daily living (ADLs) of those patients experiencing frequent stools with those of patients experiencing infrequent stools.

Methods

Longitudinally during radiotherapy, 193 patients (64% had gynecological tumors) documented stool frequency, medications, and QoL using the Functional Assessment of Cancer Therapy–General.

Results

Fifty (26%) experienced frequent stools (≥28 stools a week), and 17 (9%) experienced infrequent stools (<3 stools a week). The frequency of stools and the consumption of medication for diarrhea were highest the last week of the radiotherapy period (50% had ≥49 stools a week, and 50% could not even define the number of stools). Thirty-seven of the patients experiencing frequent stools used antidiarrhea medications. Patients with frequent stools experienced lower QoL (P = .035) and capacity in ADLs (P = .023) compared with patients not experiencing frequent stools.

Conclusions

A fourth of patients irradiated over pelvic or abdominal fields experienced frequent stools, defined as moderate to severe diarrhea, and those patients experienced lower QoL and capacity in ADLs compared with patients who did not experience frequent stools. Infrequent stools were rarely experienced.

Implications for Practice

Cancer nursing professionals should deliver evidence-based strategies to prevent frequent stools and treat frequent stools as an approach to lower the risk of impaired capacity in daily living and worsened QoL.
Serious Illness Conversations
Authors: Billie Mary Elizabeth , Letizia MariJo
Published: May 2020

Purpose/Objectives:

The purpose of this project was to develop, implement, and evaluate an educational program and a serious illness (SI) protocol for a case management team of nurses and social workers to achieve the following: (1) utilize an SI protocol to identify patients with SI; (2) utilize a Serious Illness Structured Communication Guide to elicit these patients' goals and preferences for SI care; and (3) document in the electronic medical record the patients' elicited values and goals using a structured SI documentation template.

Primary Practice Setting and Sample:

Seventeen nurse and 3 social work case managers in an Accountable Care Organization (ACO) in a large health system in a western suburb of Chicago participated in this project. The practice setting was the primary care clinics associated with the health system. Patients eligible for the project met the SI criteria and were part of the organization's ACO or Bundle Payment for Care Improvement program.

Methodology:

Twenty members of the case management staff participated in a 4-hr face-to-face educational program, based in part on Bernacki and Block's (2014) review of best practices related to SI care and communication. Participants completed a pre- and posttest survey of knowledge; self-rated their confidence in conducting SI conversations; and evaluated the educational program. Participants then engaged in the established protocol inclusive of the following: (1) identify patients appropriate for an SI conversation; (2) initiate the SI conversation; and (3) document components of the SI in the electronic medical record.

Findings/Conclusions:

Educational Program: Ninety-five percent of the RN and SW case managers reported that that the educational module objectives were met to a moderate or great extent. One hundred percent of the participants reported that the format to deliver the program was effective, the content of the program was directly relevant to their clinical practice, and they would change their practice because of learning/understanding the content in the program. Educational program pretest scores ranged from 46.2% to 84.6%, with posttest scores ranging from 69.2% to 100%. A paired-samples t test demonstrated a statistically significant increase in posttest scores. Baseline confidence scores ranged from 1 to 4, with postproject confidence scores ranging from 2 to 4. A paired-samples t test demonstrated a statistically significant increase in confidence.

Serious Illness Protocol: The case managers correctly identified 92% of patients who met the established SI identification criteria for this project. In 91.8% of cases, the case managers conducted an SI conversation in adherence to the protocol. In 76% of the cases, documentation about the SI conversation was completed in accordance with the protocol.

Implications for Case Management Practice:
Informing the Professional Case Manager's Career Path: Five Lessons
Authors: Fink-Samnick Ellen
Published: May 2020

Professional case management's career path offers countless opportunities to pursue, from attainment of the highest levels of licensure and credentialing to education, and that terminal degree. Defining each point of the journey and individual milestones warrants keen attention to a number of areas. All of these decisions and options evolve in response to the industry landscape, as well as professional and personal development. Five key lessons provide case managers clear starting points to consider the most appropriate career path to travel amid a landscape marked by constant change.
Auditory Verbal Hallucinations in Schizophrenia
Authors: Yttri Janne-Elin , Urfer-Parnas Annick , Parnas Josef
Published: May 2020

Recent reviews on auditory verbal hallucinations (AVHs) advocate a qualitative and interdisciplinary research that not only is limited to single descriptive features, but also involves contextual issues and co-occurring psychopathology. In this study of mainly readmitted patients with the International Classification of Diseases, Tenth Revision, diagnosis of paranoid schizophrenia and experiencing AVH, we performed a qualitative, phenomenologically oriented interview study. The focus was on the beginning of hallucinatory experiences, time to disclosure of the symptom, and the context surrounding the disclosure. We found that on average the patients experiencing AVH for 6.5 years before disclosing the symptom to a psychiatrist. Moreover, the term “voices” was typically appropriated by the patient during his contact with a psychiatric treatment facility. None of the patients considered themselves as being psychotic or severely mentally ill. The AVH in the majority of the patients was associated with other pathological subjective experiences. The significance of these findings is briefly discussed in relation to the concept of insight, diagnosis of psychosis, and early detection.
Independent Validation of Tumor Budding Activity and Cell Nest Size as Determinants of Patient Outcome in Squamous Cell Carcinoma of the Uterine Cervix
Authors: Zare Somaye Y. , Aisagbonhi Omonigho , Hasteh Farnaz , Fadare Oluwole
Published: May 2020

