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Isolation of patients in psychiatric hospitals in the context of the COVID-19 pandemic: An ethical, legal, and practical challenge

Psychiatric inpatients are particularly vulnerable to the transmission and effects of COVID-19. As such, healthcare providers should implement measures to prevent its spread within mental health units, including adequate testing, cohorting, and in some cases, the isolation of patients. Respiratory isolation imposes a significant limitation on an individual's right to liberty, and should be accompanied by appropriate legal safeguards. This paper explores the implications of respiratory isolation in English law, considering the applicability of the common law doctrine of necessity, the Mental Capacity Act 2005, the Mental Health Act 1983, and public health legislation. We then interrogate the practicality of currently available approaches by applying them to a series of hypothetical cases. There are currently no 'neat' or practicable solutions to the problem of lawfully isolating patients on mental health units, and we discuss the myriad issues with both mental health and public health law approaches to the problem. We conclude by making some suggestions to policymakers.

Overweight/obesity as the potentially most important lifestyle factor associated with signs of pneumonia in COVID-19

OBJECTIVE: The occurrence of pneumonia separates severe cases of COVID-19 from the majority of cases with mild disease. However, the factors determining whether or not pneumonia develops remain to be fully uncovered. We therefore explored the associations of several lifestyle factors with signs of pneumonia in COVID-19. METHODS: Between May and July 2020, we conducted an online survey of 201 adults in Germany who had recently gone through COVID-19, predominantly as outpatients. Of these, 165 had a PCR-based diagnosis and 36 had a retrospective diagnosis by antibody testing. The survey covered demographic information, eight lifestyle factors, comorbidities and medication use. We defined the main outcome as the presence vs. the absence of signs of pneumonia, represented by dyspnea, the requirement for oxygen therapy or intubation. RESULTS: Signs of pneumonia occurred in 39 of the 165 individuals with a PCR-based diagnosis of COVID-19 (23.6%). Among the lifestyle factors examined, only overweight/obesity was associated with signs of pneumonia (odds ratio 2.68 (1.29-5.59) p = 0.008). The observed association remained significant after multivariate adjustment, with BMI as a metric variable, and also after including the antibody-positive individuals into the analysis. CONCLUSIONS: This exploratory study finds an association of overweight/obesity with signs of pneumonia in COVID-19. This finding suggests that a signal proportional to body fat mass, such as the hormone leptin, impairs the body's ability to clear SARS-CoV-2 before pneumonia develops. This hypothesis concurs with previous work and should be investigated further to possibly reduce the proportion of severe cases of COVID-19.

Immunoradiotherapy as An Effective Therapeutic Strategy in Lung Cancer: From Palliative Care to Curative Intent

Lung cancer is one of the main causes of cancer-related mortality worldwide. Over the years, different therapeutic modalities have been adopted depending on tumor stage and patient characteristics, such as surgery, radiotherapy (RT), and chemotherapy. Recently, with the development of immune-checkpoint inhibitors (ICI), the treatment of metastatic and locally advanced non-small cell lung cancer (NSCLC) has experienced a revolution that has resulted in a significant improvement in overall survival with an enhanced toxicity profile. Despite this paradigm shift, most patients present some kind of resistance to ICI. In this setting, current research is shifting towards the integration of multiple therapies, with RT and ICI being one of the most promising based on the potential immunostimulatory synergy of this combination. This review gives an overview of the evolution and current state of the combination of RT and ICI and provides evidence-based data that can improve patient selection. The combination in lung cancer is a safe therapeutic approach that improves local control and progression-free survival, and it has the potential to unleash abscopal responses. Additionally, this treatment strategy seems to be able to re-sensitize select patients that have reached a state of resistance to ICI, further enabling the continuation of systemic therapy.

Impact of the covid-19 pandemic upon the ophthalmological clinical practice

Introduction. With more than 1,000,000 infections around the world, SARS-Cov 2 is responsible for the most severe healthcare crisis in the last 100 years. Aim. The paper analyzes the impact of COVID 19 pandemic upon the current ophthalmological clinical activity. Materials and Method. A comparative analyses was carried regarding the clinical activity in March 2019 and March 2020: the number of one day hospitalizations, of continuous hospitalizations, the percentage of emergencies, the number of surgeries, bed turn over, mean hospital stay. The protocols for the health care personnel protection and decontamination were analyzed. Results. During March 2019, 381 patients were treated in the day hospitalization and 297 patients in the continuous hospitalization regime, with an average length of hospitalization of 3.2 days, and a bed turnover of 6.05. Of these, 76.43% underwent ophthalmic surgery and 14.1% represented ophthalmological emergencies. The comparative analysis shows that in March 2020, the number of one day hospitalizations decreased by 87.4%, and that of the hospitalizations continued with 89.2%. Of the patients admitted, 46.8% were in emergency. Clinical ophthalmological practice has been deeply changed in the context of the COVID 19 pandemic in order to prevent contamination both for patients and medical personnel. Conclusions. The ocular manifestations associated to SARS-Cov 2 infection are self-limited, but the possibility of infection due to the presence of the virus at the level of the tear secretion is an aspect that we must consider in the ophthalmological clinical practice.

Improving Baseline Subtraction for Increased Sensitivity of Quantitative PCR Measurements

Motivated by the current COVID-19 health-crisis, we examine the task of baseline subtraction for quantitative polymerase chain-reaction (qPCR) measurements. In particular, we present an algorithm that leverages information obtained from non-template and/or DNA extraction-control experiments to remove systematic bias from amplification curves. We recast this problem in terms of mathematical optimization, i.e. by finding the amount of control signal that, when subtracted from an amplification curve, minimizes background noise. We demonstrate that this approach can yield a decade improvement in sensitivity relative to standard approaches, especially for data exhibiting late-cycle amplification. Critically, this increased sensitivity and accuracy promises more effective screening of viral DNA and a reduction in the rate of false-negatives in diagnostic settings.

Psychometric Assessment of Morbid Fear of COVID-19 and Its Homoeopathic Management—A Treatment Perspective through Case Reports

Fear of an infection is posing a major threat in the current coronavirus disease 2019 (COVID-19) crisis Although nothing novel but still when we see historically over the times, fear of infection in any pandemic crisis remains the same even after the advent of modern medical advancements This morbid fear of risk of infection has more traumatic effect psychologically than reality of succumbing to an infection and its recovery Nevertheless, the cause of the fear and its management is very important in this COVID-19 crisis situation Homoeopathy system of medicine offers a safe, palatable, economical and an eco-friendly management solution to tackle this morbid fear Homoeopathy is being used by the public since a very long time and people continue to experience its overall health benefits with utmost trust and diligence Two cases of morbid fear of COVID-19 infection treated homoeopathically with positive outcome are presented here

CT and FDG-PET radiologic biomarkers in p16+ oropharyngeal squamous cell carcinoma patients treated with definitive chemoradiotherapy

PURPOSE: To assess associations between imaging biomarkers from standard of care pre-treatment CT and FDG-PET scans and loco-regional (LR) and distant metastatic (DM) recurrences in patients with p16+ oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive chemoradiotherapy (CRT). METHODS: An institutional database from a single NCI-designated cancer center identified 266 patients with p16+ OPSCC treated with definitive CRT in our department from 2005-2016 with evaluable pre-treatment FDG-PET scans. Quantitative SUV metrics and qualitative imaging metrics were determined from FDG-PET and CT scans, while clinical characteristics were abstracted from the medical record. Associations between clinical/imaging features and time to LR (TTLRF) or DM (TTDMF) failure and overall survival (OS) were assessed using univariable Cox regression and penalized stepwise regression for multivariable analyses (MVA). RESULTS: There were 27 LR and 32 DM recurrences as incident failures. Imaging biomarkers were significantly associated with TTLRF, TTDMF and OS. FDG-PET metrics outperformed CT and clinical metrics for TTLRF, with metabolic tumor volume being the only significant feature selected on MVA: C-index=0.68 (p=0.01). Radiographic extranodal extension (rENE), positive retropharyngeal nodes (RPN+), and clinical stage were significant on MVA for TTDMF: C-index=0.84 (p<0.001). rENE, group stage, and RPN+ were significant on MVA for OS: C-index=0.77 (p<0.001). CONCLUSIONS: In the largest study to date of uniformly treated patients with CRT to evaluate both pretreatment CT and FDG-PET, radiographic biomarkers were significantly associated with TTLRF, TTDMF and OS among patients with p16+ OPSCC treated with CRT. CT metrics performed best to predict TTDMF, while FDG-PET metrics showed improved prediction for LRRFS. These metrics may help identify candidates for treatment intensification or de-escalation of therapy. STATEMENT OF TRANSLATIONAL RELEVANCE: Pre-treatment imaging features from standard-of-care PET/CT imaging show promise for predicting long-term outcomes following HPV-associated oropharynx cancer (HPV-OPC) therapy. This study comprehensively characterizes qualitative and quantitative pre-treatment imaging metrics associated with time to pattern-specific failure in a cohort of 266 patients treated uniformly with definitive chemoradiation. Multivariate analysis (MVA) for time to loco-regional failure (TTLRF), time to distant metastatic failure (TTDMF), and overall survival (OS) was performed. FDG-PET metrics outperformed CT and clinical metrics for TTLRF. CT radiographic extranodal extension, positive retropharyngeal nodes, and stage strongly predicted TTDMF (combined C-index=0.84, log rank p<0.001). Number of smoking pack-years complemented clinical and imaging features only in patients without radiographic extranodal extension or positive retropharyngeal nodes. Time to pattern-specific failure is important for guiding treatment de-escalation strategies, which intend to reduce treatment-related toxicity in patients with relatively long expected survival times. This study suggests that PET/CT features should play a crucial role in future de-escalation trials and management of HPV-OPC patients.

The Dandelion Fruit Sign: A CT Sign to Diagnose Novel Coronavirus Pneumonia./ 蒲公英果实征:一种诊断新型冠状病毒肺炎的CT征象

Objective To explore the diagnostic value of “The Dandelion Fruit sign” on chest CT in Novel Coronavirus Pneumonia (NCP) Methods A retrospective analysis was performed on the data of 119 cases who underwent chest HRCT examinations from the fever and infection department during January 24 to February 10, 2020 in Sanshui District People's Hospital of Foshan City Excluding cases with no abnormality on chest CT, 23 cases were diagnosed as pneumonia, including 9 cases of NCP and 14 cases of other types of pneumonia The CT signs and lesions of each type of pneumonia were analyzed and compared、“Dandelion Fruit sign” Results Among the 23 cases of pneumonia, 9 (39 1%) cases with common or severe NCP, with epidemiological history and corresponding respiratory symptoms；7 cases showed multiple lesions and bilateral distribution, mainly in the lung field and subpleural area, showing patchy, lumpy, and umbrella- shaped ground glass shadows, often accompanied by pulmonary vascular thickening and increased micro vessels, interlobular septal thickening and fibrosis, lined with grid-like and small-bubble-like "crazy-paving pattern signs" "Dandelion Fruit sign" was found in 9 cases with NCP, with a total of 46 lesions (60 5%, 76 total lesions), presenting as "Dandelion Fruit Clew-like sign" (9 lesions) and "Dandelion Seed sign" (37 lesions) The above signs did not appear in 14 patients with other types of pneumonia Conclusion The Dandelion Fruit sign is common and characteristic sign of NCP, which can help distinguish NCP from other types of pneumonia

Eating disorders in times of the COVID-19 pandemic-Results from an online survey of patients with anorexia nervosa

OBJECTIVE: The COVID-19 pandemic and the resulting public restrictions pose a psychological burden for humans worldwide and may be particularly detrimental for individuals with mental disorders. Therefore, the current study explored effects of the COVID-19 pandemic on eating disorder (ED) symptoms and other psychological aspects in former inpatients with anorexia nervosa (AN). METHOD: One-hundred and fifty-nine patients with AN-discharged from inpatient treatment in 2019-completed an online survey on contact history with COVID-19, changes in ED symptoms and other psychological aspects, health care utilization, and strategies patients employed to cope during the pandemic. RESULTS: Approximately 70% of patients reported that eating, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness increased during the pandemic. Access to in-person psychotherapies and visits at the general practitioner (including weight checks) decreased by 37% and 46%, respectively. Videoconference therapy was used by 26% and telephone contacts by 35% of patients. Patients experienced daily routines, day planning and enjoyable activities as the most helpful among the most used coping strategies. DISCUSSION: The COVID-19 pandemic poses great challenges to patients with AN. ED-related thoughts and behaviors may be used as dysfunctional coping mechanisms to regain control over the current circumstances. E-mental health interventions appear to be promising for supporting AN patients during these hard times. Furthermore, interventions addressing symptoms of depression and anxiety, as well as intolerance of uncertainty might help them manage their ED symptoms.

User roles for emergency management in social media: Understanding actors' behavior during the 2018 Majorca Island flash floods

Social media assemble multiple users' interactions across singular events. Authorities need to navigate this diversity to effectively communicate and promote collaborative strategies. During emergency situations, discerning “who is there” is even more important for authorities, as this tracing process can save lives reaching the appropriate targets. This article contributes to this problem during emergency situations by proposing a user role taxonomy. We argue that focusing on functional behaviors could bypass the complexity of defining audiences during critical events. We test our framework using data from the 2018 flash floods in Sant Llorenç, Majorca island (Spain). Results show a diverse set of audience roles that emerge during crisis and post-crisis stages. We also identify the inclination of actors to represent certain roles and not others. Our findings contribute to understand crisis development models, and also crisis coordination configurations, such as the four-channel model or the network coordination perspective. Practical implications for public managers vary from improving coordination to influence audience's behavior during crises.

Update on therapeutic approaches and emerging therapies for SARS-CoV-2 virus

The global pandemic of coronavirus disease 2019 (COVID-19), caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in over 7,273,958 cases with almost over 413,372 deaths worldwide as per the WHO situational report 143 on COVID-19. There are no known treatment regimens with proven efficacy and vaccines thus far, posing an unprecedented challenge to identify effective drugs and vaccines for prevention and treatment. The urgency for its prevention and cure has resulted in an increased number of proposed treatment options. The high rate and volume of emerging clinical trials on therapies for COVID-19 need to be compared and evaluated to provide scientific evidence for effective medical options. Other emerging non-conventional drug discovery techniques such as bioinformatics and cheminformatics, structure-based drug design, network-based methods for prediction of drug-target interactions, artificial intelligence (AI) and machine learning (ML) and phage technique could provide alternative routes to discovering potent Anti-SARS-CoV2 drugs. While drugs are being repurposed and discovered for COVID-19, novel drug delivery systems will be paramount for efficient delivery and avoidance of possible drug resistance. This review describes the proposed drug targets for therapy, and outcomes of clinical trials that have been reported. It also identifies the adopted treatment modalities that are showing promise, and those that have failed as drug candidates. It further highlights various emerging therapies and future strategies for the treatment of COVID-19 and delivery of Anti-SARS-CoV2 drugs.

