bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of resuscitation with fibrinogen concentrate and platelets in traumatic hemorrhage swine model
Authors: Martini Wenjun Z. , Rodriguez Cassandra M. , Cap Andrew P. , Dubick Michael A. 
Published: April 2020

BACKGROUND
This study compared the resuscitation effects of platelets and fibrinogen concentrate (FC) on coagulation and hemodynamics in pigs with traumatic hemorrhage and reduced platelet counts.

METHODS
Thirty pigs (40 ± 3 kg) were anesthetized and catheterized with an apheresis catheter to remove platelets using the Haemonetics 9000 (Haemonetics, Braintree, MA). Afterward, a femur fracture was induced, followed by hemorrhage of 35% the estimated blood volume. Pigs were then randomized to be resuscitated with 5% human albumin (12.5 mL/kg), FC (250 mg/kg, 12.5 mL/kg), or platelets collected from apheresis (11.0 ± 0.5 mL/kg). Animals were monitored for 2 hours or until death. Blood samples were collected before (baseline [BL]) and after apheresis, after hemorrhage, and after resuscitation to assess changes in hemodynamics and coagulation using Rotem.

RESULTS
No change in mean arterial pressure (MAP) or heart rate (HR) was observed by platelet apheresis. Hemorrhage reduced MAP to 57% ± 5% and elevated HR to 212% ± 20% of BL (both p < 0.05). Resuscitation with albumin, FC, or platelets did not revert MAP or HR to BL. Platelet counts were reduced by apheresis from BL 383 ± 20 × 103/μL to 141 ± 14 × 103/μL and were reduced further after resuscitation with albumin (88 ± 18 × 103/μL) or FC (97 ± 13 × 103/μL, all p < 0.05), but improved with platelet resuscitation (307 ± 24 × 103/μL). Fibrinogen concentration was reduced by apheresis from BL 225 ± 9 mg/dL to 194 ± 8 mg/dL, fell after albumin infusion (134 ± 11 mg/dL), increased to 269 ± 10 mg/dL after FC resuscitation (all p < 0.05), and was not affected by platelet resuscitation. Rotem α-angle decreased from 79 ± 2 degrees to 69 ± 1 degrees by apheresis and hemorrhage (p < 0.05), and recovered similarly by resuscitation with FC (87 ± 1 degrees) or platelets (78 ± 2 degrees), but not by albumin (63 ± 3 degrees). Similar responses were observed in Rotem maximum clot firmness.

CONCLUSION
In this traumatic hemorrhage swine model, low-volume resuscitation with FC or platelets was similarly effective in restoring coagulation.
Are all trauma centers created equal? Level 1 to level 1 trauma center patient transfers in the setting of rapid trauma center proliferation
Authors: Jones Mike D. , Kalamchi Louay D. , Schlinkert Andrew B. , Chapple Kristina M. , Jacobs Jordan V. , Bogert James N. , Soe-Lin Hahn , Weinberg Jordan A. 
Published: April 2020

BACKGROUND
Level 1 trauma centers should provide definitive care for every aspect of injury. However, in environments that have experienced trauma center proliferation, not all level 1 centers may have the resources or expertise needed for every patient, necessitating transfer to another trauma center. The purpose of this study was to assess the incidence of such transfers and associated impact on patient outcome and burden on the receiving level 1 center.

METHODS
In a metropolitan area experiencing trauma center proliferation, we performed a 5.5-year review of patient transfers to an established level 1 (index center) from other state designated level 1 centers. American College of Surgeons verification level was identified for each facility. Comparisons were performed between the cohort of transferred patients and patients with similar demographics, injury patterns, and severity managed at the index center using propensity score matching.

RESULTS
A total of 104 patients were received from other state level 1 centers (39% American College of Surgeons level 2, 61% American College of Surgeons level 1). Nearly 70% of patients were transferred for definitive evaluation and/or management of brain, spine, or cerebrovascular injury. For 76% of this subgroup, specialty consultation was available, but the injury was deemed beyond their capability. Comparison of the transfer cohort propensity score matched to the control cohort (93 vs. 558 patients) demonstrated increased length of stay (6.5 days vs. 4.6 days, p = 0.001) and cost (US $36,027 vs. US $30,654, p = 0.033) associated with the transfer cohort, with similar mortality (12.1% vs. 9.7%, p = 0.492).

