bluuebunny/crossref_metadata_2025 huggingface dataset:
Using nursing notes to improve clinical outcome prediction in intensive care patients: A retrospective cohort study
Authors: Huang Kexin , Gray Tamryn F , Romero-Brufau Santiago , Tulsky James A , Lindvall Charlotta
Published: March 2021

Objective

Electronic health record documentation by intensive care unit (ICU) clinicians may predict patient outcomes. However, it is unclear whether physician and nursing notes differ in their ability to predict short-term ICU prognosis. We aimed to investigate and compare the ability of physician and nursing notes, written in the first 48 hours of admission, to predict ICU length of stay and mortality using 3 analytical methods.

Materials and Methods

This was a retrospective cohort study with split sampling for model training and testing. We included patients ≥18 years of age admitted to the ICU at Beth Israel Deaconess Medical Center in Boston, Massachusetts, from 2008 to 2012. Physician or nursing notes generated within the first 48 hours of admission were used with standard machine learning methods to predict outcomes.

Results

For the primary outcome of composite score of ICU length of stay ≥7 days or in-hospital mortality, the gradient boosting model had better performance than the logistic regression and random forest models. Nursing and physician notes achieved area under the curves (AUCs) of 0.826 and 0.796, respectively, with even better predictive power when combined (AUC, 0.839).

Discussion

Models using only nursing notes more accurately predicted short-term prognosis than did models using only physician notes, but in combination, the models achieved the greatest accuracy in prediction.

Conclusions

Our findings demonstrate that statistical models derived from text analysis in the first 48 hours of ICU admission can predict patient outcomes. Physicians’ and nurses’ notes are both uniquely important in mortality prediction and combining these notes can produce a better predictive model.
Metaplastic breast cancer with chondroid differentiation—case report and literature review
Authors: Leite Cláudia , Dias Nuno , Oliveira Domingos , Mesquita Pinto Rita , Cortez Vaz Francisco
Published: March 2021

Metaplastic breast cancer (MBC) comprises less than 1% of all breast cancers, and it is defined by a mixture of adenocarcinoma plus mesenchymal and epithelial components. It is more common in older and black female patients. It has a larger size and faster growth, and it is frequently node-negative and triple-negative when compared with invasive ductal carcinoma. The authors report the case of a 72-year-old female patient, presenting with a breast lump, whose biopsy revealed a probable MBC with chondroid differentiation. She underwent a breast conservative surgery (BCS) and axillary sentinel lymph node dissection (SLND). The pathological report was concordant with the biopsy, and the patient was proposed to chemoradiotherapy. Despite its rarity and more severe features at diagnosis, BCS plus SLND plus radiotherapy should be offered to these patients, associated with chemotherapy. Chondroid differentiation is the rarest of all histological subtypes.
Effectiveness of web-based and mobile health interventions designed to enhance adherence to physical activity for people with inflammatory arthritis: a systematic review
Authors: Sekhon Mandeep , White Claire , Godfrey Emma , Amirova Aliya , Revenäs Åsa , King Sinead , Pedro Joshua , Quailey Jamaal , Bearne Lindsay
Published: March 2021

Objective

The aim of this systematic review was to assess the evidence from randomized controlled trials (RCTs) and cohort studies for the effectiveness of digital interventions designed to enhance adherence to physical activity (PA) for people with inflammatory arthritis and describe the intervention content using established coding criteria.

Methods

Six electronic databases were searched for published and unpublished studies. Independent data extraction and quality assessment (Cochrane risk of bias II or ROBINS-I) were conducted by two reviewers. The primary outcome was self-reported adherence to PA post-intervention. Secondary outcomes included self-reported adherence to PA at other time points, level of PA or engagement with intervention at any follow-up time point. Intervention content was assessed using the Consensus on Exercise Reporting Template and the Behaviour Change Techniques Taxonomy version 1.

Results

From 11 136 citations, four moderate risk of bias studies (three RCTs and one cohort study) including 1160 participants with RA or JIA were identified. Owing to heterogeneity of outcomes, a narrative synthesis was conducted. Only one RCT reported a small between-group difference in adherence to PA [mean difference (95% CI) −0.46 (−0.82, −0.09)] in favour of the intervention. There were no between-group differences in any secondary outcomes. Interventions included between 3 and 11 behaviour change techniques but provided minimal information on exercise prescription.

Conclusion

There is currently limited moderate-quality evidence available to provide confident evaluation of the effect of web-based and mobile health interventions on adherence to PA or level of PA post-intervention in people with inflammatory arthritis.
β-blocker prescription is associated with lower cumulative risk of knee osteoarthritis and knee pain consultations in primary care: a propensity score–matched cohort study
Authors: Nakafero Georgina , Grainge Matthew J , Valdes Ana M , Townsend Nick , D. Mallen Christian  , Zhang Weiya , Doherty Michael , Mamas Mamas , Abhishek Abhishek 
Published: March 2021

Objectives

To examine the association between β-blocker prescription and first primary-care consultation for knee OA, hip OA, knee pain and hip pain.

Methods

Data source: Clinical Practice Research Datalink. Participants aged ≥40 years in receipt of new oral β-blocker prescriptions were propensity score (PS) matched to an unexposed control. Cox proportional hazard ratios (HRs) and 95% CIs were calculated, and adjusted for non-osteoporotic fractures, number of primary-care consultations for knee or hip injury, and, the number of primary-care consultations, out-patient referrals and hospitalizations in the 12 months preceding cohort entry. Analysis was stratified according to β-blocker class and for commonly prescribed drugs. P < 0.05 was considered statistically significant.

