Showing papers by "McMaster University published in 2021"
TL;DR: In this article, the authors reported several cases of unusual thrombotic events and thrombo-cellocytopenia after vaccination with the recombinant adenoviral vector encoding the spike protein antigen of spike proteins.
Abstract: Background Several cases of unusual thrombotic events and thrombocytopenia have developed after vaccination with the recombinant adenoviral vector encoding the spike protein antigen of sev...
1,538 citations
University of Washington1, St George’s University Hospitals NHS Foundation Trust2, McMaster University3, Agostino Gemelli University Polyclinic4, Emory University5, Federal University of São Paulo6, Ottawa Hospital7, St Thomas' Hospital8, University of Michigan9, Cooper University Hospital10, University of Kansas11, University of Amsterdam12, United Arab Emirates University13, University of Pittsburgh14, King Saud bin Abdulaziz University for Health Sciences15, University of São Paulo16, University of Minnesota17, Population Health Research Institute18, University of Toronto19, Humanitas University20, University of Kentucky21, Ghent University Hospital22, University of Tokyo23, Peking Union Medical College Hospital24, Hebron University25, Monash University26, Copenhagen University Hospital27, Liverpool School of Tropical Medicine28, Vanderbilt University29, Harvard University30, Brigham and Women's Hospital31, University of Ulsan32, University of Manitoba33, Makerere University34, Faculdade de Medicina de São José do Rio Preto35, Mount Sinai Hospital, Toronto36, Medanta37, University of the Witwatersrand38, New York University39, Washington University in St. Louis40, University of Alberta41, Hennepin County Medical Center42, University of Pennsylvania43, Hadassah Medical Center44, Hebrew University of Jerusalem45, Hochschule Hannover46, Brown University47
TL;DR: The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications as discussed by the authors, which are either strong or weak, or in the form of best practice statements.
Abstract: Background
Sepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.
Methods
We formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.
Results
The SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.
Conclusion
The SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.
893 citations
Ben-Gurion University of the Negev1, Population Health Research Institute2, McMaster University3, University of North Carolina at Chapel Hill4, Sanjay Gandhi Post Graduate Institute of Medical Sciences5, University of Gothenburg6, Katholieke Universiteit Leuven7, Iuliu Hațieganu University of Medicine and Pharmacy8, Peking Union Medical College Hospital9, Tohoku University10, University of Sydney11, University of Jos12, Cornell University13, National Autonomous University of Mexico14, University of Manchester15, University of Ghana16, Isfahan University of Medical Sciences17, University of Amsterdam18, Ege University19, Wonkwang University20, Universidade Federal do Rio Grande do Sul21, Pontifical Xavierian University22, Moscow State University of Medicine and Dentistry23, Universiti Sains Malaysia24, Wrocław Medical University25, Dhaka Medical College and Hospital26, Autonomous University of Barcelona27, University of Cape Town28, University of Indonesia29, Queen's University30, National University of Singapore31, Rabin Medical Center32, University of Alberta33, Mazandaran University of Medical Sciences34, Université de Montréal35
TL;DR: It is found that more than 40% of persons worldwide have FGIDs, which affect quality of life and healthcare use, and similar trends and relative distributions were found in people who completed internet vs personal interviews.
763 citations
Memorial Sloan Kettering Cancer Center1, Yonsei University2, Royal Free London NHS Foundation Trust3, University of Duisburg-Essen4, Texas Oncology5, Catholic University of Korea6, McMaster University7, University of Miami8, University of Western Ontario9, Autonomous University of Barcelona10, University of Queensland11, Seoul National University12, Macquarie University13, Rambam Health Care Campus14, Kyushu University15, University of Tübingen16, Medical University of Vienna17, Eisai18, Merck & Co.19, Harvard University20
TL;DR: In this article, Lenvatinib in combination with pembrolizumab or everolimus has been shown to have activity against advanced renal cell carcinoma (RCC).
Abstract: Background Lenvatinib in combination with pembrolizumab or everolimus has activity against advanced renal cell carcinoma. The efficacy of these regimens as compared with that of sunitinib ...
