medRxiv : serveur de preprint pour les sciences médicales

Background Anxiety is one of the most common psychiatric symptoms in Parkinson's disease (PD). Whether anxiety shapes disease progression and brain network aberrations in PD remain largely unknown. The objective of present study is to investigate whether anxiety exacerbates clinical symptoms and brain network abnormalities of PD patients. Methods PD patients performing magnetic resonance imaging from Parkinson's Progression Markers Initiative (PPMI) database were specifically included. According to the scores of State-Trait Anxiety Inventory (STAI), PD patients were classified into lower quartile group (STAI score rank: 0%~25%), interquartile group (STAI score rank: 26%~75%), and upper quartile group (STAI score rank: 76%~100%) based on their STAI score quartiles to investigate how anxiety affects clinical manifestations and brain networks. Results Anxiety was independently associated with both motor and non-motor symptoms of PD patients. Consistently, PD patients in the upper quartile group showed more severe non-motor symptoms compared to lower quartile group. Moreover, they also exhibited significantly different topological metrics in structural network compared to lower quartile group. Furthermore, we demonstrated that differential network metrics mediated the associations between anxiety and motor and non-motor symptoms of PD patients. Conclusions PD patients with higher anxiety level exhibited more severe clinical manifestations and disruptions of brain network topology. Diverse structural network metrics were associated with motor and non-motor symptoms of PD patients.

Suicide, a serious public health concern affecting millions of individuals worldwide, refers to the intentional act of ending one's own life. Mental health issues such as depression, frustration, and hopelessness can directly or indirectly influence the emergence of suicidal thoughts. Early identification of these thoughts is crucial for timely diagnosis. In recent years, advances in artificial intelligence (AI) and natural language processing (NLP) have paved the way for revolutionizing mental health support and education. In this proof-of-concept study, we have created MindWatch, a cutting-edge tool that harnesses the power of AI-driven language models to serve as a valuable computer-aided system for the mental health professions to achieve two important goals such as early symptom detection, and personalized psychoeducation. We utilized ALBERT and Bio-Clinical BERT language models and fine-tuned them with the Reddit dataset to build the classifiers. We evaluated the performance of bi-LSTM, ALBERT, Bio-Clinical BERT, OpenAI GPT3.5 (via prompt engineering), and an ensembled voting classifier to detect suicide ideation. For personalized psychoeducation, we used the state-of-the-art Llama 2 foundation model leveraging prompt engineering. The tool is developed in the Amazon Web Service environment. All models performed exceptionally well, with accuracy and precision/recall greater than 92%. ALBERT performed better (AUC=.98) compared to the zero-shot classification accuracies obtained from OpenAI GPT3.5 Turbo (ChatGPT) on hidden datasets (AUC=.91). Furthermore, we observed that the inconclusiveness rate of the Llama 2 model is low while tested for few examples. This study emphasizes how transformer models can help provide customized psychoeducation to individuals dealing with mental health issues. By tailoring content to address their unique mental health conditions, treatment choices, and self-help resources, this approach empowers individuals to actively engage in their recovery journey. Additionally, these models have the potential to advance the automated detection of depressive disorders.

We have recently demonstrated that humans with motor-and-sensory complete cervical spinal cord injury (SCI) can modulate the activity of spared motor neurons that control the movements of paralyzed muscles. These motor neurons still receive highly functional cortical inputs that proportionally control flexion and extension movements of the paralyzed hand digits. In this study, we report a series of longitudinal experiments in which subjects with motor complete SCI received motor unit feedback from NeurOne. NeurOne is a software that realizes super-fast digitalization of motor neuron spiking activity (32 frames/s) and control of these neural ensembles through a physiological motor unit twitch model that enables intuitive brain-computer interactions closely matching the voluntary force modulation of healthy hand digits. We asked the subjects (n=3, 3-4 laboratory visits) to match a target displayed on a monitor through a cursor that was controlled by the modulation of the recruitment and rate coding of the spared motor units using a motor unit twitch model. The attempted movements of the paralyzed hands involved grasping and hand digit extension/flexion. The target cursor was scaled in a way that the subjects could increase or decrease feedback by either recruiting or derecruiting motor units, or by modulating the instantaneous discharge rate. The subjects learned to control the motor unit output with high levels of accuracy across different target intensities up to the maximal achievable discharge rate. Indeed, the high-performance motor output was surprisingly stable in a similar way as healthy subjects modulated the muscle force output recorded by a dynamometer. Therefore, NeurOne enables tetraplegic individuals an intuitive control of the paralyzed muscles through a digital neuromuscular system.

