bluuebunny/crossref_metadata_2025_split huggingface dataset:
HYDROXYCHLOROQUINE FOR THE TREATMENT OF SEVERE RESPIRATORY INFECTION BY COVID-19: A RANDOMIZED CONTROLLED TRIAL
Authors: Hernandez-Cardenas Carmen , Thirion-Romero Ireri , Rivera-Martinez Norma E. , Meza-Meneses Patricia , Remigio-Luna Arantxa , Perez-Padilla Rogelio 
Published: February 2021

ABSTRACTThe novel coronavirus pandemic (COVID–19) represents a major public health problem due to its rapid spread and its ability to generate severe pneumonia. Thus, it is essential to find a treatment that reduces mortality. Our objective was to estimate whether treatment with 400 mg/day of Hydroxychloroquine for 10 days reduces in-hospital mortality in subjects with severe respiratory disease due to COVID-19 compared with placebo.Material and methodsA double-blind, randomized, placebo-controlled trial to evaluate the safety and efficacy of Hydroxychloroquine for the treatment of severe disease by COVID-19 through an intention-to-treat analysis. Eligible for the study were adults aged more than 18 years with COVID-19 confirmed by RT-PCR and lung injury requiring hospitalization with or without mechanical ventilation. Primary outcome was 30-day mortality. Secondary outcomes: days of mechanical ventilation, days of hospitalization and cumulative incidence of serious adverse events.ResultsA total of 214 patients with COVID-19 were recruited, randomized and analyzed. They were hypoxemic with a mean SpO2 of 65% ± 20, tachycardic (pulse rate 108±17 min-1) and tachypneic (32 ±10 min-1); 162 were under mechanical ventilation at randomization. Thirty-day mortality was similar in both groups (38% in Hydroxychloroquine vs. 41% in placebo, hazard ratio [HR] 0.88, 95% Confidence Interval [95%CI] 0.51-1.53). In the surviving participants, no significant difference was found in secondary outcomes.ConclusionNo beneficial effect or significant harm could be demonstrated in our randomized controlled trial including 214 patients, using relatively low doses of Hydroxychloroquine compared with placebo in hospitalized patients with severe COVID-19.CONSORT GUIDELINES
Concentrations and immunostimulatory potential of circulating cell-free membrane-bound and membrane-unbound mitochondrial DNA in preeclampsia
Authors: Cushen Spencer C. , Ricci Contessa A. , Bradshaw Jessica L. , Silzer Talisa , Blessing Alexandra , Sun Jie , Scroggins Sabrina M. , Santillan Mark K. , Santillan Donna A. , Phillips Nicole R. , Goulopoulou Styliani 
Published: February 2021

ABSTRACTCell-free circulating mitochondrial DNA (CFCmtDNA) is a damage-associated molecular pattern (DAMP) that can activate Toll-like receptor 9 (TLR-9). The main objectives of this case-control study were 1) to determine absolute concentrations and immunostimulatory capacity of CFCmtDNA, in membrane-bound and -unbound states, in cases with preeclampsia and healthy controls and 2) to implement a bootstrapped penalized regression analysis to establish the contribution of CFCmtDNA to preeclampsia diagnosis and its interaction with commonly collected patient characteristics. To determine the contribution of membrane-bound and -unbound CFCmtDNA in preeclampsia, DNA from plasma samples was exctracted with lysis buffer (membrane-unbound) and without lysis buffer (membrane-bound). CFCmtDNA, quantified using absolute PCR quantification protocol, was reduced in preeclampsia compared to healthy controls (P≤0.02). While the pattern of reduced CFCmtDNA in preeclampsia was similar between methods of DNA extraction, DNA isolation with membrane lysis buffer resulted in 1,000-fold higher CFCmtDNA quantification in the preeclampsia group (P=0.0014) and 430-fold higher CFCmtDNA quantification in the control group (P<0.0001). Even though CFCmtDNA concentrations were reduced, plasma from women with preeclampsia induced greater TLR-9 activation than plasma from gestational age matched controls (P≤0.01) as monitored using SEAP reporter 293 cells expressing humanTLR-9. Penalized regression analysis showed that women with preeclampsia are strongly likely to have high concentrations of nDNA and DNase I along with a prior history of preeclampsia. Low concentrations of CFCmtDNA and mode of delivery were also associated with preeclampsia. In conclusion, our data demonstrate increases in the immunostimulatory potential of CFCmtDNA and upregulation of DNA degradation mechanisms in women with preeclampsia at the third trimester.
COVID19-related and all-cause mortality among middle-aged and older adults across the first epidemic wave of SARS-COV-2 infection in the region of Tarragona, Spain: results from the COVID19 TARRACO Cohort Study, March-June 2020
Authors: Vila-Corcoles Angel , Satue-Gracia Eva , Vila-Rovira Angel , de Diego-Cabanes Cinta , Forcadell-Peris Maria Jose , Ochoa-Gondar Olga 
Published: February 2021

