bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Cranial Shape on Esthetic Self-Worth in Bald Men
Authors: Feijen Michelle Marlena Wilhelmina , van Cruchten Cas , van der Hulst Rene Remmelt Willie Johan
Published: August 2020

During the last 3 decades, the incidence of positional plagiocephaly and brachycephaly has increased. Treatment options are conservative and can include physiotherapy and molding helmet therapy. The decision to start therapy is based on patient history and subjective assessment of cranial shape by the physician and the parents. To determine the impact of these deformations on esthetic self-worth, as well as cranial shape, this study was conducted on a population of adult bald men.

Participants were asked to fill in a questionnaire about the amount of comments received on cranial shape, as well as grade their general esthetic and grade craniofacial features using a visual analogue scale. The cranial proportions and symmetry were measured using plagiocephalometry.

50 adult bald men were included in this study. The prevalence of nonsynostotic plagiocephaly was 12%; the prevalence of nonsynostotic brachycephaly was 0%. No significant correlation was found between plagiocephaly or brachycephaly, cranial circumference, width or length and amount of comments on cranial shape, cosmetic assessment of appearance or cosmetic assessment of cranial shape. On average, teeth and eyes were given the highest cosmetic value, eyebrows and chin were given the lowest scores.

Cranial shape does not have a significant impact on the amount of comments received on cranial shape, nor the cosmetic assessment of either overall appearance or cranial shape in bald men. For bald men, eyes and teeth are more important craniofacial features in cosmetic assessment. There is no clear esthetic need to treat deviating cranial shape with helmet therapy in male patients.
Progress in the therapy of myasthenia gravis: getting closer to effective targeted immunotherapies
Authors: Dalakas Marinos C.
Published: August 2020

Purpose of review

To provide an update on immunomodulating and immunosuppressive therapies in myasthenia gravis and highlight newly approved, or pending approval, therapies with new biologics.

Recent findings

Preoperative IVIg is not needed to prevent myasthenic crisis in stable myasthenia gravis patients scheduled for surgery under general anesthesia, based on controlled data. Rituximab, if initiated early in new-onset myasthenia gravis, can lead to faster and more sustained remission even without immunotherapies in 35% of patients at 2 years. Biomarkers determining the timing for follow-up infusions in Rituximab-responding AChR-positive patients are discussed. Most patients with MuSK-positive myasthenia gravis treated with Rituximab have sustained long-term remission with persistent reduction of IgG4 anti-MuSK antibodies. Eculizumb in the extension REGAIN study showed sustained long-term pharmacological remissions and reduced exacerbations. Three new biologic agents showed promising results in phase-II controlled myasthenia gravis trials: Zilucoplan, a subcutaneous macrocyclic peptide inhibiting complement C5; Efgartigimod, an IgG1-derived Fc fragment binding to neonatal FcRn receptor; and Rozanolixizumab, a high-affinity anti-FcRn monoclonal antibody. Finally, the safety of ongoing myasthenia gravis immunotherapies during COVID19 pandemic is discussed.

New biologics against B cells, complement and FcRn receptor, are bringing us closer to successful targeted immunotherapies in the chronic management of myasthenia gravis promising an exciting future for antibody-mediated neurological diseases.
The role of stigma in children and adolescents with mental health difficulties
Authors: Telesia Laurence , Kaushik Anya , Kyriakopoulos Marinos
Published: August 2020

Purpose of review

Children and adolescents with mental health difficulties, and people associated with them, can experience stigma as a result of these difficulties. This article aims to provide an update on the literature pertaining to mental health-related stigma in children and adolescents.

Recent findings

Recent studies have investigated public stigma, self-stigma and affiliate stigma related to child and adolescent mental health difficulties. Research has typically employed a cross-sectional design. Significant variation was identified in both study methodology and study findings. Qualitative studies offer a unique perspective of stigma from the point of view of the stigmatized individual. Significantly, quantitative analysis has found different variables to be associated with stigma in different geographical locations, even when similar measures are used.

Stigma can have a significant detrimental impact on the quality of life for those affected. Careful attention should therefore be paid to stigma in the assessment and treatment of children and adolescents with mental health difficulties. Furthermore, its impact on their caregivers should not be overlooked. Further research is needed to understand the role of social and cultural factors in the development and impact of stigma, and may aid production of antistigma interventions.
Bayesian Spatio-Temporal Modeling of COVID-19: Inequalities on Case-Fatality Risk
Authors: Polo Gina , Acosta Carlos Mera , Soler-Tovar Diego , Villamil Julián Felipe Porras , Palencia Natalia Polanco , Penagos Marco , Martinez Juan Meza , Bobadilla Juan Nicolás , Martin Laura Victoria , Durán Sandra , Rodriguez Martha , Carvajalino Carlos Meza , Villamil Luis Carlos , Ortiz Efrain Benavides
Published: August 2020

