bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart Rate Reactivity to Acute Psychological Stress Predicts Higher Levels of Posttraumatic Stress Disorder Symptoms During the COVID-19 Pandemic
Authors: Ginty Annie T. , Young Danielle A. , Tyra Alexandra T. , Hurley Page E. , Brindle Ryan C. , Williams Sarah E. 
Published: August 2020

ABSTRACT

Objective
Increased autonomic arousal is a proposed risk factor for posttraumatic stress disorder (PTSD). Few studies have prospectively examined the association between physiological responses to acute psychological stress before a traumatic event and later PTSD symptoms. The present prospective study examined whether cardiovascular responses to an acute psychological stress task before the COVID-19 global pandemic predicted PTSD symptoms related to the ongoing pandemic.

Methods
Participants (n = 120) were a subsample of an ongoing research study. Phase 1 consisted of a 10-minute baseline and 4-minute acute psychological stress task with blood pressure and heart rate recorded throughout. Phase 2 was initiated 2 weeks after the COVID-19 pandemic declaration. Participants completed the Impact of Event Scale—Revised (IES-R) with respect to the ongoing pandemic. Hierarchical linear regression analyses were used to examine whether cardiovascular stress reactivity predicted COVID-19 PTSD symptoms.

Results
Heart rate reactivity significantly predicted IES intrusion (β = −0.208, t = −2.28, p = .025, ΔR
2 = 0.041, confidence interval = −0.021 to −0.001) and IES hyperarousal (β = −0.224, t = −2.54, p = .012, ΔR
2 = 0.047, confidence interval = −0.22 to − 0.003), but not IES avoidance (p = .077). These results remained statistically significant after adjustment for sex, socioeconomic status, baseline cardiovascular activity, neuroticism, race, ethnicity, body mass index, and adverse childhood experiences. There were no statistically significant associations between blood pressure and any of the Impact of Event Scale—Revised subscales (p values > .12).

Conclusions
Diminished heart rate responses (i.e., lower physiological arousal) to acute psychological stress before the COVID-19 pandemic significantly predicted reported PTSD symptoms during the crisis.
The Oswald injury
Authors: Barr Justin , Jones Ronald C. , Pappas Theodore N. 
Published: August 2020

ABSTRACT
On November 22, 1963, John F. Kennedy, the 35th president of the United States, was assassinated in Dallas, Texas. John B. Connally, the Governor of Texas, simultaneously was injured in the shooting. Both Kennedy and Connally were transported to and cared for at the Parkland Memorial Hospital. Within 3 hours, the accused assassin, Lee Harvey Oswald, was arrested and taken to the Dallas City Jail in the Downtown Municipal Building. When the authorities were transferring Oswald from the City to the County Jail at midday on November 24, Jack Ruby shot him as the event was televised and broadcast live to the nation. Oswald was rushed to Parkland Memorial Hospital where he was operated on by the same surgeons who had attended Kennedy and Connally 2 days previously. This article reviews the operative treatment that Oswald received before discussing the state of abdominal vascular trauma in the 1960s.
Outcomes and implications of a single brain death examination policy on organ donation outcomes at a high-volume trauma center
Authors: Matar Abraham J. , Wichmann Hannah , Kenney Lisa , Subramanian Anuradha , Ratcliff Jonathan , Patel Vishal , Tracy Brett M. , Gelbard Rondi B. 
Published: August 2020

BACKGROUND
Despite current neurological guidelines that a single brain death examination (SBDE) is sufficient to determine brain death, a vast majority of hospitals still use a two brain death examination (TBDE) policy based on historical practice. The purpose of this study was to analyze the outcomes and implications of an SBDE policy compared with a TBDE policy with respect to organ donation outcomes.

METHODS
We retrospectively reviewed all adult patients declared dead by neurological criteria between 2010 and 2018 at a high-volume trauma center. The study population was divided into SBDE and TBDE cohorts. Primary outcomes included time to organ donation, terminal donor creatinine and bilirubin, and number of procured and transplanted organs.

