bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing the accuracy of lay diagnosis of childhood malaria and pneumonia with that of the revised IMCI guidelines in Nigeria
Authors: Elimian K O , Myles P R , Phalkey R , Sadoh A , Pritchard C 
Published: June 2020

Abstract

Background
Improving caregivers’ recognition of childhood malaria and pneumonia is crucial to early treatment and improving outcomes. The objective of this study was to assess the accuracy and reliability of caregivers’ recognition of malaria and pneumonia (lay diagnosis) as compared to the revised IMCI guidelines.

Methods
A cross-sectional study design was used to recruit 903 children aged 2–59 months who were assessed for malaria and pneumonia by health workers at five primary healthcare centres in Benin City, Nigeria. Accuracy of lay diagnosis as compared to the revised IMCI guidelines was assessed using sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUROC) values.

Results
The accuracy of caregivers’ ability to recognise malaria (AUROC: 0.60; 95% CI: 0.57–0.64) and pneumonia (AUROC: 0.54; 95% CI: 0.50–0.58) was, respectively, moderate and poor as compared to the IMCI guidelines. Caregivers were better able to identify children without than those with malaria and pneumonia. Agreement between caregivers and the IMCI guidelines for malaria and pneumonia diagnosis was poor (k = 0.14, 95% CI: 0.09–0.19; P = 0.0001).

Conclusion
Caregivers’ ability to recognise these childhood diseases as compared to the IMCI guidelines was poor overall, which was partly due to the approach used to ascertain lay diagnosis.
Underestimation of COVID-19 cases in Japan: an analysis of RT-PCR testing for COVID-19 among 47 prefectures in Japan
Authors: Sawano T , Kotera Y , Ozaki A , Murayama A , Tanimoto T , Sah R , Wang J 
Published: June 2020

SummaryBackgroundUnder the unique Japanese policy to restrict reverse transcriptase–polymerase chain reaction (RT-PCR) testing against severe acute respiratory syndrome coronavirus 2, a nationwide number of its confirmed cases and mortality remains to be low. Yet the information is lacking on geographical differences of these measures and their associated factors.AimEvaluation of prefecture-based geographical differences and associated predictors for the incidence and number of RT-PCR tests for coronavirus disease 2019 (COVID-19).DesignCross-sectional study using regression and correlation analysis.MethodsWe retrieved domestic laboratory-confirmed cases, deaths and the number of RT-PCR testing for COVID-19 from 15 January to 6 April 2020 in 47 prefectures in Japan, using publicly available data by the Ministry of Health, Labour and Welfare. We did descriptive analyses of these three measures and identified significant predictors for the incidence and RT-PCR testing through multiple regression analyses and correlates with the number of deaths through correlation analysis.ResultsThe median prefectural-level incidence and number of RT-PCR testing per 100 000 population were 1.14 and 38.6, respectively. Multiple regression analyses revealed that significant predictors for the incidence were prefectural-level population (P &lt; 0.001) and the number of RT-PCR testing (P = 0.03); and those for RT-PCR testing were the incidence (P = 0.025), available beds (P = 0.045) and cluster infections (P = 0.034).ConclusionConsidering bidirectional association between the incidence and RT-PCR testing, there may have been an underdiagnosed population for the infection. The restraint policy for RT-PCR testing should be revisited to meet the increasing demand under the COVID-19 epidemic.
Mycophenolate mofetil for methotrexate-resistant juvenile localized scleroderma
Authors: Martini Giorgia , Saggioro Laura , Culpo Roberta , Vittadello Fabio , Meneghel Alessandra , Zulian Francesco 
Published: June 2020