A novel 3-tiered grading system that combines tumor budding activity and cell nest size has been found to be highly prognostic in squamous cell carcinomas (SCCs) of various sites, including lung, oral cavity, larynx, hypopharynx, and esophagus. A similar grading system has recently been proposed for SCC of the uterine cervix. In this study, we appraise this grading system in an institutional cohort of cervical SCC to assess its prognostic value in an independent dataset. Our study cohort consisted of 94 consecutive, surgically excised, neoadjuvant therapy-naive cases of SCC of the uterine cervix, stage pT1b or higher. Tumor budding activity and cell nest size were scored on each case, the sum of which formed the basis for assigning a grade in the 3-tiered grading system hereafter referred to as the “tumor budding/nest size” (TBNS) system. As individual variables, both high tumor budding and small nest size were each associated with reduced overall survival (OS), disease-specific survival, and disease-free survival. The full TBNS system was associated with decreased OS, disease-specific survival, and disease-free survival independent of patient age, pathologic stage, and regional lymph node status. TBNS grades 1, 2, and 3 subgroups were clearly distinguishable on multivariate analyses (hazard ratio for OS of 2.06 [95% confidence interval: 0.5-8.42] for grade 2 and 4.58 [95% confidence interval: 1.24-16.87] for grade 3 tumors, relative to their grade 1 counterparts [P=0.035]). Higher grade tumors in the TBNS system were significantly correlated with advanced pathologic stage and lymph node metastasis (P=0.044 and 0.04, respectively). Among the other, potentially prognostic factors, higher pathologic stage, and lymph node metastasis were associated with decreased OS (P<0.001 and 0.004, respectively), whereas keratinization, nuclear size, mitotic count, and World Health Organization (WHO) grade were not. In conclusion, the proposed TBNS grading system is an excellent prognostic indicator that may potentially provide information that is useful in clinical decision-making. Our findings validate the previous study that proposed this system for prognostically stratifying cervical SCC patients. If further confirmed, consideration should be given to routinely adding a TBNS grade to pathologic descriptions of cervical SCC.
Decellularized Fetal Matrix Suppresses Fibrotic Gene Expression and Promotes Myogenesis in a Rat Model of Volumetric Muscle Loss
Authors: Wu Young Mimi Y. , Dolivo David M. , Hong Seok J. , Iyer Hari , Mustoe Thomas A. , Galiano Robert D.
Published: May 2020

Background:

Traumatic muscle loss often results in poor functional restoration. Skeletal muscle injuries cannot be repaired without substantial fibrosis and loss of muscle function. Given its regenerative properties, the authors evaluated outcomes of fetal tissue-derived decellularized matrix for skeletal muscle regeneration. The authors hypothesized that fetal matrix would lead to enhanced myogenesis and suppress inflammation and fibrosis.

Methods:

Composite tissue composed of dermis, subcutaneous tissue, and panniculus carnosus was harvested from the trunk of New Zealand White rabbit fetuses on gestational day 24 and from Sprague-Dawley rats on gestational day 18 and neonatal day 3, and decellularized using a sodium dodecyl sulfate–based negative-pressure protocol. Six, 10-mm-diameter, full-thickness rat latissimus dorsi wounds were created for each treatment, matrix was implanted (excluding the defect groups), and the wounds were allowed to heal for 60 days. Analyses were performed to characterize myogenesis, neovascularization, inflammation, and fibrosis at harvest.

Results:

Significant myocyte ingrowth was visualized in both allogeneic and xenogeneic fetal matrix groups compared to neonatal and defect groups based on myosin heavy chain immunofluorescence staining. Microvascular networks were appreciated within all implanted matrices. At day 60, expression of Ccn2, Col1a1, and Ptgs2 were decreased in fetal matrix groups compared to defect. Neonatal matrix-implanted wounds failed to show decreased expression of Col1a1 or Ptgs2, and demonstrated increased expression of Tnf, but also demonstrated a significant reduction in Ccn2 expression.

Conclusions:

Initial studies of fetal matrices demonstrate promise for muscle regeneration in a rat latissimus dorsi model. Further research is necessary to evaluate fetal matrix for future translational use and better understand its effects.
Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients
Authors: Osho Asishana A. , Moonsamy Philicia , Hibbert Kathryn A. , Shelton Kenneth T. , Trahanas John M. , Attia Rizwan Q. , Bloom Jordan P. , Onwugbufor Michael T. , D’Alessandro David A. , Villavicencio Mauricio A. , Sundt Thoralf M. , Crowley Jerome C. , Raz Yuval , Funamoto Masaki
Published: May 2020

Summary and Background Data:

VV ECMO can be utilized as an advanced therapy in select patients with COVID-19 respiratory failure refractory to traditional critical care management and optimal mechanical ventilation. Anticipating a need for such therapies during the pandemic, our center created a targeted protocol for ECMO therapy in COVID-19 patients that allows us to provide this life-saving therapy to our sickest patients without overburdening already stretched resources or excessively exposing healthcare staff to infection risk.

Methods:

As a major regional referral program, we used the framework of our well-established ECMO service-line to outline specific team structures, modified patient eligibility criteria, cannulation strategies, and management protocols for the COVID-19 ECMO program.

