bluuebunny/crossref_metadata_2025_split huggingface dataset:
The STarT Back stratified care model for nonspecific low back pain: a model-based evaluation of long-term cost-effectiveness
Authors: Hall James A. , Jowett Sue , Lewis Martyn , Oppong Raymond , Konstantinou Kika 
Published: August 2020

Abstract
The STarT Back approach comprises subgrouping patients with low back pain (LBP) according to the risk of persistent LBP-related disability, with appropriate matched treatments. In a 12-month clinical trial and implementation study, this stratified care approach was clinically and cost-effective compared with usual, nonstratified care. Despite the chronic nature of LBP and associated economic burden, model-based economic evaluations in LBP are rare and have shortcomings. This study therefore produces a de novo decision model of this stratified care approach for LBP management to estimate the long-term cost-effectiveness and address methodological concerns in LBP modelling. A cost-utility analysis from the National Health Service perspective compared stratified care with usual care in patients consulting in primary care with nonspecific LBP. A Markov state-transition model was constructed where patient prognosis over 10 years was dependent on physical function achieved at 12 months. Data from the clinical trial and implementation study provided short-term model parameters, with extrapolation using 2 cohort studies of usual care in LBP. Base-case results indicate this model of stratified care is cost-effective, delivering 0.14 additional quality-adjusted life years at a cost saving of £135.19 per patient over a time horizon of 10 years. Sensitivity analyses indicate the approach is likely to be cost-effective in all scenarios and cost saving in most. It is likely this stratified care model will help reduce unnecessary healthcare usage while improving the patient's quality of life. Although decision-analytic modelling is used in many conditions, its use has been underexplored in LBP, and this study also addresses associated methodological challenges.
LATCH Score at Discharge
Authors: Shah Mubashir Hassan , Roshan Reashma , Parikh Tushar , Sathe Sayali , Vaidya Umesh , Pandit Anand 
Published: August 2020

ABSTRACTObjectives:World Health Organization recommends exclusive breastfeeding (EBF) for 6 months after birth. However, problems with the baby failing to latch properly are common in the postpartum period contributing to breastfeeding cessation. The aim of the study was to evaluate the utility of LATCH score to predict EBF and weight gain at 6 weeks postpartum along with an optimum LATCH score cutoff.Patients and Methods:This prospective cohort study was conducted in India. Ninety‐three mother‐infant dyads at term gestation were enrolled. Two LATCH score assessments were done by a lactation consultant: first within 24 hours of birth and second at discharge. Mothers with low LATCH scores were counselled before discharge. EBF rate and weight gain velocity were analyzed at 6 weeks.Results:LATCH score ≥6 at discharge has the highest sensitivity (92.1%) and specificity (66.7%) for predicting EBF at 6 weeks postpartum (RR, 95% CI; 5.63 [4.32–12.65], P = 0.0003). Receiver operating characteristic (ROC) of LATCH score at discharge and EBF at 6 weeks had an area under the curve of 0.785 with a cutoff ≥5.5, showing the highest sensitivity of 93.6% with a false‐positive rate of 30.1%. LATCH score >6 at discharge was significantly associated with higher EBF rate (RR, 95% CI; 0.61 [0.39–0.94]) and appropriate weight gain (≥ 20 grams/day) at 6 weeks of age (RR, 95% CI; 0.44 [0.25–0.75]). After counselling, the LATCH score significantly improved at discharge in mothers (n = 62) with an initial score <6 (P < 0.001).Conclusion:LATCH score is a simple tool to identify mothers who require breastfeeding support and counselling before discharge from the hospital to prevent early breastfeeding cessation.
Variation in zoobenthic blue carbon in the Arctic's Barents Sea shelf sediments
Authors: Souster T. A. , Barnes D. K. A. , Hopkins J. 
Published: August 2020