Retrofitting an environmental monitor with a silicon photomultiplier sensor

We report on the retrofitting of a standard DP2 environmental radiation monitor replacing the photomultiplier tube with a silicon photomultiplier (SiPM). The use of a SiPM has several advantages for a hand-held radiation monitor, including convenient low voltage operation and physical robustness. The SiPM is used to replace the existing photomultiplier tube, and we report the detection efficiency and alpha/beta discrimination performance of the modified probe compared to an unmodified version.

Unreported Cases for Age Dependent COVID-19 Outbreak in Japan

We investigate the age structured data for the COVID-19 outbreak in Japan. We consider a mathematical model for the epidemic with unreported infectious patient with and without age structure. In particular, we build a new mathematical model and a new computational method to fit the data by using age classes dependent exponential growth at the early stage of the epidemic. This allows to take into account differences in the response of patients to the disease according to their age. This model also allows for a heterogeneous response of the population to the social distancing measures taken by the local government. We fit this model to the observed data and obtain a snapshot of the effective transmissions occurring inside the population at different times, which indicates where and among whom the disease propagates after the start of public mitigation measures.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians' awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

An early estimation of the number of affected people in South Asia due to Covid-19 pandemic using susceptible, infected and recover model

The Susceptible, Infected and Recover (SIR) model is a very simple model to estimate the dynamics of an epidemic In the current pandemic due to Covid-19, the SIR model has been used to estimate the dynamics of infection for Bangladesh, India, Pakistan and compared with that of China Numerical solutions are used to obtain the value of parameters for the SIR model It is predicted that the active case in Pakistan due to the SARS-CoV-2 will be comparable with that in China whereas it will be low for Bangladesh and India The basic reproduction number, with fluctuations, for South Asian countries are predicted to be less than that of China The susceptible population is also estimated to be under a million for Bangladesh and India but it becomes very large for Pakistan © 2020 World Scientific Publishing Company

Association entre la frequence de consultation des medias d'information et la detresse psychologique chez les femmes enceintes durant la pandemie de COVID-19: Association between news media consulting frequency and psychological distress in pregnant women during the COVID-19 pandemic

OBJECTIVE: Examine the association between news media use frequency during the COVID-19 pandemic and the scale of psychological distress in pregnant women, considering this distress known harmful effects on the fetus development METHOD: Pregnant women living in Quebec province (N = 1014) have been recruited in April 2020 through social media, while a state of health emergency was declared Participants were divided in 4 groups, according to self-reported frequency of news media consulting (little or none;one time a day;several times a day;constant) They filled measures of depressive symptoms, negative affects, post-traumatic stress symptoms and anxiety specific to COVID-19 Instrument scores were grouped under a unique factor of psychological distress RESULTS: An ANCOVA controlling for age, gestational age, education level, household annual revenue and a diagnosed mental disorder present at the time of participation in study shows that news media exposure frequency is significantly associated with psychological distress severity in pregnant women, during COVID-19 pandemic, F(3,998) = 27 02, p &lt; 0 001, eta2 partial = 0 08 Given the mean comparisons a posteriori, higher psychological distress rates are found as soon as news media exposure exceeds once a day (effect sizes between 0 38 and 0 81) CONCLUSIONS: The more pregnant women report consulting the news media during the COVID-19 pandemic, the more likely they are to exhibit psychological distress Results provide one of the first empirical supports to recommendations of World Health Organization, Canada government and psychiatric associations that encourage population to limit their news media consulting during the COVID-19 pandemic

Association entre la fréquence de consultation des médias d’information et la détresse psychologique chez les femmes enceintes durant la pandémie de COVID-19: Association between news media consulting frequency and psychological distress in pregnant women during the COVID-19 pandemic

OBJECTIVE: Examine the association between news media use frequency during the COVID-19 pandemic and the scale of psychological distress in pregnant women, considering this distress known harmful effects on the fetus development METHOD: Pregnant women living in Quebec province (N = 1014) have been recruited in April 2020 through social media, while a state of health emergency was declared Participants were divided in 4 groups, according to self-reported frequency of news media consulting (little or none;one time a day;several times a day;constant) They filled measures of depressive symptoms, negative affects, post-traumatic stress symptoms and anxiety specific to COVID-19 Instrument scores were grouped under a unique factor of psychological distress RESULTS: An ANCOVA controlling for age, gestational age, education level, household annual revenue and a diagnosed mental disorder present at the time of participation in study shows that news media exposure frequency is significantly associated with psychological distress severity in pregnant women, during COVID-19 pandemic, F(3,998) = 27 02, p &lt; 0 001, η2 partial = 0 08 Given the mean comparisons a posteriori, higher psychological distress rates are found as soon as news media exposure exceeds once a day (effect sizes between 0 38 and 0 81) CONCLUSIONS: The more pregnant women report consulting the news media during the COVID-19 pandemic, the more likely they are to exhibit psychological distress Results provide one of the first empirical supports to recommendations of World Health Organization, Canada government and psychiatric associations that encourage population to limit their news media consulting during the COVID-19 pandemic

Prolonged SARS-CoV-2 shedding and mild course of COVID-19 in a patient after recent heart transplantation

In the coronavirus disease 2019 (COVID-19) pandemic, organ transplant recipients are considered to be at high risk for an unfavorable outcome. However, in particular the role of immunosuppression in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains undetermined. Here, we present a 62-year-old male COVID-19 patient with recent heart transplantation who developed only mild symptoms, but had prolonged virus shedding, and summarize the available data on COVID-19 in cardiac allograft recipients. Initially the patient presented with a transient episode of fever and sore throat but no other symptoms, in particular no cough or dyspnea at rest. After diagnosis, immunosuppression was continued unchanged. On day 7, his temperature increased again with concurrent mild rise of C-reactive protein, IL-6, and pro-B-type natriuretic peptide levels. Hydroxychloroquine was started and continued for 7 days. While the patient no longer had clinical symptoms 20 days after initial presentation, virus culture of throat swabs on days 18 and 21 confirmed active virus replication and SARS-CoV-2 PCR remained positive on day 35 with copy numbers similar to the onset of infection. In conclusion, the immunosuppression regimen in transplant recipients with mild COVID-19-associated symptoms may be continued unchanged. However, it may contribute to delayed virus polymerase chain reaction conversion and thus possible prolonged infectivity.

COVID-19 Transmission in Dental Practice: Brief Review of Preventive Measures in Italy

The outbreak and diffusion of SARS-CoV-2, responsible for the coronavirus disease (COVID-19), has caused an emergency in the health system worldwide. After a first development in Wuhan, China, the virus spread in other countries, with Italy registering the second highest number of cases in Europe on the 7th of April 2020 (135,586 in total). The World Health Organization declared the pandemic diffusion of COVID-19, and restrictive measures to limit contagion have been taken in several countries. The virus has a predominantly respiratory transmission through aerosol and droplets. The importance of infection control is therefore crucial in limiting the effects of virus diffusion. We aim to discuss the risks related to dental practice and current recommendations for dental practitioners. A literature search was performed to retrieve articles on the management of COVID-19 diffusion in dental practice. The documented clinical experience, the measures of professional prevention, and the actual Italian situation were reported and described. Four articles were retrieved from the literature search. Among the eligible articles, 3 reported measures to contrast COVID-19 diffusion. The infection management protocols suggested were reviewed. Finally, recommendations based on the Italian experience in terms of patient triage, patients' entrance into the practice, dental treatment, and after-treatment management are reported and discussed. COVID-19 is a major emergency worldwide, which should not be underestimated. Due to the rapidly evolving situation, further assessment of the implications of COVID-19 outbreak in dental practice is needed.

Delayed subclavian vein stent perforation causing adjacent arterial pseudoaneurysm formation in a patient with granulomatosis with polyangiitis

Stenting is necessary when vascular patency is not adequately achieved with angioplasty alone. Common causes of pseudoaneurysms are iatrogenic and traumatic. We describe a case of a perforated left subclavian vein Gianturco stent causing a pseudoaneurysm of the left common carotid artery in a patient with granulomatosis with polyangiitis, detected 8 years after stent insertion.

Prudent public health intervention strategies to control the coronavirus disease 2019 transmission in India: A mathematical model-based approach

Background & objectives: Coronavirus disease 2019 (COVID-19) has raised urgent questions about containment and mitigation, particularly in countries where the virus has not yet established human-to-human transmission. The objectives of this study were to find out if it was possible to prevent, or delay, the local outbreaks of COVID-19 through restrictions on travel from abroad and if the virus has already established in-country transmission, to what extent would its impact be mitigated through quarantine of symptomatic patients? Methods: These questions were addressed in the context of India, using simple mathematical models of infectious disease transmission. While there remained important uncertainties in the natural history of COVID-19, using hypothetical epidemic curves, some key findings were illustrated that appeared insensitive to model assumptions, as well as highlighting critical data gaps. Results: It was assumed that symptomatic quarantine would identify and quarantine 50 per cent of symptomatic individuals within three days of developing symptoms. In an optimistic scenario of the basic reproduction number (R0) being 1.5, and asymptomatic infections lacking any infectiousness, such measures would reduce the cumulative incidence by 62 per cent. In the pessimistic scenario of R0=4, and asymptomatic infections being half as infectious as symptomatic, this projected impact falls to two per cent. Interpretation & conclusions: Port-of-entry-based entry screening of travellers with suggestive clinical features and from COVID-19-affected countries, would achieve modest delays in the introduction of the virus into the community. Acting alone, however, such measures would be insufficient to delay the outbreak by weeks or longer. Once the virus establishes transmission within the community, quarantine of symptomatics may have a meaningful impact on disease burden. Model projections are subject to substantial uncertainty and can be further refined as more is understood about the natural history of infection of this novel virus. As a public health measure, health system and community preparedness would be critical to control any impending spread of COVID-19 in the country.

Supporting lives lived whilst protecting lives saved during COVID-19: The relational invariant in person-centred care

There has been an impressive development of nursing knowledge around the ethics, principles, frameworks, models and practices of person-centred care over the last 15 years, with colleagues from the Nordic countries making significant contributions to global knowledge across the discipline of nursing and beyond. A disciplinary challenge remains to map the variability in person-centred care with an aim to empirically clarify the invariant in person-centred care. Based on current research and practice, as well as the COVID-19 pandemic, this article argues that the relational aspect of person-centred care is such an invariant, building on the socially constructive notion of ‘personhood’ being a standing or status that is bestowed on one human being by another in the context of relationship and social being. During the current COVID-19 pandemic, several of the key determinants of person-centred care are under threat due to health service responses and/or infection control measures, such as keeping older adults safe, imposing relationship restrictions, social distancing and isolation (or the lack thereof). Clinical examples from an Australian health service are used to show how recognizing the relational invariant of person-centred aged care facilitated supporting lives lived whilst also protecting lives saved. The relational invariant to person-centred care is who we are, constructed or deconstructed by and with others; something that may have become more visible through the relational restrictions imposed due to COVID-19. Protecting relationality in life and care and advocating for both safe and person-centred care for those who need it most is now more important than ever.

Society of Robotic Surgery review: recommendations regarding the risk of COVID-19 transmission during minimally invasive surgery

OBJECTIVES: To determine the risk of COVID-19 transmission during minimally invasive surgical (MIS) procedures METHODS: Surgical society statements regarding the risk of COVID transmission during MIS procedures were reviewed. In addition, the available literature on COVID-19 and other viral transmission in CO2 pneumoperitoneum, as well as the presence of virus in the plume created by electrocautery during MIS was reviewed. The society recommendations were compared to the available literature on the topic to create our review and recommendations to mitigate COVID-19 transmission. RESULTS: The recommendations promulgated by various surgical societies evolved over time as more information became available on COVID-19 transmission. Review of the available literature on the presence of COVID-19 in CO2 pneumoperitoneum was inconclusive. There is no clear evidence of the presence of COVID-19 in plume created by electrocautery. Technologies to reduce CO2 pneumoperitoneum release into the operating room as well as filter viral particles are available and should reduce the exposure risk to operating room personnel. CONCLUSION: There is no clear evidence of COVID-19 virus in the CO2 used during MIS procedures or in the plume created by electrocautery. Until the presence or absence of COVID-19 viral particles has been clearly established, measures to mitigate CO2 and surgical cautery plume release into the operating room should be performed. Further study on the presence of COVID-19 in MIS pneumoperitoneum and cautery plume is needed.

Could It Be Pneumonia? Lung Ultrasound in Children With Low Clinical Suspicion for Pneumonia

Background: Community-acquired pneumonia (CAP) is a significant cause of pediatric morbidity and mortality worldwide. Emergency department point of care ultrasound (POCUS) is a first-line modality for diagnosis of CAP. The current coronavirus disease 2019 pandemic creates a unique opportunity to incorporate lung POCUS into the evaluation of a broader range of children. It has increased the utility of lung POCUS in both evaluation and follow-up of pediatric coronavirus cases. An increased use of lung POCUS creates an opportunity for earlier diagnosis while allowing the opportunity for overdiagnosis of small infiltrates and atelectasis. We collated a case series to demonstrate the benefit of lung POCUS in a very broad range of children. Methods: We collected a case series of 5 patients between December 2018 and December 2019 who presented nonclassically and were diagnosed with CAP on POCUS by a pediatric emergency physician. Conclusion: Routine lung POCUS in ill children will allow treating physicians to identify and follow a pulmonary infiltrate consistent with CAP quickly. We anticipate that early and more frequent use of POCUS and earlier diagnosis of CAP may improve outcomes by decreasing healthcare encounters within the same illness and by reducing the incidence of late sequelae of pneumonia such as empyema and effusions. However, we acknowledge that this may come at the expense of the overtreatment of viral infiltrates and atelectasis. Further study is required to improve the specificity of lung POCUS in the evaluation of CAP.

Strategies to maximize clinical efficiency while maintaining patient safety during the COVID-19 pandemic: an interview-based study from private practice dermatologists

BACKGROUND: Many dermatologists have experienced significant changes to their practices due to the COVID-19 pandemic. OBJECTIVE: It is vital to recognize how the pandemic has affected dermatology practices and identify methods to maximize clinical efficiency while maintaining patient safety. METHODS: Private practice dermatologists in metropolitan areas were interviewed regarding various issues, including patient volume, types of visits or procedures being performed, screening for COVID-19, and operational modifications. RESULTS: On average, there was a 65.2% decrease in patient volume during the initial surge of the COVID-19 outbreak, which was improved to a 15.5% decrease in July 2020. Despite this reduction in patient volume, the proportion of acute dermatologic issues, biopsies performed, and skin cancer concerns were all increased compared to pre-COVID. All of the dermatologists reported notable changes in regards to scheduling, staff, operations, and workplaces. LIMITATIONS: Interview participants were limited to metropolitan dermatologists mainly within the California region. CONCLUSION: Improving patient communication, implementing protocols to facilitate social distancing, and utilizing teledermatology were reported to be essential to optimizing efficiency and safety. As the COVID-19 pandemic continues to evolve, it is important that dermatologists identify specific ways to practice efficiently and effectively, while mitigating the spread of the virus.