722 citations
University of Washington1, St George’s University Hospitals NHS Foundation Trust2, McMaster University3, Agostino Gemelli University Polyclinic4, Emory University5, Federal University of São Paulo6, Ottawa Hospital7, St Thomas' Hospital8, University of Michigan9, Cooper University Hospital10, University of Kansas11, University of Amsterdam12, United Arab Emirates University13, University of Pittsburgh14, King Saud bin Abdulaziz University for Health Sciences15, University of São Paulo16, University of Minnesota17, Population Health Research Institute18, University of Toronto19, Humanitas University20, University of Kentucky21, Ghent University Hospital22, University of Tokyo23, Peking Union Medical College Hospital24, Hebron University25, Monash University26, Copenhagen University Hospital27, Liverpool School of Tropical Medicine28, Vanderbilt University29, Brigham and Women's Hospital30, University of Ulsan31, University of Manitoba32, Makerere University33, Faculdade de Medicina de São José do Rio Preto34, National Institutes of Health35, Mount Sinai Hospital, Toronto36, Medanta37, University of the Witwatersrand38, New York University39, Washington University in St. Louis40, University of Alberta41, Hennepin County Medical Center42, Royal Brisbane and Women's Hospital43, University of Pennsylvania44, Hebrew University of Jerusalem45, Hochschule Hannover46, Brown University47
TL;DR: The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications as mentioned in this paper, which are either strong or weak, or in the form of best practice statements.
Abstract: Background
Sepsis poses a global threat to millions of lives. The Surviving Sepsis Campaign (SSC) guidelines provide evidence-based recommendations on the recognition and management of sepsis and its complications.
Methods
We formed a panel of 60 experts from 22 countries and 11 members of the public. The panel prioritized questions that are relevant to the recognition and management of sepsis and septic shock in adults. New questions and sections were addressed, relative to the previous guidelines. These questions were grouped under 6 subgroups (screening and early treatment, infection, hemodynamics, ventilation, additional therapies, and long-term outcomes and goals of care). With input from the panel and methodologists, professional medical librarians performed the search strategy tailored to either specific questions or a group of relevant questions. A dedicated systematic review team performed screening and data abstraction when indicated. For each question, the methodologists, with input from panel members, summarized the evidence assessed and graded the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The panel generated recommendations using the evidence-to-decision framework. Recommendations were either strong or weak, or in the form of best practice statements. When evidence was insufficient to support a recommendation, the panel was surveyed to generate “in our practice” statements.
Results
The SSC panel issued 93 statements: 15 best practice statements, 15 strong recommendations, and 54 weak recommendations and no recommendation was provided for 9 questions. The recommendations address several important clinical areas related to screening tools, acute resuscitation strategies, management of fluids and vasoactive agents, antimicrobials and diagnostic tests and the use of additional therapies, ventilation management, goals of care, and post sepsis care.
Conclusion
The SSC panel issued evidence-based recommendations to help support key stakeholders caring for adults with sepsis or septic shock and their families.
664 citations
TL;DR: A systematic review and random‐effects meta‐analysis to assess the prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients found no significant differences in the prevalence estimates between different genders; however, the depression and anxiety prevalence estimates varied based on different screening tools.
Abstract: Evidence from previous coronavirus outbreaks has shown that infected patients are at risk for developing psychiatric and mental health disorders, such as depression, anxiety, and sleep disturbances. To construct a comprehensive picture of the mental health status in COVID-19 patients, we conducted a systematic review and random-effects meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbances in this population. We searched MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Wanfang Data, Wangfang Med Online, CNKI, and CQVIP for relevant articles, and we included 31 studies (n = 5153) in our analyses. We found that the pooled prevalence of depression was 45% (95% CI: 37-54%, I2 = 96%), the pooled prevalence of anxiety was 47% (95% CI: 37-57%, I2 = 97%), and the pooled prevalence of sleeping disturbances was 34% (95% CI: 19-50%, I2 = 98%). We did not find any significant differences in the prevalence estimates between different genders; however, the depression and anxiety prevalence estimates varied based on different screening tools. More observational studies assessing the mental wellness of COVID-19 outpatients and COVID-19 patients from countries other than China are needed to further examine the psychological implications of COVID-19 infections.
