bluuebunny/crossref_metadata_2025_split huggingface dataset:
Population risk stratification for health systems via accretive predictive modeling
Authors: Bandhakavi Sricharan , Karigowda Sunil , Liu Zhipeng , McCammon Jasmine , Rahmanian Farbod , Lavoie Heather 
Published: July 2021

ABSTRACTObjectiveHealth systems rely on multiple approaches for population-level risk stratification/management. However, they can under-represent members with rising risk and complex treatment needs. To address these gaps and broaden the coverage of members at risk, we present an accretive framework of six predictive models across complementary risk measures for population-level stratification/management.Materials and MethodsLogistic regression models were trained/tested for six outcomes across cost (rising and elevated cost), utilization (rising and elevated utilization), and chronic-disease related (multimorbidities and polypharmacy) risk measures in 2016 using claims-based features from 2015 for ∼8.97 million members in a nation-wide administrative claims database. Model performances were validated against a holdout cohort of ∼2.99 million members. The presence/absence of each outcome prediction for members was summed into an accretive predictive risk index (aPRI) for population-level risk stratification evaluation.ResultsIntegrating predictions from the six models enabled member stratification across risk measures including future costs, utilizations, and comorbidities. Each of the risk predictions is represented in aPRI levels 0– 6, and their underlying model probabilities/risk measures increase with increasing aPRI levels. ∼83% of members grouped into a “low risk” (aPRI = 0) or “rising risk” category (aPRI = 1 - 2) and ∼17% into a “high risk” (aPRI = 3 - 6) category. Overlap/correlation analyses of risk predictions and comparison of their drivers further support the complementarity of predictions within aPRI and its enhanced coverage of members at risk.DiscussionBy integrating targeted and complementary risk predictions, aPRI enhances current population-level risk stratification approaches.ConclusionWe have developed an accretive predictive modeling framework for enhanced population-level risk stratification/management.
Does COVID-19 vaccination improve mental health? A difference-in-difference analysis of the Understanding Coronavirus in America study
Authors: Koltai Jonathan , Raifman Julia , Bor Jacob , McKee Martin , Stuckler David 
Published: July 2021

AbstractBackgroundMental health problems increased during the COVID-19 pandemic. Knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. Here we test whether psychological distress declined in those vaccinated against COVID-19 in the US and whether changes in perceived risk mediated any association.MethodsA nationally-representative cohort of U.S. adults (N=5,792) in the Understanding America Study were interviewed every two weeks from March 2020 to June 2021 (28 waves). Difference-in-difference regression tested whether getting vaccinated reduced distress (PHQ-4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death.ResultsVaccination was associated with a 0.09 decline in distress scores (95% CI:-0.15 to -0.04) (0-12 scale), a 5.7% relative decrease compared to mean scores in the wave prior to vaccination. Vaccination was also associated with an 8.44 percentage point reduction in perceived risk of infection (95% CI:-9.15% to -7.73%), a 7.44-point reduction in perceived risk of hospitalization (95% CI:-8.07% to -6.82%), and a 5.03-point reduction in perceived risk of death (95% CI:-5.57% to -4.49%). Adjusting for risk perceptions decreased the vaccination-distress association by two-thirds. Event study models suggest vaccinated and never vaccinated respondents followed similar PHQ-4 trends pre-vaccination, diverging significantly post-vaccination. Analyses were robust to individual and wave fixed effects, time-varying controls, and several alternative modelling strategies. Results were similar across sociodemographic groups.ConclusionReceiving a COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of being vaccinated.
Subgrouping School-Aged Children on the Autism Spectrum Based on Co-Occurring Psychiatric Symptoms
Authors: Piergies Antonia M. H. , Hirota Tomoya , Monden Rei , Zheng Shuting 
Published: July 2021

