bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in burden of disease in UK children and young people (0-24 years) over the past 20 years and estimation of potential burden in 2040: analysis using Global Burden of Disease (GBD) data
Authors: Ward Joseph L. , Hargreaves Dougal , Turner Steve , Viner Russell M. 
Published: February 2021

AbstractBackgroundThe epidemiological transition and medical innovations have led to changes in causes of ill-health and disability by children and young people (CYP) in many wealthy countries over the past two decades. However this has not been systematically examined at a national level in the UK. Here we examined changes in disability-adjusted life-years (DALYs) by cause for 0-24 year olds by age-group.MethodsWe used data on DALYS by cause, sex and age-group for the UK from 1998 to 2017 from the 2017 Global Burden of Disease (GBD) study. We modified the GBD cause-hierarchy to be more relevant to paediatrics. We assessed current causes of burden in 2017 and change at cause-level for 1998-2007 and 2008-2017 by age. We then used Holt-Winters doubly exponentiated time-series models to forecast change in DALYs by age to 2040.ResultsIn 2017, neonatal and congenital disorders were the main causes of DALYS across 0-24 year olds, with other the other large causes being anxiety and depression, endocrine and immune disorders, and lower respiratory tract infections. Total DALYS were highest amongst neonates and lowest amongst 1-9 year olds, rising with age amongst 10-24 year olds. Between 1998-2017, total DALYs fell in each age-group, with the largest falls in infants. The greatest changes in DALYS from 2008 to 2017 were falls in neonatal and congenital causes amongst infants, falls in infectious diseases and injuries in older age-groups, and rises in neonatal causes, mental health, acne and somatic symptoms in all age-groups other than infants. These patterns were forecast to continue to 2040.ConclusionsWe forecast falls in causes that have historically dominated disease in CYP, particularly congenital disorders, infectious diseases, cancers and injuries, representing falls in the prevalence of many infectious diseases and improvements in road safety and also improvements in survival from cancer and many congenital conditions. Forecast increases in DALYS from mental health problems, other adolescent health issues and the consequences of neonatal survival, such as neuro-disability and epilepsy, have potential implications for the training of paediatricians and workforce needs over the next two decades. The impact of the COVID-19 pandemic, climate change and changes in child poverty require further research.
Modeling the evolution of SARS-CoV-2 under non-pharmaceutical interventions
Authors: Gurevich Yael , Ram Yoav , Hadany Lilach 
Published: February 2021

AbstractSocial and behavioral non-pharmaceutical interventions (NPIs), such as mask-wearing, social distancing, and travel restrictions, as well as diagnostic tests, have been broadly implemented in response to the COVID-19 pandemic. Epidemiological models and data analysis affirm that wide adoption of NPIs helps to control the pandemic. However, SARS-CoV-2 has extensively demonstrated its ability to evolve. Therefore, it is crucial to examine how NPIs may affect the evolution of the virus. Such evolution could have important effects on the spread and impact of the pandemic.We used evo-epidemiological models to examine the effect of non-pharmaceutical interventions and testing on two evolutionary trajectories for SARS-CoV-2: attenuation and test evasion. Our results show that when stronger measures are taken, selection may act to reduce virulence. Additionally, the timely application of NPIs could significantly affect the competition between viral strains, favoring reduced virulence. Furthermore, a higher testing rate can select for a test-evasive viral strain, even if that strain is less infectious than the detectable competing strain. Importantly, if a less detectable strain evolves, epidemiological metrics such as confirmed daily cases may distort our assessment of the pandemic. Our results highlight the important implications NPIs can have on the evolution of SARS-CoV-2.
A novel benchmark for COVID-19 pandemic testing effectiveness enables the accurate prediction of new Intensive Care Unit admissions
Authors: Nikoloudis Dimitris , Kountouras Dimitrios , Hiona Asimina 
Published: February 2021

