bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deaths following withdrawal of life-sustaining therapy: Opportunities for quality improvement?
Authors: Guttman Matthew P. , Tillmann Bourke W. , Haas Barbara , Nathens Avery B. 
Published: July 2020

BACKGROUND
Mortality is an important trauma center outcome. With many patients initially surviving catastrophic injuries and a growing proportion of geriatric patients, many deaths might occur following withdrawal of life-sustaining therapy (WLST). We utilized the American College of Surgeons Trauma Quality Improvement Program database to explore whether deaths following WLST might be preventable and to evaluate the impact of excluding patients who died following WLST on hospital performance.

METHODS
A retrospective cohort study was conducted using data derived from American College of Surgeons Trauma Quality Improvement Program. Adult trauma patients treated at Levels I and II centers in 2016 were included. Three cohorts of deceased patients were created to assess differences in hospital performance. The first included all deaths, the second included only those who died without WLST, and the third included deaths without WLST and deaths with WLST where death was preceded by a major complication. Hospitals were ranked based on their observed-to-expected mortality ratio calculated using each of the three decedent cohorts. Outcomes included absolute change in hospital ranking and change in performance outlier status between cohorts.

RESULTS
We identified 275,939 patients treated at 447 centers who met inclusion criteria. Overall mortality was 6.9% (n = 19,145). Withdrawal of life-sustaining therapy preceded 43.6% (n = 8,343) of deaths and 23% (n = 1,920) of these patients experienced a major complication before death. The median absolute change in hospital performance rank between the first and second cohort was 58 (p < 0.001), between the first and third cohort was 44 (p < 0.001), and between the second and third cohort was 23 (p < 0.001). Hospital performance outlier status changed significantly between cohorts.

CONCLUSION
The exclusion of patients who die following WLST from benchmarking efforts leads to a major change in hospital ranks. Potentially preventable deaths, such as those following a major complication, should not be excluded.

LEVEL OF EVIDENCE
Epidemiological study, level III.
Kidney Dyads: Caregiver Burden and Relationship Strain Among Partners of Dialysis and Transplant Patients
Authors: Van Pilsum Rasmussen Sarah E. , Eno Ann , Bowring Mary G. , Lifshitz Romi , Garonzik-Wang Jacqueline M. , Al Ammary Fawaz , Brennan Daniel C. , Massie Allan B. , Segev Dorry L. , Henderson Macey L. 
Published: July 2020

Background.
Caring for dialysis patients is difficult, and this burden often falls on a spouse or cohabiting partner (henceforth referred to as caregiver-partners). At the same time, these caregiver-partners often come forward as potential living kidney donors for their loved ones who are on dialysis (henceforth referred to as patient-partners). Caregiver-partners may experience tangible benefits to their well-being when their patient-partner undergoes transplantation, yet this is seldom formally considered when evaluating caregiver-partners as potential donors.

Methods.
To quantify these potential benefits, we surveyed caregiver-partners of dialysis patients and kidney transplant (KT) recipients (N = 99) at KT evaluation or post-KT. Using validated tools, we assessed relationship satisfaction and caregiver burden before or after their patient-partner’s dialysis initiation and before or after their patient-partner’s KT.

Results.
Caregiver-partners reported increases in specific measures of caregiver burden (P = 0.03) and stress (P = 0.01) and decreases in social life (P = 0.02) and sexual relations (P < 0.01) after their patient-partner initiated dialysis. However, after their patient-partner underwent KT, caregiver-partners reported improvements in specific measures of caregiver burden (P = 0.03), personal time (P < 0.01), social life (P = 0.01), stress (P = 0.02), sexual relations (P < 0.01), and overall quality of life (P = 0.03). These improvements were of sufficient impact that caregiver-partners reported similar levels of caregiver burden after their patient-partner’s KT as before their patient-partner initiated dialysis (P = 0.3).

Conclusions.
These benefits in caregiver burden and relationship quality support special consideration for spouses and partners in risk-assessment of potential kidney donors, particularly those with risk profiles slightly exceeding center thresholds.
Trends in Living Donation by Race and Ethnicity Among Children With End-stage Renal Disease in the United States, 1995–2015
Authors: Amaral Sandra , McCulloch Charles E. , Black Elizabeth , Winnicki Erica , Lee Brian , Roll Garret R. , Grimes Barbara , Ku Elaine 
Published: July 2020

Background.
Living donor kidney transplants have declined among adults with end-stage renal disease (ESRD), with increases in racial/ethnic disparities over time. Secular trends in racial/ethnic disparities in living donor kidney transplantation have not been well studied in children.

Methods.
Using multivariable Cox modeling, we examined changes in living donor kidney transplant rates over time and probability of receiving living donor kidney transplantation within 2 years of incident ESRD by race/ethnicity among 19 772 children in the US Renal Data System, 1995–2015. We also examined racial/ethnic concordance between donors and recipients.

Results.
Overall, living donor kidney transplant rates declined by 3% annually since 1995 for all racial/ethnic groups except Asians for whom living donor kidney transplant rates remained stable; however, disparities persist. Compared with non-Hispanic white children, Hispanics were 42% less likely (adjusted hazard ratio: 0.58; 95% confidence interval: 0.49-0.67), Asians 39% less likely (0.61; 0.47-0.79), and blacks 66% less likely (0.34; 0.28-0.42) to receive living kidney donor transplantation within 2 years, even when accounting for deceased donor transplantation as a competing risk. Additionally, while 95% of non-Hispanic white children had non-Hispanic white donors, only 56% of Asian recipients had Asian donors (P < 0.001). Asian recipients were more likely to have nonrelated donors (P < 0.001).

Conclusions.
There are ongoing declines in living donation for children with ESRD for uncertain reasons, and minority populations experience significantly reduced access to timely living donor transplant, even when accounting for changes in deceased donation and donor-recipient relationships.
Brief Bubble and Intermittent Surface Oxygenation Is a Simple and Effective Alternative for Membrane Oxygenation During Hypothermic Machine Perfusion in Kidneys
Authors: Darius Tom , Vergauwen Martial , Mueller Matteo , Aydin Selda , Dutkowski Philipp , Gianello Pierre , Mourad Michel 
Published: July 2020

Background.
The aim of this feasibility study was to determine an alternative oxygenation technique (easy, cheap, and compatible with air transport) for membrane oxygenation during hypothermic machine perfusion (HMP) to improve early graft function in a porcine ischemia-reperfusion autotransplant model.

Methods.
The left kidney of a ±40- kg pig was exposed to 30 minutes of warm ischemia before 22 hours of preservation and autotransplantation. In the experimental group, oxygenation of the perfusate during HMP was obtained by direct bubble and 30-minute surface oxygenation at start and 1-hour end ischemic (n = 4) and outcome measures compared with historical HMP without active oxygenation (n = 6), 22-hour continuous oxygenated HMP (HMPO2) (n = 8), and 2-hour HMPO2 + 20-hour HMP (n = 6) using membrane oxygenation in both historical oxygenated control groups.

Results.
Brief bubble and 30-minute surface oxygenation of the perfusate effectively maintained supraphysiological Po
2 levels during the first 2 hours of HMP with improved flow dynamics. Although the metabolic profile of the perfusate (ie, flavin mononucleotide) and tissue (ie, glutamate, ATP) after brief O2 uploading at the start of HMP seemed to be slightly better with the use of a membrane oxygenator compared with bubble and interrupted surface oxygenation, both techniques yielded similar, superior early graft function when compared with HMP without active oxygenation.

Conclusions.
The data presented in this feasibility study support the conclusion that brief bubble and intermittent surface oxygenation could be an alternative oxygenation technique during HMP to achieve an improved kidney graft function compared with HMP without active oxygenation and similar functional outcome when compared with membrane HMPO2.
Preliminary optimisation of simplified sample preparation method to permit direct detection of SARS-CoV-2 within saliva samples using reverse- transcription loop-mediated isothermal amplification (RT-LAMP)
Authors: Howson Emma L. A. , Kidd Stephen P. , Sawyer Jason , Cassar Claire , Cross David , Lewis Tom , Hockey Jess , Rivers Samantha , Cawthraw Saira , Banyard Ashley , Andreou Michael , Morant Nick , Clark Duncan , Walsh Charlotte , Laxman Shailen , Houghton Rebecca , Slater-Jefferies Joanne , Costello Paula , Brown Ian , Cortes Nicholas , Godfrey Keith M. , Fowler Veronica L. 
Published: July 2020