CONCLUSION
The number of level 1 to level 1 transfers observed imply a disparity in resources and capability among level 1 trauma centers in the region. The majority of transfers were for neurosurgical care, suggestive of a deficit of adequate neurosurgical coverage in the setting of trauma center proliferation. Both patients and established trauma centers bear the burden for these transfers with respect to increased cost and length of stay.

LEVEL OF EVIDENCE
Care management, level IV.
Pulmonary radiological change of COVID-19 patients with 99mTc-MDP treatment
Authors: Yuan Xiaolin , Yi Wanrong , Liu Baoyi , Tian Simiao , Cao Fang , Wang Ruoyu , Qi Baiwen , Lu Faqiang , Fang Meiyun , Pei Fuyang , Chen Ming , Zhang Lichuan , Zhang Yong , Zhang Xiuzhi , Pan Zhenyu , Zhao Dewei , Yu Aixi 
Published: April 2020

AbstractBackgroundAs increasing cases of COVID-19 around world, urgent need for effective COVID-19-specific therapeutic drugs is necessary; therefore, we conducted a pilot randomized-controlled study to evaluate the efficacy of 99mTc-MDP for COVID-19 therapeutic treatment.MethodsA total of 21 mild patients with COVID-19 were enrolled in this pilot RCT from February 2020 through March 2020, and then were assigned, in a 1:1 ratio, into control (11 patients) and 99mTc-MDP group (10 patients). Patients in the control group received routine treatment and patients assigned to the 99mTc-MDP group received a combination of routine treatment and an administration of 99mTc-MDP injection of 5ml/day. Both of the patients in the control and 99mTc-MDP groups were treated for 7 days with the primary end point of CT-based radiological pulmonary changes during 7-day follow-up.FindingsFrom baseline to the day 7, 8 (80%) of 10 mild patients in the 99mTc-MDP group had a significant radiological improvement in lung and a decline in inflammatory infiltration, whereas only 1 (9.1%) of 11 patients in the control group had a radiological improvement in lung. None of the patients in the 99mTc-MDP group had disease progression from mild to severe, as well as an inflammatory cytokine storm, and 2 mild patients (18.2%) in the control group developed severe. During days 7 through 14, the number of patients with radiological improvement in the 99mTc-MDP group remained consistent, and only 1 additional case (22%) in the control group were reported.ConclusionIn this randomized pilot study, 99mTc-MDP had an effective inhibitory effect on the inflammatory disease progression for the therapy of COVID-19, and it can accelerate the absorption of pulmonary inflammation in a short period of time during the process of treatment.
Meeting radiation dosimetry capacity requirements of population-scale exposures by geostatistical sampling
Authors: Rogan Peter K. , Mucaki Eliseos J. , Lu Ruipeng , Shirley Ben C. , Waller Edward , Knoll Joan H.M. 
Published: April 2020

AbstractBackgroundAccurate radiation dose estimates are critical for determining eligibility for therapies by timely triaging of exposed individuals after large-scale radiation events. However, the universal assessment of a large population subjected to a nuclear spill incident or detonation is not feasible. Even with high-throughput dosimetry analysis, test volumes far exceed the capacities of first responders to measure radiation exposures directly, or to acquire and process samples for follow-on biodosimetry testing.AimTo significantly reduce data acquisition and processing requirements for triaging of treatment-eligible exposures in population-scale radiation incidents.MethodsPhysical radiation plumes modelled nuclear detonation scenarios of simulated exposures at 22 US locations. Models assumed only location of the epicenter and historical, prevailing wind directions/speeds. The spatial boundaries of graduated radiation exposures were determined by targeted, multistep geostatistical analysis of small population samples. Initially, locations proximate to these sites were randomly sampled (generally 0.1% of population). Empirical Bayesian kriging established radiation dose contour levels circumscribing these sites. Densification of each plume identified critical locations for additional sampling. After repeated kriging and densification, overlapping grids between each pair of contours of successive plumes were compared based on their diagonal Bray-Curtis distances and root-mean-square deviations, which provided criteria (<10% difference) to discontinue sampling.Results/ConclusionsWe modeled 30 scenarios, including 22 urban/high-density and 2 rural/low-density scenarios under various weather conditions. Multiple (3-10) rounds of sampling and kriging were required for the dosimetry maps to converge, requiring between 58 and 347 samples for different scenarios. On average, 70±10% of locations where populations are expected to receive an exposure ≥2Gy were identified. Under sub-optimal sampling conditions, the number of iterations and samples were increased and accuracy was reduced. Geostatistical mapping limits the number of required dose assessments, the time required, and radiation exposure to first responders. Geostatistical analysis will expedite triaging of acute radiation exposure in population-scale nuclear events.
Results of intensified source finding efforts among community-acquired cases of Legionnaires’ disease – first results of the German LeTriWa study; Berlin, 2016−2019
Authors: Buchholz U. , Jahn H. J. , Brodhun B. , Lehfeld A-S. , Lewandowsky M. , Reber F. , Adler K. , Bochmann J. , Förster C. , Koch M. , Schreiner Y. , Stemmler F. , Gagell C. , Harbich E. , Haas W. , Schaefer B. , Lück C. 
Published: April 2020