AbstractBackgroundPhenotypic heterogeneity along the autism spectrum is compounded by co-occurring psychiatric conditions. Deriving subgroups of autistic individuals based on symptoms of these conditions could better our understanding of psychiatric symptom patterns existing within this population. This study’s goals were to derive subgroups of school-aged autistic children based on co-occurring psychiatric symptoms while controlling for age and sex and to examine correlates of subgroup membership while controlling for the degree of ASD-related diagnostic features.MethodLatent class models were estimated in a sample from the Simons Simplex Collection (n = 2,087) using “borderline/clinical” versus “normative” range data from five of the DSM-Oriented Scales from the CBCL/6-18 as indicator variables. We evaluated the predictive value of NVIQ < 70, atypical sleep duration, allergies/autoimmune conditions, gastrointestinal conditions, and neurological conditions on subgroup membership using multinomial logistic regression.ResultsFour subgroups emerged: Low Psychiatric Symptoms (41.02%), Externalizing Symptoms (12.36%), Internalizing Symptoms (31.58%), and High Psychiatric Symptoms (15.05%). Key findings were that NVIQ < 70 was associated with decreased odds of belonging to the Internalizing Symptoms and High Psychiatric Symptoms subgroups over the Low Psychiatric Symptoms subgroup, while atypical sleep duration and gastrointestinal conditions were associated with increased odds of belonging to the Externalizing Symptoms and High Psychiatric Symptoms subgroups. Neurological conditions were also associated with increased odds of belonging to the Externalizing Symptoms subgroup.ConclusionDistinct patterns of psychiatric symptoms exist within school-aged autistic children and are correlated with NVIQ < 70, atypical sleep duration, and medical conditions, providing insights for clinical practice and etiology-driven research.
B cell numbers predict humoral and cellular response upon SARS-CoV-2 vaccination among patients treated with rituximab
Authors: Stefanski Ana-Luisa , Rincon-Arevalo Hector , Schrezenmeier Eva , Karberg Kirsten , Szelinski Franziska , Ritter Jacob , Jahrsdörfer Bernd , Schrezenmeier Hubert , Ludwig Carolin , Sattler Arne , Kotsch Katja , Chen Yidan , Claußnitzer Anne , Haibel Hildrun , Proft Fabian , Guerra Gabriella Maria , Durek Pawel , Heinrich Frederik , Gomes Marta Ferreira , Burmester Gerd R. , Radbruch Andreas , Mashreghi Mir-Farzin , Lino Andreia C. , Dörner Thomas 
Published: July 2021

AbstractObjectivesPatients with autoimmune inflammatory rheumatic diseases receiving rituximab (RTX) therapy show substantially impaired anti-SARS-CoV-2 vaccine humoral but partly inducible cellular immune responses. However, the complex relationship between antigen-specific B and T cells and the level of B cell repopulation necessary to achieve anti-vaccine responses remain largely unknown.MethodsAntibody responses to SARS-CoV-2 vaccines and induction of antigen-specific B and CD4/CD8 T cell subsets were studied in 19 rheumatoid arthritis (RA) and ANCA-associated vasculitis (AAV) patients receiving RTX, 12 RA patients on other therapies and 30 healthy controls after SARS-CoV-2 vaccination with either mRNA or vector based vaccines.ResultsA minimum of 10 B cells/µL in the peripheral circulation was necessary in RTX patients to mount seroconversion to anti-S1 IgG upon SARS-CoV-2 vaccination. RTX patients lacking IgG seroconversion showed reduced antigen-specific B cells, lower frequency of TfH-like cells as well as less activated CD4 and CD8 T cells compared to IgG seroconverted RTX patients. Functionally relevant B cell depletion resulted in impaired IFNγ secretion by spike-specific CD4 T cells. In contrast, antigen-specific CD8 T cells were reduced in patients independently of IgG formation.ConclusionsPatients receiving rituximab with B cell numbers above 10 B cells/µl were able to mount humoral and more robust cellular responses after SARS-CoV-2 vaccination that may permit optimization of vaccination in these patients. Mechanistically, the data emphasize the crucial role of co-stimulatory B cell functions for the proper induction of CD4 responses propagating vaccine-specific B and plasma cell differentiation.
Impact of real-time assessment on the training of trainers for the introduction of rotavirus vaccine in India
Authors: Kaur Amanjot , Ray Arindam , Koshal Seema Singh , Quadri Syed F , Shersiya Mayank , Haldar Pradeep , Kapur Sanjay , Haseeb Mohammed , Roy Arup Deb 
Published: July 2021