AbstractWe describe the optimization of a simplified sample preparation method which permits rapid and direct detection of SARS-CoV-2 RNA within saliva using reverse-transcription loop-mediated isothermal amplification (RT-LAMP). Treatment of saliva samples prior to RT-LAMP by dilution 1:1 in Mucolyse™, followed by dilution (within the range of 1:5 to 1:40) in 10% (w/v) Chelex© 100 Resin and a 98°C heat step for 2 minutes enabled detection of SARS-CoV-2 RNA in all positive saliva samples tested, with no amplification detected in pooled negative saliva. The time to positivity for which SARS- CoV-2 RNA was detected in these positive saliva samples was proportional to the real-time reverse- transcriptase PCR cycle threshold (CT), with SARS-CoV-2 RNA detected in as little as 05:43 (CT 21.08), 07:59 (CT 24.47) and 08:35 (CT 25.27) minutes, respectively. The highest CT where direct RT-LAMP detected SARS-CoV-2 RNA was 31.39 corresponding to a 1:40 dilution of a positive saliva sample with a starting CT of 25.27. When RT-LAMP was performed on pools of SARS-CoV-2 negative saliva samples spiked with whole inactivated SARS-CoV-2 virus, RNA was detected at dilutions spanning 1:5 to 1:160 representing CT’s spanning 22.49-26.43. Here we describe a simple but critical rapid sample preparation method which can be used up front of RT-LAMP to permit direct detection of SARS-CoV- 2 within saliva samples. Saliva is a sample which can be collected non-invasively without the use of highly skilled staff and critically can be obtained from both health care and home settings. Critically, this approach overcomes both the requirement and validation of different swabs and the global bottleneck observed in obtaining RNA extraction robots and reagents to enable molecular testing by PCR. Such testing opens the possibility of public health approaches for effective intervention to control the COVID-19 pandemic through regular SARS-CoV-2 testing at a population scale, combined with isolation and contact tracing for positive cases.
Detecting Emerging COVID-19 Community Outbreaks at High Spatiotemporal Resolution — New York City, June–July 2020
Authors: Greene Sharon K. , Peterson Eric R. , Balan Dominique , Jones Lucretia , Culp Gretchen M. , Fine Annie D. , Kulldorff Martin 
Published: July 2020

AbstractNew York City’s Health Department developed a SARS-CoV-2 percent test positivity cluster detection system using census tract resolution and the SaTScan prospective space-time scan statistic. One cluster led to identifying a gathering with inadequate social distancing where viral transmission likely occurred, and another cluster prompted targeted community testing and outreach.
Evaluation of diversity levels of the integrase gene sequences coming from HIV-1 virus, supporting the lack of target specificity of ivermectinversusthe integrase-importin complex in SARS-CoV-2 infection
Authors: Félix Pierre Teodósio 
Published: July 2020

AbstractTherapies with new drugs have been appearing in tests worldwide as potential inhibitors of sars-cov-2 virus replication. Recently, one of these drugs, Ivermectin, was reported as an inhibitor of the nuclear import of HIV-1 proteinsin vitro, soon becoming the target of an international prospecting work (not yet published), with patients tested for COVID-19. However, understanding the evolutionary aspects of the biological components involved in the complex drug-nuclear import helps in understanding how these relationships exist in the deactivation of viral infections. Thus, 153 sequences of the HIV-1 integrase gene were analyzed for their genetic structure and molecular diversity and the presence of two distinct groups for the Gene and not only one, was detected; As well as different degrees of structuring for each of these groups. These results support the interpretation of the lack of conservation of the HIV-1 gene and that the number of existing polymorphisms, only for this structure of the complex, implies the non-efficiency of a drug at population levels. Thus, the molecular diversity found in HIV-1 can be extrapolated to other viruses, such as Including, SARS-CoV-2 and the functionality of the drug, interacting with the integrase-importin complex, can be further decreased.
High Community SARS-CoV-2 Antibody Seroprevalence in a Ski Resort Community, Blaine County, Idaho, US. Preliminary Results
Authors: McLaughlin Colleen C. , Doll Margaret K. , Morrison Kathryn T. , McLaughlin William L. , O’Connor Terry , Sholukh Anton M. , Bossard Emily L. , Phasouk Khamsone , Ford Emily S. , Diem Kurt , Klock Alexis M. , Jerome Keith R. , Corey Lawrence 
Published: July 2020