Background: Primary dysmenorrhea (PD) is a gynecological disease that seriously affects women 's physical and mental health and quality of life. Sanyinjiao (SP6) is the most used acupoint for acupuncture treatment of PD, and acupuncture SP6 is more commonly used in the clinical treatment of PD, but evidence of effectiveness and safety is lacking. The purpose of this systematic review plan is to develop a study protocol that can evaluate the efficacy and safety of acupuncture SP6 in the treatment of PD. Methods: The upper limit of retrieval time will be set to September 2023. Foreign and Chinese databases will be searched respectively: Cochrane Library, PubMed, EMBASE, Ovid, Korea Med, J-Global, J-Stage databases, and CNKI, CBM, SinoMed, VIP, Wanfang. Randomized controlled trials meeting the inclusion criteria will be screened by two independent reviewers, and data extraction and risk of bias assessment will be carried out. The primary outcome is dysmenorrhea symptoms, and the secondary outcomes include recent clinical cure rate, concomitant symptoms, serum prostaglandins, uterine artery blood flow resistance under ultrasound monitoring, and adverse reactions. Use RevMan V.5.3 software to perform the following operations: data synthesis, subgroup analysis, heterogeneity analysis, and sensitivity analysis. The evidence quality of clinical studies included in this study will be evaluated by the software of " Grading of Recommendations Assessment, Development, and Evaluation ". Results: This study will provide comprehensive clinical evidence for treating PD with acupuncture SP6. Conclusion: This systematic review will confirm whether acupuncture SP6 is safe and effective in treating PD clinically.

An analytical model for calculating the spread of the COVID-19 epidemic is described, and it is shown that the main patterns of epidemic development are determined by three dimensionless complexes representing the ratios of transmission rates, contact limitation due to lockdown, and population vaccination. A comparison of statistical data on the growth of the epidemic in Germany, Berlin and its various neighbourhoods shows that the development of the epidemic depends to a large extent on the ethnic composition of the population. In the same way as it is accepted in some sections of physics, it is proposed to use the methods of similarity theory to investigate the regularities of the emergence and development of the epidemic.

To assess the long-term effect of a vaccination programme, understanding both the efficacy and the mode of action of the vaccine is crucial. The actual mode of action is difficult to infer from field trials, because of the heterogeneity of exposure to infection. Here we show an approach to determine both vaccine efficacy and the mode of action of vaccines from human challenge studies. Our approach reveals how vaccines alter an individual's susceptibility, and identifies a mixture of different modes of action as a function of the challenged dose. By applying the proposed method to influenza challenge data, we illustrate that potentially the lowest vaccine efficacy may occur at intermediate doses, suggesting a hypothesis that moderate transmission intensities might be optimal for establishing infections in vaccinated individuals.

