bluuebunny/crossref_metadata_2025_split huggingface dataset:
Education of Infectious Diseases Fellows During the COVID-19 Pandemic Crisis: Challenges and Opportunities
Authors: Chirch Lisa M , Armstrong Wendy S , Balba Gayle P , Kulkarni Prathit A , Benson Constance A , Konold Victoria , Luther Vera P , Nnedu Obinna N , Perloff Sarah , Razonable Raymund R , Stead Wendy , Thompson George R , Melia Michael T 
Published: December 2020

AbstractOne of the many challenges that has befallen the Infectious Diseases and Graduate Medical Education communities during the coronavirus disease 2019 (COVID-19) pandemic is the maintenance of continued effective education and training of the future leaders of our field. With the remarkable speed and innovation that has characterized the responses to this pandemic, educators everywhere have adapted existing robust and safe learning environments to meet the needs of our learners. This paper will review distinct aspects of education and training of the Infectious Diseases fellows we believe the COVID-19 pandemic has impacted most, including mentoring, didactics, and wellness. We anticipate that several strategies developed in this context and described herein will help to inform training and best practices during the pandemic and beyond.
Self-Rated Smell Ability Enables Highly Specific Predictors of COVID-19 Status: A Case–Control Study in Israel
Authors: Karni Noam , Klein Hadar , Asseo Kim , Benjamini Yuval , Israel Sarah , Nammary Musa , Olshtain-Pops Keren , Nir-Paz Ran , Hershko Alon , Muszkat Mordechai , Niv Masha Y 
Published: December 2020

Abstract

Background
Clinical diagnosis of coronavirus disease 2019 (COVID-19) is essential to the detection and prevention of COVID-19. Sudden onset of loss of taste and smell is a hallmark of COVID-19, and optimal ways for including these symptoms in the screening of patients and distinguishing COVID-19 from other acute viral diseases should be established.

Methods
We performed a case–control study of patients who were polymerase chain reaction–tested for COVID-19 (112 positive and 112 negative participants), recruited during the first wave (March 2020–May 2020) of the COVID-19 pandemic in Israel. Patients reported their symptoms and medical history by phone and rated their olfactory and gustatory abilities before and during their illness on a 1–10 scale.

Results
Changes in smell and taste occurred in 68% (95% CI, 60%–76%) and 72% (95% CI, 64%–80%) of positive patients, with odds ratios of 24 (range, 11–53) and 12 (range, 6–23), respectively. The ability to smell was decreased by 0.5 ± 1.5 in negatives and by 4.5 ± 3.6 in positives. A penalized logistic regression classifier based on 5 symptoms had 66% sensitivity, 97% specificity, and an area under the receiver operating characteristics curve (AUC) of 0.83 on a holdout set. A classifier based on degree of smell change was almost as good, with 66% sensitivity, 97% specificity, and 0.81 AUC. The predictive positive value of this classifier was 0.68, and the negative predictive value was 0.97.

Conclusions
Self-reported quantitative olfactory changes, either alone or combined with other symptoms, provide a specific tool for clinical diagnosis of COVID-19. A simple calculator for prioritizing COVID-19 laboratory testing is presented here.
Medicaid Expansion’s Impact on Human Immunodeficiency Virus Outcomes in a Nonurban Southeastern Ryan White HIV/AIDS Program Clinic
Authors: McManus Kathleen A , Srikanth Karishma , Powers Samuel D , Dillingham Rebecca , Rogawski McQuade Elizabeth T 
Published: December 2020

Abstract

Background
Although the Ryan White HIV/AIDS Program supports high-quality human immunodeficiency virus (HIV) care, Medicaid enrollment provides access to non-HIV care. People with HIV (PWH) with Medicaid historically have low viral suppression (VS) rates. In a state with previously high Qualified Health Plan coverage of PWH, we examined HIV outcomes by insurance status during the first year of Medicaid expansion (ME).

Methods
Participants were PWH ages 18–63 who attended ≥1 HIV medical visit/year in 2018 and 2019. We estimated associations of sociodemographic characteristics with ME enrollment prevalence and associations between insurance status and engagement in care and VS.

