bluuebunny/crossref_metadata_2025_split huggingface dataset:
The implementation and outcome of a 2-year prospective audit and feedback based antimicrobial stewardship program at a private tertiary care hospital
Authors: Thakkar Pooja , Singhal Tanu , Shah Sweta , Bhavsar Rohit , Ladi Shweta , John Roshan Elizabeth , Chavhan Rubina , Naik Reshma 
Published: February 2021

AbstractPurposeAntimicrobial resistance has emerged as a major public health problem with India being one of the worst affected nations. Hence effective antimicrobial stewardship programs (AMSP) are needed. We report the design, implementation and results of a prospective audit and feedback based AMSP at a private tertiary care hospital.MethodsDuring the study period – January 2018 to December 2019 – the prescription of restricted antimicrobials required the filling of a justification form which was reviewed by the antimicrobial stewardship committee (AMSC) at 48-72 hours. Patients in whom the restricted antimicrobial was stopped earlier than 48 hours were not applicable for review. The eligible prescriptions were judged as justified/unjustified by AMSC based on the patient’s clinical and previous antimicrobial history, course and results of investigations/ cultures, and communicated to the treating team. Compliance to the recommendations of the AMSC was measured. Days of therapy for each restricted antimicrobial/1000 patient days was calculated. Colistin resistance rates in pathogens causing central line associated blood stream infections were compared with previous years.ResultsA total of 2397 restricted antimicrobials in 1366 patients were prescribed in the study period of which 1801 prescriptions were applicable for review (75%). Overall, 1.4% of admitted patients were prescribed restricted antimicrobials. The total days of therapy with restricted antimicrobials was 41.5/1000 patient days. The AMSC committee adjudged 12.5% of prescriptions as unjustified and recommendations for de-escalation were accepted in 89%. There was no significant difference in any of the study outcomes between 2018 and 2019. Colistin resistance rates in CLABSI remained stable as compared to previous years.ConclusionThe prospective audit and feedback component of AMSP provides insights into the use of restricted antimicrobials. This component should be considered by hospitals for inclusion in their program on an ongoing basis even if limited for a few drugs and in few areas of the hospital.
“This is really like waiting for war and this is not good” – Intertwining between pandemic experiences, and the development of professional action of healthcare professionals in critical care at the beginning of the COVID-19 pandemic in Germany: a qualitative study
Authors: Hörold Madlen , Drewitz Karl Philipp , Brunnthaler Vreni , Piel Julia , Rohr Magdalena , Hrudey Ilona , Hasenpusch Claudia , Ulrich Angela , Otto Niklas , Brandstetter Susanne , Apfelbacher Christian 
Published: February 2021

AbstractHealthcare professionals (HCPs) are facing remarkable challenges in their daily work since the outbreak of the COVID-19 pandemic. Being well prepared is crucial for dealing with such a pandemic. The aim of our study was to explore HCPs’ subjective perspectives on their professional action and coping strategies in critical care during the preparation and coping phase after the outbreak of the COVID-19 pandemic in Germany.Together with HCPs working in critical care, we collaboratively designed an interview study based on an ethnomethodological approach. We performed semi-structured qualitative interviews via telephone or video call and analysed the data based on grounded theory.Our research interest was focused on HCPs (qualified nurses, physicians, medical students) working in critical care during the first wave of the COVID-19 pandemic in Germany between April and July 2020.Our sample consisted of 39 HCPs (19 nurses, 17 physicians, three medical students, 18/39 female) from ten German federal states. All participants were involved in the acute care of COVID-19 infected patients in hospitals and had a mean professional experience of 14.8±10.1 years, 15 participants held a management position (e.g. senior physician or head nurse). We recruited participants via personal contacts and snowballing.Initial and focused coding resulted in seven categories: Creating structural measures, handling operational changes, dealing with personal protective equipment, building up knowledge and skills, managing information, perceiving peer support and experiencing emotions.Professional action and subjectively perceived preparedness (professional and emotional) interacted with each other. Their interrelation was not static, but rather dynamic and ambiguous according to the situation. The findings of our study can be beneficial in developing guidelines, policy interventions or personnel and work practice strategies.
Using simulated infectious disease outbreaks to guide the design of individually randomized vaccine trials
Authors: Madewell Zachary J. , Piontti Ana Pastore Y , Zhang Qian , Burton Nathan , Yang Yang , Longini Ira M. , Halloran M. Elizabeth , Vespignani Alessandro , Dean Natalie E. 
Published: February 2021

