Oral Bacteriotherapy Reduces the Occurrence of Chronic Fatigue in COVID-19 Patients

Long COVID refers to patients with symptoms as fatigue, “brain fog,” pain, suggesting the chronic involvement of the central nervous system (CNS) in COVID-19. The supplementation with probiotic (OB) would have a positive effect on metabolic homeostasis, negatively impacting the occurrence of symptoms related to the CNS after hospital discharge. On a total of 58 patients hospitalized for COVID-19, 24 (41.4%) received OB during hospitalization (OB+) while 34 (58.6%) taken only the standard treatment (OB–). Serum metabolomic profiling of patients has been performed at both hospital acceptance (T0) and discharge (T1). Six months after discharge, fatigue perceived by participants was assessed by administrating the Fatigue Assessment Scale. 70.7% of participants reported fatigue while 29.3% were negative for such condition. The OB+ group showed a significantly lower proportion of subjects reporting fatigue than the OB– one (p < 0.01). Furthermore, OB+ subjects were characterized by significantly increased concentrations of serum Arginine, Asparagine, Lactate opposite to lower levels of 3-Hydroxyisobutirate than those not treated with probiotics. Our results strongly suggest that in COVID-19, the administration of probiotics during hospitalization may prevent the development of chronic fatigue by impacting key metabolites involved in the utilization of glucose as well as in energy pathways.

Pregnancy, childbirth and health of female labour migrants from Central Asia in Russia

The research note contains an analysis of data on health, pregnancy, and childbirth experience among female labour migrants arriving in Russia from Central Asia. Empirically, the study bases on the data of three surveys conducted in 2015, 2017, and 2020. In total, the surveys contain information on 2,028 migrants from Tajikistan, Kyrgyzstan, and Uzbekistan living in Russia. The analysis proves that with gradual feminization of labour migration from Central Asia, pregnancy and childbirth in a significant part of labour migrants take place in risky living conditions; the existing system of maternal health protection for migrants in Russia needs modernization. Compared to earlier studies on this topic, the survey data showed a higher proportion of female migrants who had got pregnant and gave birth in Russia along with a lower proportion of migrants who terminated pregnancy. These differences may indicate a change in the reproductive behaviour of women who come to work in Russia from the countries of Central Asia. The presented note shows the need for in-depth studies of the reproductive behaviour of labour migrants in Russia, as well as the development of national migration statistics, which should become gender sensitive.

Children develop causatives despite pervasive ellipsis: Evidence from Turkish

Children use causative verbs in language to express causality. The learning of causatives relies on cues in children's interaction with caregivers. Argument structure has been widely posited as a facilitative cue for learning causatives. However, it may lack reliability due to ellipsis allowed in many languages, thus affecting children's acquisition of causatives. In this study, we investigate the role of object ellipsis in the learning of two prevalent types of causatives, namely lexical and morphological causatives. We take Turkish as a test case, which employs both types of causatives. The results show that the ellipsis in child-directed speech is pervasive in both causatives, with morphological causatives exhibiting a substantially lower proportion of ellipsis. However, by examining children's developmental trajectory, we show that lexical causatives develop with a pattern strikingly similar to the general development of verbs, whereas morphological causatives develop more slowly, despite less object ellipsis and explicit morphological marking. The findings suggest that argument structure may not play a major role in the learning of causatives. Our general conclusion is that children acquire causatives despite the challenge posed by pervasive ellipsis.

High glycemic variability is associated with worse Continuous Glucose Monitoring metrics in children and adolescents with type 1 diabetes

Objective: The primary aim of this study was to quantify the prevalence of children and adolescents with T1D who achieve the recommended target for CV identifying the determining factors to reach this target. The secondary aim was to examine the relationship between CV, the other metrics derived from CGM data and clinical parameters. Method: CGM data were collected from 805 children/adolescents with T1D. Several CGM metrics and patients' characteristics were evaluated. Participants were stratified by CV≤36% and CV>36%. Binary logistic regression analysis was run to identify the determining factors of high CV. Results CV was positively correlated with %TBR<70mg/dL, %TBR<54 mg/dL, %TAR>250 mg/dL, LBGI, HBGI and negatively with %TIR. CV≤36% was found in 31.4% of the subjects. The CV>36% group spent less time in %TIR, more time in hypoglycemia and hyperglycemia with lower proportion of subjects using rtCGM and CSII. Percentage of TBR<70mg/dL and TAR>250mg/dL were significant predictors of CV>36%, whereas age, gender, BMI, duration of diabetes, type of CGM device, type of insulin therapy administration and %TIR were not significant predictors (p<0.001,R2Nagelkerke=0.48). Conclusions: CV identifies children and adolescents with worse glycemic control at higher risk of both hypoglycemia and hyperglycemia.

