bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus
Authors: Pacis Michelle , Azor-Ocampo Annielyn , Burnett Emily , Tanasapphaisal Chutiwan , Coleman Bernice 
Published: November 2020

PURPOSE:
Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19.

PARTICIPANTS AND SETTING:
This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory.

APPROACH:
We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period.

OUTCOMES:
We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings).

CONCLUSION:
Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.
Effectiveness of Multilayered Polyurethane Foam Dressings to Prevent Hospital-Acquired Sacral Pressure Injuries in Patients With Hip Fracture
Authors: Gazineo Domenica , Chiarabelli Matteo , Cirone Rosanna , Chiari Paolo , Ambrosi Elisa 
Published: November 2020

PURPOSE:
The purpose of this study was to determine the effectiveness of a multilayered polyurethane foam dressing applied within 24 hours of hospital admission compared with standard preventive pressure injury (PI) care in reducing sacral PI occurrence in older patients with hip fractures.

DESIGN:
Open-label, parallel-group, 2-arm, superiority trial.

SUBJECTS AND SETTING:
The sample comprised older patients aged 69 to 97 years admitted to a 1500-bed university hospital in Bologna, Italy, for hip fracture surgery.

METHODS:
Patients were randomly allocated to an intervention or control group. Both groups received standard evidence-based PI preventive care in accordance with National Pressure Ulcer Advisory Panel guidelines. In addition, patients in the intervention group received a single 12.9 × 12.9-cm2 multilayered polyurethane foam dressing shaped for the sacrum area applied within 24 hours of hospital admission. Bivariate analysis on primary and secondary outcomes and baseline characteristics was performed to compare group differences, and a survival analysis was used to determine the difference in PI incidence rates per group.

RESULTS:
Sixty-eight patients completed the trial; 34 patients were allocated to the intervention group and 34 patients to the control group. A trend toward significance was observed for sacral PI occurrence in the intervention group (intervention: 20.6%; control: 2.9%; P = .054). The foam dressing allowed significantly longer time (days) to PI occurrence (intervention: 5.9 ± 1.60; control: 2.7 ± 0.96; P = .003).

CONCLUSIONS:
These findings suggest that multilayered polyurethane foam dressings are not superior to the standard preventive PI care alone and should be used with caution, especially when multiple dressing changes may occur. Further exploration of the role of multilayered polyurethane foam dressings in preventing PI development is warranted.
Mathematical analysis of Córdoba calcifediol trial suggests strong role for Vitamin D in reducing ICU admissions of hospitalized COVID-19 patients
Authors: Jungreis Irwin , Kellis Manolis 
Published: November 2020

AbstractA randomized controlled trial of calcifediol (25-hydroxyvitamin D3) as a treatment for hospitalized COVID-19 patients in Córdoba, Spain, found that the treatment was associated with reduced ICU admissions with very large effect size and high statistical significance, but the study has had limited impact because it had only 76 patients and imperfect blinding, and did not measure vitamin D levels pre- and post-treatment or adjust for several comorbidities. Here we reanalyze the reported results of the study using rigorous and well established statistical techniques, and find that the randomization, large effect size, and high statistical significance address many of these concerns. We show that random assignment of patients to treatment and control groups is highly unlikely to distribute comorbidities or other prognostic indicators sufficiently unevenly to account for the large effect size. We also show that imperfect blinding would need to have had an implausibly large effect to account for the reported results. Finally, comparison with two additional randomized clinical trials of vitamin D supplementation for COVID-19 in India and Brazil indicates that early intervention and rapid absorption may be crucial for the observed benefits of vitamin D. We conclude that the Córdoba study provides sufficient evidence to warrant immediate, well-designed pivotal clinical trials of early calcifediol administration in a broader cohort of inpatients and outpatients with COVID-19.
State- and County-Level COVID-19 Public Health Orders in California: Constructing a Dataset and Describing Their Timing, Content, and Stricture
Authors: Goldhaber-Fiebert Jeremy D. , Holsinger Alexander F. , Holsinger Erin , Long Elizabeth 
Published: November 2020