The ongoing outbreak of COVID-19 challenges health systems and epidemiological responses of all countries worldwide. Although mitigation measures have been globally considered, the spatial heterogeneity of its effectiveness is evident, underscoring global health inequalities. Using Bayesian-based Markov chain Monte Carlo simulations, we evidenced that factors contributing to poverty are also risk factors for COVID-19 case-fatality, and unexpectedly, their impact on the case-fatality risk is comparable to that produced by health factors. Additionally, we confirm that both case-fatality risk and multidimensional poverty index have a heterogeneous spatial distribution, where the lastest consists of health, educational, dwelling, and employment dimensions. Spatio-temporal analysis reveals that the spatial heterogeneity in case-fatalities is associated with the percentage contribution of the health (RR 1.89 95%CI=1.43-2.48) and dwelling (RR 2.01 95%CI=1.37-2.63) dimensions to the multidimensional poverty, but also with the educational (RR 1.21 95%CI=1.03-1.49), and employment (RR 1.23 95%CI=1.02-1.47) dimensions. This spatial correlation indicates that the case-fatality risk increase by 189% and 201% in regions with a higher contribution of the health dimension (i.e., lack of health insurance and self-reporting) and dwelling dimension (i.e., lack of access to safe water, inadequate disposal of human feces, poor housing construction, and critical overcrowding), respectively. Furthermore, although a temporal decrease is evident, the relative risk of dying by COVID-19 in Colombia is still 200% higher than the established case-fatality risk based on the COVID-19 dynamics in Italy and China. These findings assist policy-makers in the spatial and temporal planning of strategies focused on mitigating the case-fatality risk in most vulnerable communities and preparing for future pandemics by progressively reducing the factors that generate health inequality.
Development of prediction model for trauma assessment using electronic medical records
Authors: Ogura Kentaro , Goto Tadahiro , Shirakawa Toru , Sonoo Tomohiro , Nakano Hidehiko , Nakamura Kensuke
Published: August 2020

Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) scores are used to measure the severity of trauma patients in the emergency department, but they have several problems such as a calculation complexity. In this study, we developed a mortality prediction model of trauma patients using the data from electronic medical records and compared it with a model using AIS/ISS scores. This is a prognostic study using the data of patients who were admitted to Hitachi General Hospital Emergency and Critical Care Center from April 2018 to March 2019. The features were age, sex, vital signs, and clinical diagnoses, and the outcome was in-hospital death. Of 337 eligible patients, 11 died during the hospitalization. The predictive performance of our model was comparable to that of the AIS/ISS scores model (AUC 0.912 vs 0.961). Clinical diagnoses were important in predicting the mortality rate. Our study suggests that a trauma severity index calculated by the predicting model using information from electronic medical records might replace AIS/ISS score.
A Syndromic Surveillance Tool to Detect Anomalous Clusters of COVID-19 Symptoms in the United States
Authors: Güemes Amparo , Ray Soumyajit , Aboumerhi Khaled , Desjardins Michael R. , Kvit Anton , Corrigan Anne E , Fries Brendan , Shields Timothy , Stevens Robert D , Curriero Frank C , Etienne-Cummings Ralph
Published: August 2020

Coronavirus SARS-COV-2 infections continue to spread across the world, yet effective large-scale disease detection and prediction remain limited. COVID Control: A Johns Hopkins University Study, is a novel syndromic surveillance approach, which collects body temperature and COVID-like illness (CLI) symptoms across the US using a smartphone app and applies spatio-temporal clustering techniques and cross-correlation analysis to create maps of abnormal symptomatology incidence that are made publicly available. The results of the cross-correlation analysis identify optimal temporal lags between symptoms and a range of COVID-19 outcomes, with new taste/smell loss showing the highest correlations. We also identified temporal clusters of change in taste/smell entries and confirmed COVID-19 incidence in Baltimore City and County. Further, we utilized an extended simulated dataset to showcase our analytics in Maryland. The resulting clusters can serve as indicators of emerging COVID-19 outbreaks, and support syndromic surveillance as an early warning system for disease prevention and control.
Time-use and mental health during the COVID-19 pandemic: a panel analysis of 55,204 adults followed across 11 weeks of lockdown in the UK
Authors: Bu Feifei , Steptoe Andrew , Mak Hei Wan , Fancourt Daisy
Published: August 2020

There is currently major concern about the impact of the global COVID-19 outbreak on mental health. But it remains unclear how individual behaviors could exacerbate or protect against adverse changes in mental health. This study aimed to examine the associations between specific activities (or time-use) and mental health and wellbeing amongst people during the Covid-19 pandemic. Data were from the UCL COVID-19 Social Study; a panel study collecting data weekly during the COVID-19 pandemic. The analytical sample consisted of 55,204 adults living in the UK who were followed up for the strict 11-week lockdown period from 21st March to 31st May 2020. Data were analyzed using fixed-effects and Arellano–Bond models. We found that changes in time spent on a range of activities were associated with changes in mental health and wellbeing. After controlling for bidirectionality, behaviors involving outdoor activities including gardening and exercising predicted subsequent improvements in mental health and wellbeing, while increased time spent on following news about COVID-19 predicted declines in mental health and wellbeing. These results are relevant to the formulation of guidance for people obliged to spend extended periods in isolation during health emergencies, and may help the public to maintain wellbeing during future pandemics.
Comprehensive Surveillance of SARS-CoV-2 Spread Using Wastewater-based Epidemiology Studies
Authors: Hemalatha Manupati , Kiran Uday , Kuncha Santosh Kumar , Kopperi Harishankar , Gokulan C. G. , Mohan S Venkata , Mishra Rakesh K
Published: August 2020