425 citations
University of California1, Boston University2, University of Ferrara3, McMaster University4, Brigham and Women's Hospital5, HealthPartners6, Harvard University7, University of Alcalá8, Manchester Academic Health Science Centre9, Institute of Chartered Accountants of Nigeria10, University of Otago11, University of Giessen12, University of Queensland13, Royal Brisbane and Women's Hospital14
TL;DR: In this paper, the authors determined factors associated with COVID-19-related death in people with rheumatic diseases, including age, sex, smoking status, comorbidities, diagnosis, disease activity and medications.
Abstract: OBJECTIVES: To determine factors associated with COVID-19-related death in people with rheumatic diseases. METHODS: Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. RESULTS: Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. CONCLUSION: Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
405 citations
TL;DR: New, interim guidance to support the conduct of rapid reviews (RRs) produced within Cochrane and beyond is offered in response to requests for timely evidence syntheses for decision-making purposes including urgent health issues of high priority.
359 citations
287 citations
Fred Hutchinson Cancer Research Center1, University of Washington2, Ottawa Hospital Research Institute3, Medical University of Vienna4, University of Chieti-Pescara5, University of Toronto6, Case Western Reserve University7, University of California, San Francisco8, Provincial Health Services Authority9, University of British Columbia10, McMaster University11, Cardiff University12, University of Minnesota13, American University of Beirut14, Cochrane Collaboration15
TL;DR: In this paper, the authors present evidence-based guidelines of the American Society of Hematology (ASH) to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer.
284 citations
TL;DR: The TOGETHER trial as discussed by the authors evaluated the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to CoV-19.
The Feinstein Institute for Medical Research1, Hofstra University2, I.M. Sechenov First Moscow State Medical University3, Lenox Hill Hospital4, Newark Beth Israel Medical Center5, York Hospital6, NorthShore University HealthSystem7, University of Chicago8, Medical College of Wisconsin9, University of Colorado Denver10, Cardiovascular Institute of the South11, McMaster University12
TL;DR: In this article, the authors evaluated the effects of therapeutic-dose low-molecular-weight heparin (LMWH) vs institutional standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.
Abstract: Importance Hospitalized patients with COVID-19 are at risk for venous and arterial thromboembolism and death. Optimal thromboprophylaxis dosing in high-risk patients is unknown. Objective To evaluate the effects of therapeutic-dose low-molecular-weight heparin (LMWH) vs institutional standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19. Design, setting, and participants The HEP-COVID multicenter randomized clinical trial recruited hospitalized adult patients with COVID-19 with D-dimer levels more than 4 times the upper limit of normal or sepsis-induced coagulopathy score of 4 or greater from May 8, 2020, through May 14, 2021, at 12 academic centers in the US. Interventions Patients were randomized to institutional standard prophylactic or intermediate-dose LMWH or unfractionated heparin vs therapeutic-dose enoxaparin, 1 mg/kg subcutaneous, twice daily if creatinine clearance was 30 mL/min/1.73 m2 or greater (0.5 mg/kg twice daily if creatinine clearance was 15-29 mL/min/1.73 m2) throughout hospitalization. Patients were stratified at the time of randomization based on intensive care unit (ICU) or non-ICU status. Main outcomes and measures The primary efficacy outcome was venous thromboembolism (VTE), arterial thromboembolism (ATE), or death from any cause, and the principal safety outcome was major bleeding at 30 ± 2 days. Data were collected and adjudicated locally by blinded investigators via imaging, laboratory, and health record data. Results Of 257 patients randomized, 253 were included in the analysis (mean [SD] age, 66.7 [14.0] years; men, 136 [53.8%]; women, 117 [46.2%]); 249 patients (98.4%) met inclusion criteria based on D-dimer elevation and 83 patients (32.8%) were stratified as ICU-level care. There were 124 patients (49%) in the standard-dose vs 129 patients (51%) in the therapeutic-dose group. The primary efficacy outcome was met in 52 of 124 patients (41.9%) (28.2% VTE, 3.2% ATE, 25.0% death) with standard-dose heparins vs 37 of 129 patients (28.7%) (11.7% VTE, 3.2% ATE, 19.4% death) with therapeutic-dose LMWH (relative risk [RR], 0.68; 95% CI, 0.49-0.96; P = .03), including a reduction in thromboembolism (29.0% vs 10.9%; RR, 0.37; 95% CI, 0.21-0.66; P Conclusions and relevance In this randomized clinical trial, therapeutic-dose LMWH reduced major thromboembolism and death compared with institutional standard heparin thromboprophylaxis among inpatients with COVID-19 with very elevated D-dimer levels. The treatment effect was not seen in ICU patients. Trial registration ClinicalTrials.gov Identifier: NCT04401293.
University of Pennsylvania1, University of Toronto2, Cochrane Collaboration3, McMaster University4, Mahidol University5, Johns Hopkins University6, Albert Einstein College of Medicine7, NewYork–Presbyterian Hospital8, Columbia University9, McGill University10, Leiden University Medical Center11, Yale University12, Pontifical Catholic University of Chile13, Kaiser Permanente14, University of Geneva15, Washington University in St. Louis16, Ottawa Hospital Research Institute17, American University of Beirut18, St. Joseph's Healthcare Hamilton19, University of Guadalajara20, King Hussein Cancer Center21, University of Chicago22, University of Freiburg23
TL;DR: The evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected venous thromboembolism (VTE) as mentioned in this paper.
McMaster University1, University of Washington2, United Arab Emirates University3, Copenhagen University Hospital4, St Thomas' Hospital5, University of Michigan6, King Saud bin Abdulaziz University for Health Sciences7, Albert Einstein College of Medicine8, University of Toronto9, Rhode Island Hospital10, Brown University11, Utrecht University12, NewYork–Presbyterian Hospital13, Peking Union Medical College Hospital14, Federal University of São Paulo15, Humanitas University16, University of Ulsan17, National Institutes of Health18, Jagiellonian University Medical College19, Population Health Research Institute20, University of Manitoba21, University at Buffalo22, Homi Bhabha National Institute23, Baylor College of Medicine24, Vanderbilt University25, University of Milano-Bicocca26, King Saud Medical City27, Royal North Shore Hospital28, The George Institute for Global Health29, University of Virginia30, University of Dammam31, Emory University32, University of Pennsylvania33, Agostino Gemelli University Polyclinic34, St George’s University Hospitals NHS Foundation Trust35
TL;DR: The Surviving Sepsis Campaign Coronavirus Diease 2019 (SCCD) 2019 panel as mentioned in this paper provided guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU.
Abstract: Background The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU. Methods The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Results The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning. Conclusion The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.
University of Otago1, Monash University2, McMaster University3, University of Kansas4, University of Oslo5, Sichuan University6, University of Dundee7, University of Sydney8, University of Bari9, Princess Alexandra Hospital10, University of Calgary11, The George Institute for Global Health12, Hôpital Maisonneuve-Rosemont13, University of Alberta14, Royal Adelaide Hospital15, Garvan Institute of Medical Research16, University of Melbourne17, Universidad Autónoma de Nuevo León18, Jiangxi University of Traditional Chinese Medicine19, Cochrane Collaboration20, Population Health Research Institute21
TL;DR: In this paper, the authors evaluated the effect of SGLT-2 inhibitors and GLP-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk.
Abstract: Objective To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. Design Network meta-analysis. Data sources Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. Eligibility criteria for selecting studies Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. Main outcome measures Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. Results 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced mortality and admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 5 to 48 fewer deaths in 1000 patients over five years; see interactive decision support tool (https://magicevidence.org/match-it/200820dist/#!/) for all outcomes. Conclusions In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with notable differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. Systematic review registration PROSPERO CRD42019153180.