SUMMARYBackgroundDirect and indirect COVID19-related mortality is uncertain. This study investigated COVID19-related and all-cause deaths among middle-aged and older adults during the first wave of COVID19 epidemic period, assessing mortality risks by pre-existing socio-demographic and medical underlying conditions.MethodsPopulation-based cohort study involving 79,083 individuals ≥50 years-old in Tarragona (Southern Catalonia, Spain). Baseline cohort characteristics (age/sex, comorbidities and medications/vaccinations history) were established at study start (01/03/2020) and main outcomes were COVID19-related deaths (occurred in patients diagnosed with the disease) and all-cause deaths occurred among cohort members between 01/03/2020-30/06/2020. Mortality risks were assessed by Cox regression analyses.ResultsCohort members were followed for 1,356,358 persons-weeks, occurring 576 all-cause deaths (124 COVID19-related). All-cause mortality rate was 42.5 deaths per 100,000 persons-week, being 22.8 in healthy/unrelated-COVID19 subjects, 236.4 in COVID19-excluded/PCR-negative subjects, 493.7 in COVID19-compatible/PCR-unperformed subjects and 4009.1 in COVID19-confirmed patients. In multivariable analyses, increasing age, sex male, nursing-home residence, cancer, neurologic, cardiac or liver disease, receiving diuretics, systemic corticosteroids, proton-pump inhibitors and benzodiazepines were associated with increased risk of all-cause mortality; conversely, receiving renin-angiotensin inhibitors and statins were associated with reduced risk. Age/years, sex male and nursing-home residence were strong predictors for COVID19-related mortality, but none comorbidity appeared significantly associated with an increased risk.ConclusionApart from direct COVID19-related deaths (which represented almost 22% of all-cause mortality), theoretically COVID19-excluded patients (PCR-negative) suffered considerable greater all-cause mortality than healthy/unrelated-COVID19 subjects, which could explain, in part, the large excess deaths observed across the COVID19 pandemic.
DermoExpert: Skin lesion classification using a hybrid convolutional neural network through segmentation, transfer learning, and augmentation
Authors: Hasan Md. Kamrul , Elahi Md. Toufick E , Alam Md. Ashraful , Jawad Md. Tasnim 
Published: February 2021

