Routine blood tests as an active surveillance to monitor COVID-19 prevalence. A retrospective study

Background: In Italy, one of the country most affected by the COVID-19 pandemic, the first autoch-thonous case appeared in Lombardy on February 20th, 2020. One month later, the number of COVID-19 patients in Lombardy exceeded 17000 and about 3500 had died. Because of this rapid increase in infected people scientists wonder whether SARS-CoV-2 was already highly circulating in Lombardy before such date. Plasma levels of aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were shown to be highly increased in COVID-19 patients. Monitoring their levels in Emergency Room patients during the months preceding February 20th, 2020, might shade light on the prevalence of the disease in the pre-COVID-19 period. Methods: We retrospectively analyzed the AST and LDH levels from more than 30.000 patients admitted to the San Raffaele Hospital Emergency Room (ER) between September 2019 and May 2020 as well as between September 2018 and May 2019. The number of patients diagnosed with respiratory tract diseases were also analyzed. Results: Data showed that the ER averaged AST and LDH levels are highly sensitive to the presence of COVID-19 patients. During, the months preceding February 20th, 2020, AST and LDH levels, as well as the number of patients diagnosed with respiratory tract diseases were similar to their 2019 counterparts. Conclusions: No significant evidence showing that a large number of COVID-19 patients were admitted to the San Raffaele Hospital ER before February 20th, 2020, was found. Thus, the virus was likely circulating, within the Hospital catchment area, either in low amounts or through asymptomatic individuals. Because of the high LDH and AST levels’ variations induced by COVID-19, routine blood tests might be exploited as a surveillance indicator for a possible second wave

A novel method for validating multi-classifiers. A case study for ICF-based health status classification

In this paper, we propose a novel method for the validation of a multi-classification model according to the intended use and aim of a device for health status classification and the clinical needs of the practitioners involved

Development, evaluation, and validation of machine learning models for COVID-19 detection based on routine blood tests

The rRT-PCR test, the current gold standard for the detection of coronavirus disease (COVID-19), presents with known shortcomings, such as long turnaround time, potential shortage of reagents, false-negative rates around 15-20%, and expensive equipment. The hematochemical values of routine blood exams could represent a faster and less expensive alternative. Three different training data set of hematochemical values from 1,624 patients (52% COVID-19 positive), admitted at San Raphael Hospital (OSR) from February to May 2020, were used for developing machine learning (ML) models: the complete OSR dataset (72 features: complete blood count (CBC), biochemical, coagulation, hemogasanalysis and CO-Oxymetry values, age, sex and specific symptoms at triage) and two sub-datasets (COVID-specific and CBC dataset, 32 and 21 features respectively). 58 cases (50% COVID-19 positive) from another hospital, and 54 negative patients collected in 2018 at OSR, were used for internal-external and external validation. We developed five ML models: for the complete OSR dataset, the area under the receiver operating characteristic curve (AUC) for the algorithms ranged from 0.83 to 0.90; for the COVID-specific dataset from 0.83 to 0.87; and for the CBC dataset from 0.74 to 0.86. The validations also achieved good results: respectively, AUC from 0.75 to 0.78; and specificity from 0.92 to 0.96. ML can be applied to blood tests as both an adjunct and alternative method to rRT-PCR for the fast and cost-effective identification of COVID-19-positive patients. This is especially useful in developing countries, or in countries facing an increase in contagions

Classification of Polarimetric SAR Data Using Dictionary Learning

End-user development (EUD) research has yielded a variety of novel environments and techniques, often accompanied by lab-based usability studies that test their effectiveness in the completion of representative real-world tasks. While lab studies play an important role in resolving frustrations and demonstrating the potential of novel tools, they are insufficient to accurately determine the acceptance of a technology in its intended context of use, which is highly dependent on the diverse and dynamic requirements of its users, as we show here. As such, usability in the lab is unlikely to represent usability in the field. To demonstrate this, we first describe the results of a think-aloud usability study of our EUD tool “Jeeves”, followed by two case studies where Jeeves was used by psychologists in their work practices. Common issues in the artificial setting were seldom encountered in the real context of use, which instead unearthed new usability issues through unanticipated user needs. We conclude with considerations for usability evaluation of EUD tools that enable development of software for other users, including planning for collaborative activities, supporting developers to evaluate their own tools, and incorporating longitudinal methods of evaluation.Postprin

