title: Simulating COVID-19 in a University Environment

text: Residential colleges and universities face unique challenges in providing in-person instruction during the COVID-19 pandemic. Administrators are currently faced with decisions about whether to open during the pandemic and what modifications of their normal operations might be necessary to protect students, faculty and staff. There is little information, however, on what measures are likely to be most effective and whether existing interventions could contain the spread of an outbreak on campus. We develop a full-scale stochastic agent-based model to determine whether in-person instruction could safely continue during the pandemic and evaluate the necessity of various interventions. Simulation results indicate that large scale randomized testing, contact-tracing, and quarantining are important components of a successful strategy for containing campus outbreaks. High test specificity is critical for keeping the size of the quarantine population manageable. Moving the largest classes online is also crucial for controlling both the size of outbreaks and the number of students in quarantine. Increased residential exposure can significantly impact the size of an outbreak, but it is likely more important to control non-residential social exposure among students. Finally, necessarily high quarantine rates even in controlled outbreaks imply significant absenteeism, indicating a need to plan for remote instruction of quarantined students.


title: Potential role of endothelial cell surface ectopic redox complexes in COVID-19 disease pathogenesis

text: The novel coronavirus infectious disease (COVID-19) has rapidly spread and poses a great challenge to researchers, both in elucidating its pathogenic mechanism and developing effective treatments. It has been recently proposed that COVID-19 is an endothelial disease. Indeed, the COVID-19 virus binds to angiotensin-converting enzyme type 2 (ACE2), which is expressed in endothelial cells. ACE2 could be implicated in the production of reactive oxygen species (ROS) caused by endothelial dysfunction due to viral damage. Consequently, oxidative stress could prime these cells to acquire a pro-thrombotic and pro-inflammatory phenotype, predisposing patients to thromboembolic and vasculitic events and to disseminated intravascular coagulopathy (DIC). This implies a pivotal role played by oxygen in the pathogenetic mechanism of COVID-19 disease, in that its availability would tune the oxidant state and consequent damage.


title: Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy

text: The COST CARES project aims to support healthcare cost containment and improve healthcare quality across Europe by developing the research and development necessary for person-centred care (PCC) and health promotion. This paper presents an overview evaluation strategy for testing 'Exploratory Health Laboratories' to deliver these aims. Our strategy is theory driven and evidence based, and developed through a multi-disciplinary and European-wide team. Specifically, we define the key approach and essential criteria necessary to evaluate initial testing, and on-going large-scale implementation with a core set of accompanying methods (metrics, models, and measurements). This paper also outlines the enabling mechanisms that support the development of the "Health Labs" towards innovative models of ethically grounded and evidenced-based PCC.


Sleep quality among health care workers during the COVID-19 pandemic


David Oliver: Let's be open and honest about covid-19 deaths in care homes


title: In bid to rapidly expand coronavirus testing, U.S. agency abruptly changes rules ;Science ;AAAS

text: The Food and Drug Administration (FDA) today recommended a dramatic shift in how it implements regulations that control whether laboratories can use diagnostic kits created in-house to test for infections of coronavirus-2019 (COVID-19) “We issued a policy this morning that allows us to have a lot of flexibility around the development of diagnostic tests,” said FDA Commissioner Stephen Hahn at a White House briefing with President Donald Trump this afternoon “We expect this policy to have a significant impact ” The change could greatly expand the number of laboratories able to do coronavirus testing The U S government has come under severe criticism for not providing nearly enough tests needed to understand the extent of spread in the population A test kit produced and distributed by the U S Centers for Disease Control and Prevention (CDC) was shelved after state and local lab trying it out discovered that it contained a faulty reagent As a result, many labs that have the capability to test themselves have not been allowed to do so The new recommendations focus on “high-complexity testing laboratories” that are certified under federal rules known as Clinical Laboratory Improvement Amendments This group of facilities includes many hospital labs, like the one that epidemiologist Michael Mina works at Brigham and Women’s Hospital in Boston “Essentially it’s opening up a clear and concise avenue for labs like the one at Brigham and Women’s,” says Mina “It’s what I’ve been advocating for a month now ”


title: Pearls of experience for safe and efficient hospital practices in otorhinolaryngology-head and neck surgery in Hong Kong during the 2019 novel coronavirus disease (COVID-19) pandemic

text: The 2019 novel coronavirus disease (COVID-19) epidemic originated in Wuhan, China and spread rapidly worldwide, leading the World Health Organization to declare an official global COVID-19 pandemic in March 2020. In Hong Kong, clinicians and other healthcare personnel collaborated closely to combat the outbreak of COVID-19 and minimize the cross-transmission of disease among hospital staff members. In the field of otorhinolaryngology-head and neck surgery (OHNS) and its various subspecialties, contingency plans were required for patient bookings in outpatient clinics, surgeries in operating rooms, protocols in wards and other services. Infected patients may shed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) particles into their environments via body secretions. Therefore, otolaryngologists and other healthcare personnel in this specialty face a high risk of contracting COVID-19 and must remain vigilant when performing examinations and procedures involving the nose and throat. In this article, we share our experiences of the planning and logistics undertaken to provide safe and efficient OHNS practices over the last 2 months, during the COVID-19 pandemic. We hope that our experiences will serve as pearls for otolaryngologists and other healthcare personnel working in institutes that serve large numbers of patients every day, particularly with regard to the sharing of clinical and administrative tasks during the COVID-19 pandemic.


title: Impact of COVID-19 on Mohs micrographic surgery: UK-wide survey and recommendations for practice

text: Coronavirus Disease 2019 (COVID-19) pandemic has overwhelmed and disrupted healthcare systems including dermatology services. National directives were issued to reduce patient footfall within hospitals in anticipation of a deluge of COVID-19 admissions. We conducted a survey focusing on the impact of the pandemic upon Mohs micrographic surgery (MMS) practices and invited all British Society for Dermatological Surgery (BSDS) members undertaking MMS to complete over three weeks commencing 27th April 2020.


