bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Gaming Practices and its effect on scholastic performance of medical students in India: A Case Control study
Authors: Deodatt M S , Divya R , Anju J , Raghuram V , Goyal R
Published: July 2020

Introduction

Gaming is a billion-dollar industry growing at a Compound annual growth rate (CAGR) of 9 %-14.3% with biggest market in South East Asian countries. Availability of Low-cost smart phones, ease of internet access has made gaming popular among youth who enjoy it as a leisure activity. According to the WHO excessive indulgence in Gaming can lead to Gaming disorder. Medical students indulging in excessive gaming can succumb to gaming disorder which can affect their scholastic performance. Hence this study was done to assess the gaming practices and its effect on scholastic performance.

Objective

To assess the various Gaming practices and the Prevalence of Gaming addiction among medical students.

To study the effect of Gaming practices on Scholastic performance of medical students.

Methods

The present study used a case control design where the 448(N) study participants were recruited using non probability sampling technique. 91 (Nc) cases who were Gaming for past 6 months were identified using rapid preliminary survey .91 controls (Nco) who never played games were selected and matched for age and sex. Internal Assessment scores (%) of cases and controls were compared. Snedecor F test and Student t test were used to find out the association between the hours of gaming and internal assessment scores (%) and difference of Internal assessment scores between cases and controls respectively. Odds ratio was calculated to identify the risk of Poor scholastic performance. Prevalence of Gaming addiction was assessed using Lemmen’s Gaming addiction scale (GAS).

Results

Frequency of gaming (hrs) was not associated with the Mean internal assessment scores (p>0.05). Male students (cases) showed significant reduction in both their internal assessment scores (p<0.001,<0.01) whereas no reduction was observed in Female cases. A negative correlation was observed between GAS and internal assessment scores (r=-0.02). Prevalence of Gaming addiction using GAS was found to be 6.2% among the study population(N=448) and 31% among Cases (Nc=91). The risk of low scores was (OR =1.80-1.89) times more in cases than controls.

Conclusions

Excessive Gaming adversely affects scholastic performance in males than females. Awareness about Gaming addiction needs to be created among students, parents and teachers. Institutionalised De -addiction services should be made available to medical students.
Association of contact to small children with mild course of COVID-19
Authors: Dugas Martin , Schrempf Inga-Marie , Ochs Kevin , Frömmel Christopher , Greulich Leonard , Neuhaus Philipp , Tepasse Phil-Robin , Schmidt Hartmut H-J
Published: July 2020

It is known that severe COVID-19 cases in small children are rare. If a childhood-related infection would be protective against severe course of COVID-19, it would be expected that adults with intensive and regular contact to small children also may have a mild course of COVID-19 more frequently. To test this hypothesis, a survey among 4,010 recovered COVID-19 patients was conducted in Germany. 1,186 complete answers were collected. 6.9% of these patients reported frequent and regular job-related contact to children below 10 years of age and 23.2% had own small children, which is higher than expected. In the relatively small subgroup with intensive care treatment (n=19), patients without contact to small children were overrepresented. These findings are not well explained by age, gender or BMI distribution of those patients and should be validated in other settings.
Genetic variation affects morphological retinal phenotypes extracted from UK Biobank Optical Coherence Tomography images
Authors: Currant Hannah , Hysi Pirro , Fitzgerald Tomas W , Gharahkhani Puya , Bonnemaijer Pieter W M ,   UK Biobank Eye and Vision Consortium,   International Glaucoma Genetics Consortium, Atan Denize , Aung Tin , Charng Jason , Choquet Hélène , Craig Jamie , Hewitt Alex W , Khaw Peng T , Klaver Caroline C W , Kubo Michiaki , Ong Jue-Sheng , Pasquale Louis R , Reisman Charles A , Simcoe Mark J , Thiadens Alberta A H J , van Duijn Cornelia M , Yazar Seyhan , Jorgenson Eric , MacGregor Stuart , Hammond Chris J , Mackey David A , Wiggs Janey L , Foster Paul J , Patel Praveen J , Birney Ewan , Khawaja Anthony P
Published: July 2020

Optical Coherence Tomography (OCT) enables non-invasive imaging of the retina and is often used to diagnose and manage multiple ophthalmic diseases including glaucoma. We present the first large-scale quantitative genome-wide association study of inner retinal morphology using phenotypes derived from OCT images of 31,434 UK Biobank participants. We identify 46 loci associated with thickness of the retinal nerve fibre layer or ganglion cell inner plexiform layer. Only one of these loci has previously been associated with glaucoma, and Mendelian randomisation confirms that inner retinal thickness, despite being a valid biomarker for the disease, is not on the same genetic causal pathway as glaucoma. Image analysis methods were used to extract overall retinal thickness at the fovea, representative of hypoplasia, with which three out of the 46 SNPs were associated. These SNPs have been previously linked with pigmentation, confirmed by their association with hair colour in the UK Biobank dataset. We additionally associate these three loci with visual acuity. In contrast to the already known Mendelian causes of severe foveal hypoplasia, our results suggest a previously unknown spectrum of foveal hypoplasia in the population, in part genetically determined, that has consequences on visual function.
A Cluster-Randomized Trial of Hydroxychloroquine as Prevention of Covid-19 Transmission and Disease
Authors: Mitjà Oriol , Ubals Maria , Corbacho-Monné Marc , Alemany Andrea , Suñer Clara , Tebe Cristian , Tobias Aurelio , Peñafiel Judith , Ballana Ester , Pérez Carla A. , Admella Pol , Riera-Martí Nuria , Laporte Pep , Mitja Jordi , Clua Mireia , Bertran Laia , Sarquella Maria , Gavilán Sergi , Ara Jordi , Argimon Josep M , Cuatrecasas Gabriel , Cañadas Paz , Elizalde-Torrent Aleix , Fabregat Robert , Farré Magí , Forcada Anna , Flores-Mateo Gemma , López Cristina , Muntada Esteve , Nadal Núria , Narejos Silvia , Gil-Ortega Aroa N , Prat Nuria , Puig Jordi , Quiñones Carles , Ramírez-Viaplana Ferran , Urueña Juliana Reyes- , Riveira-Muñoz Eva , Ruiz Lidia , Sanz Sergi , Sentis Alexis , Sierra Alba , Velasco César , Vivanco-Hidalgo Rosa Maria , Zamora Juani , Casabona Jordi , Vall-Mayans Martí , G-Beiras Camila , Clotet Bonaventura
Published: July 2020