Results

A total of 111 718 β-blocker–exposed participants were 1:1 PS matched to unexposed controls. β-blocker prescription was associated with reduced cumulative risk of knee OA, knee pain, and hip pain consultations [with a HR (95% CI) of 0.90 (0.83, 0.98), 0.88 (0.83, 0.92) and 0.85 (0.79, 0.90), respectively]. Propranolol and atenolol were associated with a lower incidence of knee OA and knee pain consultations with a HR of between 0.78 and 0.91. β-blockers were associated with reduced incidence of consultation for large-joint lower-limb OA/pain as a composite outcome, defined as the earliest of knee OA, knee pain, hip OA or a hip pain consultation [with a HR (95% CI) of 0.87 (0.84, 0.90)].

Conclusion

Commonly used β-blockers have analgesic properties for musculoskeletal pain. Atenolol might be a therapeutic option for OA and cardiovascular co-morbidities in which β-blockers are indicated, while propranolol may be suitable for people with co-morbid anxiety. A confirmatory randomized controlled trial is needed before clinical practice is changed.
Identification of Dose-Dependent DNA Damage and Repair Responses From Subchronic Exposure to 1,4-Dioxane in Mice Using a Systems Analysis Approach
Authors: Charkoftaki Georgia , Golla Jaya Prakash , Santos-Neto Alvaro , Orlicky David J , Garcia-Milian Rolando , Chen Ying , Rattray Nicholas J W , Cai Yuping , Wang Yewei , Shearn Colin T , Mironova Varvara , Wang Yensheng , Johnson Caroline H , Thompson David C , Vasiliou Vasilis
Published: March 2021

1,4-Dioxane (1,4-DX) is an environmental contaminant found in drinking water throughout the United States. Although it is a suspected liver carcinogen, there is no federal or state maximum contaminant level for 1,4-DX in drinking water. Very little is known about the mechanisms by which this chemical elicits liver carcinogenicity. In the present study, female BDF-1 mice were exposed to 1,4-DX (0, 50, 500, and 5,000mg/L) in their drinking water for 1 or 4 weeks, to explore the toxic effects. Histopathological studies and a multi-omics approach (transcriptomics and metabolomics) were performed to investigate potential mechanisms of toxicity. Immunohistochemical analysis of the liver revealed increased H2AXγ-positive hepatocytes (a marker of DNA double-strand breaks), and an expansion of precholangiocytes (reflecting both DNA damage and repair mechanisms) after exposure. Liver transcriptomics revealed 1,4-DX-induced perturbations in signaling pathways predicted to impact the oxidative stress response, detoxification, and DNA damage. Liver, kidney, feces, and urine metabolomic profiling revealed no effect of 1,4-DX exposure, and bile acid quantification in liver and feces similarly showed no effect of exposure. We speculate that the results may be reflective of DNA damage being counterbalanced by the repair response, with the net result being a null overall effect on the systemic biochemistry of the exposed mice. Our results show a novel approach for the investigation of environmental chemicals that do not elicit cell death but have activated the repair systems in response to 1,4-DX exposure.
Comparison of the Species Communities ofPhytophthora, Pythium, andPhytopythiumAssociated with Soybean Genotypes in High Disease Environments in Ohio
Authors: Navarro Krystel A. , Wijeratne Saranga , Culman Steve , Benitez Maria-Soledad , Dorrance Anne E.
Published: March 2021

The roles that specific cultivars with different levels and types of resistance may play on the diversity and abundance of Phytophthora, Phytopythium, and Pythium spp. communities were compared. Three soybean cultivars were planted in a total of 11 different high disease environments in Ohio and seedlings were collected for direct isolation and amplicon sequencing of the rhizosphere soil. Plant population and yields were lower for the moderately susceptible cultivar Sloan compared with the cultivars Kottman, with high partial resistance to Phytophthora sojae, and Lorain, with high partial resistance to both Pythium spp. and Phytophthora sojae. Based on both direct isolation and amplicon sequencing, distinct communities with key indicator species were identified at each environment, including differences at 14 and 25 day after planting for two environments. The environment had the largest influence on the community composition. Soybean genotype did influence the abundance of the hemibiotroph Phytophthora sojae but not species of Phytopythium or Pythium. In addition, from all environments and cultivars, operational taxonomic units (OTUs) classified as Pythium attrantheridium, P. heterothallicum, and P. sylvaticum were always detected. This is also the first report of an OTU of P. periilum from soils and the first one to recover undescribed species that match the sequence of Pythium sp. CAL2011f from soybean seedlings in Ohio This study highlights which species to target for the identification and development of resistant cultivars or for fungicide screening.
Transplanted hepatocytes rescue mice in acetaminophen‐induced acute liver failure through paracrine signals for hepatic ATM and STAT3 pathways
Authors: Viswanathan Preeti , Sharma Yogeshwar , Jaber Fadi‐Luc , Tchaikovskaya Tatyana , Gupta Sanjeev
Published: March 2021