The Impact of COVID-19 on Clinical Trials


More on: 'COVID-19 coagulopathy in Caucasian patients'


title: Fake Science: XMRV, COVID-19, and the Toxic Legacy of Dr. Judy Mikovits

text: One cannot spend >5 min on social media at the moment without finding a link to some conspiracy theory or other regarding the origin of SARS-CoV2, the coronavirus responsible for the COVID-19 pandemic. From the virus being deliberately released as a bioweapon to pharmaceutical companies blocking the trials of natural remedies to boost their dangerous drugs and vaccines, the Internet is rife with far-fetched rumors. And predictably, now that the first immunization trials have started, the antivaccine lobby has latched on to most of them. In the last week, the trailer for a new "bombshell documentary" Plandemic has been doing the rounds, gaining notoriety for being repeatedly removed from YouTube and Facebook. We usually would not pay much heed to such things, but for retrovirologists like us, the name associated with these claims is unfortunately too familiar: Dr. Judy Mikovits.


docid: budazubl

title: Q&A with Albert S. Woo, MD Forging a New Frontier in 3D Printing during COVID-19 Pandemic


title: Global trends in mangrove forest fragmentation

text: Fragmentation is a major driver of ecosystem degradation, reducing the capacity of habitats to provide many important ecosystem services. Mangrove ecosystem services, such as erosion prevention, shoreline protection and mitigation of climate change (through carbon sequestration), depend on the size and arrangement of forest patches, but we know little about broad-scale patterns of mangrove forest fragmentation. Here we conduct a multi-scale analysis using global estimates of mangrove density and regional drivers of mangrove deforestation to map relationships between habitat loss and fragmentation. Mangrove fragmentation was ubiquitous; however, there are geographic disparities between mangrove loss and fragmentation; some regions, like Cambodia and the southern Caribbean, had relatively little loss, but their forests have been extensively fragmented. In Southeast Asia, a global hotspot of mangrove loss, the conversion of forests to aquaculture and rice plantations were the biggest drivers of loss (>50%) and fragmentation. Surprisingly, conversion of forests to oil palm plantations, responsible for >15% of all deforestation in Southeast Asia, was only weakly correlated with mangrove fragmentation. Thus, the management of different deforestation drivers may increase or decrease fragmentation. Our findings suggest that large scale monitoring of mangrove forests should also consider fragmentation. This work highlights that regional priorities for conservation based on forest loss rates can overlook fragmentation and associated loss of ecosystem functionality.


title: Generalized Z-numbers with hesitant fuzzy linguistic information and its application to medicine selection for the patients with mild symptoms of the COVID-19

text: Fuzzy set theory and a series of theories derived from it have been widely used to deal with uncertain phenomena in multi-criterion decision-making problems. However, few methods except the Z-number considered the reliability of information. In this paper, we propose a multi-criterion decision-making method based on the Dempster-Shafer (DS) theory and generalized Z-numbers. To do so, inspired by the concept of hesitant fuzzy linguistic term set, we extend the Z-number to a generalized form which is more in line with human expression habits. Afterwards, we make a bridge between the knowledge of Z-numbers and the DS evidence theory to integrate Z-valuations. The identification framework in the DS theory is used to describe the generalized Z-numbers to avoid ambiguity. Then, the knowledge of Z-numbers is used to derive the basic probability assignment of evidence and the synthetic rules in the DS theory are used to integrate evaluations. An illustrative example of medicine selection for the patients with mild symptoms of the COVID-19 is provided to show the effectiveness of the proposed method.


title: Emergency Responses to Covid-19 Outbreak: Experiences and Lessons from a General Hospital in Nanjing, China

text: BACKGROUND: The novel coronavirus 2019 (SARS-CoV-2) has caused wide dissemination across the world. Global health systems are facing the unprecedented challenges. Here we shared the experiences and lessons in emergency responses and management from our hospital, a government-assigned regional anti-Covid-19 general hospital in Nanjing, Jiangsu Province, China. METHODS: Our periodic strategies in dealing with Covid-19 were described in detail. An administrative response including the establishment of Emergency Leadership Committee that was in full charge of management was established. Modifications of infrastructure including the Fever Clinic, inpatient ward, outpatient clinic and operation room were carried out. Special arrangements for outpatient services, hospitalization and surgeries were introduced. Medical personnel training and patient educations were performed. Initiations of Covid-19 researches and application of information technology were introduced. FINDINGS: Since January 16, three cases have been confirmed in our hospital and no healthcare-associated infection was found. During the epidemics, 6.46% staffs suffered depression, 9.87% had anxiety, and 98% were satisfied with the infection control policy. Shortages in staffs and medical consumables, and limitation in space were the obstacles we encountered. INTERPRETATION: As the cost of in-hospital transmission is unbearable, our experiences and lessons suggested that prompt actions should be taken immediately to decrease or eliminate potential in-hospital transmission. Experience shared herein may be useful for those facilities that are and may encounter Covid-19.