AbstractObjectivesTo assess the effectiveness of training workshops for knowledge enhancement of program managers prior to rotavirus vaccine (RVV) introduction in the routine immunization program.MethodThe study was conducted among the participants attending two training workshops for the introduction of RVV; a state workshop in Pune and a regional workshop in Guwahati. The participants who attended the workshops and participated in both the pre and post-test - 53 for Guwahati and 59 for Pune. Data was collected in real-time via pre-post-test.ResultsIn both workshops, a comparison of pre-test and post-test scores of all questions taken together showed a significant increase in the knowledge level of the participants (p<0.05). In Guwahati, the knowledge of the participants regarding doses of RVV, inadequate dosing, Vaccine Vial Monitor (VVM), open vial policy, operationalization of RVV, and monetary incentive increased significantly. In Pune, the knowledge of the participants regarding doses of RVV, bundling approach, schedule and dose, storage temperature for Rotavirus vaccine, VVM, open vial policy, vaccine delivery, and operationalization of RVV increased significantly after the training.ConclusionsA pre-planned and well-designed knowledge assessment tool can be used to understand the impact of training workshops in enhancing the knowledge and practical skills of the participants prior to the introduction of a new vaccine.
Re-estimating prevalence of hepatitis B virus immunity among adults in the United States: self-reported vaccination, immunologic markers, and bias correction
Authors: Vader Daniel T. , Cohen Chari , Goldstein Neal D. , Lee Brian K. , Quick Harrison , Evans Alison A. 
Published: July 2021

AbstractBackgroundTwo instruments used to measure adult hepatitis B vaccination coverage in the United States are self-report and antibody to hepatitis B surface antigen (anti-HBs). Estimates based on either of these measures are subject to misclassification when used to determine immunity to hepatitis B. This study presents misclassification-corrected estimates of hepatitis B immune prevalence in the US and compares them to self-report- and antibody-based estimates.MethodsWe used cross-sectional data from the 2015-2016 NHANES cycle on 5,151 adults in the US age 18 and older. Existing literature on long-term immunity after vaccination informed anti-HBs sensitivity as a measure of immunity. Our model incorporated literature-based distributions for sensitivity and specificity using a Bayesian approach to correct for misclassification of true immune status by anti-HBs.ResultsAfter correcting for misclassification, overall adult immune prevalence was estimated at 31.0% (95% credible interval, 27.9% to 34.1%). Anti-HBs prevalence was 6.4 (3.9 to 8.8) and self-report prevalence 2.6 (−0.6 to 5.8) percentage points lower than overall immune prevalence. Among Asian Americans, anti-HBs and self-report underestimated immune prevalence by 15.8% (11.5% to 20.9%) and 25.1% (17.3% to 33.2%), respectively. Among 19 to 25-year-olds, anti-HBs and self-report underestimated immune prevalence by 26.5% (20.7% to 32.5%) and 21.0% (12.6% to 28.9%).ConclusionsBoth self-reported vaccination and antibody-based measures underestimate hepatitis B immunity among adults. This underestimation was especially large among younger adults and Asian Americans. The consequences of treating these surrogates as unbiased measures of vaccination or immunity may only increase as more vaccinated children age into adulthood.
Intestinal fungal dynamics and linkage to hematopoietic cell transplantation outcomes
Authors: Rolling Thierry , Zhai Bing , Gjonbalaj Mergim , Tosini Nicholas , Yasuma-Mitobe Keiko , Fontana Emily , Amoretti Luigi A , Wright Roberta J , Ponce Doris M , Perales Miguel A , Xavier Joao B , van den Brink Marcel R M , Markey Kate A , Peled Jonathan U , Taur Ying , Hohl Tobias M 
Published: July 2021