Results:

During the first month of the COVID-19 outbreak in Massachusetts, 6 patients were placed on VV ECMO for refractory hypoxemic respiratory failure. The median (interquartile range) age was 47 years (43–53) with most patients being male (83%) and obese (67%). All cannulations were performed at the bedside in the intensive care unit in patients who had undergone a trial of rescue therapies for acute respiratory distress syndrome including lung protective ventilation, paralysis, prone positioning, and inhaled nitric oxide. At the time of this report, 83% (5/6) of the patients are still alive with 1 death on ECMO, attributed to hemorrhagic stroke. 67% of patients (4/6) have been successfully decannulated, including 2 that have been successfully extubated and one who was discharged from the hospital. The median duration of VV ECMO therapy for patients who have been decannulated is 12 days (4–18 days).

Conclusions:

This is 1 the first case series describing VV ECMO outcomes in COVID-19 patients. Our initial data suggest that VV ECMO can be successfully utilized in appropriately selected COVID-19 patients with advanced respiratory failure.
Safety and Efficacy of a Disposable Vaginal Device for Stress Urinary Incontinence
Authors: Duenas-Garcia Omar Felipe , Shapiro Robert Edward , Gaccione Peter
Published: May 2020

Objective

The aim of this study was to evaluate the efficacy and safety of an over-the-counter device for the treatment of stress urinary incontinence (SUI) in females.

Methods

A multicenter, interventional, single-arm study involving 5 different sites was conducted including women diagnosed with symptomatic SUI using a self-inserted pessary device. A 1-week baseline period was followed by a 2-week period of wearing the device. The main outcome of our study was to determine if the device was able to reduce at least 50% the number of leakage events and pad weight.

Results

Across all study sites, 73 subjects were enrolled and 51 completed the study. Efficacy analyses were conducted on the modified intent-to-treat population (n = 48), whereas the safety analysis was conducted on all consented participants. The average pad weight gain was 0.9 g/h at baseline and 0.5 g/h during the treatment phase. The number of leakage episodes per day decreased from 2 at baseline to 0.9 during the treatment phase (P < 0.0001). Seventy-one percent of the study population experienced a more than 50% reduction in leakage volume, leakage episodes, or both. The quality of life scores improved from baseline to posttreatment phase by 4.35 points on average (P < 0.0001). A total of 40 adverse events were recorded, and only 4 subjects withdrew due to adverse events.

Conclusions

The self-deployable pessary device evaluated in this study is an alternative option for women seeking an over-the-counter method to manage symptoms of SUI. Further studies are required to determine the long-term effects and compliance using the device.
Immunologic Complications and Graft Survival in Crohn’s Disease and NOD2 Mutant Non-Crohn’s Disease Adult Recipients Following Intestine Transplantation
Authors: Belyayev Leonid , Hawksworth Jason , Khan Khalid , Kaufman Stuart , Subramanian Sukanya , Kroemer Alexander , Loh Katrina , Girlanda Raffaele , Fishbein Thomas M. , Matsumoto Cal S.
Published: May 2020

Background.

Despite improved outcomes in the modern era of targeted immunotherapy, intestinal failure and chronic parenteral nutrition remains a significant burden for patients with Crohn’s disease (CD) worldwide. Transplantation is a key component of management when a patient with CD suffers from life-threatening complications of parenteral nutrition. Nucleotide-binding oligomerization domain 2 (NOD2) mutation is a risk factor for both development of CD and intestinal allograft rejection.

Methods.

A retrospective review of a prospectively maintained database of intestinal transplants at a single center from 2003 to 2015 was conducted. Eleven adult patients with CD were identified and were compared with 103 adult control recipients. A sub-analysis was performed comparing the 11 CD recipients to the 13 NOD2 mutant non-CD recipients.

Results.

Patient and allograft characteristics were similar between the CD and control recipients. Although overall rejection-free survival was not significantly different, patients with CD suffered from more frequent, earlier, and more severe rejection compared with control patients. The onset, severity, and frequency of rejection was comparable between patients with CD and NOD2 mutant non-CD patients. There was a trend toward lower 5-year allograft survival for CD compared with control recipients (33% versus 63.3%; P = 0.19) and NOD2 mutant non-CD recipients (33% versus 57.14%; P = 0.41).

Conclusions.

Patients with CD remain a challenging population in intestine transplantation, and NOD2 mutant non-CD patients appear to have a similar immunologic phenotype. These high-risk recipients may require specialized immunosuppression protocols and management at experienced transplant centers.
Tea polyphenols protect learning and memory in sleep-deprived mice by promoting AMPA receptor internalization
Authors: Yang Haifan , Xie Jiangang , Mu Wei , Ruan Xiaofei , Zhang Jinming , Yao Li , Diao Zhijun , Wu Meilin , Li Yongfeng , Ren Wei , Han Jing
Published: May 2020