Although the use of evidence products has been identified as beneficial in improving reproductive, maternal and child health, very little is known about the processes that facilitate the use of these evidence products by frontline Maternal, Newborn and Child Health and Reproductive and Child Health (RNCH/RCH) practitioners in decision-making on the issues that confront them in their line of work. This study explored the processes that facilitate the use of evidence products in reproductive, maternal and child health service provision in selected healthcare facilities in Ghana. Using a cross-sectional qualitative design, interviews of 24 frontline RNCH/RCH practitioners across 16 healthcare facilities in the Greater Accra, Eastern, and Ashanti regions of Ghana were conducted. The study employed a semi-structured interview guide modelled along the Action Cycle phase of the Knowledge-To-Action (KTA) framework, and the objectives of the study. Themes were built out of the transcribed data. The study revealed that the processes that facilitate the use of evidence products include problem identification activities (such as service evaluation, using accepted benchmarks, inadequate logistics for providing service and client feedback) and, adapting knowledge to their local context. The usual suspects of socio-cultural and health systems-related factors such as resource constraints and human factors were found to hinder the use of evidence products in providing RNCH/RCH services. The study contributes to knowledge by operationaliing the KTA, simplifying the concept of knowledge sustainability and makes it easy for adoption and implementation especially at the frontline. Appropriate interventions that rely on strong education to navigate the societal norms and beliefs that inhibit the uptake of evidence-based care by clients will be essential in improving the use of evidence to inform practice decisions.

Background: Congenital heart disease is typically defined as a structural abnormality of the heart and great vessels present at birth. The incidence and mortality of congenital heart disease in neonates vary worldwide and it is the leading cause of birth defects, morbidity and mortality. Objective; to assess incidence and predictors of mortality among neonates admitted for congenital heart disease in public comprehensives specialized hospitals Amhara region, Ethiopia a Retrospective follow -up study 2023 Method; Institution-based retrospective follow-up study was conducted among 583 neonates with congenital heart disease admitted to Amhara region public comprehensive specialized hospitals from January 1st 2018 to December 30th , 2022. The study subjects was selected using simple random sampling techniques. Data were entered into EPI data version 4.6, then exported to STATA version 16. The log-rank test and Kaplan Meier failure curve was used to estimate and compare the probability of death. First bivariable then multivariable regression was done. After computing a hazard ratio with a 95% confidence interval, variables with a p-value of 0.05 or lower was considered to be significant predictors of mortality Results: Out of 583 congenital heart disease neonate 9.9% were developed death. The incidence rate of mortality among congenital heart disease neonates was 11.9% per 1000 with 4844 person-days of observation (95% CI;-0.009-0.015). In this study were found to be Sepsis(AHR:2.24(95%CI:-1.184.23),Cyanoticcongenital heart disease(AHR:3.49(95%CI:1.93-6.28), Home delivery(AHR:1.9(95%,CI:1.06-3.6), had maternal history of Gestational diabetes multiuse (AHR: 1.94 (95% CI 1.04-3.61). Neonates having another congenital malformations. (AHR 2.49(1.33-4.67). neonates have been Airway resuscitation needed during delivery (AHR: 0.43(95%CI: 0.18-0.98). were found to be a significant predictors of Congenital heart disease neonatal mortality. Conclusion and recommendation: The incidence rate of neonatal mortality among congenital heart disease neonate was high as compared to findings of other studies. sepsis, cyanotic congenital heart disease, home delivery, maternal history of gestational diabetes malts, others congenital malformation and Airway resuscitations needed during delivery were significant predictors of mortality for neonates with congenital heart disease. Hence, giving special attention to patients with identified predictors should be better

Objectives: This study aimed to assess the effect of varying the reference electrode position, specifically comparing position A3 (medial patella) to routine position 1 (R1) and the MScan multicenter protocol position (M1), on compound muscle action potential (CMAP) and motor unit number estimation (MUNE) in the tibialis anterior muscle of healthy participants. Methods: Twenty healthy participants underwent repeated MScanFit MUNE assessments with a 7-14 day interval between tests. The reference electrode (E2) was placed in three positions at each visit (A3, R1, and M1), while the active electrode (E1) remained constant. An additional seventeen participants were included to establish the minimal detectable true change in MUNE values using MScanFit, with the reference electrode exclusively in the M1 position. Results: The reference electrode position significantly influenced CMAP and MUNE, with R1 resulting in lower values. However, no significant difference was observed between M1 and A3 positions. Relative and absolute reliability indicators favored using the M1 position for reference in MScanFit MUNE. In a combined dataset of 37 healthy participants, the average tibialis anterior muscle motor unit count was estimated at 148 (SD 25.2), with a minimal detectable true change of 55 units. Conclusions: The preference for the M1 position over the alternative A3 position is supported, particularly for MScanFit MUNE assessments in the tibialis anterior muscle. Clinically, a true change in MUNE should consider the minimal detectable change of 55 motor units, underscoring the reality that large changes in MUNE are required to conclude a genuine change beyond measurement error. Significance: For MUNE examinations of the tibialis anterior muscle, adhering to the electrode positions outlined in the MScan multicenter protocol is advisable. Awareness of measurement error limitations in MScanFit MUNE underscores its applicability in making longitudinal clinical decisions for individual patients.

