The current Covid-19 outbreak poses many challenges on hospital organisation and patient care. Our hospital lies at the epicentre of the Belgian epidemic. On April 1st, a total of 235 Covid-19 ...patients had been admitted to our hospital. This demanded an unprecedented adaptation of our hospital organisation, and we have met many clinical issues in the care for Covid-19 patients. In this article, we share our experience in the handling of some of the practical and organisational issues in the care for Covid-19 patients.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Repeated echocardiographic assessment of cardiac function is integral in management of intensive care units (ICU) patients. ...Machine learning (ML) can assist by integrating whole-cardiac cycle echo data derived from flow assessment and deformation imaging, and grouping patients on the basis of patterns of cardiac dysfunction and its evolution over time. Cardiac involvement has been suggested to be important in COVID-19 outcome and echo evaluation can inform on cardiac status. We use unsupervised ML to investigate and integrate longitudinal data from the COVID-HO study (NCT04371679) to determine the potential of tracking changes in cardiac function during ICU hospitalization.
Methods
In a single-centre, COVID-19 patients (n = 38) were prospectively followed with echocardiography as part of ICU management. The endpoint was defined as death or ICU discharge. LV myocardial deformation, as well as aortic, mitral and pulmonary artery blood-pool Doppler velocity profiles were used as input for ML. Clinical data was used to validate the ML derived phenotypes. Echo data from the initial and final echo examination were used to create an output space where participants were positioned based on cardiac function blinded to outcome status. Regression was used to estimate the echo and clinical characteristics of different regions in the space. Patient trajectories in the output space were investigated for each patient.
Results
Endpoint was not reached in 24% (n = 9) at the time of analysis. The cohort was 68% male, aged 65 ± 12 years, and with an ICU mortality 21% (n = 8). The median spent in ICU was 10 (IQR 7-18) days. The ML analysis demonstrated a heterogeneous output space (Fig 1A) we could define a gradual change in the shape of the pulmonary outflow velocity profile, from a normal towards pulmonary hypertension (Fig 1A, x axis). Jointly with differences in diastolic function (mitral inflow fusion and A wave accentuation) defined two regions: with signs of pulmonary hypertension (gray); and with normal pulmonary pressures but LV diastolic dysfunction (yellow). Investigation of patient trajectories (Fig 1B) demonstrated the feasibility of tracking changes during ICU hospitalization, showing a shift of a patient that died in the ICU, from initial diastolic dysfunction towards pulmonary hypertension (red), and a patient shifting from a region with normal diastolic function towards pulmonary hypertension, but with a positive outcome (blue). Echo data concurs with observed dynamics (Fig 1C and 1D).
Conclusion
ML can integrate complex, whole-cardiac cycle echo data to group heterogeneous patients based on similarity of cardiac function. Patient trajectories across the output space demonstrate the feasibility of ML for echo data-based follow-up of patients during ICU hospitalization. Further echo and clinical data integration can improve characterisation of the output space regions and better define changes in cardiac function during hospitalization.
Abstract Figure 1
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016
Background
Although the ...cardiac burden of COVID-19 has been demonstrated, follow-up imaging studies are scarce. The aim was to use speckle-tracking deformation imaging (STE) to prospectively assess cardiac function during intensive care unit (ICU) hospitalisation, comparing ventricular and atrial function of COVID-10 patients that died and those that were discharged.
Methods
In a single-centre, COVID-19 patients (n = 41) (71% male, aged 65 ± 11 years) were prospectively followed with echocardiography as part of ICU treatment. The left and right ventricles (LV, RV, respectively) were studied with STE in the 4-chamber cardiac view. The endpoint was defined as death or ICU discharge. Average values of the strain parameters from the first and final scans in the ICU, respectively, were calculated for the two outcome groups.
Results
Endpoint was not reached in 15% (n = 6) at the time of analysis. The remaining patients (n = 32) were 69% male, aged 66 (interquartile range (IQR) 60-72) years, and with an ICU mortality 26% (n = 9). The median spent in ICU was 24 (IQR 15-43) days. On average, echocardiography was performed three times during ICU hospitalisation, amounting to 103 examinations. The changes in cardiac strain are shown in Table 1. The change in LV longitudinal strain during ICU hospitalisation is shown in Figure 1.