RESULTS
A total of 327 patients comprised the study population: 66.7% SBDE (n = 218 of 327 patients) and 33.3% TBDE (n = 109 of 327 patients). The SBDE group had a shorter median time from examination to procurement (38 vs. 44 hours, p = 0.02) as well as lower terminal donor creatinine (1.1 vs. 1.35 mg/dL, p = 0.004) and bilirubin (0.8 vs. 1.1 mg/dL, p = 0.04). Furthermore, the SBDE group had a significantly greater proportion of kidneys (90.6% vs. 81.6%, p = 0.02), lungs (11.8% vs. 4.6%, p = 0.02), and total organs (58.2% vs. 46.6%; p = 0.0001) procured with intent to transplant and a greater proportion of total organs transplanted (53.1% vs. 42.4%, p = 0.0004). Multivariable regression analysis confirmed that SBDE was independently associated with a shorter time to procurement, lower terminal creatinine, and increased number of procured organs.

CONCLUSION
These data highlight the potential benefit of an SBDE policy with regards to organ donation outcomes at a high-volume trauma center and should facilitate future randomized prospective studies to more rigorously test this hypothesis.

LEVEL OF EVIDENCE
Therapeutic/Care Management, level IV.
Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden
Authors: van Hoeken Daphne , Hoek Hans W. 
Published: August 2020

Purpose of review
To review the recent literature on the burden of eating disorders in terms of mortality, disability, quality of life, economic cost, and family burden, compared with people without an eating disorder.

Recent findings
Estimates are that yearly over 3.3 million healthy life years worldwide are lost because of eating disorders. In contrast to other mental disorders, in anorexia nervosa and bulimia nervosa years lived with disability (YLDs) have increased. Despite treatment advances, mortality rates of anorexia nervosa and bulimia nervosa remain very high: those who have received inpatient treatment for anorexia nervosa still have a more than five times increased mortality risk. Mortality risks for bulimia nervosa, and for anorexia nervosa treated outside the hospital, are lower but still about twice those of controls. In people with an eating disorder, quality of life is reduced, yearly healthcare costs are 48% higher than in the general population, the presence of mental health comorbidity is associated with 48% lower yearly earnings, the number of offspring is reduced, and risks for adverse pregnancy and neonatal outcomes are increased.

Summary
People with a current or former eating disorder are at risk of increased mortality, high YLD rates, a reduced quality of life, increased costs, and problems with childbearing.
Developments in the psychological treatment of anorexia nervosa and their implications for daily practice
Authors: Jansingh Alberte , Danner Unna N. , Hoek Hans W. , van Elburg Annemarie A. 
Published: August 2020

Purpose of review
Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of the findings for clinical practice.

Recent findings
Three systematic reviews and meta-analyses have recently been published on psychological treatments for anorexia nervosa. Treatment outcomes are still modest and mainly focus on weight outcome, although outcomes for eating disorder disease and quality of life have also been reported. Adhering to a treatment protocol might lead to faster and better results.

Summary
For children and adolescents with anorexia nervosa, the major guidelines recommend a family-based treatment. The treatments of choice for young adults and adults with anorexia nervosa are the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behaviour Therapy-Enhanced (CBT-E) and Specialist Supportive Clinical Management (SSCM), but none of these treatments seem to be superior. In search of other ways to improve outcome, shared decision making may be a way to help patients become more involved in their treatment, enhance their motivation and consequently improve the outcome.
Clinical and immunological factors that distinguish COVID-19 from pandemic influenza A(H1N1)
Authors: Choreño-Parra José Alberto , Jiménez-Álvarez Luis Armando , Cruz-Lagunas Alfredo , Rodríguez-Reyna Tatiana Sofía , Ramírez-Martínez Gustavo , Sandoval-Vega Montserrat , Hernández-García Diana Lizzeth , Choreño-Parra Eduardo M. , Balderas-Martínez Yalbi I. , Martinez-Sanchez Mariana Esther , Márquez-García Eduardo , Shiutto Edda , Moreno-Rodríguez José , Barreto-Rodríguez José Omar , Vázquez-Rojas Hazel , Centeno-Sáenz Gustavo Iván , Alvarado-Peña Néstor , Salinas-Lara Citlaltepetl , Sanchez-Garibay Carlos , Hernández Gabriela , Mendoza-Milla Criselda , Domínguez Andrea , Granados Julio , Mena-Hernández Lula , Pérez-Buenfil Luis Ángel , Domínguez-Cheritt Guillermo , Cabello-Gutiérrez Carlos , Luna Cesar , Salas-Hernández Jorge , Santillán-Doherty Patricio , Regalado Justino , Hernández-Martínez Angélica , Orozco Lorena , García-Latorre Ethel Awilda , Hernández-Cárdenas Carmen M. , Khader Shabaana A. , Zlotnik Albert , Zúñiga Joaquín 
Published: August 2020

AbstractThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a global health threat with the potential to cause severe disease manifestations in the lungs. Although clinical descriptions of COVID-19 are currently available, the factors distinguishing SARS-CoV-2 from other respiratory viruses are unknown. Here, we compared the clinical, histopathological, and immunological characteristics of patients with COVID-19 and pandemic influenza A(H1N1). We observed a higher frequency of respiratory symptoms, increased tissue injury markers, a histological pattern of alveolar pneumonia, and higher levels of IL-1RA, TNF-α, CCL3, G-CSF, APRIL, sTNF-R1, sTNF-R2, sCD30, and sCD163 in influenza patients. Conversely, dry cough, gastrointestinal symptoms, interstitial lung pathology, increased Th1 (IL-12, IFN-γ) and Th2 (IL-4, IL-5, IL-10, IL-13) cytokine levels, along with IL-1β, IL-6, CCL11, VEGF, TWEAK, TSLP, MMP-1, and MMP-3, were observed in COVID-19 cases. We demonstrated the diagnostic potential of some clinical and immune factors to differentiate COVID-19 from pandemic influenza A(H1N1). Our data suggest that SARS-CoV-2 induces a dysbalanced polyfunctional inflammatory response that is different from the immune response against influenza. These findings might be relevant for the upcoming 2020-2021 influenza season, which is projected to be historically unique due to its convergence with COVID-19.
Combining structured and unstructured data for predictive models: a deep learning approach
Authors: Zhang Dongdong , Yin Changchang , Zeng Jucheng , Yuan Xiaohui , Zhang Ping 
Published: August 2020

AbstractBackgroundThe broad adoption of Electronic Health Records (EHRs) provides great opportunities to conduct health care research and solve various clinical problems in medicine. With recent advances and success, methods based on machine learning and deep learning have become increasingly popular in medical informatics. However, while many research studies utilize temporal structured data on predictive modeling, they typically neglect potentially valuable information in unstructured clinical notes. Integrating heterogeneous data types across EHRs through deep learning techniques may help improve the performance of prediction models.MethodsIn this research, we proposed 2 general-purpose multi-modal neural network architectures to enhance patient representation learning by combining sequential unstructured notes with structured data. The proposed fusion models leverage document embeddings for the representation of long clinical note documents and either convolutional neural network or long short-term memory networks to model the sequential clinical notes and temporal signals, and one-hot encoding for static information representation. The concatenated representation is the final patient representation which is used to make predictions.ResultsWe evaluate the performance of proposed models on 3 risk prediction tasks (i.e., in-hospital mortality, 30-day hospital readmission, and long length of stay prediction) using derived data from the publicly available Medical Information Mart for Intensive Care III dataset. Our results show that by combining unstructured clinical notes with structured data, the proposed models outperform other models that utilize either unstructured notes or structured data only.ConclusionsThe proposed fusion models learn better patient representation by combining structured and unstructured data. Integrating heterogeneous data types across EHRs helps improve the performance of prediction models and reduce errors.AvailabilityThe code for this paper is available at: https://github.com/onlyzdd/clinical-fusion.
Clinical and Epidemiological Characteristics of the First Month of the Covid-19 Pandemic in Chile
Authors: Vial Macarena R. , Peters Anne , Pérez Inia , Spencer María , Barbé Mario , Porte Lorena , Weitzel Thomas , Aylwin Mabel , Vial Pablo , Araos Rafael , Munita Jose M. ,   for the CAS-UDD Covid-19 Working Group
Published: August 2020