AbstractBackground/AimsNovel strategies are needed to make vaccine efficacy trials more robust given the uncertain epidemiology of outbreaks. Spatially resolved mathematical and statistical models can help investigators identify sites at highest risk of future transmission and prioritize these for inclusion in trials. Models can also characterize the uncertainty in whether transmission will occur at a site, and how nearby or connected sites may have correlated outcomes. A structure is needed for how trials can use models to address key design questions, including how to prioritize sites, the optimal number of sites, and how to allocate participants across sites.MethodsWe illustrate the added value of models using the motivating example of Zika vaccine trial planning during the 2015-2017 Zika epidemic. We used a stochastic, spatially resolved, agent-based transmission model (GLEAM) to generate 1,142 epidemics and site-level incidence at 100 high-risk sites in the Americas. We considered several strategies for prioritizing sites (average site-level incidence of infection across epidemics, median incidence, probability of exceeding 1% incidence), selecting the number of sites, and allocating sample size across sites (equal enrollment, proportional to average incidence, proportional to rank). To evaluate each design, we stochastically simulated trials in each hypothetical epidemic by drawing observed cases from site-level incidence data.ResultsWhen constraining the overall trial sample size, the optimal number of sites represents a balance between prioritizing highest-risk sites and having enough sites to reduce the chance of observing too few endpoints. The optimal number of sites remained roughly constant despite varying the targeted number of events, although it is necessary to increase the total sample size to achieve the desired power. Though different ranking strategies returned different site orders, they performed similarly with respect to trial power. Instead of enrolling participants equally from each site, investigators can allocate participants proportional to projected incidence, though this did not provide an advantage in our example because the top sites had a roughly similar risk profile. Sites from the same geographic region may have similar outcomes, so optimal combinations of sites may be those that are more geographically dispersed, even when these are not the highest ranked sites.ConclusionsMathematical and statistical models may assist in the design of successful vaccination trials by capturing uncertainty and correlation in future transmission. Although many factors affect site selection, such as logistical feasibility, models can help investigators optimize site selection and the number and size of participating sites.
The effects of time-restricted eating vs. standard dietary advice on weight, metabolic health and the consumption of processed food: A pragmatic randomised controlled trial in community-based adults
Authors: Phillips Nicholas Edward , Mareschal Julie , Schwab Nathalie , Manoogian Emily N.C. , Borloz Sylvie , Ostinelli Giada , Gauthier-Jaques Aude , Umwali Sylvie , Rodriguez Elena Gonzalez , Aeberli Daniel , Hans Didier , Panda Satchidananda , Rodondi Nicolas , Naef Felix , Collet Tinh-Hai 
Published: February 2021

AbstractWeight loss is key to control the increasing prevalence of metabolic syndrome (MS) and its components, i.e. central obesity, hypertension, prediabetes, and dyslipidaemia. We characterised the relationships between eating duration, unprocessed and processed food consumption, and metabolic health. During 4 weeks of observation, 213 adults used a smartphone application to record food and drink consumption, which was annotated for food processing levels following the NOVA classification. Consumption of unprocessed food items showed the highest number of significant associations with MS components after age and sex. In a pragmatic randomised controlled trial, we compared the metabolic benefits of 12h time-restricted eating (TRE) to standard dietary advice (SDA) in 54 adults with an eating duration >14h and at least one MS component. After 6 months, those randomised to TRE lost 1.6% of initial body weight (SD 2.9, p=0.01), compared to the absence of weight loss with SDA (−1.1%, SD 3.5, p=0.19). There was no significant difference in weight loss between TRE and SDA (between-group difference −0.88%, 95% confidence interval −3.1 to 1.3, p=0.43). Our results show the potential of smartphone records to predict metabolic health and highlight that further research is needed to understand individual responses to TRE.
Paclitaxel-Coated or Uncoated Devices: Significant Differences in Patient Populations and Mortality Led to Study Incomparability
Authors: Zhang Chenyang , Yin Guosheng 
Published: February 2021