AbstractCommunity-level seroprevalence surveys are needed to determine the proportion of the population with previous SARS-CoV-2 infection, a necessary component of COVID-19 disease surveillance. In May, 2020, we conducted a cross-sectional seroprevalence study of IgG antibodies for nucleocapsid of SARS-CoV-2 among the residents of Blaine County, Idaho, a ski resort community with high COVID-19 attack rates in late March and Early April (2.9% for ages 18 and older). Participants were selected from volunteers who registered via a secure web link, using prestratification weighting to the population distribution by age and gender within each ZIP Code. Participants completed a survey reporting their demographics and symptoms; 88% of volunteers who were invited to participate completed data collection survey and had 10 ml of blood drawn. Serology was completed via the Abbott Architect SARS-CoV-2 IgG immunoassay. Primary analyses estimated seroprevalence and 95% credible intervals (CI) using a hierarchical Bayesian framework to account for diagnostic uncertainty. Stratified models were run by age, sex, ZIP Code, ethnicity, employment status, and a priori participant-reported COVID-19 status. Sensitivity analyses to estimate seroprevalence included base models with post-stratification for ethnicity, age, and sex, with or without adjustment for multi-participant households. IgG antibodies to the virus that causes COVID-19 were found among 22.7% (95% CI: 20.1%, 25.5%) of residents of Blaine County. Higher levels of antibodies were found among residents of the City of Ketchum 34.8% (95% CI 29.3%, 40.5%), compared to Hailey 16.8% (95%CI 13.7%, 20.3%) and Sun Valley 19.4% (95% 11.8%, 28.4%). People who self-identified as not believing they had COVID-19 had the lowest prevalence 4.8% (95% CI 2.3%, 8.2%). The range of seroprevalence after correction for potential selection bias was 21.9% to 24.2%. This study suggests more than 80% of SARS-CoV-2 infections were not reported. Although Blaine County had high levels of SARS-CoV-2 infection, the community is not yet near the herd immunity threshold.
“Sleepless in Lockdown”: unpacking differences in sleep loss during the coronavirus pandemic in the UK
Authors: Falkingham Jane , Evandrou Maria , Qin Min , Vlachantoni Athina 
Published: July 2020

AbstractBackgroundCovid-19 has been shown to be having a disproportionate impact on the health of individuals from different ethnic groups and those employed in certain occupations, whilst the indirect impacts of Covid-19, including the closure of schools and business and the move to home working, fall disproportionately on the young and on women. These factors may in turn impact upon sleep health. Research on sleep deprivation during the pandemic crisis to date has been limited. The present study aimed to explore the levels and social determinants of self-reported sleep loss among the general population during the Covid-19 pandemic in the UK, with a particular focus on ethnic and gender disparities.MethodsNewly available national representative survey data from Understanding Society COVID- 19 Study collected during April 2020 were analysed. These data were linked to Wave 9 of Understanding Society conducted in 2018/19, providing information about the respondents prior to the outbreak of the pandemic. Cross-sectional analysis provided prevalence estimates, whilst analysis of the linked longitudinal data provided incidence estimates. The analytical sample included 15,360 respondents aged 16 and above; among these, 12,206 reported no problem of sleep loss before the epidemic.ResultsPrevalence and incidence rates of perceived sleep loss were 24.7% and 20.2% respectively. Women (at the level of 31.8% and 27.0%) and individuals from Black, Asian, and minority ethnic (BAME) communities (at the level of 32.0% and 24.6%) were more vulnerable to sleep deprivation due to the pandemic. Multivariate regression analysis shows that being female, the presence of young children in the household, perceived financial difficulties and being a Covid-19-related key worker were all predictive of sleep loss. Once these covariates were controlled for the bivariate relationship between ethnicity and sleep loss was reversed, reflecting the complex interaction between the coronavirus epidemic and ethnicity.ConclusionsThe pandemic has widened the disparity of sleep deprivation across different groups, with women with young children, key workers and people of BAME heritage all experiencing difficulty in sleeping, which in turn may negatively affect mental and physical health and well-being.
Recurrent SARS-CoV-2 RNA positivity after COVID-19: A systematic review and meta-analysis
Authors: Azam Mahalul , Sulistiana Rina , Ratnawati Martha , Fibriana Arulita Ika , Bahrudin Udin , Aljunid Syed Mohamed 
Published: July 2020