SARS-CoV-2 pandemic is having a devastating effect on human lives. Individuals who are symptomatic/asymptomatic or have recovered are reported to have/will have serious health complications in the future, which is going to be huge economic burden globally. Given the wide-spread transmission of SARS-CoV-2 it is almost impossible to test each and every individual for the same and isolate them. Recent reports have shown that sewage can be used as a holistic approach to estimate the epidemiology of the virus. Here we have estimated the spread of SARS-CoV-2 in the city of Hyderabad, India which is populated with nearly 10 million people. The sewage samples were collected from all the major sewage treatment plants (STPs) and were processed for detecting the viral genome using the standard RT-PCR method. Based on the average viral particle shedding per individual, the total number of individuals exposed to SARS-CoV-2 (in a window of 35 days) is about 6.6% of the population, which clearly indicates the rate of community transmission and asymptomatic carriers is higher than the number of reported cases. It is important to note here that the samples collected from the inlet of STPs were positive for SARS-CoV-2, while the outlets were negative indicating the efficient treatment of sewage at STPs. These studies are going to be essential to manage the pandemic better and also to assess the effectiveness of control measure.
Absence of relevant QT interval prolongation in not critically ill COVID-19 patients
Authors: Jiménez-Jáimez Juan , Macías-Ruiz Rosa , Bermúdez-Jiménez Francisco , Rubini-Costa Ricardo , Taboada Jessica Ramírez , Flores Paula Isabel García , Padilla Laura Gallo , García Juan Diego Mediavilla , García Concepción Morales , Suárez Sara Moreno , Molina Celia Fignani , Álvarez López Miguel , Tercedor Luis
Published: August 2020

Objectives

SARS-CoV-2 is a rapidly evolving pandemic causing great morbimortality. Medical therapy with hydroxicloroquine, azitromycin and protease inhibitors is being empirically used, with reported data of QTc interval prolongation. Our aim is to assess QT interval behaviour in a not critically ill and not monitored cohort of patients.

Design

We evaluated admitted and ambulatory patients with COVID-19 patients with 12 lead electrocardiogram at 48 hours after treatment initiation. Other clinical and analytical variables were collected. Statistical analysis was performed to assess the magnitude of the QT interval prolongation under treatment and to identify clinical, analytical and electrocardiographic risk markers of QT prolongation independent predictors.

Results

We included 219 patients (mean age of 63.6 ± 17.4 years, 48.9% were women and 16.4% were outpatients. The median baseline QTc was 416 ms (IQR 404–433), and after treatment QTc was prolonged to 423 ms (405–438) (P < 0.001), with an average increase of 1.8%. Most of the patients presented a normal QTc under treatment, with only 31 cases (14,1 %) showing a QTc interval > 460 ms, and just one case with QTc > 500 ms. Advanced age, longer QTc basal at the basal ECG and lower potassium levels were independent predictors of QTc interval prolongation.

Conclusions

Ambulatory and not critically ill patients with COVID-19 treated with hydroxychloroquine, azithromycin and/or antiretrovirals develop a significant, but not relevant, QT interval prolongation.

What is already known about this subject?

Treatment for COVID 19 with empirical drugs hydroxicloroquine, azitromycin and protease inhibitors affects ventricular repolarization by prolonging the QT interval in a variable degree basing upon heterogeneous studies

What does this study add?

Not critically ill patients with COVID 19 develop a non relevant QT interval prolongation, leading to a modest arrhythmic risk increase, overall in patients with normal basal ECG

How might this impact on clinical practice?

Our findings are significant as ECG monitoring of COVID 19 patients is costly and difficult. Ambulatory and stable patients with normal basal ECG might nor benefit from QT assessment afeter treatment initiation
Comparison Between Influenza and COVID-19 at a Tertiary Care Center
Authors: Donnino Michael W. , Moskowitz Ari , Thompson Garrett S. , Heydrick Stanley J. , Pawar Rahul D , Berg Katherine M. , Mehta Shivani , Patel Parth V. , Grossestreuer Anne V.
Published: August 2020

Background

Widespread reports suggest the characteristics and disease course of coronavirus disease 2019 (COVID-19) and influenza differ, yet detailed comparisons of their clinical manifestations are lacking.

Objective

Comparison of the epidemiology and clinical characteristics of COVID-19 patients with those of influenza patients in previous seasons at the same hospital

Design

Admission rates, clinical measurements, and clinical outcomes from confirmed COVID-19 cases between March 1 and April 30, 2020 were compared with those from confirmed influenza cases in the previous five influenza seasons (8 months each) beginning September 1, 2014.

Setting

Large tertiary care teaching hospital in Boston, Massachusetts

Participants

Laboratory-confirmed COVID-19 and influenza inpatients

Measurements

Patient demographics and medical history, mortality, incidence and duration of mechanical ventilation, incidences of vasopressor support and renal replacement therapy, hospital and intensive care admissions.

Results

Data was abstracted from medical records of 1052 influenza patients and 583 COVID-19 patients. An average of 210 hospital admissions for influenza occurred per 8-month season compared to 583 COVID-19 admissions over two months. The median weekly number of COVID-19 patients requiring mechanical ventilation was 17 (IQR: 4, 34) compared to a weekly median of 1 (IQR: 0, 2) influenza patient (p=0.001). COVID-19 patients were significantly more likely to require mechanical ventilation (31% vs 8%), and had significantly higher mortality (20% vs. 3%; p<0.001 for all). Relatively more COVID-19 patients on mechanical ventilation lacked pre-existing conditions compared with mechanically ventilated influenza patients (25% vs 4%, p<0.001).