AbstractThe SWEDEPAD trial reported an unplanned interim analysis to show no difference in the mortality rate between the paclitaxel-coated and uncoated groups (Nordanstig et al., 2020), which contradicts the long-term risk of paclitaxel-coated devices claimed by a meta-analysis (Katsanos et al., 2018). However, there existed significant differences in mortality rates between the SWEDEPAD trial and the trials included in the meta-analysis, which were caused by significant differences in the patient populations. As a result, the SWEDEPAD trial and meta-analysis results are not directly comparable. An updated meta-analysis including the SWEDPEPAD trial and all studies in the meta-analysis (Katsanos et al., 2018) shows marginal differences in mortality rates between the paclitaxel-coated and control groups at two years with Bayesian relative risk (RR) 1.39 (95% credible interval (CrI) [1.01, 2.39]) and frequentist RR 1.16 (95% confidence interval (CI) [0.99, 1.36]) and differences in mortality rates during the entire follow-up period with Bayesian RR 1.29 (95% CrI [1.01, 1.72]) and frequentist RR 1.13 (95% CI [0.99, 1.28]) under random-effects models. Given the relatively short follow-up thus far in the SWEDEPAD trial (with a mean follow-up of 2.49 years) and the paclitaxel-coated risk being long-term (e.g., 4 or 5 years), the interim results on the risk of paclitaxel-coated devices reported by the SWEDEPAD trial warrant further investigation.
COVID-19 vaccine uptake among healthcare workers in the fourth country to authorize BNT162b2 during the first month of rollout
Authors: Barry Mazin , Temsah Mohamad-Hani , Aljamaan Fadi , Saddik Basema , Al-Eyadhy Ayman , Alenezi Shuliweeh , Alamro Nurah , Alhuzaimi Abdullah N , Alhaboob Ali , Alhasan Khalid , Alsohime Fahad , Alaraj Ali , Halwani Rabih , Jamal Amr , Temsah Omar , Alzamil Fahad , Somily Ali , Al-Tawfiq Jaffar A. 
Published: February 2021