Queen Mary University of London1, Harvard University2, University of Auckland3, St. Michael's Hospital4, Winthrop-University Hospital5, Karolinska Institutet6, University of Zurich7, Pontifical Catholic University of Chile8, University of Copenhagen9, Boston Children's Hospital10, University of Parma11, University of London12, University of Colorado Denver13, Ben-Gurion University of the Negev14, McMaster University15, Case Western Reserve University16, Katholieke Universiteit Leuven17, University of Tampere18, Columbia University Medical Center19, Medical University of Łódź20, Pennsylvania State University21, University of Birmingham22, University of Otago23, Jikei University School of Medicine24, QIMR Berghofer Medical Research Institute25, Dartmouth College26, University of Helsinki27, University College of Medical Sciences28, University of Melbourne29, Menzies Research Institute30, University of Delhi31
TL;DR: A 2017 meta-analysis of data from 25 randomised controlled trials (RCTs) of vitamin D supplementation for the prevention of acute respiratory infections (ARIs) revealed a protective effect of this intervention as discussed by the authors.
TL;DR: In this paper, the left atrial appendage occlusion has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved.
Abstract: Background Surgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedur...
Deakin University1, University of Melbourne2, King's College London3, University of Sydney4, University of Manchester5, University College Cork6, China Medical University (Taiwan)7, Harvard University8, University of California, Los Angeles9, McMaster University10, Université catholique de Louvain11, Carlos III Health Institute12, University of Las Palmas de Gran Canaria13, Université Paris-Saclay14, University College London15
TL;DR: The nascent nature of the nutritional psychiatry field to date means that the existing literature identified is largely comprised of preclinical animal studies, and intervention studies that assess markers related to these pathways within clinically diagnosed human populations are needed.
Abstract: The field of nutritional psychiatry has generated observational and efficacy data supporting a role for healthy dietary patterns in depression onset and symptom management. To guide future clinical trials and targeted dietary therapies, this review provides an overview of what is currently known regarding underlying mechanisms of action by which diet may influence mental and brain health. The mechanisms of action associating diet with health outcomes are complex, multifaceted, interacting, and not restricted to any one biological pathway. Numerous pathways were identified through which diet could plausibly affect mental health. These include modulation of pathways involved in inflammation, oxidative stress, epigenetics, mitochondrial dysfunction, the gut microbiota, tryptophan-kynurenine metabolism, the HPA axis, neurogenesis and BDNF, epigenetics, and obesity. However, the nascent nature of the nutritional psychiatry field to date means that the existing literature identified in this review is largely comprised of preclinical animal studies. To fully identify and elucidate complex mechanisms of action, intervention studies that assess markers related to these pathways within clinically diagnosed human populations are needed.
TL;DR: A new LIB RUL prediction method based on improved convolution neural network (CNN) and long short-term memory (L STM), namely Auto-CNN-LSTM, is proposed in this article, developed based on deep CNN and LSTM to mine deeper information in finite data.
Abstract: Integration of each aspect of the manufacturing process with the new generation of information technology such as the Internet of Things, big data, and cloud computing makes industrial manufacturing systems more flexible and intelligent. Industrial big data, recording all aspects of the industrial production process, contain the key value for industrial intelligence. For industrial manufacturing, an essential and widely used electronic device is the lithium-ion battery (LIB). However, accurately predicting the remaining useful life (RUL) of LIB is urgently needed to reduce unexpected maintenance and avoid accidents. Due to insufficient amount of degradation data, the prediction accuracy of data-driven methods is greatly limited. Besides, mathematical models established by model-driven methods to represent degradation process are unstable because of external factors like temperature. To solve this problem, a new LIB RUL prediction method based on improved convolution neural network (CNN) and long short-term memory (LSTM), namely Auto-CNN-LSTM, is proposed in this article. This method is developed based on deep CNN and LSTM to mine deeper information in finite data. In this method, an autoencoder is utilized to augment the dimensions of data for more effective training of CNN and LSTM. In order to obtain continuous and stable output, a filter to smooth the predicted value is used. Comparing with other commonly used methods, experiments on a real-world dataset demonstrate the effectiveness of the proposed method.