Chronic sleep loss caused lots of health problems, also including cognition impairment. Tea is one of the most popular drinks when people stay up late. Nevertheless, the effects of tea on sleep deprivation-induced cognition impairment are still unclear. In the present study, we found 24-h sleep deprivation (S-DEP) increased membrane α-amino-3-hydroxy-5-methyl-4-isoxa-zolep-propionate (AMPA) receptor level through a tumor necrosis factor α (TNFα)-dependent pathway in hippocampi. Blocking elevated TNFα level can protect S-DEP mice from impaired learning ability according to behavioral test. Tea polyphenols, major active compounds in green tea, suppressed TNFα production through downregulating TNFα converting enzyme (TACE) level. Meanwhile, tea polyphenols treatment could ameliorate recognition impairment and anxiety-like behaviors in S-DEP mice. The aforementioned results demonstrate cognition protective effects of tea polyphenols in S-DEP mice model, which provide a theoretical basis for the treatments of S-DEP-induced cognition impairment by targeting the TACE/TNFα/AMPA pathway.
Enhanced phosphorylation of S6 protein in mouse cortical layer V and subplate neurons.
Authors: Lee Seong-Eun , Hwang Seojin , Ahn Sang-Gun , D’Arcangelo Gabriella , Lee Gum Hwa
Published: May 2020

The mammalian neocortex is composed of six major layers of neurons. Each group of neurons in the cortical layers has distinct characteristics based on the expression of specific genes and connectivity patterns of neural circuits. Neuronal subtype transition and regional identity acquisition are established by temporal cues and interaction between several transcription factors during neurogenesis. The impairment of cortical lamination or neural circuits results in a wide range of neurodevelopmental disorders such as autism, schizophrenia, and certain forms of childhood epilepsy. Despite continuous efforts to classify neurons with the aid of genetic and epigenetic analyses, the neuron-specific properties associated with post-transcriptional modification remain unclear. In the present study, the distribution of phosphorylated S6-positive layers across the neocortex was examined using several layer markers. The development of pS6 S235/236 layers in layer V and the subplate was spatiotemporally regulated in the mouse brain. In addition, enhanced phosphorylation of ribosomal protein S6 in Ctip2-positive layer V neurons in vivo was sustained under in-vitro conditions using a culture of primary cortical neurons.
Forty-five years later: the challenge of optimizing assertive community treatment
Authors: Thorning Helle , Dixon Lisa
Published: May 2020

Purpose of review:

Assertive Community Treatment is an established evidenced based practice that provides intensive community treatment for individuals with severe mental illness with recurrent hospitalizations and/or homelessness. Emerging evidence indicates limitations in its implementation in terms of to the original ACT model and its current relevance.

Recent findings:

Findings from recent studies (2018–2020) reveals challenges with implementation centered around basic implementation activities, such as changes in the psychosocial context of individuals with SMI, clinicians’ abilities to demonstrate competencies with new practices, and ongoing evolution of mental health systems of care worldwide. Intermediary and purveyor organizations (IPO) can provide the infrastructure to support the spread of EBPs while addressing challenges and opportunities. Thus, implementation of ACT can be accomplished when employing a rigorous framework and infrastructure that can synthesize and translate science relevant for practice.

The relevance of ACT depends on its implementation that is responsive to change. An implementation science-informed approach is key to providing ACT to individuals in the critical space between the hospital and community. With this approach, we can optimize ACT as a service delivery vehicle by careful analysis of how best to furnish and evaluate the latest, most effective and efficient treatments, rehabilitation and support services.
Electrocardiogram Corrected Q-T Interval Predicts Response to Vagus Nerve Stimulation in Depression
Authors: Longpré-Poirier Christophe , Desbeaumes Jodoin Véronique , Miron Jean-Philippe , Fournier-Gosselin Marie-Pierre , Lespérance Paul
Published: May 2020

Introduction

Recent studies have revealed a possible link between heart rate variability (HRV) and major depressive disorder (MDD), with decreased HRV in MDD compared with healthy subjects. Corrected Q-T interval (QTc) has been suggested to represent an indirect estimate of HRV, as QTc length is inversely correlated to parasympathetic activity in healthy subjects. This retrospective study assessed the ability of QTc length in predicting response to vagus nerve stimulation (VNS) treatment in refractory depression.

Methods

We measured QTc length in 19 patients suffering from refractory depression, selected to be implanted with VNS. Correlations were calculated between baseline QTc (preimplantation) and long-term mood response.

Results

Nineteen patients selected for VNS surgery were included in the study. Baseline 28-item Hamilton Depression Rating Scale scores were 28.5 ± 6.8 and decreased to 15.1 ± 9.5 at 12 months and 12.4 ± 10.4 at 24 months post-VNS. Among the 19 patients, 53% (10) were responders and 26% (5) were in remission at 12 months. Pretreatment QTc averaged 425.5 ± 22.0. Patients with longer baseline QTc displayed larger improvement, with a significant correlation between mood and QTc values after 12 months (r(18) = −0.526, P = 0.02) and also after 24 months of VNS therapy (r(17) = −0.573, P = 0.016).

Conclusions

The presented analysis showed that increased QTc in patients with MDD might be used as a baseline biomarker for depressive episodes that might respond preferentially to VNS. The link between cardiovagal activity in depression and response to VNS treatment requires further investigation in larger cohorts and randomized controlled trials.
A Comparison of Computerized Versus Pen-and-Paper Cognitive Tests for Monitoring Electroconvulsive Therapy–Related Cognitive Side Effects
Authors: Martin Donel M. , Kumar Divya , Wong Ada , Loo Colleen K.
Published: May 2020

Objective

Cognitive side effects are a common unintended outcome of electroconvulsive therapy (ECT). Routine cognitive assessment is important for monitoring patient outcomes, although it can pose challenges in busy clinical settings. Computerized cognitive testing has advantages that can facilitate routine monitoring. This study explored the construct and criterion validity of computerized cognitive testing compared with standard pen-and-paper tests for monitoring cognition in ECT patients.

