An Augmented Reality system for the treatment of phobia to small animals viewed via an optical see-through HMD. Comparison with a similar system viewed via a video see-through

This article presents an optical see-through (OST) Augmented Reality system for the treatment of phobia to small animals. The technical characteristics of the OST system are described, and a comparative study of the sense of presence and anxiety in a nonphobic population (24 participants) using the OST and an equivalent video see-though (VST) system is presented. The results indicate that if all participants are analyzed, the VST system induces greater sense of presence than the OST system. If the participants who had more fear are analyzed, the two systems induce a similar sense of presence. For the anxiety level, the two systems provoke similar and significant anxiety during the experiment. © Taylor & Francis Group, LLC.Juan, M.; Calatrava, J. (2011). An Augmented Reality system for the treatment of phobia to small animals viewed via an optical see-through HMD. Comparison with a similar system viewed via a video see-through. International Journal of Human-Computer Interaction. 27(5):436-449. doi:10.1080/10447318.2011.552059S436449275Azuma, R. and Bishop, G. Improving static and dynamic registration in an optical see-through HMD. Proceedings of 21st Annual Conference on Computer Graphics and Interactive techniques (SIGGRAPH'94). pp.197–204.Bimber, O., & Raskar, R. (2005). Spatial Augmented Reality. doi:10.1201/b10624Botella, C., Quero, S., Banos, R. M., Garcia-Palacios, A., Breton-Lopez, J., Alcaniz, M., & Fabregat, S. (2008). Telepsychology and Self-Help: The Treatment of Phobias Using the Internet. CyberPsychology & Behavior, 11(6), 659-664. doi:10.1089/cpb.2008.0012Botella, C. M., Juan, M. C., Baños, R. M., Alcañiz, M., Guillén, V., & Rey, B. (2005). Mixing Realities? An Application of Augmented Reality for the Treatment of Cockroach Phobia. CyberPsychology & Behavior, 8(2), 162-171. doi:10.1089/cpb.2005.8.162Carlin, A. S., Hoffman, H. G., & Weghorst, S. (1997). Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behaviour Research and Therapy, 35(2), 153-158. doi:10.1016/s0005-7967(96)00085-xGarcia-Palacios, A., Hoffman, H., Carlin, A., Furness, T. ., & Botella, C. (2002). Virtual reality in the treatment of spider phobia: a controlled study. Behaviour Research and Therapy, 40(9), 983-993. doi:10.1016/s0005-7967(01)00068-7Genc, Y., Tuceryan, M., & Navab, N. (s. f.). Practical solutions for calibration of optical see-through devices. Proceedings. International Symposium on Mixed and Augmented Reality. doi:10.1109/ismar.2002.1115086Hoffman, H. G., Garcia-Palacios, A., Carlin, A., Furness III, T. A., & Botella-Arbona, C. (2003). Interfaces That Heal: Coupling Real and Virtual Objects to Treat Spider Phobia. International Journal of Human-Computer Interaction, 16(2), 283-300. doi:10.1207/s15327590ijhc1602_08Juan, M. C., Alcaniz, M., Monserrat, C., Botella, C., Banos, R. M., & Guerrero, B. (2005). Using Augmented Reality to Treat Phobias. IEEE Computer Graphics and Applications, 25(6), 31-37. doi:10.1109/mcg.2005.143Juan, M. C., Baños, R., Botella, C., Pérez, D., Alcaníiz, M., & Monserrat, C. (2006). An Augmented Reality System for the Treatment of Acrophobia: The Sense of Presence Using Immersive Photography. Presence: Teleoperators and Virtual Environments, 15(4), 393-402. doi:10.1162/pres.15.4.393Kato, H., & Billinghurst, M. (s. f.). Marker tracking and HMD calibration for a video-based augmented reality conferencing system. Proceedings 2nd IEEE and ACM International Workshop on Augmented Reality (IWAR’99). doi:10.1109/iwar.1999.803809Nash, E. B., Edwards, G. W., Thompson, J. A., & Barfield, W. (2000). A Review of Presence and Performance in Virtual Environments. International Journal of Human-Computer Interaction, 12(1), 1-41. doi:10.1207/s15327590ijhc1201_1Owen, C. B., Ji Zhou, Tang, A., & Fan Xiao. (s. f.). Display-Relative Calibration for Optical See-Through Head-Mounted Displays. Third IEEE and ACM International Symposium on Mixed and Augmented Reality. doi:10.1109/ismar.2004.28Özbek, C., Giesler, B. and Dillmann, R. Jedi training: Playful evaluation of head-mounted augmented reality display systems. SPIE Conference Medical Imaging. Vol. 5291, pp.454–463.Renaud, P., Bouchard, S., & Proulx, R. (2002). Behavioral avoidance dynamics in the presence of a virtual spider. IEEE Transactions on Information Technology in Biomedicine, 6(3), 235-243. doi:10.1109/titb.2002.802381Schwald, B. and Laval, B. An Augmented Reality system for training and assistance to maintenance in the industrial context. International Conference in Central Europe on Computer Graphics, Visualization and Computer Vision. pp.425–432.Slater, M., Usoh, M., & Steed, A. (1994). Depth of Presence in Virtual Environments. Presence: Teleoperators and Virtual Environments, 3(2), 130-144. doi:10.1162/pres.1994.3.2.130Szymanski, J., & O’Donohue, W. (1995). Fear of Spiders Questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 26(1), 31-34. doi:10.1016/0005-7916(94)00072-

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Impact on disease mortality of clinical, biological, and virological characteristics at hospital admission and overtime in COVID‐19 patients

International audienc

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes