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1.
Med Sci Monit ; 27: e935379, 2021 Dec 30.
Article in English | MEDLINE | ID: covidwho-1593238

ABSTRACT

BACKGROUND This retrospective study aimed to investigate outcomes and hospitalization rates in patients with a confirmed diagnosis of early COVID-19 treated at home with prescribed and non-prescribed treatments. MATERIAL AND METHODS The medical records of a cohort of 158 Italian patients with early COVID-19 treated at home were analyzed. Treatments consisted of indomethacin, low-dose aspirin, omeprazole, and a flavonoid-based food supplement, plus azithromycin, low-molecular-weight heparin, and betamethasone as needed. The association of treatment timeliness and of clinical variables with the duration of symptoms and with the risk of hospitalization was evaluated by logistic regression. RESULTS Patients were divided into 2 groups: group 1 (n=85) was treated at the earliest possible time (<72 h from onset of symptoms), and group 2 (n=73) was treated >72 h after the onset of symptoms. Clinical severity at the beginning of treatment was similar in the 2 groups. In group 1, symptom duration was shorter than in group 2 (median 6.0 days vs 13.0 days, P<0.001) and no hospitalizations occurred, compared with 19.18% hospitalizations in group 2. One patient in group 1 developed chest X-ray alterations and 2 patients experienced an increase in D-dimer levels, compared with 30 and 22 patients, respectively, in group 2. The main factor determining the duration of symptoms and the risk of hospitalization was the delay in starting therapy (P<0.001). CONCLUSIONS This real-world study of patients in the community showed that early diagnosis and early supportive patient management reduced the severity of COVID-19 and reduced the rate of hospitalization.


Subject(s)
COVID-19/diagnosis , COVID-19/drug therapy , Hospitalization/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , Aged, 80 and over , Aspirin/therapeutic use , Betamethasone/therapeutic use , Cohort Studies , Dietary Supplements , Early Diagnosis , Female , Flavonoids/therapeutic use , Follow-Up Studies , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Indomethacin/therapeutic use , Italy , Male , Middle Aged , Omeprazole/therapeutic use , Patient Acuity , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Time , Treatment Outcome
3.
Sensors (Basel) ; 21(21)2021 Oct 27.
Article in English | MEDLINE | ID: covidwho-1512560

ABSTRACT

Providing a stable, low-price, and safe supply of energy to end-users is a challenging task. The energy service providers are affected by several events such as weather, volatility, and special events. As such, the prediction of these events and having a time window for taking preventive measures are crucial for service providers. Electrical load forecasting can be modeled as a time series prediction problem. One solution is to capture spatial correlations, spatial-temporal relations, and time-dependency of such temporal networks in the time series. Previously, different machine learning methods have been used for time series prediction tasks; however, there is still a need for new research to improve the performance of short-term load forecasting models. In this article, we propose a novel deep learning model to predict electric load consumption using Dual-Stage Attention-Based Recurrent Neural Networks in which the attention mechanism is used in both encoder and decoder stages. The encoder attention layer identifies important features from the input vector, whereas the decoder attention layer is used to overcome the limitations of using a fixed context vector and provides a much longer memory capacity. The proposed model improves the performance for short-term load forecasting (STLF) in terms of the Mean Absolute Error (MAE) and Root Mean Squared Errors (RMSE) scores. To evaluate the predictive performance of the proposed model, the UCI household electric power consumption (HEPC) dataset has been used during the experiments. Experimental results demonstrate that the proposed approach outperforms the previously adopted techniques.


