bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knowledge and Behaviors towards COVID-19 among University of Aleppo Students: An Online Cross-sectional Survey
Authors: Alhamid Aos , Aljarad Ziad , Alhamid Ahmad 
Published: July 2020

AbstractBackgroundCoronavirus Disease 2019 (COVID-19) is an infection caused by a novel coronavirus that affects respiratory tract. People’s awareness and knowledge of, and behavior and attitude toward COVID-19 are scarcely investigated, making medical literature related to this point poor. we aim to measure the knowledge of, and the reaction to COVID-19 among University of Aleppo students in Syria, and the determinants of their awareness and behavior regarding this disease.Materials and MethodsThis was an online, questionnaire-based cross-sectional study, that was conducted from 21st March to 30 March 2020. We included undergraduate students of the University of Aleppo (Syria). The questionnaire consisted of three sections: Demographics,knowledge and behaviours. Every participant’s knowledge was scored from 0-13 depending on the number of correct answers in the knowledge section. The correctness was judged depending on WHO recommendations at the time of questionnaire administration. P-value of 0.05 was considered significant.ResultsAmong this well-educated and predominantly medical and health-related students, 682 (45.4%) students had a good knowledge level, which is somehow disappointing. The current study shows that 1st year students and non-medical specialties students and smokers had significantly lower knowledge levels than others. On contrary, residing with less people-which may indicate a higher socioeconomic status-, was associated with a higher knowledge level. We also found that commitment to preventive measures was in general satisfying and correlated significantly with knowledge level and gender in most cases.ConclusionJunior students, non-medical specialties, smokers and those who live with high number of people are vulnerable to less knowledge level and awareness campaigns should concentrate on them. Increasing awareness is useful to increase commitment to preventive measures, and groups that have less adherence to preventive measures, as described in detail, should be taken into consideration while designing public health responses. Finally, we should be aware of the negative impact of quarantine on public health to take it into consideration for current campaigns and future policies.
‘Trained immunity’ from Mycobacterium spp. exposure or BCG vaccination and COVID-19 outcomes
Authors: Singh Samer , Maurya Rajendra P. , Singh Rakesh K. 
Published: July 2020

ABSTRACTProtective variables for COVID-19 are unknown. ‘Trained immunity’ of the populace as a result of BCG immunization policy implementation and coverage had been suggested to be one of the factors responsible for the differential impact of COVID-19 on different countries. Several trials are underway to evaluate the potential protective role of BCG vaccination in COVID-19. However, the lack of clarity on the use of appropriate controls concerning the measures of ‘trained immunity’ or the heterologous cell-mediated immunity conferred by BCG vaccination has been a cause of concern leading to more confusion as exemplified by a recently concluded trial in Israel that failed to find any protective correlation with regard to BCG vaccination. Whereas, when we analyze the COVID-19 data of European countries without any regard for BCG vaccination policy but with similar age distribution, comparable confounding variables, and the stage of the pandemic, the prevalence of tuberculin immunoreactivity - a measure of cell-mediated immunity persistence as a result of Mycobacterium spp. (including BCG vaccine) exposure of the populations, is found consistently negatively correlated with COVID-19 infections and mortality per million population, at all the time points evaluated. We propose that on-going and future studies evaluating the effect of BCG vaccination on COVID-19 outcomes may actively consider, if not already, the inclusion of controls for underlying ‘trained immunity’ and heterologous cell-mediated immunity prevalence that may be pre-existing or resulting from the intervention (e.g., BCG vaccine) in such trials to arrive at more dependable conclusions concerning their potential benefit.
Diagnosis of COVID-19 using CT scan images and deep learning techniques
Authors: Shah Vruddhi , Keniya Rinkal , Shridharani Akanksha , Punjabi Manav , Shah Jainam , Mehendale Ninad 
Published: July 2020