TL;DR: One year into the global COVID-19 pandemic, the focus of attention has shifted to the emergence and spread of SARS-CoV-2 variants of concern (VOCs) as discussed by the authors.
Ohio State University1, Los Angeles Biomedical Research Institute2, University of Leicester3, French Institute of Health and Medical Research4, Salem Hospital5, University of Hong Kong6, Imperial College London7, Mayo Clinic8, University of North Carolina at Chapel Hill9, University of California, Los Angeles10, University of Cambridge11, The George Institute for Global Health12, Mount Elizabeth Novena Hospital13, Nanjing University14, University of Iowa15, Columbia University Medical Center16, University of Toronto17, University of Groningen18, Juntendo University19, Charles University in Prague20, Radboud University Nijmegen21, McMaster University22, Flinders University23, University of Sydney24, University of Calgary25, RWTH Aachen University26
TL;DR: The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Glomerular Diseases is an update to the KDIGO 2012 guideline.
TL;DR: In this article, the authors assess the properties of cellulose nanocrystals from more than 30 production routes and 40 biomass sources to help CNC users select the right material for their desired application.
Abstract: Cellulose nanocrystals (CNCs) are bio-based, high aspect ratio nanoparticles that are industrially produced in tonne-per-day quantities across the globe. CNCs can be used to improve the performance of a large range of materials such as emulsions and foams, biomedical devices, electronics and sensors, high-viscosity fluids and polymer composites. Their ability to do so, however, is highly dependent on the way they are produced. In this Review, we assess the properties of CNCs from more than 30 production routes and 40 biomass sources to help CNC users select the right material for their desired application. CNCs produced by various methods are evaluated against three target properties: colloidal stability, size and crystallinity index. Alternative production routes and/or starting materials are suggested to overcome challenges associated with CNC use, including increasing compatibility with hydrophobic materials, resistance to thermal degradation and colloidal stability in high ionic strength environments. Additionally, we discuss industrial production of CNCs, as well as considerations for increasing the yield and reducing the environmental impact of these processes. Overall, this Review guides researchers and CNC users towards a deeper understanding of how production processes can be modified to control CNC properties and subsequently tailor their performance. Cellulose nanocrystals are rigid rod-shaped nanoparticles that show promise as additives in composites, emulsions, foams and biomedical devices and as rheological modifiers. In this Review, the authors guide end users towards selecting cellulose sources and production routes that optimize the performance of cellulose nanocrystals in their intended application.
TL;DR: In this article, super-resolution microscopy visualized vaccine components forming antigenic complexes with platelet factor 4 (PF4) on platelet surfaces to which anti-PF4 antibodies obtained from VITT patients bound.
TL;DR: In this article, the binding sites on platelet factor 4 (PF4) were determined by using alanine-scanning mutagenesis to identify the epitope that is recognized by anti-PF4 antibodies in patients with vaccine-induced immune thrombocytopaenia.
Abstract: Vaccine-induced immune thrombotic thrombocytopaenia (VITT) is a rare adverse effect of COVID-19 adenoviral vector vaccines1–3. VITT resembles heparin-induced thrombocytopaenia (HIT) in that it is associated with platelet-activating antibodies against platelet factor 4 (PF4)4; however, patients with VITT develop thrombocytopaenia and thrombosis without exposure to heparin. Here we sought to determine the binding site on PF4 of antibodies from patients with VITT. Using alanine-scanning mutagenesis5, we found that the binding of anti-PF4 antibodies from patients with VITT (n = 5) was restricted to eight surface amino acids on PF4, all of which were located within the heparin-binding site, and that the binding was inhibited by heparin. By contrast, antibodies from patients with HIT (n = 10) bound to amino acids that corresponded to two different sites on PF4. Biolayer interferometry experiments also revealed that VITT anti-PF4 antibodies had a stronger binding response to PF4 and PF4–heparin complexes than did HIT anti-PF4 antibodies, albeit with similar dissociation rates. Our data indicate that VITT antibodies can mimic the effect of heparin by binding to a similar site on PF4; this allows PF4 tetramers to cluster and form immune complexes, which in turn causes Fcγ receptor IIa (FcγRIIa; also known as CD32a)-dependent platelet activation. These results provide an explanation for VITT-antibody-induced platelet activation that could contribute to thrombosis. Alanine-scanning mutagenesis is used to identify the PF4 epitope that is recognized by anti-PF4 antibodies in patients with vaccine-induced immune thrombotic thrombocytopaenia, revealing that the epitope corresponds to the heparin-binding site on PF4.