AbstractThe positivity rate of testing is currently used both as a benchmark of testing adequacy and for assessing the evolution of the COVID-19 pandemic. However, since the former is a prerequisite for the latter, its interpretation is often conflicting. We propose as a benchmark for COVID-19 testing effectiveness a new metric, termed ‘Severity Detection Rate’ (SDR), that represents the daily needs for new Intensive Care Unit (ICU) admissions, per 100 cases detected (t-i) days ago, per 10,000 tests performed (t-i) days ago. Based on the announced COVID-19 monitoring data in Greece from May 2020 until August 2021, we show that beyond a certain threshold of daily tests, SDR reaches a plateau of very low variability that begins to reflect testing adequacy. Due to the stabilization of SDR, it was possible to predict with great accuracy the daily needs for new ICU admissions, 12 days ahead of each testing data point, over a period of 10 months, with Pearson r = 0.98 (p = 10−197), RMSE = 7,16. We strongly believe that this metric will help guide the timely decisions of both scientists and government officials to tackle pandemic spread and prevent ICU overload by setting effective testing requirements for accurate pandemic monitoring. We propose further study of this novel metric with data from more countries to confirm the validity of the current findings.
Nanoceutical Fabric Prevents COVID-19 Spread through Expelled Respiratory Droplets: A Combined Computational, Spectroscopic and Anti-microbial Study
Authors: Adhikari Aniruddha , Pal Uttam , Bayan Sayan , Mondal Susmita , Ghosh Ria , Darbar Soumendra , Saha-Dasgupta Tanusri , Ray Samit Kumar , Pal Samir Kumar 
Published: February 2021

ABSTRACTCenters for Disease Control and Prevention (CDC) warns the use of one-way valves or vents in free masks for potential threat of spreading COVID-19 through expelled respiratory droplets. Here, we have developed a nanoceutical cotton fabric duly sensitized with non-toxic zinc oxide nanomaterial for potential use as membrane filter in the one way valve for the ease of breathing without the threat of COVID-19 spreading. A detailed computational study revealed that zinc oxide nanoflowers (ZnO NF) with almost two-dimensional petals trap SARS-CoV-2 spike proteins, responsible to attach to ACE-2 receptors in human lung epithelial cells. The study also confirm significant denaturation of the spike proteins on the ZnO surface, revealing removal of virus upon efficient trapping. Following the computational study, we have synthesized ZnO NF on cotton matrix using hydrothermal assisted strategy. Electron microscopic, steady-state and picosecond resolved spectroscopic studies confirm attachment of ZnO NF to the cotton (i.e., cellulose) matrix at atomic level to develop the nanoceutical fabric. A detailed antimicrobial assay using Pseudomonas aeruginosa bacteria (model SARS-CoV-2 mimic) reveals excellent anti-microbial efficiency of the developed nanoceutical fabric. To our understanding the novel nanoceutical fabric used in one-way valve of a face mask would be the choice to assure breathing comfort along with source control of COVID-19 infection. The developed nanosensitized cloth can also be used as antibacterial/anti CoV-2 washable dress material in general.GRAPHICAL ABSTRACTA novel nanoceutical cotton fabric duly sensitized with non-toxic zinc oxide nanoflower can potentially be used as membrane filter in the one way valve of face mask to assure breathing comfort along with source control of COVID-19 infection. The nanoceutical fabric denatures the SARS-CoV-2 spike protein and makes the microorganism ineffective.
Estimating VO2peak in 18-91 year-old adults: Development and Validation of the FitMáx© - Questionnaire
Authors: Meijer Renske , Hooff Martijn van , Papen-Botterhuis Nicole E. , Molenaar Charlotte J.L. , Regis Marta , Timmers Thomas , van de Poll-Franse Lonneke V. , Savelberg Hans H.C.M. , Schep Goof 
Published: February 2021