Bilingualism has been associated with cognitive benefits and a potential protective effect against neurodegenerative conditions. Previous research has shown that bilingual individuals exhibit greater white matter integrity compared to monolinguals of the same age. However, the impact of foreign-language learning on brain structure in older adults during the initial stages of language acquisition remains uncertain. This study aimed to investigate the cognitive and structural effects of a four-month-long foreign language learning program in a group of healthy older adult monolinguals. Thirteen Italian-speaking participants (aged 59-78) underwent a four-month intensive English course for beginners. Pre- and post-assessments were conducted to evaluate executive cognitive functions, as well as diffusion tensor imaging (DTI) to examine brain structural changes. The study findings showed substantial increases in axial, radial, and mean diffusivity during the four-month language learning period. The most prominent variations were observed in key brain regions, namely the fronto-occipital fasciculus, the superior longitudinal fasciculus, and the corpus callosum areas. Notably, brain-behaviour correlations indicated a robust positive relationship between changes in axial diffusivity and performance on the Stroop task, which assesses cognitive interference inhibition. These findings suggest that a four-month foreign language learning program can induce structural changes in the brain, particularly affecting white matter integrity, and that these structural changes are associated with improvements in executive functions. The study highlights the potential of short-term language learning interventions to impact brain structure and cognitive abilities in older adults.

Objective: Long-term steroid use increases the risk of developing Pneumocystis pneumonia (PcP), but there are limited reports on the relation of long-term steroid and PcP mortality. Methods: Retrospective multicenter study to identify risk factors for PcP mortality, including average steroid dose before the first visit for PcP in non-human immunodeficiency virus (HIV)-PcP patients. We generated receiver operating characteristic (ROC) curves for 90-day all-cause mortality and the mean daily steroid dose per unit body weight in the preceding 10 to 90 days in 10-day increments. Patients were dichotomized by 90-day mortality and propensity score-based stabilized inverse probability of treatment weighting (IPTW) adjusted covariates of age, sex, and underlying disease. Multivariate analysis with logistic regression assessed whether long-term corticosteroid use affected outcome. Results: Of 133 patients with non-HIV-PcP, 37 died within 90 days of initial diagnosis. The area under the ROC curve for 1-40 days was highest, and the optimal cutoff point of median adjunctive corticosteroid dosage was 0.34 mg/kg/day. Past steroid dose, underlying interstitial lung disease and emphysema, lower serum albumin and lower lymphocyte count, higher lactate dehydrogenase, use of therapeutic pentamidine and therapeutic high-dose steroids were all significantly associated with mortality. Underlying autoimmune disease, past immunosuppressant use, and a longer time from onset to start of treatment, were associated lower mortality. Logistic regression analysis after adjusting for age, sex, and underlying disease with IPTW revealed that steroid dose 1-40 days before the first visit for PcP (per 0.1 mg/kg/day increment, odds ratio 1.36 [95% confidence interval = 1.16-1.66], P<0.001), low lymphocyte counts, and high lactate dehydrogenase revel were independent mortality risk factor, while respiratory failure, early steroid, and sulfamethoxazole/trimethoprim for PcP treatment did not. Conclusion: A steroid dose before PcP onset was strongly associated with 90-day mortality in non-HIV-PcP patients, emphasizing the importance of appropriate prophylaxis especially in this population.