The flow of carbon from atmosphere to sediment fauna and sediments reduces atmospheric CO2, which in turn reduces warming. Here, during the Changing Arctic Ocean Seafloor programme, we use comparable methods to those used in the Antarctic (vertical, calibrated camera drops and trawl-collected specimens) to calculate the standing stock of zoobenthic carbon throughout the Barents Sea. The highest numbers of morphotypes, functional groups and individuals were found in the northernmost sites (80–81.3° N, 29–30° E). Ordination (non-metric multidimensional scaling) suggested a cline of faunal transition from south to north. The functional group dominance differed across all six sites, despite all being apparently similar muds. Of the environmental variables we measured, only water current speed could significantly explain any of our spatial carbon differences. We found no obvious relationship with sea ice loss and thus no evidence of Arctic blue carbon–climate feedback. Blue carbon in the Barents Sea can be comparable with the highest levels in Antarctic shelf sediments.This article is part of the theme issue ‘The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.
Evaluation of the comparative risk of aerosol generation by tracheal intubation and extubation in the operating theatre
Authors: Brown Jules , Gregson Florence K.A. , Shrimpton Andrew , Bzdek Bryan R. , Pickering Anthony E. , Reid Jonathan P. 
Published: August 2020

AbstractBackgroundTransmission of SARS-CoV-2 by bioaerosols is of increasing concern. The enhanced levels of personal protective equipment (PPE) and preventative measures to attenuate viral transmission during aerosol generating procedures (AGPs) are having a huge impact on healthcare provision. There is no quantitative evidence on the number and size of airborne particles produced during AGPs to inform risk assessments.MethodsReal-time, high-resolution environmental monitoring was conducted in ultraclean ventilation operating theatres. Continuous sampling with an optical particle sizer allowed characterization of aerosol generation within the airway management zone during endotracheal intubation and extubation for urgent orthopaedic trauma or neuro-surgery.ResultsAerosol monitoring showed a very low background particle count allowing resolution of the transient airborne particle plume produced by reference volitional coughs (maximum concentration, 1,690±140 particles.L-1,n=38). By comparison, endotracheal intubation including mask ventilation produced negligible quantities of aerosolized particles (maximum concentration, 80±10 L-1,n=14, P<0·001 vs cough). Extubation, particularly when the patient coughed, produced a detectable aerosol plume but with a smaller number of particles (<25%) than a volitional cough.ConclusionsUsing a volitional cough as a reference we have been able to produce a relative risk ranking for endotracheal intubation and extubation as potential AGPs. The study does not support the assignation of endotracheal intubation by direct laryngoscopy with manual ventilation as an AGP. Extubation does generate aerosols, particularly if the patient coughs, but these are weaker than a standard reference. These findings indicate the need for a reappraisal of guidance on PPE for AGPs.
Disease-dependent interaction policies to support health and economic outcomes during the COVID-19 epidemic
Authors: Li Guanlin , Shivam Shashwat , Hochberg Michael E. , Wardi Yorai , Weitz Joshua S. 
Published: August 2020

AbstractLockdowns and stay-at-home orders have partially mitigated the spread of Covid-19. However, the indiscriminate nature of mitigation — applying to all individuals irrespective of disease status — has come with substantial socioeconomic costs. Here, we explore how to leverage the increasing reliability and scale of both molecular and serological tests to balance transmission risks with economic costs involved in responding to Covid-19 epidemics. First, we introduce an optimal control approach that identifies personalized interaction rates according to an individual’s test status; such that infected individuals isolate, recovered individuals can elevate their interactions, and activity of susceptible individuals varies over time. Critically, the extent to which susceptible individuals can return to work depends strongly on isolation efficiency. As we show, optimal control policies can yield mitigation policies with similar infection rates to total shutdown but lower socioeconomic costs. However, optimal control policies can be fragile given mis-specification of parameters or mis-estimation of the current disease state. Hence, we leverage insights from the optimal control solutions and propose a feedback control approach based on monitoring of the epidemic state. We utilize genetic algorithms to identify a ‘switching’ policy such that susceptible individuals (both PCR and serological test negative) return to work after lockdowns insofar as recovered fraction is much higher than the circulating infected prevalence. This feedback control policy exhibits similar performance results to optimal control, but with greater robustness to uncertainty. Overall, our analysis shows that test-driven improvements in isolation efficiency of infectious individuals can inform disease-dependent interaction policies that mitigate transmission while enhancing the return of individuals to pre-pandemic economic activity.
Interplay of antibody and cytokine production reveals CXCL-13 as a potential novel biomarker of lethal SARS-CoV-2 infection
Authors: Horspool Alexander M. , Kieffer Theodore , Russ Brynnan P. , DeJong Megan A. , Wolf M. Allison , Karakiozis Jacqueline M. , Hickey Brice J. , Fagone Paolo , Tacker Danyel H. , Bevere Justin R. , Martinez Ivan , Barbier Mariette , Perrotta Peter L. , Damron F. Heath 
Published: August 2020

