bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Incidence and Cumulative Risk of Major Surgery in Older Persons in the United States
Authors: Becher Robert D. , Wyk Brent Vander , Leo-Summers Linda , Desai Mayur M. , Gill Thomas M. 
Published: November 2020

ABSTRACTImportanceAs the population of the United States (US) ages, there is considerable interest in ensuring safe and high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse.ObjectiveTo estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to demographic and geriatric characteristics.DesignProspective longitudinal study.SettingContinental US from 2011 to 2016.Participants5,571 community-living fee-for-service Medicare beneficiaries, aged 65+, from the National Health and Aging Trends Study (NHATS).Main Outcomes and MeasuresMajor surgeries were identified through linkages with data from the Centers for Medicare & Medicaid Services. Data on frailty and dementia were obtained from the baseline NHATS assessment.ResultsThe nationally-representative incidence of major surgery per 100 person-years was 8.8 (95% confidence interval [CI], 8.2-9.5), with estimates of 5.2 (95% CI, 4.7-5.7) and 3.7 (95% CI, 3.3-4.1) for elective and non-elective surgeries. The adjusted incidence of major surgery peaked at 10.8 (95% CI, 9.4-12.4) in persons 75-79 years, increased from 6.6 (95% CI, 5.8-7.5) in the non-frail group to 10.3 (95% CI, 8.9-11.9) in the frail group, and was similar by sex (males 8.6 [95% CI, 7.7-9.6]; females 8.3 [95% CI, 7.5-9.1]) and dementia (no 8.6 [95% CI, 7.9-9.3]; possible 7.8 [95% CI, 6.3-9.6]; probable 8.1 [95% CI, 6.7-9.9]). The 5-year cumulative risk of major surgery was 13.8% (95% CI, 12.2%-15.5%), representing nearly 5 million unique older persons (4,958,048 [95% CI, 4,345,342-5,570,755]), including 12.1% (95% CI, 9.5%-14.6%) in persons 85-89 years, 9.1% (95% CI, 7.2%-11.0%) in those ≥90 years, 12.1% (95% CI, 9.9%-14.4%) in those with frailty, and 12.4% (95% CI, 9.8%-15.0%) in those with probable dementia.Conclusions and RelevanceMajor surgery is a common event in the lives of community-living older persons, including high-risk vulnerable subgroups such as the oldest old, those with frailty or dementia, and those undergoing non-elective surgery. The burden of major surgery in older Americans will add to the challenges ahead for the US health care system in our aging society.KEY POINTSQuestionWhat is the incidence and cumulative risk of major surgery in older persons in the United States?FindingsIn this prospective longitudinal study, data from 5,571 community-living fee-for-service Medicare beneficiaries were used to calculate nationally-representative estimates for the incidence and cumulative risk of major surgery over a 5-year period. Nearly 9 major surgeries were performed annually for every 100 older persons, and more than 1 in 7 Medicare beneficiaries underwent a major surgery over 5 years, representing nearly 5 million unique older persons.MeaningMajor surgery is a common event in the lives of community-living older persons.
Risk exposures, risk perceptions, negative attitudes toward general vaccination, and COVID-19 vaccine acceptance among college students in South Carolina
Authors: Qiao Shan , Tam Cheuk Chi , Li Xiaoming 
Published: November 2020

AbstractGrowing attention has been paid to vaccination in control of the COVID-19 pandemic and young adults is one of the key populations for vaccination. Advanced understanding of young adults’ willingness to take a COVID-19 vaccine and the potential factors influencing their vaccine intention will contribute to the development and implementation of effective strategies to promote COVID-19 vaccine uptake among this group. The current study investigated how risk exposures and risk perceptions of COVID-19 (e.g., perceived susceptibility, severity, and fear of COVID-19) as well as negative attitudes toward general vaccination were related to COVID vaccine acceptance among college students based on online survey data from 1062 college students in South Carolina. Hierarchical linear regression was used to examine the association of these factors with COVID-19 vaccine acceptance controlling for key demographics. Results suggested that perceived severity and fear of COVID-19 were positively associated with vaccine acceptance, while higher level of risk exposures (work/study place exposure) and negative attitude toward general vaccination were associated with low vaccine acceptance. Our findings suggested that we need tailored education messages for college students to emphasize the severity of COVID-19, particularly potential long-term negative consequences on health, address the concerns of side effects of general vaccines by dispelling the misconception, and target the most vulnerable subgroups who reported high level of risk exposures while showed low intention to take the vaccine. Efforts are warranted to increase college students’ perceived susceptibility and severity and promote their self-efficacy in health management and encourage them to take protective behaviors including vaccine uptake.
Immunity status of Health Care Workers post recovery from COVID-19: An online longitudinal panel survey
Authors: Shah S B , Chawla R , Pahade A , Bansal N , Mehta A , Dewan A.K. , Prakash A , Bhatia M 
Published: November 2020