The 3d body centre of mass trajectory before and after total knee arthroplasty:symmetry and mechanical work

The kinematics of walking on treadmill were collected and the 3D trajectory of the body centre of mass was computed in subjects suffering from mono-lateral knee osteoarthritis, before and after total knee arthroplasty. Experimental data showed after 6 months from surgery significant improvements in many biomechanical parameters as gait symmetry indices and total work done

Regenerative Medicine in Rotator Cuff Injuries

Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP) is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs). Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research

Repair versus shaving of partial-thickness articular-sided tears of the upper subscapularis tendon : a prospective randomized controlled trial

Purpose: The purpose of this study was to evaluate whether treating partial-thickness articular-sided tears of the upper subscapularis (ssC) tendon with a dedicated suture anchor would result in an internal rotation strength improvement compared with simple shaving of the ssC tendon and footprint. Methods: Twenty-six patients with a limited ssC tendon tear (equal or inferior to the most superior centimeter) in association with a posterosuperior cuff lesion were prospectively randomized to two treatments: repair with a dedicated suture anchor versus shaving of the tendon and footprint. the patients also underwent long head of the biceps (LHB) treatment and posterosuperior cuff tear repair. in each patient the following parameters were measured both preoperatively and at a minimum follow-up of 2.5 years: strength in internal rotation in the bear-hug testing position (using a digital tensiometer), DAsH score and Constant scores. MRi assessment of tendon healing was performed at the final follow-up. Results: Twenty of the 26 patients (76%) were reviewed after a mean follow-up time of 42 months: 11 patients had undergone ssC tendon repair and nine simple shaving. At final follow-up no significant differences were found between the repaired and shaving group in strength in internal rotation (9.5 \ub1 3.8 kg versus 10.3\ub15.4 kg; p=0.7). the DAsH score and Constant score also failed to show significant differences between the two groups. Furthermore, no significant difference in ssC tendon healing rate was observed on MRi evaluation. Conclusions: Partial-thickness articular-sided tear of the upper ssC tendon in association with a posterosuperior rotator cuff repair and LHB treatment, when limited to the superior centimeter of the ssC tendon, shows a comparable performance in terms of strength in internal rotation either after simple shaving or a tendon-to-bone repair. Level of evidence: Level II, prospective comparative study

Making it work for me: beliefs about making a personal health record relevant and useable.

BACKGROUND: A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their health information, e.g. data from their medical records and data collected by apps. However, engagement with their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and other services. We have explored the beliefs potential users have about a PHR, how it could be made personally relevant, and barriers to its use. METHODS: A qualitative design comprising eight focus groups, each with 6-8 participants. Groups included adults with long-term health conditions, young people, physically active adults, data experts, and members of the voluntary sector. Each group lasted 60-90 min, was audio recorded and transcribed verbatim. We analysed the data using thematic analysis to address the question "What are people's beliefs about making a Personal Health Record have relevance and impact?" RESULTS: We found four themes. Making it work for me is about how to encourage individuals to actively engage with their PHR. I control my information is about individuals deciding what to share and who to share it with. My concerns is about individuals' concerns about information security and if and how their information will be acted upon. Potential impact shows the potential benefits of a PHR such as increasing self-efficacy, uptake of health-protective behaviours, and professionals taking a more holistic approach to providing care and facilitating behaviour change. CONCLUSIONS: Our research shows the functionality that a PHR requires in order for people to engage with it. Interactive functions and integration with lifestyle and health apps are particularly important. A PHR could increase the effectiveness of behaviour change apps by specifying evidence-based behaviour change techniques that apps should incorporate. A PHR has the potential to increase health-protective behaviours and facilitate a more person-driven health and social care system. It could support patients to take responsibility for self-managing their health and treatment regimens, as well as helping patients to play a more active role when care transfers across boundaries of responsibility