AbstractEarly diagnosis of the coronavirus disease in 2019 (COVID-19) is essential for controlling this pandemic. COVID-19 has been spreading rapidly all over the world. There is no vaccine available for this virus yet. Fast and accurate COVID-19 screening is possible using computed tomography (CT) scan images. The deep learning techniques used in the proposed method was based on a convolutional neural network (CNN). Our manuscript focuses on differentiating the CT scan images of COVID-19 and non-COVID 19 CT using different deep learning techniques. A self developed model named CTnet-10 was designed for the COVID-19 diagnosis, having an accuracy of 82.1 %. Also, other models that we tested are DenseNet-169, VGG-16, ResNet-50, InceptionV3, and VGG-19. The VGG-19 proved to be superior with an accuracy of 94.52 % as compared to all other deep learning models. Automated diagnosis of COVID-19 from the CT scan pictures can be used by the doctors as a quick and efficient method for COVID-19 screening.
Correlations between individual factors, meteorological factors, and hemorrhagic fever with renal syndrome in the Tai’an area of China, 2005–2019
Authors: Bi XiuJuan , Yi Shuying , Zhang Aihua , Zhao Zhenghua , Liu Yunqiang , Wang Tao , Zhang Chao , Ye Zhen 
Published: July 2020

AbstractHemorrhagic fever with renal syndrome (HFRS), is a serious threat to human health. The relative risks factors for different occupations, ages, and sexes are unknown.The results showed that compared with the whole population, the risk ratio was 5.05 (p <0.05) among the rural medical staff. GAM showed that air temperature was positively correlated with disease risk from January to June and that relative humidity was negatively correlated with risk from July to December. From January to June, the cumulative risk of disease increased at low temperatures.Rural medical staff showed a high risk of developing the disease. The possibility of human-to-human transmission of HFRS among rural medical staff is worthy of interest and deserves to be explored by further studies. Moreover, air temperature and relative humidity are important factors that affect the occurrence of the disease. These associations show lagged effects and differing effects according to the season.
The competing risk between in-hospital mortality and recovery: A pitfall in COVID-19 survival analysis research
Authors: Oulhaj Abderrahim , Ahmed Luai A. , Prattes Juergen , Suliman Abubaker , Alsuwaidi Ahmed R. , Al-Rifai Rami H. , Sourij Harald , Van Keilegom Ingrid 
Published: July 2020

ABSTRACTBackgroundA plethora of studies on COVID-19 investigating mortality and recovery have used the Cox Proportional Hazards (Cox PH) model without taking into account the presence of competing risks. We investigate, through extensive simulations, the bias in estimating the hazard ratio (HR) and the absolute risk reduction (ARR) of death when competing risks are ignored, and suggest an alternative method.MethodsWe simulated a fictive clinical trial on COVID-19 mimicking studies investigating interventions such as Hydroxychloroquine, Remdesivir, or convalescent plasma. The outcome is time from randomization until death. Six scenarios for the effect of treatment on death and recovery were considered. The HR and the 28-day ARR of death were estimated using the Cox PH and the Fine and Gray (FG) models. Estimates were then compared with the true values, and the magnitude of misestimation was quantified.ResultsThe Cox PH model misestimated the true HR and the 28-day ARR of death in the majority of scenarios. The magnitude of misestimation increased when recovery was faster and/or chance of recovery was higher. In some scenarios, this model has shown harmful treatment effect when it was beneficial. Estimates obtained from FG model were all consistent and showed no misestimation or changes in direction.ConclusionThere is a substantial risk of misleading results in COVID-19 research if recovery and death due to COVID-19 are not considered as competing risk events. We strongly recommend the use of a competing risk approach to re-analyze relevant published data that have used the Cox PH model.
Municipality- level predictors of COVID-19 mortality in Mexico: a cautionary tale
Authors: Contreras-Manzano Alejandra , Guerrero-López Carlos M. , Aguerrebere Mercedes , Sedas Ana Cristina , Lamadrid-Figueroa Héctor 
Published: July 2020