AbstractBackgroundCorona virus has literally travelled “around the world in 80 days” akin to Fogg and Passepartoute of Jules Verne fame. Manning of corona virus disease 2019 (COVID-19) wards and ICUs, also surgery on COVID-positive patients is increasingly being relegated to that subset of health care workers (HCW) who themselves have resumed duties after surviving COVID-19 infection. Convalescent plasma therapy has been widely endorsed. Several vaccines are in the pipeline as potential preventive measures against the virus keeping HCW on the priority-list of recipients. Immunity passports are being validated for foreign travel. These events share a common presumption that exposure to COVID-19 virus (natural infection/inoculation) produces protective adaptive immunity. It is unknown whether all (COVID-19) infected patients mount a protective immune response and for how long any protective effect will last.MethodsThis single institutional prospective longitudinal panel survey questions were deployed to the respondents online via email/WhatsApp groups to ascertain the symptomology and immunity status of HCW in the months following COVID-19 infection. The survey was administered to the same set/cohort of health care workers over 6 months.Results165 responses from 151 respondents (70 at 1-2months; 95 at 3-4 months including 14 at both time points) were analysed. 7.14% of infected HCW failed to develop IgG antibodies at 4-6 weeks. 91.7% HCW with IgG titres in the highest bracket had experienced anosmia. Mean antibody titres were 12.08 ± 9.56 and 9.72 ± 9.34 at 1-2 months and 3-4 months post-development of first symptom, respectively.ConclusionUnderstanding of COVID-19 patterns of variation in HCW may guide their deployment in the COVID ward and COVID-OTs. Revelation of this enigma (by quantification of serial IgG antibody levels) is critical for predicting response to vaccines under trial, fostering effective stratagems and tactics for pandemic control, ascertaining validity of immunity passports and understanding longevity/durability of protection by forecasting immunological memory against SARS-CoV-2.
Obesity as a predictor for adverse outcomes among COVID-19 patients: A meta-analysis
Authors: Das Pranta , Samad Nandeeta , Seidu Abdul-Aziz , Aboagye Richard Gyan , Tetteh Justice Kanor , Ahinkorah Bright Opoku 
Published: November 2020

AbstractBackgroundThis meta-analysis sought to determine the estimated association between obesity and adverse outcomes among COVID-19 patients.MethodsWe followed the recommended PRISMA guidelines. A systematic literature search was conducted in PubMed, Google Scholar, and ScienceDirect for published literature between December 1, 2019, and October 2, 2020. The data for the study were pooled from studies that contained the search terms “Obesity” AND (COVID-19 or 2019-nCoV or Coronavirus or SARS-CoV-2) AND (“ICU admission” OR “Hospitalization” OR “Disease severity” OR “Invasive mechanical ventilator” OR “Death” OR “Mortality”). All the online searches were supplemented by reference screening of retrieved studies for additional literature. The pooled odds ratio (OR) and confidence intervals (CI) from the retrieved studies were calculated using the random effect model (Inverse-Variance method).FindingsFive studies with a combined sample size of 335,192 patients were included in the meta-analysis. The pooled OR from the final analysis showed that patients who are severely obese were more likely to experience adverse outcome (death or ICU admission or needing IMV or hospitalization) compared to the normal patients [OR = 2.81, 95% CI = 2.33 – 3.40, I2= 29%].ConclusionSevere obesity is a risk factor in developing adverse outcomes among COVID-19 patients. The finding of the study signifies promotive, preventive, and curative attention to be accorded patients diagnosed with severe obesity and COVID-19.
Setting a course for preventing hepatitis E in low and lower-middle-income countries: A systematic review of burden and risk factors
Authors: Koyuncu Aybüke , Mapemba Daniel , Ciglenecki Iza , Gurley Emily S. , Azman Andrew S. 
Published: November 2020