Multi-Reader Multi-Case (MRMC) studies are typically used to evaluate improvement in diagnostic accuracy of readers (diagnosticians) when they are assisted by a computer-assisted device (CAD) such as, but not limited to, those based on Artificial Intelligence (AI) algorithms. Statistical analysis of MRMC study data is not trivial and these studies can consume a lot of resources. Optimal planning is crucial and estimation of sample size is a significant step during the study planning phase. MRMC sample size estimations require many parameter assumptions and without pilot data this is generally not intuitive. MRMCsamplesize package can help researchers to estimate sample sizes for an MRMC study in the absence of any pilot data. The program outputs the number of cases required for a given number of readers. The package can also estimate sample sizes for scenarios where intra-cluster correlation (ICC) needs to be adjusted.

Introduction. The White House has called for an "all-hands-on-deck" response to address chronic absenteeism and disrupted learning among K-12 students that spiked during the COVID-19 pandemic due to school closures and shifts to remote learning in the United States. Such learning disruptions are linked to test score declines with lifelong implications for earnings and well-being. This study aimed to identify higher-risk student populations that might benefit from interventions to reduce such disruptions and related inequities by estimating the linkages between the racial and ethnic composition of U.S. K-12 school districts as predictors of average wildfire smoke levels and year-over-year declines in in-person student visits to schools during the pandemic. Methods. Using multivariable logistic regression, 5-year (2012-2016) mean percentages of non-White students grouped into quartiles were investigated as predictors of school district-level outcomes consisting of: 1) 5-year (2012-2016) mean levels of wildfire smoke fine particulate matter 2.5 m or smaller in diameter (PM2.5) above 35 g/m3 (EPA health-based standard) during school days for grade 3-8 students from August 15 to June 15 of the following year; and 2) being above the median for the mean decline in in-person student attendance (vs. the same month in 2019), from September 2020 to May 2021 and September 2021 to May 2022. Results. Across 11,190 (82.4% of all) U.S. school districts, the highest (vs. lowest) quartile for the percentage of non-White students predicted a nearly 3-fold higher odds (adjusted odds ratio, AOR=2.82; 95% CI=2.14-3.72; P<.001) for high wildfire smoke exposure and a 9-fold higher odds (AOR=9.12; 95% CI=7.15-11.63; P<.001) for substantially reduced in-person learning levels. Successively higher odds were observed in higher quartiles (P for trend <.001). Similar patterns were seen when high (vs. low) percentages of Asian-, Black-, and Hispanic-American students were modeled simultaneously. Conclusions: U.S. school districts with higher percentages of non-White students showed a convergence of elevated odds of wildfire smoke exposure and distance learning consistent with dose-response relationships. These concomitant risks could be mitigated by school-based air filtration interventions that reduce wildfire smoke PM2.5 and transmission of airborne particulates carrying the coronavirus. One potential cost-effective intervention to address these joint risks would be the placement of Corsi-Rosenthal boxes (DIY inexpensive portable air filtration devices shown to effectively reduce PM2.5 concentrations) in school classrooms and other school indoor areas. Supplying Corsi-Rosenthal boxes to school districts could markedly reduce learning disruptions and wildfire smoke and COVID-19 health impacts and their related inequities at a cost of less than $1 billion annually, 0.5% of the $190 billion in federal relief available to school districts to address pandemic-related needs including learning loss.

Major Depressive Disorder (MDD) is a heterogenous and etiologically complex disease encompassing a broad spectrum of psychopathology, presumably arising from distinct pathophysiological mechanisms. Divergent appetitive phenotypes including Hyperphagic MDD (characterized by an increased appetite) and Hypophagic MDD (characterized by a decrease in appetite) are important clinical characteristics that are closely related to comorbidities, including cardiometabolic disorders. Prior evidence supports the notion that hyperphagia is associated with atypical depression, decreased stress-hormone signaling, a pro-inflammatory status, hypersomnia, and poorer clinical outcomes. Yet, our understanding of the underlying mechanisms of Hyperphagic and Hypophagic MDD is limited, and knowledge of associated biological correlates of these endophenotypes remain fragmented. We performed an exploratory study on peripheral blood RNA profiling using bulk RNAseq in unmedicated individuals with Hyperphagic and Hypophagic MDD (n=8 and n=13, respectively) and discovered individual genes and gene pathways associated with appetitive phenotypes. In addition, we used the Maastricht Acute Stress Task to uncover stress-related transcriptomic profiles in Hyper- and Hypophagic MDD.

