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The evolution of patients hospitalized with coronavirus disease 2019 (COVID-19) is still hard to predict, even after several months of dealing with the pandemic.To develop and validate a score to predict outcomes in patients hospitalized with COVID-19.All consecutive adults hospitalized for COVID-19 from February to April 2020 were included in a nationwide observational study. Primary composite outcome was transfer to an intensive care unit from an emergency department or conventional ward, or in-hospital death. A score that estimates the risk of experiencing the primary outcome was constructed from a derivation cohort using stacked LASSO (Least Absolute Shrinkage and Selection Operator), and was tested in a validation cohort.Among 2873 patients analysed (57.9% men; 66.6±17.0 years), the primary outcome occurred in 838 (29.2%) patients: 551 (19.2%) were transferred to an intensive care unit; and 287 (10.0%) died in-hospital without transfer to an intensive care unit. Using stacked LASSO, we identified 11 variables independently associated with the primary outcome in multivariable analysis in the derivation cohort (n=2313), including demographics (sex), triage vitals (body temperature, dyspnoea, respiratory rate, fraction of inspired oxygen, blood oxygen saturation) and biological variables (pH, platelets, C-reactive protein, aspartate aminotransferase, estimated glomerular filtration rate). The Critical COVID-19 France (CCF) risk score was then developed, and displayed accurate calibration and discrimination in the derivation cohort, with C-statistics of 0.78 (95% confidence interval 0.75-0.80). The CCF risk score performed significantly better (i.e. higher C-statistics) than the usual critical care risk scores.The CCF risk score was built using data collected routinely at hospital admission to predict outcomes in patients with COVID-19. This score holds promise to improve early triage of patients and allocation of healthcare resources.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to a public health crisis. Only limited data are available on the characteristics and outcomes of patients hospitalized for COVID-19 in France. Aims: To investigate the characteristics, cardiovascular complications and outcomes of patients hospitalized for COVID-19 in France. Methods: The Critical COVID-19 France (CCF) study is a French nationwide study including all consecutive adults with a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection hospitalized in 24 centres between 26 February and 20 April 2020. Patients admitted directly to intensive care were excluded. Clinical, biological and imaging parameters were systematically collected at hospital admission. The primary outcome was in-hospital death. Results: Of 2878 patients included (mean ± SD age 66.6 ± 17.0 years, 57.8% men), 360 (12.5%) died in the hospital setting, of which 7 (20.7%) were transferred to intensive care before death. The majority of patients had at least one (72.6%) or two (41.6%) cardiovascular risk factors, mostly hypertension (50.8%), obesity (30.3%), dyslipidaemia (28.0%) and diabetes (23.7%). In multivariable analysis, older age (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03−1.06; P < 0.001), male sex (HR 1.69, 95% CI 1.11−2.57; P = 0.01), diabetes (HR 1.72, 95% CI 1.12−2.63; P = 0.01), chronic kidney failure (HR 1.57, 95% CI 1.02−2.41; P = 0.04), elevated troponin (HR 1.66, 95% CI 1.11−2.49; P = 0.01), elevated B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide (HR 1.69, 95% CI 1.0004−2.86; P = 0.049) and quick Sequential Organ Failure Assessment score ≥ 2 (HR 1.71, 95% CI 1.12−2.60; P = 0.01) were independently associated with in-hospital death. Conclusions: In this large nationwide cohort of patients hospitalized for COVID-19 in France, cardiovascular comorbidities and risk factors were associated with a substantial morbi-mortality burden.

SignificanceSyllables are important building blocks of speech. They occur at a rate between 4 and 8 Hz, corresponding to the theta frequency range of neural activity in the cerebral cortex. When listening to speech, the theta activity becomes aligned to the syllabic rhythm, presumably aiding in parsing a speech signal into distinct syllables. However, this neural activity cannot only be influenced by sound, but also by somatosensory information. Here, we show that the presentation of vibrotactile signals at the syllabic rate can enhance the comprehension of speech in background noise. We further provide evidence that this multisensory enhancement of speech comprehension reflects the multisensory integration of auditory and tactile information in the auditory cortex.

Contemporary robotics gives us mechatronic capabilities for augmenting human bodies with extra limbs. However, how our motor control capabilities pose limits on such augmentation is an open question. We developed a Supernumerary Robotic 3rd Thumbs (SR3T) with two degrees-of-freedom controlled by the user’s body to endow them with an extra contralateral thumb on the hand. We demonstrate that a pianist can learn to play the piano with 11 fingers within an hour. We then evaluate 6 naïve and 6 experienced piano players in their prior motor coordination and their capability in piano playing with the robotic augmentation. We show that individuals’ augmented performance with the SR3T could be explained by our new custom motor coordination assessment, the Human Augmentation Motor Coordination Assessment (HAMCA) performed pre-augmentation. Our work demonstrates how supernumerary robotics can augment humans in skilled tasks and that individual differences in their augmentation capability are explainable by their individual motor coordination abilities.