Subject(s)
Machine Learning , Neural Networks, Computer , Forecasting , Time , Weather
4.
PLoS One ; 16(11): e0259282, 2021.
Article in English | MEDLINE | ID: covidwho-1502073

ABSTRACT

Infectious diseases and widespread outbreaks influence different sectors of the economy, including the stock market. In this article, we investigate the effect of EBOV and COVID-19 outbreaks on stock market indices. We employ time-varying and constant bivariate copula methods to measure the dependence structure between the infectious disease equity market volatility index (IEMV) and the stock market indices of several sectors. The results show that the financial and communication services sectors have the highest and the lowest negative dependency on IEMV during the Ebola virus (EBOV) pandemic, respectively. However, the health care and energy sectors have the highest and lowest negative dependency on IEMV during the COVID-19 outbreak, respectively. Therefore, the results confirm the heterogeneous time-varying dependency between infectious diseases and the stock market indices. The finding of our study contributes to the ongoing literature on the impact of disease outbreaks, especially the novel coronavirus outbreak on global large-cap companies in the stock market.


Subject(s)
COVID-19/economics , Cost of Illness , Disease Outbreaks/economics , Hemorrhagic Fever, Ebola/economics , Commerce , Ebolavirus , Humans , Time
6.
Chronobiol Int ; 38(10): 1432-1440, 2021 10.
Article in English | MEDLINE | ID: covidwho-1447449

ABSTRACT

Social distancing (SDIST) to contain COVID-19 pandemic spread implies reduced sunlight exposure and social daily life, which delay the circadian system and increase eveningness preference. The regular practice of physical activity (PA) is a time cue that decreased during SDIST. However, it is unknown if decreased PA may be associated with increase of eveningness preference. This study aimed to investigate if PA changes might be associated with changes in the morningness-eveningness preference of individuals practicing SDIST in Brazil. For this, 322 adults (18-89 years-old) regularly living in Brazil between March and October 2020 answered an online survey including questions considering the before and during SDIST period on PA (min/week) and morningness-eveningness questionnaire score. Sociodemographic, SDIST, anthropometric, and health characteristics were also included in the online survey. Participants self-reported an increase of eveningness preference comparing Before-SDIST with During-SDIST scores (56 ± 12 vs. 52 ± 13, p < .0001). Self-reported PA decreased comparing Before-SDIST with During-SDIST (230 ± 170 vs. 149 ± 155 min/week, p < .0001). Decrease in the total volume of PA and hours spent outside per day, and higher body mass index were associated with the increase in eveningness preference (R2 = .077), although the decrease in the total volume of PA was the strongest association (R2 = .037). In summary, our results show that SDIST may cause a delay in the circadian system, which is associated with the decrease of PA, a reduction in the hours spent outside per day with sunlight exposure, and obesity.


Subject(s)
COVID-19 , Exercise , Pandemics , Adult , Brazil , Circadian Rhythm , Cross-Sectional Studies , Humans , Physical Distancing , Sleep , Surveys and Questionnaires , Time
8.
Clin Trials ; 18(3): 286-294, 2021 06.
Article in English | MEDLINE | ID: covidwho-1400653

ABSTRACT

BACKGROUND: Vaccines are potent tools to prevent outbreaks of emerging infectious diseases from becoming epidemics and need to be developed at an accelerated pace to have any impact on the course of an ongoing epidemic. The aim of this study was to describe time use in the execution of vaccine trials, to identify steps that could be accelerated to improve preparedness and planning for future emerging infectious diseases vaccine trials. METHODS: We used a mixed-methods approach to map time use and process steps that could be accelerated during vaccine trials. Trials for vaccines against infectious diseases registered in three global trial databases reported in the period 2011-2017 were eligible to join the survey. We invited sponsors to contribute data through a predefined structured questionnaire for clinical trial process metrics. Data were stratified by trial phase, disease type (i.e. emerging infectious diseases or not emerging infectious diseases), sponsor type, and continent. Qualitative interviews were conducted with purposively selected sponsors, and thematic analysis of the interview transcripts was performed. RESULTS: Based on data from 155 vaccine trials including 29,071 subjects, 52% were phase I, 23% phase II, and 25% phase III. We found that the regulatory approval, subject enrollment, study execution, and study close-out accounted for most of the cycle time of the vaccine trial process. Cycle times for the regulatory and ethical approvals, contract agreement, site initiation, and study execution were shorter in trials conducted during outbreaks. Qualitative interviews indicated that early engagement of the regulatory and independent ethical committee authorities in planning the vaccine trials was critical for saving time in trial approval. Furthermore, adapting the trial implementation to the reality of the study sites and active involvement of the local investigators during the planning of the trial and protocol writing were stated to be of paramount importance to successful completion of trials at an accelerated pace. CONCLUSION: The regulatory approval, subject recruitment, study execution, and close-out cycle times accounted for most of the vaccine trial time use and are activities that could be accelerated during a vaccine trial planning and implementation. We encourage tracking of key cycle time metrics and facilitating sharing of knowledge across industry and academia, as this may serve to reduce the time from index case detection to access of a vaccine during emerging infectious diseases epidemics.