Conclusion
Worsening of LV strain and lack of improvement of RV strain is linked to higher mortality in the ICU. The assessment of cardiac function might contain prognostic information in COVID-19 patients that are admitted to the ICU.
Patients discharged from thee OCU (n = 23) Patients that died in the ICU (n = 9) P value Initial echo in the ICU LV strain, % (IQR) 18.00 (15.6-19.95) 14.4 (10.56-20.42) 0.158 RV strain, % (IQR) 16.00 (14.70-20.05) 15.50 (10.38-23.70) 0.712 Final echo before discharge LV strain, % (IQR) 17.35 (15.13-18.98) 13.20 (10.75-15.40) 0.007 RV strain, % (IQR) 17.65 (16.83-19.60) 15.75 (10.68-20.43) 0.438 ICU - intensive care unit; IQR-inter-quartile range Abstract Figure 1
•As(III) oxidation by eAOP is dependent on charge dosage and current density.•eAOP achieves up-to 99.9 % oxidation (<0.3 µg/L) of 2–75 µg/L influent As(III).•Coulombic efficiencies ranged from 0.13 % ...in groundwater to 0.95 % in synthetic water.•Formation of THMs and bromate by eAOP did not exceed regulatory standards (<1 µg/L).
The mechanisms and by-product formation of electrochemical oxidation (EO) for As(III) oxidation in drinking water treatment using groundwater was investigated. Experiments were carried out using a flowthrough system, with an RuO2/IrO2 MMO Ti anode electrode, fed with synthetic and natural groundwater containing As(III) concentrations in a range of around 75 and 2 µg/L, respectively. Oxidation was dependent on charge dosage (CD) C/L and current density A/m2, with the latter showing plateau behaviour for increasing intensity. As(III) concentrations of <0.3 µg/L were obtained, indicating oxidation of 99.9 % of influent As(III). Achieving this required a higher charge dosage for the natural groundwater (>40 C/L) compared to the oxidation in the synthetic water matrix (20 C/L), indicating reaction with natural organic matter or other compounds. As(III) oxidation in groundwater required an energy consumption of 0.09 and 0.21 kWh/m3, for current densities of 20 and 60 A/m2, respectively. At EO settings relevant for As(III) oxidation, in the 30–100 C/L CD range, the formation of anodic by-products, as trihalomethanes (THMs) (0.11–0.75 µg/L) and bromate (<0.2 µg/L) was investigated. Interestingly, concentrations of the formed by-products did not exceed strictest regulatory standards of 1 µg/L, applicable to Dutch tap water. This study showed the promising perspective of EO as electrochemical advanced oxidation process (eAOP) in drinking water treatment as alternative for the conventional use of strong oxidizing chemicals.
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•As-rich sludge from different groundwater treatment plants was characterized.•As and P content of sludge reached up to 1200 mg/kg and 2 mass%, respectively.•As sludge mass fraction was decoupled ...from groundwater As concentration.•All sludge consisted of As(V) adsorbed in 2C geometry to disordered Fe(III) solids.•Groundwater treatment sludge can be a local source of critical raw materials.