AbstractBackground and ObjectiveAlthough automated Skin Lesion Classification (SLC) is a crucial integral step in computeraided diagnosis, it remains challenging due to inconsistency in textures, colors, indistinguishable boundaries, and shapes.MethodsThis article proposes an automated dermoscopic SLC framework named Dermoscopic Expert (DermoExpert). The DermoExpert consists of preprocessing and hybrid Convolutional Neural Network (hybrid-CNN), leveraging a transfer learning strategy. The proposed hybrid-CNN classifier has three different feature extractor modules taking the same input images, which are fused to achieve better-depth feature maps of the corresponding lesion. Those unique and fused feature maps are classified using different fully connected layers, which are then ensembled to predict the lesion class. We apply lesion segmentation, augmentation, and class rebalancing in the proposed preprocessing. We have also employed geometry- and intensity-based augmentations and class rebalancing by penalizing the majority class’s loss and combining additional images to the minority classes to enhance lesion recognition outcomes. Moreover, we leverage the knowledge from a pre-trained model to build a generic classifier, although small datasets are being used. In the end, we design and implement a web application by deploying the weights of our DermoExpert for automatic lesion recognition.ResultsWe evaluate our DermoExpert on the ISIC-2016, ISIC-2017, and ISIC-2018 datasets, where the DermoExpert has achieved the area under the receiver operating characteristic curve (AUC) of 0.96, 0.95, and 0.97, respectively. The experimental results defeat the recent state-of-the-art by the margins of 10.0 % and 2.0 % respectively for the ISIC-2016 and ISIC-2017 datasets in terms of AUC. The DermoExpert also outperforms by a border of 3.0 % for the ISIC-2018 dataset concerning a balanced accuracy.ConclusionSince our framework can provide better-classification outcomes on three different test datasets, it can lead to better-recognition of melanoma to assist dermatologists. Our source code and segmented masks for the ISIC-2018 dataset will be publicly available for further improvements.
Antibiotic Resistance in Wastewater Treatment Plants and Transmission Risks for Employees and Residents: The Concept of the AWARE Study
Authors: Wengenroth Laura , Berglund Fanny , Blaak Hetty , Chifiriuc Mariana Carmen , Flach Carl-Fredrik , Pircalabioru Gratiela Gradisteanu , Larsson D. G. Joakim , Marutescu Luminita , van Passel Mark , Popa Marcela , Radon Katja , de Roda Husman Ana Maria , Rodríguez-Molina Daloha , Weinmann Tobias , Wieser Andreas , Schmitt Heike 
Published: February 2021

AbstractBackgroundAntibiotic resistance has become a serious global health threat. Wastewater treatment plants (WWTPs) may become unintentional collection points for bacteria resistant to antimicrobials. Little is known about the transmission of antibiotic resistance from wastewater treatment plants to humans, most importantly to WWTP workers and residents living in the vicinity. We aim to deliver precise information about the methods used in the AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Waste Water Treatment Plants) study.Methods/DesignWithin the AWARE study, we gather data on the prevalence of two antibiotic resistance phenotypes, ESBL-producing E.coli (ESBL-EC) and carbapenemase-producing Enterobacteriaceae (CPE) as well as on their corresponding antibiotic resistance genes (ARGs) isolated from air, water, and sewage samples taken from inside and outside of different WWTPs in Germany, Netherlands and Romania. Additionally, we analyse stool samples of WWTP workers, nearby residents and members of a comparison group living ≥1,000 m away from the closest WWTP.DiscussionThe study results will enable the assessment of the potential health impact of exposure to ESBL-EC, CPE and ARGs in and around WWTPs. Quantifying the contribution of different wastewater treatment processes to the ESBL-EC, CPE and ARGs removal efficiency will provide us with evidence-based support for possible mitigation strategies.
Intention to receive a COVID-19 vaccine: Results from a population-based survey in Canada
Authors: Ogilvie Gina S. , Gordon Shanlea , Smith Laurie W. , Albert Arianne , Racey C. Sarai , Booth Amy , Gottschlich Anna , Goldfarb David , Murray Melanie C.M. , Galea Liisa A.M. , Kaida Angela , Brotto Lori A. , Sadarangani Manish 
Published: February 2021