SummaryBackgroundInequalities and burden of comorbidities of the Coronavirus disease 2019 (COVID-19) vary importantly inside the countries. We aimed to analyze the Municipality-level factors associated with a high COVID-19 mortality rate of in Mexico.MethodsWe retrieved information from 142,643 cumulative confirmed symptomatic cases and 18,886 deaths of COVID-19 as of June 20th, 2020 from the publicly available database of the Ministry of Health of Mexico. Public official data of the most recent census and surveys of the country were used to adjust a negative binomial regression model with the quintiles (Q) of the distribution of sociodemographic and health outcomes among 2,457 Municipality-level. Expected Mortality Rates (EMR), Incidence Rate Ratios (IRR) and 95% Confidence Intervals are reported.ResultsFactors associated with high MR of COVID-19, relative to Quintile 1 (Q1), were; diabetes prevalence (Q4, IRR=2.60), obesity prevalence (Q5, IRR=1.93), diabetes mortality rate (Q5, IRR=1.58), proportion of indigenous population (Q2, IRR=1.68), proportion of economically active population (Q5, IRR=1.50), density of economic units that operate essential activities (Q4, IRR=1.54) and population density (Q5, IRR=2.12). We identified 1,351 Municipality-level without confirmed COVID-19 deaths, of which, 202 had nevertheless high (Q4, Mean EMR= 8.0 deaths per 100,000) and 82 very high expected COVID-19 mortality (Q5, Mean EMR= 13.8 deaths per 100,000).ConclusionThis study identified 1,351 Municipality-level of Mexico that, in spite of not having confirmed COVID-19 deaths yet, share characteristics that could eventually lead to a high mortality scenario later in the epidemic and warn against premature easing of mobility restrictions. Local information should be used to reinforce strategies of prevention and control of outbreaks in communities vulnerable to COVID-19.Key messagesPredictors of COVID-19 mortality varied importantly between Municipality-level.Municipality-level factors associated with high mortality of COVID-19 were the prevalence of obesity and diabetes, mortality rate of diabetes, the proportion of indigenous and economically active population and population density.Municipality-level with high case-fatality rates of COVID-19 are likely undergoing insufficient testing and should improve its availability.Identified predictors ought to be considered by local governments to reinforce tailored strategies to prevent casualties in populations vulnerable to COVID-19, as mortality is expected to be eventually high in some Municipality-level that may not have reached the apex of the epidemic yet.
COVID-19 among people living with HIV: A systematic review
Authors: Mirzaei Hossein , McFarland Willi , Karamouzian Mohammad , Sharifi Hamid 
Published: July 2020

AbstractThis systematic review summarizes the evidence on the earliest patients with COVID-19-HIV co-infection. We searched PubMed, Scopus, Web of Science, Embase, preprint databases, and Google Scholar from December 01, 2019 to June 1, 2020. From an initial 547 publications and 75 reports, 25 studies provided specific information on COVID-19 patients living with HIV. Studies described 252 patients, 80.9% were male, mean age was 52.7 years, and 98% were on ART. Co-morbidities in addition to HIV and COVID-19 (multimorbidity) included hypertension (39.3%), obesity or hyperlipidemia (19.3%), chronic obstructive pulmonary disease (18.0%), and diabetes (17.2%). Two-thirds (66.5%) had mild to moderate symptoms, the most common being fever (74.0%) and cough (58.3%). Among patients who died, the majority (90.5%) were over 50 years old, male (85.7%), and had multimorbidity (64.3%). Our findings highlight the importance of identifying co-infections, addressing co-morbidities, and ensuring a secure supply of ART for PLHIV during the COVID-19 pandemic.
Comparisons of the genome of SARS-CoV-2 and those of other betacoronaviruses
Authors: Rodríguez-Román Eduardo , Gibbs Adrian J. 
Published: July 2020

AbstractThe genome of SARS-CoV-2 virus causing the worldwide pandemic of COVID-19 is most closely related to viral metagenomes isolated from bats and, more distantly, pangolins. All are of sarbecoviruses of the genusBetacoronavirus. We have unravelled their recombinational and mutational histories. All showed clear evidence of recombination, most events involving the 3’ half of the genomes. The 5’ region of their genomes was mostly recombinant free, and a phylogeny calculated from this region confirmed that SARS-CoV-2 is closer to RmYN02 than RaTG13, and showed that SARS-CoV-2 diverged from RmYN02 at least 26 years ago, and both diverged from RaTG13 at least 37 years ago; recombinant regions specific to these three viruses provided no additional information as they matched no other Genbank sequences closely. Simple pairwise comparisons of genomes show that there are three regions where most non-synonymous changes probably occurred; the DUF3655 region of the nsp3, the S gene and ORF 8 gene. Differences in the last two of those regions have probably resulted from recombinational changes, however differences in the DUF3655 region may have resulted from selection. A hexamer of the proteins encoded by the nsp3 region may form the molecular pore spanning the double membrane of the coronavirus replication organelle (Wolff et al., 2020), and perhaps the acidic polypeptide encoded by DUF3655 lines it, and presents a novel target for pharmaceutical intervention.
Outbreak of COVID-19 and Interventions in One of the Largest Jails in the United States — Cook County, IL, 2020
Authors: Zawitz Chad , Welbel Sharon , Ghinai Isaac , Mennella Connie , Levin Rebecca , Samala Usha , Smith Michelle Bryant , Gubser Jane , Jones Bridgette , Varela Kate , Kirbiyik Uzay , Rafinski Josh , Fitzgerald Anne , Orris Peter , Bahls Alex , Black Stephanie R. , Binder Alison M. , Armstrong Paige A. 
Published: July 2020