Detecção simultânea de Coronavírus bovino e Rotavírus do grupo A em amostras fecais de bovinos utilizando uma multiplex hemi-nested RT-PCR/ Simultaneous detection of bovine Coronavirus and group A Rotavirus in bovine fecal samples by a multiplex semi-nested RT-PCR

O coronavírus bovino (BCoV) e rotavírus (RV) são importantes agentes da diarréia neonatal bovina, causando grandes perdas econômicas. O BCoV é também responsável pela disenteria de inverno em vacas adultas e por desordens respiratórias e o RV possui um aspecto zoonótico de importância na saúde pública. Este estudo teve o objetivo de desenvolver uma multiplex hemi-nested RT-PCR para detecção simultânea de BCoV e RV do grupo A com a utilização de um controle interno. Para tanto, foram desenhados três primers dirigidos ao gene N de BCoV (306pb) e três primers dirigidos ao gene VP1 do RV do grupo A (228pb); para o controle interno, foram utilizados dois primers dirigidos ao mRNA do gene mitocondrial bovino ND5 (191pb). Foram utilizados como controles positivos a amostra Kakegawa de BCoV (título HA de 256), a amostra 8209 de rotavírus do grupo A (título viral de 101.66TCID50%/200µL) e suspensão de células MDBK para o controle interno. A extração de RNA foi realizada com o reagente comercial TRIzol, de acordo com as recomendações do fabricante. Foram realizados gradientes de temperatura para a determinação da temperatura ótima de hibridação para cada par de primers, resultando em 50ºC para PCR e 55ºC para a hemi-nested. Doze protocolos com diferentes concentrações de Taq DNA polymerase, MgCl2, primers e DNA-alvo foram testados. Para determinação do limiar de detecção, o protocolo final foi utilizado em diluições dos dois vírus em suspensão de amostras fecais negativas para BCoV e RV adicionadas de 10% de suspensão de células MDBK, obtendo o limiar de detecção de 10-8 para os dois vírus e aplicado em amostras fecais de bezerros (53) e vacas adultas (22). Todas as amostras foram previamente testadas para BCoV por uma nested RT-PCR dirigida ao gene RdPd, sendo 15 positivas, e para rotavírus pela PAGE, sendo 3 positivas. Para a multiplex, 15 amostras foram positivas para BCoV e 6 para rotavírus. O seqüenciamento de DNA das amostras positivas para multiplex demonstrou a especificidade do teste. Uma concordância ótima foi encontrada para BCoV (0,833) e substancial para rotavírus (0,648) calculada pela estatística kappa, comparando-se com os testes de referência. Estes resultados demonstram que a padronização da multiplex foi eficiente para a detecção de BCoV e RV, com elevadas sensibilidade e especificidade. Além disso, o diagnóstico simultâneo dos dois agentes permite um diagnóstico rápido e a um menor custo devido à utilização de reduzidas quantidades de reagentes e mão de obra, fornecendo uma importante ferramenta para o diagnóstico e estudo da etiologia da diarréia em bovinos

Development and suggestion of China HACCP in the new era

Under the background of novel coronavirus pneumonia, food safety risk has aroused the close attention from consumers again The food industry is facing many challenges Consumers put forward higher requirements for the food industry in strengthening food safety management, preventing food safety risks and improving the ability of sanitation and cleaning Hazard Analysis and Critical Control Point (HACCP), as a prevention system to control food safety in the food production process, can effectively reduce the risk of food safety and is widely used in the world This paper summarized the development and application of HACCP system in China, and the acceptance and international mutual recognition of government departments to promote the modernization of national governance system and governance capacity, analyzed the problems existing in the application of HACCP system in Chinese food production enterprises, and put forward the development suggestions of HACCP system based on the actual situation

Circulating plasma factors involved in rejuvenation

Aging is defined as a time-dependent functional decline that occurs in many physiological systems. This decline is the primary risk factor for prominent human pathologies such as cancer, metabolic disorders, cardiovascular disorders, and neurodegenerative diseases. Aging and age-related diseases have multiple causes. Parabiosis experiments, in which the circulatory systems of young and old mice were surgically joined, revealed that young plasma counteracts aging and rejuvenates organs in old mice, suggesting the existence of rejuvenating factors that become less abundant with aging. Diverse approaches have identified a large number of plasma proteins whose levels differ significantly between young and old mice, as well as numerous rejuvenating factors that reverse aged-related impairments in multiple tissues. These observations suggest that increasing the levels of key rejuvenating factors could promote restorative biological processes or inhibit pathological degeneration. Inspired by such findings, several companies have begun selling "young blood transfusions," and others have tested young plasma as a treatment for Alzheimer's disease. Here, we summarize the current findings regarding rejuvenating factors.

Case report: Nutrition therapy and side-effects monitoring in critically ill coronavirus disease 2019 patients

An outbreak of pneumonia proved to be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), named Coronavirus Disease 2019 (COVID-19) by World Health Organization (WHO), has rapidly and widely spread to the whole world, affecting thousands of people COVID-19 patients have poor gastrointestinal function and microecological disorders, which lead to the frequent occurrence of aspiration pneumonia, gastric retention, and diarrhea In the meanwhile, it takes a certain period of time for nutrition therapy to reach the patient's physiological amount Refeeding syndrome and hypoglycemia may occur during this period, causing the high risk of death in critical patients Therefore, we reported the nutrition therapy and side-effects monitoring as well as the adjustment of the nutrition therapy of 2 critical COVID-19 patients, thus provide clinical evidence for nutrition therapy and prevention of the side effects

Beyond HIV infection: Neglected and varied impacts of CCR5 and CCR5Δ32 on viral diseases

The interactions between chemokine receptors and their ligands may affect susceptibility to infectious diseases as well as their clinical manifestations. These interactions mediate both the traffic of inflammatory cells and virus-associated immune responses. In the context of viral infections, the human C-C chemokine receptor type 5 (CCR5) receives great attention from the scientific community due to its role as an HIV-1 co-receptor. The genetic variant CCR5&#916;32 (32 base-pair deletion in CCR5 gene) impairs CCR5 expression on the cell surface and is associated with protection against HIV infection in homozygous individuals. Also, the genetic variant CCR5&#916;32 modifies the CCR5-mediated inflammatory responses in various conditions, such as inflammatory and infectious diseases. CCR5 antagonists mimic, at least in part, the natural effects of the CCR5&#916;32 in humans, which explains the growing interest in the potential benefits of using CCR5 modulators for the treatment of different diseases. Nevertheless, beyond HIV infection, understanding the effects of the CCR5&#916;32 variant in multiple viral infections is essential to shed light on the potential effects of the CCR5 modulators from a broader perspective. In this context, this review discusses the involvement of CCR5 and the effects of the CCR5&#916;32 in human infections caused by the following pathogens: West Nile virus, Influenza virus, Human papillomavirus, Hepatitis B virus, Hepatitis C virus, Poliovirus, Dengue virus, Human cytomegalovirus, Crimean-Congo hemorrhagic fever virus, Enterovirus, Japanese encephalitis virus, and Hantavirus. Subsequently, this review addresses the impacts of CCR5 gene editing and CCR5 modulation on health and viral diseases. Also, this article connects recent findings regarding extracellular vesicles (e.g., exosomes), viruses, and CCR5. Neglected and emerging topics in "CCR5 research" are briefly described, with focus on Rocio virus, Zika virus, Epstein-Barr virus, and Rhinovirus. Finally, the potential influence of CCR5 on the immune responses to coronaviruses is discussed.

Beyond HIV infection: Neglected and varied impacts of CCR5 and CCR5Δ32 on viral diseases

The interactions between chemokine receptors and their ligands may affect susceptibility to infectious diseases as well as their clinical manifestations. These interactions mediate both the traffic of inflammatory cells and virus-associated immune responses. In the context of viral infections, the human C-C chemokine receptor type 5 (CCR5) receives great attention from the scientific community due to its role as an HIV-1 co-receptor. The genetic variant CCR5&#916;32 (32 base-pair deletion in CCR5 gene) impairs CCR5 expression on the cell surface and is associated with protection against HIV infection in homozygous individuals. Also, the genetic variant CCR5&#916;32 modifies the CCR5-mediated inflammatory responses in various conditions, such as inflammatory and infectious diseases. CCR5 antagonists mimic, at least in part, the natural effects of the CCR5&#916;32 in humans, which explains the growing interest in the potential benefits of using CCR5 modulators for the treatment of different diseases. Nevertheless, beyond HIV infection, understanding the effects of the CCR5&#916;32 variant in multiple viral infections is essential to shed light on the potential effects of the CCR5 modulators from a broader perspective. In this context, this review discusses the involvement of CCR5 and the effects of the CCR5&#916;32 in human infections caused by the following pathogens: West Nile virus, Influenza virus, Human papillomavirus, Hepatitis B virus, Hepatitis C virus, Poliovirus, Dengue virus, Human cytomegalovirus, Crimean-Congo hemorrhagic fever virus, Enterovirus, Japanese encephalitis virus, and Hantavirus. Subsequently, this review addresses the impacts of CCR5 gene editing and CCR5 modulation on health and viral diseases. Also, this article connects recent findings regarding extracellular vesicles (e.g., exosomes), viruses, and CCR5. Neglected and emerging topics in "CCR5 research" are briefly described, with focus on Rocio virus, Zika virus, Epstein-Barr virus, and Rhinovirus. Finally, the potential influence of CCR5 on the immune responses to coronaviruses is discussed.

Calcaneal skeletal traction versus elastic intramedullary nailing of displaced tibial shaft fractures in children

BACKGROUND: The objective of this study was to compare the outcomes and complications of patients who underwent either the calcaneal skeletal traction (CST) or the elastic intramedullary nails (EIN) procedure. METHODS: We retrospectively reviewed data of patients who underwent EIN or CST surgery for tibia shaft fracture at our center from 2013 to 2018. The patient demographics, fracture characteristics, radiographic information, length of hospital stay, and medical expenses were recorded. All patients were clinically followed-up until they started to walk or for at least 6 months. The treatment outcomes and postoperative complications of the two procedures were compared. RESULTS: Overall, 186 patients who underwent EIN and CST were included in the study. The EIN patients had more low-energy mechanism of injury. In radiographic evaluation, significant differences were observed in distributions of fracture classification and location. Moreover, associated fibula fractures were higher in the EIN group than in the CST group. The CST procedure had faster surgical time, cast duration and lower expenses, and longer hospitalization time. Although they required more clinical visits, patients in the EIN group began exercising and endured weight-bearing earlier than those in the CST group. The average time for bone healing was 68.5 days in the EIN group, and 69.6 days in the CST group. However, the CST provided slight better results of coronal correction than EIN. Moreover, CST patients had less malalignment (> 5°) in complications. None had delay union, nonunion, and shortening over 10 mm at final assessment. CONCLUSIONS: Both EIN and CST patients showed similar treatment outcomes. Hence, not only the characteristics of the patient and fracture, but also the individual's situation and expectation should be considered when choosing the best approach.

Quality of sleep and health-related quality of life among health care professionals treating patients with coronavirus disease-19

BACKGROUND: Health care professionals exposed to coronavirus disease 2019 (COVID-19) are facing high levels of stress. AIM: The aim was to evaluate the quality of sleep (QoS) and health-related quality of life (HRQoL), among health care professionals treating patients with COVID-19, as well as quantifying the magnitude of symptoms of depression and levels of anxiety. METHODS: We included 201 health care professionals in a cross-sectional, web-based study by applying 7-item Generalized Anxiety Disorder (GAD-7) Scale, Zung Self-rating Depression Scale, 36-item Health Survey of the Medical Outcomes Study Short Form (SF36), Pittsburgh Sleep Quality Index (PSQI) and additional survey constructed for the purpose of the study. RESULTS: Health care workers who treated COVID-19 patients were more afraid of becoming infected or of transmitting the infection to a family member with a significantly low self-assessment of their mental status. Poor QoS and HRQoL correlated with high health anxiety and severe depressive symptoms and several demographic characteristics. Multiple linear regression analysis showed that higher scores on GAD-7 (beta = .71, p < .01) and lower scores on mental health (MH) subscale on SF36 questionnaire (beta = -.69; p < .01) were independent predictors of the higher PSQI score (adjusted R2 = .61, p < .01 for overall model). Higher scores on GAD-7 (beta = .68, p < .01) and worse self-perceived mental status (beta = .25; p < .05) were independent predictors of the lower SF36 scores (adjusted R2 = .73, p < .01 for overall model). CONCLUSION: The major MH burden of health care professionals treating infected patients during the COVID-19 pandemic indicates that they need psychological support.

Populism and health policy: three international case studies of right-wing populist policy frames

Over the past decade, some of the world's most stable parliamentary democracies have witnessed a revival in right-wing populist political parties, movements and leaders. Although there is a growing body of theoretical and empirical literature documenting the rise of populism, there has been very little exploration of the implications for health policy of this important political development. In this article, we draw from three illustrative international cases, originating from the USA, the UK and Italy, to explore the ways in which right-wing populism influences health policy: the election of President Trump in the United States (and subsequent healthcare reforms), the United Kingdom's vote to withdraw from the European Union (Brexit), and how this has played out in the context of the UK National Health Service, and the rise of a politically aligned anti-vaccination movement in Italy. Drawing on the work of the influential socio-political theorist Ernesto Laclau, we interpret populism as a performative political act, predicated on drawing logics of equivalence (and difference) between different actors. We use this theoretical framing to explore the ways in which the recent upsurge in right-wing populism creates a specific set of barriers and challenges for access to healthcare and the health of populations.

The ocular surface, coronaviruses and COVID-19

The ocular surface has been suggested as a site of infection with Coronavirus-2 (SARS-CoV-2) responsible for the coronavirus disease-19 (COVID-19). This review examines the evidence for this hypothesis, and its implications for clinical practice. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), responsible for the COVID-19 pandemic, is transmitted by person-to-person contact, via airborne droplets, or through contact with contaminated surfaces. SARS-CoV-2 binds to angiotensin converting enzyme-2 (ACE2) to facilitate infection in humans. This review sets out to evaluate evidence for the ocular surface as a route of infection. A literature search in this area was conducted on 15 April 2020 using the Scopus database. In total, 287 results were returned and reviewed. There is preliminary evidence for ACE2 expression on corneal and conjunctival cells, but most of the other receptors to which coronaviruses bind appear to be found under epithelia of the ocular surface. Evidence from animal studies is limited, with a single study suggesting viral particles on the eye can travel to the lung, resulting in very mild infection. Coronavirus infection is rarely associated with conjunctivitis, with occasional cases reported in patients with confirmed COVID-19, along with isolated cases of conjunctivitis as a presenting sign. Coronaviruses have been rarely isolated from tears or conjunctival swabs. The evidence suggests coronaviruses are unlikely to bind to ocular surface cells to initiate infection. Additionally, hypotheses that the virus could travel from the nasopharynx or through the conjunctival capillaries to the ocular surface during infection are probably incorrect. Conjunctivitis and isolation of the virus from the ocular surface occur only rarely, and overwhelmingly in patients with confirmed COVID-19. Necessary precautions to prevent person-to-person transmission should be employed in clinical practice throughout the pandemic, and patients should be reminded to maintain good hygiene practices.