AbstractBackgroundHepatitis E virus is responsible for outbreaks of acute jaundice in Africa and Asia, many of which occur among displaced people or in crisis settings. While an efficacious vaccine for HEV has been developed, we lack key epidemiologic data needed to understand how best to use the vaccine for hepatitis E control in endemic countries.MethodsWe conducted a systematic review of articles published on hepatitis E in low and lower-middle-income countries (LMIC) in Africa and Asia. We searched PubMed, Scopus, and Embase databases to identify articles with data on anti-HEV IgG seroprevalence, outbreaks of HEV, or risk factors for HEV infection, disease, or death, and all relevant data were extracted. Using these data we describe the evidence around temporal and geographical distribution of HEV transmission and burden. We estimated pooled age-specific seroprevalence and assessed the consistency in risk factor estimates.ResultsWe extracted data from 148 studies. Studies assessing anti-HEV IgG antibodies used 18 different commercial assays. Most cases of hepatitis E during outbreaks were not confirmed. Risk factor data suggested an increased likelihood of current or recent HEV infection and disease associated with fecal-oral transmission of HEV, as well as exposures to blood and animals.ConclusionHeterogeneity in diagnostic assays used and exposure and outcome assessment methods hinder public health efforts to quantify burden of disease and evaluate interventions over time and space. Prevention tools such as vaccines are available, but require a unified global strategy for hepatitis E control to justify widespread use.
Lower blood lactate and higher circulating natural killer cells at admission predict spontaneous survival in non-acetaminophen induced acute Liver failure
Authors: Agrawal Tanvi , Maiwall Rakhi , V Rajan , Bajpai Meenu , Jagdish Rakesh Kumar , Sarin Shiv Kumar , Trehanpati Nirupma 
Published: November 2020

AbstractBackground and AimsMassive cellular necrosis in ALF is dominantly immune mediated and innate immune cells are major pathophysiological determinants in liver damage. Our aim was to investigate specific innate immune cells or damage associated molecular patterns (DAMPs) relating to the final outcome of patient.MethodsIn fifty ALF patients and in fifteen age-matched healthy controls (HC), DAMPs were measured in plasma using ELISA. Phenotypic analysis of neutrophils, monocytes, natural killer (NK) and NKT cells was done by flow-cytometry and correlated with clinical and biochemical parameters.ResultsALF patients (aged 27±9 yr, 56% males, 78% viral etiology) had MELD of 31.5±8, jaundice to hepatic encephalopathy (HE) of 4.6±3.2 days, HE grade III-IV, 82% with cerebral edema, 38% met KCH criteria, 56% had suspected sepsis. Percentage of intermediate monocytes (CD14+CD16+) was increased (p<0.01) and non-classical monocytes (CD14-CD16+) was decreased in ALF compared to HC. CD16+CD56+ NK cells in total lymphocytes was significantly lower in ALF patients compared to HC, but was higher in survivors {9.28% (0.5-20.3)} than non-survivors {5.1% (0.2-10.6)} (p<0.001). Higher percentage of circulating NK cells (>6.7%) at admission was a good predictor of survival. Non-survivors had higher levels of serum lactate (6.1 vs. 28, Odds ratio 2.23, CI 1.27-3.94) and granzymeB positive NK cells than survivors. Logistic regression model predicted the combination of lactate levels with NK cell percentage at admission for survival (AUROC of 0.94; sensitivity 95.8%, specificity of 78.5%).ConclusionCombination of NK cell frequency and lactate levels at admission can reliably predict survival of ALF patients.KEY POINTSALF is generally immune mediated and predominantly caused by viral infections or acetaminophen toxicity.Therapeutic options are limited in ALF, important to know key immune players for their survival.CD16+CD56+ NK cells were found to be higher in survivors than non survivors.Combination of lactate levels with NK cell percentage at the time of admission can reliably predict the survival of ALF patients.
Willingness to vaccinate against COVID-19 in the US: Longitudinal evidence from a nationally representative sample of adults from April–October 2020
Authors: Daly Michael , Robinson Eric 
Published: November 2020