ABSTRACTBackgroundCorrectional and detention facilities are disproportionately affected by COVID-19 due to shared space, contact between staff and detained persons, and movement within facilities of detained persons, many with pre-existing medical conditions. On March 18, 2020, Cook County Jail, one of the United States’ largest, identified its first suspected case of COVID-19 in a detained person.MethodsThis analysis includes SARS-CoV-2 cases confirmed by molecular detection among detained persons and Cook County Sheriff’s Office staff. We examined occurrence of symptomatic cases in each building and proportions of asymptomatic detained persons testing positive. We describe timing of interventions including social distancing, mask use, and expanded testing and show outbreak trajectory in the jail versus contemporaneous case counts in Chicago.ResultsDuring March 1–April 30, 907 symptomatic and asymptomatic cases of SARS-CoV-2 infection were detected among detained persons (n = 628) and staff (n = 279), with nine deaths. Symptomatic cases occurred in all housing divisions; in 9/13 buildings, staff cases occurred first. Among asymptomatic detained persons in quarantine, 23.6% tested positive. Visitation stopped March 15, programmatic activities were suspended March 23, cells were converted into single occupancy beginning March 26, and universal masking was implemented for staff (April 2) and detained persons (April 13). Cases at the jail declined while cases in Chicago increased.ConclusionAggressive intervention strategies coupled with widespread diagnostic testing of detained and staff populations can limit introduction and mitigate transmission of SARS-CoV-2 infection in correctional and detention facilities.
Identification of novel mechanistically distinct endotypes of pandemic influenza-associated acute respiratory failure
Authors: Samanta Romit , Dunning Jake , Taylor Adam , Bayliffe Andrew I. , Chambers Rachel C. , Chilvers Edwin R. , Openshaw Peter JM. , Summers Charlotte 
Published: July 2020

AbstractRespiratory viral pandemics result in large numbers of cases of acute respiratory failure arising from a single etiology, thus reducing the heterogeneity of precepting insult and allowing improved insight into the variation of host responses. In 2009-2011, an influenza pandemic occurred, with pH1N1 infecting millions of people worldwide. Here, we have used novel bioinformatic methods to combine clinical, protein biomarker, and genomic data from patients with influenza-associated acute respiratory failure to identify three mechanistically discrete sub-types with significantly different clinical outcomes. The three endotypes identified can be described as “neutrophil-driven” (16.3%), “adaptive” (51.9%), and “endothelial leak” (31.7%). The neutrophil driven patients display evidence of innate immune activation with associated multi-organ dysfunction and reduced 30-day survival. These patients could be differentiated from the adaptive endotype by an alteration in the GAIT-mechanism, a late transcriptional regulatory response to IFN-γ that acts to suppress innate immunity by reducing caeruloplasmin mRNA translation. Patients with the neutrophil-driven endotype had significantly increased IFN-γ levels but appeared unable to suppress their innate immune response. The endothelial leak endotype could be distinguished from both the neutrophil driven and adaptive endotypes by alterations in Slit-Robo signalling, a pathway important in the maintenance of endothelial barrier integrity; Although patients with this endotype required mechanical ventilation, they did not develop multi-organ failure in the manner of the neutrophil-driven endotype patients, and had significantly better clinical outcomes. Importantly, the endotypes identified were stable over 48 hours opening up the possibility of stratified interventional clinical trials in the future.One Sentence SummaryWe have identified three new mechanistically distinct subtypes of influenza associated acute respiratory failure, with differential clinical outcomes.
Public Opinions towards COVID-19 in California and New York on Twitter
Authors: Wang Xueting , Zou Canruo , Xie Zidian , Li Dongmei 
Published: July 2020