University of California, San Francisco1, Cleveland Clinic2, University of Kansas3, Mayo Clinic4, Columbia University5, McMaster University6, Northwestern University7, Emory University8, National Institutes of Health9, Children's Mercy Hospital10, University of Pennsylvania11, Johns Hopkins University12, Harvard University13, Boston Children's Hospital14, Vanderbilt University15, St Mary's Hospital16, University of Utah17, University at Buffalo18, University of South Florida19, American College of Rheumatology20
TL;DR: In this article, the authors provided evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangisitis (MPA), and eosinophilic granulomas with polyanagliitis (EGPA), which required ≥70% consensus among the Voting Panel.
Abstract: Objective To provide evidence-based recommendations and expert guidance for the management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Methods Clinical questions regarding the treatment and management of AAV were developed in the population, intervention, comparator, and outcome (PICO) format (47 for GPA/MPA, 34 for EGPA). Systematic literature reviews were conducted for each PICO question. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of evidence and formulate recommendations. Each recommendation required ≥70% consensus among the Voting Panel. Results We present 26 recommendations and 5 ungraded position statements for GPA/MPA, and 15 recommendations and 5 ungraded position statements for EGPA. This guideline provides recommendations for remission induction and maintenance therapy as well as adjunctive treatment strategies in GPA, MPA, and EGPA. These recommendations include the use of rituximab for remission induction and maintenance in severe GPA and MPA and the use of mepolizumab in nonsevere EGPA. All recommendations are conditional due in part to the lack of multiple randomized controlled trials and/or low-quality evidence supporting the recommendations. Conclusion This guideline presents the first recommendations endorsed by the American College of Rheumatology and the Vasculitis Foundation for the management of AAV and provides guidance to health care professionals on how to treat these diseases.
21 Jul 2021
TL;DR: The authors found that using the most positive 6 adjectives reduces violent completions for Muslims from 66% to 20%, but which is still higher than for other religious groups, and quantify the positive distraction needed to overcome this bias with adversarial text prompts.
Abstract: It has been observed that large-scale language models capture undesirable societal biases, e.g. relating to race and gender; yet religious bias has been relatively unexplored. We demonstrate that GPT-3, a state-of-the-art contextual language model, captures persistent Muslim-violence bias. We probe GPT-3 in various ways, including prompt completion, analogical reasoning, and story generation, to understand this anti-Muslim bias, demonstrating that it appears consistently and creatively in different uses of the model and that it is severe even compared to biases about other religious groups. For instance, Muslim is analogized to terrorist in 23% of test cases, while Jewish is mapped to its most common stereotype, money, in 5% of test cases. We quantify the positive distraction needed to overcome this bias with adversarial text prompts, and find that use of the most positive 6 adjectives reduces violent completions for Muslims from 66% to 20%, but which is still higher than for other religious groups.
Université de Montréal1, McMaster University2, University of Waterloo3, Canadian Blood Services4, Ottawa Hospital Research Institute5, University of Ottawa6, Gulf Coast Regional Blood Center7, Héma-Québec8, Cornell University9, Sunnybrook Health Sciences Centre10, University of British Columbia11, Laval University12, University of Calgary13, University of Toronto14, New York Blood Center15, Mount Sinai Hospital, Toronto16, Public Health Agency of Canada17, University of Manitoba18
TL;DR: In this paper, the authors conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset ( NCT04348656 ).
Abstract: The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset ( NCT04348656 ). Patients were allocated 2:1 to 500 ml of convalescent plasma or standard of care. The composite primary outcome was intubation or death by 30 d. Exploratory analyses of the effect of convalescent plasma antibodies on the primary outcome was assessed by logistic regression. The trial was terminated at 78% of planned enrollment after meeting stopping criteria for futility. In total, 940 patients were randomized, and 921 patients were included in the intention-to-treat analysis. Intubation or death occurred in 199/614 (32.4%) patients in the convalescent plasma arm and 86/307 (28.0%) patients in the standard of care arm-relative risk (RR) = 1.16 (95% confidence interval (CI) 0.94-1.43, P = 0.18). Patients in the convalescent plasma arm had more serious adverse events (33.4% versus 26.4%; RR = 1.27, 95% CI 1.02-1.57, P = 0.034). The antibody content significantly modulated the therapeutic effect of convalescent plasma. In multivariate analysis, each standardized log increase in neutralization or antibody-dependent cellular cytotoxicity independently reduced the potential harmful effect of plasma (odds ratio (OR) = 0.74, 95% CI 0.57-0.95 and OR = 0.66, 95% CI 0.50-0.87, respectively), whereas IgG against the full transmembrane spike protein increased it (OR = 1.53, 95% CI 1.14-2.05). Convalescent plasma did not reduce the risk of intubation or death at 30 d in hospitalized patients with COVID-19. Transfusion of convalescent plasma with unfavorable antibody profiles could be associated with worse clinical outcomes compared to standard care.
TL;DR: In this paper, the authors review the patterns and potential underlying mechanisms of interactions between secondary metabolites and plant microbiomes and describe the recent developments in analytical approaches and methods in this field.
Abstract: Plant secondary metabolites (PSMs) play many roles including defense against pathogens, pests, and herbivores; response to environmental stresses, and mediating organismal interactions. Similarly, plant microbiomes participate in many of the above-mentioned processes directly or indirectly by regulating plant metabolism. Studies have shown that plants can influence their microbiome by secreting various metabolites and, in turn, the microbiome may also impact the metabolome of the host plant. However, not much is known about the communications between the interacting partners to impact their phenotypic changes. In this article, we review the patterns and potential underlying mechanisms of interactions between PSMs and plant microbiomes. We describe the recent developments in analytical approaches and methods in this field. The applications of these new methods and approaches have increased our understanding of the relationships between PSMs and plant microbiomes. Though the current studies have primarily focused on model organisms, the methods and results obtained so far should help future studies of agriculturally important plants and facilitate the development of methods to manipulate PSMs-microbiome interactions with predictive outcomes for sustainable crop productions.
TL;DR: In this paper, the safety and efficacy of peginterferon lambda in the treatment of outpatients with mild-to-moderate COVID-19 was investigated in a double-blind, placebo-controlled trial.
TL;DR: In this paper, a systematic search of English and Chinese databases was conducted to assess the prevalence of depressive symptoms, anxiety symptoms and sleep disturbances in higher education students during the COVID-19 pandemic.
Abstract: The COVID-19 pandemic and its accompanying infection control measures introduced significant disruptions to the routines of many higher education students around the world. It also deprived them of in-person counselling services and social support. These changes have put students at a greater risk of developing mental illness. The objective of this review is to assess the prevalence of depressive symptoms, anxiety symptoms and sleep disturbances in higher education students during the pandemic. A systematic search of English and Chinese databases was conducted current to January 1st, 2021. The quality of included studies was evaluated using a modified Newcastle-Ottawa scale. Prevalence of depressive symptoms, anxiety symptoms and sleep disturbances were pooled using random-effects meta-analysis. Eighty-nine studies (n=1,441,828) were included. The pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances was 34%, 32% and 33%, respectively. The prevalence values differ based on geographical regions, diagnostic criteria, education level, undergraduate year of study, financial situation, living arrangements and gender. Overall, the prevalence of depressive symptoms and anxiety symptoms synthesized in this study was higher compared to pre-pandemic prevalence in similar populations. Evidently, mental health screening and intervention should be a top priority for universities and colleges during the pandemic.