AbstractIntroductionSources of infection of most cases of community-acquired Legionnaires’ disease (CALD) are unknown.ObjectiveIdentification of sources of infection of CALD.SettingBerlin; December 2016–May 2019.ParticipantsAdult cases of CALD reported to district health authorities and consenting to the study; age and hospital matched controls.Main outcome measurePercentage of cases of CALD with identified source of infection.MethodsAnalysis of secondary patient samples for monoclonal antibody (MAb) type (and sequence type); questionnaire-based interviews, analysis of standard household water samples for Legionella concentration followed by MAb (and sequence) typing of Legionella pneumophila serogroup 1 (Lp1) isolates; among cases taking of additional water samples to identify the infectious source as appropriate; recruitment of control persons for comparison of exposure history and contents of standard household water samples. For each case an appraisal matrix was filled in to attribute any of three source types (external (non-residence) source, residential non-drinking water (RnDW) source, residential drinking water (RDW) as source) using three evidence types (microbiological results, cluster evidence, analytical-comparative evidence (using added information from controls)).ResultsInclusion of 111 study cases and 202 controls. Median age of cases was 67 years (range 25– 93 years), 74 (67 %) were male. Among 65 patients with urine typable for MAb type we found a MAb 3/1-positive strain in all of them.Compared to controls being a case was not associated with a higher Legionella concentration in standard household water samples, however, the presence of a MAb 3/1-positive strain was significantly associated (OR = 4.9, 95 % confidence interval (CI) 1.7 to 11). Thus, a source was attributed by microbiological evidence if it contained a MAb 3/1-positive strain, by cluster evidence if at least two cases were exposed to it and by analytical-comparative evidence if a case was exposed to it and the type of source was statistically significantly associated with being a case. We identified an infectious source in 53 (48 %) of 111 cases: in 16 (14 %) an external source, in 9 (8 %) a RnDW source, and in 28 (25 %) we attributed RDW. We attributed 9 cases to RnDW because cases were associated with wearing not regularly disinfected dentures (OR = 3.2, 95 % CI 1.3 to 7.8).ConclusionUsing the appraisal matrix we attributed almost half of all cases of CALD to an infectious source, predominantly RDW. Risk for LD seems to be conferred primarily by the type of Legionella rather than the amount. Dentures as a new infectious source needs further, in particular, integrated microbiological, molecular and epidemiological confirmation.
COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey
Authors: Rossi Rodolfo , Socci Valentina , Talevi Dalila , Mensi Sonia , Niolu Cinzia , Pacitti Francesca , Di Marco Antinisca , Rossi Alessandro , Siracusano Alberto , Di Lorenzo Giorgio 
Published: April 2020