AbstractObjectivesTo investigate safety and efficacy of MMF in patients with severe or MTX-refractory juvenile localized scleroderma.MethodsConsecutive juvenile localized scleroderma patients undergoing systemic treatment were included in a retrospective longitudinal study. Patients treated with MMF because they were refractory or intolerant to MTX (MMF-group) were compared with responders to MTX (MTX-group). Disease activity was assessed by Localized Scleroderma Cutaneous Assessment Tool and thermography. Disease course was established on the number of relapses and treatment changes. Relapse-free survival was examined by Kaplan–Meier analysis.ResultsMMF and MTX groups included 22 and 47 patients, respectively. No significant difference in demographics, follow-up duration and treatment before diagnosis was observed between groups. The most represented clinical subtypes in the MMF-group were pansclerotic morphea and mixed subtype (P = 0.008 and P = 0.029, respectively), and linear scleroderma of the face in the MTX-group (P = 0.048). MMF was started because of MTX resistance (18 patients), relapse during MTX tapering/withdrawal (3 patients) and anaphylaxis to MTX (1 patient). After mean 9.4 years of follow-up, 90.9% of patients on MMF and 100% of those on MTX had inactive disease. No significant difference in relapse-free survival between the groups was found (P = 0.066, log-rank test), although MMF likely induced more persistent remission. MMF was well tolerated and combination of MMF and MTX did not increase its efficacy.ConclusionThe present study adds strong evidence on the efficacy and tolerance of MMF in severe and/or MTX-refractory juvenile localized scleroderma. Further controlled studies are needed to prove its efficacy as first line treatment.
Comparison of three different definitions of low disease activity in patients with systemic lupus erythematosus and their prognostic utilities
Authors: Kang Ji-Hyoun , Shin Min-Ho , Choi Sung-Eun , Xu Haimuzi , Park Dong-Jin , Lee Shin-Seok 
Published: June 2020

Abstract

Objectives
Three definitions of low-level disease activity in patients with SLE have been proposed by different groups. These include minimal disease activity (MDA), low disease activity (LDA) and the lupus low disease activity state (LLDAS). We investigated the performance of these definitions in SLE patients.

Methods
We recruited 299 SLE patients who were followed up annually for 4 consecutive years. We compared the three definitions of low disease activity via longitudinal analysis; we used a generalized, linear-mixed effects model and generalized estimating equations.

Results
The LLDAS was significantly associated with a lower SLICC/ACR damage index (β coefficient=−0.064, 95% CI: −0.129, −0.002, P=0.050), reduced flare (odds ratio = 0.090, 95% CI: 0.034, 0.239, P&lt;0.001), an improved SF-36 physical component score (β coefficient=0.782, 95% CI: 0.046, 1.519, P=0.037), and an improved SF-36 mental component score (β coefficient=1.522, 95% CI: 0.496, 2.547, P=0.004). Neither the MDA nor the LDA were associated with these variables.

Conclusion
The LLDAS definition performs better than the MDA and LDA definitions, showing that LLDAS is associated with less organ damage and flare, and a better quality of life, during follow-up.
Quantifying the Core Deficit in Classical Schizophrenia
Authors: Rathnaiah Mohanbabu , Liddle Elizabeth B , Gascoyne Lauren , Kumar Jyothika , Zia Ul Haq Katshu Mohammad , Faruqi Catherine , Kelly Christina , Gill Malkeet , Robson Sian , Brookes Matt , Palaniyappan Lena , Morris Peter , Liddle Peter F 
Published: June 2020

Abstract
In the classical descriptions of schizophrenia, Kraepelin and Bleuler recognized disorganization and impoverishment of mental activity as fundamental symptoms. Their classical descriptions also included a tendency to persisting disability. The psychopathological processes underlying persisting disability in schizophrenia remain poorly understood. The delineation of a core deficit underlying persisting disability would be of value in predicting outcome and enhancing treatment. We tested the hypothesis that mental disorganization and impoverishment are associated with persisting impairments of cognition and role function, and together reflect a latent core deficit that is discernible in cases diagnosed by modern criteria. We used Confirmatory Factor Analysis to determine whether measures of disorganization, mental impoverishment, impaired cognition, and role functioning in 40 patients with schizophrenia represent a single latent variable. Disorganization scores were computed from the variance shared between disorganization measures from 3 commonly used symptom scales. Mental impoverishment scores were computed similarly. A single factor model exhibited a good fit, supporting the hypothesis that these measures reflect a core deficit. Persisting brain disorders are associated with a reduction in post-movement beta rebound (PMBR), the characteristic increase in electrophysiological beta amplitude that follows a motor response. Patients had significantly reduced PMBR compared with healthy controls. PMBR was negatively correlated with core deficit score. While the symptoms constituting impoverished and disorganized mental activity are dissociable in schizophrenia, nonetheless, the variance that these 2 symptom domains share with impaired cognition and role function, appears to reflect a pathophysiological process that might be described as the core deficit of classical schizophrenia.
Characteristics and Outcomes of 241 Births to Women With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection at Five New York City Medical Centers
Authors: Khoury Rasha , Bernstein Peter S. , Debolt Chelsea , Stone Joanne , Sutton Desmond M. , Simpson Lynn L. , Limaye Meghana A. , Roman Ashley S. , Fazzari Melissa , Penfield Christina A. , Ferrara Lauren , Lambert Calvin , Nathan Lisa , Wright Rodney , Bianco Angela , Wagner Brian , Goffman Dena , Gyamfi-Bannerman Cynthia , Schweizer William E. , Avila Karina , Khaksari Bijan , Proehl Meghan , Heitor Fabiano , Monro Johanna , Keefe David L. , D'Alton Mary E. , Brodman Michael , Makhija Sharmila K. , Dolan Siobhan M. 
Published: June 2020