Higher chances of survival to hospital admission after out-of-hospital cardiac arrest in patients with previously diagnosed heart disease

AimThis study aimed to determine whether patients suffering from out-of-hospital cardiac arrest (OHCA) with a pre-OHCA diagnosis of heart disease have higher survival chances than patients without such a diagnosis and to explore possible underlying mechanisms.MethodsA retrospective cohort study in 3760 OHCA patients from the Netherlands (2010–2016) was performed. Information from emergency medical services, treating hospitals, general practitioner, resuscitation ECGs and civil registry was used to assess medical histories and the presence of pre-OHCA diagnosis of heart disease. We used multivariable regression analysis to calculate associations with survival to hospital admission or discharge, immediate causes of OHCA (acute myocardial infarction (AMI) vs non-AMI) and initial recorded rhythm.ResultsOverall, 48.1% of OHCA patients had pre-OHCA heart disease. These patients had higher odds to survive to hospital admission than patients without pre-OHCA heart disease (OR 1.25 (95%CI 1.05 to 1.47)), despite being older and more often having cardiovascular risk factors and some non-cardiac comorbidities. These patients also had higher odds of shockable initial rhythm (SIR) (OR 1.60 (1. 36 to 1.89)) and a lower odds of AMI as immediate cause of OHCA (OR 0.33 (0.25 to 0.42)). Their chances of survival to hospital discharge were not significantly larger (OR 1.16 (0.95 to 1.42)).ConclusionHaving pre-OHCA diagnosed heart disease is associated with better odds to survive to hospital admission, but not to hospital discharge. This is associated with higher odds of a SIR and in a subgroup with available diagnosis a lower proportion of AMI as immediate cause of OHCA.

A matched comparison of the patient-reported outcome measures of cemented and cementless total knee replacements, based on the National Joint Registry of England, Wales, Northern Ireland, and Isle of Man and England’s National PROM collection programme

Background and purpose — Total knee replacement (TKR) can be implanted with or without bone cement. It is currently unknown how the functional outcomes compare. Therefore, we compared the patient-reported outcome measures (PROMS) of both fixation methods. Patients and methods — We performed a propensitymatched comparison of 14,404 TKRs (7,202 cemented and 7,202 cementless) enrolled in the National Joint Registry and the English National PROMs collection programme. Subgroup analyses were performed in different age groups (1) < 55 years; (2) 55–64 years; (3) 65–74 years; (4) ≥ 75 years. Results — The 6-month postoperative Oxford Knee Score (OKS) was significantly (p < 0.001) higher for cemented TKR (35, SD 9.7) than cementless TKR (34, SD 9.9). The OKS was also significantly higher for the cemented TKR in all age groups, except the 55–64-year group. A significantly higher proportion of cemented TKRs had an excellent OKS (≥ 41) compared with cementless (32% vs. 28%, p < 0.001) and a lower proportion of poor (< 27) scores (19% vs. 22%, p = 0.001). This was also observed for all age subgroups. Therewere no significant differences in EQ-5D points gained postoperatively between the groups respectively (0.31 vs. 0.30, p = 0.1). Interpretation — Cemented TKRs had a greater proportion of excellent OKS scores and lower proportion of poor scores both overall and across all age groups. However, the absolute differences are small and below the minimally clinically important difference, making both fixation types acceptable. Currently the vast majority of TKRs are cemented and the results from this study suggest that this isappropriate.