A Sensitive Reverse Transcription Loop-Mediated Isothermal Amplification Assay for Direct Visual Detection of SARS-CoV-2

A simple and rapid reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay was developed for the detection of SARS-CoV-2. The RT-LAMP assay was highly specific for SARS-CoV-2 and was able to detect one copy of transcribed SARS-CoV-2 RNA within 24 minutes. Assay validation performed using 50 positive and 32 negative clinical samples showed 100% sensitivity and specificity. The RT-LAMP would be valuable for clinical diagnosis and epidemiological surveillance of SARS-CoV-2 infection in resource-limited areas as it does not require the use of sophisticated and costly equipment.

COVID stress syndrome: Concept, structure, and correlates

BACKGROUND: Research shows that the COVID Stress Scales have a robust multifactorial structure, representing five correlated facets of COVID-19-related distress: (a) Fear of the dangerousness of COVID-19, which includes fear of coming into contact with fomites potentially contaminated with SARSCoV2, (b) worry about socioeconomic costs of COVID-19 (e.g., worry about personal finances and disruption in the supply chain), (c) xenophobic fears that foreigners are spreading SARSCoV2, (d) traumatic stress symptoms associated with direct or vicarious traumatic exposure to COVID-19 (nightmares, intrusive thoughts, or images related to COVID-19), and (e) COVID-19-related compulsive checking and reassurance seeking. These factors cohere to form a COVID stress syndrome, which we sought to further delineate in the present study. METHODS: A population-representative sample of 6,854 American and Canadian adults completed a self-report survey comprising questions about current mental health and COVID-19-related experiences, distress, and coping. RESULTS: Network analysis revealed that worry about the dangerousness of COVID-19 is the central feature of the syndrome. Latent class analysis indicated that the syndrome is quasi-dimensional, comprising five classes differing in syndrome severity. Sixteen percent of participants were in the most severe class and possibly needing mental health services. Syndrome severity was correlated with preexisting psychopathology and with excessive COVID-19-related avoidance, panic buying, and coping difficulties during self-isolation. CONCLUSION: The findings provide new information about the structure and correlates of COVID stress syndrome. Further research is needed to determine whether the syndrome will abate once the pandemic has passed or whether, for some individuals, it becomes a chronic condition.

Whole-Process Emergency Training of Personal Protective Equipment Helps Healthcare Workers Against COVID-19: Design and Effect

OBJECTIVE: To develop an emergency training program of personal protective equipment (PPE) for general healthcare workers (HCWs) who may be under the threat of Corona Virus Disease 2019 (COVID-19) and evaluate the effect of the program. METHODS: A three-stage training program was designed. The complete clinical workflow together with infectious disease ward was simulated. To verify the effect of the program, an experimental training with pre- and post-test was conducted before large-scale training. RESULTS: Post-test scores were significantly improved when compared with the pre-test scores. Among all PPE, N95 respirator and protective coverall needed training most. Meanwhile, "proficiency level" and "mutual check & help" also needed to be strengthened as independent scoring points. CONCLUSION: This training program significantly improved the performances of participants. It may therefore be applied for general HCWs on a larger scale.

Whole-Process Emergency Training of Personal Protective Equipment Helps Healthcare Workers Against COVID-19: Design and Effect

OBJECTIVE: To develop an emergency training program of personal protective equipment (PPE) for general healthcare workers (HCWs) who may be under the threat of Corona Virus Disease 2019 (COVID-19) and evaluate the effect of the program. METHODS: A three-stage training program was designed. The complete clinical workflow together with infectious disease ward was simulated. To verify the effect of the program, an experimental training with pre- and post-test was conducted before large-scale training. RESULTS: Post-test scores were significantly improved when compared with the pre-test scores. Among all PPE, N95 respirator and protective coverall needed training most. Meanwhile, "proficiency level" and "mutual check & help" also needed to be strengthened as independent scoring points. CONCLUSION: This training program significantly improved the performances of participants. It may therefore be applied for general HCWs on a larger scale.

Whole-Process Emergency Training of Personal Protective Equipment Helps Healthcare Workers Against COVID-19: Design and Effect

OBJECTIVE: To develop an emergency training program of personal protective equipment (PPE) for general healthcare workers (HCWs) who may be under the threat of Corona Virus Disease 2019 (COVID-19) and evaluate the effect of the program. METHODS: A three-stage training program was designed. The complete clinical workflow together with infectious disease ward was simulated. To verify the effect of the program, an experimental training with pre- and post-test was conducted before large-scale training. RESULTS: Post-test scores were significantly improved when compared with the pre-test scores. Among all PPE, N95 respirator and protective coverall needed training most. Meanwhile, "proficiency level" and "mutual check & help" also needed to be strengthened as independent scoring points. CONCLUSION: This training program significantly improved the performances of participants. It may therefore be applied for general HCWs on a larger scale.

Litopenaeus vannamei oxygen consumption and HSP gene expression at cyclic conditions of hyperthermia and hypoxia

Although Litopenaeus vannamei is a widely studied species, the information on how the organisms respond to natural daily variations of environmental conditions such as temperature and dissolved oxygen, and how such conditions alter the physiological responses, is scarce. In the present work, the strategies used by shrimps to cope with temperature and dissolved oxygen fluctuations during 24 days were investigated through the evaluation of oxygen consumption and heat shock proteins (HSP) gene expression. During daily fluctuations, no change in oxygen consumption in the short-term, but a significant increase in the long-term during hyperthermia conditions was registered, whereas a significant decrease during hypoxia was observed during all the bioassay. On the other hand, HSP70 and HSP90 gene expression increased in gills under thermal stress but was down-regulated under hypoxia, in both the short- and the long-term. This study highlights that to counteract environmental variations of temperature and dissolved oxygen, the shrimps use molecular compensatory mechanisms (HSP gene expression) that are different to those used under constant hypoxic conditions, suggesting that hypoxia can compromise physiological cytoprotection.

COVID-19 and Cancer: a Comprehensive Review

PURPOSE OF REVIEW: The outbreak of the novel coronavirus disease 2019 (COVID-19) has emerged to be the biggest global health threat worldwide, which has now infected over 1.7 million people and claimed more than 100,000 lives around the world. Under these unprecedented circumstances, there are no well-established guidelines for cancer patients. RECENT FINDINGS: The risk for serious disease and death in COVID-19 cases increases with advancing age and presence of comorbid health conditions. Since the emergence of the first case in Wuhan, China, in December 2019, tremendous research efforts have been underway to understand the mechanisms of infectivity and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a fatal virus responsible for abysmal survival outcomes. To minimize the mortality rate, it becomes prudent to identify symptoms promptly and employ treatments appropriately. Even though no cure has been established, multiple clinical trials are underway to determine the most optimal strategy. Managing cancer patients under these circumstances is rather challenging, given their vulnerable status and the aggressive nature of their underlying disease. In this comprehensive review, we discuss the impact of COVID-19 on health and the immune system of those affected, reviewing the latest treatment approaches and ongoing clinical trials. Additionally, we discuss challenges faced while treating cancer patients and propose potential approaches to manage this vulnerable population during this pandemic.

Novel coronavirus pneumonia TCM treatment plan in Tianjin/ 新型冠状病毒肺炎中医诊疗天津方案

2019年12月以来，湖北省武汉市陆续发现了多例新型冠状病毒肺炎患者，随着疫情的蔓延，我国其他地区及境外也相继发现此类病例。2020年1月21日天津确诊首例输入性新型冠状病毒肺炎，为切实做好我市新型冠状病毒肺炎中医药救治工作，天津市卫生健康委员会建立了定点医院市级中医专家会诊制度，由天津中医药大学第一附属医院派专家组常驻我市医疗救治定点医院（海河医院）开展中医药诊治工作。

A recombinant infectious bronchitis virus from a chicken with a spike gene closely related to that of a turkey coronavirus

Using viral metagenomics, the complete genome sequence of an infectious bronchitis virus (IBV) strain (named ahysx-1) from a fecal sample from a healthy chicken in Anhui province, China, was determined. The genome sequence of ahysx-1 was found to be very similar to that of IBV strain ck/CH/LLN/131040 (KX252787), except for the spike gene region, which is similar to that of a turkey coronavirus strain (EU022526), suggesting that ahysx-1 is a recombinant. Recombination analysis and phylogenetic analysis based on the genomic sequences of ahysx-1 and other related strains confirmed that ahysx-1 appears to be a recombinant resulting from a recombination event that occurred between a chicken coronavirus and a turkey coronavirus. Further studies need to be performed to determine whether this recombinant IBV strain is pathogenic and whether it is transmitted between chickens and turkeys.

Leveraging Insight from Centuries of Outbreak Preparedness to Improve Modern Planning Efforts

Though pandemic preparedness has been a focus of public health planning for centuries, during which our understanding of infectious disease dynamics has grown, our methodologies for managing outbreaks have remained relatively unchanged. We propose leveraging this history to identify opportunities for actual progress. We contrast current plans with historical outbreak control measures and isolate how the complexities of a modern era yield additional challenges in how best to anticipate and mitigate outbreaks. We analyze a diversity of publicly available modern preparedness plans against the context of a historically-based fictional outbreak control strategy described in Defoe's A Journal of the Plague Year (published 1720). We identify themes in preparedness planning that remain unchanged from historical settings even though they continue to be actively evaluated in planning efforts. More importantly, we isolate critical modern challenges in preparedness planning that remain predominantly unsolved. These modern, unsolved issues offer best avenues for meaningful improvement. Shifting our planning efforts to focus on identified novel issues may greatly strengthen our local- to global- capacity to deal with infectious threats.

Outcomes and Mortality Associated with Atrial Arrhythmias Among Patients Hospitalized with COVID-19

INTRODUCTION: The impact of atrial arrhythmias on COVID-19-associated outcomes are unclear We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID-19 METHODS: An observational cohort study of 1053 patients with SARS-CoV2 infection admitted to a quaternary care hospital and a community hospital was conducted Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL) The association between atrial arrhythmias and 30-day mortality was assessed with multivariable analysis RESULTS: Mean age of patients was 62 ± 17 years and 62% were men Atrial arrhythmias were identified in 166 (15 8%) patients, with AF in 154 (14 6%) patients and AFL in 40 (3 8%) patients Newly detected atrial arrhythmias occurred in 101 (9 6%) patients Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence Compared to patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B-type natriuretic peptide, C-reactive protein, ferritin and D-dimer Mortality was significantly higher among patients with AF/AFL (39 2%) compared to patients without (13 4%;P&lt;0 001) After adjustment for age and co-morbidities, AF/AFL (adjusted OR 1 93;P = 0 007) and newly detected AF/AFL (adjusted OR 2 87;P &lt;0 001) were independently associated with 30-day mortality CONCLUSIONS: Atrial arrhythmias are common among patients hospitalized with COVID-19 The presence of AF/AFL tracked with markers of inflammation and cardiac injury Atrial arrhythmias were independently associated with increased mortality This article is protected by copyright All rights reserved

US Policies Increase Vulnerability of Immigrant Communities to the COVID-19 Pandemic

The adverse policy environment in the United States (US) has made immigrant communities particularly vulnerable to uncontrolled community spread of COVID-19. Past and recent federal and state policy actions may exacerbate undetected community spread in immigrant communities and commensurate economic impact. Given the importance of immigrants to the US economy and society, and the human toll this pandemic is having on migrants worldwide, federal and state policies should pivot to find ways to improve access to healthcare for immigrants.

Is naso-pharyngeal swab always safe for SARS-CoV-2 testing? An unusual, accidental foreign body swallowing

Long and sharp objects can be foreign body intentionally or accidentally ingested. Timing of endoscopy relies on foreign body shape and size, localization in gastrointestinal tract, patient's clinical conditions, occurrence of symptoms, or onset of complications. We present a case of a 47-year-old male with no known comorbidity, who accidentally swallowed a portion of a naso-pharyngeal swab half-broken during the second diagnostic test for SARS-CoV-2. The intact swab had a total length of 15 cm and was made of wood. The patient was asymptomatic, laboratory tests were normal, and neck-chest-abdominal X-ray and CT scan were negative for major complications. Upper gastrointestinal endoscopy was promptly performed to prevent the long sharp swab from crossing the pylorus leading to serious complications and, therefore, risk surgical intervention. The patient was intubated and the procedure was carried out under general anesthesia. In the gastric body, broken naso-pharyngeal swab was detected among the food debris, and using a latex rubber hood, the 7.5 cm foreign body was removed with a retrieval alligator-tooth forceps. Our hospital is located in a high-risk area of COVID-19 outbreak where many naso-pharyngeal swabs are performed, and to our knowledge, this is the first report of swab ingestion during SARS-CoV-2 test.

COVID-19, the climate, and transformative change: Comparing the social anatomies of crises and their regulatory responses

Despite forces struggling to reduce global warming growing stronger, there has been mixed success in generating substantive policy implementation, while the global spread of the coronavirus has prompted strong and far-reaching governmental responses around the world This paper addresses the complex and partly contradictory responses to these two crises, investigating their social anatomies Using temporality, spatiality, and epistemic authority as the main conceptual vehicles, the two crises are systematically compared Despite sharing a number of similarities, the most striking difference between the two crises is the urgency of action to counter the rapid spread of the pandemic as compared to the slow and meager action to mitigate longstanding, well-documented, and accelerating climate change Although the tide now seems to have turned towards a quick and massive effort to restore the status quo-including attempts to restart the existing economic growth models, which imply an obvious risk for substantially increasing CO2 emissions-the article finally points at some signs of an opening window of opportunity for green growth and degrowth initiatives However, these signs have to be realistically interpreted in relation to the broader context of power relations in terms of governance configurations and regulatory strategies worldwide at different levels of society © 2020 by the authors

Effectiveness of a Technology-Enhanced Integrated Care Model for Frail Older People: A Stepped-Wedge Cluster Randomized Trial in Nursing Homes

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the impact of an information and communication technologies- (ICT-) enhanced, multidisciplinary integrated care model, called Systems for Person-centered Elder Care (SPEC), on frail older adults at nursing homes. RESEARCH DESIGN AND METHODS: SPEC was implemented at ten nursing homes in South Korea in random order using a stepped-wedge design. Data were collected on all participating older residents in the homes before the first implementation and until six months after the last implementation. The 21-month SPEC intervention guided by the chronic care model (CCM) consists of five strategies: comprehensive geriatric assessment, care planning, optional interdisciplinary case conferences, care coordination, and a cloud-based ICT tool along with free messaging app. The primary outcome was quality of care measured by a composite quality indicator (QI) from the interRAI assessment system. Usual care continued over the control periods. Nursing home staff were not blinded to the intervention. RESULTS: There were a total of 482 older nursing home residents included in the analysis. Overall quality of care measured by the composite QI was significantly improved (adjusted mean difference: -0.025 [95% CI: -0.037 ~ -0.014, p <.0001]). The intervention effect was consistent in the subgroup analysis by cognition and activities of daily living. There were no important adverse events or side effects. DISCUSSION AND IMPLICATIONS: The SPEC, a CCM-guided, ICT-supported, multidisciplinary integrated care management intervention, can improve quality of care measured by health and functional outcomes for frail older persons residing in nursing homes with limited healthcare provision. TRIAL REGISTRATION: ISRCTN11972147; ethical approval: Seoul National University University Institutional Review Board.

Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019

BACKGROUND: The clinical presentation of European patients with mild-to-moderate COVID-19 infection is still unknown. OBJECTIVE: To study the clinical presentation of COVID-19 in Europe. METHODS: Patients with positive diagnosis of COVID-19 were recruited from 18 European hospitals. Epidemiological and clinical data were obtained through a standardized questionnaire. Bayesian analysis was used for analysing the relationship between outcomes. RESULTS: A total of 1,420 patients completed the study (962 females, 30.7% of healthcare workers). The mean age of patients was 39.17 ± 12.09 years. The most common symptoms were headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%), cough (63.2%), asthenia (63.3%), myalgia (62.5%), rhinorrhea (60.1%), gustatory dysfunction (54.2%) and sore throat (52.9%). Fever was reported by 45.4%. The mean duration of COVID-19 symptoms of mild-to-moderate cured patients was 11.5 ± 5.7 days. The prevalence of symptoms significantly varied according to age and sex. Young patients more frequently had ear, nose and throat complaints, whereas elderly individuals often presented fever, fatigue and loss of appetite. Loss of smell, headache, nasal obstruction and fatigue were more prevalent in female patients. The loss of smell was a key symptom of mild-to-moderate COVID-19 patients and was not associated with nasal obstruction and rhinorrhea. Loss of smell persisted at least 7 days after the disease in 37.5% of cured patients. CONCLUSION: The clinical presentation of mild-to-moderate COVID-19 substantially varies according to the age and the sex characteristics of patients. Olfactory dysfunction seems to be an important underestimated symptom of mild-to-moderate COVID-19 that needs to be recognized as such by the WHO.

Luminescence properties and energy transfer of Tb3+, Eu3+ co-doped YTaO4 phosphors obtained via sol–gel combustion process

Tantalate is considered as a valuable and efficient luminescence host because of its intense absorption in the ultraviolet area and excellent chemical properties In this work, a series of pure YTaO 4 :Eu 3+ and/or Tb 3+ crystals were prepared via a sol-gel combustion method The morphology, structure, and optical properties of the samples were discussed in detail The Eu 3+ , Tb 3+ co-doped YTaO 4 samples are consisted of small spherical particles of around 18 nm The prepared YTaO 4 :Tb 3+ and/or Eu 3+ samples exhibit the characteristic wide excitation band around 210-300 nm, the characteristic narrow red emission of Eu 3+ (5 D 0 → 7 F 2) transitions and green emission of the Tb 3+ (5 D 4 → 7 F 5) transitions when excited by UV light It is focused on the energy transfer processes from the YTaO 4 to Tb 3+ as well as Eu 3+ ions and from Tb 3+ to Eu 3+ ions of YTaO 4 :Eu 3+ /Tb 3+ phosphors Color-tunable emissions are realized through adjusting the types of rare earth ion (Eu 3+ and Tb 3+) and relative doping concentrations excited by a single wavelength That is to say, the obtained Tb 3+ and Eu 3+ co-doped YTaO 4 phosphors have a promising prospect in lasers, white light diodes (WLED), fluorescent lamp, and field emission display devices, etc

Universal Masking is Urgent in the COVID-19 Pandemic: SEIR and Agent Based Models, Empirical Validation, Policy Recommendations

We present two models for the COVID-19 pandemic predicting the impact of universal face mask wearing upon the spread of the SARS-CoV-2 virus--one employing a stochastic dynamic network based compartmental SEIR (susceptible-exposed-infectious-recovered) approach, and the other employing individual ABM (agent-based modelling) Monte Carlo simulation--indicating (1) significant impact under (near) universal masking when at least 80% of a population is wearing masks, versus minimal impact when only 50% or less of the population is wearing masks, and (2) significant impact when universal masking is adopted early, by Day 50 of a regional outbreak, versus minimal impact when universal masking is adopted late. These effects hold even at the lower filtering rates of homemade masks. To validate these theoretical models, we compare their predictions against a new empirical data set we have collected that includes whether regions have universal masking cultures or policies, their daily case growth rates, and their percentage reduction from peak daily case growth rates. Results show a near perfect correlation between early universal masking and successful suppression of daily case growth rates and/or reduction from peak daily case growth rates, as predicted by our theoretical simulations. Our theoretical and empirical results argue for urgent implementation of universal masking. As governments plan how to exit societal lockdowns, it is emerging as a key NPI; a"mouth-and-nose lockdown"is far more sustainable than a"full body lockdown", on economic, social, and mental health axes. An interactive visualization of the ABM simulation is at http://dek.ai/masks4all. We recommend immediate mask wearing recommendations, official guidelines for correct use, and awareness campaigns to shift masking mindsets away from pure self-protection, towards aspirational goals of responsibly protecting one's community.

A Preventive Role of Exercise Across the Coronavirus 2 (SARS-CoV-2) Pandemic

The coronavirus 2019 (COVID-19) pandemic has posed a significant threat to human health around the world A severe risk of infection has been observed in elderly populations In addition, individuals with obesity and obesity-related comorbidities have also been identified to be at a higher risk of infection for COVID-19 We have attempted here to provide evidence in support of exercise management as a prevention strategy for improving health and minimizing the effects of COVID-19 Therefore, exercise duration, frequency, and intensity benefits are summarized in an attempt to provide guidelines for the general population In terms of exercise effects, there are multiple benefits of exercise related to human health These include, decreases in adipose tissue, improvements in cardio-respiratory fitness, enhanced metabolic homeostasis, and suppress inflammation active With respect to the amount of exercise performed individuals should exercise at a moderate intensity for at least 150 min/wk as an initial target Increases in intensity and duration of exercise training are necessary for significant fitness benefits, weight loss, and prevention of weight regain In relation to walking, 10,000 steps/day at a rate of 64–170 steps/minute for at least 10 min duration is reasonable for healthy adults For exercise intensity, a combination of resistance training (RT), aerobic training (AT) as well as high-intensity interval training (HIIT) incorporated with moderate-intensity continuous training (MICT) can be recognized as an optimal exercise mode for health benefits Aerobic training and MICT should be viewed as a basis for exercise in combination with appropriate volumes and types of RT and HIIT Activities should be performed according to professional guidelines and advice If implemented, these measures may reduce infection rates, underlying pathologies, and assist in decreasing mortality associated with COVID-19 pandemic

Death of Utopia

The outbreak of the COVID-19 crisis has exposed the limits of the dominant ideologies Western liberals champion global solutions to unlock ever-more individual liberty, whereas communities want greater state protection and social solidarity National populists or authoritarians from the United States to Brazil, Eastern Europe, India, and China offer simplistic slogans and blame foreign forces, whereas countries need real leadership and international cooperation to be more resilient We face a conflict between liberal calls for greater global technocracy and an authoritarian retreat to national isolation Both worldviews are ugly Utopias with dystopian consequences They rest on the Utopian promise of biosurveil-lance, disruptive technology, and capitalism to restore prosperity coupled with public health In reality, the emerging economic models are based on the Darwinist power of the strong over the weak the oligarchy of U S tech platforms and of Chinese state corporations raises questions about citizenship and what makes us human A revived social Darwinism erodes the dignity of the person and fundamental freedoms linked to mutual obligations upon which a healthy democracy depends

Coordinating the research response to COVID-19: Mali's approach

Mali, like the rest of the world, has seen a rapid spread of COVID-19 since the first report of imported cases. Despite being a low-income country, Mali has leveraged scientific research resources via coordinated approaches to enable public health emergency planning and response to the COVID-19 pandemic. Mali's approach includes the harmonization of research activities; leveraging of research laboratory capacity of the University Clinical Research Center, Mali International Center for Excellence and three other in-country laboratories for community COVID-19 testing; strengthening relationships amongst local and international stakeholders; and collaboration with the Ministry of Health to integrate scientific evidence into public policy and emergency management of COVID-19 through a platform of consultation and open communication. The country has implemented national coordination of its COVID-19 response by establishing a COVID-19 Scientific Advisory Committee and a COVID-19 Technical Coordination Committee, both within the Ministry of Health and working collaboratively with other stakeholders. Members of Mali's COVID-19 Scientific Advisory Committee also serve as leaders of its principal academic and government clinical and public health research entities. This centralised approach has enabled the prioritisation of COVID-19 control activities, informed allocation of resources, evidence-based public health practices and timely decision-making in the pandemic setting. Though challenges remain, lessons learned from Mali's harnessing of clinical research capacity to guide and support its COVID-19 response can be applied to future global health research challenges and illustrate the power of building public health-responsive research capacity in resource-limited settings through international collaboration.

SARS-CoV-2 Entry Receptor ACE2 Is Expressed on Very Small CD45- Precursors of Hematopoietic and Endothelial Cells and in Response to Virus Spike Protein Activates the Nlrp3 Inflammasome

Angiotensin-converting enzyme 2 (ACE2) plays an important role as a member of the renin-angiotensin-aldosterone system (RAAS) in regulating the conversion of angiotensin II (Ang II) into angiotensin (1-7) (Ang [1-7]). But at the same time, while expressed on the surface of human cells, ACE2 is the entry receptor for SARS-CoV-2. Expression of this receptor has been described in several types of cells, including hematopoietic stem cells (HSCs) and endothelial progenitor cells (EPCs), which raises a concern that the virus may infect and damage the stem cell compartment. We demonstrate for the first time that ACE2 and the entry-facilitating transmembrane protease TMPRSS2 are expressed on very small CD133+CD34+Lin-CD45- cells in human umbilical cord blood (UCB), which can be specified into functional HSCs and EPCs. The existence of these cells known as very small embryonic-like stem cells (VSELs) has been confirmed by several laboratories, and some of them may correspond to putative postnatal hemangioblasts. Moreover, we demonstrate for the first time that, in human VSELs and HSCs, the interaction of the ACE2 receptor with the SARS-CoV-2 spike protein activates the Nlrp3 inflammasome, which if hyperactivated may lead to cell death by pyroptosis. Based on this finding, there is a possibility that human VSELs residing in adult tissues could be damaged by SARS-CoV-2, with remote effects on tissue/organ regeneration. We also report that ACE2 is expressed on the surface of murine bone marrow-derived VSELs and HSCs, although it is known that murine cells are not infected by SARS-CoV-2. Finally, human and murine VSELs express several RAAS genes, which sheds new light on the role of these genes in the specification of early-development stem cells. Graphical Abstract •Human VSELs and HSCs express ACE2 receptor for SARS-CoV2 entry. •Interaction of viral spike protein with ACE2 receptor may hyperactivate Nlrp3 inflammasome which induces cell death by pyroptosis. •SARS-CoV2 may also enter cells and eliminate them by cell lysis. •What is not shown since these cells express also Ang II receptor they may hyperactivate Nlrp3 inflammasome in response to Ang II which may induce pyroptosis. Our data indicates that Ang 1-7 may have a protective effect.

Evolution of aesthetic surgery in India, current practice scenario, and anticipated post-COVID-19 changes: a survey-based analysis

Background: The declaration of COVID pandemic by the WHO can certainly be seen as a watershed era the world has witnessed in modern times. All non-essential industries and services have taken a back seat including aesthetic medicine. Over the last decade, India has witnessed a steady growth in medical tourism owing to global standards of care and services at a relatively modest cost. The following study was conducted to ascertain the sea change that this pandemic has brought into aesthetic surgeons' practice, patient management, planning and consultation. This paper throws light on the journey of Indian aesthetic surgery from its infancy to its current presence in the global market as a context of the study. We have also discussed the impact of social media on aesthetic surgeons' practice, lifestyle and its role as an emerging new method of medical education. Methods: A questionnaire consisting of 62 questions divided in 3 sections was rolled out to 150 Indian aesthetic surgeons who have been practising either independently in their clinics or are associated with hospitals. A: Pre-COVID practice management and lifestyle; B: life during the lockdown; C: anticipated changes in post-COVID era. Results: In the pre-COVID era, an average aesthetic surgeon was finely balancing his profession, personal lifestyle, learning, and recreation. The lockdown clamped their practices which lead into a financial drought; despite which, they were able to maintain their productivity by engaging in webinars, reading, and research. The post-COVID times demand an implementation of safety protocols along with changes in set-up, regulating patient traffic, engaging in distant learning through virtual conferences, and maintaining a healthy lifestyle acquired during the lockdown. Conclusions: India was rightly witnessing a surge in popularity of aesthetic surgery and medical tourism over the last decade. The corona pandemic has definitely hit this escalating growth curve hard, and it will take some time for the demand to recover. Our study revealed the following conclusions: The effect of COVID 19 demands a major change in aesthetic surgeons' professional practice like limiting consultations, changing hospital floor plan, following COVID testing, and having new safety protocols. Social media is rightly poised to be a major tool for education and marketing as also for recreation and leisure. The role of teleconsultation needs to be reprised and legalised. Webinars and virtual conferences will find more takers in future.Level of evidence: not ratable.

A Positive-Pressure Environment Disposable Shield (PEDS) for COVID-19 Health Care Worker Protection

The COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. One strategy to reduce risk of infection and preserve existing equipment is the implementation of secondary barrier devices placed directly over patients or providers. The authors describe an inexpensive, disposable, positive-pressure head isolation unit that can be rapidly constructed from materials readily available in nearly all health care settings for under five US dollars. The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.

Ultrafast optical spectroscopy of semiconducting and plasmonic nanostructures and their hybrids

The knowledge of the carrier dynamics in nanostructures is of fundamental importance for the development of (opto)electronic devices. This is true for semiconducting nanostructures as well as for plasmonic nanoparticles (NPs). Indeed, improvement of photocatalytic efficiencies by combining semiconductor and plasmonic nanostructures is one of the reasons why their ultrafast dynamics are intensively studied. In this work, we will review our activity on ultrafast spectroscopy in nanostructures carried out in the recently established EuroFEL Support Laboratory. We have investigated the dynamical plasmonic responses of metal NPs both in solution and in 2D and 3D arrays on surfaces, with particular attention being paid to the effects of the nanoparticle shape and to the conversion of absorbed light into heat on a nano-localized scale. We will summarize the results obtained on the carrier dynamics in nanostructured perovskites with emphasis on the hot-carrier dynamics and in semiconductor nanosystems such as ZnSe and Si nanowires, with particular attention to the band-gap bleaching dynamics. Subsequently, the study of semiconductor-metal NP hybrids, such as CeO$_2$-Ag NPs, ZnSe-Ag NPs and ZnSe-Au NPs, allows the discussion of interaction mechanisms such as charge carrier transfer and F{"o}rster interaction. Finally, we assess an alternative method for the sensitization of wide band gap semiconductors to visible light by discussing the relationship between the carrier dynamics of TiO$_2$ NPs and V-doped TiO$_2$ NPs and their catalytic properties.