Results
Among 577 patients, 151 (33%) were newly eligible for Medicaid, and 77 (51%) enrolled. Medicaid enrollment was higher for those with incomes &lt;100% federal poverty level (adjusted prevalence ratio, 1.67; 95% confidence interval [CI], 1.00–1.86) compared with others. Controlling for age, income, and 2018 engagement, those with employment-based private insurance (adjusted risk difference [aRD], −8.5%; 95% CI, −16.9 to 0.1) and Medicare (aRD, −12.5%; 95% CI, −21.2 to −3.0) had lower 2019 engagement than others. For those with VS data (n = 548), after controlling for age and baseline VS, those with Medicaid (aRD, −4.0%; 95% CI, −10.3 to 0.3) and with Medicaid due to ME (aRD, −6.2%; 95% CI, −14.1 to −0.8) were less likely to achieve VS compared with others.

Conclusions
Given that PWH who newly enrolled in Medicaid had high engagement in care, the finding of lower VS is notable. The discordance may be due to medication access gaps associated with changes in medication procurement logistics.
Lessons Learned From Conducting Internet-Based Randomized Clinical Trials During a Global Pandemic
Authors: Pullen Matthew F , Pastick Katelyn A , Williams Darlisha A , Nascene Alanna A , Bangdiwala Ananta S , Okafor Elizabeth C , Hullsiek Katherine Huppler , Skipper Caleb P , Lofgren Sarah M , Engen Nicole , Abassi Mahsa , McDonald Emily G , Lee Todd C , Rajasingham Radha , Boulware David R 
Published: December 2020

Abstract
As the severe acute respiratory syndrome coronavirus 2 pandemic evolved, it was apparent that well designed and rapidly conducted randomized clinical trials were urgently needed. However, traditional clinical trial design presented several challenges. Notably, disease prevalence initially varied by time and region, and the pockets of outbreaks evolved geographically over time. Coupled with an occupational hazard from in-person study visits, timely recruitment would prove difficult in a traditional in-person clinical trial. Thus, our team opted to launch nationwide internet-based clinical trials using patient-reported outcome measures. In total, 2795 participants were recruited using traditional and social media, with screening and enrollment performed via an online data capture system. Follow-up surveys and survey reminders were similarly managed through this online system with manual participant outreach in the event of missing data. In this report, we present a narrative of our experience running internet-based clinical trials and provide recommendations for the design of future clinical trials during a world pandemic.
Integrase Strand Transfer Inhibitors Play the Main Role in Greater Weight Gain Among Men With Acute and Early HIV Infection
Authors: Wu Kuan-Sheng , Anderson Christy , Little Susan J 
Published: December 2020

AbstractBackgroundThe predictors of weight gain remain unclear in people with acute and early HIV infection (AEH).MethodsEligible antiretroviral-naïve men diagnosed with AEH from January 1, 2000, to December 31, 2019, were enrolled in an observational cohort study at the University California, San Diego. The study used multivariable mixed-effect linear regression models to analyze differences in the rate of weight gain over time between participants receiving early vs deferred antiretroviral therapy (ART) treatment, low vs high baseline CD4 count and HIV RNA, and different classes of ART.ResultsA total of 463 participants were identified, with mean CD4 cell count of 507 cells/μL and log HIV RNA of 5.0 copies/mL at study entry. There was no difference in the rate of weight gain between participants who did and did not receive ART within 96 weeks of incident HIV infection. Neither a baseline CD4 count of &lt;350 cells/μL nor a baseline HIV RNA of &gt;100 000 copies/mL was a predictor of weight gain. Compared with persons taking non-nucleoside reverse transcriptase inhibitor–based regimens, those who received integrase strand transfer inhibitor (INSTI)–based regimens showed greater weight gain over time.ConclusionsNeither baseline CD4 count and HIV RNA nor early ART was associated with weight change in the first 96 weeks following incident HIV infection. Use of INSTI-based regimens represented a major driver of weight gain in men who initiated ART with relatively higher CD4 cell counts.
A patient with sporadic Creutzfeldt–Jakob disease: challenges of rare diseases in the COVID-19 era
Authors: McMurran Christopher E , Chaggar Gurjeevun H , Ugoya Solomon O 
Published: December 2020