OBJECTIVE:
To describe the characteristics and birth outcomes of women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as community spread in New York City was detected in March 2020.

METHODS:
We performed a prospective cohort study of pregnant women with laboratory-confirmed SARS-CoV-2 infection who gave birth from March 13 to April 12, 2020, identified at five New York City medical centers. Demographic and clinical data from delivery hospitalization records were collected, and follow-up was completed on April 20, 2020.

RESULTS:
Among this cohort (241 women), using evolving criteria for testing, 61.4% of women were asymptomatic for coronavirus disease 2019 (COVID-19) at the time of admission. Throughout the delivery hospitalization, 26.5% of women met World Health Organization criteria for mild COVID-19, 26.1% for severe, and 5% for critical. Cesarean birth was the mode of delivery for 52.4% of women with severe and 91.7% with critical COVID-19. The singleton preterm birth rate was 14.6%. Admission to the intensive care unit was reported for 17 women (7.1%), and nine (3.7%) were intubated during their delivery hospitalization. There were no maternal deaths. Body mass index (BMI) 30 or higher was associated with COVID-19 severity (P=.001). Nearly all newborns tested negative for SARS-CoV-2 infection immediately after birth (97.5%).

CONCLUSION:
During the first month of the SARS-CoV-2 outbreak in New York City and with evolving testing criteria, most women with laboratory-confirmed infection admitted for delivery did not have symptoms of COVID-19. Almost one third of women who were asymptomatic on admission became symptomatic during their delivery hospitalization. Obesity was associated with COVID-19 severity. Disease severity was associated with higher rates of cesarean and preterm birth.
Changes in kidney function during the menopausal transition: the Study of Women's Health Across the Nation (SWAN) – Michigan site
Authors: Kim Catherine , Saran Rajiv , Hood Michelle , Karvonen-Gutierrez Carrie , Peng Mia Q. , Randolph John F. , Harlow Siobán D. 
Published: June 2020

Abstract

Objective:
The aim of the study was to examine changes in kidney function during the menopausal transition (MT) and associations with levels of sex hormones (follicle stimulating hormone [FSH], sex hormone binding globulin [SHBG], estradiol, and testosterone).

Methods:
We used data from the Michigan site of Study of the Women's Health Across the Nation, a longitudinal study of the MT. For this analysis, we included women who had at least one creatinine measure before the final menstrual period (FMP) and at least one creatinine measure after the FMP (n = 101 women with 440 observations). To determine whether the declines in estimated glomerular filtration rate (eGFR) remained constant during the MT, we used local weighted regression curves to fit eGFR estimates. We examined the association between sex hormones and eGFR with longitudinal mixed models adjusting for baseline age, day of menstrual cycle, and time from FMP.

Results:
At baseline, women had a mean age of 45.4 ± 2.5 years; 54% were African-American and 46% were white. Although eGFR declined significantly over time, declines were linear, consistent with declines in eGFR due to age alone rather than the MT. Total testosterone, estradiol, ratio of testosterone:estradiol, and free androgen index were not significantly associated with eGFR, whereas lower FSH (−0.039, 95% confidence interval [CI] −0.067 to −0.012) and higher SHBG (0.050, 95% CI 0.004-0.096) were associated with higher eGFR.