Background

Current strategies for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are limited to non-pharmacological interventions. Hydroxychloroquine (HCQ) has been proposed as a postexposure therapy to prevent Coronavirus disease 2019 (Covid-19) but definitive evidence is lacking.

Methods

We conducted an open-label, cluster-randomized trial including asymptomatic contacts exposed to a PCR-positive Covid-19 case in Catalonia, Spain. Clusters were randomized to receive no specific therapy (control arm) or HCQ 800mg once, followed by 400mg daily for 6 days (intervention arm). The primary outcome was PCR-confirmed symptomatic Covid-19 within 14 days. The secondary outcome was SARS-CoV-2 infection, either symptomatically compatible or a PCR-positive result regardless of symptoms. Adverse events (AEs) were assessed up to 28 days.

Results

The analysis included 2,314 healthy contacts of 672 Covid-19 index cases identified between Mar 17 and Apr 28, 2020. A total of 1,198 were randomly allocated to usual care and 1,116 to HCQ therapy. There was no significant difference in the primary outcome of PCR-confirmed, symptomatic Covid-19 disease (6.2% usual care vs. 5.7% HCQ; risk ratio 0.89 [95% confidence interval 0.54-1.46]), nor evidence of beneficial effects on prevention of SARS-CoV-2 transmission (17.8% usual care vs. 18.7% HCQ). The incidence of AEs was higher in the intervention arm than in the control arm (5.9% usual care vs 51.6% HCQ), but no treatment-related serious AEs were reported.

Conclusions

Postexposure therapy with HCQ did not prevent SARS-CoV-2 disease and infection in healthy individuals exposed to a PCR-positive case. Our findings do not support HCQ as postexposure prophylaxis for Covid-19.

ClinicalTrials.gov registration number

NCT04304053
Efficacy and safety of hydroxychloroquine for the treatment of osteoarthritis: protocol for a systematic review of randomized controlled trials
Authors: Singh Ambrish , Kotlo Anirudh , Dissanayaka Thusharika , Wang Zhiqiang , Antony Benny
Published: July 2020

Hydroxychloroquine (HCQ) is a conventional disease-modifying antirheumatic drug (DMARD), which is considered as relatively safe, and offers a modest efficacy profile for the treatment of inflammatory rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. In view of the anecdotal evidence on its immunomodulatory and anti-inflammatory properties, HCQ has been used as an off-label option in patients with osteoarthritis (OA), mainly for the treatment of inflammatory OA. Recently, many investigators have evaluated the safety and efficacy of HCQ for the treatment of OA in various randomized control trials (RCTs). While most RCTs have evaluated the HCQ in inflammatory OA (erosive hand OA), there are studies constituting knee OA patients as well. Currently, there are no systematic reviews that have summarized the evidence on the efficacy and safety of HCQ in OA population. Hence, this study aims to systematically review the evidence from RCTs assessing the efficacy and safety of HCQ for the treatment of OA. Biomedical databases such as PubMed, Embase, and Google Scholar will be searched to identify the RCTs of HCQ in patients with OA (hand, knee, hip, or any other OA). Cochrane risk of bias tool will be used to assess the quality of included studies. Review Manager 5 (Rev Man) and STATA Version 16 will be used to conduct the statistical analysis.
Evidence of gender bias in the diagnosis and management of COVID-19 patients: A Big Data analysis of Electronic Health Records
Authors: Ancochea Julio , Izquierdo Jose L. ,   Savana COVID-19 Research Group, Soriano Joan B.
Published: July 2020

Background

It remains unknown whether the frequency and severity of COVID-19 affect women differently than men. Here, we aim to describe the characteristics of COVID-19 patients at disease onset, with special focus on the diagnosis and management of female patients with COVID-19.

Methods

We explored the unstructured free text in the electronic health records (EHRs) within the SESCAM Healthcare Network (Castilla La-Mancha, Spain). The study sample comprised the entire population with available EHRs (1,446,452 patients) from January 1st to May 1st, 2020. We extracted patients’ clinical information upon diagnosis, progression, and outcome for all COVID-19 cases.