Acute liver failure constitutes a devastating condition that needs novel cell and molecular therapies. To elicit synergisms in cell types of therapeutic interest, we studied hepatocytes and liver sinusoidal endothelial in mice with acetaminophen‐induced acute liver failure. The context of regenerative signals was examined by transplants in peritoneal cavity because it possesses considerable capacity and allows soluble signals to enter the systemic circulation. Whereas transplanted hepatocytes and liver sinusoidal endothelial cells engrafted in peritoneal cavity, only the former could rescue mice in liver failure by improving injury outcomes, activating hepatic DNA damage repair, and inducing liver regeneration. The cytokines secreted by donor hepatocytes or liver sinusoidal endothelial cells differed and in hepatocytes from mice undergoing acetaminophen toxicity major cytokines were even rendered deficient (eg, G‐CSF, VEGF, and others). Significantly, recapitulating hepatotoxicity‐related DNA damage response in cultured cells identified impairments in ATM and JAK/STAT3 intersections since replacing cytokines produced less from injured hepatocytes restored these pathways to avoid acetaminophen hepatotoxicity. Similarly, hepatocyte transplantation in acute liver failure restored ATM and JAK/STAT3 pathways to advance DNA damage/repair and liver regeneration. The unexpected identification of novel hepatic G‐CSF receptor expression following injury allowed paradigmatic studies of G‐CSF supplementation to confirm the centrality of this paracrine ATM and STAT3 intersection. Remarkably, DNA damage/repair and hepatic regeneration directed by G‐CSF concerned rebalancing of regulatory gene networks overseeing inflammation, metabolism, and cell viability. We conclude that healthy donor hepatocytes offer templates for generating specialized cell types to replace metabolic functions and regenerative factors in liver failure.
The use of a participatory patient engagement research project to meaningfully engage those with lived experience of diabetes and homelessness
Authors: Campbell David J.T. , Campbell Rachel B. , DiGiandomenico Anna , Larsen Matthew , Davidson Marleane A. , McBrien Kerry A. , Booth Gillian L. , Hwang Stephen W.
Published: March 2021

Introduction

Participatory research is a study method that engages patient partners in research programs from study design through to completion. It has seldom been used in diabetes health services research. Our objectives were to describe the process and challenges of conducting a patient-engagement project and to highlight the experiences of patient participants and academic researchers.

Research Design & Methods

We recruited PWLEH and diabetes in Toronto, Canada to be patient partners. Group members were asked to commit to attending biweekly meetings. We undertook two major research projects: Concept mapping to choose a research focus; and photovoice to explore accessing healthy food while homeless. We used a convergent mixed methods design to evaluate their experience.

Results

A diverse group of 8 PWLEH had an average attendance of 82% over 21 meetings – despite this success, we encountered a number of challenges to conducting this research. Group members reported that participation improved their ability to be self-advocates in their diabetes care and provided them with tangible skills and social benefits. Group members stated that they valued being involved in all aspects of the research, in particular knowledge translation activities, including advocating for nutritious food at shelters; presenting to stakeholders; and meeting with policy makers.

Conclusions

The use of participatory patient engagement research methods enables academic researchers to support community members in pursuing research that is pertinent to them and which has a positive impact. In our study, group members contributed in meaningful ways and also valued the experience.

What is already known about this subject?

Patient oriented research is important to public health research as it helps with the development of relevant interventions and knowledge translation.

Participatory research is a form of research that maximally involves patients in all phases of the research.

Participatory research has rarely been used in research on diabetes and diabetes-related interventions.

What are the new findings?

Patient engagement is important for studies involving socially disadvantaged populations with diabetes.

Community members involved in research contribute substantially to research projects but also find the experience to be enriching and valuable.

How might these results change the focus of research or clinical practice?

Those who conduct research with and develop programs to provide diabetes care, especially to socially disadvantaged populations, should involve community members through all phases of the process to ensure the intervention is maximally useful for patients.
Social support & sustained physical activity during the COVID-19 pandemic
Authors: Hailey Verity , Fisher Abi , Hamer Mark , Fancourt Daisy
Published: March 2021

COVID-19 lockdown introduced substantial barriers to physical activity, providing a unique natural experiment to understand the social factors associated with sustained physical activity. Longitudinal data from the COVID-19 Social Study was used to identify a sample of participants who maintained their physical activity despite lockdown. 16% were consistently active while 44% were completely inactive. After adjustment for multiple confounders high social support was associated with a 39% (95% CI, 12-74%) increased odds of sustaining physical activity. Association between physical activity and loneliness and social isolation were not found. This study supports previous research showing the importance of social support for the long-term maintenance of physical activity behaviour but shows that such effects extend to contexts of social restrictions.
mouth-to-mouth ventilation through cardiopulmonary resuscitation, is there any other way?
Authors: Maimaitiming Aini , Wang Xiaohai
Published: March 2021

objective

to provide and explore possibility of new idea that perform mouth-to-mouth ventilation through cardiopulmonary resuscitation.

Methods

stage one is establishing the ventilation technique using cola bottle, stage two is measuring the tidal volume when different sized cola bottles were used.

Result

the smallest sized cola bottle(500ml) can also make obvious thorax rise in manikin CPR model. The tidal volume is 174.5+9.1ml, 220+7.6ml and 447+15.9ml respectively for 500ml, 600ml and 1.25L cola bottles when using single hand performance. There are statistical differences (0.001) in tidal volume of different sized cola bottle by using one hand performance and two hands.