AbstractThe SARS-CoV-2 pandemic is continuing to impact the global population. This study was designed to assess the interplay of antibodies with the systemic cytokine response in SARS-CoV-2 patients. We demonstrate that significant anti-SARS-CoV-2 antibody production to Receptor Binding Domain (RBD), Nucleocapsid (N), and Spike S1 subunit (S1) of SARS-CoV-2 develops over the first 10 to 20 days of infection. The majority of patients produced antibodies against all three antigens (219/255 SARS-CoV-2 positive patient specimens, 86%) suggesting a broad response to viral proteins. Patient mortality, sex, blood type, and age were all associated with differences in antibody production to SARS-CoV-2 antigens which may help explain variation in immunity between these populations. To better understand the systemic immune response, we analyzed the production of 20 cytokines by SARS-CoV-2 patients over the course of infection. Cytokine analysis of SARS-CoV-2 positive patients exhibited increases in proinflammatory markers (IL-6, IL-8, IL-18) and chemotactic markers (IP-10, SDF-1, MIP-1β, MCP-1, and eotaxin) relative to healthy individuals. Patients who succumbed to infection produced decreased IL-2, IL-4, IL-12, IL-13, RANTES, TNF-α, GRO-α, and MIP-1α relative to patients who survived infection. We also observed that the chemokine CXCL13 was particularly elevated in patients that succumbed to infection. CXCL13 is involved in B cell activation, germinal center development, and antibody maturation, and we observed that CXCL13 levels in blood trended with anti-SARS-CoV-2 antibody production. Furthermore, patients that succumbed to infection produced high CXCL13 and also tended to have high ratio of nucleocapsid to RBD antibodies. This study provides insights into SARS-CoV-2 immunity implicating the magnitude and specificity of response in relation to patient outcomes.
Correction of Daily Positivity Rates for contribution of various test protocols being used in a pandemic
Authors: Bansal Bhavik 
Published: August 2020

AbstractDaily positivity rate (DPR) is a popular metric to judge the prevalence of an infection in the population and the testing response to it as a single number. It has been widely implicated in predicting future course of the SARS CoV-2 pandemic in India. With increasing use of multiple testing protocols with varying sensitivity and specificity in various proportions, the naïve calculation loses meaning particularly during comparison between states/countries with large daily variations in contribution of different testing protocols to the testing response. We propose an adjustment to the naïve DPR based on the testing parameters and the relative proportional use of each such protocol. Such a correction has become essential for comparing testing response of Indian states from Jun 2020 – Aug 2020 because of steep variations in testing protocol in certain states.
Neighborhood-Level Public Facilities and COVID-19 Transmission: A Nationwide Geospatial Study In China
Authors: Jin Xurui , Leng Yu , Gong Enying , Xiong Shangzhi , Yao Yao , Vedanthan Rajesh , Wu Chenkai , Yan Lijing L. 
Published: August 2020