Subject(s)
Clinical Trials as Topic , Communicable Diseases, Emerging , Epidemics , Vaccines , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/prevention & control , Epidemics/prevention & control , Humans , Research Design , Time
9.
BMJ Open Respir Res ; 7(1)2020 11.
Article in English | MEDLINE | ID: covidwho-1388517

ABSTRACT

INTRODUCTION: Acute respiratory distress syndrome (ARDS) is the major cause of mortality in patients with SARS-CoV-2 pneumonia. It appears that development of 'cytokine storm' in patients with SARS-CoV-2 pneumonia precipitates progression to ARDS. However, severity scores on admission do not predict severity or mortality in patients with SARS-CoV-2 pneumonia. Our objective was to determine whether patients with SARS-CoV-2 ARDS are clinically distinct, therefore requiring alternative management strategies, compared with other patients with ARDS. We report a single-centre retrospective study comparing the characteristics and outcomes of patients with ARDS with and without SARS-CoV-2. METHODS: Two intensive care unit (ICU) cohorts of patients at the Queen Elizabeth Hospital Birmingham were analysed: SARS-CoV-2 patients admitted between 11 March and 21 April 2020 and all patients with community-acquired pneumonia (CAP) from bacterial or viral infection who developed ARDS between 1 January 2017 and 1 November 2019. All data were routinely collected on the hospital's electronic patient records. RESULTS: A greater proportion of SARS-CoV-2 patients were from an Asian ethnic group (p=0.002). SARS-CoV-2 patients had lower circulating leucocytes, neutrophils and monocytes (p<0.0001), but higher CRP (p=0.016) on ICU admission. SARS-CoV-2 patients required a longer duration of mechanical ventilation (p=0.01), but had lower vasopressor requirements (p=0.016). DISCUSSION: The clinical syndromes and respiratory mechanics of SARS-CoV-2 and CAP-ARDS are broadly similar. However, SARS-CoV-2 patients initially have a lower requirement for vasopressor support, fewer circulating leukocytes and require prolonged ventilation support. Further studies are required to determine whether the dysregulated inflammation observed in SARS-CoV-2 ARDS may contribute to the increased duration of respiratory failure.


Subject(s)
COVID-19/complications , Critical Care/methods , Patient Outcome Assessment , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/etiology , C-Reactive Protein/metabolism , Cohort Studies , Female , Humans , Leukocytes/metabolism , Male , Middle Aged , Monocytes/metabolism , Neutrophils/metabolism , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/therapy , Respiratory Mechanics , Retrospective Studies , SARS-CoV-2 , Time , United Kingdom , Vasoconstrictor Agents/therapeutic use
11.
Microbiol Spectr ; 9(1): e0016221, 2021 09 03.
Article in English | MEDLINE | ID: covidwho-1361969