Limitation

This is a single-center study which could limit generalization.

Conclusion

COVID-19 resulted in more hospitalizations, higher morbidity, and higher mortality than influenza at the same hospital.
International Randomised Controlled Trial evaluating metabolic syndrome in type 2 Diabetic Cigarette Smokers following switching to Combustion-Free Nicotine Delivery Systems: the DIASMOKE protocol
Authors: Krysiński Arkadiusz , Russo Cristina , John Sarah , Belsey Jonathan , Campagna Davide , Caponnetto Pasquale , Vudu Lorina , Wei Lim Chong , Purrello Francesco , Di Mauro Maurizio , Iqbal Farrukh , Fluck David , Franek Edward , Polosa Riccardo , Sharma Pankaj
Published: August 2020

Reducing exposure to cigarette smoke is an imperative for public health, and even more so for diabetic patients. Increasingly, combustion-free technologies for nicotine delivery such as e-cigarettes and heated tobacco products are substituting conventional cigarettes and accelerating the current downward trends in smoking prevalence. However, there is limited information about the long-term health impact in diabetics who use these technologies.

This international randomised controlled trial of type 2 diabetic cigarette smokers will test the hypothesis that following a switch from conventional cigarettes to Combustion-Free Nicotine Delivery Systems (C-F NDS), a measurable improvement in metabolic syndrome (MetS) risk factors and functional parameters will be shown over the course of 2 years.

A total of 576 patients will be randomized (1:2 ratio) to either a control arm (Study Arm A), in which they will be offered referral to smoking cessation programs or to an intervention arm (Study Arm B), in which they will be assigned to C-F NDS use. The primary outcome will be the prevalence of the a difference in MetS score between baseline and 2 years follow-up, with comparison being made between diabetic patients randomized to each arm of the study. Patient recruitment will start in October 2020 and enrolment is expected to be completed by August 2021.

This will be the first study determining the overall health impact of using such technologies in diabetic patients. Data from this study will provide valuable insights into the overall potential of C-F NDS to reduce the risk of cardiovascular disease in individuals, particularly diabetic patients.

Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04231838
This time is different: model-based evaluation of the implications of SARS-CoV-2 infection kinetics for disease control
Authors: Johnson Kaitlyn E. , Stoddard Madison , Nolan Ryan P. , White Douglas E. , Hochberg Natasha , Chakravarty Arijit
Published: August 2020

As the ongoing COVID-19 pandemic passes from an acute to a chronic situation, countries and territories are grappling with the issue of how to reopen safely. The unique kinetics of infectivity of SARS-CoV-2, with its significant presymptomatic transmission, presents an unprecedented challenge to our intuitions. In this context, a generalizable quantitative understanding of the impact of SARS-CoV-2 infectivity on disease control strategies is vital. We used a previously published time-dependent model of SARS-CoV-2 infectivity (Heet al., 2020) to parameterize an epidemiological model of transmission, which was then used to explore the effect of various disease control measures. Our analysis suggests that using symptom-based isolation alone as a control strategy is ineffective in limiting the spread of COVID-19, in contrast to its effectiveness in other diseases, such as SARS and influenza. Additionally, timeliness of testing and tracing strategies to reduce time to isolation, along with widespread adoption of measures to limit transmission are critical for any containment strategy. Our findings suggest that for symptom-based isolation and testing strategies to be effective, reduced transmission is required, reinforcing the importance of measures to limit transmission. From a public health strategy perspective, our findings lend support to the idea that symptomatic isolation should not form the primary basis for COVID-19 disease control.
How early into the outbreak can surveillance of SARS-CoV-2 in wastewater tell us?
Authors: Hong Peiying , Rachmadi Andri Taruna , Mantilla-Calderon David , Alkahtani Mohsen , Bashwari Yasir M. , Al Qarni Hamed , Zhou Jianqiang
Published: August 2020

There is increasing interest to use wastewater-based surveillance of SARS-CoV-2 as an early warning of the outbreak within a community. Despite successful detection of SARS-CoV-2 in wastewaters sampled from multiple locations, there is still no clear idea on the minimal number of cases needed in a community to result in a positive detection of the virus in wastewaters. To address this knowledge gap, we sampled wastewaters from a septic tank and biological activated sludge tank located on-site of a hospital. The hospital is providing treatment for SARS-CoV-2 infected patients, with the number of hospitalized patients per day known. It was observed that > 253 positive cases out of 10,000 persons are required prior to detecting SARS-CoV-2 in wastewater. There was a weak correlation between N1 and N2 gene abundances in wastewater with the number of hospitalized cases. This correlation was however not observed for N3 gene. The occurrence frequency of SARS-CoV-2 is at least 5 times lower in the partially treated wastewater than in the septic tank. Furthermore, abundance of N1 and N3 genes in the activated sludge tank were 50 and 70% of the levels detected in septic tank, suggesting poor persistence of the SARS-CoV-2 gene fragments in wastewater.
Impact of Bilateral Transmuscular Quadratus Lumborum Block Using Different Doses of Dexmedetomidine as an Adjuvant Combined with Ropivacaine for Postoperative Analgesia in Laparoscopic Myomectomy
Authors: Li Yue , Zhang Le , Jiao Jing , Yu Xinhua , Huang Shaoqiang
Published: August 2020

Introduction

The optimal dosage of dexmedetomidine (DEX) as an adjuvant combined with ropivacaine for postoperative analgesia in laparoscopic myomectomy is still controversial. The main aim of this prospective clinical trial was to evaluate the analgesic effect and relevant adverse effects of different doses of dexmedetomidine applied locally for ropivacaine-induced bilateral transmuscular quadratus lumborum block (TQLB).

