Nevin Manimala

PLoS One. 2021 Mar 3;16(3):e0247251. doi: 10.1371/journal.pone.0247251. eCollection 2021.

ABSTRACT

In the context of COVID-19 pandemic, we aimed to analyze the epidemiology, clinical characteristics, risk factors for mortality and impact of COVID-19 on outcomes of solid organ transplant (SOT) recipients compared to a cohort of non transplant patients, evaluating if transplantation could be considered a risk factor for mortality. From March to May 2020, 261 hospitalized patients with COVID-19 pneumonia were evaluated, including 41 SOT recipients. Of these, thirty-two were kidney recipients, 4 liver, 3 heart and 2 combined kidney-liver transplants. Median time from transplantation to COVID-19 diagnosis was 6 years. Thirteen SOT recipients (32%) required Intensive Care Unit (ICU) admission and 5 patients died (12%). Using a propensity score match analysis, we found no significant differences between SOT recipients and non-transplant patients. Older age (OR 1.142; 95% [CI 1.08-1.197]) higher levels of C-reactive protein (OR 3.068; 95% [CI 1.22-7.71]) and levels of serum creatinine on admission (OR 3.048 95% [CI 1.22-7.57]) were associated with higher mortality. The clinical outcomes of SARS-CoV-2 infection in our cohort of SOT recipients appear to be similar to that observed in the non-transplant population. Older age, higher levels of C-reactive protein and serum creatinine were associated with higher mortality, whereas SOT was not associated with worse outcomes.

PMID:33657157 | DOI:10.1371/journal.pone.0247251

PLoS One. 2021 Mar 3;16(3):e0247259. doi: 10.1371/journal.pone.0247259. eCollection 2021.

ABSTRACT

INTRODUCTION: Empathy is essential for high quality health care. Health care disparities may reflect a systemic lack of empathy for disadvantaged people; however, few data exist on disparities in patient experience of empathy during face-to-face health care encounters with individual clinicians. We systematically analyzed the literature to test if socioeconomic status (SES) and race/ethnicity disparities exist in patient-reported experience of clinician empathy.

METHODS: Using a published protocol, we searched Ovid MEDLINE, PubMed, CINAHL, EMBASE, CENTRAL and PsychINFO for studies using the Consultation and Relational Empathy (CARE) Measure, which to date is the most commonly used and well-validated methodology for measuring clinician empathy from the patient perspective. We included studies containing CARE Measure data stratified by SES and/or race/ethnicity. We contacted authors to request stratified data, when necessary. We performed quantitative meta-analyses using random effects models to test for empathy differences by SES and race/ethnicity.

RESULTS: Eighteen studies (n = 9,708 patients) were included. We found that, compared to patients whose SES was not low, low SES patients experienced lower empathy from clinicians (mean difference = -0.87 [95% confidence interval -1.72 to -0.02]). Compared to white patients, empathy scores were numerically lower for patients of multiple race/ethnicity groups (Black/African American, Asian, Native American, and all non-whites combined) but none of these differences reached statistical significance.

CONCLUSION: These data suggest an empathy gap may exist for patients with low SES. More research is needed to further test for SES and race/ethnicity disparities in clinician empathy and help promote health care equity.

TRIAL REGISTRATION: Registration (PROSPERO): CRD42019142809.

PMID:33657153 | DOI:10.1371/journal.pone.0247259

PLoS One. 2021 Mar 3;16(3):e0246691. doi: 10.1371/journal.pone.0246691. eCollection 2021.

ABSTRACT

AIM: Real-world predictors of major bleeding (MB) have been well-studied among warfarin users, but not among all direct oral anticoagulant (DOAC) users diagnosed with atrial fibrillation (AF). Thus, our goal was to build a predictive model of MB for new users of all oral anticoagulants (OAC) with AF.

METHODS: We identified patients hospitalized for any cause and discharged alive in the community from 2011 to 2017 with a primary or secondary diagnosis of AF in Quebec’s RAMQ and Med-Echo administrative databases. Cohort entry occurred at the first OAC claim. Patients were categorized according to OAC type. Outcomes were incident MB, gastrointestinal bleeding (GIB), non-GI extracranial bleeding (NGIB) and intracranial bleeding within 1 year of follow-up. Covariates included age, sex, co-morbidities (within 3 years before cohort entry) and medication use (within 2 weeks before cohort entry). We used logistic-LASSO and adaptive logistic-LASSO regressions to identify MB predictors among OAC users. Discrimination and calibration were assessed for each model and a global model was selected. Subgroup analyses were performed for MB subtypes and OAC types.