Indoor temperature and relative humidity in hospitals: workplace considerations during the novel coronavirus pandemic


title: Acidified sodium chlorite solution: A potential prophylaxis to mitigate impact of multiple exposures to COVID-19 in frontline health-care providers

text: Limited availability of personal protective equipment is endangering first-line health-care providers treating patients with presumed or confirmed COVID-19 infections. This editorial has multiple objectives in regard to this reality: First, to raise awareness of the need for safe and effective prophylaxis to protect health-care providers with insufficient personal protective equipment from repeated exposures to COVID-19. Second, to summarize the scientific evidence in support of solutions of acidified sodium chlorite (ASC) and its daughter compounds, chlorous acid and chlorine dioxide, as potential targets for said prophylactic use. Third, to propose a regimented protocol using commercially available solutions of ASC having sufficient concentrations of chlorine dioxide for virucidal activity to support safe and effective prophylactic use. And fourth, to raise awareness of and compare other potential prophylactic options currently under investigation.


When preserving life becomes imperative, quality of life is eclipsed! COVID-19 outbreak impacting patients with pelvic floor disorders undergoing pelvic floor rehabilitation


Mechanics of Breathing and Gas Exchange in Mechanically Ventilated Patients with COVID-19 Associated Respiratory Failure


Hydroxychloroquine and coronavirus disease 2019


title: Recommendations for Keeping Parks and Green Space Accessible for Mental and Physical Health During COVID-19 and Other Pandemics

text: The importance of engaging in any type of physical activity regularly, for both physical and mental health, is well established, and may be particularly beneficial in protecting the body and limiting the damage caused by the coronavirus disease 2019 (COVID-19). Exposure to nature or green space also has positive physical and mental health benefits. Closures of parks and green spaces during the COVID-19 pandemic has limited the options for physical activity and may affect vulnerable populations more than others. We provide both short-term and long-term recommendations to encourage access to green space for people while allowing for physical distancing.


COVID-19, the Anthropocene, and transformative change


The COVID-19 epidemic


'I am not an angel, I am a nurse, I am human'


title: Group Testing for COVID-19: How to Stop Worrying and Test More

text: The corona virus disease 2019 (COVID-19) caused by the novel corona virus has an exponential rate of infection. COVID-19 is particularly notorious as the onset of symptoms in infected patients are usually delayed and there exists a large number of asymptomatic carriers. In order to prevent overwhelming of medical facilities and large fatality rate, early stage testing and diagnosis are key requirements. In this article, we discuss the methodologies from the group testing literature and its relevance to COVID-19 diagnosis. Specifically, we investigate the efficiency of group testing using polymerase chain reaction (PCR) for COVID-19. Group testing is a method in which multiple samples are pooled together in groups and fewer tests are performed on these groups to discern all the infected samples. We study the effect of dilution due to pooling in group testing and show that group tests can perform well even in the presence of dilution effects. We present multiple group testing algorithms that could reduce the number of tests performed for COVID-19 diagnosis. We analyze the efficiency of these tests and provide insights on their practical relevance. With the use of algorithms described here, test plans can be developed that can enable testing centers to increase the number of diagnosis performed without increasing the number of PCR tests. The codes for generating test plans are available online at [1].


title: Use of systemic therapies for psoriasis in the COVID-19 era

text: BACKGROUND: In late 2019 a viral pneumonia began to spread across the world. The viral disease, COVID-19, is now officially a pandemic, causing concern for the potential risk of systemic therapies for patients with psoriasis. OBJECTIVE: The purpose of this review is to analyze what is currently known about COVID-19 in regard to the safety of systemic treatment, and to provide guidelines for use in psoriasis during this pandemic. METHODS: Review of guidelines from various dermatologic regulatory bodies regarding the use of systemic medications during the COVID-19 pandemic was performed and summarized. RESULTS: The AAD,NPF and IPC are in agreement regarding their recommendation that patients with active COVID-19 infection should discontinue any biologic therapy. CONCLUSION: Patients with active COVID-19 infections should discontinue systemic treatment for psoriasis. Patients with risk factors should discuss continuing treatment on a case by case basis.


title: Triplex Real-Time RT-PCR for Severe Acute Respiratory Syndrome Coronavirus 2

text: Most reverse transcription PCR protocols for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include 2-3 targets for detection. We developed a triplex, real-time reverse transcription PCR for SARS-CoV-2 that maintained clinical performance compared with singleplex assays. This protocol could streamline detection and decrease reagent use during current high SARS-CoV-2 testing demands.


title: Experience of Clinical Management for Pregnant Women and Newborns with Novel Coronavirus Pneumonia in Tongji Hospital, China

text: Based on the New Diagnosis and Treatment Scheme for Novel Coronavirus Infected Pneumonia (Trial Edition 5), combined with our current clinical treatment experience, we recently proposed a revision of the first edition of "Guidance for maternal and fetal management during pneumonia epidemics of novel coronavirus infection in the Wuhan Tongji Hospital". This article focused on the issues of greatest concern of pregnant women including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnostic criteria, inspection precautions, drug treatment options, indications and methods of termination of pregnancy, postpartum fever, breastfeeding considerations, mode of mother-to-child transmission, neonatal isolation and advice on neonatal nursing, to provide valuable experience for better management of SARS-CoV-2 infection in pregnant women and newborns.