ABSTRACT
We describe a patient who presented to hospital during the coronavirus disease 2019 (COVID-19) pandemic with sporadic Creutzfeldt–Jakob disease (sCJD). The case demonstrates the typical clinical, radiological and laboratory features of this condition. It also highlights some of the challenges associated with diagnosis and care of patients with rare diseases such as sCJD, and how these have been intensified by COVID-19.
Bronchoesophageal fistula formation after three courses of nivolumab for carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma
Authors: Nishiyama Akihiro , Sakaguchi Hiroyuki , Yanagimura Naohiro , Suzuki Chiaki , Otani Sakiko , Tanimoto Azusa , Yamashita Kaname , Takeuchi Shinji , Ohtsubo Koushiro , Ikeda Hiroko , Yano Seiji 
Published: December 2020

ABSTRACT
Immune checkpoint inhibitors (ICIs) are widely used in both monotherapy and combination chemotherapy for various types of cancers. Nivolumab is the most popular among ICIs, and the number of adapted malignant diseases for nivolumab is increasing. Bronchoesophageal fistula formation is a serious complication of the treatment for esophageal or lung cancer. However, the development of bronchoesophageal fistula as a complication of ICIs is obscure. A 59-year-old man who was diagnosed with carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma had bronchoesophageal fistula formation after three cycles of nivolumab as the fourth line treatment. Before the initiation of nivolumab, he had received two esophageal stents and an angiogenesis inhibitor. These are known risk factors for fistula formation. This is a rare case showing that nivolumab monotherapy might induce bronchoesophageal fistulae. Therefore, clinicians should be aware of the factors related to fistula formation when using ICIs.
Clinical longitudinal evaluation of COVID-19 patients and prediction of organ-specific recovery using artificial intelligence
Authors: Wang Winston T , Zhang Charlotte L , Wei Kang , Sang Ye , Shen Jun , Wang Guangyu , Lozano Alexander X 
Published: December 2020

Abstract
Within COVID-19 there is an urgent unmet need to predict at the time of hospital admission which COVID-19 patients will recover from the disease, and how fast they recover to deliver personalized treatments and to properly allocate hospital resources so that healthcare systems do not become overwhelmed. To this end, we have combined clinically salient CT imaging data synergistically with laboratory testing data in an integrative machine learning model to predict organ-specific recovery of patients from COVID-19. We trained and validated our model in 285 patients on each separate major organ system impacted by COVID-19 including the renal, pulmonary, immune, cardiac, and hepatic systems. To greatly enhance the speed and utility of our model, we applied an artificial intelligence method to segment and classify regions on CT imaging, from which interpretable data could be directly fed into the predictive machine learning model for overall recovery. Across all organ systems we achieved validation set area under the receiver operator characteristic curve (AUC) values for organ-specific recovery ranging from 0.80 to 0.89, and significant overall recovery prediction in Kaplan-Meier analyses. This demonstrates that the synergistic use of an artificial intelligence (AI) framework applied to CT lung imaging and a machine learning model that integrates laboratory test data with imaging data can accurately predict the overall recovery of COVID-19 patients from baseline characteristics.
Large Postural Sways Prevent Foot Tactile Information From Fading: Neurophysiological Evidence
Authors: Fabre Marie , Antoine Marine , Robitaille Mathieu Germain , Ribot-Ciscar Edith , Ackerley Rochelle , Aimonetti Jean-Marc , Chavet Pascale , Blouin Jean , Simoneau Martin , Mouchnino Laurence 
Published: December 2020

Abstract
Cutaneous foot receptors are important for balance control, and their activation during quiet standing depends on the speed and the amplitude of postural oscillations. We hypothesized that the transmission of cutaneous input to the cortex is reduced during prolonged small postural sways due to receptor adaptation during continued skin compression. Central mechanisms would trigger large sways to reactivate the receptors. We compared the amplitude of positive and negative post-stimulation peaks (P50N90) somatosensory cortical potentials evoked by the electrical stimulation of the foot sole during small and large sways in 16 young adults standing still with their eyes closed. We observed greater P50N90 amplitudes during large sways compared with small sways consistent with increased cutaneous transmission during large sways. Postural oscillations computed 200 ms before large sways had smaller amplitudes than those before small sways, providing sustained compression within a small foot sole area. Cortical source analyses revealed that during this interval, the activity of the somatosensory areas decreased, whereas the activity of cortical areas engaged in motor planning (supplementary motor area, dorsolateral prefrontal cortex) increased. We concluded that large sways during quiet standing represent self-generated functional behavior aiming at releasing skin compression to reactivate mechanoreceptors. Such balance motor commands create sensory reafference that help control postural sway.
Considerations for a sustainability framework for neglected tropical diseases programming
Authors: Espinal Marcos , Kruk Margaret E , Mohamed Madame Cisse Mariama , Wainwright Emily 
Published: December 2020