Conclusion

larger sized cola bottles(600ml,1.25L) could be used as substitute ventilation technique for mouth-to-mouth ventilation in special circumnutates.
Analysis of the Factors Affecting the Adoption and Compliance of the NHS COVID-19 Mobile Application: A National Online Questionnaire Survey in England
Authors: Panchal Marcus , Singh Sukhpreet , Rodriguez-Villegas Esther
Published: March 2021

Objectives

To conduct an independent study investigating how adults perceive the usability, and functionality of the “NHS COVID-19” app. This study aims to highlight strengths, and provide recommendations to improve adoption of future contact tracing developments.

Design

A 60-item, anonymous online questionnaire, disseminated through social media outlets and email-lists by a team from Imperial College London.

Setting

England

Participants

Convenience sample of 1036 responses, from participants aged 18 and above, between December 2020 to February 2021.

Primary Outcome Measures

Evaluate the compliance and public attitude towards the “NHS COVID-19” app, regarding its functionality and features. This included whether participants expectations were met, and their thoughts on the app privacy and security. Furthermore, to distinguish how usability, perception, and adoption differed with varying demographics and user values.

Results

Fair app compliance was identified, with the app meeting expectations of 62.1% of participants who stated they downloaded it after weighted analysis. However, participants finding the interface challenging were less likely to read information in the app and had a lesser understanding of its functionality. Furthermore, lack of understanding regarding the app’s functionality and privacy concerns were possibly reasons why users did not download it. A readability analysis of the text revealed that app information was conveyed at a level which might only be accessible to under 60% of the population. The study highlighted issues related to the potential of false positives caused by the design choices in the “Check-In” feature.

Conclusion

This study showed that while the “NHS COVID-19” app was viewed positively, there remained issues regarding participants’ perceived knowledge of the app functionality, potentially affecting compliance. Therefore, we recommended improvements regarding the delivery and presentation of the app’s information, and highlighted the potential need for the ability to check out of venues to reduce the number of false positive contacts.

Strengths and Limitations

This is the first study assessing the perceived usability and functionality of the “NHS COVID-19” app directly from app users.

Diverse sample size, with representation from all major regions of England.

Statistical analysis to compare perceived app usability and functionality across demographics and the participants values regarding privacy and information.

Study was conducted during lockdown where app use may have been minimal.

Study may have missed potential participants who were not active on the relevant social media channels and email mailing lists which were used to disseminate the survey.
Adjusting COVID-19 seroprevalence survey results to account for test sensitivity and specificity
Authors: Meyer Mark J. , Yan Shuting , Schlageter Samantha , Kraemer John D. , Rosenberg Eli S. , Stoto Michael A.
Published: March 2021

Population-based seroprevalence surveys can provide useful estimates of the number of individuals previously infected with SARS-CoV-2 and still susceptible as well as contribute to better estimates of the case fatality rate and other measures of COVID-19 severity. No serological test is 100% accurate, however, and the standard correction that epidemiologists use to adjust estimates relies on estimates of the test sensitivity and specificity often based on small validation studies. This paper develops a fully Bayesian approach to adjust observed prevalence estimates for sensitivity and specificity. Application to a seroprevalence survey conducted in New York State in 2020 demonstrates that this approach results in more realistic – and narrower – credible interval than the standard sensitivity analysis using confidence interval endpoints. In addition, the model permits incorporating data on the geographical distribution of reported case counts to create informative priors on the cumulative incidence to produce estimates and credible intervals for smaller geographic areas than often can be precisely estimated with seroprevalence surveys.
A single-center retrospective cohort study of Covid-19 medications: Remdesivir, Favipiravir, Methylprednisolone, Dexamethasone, and Interferon β1a and their combinations
Authors: Fateh Sahand Tehrani , Fateh Sepand Tehrani , Salehi Esmaeil , Rezai Nima , Haririan Nazanin , Asgari Abdollah , Salehi-Najafabadi Amir
Published: March 2021

Many drugs have been suggested to be used for Covid-19. A suitable and efficient choice of drug would make the course of Covid-19 easier. we have investigated the efficacy of different treatment regimen in reducing hospitalization period (HP) and mortality of 324 confirmed Covid-19 patients. Received drugs included single therapy or combinations of Methylprednisolone, Remdesivir, Favipiravir, Interferon β1a, and Dexamethasone. HP and mortality were compared between different treatment groups to evaluate efficacy of each drug. HP and mortality were also calculated for patients in each treatment group based on their underlying diseases and age. we suggest that using IFN-β1a, RDV and corticosteroids might not have a significant effect on the HP or mortality of the Covid-19 patients as it was thought before.
Deep learning-based end-to-end automated stenosis classification and localization on catheter coronary angiography
Authors: Cong Chao , Kato Yoko , Vasconcellos Henrique D. , Ostovaneh Mohammad R. , Lima Joao A.C. , Ambale-Venkatesh Bharath
Published: March 2021

Background

Automatic coronary angiography (CAG) assessment may help in faster screening and diagnosis of patients. Current CNN-based vessel-segmentation suffers from sampling imbalance, candidate frame selection, and overfitting; few have shown adequate performance for CAG stenosis classification. We aimed to provide an end-to-end workflow that may solve these problems.