Building a Framework for Indigenous Astronomy Collaboration: Native Skywatchers, Indigenous Scientific Knowledge Systems, and The Bell Museum

Hundreds of years ago, colonization happened. Today we are still living out the ripple effects of this history. How does this relate to science, informal science education, and institutions that promote science communication? What obligations or considerations should a science museum have before integrating Indigenous knowledge into their existing programming? Presented in this document is the process of building a framework intended to provide a roadmap for developing Indigenous astronomy programming which can be a model for other institutions that may be interested in collaborating with Indigenous communities.

Anti-coagulation for COVID-19 treatment: both anti-thrombotic and anti-inflammatory?

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has been linked to a higher risk of mortality compared to influenza, which is mainly due to severe secondary diseases, such as acute respiratory distress syndrome (ARDS). In turn, ARDS is characterized by an acute inflammation and an excessive activity of the coagulation cascade, rising the vulnerability for venous thromboembolic events. In order to investigate the relation of inflammation and the influence of coagulation factors on their release, human peripheral mononuclear blood cells (PBMCs) were treated with autologous serum, heparinized plasma and different doses of fibrin. Thereafter, the concentration of pro-inflammatory cytokines and chemokines in the secretome of PBMCs was measured by enzyme-linked immunosorbent assay. Our analyses revealed autologous serum to significantly increase the secretion of cytokines and chemokines after 24 h of incubation time. Furthermore, the addition of fibrin markedly increased the secretion of cytokines and chemokines by PBMCs in a dose-dependent manner. Consequently, in accordance with previous studies, our study outlines that anti-coagulation may constitute a promising tool for the treatment of SARS-CoV-2, reducing both, the cytokine storm, as well as the risk for thrombotic complications.

Infectiepreventie in de mondzorg tijdens de uitbraak van SARS-CoV-2./ [Infection prevention in dental care during the outbreak of SARS-CoV-2]

COVID-19 is an emerging infectious disease with widespread transmission of the coronavirus SARS-CoV-2 in the Netherlands. Some of those infected become seriously ill. Others do not show any symptoms, but can still contribute to the transmission of the virus. SARS-CoV-2 is excreted in the oral cavity and can be spread via aerosols. Therefore, there is an increased risk of its spread during aerosol-producing treatments in dental care clinics. Due to the risk of infection of dental care workers and patients, and based on the evidence currently available, additional infection control measures for all patients are strongly recommended when providing emergency dental care in this phase of the pandemic. Other treatments should be postponed. Based on guidance in scientific literature and advice from the Dutch National Institute for Public Health and the Environment (RIVM), consideration should be given to what infection control measures are necessary when providing emergency and regular dental care in both the current situation and in the future.

Implications of SARS-CoV-2 Infection and COVID-19 Crisis on Clinical Cancer Care: Report of the University Cancer Center Hamburg

With the outbreak of the COVID-19 pandemia, routine clinical work was immediately, deeply, and sustainably impacted in Germany and worldwide. The infrastructure of almost all hospitals is currently redirected to provide a maximum of intensive care resources, including the necessary staff. In parallel, routine as well as emergency clinical care for all patients in need has to be secured. This challenge becomes particularly evident in cancer care. In order to maintain adequate oncological care at all levels of provision and to conduct especially curative and intensive treatments with a maximum of safety, continuous adaption of the oncology care system has to be ensured. Intensive communication with colleagues and patients is needed as is consequent expert networking and continuous reflection of the own developed strategies. In parallel, it is of high importance to actively avoid cessation of innovation in order not to endanger the continuous improvement in prognosis of cancer patients. This includes sustained conduction of clinical trials as well as ongoing translational research. Here, we describe measures taken at the University Cancer Center Hamburg (UCCH) - a recognized comprehensive oncology center of excellence - during the COVID-19 crisis. We aim to provide support and potential perspectives to generate a discussion basis on how to maintain high-end cancer care during such a crisis and how to conduct patients safely into the future.

Implications of SARS-CoV-2 Infection and COVID-19 Crisis on Clinical Cancer Care: Report of the University Cancer Center Hamburg

With the outbreak of the COVID-19 pandemia, routine clinical work was immediately, deeply, and sustainably impacted in Germany and worldwide. The infrastructure of almost all hospitals is currently redirected to provide a maximum of intensive care resources, including the necessary staff. In parallel, routine as well as emergency clinical care for all patients in need has to be secured. This challenge becomes particularly evident in cancer care. In order to maintain adequate oncological care at all levels of provision and to conduct especially curative and intensive treatments with a maximum of safety, continuous adaption of the oncology care system has to be ensured. Intensive communication with colleagues and patients is needed as is consequent expert networking and continuous reflection of the own developed strategies. In parallel, it is of high importance to actively avoid cessation of innovation in order not to endanger the continuous improvement in prognosis of cancer patients. This includes sustained conduction of clinical trials as well as ongoing translational research. Here, we describe measures taken at the University Cancer Center Hamburg (UCCH) - a recognized comprehensive oncology center of excellence - during the COVID-19 crisis. We aim to provide support and potential perspectives to generate a discussion basis on how to maintain high-end cancer care during such a crisis and how to conduct patients safely into the future.

Infectious Diseases and Hotel Service Quality - Focus on 2015 MERS and 2020 COVID-19

The topic of this study is an analysis of how infectious diseases affect the quality of hotel service When external shocks such as Corona-19 occur, I would like to analyze whether these events affected the overall service quality of hotels Based on the KS-SQI model from 2012 to 2019, this study conducted an empirical analysis of the service quality, customer revisit and the intention of recommending others Through this, the quality of service affected both the customer's revisit and the other person's recommendation in the positive direction, and the customer's re-visit also affected the other person's recommendation in the positive direction Furthermore, while quality of service directly affects other people's recommendations, it was also shown through customer re-visits that indirectly affected other people's recommendations In addition, analysis of the previous and subsequent timing of the MERS outbreak in 2015 indicates that hotels may be more affected by external shocks than resorts As a result, external shocks, such as epidemics, have a large impact on non-loyal customers such as outgoing customers This study analyzed how much the epidemic affected the quality of hotel service, and found implications that could help the hotel provide the level of service quality expected by customers, apart from the external shock in the future

Computational search for potential COVID-19 drugs from FDAapproved drugs and small molecules of natural origin identifies several anti-virals and plant products

The world is currently facing the COVID-19 pandemic, for which mild symptoms include fever and dry cough In severe cases, it could lead to pneumonia and ultimately death in some instances Moreover, the causative pathogen is highly contagious and there are no drugs or vaccines for it yet The pathogen, SARS-CoV-2, is one of the human coronaviruses which was identified to infect humans first in December 2019 SARS-CoV-2 shares evolutionary relationship to other highly pathogenic viruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East respiratory syndrome (MERS) We have exploited this similarity to model a target non-structural protein, NSP1, since it is implicated in the regulation of host gene expression by the virus and hijacking of host machinery We next interrogated the capacity to repurpose around 2300 FDA-approved drugs and more than 3,00,000 small molecules of natural origin towards drug identification through virtual screening and molecular dynamics Interestingly, we observed simple molecules like lactose, previously known anti-virals and few secondary metabolites of plants as promising hits These herbal plants are already practiced in Ayurveda over centuries to treat respiratory problems and inflammation Disclaimer: we would not like to recommend uptake of these small molecules for suspect COVID patients until it is approved by competent national or international authorities

Decrease in sweet taste response and T1R3 sweet taste receptor expression in pregnant mice highlights a potential mechanism for increased caloric consumption in pregnancy

While much is known on how the maternal diet affects offspring fitness, less is known on the role of taste in guiding and promoting food intake during this crucial period. Women have intense food cravings and exhibit altered taste preferences during pregnancy, however the mechanistic details underlying these changes are presently unclear. We performed longitudinal brief-access taste testing in female mice before, during, and after pregnancy, along with quantitative PCR on taste buds and morphological analysis of taste tissues from pregnant and non-pregnant mice. Sucrose licking response decreased progressively during pregnancy compared to that prior to mating, with partial recovery in the post-partum period. No change in taste morphology was evident between pregnant and non-pregnant mice, however a notable decrease in T1R3 sweet taste receptor mRNA expression was recorded in pregnant dams. We conclude that altered taste preferences during pregnancy likely result from changes in the expression profile of taste buds in the mother, which may promote a less healthy diet while expecting.

Evaluation of the immune response in conventionally weaned pigs infected with porcine deltacoronavirus

Although porcine deltacoronavirus (PDCoV) is a significant pandemic threat in the swine population and has caused significant economic losses, information regarding the immune response in conventionally weaned pigs infected with PDCoV is scarce. Hence, the immune response in conventionally weaned pigs infected with PDCoV was assessed after challenge and rechallenge. After the first challenge, obvious diarrhea and viral shedding developed successively in all pigs in the four inoculation dose groups from 3 to 14 days postinfection (dpi), and all pigs recovered (no clinical symptoms or viral shedding) by 21 dpi. All pigs in the four groups exhibited significantly increased PDCoV-specific IgG, IgA and virus-neutralizing (VN) antibody (Ab) titers and IFN-γ levels in the serum after the first challenge. All pigs were completely protected against rechallenge at 21 dpi. The serum levels of PDCoV-specific IgG, IgA, and VN Abs increased further after rechallenge. Notably, the IFN-γ level declined continuously after 7 dpi. In addition, the levels of PDCoV-specific IgG, IgA and VN Abs in saliva increased significantly after rechallenge and correlated well with the serum Ab titers. Furthermore, the appearance of clinical symptoms of PDCoV infection in conventionally weaned pigs was delayed with reduced inoculation doses. In summary, the data presented here offer important reference information for future PDCoV animal infection and vaccine-induced immunoprotection experiments.

How Patients With Chronic Liver Diseases Succeed to Deal With COVID-19?

The human pathogenic coronaviruses cause infections of the respiratory tract from mild to severe ranges. Mild cases may look like the common cold, while cases with severe disease may represent severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and coronavirus disease 2019 (COVID-19). Currently, COVID-19 is a rapidly emerging infection and the number of COVID-19 cases and its associated deaths are quickly growing around the world. COVID-19 infection can involve multiple body organs other than respiratory tract and lungs such as liver. It is hypothesized that COVID-19-associated liver injury can hamper the host drug metabolism and excretion. Liver involvement present with the elevation of enzymatic levels of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) accompanied by enhanced total bilirubin and decreased albumin levels has been reported in COVID-19 cases. One of the major concerns during COVID-19 outbreak is the population with a history of pre-existing liver disorders including viral hepatitis, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), autoimmune hepatitis, hepatic compensated, and decompensated cirrhosis. Herein, we discussed the probable correlation between COVID-19 infection and liver damages, particularly chronic and pre-existing liver diseases during COVID-19 outbreak. Furthermore, we explained about the liver transplant recipients and post-transplant drugs used in patients with COVID-19 infection. Finally, we discussed about the therapeutic medications administered in COVID-19 patients with underlying liver injuries and their significant considerations.

COVID-19 and pediatric inflammatory bowel disease: How to manage it?

Pediatric gastroenterologists, family members, and caregivers of patients with inflammatory bowel disease (IBD) are on alert; they are all focused on implementing prophylactic measures to prevent infection by severe acute respiratory syndrome coronavirus 2, evaluating the risks in each patient, guiding them in their treatment, and keeping IBD in remission. To face the current issues of the coronavirus disease pandemic, we have developed a synthesis of the main recommendations of the literature directed at pediatric gastroenterologists in control of patients with pediatric IBD and adapted to the national reality.

COVID-19 and pediatric inflammatory bowel disease: How to manage it?

Pediatric gastroenterologists, family members, and caregivers of patients with inflammatory bowel disease (IBD) are on alert; they are all focused on implementing prophylactic measures to prevent infection by severe acute respiratory syndrome coronavirus 2, evaluating the risks in each patient, guiding them in their treatment, and keeping IBD in remission. To face the current issues of the coronavirus disease pandemic, we have developed a synthesis of the main recommendations of the literature directed at pediatric gastroenterologists in control of patients with pediatric IBD and adapted to the national reality.

Characterizing information leaders in Twitter during COVID-19 crisis

Information is key during a crisis such as the current COVID-19 pandemic as it greatly shapes people opinion, behaviour and even their psychological state. It has been acknowledged from the Secretary-General of the United Nations that the infodemic of misinformation is an important secondary crisis produced by the pandemic. Infodemics can amplify the real negative consequences of the pandemic in different dimensions: social, economic and even sanitary. For instance, infodemics can lead to hatred between population groups that fragment the society influencing its response or result in negative habits that help the pandemic propagate. On the contrary, reliable and trustful information along with messages of hope and solidarity can be used to control the pandemic, build safety nets and help promote resilience and antifragility. We propose a framework to characterize leaders in Twitter based on the analysis of the social graph derived from the activity in this social network. Centrality metrics are used to identify relevant nodes that are further characterized in terms of users parameters managed by Twitter. We then assess the resulting topology of clusters of leaders. Although this tool may be used for surveillance of individuals, we propose it as the basis for a constructive application to empower users with a positive influence in the collective behaviour of the network and the propagation of information.

Estimation of the diagnostic accuracy of real-time reverse transcription quantitative polymerase chain reaction for SARS-CoV-2 using re-analysis of published data

INTRODUCTION: As the coronavirus disease 2019 (COVID-19) epidemic evolves and test strategies change, understanding the concepts of testing (gold standard and test performance measures) becomes essential The challenge of any novel disease is that the gold standard has yet to be defined METHODS: We reanalysed published data on real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) of severe acute respiratory syndrome coronavirus-2 to illustrate how predictive values vary with disease prevalence, sensitivity (set to values between 30% and 95%) and specificity (set to 99% or 99 98%) We used published data on chest CT and RT-qPCR to examine the potential of latent class analysis to estimate the sensitivity and specificity of RT-qPCR when no single gold standard exists RESULTS: For the various sensitivity values, the negative predictive value of a RT-qPCR test remained above 92% until a COVID-19 prevalence of &gt; 10% The positive predictive value (PPV) was more variable For a sensitivity of 95% and a specificity of 99%, the PPV was less-than 10% at a prevalence of 0 1%, increasing to about 90% at a prevalence of 10% This improved to a PPV of 85% and almost 100%, respectively, when specificity increased to 99 98% In a restricted latent class analysis, the sensitivity was 97 1% and the specificity was 99 9%, which is similar to figures from the Danish Health Authority However, derived predictive values depended on model specification CONCLUSIONS: A high risk of false-positives should be considered when extending the testing strategy, whereas false-negatives may occur during local outbreaks This may have consequences for, e g , containment strategies and research A confirmatory test (e g , demonstrating seroconversion or repeated RT-qPCR) may be warranted FUNDING: none TRIAL REGISTRATION: not relevant

Bayesian Modeling of COVID-19 Positivity Rate -- the Indiana experience

In this short technical report we model, within the Bayesian framework, the rate of positive tests reported by the the State of Indiana, accounting also for the substantial variability (and overdispeartion) in the daily count of the tests performed. The approach we take, results with a simple procedure for prediction, a posteriori, of this rate of 'positivity' and allows for an easy and a straightforward adaptation by any agency tracking daily results of COVID-19 tests. The numerical results provided herein were obtained via an updatable R Markdown document.