Methods

The study included 24 participants with major depression who received an acute course of ECT. Cognition was assessed at pretreatment and at posttreatment with 3 computerized tests from the CogState battery (International Shopping List task, One-Card Learning, and One-Back Task) and 3 conceptually matched pen-and-paper–administered neuropsychological tests.

Results

At pretreatment, only performance on the computer-administered test of verbal anterograde memory (International Shopping List task) was significantly correlated with the analogous pen-and-paper measure, whereas the other computerized tests were not. Of the computerized measures, only the International Shopping List task showed significant changes from pretreatment to posttreatment (P < 0.01, Cohen d > 1.0). In contrast, all the pen-and-paper–administered tests showed significant changes from pretreatment to posttreatment (P < 0.01, Cohen d range, 0.8–1.2). Pretreatment to posttreatment cognitive changes on the computerized measures were not correlated with changes on the pen-and-paper–administered tests.

Conclusion

Construct and criterion validity and tolerability varied between the computerized measures. The results highlighted potentially important issues related to the interpretation and utility of computerized tests in this patient population.
The Effect of Pulse Width on Subjective Memory Impairment and Remission Rate 6 Months After Electroconvulsive Therapy
Authors: Tornhamre Elsa , Ekman Carl Johan , Hammar Åsa , Landen Mikael , Lundberg Johan , Nordanskog Pia , Nordenskjöld Axel
Published: May 2020

Objectives

The aim of this study was to compare the 0.5-millisecond pulse width with broader brief width stimulus and ultrabrief pulse width stimulus in respect to rates of subjective memory impairment and remission 6 months after completion of electroconvulsive therapy (ECT).

Methods

This study used data from the Swedish National Quality Register for ECT. Inclusion criteria were bipolar or unipolar depression with or without psychosis, ECT with unilateral electrode placement, and data on the Montgomery-Åsberg Depression Rating Scale—Self-Assessment and the memory item of the Comprehensive Psychopathological Rating Scale (CPRS-M) before and 6 months after ECT. The primary outcomes were the distributions of patients with a maximum of 10 on the Montgomery-Åsberg Depression Rating Scale—Self-Assessment (remission) and a minimum of 2-step worsening in CPRS-M score according to the ECT pulse widths of <0.5, 0.5, and >0.5 millisecond.

Result

This study included 312 patients. The distributions of patients with remission or a minimum of 2-step worsening on the CPRS-M 6 months after completion of ECT showed no significant differences between the 3 pulse width groups. Older age was associated with a significantly higher rate of remission 6 months after ECT.

Conclusions

In this cohort of patients, no support was found for the previous research finding of lower rates of subjective memory disturbances 6 months after ultrabrief pulse width ECT in comparison with brief pulse width ECT. Older age was associated with higher remission rate 6 months after ECT. Large randomized studies are required to exclude the possibility of long-term differential effects between pulse widths.
Predicting community dynamics of antibiotic-sensitive and -resistant species in fluctuating environments
Authors: Nev Olga A. , Jepson Alys , Beardmore Robert E. , Gudelj Ivana
Published: May 2020

Microbes occupy almost every niche within and on their human hosts. Whether colonizing the gut, mouth or bloodstream, microorganisms face temporal fluctuations in resources and stressors within their niche but we still know little of how environmental fluctuations mediate certain microbial phenotypes, notably antimicrobial-resistant ones. For instance, do rapid or slow fluctuations in nutrient and antimicrobial concentrations select for, or against, resistance? We tackle this question using an ecological approach by studying the dynamics of a synthetic and pathogenic microbial community containing two species, one sensitive and the other resistant to an antibiotic drug where the community is exposed to different rates of environmental fluctuation. We provide mathematical models, supported by experimental data, to demonstrate that simple community outcomes, such as competitive exclusion, can shift to coexistence and ecosystem bistability as fluctuation rates vary. Theory gives mechanistic insight into how these dynamical regimes are related. Importantly, our approach highlights a fundamental difference between resistance in single-species populations, the context in which it is usually assayed, and that in communities. While fast environmental changes are known to select against resistance in single-species populations, here we show that they can promote the resistant species in mixed-species communities. Our theoretical observations are verified empirically using a two-species
Candida
community.
Long-term Exposure to Air Pollution and Lipometabolic Disturbance: A Systematic Review and Meta-Analysis
Authors: Chen Haohao , Zhu Ye , Shi Liuhua , Rosenberg Andrew , Tao Lixin , Zhou Xingfan , Chen Rui , Wang Ji
Published: May 2020

Objectives

To reveal the chronic effects of air pollutants on lipometabolic disturbance via detectable lipoprotein parameters.

Study Design

This is a systematic review and meta-analysis.

Methods

Seven online databases were searched to conduct a meta-analysis of epidemiological studies examining the relationship between air pollution and lipid parameter levels. Subgroup analysis was additionally carried out for each air pollutant studied.