Methods

A deep learning-based end-to-end workflow was employed as follows: 1) Candidate frame selection from CAG videograms with CNN+LSTM network, 2) Stenosis classification with Inception-v3 using 2 or 3 categories (<25%, >25%, and/or total occlusion) with and without redundancy training, and 3) Stenosis localization with two methods of class activation map (CAM) and anchor-based feature pyramid network (FPN). Overall 13744 frames from 230 studies were used for the stenosis classification training and 4-fold cross-validation for image-, artery-, and per-patient-level. For the stenosis localization training and 4-fold cross-validation, 690 images with >25% stenosis were used.

Results

Our model achieved an accuracy of 0.85, sensitivity of 0.96, and AUC of 0.86 in per-patient level stenosis classification. Redundancy training was effective to improve classification performance. Stenosis position localization was adequate with better quantitative results in anchor-based FPN model, achieving global-sensitivity for LCA and RCA of 0.68 and 0.70 with mean square error (MSE) values of 39.3 and 37.6 pixels respectively, in the 520 × 520 pixel image.

Conclusion

A fully-automatic end-to-end deep learning-based workflow that eliminates the vessel extraction and segmentation step was feasible in coronary artery stenosis classification and localization on CAG images.

Key Points

The fully-automatic, end-to-end workflow which eliminated the vessel extraction and segmentation step for supervised-learning was feasible in the stenosis classification on CAG images, achieving an accuracy of 0.85, sensitivity of 0.96, and AUC of 0.86 in per-patient level.

The redundancy training improved the AUC values, accuracy, F1-score, and kappa score of the stenosis classification.

Stenosis position localization was assessed in two methods of CAM-based and anchor-based models, which performance was acceptable with better quantitative results in anchor-based models.

Summary Statement

A fully-automatic end-to-end deep learning-based workflow which eliminated the vessel extraction and segmentation step was feasible in the stenosis classification and localization on CAG images. The redundancy training improved the stenosis classification performance.
Decisive Conditions for Strategic Vaccination against SARS-CoV-2
Authors: Böttcher Lucas , Nagler Jan
Published: March 2021

While vaccines against SARS-CoV-2 are being administered, in most countries it may still take months until their supply can meet demand. The majority of available vaccines elicits strong immune responses when administered as prime-boost regimens. Since the immunological response to the first (“prime”) injection may provide already a substantial reduction in infectiousness and protection against severe disease, it may be more effective—under certain immunological and epidemiological conditions—to vaccinate as many people as possible with only one shot, instead of administering a person a second (“boost”) shot. Such a vaccination campaign may help to more effectively slow down the spread of SARS-CoV-2, reduce hospitalizations, and reduce fatalities, which is our objective. Yet, the conditions which make single-dose vaccination favorable over prime-boost administrations are not well understood. By combining epidemiological modeling, random sampling techniques, and decision tree learning, we find that single-dose vaccination is robustly favored over prime-boost vaccination campaigns, even for low single-dose efficacies. For realistic scenarios and assumptions for SARS-CoV-2, recent data on new variants included, we show that the difference between prime-boost and single-shot waning rates is the only discriminative threshold, falling in the narrow range of 0.01–0.02 day−1below which single-dose vaccination should be considered.
Diagnostic accuracy and predictive value of clinical symptoms for the diagnosis of mild COVID-19
Authors: Popovych V. , Koshel I. , Haman Y. , Leschak V. , Duplikhin R.
Published: March 2021

Objective

To assess the diagnostic accuracy of clinical symptoms and their predictive values in patients with suspected mild COVID-19 and to identify target groups for self-isolation and outpatient treatment without additional testing in the primary health care system.

Methods

We conducted an open-label prospective study in both male and female patients aged 18 to 72 years with suspected mild COVID-19 who were sequentially enrolled in the study. The clinical diagnosis was performed in accordance with the WHO recommendations based on the acute onset of such symptoms as olfactory dysfunction, hyperthermia, myalgia, nasal congestion, nasal discharge, cough, rhinolalia, sore throat, without pneumonia or hypoxia in persons in contact with a confirmed case of COVID-19. The physician assessed clinical symptoms using a 4-point scale. The patient self-assessed clinical symptoms using a ten-point visual analogue scale (VAS). All enrolled patients underwent laboratory testing to confirm the diagnosis of COVID-19.

Results

Of the 120 patients underwent testing, the diagnosis of mild COVID-19 was confirmed in 96 patients and ruled out in 24 patients. When assessing symptoms by a physician according to the correlation analysis, hyperthermia, myalgia, nasal congestion and rhinolalia have a positive predictive value with a significance level of more than 0.6. When self-assessing symptoms by a patient, fever, myalgia and nasal congestion have a diagnostic accuracy with a significance level of more than 0.5. Nasal discharge, cough and sore throat have negative predictive values.

Discussion

The presence of these symptoms in patients with an acute onset of the disease can help to make a clinical diagnosis of coronavirus disease and identify target groups for self-isolation and outpatient treatment without additional testing. Highly suspect asymptomatic patients are not considered as those who have possible mild COVID-19 infection.