Sixty-eight consecutive patients assessed for COVID-19 infection: Experience from a UK Regional infectious diseases Unit

BACKGROUND: Assessment of possible infection with SARS-CoV-2, the novel coronavirus responsible for COVID-19 illness, has been a major activity of infection services since the first reports of cases in December 2019. OBJECTIVES: We report a series of 68 patients assessed at a Regional Infection Unit in the UK. METHODS: Between 29 January 2020 and 24 February 2020, demographic, clinical, epidemiological and laboratory data were collected. We compared clinical features between patients not requiring admission for clinical reasons or antimicrobials with those assessed as needing either admission or antimicrobial treatment. RESULTS: Patients assessed were aged from 0 to 76 years; 36/68 were female. Peaks of clinical assessments coincided with updates to the case definition for suspected COVID-19. Microbiological diagnoses included SARS-CoV-2, mycoplasma pneumonia, influenza A, non-SARS/MERS coronaviruses and rhinovirus/enterovirus. Nine of sixty-eight received antimicrobials, 15/68 were admitted, 5 due to inability to self-isolate. Patients requiring admission on clinical grounds or antimicrobials (14/68) were more likely to have fever or raised respiratory rate compared to those not requiring admission or antimicrobials. CONCLUSIONS: The majority of patients had mild illness, which did not require clinical intervention. This finding supports a community testing approach, supported by clinicians able to review more unwell patients. Extensions of the epidemiological criteria for the case definition of suspected COVID-19 lead to increased screening intensity; strategies must be in place to accommodate this in time for forthcoming changes as the epidemic develops.

Upregulation of TRIAP1 by the lncRNA MFI2-AS1/miR-125a-5p Axis Promotes Thyroid Cancer Tumorigenesis

Background: Thyroid cancer is a very common endocrine cancer worldwide. How long noncoding RNA (lncRNA) regulates thyroid cancer is elusive. LncRNA MFI2-AS1 has been demonstrated to initiate colorectal cancer. Nevertheless, the role of MFI2-AS1 in thyroid cancer remains unknown. This study aims to determine the roles of MFI2-AS1 in thyroid cancer. Methods: qRT-PCR was used to determine the expression of MFI2-AS1 in thyroid cancer tissues and cells. Proliferation was determined by using CCK8 and colony formation assays. Transwell assay was utilized to analyze migration and invasion. Luciferase reporter assay was performed to confirm the interaction between MFI2-AS1 and miR-125a-5p. Results: MFI2-AS1 was shown to be highly expressed in thyroid cancer tissues and predicted poor prognosis. Knockdown of MFI2-AS1 inhibited proliferation, colony formation, migration and invasion of thyroid cancer cells in vitro. Bioinformatics screening identified MFI2-AS1 as the sponge for miR-125a-5p. And miR-125a-5p was further confirmed to target TRIAP1 directly. Our data further demonstrated that MFI2-AS1 promoted TRIAP1 expression via repressing miR-125a-5p. Finally, TRIAP1 was found to be upregulated in thyroid cancer tissues and its restoration reversed the effects of MFI2-AS1 depletion. Conclusion: Our results elucidated a novel mechanism that MFI2-AS1 promotes thyroid cancer progression via the miR-125a-5p/TRIAP1 pathway.

Avaliação da virulência de estirpes de Mycobacterium avium presentes na população de suínos no sul do Brasil/ Evaluation of Mycobacterium avium strains virulence from porcine population of south Brazil

Tendo sido comprovada a existência da famílias molecularmente distintas de M. avium circulando em suínos de região sul do Brasil, e havendo dúvidas a respeito da importância da transmissão horizontal como mecanismo de manutenção da doença, o presente teve por objetivo estudar a virulência dessas estirpes, informação importente para o aperfeiçoamento dos métodos de controle. As estirpes emergiram do estudo caso-controle, onde as tipagens moleculares por RFLP mostraram a existência de quatro famílias de M. avium (PIG-A, B, C e D). Um estirpe representante de cada família foi inoculada pela via intra-peritoneal em 48 hamsters com uma dose de 30.000 U.F.C. por animal. Após 2, 13, 26 e 40 dias da inoculação, 12 hamsters inoculados de cada família foram anestesiados, sacrificados e os agentes foram quantificados no fígado, baço e pulmão. A presença das estirpes foi verificada no sangue e também foram realizados exames histológicos. As estipers PIG-A, B, C e D desenvolveram lesões granulomatosas no fígado e baço nos quatro tempos experimentais; disseminaram-se pela via linfo-hemática, multiplicando-se em fígado, baço e pulmão. Nos quatro tempos experimentais houve diferença entre as contagens de U.F.C./g entre os órgãos (T1: p<0,001; T2: p<0,001; T3: p<0,001 e T4: p<0,001) e as obtidas do baço foram sempre superiores às do fígado e pulmão. Nos quatro tempos experimentais houve diferença entre as contagens de U.F.C./g entre as estirpes (T1: p<0,001; T2: <0,001; T3: p<0,001 e T4: p<0,001) e foi possível construir a seguinte escala decrescente de virulência: PIG-B > PIG-A > PIG-D > PIG-C

Dynamic Pricing and Inventory Management with Demand Learning: A Bayesian Approach

We consider a retail firm selling a durable product in a volatile market where the demand is price-sensitive and random but its distribution is unknown. The firm dynamically replenishes inventory and adjusts prices over time and learns about the demand distribution. Assuming that the demand model is of the multiplicative form and unmet demand is partially backlogged, we take the empirical Bayesian approach to formulate the problem as a stochastic dynamic program. We first identify a set of regularity conditions on demand models and show that the state-dependent base-stock list-price policy is optimal. We next employ the dimensionality reduction approach to separate the scale factor that captures observed demand information from the optimal profit function, which yields a normalized dynamic program that is more tractable. We also analyze the effect of demand learning on the optimal policy using the system without Bayesian update as a benchmark. We further extend our analysis to the case with unobserved lost sales and the case with additive demand.

Using rapid online surveys to assess perceptions during infectious disease outbreaks: a cross-sectional survey on Covid-19 among the general public in the United States and United Kingdom

BACKGROUND: Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate in phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks OBJECTIVE: To apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (Covid-19) among the general public in the United States (US) and the United Kingdom (UK) METHODS: An online questionnaire was administered to 3,000 adults residing in the US and 3,000 adults residing in the UK who had registered with Prolific Academic to participate in online research Strata by age (18 - 27, 28 - 37, 38 - 47, 48 - 57, or =58 years), sex (male or female), and ethnicity (White, Black or African American, Asian or Asian Indian, Mixed, or "Other"), and all permutations of these strata, were established The number of participants who could enrol in each of these strata was calculated to reflect the distribution in the US and UK general population Enrolment into the survey within the strata was on a first-come, first-served basis Participants completed the questionnaire between February 23 and March 2 2020 RESULTS: 2,986 and 2,988 adults residing in the US and the UK, respectively, completed the questionnaire 64 4% (1,924/2,986) of US and 51 5% (1,540/2,988) of UK participants had a tertiary education degree 67 5% (2,015/2,986) of US participants had a total household income between $20,000 and $99,999, and 74 4% (2,223/2,988) of UK participants had a total household income between GBP15,000 and GBP74,999 US and UK participants' median estimate for the probability of a fatal disease course among those infected with SARS-CoV-2 was 5 0% (IQR: 2 0% - 15 0%) and 3 0% (IQR: 2 0% - 10 0%), respectively Participants generally had good knowledge of the main mode of disease transmission and common symptoms of Covid-19 However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior For instance, 37 8% (95% CI: 36 1% - 39 6%) of US and 29 7% (95% CI: 28 1% - 31 4%) of UK participants thought that wearing a common surgical mask was 'highly effective' in protecting them from acquiring Covid-19 25 6% (95% CI: 24 1% - 27 2%) of US and 29 6% (95% CI: 28 0% - 31 3%) of UK participants thought it prudent to refrain from eating at Chinese restaurants Around half (53 8% [95% CI: 52 1% - 55 6%] of US and 39 1% [95% CI: 37 4% - 40 9%] of UK participants) thought that children were at an especially high risk of death when infected with SARS-CoV-2 CONCLUSIONS: The distribution of participants by total household income and education followed approximately that of the general population The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media More broadly, rapid online surveys could be an important tool in tracking the public's knowledge and misperceptions during rapidly moving infectious disease outbreaks

American Neurogastroenterology and Motility Society Task Force Recommendations for Resumption of Motility Laboratory Operations During the COVID-19 Pandemic

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.

Rapid isolation and profiling of a diverse panel of human monoclonal antibodies targeting the SARS-CoV-2 spike protein

Antibodies are a principal determinant of immunity for most RNA viruses and have promise to reduce infection or disease during major epidemics. The novel coronavirus SARS-CoV-2 has caused a global pandemic with millions of infections and hundreds of thousands of deaths to date1,2. In response, we used a rapid antibody discovery platform to isolate hundreds of human monoclonal antibodies (mAbs) against the SARS-CoV-2 spike (S) protein. We stratify these mAbs into five major classes on the basis of their reactivity to subdomains of S protein as well as their cross-reactivity to SARS-CoV. Many of these mAbs inhibit infection of authentic SARS-CoV-2 virus, with most neutralizing mAbs recognizing the receptor-binding domain (RBD) of S. This work defines sites of vulnerability on SARS-CoV-2 S and demonstrates the speed and robustness of advanced antibody discovery platforms.

Comparative Effectiveness of Commercial Bowel Preparations in Ambulatory Patients Presenting for Screening or Surveillance Colonoscopy

BACKGROUND: Inadequate bowel preparation (IBP) is associated with reduced adenoma detection. However, limited research has examined the impact of different commercial bowel preparations (CBPs) on IBP and adenoma detection. We aim to determine whether type of CBP used is associated with IBP or adenoma detection. METHODS: We retrospectively evaluated outpatient, screening or surveillance colonoscopies performed in the Cleveland Clinic health system between January 2011 and June 2017. IBP was defined by the Aronchick scale. Multilevel mixed-effects logistic regression was performed to assess the association between CBP type and IBP and adenoma detection. Fixed effects were defined as demographics, comorbidities, medication use, and colonoscopy factors. Random effect of individual endoscopist was considered. RESULTS: Of 153,639 colonoscopies, 75,874 records met inclusion criteria. Median age was 54; 50% were female; 17.7% had IBP, and adenoma detection rate was 32.6%. In adjusted analyses, compared to GoLYTELY, only NuLYTELY [OR 0.66 (95% CI 0.60, 0.72)] and SuPREP [OR 0.53 (95% CI 0.40, 0.69)] were associated with reduced IBP. Adenoma detection did not vary based on the type of bowel preparation used. CONCLUSIONS: Among patients referred for screening or surveillance colonoscopy, choice of CBP was not associated with adenoma detection. Decisions about CBP should be based on other factors, such as tolerability, cost, or safety.

Telemedicine in Otolaryngology in the COVID-19 Era: Initial Lessons Learned

OBJECTIVES/HYPOTHESIS: The COVID-19 pandemic has led to unprecedented global changes in the delivery of healthcare over a short period of time. With the implementation of shelter-in-place orders, otolaryngology clinic visits at our institution were transitioned to telemedicine. This change enabled the rapid characterization of the patients who accepted and declined telemedicine. STUDY DESIGN: Cross-sectional analysis. METHODS: A review was conducted of 525 otolaryngology patients at a tertiary-care referral center with scheduled visits requiring rescheduling to a future date or a telemedicine visit. Visit, demographic information, and reason for deferring telemedicine were collected for analysis. RESULTS: Seventy-two percent of patients declined a telemedicine visit, with the most common reason being the lack of a physical exam (97%). There was an even distribution of demographics between those who accepted and declined visits. There was an association between declining telemedicine with older age (P = .0004) and otology visits (P = .0003), whereas facial plastics patients were more likely to accept (P < .0001). Patients scheduled earlier during the pandemic were more likely to accept a visit with a median of 28 days from onset of shelter-in-place orders versus 35 for those who declined (P < .0001). CONCLUSIONS: We describe our initial experience with a transition to telemedicine, where the majority of patients would decline a virtual visit due to the lack of a physical exam. Although the future remains uncertain, telemedicine will continue to play a vital role in healthcare delivery. We believe that understanding our patient base gives critical insights that will help guide and improve virtual care to meet patients' needs. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

Challenges posed by COVID-19 to the health of people with disabilities living in residential care facilities in Romania

In this contribution, I discuss potential risk to the health of people with disabilities in residential care institutions during the COVID-19 outbreak by looking at evidence from Romania. As an academic who has studied deinstitutionalization of services for people with disabilities in Romania, I argue that residential care institutions for people with disabilities are at risk of becoming sites for community contagion with COVID-19. These institutions are often located in remote and economically peripheral areas of the country that have been characterized by high rates of outmigration. Now, these are becoming areas of intense return migration. Community contagion in adjacent locations can easily spill over to residential institutions through care and health workers’ trajectories. Once spread to residential institutions, COVID-19 has a high chance of adversely affecting the health of residents with disabilities. It is vital to ensure disabled people’s health and wellbeing through adequate contagion prevention measures.

Is the Gill Skeleton of Acorn Worms (Enteropneusta) Similar to the Gill Skeleton of Amphioxus (Cephalochordata)?

The gill skeleton of the enteropneust Saccoglossus mereschkowskii consists of a series of tridents. The central prong of each trident bifurcates in its ventral end. The most anterior gill skeletal element has a simple horseshoe shape. Homologues of the elements of the enteropneust gill apparatus were found in the structure of the gill apparatus of Cephalochordata. The organization of the gill skeleton of Enteropneusta and Cephalochordata can be derived from the metameric horseshoe-shaped elements. The similarity of the structure of the gill skeleton of Enteropneusta and Cephalochordata contradicts a common "upside-down theory" of the origin of Chordata.