Background Atrial fibrillation (AF) and heart failure (HF) often co-exist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We aimed to address the outcomes of patients hospitalized with HF and AF based on the chronology of the onset of the two disorders. Methods From the administrative database for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018, 956,086 of these AF patients developed HF first (prevalent HF), and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular (CV) death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity score-matched patients. Results During follow-up (mean follow-up 1.6 ± 1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs. 19.3%/year, hazard ratio (HR) 1.10, 95% CI 1.08–1.11), CV death (7.7 vs. 6.5%/year, HR 1.14, 95% CI 1.12–1.16) as well as re-hospitalization for HF (19.4 vs. 13.2%/year, HR 1.44, 95% CI 1.41–1.46) than those with incident HF. The risk for ischemic stroke was lower in prevalent HF than in incident HF (1.2 vs. 2.4%/year, HR 0.50, 95% CI 0.48–0.52). Conclusions We identified two distinct clinical entities: patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of re-hospitalization for HF.

Background. – Although women account for up to half of patients hospitalized for coronavirus disease 2019 (COVID-19), no specific data have been reported in this population. Aims. − To assess the burden and impact of cardiovascular comorbidities in women with COVID-19. Methods. − All consecutive patients hospitalized for COVID-19 across 24 hospitals from 26 February to 20 April 2020 were included. The primary composite outcome was transfer to an intensive care unit or in-hospital death. Results. − Among 2878 patients, 1212 (42.1%) were women. Women were older (68.3 ± 18.0 vs 65.4 ± 16.0 years; P < 0.001), but had less prevalent cardiovascular comorbidities than men. Among women, 276 (22.8%) experienced the primary outcome, including 161 (13.3%) transfers to an intensive care unit and 115 (9.5%) deaths without transfer to intensive care unit. The rate of in-hospital death or transfer to an intensive care unit was lower in women versus men (crude hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.53–0.72). Age (adjusted HR 1.05 per 5-year increase, 95% CI 1.01–1.10), body mass index (adjusted HR 1.06 per 2-unit increase, 95% CI 1.02–1.10), chronic kidney disease (adjusted HR 1.57, 95% CI 1.11–2.22) and heart failure (adjusted HR 1.52, 95% CI 1.04–2.22) were independently associated with the primary outcome in women. Elevated B-type natriuretic peptide/N-terminal prohormone of B-type natriuretic peptide (adjusted HR 2.41, 95% CI 1.70–3.44) and troponin (adjusted HR 2.00, 95% CI 1.39–2.88) concentrations at admission were also associated with the primary outcome, even in women free of previous coronary artery disease or heart failure. Conclusions. – Although female sex was associated with a lower risk of transfer to an intensive care unit or in-hospital death, COVID-19 remained associated with considerable morbimortality in women, especially in those with cardiovascular diseases.

Aims Although cardiac involvement has prognostic significance in coronavirus disease 2019 (COVID-19) and is associated with severe forms, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Methods and results Consecutive patients with COVID-19 admitted to 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Among 2878 patients, 445 (15%) underwent TTE. Most of these had cardiovascular risk factors, a history of cardiovascular disease, and were on cardiovascular treatments. Dilatation and dysfunction were observed in, respectively, 12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV). Primary composite outcome occurred in 44% (n = 196) of patients [9% (n = 42) for death without ICU transfer and 35% (n = 154) for admission to ICU]. RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex [hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.09 − 2.25; P = 0.02], higher body mass index (HR 1.10, 95% CI 1.02 − 1.18; P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86; P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64; P = 0.03) remained independently associated with the primary outcome. Conclusion Echocardiographic evaluation of RV dilatation could be useful for assessing risk of severe COVID-19 developing in hospitalized patients.

Background: To compare the clinical outcomes between patients with and without diabetes admitted to hospital with COVID-19.Methods: Retrospective multicentre cohort study from 24 academic tertiary medical centres in France including 2851 patients (675 with diabetes) hospitalised for COVID-19 between February 26 and April 20, 2020. A propensity score matching method (1:1 matching including patient characteristics, medical history, vital signs, and laboratory results) was used to compare patients with and without diabetes (n=603 in each group). The primary outcome was admission to intensive care unit (ICU) or in-hospital death. Results: Patients with diabetes were older (71 ± 13 vs. 65 ± 18 years; pConclusions: In this retrospective cohort of patients hospitalised for COVID-19, diabetes was not significantly associated with a higher risk of COVID-19 severe outcomes after propensity score matching.Trial registration NCT04344327