Abstract
Addressing neglected tropical diseases (NTDs) is critical to achieving universal healthcare and the Sustainable Development Goals. Significant strides are being made to expand NTD programs, but these programs still need to be fully incorporated into national governance, financing, planning and service delivery structures. The World Health Organization has developed a sustainability framework that calls for governments to create a vision and a multisector plan to achieving sustainability. Several critical factors need to be considered to avoid undermining progress toward disease elimination and control targets, while merging program components into national systems.
Review of transapical off-pump mitral valve intervention with NeoChord implantation
Authors: Fatehi Hassanabad Ali , Kent William D.T. , Adams Corey 
Published: December 2020

Purpose of review
Mitral valve repair surgery has recently shifted from resection-based techniques to leaflet sparing approaches using synthetic neochordae. This has facilitated the growth of a new strategy of transapical off-pump mitral valve intervention with neochord implantation.

Recent findings
Minimally invasive approaches for mitral valve repair with robotic or video-assisted mini-right anterolateral thoracotomy have been developed to mitigate the morbidity associated with conventional median sternotomy. Recently, an alternative, less invasive surgical strategy has emerged. This transapical off-pump technique employs the NeoChord DS1000 (NeoChord, Inc., Minneapolis, MN, USA) system to achieve repair with neochordae via a left minithoracotomy incision. With appropriate patient selection, advanced cardiac imaging, and training in device deployment are important for procedural success.

Summary
Early results suggest that transapical off-pump mitral valve intervention with NeoChord implantation is a safe procedure with favorable outcomes for select patients with degenerative mitral regurgitation. Continued experience and clinical trials will assess the potential of this minimally invasive strategy, but this technique is likely to become part of the surgical repertoire for managing chronic degenerative mitral valve disease.
Novel technologies in the management of heart failure with preserved ejection fraction: a promise during the time of disappointment from pharmacological approaches?
Authors: Nachman Dean , Asleh Rabea , Amir Offer 
Published: December 2020

Purpose of review
Despite numerous attempts, none of a wide variety of tested drugs achieved meaningful improvement in the outcomes of heart failure with preserved ejection fraction (HFpEF), making new therapeutic strategies a major unmet medical need. The medical device industry embraced the challenge, developing novel technologies directed to face specific aspects of the pathophysiology of HFpEF. This review focuses on some of the most promising technologies attaining meaningful clinical progress recently in the field of HFpEF therapy.

Recent findings
Implantable pulmonary artery pressure, monitoring for optimization of medical therapy, proved to be beneficial in heart failure admissions in a large postmarketing clinical study. Investigational devices, such as inter-atrial shunts and transvenous phrenic nerve stimulators for the treatment of central sleep apnea with Cheyne–Stokes breathing, are currently being evaluated in HFpEF cohorts in recent trials.

Summary
Device-based therapies for HFpEF demonstrated encouraging safety and efficacy results in various stages of the disease. Further efforts are needed to ensure that these devices will reach clinical use and contribute to the management of HFpEF patients.
Arterial hypertension and morphologic abnormalities of cardiac chambers: results from the Copenhagen General Population Study
Authors: Fuchs Andreas , Kühl J. Tobias , Sigvardsen Per E. , Knudsen Andreas D. , Nilsson Emma Julia P. , Stisen Zara R. , Jeppesen Jørgen L. , Nordestgaard Børge G. , Køber Lars V. , Kofoed Klaus F. 
Published: December 2020

Objectives:
In patients with arterial hypertension (AH), hypertension-mediated organ damage may be manifested by cardiac chamber enlargement and/or remodeling. Cardiac computed tomography imaging has emerged as an important method for morphological assessment of cardiac chambers. We tested the hypothesis that prevalence of cardiac chamber abnormalities is specifically related to clinical categories of AH in the general population.

Methods:
We studied 4747 individuals, mean age was 60 years (range: 40–93), 46% were men, undergoing 320-detector computed tomography in the Copenhagen General Population Study. Clinical categories of AH were: normotensive (n = 2484), untreated hypertensive (n = 1301), treated controlled hypertensive (n = 412) and treated uncontrolled hypertensive (n = 550). Chamber abnormalities in the form of left ventricular (LV) concentric remodeling, LV eccentric hypertrophy, LV concentric hypertrophy or left atrial enlargement were assessed, in addition to LV or right ventricular enlargement.