AbstractBackgroundWith the pandemic of COVID-19 and the release of related policies, discussions about the COVID-19 are widespread online. Social media becomes a reliable source for understanding public opinions toward this virus outbreak.ObjectiveThis study aims to explore public opinions toward COVID-19 on social media by comparing the differences in sentiment changes and discussed topics between California and New York in the United States.MethodsA dataset with COVID-19-related Twitter posts was collected from March 5, 2020 to April 2, 2020 using Twitter streaming API. After removing any posts unrelated to COVID-19, as well as posts that contain promotion and commercial information, two individual datasets were created based on the geolocation tags with tweets, one containing tweets from California state and the other from New York state. Sentiment analysis was conducted to obtain the sentiment score for each COVID-19 tweet. Topic modeling was applied to identify top topics related to COVID-19.ResultsWhile the number of COVID-19 cases increased more rapidly in New York than in California in March 2020, the number of tweets posted has a similar trend over time in both states. COVID-19 tweets from California had more negative sentiment scores than New York. There were some fluctuations in sentiment scores in both states over time, which might correlate with the policy changes and the severity of COVID-19 pandemic. The topic modeling results showed that the popular topics in both California and New York states are similar, with “protective measures” as the most prevalent topic associated with COVID-19 in both states.ConclusionsTwitter users from California had more negative sentiment scores towards COVID-19 than Twitter users from New York. The prevalent topics about COVID-19 discussed in both states were similar with some slight differences.
Impact of a medical-legal partnership program on readmissions to a family medicine inpatient service
Authors: James Emma , Samson Emily , Manek Megha , Robinson Robert 
Published: July 2020

BackgroundThe Centers for Medicare and Medicaid Services (CMS) value-based reimbursement prioritizes health outcomes and population health in a way that emphasizes social determinants of health, access disparities, and prevention. Unmet legal assistance needs are an area of considerable interest because it can impact access to healthcare services and can be a social determinant of health. Medical-Legal Partnerships (MLP) are tools to link patients with unmet legal needs with lawyers and other legal services. The goal of these programs is to address legal issues that complicate the life and healthcare of patients. With the hypothesis that unmet legal needs were a risk factor for poor health outcomes, we studied the impact of unmet legal needs on the readmission rate to the SIU Family and Community Medicine inpatient service at Memorial Medical Center in Springfield, Illinois.MethodsAll adult patients discharged between January 2016 and March 2018 were retrospectively studied to determine if the need for legal services was a significant predictor of all-cause hospital readmission within 30 days of discharge. Patients in need of legal services were identified using an interview-based screening tool and were referred to an HRSA-grant funded MLP. The impact of unmet needs for legal services was compared to validated risk factors for hospital readmissions such as the LACE index and HOSPITAL score.ResultsData from 2500 hospital discharges from the SIU FCM service were analyzed. The overall readmission rate was 27%. Univariate analysis showed patients who were readmitted were older (57 vs 53 years, p < 0.001), had longer hospital stays (4.69 vs 4.17 days, p < 0.014), had higher Charlson Comorbidity Index values (2.31 vs 1.57, p < 0.001), HOSPITAL scores (4.79 vs. 3.14, p < 0.001), LACE index values (10.13 vs. 8.33, p < 0.001) and were more likely to need legal services (12% vs. 3%, p < 0.001). Multivariate analysis showed the HOSPITAL score (OR 2.12, p<0.001), LACE index (OR 1.16, p<0.001), Charlson Comorbidity Index (OR 0.70, p<0.001), hospital length of stay (OR 0.85, p<0.001), congestive heart failure (OR 2.10, p<0.001), COPD (OR 1.85, p<0.001), diabetes with complications (OR 1.88, p<0.001), and a need for legal services (OR 2.21, p<0.001) to be independent predictors of an increased risk of hospital readmission.ConclusionUnmet legal needs identified in this study via an interview-based screening tool appear to be an independent risk factor for hospital readmission. The predicted risk of readmission (OR 2.21) compares favorably with validated HOSPITAL score (OR 2.12) and LACE index (OR 1.16) readmission risk assessment tools. These findings suggest that the presence of unaddressed legal issues may be a modifiable non-medical risk factor for hospital readmission. Further study of the impact of MLP programs on hospital readmission is necessary to clarify the implications of this social determinant of health on a critical value-based care measurement.