Registration

Ethics Committee of Ivano-Frankivsk National Medical University, Protocol No. 114/20 as of 21 May 2020.
Using Project-based Learning to Enhance Curricular Integration and Relevance of Basic Medical Sciences in Pre-clerkship Years
Authors: Elkhamisy Fatma Alzahraa Abdelsalam , Zidan Azza Hassan , Fathelbab Mohamed Fathelbab
Published: March 2021

Introduction

Integration levels vary in the basic medical pre-clerkship years. We aimed to discover the deficiencies and increase the level of integration for the multidisciplinary curriculum of the 1st 2 academic years at The Faculty of Medicine, Helwan University. We used Project-based learning (PtBL) via designing “Clinically-applied team-based integrated research project” tasks. The purpose was to make students fully appreciate the relationship between basic disciplines and their relevance to practice hence boosts their learning.

Methods

We designed interdisciplinary integrated research project tasks (cases/symptoms/signs) that followed each module’s objectives. Students worked in teams to write and deliver project reports. They analyzed the assigned tasks and used reasoning to create diagnoses, relate the condition to the disrupted normal structure/functions, suggest/contraindicate specific treatment plans, and create preventive plans based on their understanding of the basic medical sciences. A survey was introduced to assess students’ perceptions of the learning approach used. Students’ responses were analyzed.

Results

Deficient-, unrelated-, & should be related in an interdisciplinary way-topics in the curriculum were discovered and reported during the projects’ design. Students (n=694) completed the survey (52% response rate). Most (84.6%) were satisfied by the integrated interdisciplinary project, and 57.9% preferred substituting the traditional lectures completely by integrated PtBL. Students significantly (P=0.000) understood the relation between objectives of disciplines after project completion (mean 3.66, SD ±0.92) than before it (mean 3.46, SD ±0.91). A significant relation was detected between the rank given to the perceived degree of the integration between basic to clinical sciences in the projects and both the rank perceived for students’ developed clinical reasoning (P=0.000) and the students’ choice of implementing future learning via the integrated project tasks (P=0.002).

Conclusions

The PtBL can be used as a complementary learning method to elevate the level of integration within a multidisciplinary approach to boost students’ learning.
Early and long-term risk of new-onset atrial fibrillation after transient ischemic attack
Authors: Purroy Francisco , Vicente-Pascual Mikel , Arque Gloria , Baraldes-Rovira Mariona , Begue Robert , Farre Joan , Gallego Yhovany , Gil-Villar M. Pilar , Mauri Gerard , Montalà Nuria , Paul-Arias Miriam , Pereira Cristina , Torres-Querol Coral , Vazquez-Justes Daniel
Published: March 2021

Background

Transient ischemic attack (TIA) provides a unique opportunity to optimize secondary preventive treatments to avoid subsequent ischemic stroke (IS). Although atrial fibrillation (AF) is the leading cause of cardioembolism in IS and anticoagulation prevents stroke recurrence (SR), limited data exists about the risk of new-onset AF after TIA.

Methods

We carried out a prospective cohort study of consecutive patients with TIA from January 2006 to June 2010. The risk of new diagnosis of AF and SR was defined after a median follow-up time of 6.5 (5.0-9.6) years. In a subgroup of consecutive patients, a panel of biomarkers was assessed during the first 24 h of the onset of symptoms.

Results

723 TIA patients were included. New-onset AF was diagnosed in 116 (16.0%) patients, 42 (36.2%) of them during admission. 204 (28.2%) patients were included in the biomarker substudy. New-onset AF was associated with sex (female) (hazard ratio [HR] 1.61 [95% CI, 1.07-2.41]), age (HR 1.05 [95% CI, 1.03-1.07]), previous ischemic heart disease (HR 1.84 [95% CI 1.15-2.97]) and cortical DWI pattern (HR 2.81 [95% CI 1.87-4.21]). In the Kaplan-Meier analysis, NT-proBNP ≥218.2 pg/ml (log-rank test P<0.001) was associated with significant risk of new-onset AF during the first five years of follow-up. Patients with a new diagnosis of AF after admission and before five years of follow-up had the highest risk of SR (P=0.002).

Conclusion

The risk of new diagnosis of AF after TIA is clinically relevant. We identified clinical, neuroimaging and biomarker predictors of new-onset AF.
Nano-CT characterization reveals coordinated growth of a rudimentary organ necessary for soldier development in the antPheidole hyatti
Authors: Koch Sophie , Tahara Rui , Vasquez-Correa Angelly , Abouheif Ehab
Published: March 2021