AbstractObjectivesCardiorespiratory fitness plays an essential role in health outcomes and quality of life. Objective assessment of cardiorespiratory fitness is costly, labour intensive and not widely available. Although patient-reported outcome measures estimate cardiorespiratory fitness more cost-efficiently, the current questionnaires lack accuracy. The aim of this study is to develop and validate the FitMáx©-questionnaire, a self-reported questionnaire to estimate cardiorespiratory fitness in healthcare.MethodsWe developed the FitMáx©-questionnaire, consisting of three questions assessing walking, stair climbing, and cycling capacity. A comparison on estimating VO2peak was made with the Duke Activity Status Index (DASI), Veterans Specific Activity Questionnaire (VSAQ) and cardiopulmonary exercise testing as the gold standard. A total of 716 patients and athletes (520 men, 196 women) aged 18□91 performed a CPET in our hospital. We randomly selected 70% of the subjects to fit a linear regression model to estimate VO2peak based on the FitMáx© scores. The remaining 30% of participants was used for validation of this model.ResultsThe VO2peak estimated by the FitMáx© strongly correlates with the VO2peak measured objectively with CPET; r=0.95 (0.93□0.96) SEE=3.94 ml·kg-1·min-1. Bias between predicted and measured VO2peak was 0.32 ml·kg-1·min-1 and the 95% limits of agreement were −8.11 □ 9.40 ml·kg-1·min-1. In our sample, the FitMáx scored superiorly on correlation and SEE compared with those from the DASI and VSAQ, r=0.80 (0.73□0.86) SEE=4.22 ml·kg-1·min-1 and r=0.88 (0.84□0.91) SEE=6.61 ml·kg-1·min-1, respectively.ConclusionFitMáx© is a valid and accessible questionnaire to estimate cardiorespiratory fitness expressed as VO2peak and shows substantial improvement compared to currently used questionnaires.Key pointsFitMáx© relies on three simple single-answer questions, which are recognizable for a large population, to accurately estimate cardiorespiratory fitness.The FitMáx© is a self-reported instrument in which involvement of physicians, healthcare providers or other instrumentation is not necessary.Cardiorespiratory fitness estimated by the FitMáx© may serve as an easily applicable measure in clinical and non-clinical settings.
Subphenotyping of COVID-19 patients at pre-admission towards anticipated severity stratification: an analysis of 778 692 Mexican patients through an age-gender unbiased meta-clustering technique
Authors: Zhou Lexin , Romero Nekane , Martínez-Miranda Juan , Conejero J Alberto , García-Gómez Juan M , Sáez Carlos 
Published: February 2021

AbstractWe apply a meta-clustering technique to discover age-gender unbiased COVID-19 patient subphenotypes based on phenotypical before admission, including pre-existing comorbidities, habits and demographic features, to study the potential early severity stratification capabilities of the discovered subgroups through characterizing their severity patterns including prognostic, ICU and morbimortality outcomes. We used the Mexican Government COVID-19 open data including 778,692 SARS-CoV-2 population-based patient-level data as of September 2020. The meta-clustering technique consists of a two-stage clustering approach combining dimensionality reduction and hierarchical clustering: 56 clusters from independent age-gender clustering analyses supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27-95.22%), including healthy patients of all ages; children with comorbidities alongside priority in medical resources; and young obese smokers. MCs 4-5 showed moderate recovery rates (81.3-82.81%): patients with hypertension or diabetes of all ages; and obese patients with pneumonia, hypertension and diabetes. MCs 6-11 showed low recovery rates (53.96-66.94%): immunosuppressed patients with high comorbidity rate; CKD patients with poor survival length and recovery; elderly smokers with COPD; severe diabetic elderly with hypertension; and oldest obese smokers with COPD and mild cardiovascular disease. Group outcomes conformed to the recent literature on dedicated age-gender groups. These results can potentially help in the clinical patient understanding and their stratification towards automated early triage, prior to further tests and laboratory results are available, or help decide priority in vaccination or resource allocation among vulnerable subgroups or locations where additional tests are not available.Code available at:https://github.com/bdslab-upv/covid19-metaclustering
Dominant Clade-featured SARS-CoV-2 Co-occurring Mutations Reveals Plausible Epistasis: An in silico based Hypothetical Model
Authors: Alam A. S. M. Rubayet Ul , Islam Ovinu Kibria , Hasan Md. Shazid , Islam Mir Raihanul , Mahmud Shafi , Al□Emran Hassan M. , Jahid Iqbal Kabir , Crandall Keith A. , Hossain M. Anwar 
Published: February 2021