Results:
Chamber abnormalities were present in 23% of all individuals. Combined LV and left atrial abnormalities were rare (<2%). LV concentric remodeling (10%) was the most prevalent abnormality, and most commonly found in individuals with treated hypertension. LV and right ventricular enlargements were unrelated to hypertension. The highest frequencies of chamber abnormalities were found in individuals of elevated blood pressure (BP) with (40%) or without (32%) treatment, as opposed to individuals of normal BP with (27%) or without (14%) treatment, P less than 0.0001.

Conclusion:
In a general population cohort, untreated or inadequately treated AH was associated with the highest prevalence of cardiac chamber enlargement and remodeling. These observations suggest a strong link between elevated BPs and development of hypertension-mediated organ damage.
A Case Report of Ependymoma in a Pregnant Client With Thoracic and Lumbopelvic Pain
Authors: Fischer Melissa , Boissonnault Jill , Colquitt Jose 
Published: December 2020

Background:
Literature exists for both management of lumbopelvic pain during pregnancy and physical therapy medical screening for cancer. However, little has been written on spinal cord tumors masked by pregnancy-related thoracic or lumbopelvic pain. This case presents management of a client with pregnancy-related back pain complaints and also highlights how a spinal tumor can mimic many common pregnancy symptoms.

Case Description:
This case describes the physical therapy (PT) management of a pregnant client presenting with thoracic and lumbopelvic pain. Initially, treatment focused on core and pelvic girdle strengthening along with postural retraining and stretching. The client attended a total of 5 PT visits after which point progressive neurological symptoms developed. Medical examination, including imaging, revealed arachnoid cysts secondary to an ependymoma, a rare spinal tumor.

Outcomes:
The client delivered a viable preterm infant and passed away 2 months after her initial diagnosis secondary to the malignancy.

Discussion:
This case describes how systemic disease may present as pregnancy-related musculoskeletal dysfunction. Recognition of non–mechanical-based symptom complaints may assist in the detection of occult pathology. There are, however, rare occurrences when red flag signs appear only in the final stages of the disease with irreversible tumor expansion and metastases, ultimately leading to death.

Informed Consent:
This case is unique as the individual under discussion is deceased and therefore unable to provide consent.
Unprecedented: the toxic synergism of Covid-19 and climate change
Authors: Joshi Manish , Caceres Jose , Ko Steven , Epps Sarenthia M. , Bartter Thaddeus 
Published: December 2020

Purpose of review
To review and compare the constellations of causes and consequences of the two current pandemics, Covid-19 and climate change.

Recent findings
There has been a transient counterbalancing, in which the response to Covid-19 has briefly mitigated pollution and greenhouse gasses. This divergence belies multiple commonalities of cause and effect.

Summary
The convergence of these two pandemics is unprecedented. Although at first glance, they appear to be completely unrelated, they share striking commonalities. Both are caused by human behaviors, and some of those behaviors contribute to both pandemics at the same time. Both illustrate the fact that isolation is not an option; these are global issues that inescapably affect all persons and all nations. Both incur prodigious current and anticipated costs. Both have similar societal impacts, and disproportionately harm those with lesser resources, widening the gap between the ‘haves and the have-nots.’ One can only hope that the devastation caused by these unprecedented pandemics will lead to increased awareness of how human beings have helped to create them and how our responses can and will shape our future.
Effect on Quality of Care of a Delirium Prevention Campaign for Surgical Intensive Care Nurses
Authors: Kim Heejeong , Lee Sun-Mi 
Published: December 2020

Background:
Delirium is an important issue related to mortality in patients treated in intensive care units.

Local problem:
Although there are guidelines for preventing delirium, its importance may be overlooked compared with the treatment of physical illness.

Methods:
A 2-step delirium prevention campaign (DPC) was implemented and its effects compared (before and after the DPC).

Interventions:
The DPC comprised the Confusion Assessment Method for the Intensive Care Unit and a checklist for delirium prevention.

Results:
Hospital mortality declined after the DPC, but there were no significant changes in the incidence and duration of delirium.

Conclusions:
Nurses led the delirium preventive care intervention. Delirium prevention care may be more effective with policy approaches to progress the DPC.