Background: Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self-reported survey data, or data on hospital-recorded infections only, resulting in gaps in data collection. Methods: This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, in 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 weeks or 27-30 months health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention, and speech-language-communication), and (b) the trimester(s) in which infections occurred. Results: After confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was consistent across almost all developmental outcome types, and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), i.e. the trimesters in which fetal brain myelination occurs. Infection-related prescriptions were not associated with a significant increase in odds of having at least one developmental concern after confounders/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development. Conclusions: Prenatal infections, particularly those which are hospital-diagnosed (and likely more severe) are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.

Aim: DPP4 inhibitors are widely prescribed as treatments for type 2 diabetes. Because drug responses vary among individuals, we initiated investigations to identify genetic variants associated with the magnitude of drug responses. Methods: Sitagliptin (100 mg) was administered to 47 healthy volunteers. Several endpoints were measured to assess clinically relevant responses, including the effect of sitagliptin on glucose and insulin levels during an oral glucose tolerance test (OGTT). Results: This pilot study confirmed that sitagliptin (100 mg) decreased the area under the curve for glucose during an OGTT (p=0.0003). Furthermore, sitagliptin promoted insulin secretion during the early portion of the OGTT as reflected by in increase in the ratio of plasma insulin at 60 min divided by plasma insulin at 30 min (T30:T60) from 0.87+/-0.05 to 1.62+/-0.36 mU/L (p=0.04). The magnitude of the effect of sitagliptin on insulin secretion (as judged by the increase in the T30:T60 ratio for insulin) was correlated with the magnitude of sitagliptin-induced increase in the area under the curve for intact plasma GLP1 levels during the first hour of the OGTT. This study confirmed previously reported sex differences in glucose and insulin levels during an OGTT. Specifically, females exhibited higher levels of glucose and insulin at the 90-180 min time points. However, there did not appear to be significant differences in the magnitude of sitagliptin-induced changes in T30:T60 raios for either glucose or insulin. Conclusions: T30:T60 ratios for insulin and glucose during an OGTT provide useful indices to assess pharmacodynamic responses to DPP4 inhibitors.

Background: A diagnosis of an inherited cardiac condition may cause guilt for having the condition (i.e. personal guilt), for passing it to ones offspring (i.e. reproductive guilt), and may also impact the reproductive decision-making. We sought to identify factors that are associated with guilt and reproduction decision-making amongst patients with inherited cardiomyopathy and arrhythmia syndromes. Methods: We used an anonymous web-based survey that included validated measures to assess patients perceptions of their illness and quality of life and questions on feeling personal guilt and reproductive guilt, genetic testing results, family planning, and cascade screening. Results: Of 514 potential participants, 128(24.9%) responded to the survey. Most respondents had cardiomyopathy(66.4%). Thirty-eight(29.6%) respondents were probands and 41 (32.0%) had ICDs. Probands had a more severe perception of illness score compared to non-probands(p<0.01). Thirty-four percent(13/38) of probands and 8.8% (8/90) of non-probands reported reproductive guilt(p<0.001). Reproductive guilt was associated with a more severe perception of illness(p<0.001) and a proband status (p=<0.001). After adjusting for illness perception, being a proband was no longer a predictor for reproductive guilt. Twenty-two participants (17.2%) reported experiencing current or past personal guilt, with a trend of more personal guilt amongst patients with inherited arrhythmia (33.3%vs.15%,p=0.06). Personal guilt was associated with a worse illness perception (p<0.001), a lower quality of life (p=0.01) and proband status (p<0.001), with thirty-four percent (13/38) of probands vs. ten percent of non-probands (9/90) (p<0.001) feeling or having felt personal guilt. After adjusting for quality of life and illness perception proband status did not remain an independent predictor for personal guilt. Conclusion: Personal and reproductive guilt are common among individuals with inherited cardiac conditions despite having good quality of life. Probands are more prone to feeling guilt due to a worse illness perception. Better opportunities for psychologic and genetic counseling for these patients are warranted.