The growth of imaginal discs in holometabolous insects is coordinated with larval growth to ensure the symmetrical and proportional development of the adult appendages. In ants, the differential growth of these discs generates distinct castes – the winged male and queen castes and the wingless worker caste. In the hyperdiverse ant genusPheidole, the worker caste is composed of two morphologically distinct subcastes: small minor workers and larger, big-headed soldiers. Although these worker subcastes are completely wingless, soldier larvae develop rudimentary forewing discs that are necessary for generating the disproportionate head-to-body scaling of the big-headed soldier subcaste. However, it remains unclear whether rudimentary forewing discs in soldier larvae are coordinated with other imaginal discs, and whether disc growth and coordination patterns vary between the minor worker and soldier subcastes. Here we show, using quantitative nano-CT three-dimensional analyses, that growth of the soldier rudimentary forewing discs is coordinated with the increase in volume of the leg and eye-antennal (head) discs as well as with larval size. We found that the growth rate of the rudimentary forewing discs differs from the leg discs but is similar to the growth of the head (eye-antennal) discs relative to larval size, suggesting that growth of each type of imaginal disc may be differentially regulated. In addition to their larger size, the soldier eye-antennal discs increase in width as they undergo morphogenesis to generate the characteristic shape of the large soldier head, suggesting that the rudimentary forewing discs may regulate their patterning in addition to their growth. Finally, we observe little growth of the leg and eye-antennal discs during the bipotential stage, while in minor worker development these discs grow at similar rates to one another in coordination with larval size to generate the smaller minor worker subcaste. Our results suggest that rudimentary organs with regulatory functions may participate in new patterns of inter-organ coordination and regulation to produce novel phenotypes and complex worker caste systems. We provide characterization of larval development and imaginal disc growth and morphogenesis with the aim of highlighting this as an emerging system for the study of rudimentary organs during development and evolution.
SARS-CoV-2 infects blood monocytes to activate NLRP3 and AIM2 inflammasomes, pyroptosis and cytokine release
Authors: Junqueira Caroline , Crespo Ângela , Ranjbar Shahin , Ingber Jacob , Parry Blair , Ravid Sagi , Lacerda Luna B. de , Lewandrowski Mercedes , Clark Sarah , Ho Felicia , Vora Setu M. , Leger Valerie , Beakes Caroline , Margolin Justin , Russell Nicole , Gehrke Lee , Adhikari Upasana Das , Henderson Lauren , Janssen Erin , Kwon Douglas , Sander Chris , Abraham Jonathan , Filbin Michael , Goldberg Marcia B. , Wu Hao , Mehta Gautam , Bell Steven , Goldfeld Anne E. , Lieberman Judy
Published: March 2021

SARS-CoV-2 causes acute respiratory distress that can progress to multiorgan failure and death in some patients. Although severe COVID-19 disease is linked to exuberant inflammation, how SARS-CoV-2 triggers inflammation is not understood. Monocytes are sentinel blood cells that sense invasive infection to form inflammasomes that activate caspase-1 and gasdermin D (GSDMD) pores, leading to inflammatory death (pyroptosis) and processing and release of IL-1 family cytokines, potent inflammatory mediators. Here we show that ~10% of blood monocytes in COVID-19 patients are dying and infected with SARS-CoV-2. Monocyte infection, which depends on antiviral antibodies, activates NLRP3 and AIM2 inflammasomes, caspase-1 and GSDMD cleavage and relocalization. Signs of pyroptosis (IL-1 family cytokines, LDH) in the plasma correlate with development of severe disease. Moreover, expression quantitative trait loci (eQTLs) linked to higherGSDMDexpression increase the risk of severe COVID-19 disease (odds ratio, 1.3, p<0.005). These findings taken together suggest that antibody-mediated SARS-CoV-2 infection of monocytes triggers inflammation that contributes to severe COVID-19 disease pathogenesis.

One sentence summary

Antibody-mediated SARS-CoV-2 infection of monocytes activates inflammation and cytokine release.
SARS-CoV2 sero-survey among adults involved in health care and health research in Guinea-Bissau, West Africa
Authors: Benn Christine Stabell , Salinha Alberto , Mendes Sabado , Cabral Carlos , Martins Cesario , Nielsen Sebastian , Bærent Fisker Ane , Schaltz-Buchholzer Frederik , Sværke Jørgensen Charlotte , Aaby Peter
Published: March 2021

Background

Many African countries have reported fewer COVID-19 cases than countries elsewhere. By the end of 2020, Guinea-Bissau, West Africa, had <2500 PCR-confirmed cases corresponding to 0.1% of the ∼1.8 million national population. We assessed the prevalence of SARS-CoV2 antibodies in urban Guinea-Bissau.

Methods

We measured IgG antibody in point-of-care rapid tests among 140 staff and associates at a biometric research field station in Bissau, the capital of Guinea-Bissau, during November 2020.

Results

Of 140 participants, 25 (18%) were IgG-positive. Among IgG-positives, 12 (48%) reported an episode of illness since the onset of the pandemic. Twenty-five (18%) participants had been PCR-tested between May and September; 7 (28%) were PCR-positive. Four of these 7 tested IgG-negative in the present study. Five participants reported a death in their house, corresponding to a crude annual death rate of 4.5/1000 people; no death was attributed to COVID-19.

Conclusions

In spite of low official number of COVID-19 cases, our serosurvey found a high prevalence of IgG-positivity. Most IgG-positives had not been ill. The official number of PCR-confirmed COVID-19 cases grossly underestimates the prevalence during the pandemic. The observed overall mortality rate is not higher than the official Guinean mortality rate of 9.6/1000 people.
In vivo co-registered hybrid-contrast imaging by successive photoacoustic tomography and magnetic resonance imaging
Authors: Zhang Shuangyang , Qi Li , Li Xipan , Liang Zhichao , Wu Jian , Huang Shixian , Liu Jiaming , Zhuang Zhijian , Feng Yanqiu , Feng Qianjin , Chen Wufan
Published: March 2021

