The first 20 months of the COVID-19 pandemic: Mortality, intubation and ICU rates among 104,590 patients hospitalized at 21 United States health systems

Main objective There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic. Study design and methods University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR test in a 14-day window (+/- 7 days of hospital admission); and (3) health system contact prior to COVID-19 hospitalization. Outcomes assessed were: (1) mortality (primary), (2) endotracheal intubation, and (3) ICU admission. Results and significance The 104,590 hospitalized participants had a mean age of 61.7 years and were 50.4% female, 24% Black, and 56.8% White. Overall risk-standardized mortality (adjusted for age, sex, race, ethnicity, body mass index, insurance status and medical comorbidities) declined from 16% of hospitalized COVID-19 patients (95% CI: 16% to 17%) early in the pandemic (February-April 2020) to 9% (CI: 9% to 10%) later (July-September 2021). Among subpopulations, males (vs. females), those on Medicare (vs. those on commercial insurance), the severely obese (vs. normal weight), and those aged 60 and older (vs. younger individuals) had especially high mortality rates both early and late in the pandemic. ICU admission and intubation rates also declined across these 20 months. Conclusions Mortality, intubation, and ICU admission rates improved markedly over the first 20 months of the pandemic among adult hospitalized COVID-19 patients although gains varied by subpopulation. These data provide important information on the course of COVID-19 and identify hospitalized patient groups at heightened risk for negative outcomes. Trial registration ClinicalTrials.gov Identifier: NCT04506528 (https://clinicaltrials.gov/ct2/show/NCT04506528)

Modeling ‘yield-population’ relationships in soybean

Our objectives were to evaluate the seed yield of soybean, and Duncan\u27s model with respect to relationship between seed yield and plant population, and analyze the response of soybean seed yield components to light enrichment initiated at different growth stages. Duncan coined the term crowding to include the effects of density and planting pattern. Duncan\u27s model states that there is a linear relationship between natural logarithm of yield plant−1 and crowding. Results of the studies fitting Duncan\u27s model to the data obtained from different soybean cultivars planted at different densities and planting patterns indicated that the model can predict the changes in yield with changing densities and planting pattern especially if the variability in the data is low. In order to analyze the response of soybean seed yield components to non-destructive light enrichment initiated at different growth stages, light enrichment was imposed on the indeterminate soybean cultivar Evans by installing wire mesh fencing on either side of the center row to push the adjacent rows aside at different growth stages. Fences prevented plants in the neighboring rows from encroaching on the growing space of the center row plants. Pod number per plant and to a lesser extent seed size accounted for variation in seed yield. Light enrichment initiated at late vegetative or early flowering stages increased seed yield 217%, mainly by increasing pod number, while light enrichment beginning at early pod formation increased seed size 23%, resulting in a 115% increase in seed yield. Responses to light enrichment occurred proportionately across all node positions despite the differences in the time (15 to 20 days) of development of yield components at the different node positions. Although maximum seed size may be under genetic control in soybean plants, our results suggested seed size can still be modified by the environment with some internal control moderating the final size of most seeds in all pods. It indicates that plants are able to redistribute the available resources to components not yet determined, in an attempt to maintain or improve yield

Data Integration for Translational Cancer Research

<p>Archival of clinical and molecular data in easily retrievable standardized formats, aggregation, integration, and data analysis will provide opportunities for the next-generation biomedical discoveries that can impact cancer research and treatment.</p

Protein Profiling for Cancer Diagnosis and Prognosis

<p>Generation of protein profiles using mass spectrometry is an example of an experimental technique that produces massive amounts of data that is difficult to interpret without computational and statistical algorithms. For instance, comparison of disease versus control sample profiles can lead to identification of disease-specific protein expression signatures, which could be used as diagnostic or prognostic markers. Aggregation of such data from multiple sources and pooled analysis requires proper annotation of sample source, sample handling, and experiment information.</p

OncDRS: An integrative clinical and genomic data platform for enabling translational research and precision medicine

We live in the genomic era of medicine, where a patient's genomic/molecular data is becoming increasingly important for disease diagnosis, identification of targeted therapy, and risk assessment for adverse reactions. However, decoding the genomic test results and integrating it with clinical data for retrospective studies and cohort identification for prospective clinical trials is still a challenging task. In order to overcome these barriers, we developed an overarching enterprise informatics framework for translational research and personalized medicine called Synergistic Patient and Research Knowledge Systems (SPARKS) and a suite of tools called Oncology Data Retrieval Systems (OncDRS). OncDRS enables seamless data integration, secure and self-navigated query and extraction of clinical and genomic data from heterogeneous sources. Within a year of release, the system has facilitated more than 1500 research queries and has delivered data for more than 50 research studies

Smoking Status, Nicotine Medication, Vaccination, and COVID-19 Hospital Outcomes: Findings from the COVID EHR Cohort at the University of Wisconsin (CEC-UW) Study.

IntroductionAvailable evidence is mixed concerning associations between smoking status and COVID-19 clinical outcomes. Effects of nicotine replacement therapy (NRT) and vaccination status on COVID-19 outcomes in smokers are unknown.MethodsElectronic health record data from 104 590 COVID-19 patients hospitalized February 1, 2020 to September 30, 2021 in 21 U.S. health systems were analyzed to assess associations of smoking status, in-hospital NRT prescription, and vaccination status with in-hospital death and ICU admission.ResultsCurrent (n = 7764) and never smokers (n = 57 454) did not differ on outcomes after adjustment for age, sex, race, ethnicity, insurance, body mass index, and comorbidities. Former (vs never) smokers (n = 33 101) had higher adjusted odds of death (aOR, 1.11; 95% CI, 1.06-1.17) and ICU admission (aOR, 1.07; 95% CI, 1.04-1.11). Among current smokers, NRT prescription was associated with reduced mortality (aOR, 0.64; 95% CI, 0.50-0.82). Vaccination effects were significantly moderated by smoking status; vaccination was more strongly associated with reduced mortality among current (aOR, 0.29; 95% CI, 0.16-0.66) and former smokers (aOR, 0.47; 95% CI, 0.39-0.57) than for never smokers (aOR, 0.67; 95% CI, 0.57, 0.79). Vaccination was associated with reduced ICU admission more strongly among former (aOR, 0.74; 95% CI, 0.66-0.83) than never smokers (aOR, 0.87; 95% CI, 0.79-0.97).ConclusionsFormer but not current smokers hospitalized with COVID-19 are at higher risk for severe outcomes. SARS-CoV-2 vaccination is associated with better hospital outcomes in COVID-19 patients, especially current and former smokers. NRT during COVID-19 hospitalization may reduce mortality for current smokers.ImplicationsPrior findings regarding associations between smoking and severe COVID-19 disease outcomes have been inconsistent. This large cohort study suggests potential beneficial effects of nicotine replacement therapy on COVID-19 outcomes in current smokers and outsized benefits of SARS-CoV-2 vaccination in current and former smokers. Such findings may influence clinical practice and prevention efforts and motivate additional research that explores mechanisms for these effects