Showing papers by "University of Manitoba published in 2020"

A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19.

Abstract: Background Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is o...

Predicting infectious severe acute respiratory syndrome coronavirus 2 from diagnostic samples

Abstract: BACKGROUND: Reverse-transcription polymerase chain reaction (RT-PCR) has become the primary method to diagnose viral diseases, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RT-PCR detects RNA, not infectious virus; thus, its ability to determine duration of infectivity of patients is limited. Infectivity is a critical determinant in informing public health guidelines/interventions. Our goal was to determine the relationship between E gene SARS-CoV-2 RT-PCR cycle threshold (Ct) values from respiratory samples, symptom onset to test (STT), and infectivity in cell culture. METHODS: In this retrospective cross-sectional study, we took SARS-CoV-2 RT-PCR-confirmed positive samples and determined their ability to infect Vero cell lines. RESULTS: Ninety RT-PCR SARS-CoV-2-positive samples were incubated on Vero cells. Twenty-six samples (28.9%) demonstrated viral growth. Median tissue culture infectious dose/mL was 1780 (interquartile range, 282-8511). There was no growth in samples with a Ct > 24 or STT > 8 days. Multivariate logistic regression using positive viral culture as a binary predictor variable, STT, and Ct demonstrated an odds ratio (OR) for positive viral culture of 0.64 (95% confidence interval [CI], .49-.84; P   24. CONCLUSIONS: SARS-CoV-2 Vero cell infectivity was only observed for RT-PCR Ct   24 and duration of symptoms > 8 days may be low. This information can inform public health policy and guide clinical, infection control, and occupational health decisions. Further studies of larger size are needed.

The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics

Abstract: In May 2019, the International Scientific Association for Probiotics and Prebiotics (ISAPP) convened a panel of nutritionists, physiologists and microbiologists to review the definition and scope of synbiotics. The panel updated the definition of a synbiotic to “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host”. The panel concluded that defining synbiotics as simply a mixture of probiotics and prebiotics could suppress the innovation of synbiotics that are designed to function cooperatively. Requiring that each component must meet the evidence and dose requirements for probiotics and prebiotics individually could also present an obstacle. Rather, the panel clarified that a complementary synbiotic, which has not been designed so that its component parts function cooperatively, must be composed of a probiotic plus a prebiotic, whereas a synergistic synbiotic does not need to be so. A synergistic synbiotic is a synbiotic for which the substrate is designed to be selectively utilized by the co-administered microorganisms. This Consensus Statement further explores the levels of evidence (existing and required), safety, effects upon targets and implications for stakeholders of the synbiotic concept. Gut microbiota can be manipulated to benefit host health, including the use of probiotics, prebiotics and synbiotics. This Consensus Statement outlines the definition and scope of the term ‘synbiotics’ as determined by an expert panel convened by the International Scientific Association for Probiotics and Prebiotics in May 2019.

Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition.

Abstract: Background:High-quality epidemiologic data worldwide are needed to improve our understanding of disease risk, support health policy to meet the diverse needs of people with multiple sclerosis (MS) ...

The FLUXNET2015 dataset and the ONEFlux processing pipeline for eddy covariance data

Abstract: The FLUXNET2015 dataset provides ecosystem-scale data on CO2, water, and energy exchange between the biosphere and the atmosphere, and other meteorological and biological measurements, from 212 sites around the globe (over 1500 site-years, up to and including year 2014). These sites, independently managed and operated, voluntarily contributed their data to create global datasets. Data were quality controlled and processed using uniform methods, to improve consistency and intercomparability across sites. The dataset is already being used in a number of applications, including ecophysiology studies, remote sensing studies, and development of ecosystem and Earth system models. FLUXNET2015 includes derived-data products, such as gap-filled time series, ecosystem respiration and photosynthetic uptake estimates, estimation of uncertainties, and metadata about the measurements, presented for the first time in this paper. In addition, 206 of these sites are for the first time distributed under a Creative Commons (CC-BY 4.0) license. This paper details this enhanced dataset and the processing methods, now made available as open-source codes, making the dataset more accessible, transparent, and reproducible.

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Abstract: Importance Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures The primary end point was organ support–free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned –1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support–free days were 0 (IQR, –1 to 15), 0 (IQR, –1 to 13), and 0 (–1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support–free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support–free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration ClinicalTrials.gov Identifier:NCT02735707

Antimicrobial host defence peptides: functions and clinical potential

Abstract: Cationic host defence peptides (CHDP), also known as antimicrobial peptides, are naturally occurring peptides that can combat infections through their direct microbicidal properties and/or by influencing the host's immune responses. The unique ability of CHDP to control infections as well as resolve harmful inflammation has generated interest in harnessing the properties of these peptides to develop new therapies for infectious diseases, chronic inflammatory disorders and wound healing. Various strategies have been used to design synthetic optimized peptides, with negligible toxicity. Here, we focus on the progress made in understanding the scope of functions of CHDP and the emerging potential clinical applications of CHDP-based therapies.

Virology, transmission, and pathogenesis of SARS-CoV-2.

Abstract: ### What you need to know Since the emergence of SARS-CoV-2 in December 2019, there has been an unparalleled global effort to characterise the virus and the clinical course of disease. Coronavirus disease 2019 (covid-19), caused by SARS-CoV-2, follows a biphasic pattern of illness that likely results from the combination of an early viral response phase and an inflammatory second phase. Most clinical presentations are mild, and the typical pattern of covid-19 more resembles an influenza-like illness—which includes fever, cough, malaise, myalgia, headache, and taste and smell disturbance—rather than severe pneumonia (although emerging evidence about long term consequences is yet to be understood in detail).1 In this review, we provide a broad update on the emerging understanding of SARS-CoV-2 pathophysiology, including virology, transmission dynamics, and the immune response to the virus. Any of the …

Multiple wheat genomes reveal global variation in modern breeding.

Abstract: Advances in genomics have expedited the improvement of several agriculturally important crops but similar efforts in wheat (Triticum spp.) have been more challenging. This is largely owing to the size and complexity of the wheat genome1, and the lack of genome-assembly data for multiple wheat lines2,3. Here we generated ten chromosome pseudomolecule and five scaffold assemblies of hexaploid wheat to explore the genomic diversity among wheat lines from global breeding programs. Comparative analysis revealed extensive structural rearrangements, introgressions from wild relatives and differences in gene content resulting from complex breeding histories aimed at improving adaptation to diverse environments, grain yield and quality, and resistance to stresses4,5. We provide examples outlining the utility of these genomes, including a detailed multi-genome-derived nucleotide-binding leucine-rich repeat protein repertoire involved in disease resistance and the characterization of Sm16, a gene associated with insect resistance. These genome assemblies will provide a basis for functional gene discovery and breeding to deliver the next generation of modern wheat cultivars.

Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial.

Abstract: BACKGROUND: No effective oral therapy exists for early coronavirus disease 2019 (COVID-19). OBJECTIVE: To investigate whether hydroxychloroquine could reduce COVID-19 severity in adult outpatients. DESIGN: Randomized, double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. (ClinicalTrials.gov: NCT04308668). SETTING: Internet-based trial across the United States and Canada (40 states and 3 provinces). PARTICIPANTS: Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset. INTERVENTION: Oral hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 more days) or masked placebo. MEASUREMENTS: Symptoms and severity at baseline and then at days 3, 5, 10, and 14 using a 10-point visual analogue scale. The primary end point was change in overall symptom severity over 14 days. RESULTS: Of 491 patients randomly assigned to a group, 423 contributed primary end point data. Of these, 341 (81%) had laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or epidemiologically linked exposure to a person with laboratory-confirmed infection; 56% (236 of 423) were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between the hydroxychloroquine and placebo groups (difference in symptom severity: relative, 12%; absolute, -0.27 point [95% CI, -0.61 to 0.07 point]; P = 0.117). At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (P = 0.21). Medication adverse effects occurred in 43% (92 of 212) of participants receiving hydroxychloroquine versus 22% (46 of 211) receiving placebo (P < 0.001). With placebo, 10 hospitalizations occurred (2 non-COVID-19-related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (P = 0.29). LIMITATION: Only 58% of participants received SARS-CoV-2 testing because of severe U.S. testing shortages. CONCLUSION: Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19. PRIMARY FUNDING SOURCE: Private donors.

Machine Learning in IoT Security: Current Solutions and Future Challenges

Abstract: The future Internet of Things (IoT) will have a deep economical, commercial and social impact on our lives. The participating nodes in IoT networks are usually resource-constrained, which makes them luring targets for cyber attacks. In this regard, extensive efforts have been made to address the security and privacy issues in IoT networks primarily through traditional cryptographic approaches. However, the unique characteristics of IoT nodes render the existing solutions insufficient to encompass the entire security spectrum of the IoT networks. Machine Learning (ML) and Deep Learning (DL) techniques, which are able to provide embedded intelligence in the IoT devices and networks, can be leveraged to cope with different security problems. In this paper, we systematically review the security requirements, attack vectors, and the current security solutions for the IoT networks. We then shed light on the gaps in these security solutions that call for ML and DL approaches. Finally, we discuss in detail the existing ML and DL solutions for addressing different security problems in IoT networks. We also discuss several future research directions for ML- and DL-based IoT security.

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update).

Abstract: The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.

Microbial and Enzymatic Degradation of Synthetic Plastics

Abstract: Synthetic plastics are pivotal in our current lifestyle and therefore, its accumulation is a major concern for environment and human health. Petroleum-derived (petro-)polymers such as polyethylene (PE), polyethylene terephthalate (PET), polyurethane (PU), polystyrene (PS), polypropylene (PP), and polyvinyl chloride (PVC) are extremely recalcitrant to natural biodegradation pathways. Some microorganisms with the ability to degrade petro-polymers under in vitro conditions have been isolated and characterized. In some cases, the enzymes expressed by these microbes have been cloned and sequenced. The rate of polymer biodegradation depends on several factors including chemical structures, molecular weights, and degrees of crystallinity. Polymers are large molecules having both regular crystals (crystalline region) and irregular groups (amorphous region), where the latter provides polymers with flexibility. Highly crystalline polymers like polyethylene (95%), are rigid with a low capacity to resist impacts. PET-based plastics possess a high degree of crystallinity (30-50%), which is one of the principal reasons for their low rate of microbial degradation, which is projected to take more than 50 years for complete degraded in the natural environment, and hundreds of years if discarded into the oceans, due to their lower temperature and oxygen availability. The enzymatic degradation occurs in two stages: adsorption of enzymes on the polymer surface, followed by hydro-peroxidation/hydrolysis of the bonds. The sources of plastic-degrading enzymes can be found in microorganisms from various environments as well as digestive intestine of some invertebrates. Microbial and enzymatic degradation of waste petro-plastics is a promising strategy for depolymerization of waste petro-plastics into polymer monomers for recycling, or to covert waste plastics into higher value bioproducts, such as biodegradable polymers via mineralization. The objective of this review is to outline the advances made in the microbial degradation of synthetic plastics and, overview the enzymes involved in biodegradation.

Plant food anti-nutritional factors and their reduction strategies: an overview

Abstract: Legumes and cereals contain high amounts of macronutrients and micronutrients but also anti-nutritional factors. Major anti-nutritional factors, which are found in edible crops include saponins, tannins, phytic acid, gossypol, lectins, protease inhibitors, amylase inhibitor, and goitrogens. Anti-nutritional factors combine with nutrients and act as the major concern because of reduced nutrient bioavailability. Various other factors like trypsin inhibitors and phytates, which are present mainly in legumes and cereals, reduce the digestibility of proteins and mineral absorption. Anti-nutrients are one of the key factors, which reduce the bioavailability of various components of the cereals and legumes. These factors can cause micronutrient malnutrition and mineral deficiencies. There are various traditional methods and technologies, which can be used to reduce the levels of these anti-nutrient factors. Several processing techniques and methods such as fermentation, germination, debranning, autoclaving, soaking etc. are used to reduce the anti-nutrient contents in foods. By using various methods alone or in combinations, it is possible to reduce the level of anti-nutrients in foods. This review is focused on different types of anti-nutrients, and possible processing methods that can be used to reduce the level of these factors in food products. A brief overview of beneficial effects of anti-nutrients and reduction strategy.

The Karl G. Jansky Very Large Array Sky Survey (VLASS). Science Case and Survey Design

Abstract: The Very Large Array Sky Survey (VLASS) is a synoptic, all-sky radio sky survey with a unique combination of high angular resolution (≈2.5\"), sensitivity (a 1σ goal of 70 μJy/beam in the coadded data), full linear Stokes polarimetry, time domain coverage, and wide bandwidth (2-4 GHz). The first observations began in September 2017, and observing for the survey will finish in 2024. VLASS will use approximately 5500 hours of time on the Karl G. Jansky Very Large Array (VLA) to cover the whole sky visible to the VLA (Declination > −40∘), a total of 33,885 deg^2. The data will be taken in three epochs to allow the discovery of variable and transient radio sources. The survey is designed to engage radio astronomy experts, multi-wavelength astronomers, and citizen scientists alike. By utilizing an \"on the fly\" interferometry mode, the observing overheads are much reduced compared to a conventional pointed survey. In this paper, we present the science case and observational strategy for the survey, and also results from early survey observations.

A Review of Exosomal Isolation Methods: Is Size Exclusion Chromatography the Best Option?

Abstract: Extracellular vesicles (EVs) are membranous vesicles secreted by both prokaryotic and eukaryotic cells and play a vital role in intercellular communication. EVs are classified into several subtypes based on their origin, physical characteristics, and biomolecular makeup. Exosomes, a subtype of EVs, are released by the fusion of multivesicular bodies (MVB) with the plasma membrane of the cell. Several methods have been described in literature to isolate exosomes from biofluids including blood, urine, milk, and cell culture media, among others. While differential ultracentrifugation (dUC) has been widely used to isolate exosomes, other techniques including ultrafiltration, precipitating agents such as poly-ethylene glycol (PEG), immunoaffinity capture, microfluidics, and size-exclusion chromatography (SEC) have emerged as credible alternatives with pros and cons associated with each. In this review, we provide a summary of commonly used exosomal isolation techniques with a focus on SEC as an ideal methodology. We evaluate the efficacy of SEC to isolate exosomes from an array of biological fluids, with a particular focus on its application to adipose tissue-derived exosomes. We argue that exosomes isolated via SEC are relatively pure and functional, and that this methodology is reproducible, scalable, inexpensive, and does not require specialized equipment or user expertise. However, it must be noted that while SEC is a good candidate method to isolate exosomes, direct comparative studies are required to support this conclusion.

Advances in artificial spin ice

Abstract: Artificial spin ices consist of nanomagnets arranged on the sites of various periodic and aperiodic lattices. They have enabled the experimental investigation of a variety of fascinating phenomena such as frustration, emergent magnetic monopoles and phase transitions that have previously been the domain of bulk spin crystals and theory, as we discuss in this Review. Artificial spin ices also show promise as reprogrammable magnonic crystals and, with this in mind, we give an overview of the measurements of fast dynamics in these magnetic metamaterials. We survey the variety of geometries that have been implemented, in terms of both the form of the nanomagnets and the lattices on which they are placed, including quasicrystalline systems and artificial spin systems in 3D. Different magnetic materials can also be incorporated to modify anisotropies and blocking temperatures, for example. With this large variety of systems, the way is open to discover new phenomena, and we complete this Review with possible directions for the future. Artificial spin ices are metamaterials displaying fascinating phenomena arising from the collective behaviour of nanoscale magnets. We review recent developments in terms of emergent magnetic monopoles, phase transitions, dynamics and geometries, and discuss future directions for research and potential applications.

An ethical framework for global vaccine allocation.

Abstract: The Fair Priority Model offers a practical way to fulfill pledges to distribute vaccine fairly and equitably

Zika among international travellers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice.

Abstract: INTRODUCTION International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site. METHODS Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites. RESULTS GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, eight cases were reported, and all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean, a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean, peak reporting to these regions occurred in 2016 [330 cases (78%)]. The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travellers were pregnant during or after travel; one had a sexually acquired ZIKV infection. There was one case of fetal anomaly and two travellers with Guillain-Barre syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively. CONCLUSION ZIKV should remain a consideration for travellers returning from areas with risk of ZIKV transmission. Travellers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken.

Federated Learning for Internet of Things: Recent Advances, Taxonomy, and Open Challenges

Abstract: The Internet of Things (IoT) will be ripe for the deployment of novel machine learning algorithms for both network and application management. However, given the presence of massively distributed and private datasets, it is challenging to use classical centralized learning algorithms in the IoT. To overcome this challenge, federated learning can be a promising solution that enables on-device machine learning without the need to migrate the private end-user data to a central cloud. In federated learning, only learning model updates are transferred between end-devices and the aggregation server. Although federated learning can offer better privacy preservation than centralized machine learning, it has still privacy concerns. In this paper, first, we present the recent advances of federated learning towards enabling federated learning-powered IoT applications. A set of metrics such as sparsification, robustness, quantization, scalability, security, and privacy, is delineated in order to rigorously evaluate the recent advances. Second, we devise a taxonomy for federated learning over IoT networks. Third, we propose two IoT use cases of dispersed federated learning that can offer better privacy preservation than federated learning. Finally, we present several open research challenges with their possible solutions.

Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies.

Abstract: Segregation of published research Patients with an acute illness frequently acquire an acute, global disturbance in cognition variably referred to as delirium, encephalopathy, acute confusional state, acute brain dysfunction, acute brain failure, and altered mental status [1]. Although these different terms may have been perceived as distinct clinical entities [2], evidence to support such distinctions is lacking. Acute disturbances in cognition are particularly prevalent among individuals admitted to the intensive-care unit [3]. These disturbances have been linked to predisposing and triggering factors [4], and have been independently associated with adverse shortand long-term outcomes, including higher mortality and chronic cognitive impairment [5, 6]. While progress has been made in the detection of this problem, research is needed to identify effective interventions for prevention and treatment. A rational approach to nomenclature represents an important basis to enable such advances. A definition of delirium is provided in the 5th version of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association [7] and in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) [8]. Encephalopathy is a generic term that has been used to describe a global disturbance in brain function. However, the terms acute encephalopathy, acute confusional state, acute brain dysfunction, acute brain failure, and altered mental status lack uniform definitions and are not present in formal diagnostic systems. Our analysis focuses on delirium and acute encephalopathy, as these are the most frequently used terms. We hypothesized that published research on delirium and encephalopathy is highly segregated, and that this segregation would be linked to the clinical discipline of investigators. We conducted a systematic search (see details in the Supplementary Materials) which led to three findings. First, journals on clinical neurology, neurosciences, or general or internal medicine published significantly more articles with ‘encephalopathy’ in the title, whereas journals associated with geriatrics, gerontology, psychiatry, psychology, intensive-care medicine, or anaesthesiology published significantly more delirium-titled articles (P < 0.001). Second, articles with ‘encephalopathy’ in the title rarely (1%, n = 1 of 100 randomly selected articles) mentioned ‘delirium’ in the text, and conversely articles with ‘delirium’ in the title used the word ‘encephalopathy’ in not more than 2% of publications (n = 2 out of 100). Third, almost all citations in the delirium and encephalopathy literature (98.77%, n = 36,729) were between papers with matching terms in the titles (i.e., delirium-titled articles citing other delirium-titled articles *Correspondence: a.slooter‐3@umcutrecht.nl 1 Department of Intensive Care Medicine and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Room F06.149, PO Box 85500, 3508 GA Utrecht, The Netherlands Full author information is available at the end of the article

Drinking to Cope During COVID-19 Pandemic: The Role of External and Internal Factors in Coping Motive Pathways to Alcohol Use, Solitary Drinking, and Alcohol Problems.

Abstract: Background The COVID-19 pandemic has resulted in massive disruptions to society, to the economy, and to daily life. Some people may turn to alcohol to cope with stress during the pandemic, which may put them at risk for heavy drinking and alcohol-related harms. Research is needed to identify factors that are relevant for coping-motivated drinking during these extraordinary circumstances to inform interventions. This study provides an empirical examination of coping motive pathways to alcohol problems during the early stages of the COVID-19 pandemic. Methods Participants (N = 320; 54.7% male; mean age of 32 years) were Canadian adult drinkers who completed an online survey assessing work- and home-related factors, psychological factors, and alcohol-related outcomes over the past 30 days, covering a time period beginning within 1 month of the initiation of the COVID-19 emergency response. Results The results of a theory-informed path model showed that having at least 1 child under the age of 18, greater depression, and lower social connectedness each predicted unique variance in past 30-day coping motives, which in turn predicted increased past 30-day alcohol use (controlling for pre-COVID-19 alcohol use reported retrospectively). Income loss was associated with increased alcohol use, and living alone was associated with increased solitary drinking (controlling for pre-COVID-19 levels), but these associations were not mediated by coping motives. Increased alcohol use, increased solitary drinking, and greater coping motives for drinking were all independently associated with past 30-day alcohol problems, and indirect paths to alcohol problems from having children at home, depression, social connectedness, income loss, and living alone were all supported. Conclusions Findings provide insight into coping-motivated drinking early in the COVID-19 pandemic and highlight the need for longitudinal research to establish longer term outcomes of drinking to cope during the pandemic.