AbstractBackgroundThe Kingdom of Saudi Arabia (KSA) was the fourth country in the world to authorize the BNT162b2 coronavirus disease 2019 (COVID-19) vaccine, which it rolled out on December 17, 2020 and first targeted at healthcare workers (HCWs). This study assesses vaccine uptake among this group during the first month of its availability.MethodsA national cross-sectional, pilot-validated, self-administered survey was conducted among HCWs in the KSA between December 27, 2020 and January 3, 2021. The survey included sociodemographic details, previous contact with COVID-19 patients, previous infection with COVID-19, receiving (or registering with the Ministry of Health website to receive) the COVID-19 vaccine, sources of HCWs’ information on vaccines, awareness of emerging variants of concern, and anxiety level using the 7-item Generalized Anxiety Disorder assessment. A descriptive bivariate analysis and multivariate logistic binary regression analysis were performed. The primary evaluated outcome was vaccine uptake.ResultsOf the 1,058 participants who completed the survey, 704 (66.5%) were female, and 626 (59.2%) were nurses. Of all the respondents, 352 (33.27%) were enrolled to receive or had already received the vaccine, while 706 (66.73%) had not registered. In a bivariate analysis, not enrolling for vaccination was more likely in females than males (78.5% vs. 21.5%, P < 0.001), HCWs between the ages of 20 and 40 years than those > 40 years (70.4% vs. 29.6%, P = 0.005), Saudi HCWs than expatriates (78% vs 22%, P < 0.001), and among HCWs who used social media as a source of information than those who did not (69.8% vs. 38.6%, P < 0.001). In a multivariate analysis, independent factors for not enrolling to receive the vaccine included being female (aOR = 0.287, 95%CI = 0.206–0.401, P < 0.001), being less than 40 years of age (aOR = 1.021, 95%CI = 1.002–1.040, P = 0.032), and using social media as a source of information (aOR = 0.207, 95%CI = 0.132-1.354, P = 0.001). Factors associated with uptake were being a Saudi national (aOR = 1.918, 95%CI = 1.363–2.698, P < 0.001), working in an intensive care unit (aOR = 1.495, 95%CI = 1.083–2.063, P = 0.014), and working at a university hospital (aOR = 1.867, 95%CI = 1.380–2.525, P < 0.001).ConclusionsA low level of vaccine uptake was observed especially in female HCWs, those younger than 40 years old, and those who used social media as their source of vaccine information. This survey provides important information for public health authorities in order to scale up vaccination campaigns targeting these HCWs to increase vaccine enrollment and uptake.
Discontinuation of isolation for persons with COVID-19: Is 10 days really safe?
Authors: Felix Alvina Clara , de Paula Anderson V , Ribeiro Andreia Cristina , da Silva Francini Camila , Inemami Marta , Costa Angela A , Leal Cibele Odete D , Figueiredo Walter M , Sérgio Pannuti Claudio , Romano Camila Malta 
Published: February 2021

AbstractBackgroundThe detection of SARS-CoV-2 RNA by real-time polymerase chain reaction (PCR) in respiratory samples from COVID-19 patients is not a direct indication of the presence of viable viruses. The isolation of SARS-CoV-2 in cell culture system however, can acts as surrogate marker of infectiousness. Cell culture based studies performed mostly with hospitalized and moderate/severe COVID-19 claims that no replication competent virus is found after 9 days of the symptoms onset in respiratory samples. Therefore, it is now recommended 10 days isolation before patient discharge.MethodsWe cell-cultured 29 SARS-COV-2 RT-PCR positive respiratory samples at the 10th day after the illness in Vero E6 cells. After two passages, cytopathic effect and cycle threshold (CT) lower than the obtained in the original sample were used to determine positivity.FindingsWe found viable particles in (7/29) 24% of samples tested. The positivity in cell culture was strongly associated (p<0.0001) to the low cycle thresholds in clinical samples (Ct <21).ConclusionThis data adds important knowledge to the current protocols for de-isolation of patients with non-hospitalized mild COVID-19.
Genetically predicted serum vitamin D and COVID-19: a Mendelian randomization study
Authors: Patchen Bonnie K , Clark Andrew G , Hancock Dana B , Gaddis Nathan , Cassano Patricia A 
Published: February 2021

