290 research outputs found

    Potential pitfalls in the use of real-world data for studying long COVID

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    Clinical phenotypes and outcomes in children with multisystem inflammatory syndrome across SARS-CoV-2 variant eras: a multinational study from the 4CE consortiumResearch in context

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    Summary: Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection. It remains unclear how MIS-C phenotypes vary across SARS-CoV-2 variants. We aimed to investigate clinical characteristics and outcomes of MIS-C across SARS-CoV-2 eras. Methods: We performed a multicentre observational retrospective study including seven paediatric hospitals in four countries (France, Spain, U.K., and U.S.). All consecutive confirmed patients with MIS-C hospitalised between February 1st, 2020, and May 31st, 2022, were included. Electronic Health Records (EHR) data were used to calculate pooled risk differences (RD) and effect sizes (ES) at site level, using Alpha as reference. Meta-analysis was used to pool data across sites. Findings: Of 598 patients with MIS-C (61% male, 39% female; mean age 9.7 years [SD 4.5]), 383 (64%) were admitted in the Alpha era, 111 (19%) in the Delta era, and 104 (17%) in the Omicron era. Compared with patients admitted in the Alpha era, those admitted in the Delta era were younger (ES −1.18 years [95% CI −2.05, −0.32]), had fewer respiratory symptoms (RD −0.15 [95% CI −0.33, −0.04]), less frequent non-cardiogenic shock or systemic inflammatory response syndrome (SIRS) (RD −0.35 [95% CI −0.64, −0.07]), lower lymphocyte count (ES −0.16 × 109/uL [95% CI −0.30, −0.01]), lower C-reactive protein (ES −28.5 mg/L [95% CI −46.3, −10.7]), and lower troponin (ES −0.14 ng/mL [95% CI −0.26, −0.03]). Patients admitted in the Omicron versus Alpha eras were younger (ES −1.6 years [95% CI −2.5, −0.8]), had less frequent SIRS (RD −0.18 [95% CI −0.30, −0.05]), lower lymphocyte count (ES −0.39 × 109/uL [95% CI −0.52, −0.25]), lower troponin (ES −0.16 ng/mL [95% CI −0.30, −0.01]) and less frequently received anticoagulation therapy (RD −0.19 [95% CI −0.37, −0.04]). Length of hospitalization was shorter in the Delta versus Alpha eras (−1.3 days [95% CI −2.3, −0.4]). Interpretation: Our study suggested that MIS-C clinical phenotypes varied across SARS-CoV-2 eras, with patients in Delta and Omicron eras being younger and less sick. EHR data can be effectively leveraged to identify rare complications of pandemic diseases and their variation over time. Funding: None

    Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-centre observational cohort study

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    Background: While acute kidney injury (AKI) is a common complication in COVID-19, data on post-AKI kidney function recovery and the clinical factors associated with poor kidney function recovery is lacking. Methods: A retrospective multi-centre observational cohort study comprising 12,891 hospitalized patients aged 18 years or older with a diagnosis of SARS-CoV-2 infection confirmed by polymerase chain reaction from 1 January 2020 to 10 September 2020, and with at least one serum creatinine value 1–365 days prior to admission. Mortality and serum creatinine values were obtained up to 10 September 2021. Findings: Advanced age (HR 2.77, 95%CI 2.53–3.04, p < 0.0001), severe COVID-19 (HR 2.91, 95%CI 2.03–4.17, p < 0.0001), severe AKI (KDIGO stage 3: HR 4.22, 95%CI 3.55–5.00, p < 0.0001), and ischemic heart disease (HR 1.26, 95%CI 1.14–1.39, p < 0.0001) were associated with worse mortality outcomes. AKI severity (KDIGO stage 3: HR 0.41, 95%CI 0.37–0.46, p < 0.0001) was associated with worse kidney function recovery, whereas remdesivir use (HR 1.34, 95%CI 1.17–1.54, p < 0.0001) was associated with better kidney function recovery. In a subset of patients without chronic kidney disease, advanced age (HR 1.38, 95%CI 1.20–1.58, p < 0.0001), male sex (HR 1.67, 95%CI 1.45–1.93, p < 0.0001), severe AKI (KDIGO stage 3: HR 11.68, 95%CI 9.80–13.91, p < 0.0001), and hypertension (HR 1.22, 95%CI 1.10–1.36, p = 0.0002) were associated with post-AKI kidney function impairment. Furthermore, patients with COVID-19-associated AKI had significant and persistent elevations of baseline serum creatinine 125% or more at 180 days (RR 1.49, 95%CI 1.32–1.67) and 365 days (RR 1.54, 95%CI 1.21–1.96) compared to COVID-19 patients with no AKI. Interpretation: COVID-19-associated AKI was associated with higher mortality, and severe COVID-19-associated AKI was associated with worse long-term post-AKI kidney function recovery. Funding: Authors are supported by various funders, with full details stated in the acknowledgement section

    Characterization of long COVID temporal sub-phenotypes by distributed representation learning from electronic health record data: a cohort studyResearch in Context

