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The clinical outcome of SARS-CoV-2 infection varies widely between individuals. Machine learning models can support decision making in healthcare by assessing fatality risk in patients that do not yet show severe signs of COVID-19. Most predictive models rely on static demographic features and clinical values obtained upon hospitalization. However, time-dependent biomarkers associated with COVID-19 severity, such as antibody titers, can substantially contribute to the development of more accurate outcome models. Here we show that models trained on immune biomarkers, longitudinally monitored throughout hospitalization, predicted mortality and were more accurate than models based on demographic and clinical data upon hospital admission. Our best-performing predictive models were based on the temporal analysis of anti-SARS-CoV-2 Spike IgG titers, white blood cell (WBC), neutrophil and lymphocyte counts. These biomarkers, together with C-reactive protein and blood urea nitrogen levels, were found to correlate with severity of disease and mortality in a time-dependent manner. Shapley additive explanations of our model revealed the higher predictive value of day post-symptom onset (PSO) as hospitalization progresses and showed how immune biomarkers contribute to predict mortality. In sum, we demonstrate that the kinetics of immune biomarkers can inform clinical models to serve as a powerful monitoring tool for predicting fatality risk in hospitalized COVID-19 patients, underscoring the importance of contextualizing clinical parameters according to their time post-symptom onset.

Background Women's self-help groups (SHGs) have become one of the largest institutional platforms serving the poor. Nutrition behavior change communication (BCC) interventions delivered through SHGs may improve maternal and child nutrition outcomes. Objective To understand the effects of a nutrition BCC intervention delivered through SHGs in rural India on intermediate outcomes and nutrition outcomes. Methods We compared 16 matched blocks where communities were supported to form SHGs and improve livelihoods; 8 blocks received a 3-year nutrition intensive (NI) intervention with nutrition BCC, agriculture- and rights-based information, facilitated by a trained female volunteer; another 8 blocks received standard activities (STD) to support savings/livelihoods. Repeated cross-sectional surveys of mother-child pairs were conducted in 2017-18 (n = 1609 pairs) and 2019-20 (n = 1841 pairs). We matched treatment groups over time and applied difference-in-difference regression models to estimate impacts on intermediate outcomes (knowledge, income, agriculture/livelihoods, rights, empowerment) and nutrition outcomes (child feeding, woman's diet, woman and child anthropometry). Analyses were repeated on households with at least one SHG member. Results 40% of women were SHG members and 50% were from households with at least one SHG member. Only 10% of women in NI blocks had heard of intervention content at endline. Knowledge improved in both NI and STD groups. There was a positive NI impact on knowledge of timely introduction of animal sourced foods to children (p<0.05) but not on other intermediate outcomes. No impacts were observed for anthropometry or diet indicators except child animal source food consumption (p<0.01). In households with at least one SHG member, there was a positive NI impact on child unhealthy food consumption (p<0.05). Conclusions Limited impacts may be due to limited exposure or skills of volunteers, and a concurrent national nutrition campaign. Our findings add to a growing literature on SHG-based BCC interventions and the conditions necessary for their success.

Context: Salivary pH is a fair indicator of health for extracellular fluids and their alkaline mineral reserves. Similarly, tongue pH is indicative of the existing flora and conditions of the tongue. Objectives: The purpose of the study was to evaluate effectiveness and acceptability of aqueous cinnamon extract mouthrinse in maintaining salivary and tongue coating pH as compared to 0.2% chlorhexidine mouthwash. Setting and Design: A randomized, parallel-group study was conducted among 70 volunteer subjects, who were randomly assigned to two groups of 35 each (20% aqueous cinnamon extract and 0.2% chlorhexidine mouthwash). Materials and Methods: Salivary pH was measured by a digital pH meter, while tongue pH was assessed using color changing pH strips. Participants were asked to rinse with the respective mouthwash (10 ml for 1 minute) and expectorate. Salivary and tongue pH were recorded 5 and 30 minutes after rinsing. Participants were instructed to use the mouthwash twice a day in the prescribed manner. The same procedure was repeated on third and seventh day. Responses to a questionnaire related to taste acceptability were collected on the last day. Data were analyzed statistically using repeated measure analysis of variance and Student's t-test. Results: Mean salivary pH values showed significant increase throughout the duration of the study after rinsing with both cinnamon and chlorhexidine mouthwashes (p<0.05). Tongue coating pH showed an increase toward alkalinity in both the groups, but this difference was statistically significant only in the cinnamon extract group 30 minutes after rinsing and on third day. Both agents performed equally well and were equally accepted; there was no statistically significant difference between the two groups. Conclusion: Traditional herbal products such as cinnamon can able to regulate the salivary and tongue coating pH as well as standard chlorhexidine mouthwash.

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