ABSTRACT

The continued need for molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the potential for self-collected saliva as an alternative to nasopharyngeal (NP) swabs for sample acquisition led us to compare saliva to NP swabs in an outpatient setting without restrictions to avoid food, drink, smoking, or tooth-brushing. A total of 385 pairs of NP and saliva specimens were obtained, the majority from individuals presenting for initial evaluation, and were tested on two high-sensitivity reverse transcriptase PCR (RT-PCR) platforms, the Abbott m2000 and Abbott Alinity m (both with limits of detection [LoD] of 100 copies of viral RNA/ml). Concordance between saliva and NP swabs was excellent overall (Cohen's κ = 0.93) for both initial and follow-up testing, for both platforms, and for specimens treated with guanidinium transport medium as preservative as well as for untreated saliva (κ = 0.88 to 0.95). Viral loads were on average 16× higher in NP specimens than saliva specimens, suggesting that only the relatively small fraction of outpatients (∼8% in this study) who present with very low viral loads (<1,600 copies/ml from NP swabs) would be missed by testing saliva instead of NP swabs when using sensitive testing platforms. Special attention was necessary to ensure leak-resistant specimen collection and transport. The advantages of self-collection of saliva, without behavioral restrictions, will likely outweigh a minor potential decrease in clinical sensitivity in individuals less likely to pose an infectious risk to others for many real-world scenarios, especially for initial testing. IMPORTANCE In general, the most accurate COVID-19 testing is hands-on and uncomfortable, requiring trained staff and a "brain-tickling" nasopharyngeal swab. Saliva would be much easier on both fronts, since patients could collect it themselves, and it is after all just spit. However, despite much interest, it remains unclear how well saliva performs in real-world settings when just using it in place of an NP swab without elaborate or cumbersome restrictions about not eating/drinking before testing, etc. Also, almost all studies of COVID-19 testing, whether of NP swabs, saliva, or otherwise, have been restricted to reporting results in the abstruse units of "CT values," which only mean something in the context of a specific assay and testing platform. Here, we compared saliva versus NP swabs in a real-world setting without restriction and report all results in natural units-the amount of virus being shed-showing that saliva is essentially just as good as NP swabs.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/diagnosis , Nasopharynx/virology , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Saliva/virology , Specimen Handling/methods , Diagnostic Tests, Routine , Humans , Limit of Detection , Polymerase Chain Reaction/methods , RNA, Viral , Sensitivity and Specificity , Time , Viral Load
12.
Microbiol Spectr ; 9(1): e0031221, 2021 09 03.
Article in English | MEDLINE | ID: covidwho-1352539

ABSTRACT

Pooled testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection is instrumental for increasing test capacity while decreasing test cost. Pooled testing programs permit sustainable, long-term surveillance measures, which are essential for the early detection of virus resurgence in communities or the emergence of variants of concern. While numerous pooled approaches have been proposed to increase test capacity, uptake by laboratories has been limited. On 9 December 2020, we invited 362 U.S. laboratories that inquired about the Yale School of Public Health SalivaDirect test to participate in a survey to evaluate testing constraints and pooling strategies for SARS-CoV-2 testing. The survey was distributed using Qualtrics, and three reminders were sent. The survey closed on 21 January 2021. Of 93 responses received (25.7% response rate), 90 were from Clinical Laboratory Improvement Amendments (CLIA)-certified laboratories conducting SARS-CoV-2 testing. The remaining three were excluded from the analyses. Responses indicated that the major barriers to the uptake of pooled testing in the United States may not simply be the number of tests a laboratory can process per day, but rather the lack of clear protocols and adequate resources; laboratories are working with fixed physical and human capital constraints. Importantly, laboratories across the country are heterogeneous in infrastructure and workflow. The need for SARS-CoV-2 testing will remain for years to come. Testing programs can be maintained through pooled PCR testing strategies, and while statisticians, operations researchers, and others with expertise in sampling design have important value to add, laboratories require support on how to transition from traditional diagnostic testing to pooled surveillance. IMPORTANCE While numerous pooled SARS-CoV-2 testing approaches have been described in an effort to increase testing capacity and decrease test prices, uptake by laboratories has been limited. Responses to our survey of United States-based laboratories highlight the importance of consulting end-users-those that solutions are being designed for-so challenges can be addressed in a manner tailored to meet the specific needs out in the field. It may be surprising to those designing pooled testing strategies to learn that laboratories view pooling as more time-consuming than testing samples individually, and therefore that it is thought to create delays in test reporting.