ABSTRACTSARS-CoV-2 is evolved into eight fundamental clades where four (G, GH, GR, and GV) are globally prevalent in 2020. How the featured co-occurring mutations of these clades are linked with viral fitness is the main question here and we thus proposed a hypothetical model using in silico approach to explain the plausible epistatic effects of those mutations on viral replication and transmission. Molecular docking and dynamics analyses showed the higher infectiousness of a spike mutant through more favorable binding of G614 with the elastase-2. RdRp mutation p.P323L significantly increased genome-wide mutations (p<0.0001) since more flexible RdRp (mutated)-NSP8 interaction may accelerate replication. Superior RNA stability and structural variation at NSP3:C241T might impact protein and/or RNA interactions. Another silent 5’UTR:C241T mutation might affect translational efficiency and viral packaging. These four G-clade-featured co-occurring mutations might increase viral replication. Sentinel GH-clade ORF3a:p.Q57H constricted ion-channel through inter-transmembrane-domain interaction of cysteine(C81)-histidine(H57) and GR-clade N:p.RG203-204KR would stabilize RNA interaction by a more flexible and hypo-phosphorylated SR-rich region. GV-clade viruses seemingly gained the evolutionary advantage of the confounding factors; nevertheless, N:p.A220V might modulate RNA binding with no phenotypic effect. Our hypothetical model needs further retrospective and prospective studies to understand detailed molecular events featuring the fitness of SARS-CoV-2.
Neurophobia: A study of Australian medical students and junior doctors
Authors: Yeung Alex , Karimi Leila , Wijeratne Tissa 
Published: February 2021

AbstractBackgroundNeurological disorders are the leading cause disability in Australia and the world. Combating the perceived difficulty of neurology or “neurophobia” and improving physician education is a key component in addressing this problem. We aim to conduct the first study to identify whether neurophobia exists in medical students and junior doctors in an Australian population and try to identify factors that may contribute to this in this population.MethodsA 24 question online validated survey was distributed via email broadcast to all medical students and junior doctors at a metropolitan tertiary care centre in Australia. Responses were collected over 6 weeks with weekly reminder emails for 4 weeks after the initial invitation email.Results114 medical students and junior doctors participated in the study. Participants perceived neurology as the most difficult medical speciality compared to 10 other medical specialties (p=0.001). The top three factors contributing to this perceived difficulty were: a lack of understanding of neuroanatomy, lack of diagnostic certainty and lack of clinical exposure. 65% of the participants stated that they had too little planned teaching in neurology with only 36% of the participants having performed a neurology rotation during medical school.ConclusionThe prevalence of neurophobia in this Australian cohort of medical students and junior doctors is consistent with previous findings from around the world. This concerning finding requires further examination into the contributing factors in order to created trials of targeted interventions in order to resolve this.
A Second Wave? What Do People Mean By COVID Waves? – A Working Definition of Epidemic Waves
Authors: Zhang Stephen X. , Marioli Francisco Arroyo , Gao Renfei 
Published: February 2021

ABSTRACTPolicymakers and researchers describe the COVID-19 epidemics by waves without a common vocabulary on what constitutes an epidemic wave, either in terms of a working definition or operationalization, causing inconsistencies and confusions. A working definition and operationalization can be helpful to characterize and communicate about epidemics. We propose a working definition of epidemic waves in the ongoing COVID-19 pandemic and an operationalization based on the public data of the effective reproduction number R. Our operationalization characterizes the numbers and durations of waves (upward and downward) in 179 countries and reveals patterns that can enable healthcare organizations and policymakers to make better description and assessment of the COVID crisis to make more informed resource planning, mobilization, and allocation temporally in the continued COVID-19 pandemic.ONE SENTENCE SUMMARYA working definition and operationalization of waves to enable common ground to understand and communicate COVID-19 crisis.
Risk of plague transmission from human cadavers: a systematic review
Authors: Jullien Sophie , de Silva Nipun Lakshitha , Garner Paul 
Published: February 2021

AbstractPlague can be fatal. Ebola has raised concern of the risk of infection from bodies of people that have died from other dangerous infectious diseases. We sought to estimate the risk of human remains from someone who was infected with plague transmitting Yersinia pestis. With no clear direct evidence, we developed a causal chain and carefully searched and assessed the literature at each step: we assessed the infectiousness of body fluids of people ill with plague; we sought for reported infection acquired from human and animal cadavers; and examined evidence of body fluid infectiousness of cadavers, seeking any information about the length of infectiousness. We concluded that pneumonic plague can occur after intense manipulation of the cadaver, presumably from inhalation of respiratory droplets; and that bubonic plague can occur after contact with infected blood in people with skin cuts or abrasions. Establishing a quantitative measure of risk was not possible from the evidence available.Author summaryPlague is an infectious disease that is of particular concern due to its high risk for human outbreaks. Understanding the level and duration of infectiousness of the body of someone who was infected with plague is essential to establish adequate preventive measures while handling corpses. We found limited evidence that human cadavers who have died from plague remain infectious, both from inhalation of particles generated by handling and by direct skin contact.
A Complex Model of Clinical Narrative Information for the Diagnostic Act
Authors: Chartash David , Rosenman Marc B , Bollen Johan , Dickinson Markus , Downs Stephen M 
Published: February 2021