RESULTS: Our cohort consisted of 14,741 warfarin, 3,722 dabigatran, 6,722 rivaroxaban and 11,196 apixaban users aged 70-86 years old. The important MB predictors were age, prior MB and liver disease with ORs ranging from 1.37-1.64. The final model had a c-statistic of 0.63 (95% CI 0.60-0.65) with adequate calibration. The GIB and NGIB models had similar c-statistics of 0.65 (95% CI 0.63-0.66) and 0.67 (95% CI 0.64-0.70), respectively.

CONCLUSIONS: MB and MB subtype predictors were similar among DOAC and warfarin users. The predictors selected by our models and their discriminative potential are concordant with published data. Thus, these models can be useful tools for future pharmacoepidemiologic studies involving older oral anticoagulant users with AF.

PMID:33657116 | DOI:10.1371/journal.pone.0246691

PLoS Med. 2021 Mar 3;18(3):e1003415. doi: 10.1371/journal.pmed.1003415. eCollection 2021 Mar.

ABSTRACT

BACKGROUND: Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression.

METHODS AND FINDINGS: The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32-2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19-2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion.

CONCLUSIONS: In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration.

TRIAL REGISTRATION: NCT04375098.

PMID:33657114 | DOI:10.1371/journal.pmed.1003415

PLoS One. 2021 Mar 3;16(3):e0246698. doi: 10.1371/journal.pone.0246698. eCollection 2021.

ABSTRACT

In all competitions where results are based upon an individual’s performance the question of whether the outcome is a consequence of skill or luck arises. We explore this question through an analysis of a large dataset of approximately one million contestants playing Fantasy Premier League, an online fantasy sport where managers choose players from the English football (soccer) league. We show that managers’ ranks over multiple seasons are correlated and we analyse the actions taken by managers to increase their likelihood of success. The prime factors in determining a manager’s success are found to be long-term planning and consistently good decision-making in the face of the noisy contests upon which this game is based. Similarities between managers’ decisions over time that result in the emergence of ‘template’ teams, suggesting a form of herding dynamics taking place within the game, are also observed. Taken together, these findings indicate common strategic considerations and consensus among successful managers on crucial decision points over an extended temporal period.

PMID:33657110 | DOI:10.1371/journal.pone.0246698

PLoS One. 2021 Mar 3;16(3):e0241156. doi: 10.1371/journal.pone.0241156. eCollection 2021.

ABSTRACT

BACKGROUND AND OBJECTIVES: Based on some previous observational studies, there is a theory that suggests a potential relationship between Helicobacter pylori (H. pylori) colonization and celiac disease (CeD); however, the type of this relationship is still controversial. Therefore, we aimed to conduct a systematic review and meta-analysis to explore all related primary studies to find any possible association between CeD and human H. pylori colonization.

DATA SOURCES: Studies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After screening, the quality and risk of bias assessment of the selected articles were evaluated.

SYNTHESIS METHODS: Meta-analysis calculated pooled odds ratio (OR) on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed.

RESULTS: Twenty-six studies were included in this systematic review, with a total of 6001 cases and 135512 control people. The results of meta-analysis on 26 studies showed a significant and negative association between H. pylori colonization and CeD (pooled OR = 0.56; 95% CI = 0.45-0.70; P < 0.001), with no publication bias (P = 0.825). The L’Abbé plots also showed a trend of having more H. pylori colonization in the control group. Among subgroups, ORs were notably different only when the data were stratified by continents or risk of bias; however, subgroup analysis could not determine the source of heterogeneity.

CONCLUSIONS: According to the meta-analysis, this negative association might imply a mild protective role of H. pylori against celiac disease. Although this negative association is not strong, it is statistically significant and should be further considered. Further investigations in both molecular and clinic fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of H. pylori colonization in CeD patients.

SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO): CRD42020167730 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167730.

PMID:33657108 | DOI:10.1371/journal.pone.0241156

PLoS One. 2021 Mar 3;16(3):e0245158. doi: 10.1371/journal.pone.0245158. eCollection 2021.

ABSTRACT

Do individuals modify their bodies in order to be unique? The present study sought to investigate need for uniqueness (NfU) subcomponents as possible motives for modifying one’s body. To this end, the study obtained information from 312 participants about their NfU (using the German NfU-G global scale and three sub-scales) and their body modifications (tattoos, piercings, and extreme body modifications such as tongue splitting). By analyzing the three subcomponents of NfU, the study was able to investigate the differential relationship of the sub-scales with the outcome measures, which facilitated a fine-grained understanding of the NfU-body-modification relationship. The study found that tattooed, pierced, and extreme-body-modified individuals had higher NfU-G scores than individuals without body modifications. Moreover, it seemed that individuals with tattoos took a social component into consideration while lacking concern regarding others’ reaction toward their tattoos, although not wanting to cause affront. Pierced and extreme-body-modified individuals, contrarily, tended to display a propensity to actively flout rules and not worry about others’ opinions on their modifications. However, although statistically significant, the effect size (d) for the NfU-G differences in the tattooed and pierced participants’ mean scores was small to medium in all three subcomponents. The extreme-body-modified group presented medium and medium to large effects. Further, the study observed that the number of body modifications increased with an increasing NfU in tattooed and pierced individuals. These findings demonstrated multifaceted interrelations between the NfU, its subcomponents, and the three kinds of body modifications investigated in the present study.