AbstractIndividual-level studies on the coronavirus disease 2019 (COVID-19) have proliferated; however, research on neighborhood-level factors associated with COVID-19 is limited. We gathered the geographic data of all publically released COVID-19 cases in China and used a case-control (1:4 ratio) design to investigate the association between having COVID-19 cases in a neighborhood and number and types of public facilities nearby. Having more restaurants, shopping centers, hotels, living facilities, recreational facilities, public transits, educational institutions, and health service facilities was associated with significantly higher odds of having COVID-19 cases in a neighborhood. The associations for restaurants, hotels, reactional and education facilities were more pronounced in cities with fewer than six million people than those in larger cities. Our results have implications for designing targeted prevention strategies at the neighborhood level to reduce the burden of COVID-19.
Trying to Find the Answer for Two Questions in Patients with COVID-19:1. Is pulmonary infiltrate of COVID-19 infective or inflammatory in nature (Pneumonia or Pneumonitis)? 2. Is Hydroxychloroquine plus Azithromycin or Favipiravir plus Dexamethasone more effective in the COVID-19 treatment?
Authors: Dirican Adem , Uzar Tugce , Karaman Irem , Uluisik Aziz , Ozkaya Sevket 
Published: August 2020

AbstractBackgroundDuring the current pandemic, a great effort is made to understand the COVID-19 and find an effective treatment. As of 17 August 2020, there is no specific drug or biologic agent which have been approved by the FDA for the prevention or treatment of COVID-19.MethodsWe retrospectively analyzed the clinical and radiological findings of 211 COVID-19 in-patients that were treated between March - August 2020. Confirmation of a COVID-19 diagnosis was made according to a positive RT-PCR result with a consistent high-resolution-CT (HRCT) finding. Radiological images and the rate of clinical response of patients were investigated.ResultWhile 128 patients (58.7) did not develop pneumonia, the mild, moderate and severe pneumonia ratios were 28(13.2%), 31(18.7%) and 27(22.9%). 72 patients (34.1%) whose PCR tests were positive did not show any symptom and they were followed in isolation without treatment. 52 patients (24.6%) received hydroxychloroquine plus azithromycin, 57 patients (27%) received favipiravir and 30 patients (14.2%) received favipiravir plus dexamethasone as the first line of treatment. 63.1% of pneumonia patients who received hydroxychloroquine plus azithyromycine, 28.3% of patients who received favipiravir and 10% of patients who received favipiravir plus dexamethasone showed a failure of treatment.ConclusionThe pulmonary infiltrates of COVID-19 are not infective; therefore, the characteristic of the disease should be described as COVID-19 pneumonitis instead of pneumonia. The favipiravir plus dexamethasone seems to be the only drug combination to achieve the improvement of radiological presentation and clinical symptoms in COVID-19 pneumonia patients.
Perturbations in the mononuclear phagocyte landscape associated with COVID-19 disease severity
Authors: Kvedaraite Egle , Hertwig Laura , Sinha Indranil , Ponzetta Andrea , Myrberg Ida Hed , Lourda Magda , Dzidic Majda , Akber Mira , Klingström Jonas , Folkesson Elin , Muvva Jagadeeswara Rao , Chen Puran , Brighenti Susanna , Norrby-Teglund Anna , Eriksson Lars I. , Rooyackers Olav , Aleman Soo , Strålin Kristoffer , Ljunggren Hans-Gustaf , Ginhoux Florent , Björkström Niklas K. , Henter Jan-Inge , Svensson Mattias ,   Karolinska COVID-19 Study Group
Published: August 2020

ABSTRACTMonocytes and dendritic cells are crucial mediators of innate and adaptive immune responses during viral infection, but misdirected responses by these cells might contribute to immunopathology. A comprehensive map of the mononuclear phagocyte (MNP) landscape during SARS-CoV-2 infection and concomitant COVID-19 disease is lacking. We performed 25-color flow cytometry-analysis focusing on MNP lineages in SARS-CoV-2 infected patients with moderate and severe COVID-19. While redistribution of monocytes towards intermediate subset and decrease in circulating DCs occurred in response to infection, severe disease associated with appearance of Mo-MDSC-like cells and a higher frequency of pre-DC2. Furthermore, phenotypic alterations in MNPs, and their late precursors, were cell-lineage specific and in select cases associated with severe disease. Finally, unsupervised analysis revealed that the MNP profile, alone, could identify a cluster of COVID-19 non-survivors. This study provides a reference for the MNP response to clinical SARS-CoV-2 infection and unravel myeloid dysregulation associated with severe COVID-19.
“I walk around like my hands are covered in mud”: food safety and hand hygiene behaviours of Canadians during the COVID-19 pandemic
Authors: Haas Robyn , Sekercioglu Fatih , Meldrum Richard , Young Ian 
Published: August 2020