AbstractIntroductionVaccines against COVID-19 have been developed in unprecedented time. However, the effectiveness of any vaccine is dictated by the proportion of the population willing to be vaccinated. In this observational population-based study we examined intentions to be vaccinated against COVID-19 over the course of the pandemic.MethodsWe analyzed longitudinal data from a nationally representative sample of 7,547 US adults enrolled in the Understanding America Study (UAS). Participants reporting being willing, undecided and unwilling to get vaccinated against coronavirus across 13 assessments conducted from April-October, 2020. Public attitudes to vaccination against the coronavirus were also assessed.ResultsWillingness to vaccinate declined from 71% in April to 53.6% in October. This was explained by an increase in the percentage of participants undecided about vaccinating (from 10.5% to 14.4%) and the portion of the sample unwilling to vaccinate (from 18.5% to 32%). The population subgroups most likely to be undecided/unwilling to vaccinate were those without a degree (undecided: RRR=2.47, 95% CI: 2.04-3.00; unwilling: RRR=1.92, 95% CI: 1.67-2.20), Black participants (undecided: RRR=2.18, 95% CI: 1.73-2.74; unwilling: RRR=1.98, 95% CI: 1.63-2.42), and females (undecided: RRR=1.41, 95% CI: 1.20-1.65; unwilling: RRR=1.29, 95% CI: 1.14-1.46). Those aged 65+, those on high incomes, and other race/ethnicity participants were least likely to be undecided or unwilling to vaccinate. Concerns about potential side effects of a vaccine were common.ConclusionsIntentions to be vaccinated against coronavirus have declined rapidly during the pandemic and close to half of Americans are undecided or unwilling to be vaccinated.
Extinction of COVID-19 Clusters in a Lebanese Village: A Quick, Adapted Molecular and Contact tracing
Authors: Chamieh Amanda , Warrak Rania , Tawk Lucie , Zmerli Omar , Afif Claude , Rolain Jean-Marc , Azar Eid 
Published: November 2020

AbstractThere is growing evidence of cluster transmission and superspreading of SARS-CoV-2, implying heterogeneous dispersion. We discuss the successful containment of COVID-19 local outbreak in Bcharreh, the small town of 4500 inhabitants, in Northern Lebanon. We look at the dynamics of cluster transmission and viral load evolution throughout the outbreak.SARS-CoV-2 PCR test was proposed to all exposed individuals. Persons under investigation that tested negative by PCR were periodically retested. We define: a cluster as more than 3 people with a common suspicious or confirmed SARS-CoV-2 positive contact, clinical cure as the resolution of symptoms, and virologic cure as SARS-CoV-2 PCR Cycle threshold(Ct) >35. We analyzed all obtained Ct into corresponding clusters and performed a time series analysis.A total of 713/871 SARS-CoV-2 PCR tests were performed at Saint George Hospital University Medical Center (SGHUMC) from April 5th 2020 -June 14th 2020. We used the LightMix® Modular SARS-CoV-2 (COVID19) E, N, and RdRP-genes (Tib Molbiol, Berlin, Germany). Week one of epidemiologic surveillance began on March 31st when the first case was detected. A strict lockdown was imposed on Bcharreh village 5 days later, on top of the national lockdown. We identified 4 different clusters ranging from 3 to 27 cases and 3 sporadic unrelated cases.Almost 70% of each cluster was diagnosed within 7 days. After 2 weeks, we saw a significant increase in the average initial diagnostic Ct 27.9 to 34.72 (P<0.0001). A total of 73/74 SARS-CoV-2 PCR positive individuals achieved cure (98.6%). We recorded one death of a 90-year-old man with multiple comorbidities.In explosive new epidemics, we can derive from previous experience and not be blinded by it. To safely navigate out of the lockdown, focus on where new transmission is likely to emerge and accordingly target available diagnostic technologies.
Contribution of age-related effects to COVID-19 differences of crude fatality ratios in two Argentine provinces between March and August 2020
Authors: Bramajo Octavio Nicolas , Bathory María Florencia 
Published: November 2020

AbstractThe following paper presents temporary estimations of CFR (the ratio between deaths and infected positive cases) attributed to COVID-19 for two provinces in Argentina (Jujuy and Buenos Aires Province), using public data provided by the Argentine Ministry of Health. In order to make comparisons between jurisdictions, we applied a series of exploratory measures (which resulted in excluding many other jurisdictions from the comparison), and later on the Kitagawa decomposition procedure, trying to separate rate (“net” fatality) and structure components (age-attributable effects) from CFR estimations in those provinces. After the decomposition we can observe that between almost non existant differences on average, the magnitude of structure and net rate effects tend to go into different directions across age groups, indicating some premature mortality in Buenos Aires and an excess net CFR in Jujuy for older age-groups
Impact of comorbidities on COVID-19 outcome
Authors: khedr Eman M , Daef Enas , Mohamed-Hussein Aliae , Mostafa Ehab F , zein Mohamed , Hassany Sahar M , Galal Hanan , Hassan Shimaa Abbas , Galal Islam , Zarzour Amro A. , Hetta Helal F , Hassan Hebatallah M. , Amin Mariam Taher , Hashem Maiada k 
Published: November 2020