Diagnostic criteria of lymphoproliferative diseases from the peripheral blood samples using a cell biochip

Background: At present, the diagnosis of lymphoproliferative disorders is based on the combination of blood or bone marrow smear morphology and immunophenotyping by flow cytometry. Immunophenotypic testing by flow cytometry technique is available only in big medical centers, which is not always convenient for a patient. Therefore, development of an available method for preliminary diagnosis of lymphoproliferative diseases not requiring special equipment seems relevant.Materials and methods: Peripheral blood mononuclear cells from 17 patients admitted to the hospital with suspicion of a lymphoproliferative disorder, and 17 healthy donors were studied on a cell biochip for determination of proportions of cells positive for various surface CD antigens. The diagnosis was verified by flow cytometry.Results: Compared to healthy controls and patients with T-cell lymphoproliferative disorders (TCLPD), the patients with B-cell lymphoproliferative disorders (BCLPD) had significantly lower proportion of CD7+ cells (medians, 7% and 73% respectively, p=2×10-6 for comparison with healthy controls; median 7% and 93% for comparison with TCLPD, p=0.032). In addition, the patients with BCLPD had higher proportion of peripheral СD19+ mononuclear cells, compared to that in the patients with TCLPD and healthy donors (medians 84% and 13% for comparison between BCLPD and healthy control, p=2×10-5; 84% and 3% for comparison of BCLPD and TCLPD, p=0.033). The patients with B-cell chronic lymphocytic leukemia had significantly higher CD5+ cells in the cell biochip compared to the patients with other BCLPD (medians 72% and 9%, p=0.024). The patients with TCLPD had significantly lower proportion of CD19+ cells than the healthy controls (medians, 3% and 13%, respectively, р=0.042).Conclusion: The study has demonstrated the potential to use the previously developed cell biochip for diagnosis of lymphoproliferative diseases. The biochip makes it possible to sort out white blood cells according to their surface differentiation antigen for their further morphological analysis. The cell biochip allows for the differential diagnosis between BCLPD and TCLPD and determination the lymphocyte clones based on the expression of immunoglobulin light chains.

Sex Differences in Anemia and Red Blood Cell Transfusions Among General Internal Medicine Inpatients

Background: Epidemiological data from the general population have shown that women have lower hemoglobin values compared to men. Previous research on surgical patients showed that women were significantly more likely to receive red blood cell (RBC) transfusions compared to men in the peri-operative period due to multiple factors including the application of absolute transfusion thresholds. Sex differences in RBC transfusion frequencies have not been well studied in non-surgical settings. Here we investigated sex differences in anemia and in RBC transfusion frequencies in patients admitted to General Internal Medicine (GIM) wards. Study design and methods: This was a retrospective cohort study using de-identified electronic patient data from all patients admitted to the GIM wards from the emergency department across 4 different hospitals between 2010 and 2017, who had at least 1 CBC test during their admission. Patients with multiple hospital admissions during the study period, those who were pregnant, those who underwent surgery during the admission, and those transferred to or from another service besides GIM during their admission were excluded. Severity of anemia was stratified using the WHO sex-specific quantitative thresholds for hemoglobin: mild anemia (110 to 119 g/L in women and 110 to 129 g/L in men), moderate anemia (80 to 109 g/L in both men and women) and severe anemia (lower than 80 g/L in both men and women). Results: The study cohort consisted of 51,073 inpatients (24,666 men and 26,407 women). The median hemoglobin at the time of admission was significantly higher (p &lt; 0.001) in men (median 135 g/L, IQR 31) compared to women (median 127 g/L, IQR 25). The prevalence of moderate and severe anemia was significantly higher (p &lt; 0.001) in female inpatients (56%) compared to males (44%). The proportion of patients who received RBC transfusions during their admission was not significantly different (p = 0.36) between men (49%) and women (51%). There was no significant sex difference (p = 0.28) observed in the median hemoglobin prior to RBC transfusions between men (median 68 g/L, IQR 10.5) and women (median 68 g/L, IQR 11). The number of patients with pre-transfusion hemoglobin less than 70 g/L, the commonly used threshold for transfusion in the in-patient setting, was not significantly different (p = 0.91) between men and women. However, among the patients with hemoglobin &lt; 70 g/L, a significantly lower proportion (p &lt; 0.001) of women (82%) received RBC transfusions compared to men (91%). Conclusions: In a large cohort of GIM inpatients, we observed significantly higher prevalence of moderate and severe anemia in women compared to men. While there was no sex difference in overall RBC transfusion frequencies in this inpatient population, there was a lower proportion of women receiving RBC transfusions compared to men in the subgroup of patients with hemoglobin less than 70 g/L. Disclosures No relevant conflicts of interest to declare.