Results

A total of 4,780 patients with a test-confirmed diagnosis of COVID-19 were identified. Of these, 2,443 (51%) were female, who were on average 1.5 years younger than males (61.7±19.4 vs. 63.3±18.3, p=0.0025). There were more female COVID-19 cases in the 15-59 yr.-old interval, with the greatest sex ratio (SR; 95% CI) observed in the 30-39 yr.-old interval (1.69; 1.35-2.11). Upon diagnosis, headache, anosmia, and ageusia were significantly more frequent in females than males. Imaging by chest X-ray or blood tests were performed less frequently in females (65.5% vs. 78.3% and 49.5% vs. 63.7%, respectively), all p<0.001. Regarding hospital resource use, females showed less frequency of hospitalization (44.3% vs. 62.0%) and ICU admission (2.8% vs. 6.3%) than males, all p<0.001.

Conclusion

Our results indicate important sex-dependent differences in the diagnosis, clinical manifestation, and treatment of patients with COVID-19. These results warrant further research to identify and close the gender gap in the ongoing pandemic.
Sunlight exposure exerts immunomodulatory effects to reduce multiple sclerosis severity
Authors: Ostkamp Patrick , Salmen Anke , Pignolet Béatrice , Görlich Dennis , Andlauer Till F. M. , Schulte-Mecklenbeck Andreas , Gonzalez-Escamilla Gabriel , Bucciarelli Florence , Gennero Isabelle , Breuer Johanna , Antony Gisela , Schneider-Hohendorf Tilman , Mykicki Nadine , Bayas Antonios , Bergh Florian Then , Bittner Stefan , Hartung Hans-Peter , Friese Manuel A. , Linker Ralf A. , Luessi Felix , Lehmann-Horn Klaus , Mühlau Mark , Paul Friedemann , Stangel Martin , Tackenberg Björn , Tumani Hayrettin , Warnke Clemens , Weber Frank , Wildemann Brigitte , Zettl Uwe K. , Ziemann Ulf , Müller-Myhsok Bertram , Kümpfel Tania , Klotz Luisa , Meuth Sven G. , Zipp Frauke , Hemmer Bernhard , Hohlfeld Reinhard , Brassat David , Gold Ralf , Gross Catharina C. , Lukas Carsten , Groppa Sergiu , Loser Karin , Wiendl Heinz , Schwab Nicholas
Published: July 2020

Background

Multiple sclerosis (MS) disease risk is associated with reduced sun exposure. This study assessed the relationship between measures of sun-exposure (vitamin D (vitD), latitude) and MS disease severity, the mechanisms of action, and effect-modification by medication and sun-sensitivity associated MC1R variants.

Methods

Two multi-center cohort studies (nNationMS=946, nBIONAT=991). Outcomes were the multiple sclerosis severity score (MSSS) and the number of Gd-enhancing lesion (GELs). RNAseq of four immune cell populations before and after UV-phototherapy of five MS patients.

Results

High serum vitD was associated with reduced MSSS (PNationMS=0.021; PBIONAT=0.007) and reduced risk for disease aggravation (PNationMS=0.032). Low latitude was associated with higher vitD, lower MSSS (PNationMS=0.018), fewer GELs (PNationMS=0.030) and reduced risk for aggravation (PNationMS=0.044). The influence of latitude on disability seemed to be lacking in the subgroup of interferon-β treated patients (interaction-PBIONAT=0.042, interaction-PNationMS=0.053). In genetic analyses, for carriers of MC1R:rs1805008(T), who reported increased sensitivity towards sunlight (PNationMS=0.038), the relationship between latitude und the number of GELs was inversed (PNationMS=0.001). Phototherapy induced a vitD and type I interferon signature that was most apparent in the transcriptome of monocytes (P=1×10−6).

Conclusion

VitD is associated with reduced MS severity and disease aggravation. This is likely driven by sun-exposure, as latitude also correlated with disability and serum vitD. However, sun-exposure might be detrimental for sun-sensitive patients. A direct induction of type I interferons through sun-exposure could explain a reduced effect of latitude in interferon-β treated patients. This could also explain opposite effects of sun-exposure in MS and the type I interferon and sun-sensitivity-associated disease Lupus.
Optimal Testing Strategy for the Identification of COVID-19 Infections
Authors: Chatzimanolakis Michail , Weber Pascal , Arampatzis George , Wälchli Daniel , Kičić Ivica , Karnakov Petr , Papadimitriou Costas , Koumoutsakos Petros
Published: July 2020

The systematic identification of infectious, yet unreported, individuals is critical for the containment of the COVID-19 pandemic. We present a strategy for identifying the location, timing and extent of testing that maximizes information gain for such infections. The optimal testing strategy relies on Bayesian experimental design and forecasting epidemic models that account for time dependent interventions. It is applicable at the onset and spreading of the epidemic and can forewarn for a possible recurrence of the disease after relaxation of interventions. We examine its application in Switzerland and show that it can provide timely and systematic guidance for the effective identification of infectious individuals with finite testing resources. The methodology and the open source code are readily adaptable to countries around the world.

We present a strategy for the optimal allocation of testing resources in order to detect COVID-19 infections in a country’s population.
Screening Diabetic Retinopathy Using an Automated Retinal Image Analysis System in Mexico: Independent and Assistive use Cases
Authors: Noriega Alejandro , Meizner Daniela , Camacho Dalia , Enciso Jennifer , Quiroz-Mercado Hugo , Morales-Canton Virgilio , Almaatouq Abdullah , Pentland Alex
Published: July 2020

Background

The automated screening of patients at risk of developing diabetic retinopathy (DR) represents an opportunity to improve their mid-term outcome, and lower the public expenditure associated with direct and indirect costs of common sight-threatening complications of diabetes.