ABSTRACTObjectivesTo investigate causality of the association of serum vitamin D with the risk and severity of COVID-19 infection.DesignTwo-sample Mendelian randomization study.SettingSummary data from genome-wide analyses in the population-based UK Biobank and SUNLIGHT Consortium, applied to meta-analyzed results of genome-wide analyses in the COVID-19 Host Genetics Initiative.Participants17,965 COVID-19 cases including 11,085 laboratory or physician confirmed cases, 7,885 hospitalized cases, and 4,336 severe respiratory cases, and 1,370,547 controls, primarily of European ancestry.ExposuresGenetically predicted variation in serum vitamin D status, based on genome-wide significant single nucleotide polymorphisms (SNPs) associated with serum vitamin D or risk of vitamin D deficiency/insufficiency.Main outcome measuresSusceptibility to and severity of COVID-19 infection, including severe respiratory infection and hospitalization.ResultsMendelian randomization analysis, powered to detect moderate effects comparable to those seen in observational studies, provided little to no evidence for an effect of genetically predicted serum vitamin D on susceptibility to or severity of COVID-19 infection. Using SNPs in loci related to vitamin D metabolism as proxies for serum vitamin D concentration, the odds ratio for a standard deviation increase in serum vitamin D was 1.04 (95% confidence interval 0.92 to 1.18) for any COVID-19 infection versus population controls, 1.05 (0.84-1.31) for hospitalized COVID-19 versus population controls, 0.96 (0.64 to 1.43) for severe respiratory COVID-19 versus population controls, 1.15 (0.99 to 1.35) for COVID-19 positive versus COVID-19 negative, and 1.44 (0.75 to 2.78) for hospitalized COVID-19 versus non-hospitalized COVID-19. Results were similar in analyses that used all SNPs with genome-wide significant associations with serum vitamin D (i.e., including SNPs in loci with no known relationship to vitamin D metabolism) and in analyses using SNPs with genome-wide significant associations with risk of vitamin D deficiency or insufficiency.ConclusionsThese findings suggest that genetically predicted differences in long-term vitamin D nutritional status do not causally affect susceptibility to and severity of COVID-19 infection, and that associations observed in previous studies may have been driven by confounding. These results do not exclude the possibility of low-magnitude causal effects, nor do they preclude potential causal effects of acute responses to therapeutic doses of vitamin D. Future directions include extension of this work to non-European ancestry populations, and high-risk populations, for example persons with comorbid disease.
Relative humidity predicts day-to-day variations in COVID-19 cases in the city of Buenos Aires
Authors: Pineda Rojas Andrea L. , Cordo Sandra M. , Saurral Ramiro I. , Jimenez Jose L. , Marr Linsey C. , Kropff Emilio 
Published: February 2021

ABSTRACTPossible links between the transmission of COVID-19 and meteorology have been investigated by comparing positive cases across geographical regions or seasons. Little is known, however, about the degree to which environmental conditions modulate the daily dynamics of COVID-19 spread at a given location. One reason for this is that individual waves of the disease are typically too abrupt, making it hard to isolate the contribution of meteorological cycles. To overcome this shortage, we here present a case study of the first wave of the outbreak in the city of Buenos Aires, which had a slow evolution of the case load extending along most of 2020. We found that humidity plays a prominent role in modulating the variation of COVID-19 positive cases through a negative-slope linear relationship, with an optimal lag of 9 days between the meteorological observation and the positive case report. This relationship is specific to winter months, when relative humidity predicts up to half of the variance in positive cases. Our results provide a tool to anticipate local surges in COVID-19 cases after events of low humidity. More generally, they add to accumulating evidence pointing to dry air as a facilitator of COVID-19 transmission.
Pelvic Pain: what are the symptoms and predictors for surgery, endometriosis and endometriosis severity?
Authors: Conroy Isabelle , Mooney Samantha S , Kavanagh Shane , Duff Michael , Jakab Ilona , Robertson Katharine , Fitzgerald Amy L , Mccutchan Alexandra , Madden Siana , Maxwell Sarah , Nair Shweta , Origanti Nimita , Quinless Alish , Mirowska-Allen Kelly , Sewell Megan , Grover Sonia R 
Published: February 2021

AbstractBackgroundChronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women.Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never-the-less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30-50% of women with pain.AimsTo explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP.Materials and MethodsThis study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of 2 gynaecology units for routine care and followed for 36-months with 6-monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Operative notes were reviewed, and endometriosis staged.ResultsOf 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis (n=37 stage I-II; n=15 stage III-IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (Odds ratio (OR) 0.342; 95%CI 0.209-0.561; OR 1.303; 95%CI: 1.079-1.573; OR 0.767; 95%CI: 0.620-0.949 respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155; 95%CI: 1.047-1.310).ConclusionsPain intensity and gynaecology unit were key predictors of undergoing laparoscopy, however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice towards surgery for pelvic pain.