title: Assessing the application of a pseudovirus system for emerging SARS-CoV-2 and re-emerging avian influenza virus H5 subtypes in vaccine development

text: BACKGROUND: Highly pathogenic emerging and re-emerging viruses continuously threaten lives worldwide. In order to provide prophylactic prevention from the emerging and re-emerging viruses, vaccine is suggested as the most efficient way to prevent individuals from the threat of viral infection. Nonetheless, the highly pathogenic viruses need to be handled in a high level of biosafety containment, which hinders vaccine development. To shorten the timeframe of vaccine development, the pseudovirus system has been widely applied to examine vaccine efficacy or immunogenicity in the emerging and re-emerging viruses. METHODS: We developed pseudovirus systems for emerging SARS coronavirus 2 (SARS-CoV-2) and re-emerging avian influenza virus H5 subtypes which can be handled in the biosafety level 2 facility. Through the generated pseudovirus of SARS-CoV-2 and avian influenza virus H5 subtypes, we successfully established a neutralization assay to quantify the neutralizing activity of antisera against the viruses. RESULTS: The result of re-emerging avian influenza virus H5Nx pseudoviruses provided valuable information for antigenic evolution and immunogenicity analysis in vaccine candidate selection. Together, our study assessed the potency of pseudovirus systems in vaccine efficacy, antigenic analysis, and immunogenicity in the vaccine development of emerging and re-emerging viruses. CONCLUSION: Instead of handling live highly pathogenic viruses in a high biosafety level facility, using pseudovirus systems would speed up the process of vaccine development to provide community protection against emerging and re-emerging viral diseases with high pathogenicity.


docid: wkjsxjcp

title: Effects of the COVID-19 Outbreak on Elder Mistreatment and Response in New York City: Initial Lessons

text: New York City is currently experiencing an outbreak of COVID-19, a highly contagious and potentially deadly virus, which is particularly dangerous for older adults. This pandemic has led to public health policies including social distancing and stay-at-home orders. We explore here the impact of this unique crisis on victims of elder mistreatment and people at risk of victimization. The COVID-19 outbreak has also had a profound impact on the organizations from many sectors that typically respond to protect and serve victims of elder mistreatment. We examine this impact and describe creative solutions developed by these organizations and initial lessons learned in New York City to help inform other communities facing this pandemic and provide guidance for future crises.


title: COVID-19 in a MS patient treated with ocrelizumab: does immunosuppression have a protective role?

text: BACKGROUND: Coronavirus disease 19 (COVID-19) is a novel disease entity that is spreading throughout the world. It has been speculated that patients with comorbidities and elderly patients could be at high risk for respiratory insufficiency and death. Immunosuppression could expose infected patients to even higher risks of disease complications due to dampened immune response. However, it has been speculated that overactive immune response could drive clinical deterioration and, based on this hypothesis, several immunosuppressants are currently being tested as potential treatment for COVID-19. METHODS: In this paper we report on a patient that has been treated with ocrelizumab (a B-cell depleting monoclonal antibody) for primary progressive multiple sclerosis who developed COVID-19. RESULTS: Despite complete B cell depletion, patient symptoms abated few days after hospitalization, and he was discharged to home-quarantine. Phone interview follow-up confirmed that, after 14 days, no new symptoms occurred. DISCUSSION: This report supports the putative role of immunosuppressive therapy in COVID-19 affected patients.


title: Tissue Oximetry Readings Accurately Predict Late Complications in Patients Undergoing Free Flap Breast Reconstruction: Exploring the Optimal Cut Point Value

text: BACKGROUND: The use of tissue oximetry for monitoring following free tissue transfer has become a common practice across the United States to facilitate early detection of poor flap perfusion in the postoperative setting. There is no consensus on the optimal value, below which there is a higher chance of wound complications in patients undergoing free flap breast reconstruction. METHODS: Patients undergoing free flap breast reconstruction from 2015 to 2018 were retrospectively reviewed. Patients who returned to the operating room for a revision of the anastomosis were excluded from analysis. Patients were divided in two groups based on the development of late complications. Those were defined as fat necrosis, wound dehiscence, or distal flap ischemia/necrosis that developed after discharge from the hospital. Mean percutaneous oximetry readings of the first 24 hours were recorded and the mean change from the initial reading was calculated. The correlation between tissue oximetry change and development of complications was explored. RESULTS: A total of 120 patients were identified. The mean age was 53, while the mean body mass index was 33. A total of 38 patients developed late wound complication. History of smoking, diabetes mellitus, neoadjuvant radiation therapy, and the mean change of the tissue oximetry reading were identified as independent predictors of wound complications. The absolute number of the tissue oximetry reading did not predict late complications. A multivariate analysis revealed that patients who experienced a mean decrease < 15% from the initial reading during the first 24 hours were significantly more likely to develop late flap-related wound complications. CONCLUSION: In patients undergoing free tissue breast reconstruction, tissue oximetry readings do not predict late wound complications. However, the mean change at 24 hours from the initial reading does. A decrease of <15% in tissue perfusion was associated with a significant increase in the probability of developing flap-related wound complications.