Patients' Experiences of Remote Neurology Consultations during the COVID-19 Pandemic

Telemedicine has been widely implemented during the COVID-19 global pandemic to enable continuity of care of chronic illnesses. We modified our general neurology clinic to be conducted using remote audio-only telephone consultations. We included all patients over a 10-week period who agreed to both a telephone consultation and a questionnaire afterwards in order to ascertain the patient's perspective of the experience. There were 212 participants consisting of men (43.8%) and women (56.2%). The mean ± standard deviation of age was 47.8 ± 17.0 (range 17-93) years. For the most part, patients found remote consultations either "just as good" (67.1%) or "better" (9.0%) than face-to-face consultations. Those who deemed it to be "not as good" were significantly older (52.3 ± 17.9 years vs. 46.6 ± 16.6 years, p =0.045) or were more likely to have a neurological disorder that required clinical examination, namely, a neuromuscular condition (66.7%, p = 0.002) or an undiagnosed condition (46.7%, p = 0.031). At the height of the COVID-19 global pandemic, most patients were satisfied with remote consultations. The positive feedback for remote consultations needs to be verified outside of this unique scenario because the results were likely influenced by the patients' apprehension to attend the hospital amongst other factors.

Wie stark trifft die Corona-Pandemie die chirurgische Klinik eines universitären Maximalversorgers? : Eine Analyse der ersten 7 Wochen./ [How severe is the effect of the coronavirus pandemic on the department of surgery of a university hospital? : An analysis of the first 7 weeks]

BACKGROUND: The corona pandemic poses enormous financial challenges for hospitals. Using the example of a clinic for visceral, transplantation, thorax and vascular surgery (VTTG), the performance development of inpatient care in the first 7 weeks in comparison to the previous year as well as an evaluation of the compensation measures laid down by law were evaluated. METHODOLOGY: Based on the performance figures, a comparison was made between the period from 16 March to 3 May 2019 and the same period in 2020. Changes in the number of cases, case mix, case mix index and day mix index as well as the bed occupancy days were recorded. The monetary measures from the COVID-19 Hospital Relief Act were applied to these changes and the adequacy was evaluated. RESULTS: Compared to the previous year there was a decrease in inpatient admissions of 120 patients during the observation period. As a result there was a decrease of 370 points in case mix and 1433 days of occupancy. For the whole VTTG this resulted in a decrease in revenue of approximately 0.8 million €, which was completely compensated by the flat rate payment for empty beds. The individual areas of the VTTG showed a heterogeneous picture in relation to the compensation for the loss of revenue. Elective units in particular showed a shortfall up to 128,163 € with respect to inpatient treatment for 7 weeks. CONCLUSION: The measures taken by the Government are an important support for the economic security of German hospitals. The lack of differentiation of measures by specialty leads to a heterogeneous picture in compensation for VTTG revenues and has to be understood as an alarm signal especially for elective surgical healthcare.

Wie stark trifft die Corona-Pandemie die chirurgische Klinik eines universitären Maximalversorgers? : Eine Analyse der ersten 7 Wochen./ [How severe is the effect of the coronavirus pandemic on the department of surgery of a university hospital? : An analysis of the first 7 weeks]

BACKGROUND: The corona pandemic poses enormous financial challenges for hospitals. Using the example of a clinic for visceral, transplantation, thorax and vascular surgery (VTTG), the performance development of inpatient care in the first 7 weeks in comparison to the previous year as well as an evaluation of the compensation measures laid down by law were evaluated. METHODOLOGY: Based on the performance figures, a comparison was made between the period from 16 March to 3 May 2019 and the same period in 2020. Changes in the number of cases, case mix, case mix index and day mix index as well as the bed occupancy days were recorded. The monetary measures from the COVID-19 Hospital Relief Act were applied to these changes and the adequacy was evaluated. RESULTS: Compared to the previous year there was a decrease in inpatient admissions of 120 patients during the observation period. As a result there was a decrease of 370 points in case mix and 1433 days of occupancy. For the whole VTTG this resulted in a decrease in revenue of approximately 0.8 million €, which was completely compensated by the flat rate payment for empty beds. The individual areas of the VTTG showed a heterogeneous picture in relation to the compensation for the loss of revenue. Elective units in particular showed a shortfall up to 128,163 € with respect to inpatient treatment for 7 weeks. CONCLUSION: The measures taken by the Government are an important support for the economic security of German hospitals. The lack of differentiation of measures by specialty leads to a heterogeneous picture in compensation for VTTG revenues and has to be understood as an alarm signal especially for elective surgical healthcare.

Wie stark trifft die Corona-Pandemie die chirurgische Klinik eines universitären Maximalversorgers? : Eine Analyse der ersten 7 Wochen./ [How severe is the effect of the coronavirus pandemic on the department of surgery of a university hospital? : An analysis of the first 7 weeks]

BACKGROUND: The corona pandemic poses enormous financial challenges for hospitals. Using the example of a clinic for visceral, transplantation, thorax and vascular surgery (VTTG), the performance development of inpatient care in the first 7 weeks in comparison to the previous year as well as an evaluation of the compensation measures laid down by law were evaluated. METHODOLOGY: Based on the performance figures, a comparison was made between the period from 16 March to 3 May 2019 and the same period in 2020. Changes in the number of cases, case mix, case mix index and day mix index as well as the bed occupancy days were recorded. The monetary measures from the COVID-19 Hospital Relief Act were applied to these changes and the adequacy was evaluated. RESULTS: Compared to the previous year there was a decrease in inpatient admissions of 120 patients during the observation period. As a result there was a decrease of 370 points in case mix and 1433 days of occupancy. For the whole VTTG this resulted in a decrease in revenue of approximately 0.8 million €, which was completely compensated by the flat rate payment for empty beds. The individual areas of the VTTG showed a heterogeneous picture in relation to the compensation for the loss of revenue. Elective units in particular showed a shortfall up to 128,163 € with respect to inpatient treatment for 7 weeks. CONCLUSION: The measures taken by the Government are an important support for the economic security of German hospitals. The lack of differentiation of measures by specialty leads to a heterogeneous picture in compensation for VTTG revenues and has to be understood as an alarm signal especially for elective surgical healthcare.

Dog and cat population dynamics in an urban area: evaluation of a birth control strategy/ Dinâmica populacional canina e felina em área urbana: avaliação da estratégia de controle reprodutivo

For canine and feline population management in an urban area, a set of well-developed strategies is required to prevent overpopulation, the abandonment of animals, and zoonosis. An understanding of the dynamics of these populations and a characterization of these populations are necessary for action planning. The proposed strategies should be monitored and evaluated so that canine and feline population management programs are properly implemented. Population management programs can be improved through evidence based adaptive management. The objective of this study was to characterize the canine and feline populations and their dynamics in an urban area and to evaluate the impact of a birth control program. Three cross-sectional census surveys and a birth control program were conducted in a neighborhood of São Paulo area with 4,275 households. The two first surveys were performed in 2005 and 2006, prior to implementation of the birth control program, and were used to characterize the canine and feline populations. The third survey was performed in 2008, eighteen months after the birth control strategy had been established. The canine population decreased from 2006 to 2008, after birth control. The mean age for the canine population was 3.36 years; 65% of the dogs were younger than 3 years of age. The mean life expectancy at birth was 3.9 years for male dogs and 5.9 years for female dogs. The mean age for the feline population was 1.66 years; 74% of the cats were 1 year of age or less. The canine and feline populations had a high mortality rate for juveniles younger than 1 year of age. There was an 8% and an 18% decrease in canine and feline birth rates, respectively, after spay or neuter intervention. There was a high animal population turnover, which was more pronounced in the feline population.(AU)

Partisan public health: how does political ideology influence support for COVID-19 related misinformation?

This study analyzes over 4000 tweets related to six misinformation topics about the COVID-19 pandemic: the use of hydroxychloroquine as treatment, the use of bleach as a preventative measure, Bill Gates intentionally causing the virus, the Chinese Communist Party intentionally causing the virus, and the Deep State causing the virus to ruin the economy and threaten President Trump's reelection chances. Across 5 of 6 topics (excluding bleach), conservatives dominate the discourse on Twitter. Conservatives are also more likely than their liberal peers to believe in and push conspiracy theories that the Chinese Communist Party, Bill Gates, and the Deep State are working in conjunction to infect the population and enact a surveillance state. Pandemic related misinformation has previously been associated with decreased adherence to public health recommendations and adverse health effects and evidence from the current pandemic indicates that adherence to public health recommendations is starkly partisan. This study suggests that the political and informational polarization further facilitated by social media platforms such as Twitter may have dire consequences for public health.

Summary of global surveillance data of infectious diseases in December 2019

In December 2019, a total of 64 infectious diseases were reported globally, affecting 82 countries and regions Except for influenza, the top five infectious diseases affecting greatest number of countries and regions were measles (49), dengue fever (26), chikungunya fever (8), poliomyelitis (8) and cerebrospinal meningitis (8) The top four infectious diseases with highest case fatality rates were Ebola virus disease (66 0%), Middle East respiratory syndrome (34 4%), Lassa fever (20 8%) and plague (16 0%) The top five infectious diseases with greatest number of deaths were measles, malaria, dengue fever, cholera and Ebola virus disease The prevalent infectious diseases in Africa were Ebola virus disease, plague, cholera, yellow fever, Lassa fever and measles, the prevalent infectious diseases in Asia were dengue fever and Middle East respiratory syndrome, the prevalent infectious diseases in America was dengue fever, the prevalent infectious diseases in Europe was measles

Computational study of pomegranate peel extract polyphenols as potential inhibitors of SARS-CoV-2 virus internalization

The search for effective coronavirus disease (COVID-19) therapy has attracted a great deal of scientific interest due to its unprecedented health care system overload worldwide. We have carried out a study to investigate the in silico effects of the most abundant pomegranate peel extract constituents on the multi-step process of serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) internalization in the host cells. Binding affinities and interactions of ellagic acid, gallic acid, punicalagin and punicalin were studied on four selected protein targets with a significant and confirmed role in the process of the entry of virus into a host cell. The protein targets used in this study were: SARS-CoV-2 spike glycoprotein, angiotensin-converting enzyme 2, furin and transmembrane serine protease 2. The results showed that the constituents of pomegranate peel extracts, namely punicalagin and punicalin had very promising potential for significant interactions with the selected protein targets and were therefore deemed good candidates for further in vitro and in vivo evaluation.

Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison

BACKGROUND: There are now over 800,000 registered deaths due to the COVID-19 pandemic worldwide. Researchers have suggested that COVID-19 death characteristics (e.g., intensive care admission, unexpected death) and circumstances (e.g., secondary stressors, social isolation) will precipitate a worldwide increase of prolonged grief disorder (PGD) and persistent complex bereavement disorder (PCBD). Yet, no study has investigated this. Since acute grief is a strong predictor of future pathological grief, we compared grief levels among people recently bereaved due to COVID-19, natural, and unnatural causes. METHODS: People bereaved through COVID-19 (n = 49), natural causes (n = 1182), and unnatural causes (n = 210), completed self-report measures of demographic and loss-related characteristics and PGD and PCBD symptoms. RESULTS: COVID-19 bereavement yielded higher symptom levels of PGD (d = 0.42) and PCBD (d = 0.35) than natural bereavement (but not unnatural bereavement). Effects held when limiting analyses to recent losses and those who participated during the pandemic. Expectedness of the death explained this effect. LIMITATIONS: Limitations include using a convenience sample and self-report measures. CONCLUSIONS: Higher grief levels occur among people bereaved due to COVID-19 compared to people bereaved due to natural loss. We predict that pandemic-related increases in pathological grief will become a worldwide public health concern.

Identifying differences in physical activity and autonomic function patterns between psychotic patients and controls over a long period of continuous monitoring using wearable sensors

Digital phenotyping is a nascent multidisciplinary field that has the potential to revolutionize psychiatry and its clinical practice. In this paper, we present a rigorous statistical analysis of short-time features extracted from wearable data, during long-term continuous monitoring of patients with psychotic disorders and healthy control counterparts. Our novel analysis identifies features that fluctuate significantly between the two groups, and offers insights on several factors that differentiate them, which could be leveraged in the future for relapse prevention and individualized assistance.

Multimodal Emotion Evaluation: A Physiological Model for Cost-Effective Emotion Classification

Emotional responses are associated with distinct body alterations and are crucial to foster adaptive responses, well-being, and survival Emotion identification may improve peoples’ emotion regulation strategies and interaction with multiple life contexts Several studies have investigated emotion classification systems, but most of them are based on the analysis of only one, a few, or isolated physiological signals Understanding how informative the individual signals are and how their combination works would allow to develop more cost-effective, informative, and objective systems for emotion detection, processing, and interpretation In the present work, electrocardiogram, electromyogram, and electrodermal activity were processed in order to find a physiological model of emotions Both a unimodal and a multimodal approach were used to analyze what signal, or combination of signals, may better describe an emotional response, using a sample of 55 healthy subjects The method was divided in: (1) signal preprocessing;(2) feature extraction;(3) classification using random forest and neural networks Results suggest that the electrocardiogram (ECG) signal is the most effective for emotion classification Yet, the combination of all signals provides the best emotion identification performance, with all signals providing crucial information for the system This physiological model of emotions has important research and clinical implications, by providing valuable information about the value and weight of physiological signals for emotional classification, which can critically drive effective evaluation, monitoring and intervention, regarding emotional processing and regulation, considering multiple contexts

Point-of-Care RNA-Based Diagnostic Device for COVID-19

At the end of 2019, the novel coronavirus disease (COVID-19), a fast-spreading respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported in Wuhan, China and has now affected over 123 countries globally [...].

Neutrophils and Neutrophil Extracellular Traps Drive Necroinflammation in COVID-19

The COVID-19 pandemic is progressing worldwide with an alarming death toll. There is an urgent need for novel therapeutic strategies to combat potentially fatal complications. Distinctive clinical features of severe COVID-19 include acute respiratory distress syndrome, neutrophilia, and cytokine storm, along with severe inflammatory response syndrome or sepsis. Here, we propose the putative role of enhanced neutrophil infiltration and the release of neutrophil extracellular traps, complement activation and vascular thrombosis during necroinflammation in COVID-19. Furthermore, we discuss how neutrophilic inflammation contributes to the higher mortality of COVID-19 in patients with underlying co-morbidities such as diabetes and cardiovascular diseases. This perspective highlights neutrophils as a putative target for the immunopathologic complications of severely ill COVID-19 patients. Development of the novel therapeutic strategies targeting neutrophils may help reduce the overall disease fatality rate of COVID-19.

Potential role of viral metagenomics as a surveillance tool for the early detection of emerging novel pathogens

Since the early times, human beings have always been faced with deadly microbial infections, both bacterial and viral. Pathogens such as viruses are always evolving owing to the processes of antigenic shift and drift. Such viral evolution results in the emergence of new types and serovars that prove deadly for humans-like influenza pandemics, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The pandemic of novel coronavirus SARS-CoV-2 is the recent example. It has resulted in a great loss of human lives and a serious burden on economy across the globe. To counter such situations, a system should exist for the early detection of emerging viral pathogens. This will help prevent possible outbreaks and save human lives. Most of such deadly novel viruses and viral outbreaks are known to be originated from animal hosts. Regular monitoring of potential hot spots of such emerging microbes, such as zoos and animal markets, through metagenomics could help assess the presence of new viruses and pathogens. In this review, we focus on the potential of viral metagenomics and propose a surveillance system based on it for the early detection and hence prevention of such emerging viral infections.