Subject(s)
COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , COVID-19 Testing/standards , Clinical Laboratory Techniques/methods , Diagnostic Tests, Routine , Humans , Laboratories/statistics & numerical data , RNA, Viral , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Specimen Handling , Time , United States
14.
Intensive Care Med ; 47(8): 926-927, 2021 08.
Article in English | MEDLINE | ID: covidwho-1323920

Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Time
16.
Ann Noninvasive Electrocardiol ; 26(6): e12872, 2021 11.
Article in English | MEDLINE | ID: covidwho-1319236

ABSTRACT

BACKGROUND: Interval duration measurements (IDMs) were compared between standard 12-lead electrocardiograms (ECGs) and 6-lead ECGs recorded with AliveCor's KardiaMobile 6L, a hand-held mobile device designed for use by patients at home. METHODS: Electrocardiograms were recorded within, on average, 15 min from 705 patients in Mayo Clinic's Windland Smith Rice Genetic Heart Rhythm Clinic. Interpretable 12-lead and 6-lead recordings were available for 685 out of 705 (97%) eligible patients. The most common diagnosis was congenital long QT syndrome (LQTS, 343/685 [50%]), followed by unaffected relatives and patients (146/685 [21%]), and patients with other genetic heart diseases, including hypertrophic cardiomyopathy (36 [5.2%]), arrhythmogenic cardiomyopathy (23 [3.4%]), and idiopathic ventricular fibrillation (14 [2.0%]). IDMs were performed by a central ECG laboratory using lead II with a semi-automated technique. RESULTS: Despite differences in patient position (supine for 12-lead ECGs and sitting for 6-lead ECGs), mean IDMs were comparable, with mean values for the 12-lead and 6-lead ECGs for QTcF, heart rate, PR, and QRS differing by 2.6 ms, -5.5 beats per minute, 1.0 and 1.2 ms, respectively. Despite a modest difference in heart rate, intervals were close enough to allow a detection of clinically meaningful abnormalities. CONCLUSIONS: The 6-lead hand-held device is potentially useful for a clinical follow-up of remote patients, and for a safety follow-up of patients participating in clinical trials who cannot visit the investigational site. This technology may extend the use of 12-lead ECG recordings during the current COVID-19 pandemic as remote patient monitoring becomes more common in virtual or hybrid-design clinical studies.


Subject(s)
Electrocardiography/methods , Heart Diseases/diagnosis , Adult , Electrocardiography, Ambulatory/methods , Female , Humans , Male , Posture , Prospective Studies , Time
17.
Sci Rep ; 11(1): 13919, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1298851

ABSTRACT

Societal responses crucially shape the course of a pandemic, but are difficult to predict. Mitigation measures such as social distancing are here assumed to minimize a utility function that consists of two conflicting sub-targets, the disease related mortality and the multifaceted consequences of mitigation. The relative weight of the two sub-targets defines the mitigation readiness H, which entails the political, social, and psychological aspects of decision making. The dynamics of social and behavioral mitigation thus follows an adaptive rule, which in turn is mediated by a non-adaptive dynamics of H. This framework for social dynamics is integrated into an epidemiological model and applied to the ongoing SARS-CoV-2 pandemic. Unperturbed simulations accurately reproduce diverse epidemic and mitigation trajectories from 2020 to 2021, reported from 11 European countries, Iran, and 8 US states. High regional variability in the severity and duration of the spring lockdown and in peak mortality rates of the first SARS-CoV-2 wave can be explained by differences in the reconstructed readiness H. A ubiquitous temporal decrease of H has greatly intensified second and third waves and slowed down their decay. The unprecedented skill of the model suggests that the combination of an adaptive and a non-adaptive rule may constitute a more fundamental mode in social dynamics. Its implementation in an epidemic context can produce realistic long-term scenarios relevant for strategic planning, such as on the feasibility of a zero-infection target or on the evolutionary arms race between mutations of SARS-CoV-2 and social responses.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Physical Distancing , SARS-CoV-2/pathogenicity , Communicable Disease Control/methods , Europe , Humans , Iran , Time
18.
Clin Nutr ESPEN ; 44: 211-217, 2021 08.
Article in English | MEDLINE | ID: covidwho-1284000