AbstractBackgroundThe psychological impact of the COronaVIrus Disease 2019 (COVID-19) outbreak and lockdown measures on the Italian population are unknown.The current study assesses rates of mental health outcomes in the Italian general population three to four weeks into lockdown measures and explores the impact of COVID-19 related potential risk factors.MethodsA web-based survey spread throughout the internet between March 27th and April 6th 2020. 18147 individuals completed the questionnaire, 79.6% women.Selected outcomes were post-traumatic stress symptoms (PTSS), depression, anxiety, insomnia, perceived stress and adjustment disorder symptoms (ADS). Seemingly unrelated logistic regression analysis was performed to identify COVID-19 related risk factors.ResultsRespondents endorsing PTSS, depression, anxiety, insomnia, high perceived stress and adjustment disorder were 6604 (37%), 3084 (17.3%), 3700 (20.8%), 1301 (7.3%), 3895 (21.8%) and 4092 (22.9%), respectively. Being woman and younger age were associated with all of the selected outcomes. Quarantine was associated with PTSS, anxiety and ADS. Any recent COVID-related stressful life event was associated with all the selected outcomes. Discontinued working activity due to the COVID-19 was associated with all the selected outcomes, except for ADS; working more than usual was associated with PTSS, Perceived stress and ADS. Having a loved one deceased by COVID-19 was associated with PTSS, depression, perceived stress and insomnia.ConclusionWe found high rates of negative mental health outcomes in the Italian general population three weeks into the COVID-19 lockdown measures and different COVID-19 related risk factors. These findings warrant further monitoring on the Italian population’s mental health.
Detection of Early HIV-1 Infection among Febrile Persons and Blood Donors in Oyo State, Nigeria
Authors: Olusola Babatunde A. , Olaleye David O. , Odaibo Georgina N. 
Published: April 2020

AbstractAbout 37.9 million persons are infected with HIV globally resulting in 770,000 deaths. Over 50% of this infection and deaths occur in Sub-Saharan Africa with countries like Nigeria greatly affected. The country also has one of the highest rate of new infections globally. Diverse HIV-1 subtypes have been identified in the country. Febrile persons and blood donors pose a great transmission risk in the country especially during the early stages of infection. HIV-1 rapid kits are routinely used for diagnosis among the general population and high risk groups. However, there is limited information on the usefulness of HIV rapid kits for early detection especially in areas where diverse HIV-1 subtypes circulate. In this study, the prevalence of early HIV-1 infection as well as circulating HIV-1 subtypes among febrile persons and blood donors were determined. Furthermore, the sensitivity of a widely used HIV-1 rapid antibody kit was compared with those of Antigen/Antibody ELISA based methods. Participants were recruited from selected hospitals in Ibadan and Saki, Nigeria. The prevalence of early HIV infection among 1028 febrile persons (Ibadan: 2.22%; Saki: 1.36%) and blood donors (5.07%) studied were significantly different (P<0.03674). CRF02_AG was the predominant subtype detected with more diverse HIV-1 subtypes observed among febrile persons compared to blood donors. About 1.2% of the samples detected on Antibody based ELISA methods were undetectable on the HIV-1 rapid antibody kit. Genetic diversity of HIV-1 strains among infected individuals in Oyo State, Nigeria is still relatively high. This diversity is likely impacting on diagnosis.
Transmission routes of Covid-19 virus in the Diamond Princess Cruise ship
Authors: Xu Pengcheng , Qian Hua , Miao Te , Yen Hui-Ling , Tan Hongwei , Kang Min , Cowling Benjamin J. , Li Yuguo 
Published: April 2020

AbstractBackgroundAn outbreak of COVID-19 occurred on the Diamond Princess cruise ship in January and February 2020. We analysed information about cases to infer transmission dynamics and potential modes of transmission.MethodsWe collected the daily number of 197 symptomatic cases, and that of the 146 passenger cases in two categories, i.e. those who stayed and did not stay in the same stateroom. We retrieved the quarantine details and the ship’s 14-day itinerary. We searched the websites of national/local health authority along the cruise routes and local news using Google for locally confirmed cases associated with the ship. We obtained the design of air conditioning and sewage treatment of the ship from literature. We back-calculated the dates of infection from the epidemic curve and compared with the start of on-board quarantine.ResultsMajor infections started on Jan 28 and completed by Feb 6 for passengers except those who stayed in the same stateroom with infected individual(s). No other confirmed cases were identified among the disembarked people in Hong Kong except an 80 years old passenger. No confirmed cases were reported in three other stopovers between Jan 27-31 associated with disembarked passengers or visitors from the ship, however two Okinawa taxi drivers became confirmed cases in association with driving the ship passengers. Infection among passengers after Feb 6 was limited to those who stayed in the same stateroom with an infected passenger. Infections in crew members peaked on Feb 7, suggesting significant transmission among crew members after quarantine on Feb 5.ConclusionsWe infer that the ship central air conditioning system did not play a role, i.e. the long-range airborne route was absent in the outbreak. Most transmission appears to have occurred through close contact and fomites.Significance StatementTransmission by the long-range airborne route for SARS-CoV-2 in the 2020 Diamond Princess Covid-19 outbreak has been debated with significant implication for intervention. We found that the transmission by close contact and fomite explains the outbreak, and the central air-conditioning system did not play a role, demonstrating the importance of social distancing, good hygiene and maintaining good building ventilation for intervention.
Efficacy of remdesivir versus placebo for the treatment of COVID-19: A protocol for systematic review and meta-analysis of randomized controlled trials
Authors: Gebrie Desye , Getnet Desalegn , Manyazewal Tsegahun 
Published: April 2020

AbstractBackgroundIn spite of the global containment on prevention efforts, the spread of coronavirus disease 2019 (COVID-19) is continuing to rise, with 1.1 million confirmed cases and 60,124 deaths recorded worldwide since 04 April 2020. The outbreak has a significant threat to international health and economy. At present, there is no approved vaccine or treatment for the disease, while efforts are underway. Remdesivir, a nucleotide-analogue antiviral drug developed for Ebola, is determined to prevent and stop infections with COVID-19, while results are yet controversial. Here, we aim to conduct a systematic review and meta-analysis of randomized controlled trials to compare the effectiveness of remdesivir and placebo in patients with COVID-19.Method and analysisWe will search MEDLINE-PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Google scholar databases without restriction in year of publication. We will include randomized controlled trials that assessed the effectiveness of remdesivir versus placebo for patients confirmed with COVID-19. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2015) guidelines for the design and reporting of the results. The primary endpoint will be time to clinical recovery. The secondary endpoints will be all cause mortality, discharged date, frequency of respiratory progression, and treatment-emergent adverse events. Two independent authors will perform study selection, data extraction, and methodology quality assessment. RevMan 5.3 software will be used for statistical analysis. Random/fixed effect model will be carried out to calculate mean differences for continuous outcomes and risk ratio for dichotomous outcomes between remdesivir and placebo.Ethics and disseminationThis study does not require ethical approval, because no participant’s data will be involved in this systematic review and meta-analysis. The findings of this study will be published in reputable and peer-reviewed journal.RegistrationThis review protocol is submitted in PROSPERO database for registration and we will include the registration number in the revised version of the manuscript.Strengths and limitations of this study➣This systematic review and meta-analysis will be derived from only randomized controlled trials which will increase the quality of evidences.➣This systematic review and meta-analysis will be derived from only randomized controlled trials which will reduce between study heterogeneity.➣Subgroup and sensitivity analysis will be carried out to identify possible reasons that may cause significant heterogeneity between studies.➣The use of Cochrane risk of bias tool to assess risk of bias for each included studies to extract and synthesize evidence based conclusions.➣One of the limitation of this study might be the restriction of trials published in English language.
Using random testing in a feedback-control loop to manage a safe exit from the COVID-19 lockdown
Authors: Müller Markus , Derlet Peter M. , Mudry Christopher , Aeppli Gabriel 
Published: April 2020

We argue that frequent sampling of the fraction of infected people (either by random testing or by analysis of sewage water), is central to managing the COVID-19 pandemic because it both measures in real time the key variable controlled by restrictive measures, and anticipates the load on the healthcare system due to progression of the disease. Knowledge of random testing outcomes will (i) significantly improve the predictability of the pandemic, (ii) allow informed and optimized decisions on how to modify restrictive measures, with much shorter delay times than the present ones, and (iii) enable the real-time assessment of the efficiency of new means to reduce transmission rates.Here we suggest, irrespective of the size of a suitably homogeneous population, a conservative estimate of 15’000 for the number of randomly tested people per day which will suffice to obtain reliable data about the current fraction of infections and its evolution in time, thus enabling close to real-time assessment of the quantitative effect of restrictive measures. Still higher testing capacity permits detection of geographical differences in spreading rates. Furthermore and most importantly, with daily sampling in place, a reboot could be attempted while the fraction of infected people is still an order of magnitude higher than the level required for a relaxation of restrictions with testing focused on symptomatic individuals. This is demonstrated by considering a feedback and control model of mitigation where the feed-back is derived from noisy sampling data.