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    Summary: Background: Characterizing Post-Acute Sequelae of COVID (SARS-CoV-2 Infection), or PASC has been challenging due to the multitude of sub-phenotypes, temporal attributes, and definitions. Scalable characterization of PASC sub-phenotypes can enhance screening capacities, disease management, and treatment planning. Methods: We conducted a retrospective multi-centre observational cohort study, leveraging longitudinal electronic health record (EHR) data of 30,422 patients from three healthcare systems in the Consortium for the Clinical Characterization of COVID-19 by EHR (4CE). From the total cohort, we applied a deductive approach on 12,424 individuals with follow-up data and developed a distributed representation learning process for providing augmented definitions for PASC sub-phenotypes. Findings: Our framework characterized seven PASC sub-phenotypes. We estimated that on average 15.7% of the hospitalized COVID-19 patients were likely to suffer from at least one PASC symptom and almost 5.98%, on average, had multiple symptoms. Joint pain and dyspnea had the highest prevalence, with an average prevalence of 5.45% and 4.53%, respectively. Interpretation: We provided a scalable framework to every participating healthcare system for estimating PASC sub-phenotypes prevalence and temporal attributes, thus developing a unified model that characterizes augmented sub-phenotypes across the different systems. Funding: Authors are supported by National Institute of Allergy and Infectious Diseases, National Institute on Aging, National Center for Advancing Translational Sciences, National Medical Research Council, National Institute of Neurological Disorders and Stroke, European Union, National Institutes of Health, National Center for Advancing Translational Sciences

    Primary Mechanical Modification to Improve Performance of <i>Miscanthus</i> as Stand-Alone Growing Substrates

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    Selecting proper mechanical processing can improve performance of miscanthus substrates. We studied the effects of mechanical processing methods on substrate morphology, hydrological properties, pH, and nitrogen immobilization. Miscanthus × giganteus biomass was processed into field chips (FC, forage harvester), shreds (S5, mechanical fraying machine through a 5-mm screen) and chips (C15, C10, C5 and C3, hammermill with screen size of 15, 10, 5, or 3 mm). Processed miscanthus materials were also tested as propagation substrates for Chinese cabbage seedlings. Results showed that particle size distribution of miscanthus substrates formed four groups in ascending order of particle size: C3 < C5 < (C10, C15, S5) < FC. The finer miscanthus substrates had higher water holding capacity following the same groupings in particle size. The hydrophobicity of processed miscanthus was low and reversible, with the increasing order of risk as C3 < C5 < C10, C15 < S5, FC. All miscanthus substrates had similar and low pH buffering capacity. Nitrogen immobilization was similar among miscanthus substrates. The seedlings in miscanthus substrates had similar germination rates but a lower biomass compared to those grown in peat and coir. Primary mechanical modification of miscanthus offers opportunities for different sizes of substrate materials with few changes to the physical or chemical properties tested in this work

    Illicit Performance and Image Enhancing Drug Markets in the Netherlands and Belgium

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    This chapter explores the illicit production and supply of performance and image enhancing drug (PIED) markets in Belgium and the Netherlands. Aside from the potential health risks related to the use of these substances, a concern is that the majority of PIEDs are not legally obtained through a physician, by means of a prescription, but instead are illegally purchased on the black market. The illicit supply of PIEDs will be the focus of this chapter. This chapter provides a historical account of the development of illicit PIED markets in Belgium and the Netherlands. Next, a categorization of supplier types will be provided based on the profession of PIED suppliers. This will be followed with an examination of the methods and motives of PIED dealers, using bodybuilding as a case study. It is highlighted that many types of suppliers are involved in the trade of PIEDs and that they are driven by multiple and often overlapping reasons (financial and non-financial motives). In the final section, the link between the illicit PIED market, organized crime and professional sport is critically explored. The chapter concludes with a discussion of the overall findings

    Digitalization and computational thinking in lower secondary science education using the example of paper chromatography

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    Paper chromatography is a simple and harmless experiment suitable for lower secondary education. Besides the training of subject-specific contents, paper chromatography allows the application of modelling and simulation since the submicroscopic processes can be simplified in a way that they become understandable in lower secondary education. Here, the application of digital tools in addition to the experimental performance of paper chromatography in a compulsory STEM course in grade 6 is reported. Following a series of experiments, chromatography is at first simulated by a board game and then by computer simulations. Such simulation program allows the variation of the parameters in order to explore the model and to introduce the particle concept of matter and molecular interactions. The implementation with a graphical programming environment such as Scratch also allows the programming by pupils in this age group. In this way, it is possible to introduce modelling and simulation in an early stage as important contributions to scientific work in natural sciences

    Park: An open platform for learning-augmented computer systems

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    © 2019 Neural information processing systems foundation. All rights reserved. We present Park, a platform for researchers to experiment with Reinforcement Learning (RL) for computer systems. Using RL for improving the performance of systems has a lot of potential, but is also in many ways very different from, for example, using RL for games. Thus, in this work we first discuss the unique challenges RL for systems has, and then propose Park an open extensible platform, which makes it easier for ML researchers to work on systems problems. Currently, Park consists of 12 real world system-centric optimization problems with one common easy to use interface. Finally, we present the performance of existing RL approaches over those 12 problems and outline potential areas of future work
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