Methods

TQLB was conducted using different doses of dexmedetomidine per side (R group: control group; DEX1 group: 0.1μg/kg; DEX2 group: 0.3μg/kg; DEX3 group: 0.5μg/kg). Numeric rating scales (NRS) of pain score, heart rate (HR) and blood pressure (BP) were assessed at different time points after performing TQLB. Dosage of additional analgesics via patient-controlled analgesia pump, recovery time for anal exsufflation, hospital stay and clinical events such as nausea, vomiting and pruritus were also compared among groups.

Results

A total of 200 patients underwent laparoscopic myomectomy were enrolled in this study and divided into 4 groups (R, DEX1, DEX2 and DEX3 group) randomly, 50 for each group. Compared with R group, NRS pain score was significantly lower in DEX2 group and DEX3group (p<0.001) 10 minutes after TQLB. Twenty minutes after TQLB, statistical significance of NRS pain score appeared between DEX1 group and R group (p<0.05) and between DEX2, 3 group and DEX1 group (p<0.001). In comparison to R group and DEX1 group, NRS pain score in DEX2 and DEX3 group were lower within 24 hours postoperatively (p<0.05). HR in DEX2 group and DEX3 group was significantly lower than DEX1 group and R group (p<0.05). 2 patients in DEX2 and DEX3 group were developed severe low HR of which HR was below 50bpm. Even 6 hours after surgery, patients in DEX3 group still remained severe low HR. Patients in DEX2 group and DEX3 group needed fewer PCA bolus deliveries than patients in R group and DEX1 group (p<0.001). Satisfaction score of postoperative analgesia was higher in DEX2 group and DEX3 group in comparison to DEX1 group and R group (p<0.001).group and DEX3 group in comparison to DEX1 group and R group (p<0.001).

Conclusion

0.3μg/kg per side of dexmedetomidine as an adjuvant for TQLB was recommended to effectively relieve postoperative pain after laparoscopic myomectomy.

Trial registration

Chinese Clinical Trial Registry with registration number ChiCTR1900028509. Date of registration: 24 November 2019. http://www.chictr.org.cn/edit.aspx?pid=42635=htm=4
Testing for coronavirus (SARS-CoV-2) infection in populations with low infection prevalence: the largely ignored problem of false positives and the value of repeat testing
Authors: Sudlow Cathie , Diggle Peter , Warlow Oliver , Seymour David , Gordon Ben , Walker Rhos , Warlow Charles
Published: August 2020

Background

Calls are increasing for widespread SARS-CoV-2 infection testing of people from populations with a very low prevalence of infection. We quantified the impact of less than perfect diagnostic test accuracy on populations, and on individuals, in low prevalence settings, focusing on false positives and the role of confirmatory testing.

Methods

We developed a simple, interactive tool to assess the impact of different combinations of test sensitivity, specificity and infection prevalence in a notional population of 100,000. We derived numbers of true positives, true negatives, false positives and false negatives, positive predictive value (PPV – the percentage of test positives that are true positives) and overall test accuracy for three testing strategies: (1) single test for all; (2) add repeat testing in test positives; (3) add further repeat testing in those with discrepant results. We also assessed the impact on test results for individuals having one, two or three tests under these three strategies.

Results

With sensitivity of 80%, infection prevalence of 1 in 2,000, and specificity 99.9% on all tests, PPV in the tested population of 100,000 will be only 29% with one test, increasing to > 99.5% (100% when rounded to the nearest %) with repeat testing in strategies 2 or 3. More realistically, if specificity is 95% for the first and 99.9% for subsequent tests, single test PPV will be only 1%, increasing to 86% with repeat testing in strategy 2, or 79% with strategy 3 (albeit with 6 fewer false negatives than strategy 2). In the whole population, or in particular individuals, PPV increases as infection becomes more common in the population but falls to unacceptably low levels with lower test specificity.

Conclusion

To avoid multiple unnecessary restrictions on whole populations, and in particular individuals, from widespread population testing for SARS-CoV-2, the crucial roles of extremely high test specificity and of confirmatory testing must be fully appreciated and incorporated into policy decisions.
A Case Study of Transfer of Lesion-Knowledge
Authors: Krishnan Soundarya , Khincha Rishab , Vig Lovekesh , Dash Tirtharaj , Srinivasan Ashwin
Published: August 2020