AbstractBackgroundThe success of any COVID-19 vaccine program ultimately depends on high vaccine uptake. This study determined overall intention to receive a COVID-19 vaccine and identified factors that predict intentions to be vaccinated against COVID-19 in Canada, specifically in key priority groups identified by the American Committee on Immunization Practice (ACIP) and the National Advisory Committee on Immunization (NACI) for early immunization.MethodsIndividuals from research cohorts from the general population of British Columbia aged 25-69 were invited complete an online survey based on validated scales and theoretical frameworks to explore intention to receive a COVID-19 vaccine. Two multivariable logistic regression models were conducted to determine factors associated with intention to receive the COVID-19 vaccine.ResultsOf 4,948 respondents, 79.8% intended to receive a COVID-19 vaccine. In multivariable modeling, respondents who intended to receive the vaccine had higher vaccine attitudinal scores (p <0.001), reported greater influence of direct social norms (p = 0.001), and indirect social norms, including their family physician (p = 0.024), and Provincial Health Officer (p = 0.011). Older individuals (>60 years) were more likely to intend to receive the vaccine, while females (95%CI 0.57,0.93), those with less than high school education (95%CI 0.5,0.76), those who self-identified as non-white (95%CI 0.60,0.92), self-identified as Indigenous (95%CI 0.36,0.84) and essential non-health care workers (95%CI 0.59,0.86) had lower adjusted odds of intending to receive a COVID-19 vaccine.ConclusionsTo optimize vaccine coverage, public health should focus on key messages around vaccine safety and benefit, and leverage trusted practitioners for messaging. As certain key populations identified by NACI and ACIP for early immunization report a lower intention to vaccinate, there is a need for in-depth education and support for these communities to ensure optimal uptake.
Impact of personal protective equipment use on health care workers’ physical health during the COVID-19 pandemic: a systematic review and meta-analysis
Authors: Galanis Petros , Vraka Irene , Fragkou Despoina , Bilali Angeliki , Kaitelidou Daphne 
Published: February 2021

SummaryBackgroundDuring the COVID-19 pandemic, health care workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) in high-risk clinical settings have been obliged to wear personal protective equipment (PPE).AimTo assess the impact of PPE use on HCWs’ physical health during the COVID-19 pandemic. Also, we examined factors related with a greater risk of adverse events among HCWs due to PPE use.MethodsWe applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane criteria for this systematic review and meta-analysis. We searched PubMed, Medline, Scopus, ProQuest, CINAHL and pre-print services (medRxiv) from January 1, 2020 to December 27, 2020.FindingsOur review included 14 studies with 11,746 HCWs from 16 countries. The estimated overall prevalence of adverse events among HCWs was 78% (95% CI: 66.7-87.5%) with a range from 42.8% to 95.1% among studies. The prevalence of adverse events was higher for the studies with poor quality compared to those with moderate quality (83.5% vs. 67.1%), while increased sample size was related with decreased prevalence (p<0.001). The most frequent adverse events were headache (55.9%), dry skin (54.4%), dyspnoea (53.4%), pressure injuries (40.4%), itching (39.8%), hyperhidrosis (38.5%), and dermatitis (31.0%). Among others, the following factors were related with the risk of adverse events among HCWs due to PPE use: female gender, younger age, obesity, diabetes mellitus, smoking pre-existing headache, longer duration of shifts wearing PPE, increased consecutive days with PPE, and increased exposure to confirmed or suspected COVID-19 patients.ConclusionThe frequency of adverse events amongst HCWs due to PPE use is very high. Further studies should be conducted since the limitations of this review do not allow us to infer conclusive results especially in case of risk factors for the occurrence of adverse events. Healthcare facilities should take the necessary precautions and change the working conditions during the COVID-19 pandemic to prevent adverse events associated with PPE use and minimize harm to HCWs.
“Breaking the silence”: Sexual victimisation in an old age psychiatry patient population in Flanders
Authors: Nobels Anne , Keygnaert Ines , Robert Egon , Vandeviver Christophe , Haekens An , Lemey Lieve , Strobbe Marieke , Noortgate Nele Van Den , Lemmens Gilbert M.D. 
Published: February 2021