SARS-CoV-2 infection presenting with hematochezia


Living Arrangements of Older Adults and COVID-19 Risk: It Is Not Just Nursing Homes


title: Eficácia da associação dupla dose PGF2 alfa-eCG no proestro de vacas leiteiras mestiças submetidas à IATF/ Efficacy of the double PGF2 alpha dose-eCG association in proestrus of crossbred dairy cows submitted to IATF

text: Objetivou-se avaliar o efeito de uma ou duas doses de prostaglandina F2α (PGF2α) associada ou não a gonadotrofina coriônica equina (eCG) sobre a dinâmica folicular, a função luteal pré-ovulatória, assim como as características morfofuncionais pós-ovulatórias do corpo lúteo (CL) em fêmeas mestiças cíclicas submetidas a um protocolo de inseminação artificial em tempo fixo (IATF). Para tanto, 29 vacas 3/4 Gir x Holandês multíparas foram submetidas ao exame de ultrassonografia (US) transretal e após a detecção do CL iniciou-se um protocolo de IATF em um dia denominado zero (D0), por meio da inserção do implante de progesterona (P4) associado à aplicação de 2,0mg de benzoato de estradiol. No D7 esses animais receberam 12,5mg de dinoprost trometamina. No D9 realizou a remoção dos dispositivos de P4 e aplicou 0,6mg de cipionato de estradiol. Nesse momento, as fêmeas foram subdivididas nos seguintes tratamentos: Grupo Controle (n=7), foi administrado 2,5mL de solução fisiológica; Grupo 2PGF (n=7), aplicou 12,5mg de dinoprost trometamina; Grupo eCG (n=7), administrou-se 300UI de eCG; Grupo 2PGF+eCG (n=8), realizou a aplicação de 300UI de eCG e 12,5mg de dinoprost trometamina. Para avaliar a dinâmica folicular foram realizados exames de US em modo B e power doppler (Mindray Z5, Shenzhen, China) a cada 12h do D7 até o momento da ovulação ou 96h após a remoção dos implantes de P4, mensurando-se o diâmetro folicular (DFOL), a área da parede folicular (AFOL) e a área de perfusão sanguínea da parede folicular (VFOL). Concomitante a cada exame, foram coletadas amostras de sangue sendo determinada a concentração sérica de P4 pré-ovulatória por meio da metodologia de quimioluminescência. No D24 foi realizada a US modo B e doppler analisando-se o diâmetro luteal (DCL), área luteal (ACL) e área de perfusão sanguínea do CL (VCL), assim como, foi coletada amostra de sangue para averiguar a concentração sérica de P4 pós-ovulatória.(AU)


title: Recomendaciones sobre reanimación cardiopulmonar en pacientes con sospecha o infección confirmada por SARS-CoV-2 (COVID-19). Resumen ejecutivo./ [Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]

text: The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into five parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.


title: Surgery during COVID-19 crisis conditions: can we protect our ethical integrity against the odds?

text: COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients' outcome within the constraints of pandemic management and its long-term outlook.


Renin-Angiotensin-Aldosterone System Inhibitors in Covid-19


Understanding the "Scope" of the Problem: Why Laparoscopy Is Considered Safe during the COVID-19 Pandemic


title: L'infection par SRAS-CoV-2 peut se traduire par un syndrome appendiculaire : tomodensitométrie thoracique avant appendicectomie./ [SARS-CoV-2 infection may result in appendicular syndrome: Chest CT scan before appendectomy]

text: The initial clinical presentation of CoronaVirus Disease 2019 may be appendicular syndrome. An abdominal CT scan ruled out a diagnosis of appendicitis and a chest CT scan yielded a diagnosis of SARS-CoV-2 infection. CT scan is required before considering emergency surgery for acute appendicitis.


title: Detection of Atrial Fibrillation from Single Lead ECG Signal Using Multirate Cosine Filter Bank and Deep Neural Network

text: Atrial fibrillation (AF) is a cardiac arrhythmia which is characterized based on the irregsular beating of atria, resulting in, the abnormal atrial patterns that are observed in the electrocardiogram (ECG) signal. The early detection of this pathology is very helpful for minimizing the chances of stroke, other heart-related disorders, and coronary artery diseases. This paper proposes a novel method for the detection of AF pathology based on the analysis of the ECG signal. The method adopts a multi-rate cosine filter bank architecture for the evaluation of coefficients from the ECG signal at different subbands, in turn, the Fractional norm (FN) feature is evaluated from the extracted coefficients at each subband. Then, the AF detection is carried out using a deep learning approach known as the Hierarchical Extreme Learning Machine (H-ELM) from the FN features. The proposed method is evaluated by considering normal and AF pathological ECG signals from public databases. The experimental results reveal that the proposed multi-rate cosine filter bank based on FN features is effective for the detection of AF pathology with an accuracy, sensitivity and specificity values of 99.40%, 98.77%, and 100%, respectively. The performance of the proposed diagnostic features of the ECG signal is compared with other existing features for the detection of AF. The low-frequency subband FN features found to be more significant with a difference of the mean values as 0.69 between normal and AF classes.


title: Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study

text: BACKGROUND: The World Health Organization has declared coronavirus disease 2019 (COVID-19) a public health emergency of global concern. Updated analysis of cases might help identify the risk factors of illness severity. RESULTS: The median age was 63 years, and 44.9% were severe cases. Severe patients had higher APACHE II (8.5 vs. 4.0) and SOFA (2 vs. 1) scores on admission. Among all univariable parameters, lymphocytes, CRP, and LDH were significantly independent risk factors of COVID-19 severity. LDH was positively related both with APACHE II and SOFA scores, as well as P/F ratio and CT scores. LDH (AUC = 0.878) also had a maximum specificity (96.9%), with the cutoff value of 344.5. In addition, LDH was positively correlated with CRP, AST, BNP and cTnI, while negatively correlated with lymphocytes and its subsets. CONCLUSIONS: This study showed that LDH could be identified as a powerful predictive factor for early recognition of lung injury and severe COVID-19 cases. METHODS: We extracted data regarding 107 patients with confirmed COVID-19 from Renmin Hospital of Wuhan University. The degree of severity of COVID-19 patients (severe vs. non-severe) was defined at the time of admission according to American Thoracic Society guidelines for community acquired pneumonia.