Iron (Fe)-based treatment methods are widely applied to remove carcinogenic arsenic (As) from drinking water, but generate toxic As-laden Fe (oxyhydr)oxide waste that has traditionally been ignored for resource recovery by the water sector. However, the European Commission recently classified As as a Critical Raw Material (CRM), thus providing new incentives to re-think As-laden groundwater treatment sludge. Before As recovery techniques can be developed for groundwater treatment waste, detailed information on its structure and composition is essential. To this end, we comprehensively characterized sludge generated from a variety of As-rich groundwater treatment plants in different geographic regions by combining a suite of macroscopic measurements, such as total digestions, leaching tests and BET surface area with molecular-scale solid-phase analysis by Fe and As K-edge X-ray absorption spectroscopy (XAS). We found that the As mass fraction of all samples ranged from ∼200–1200 mg As/kg (dry weight) and the phosphorous (P) content reached ∼0.5–2 mass%. Notably, our results indicated that the influent As level was a poor predictor of the As sludge content, with the highest As mass fractions (940–1200 mg As/kg) measured in sludge generated from treating low groundwater As levels (1.1–22 µg/L). The Fe K-edge XAS data revealed that all samples consisted of nanoscale Fe(III) precipitates with less structural order than ferrihydrite, which is consistent with their high BET surface area (up to >250 m2/g) and large As and P mass fractions. The As K-edge XAS data indicated As was present in all samples predominantly as As(V) bound to Fe(III) precipitates in the binuclear-corner sharing (2C) geometry. Overall, the similar structure and composition of all samples implies that As recovery methods optimized for one type of Fe-based treatment sludge can be applied to many groundwater treatment sludges. Our work provides a critical foundation for further research to develop resource recovery methods for As-rich waste.
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In the first week after the first COVID-19 patient was reported in the Netherlands, we conducted a pre-registered momentary assessment study (7 surveys per day, 50 participants, 7 days) to study the ...dynamic relationship between individuals' occupation with and worries about COVID-19 in daily life, and the moderating role of neuroticism in this relationship. At the group level, higher scores on occupation and worry co-occurred, and occupation predicted worry 1 h later, but not vice versa. There were substantial individual differences in the magnitudes and directions of the effects. For instance, occupation with COVID-19 was related to increases in worry for some but decreases in worry for others. Neuroticism did not predict any of these individual differences in the links between worry and occupation. This study suggests that it is important to go beyond group-level analyses and to account for individual differences in responses to COVID-19.
•Individuals differ substantially in size and direction of the relationship between worry about and occupation with COVID-19•Neuroticism was not significantly related to individual differences in these relationships•Advice to limit news-intake surrounding COVID-19 when worried may thus not be applicable to everyone
Emotion differentiation refers to the tendency to label emotions in a granular way. While differentiation is an important individual difference in the context of psychological well-being, it is ...unknown how it fluctuates within individuals. Such a within-person measure is important, since it would allow the study of how changes in differentiation predict subsequent levels of other variables of interest. Here, we present a framework to study emotion differentiation at the within-person level by introducing a momentary emotion differentiation index. This index is directly derived from the classical emotion differentiation index, the intraclass correlation. We first give a theoretical derivation of this index. Next, using data from two experience sampling studies, we show how this new momentary index is related to other momentary indicators of well-being, and take the first steps in building its nomological network. A better understanding of within-person fluctuations in emotion differentiation will allow us to identify the causes and consequences of these fluctuations, and search for ways to teach individuals to increase their level of emotion differentiation.
Periodontitis is a common chronic inflammatory disease initiated by bacteria, resulting in bone resorption, tooth loss, and systemic inflammation. Long-chain omega-3 fatty acids such as ...docosahexaenoic acid (DHA) reduce periodontitis in animals. We aimed to determine whether DHA supplementation with low-dose aspirin would reduce periodontitis in humans. We conducted a double-blind placebo-controlled parallel trial lasting 3 mo. Fifty-five adults with moderate periodontitis were randomized to 2,000 mg of DHA or identical soy/corn oil capsules. All participants received 81 mg of aspirin but received no other treatments. We analyzed the primary outcome of per-pocket change in pocket depth using mixed models among teeth with pocket depth ≥5 mm. Secondary outcomes assessed with generalized estimating equations included gingival index, plaque index, and bleeding on probing. Gingival crevicular fluid samples were analyzed for changes in high-sensitivity C-reactive protein (hsCRP) and interleukins 6 and 1β (IL-6 and IL-1β). Plasma was analyzed for changes in systemic inflammatory markers, including hsCRP. We confirmed adherence with erythrocyte fatty acid measurement. Forty-six participants completed the trial. While similar at baseline, the proportion of DHA in red blood cell plasma membranes increased from 3.6% ± 0.9% to 6.2% ± 1.6% in the intervention group but did not change among controls. DHA supplementation decreased mean pocket depth (–0.29 ± 0.13; p = .03) and gingival index (–0.26 ± 0.13; p = .04). Plaque index and bleeding on probing did not change. Significant adjusted differences were found between DHA and control for both gingival crevicular fluid hsCRP (–5.3 ng/mL, standard error SE = 2.4, p = .03) and IL-1β (–20.1 pg/mL, SE = 8.2, p = .02) but not IL-6 (0.02 pg/mL, SE = 0.71, p = .98) or systemic hsCRP (–1.19 mg/L, SE = 0.90, p = .20). In this randomized controlled trial, aspirin-triggered DHA supplementation significantly improved periodontal outcomes in people with periodontitis, indicating its potential therapeutic efficacy (clinicaltrials.gov NTC01976806).