Results

A total of 2,274 records were retrieved, resulting in 10 studies included in the final quantitative meta-analysis, comprising seven studies in Europe and the United States and three studies in mainland China. Using a random-effect model, the results showed that for each 10 μg/m3 increment in PM2.5, TC, LDL-C, and HDL-C levels and metabolic syndrome (MetS) incidence increased by 3.31% (95% CI: 2.29%, 8.91%), 2.34% (95% CI: 1.30%, 3.39%),-1.57% (95% CI: −1.85%, −1.28%), and 4.33% (95% CI: 2.69%, 5.98%), respectively; for each 10 μg/m3 increment in PM10, LDL-C, TG, HDL-C levels increased by 5.27% (95% CI: 2.03%, 8.50%), −0.24% (95% CI: −0.95%, −0.47%), and 0.45% (95% CI: −0.57%, 1.47%), respectively; for each 10 μg/m3 increment in NO2, TG and HDL-C levels increased by 4.18% (95% CI: 1.12%, 7.23%) and −0.51% (95% CI: −2.61%, 1.58%), respectively. No significant associations were detected for combinations of air pollutants on lipometabolic disturbance.

Conclusion

Increased air pollutant exposure is significantly associated with fluctuation in blood lipid parameter levels, which can be an indicator of the body’s lipometabolic disturbance.
COVID-19 Open Source Data Sets: A Comprehensive Survey
Authors: Shuja Junaid , Alanazi Eisa , Alasmary Waleed , Alashaikh Abdulaziz
Published: May 2020

Abstract

In December 2019, a novel virus named COVID-19 emerged in the city of Wuhan, China. In early 2020, the COVID-19 virus spread in all continents of the world except Antarctica causing widespread infections and deaths due to its contagious characteristics and no medically proven treatment. The COVID-19 pandemic has been termed as the most consequential global crisis after the World Wars. The first line of defense against the COVID-19 spread are the non-pharmaceutical measures like social distancing and personal hygiene. The great pandemic affecting billions of lives economically and socially has motivated the scientific community to come up with solutions based on computer-aided digital technologies for diagnosis, prevention, and estimation of COVID-19. Some of these efforts focus on statistical and Artificial Intelligence-based analysis of the available data concerning COVID-19. All of these scientific efforts necessitate that the data brought to service for the analysis should be open source to promote the extension, validation, and collaboration of the work in the fight against the global pandemic. Our survey is motivated by the open source efforts that can be mainly categorized as(a)COVID-19 diagnosis from CT scans, X-ray images, and cough sounds,(b)COVID-19 case reporting, transmission estimation, and prognosis from epidemiological, demographic, and mobility data,(c)COVID-19 emotional and sentiment analysis from social media, and(d)knowledge-based discovery and semantic analysis from the collection of scholarly articles covering COVID-19. We survey and compare research works in these directions that are accompanied by open source data and code. Future research directions for data-driven COVID-19 research are also debated. We hope that the article will provide the scientific community with an initiative to start open source extensible and transparent research in the collective fight against the COVID-19 pandemic.
Neural Stimulation in vitro and in vivo by Photoacoustic Nanotransducers
Authors: Huang Yimin , Jiang Ying , Luo Xuyi , Wu Jiayingzi , Zong Haonan , Shi Linli , Cheng Ran , Jiang Shan , Jia Xiaoting , Mei Jianguo , Man Heng-Ye , Cheng Ji-Xin , Yang Chen
Published: May 2020

Neuromodulation is an invaluable approach for study of neural circuits and clinical treatment of neurological diseases. Here, we report semiconducting polymer nanoparticles based photoacoustic nanotransducers (PANs) for neural stimulation. Our PANs strongly absorb light in the near-infrared second window and generate localized acoustic waves. PANs can also be surface-modified to selectively bind onto neurons. PAN-mediated activation of primary neurons in vitro is achieved with ten 3-nanosecond laser pulses at 1030 nm over a 3 millisecond duration. In vivo neural modulation of mouse brain activities and motor activities is demonstrated by PANs directly injected into brain cortex. With millisecond-scale temporal resolution, sub-millimeter spatial resolution and negligible heat deposition, PAN stimulation is a new non-genetic method for precise control of neuronal activities, opening potentials in non-invasive brain modulation.
A restriction-free method for gene reconstitution
Authors: Olcese Paolo , Huang Frank
Published: May 2020

This paper has been withdrawn by bioRxiv because its content, including the author names, was fabricated and fraudulently submitted in what may have been an attempt to game citation statistics or other metrics.
The emergence of SARS-CoV-2 in Europe and the US
Authors: Worobey Michael , Pekar Jonathan , Larsen Brendan B. , Nelson Martha I. , Hill Verity , Joy Jeffrey B. , Rambaut Andrew , Suchard Marc A. , Wertheim Joel O. , Lemey Philippe
Published: May 2020