AbstractBackground and aimsThe coronavirus disease 19 (COVID-19) pandemic has spread rapidly around the globe with considerable morbidity and mortality. Coexistence of comorbidities with COVID-19 have consistently been reported as risk factors for unfavorable prognosis. We aim at this study to evaluate the impact of comorbidities in COVID-19 patients on the outcome and determine predictors of prolonged hospital stay, requisite for ICU admission or decease.MethodsFour hundreds and thirty nine adult patients who are admitted through (June and July 2020) in Assiut and Aswan University Hospitals were included in the study. All participants were diagnosed with COVID-19 according to Egyptian Ministry of Health guidance as definite case or Probable case. Detection of SARS-CoV-2 RNA was done by (TaqMan™ 2019-nCoV Control Kit v1 (Cat. No. A47532) supplied by QIAGEN, Germany on the Applied Biosystem 7500 Fast RT PCR System, USA.ResultsPatients with comorbidities represented 61.7% of all cases. Constitutional symptoms especially myalgia and LRT symptoms such as dyspnea were significantly higher in patients with comorbidities (P < 0.05). Patients with comorbidities had significantly worse laboratory parameters. ICU admission was higher in patients with comorbidities (35.8%). Among different comorbidities 45.4% of CVD cases were admitted in ICU followed by DM cases (40.8%). Also, patients with comorbidities needed invasive mechanical ventilation more than those without comorbidity (31 vs. 10.7%, P<0.001). Significant lower frequency of recovery was found in COVID-19 patients with comorbidities (59% vs. 81%, P<0.001) and death rate was significantly higher in cases with comorbidities (P< 0.001). The survival rates in cases with pre-existing CVD and neurological diseases were lower than those without disease (P<0.002 and 0.001 respectively).ConclusionAssociation of cardiovascular comorbid conditions including hypertension or neurological diseases together with COVID-19 infections carries higher risks of mortality. However, other comorbidities such as diabetes mellitus, chronic pulmonary or kidney diseases may also contribute to increased COVID-19 severity.
Second versus first wave of COVID-19 deaths: shifts in age distribution and in nursing home fatalities
Authors: Ioannidis John P.A. , Axfors Cathrine , Contopoulos-Ioannidis Despina G. 
Published: November 2020

ABSTRACTOBJECTIVETo examine whether the age distribution of COVID-19 deaths and the share of deaths in nursing homes changed in the second versus the first pandemic wave.ELIGIBLE DATAWe considered all countries that had at least 4000 COVID-19 deaths occurring as of January 14, 2020, at least 200 COVID-19 deaths occurring in each of the two epidemic wave periods; and which had sufficiently detailed information available on the age distribution of these deaths. We also considered countries with data available on COVID-19 deaths of nursing home residents for the two waves.MAIN OUTCOME MEASURESChange in the second wave versus the first wave in the proportion of COVID-19 deaths occurring in people <50 years (“young deaths”) among all COVID-19 deaths and among COVID-19 deaths in people <70 years old; and change in the proportion of COVID-19 deaths in nursing home residents among all COVID-19 deaths.RESULTSData on age distribution were available for 14 eligible countries. Individuals <50 years old had small absolute difference in their share of the total COVID-19 deaths in the two waves across 13 high-income countries (absolute differences 0.0-0.4%). Their proportion was higher in Ukraine, but it decreased markedly in the second wave. The odds of young deaths was lower in the second versus the first wave (summary odds ratio 0.80, 95% CI 0.70-0.92) with large between-country heterogeneity. The odds of young deaths among deaths <70 years did not differ significantly across the two waves (summary odds ratio 0.95, 95% CI 0.85-1.07). Eligible data on nursing home COVID-19 deaths were available for 11 countries. The share of COVID-19 deaths that were accounted by nursing home residents decreased in the second wave significantly and substantially in 8 countries (odds ratio estimates: 0.22 to 0.66), remained the same in Denmark and Norway and markedly increased in Australia.CONCLUSIONSIn the examined countries, age distribution of COVID-19 deaths has been fairly similar in the second versus the first wave, but the contribution of COVID-19 deaths in nursing home residents to total fatalities has decreased in most countries in the second wave.