AbstractWithout vaccines, non-pharmaceutical interventions have been the most widely used approach to controlling the spread of COVID-19 epidemics. Various jurisdictions have implemented public health orders as a means of reducing effective contacts and controlling their local epidemics. Multiple studies have examined the effectiveness of various orders (e.g. use of face masks) for epidemic control. However, orders occur at different timings across jurisdictions and some orders on the same topic are stricter than others. We constructed a county-level longitudinal data set of more than 2,400 public health orders issues by California and its 58 counties pertaining to its 40 million residents. First, we describe methods used to construct the dataset that enables the characterization of the evolution over time of California state- and county-level public health orders dealing with COVID-19 from January 1, 2020 through June 30, 2021. Public health orders are both an interesting and important outcome in their own right and also a key input into analyses looking at how such orders may impact COVID-19 epidemics. To construct the dataset, we developed and executed a search strategy to identify COVID-19 public health orders over this time period for all relevant jurisdictions. We characterized each identified public health order in terms of the timing of when it was announced, went into effect and (potentially) expired. We also adapted an existing schema to describe the topic(s) each public health order dealt with and the level of stricture each imposed, applying it to all identified orders. Finally, as an initial assessment, we examined the patterns of public health orders within and across counties, focusing on the timing of orders, the rate of increase and decrease in stricture, and on variation and convergence of orders within regions.
Development of a highly sensitive point-of-care test to detect SARS-CoV-2 from saliva combining a simple RNA extraction method with colorimetric reverse transcription loop-mediated isothermal amplification detection
Authors: Yamazaki Wataru , Matsumura Yasufumi , Thongchankaew-Seo Uraiwan , Yamazaki Yasuko , Nagao Miki 
Published: November 2020

AbstractTo diagnose COVID-19 patients in the field, a sensitive point-of-care test using saliva was developed. Using a heat block without centrifuge, the test took 45 minutes. Naked eye judgement with color change dye outperformed the reference standard, with a diagnostic sensitivity of 82.6% (19/23) and diagnostic specificity of 100% (21/21).
The Individual and Social Determinants of COVID-19 Diagnosis in Ontario, Canada: A Population-Wide Study
Authors: Sundaram Maria E. , Calzavara Andrew , Mishra Sharmistha , Kustra Rafal , Chan Adrienne K. , Hamilton Mackenzie A. , Djebli Mohamed , Rosella Laura C. , Watson Tristan , Chen Hong , Chen Branson , Baral Stefan D. , Kwong Jeffrey C. 
Published: November 2020

AbstractBackgroundOptimizing the public health response to reduce coronavirus disease 2019 (COVID-19) burden necessitates characterizing population-level heterogeneity of COVID-19 risks. However, heterogeneity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing may introduce biased estimates depending on analytic design.MethodsWe explored the potential for collider bias and characterized individual, environmental, and social determinants of testing and diagnosis using cross-sectional analyses among 14.7 million community-dwelling people in Ontario, Canada. Among those diagnosed, we used separate analytic designs to compare predictors of: 1) individuals testing positive versus negative; 2) symptomatic individuals only testing positive versus testing negative; and 3) individuals testing positive versus individuals not testing positive (i.e., testing negative or not being tested). Analyses included tests conducted between March 1 and June 20, 2020.ResultsOf a total of 14,695,579 individuals, 758,691 were tested for SARS-CoV-2, of whom 25,030 (3.3%) tested positive. The further the odds of testing from the null, the more variability observed in the odds of diagnosis across analytic design, particularly among individual factors. There was less variability in testing by social determinants across analytic designs. Residing in areas with highest household density (adjusted odds ratio [aOR]: 1.86; 95%CI: 1.75-1.98), highest proportion of essential workers (aOR: 1.58; 95%CI: 1.48-1.69), lowest educational attainment (aOR: 1.33; 95%CI: 1.26-1.41), and highest proportion of recent immigrants (aOR: 1.10; 95%CI: 1.05-1.15) were consistently related to increased odds of SARS-CoV-2 diagnosis regardless of analytic design.InterpretationWhere testing is limited, risk factors may be better estimated using population comparators rather than test-negative comparators. Optimizing COVID-19 responses necessitates investment and sufficient coverage of structural interventions tailored to heterogeneity in social determinants of risk, including household crowding, occupation, and structural racism.
Identifying Neuroanatomical and Behavioral Features for Autism Spectrum Disorder Diagnosis in Children using Machine Learning
Authors: Han Yu , Rizzo Donna M. , Hanley John P. , Coderre Emily L. , Prelock Patricia A. 
Published: November 2020