All organs in the human body are susceptible to cancer, and we now have a growing store of images of lesions in different parts of the body. This, along with the acknowledged ability of neural-network methods to analyse image data, would suggest that accurate models for lesions can now be constructed by a deep neural network. However an important difficulty arises from the lack of annotated images from various parts of the body. Our proposed approach to address the issue of scarce training data for a target organ is to apply a form of transfer learning: that is, to adapt a model constructed for one organ to another for which there are minimal or no annotations. After consultation with medical specialists, we note that there are several discriminating visual features between malignant and benign lesions that occur consistently across organs. Therefore, in principle, these features boost the case for transfer learning on lesion images across organs. However, this has never been previously investigated. In this paper, we investigate whether lesion knowledge can be transferred across organs. Specifically, as a case study, we examine the transfer of a lesion model from the brain to lungs and lungs to the brain. We evaluate the efficacy of transfer of a brain-lesion model to the lung, and the transfer of a lung-lesion model to the brain by comparing against a model constructed: (a) without model-transfer (i.e.random weights); and (b) using model-transfer from a lesion-agnostic dataset (ImageNet). In all cases, our lesion models perform substantially better. These results point to the potential utility of transferring lesionknowledge across organs other than those considered here.
Potential interruptions in HIV prevention and treatment services for gay, bisexual, and other men who have sex with men associated with COVID-19
Authors: Rao Amrita , Rucinski Katherine , Jarrett Brooke , Ackerman Benjamin , Wallach Sara , Marcus Julia , Adamson Tyler , Garner Alex , Santos Glenn-Milo , Beyrer Chris , Howell Sean , Baral Stefan
Published: August 2020

Background

Globally, the coronavirus pandemic has necessitated a range of population-based measures in order to stem the spread of infection and reduce COVID-19-related morbidity and mortality. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 mitigation strategies and interruptions to HIV prevention and treatment services for MSM.

Methods

Data for this study were collected as part of a COVID-19 Disparities Survey implemented by the gay social networking app Hornet, with data collected between April 16th, 2020 and May 24th, 2020. Data were assessed for countries where at least 50 participants completed the survey, to best evaluate country-level heterogeneity. We used a modified Poisson regression model, with clustering at the country-level, to assess the association between stringency of pandemic control measures and access to HIV services. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index; each country received a score (0-100) based on the number and strictness of nine indicators related to school and workplace closures and travel bans.

Results

A total of 10,654 MSM across 20 countries were included in these analyses. The mean age was 34.2 (standard deviation: 10.8), and 12% (1264/10540) of participants reported living with HIV. The median stringency score was 82.31 (Range:[19.44, Belarus]-[92.59, Ukraine]). For every ten-point increase in stringency, there was a 3% reduction in the prevalence of access to in-person testing (aPR: 0.97, 95% Cl:[0.96, 0.98]), a 6% reduction in the prevalence of access to self-testing (aPR: 0.94, 95% Cl:[0.93, 0.95]), and a 5% reduction in access to PrEP (aPR: 0.95, 95% Cl:[0.95, 0.97]). Among those living with HIV, close to one in five (n = 218/1105) participants reported being unable to access their provider either in-person or via telemedicine during the COVID-19 pandemic, with a greater proportion of interruptions to treatment services reported in Belarus and Mexico. Almost half (n = 820/1254) reported being unable to refill their HIV medicine prescription remotely.

Conclusions

More stringent government responses were associated with decreased access to HIV diagnostic, prevention, and treatment services. To minimize increases in HIV-related morbidity and mortality, innovative strategies are needed to facilitate minimize service interruptions to MSM communities during this and potential future waves of COVID-19.
Evaluating aerosol and splatter during orthodontic debonding: implications for the COVID-19 pandemic
Authors: Llandro Hayley , Allison James R , Currie Charlotte C , Edwards David C , Bowes Charlotte , Durham Justin , Jakubovics Nicholas , Rostami Nadia , Holliday Richard
Published: August 2020

Introduction

Dental procedures often produce splatter and aerosol which have potential to spread pathogens such as SARS-CoV-2. Mixed guidance exists on the aerosol generating potential of orthodontic procedures. The aim of this study was to evaluate aerosol and/or splatter contamination during an orthodontic debonding procedure.

Material and Methods

Fluorescein dye was introduced into the oral cavity of a mannequin. Orthodontic debonding was carried out in triplicate with filter papers placed in the immediate environment. Composite bonding cement was removed using a slow-speed handpiece with dental suction. A positive control condition included a high-speed air-turbine crown preparation. Samples were analysed using digital image analysis and spectrofluorometric analysis.

Results

Contamination across the 8-metre experimental rig was 3% of the positive control on spectrofluorometric analysis and 0% on image analysis. There was contamination of the operator, assistant, and mannequin, representing 8%, 25%, and 28% of the positive control spectrofluorometric measurements, respectively.

Discussion

Orthodontic debonding produces splatter within the immediate locality of the patient. Widespread aerosol generation was not observed.

Conclusions

Orthodontic debonding procedures are low risk for aerosol generation, but localised splatter is likely. This highlights the importance of personal protective equipment for the operator, assistant, and patient.

Three ‘In brief’ points

Orthodontic debonding, including removal of composite using a slow speed handpiece with dental suction, appears to be a low risk procedure for aerosol generation.

Splatter was produced during the debonding procedure, however this was mainly localised to the patient, operator and assistant.

A single positive reading was identified 3.5 meters away from the patient, highlighting the need for suitable distancing and/or barriers in open clinical environments.
Inhaled corticosteroids downregulate SARS-CoV-2-related gene expression in COPD: results from a RCT
Authors: Milne Stephen , Li Xuan , Yang Chen Xi , Cordero Ana I Hernandez , Filho Fernando Sergio Leitao , Yang Cheng Wei Tony , Shaipanich Tawimas , van Eeden Stephan F , Leung Janice M , Lam Stephen , Sin Don D
Published: August 2020

Rationale

Chronic obstructive pulmonary disease (COPD) is a risk factor for severe COVID-19. Inhaled corticosteroids (ICS) are commonly prescribed for the prevention of acute exacerbations in people with COPD, but their use is associated with increased risk of respiratory infections. The effects of ICS on SARS-CoV-2 susceptibility or COVID-19 severity are currently unknown.