Magnetic resonance imaging (MRI) and photoacoustic tomography (PAT) are two advanced imaging modalities that offer two distinct image contrasts: MRI has a multi-parameter contrast mechanism that provides excellent anatomical soft tissue contrast, whereas PAT is capable of mapping tissue physiological metabolism and exogenous contrast agents with optical specificity. Attempts have been made to integrate these two modalities, but rigid and reliable registration of the images for in vivo imaging is still challenging. In this paper, we present a complete hardware-software solution for the successive acquisition and co-registration of PAT and MRI images inin vivoanimal studies. Based on commercial PAT and MRI scanners, our solution includes a 3D-printed dual-modality animal imaging bed, a 3-D spatial image co-registration algorithm with bi-model markers, and a robust modality switching protocol for in vivo imaging studies. Using the proposed solution, we successfully demonstrated co-registered hybrid-contrast PAT-MRI imaging that simultaneously display multi-scale anatomical, functional and molecular characteristics on healthy and cancerous living mice. Week-long longitudinal dual-modality imaging of tumor development reveals information on size, border, vascular pattern, blood oxygenation, and molecular probe metabolism of the tumor micro-environment at the same time. Additionally, by incorporating soft-tissue information in the co-registered MRI image, we further show that PAT image quality could be enhanced by MRI-guided light fluence correction. The proposed methodology holds the promise for a wide range of pre-clinical research applications that benefit from the PAT-MRI dual-modality image contrast.
Knowledge, Attitude and Practices towards COVID-19 Guidelines among Students in Bangladesh
Authors: Kumar Bezon , Pinky Susmita Dey , Nurudden Ashike Md.
Published: March 2021

This paper explores the level of knowledge, attitude and practices of COVID-19 guidelines among the students in Bangladesh. In achieving this objective, this paper uses primary data collected from 1822 students and three different Likert scales and a one-way ANOVA test are used to assess knowledge, attitudes, and practice (KAP) scores and mean differences with respect to different variables. The research reveals that the majority of students have a higher level of knowledge and a positive attitude towards the COVID-19 guidelines. In contrary, only 0.22 percent students show strong compliance towards COVID-19 guidelines while majority students (60.54 percent) have rather a poor adherence which is an alarming finding. Reopening the educational institutions in Bangladesh is, therefore, not advisable yet and reinforcing the preventive measures through campaigns and online discussion to persuade people to follow the preventive guidelines is highly recommended to contain this global disease.

What We Already Know

Majority papers revealed the KAP of general people or medical related people.

Majority people have moderate level of knowledge towards COVID-19.

No research is found on KAP of the students in Bangladesh.

What This Article Adds

The KAP of COVID-19 guidelines among the students in Bangladesh.

Majority students have the higher level of knowledge towards COVID-19 guideline among students.

Only 0.22 percent students show strong compliance towards COVID-19 guidelines which recommends not reopening educational institutions now.
A Macro-scale Comparison Algorithm for Analysis of TCR Repertoire Completeness
Authors: Esponda Fernando , Šulc Petr , Blattman Joseph , Forrest Stephanie
Published: March 2021

Recent advances in biotechnology are beginning to generate wholeimmunomedatasets, which will enable the comparison of immune repertoires between individuals, e.g., to assess immunocompetence. Existing algorithms cluster cell types based on the relative expression abundance of about 20 000 genes, but such algorithms have limited utility when comparing immunome datasets with many higher orders of magnitude (>1012) of variation, such as occurs in immunoreceptor sequences in highly polyclonal naive repertoires.

In this paper we present a method for comparing immune repertoires by identifying macro-level features that are conserved between similar individuals. Our method allows us to detect some blind spots in naive populations and to assess whether a repertoire is likely complete by examining only a sample of its sequences.

Author Summary

In this paper we present a method for comparing the immune repertoire of different individuals. Repertoires are represented by a sample of genetic sequences. Our technique coarse grains each individual’s data into groups, matches groups between individual’s and finds significant differences.
An integrative approach leads to the discovery of a novel anti-leukemic peptide from human milk
Authors: Chiangjong Wararat , Panachan Jirawan , Vanichapol Thitinee , Pongsakul Nutkridta , Pongphitcha Pongpak , Siriboonpiputtana Teerapong , Lerksuthirat Tassanee , Nuntnarumit Pracha , Supapannachart Sarayut , Srisomsap Chantragan , Svasti Jisnuson , Hongeng Suradej , Chutipongtanate Somchai
Published: March 2021

Chemotherapy in childhood leukemia is associated with late morbidity in leukemic survivors, while certain patient subsets are relatively resistant to standard chemotherapy. It is therefore important to identify new agents with sensitivity and selectivity towards leukemic cells, while having less systemic toxicity. Peptide-based therapeutics has gained much attention during the last few years. Here, we used an integrative workflow combining mass spectrometric peptide library construction,in silicoanticancer peptide screening, andin vitroleukemic cell studies to discover a novel anti-leukemic peptide having 3+charges and alpha-helical structure, namely HMP-S7, from human breast milk. HMP-S7 showed cytotoxic activity against four distinct leukemic cell lines in a dose-dependent manner but had no effect on solid malignancies or representative normal cells. HMP-S7 induced leukemic cell death by penetrating the plasma membrane to enter the cytoplasm and cause leakage of lactate dehydrogenase, thus acting in a membranolytic manner. Importantly, HMP-S7 exhibited anti-leukemic effect against patient-derived leukemic cellsex vivo. In conclusion, HMP-S7 is a selective anti-leukemic peptide with promise which requires further validation in preclinical and clinical studies.

Teaser

In silicoscreening of naturally occurring human milk peptides discovers a new anticancer peptide that kills leukemic cellsin vitroandex vivo.