AbstractAutism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause significant social, communication, and behavioral challenges. Diagnosis of ASD is complicated and there is an urgent need to identify ASD-associated biomarkers and features to help automate diagnostics and develop predictive ASD models. The present study adopts a novel evolutionary algorithm, the conjunctive clause evolutionary algorithm (CCEA), to select features most significant for distinguishing individuals with and without ASD, and is able to accommodate datasets having a small number of samples with a large number of feature measurements. The dataset is unique and comprises both behavioral and neuroimaging measurements from a total of 28 children from 7 to 14 years old. Potential biomarker candidates identified include brain volume, area, cortical thickness, and mean curvature in specific regions around the cingulate cortex, frontal cortex, and temporal-parietal junction, as well as behavioral features associated with theory of mind. A separate machine learning classifier (i.e., k-nearest neighbors algorithm) was used to validate the CCEA feature selection and for ASD prediction. Study findings demonstrate how machine learning tools might help move the needle on improving diagnostic and predictive models of ASD.
The metabolic fingerprint of COVID-19 severity
Authors: Dierckx Tim , van Elslande Jan , Salmela Heli , Decru Bram , Wauters Els , Gunst Jan , Van Herck Yannick ,   the CONTAGIOUS-consortium, Wauters Joost , Stessel Björn , Vermeersch Pieter 
Published: November 2020

AbstractCorona virus disease 2019 (COVID-19) has been associated with a wide range of divergent pathologies, and risk of severe disease is reported to be increased by a similarly broad range of co-morbidities. The present study investigated blood metabolites in order to elucidate how infection with severe acute respiratory syndrome coronavirus 2 can lead to such a variety of pathologies and what common ground they share. COVID-19 patient blood samples were taken at hospital admission in two Belgian patient cohorts, and a third cohort that included longitudinal samples was used for additional validation (total n=581). A total of 251 blood metabolite measures and ratios were assessed using nuclear magnetic resonance spectroscopy and tested for association to disease severity. In line with the varied effects of severe COVID-19, the range of severity-associated biomarkers was equally broad and included increased inflammatory markers (glycoprotein acetylation), amino acid concentrations (increased leucine and phenylalanine), increased lipoprotein particle concentrations (except those of very low density lipoprotein, VLDL), decreased cholesterol levels (except in large HDL and VLDL), increased triglyceride levels (only in IDL and LDL), fatty acid levels (decreased poly-unsaturated fatty acid, increased mono-unsaturated fatty acid) and decreased choline concentration, with association sizes comparable to those of routine clinical chemistry metrics of acute inflammation. Our results point to systemic metabolic biomarkers for COVID-19 severity that make strong targets for further fundamental research into its pathology (e.g. phenylalanine and omega-6 fatty acids).
Correlation of SARS-CoV-2 nucleocapsid antigen and RNA concentrations in nasopharyngeal samples from children and adults using an ultrasensitive and quantitative antigen assay
Authors: Pollock Nira R. , Savage Timothy J. , Wardell Hanna , Lee Rose , Mathew Anu , Stengelin Martin , Sigal George B. 
Published: November 2020

AbstractBackgroundDiagnosis of COVID-19 by PCR offers high sensitivity, but the utility of detecting samples with high cycle threshold (Ct) values remains controversial. Currently available rapid diagnostic tests (RDTs) for SARS-CoV-2 nucleocapsid antigens (Ag) have sensitivity well below PCR. The correlation of Ag and RNA quantities in clinical nasopharyngeal (NP) samples is unknown.MethodsAn ultrasensitive, quantitative electrochemiluminescence immunoassay for SARS-CoV-2 nucleocapsid (the MSD® S-PLEX® CoV-2 N assay) was used to measure Ag in clinical NP samples from adults and children previously tested by PCR.ResultsThe S-PLEX Ag assay had a limit of detection (LOD) of 0.16 pg/mL and a cutoff of 0.32 pg/mL. Ag concentrations measured in clinical NP samples (collected in 3.0 mL media) ranged from less than 160 fg/mL to 2.7 ug/mL. Log-transformed Ag concentrations correlated tightly with Ct values. In 35 adult and 101 pediatric PCR-positive samples, sensitivity was 91% (95% CI, 77-98%) and 79% (70-87%), respectively. In samples with Ct ≤ 35, sensitivity was 100% (88-100%) and 96% (88-99%), respectively. In 50 adult and 40 pediatric PCR-negative specimens, specificity was 100% (93-100%) and 98% (87-100%), respectively.ConclusionsNucleocapsid concentrations in clinical NP samples span 8 orders of magnitude and correlate closely with RNA concentrations (Ct values). The S-PLEX Ag assay had 96-100% sensitivity in samples from children and adults with Ct values ≤ 35, and 98-100% specificity. These results clarify Ag concentration distributions in clinical samples, providing insight into the performance of Ag RDTs and offering a new approach to diagnosis of COVID-19.Key pointsSARS-CoV-2 nucleocapsid concentrations in clinical nasopharyngeal samples, measured with an ultrasensitive assay, spanned an 8-log range and correlated closely with PCR Ct values. The assay was 96-100% sensitive in pediatric/adult samples with Ct values ≤ 35, and 98-100% specific.
A room, a bar and a classroom: how the coronavirus is spread through the air depends on heavily mask filtration efficiency
Authors: Srikrishna Devabhaktuni 
Published: November 2020