AbstractIntroductionUnderstanding the clinical course and outcomes of patients with Covid-19 in underrepresented populations like Latin America is paramount. In this study, we report the clinical characteristics of Covid-19 in Chile, with a focus on subjects requiring hospitalization during the initial phases of the SARS-CoV-2 pandemic.MethodsThis is a single center study including all consecutive patients diagnosed with Covid-19 during the first month of the pandemic. Demographics, clinical characteristics and laboratory data were collected within 24 hours of admission. The primary outcome was a composite of ICU admission or all-cause, in-hospital mortality.ResultsDuring the first month of the pandemic, 381 patients were confirmed as positive for SARS-CoV-2 by molecular testing; 88 (23.1%) of them eventually required hospitalization. Median age of the cohort was 39 years (IQR 31-49). Overall mortality was 0.7% and 18 (3.7%) out of the 88 subjects who required hospitalization either died and/or required ICU. Increased body mass index (BMI), C-reactive protein levels (CRP) and the SaTO2/FiO2 index on admission were independently associated with a higher risk of ICU care or death.DiscussionThe lower mortality observed in our prospective cohort during the first month of SARS-Cov-2 pandemic was lower than previously reported. This finding could be due to a lower threshold for admission, a healthcare system not yet overburdened and a younger population, among other factors. BMI, CRP on admission were strong predictors for ICU care or all-cause, in-hospital mortality. Our data provide important information regarding the clinical course of Covid-19 in Latin America.
Protecting healthcare workers during the COVID-19 pandemic: Australian results from the PPE-SAFE survey
Authors: Ramanan Mahesh , Laupland Kevin B , Tabah Alexis 
Published: August 2020

AbstractThe COVID-19 pandemic has led to global shortages of personal protective equipment (PPE). Healthcare workers (HCW) have comprised a significant proportion of COVID-19 cases in many countries. The PPE-SAFE survey was conducted to study current practices, availability, shortages, training and confidence in PPE amongst intensive care HCWs around the world. Herein, we describe the results of the Australian respondents to the PPE-SAFE survey. 29% of respondents reported that at least one item of usually available PPE was missing, and 12% reported reuse of single-use items. Only 40% felt that the PPE available to them offered adequate protection. Fit-testing of respirators had never been performed for 47% of respondents, and 49% reported at least one adverse effect from the use of PPE.
A population scale analysis of rare SNCA variation in the UK Biobank
Authors: Blauwendraat Cornelis , Makarious Mary B. , Leonard Hampton L. , Bandres-Ciga Sara , Iwaki Hirotaka , Nalls Mike A. , Noyce Alastair J , Singleton Andrew B. 
Published: August 2020

AbstractParkinson’s disease (PD) is a complex neurodegenerative disease with a variety of genetic and environmental factors contributing to disease. The SNCA gene encodes for the alpha-synuclein protein which plays a central role in PD, where aggregates of this protein are one of pathological hallmarks of disease. Rare point mutations and copy number gains of the SNCA gene have been shown to cause autosomal dominant PD and common DNA variants identified using GWAS are a moderate risk factor for PD. The UK Biobank is a large prospective study including ~500,000 individuals and has revolutionized human genetics. Here we assessed the frequency of SNCA variation in this cohort and identified 26 subjects carrying variants of interest including duplications (n=6), deletions (n=6) and large complex likely mosaic events (n=14). No known pathogenic missense variants were identified. None of these subjects were reported to be a PD case, although it is possible that these individuals may develop PD at a later age, and whilst three had known prodromal features, these did not meet defined thresholds for being considered ‘prodromal’ cases. Four of the 14 large complex carriers showed a history of blood based cancer. Overall, we identified copy number variants in the SNCA region in a large population based cohort without reported PD phenotype and symptoms. Putative mosaicism of the SNCA gene was identified, however it is unclear whether it is associated with Parkinson's disease. These individuals are potential candidates for further investigation by performing SNCA RNA and protein expression studies, as well as promising clinical trial candidates to understand how duplication carriers potentially escape PD.
Towards safer risperidone prescribing in Alzheimer’s disease
Authors: Reeves Suzanne , Bertrand Julie , Uchida Hiroyuki , Yoshida Kazunari , Otani Yohei , Ozer Mikail , Liu Kathy Y , Bramon Elvira , Bies Robert , Pollock Bruce , Howard Robert 
Published: August 2020