Objective

In the present study, we aim at developing and evaluating the performance of an automated deep learning–based system to classify retinal fundus images from international and Mexican patients, as referable and non-referable DR cases. In particular, we study the performance of the automated retina image analysis (ARIA) system under an independent scheme (i.e. only ARIA screening) and twoassistiveschemes (i.e., hybrid ARIA + ophthalmologist screening), using a web-based platform for remote image analysis.

Methods

We ran a randomized controlled experiment where 17 ophthalmologists were asked to classify a series of retinal fundus images under three different conditions: 1) screening the fundus image by themselves (solo), 2) screening the fundus image after being exposed to the opinion of the ARIA system (ARIA answer), and 3) screening the fundus image after being exposed to the opinion of the ARIA system, as well as its level of confidence and an attention map highlighting the most important areas of interest in the image according to the ARIA system (ARIA explanation). The ophthalmologists’ opinion in each condition and the opinion of the ARIA system were compared against agold standardgenerated by consulting and aggregating the opinion of three retina specialists for each fundus image.

Results

The ARIA system was able to classify referable vs. non-referable cases with an area under the Receiver Operating Characteristic curve (AUROC), sensitivity, and specificity of 98%, 95.1% and 91.5% respectively, for international patient-cases; and an AUROC, sensitivity, and specificity of 98.3%, 95.2%, and 90% respectively for Mexican patient-cases. The results achieved on Mexican patient-cases outperformed the average performance of the 17 ophthalmologist participants of the study. We also find that the ARIA system can be useful as an assistive tool, as significant sensitivity improvements were observed in the experimental condition where participants were exposed to the answer of theARIA systemas a second opinion (93.3%), compared to the sensitivity of the condition where participants assessed the images independently (87.3%).

Conclusions

These results demonstrate that both use cases of ARIA systems,independentandassistive, present a substantial opportunity for Latin American countries like Mexico towards an efficient expansion of monitoring capacity for the early detection of diabetes-related blindness.
Application and Reliability of Arm Use Intensities in the Free-Living Environment for Manual Wheelchair Users
Authors: Goodwin Brianna M. , Jahanian Omid , Van Straaten Meegan G. , Fortune Emma , Madansingh Stefan I. , Cloud-Biebl Beth A. , Zhao Kristin D. , Morrow Melissa M.
Published: July 2020

Arm use in individuals with spinal cord injury who use manual wheelchairs (MWC) is complex, characterized by a combination of overuse and a sedentary lifestyle. This study aimed to calculate arm use intensity levels for MWC users, describe the percentage of daily wear time MWC users and able-bodied individuals spend in each arm use intensity level, and test the reliabilities of the measurements for both MWC users and able-bodied individuals.

MWC users wore two inertial measurement units (IMUs) on their bilateral upper arms while performing six MWC-based activities in-lab. Video data were recorded and each second was coded as active or stationary. Acceleration-based signal magnitude area (SMA) ranges were defined for stationary, low, mid, and high arm use intensity levels. IMU data were also collected in the free-living environments for MWC users and able-bodied individuals for four days (3 weekdays and 1 weekend day). The SMA levels were applied to the free-living data from the dominant arm and the percentage of time spent in each level was calculated. The required number of days to achieve moderate, good, and excellent reliabilities was calculated.

Eight adult MWC users with SCI participated in the in-lab data collection and SMA arm use intensity levels were defined as, stationary: ⩽ 0.67g, low: 0.671 – 3.27g, mid: 3.271 – 5.87, and high: > 5.871. Six MWC users and 15 able-bodied individuals completed the free-living data collection. The dominant arm of both MWC users and able-bodied individuals was stationary for the majority of the day. The reliability analysis indicated that at least five and eight days of data are needed from MWC users and able-bodied individuals, respectively, to achieve reliable representation of their overall daily arm use intensities throughout a week.

Future research is needed to understand the recovery time associated with stationary arm use and if it differs between MWC users and matched able-bodied individuals. At least five days of data should be collected when utilizing these methods for MWC users. The methods presented here will contribute to understanding the mechanisms which cause increased shoulder pain and pathology for MWC users.
Factors Associated with COVID-19 Mitigation Behavior among US Adults
Authors: Lemke Debra C. , Lemke Klaus W.
Published: July 2020

In early 2020, the CDC issued guidelines for personal COVID-19 mitigation behavior, such as mask-wearing, hand-washing, and social-distancing. We examine individual socio-behavioral factors that potentially predict mitigation compliance using public data. Our analysis finds that pandemic prompted strong mitigation behavior by adults, especially among females, non-whites, urban dwellers, and the psychological unwell. Other positive predictors were post-secondary education and higher income. Health symptoms and clinical risk factors did not predict increased mitigation practices, nor did age 65+ and proximity to infected persons. Our study findings are congruent with a report that pointed to a lack of increased pandemic mitigation practices in households with confirmed infections and health risks. We also point to lower levels of psychological resilience, lower socio-economic status, and non-urban location as potential explanatory factors for lack of mitigation behavior. Understanding what factors are associated with mitigation behavior will be important for policy makers in their efforts to curb the COVID-19 pandemic.
A data-driven metapopulation model for the Belgian COVID-19 epidemic: assessing the impact of lockdown and exit strategies
Authors: Coletti Pietro , Libin Pieter , Petrof Oana , Willem Lander , Abrams Steven , Herzog Sereina A. , Faes Christel , Wambua James , Kuylen Elise ,   COVID-19 team the SIMID, Beutels Philippe , Hens Niel
Published: July 2020

Background

In response to the ongoing COVID-19 pandemic, several countries adopted measures of social distancing to a different degree. For many countries, after successfully curbing the initial wave, lockdown measures were gradually lifted. In Belgium, such relief started on May 4th with phase 1, followed by several subsequent phases over the next few weeks.