Innovation in SMEs: the role of employee training in German SMEs

PurposeThis paper explores the role of effective resource and knowledge management capabilities on product innovation capabilities of the small and medium-sized enterprises (SMEs). Specifically, the authors research the role of the human resource investments in the form of employee training in developing firm's innovation capabilities and how SMEs manage these investments when we account for the boundary conditions such as the level of employee education, SME size and the frequency of investments in research and development (R&D).Design/methodology/approachThe authors use survey data conducted by The Centre for European Economic Research (Zentrum für Europäische Wirtschaftsforschung – ZEW). The final sample for analysis includes 983 SMEs from Germany that belong to 13 different industries. The authors use hierarchical OLS regression to test the hypotheses presented in this paper.FindingsThe authors find a positive association between increased investments in employee training and product innovation capabilities in the context of SMEs. More specifically, the authors’ findings support that (1) the relationship between employee training and innovation capabilities is weaker in industries with greater proportion of employees with university degrees, (2) the effectiveness of investments in employee training is lower among larger SMEs than smaller SMEs, and (3) continuous R&D weakens the relationship between training expenditure and innovation capabilities. While on the one hand the authors’ findings contribute to the debate of whether employee training is necessary for SMEs by affirming this notion, on the other hand the authors show that investments in employee training have differing implications for small and large SMEs within boundary conditions. Moreover, these findings have practical implications for the managers of all SMEs in terms of management of their knowledge resources.Research limitations/implicationsThe authors’ research makes important contributions to the study of innovation in SMEs. First, the authors contribute evidence to the debate whether employee training is necessary for SMEs by showing that employee training is particularly important for SMEs that are smaller in size, have lower proportion of employees with university degrees and when they invest in research and development in a targeted manner. The authors also demonstrate that investments in employee training is not a waste, rather such investments can increase the likelihood of survival for many of these firms through its positive impact on product innovation.Practical implicationsFor managers of SMEs, the authors’ findings suggest that while investments in employee training are important, the managers of particular SMEs with above-mentioned qualities should be persistent in such investments and must make deliberate efforts to reap the benefits in terms of innovative capabilities. Unlike large firms, who have the financial means to carry out investments in an abundant manner, SMEs appear to be more enterprising with their scarce resources when we also consider the role of investments in human resources.Originality/valueThe authors’ research makes important contributions to the study of innovation in SMEs. First, the authors contribute evidence to the debate whether employee training is necessary for SMEs by finding that employee training is particularly important for SMEs that are smaller in size, have lower proportion of employees with university degrees and when they do not invest in R&D continuously. The authors also demonstrate that investments in employee training is not a waste, but such investments can increase the likelihood of survival for many of these firms.

Reduced seroconversion in children compared to adults with mild COVID-19

Importance: The immune response in children with SARS-CoV-2 infection is not well understood. Objective: To compare seroconversion in children and adults with non-hospitalized (mild) SARS-CoV-2 infection and to understand the factors that influence this. Design: Participants were part of a household cohort study of SARS-CoV-2 infection. Weekly nasopharyngeal/throat swabs and blood samples were collected during the acute and convalescent period following PCR diagnosis for analysis. Setting: Participants were recruited at the Royal Childrens Hospital, Melbourne, Australia between May and October 2020. Participants: Those who had a SARS-CoV-2 PCR-positive nasal/throat swab. Main outcomes and measures: SARS-CoV-2 antibody and cellular responses in children and adults. Seroconversion was defined by seropositivity in all three serological assays. Results: Among 108 SARS-CoV-2 PCR-positive participants, 57 were children (median age: 4, IQR 2-10) and 51 were adults (median age: 37, IQR 34-45). Using three established serological assays, a lower proportion of children seroconverted compared with adults [20/54 69 (37.0%) vs 32/42 (76.2%); (p<0.001)]. This was not related to viral load, which was similar in children and adults [mean Ct 28.58 (SD: 6.83) vs 24.14 (SD: 8.47)]. Age and sex also did not influence seroconversion or the magnitude of antibody response within children or adults. Notably, in adults (but not children) symptomatic adults had three-fold higher antibody levels than asymptomatic adults (median 227.5 IU/mL, IQR 133.7-521.6 vs median 75.3 IU/mL, IQR 36.9-113.6). Evidence of cellular immunity was observed in adults who seroconverted but not in children who seroconverted. Conclusion and Relevance: In this non-hospitalized cohort with mild COVID-19, children were less likely to seroconvert than adults despite similar viral loads. This has implications for future protection following COVID-19 infection in children and for interpretation of serosurveys that involve children. Further research to understand why children are less likely to seroconvert and develop symptoms following SARS-CoV-2 infection, and comparison with vaccine responses may be of clinical and scientific importance.