AbstractBackgroundPrevious studies reported recurrent SARS-CoV-2 RNA positivity in individuals who had recovered from COVID-19 infections. However, little is known regarding the systematic review of recurrent SARS-CoV-2 RNA positivity. The current study conducted a systematic review and meta-analysis, aimed to estimate the incidence of recurrent SARS-CoV-2 RNA positivity after recovery from COVID-19 and to determine the factors associated with recurrent positivity.MethodsWe searched the PubMed, MedRxiv, BioRxiv, the Cochrane Library, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry for studies published to June 12, 2020. Studies were reviewed to determine the risk of bias. A random-effects model was used to pool results. Heterogeneity was assessed using I2.ResultsFourteen studies of 2,568 individuals were included. The incidence of recurrent SARS-CoV-2 positivity was 14.81% (95% confidence interval [CI]: 11.44–18.19%). The pooled estimate of the interval from disease onset to recurrence was 35.44 days (95% CI: 32.65–38.24 days), and from the last negative to recurrent positive result was 9.76 days (95% CI: 7.31–12.22 days). Patients with younger age (mean difference [MD]=-2.27, 95% CI: -2.95 to -1.80) and a longer initial illness (MD=8.24 days; 95% CI: 7.54 – 8.95; I2=98.9%) were more likely to experience recurrent SARS-CoV-2 positivity, while patients with diabetes (RR=0.52; 95% CI: 0.30-0.90; I2=53%), severe disease (RR=0.54; 95% CI: 0.35-0.84; I2=70%), and a low lymphocyte count (RR=0.58; 95% CI: 0.39 – 0.86; I2=48%) were less likely to experience recurrent SARS-CoV-2 positivity.ConclusionsThe incidence of recurrent SARS-CoV-2 positivity was 14.81%. The estimated interval from disease onset to repeat positivity was 35.44 days, and the estimated interval from the last negative result to recurrent positive result duration was 9.76 days.
Bioaersols in orthopedic surgical procedures and implications for clinical practice in the times of COVID-19 pandemic: a protocol for systematic review and meta-analysis
Authors: Sharma Siddhartha , John Rakesh , Neradi Deepak , Patel Sandeep , Dhillon Mandeep Singh 
Published: July 2020

AbstractBackgroundOrthopedic surgical procedures involve a number of aerosol generating procedures; these include electrocautery, power instruments for bone cutting, burring and drilling, and tools for wound lavage. This assumes a great significance in the context of the current COVD-19 pandemic, as there are chances of aerosol-borne disease transmission in orthopedic surgical procedures. Hence, this systematic review and meta-analysis will be undertaken to assimilate and analyse the available evidence on bioaerosols in orthopedic surgical procedures and their significance with respect to SARS-CoV-2 virus transmission.ObjectivesTo determine the characteristics (amount and/or density, size, infectivity, and spread etc.) of bioaerosols found in orthopaedic operating rooms (ORs) and to determine the characteristics of aerosols generated by different orthopaedic power tools and devices.MethodsA systematic review and meta-analysis will be conducted. The PRISMA guidelines will be strictly followed. The primary search will be conducted on the PubMed, EMBASE, Scopus, Cochrane Library, medRxiv, bioRxix and Lancet preprint databases, using a well-defined search strategy. Any original research study (including cohort, case-control, case series, cadaveric studies and studies, animal models, laboratory based experimental studies) looking at aerosol generation in orthopedic surgical procedures, or aerosol generation by orthopaedic power tools and devices will included. Outcome measures will include characteristics (amount and/or density, size, infectivity, and spread etc.) of bioaerosols found in orthopaedic operating rooms (ORs) and those generated by various orthopaedics power tools and devices. Metanalysis using the random-effects model will be conducted to determined pooled estimates of the outcome variables. Heterogeneity will be assessed by the I2 test. Risk of bias will be assessed by the Risk of Bias in Studies estimating Prevalence of Exposure to Occupational risk factors (RoB-SPEO) tool. The overall strength of evidence will be assessed by the GRADE approach.