Methods

We analysed the expected impact of relaxing stringent lockdown measures taken according to the phased Belgian exit strategy. We developed a stochastic, data-informed, meta-population model that accounts for mixing and mobility of the age-structured population of Belgium. The model is calibrated to daily hospitalization data and serological data and is able to reproduce the outbreak at the national level. We consider different scenarios for relieving the lockdown, quantified in terms of relative reductions in pre-pandemic social mixing and mobility. We validate our assumptions by making comparisons with social contact data collected during and after the lockdown.

Results

Our model is able to successfully describe the initial wave of COVID-19 in Belgium and identifies interactions during leisure/other activities as pivotal in the exit strategy. Indeed, we find a smaller impact of school re-openings as compared to restarting leisure activities and re-openings of work places. We also assess the impact of case isolation of new (suspected) infections, and find that it allows re-establishing relatively more social interactions while still ensuring epidemic control. Scenarios predicting a second wave of hospitalizations were not observed, suggesting that the per-contact probability of infection has changed with respect to the pre-lockdown period.

Conclusions

Community contacts are found to be most influential, followed by professional contacts and school contacts, respectively, for an impending second wave of COVID-19. Regular re-assessment is crucial to adjust to evolving behavioral changes that can affect epidemic diffusion. In addition to social distancing, sufficient capacity for extensive testing and contact tracing is essential for successful mitigation.
Hospital-Based Donor Recruitment and Pre-Donation Serologic Testing for COVID-19 Convalescent Plasma
Authors: Balcerek Joanna , Trejo Evelin , Levine Kendall , Couey Paul , Kornberg Zoe V. , Rogine Camille , Young Charlotte , Li Jonathan , Shy Brian R. , Taylor Jordan E. , Bakhtary Sara , Friedlander Terence , Lynch Kara L. , Bern Caryn , Esensten Jonathan H.
Published: July 2020

Background

Major blood centers perform serologic testing on potential COVID-19 convalescent plasma donors retrospectively after blood donation. A hospital-based recruitment program for COVID-19 convalescent plasma (CCP) donors may be an efficient way to prospectively identify potential donors.

Study Design and Methods

Patients who recovered from known or suspected COVID-19 were identified and recruited through medical record searches and public appeals. Participants were screened with a modified donor history questionnaire (DHQ), and if eligible, were consented and tested for SARS-CoV-2 antibodies (IgG and IgM). Participants who were positive for SARS-CoV-2 IgG were referred to a local blood center for convalescent plasma collection.

Results

Of 179 individuals screened, 128 completed serologic testing and 89 were referred for convalescent plasma donation to a local blood center (49.7% of those screened). IgG antibodies to SARS-CoV-2 were detected in 23/51 (45.1%) of participants with suspected COVID-19 and in 66/77 (85.7%) of participants with self-reported PCR-confirmed COVID-19. Testing was performed at a median of 38 days since last symptoms. Participant age positively correlated with anti-SARS-CoV-2 IgG and IgM levels. Time since last symptoms did not correlate with IgG or IgM levels. A wide range of SARS-CoV-2 IgG levels were observed.

Conclusion

A hospital based CCP donor recruitment program can prospectively identify potential CCP donors. Variability in SARS-CoV-2 IgG levels has implications for selection of CCP units for transfusion.
Confirmed and Unreported COVID-19-Like Illness Death Counts: An Assessment of Reporting Discrepancy
Authors: Ahamad Mazbahul G. , Tanin Fahian , Talukder Byomkesh
Published: July 2020

Objective

To assess the reporting discrepancy between officially confirmed COVID-19 death counts and unreported COVID-19-like illness (CLI) death counts.

Study Design

The study is based on secondary time-series data.

Methods

We used publicly available data to explore the differences between confirmed COVID-19 death counts and deaths with probable COVID-19 symptoms in Bangladesh between March 8, 2020, and July 18, 2020. Both tabular analysis and statistical tests were performed.

Results

During the week ending May 9, 2020, the unreported CLI death count was higher than the confirmed COVID-19 death count; however, it was lower in the following weeks. On average, unreported CLI death counts were almost equal to the confirmed COVID-19 death counts during the study period. However, the reporting authority neither considers CLI deaths nor adjusts for potential seasonal influenza-like illness or other related deaths, which might produce incomplete and unreliable COVID-19 data and respective mortality rates.

Conclusions

Deaths with probable COVID-19 symptoms needs to be included in provisional death counts in order to estimate an accurate COVID-19 mortality rate and to offer data-driven pandemic response strategies. An urgent initiative is needed to prepare a comprehensive guideline for reporting COVID-19 deaths.
Acute Shortage Ventilator
Authors: Akerib D. S. , Ames A. , Breidenbach M. , Bressack M. , Breur P. A. , Charles E. , Gaba D. , Herbst R. , Ignarra C. M. , Luitz S. , Miller E. H. , Mong B. , Shutt T. A. , Wittgen M.
Published: July 2020