Objectives

To determine the effects of ICS treatment on the bronchial epithelial cell expression of key SARS-CoV-2-related genes in volunteers with COPD.

Methods

We performed a randomized, open-label, parallel treatment trial of 12 weeks treatment with ICS in combination with long-acting beta-agonist (formoterol/budesonide 12/400 µg twice daily or salmeterol/fluticasone propionate 25/250 µg twice daily), or treatment with LABA only (formoterol 12 µg twice daily), in volunteers with mild to very severe COPD. We obtained bronchial epithelial cell samples via bronchoscopy before and after treatment, and determined transcriptome-wide gene expression by RNA sequencing.

Main Results

63 volunteers were randomized to receive treatment. Compared to formoterol alone, formoterol/budesonide treatment decreased the expression of the SARS-CoV-2 receptor gene ACE2 and the host cell protease gene ADAM17. These genes were highly co-expressed with innate immune response genes, particularly those of the type I interferon and anti-viral response pathways, which also tended to decrease following ICS treatment.

Conclusions

This is the first randomized controlled trial to show that ICS affect the expression of key SARS-CoV-2-related genes in COPD. Their relation to important anti-viral response genes may have critical implications for SARS-CoV-2 susceptibility or COVID-19 severity in this vulnerable population.
Estimating healthcare resource needs for COVID-19 patients in Nigeria
Authors: Ogunbameru Adeteju , Barrett MD Kali , Joda Arinola E. , Khan MD Yasin A , Pechlivanoglou Petros , Mac Stephen , Naimark MD David , Ximenes Raphel , Sander Beate
Published: August 2020

Background

Predicting potential healthcare resource use under different scenarios will help to prepare the healthcare system for a surge in COVID-19 patients. In this study, we aim to predict the effect of COVID-19 on hospital resources in Nigeria.

Method

We adopted a previously published discrete-time, individual-level, health-state transition model of symptomatic COVID-19 patients to the Nigerian healthcare system and COVID-19 epidemiology. We simulated different combined scenarios of epidemic trajectories and acute care capacity. Primary outcomes included expected cumulative number of cases, days until depletion resources, and number of deaths associated with resource constraints. Outcomes were predicted over a 60-day time horizon.

Results

In our best-case epidemic trajectory, which implies successful implementation of public health measures to control COVID-19 spread, the current number of ventilator resources in Nigeria (conservative resources scenario), were expended within five days, and 901 patients may die while waiting for hospital resources in conservative resource scenario. In our expanded resource scenarios, ventilated ICU beds were depleted in all three epidemic trajectories within 60 days. Acute care resources were only sufficient in the best-case and intermediate epidemic scenarios, combined with a substantial increase in healthcare resources.

Conclusion

Current hospital resources are inadequate to manage the COVID-19 pandemic in Nigeria. Given Nigeria’s limited resources, it is imperative to increase healthcare resources and maintain aggressive public health measures to reduce COVID-19 transmission.

KEY QUESTIONS

What is already known on this subject?

While western countries seem to be recovering from the COVID-19 pandemic, there is an increasing community spread of the virus in many African countries.

The limited healthcare resources available in the region may not be sufficient to cope with increasing numbers of COVID-19 cases.

What this study adds?

Using the COVID-19 Resource Estimator (CORE) model, we demonstrate that implementing and maintaining aggressive public health measures to keep the epidemic growth at a low rate, while simultaneously substantially increasing healthcare resources is critical to minimize the impact of COVID-19 on morbidity and mortality.

The impact of COVID-19 in low resource settings will likely overwhelm health system capacity if aggressive public health measures are not implemented. To mitigate the impact of COVID-19 in these settings, it is essential to develop strategies to substantially increase health system capacities, including hospital resources, personal protective equipment and trained healthcare personnel and to implement and maintain aggressive public health measures.
Iota-carrageenan and Xylitol inhibit SARS-CoV-2 in cell culture
Authors: Bansal Shruti , Jonsson Colleen B. , Taylor Shannon L. , Figueroa Juan Manuel , Dugour Andrea Vanesa , Palacios Carlos , César Vega Julio
Published: August 2020

COVID-19 (coronavirus disease 2019) is a pandemic caused by SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) infection affecting millions of persons around the world. There is an urgent unmet need to provide an easy-to-produce, affordable medicine to prevent transmission and provide early treatment for this disease. The nasal cavity and the rhinopharynx are the sites of initial replication of SARS-CoV-2. Therefore, a nasal spray may be a suitable dosage form for this purpose. The main objective of our study was to test the antiviral action of three candidate nasal spray formulations against SARS-CoV-2. We have found that iota-carrageenan in concentrations as low as 6 µg/ mL inhibits SARS-CoV-2 infection in Vero cell cultures. The concentrations found to be active in vitro against SARS-CoV-2 may be easily achieved by the application of nasal sprays already marketed in several countries. Xylitol at a concentration of 5 % m/V has proved to be viricidal on its own and the association with iota-carrageenan may be beneficial, as well.
High SARS-CoV-2 Seroprevalence in Children and Adults in the Austrian Ski Resort Ischgl
Authors: Knabl Ludwig , Mitra Tanmay , Kimpel Janine , Rössler Annika , Volland André , Walser Andreas , Ulmer Hanno , Pipperger Lisa , Binder Sebastian C. , Riepler Lydia , Bates Katie , Bandyopadhyay Arnab , Schips Marta , Ranjan Mrinalini , Falkensammer Barbara , Borena Wegene , Meyer-Hermann Michael , von Laer Dorothee
Published: August 2020

Background

Early March 2020, a SARS-CoV-2 outbreak in the ski resort Ischgl in Austria initiated the spread of SARS-CoV-2 throughout Austria and Northern Europe.