Accurate understanding of the global spread of emerging viruses is critically important for public health response and for anticipating and preventing future outbreaks. Here, we elucidate when, where and how the earliest sustained SARS-CoV-2 transmission networks became established in Europe and the United States (US). Our results refute prior findings erroneously linking cases in January 2020 with outbreaks that occurred weeks later. Instead, rapid interventions successfully prevented onward transmission of those early cases in Germany and Washington State. Other, later introductions of the virus from China to both Italy and Washington State founded the earliest sustained European and US transmission networks. Our analyses reveal an extended period of missed opportunity when intensive testing and contact tracing could have prevented SARS-CoV-2 from becoming established in the US and Europe.
SARS-CoV-2 RNA detected in blood samples from patients with COVID-19 is not associated with infectious virus
Authors: Andersson Monique I , Arancibia-Cárcamo Carolina V , Auckland Kathryn , Baillie J Kenneth , Barnes Eleanor , Beneke Tom , Bibi Sagida , Carroll Miles , Crook Derrick , Dingle Kate , Dold Christina , Downs Louise O , Dunn Laura , Eyre David W , Jaramillo Javier Gilbert , Harvala Heli , Hoosdally Sarah , Ijaz Samreen , James Tim , James William , Jeffery Katie , Justice Anita , Klenerman Paul , Knight Julian , Knight Michael , Liu Xu , Lumley Sheila F , Matthews Philippa C , McNaughton Anna L , Mentzer Alexander J , Mongkolsapaya Juthathip , Oakley Sarah , Oliveira Marta S , Peto Timothy , Ploeg Rutger J , Ratcliff Jeremy , Roberts David J , Rudkin Justine , Russell Rebecca A , Screaton Gavin , Semple Malcolm G , Skelly Donal , Simmonds Peter , Stoesser Nicole , Turtle Lance , Wareing Sue , Zambon Maria
Published: May 2020

Background

Laboratory diagnosis of SARS-CoV-2 infection (the cause of COVID-19) uses PCR to detect viral RNA (vRNA) in respiratory samples. SARS-CoV-2 RNA has also been detected in other sample types, but there is limited understanding of the clinical or laboratory significance of its detection in blood.

Methods

We undertook a systematic literature review to assimilate the evidence for the frequency of vRNA in blood, and to identify associated clinical characteristics. We performed RT-PCR in serum samples from a UK clinical cohort of acute and convalescent COVID-19 cases (n=212), together with convalescent plasma samples collected by NHS Blood and Transplant (NHSBT) (n=111 additional samples). To determine whether PCR-positive blood samples could pose an infection risk, we attempted virus isolation from a subset of RNA-positive samples.

Results

We identified 28 relevant studies, reporting SARS-CoV-2 RNA in 0-76% of blood samples; pooled estimate 10% (95%CI 5-18%). Among serum samples from our clinical cohort, 27/212 (12.7%) had SARS-CoV-2 RNA detected by RT-PCR. RNA detection occurred in samples up to day 20 post symptom onset, and was associated with more severe disease (multivariable odds ratio 7.5). Across all samples collected ≥28 days post symptom onset, 0/143 (0%, 95%CI 0.0-2.5%) had vRNA detected. Among our PCR-positive samples, cycle threshold (ct) values were high (range 33.5-44.8), suggesting low vRNA copy numbers. PCR-positive sera inoculated into cell culture did not produce any cytopathic effect or yield an increase in detectable SARS-CoV-2 RNA.

Conclusions

vRNA was detectable at low viral loads in a minority of serum samples collected in acute infection, but was not associated with infectious SARS-CoV-2 (within the limitations of the assays used). This work helps to inform biosafety precautions for handling blood products from patients with current or previous COVID-19.
Sleep in disorders of consciousness: Behavioral and polysomnographic recording
Authors: Mertel Isabella , Pavlov Yuri G. , Barner Christine , Müller Friedemann , Diekelmann Susanne , Kotchoubey Boris
Published: May 2020

Background

Sleep-wakefulness cycles are an essential diagnostic criterion for Disorders of Consciousness (DOC), differentiating prolonged DOC from coma. Specific sleep features, like the presence of sleep spindles, are an important marker for the prognosis of recovery from DOC. Based on increasing evidence for a link between sleep and neuronal plasticity, understanding sleep in DOC might facilitate the development of novel methods for rehabilitation. Yet, well-controlled studies of sleep in DOC are lacking. Here, we aimed to quantify, on a reliable evaluation basis, the distribution of behavioral and neurophysiological sleep patterns in DOC over a 24h period while controlling for environmental factors (by recruiting a group of conscious tetraplegic patients who resided in the same hospital).

Methods

We evaluated the distribution of sleep and wakefulness by means of polysomnography (EEG, EOG, EMG) and video recordings in 32 DOC patients (16 Unresponsive Wakefulness Syndrome [UWS], 16 Minimally Conscious State [MCS]) and 10 clinical control patients with severe tetraplegia. Three independent raters scored the patients’ polysomnographic recordings.

Results

All but one patient (UWS) showed behavioral and electrophysiological signs of sleep. Control and MCS patients spent significantly more time in sleep during the night than during daytime, a pattern that was not evident in UWS. DOC patients (particularly UWS) exhibited less REM sleep than control patients. 44% of UWS patients and 12% of MCS patients did not have any REM sleep, while all control patients (100%) showed signs of all sleep stages and sleep spindles. Furthermore, no sleep spindles were found in 62% of UWS patients and 21% of MCS patients. In the remaining DOC patients who had spindles, their number and amplitude were significantly lower than in controls.