AbstractObjectivesTo investigate how and why Canadians engaged in different food handling and hand hygiene behaviours during the COVID-19 pandemic.MethodsSeven online, text-based focus groups were conducted with a total of 42 participants. Eligible participants included adults living in Canada that prepared meals at home at least once per week. Focus groups took place from May-June 2020 and followed a semi-structured question guide. Participants were asked about their practices relating to food preparation habits at home; food purchasing, handling, and storage; hand hygiene and sanitation; and information sources about food safety concerning the COVID-19 pandemic. A thematic analysis was conducted using the Theoretical Domains Framework as a coding guide.ResultsThe most notable changes in behaviour since the onset of the pandemic were seen in participants’ handwashing, sanitation, and grocery shopping practices. Participants tended to perceive grocery store employees, shoppers, and food service staff as having inadequate sanitation precautions and, therefore, as a source of COVID- 19 transmission risk. They heavily relied on public health, medical, and government officials as sources of information. Feelings of stress and anxiety appeared to be linked to certain sanitation behaviours. Many participants displayed a general apathy toward routine food safety practices such as safe food storage at home.ConclusionThis work supports the need for clear and concise messaging for hand hygiene and food safety behaviours during the COVID-19 pandemic and in future times of crisis. It also highlights a need for ongoing food safety messaging.
Strong gene dose dependent protective effect of Mediterranean type glucose-6-phosphate dehydrogenase deficiency against Plasmodium vivax malaria
Authors: Awab Ghulam R. , Aaram Fahima , Jamornthanyawat Natsuda , Suwannasin Kanokon , Pagornrat Watcharee , Watson James A , Woodrow Charles J , Dondorp Arjen , Day Nicholas PJ , Imwong Mallika , White Nicholas J. 
Published: August 2020

BackgroundX-linked glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy. The severe Mediterranean variant (G6PDd Med) is common across Europe and Asia. Epidemiological studies investigating the potential protective effect of G6PD deficiency against malaria have yielded conflicting results.MethodsG6PDd Med genotyping was performed in Pashtun patients in Afghanistan with acute Plasmodium vivax malaria and Pashtun subjects attending the same study centres with unrelated conditions or for routine vaccinations. A Bayesian statistical model assuming Hardy-Weinberg equilibrium was used to estimate the potential protective effects of G6PDd Med on vivax malaria, and was fitted to all available data from this and previous studies.FindingsIn patients with vivax malaria 1.6% (5 of 308) of males were G6PD Med hemizygotes compared with 8.2% (28 of 342) of controls (risk ratio; 95% confidence interval: 0.198 [0.078 to 0.507]), and 6.8% (31 of 458) of female patients were heterozygotes compared with 11.2% (40 of 358) of controls (RR 0.606 [0.387 to 0.948]). From all available data, the estimated allele frequency of G6PDd Med in the Pasthun is 8.8% (95% credible interval, 7.5-10.2). In hemizygous males and homozygous females, G6PDd Med confers a strong protective effect against symptomatic P. vivax malaria reducing the incidence by 73% (95% C.I. 53-87). In heterozygous females the estimated protective effect was 56% (95% C.I. 40-69). The protective effect in heterozygous females is 0.78 (95% CI, 1.09-0.53) of that observed in hemizygous males and homozygous females.InterpretationThe G6PD Mediterranean genotype confers a very large and gene dose proportional protective effect against vivax malaria. The proportion of patients with vivax malaria at risk of haemolysis following 8-aminoquinoline radical cure is substantially overestimated by epidemiological studies in healthy subjects.