Efficacy of therapeutic plasma exchange in severe COVID-19 patients


title: Clinical analysis of risk factors for severe patients with novel coronavirus pneumonia/ 中华传染病杂志

text: Objective To analyze the clinical features of patients with coronavirus disease 2019 (COVID-19) in Shanghai and to investigate the risk factors for disease progression to severe cases. Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20, 2020 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory examinations were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using hi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results Among the 292 patients, 21 were severe cases with the rate of 7.2% (21/292). One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.0±15.7) years old, 19 (90.5%) were male, 11 (52.4%) had underlying diseases, 7 (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t =-4.730, χ 2 =12.930, 5.938 and 4.744, respectively, all P <0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin , D -dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum troponin I (cTnI) in severe patients were all significantly higher ( U =2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 917.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 258.0 and 1 747.5, respectively, all P <0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U =1 263.5, t =4.716, U =1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P <0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR )=0.806, 95% CI 0.675-0.961), CRP ( OR =1.016, 95% CI 1.000-1.032), serum myoglobin ( OR =1.010, 95% CI 1.004-1.016), CD3 + T lymphocyte count ( OR =0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR =1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P <0.05). Conclusions Severe cases of patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.


title: Traffic Performance Score for Measuring the Impact of COVID-19 on Urban Mobility

text: Measuring traffic performance is critical for public agencies who manage traffic and individuals who plan trips, especially when special events happen. The COVID-19 pandemic has significantly influenced almost every aspect of daily life, including urban traffic patterns. Thus, it is important to measure the impact of COVID-19 on transportation to further guide agencies and residents to properly respond to changes in traffic patterns. However, most existing traffic performance metrics incorporate only a single traffic parameter and measure only the performance of individual corridors. To overcome these challenges, in this study, a Traffic Performance Score (TPS) is proposed that incorporates multiple parameters for measuring network-wide traffic performance. An interactive web-based TPS platform that provides real-time and historical spatial-temporal traffic performance analysis is developed by the STAR Lab at the University of Washington. Based on data from this platform, this study analyzes the impact of COVID-19 on different road segments and the traffic network as a whole. Considering this pandemic has greatly reshaped social and economic operations, this study also evaluates how COVID-19 is changing the urban mobility from both travel demand and driving behavior perspectives.


When the Game Changes: Guidance to Adjust Sarcoidosis Management During the COVID-19 Pandemic


Imatinib might constitute a treatment option for lung involvement in COVID-19


Síndrome coronario agudo y shock en contexto de infección aguda por COVID-19./ [Acute coronary syndrome and shock in the context of acute COVID-19 infection]


COVID-19 in Africa


title: Impact of coronavirus 2019 (COVID-19) on training and well-being in subspecialty surgery: A national survey of cardiothoracic trainees in the United Kingdom

text: OBJECTIVES: The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity. We sought to establish the impact of the COVID-19 pandemic on the well-being, practice, and progression of all trainees in cardiothoracic surgery in the United Kingdom. METHODS: A 31-item questionnaire was designed, validated, and disseminated via e-mail and an instant-messaging platform. RESULTS: In total, 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programs nationally; 48 (63%) and 24 (32%) were concerned about their physical and mental health, respectively, 25 (33%) had taken time off work due to COVID-19, 65 (86%) had treated patients with COVID-19, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time, 41 (54%) remain concerned about personal protective equipment provision at their institution, 42 (55%) had been redeployed to cover other specialties, and 23 (30%) had encountered ethical dilemmas related to care of patients. There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction), and operating theaters (78% reduction). In total, 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time. CONCLUSIONS: The duration and impact of the current pandemic is, as yet, uncertain. Timely sharing of experiences, concerns, and expectations will inform health care and education policy and influence practice in the pandemic era and beyond.


title: A Patient with Acute Cervical Cord Injury and COVID-19: A First Case Report

text: During the pandemic of Coronavirus disease 2019 (COVID-19), it is possible for rehabilitation physicians and personnel to take care of patients with concurrent spinal cord injury (SCI) and COVID-19. Here, we describe a case of acute cervical SCI resulting in complete tetraplegia C5 American Spinal Injury Association (ASIA) Impairment Scale (AIS) A with unrecognized, acute respiratory syndrome coronavirus 2 (SAR-CoV-2) infection. This resulted in large-scale quarantines of related surgical and rehabilitation staff, and the unexpected death of the patient despite receiving the treatments according to the standard guideline. Rehabilitation personnel who take care of acute SCI patients with COVID-19 should consider the effect of SCI on the course of COVID-19, the effect of COVID-19 and its treatments on the course of SCI, and risks of SAR-CoV2 transmission between patients and rehabilitation staff, to continue providing safe and effective rehabilitation programs.


title: Erythema nodosum as a cutaneous manifestation of COVID-19 infection

text: Erythema nodosum (EN) is a common dermatological manifestation with many different aetiologies. Often however, the aetiology remains unidentified. We present here a 42-year-old male patient with an EN that is due to an acute COVID-19 infection. Most of the usual aetiologies were excluded by laboratory testing and imaging studies. This case is, to our knowledge, the first report of this cutaneous manifestation in the context of a COVID-19 infection. The EN was successfully treated with the disappearance of the COVID-19 infection and topical corticosteroids.