Background: Early identification of patients at risk for severe coronavirus disease 2019 (COVID-19) is a major issue to help clinicians optimise patient-flow management and allocation of healthcare resources. Methods: This retrospective, observational, multicentre study included all consecutive patients admitted to hospital with COVID-19 across 24 centres in France between February 26 and April 20, 2020. Comprehensive data, including clinical, biological, and imaging variables, were recorded at admission. The primary outcome was a composite of transfer to intensive care unit (ICU) or in-hospital death without transfer to ICU. Findings: Among 2878 patients (57·9% men, 67±17 years), the primary outcome occurred in 838 (29·3%) patients: 19·1% were transferred to ICU and 10·0% died in-hospital without transfer to ICU. Based on the derivation cohort (n=2105), 12 variables were independently associated with the primary outcome in the final model: demographics (age, sex), triage vitals (body temperature, Glasgow coma scale, dyspnoea, respiratory frequency, fraction of inspired oxygen), biological (platelets, C-reactive protein, aspartate aminotransferase, glomerular filtration rate), and imaging (degree of scanographic lesions) data. A risk-stratification score was developed that displayed accurate calibration and discrimination, with C-statistics of 0·80 (95% confidence interval 0·78 to 0·82) in the derivation cohort and 0·79 (95% confidence interval 0·75 to 0·83) in validation cohort. Interpretation: Using data from a multicentre series of patients with COVID-19, we identified independent predictors of severe COVID-19 in hospitalised patients, including clinical, biological, and imaging variables at admission. An accurate integrative risk score was developed and externally validated to optimise early triage of patients. Trial Registration: NCT04344327 Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The CCF study was declared to and authorised by the French data protection committee (Commission Nationale Informatique et Liberte, CNIL, authorisation n°2207326v0), and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Background Our study aimed to compare the clinical outcomes of patients with and without diabetes admitted to hospital with COVID-19. Methods This retrospective multicentre cohort study comprised 24 tertiary medical centres in France, and included 2851 patients (675 with diabetes) hospitalized for COVID-19 between 26 February and 20 April 2020. A propensity score-matching (PSM) method (1:1 matching including patients’ characteristics, medical history, vital statistics and laboratory results) was used to compare patients with and without diabetes (n = 603 per group). The primary outcome was admission to an intensive care unit (ICU) and/or in-hospital death. Results After PSM, all baseline characteristics were well balanced between those with and without diabetes: mean age was 71.2 years; 61.8% were male; and mean BMI was 29 kg/m2. A history of cardiovascular, chronic kidney and chronic obstructive pulmonary diseases were found in 32.8%, 22.1% and 6.4% of participants, respectively. The risk of experiencing the primary outcome was similar in patients with or without diabetes [hazard ratio (HR): 1.16, 95% confidence interval (CI): 0.95–1.41; P = 0.14], and was 1.29 (95% CI: 0.97–1.69) for in-hospital death, 1.26 (95% CI: 0.9–1.72) for death with no transfer to an ICU and 1.14 (95% CI: 0.88–1.47) with transfer to an ICU. Conclusion In this retrospective study cohort of patients hospitalized for COVID-19, diabetes was not significantly associated with a higher risk of severe outcomes after PSM. Trial registration number NCT04344327.

Wearable robotics bring the opportunity to augment human capability and performance, be it through prosthetics, exoskeletons, or supernumerary robotic limbs. The latter concept allows enhancing human performance and assisting them in daily tasks. An important research question is, however, whether the use of such devices can lead to their eventual cognitive embodiment, allowing the user to adapt to them and use them seamlessly as any other limb of their own. This paper describes the creation of a platform to investigate this. Our supernumerary robotic 3rd thumb was created to augment piano playing, allowing a pianist to press piano keys beyond their natural hand-span; thus leading to functional augmentation of their skills and the technical feasibility to play with 11 fingers. The robotic finger employs sensors, motors, and a human interfacing algorithm to control its movement in real-time. A proof of concept validation experiment has been conducted to show the effectiveness of the robotic finger in playing musical pieces on a grand piano, showing that naive users were able to use it for 11 finger play within a few hours., Comment: 6 pages, accepted to be published at IEEE BioRob 2018

The Aniketos Secure Composition Framework supports the specification of secure and trustworthy composition plans in term of BPMN. The diversity of security and trust properties that is supported by the Aniketos framework allows, on the one hand, for expressing a large number of security and compliance requirements. On the other hand, the resulting expressiveness results in the risk that high-level compliance requirements (e.g., separation of duty) are not implemented by low-level security means (e.g., role-based access control configurations).

Modern enterprise systems are often process-based, i.e., they allow for the direct execution of business processes that are specified in a high-level language such as BPMN. In this paper, we present a service, called Security Validation as a Service (SVaaS) for validating the compliance of the business processes during design-time. Basically, while modeling a business process the business analyst specifies as well the security and compliance requirements the business process should comply to. By pressing a button, these requirements are validated and the results are presented in a graphical format to the business analysis. At the core of SVaaS lies a rigorous and industrially viable approach in which the security validation business logic is handled server-side (SVaaS Server) in the Cloud, while the client-side user interface that business analysts use is handled by a light-weight SVaaS Connector. As proof-of-concept we created a SVaaS prototype in which the SVaaS Server is deployed on the SAP NetWeaver Cloud and two SVaaS Connectors are built to enable two well-known BPMN tools, SAP NetWeaver BPM and Activiti, to consume SVaaS against industrial relevant business processes.