Development and validation of a knowledge-driven risk calculator for critical illness in COVID-19 patients.

Facing the novel coronavirus disease (COVID-19) pandemic, evidence to inform decision-making at all care levels is essential. Based on the results of a study by Petrilli et al., we have developed a calculator using patient data at admission to predict critical illness (intensive care, mechanical ventilation, hospice care, or death). We report a retrospective validation of the calculator on 145 consecutive patients admitted with COVID-19 to a single hospital in Israel. Despite considerable differences between the original and validation study populations, of 18 patients with critical illness, 17 were correctly identified (sensitivity: 94.4%, 95% CI, 72.7%-99.9%; specificity: 81.9%, 95% CI, 74.1%-88.2%). Of 127 patients with non-critical illness, 104 were correctly identified. Our results indicate that published knowledge can be reliably applied to assess patient risk, potentially reducing the cognitive burden on physicians, and helping policymakers better prepare for future needs.

Number word structure in first and second language influences arithmetic skills.

Languages differ in how they represent numerical information, and specifically whether the verbal notation of numbers follows the same order as the symbolic notation (in non-inverted languages, e.g., Hebrew, "25, twenty-five") or whether the two notations diverge (in inverted languages, e.g., Arabic, "25, five-and-twenty"). We examined how the structure of number-words affects how arithmetic operations are processed by bilingual speakers of an inverted and a non-inverted language. We examined Arabic-Hebrew bilinguals' performance in the first language, L1 (inverted) and in the second language, L2 (non-inverted). Their performance was compared to that of Hebrew L1 speakers, who do not speak an inverted language. Participants judged the accuracy of addition problems presented aurally in L1, aurally in L2 or in visual symbolic notation. Problems were presented such that they matched or did not match the structure of number words in the language. Arabic-Hebrew bilinguals demonstrated both flexibility in processing and adaptation to the language of aural-verbal presentation - they were more accurate for the inverted order of presentation in Arabic, but more accurate for non-inverted order of presentation in Hebrew, thus exhibiting the same pattern found for native Hebrew speakers. In addition, whereas native Hebrew speakers preferred the non-inverted order in visual symbolic presentation as well, the Arabic-Hebrew bilinguals showed enhanced flexibility, without a significant preference for one order over the other, in either speed or accuracy. These findings suggest that arithmetic processing is sensitive to the linguistic representations of number words. Moreover, bilinguals exposed to inverted and non-inverted languages showed influence of both systems, and enhanced flexibility in processing. Thus, the L1 does not seem to have exclusive power in shaping numerical mental representations, but rather the system remains open to influences from a later learned L2.

[Factors that influence the implementation of the guidelines for aspirin use by diabetic patients in Israel].

BACKGROUND: Aspirin use by diabetic patients, both as secondary and tertiary prevention, significantly reduces cardiovascular events. The Israeli Diabetes Association guidelines, published in 2005, recommend that all diabetic patients, at increased risk for cardiovascular events, take aspirin. AIMS: The aim of this study was to identify factors which influence the implementation of the guidelines for aspirin use by diabetic patients in Israel. METHODS: The medical records of 100 diabetic patients were reviewed in a cross sectional study conducted among patients of 4 family practitioners in a primary care clinic in Tel Aviv. Statistical analyses were performed to identify the relation between aspirin use, and medical and personal data of the diabetic patients. RESULTS: Among 100 diabetic patients, sixty one (61%) were prescribed aspirin. Prescription rate among men (60%) and women (62%) was similar. Patients who were not prescribed aspirin were younger on average (p < 0.02). Prescription of aspirin was more common as tertiary rather than secondary prevention, i.e. among patients who already showed signs of cardiovascular disease (p < 0.003). The prescription rates for aspirin were lower than for statins and ACE-inhibitors. CONCLUSIONS: Aspirin use among diabetic patients in Tel Aviv is relatively high and similar to that in other western countries. However, the relatively lower use of aspirin for secondary prevention, especially among younger patients, deserves attention.

Coronary artery disease and risk factors in people with posttraumatic vision loss.

OBJECTIVE: To examine the prevalence of coronary artery disease (CAD) and its risk factors in people with posttraumatic vision loss (PTVL). DESIGN: Cross-sectional, controlled study. SETTING: The general community. PARTICIPANTS: Study groups included 82 subjects with PTVL, 49 siblings, 58 blind subjects with retinitis pigmentosa (RP), and the general population in Israel. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sociodemographic and biomedical data collected by using a structured questionnaire and medical records. RESULTS: The prevalence of CAD among subjects with PTVL (24%) was 2 to 3 times higher than the control groups ( P <.001). However, the prevalence of the CAD risk factors in these subjects was similar to or lower than those in the control groups. For example, significantly fewer subjects with PTVL were physically inactive (16%) than patients with RP (55%, P <.01). The only variable that was significantly associated with CAD prevalence was the cause of blindness-that is, trauma versus disease; the odds of having CAD after traumatic vision loss was 3.75 times higher than after RP. CONCLUSIONS: People with PTVL exhibit elevated rates of risk for CAD similar to those of other groups with physical disability. The traumatic injury that caused vision loss might be an important factor underlying that risk.