title: Predicting Infection of COVID-19 in Japan: State Space Modeling Approach

text: The number of confirmed cases of the coronavirus disease (COVID-19) in Japan has been increasing day by day and has had a serious impact on the society especially after the declaration of the state of emergency on April 7, 2020. This study analyzes the real time data from March 1 to April 22, 2020 by adopting a sophisticated statistical modeling tool based on the state space model combined with the well-known susceptible-exposed-infected (SIR) model. The model estimation and forecasting are conducted using the Bayesian methodology. The present study provides the parameter estimates of the unknown parameters that critically determine the epidemic process derived from the SIR model and prediction of the future transition of the infectious proportion including the size and timing of the epidemic peak with the prediction intervals that naturally accounts for the uncertainty. The prediction results under various scenarios reveals that the temporary reduction in the infection rate until the planned lifting of the state on May 6 will only delay the epidemic peak slightly. In order to minimize the spread of the epidemic, it is strongly suggested that an intervention is carried out for an extended period of time and that the government and individuals make a long term effort to reduce the infection rate even after the lifting.


Emergency measures for acute oral mucosa diseases during the outbreak of COVID-19


CLL and COVID-19 at the Hospital Clinic of Barcelona: an interim report


A novel plan to deal with SARS-CoV-2 and COVID-19 disease


title: SARS-CoV-2 Vaccines: Status Report

text: SARS-CoV-2, the causal agent of COVID-19, first emerged in late 2019 in China. It has since infected more than 870,000 individuals and caused more than 43,000 deaths globally. Here, we discuss therapeutic and prophylactic interventions for SARS-CoV-2 with a focus on vaccine development and its challenges. Vaccines are being rapidly developed but will likely come too late to affect the first wave of a potential pandemic. Nevertheless, critical lessons can be learned for the development of vaccines against rapidly emerging viruses. Importantly, SARS-CoV-2 vaccines will be essential to reducing morbidity and mortality if the virus establishes itself in the population.


title: On Accelerated Testing for COVID-19 Using Group Testing

text: COVID-19 has resulted in a global health crisis that may become even more acute over the upcoming months. One of the main reasons behind the current rapid growth of COVID-19 in the U.S. population is the limited availability of testing kits and the relatively-high cost of screening tests. In this draft, we demonstrate the effectiveness of group testing (pooling) ideas to accelerate testing for COVID-19. This draft is semi-tutorial in nature and is written for a broad audience with interest in mathematical formulations relevant to COVID-19 testing. Therefore, ideas are presented through illustrative examples rather than through purely theoretical formulations. The focus is also on pools of size less than 64 such as what is practical with current RT-PCR technology.


title: Initial Clinical Impressions of the Critical Care of COVID-19 Patients in Seattle, New York City, and Chicago

text: Since the first recognition of a cluster of novel respiratory viral infections in China in late December 2019, intensivists in the United States have watched with growing concern as infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-now named coronavirus disease of 2019 (COVID-19)-have spread to hospitals in the United States. Because COVID-19 is extremely transmissible and can progress to a severe form of respiratory failure, the potential to overwhelm available critical care resources is high and critical care management of COVID-19 patients has been thrust into the spotlight. COVID-19 arrived in the United States in January and, as anticipated, has dramatically increased the usage of critical care resources. Three of the hardest-hit cities have been Seattle, New York City, and Chicago with a combined total of over 14,000 cases as of March 23, 2020.In this special article, we describe initial clinical impressions of critical care of COVID-19 in these areas, with attention to clinical presentation, laboratory values, organ system effects, treatment strategies, and resource management. We highlight clinical observations that align with or differ from already published reports. These impressions represent only the early empiric experience of the authors and are not intended to serve as recommendations or guidelines for practice, but rather as a starting point for intensivists preparing to address COVID-19 when it arrives in their community.


Preventing Frailty Progression during the COVID-19 Pandemic


Message from the Editor: Stem Cell Science in the Time of COVID-19


title: The role of children in transmission of SARS-CoV-2: A rapid review

text: Background: Understanding the role of children in the transmission of SARS-CoV-2 is urgently required given its policy implications in relation to the reopening of schools and intergenerational contacts. Methods: We conducted a rapid review of studies that investigated the role of children in the transmission of SARS-CoV-2. We synthesized evidence for four categories: 1) studies reporting documented cases of SARS-CoV-2 transmission by infected children; 2) studies presenting indirect evidence on the potential of SARS-CoV-2 transmission by (both symptomatic and asymptomatic) children; 3) studies reporting cluster outbreaks of COVID-19 in schools; 4) studies estimating the proportions of children infected by SARS-CoV-2, and reported results narratively. Results: A total of 16 unique studies were included for narrative synthesis. There is limited evidence detailing transmission of SARS-CoV-2 from infected children. We found two studies that reported a 3-month-old whose parents developed symptomatic COVID-19 seven days after caring for the infant and two children who may have contracted COVID-19 from the initial cases at a school in New South Wales. In addition, we identified six studies presenting indirect evidence on the potential for SARS-CoV-2 transmission by children, three of which found prolonged virus shedding in stools. There is little data on the transmission of SARS-CoV-2 in schools. We identified only two studies reporting outbreaks of COVID-19 in school settings and one case report of a child attending classes but not infecting any other pupils or staff. Lastly, we identified six studies estimating the proportion of children infected; data from population-based studies in Iceland, Italy, South Korea, Netherlands, California and a hospital-based study in the UK suggest children may be less likely to be infected. Conclusions: Preliminary results from population-based and school-based studies suggest that children may be less frequently infected or infect others, however current evidence is limited. Prolonged faecal shedding observed in studies highlights the potentially increased risk of faeco-oral transmission in children. Further seroprevalence studies (powered adequately for the paediatric population) are urgently required to establish whether children are in fact less likely to be infected compared to adults. Note: We plan to update this rapid review as new data becomes available. These updates are available at https://www.ed.ac.uk/usher/uncover/completed-uncover-reviews.


