Bacillus Calmette-Guérin vaccination and clinical characteristics and outcomes of COVID-19 in Rhode Island, United States: a cohort study.

Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic, and there is limited data on effective therapies. Bacillus Calmette-Guérin (BCG) vaccine, a live-attenuated strain derived from an isolate of Mycobacterium bovis and originally designed to prevent tuberculosis, has shown some efficacy against infection with unrelated pathogens. In this study, we reviewed 120 consecutive adult patients (≥18 years old) with COVID-19 at a major federally qualified health centre in Rhode Island, United States from 19 March to 29 April 2020. Median age was 39.5 years (interquartile range, 27.0-50.0), 30% were male and 87.5% were Latino/Hispanics. Eighty-two (68.3%) patients had BCG vaccination. Individuals with BCG vaccination were less likely to require hospital admission during the disease course (3.7% vs. 15.8%, P = 0.019). This association remained unchanged after adjusting for demographics and comorbidities (P = 0.017) using multivariate regression analysis. The finding from our study suggests the potential of BCG in preventing more severe COVID-19.

An accrual model for primed digit classification.

This article describes a chronometric experiment of digit classification with masked primes. EEG experiments have shown that the subliminal prime activates the cortex prior to the target signal, thusly modifying the response: Congruent primes lead to faster correct answers, while incongruent primes result in slower response. It is noticed that incorrect answers show an inverted effect: A congruent prime inhibits incorrect answers, and the reverse for incongruent primes. Within the evidence accrual paradigm, it is suggested that the prime activity in the motor cortex effectively behaves as a shift in the decision threshold. This model assumption is consistent with our experimental findings. The correct and incorrect answers and the error percentage are discussed.

A response time model for judging order relationship between two symbolic stimuli.

The response time to judge the order relationship between two symbolic stimuli is frequently modeled as the time spent in a (constant-rate) accumulative sampling process until a threshold is reached. We will show that empirical descriptions of observed effects in number comparisons suggest an accrual process that reaches the threshold at an exponential rate. The model accrual equations and stopping conditions have an immediate interpretation in terms of a simple quantitative connectionist network. The encoded stimuli and thresholds are inputs to the network. The former are considered to result from the participant's learning history, and the latter modulate the rearrangement of the network parts; each arrangement models a different task. We have found a good correlation between model predictions and other authors' experimental data, both in number comparisons and in experiments in which the ordering of the symbolic stimuli has been artificially induced. Incorrect answers are discussed, and predictions are compared with data. We will explore differences and similarities with other approaches, such as random walk and the symbolic comparison model. In a limit case, our model becomes identical to the discriminability model.

Managing care in an integrated delivery system via an Intranet.

The CareGroup Provider Service Network is a managed care contracting organization which provides central administrative services for over 1800 physicians and 200,000 managed care lives. Services include utilization management, disease management and credentialing for the entire network. The management model of the Provider Service Network empowers local physician groups with information and education. To meet the managed care information needs of the network, we implemented an intranet-based executive information system, PSNWeb, which retrieves data from a managed care data warehouse. The project required the integration of diverse technologies and development of a complex security/confidentiality infrastructure to deliver information to 8 major clinician groups, each with different information needs.

Diagnostic reliability of M-mode echocardiography for detecting mitral valve prolapse in 50 consecutive panic patients.

Fifty consecutive panic patients had M-mode echocardiographs read independently by two cardiologists with expertise in echocardiography. In this prospective study, there was poor interrater reliability (22 of 50; K = 0.11) for diagnosis of mitral valve prolapse (MVP). On repeat evaluation 10 months later there was also unacceptable intrarater reliability for each reader: 22 of 35 (K = 0.41) and 22 of 35 (K = 0.45). We conclude that M-mode echocardiography is clinically unreliable for establishing the diagnosis of mitral valve prolapse. These findings suggest that the variable reporting of M-mode-determined mitral valve prolapse in psychiatric populations may reflect differences among echocardiologists rather than differences in cardiac pathology. The clinical implications of these findings are discussed.

Mitral valve prolapse and the anxiety disorders.

Confusing and contradictory results have emerged from studies of the relationship between anxiety disorders and mitral valve prolapse (MVP), a commonly occurring heart defect that has been associated with chest pain, palpitations, tachycardia, and arrhythmias. Patients with anxiety disorders, particularly panic attacks, appear to have an increased prevalence of MVP compared with control groups or the general population, although most individuals with MVP are asymptomatic. MVP does not appear to distinguish a subgroup of patients with panic disorder on the basis of vulnerability to panic attacks, symptom presentation, biological abnormalities, or treatment response. The authors review some current hypotheses about causal relationships between anxiety disorders and MVP, describe methods of diagnosing MVP and their shortcomings, and identify possible medical complications of MVP and ways to treat or prevent them.

Noninvasive detection of aortic insufficiency in patients with mitral stenosis by pulsed Doppler echocardiography.

In patients with mitral stenosis, routine noninvasive techniques are insensitive for the detection of coexistent aortic insufficiency. The ability of pulsed Doppler echocardiography to detect the presence or absence of angiographically demonstrated aortic insufficiency was evaluated in 45 patients with rheumatic mitral stenosis. Pulsed Doppler echocardiography correctly identified the presence of aortic insufficiency in 97% of the 35 patients with documented aortic regurgitation. More important, pulsed Doppler echocardiography disclosed aortic insufficiency in all 7 patients in whom it was not suspected on physical examination and in 28 of the 29 patients in whom it was not suspected by M-mode echocardiography. Pulsed Doppler echocardiography also demonstrated excellent specificity, correctly detecting the absence of aortic insufficiency in 9 of the 10 patients who had no angiographic evidence of aortic insufficiency. It is concluded that in patients with mitral stenosis, pulsed Doppler echocardiography is a useful noninvasive diagnostic test for evaluating the presence of aortic insufficiency, even when this lesion is not detectable by physical examination or M-mode echocardiography.

Effect of amiodarone on serum quinidine and procainamide levels.

Serum levels of quinidine or procainamide were measured in patients who had amiodarone added to their antiarrhythmic regimen. Dosages of quinidine or procainamide were held constant. Eleven of 11 patients had an increase in the serum quinidine level, and 11 of 12 other patients had an increase in the serum procainamide level. The dose requirement to maintain a stable plasma level of quinidine or procainamide decreased by 37% and 20%, respectively. Clinical toxicity occasionally occurred with the increase in serum levels of quinidine and procainamide, and the dose of these drugs should be decreased when amiodarone is administered concurrently.

Assessment of valvular heart disease by Doppler echocardiography.

Doppler echocardiography provides direct hemodynamic data that are often complementary to those demonstrated by M-mode and two-dimensional echocardiographic imaging. This relatively new noninvasive technique has a number of important uses in patients with valvular heart disease. In both adults and children, Doppler measures of peak flow velocity through a stenotic valve allow accurate prediction of the pressure gradient across the valve, and the technique has particular promise for screening patients with suspected aortic or pulmonic stenosis. In patients with mitral stenosis but parasternal short-axis images of limited quality, Doppler velocity measures can provide novel data about the pressure gradient and mitral orifice area. Doppler techniques can also provide direct evidence for or against the presence of valvular regurgitation, and several approaches allow clinically useful estimation of the extent of aortic, mitral, or tricuspid regurgitation. In patients with known disease of one cardiac valve, Doppler is accurate for evaluating the integrity of a second valve. Finally, Doppler techniques have great promise for defining the nature, and perhaps the severity, of suspected prosthetic valve malfunction. Hence, we believe that Doppler echocardiography should become a routine part of the noninvasive evaluation of patients with known or suspected valvular heart disease.