We have implemented an “Acute Shortage Ventilator” (ASV) motivated by the COVID-19 pandemic and the possibility of severe ventilator shortages in the near future. The unit cost per ventilator is less than $400 US excluding the patient circuit parts. The ASV mechanically compresses a self-inflating bag resuscitator, uses a modified patient circuit, and is commanded by a microcontroller and an optional laptop. It operates in both Volume-Controlled Assist-Control mode and a Pressure-Controlled Assist-Control mode. It has been tested using an artificial lung against the EURS guidelines. The key design goals were to develop a simple device with high performance for short-term use, made primarily from common hospital parts and generally-available non-medical components, and at low cost and ease in manufacturing.
Linking Outdoor Air Temperature and SARS-CoV-2 Transmission in the US Using a Two Parameter Transmission Model
Authors: Newell Ty
Published: July 2020

Outdoor temperature lower than 50F and greater than 70F is shown to nearly double the transmission efficiency of the SARS-CoV-2 virus. Outdoor temperature is an important factor behind the current surge in US Covid-19 cases. Correlation of northern state infection data and outdoor temperatures is used to identify the change in disease transmission efficiency as northern states passed through the lower temperature bound (50F) in spring, and more recently transitioned to temperatures above the higher bound (70F). At current disease transmission efficiency levels, social distancing must be increased above a UMD Social Distance Index (SDI) level of 36 to stop the accelerated increase of daily infection cases. At current disease transmission efficiency (G=0.19) and SDI of 33, the US will approach 150,000 infections per day in September before declining as average US temperature falls below 70F.

A primary reason for enhanced disease transmission below 50F and above 70F is attributed to inadequate indoor ventilation. Swing season occurs when outdoor temperatures are between 50F and 70F, and is the time of year when homes and buildings are opened to the outdoors. Increased fresh air ventilation (greater than 40cfm per person), improved air filtration (MERV11 and greater filters), and UVGI (Ultraviolet Germicidal Irradiation, 0.02WUV per cfm airflow) coupled with wearing face masks, 6ft distancing and surface sanitation are estimated to reduce indoor disease transmission probability to a third of the transmission probability resulting from standard building ventilation practice.
Computer vision-based assessment of motor functioning in schizophrenia: Use of smartphones for remote measurement of schizophrenia symptomatology
Authors: Abbas Anzar , Yadav Vijay , Smith Emma , Ramjas Elizabeth , Rutter Sarah B. , Benavides Caridad , Koesmahargyo Vidya , Zhang Li , Guan Lei , Rosenfield Paul , Perez-Rodriguez Mercedes , Galatzer-Levy Isaac R.
Published: July 2020

Introduction

Motor abnormalities have been shown to be a distinct component of schizophrenia symptomatology. However, objective and scalable methods for assessment of motor functioning in schizophrenia are lacking. Advancements in machine learning-based digital tools have allowed for automated and remote ‘digital phenotyping’ of disease symptomatology. Here, we assess the performance of a computer vision-based assessment of motor functioning as a characteristic of schizophrenia using video data collected remotely through smartphones.

Methods

18 patients with schizophrenia and 9 healthy controls were asked to remotely participate in smartphone-based assessments daily for 14 days. Video recorded from the smartphone front-facing camera during these assessments was used to quantify head movement through a pre-trained computer vision model. The ability of head movement measurements to distinguish between patients and healthy controls as well as their relationship to schizophrenia symptom severity as measured through traditional clinical scores was assessed.

Results

A logistic regression demonstrated that head movement was a significant predictor of schizophrenia diagnosis (p < 0.05). Linear regression between head movement and clinical scores of schizophrenia symptom severity showed that head movement has a negative relationship with schizophrenia symptom severity (p < 0.05), primarily with negative symptoms of schizophrenia.

Conclusions

Remote, smartphone-based assessments were able to capture meaningful visual behavior for computer vision-based objective measurement of head movement. The measurements of head movement acquired were able to accurately classify schizophrenia diagnosis and quantify symptom severity in patients with schizophrenia.
SARS-CoV-2 antibody prevalence in health care workers: Preliminary report of a single center study
Authors: Brant-Zawadzki Michael , Fridman Deborah , Robinson Philip A. , Zahn Matthew , German Randy , Breit Marcus , Hara Junko
Published: July 2020

SARS-CoV-2 has driven a pandemic crisis. Serological surveys have been conducted to establish prevalence for covid-19 antibody in various cohorts and communities. However, the prevalence among healthcare workers is still being analyzed. The present study reports on initial sero-surveillance conducted on healthcare workers at a regional hospital system in Orange County, California, during May and June, 2020.

Study participants were recruited from the entire hospital employee workforce and the independent medical staff. Data were collected for job title, location, covid-19 symptoms, a PCR test history, travel record since January 2020, and existence of household contacts with covid-19. A blood sample was collected from each subject for serum analysis for IgG antibodies to SARS- CoV-2.

Of 3,013 tested individuals, a total 2,932 were included in the analysis due to some missing data. Observed prevalence of 1.06% (31 antibody positive cases), adjusted prevalence of 1.13% for test sensitivity and specificity were identified. Significant group differences between positive vs. negative were observed for age (z = 2.65, p = .008), race (p = .037), presence of fever (p < .001) and loss of smell (p < .001).