AbstractBackgroundIn the treatment of psychosis, agitation and aggression in Alzheimer’s disease (AD), guidelines emphasise the need to ‘use the lowest possible dose’ of antipsychotic drugs, but provide no information on optimal dosing.AimsThis analysis investigated the pharmacokinetic profiles of risperidone and active metabolite, 9-hydroxy (OH)-risperidone, and how this related to emergent extrapyramidal side effects (EPS), using data from The Clinical Antipsychotic Trials of Intervention Effectiveness-AD study.MethodA statistical model, which described the concentration-time course of risperidone and 9-OH-risperidone, was used to predict peak, trough and average concentrations of risperidone, 9-OH-risperidone and ‘active moiety’ (combined concentrations) (108 CATIE-AD participants). Logistic regression was used to investigate the associations of pharmacokinetic biomarkers with EPS. Model based predictions were used to simulate the dose adjustments needed to avoid EPS.ResultsThe model showed an age-related reduction in risperidone clearance (p<0.0001), and estimated that 22% of patients had slower active moiety clearance (concentration-to-dose ratio 20.2±7.2 versus 7.6±4.9 ng/mL per mg/day, Mann Whitney U,p<0.0001). Higher average and trough 9-OH-risperidone concentrations (p<0.0001), and lower Mini-Mental State Examination (MMSE) scores (p<0.0001), were associated with EPS. Model based predictions suggest the optimum dose ranged from 0.25mg/day in those aged 85 years with MMSEs of 5, to 1mg/day in those aged 75 years with MMSEs of 15, with alternate day dosing required for those with slower drug clearance.ConclusionsOur findings argue for age- and MMSE -related dose adjustments and suggest that a single plasma sample could be used to identify those with slower drug clearance.
Frontline healthcare workers’ knowledge and perception of COVID-19 and willingness to work during the pandemic in Nepal: a nationwide cross-sectional web-based study
Authors: Upadhyaya Dipak Prasad , Paudel Rajan , Bromberg Daniel J. , Acharya Dilaram , Khoshnood Kaveh , Lee Kwan , Park Ji-Huyuk , Yoo Seok-Ju , Shrestha Archana , Bom BC , Bhandari Sabin , Yadav Ramgyan , Timalsina Ashish , Wagle Chetan Nidhi , Das Brij Kumar , Kunwar Ramesh , Chalise Binaya , Bhatta Deepak Raj , Adhikari Mukesh 
Published: August 2020

AbstractBackgroundThe health sector’s effectiveness during a pandemic primarily depends on the availability, knowledge, skills, perceptions, and motivations of frontline healthcare workers. In this study, we aimed to investigate the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers to work during the COVID-19 pandemic in Nepal.MethodsA total of 1051 frontline health-workers from all seven Nepalese provinces were included in this web-based cross-sectional study, which was conducted in May 2020. Using a 5-point Likert scale questionnaire, we collected information on knowledge, perceptions, and the willingness of frontline healthcare workers to work during the COVID-19 pandemic. Multivariable logistic regression was applied to identify independent associations between predictors and outcome variables.ResultsOf the 1051 frontline health-workers, 17.2% were found to have inadequate knowledge on COVID-19, 63.6% reported unsatisfactory perceptions of government response, and 35.9% showed an unwillingness to work during the pandemic. Health workers at local health facilities (AOR: 0.35; 95% CI: 0.17-0.68) and those with chronic diseases were less likely to have adequate knowledge of COVID-19. Nurses (AOR: 2.10; 95% CI: 1.38-3.18), health-workers from Karnali Province (AOR: 2.62; 95% CI: 1.52-4.53), and those who had adequate knowledge of COVID-19 (AOR: 3.86; 95% CI: 2.51-6.16) were more likely to have satisfactory perception towards government response to COVID-19. In addition, laboratory-workers, health workers from Karnali province, and those with adequate knowledge (AOR: 1.81; 95% CI: 1.27-2.58) were more likely to work during the COVID-19 pandemic.ConclusionsWe concluded that frontline healthcare workers have some gaps in knowledge-related to COVID-19; about two-thirds of them had a negative perception of government response, and nearly one-third of them were unwilling to work. These observations demonstrate that prompt actions are required to improve health-worker knowledge of COVID-19, address negative perceptions to government responses, and motivate them to provide healthcare services during the pandemic.