PMID:33657106 | DOI:10.1371/journal.pone.0245158

PLoS One. 2021 Mar 3;16(3):e0241653. doi: 10.1371/journal.pone.0241653. eCollection 2021.

ABSTRACT

OBJECTIVE: Toxoplasma gondii is a worldwide protozoan parasite that could infect virtually all warm-blooded animals, including humans. Our study aimed to investigate the prevalence of T. gondii infection in college students at Anhui province, China and to assess risk factors for T. gondii infection in college students. Moreover, growing studies demonstrated the association between T. gondii infection and host behavioral changes. We also studied the linkage between T. gondii and physical education (PE) scores of college students.

METHODS: A total of 2704 serum samples of medical school students attending physical education lessons were collected from September 2017 to September 2019 and evaluated for T. gondii IgG antibodies using an enzyme-linked immunosorbent assay (ELISA). Questionnaires and statistical analysis were used to determine the risk factors for T. gondii infection. We also analysed PE scores of T. gondii -infected students and T. gondii-uninfected students.

RESULTS: The overall seroprevalence of T. gondii was 11.5%. The main risk factors related to T. gondii infection in college students were cat in the household and gardening or agriculture activity. Furthermore, in the basketball group and the soccer group, scores of T. gondii seropositive students were significantly higher than those of seronegative students, while in other sports there was no difference between scores of T. gondii-infected students and T. gondii uninfected students.

CONCLUSION: This is the first report of T. gondii seroprevalence in college students in Anhui province, China.

PMID:33657102 | DOI:10.1371/journal.pone.0241653

PLoS Comput Biol. 2021 Mar 3;17(3):e1008811. doi: 10.1371/journal.pcbi.1008811. Online ahead of print.

ABSTRACT

Forecasting the risk of pathogen spillover from reservoir populations of wild or domestic animals is essential for the effective deployment of interventions such as wildlife vaccination or culling. Due to the sporadic nature of spillover events and limited availability of data, developing and validating robust, spatially explicit, predictions is challenging. Recent efforts have begun to make progress in this direction by capitalizing on machine learning methodologies. An important weakness of existing approaches, however, is that they generally rely on combining human and reservoir infection data during the training process and thus conflate risk attributable to the prevalence of the pathogen in the reservoir population with the risk attributed to the realized rate of spillover into the human population. Because effective planning of interventions requires that these components of risk be disentangled, we developed a multi-layer machine learning framework that separates these processes. Our approach begins by training models to predict the geographic range of the primary reservoir and the subset of this range in which the pathogen occurs. The spillover risk predicted by the product of these reservoir specific models is then fit to data on realized patterns of historical spillover into the human population. The result is a geographically specific spillover risk forecast that can be easily decomposed and used to guide effective intervention. Applying our method to Lassa virus, a zoonotic pathogen that regularly spills over into the human population across West Africa, results in a model that explains a modest but statistically significant portion of geographic variation in historical patterns of spillover. When combined with a mechanistic mathematical model of infection dynamics, our spillover risk model predicts that 897,700 humans are infected by Lassa virus each year across West Africa, with Nigeria accounting for more than half of these human infections.

PMID:33657095 | DOI:10.1371/journal.pcbi.1008811

PLoS One. 2021 Mar 3;16(3):e0246785. doi: 10.1371/journal.pone.0246785. eCollection 2021.

ABSTRACT

The availability of reliable socioeconomic data is critical for the design of urban policies and the implementation of location-based services; however, often, their temporal and geographical coverage remain scarce. We explore the potential for insurance customers data to predict socioeconomic indicators of Swiss municipalities. First, we define a features space by aggregating at city-level individual customer data along several behavioral and user profile dimensions. Second, we collect official statistics shared by the Swiss authorities on a wide spectrum of categories: Population, Transportation, Work, Space and Territory, Housing, and Economy. Third, we adopt two spatial regression models exploring both global and local geographical dependencies to investigate their predictability. Results show consistently a correlation between insurance customer characteristics and official socioeconomic indexes. Performance fluctuates depending on the category, with values of R2 > 0.6 for several target variables using a 5-fold cross validation. As a case study, we focus on predicting the percentage of the population using public transportation and we discuss the implications on a regional scope. We believe that this methodology can support official statistical offices and it could open up new opportunities for the characterization of socioeconomic traits at highly-granular spatial and temporal scales.

PMID:33657089 | DOI:10.1371/journal.pone.0246785