Conclusions:
Kidney function declines during the MT. Although associated with levels of FSH and SHBG, the rate of decline in eGFR is consistent with what would be expected of age alone.
Complications of appendectomy and cholecystectomy in acute care surgery: A systematic review and meta-analysis
Authors: Al Busaidi Omar , Lee Seungwon , Kortbeek John B. , Turin Tanvir C. , Stelfox Henry T. , Austen Lea , Ball Chad G. 
Published: June 2020

INTRODUCTIONAcute care surgery (ACS) was initiated two decades ago to address timeliness and quality in emergency general surgery. We hypothesized that ACS has improved the management of acute appendicitis and biliary disease.METHODSA comprehensive systematic review and meta-analysis of outcome studies for emergent appendectomy and cholecystectomy from 1966 to 2017, comparing studies prior to and following ACS implementation, were performed.RESULTSOf 1,704 studies, 27 were selected for analysis (appendicitis, 16; biliary pathology, 7; both, 4). Following ACS introduction, the complication rate was significantly reduced in both appendectomy and cholecystectomy (risk ratios, 0.70; 95% confidence interval [CI], 0.57–0.85;I2= 9.2% and relative risk, 0.62; 95% CI, 0.41–0.94;I2= 63.5%) respectively. There was a significant reduction in the time from arrival in emergency until admission and from admission to operation (−1.37 hours: 95% CI, −1.93 to −0.80; −2.51 hours: 95% CI, −4.44 to −0.58) in the appendectomy cohort. Time to operation was shorter in the cholecystectomy group (−6.46 hours; 95% CI, −9.54 to −3.4). Length of hospital stay was reduced in both groups (appendectomy, −0.9 day; cholecystectomy, −1.09 day). There was a reduction in overall cost in cholecystectomy group (−US $854.37; 95% CI, –1,554.1 to −154.05). No statistical significance was detected for wound infection, abscess, conversion of laparoscopy to open technique, rate of negative appendectomy, after hours, readmission, and cost.CONCLUSIONThe implementation of ACS models in general surgery emergency care has significantly improved system and patient outcomes for appendicitis and biliary pathology.LEVEL OF EVIDENCESystematic review and meta-analysis of a retrospective study, level III.
Early Prediction of Alzheimer’s Disease and Related Dementias Using Electronic Health Records
Authors: Yang Xi , Li Qian , Wu Yonghui , Bian Jiang , Lyu Tianchen , Guo Yi , Marra David , Miller Amber , Shenkman Elizabeth , Maraganore Demetrius 
Published: June 2020

AbstractAlzheimer’s disease (AD) and AD-related dementias (ADRD) are a class of neurodegenerative diseases affecting about 5.7 million Americans. There is no cure for AD/ADRD. Current interventions have modest effects and focus on attenuating cognitive impairment. Detection of patients at high risk of AD/ADRD is crucial for timely interventions to modify risk factors and primarily prevent cognitive decline and dementia, and thus to enhance the quality of life and reduce health care costs. This study seeks to investigate both knowledge-driven (where domain experts identify useful features) and data-driven (where machine learning models select useful features among all available data elements) approaches for AD/ADRD early prediction using real-world electronic health records (EHR) data from the University of Florida (UF) Health system. We identified a cohort of 59,799 patients and examined four widely used machine learning algorithms following a standard case-control study. We also examined the early prediction of AD/ADRD using patient information 0-years, 1-year, 3-years, and 5-years before the disease onset date. The experimental results showed that models based on the Gradient Boosting Trees (GBT) achieved the best performance for the data-driven approach and the Random Forests (RF) achieved the best performance for the knowledge-driven approach. Among all models, GBT using a data-driven approach achieved the best area under the curve (AUC) score of 0.7976, 0.7192, 0.6985, and 0.6798 for 0, 1, 3, 5-years prediction, respectively. We also examined the top features identified by the machine learning models and compared them with the knowledge-driven features identified by domain experts. Our study demonstrated the feasibility of using electronic health records for the early prediction of AD/ADRD and discovered potential challenges for future investigations.
Random time transformation analysis of Covid19 2020
Authors: Alon Nitay , Meilijson Isaac 
Published: June 2020

AbstractThe SIR epidemiological equations model new affected and removed cases as roughly proportional to the current number of infected cases. The present report adopts an alternative that has been considered in the literature, in which the number of new affected cases is proportional to the α ≤ 1 power of the number of infected cases. After arguing that α = 1 models exponential growth while α < 1 models polynomial growth, a simple method for parameter estimation in differential equations subject to noise, the random-time transformation RTT of Bassan, Meilijson, Marcus and Talpaz 1997, will be reviewed and compared with stochastic differential equations. Both methods are applied in an attempt to uncover the growth pattern of Covid19.
A population-based study of the prevalence of COVID-19 infection in Espírito Santo, Brazil: methodology and results of the first stage
Authors: Gomes Cristiana Costa , Cerutti Crispim , Zandonade Eliana , Noia Maciel Ethel Leonor , de Alencar Filomena Euridice Carvalho , Almada Gilton Luiz , Cardoso Orlei Amaral , Jabor Pablo Medeiros , Zanotti Raphael Lubiana , Reuter Tania Queiroz , de Andrade Vera Lucia Gomes , Bastos Whisllay Maciel , de Medeiros Nésio Fernandes 
Published: June 2020

AbstractBACKGROUNDCOVID-19 is affecting almost the entire world, causing more than four hundred thousand deaths and undermining the health care systems, as much as the economy, of the afflicted countries. The strategies for prevention depend on largely lacking information, as infection prevalence and virus pathogenicity. This study aimed to determine the prevalence, the pathogenicity, and the speed of infection spreading in a large population in Brazil.MATERIALS AND METHODSThis is a serial cross-sectional study designed on a population basis and structured over houses as the sampling units. The sampling consisted of four visits at 15 days intervals in randomly selected census-designated sectors of the State major municipalities (reference municipalities) and two visits at 30 days intervals in smaller municipalities of the same regions of those of reference. At each visit, the investigators sampled houses and sampled one individual in each house for data collection. After the informed consent, the investigators performed a rapid antibody detection test (Celer Technology, Inc) and applied a questionnaire containing clinical and demographic questions.RESULTSFrom May 13th to 15th, the investigators performed 6,393 rapid tests in 4,612 individuals of the reference municipalities, 1,163 individuals of the smaller municipalities, and 166 contacts of the positive individuals. Ninety-seven dwellers were positive in the reference municipalities, giving a prevalence of 2.1% (CI 95%: 1.67-2.52%). In the smaller municipalities, the figure was 0.26% (CI 95%: 0.05%-0.75%) (three positives). There was an association of the positive result with female sex (p = 0.013) and houses with five dwellers or more (p = 0.003). Seventy-eight positive individuals reported symptoms in the previous 15 days (80.4%), being anosmia (45.4%), cough (40.2%), and myalgia (38.1%) the more frequent. About one-third of them reported fever (28.9%).CONCLUSIONSThe results reveal a still small prevalence of infection in the study area, despite the significant number of sick people overloading the health system. The figures indicate an important underreporting in the area and a frequency that still can grow, making necessary public health actions for the containment of the transmission.
Modeling the dynamics of COVID19 spread during and after social distancing: interpreting prolonged infection plateaus
Authors: Komarova Natalia L. , Wodarz Dominik 
Published: June 2020

AbstractNon-pharmaceutical intervention measures, such as social distancing, have so far been the only means to slow the spread of COVID19. In the United States, strict social distancing has resulted in different types infection dynamics. In some states, such as New York, extensive infection spread was followed by a pronounced decline of infection levels. In other states, such as California, less infection spread occurred before strict social distancing, and a different pattern was observed. Instead of a pronounced infection decline, a long-lasting plateau is evident, characterized by similar daily new infection levels. While these plateau dynamics cannot be readily reproduced with standard SIR infection models, we show that network models, in which individuals and their social contacts are explicitly tracked, can reproduce the plateau if network connections are cut due to social distancing measures. The reason is that in networks characterized by a 2D spatial structure, infection tends to spread quadratically with time, but as edges are randomly removed, the infection spreads along nearly one-dimensional infection “corridors”, resulting in plateau dynamics. Interestingly, the plateau dynamics are predicted to eventually transition into an infection decline phase without any further increase in social distancing measures. Additionally, the models suggest that a potential second wave becomes significantly less pronounced if social distancing is only relaxed once the dynamics have transitioned to the decline phase. The network models analyzed here allow us to interpret and reconcile different infection dynamics during social distancing observed in various US states.