AbstractBackgroundRecently the US CDC acknowledged by that the COVID-19 crisis is facilitated at least in part by aerosolized virus exhaled by symptomatic, asymptomatic, or pre-symptomatic infected individuals. Disposable N95 masks remain in short supply due to their use in healthcare settings during the Coronavirus pandemic, whereas NIOSH-approved elastomeric N95 (eN95) masks remain immediately available for use by essential workers and the general public. New reusable N95 mask options with symmetric filtration efficiency can be anticipated to be NIOSH approved in the coming months, today’s eN95 masks have asymmetric filtration efficiency upon inhalation (95%) and exhalation (well under 95%) but are available now during the Fall and Winter when Coronavirus cases are expected to peak.MethodsBased on the Wells-Riley model of infection risk, we examine how the rate of transmission of the virus from one infected person in a closed, congested room with poor ventilation to several other susceptible individuals is impacted by the filtration efficiency of the masks they are wearing. Three scenarios are modeled – a room (6 people, 12’ × 20’ × 10’), a bar (18 people, 20’ × 40’ × 10’), and a classroom (26 people, 20’ × 30’ × 10’) with one infectious individual and remaining susceptibles. By dynamically estimating the accumulation of virus in aerosols exhaled by the infected person in these congested spaces for four hours using a “box model,” we compare the transmission risk (probability) when susceptible people based on a realistic hypothesis of face mask protection during inhaling and exhaling e.g. using cloth masks or N95 respirators.ResultsAcross all three scenarios, cloth masks modeled with 30% symmetric filtration efficiency alone were insufficient to stop the spread (18% to 40% infection risk), whereas eN95 masks (modeled as 95% filtration efficiency on inhalation, 30% on exhalation) reduced the infection risk to 1.5% to 3.6%. Symmetric filtration of 80% reduces the risk to 1.7% to 4.1% and symmetric filtration of 95% would further reduce the risk to 0.11% to 0.26%.ConclusionThis modeling of mask filtration efficiency suggests that the pandemic could be readily controlled within several weeks if (in conjunction with sensible hygiene) a sufficiently large majority of people wear asymmetric but higher-filtration masks (e.g. eN95) that also block aerosols whenever exposed to anyone else outside their household in order to completely stop inter-household spread.
Quantitative cone contrast threshold testing in patients with differing pathophysiological mechanisms causing retinal diseases
Authors: White Kayla M. , Frambach Caroline , Doan John , Mehta Urmi V. , Livnat Itamar , Yuh Clara , Palma Anton M. , Jameson Kimberly A. , Kenney M. Cristina , Mehta Mitul C. , Boisvert Chantal J. , Crow Wade R. , Browne Andrew W. 
Published: November 2020

AbstractPurposeCone contrast threshold testing (CCT) provides quantitative measurements of color and contrast function to reveal changes in vision quality that is not a standard endpoint in clinical trials. We utilize CCT to measure visual function in patients with multiple sclerosis (MS), age-related macular degeneration (AMD), epiretinal membrane (ERM), and retinal vein occlusion (RVO).MethodsRetrospective data was gathered from 268 patients of the Gavin Herbert Eye Institute. Subjects included 17 patients with MS, 45 patients with AMD, 41 patients with ERM, 11 patients with RVO, and 123 age and visual acuity-matched healthy controls. Patients underwent the primary measurement outcome, CCT testing, as well as Sloan visual acuity test and spectral domain optical coherence tomography during normal care.ResultsColor and contrast deficits were present in MS patients regardless of history of optic neuritis. AMD with intermediate or worse disease demonstrated reduced CCT scores. All 3 stages of ERM demonstrated cone contrast deficits. Despite restoration of visual acuity, RVO-affected eyes demonstrated poorer CCT performance than unaffected fellow eyes.ConclusionsCCT demonstrates color and contrast deficits for multiple retinal diseases with differing pathophysiology. Further prospective studies of CCT in other disease states and with larger samples sizes is warranted.Brief Summary StatementIn a retrospective analysis of 268 adults, cone contrast threshold testing (CCT) demonstrates patterns of visual function deficits in multiple sclerosis and age-related macular degeneration and similar declines in epiretinal membranes and retinal vein occlusion beyond standard visual acuity. Across all disease states, color and contrast vision were negatively impacted.