ABSTRACT

BACKGROUND & AIMS: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can rapidly progress into acute respiratory distress syndrome accompanied by multi-organ failure requiring invasive mechanical ventilation and critical care treatment. Nutritional therapy is a fundamental pillar in the management of hospitalized patients. It is broadly acknowledged that overfeeding and underfeeding of intensive care unit (ICU) patients are associated with increased morbidity and mortality. This study aimed to assess the energy demands of long-term ventilated COVID-19 patients using indirect calorimetry and to evaluate the applicability of established predictive equations to estimate their energy expenditure. METHODS: We performed a retrospective, single-center study in 26 mechanically ventilated COVID-19 patients with resolved SARS-CoV-2 infection in three independent intensive care units. Resting energy expenditure (REE) was evaluated by repetitive indirect calorimetry (IC) measurements. Simultaneously the performance of 12 predictive equations was examined. Patient's clinical data were retrieved from electronic medical charts. Bland-Altman plots were used to assess agreement between measured and calculated REE. RESULTS: Mean mREE was 1687 kcal/day and 20.0 kcal relative to actual body weight (ABW) per day (kcal/kg/day). Longitudinal mean mREE did not change significantly over time, although mREE values had a high dispersion (SD of mREE ±487). Obese individuals were found to have significantly increased mREE, but lower energy expenditure relative to their body mass. Calculated REE showed poor agreement with mREE ranging from 33 to 54%. CONCLUSION: Resolution of SARS-CoV-2 infection confirmed by negative PCR leads to stabilization of energy demands at an average 20 kcal/kg in ventilated critically ill patients. Due to high variations in mREE and low agreement with calculated energy expenditure IC remains the gold standard for the guidance of nutritional therapy.


Subject(s)
COVID-19/physiopathology , Critical Care/methods , Energy Metabolism/physiology , Nutritional Requirements/physiology , Respiration, Artificial/methods , Calorimetry, Indirect , Critical Illness , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Time
19.
Turk J Med Sci ; 51(3): 1675-1681, 2021 08 30.
Article in English | MEDLINE | ID: covidwho-1264581

ABSTRACT

Background and aim: The aim of this study is to evaluate whether the long-term (≥4 weeks) use of proton pump inhibitors (PPIs) is a risk factor for intubation requirement and mortality in patients hospitalized for COVID-19. Materials and methods: In this multicentric retrospective study, a total of 382 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for treatment were enrolled. The patients were divided into two groups according to the periods during which they used PPIs: the first group included patients who were not on PPI treatment, and the second group included those who have used PPIs for more than 4 weeks. Results: The study participants were grouped according to their PPI usage history over the last 6 months. In total, 291 patients did not use any type of PPI over the last 6 months, and 91 patients used PPIs for more than 4 weeks. Older age (HR: 1.047, 95% CI: 1.026­1.068), current smoking (HR: 2.590, 95% CI: 1.334­5.025), and PPI therapy for more than 4 weeks (HR: 1.83, 95% CI: 1.06­2.41) were found to be independent risk factors for mortality. Conclusion: The results obtained in this study show that using PPIs for more than 4 weeks is associated with negative outcomes for patients with COVID-19. Patients receiving PPI therapy should be evaluated more carefully if they are hospitalized for COVID-19 treatment.


Subject(s)
COVID-19/mortality , Proton Pump Inhibitors/adverse effects , Adult , Aged , Female , Humans , Intubation, Intratracheal/statistics & numerical data , Male , Middle Aged , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time , Turkey/epidemiology
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