Possible explanation for this low prevalence includes a relatively low local geographic community prevalence (∼4.4%) at the time of testing, the hospital’s timely procurement of personal protective equipment, rigorous employee education, patient triage and treatment protocol development and implementation. In addition, possible greater presence of cross- reactive adaptive T cell mediated immunity in healthcare workers vs. the general population may have contributed. Determining antibody prevalence in front-line workers, and duration of antibody presence may help stratify the workforce for risk, establish better health place policies and procedures, and potentially better mitigate transmission.
A vulnerability analysis for the management of and response to the COVID-19 epidemic in the second most populous state in Brazil
Authors: Campos Igor Silva , Aratani Vinícius Ferreira , Cabral Karina Baltor , Limongi Jean Ezequiel , de Oliveira Stefan Vilges
Published: July 2020

The COVID-19 pandemic has the potential to affect all individuals, however in a heterogeneous way. In this sense, identifying specificities of each location is essential to minimize the damage caused by the disease. Therefore, the aim of this research was to assess the vulnerability of the 853 municipalities in the second most populous state in Brazil, Minas Gerais (MG), in order to direct public policies. Then, an epidemiological study was carried out based on Multi-Criteria Decision Analysis (MCDA) using indicators with some relation to the process of illness and death caused by COVID-19. The indicators were selected by a literature review and categorized into: demographic, social, economic, health infrastructure, population at risk and epidemiological. The variables were collected in Brazilian government databases at the municipal level and evaluated according to MCDA, through the Program to Support Decision Making based on indicators (PRADIN). Based on this approach, the study performed simulations by category of indicators and a general simulation that allowed to divide the municipalities into groups of 1 to 5, with 1 being the least vulnerable and 5 being the most vulnerable. The groupings of municipalities were exposed in their respective mesoregions of MG in a thematic map, using the software Tabwin 32. The results revealed that the mesoregion of Norte de Minas stands out with more than 40% of its municipalities belonging to group 5, according to economic, social and health infrastructure indicators. Similarly, the Jequitinhonha mesoregion exhibited almost 60% of the municipalities in this group for economic and health infrastructure indicators. For demographic and epidemiological criteria, the Metropolitana de Belo Horizonte mesoregion is the most vulnerable, with 42.9% and 26.7% of the municipalities in group 5, respectively. Considering the presence of a population at risk, Zona da Mata reported 42.3% of the municipalities in the most vulnerable group. In the joint analysis of data, the Jequitinhonha, Vale do Mucuri and Vale do Rio Doce mesoregions were the most vulnerable in the state of MG. Thus, through the outlined profile, the present study proved how socioeconomic diversity affects the vulnerability of the municipalities to face COVID-19 outbreak, highlighting the need for interventions directed to each reality.
Covid-19 serology in nephrology health care workers
Authors: Reiter Thomas , Pajenda Sahra , Wagner Ludwig , Gaggl Martina , Atamaniuk Johanna , Holzer Barbara , Zimpernik Irene , Gerges Daniela , Mayer Katharina , Aigner Christof , Straßl Robert , Jansen-Skoupy Sonja , Födinger Manuela , Sunder-Plassmann Gere , Schmidt Alice
Published: July 2020

Background

Chronic kidney disease patients show a high mortality in case of a SARS-CoV-2 infection. Thus, to be informed on Nephrology personnel’s sero-status might be crucial for patient protection. However, limited information exists about the presence of SARS-CoV-2 antibodies in asymptomatic individuals.

Methods

We examined the seroprevalence of SARS-CoV-2 IgG and IgM antibodies among health care workers of a tertiary care kidney center during the peak phase of the Covid-19 crisis in Austria using an orthogonal test strategy and a total of 12 commercial nucleocapsid protein or spike glycoprotein based assays as well as Western blotting and a neutralization assay.

Results

At baseline 60 of 235 study participants (25.5%, 95% CI: 20.4-31.5) were judged to be borderline positive or positive for IgM or IgG using a high sensitivity/low specificity threshold in one test system. Follow-up analysis after about two weeks revealed IgG positivity in 12 (5.1%, 95% CI: 2.9-8.8) and IgM positivity in six (2.6%, 95% CI: 1.1-5.6) in at least one assay. 2.1% (95% CI: 0.8-5.0) of health care workers showed IgG nucleocapsid antibodies in at least two assays. By contrast, positive controls with proven Covid-19 showed antibody positivity among almost all test systems. Moreover, serum samples obtained from health care workers did not show SARS-CoV-2 neutralizing capacity, in contrast to positive controls.

Conclusions

Using a broad spectrum of antibody tests the present study revealed inconsistent results for SARS-CoV-2 seroprevalence among asymptomatic individuals, while this was not the case among Covid-19 patients.

Trial registration number

CONEC, ClinicalTrials.gov number NCT04347694
SECOND ALLOGENEIC STEM CELL TRANSPLANTATION: A MORTALITY ANALYSIS
Authors: Alani Mustafa , Bourhis Jean Henri
Published: July 2020

Second allogeneic stem cell transplantation was realized in 48 patients with myeloid and lymphoid neoplasms at Gustave Roussy institute since 1987. Overall survival rate was about 30 % with better outcome in acute myeloid leukemia cases. Non-relapse related mortality is overwhelming, especially in myelodysplasia patients and despite the fact that complete remission was obtained in their majority. Graft versus Host disease is very common after second transplantation with many grade III – IV cases and one death from severe pulmonary GvHD lesions. Reduced intensity conditioning is certainly less toxic and together with optimal GvHD and infectious disease management, Second SCT may be a reasonable therapeutic option and the only curative treatment for many hematological malignancies.
Altered resting-state network dynamics in Schizophrenia
Authors: Lopes Ana R. , Letournel Anna , Cabral Joana
Published: July 2020