AbstractBackgroundSexual violence (SV) is linked to mental health problems in adulthood and old age. However, the extent of sexual victimisation in old age psychiatry patients is unknown. Due to insufficient communication skills in both patients and healthcare workers, assessing SV in old age psychiatry patients is challenging.MethodsBetween July 2019 and March 2020, 100 patients at three old age psychiatry wards across Flanders participated in a face-to-face structured interview receiving inpatient treatment. The participation rate was 58%. We applied the WHO definition of SV, encompassing sexual harassment, sexual abuse with physical contact without penetration, and (attempted) rape.OutcomesIn 57% of patients (65% F, 42% M) SV occurred during their lifetime and 7% (6% F, 9% M) experienced SV in the past 12-months. Half of the victims disclosed their SV experience for the first time during the interview. Only two victims had disclosed SV to a mental health care professional before.InterpretationSexual victimisation appears to be common in old age psychiatry patients, yet it remains largely undetected. Although victims did reveal SV during a face-to-face interview to a trained interviewer, they do not seem to spontaneously disclose their experiences to mental health care professionals. In order to provide tailored care for older SV victims, professionals urgently need capacity building through training, screening tools and care procedures.
Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank
Authors: Mutz Julian , Lewis Cathryn M. 
Published: February 2021

AbstractIndividuals with depression, on average, die prematurely, have high levels of physical comorbidities and may experience accelerated biological ageing. A greater understanding of age-related changes in physiology could provide novel biological insights that may help inform strategies to mitigate excess mortality in depression. We used generalised additive models to examine age-related changes in 15 cardiovascular, body composition, grip strength and lung function measures, comparing males and females with a lifetime history of depression to healthy controls. The main dataset included 342,393 adults (mean age = 55.87 years, SD = 8.09; 52.61% females). We found statistically significant case-control differences for most physiological measures. There was some evidence that age-related changes in body composition, cardiovascular function, lung function and heel bone mineral density followed different trajectories in depression. These differences did not uniformly narrow or widen with age and differed by sex. For example, BMI in female cases was 1.1 kg/m2higher at age 40 and this difference narrowed to 0.4 kg/m2at age 70. In males, systolic blood pressure was 1 mmHg lower in depression cases at age 45 and this difference widened to 2.5 mmHg at age 65. These findings suggest that targeted screening for physiological function in middle-aged and older adults with depression is warranted to potentially mitigate excess mortality.
Antibody responses boosted in seropositive healthcare workers after single dose of SARS-CoV-2 mRNA vaccine
Authors: Bradley Todd , Grundberg Elin ,   CODIEFY study team, Selvarangan Rangaraj 
Published: February 2021

AbstractCurrent guidelines recommend that individuals who have had COVID-19 should receive the identical vaccine regimen as those who have not had the infection. This includes two doses of the mRNA platform vaccines (BNT162b2/Pfizer; mRNA-1273/Moderna) that are approved for use in the United States. In this brief report, we show that after a single dose of the Pfizer SARS-CoV-2 vaccine, individuals that had prior SARS-CoV-2 infection had significantly higher antibody levels than individuals that had no history of infection. This provides the rationale for changing vaccination policy to deliver only a single dose to individuals with recent SARS-CoV-2 infection that may free up additional doses for individuals that have no preexisting immunity to the virus. Future study of other immune parameters such as T cell response and durability of immune response should be rapidly undertaken in individuals that had COVID-19 prior to vaccination.
A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients with COVID-19
Authors: Ko Justine J. , Wu Clay , Mehta Neha , Wald-Dickler Noah , Yang Wei , Qiao Renli 
Published: February 2021

ABSTRACTOBJECTIVESThis study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring ICU care.DESIGNThis is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit admission. Patients admitted and requiring oxygen supplementation were treated with either methylprednisolone or dexamethasone.SETTINGThis study takes place in the intensive care units at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles.PATIENTSAll eligible patients admitted to the intensive care unit for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study.INTERVENTIONSA total of 262 patients were grouped as receiving usual care (n=75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n=104), or dexamethasone dosed at least at 6 mg for ≥ 7 days (n=83).MEASUREMENTS and MAIN RESULTSAll-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient.In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days (p <0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, p=0.0385).CONCLUSIONSIn COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.