AbstractBackgroundThe act of diagnosis is one which precipitates semiotic closure, the complex integration of signs and symptoms through cognitive perspectives to ultimately activate causal reasoning and calibrate the assignment of a disease entity to the patient. In writing about this act, physicians encode both structured and unstructured information into the medical record. Unstructured information contains a latent structure which entwines both the cognitive components of the diagnostic act and the linguistic patterns associated with clinical documentation. Existing models of clinical language primarily use a physical or dialogic model of information as their basis, and do not adequately account for the complexity inherent in the diagnostic act.MethodsFraming the diagnostic information collected in clinical care as a narrative, we developed a model representative of said information, accounting for its content and structure, as well as the inherent complexity therein. Using an exemplar text, we present the use of known predication and semantic relations from ontological (the Unified Medical Language System) and linguistic theory (Rhetorical Structure Theory) to facilitate the operationalization of the model, and analyze the result.ResultsThe resulting model is demonstrated to be complex, representative of the clinical narrative text, and is fundamentally aligned with the clinical acts of both documentation and diagnosis. We find the model’s representation of the cognitive aspects of narrative consistent with models of reading, as well as an adequate model of information as presented by clinical medicine and the clinical sub-language.ConclusionsWe present a model to represent diagnostic information in the physician’s note which accounts for the clinical and textual narrative precipitated by the cognition involved in encoding said information into the unstructured medical record. This model prepends the development of (computational) linguistic models of the clinical sublanguage within the physician’s note as it relates to diagnosis, beyond the information level of the lexical unit. Such analysis would facilitate better reflection on the structure and meaning of the clinical note, offering improvements to medical education and care.
Antibiotics and hospital-associatedClostridioides difficileinfection: systematic review and meta-analysis 2020 update
Authors: Slimings Claudia , Riley Thomas V. 
Published: February 2021

AbstractBackgroundClostridioides difficileinfection (CDI) is the most common cause of healthcare facility-associated (HCFA) infectious diarrhoea in high-income countries. Antibiotic use is the most important modifiable risk factor for CDI. The most recent systematic review covered studies published until 31stDecember 2012.ObjectivesTo update the evidence for epidemiological associations between specific antibiotic classes and HCFA-CDI for the period 1stJanuary 2013 to 31stDecember 2020.Data sourcesPubMed, Scopus, Web of Science Core Collection, WorldCat, and Proquest Dissertations and Theses.Study eligibility criteria, participants and exposuresEligible studies were those conducted among adult hospital inpatients, measured exposure to individual antibiotics or antibiotic classes, included a comparison group, and measured the occurrence of HCFA-CDI as an outcome.Study appraisal and synthesis methodsThe Newcastle–Ottawa Scale for the Assessment of Quality was used to appraise study quality. To assess the association between each antibiotic class and HA-CDI, a pooled random effects meta-analysis was undertaken. Metaregression and sub-group analysis was used to investigate study characteristics identifieda priorias potential sources of heterogeneity.ResultsCarbapenems, and 3rdand 4thgeneration cephalosporin antibiotics remain most strongly associated with HCFA-CDI, with cases more than twice as likely to have recent exposure to these antibiotics prior to developing CDI. Modest associations were observed for fluoroquinolones clindamycin, and beta-lactamase inhibitor combination penicillin antibiotics.LimitationsIndividual study effect sizes were variable and heterogeneity was observed for most antibiotic classes. Availability of a single reviewer to select, extract and critically appraise the studies.ConclusionsThis review provides the most up to date synthesis of evidence in relation to the risk of HCFA-CDI associated with exposure to specific antibiotic classes. Studies were predominantly conducted in North America or Europe and more studies outside of these settings are needed.Registration numberProspero CRD42020181817