Schizophrenia remains a poorly understood disease, hence the interest in assessing and indirectly characterizing brain activity and connectivity. This paper aims to search for potential biomarkers in schizophrenia with functional magnetic resonance data, between subjects in the resting state. Firstly, we used fMRI from an open database, SchizConnect, of 48 subjects, in which 27 were control subjects, with no apparent disease and the others 21 were patients with schizophrenia. With the SPM tool, we proceeded to manually pre-process the images obtained, at the risk of having influenced the final results. Then, with the AAL atlas as a reference, we divided the brain into 116 areas. Then, brain activity in these areas were analysed, using the LEiDA method, which aims to characterize brain activity at each time point t by phase locking patterns of the BOLD signal. After the application of LEiDA, brain activity was evaluated based on trajectories and bar graphs of functional connectivity states in which the probability of occurrence and their dwell time were calculated for each state. It was also found that the visual cortex was the subsystem that showed significantly more probability of occurrence in schizophrenia patients to be assessed, and may correspond to symptoms of hallucinations by the patients with schizophrenia.
Candida (Diutina) mesorugosa in Non-Albicans Candida Species Clinical Isolates in South West Nigeria
Authors: Owoicho Oloche , Oguzie Judith Uche , Ogunbiyi Tosin Segun , Adulsalam Toyin , Eromon Philomena , Folarin Onikepe , Durugbo Ernest Uzodimma , Happi Christian T.
Published: July 2020

Introduction

The emerging role of non-albicans Candida species (NACS) as causal agents of mild to life-threatening mycoses is increasingly being appreciated. Some NACS are known for intrinsic resistance or reduced susceptibility to some antifungal drugs. To inform on therapeutic options and management of candidiasis, we embarked on Candida species surveillance in South west Nigeria.

Method

We obtained retrospective yeast isolates from urogenital samples of patients in a tertiary hospital in South west Nigeria. Among 47 isolates identified phenotypically, we encountered a yeast which failed to produce pseudohyphae in human serum but was morphologically similar to Candida albicans. We characterized this yeast by sequencing the internal transcribed spacer (ITS1-5.8S-ITS2) region of the ribosomal DNA.

Results

A BLAST search and sequence homology identified the yeast as Candida (Diutina)mesorugosa, with a strong bootstrap.

Conclusion

Candida mesorugosa, a rarely isolated yeast from clinical samples worldwide, should be considered among potentially relevant NACS in Nigerian clinics. To the best our knowledge, this is the first report of Candida mesorugosa from a clinical sample in Nigeria. This finding confirms the need for more specific methods, such as DNA sequencing, for extensive surveillance of NACS.
EffiCare: Better Prognostic Models via Resource-Efficient Health Embeddings
Authors: Rethmeier Nils , Serbetci Necip Oguz , Möller Sebastian , Roller Roland
Published: July 2020

Recent medical prognostic models adapted from high data-resource fields like language processing have quickly grown in complexity and size. However, since medical data typically constitute low data-resource settings, performances on tasks like clinical prediction did not improve expectedly. Instead of following this trend of using complex neural models in combination with small, pre-selected feature sets, we proposeEffiCare, which focuses on minimizing hospital resource requirements for assistive clinical prediction models. First, by embedding medical events, we eliminate manual domain feature-engineering and increase the amount of learning data. Second, we use small, but data-efficient models, that compute faster and are easier to interpret. We evaluate our approach on four clinical prediction tasks and achieve substantial performance improvements over highly resource-demanding state-of-the-art methods. Finally, to evaluate our model beyond score improvements, we apply explainability and interpretability methods to analyze the decisions of our model and whether it uses data sources and parameters efficiently.1
A new model to prioritize and optimize access to elective surgery throughout the COVID-19 pandemic: A feasibility & pilot study
Authors: Valente Roberto , Domenico Stefano Di , Mascherini Matteo , Santori Gregorio , Papadia Francesco , Orengo Giovanni , Gratarola Angelo , Cafiero Ferdinando , De Cian Franco
Published: July 2020

Mini abstract

We tested usability, safety, and ability to manage elective surgery flow of a multidisciplinary pathway adopting the SWALIS-2020 model in an interhospital setting during the COVID-19 pandemic. This pilot included 295 adults. The pathway prioritized, monitored and scheduled surgery in an 840.000-inhabitants area. Using the COVID-19-GOA-Sur-MDT-SWALIS-2020 model may be warranted.

Structured abstract

The COVID-19 outbreak burdens non-COVID elective surgery patients with figures similar to the SARS-Cov-2, by creating an overwhelming demand, increasing waiting times and costs. New tools are urgently needed to manage elective access. The study assesses the “SWALIS-2020” model’s ability to prioritize and optimize access to surgery during the pandemic.

A 2020 March - May feasibility-pilot study, tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Departments referred for urgent elective surgery were included in a multidisciplinary pathway adopting a modified Surgical Waiting List InfoSystem (SWALIS) cumulative prioritization method (PAT-2020) based on waiting time and clinical urgency, in three subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression).

Following the feasibility study (N=55 patients), 240 referrals were evaluated in 4 weeks without major criticalities (M/F=73/167, Age=68.7±14.0). Waiting lists were prioritized and monitored, and theatres allocated based on demand. The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88.7±45.2 at week 1 and then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153.29±103.52) vs. A1 (97.24 ± 107.93) (p <0.001), and A3 vs. A2 (88.05±77.51) (p<0.001). 222 patients underwent surgery, without related complications or delayed/failed discharges.

The pathway has selected the very few patients with the greatest need, optimizing access even with +30% capacity weekly modifications. We will use the pathway to manage active, backlog, and hidden waiting lists throughout the further pandemic phases, and are looking for collaboration for multi-center research.https://www.isrctn.com/ISRCTN11384058.