Conclusions

The distribution of sleep signs in DOC over 24 hours differs significantly from the normal sleep-wakefulness pattern. These abnormalities of sleep in DOC are independent of external factors such as severe immobility and hospital environment.
Renin-angiotensin-aldosterone system inhibitors and mortality in patients with hypertension hospitalized for COVID-19: a systematic review and meta-analysis
Authors: Ssentongo Anna , Ssentongo Paddy , Heilbrunn Emily S. , Lekoubou Alain , Du Ping , Liao Duanping , Oh John S , Chinchilli Vernon M.
Published: May 2020

Objective: The association between renin-angiotensin-aldosterone (RAAS) inhibitors and Coronavirus diseases 2019 (COVID-19) mortality is unclear. We aimed to explore the association of RAAS inhibitors, including angiotensin-converting inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality in patients with hypertension.
Methods: MEDLINE, SCOPUS, OVID, and Cochrane Library were searched for the period of January 1, 2020 to May 20, 2020. Studies reporting the association of RAAS inhibitors (ACEi and ARBs) and mortality in patients with hypertension, hospitalized for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio estimates, and heterogeneity was quantified.
Results: Data were collected on 2,065,805 individuals (mean age, 58.73 years; 53.4% male). Patients with hypertension taking RAAS inhibitors were 35% less likely to die from COVID-19 compared to patients with hypertension not taking RAAS inhibitors (pooled RR= 0.65, 95% Confidence Intervals (CI): 0.45-0.94). To explore the association of COVID-19 and specific classes of RAAS inhibitors, we conducted a subgroup analysis of ARBs and ACEi separately from studies that provided them. Pooled risk ratio estimates from ARBs and ACEi showed a lower but not significant risk of death from COVID-19 (RR=0.93, 95% CI: 0.70-1.22) and ACEi (RR=0.65, 95% CI: 0.32-1.30).
Conclusions: In this meta-analysis, it was discovered that taking RAAS inhibitors, significantly decreased the risk of COVID-19 mortality in patients with hypertension. This indicates a potential protective role that RAAS-inhibitors may have in COVID-19 patients with hypertension.
Comparing rapid micro-induction and standard induction of buprenorphine/naloxone for treatment of opioid use disorder: Protocol for an open-label, parallel-group, superiority, randomized controlled trial
Authors: Wong James S.H. , Nikoo Mohammadali , Westenberg Jean N. , Suen Janet G. , Wong Jennifer , Krausz Reinhard M. , Schutz Christian G. , Vogel Marc , Sidhu Jesse A. , Moe Jessica , Arishenkoff Shane , Griesdale Donald , Mathew Nickie , Azar Pouya
Published: May 2020

Background: Buprenorphine/naloxone (Suboxone) is a current first-line treatment for opioid use disorder (OUD). The standard induction method of buprenorphine/naloxone requires patients to be abstinent from opioids and therefore experience withdrawal symptoms prior to induction, which can be a barrier in starting treatment. Rapid micro-induction (micro-dosing) involves the administration of small, frequent does of buprenorphine/naloxone and removes the need for a period of withdrawal prior to the start of treatment. This study aims to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone in patients with OUD.

Methods: This is a randomized, open-label, two-arm, superiority, controlled trial comparing the safety and effectiveness of rapid micro-induction versus standard induction of buprenorphine/naloxone for the treatment of OUD. A total of 50 participants with OUD will be randomized at one Canadian hospital. The primary outcome is successful induction of buprenorphine/naloxone with low levels of withdrawal. Secondary outcomes are treatment retention, illicit drug use, self-reported drug use behaviour, craving, pain, physical health, safety, and client satisfaction.

Discussion: This is the first randomized controlled trial to compare the effectiveness and safety of rapid micro-induction versus standard induction of buprenorphine/naloxone. This study will thereby generate evidence for a novel induction method which eliminates substantial barriers to the use of buprenorphine/naloxone in the midst of the ongoing opioid crisis.
Assessment of small pulmonary blood vessels in COVID-19 patients using HRCT
Authors: Lins Muriel , Vandevenne Jan , Thillai Muhunthan , Lavon Ben R. , Lanclus Maarten , Bonte Stijn , Godon Rik , Kendall Irvin , De Backer Jan , De Backer Wilfried
Published: May 2020

Background

Mounting evidence supports the role of pulmonary hemodynamic alternations in the pathogenesis of COVID-19. Previous studies have demonstrated that changes in pulmonary blood volumes measured on CT are associated with histopathological markers of pulmonary vascular pruning, suggesting that quantitative HRCT analysis may eventually be useful in the assessment pulmonary vascular dysfunction more broadly.

Methods

Building upon previous work, automated HRCT measures of small blood vessel volume and pulmonary vascular density were developed. Scans from 103 COVID-19 patients and 108 healthy volunteers were analyzed and their results compared, with comparisons made both on lobar and global levels.

Results

Compared to healthy volunteers, COVID-19 patients showed significant reduction in BV5 (pulmonary blood volume contained in blood vessels of <5 mm2) expressed as BV5/(Total pulmonary blood volume) (p<0.0001), and significant increases in BV5_10 and BV 10 (pulmonary blood volumes contained in vessels between 5 and 10 mm2 and above 10 mm2, respectively) (p<0.0001). These changes were consistent across lobes.

Conclusions

COVID-19 patients display striking anomalies in the distribution of blood volume within the pulmonary vascular tree, consistent with increased pulmonary vasculature resistance in the pulmonary vessels below the resolution of HRCT.