Current groundwater treatment facilities, mostly relying on aeration-filtration configurations, aim at the removal of iron (Fe), ammonia (NH
) and manganese (Mn). However, recently water companies ...expressed the ambition to also reduce arsenic (As) concentrations in these rapid sand filters. The aim of this study was to investigate the effect of the Fe oxidation state entering a biological filter bed on As removal. By varying supernatant water level, either Fe(II) or Fe(III) in the form of hydrous ferric oxides (HFO) could be stimulated to enter the filter bed at alkaline groundwater pH (7.6). The experimental pilot column filters showed that once the As(III) oxidation stabilised in the top layer of the filter sand, As removal reached its maximum (±75% at 120 cm supernatant level and 1.5 m/h filtration velocity). The increase in supernatant level from 5 to 120 cm resulted in additional HFO production prior to rapid filtration (1.5, 5 and 10 m/h), i.e. homogeneous Fe(II) oxidation and flocculation, and subsequently, HFO ending up deeper into the filter bed (120 cm filter depth). At a low supernatant water level of 5 cm, Fe(II) oxidised heterogeneously and was removed within the top 20 cm of the filter bed. Consequently, filters with high supernatant levels removed As to lower levels (by 20%) than in filters with low supernatant water levels. The benefits of Fe(II) oxidation prior to filtration for As removal was confirmed by comparing Fe(III) to Fe(II) additions in the supernatant water or in the filter bed. Overall it is concluded that in biological groundwater filters, the combination of a higher supernatant level and/or Fe(III) addition with biological As(III) oxidation in the top of the filter bed promotes As removal.
This study aimed to evaluate the potential of handpump tubewell platform color as a low-cost, quick and convenient screening tool for As and Mn in drinking water tubewells. For this study, ...groundwater samples and corresponding tubewell platform pictures were collected from 272 shallow tubewells in Matlab Upazila of South-Eastern Bangladesh. The result shows that arsenic concentration within the surveyed (n = 272) tubewells, 99% (n = 269) exceeded the World Health Organization (WHO) guideline value of 10µg/L, and 98% (n = 267) exceeded the Bangladesh drinking water standards (BDWS) of 50µg/L. In relation to the platform color concept, within 233 (total 272) red colored platform tubewells, 230 (99%) exceeded the WHO guideline value of 10µg/L, and 229 (98%) tubewells exceeded BDWS of 50µg/L. This result shows a strong correlation between the development of red color stain on tubewell platform and As concentrations in the corresponding tubewell water. This study suggests that red-colored platform can be used for primary identification of tubewells with an elevated level of As and thus could prioritize sustainable As mitigation management in developing countries where water comes from reductive shallow aquifers. This study did not confirm the potential for Mn screening, as red discoloration by Fe oxides was found to mask the black discoloration of Mn oxides. It is recommended to further investigate this screening tool in regions with a higher well-to-well variability of As contaminations, as in the presented study As was found >10ug/L in 99% of the tubewells.
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•Tubewell is the most common source of drinking water in Bangladesh.•Nearly all the shallow (<70m) tubewells contain Arsenic (As) and Manganese (Mn).•Tubewells platform color as an alternative low cost and user friendly As and Mn screening tool.•Tubewells platform with red color can be used as an effective screening tool to identify As safe/unsafe tubewells.•Black colored and none identified colored platform tubewells contains high concentration of both As and Mn.
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