AbstractAllogeneic hematopoietic cell transplantation (allo-HCT) induces profound shifts in the intestinal bacterial microbiota. The dynamics of intestinal fungi and their impact on clinical outcomes have not yet been integrated into a model of microbiota function during allo-HCT. Here, we combined parallel high-throughput fungal ITS1 amplicon sequencing, bacterial 16S amplicon sequencing, and fungal cultures to reveal striking trans-kingdom dynamics and their association with patient outcomes. We saw that the overall density and the biodiversity of intestinal fungi were stable during allo-HCT, but the species composition changed drastically from day to day. We identified a subset of patients with fungal dysbiosis characterized by culture positivity, stable expansion of Candida parapsilosis complex species, and distinct trans-kingdom microbiota profiles. These patients had worse overall survival and higher transplant-related mortality independent of candidemia. Our data expand the clinical significance of the mycobiota and suggest that targeting fungal dysbiosis may help to improve long-term patient survival.
Typically asymptomatic but with robust antibody formation: Children’s unique humoral immune response to SARS-CoV-2
Authors: Renk Hanna , Dulovic Alex , Becker Matthias , Fabricius Dorit , Zernickel Maria , Junker Daniel , Seidel Alina , Groß Rüdiger , Hilger Alexander , Bode Sebastian , Fritsch Linus , Frieh Pauline , Haddad Anneke , Görne Tessa , Remppis Jonathan , Ganzemueller Tina , Dietz Andrea , Huzly Daniela , Hengel Hartmut , Kaier Klaus , Weber Susanne , Jacobsen Eva-Maria , Kaiser Philipp D. , Traenkle Bjoern , Rothbauer Ulrich , Stich Maximilian , Tönshoff Burkhard , Hoffmann Georg F. , Müller Barbara , Ludwig Carolin , Jahrsdörfer Bernd , Schrezenmeier Hubert , Peter Andreas , Hörber Sebastian , Iftner Thomas , Münch Jan , Stamminger Thomas , Groß Hans-Jürgen , Wolkewitz Martin , Engel Corinna , Rizzi Marta , Henneke Philipp , Franz Axel R. , Debatin Klaus-Michael , Schneiderhan-Marra Nicole , Janda Ales , Elling Roland 
Published: July 2021

AbstractBackgroundLong-term persistence of antibodies against SARS-CoV-2, particularly the SARS-CoV-2 Spike Trimer, determines individual protection against infection and potentially viral spread. The quality of children’s natural humoral immune response following SARS-CoV-2 infection is yet incompletely understood but crucial to guide pediatric SARS-CoV-2 vaccination programs.MethodsIn this prospective observational multi-center cohort study, we followed 328 households, consisting of 548 children and 717 adults, with at least one member with a previous laboratory-confirmed SARS-CoV-2 infection. The serological response was assessed at 3-4 months and 11-12 months after infection using a bead-based multiplex immunoassay for 23 human coronavirus antigens including SARS-CoV-2 and its Variants of Concern (VOC) and endemic human coronaviruses (HCoVs), and additionally by three commercial SARS-CoV-2 antibody assays.ResultsOverall, 33.76% of SARS-CoV-2 exposed children and 57.88% adults were seropositive. Children were five times more likely to have seroconverted without symptoms compared to adults. Despite the frequently asymptomatic course of infection, children had higher specific antibody levels, and their antibodies persisted longer than in adults (96.22% versus 82.89% still seropositive 11-12 months post infection). Of note, symptomatic and asymptomatic infections induced similar humoral responses in all age groups. In symptomatic children, only dysgeusia was found as diagnostic indicator of COVID-19. SARS-CoV-2 infections occurred independent of HCoV serostatus. Antibody binding responses to VOCs were similar in children and adults, with reduced binding for the Beta variant in both groups.ConclusionsThe long-term humoral immune response to SARS-CoV-2 infection in children is robust and may provide long-term protection even after asymptomatic infection.(Study ID at German Clinical Trials Register: 00021521)
Sensitivity of excess mortality due to the COVID-19 pandemic to the choice of the mortality index, method, reference period, and the time unit of the death series
Authors: Nepomuceno Marília R. , Klimkin Ilya , Jdanov Dmitry A. , Galarza Ainhoa Alustiza , Shkolnikov Vladimir 
Published: July 2021