Methods

Between April 21 and 27, a cross-sectional epidemiologic study targeting the full population of Ischgl (n = 1867), of which 79 % could be included (n = 1473, incl. 214 children), was performed. For each individual, the study involved a SARS-CoV-2 PCR, antibody testing and structured questionnaires. A mathematical model was used to help understand the influence of the determined seroprevalence on virus transmission.

Findings

The seroprevalence was 42.4% (95% CI 39.8–44.7). Individuals under 18 showed a significantly lower seroprevalence of 27.1% (95% CI 21.3–33.6) than adults (45%; 95% CI 42.2–47.7; OR of 0.455, 95% CI 0.356–0.682, p< 0.001). Of the seropositive individuals, 83.7% had not been diagnosed to have had SARS-CoV-2 infection previously. The clinical course was generally mild. Over the previous two months, two COVID-19-related deaths had been recorded, corresponding to an infection fatality rate (IFR) of 0.25% (95% CI 0.03–0.91). Only 8 (0.5 %) individuals were newly diagnosed to be infected with SARS-CoV-2 during this study.

Interpretation

Ischgl was hit early and hard by SARS-CoV-2 leading to a high local seroprevalence of 42.4%, which was lower in individuals below the age of 18 than in adults. Mathematical modeling suggests that a drastic decline of newly infected individuals in Ischgl by the end of April occured due to the dual impact from the non-pharmacological interventions (NPIs) and a significant immunization of the Ischgl population.

Funding

Helmholtz Association, European Union’s Horizon 2020 research and innovation program, German Research Foundation (DFG), state Tyrol.
COVID-19 Pandemic Preparedness in a United Kingdom Tertiary and Quaternary Children’s Hospital: Tales of the Unexpected
Authors: Alders Nele , Penner Justin , Grant Karlie , Patterson Charlotte , Hassell Jane , MacDermott Nathalie , Pincott Sian , Bamford Alasdair , Pré Pascale du , Johnson Mae , Moshal Karyn
Published: August 2020

Background

The paucity of data describing SARS-CoV-2 in the paediatric population necessitated a broad-arching approach to pandemic planning, with preparations put in place to manage a heterogeneous cohort. We describe a diverse group of SARS-CoV-2 positive paediatric patients treated at a large tertiary/quaternary children’s hospital in the United Kingdom and the adaptive coping strategies required.

Methods

All paediatric patients with positive RT-PCR on a respiratory sample and/or serology for SARS-CoV-2 up to 19th May 2020 were included.

Results

57 children met the inclusion criteria. 70% were of non-Caucasian ethnicity with a median age of 9.3 years (IQR 5.16–13.48). Four distinct groups were identified: paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) (54%), primary respiratory (18%), incidental (7%), and non-specific febrile illnesses with or without extra-pulmonary organ dysfunction (21%). These groups presented in distinct chronological blocks as the pandemic unfolded.

Discussion

The diverse range of presentations of SARS-CoV-2 infection in this population exemplified the importance of preparedness for the unknown in the midst of a novel infectious pandemic. Descriptions of paediatric patients during the initial phase of the pandemic from other parts of the globe and extrapolation from adult data did not serve as an accurate representation of paediatric COVID-19 in our centre. An adaptive, multidisciplinary approach was paramount. Expanded laboratory testing and incorporation of technology platforms to facilitate remote collaboration in response to strict infection control precautions were both indispensable. Lessons learned during the preparation process will be essential in planning for a potential second wave of SARS-CoV-2.
Engagement and adherence trade-offs for SARS-CoV-2 contact tracing
Authors: Lucas Tim C. D. , Davis Emma L. , Ayabina Diepreye , Borlase Anna , Crellen Thomas , Pi Li , Medley Graham F. , Yardley Lucy , Klepac Petra , Gog Julia , Hollingsworth T. Déirdre
Published: August 2020

Contact tracing is an important tool for allowing countries to ease lock-down policies introduced to combat SARS-CoV-2. For contact tracing to be effective, those with symptoms must self-report themselves while their contacts must self-isolate when asked. However, policies such as legal enforcement of self-isolation can create trade-offs by dissuading individuals from self-reporting. We use an existing branching process model to examine which aspects of contact tracing adherence should be prioritised. We consider an inverse relationship between self-isolation adherence and self-reporting engagement, assuming that increasingly strict self-isolation policies will result in fewer individuals self-reporting to the programme. We find that policies that increase the average duration of self-isolation, or that increase the probability that people self-isolate at all, at the expense of reduced self-reporting rate, will not decrease the risk of a large outbreak and may increase the risk, depending on the strength of the trade-off. These results suggest that policies to increase self-isolation adherence should be implemented carefully. Policies that increase self-isolation adherence at the cost of self-reporting rates should be avoided.