Vaccine is the most efficient method for controlling of infectious disease. Vaccine effectiveness estimation is extremely important in monitoring vaccine efficacy and controlling disease spreading. To study about the COVID-19 vaccine effectiveness from EHR data, we apply the counterfactual reasoning method with deep neural network for vaccine effectiveness estimation from the time-to-event data which are extracted from Optum EHR dataset. The estimated vaccine effectiveness by the counterfactual reasoning is compared with the Cox regression model and Random survival forest model. The preliminary results show that the proposed model is more unbiased than the Cox regression and Random survival forest models.

Introduction: Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two diseases in this vulnerable local population. Methods: A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three one-stop centers, set up at the Panzi, Mulamba and Bulenga hospitals. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Viral load quantification for HBV and HIV were performed using the GeneXpert. Results: For HBV, overall prevalence was 8.9% (95% CI [7.2-10.8%]), 32.1% [29.3-35.0%], and 14.5% [12.3-16.8%] for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The mean age was 40.57{+/-}14.99 years in the HBsAg-positive group (p=0.025). Risk factors for HBV infection were age ([≥]35 years) (AOR=1.83 [1.02-3.32]; p=0.041), having no schooling (AOR=4.14 [1.35-12.62]; p=0.012) or only primary school-level (AOR=4.88 [1.61-14.75]; p=0.005), and multiple aggressors (AOR=1.76 [1.09-2.84], p=0.019). The prevalence of HIV was 4.3% [3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (>2,000 copies/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (>1,000 copies/mL). Conclusion: This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. These results highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs

Importance: Cataract is the leading cause of curable blindness in India needing scale-up of coverage. However, the costs and benefits of such scale-up remain unknown. Objective: To calculate the annual scale-up costs, economic benefits of disease burden averted, and the net benefits of covering cataract needs. Design: This is a retrospective cross-sectional analysis for 2018-19. Setting: We look at population level data of India and its 30 states. Main Outcomes and Measures: Data on cataract prevalence and disability-adjusted life-years (DALYs) was taken from the Global Burden of Disease (GBD) 2019 while cataract operations were taken from the National Health Profile (NHP) 2020. We used ten per capita surgical costs from three sources. Gross domestic product and health expenditure were taken from the National Health Accounts (2021). For the cataract scale-up costs, we calculated the total need by multiplying cataract prevalence with per capita costs and the unmet need by multiplying the difference between the prevalence and surgeries achieved with the same costs. For economic benefits of averted cataract burden, we multiplied DALYs with non-health gross domestic product, i.e., GDP minus the government health expenditure. To calculate DALYs for unmet needs we multiplied DALYs for total need with the ratio of unmet to total needs. For net benefits, we subtracted the scale-up costs for meeting total and unmet needs from economic benefits. All monetary values were adjusted for inflation and converted to USD 2020. Results: The annual scale-up costs for covering total cataract needs in India were 0.92 - 4.9 billion USD. Costs for covering unmet needs were 0.72 - 3.82 billion USD. Nationally, the economic benefit of averting the total cataract disease burden was 12.4 (95%UI: 8.9 - 16.7) billion USD, while the for covering the unmet burden was 9.7 (95%UI: 6.93 - 13) billion USD. Annual net benefits of covering total needs were 7.53 - 11.5 billion USD. Net benefits of covering unmet needs were 5.9 - 9 billion USD. Net benefits varied widely across states. Conclusion and Relevance: Scaling up cataract coverage is cost-beneficial. In over 90% of the scenarios considered, all Indian states have net economic benefits from the scale-up.