AbstractEstimating excess mortality is challenging. The metric depends on the expected mortality level, which can differ based on given choices, such as the method and the time series length used to estimate the baseline. However, these choices are often arbitrary, and are not subject to any sensitivity analysis. We bring to light the importance of carefully choosing the inputs and methods used to estimate excess mortality. Drawing on data from 26 countries, we investigate how sensitive excess mortality is to the choice of the mortality index, the number of years included in the reference period, the method, and the time unit of the death series. We employ two mortality indices, three reference periods, two data time units, and four methods for estimating the baseline. We show that excess mortality estimates can vary substantially when these factors are changed, and that the largest variations stem from the choice of the mortality index and the method. We also find that the magnitude of the variation in excess mortality can change markedly within countries, resulting in different cross-country rankings. We conclude that the inputs and method used to estimate excess mortality should be chosen carefully based on the specific research question.
Turnover of SARS-CoV-2 lineages shaped the pandemic and enabled the emergence of new variants in the state of Rio de Janeiro, Brazil
Authors: Francisco Junior Ronaldo da Silva , Lamarca Alessandra P , de Almeida Luiz G P , Cavalcante Liliane , Machado Douglas Terra , Martins Yasmmin , Brustolini Otávio , Gerber Alexandra L , Guimarães Ana Paula de C , Gonçalves Reinaldo Bellini , Alves Cassia , Mariani Diana , Cruz Thais Felix , de Souza Isabelle Vasconcellos , de Carvalho Erika Martins , Ribeiro Mario Sergio , Carvalho Silvia , da Silva Flávio Dias , Garcia Marcio Henrique de Oliveira , de Souza Leandro Magalhães , Da Silva Cristiane Gomes , Pereira Ribeiro Caio Luiz , Cavalcanti Andréa Cony , de Mello Claudia Maria Braga , Struchiner Cláudio J. , Tanuri Amilcar , Vasconcelos Ana Tereza R 
Published: July 2021

AbstractIn the present study, we provide a retrospective genomic epidemiology analysis of the SARS-CoV-2 pandemic in the state of Rio de Janeiro, Brazil. We gathered publicly available data from GISAD and sequenced more 1,927 new genomes sampled periodically from March 2021 to June 2021 from 91 out of the 92 cities of the state. Our results showed that the pandemic was characterized by three different phases driven by a successive replacement of lineages. All stages occurred in distinct mortality and mobility contexts, with higher evidence of social distancing measures being observed in early pandemic and relaxed in the last two phases. Interestingly, we noticed that viral supercarriers accounted for the overwhelming majority of the circulating virus (> 90%) among symptomatic individuals in the state. Moreover, SARS-CoV-2 genomic surveillance also revealed the emergence and spread of two new variants (P.5 and P.1.2) firstly reported in this study. Altogether, our findings provided important lessons learned from the different epidemiological aspects of the SARS-CoV-2 dynamic in the state of Rio de Janeiro that have a strong potential to shape future decisions aiming to improve public health management and understanding mechanisms underlying virus dispersion.
Variation in SARS-CoV-2 bioaerosol production in exhaled breath
Authors: Verma Renu , Kim Eugene , Degner Nicholas , Walter Katharine S. , Singh Upinder , Andrews Jason R. 
Published: July 2021

AbstractUsing face mask bioaerosol sampling, we found substantial variation between individuals in SARS-CoV-2 copies exhaled over a 15-minute period, which moderately correlated with nasal swab viral load. Talking was associated with a median of 2 log10 greater exhaled viral copies. Exposure varies substantially between individuals but may be risk stratified by nasal swab viral load and whether the exposure involved conversation.
Protocol for systematic review of measurement of fatigue in people with cerebral palsy
Authors: Dutia I. M. , Eres R. , Sawyer S. M. , Johnston L. , Reddihough D. , Cleary S. , Coghill D. 
Published: July 2021

AbstractBackgroundFatigue is a common problem for people with cerebral palsy (CP), which adversely affects health-related outcomes. The emerging body of literature on fatigue in people with CP is characterised by substantial heterogeneity in assessment methods. To date, a systematic analysis of the measurement methods, and appraisal of the tools used to measure fatigue in people with CP has not been carried out. The aim of this review is to use The International Classification of Functioning, Disability and Health (ICF) as a framework to categorise and appraise current methods for measuring fatigue in people with CP.Methods and DesignLiterature searches will be conducted in MEDLINE, PsycInfo, CINAHL, Web of Science and Cochrane databases. Studies will be included in this systematic review if they purport to measure any type of fatigue in people with CP of any age through original research, are written in English and are published in peer-reviewed literature since 1980. From included studies we will extract the assessment methods used to measure fatigue, and demographic and clinical characteristics of the sample of people with CP. We will then provide a narrative synthesis of the type and ICF domain of fatigue purportedly measured and critical appraisal of the assessment methods used.DiscussionThis review will summarise current methods for measuring fatigue in people with CP. Critical appraisal and systematic categorisation of assessment methods will allow us to identify areas for further research on the domains in which fatigue occurs, and the role of fatigue in relation to clustering with other symptoms. Findings are expected to guide future assessment of fatigue in people with CP.