"COVID-19 and Obesity: Postoperative Risk in Patients Who Have Undergone Bariatric Surgery. Preliminary Report from High Volume Center in Italy (Lombardy)"


Domestic violence in the COVID-19 pandemic: a forensic psychiatric perspective


Diversifying medical school education to represent BAME backgrounds


Empowering global mental health in the time of Covid19


Managing the R0 of COVID-19: mathematics fights back


title: Detecting SARS-CoV-2 RNA in conjunctival secretions: Is it a valuable diagnostic method of COVID-19?

text: The main purpose of this study is to evaluate the presence of viral RNA of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab specimen of coronavirus disease 2019 (COVID-19) patients with and without conjunctivitis to establish the diagnostic value of reverse transcription-polymerase chain reaction (RT-PCR) in each case and to describe its clinical characteristics. A cross-sectional study was conducted at the Hospital Clinico San Carlos of Madrid, Spain. Thirty-six subjects from the COVID admission unit with laboratory-confirmed SARS-CoV-2 infection were included. Conjunctival swabs were collected from 18 patients with conjunctivitis and 18 patients without conjunctivitis and RT-PCR was performed. Conjunctival swab was collected from both eyes of 36 patients (72 eyes), detecting SARS-CoV-2 RNA in conjunctival swab of two patients (5.5%). Among the 18 patients with conjunctivitis, only one of them (5.5%) showed positive results. Likewise, SARS-CoV-2 RNA was detected in one patient without conjunctivitis (5.5%). The mean age of the 36 patients was 67.9 years (range, 28-92 years) and the male-to-female ratio was 0.44 (16:20). The mean days since the onset of COVID-19 symptoms until conjunctivitis manifestation was 8 (range, 1-24 days). The mean duration of the conjunctivitis was 3 days (range, 1-7 days). SARS-CoV-2 RNA may be detected in conjunctival swabs of both patients with and without conjunctivitis. This study revealed the same rate of positive results amongst the group with and without conjunctivitis, suggesting that detecting SARS-CoV-2 in ocular fluids is not conditioned on the presence of conjunctivitis. The presence of SARS-CoV-2 RNA in ocular samples highlights the role of the eye as a possible route of transmission of the disease.


Pancreatic involvement in SARS-CoV-2: case report and living review


title: Clinical management of COVID-19

text: The novel coronavirus disease 2019 (COVID-19) with its early origin from Wuhan city in China has evolved into a global pandemic. Maximal precautionary measures and resources have been put forward by most nations in war footing to mitigate transmission and decrease fatality rates. This article was aimed to review the evidence on clinical management and to deal with the identification of high-risk groups, warning signs, appropriate investigations, proper sample collection for confirmation, general and specific treatment measures, strategies as well as infection control in the healthcare settings. Advanced age, cardiovascular disease, diabetes, hypertension and cancer have been found to be the risk factors for severe disease. Fever lasting for >five days with tachypnoea, tachycardia or hypotension are indications for urgent attention and hospitalization in a patient with suspected COVID-19. At present, reverse transcription-polymerase chain reaction (RT-PCR) from the upper respiratory tract samples is the diagnostic test of choice. While many drugs have shown in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are insufficient clinical data to promote or dissuade their usage. Among the currently available drugs, hydroxychloroquine and lopinavir/ritonavir may be considered for patients with severe COVID-19 infection, awaiting further clinical trials. Stringent droplet and contact precautions will protect healthcare workers against most clinical exposures to COVID-19.


title: Clinical Characterization of 162 COVID-19 patients in Israel: Preliminary Report from a Large Tertiary Center

text: BACKGROUND: In February 2020, the World Health Organisation designated the name COVID-19 for a clinical condition caused by a virus identified as a cause for a cluster of pneumonia cases in Wuhan, China. The virus subsequently spread worldwide, causing havoc to medical systems and paralyzing global economies. The first COVID-19 patient in Israel was diagnosed on 27 February 2020. OBJECTIVES: To present our findings and experiences as the first and largest center for COVID-19 patients in Israel. METHODS: The current analysis included all COVID-19 patients treated in Sheba Medical Center from February 2020 to April 2020. Clinical, laboratory, and epidemiological data gathered during their hospitalization are presented. RESULTS: Our 162 patient cohort included mostly adult (mean age of 52 ± 20 years) males (65%). Patients classified as severe COVID-19 were significantly older and had higher prevalence of arterial hypertension and diabetes. They also had significantly higher white blood cell counts, absolute neutrophil counts, and lactate dehydrogenase. Low folic acid blood levels were more common amongst severe patients (18.2 vs. 12.9 vs. 9.8, P = 0.014). The rate of immune compromised patients (12%) in our cohort was also higher than in the general population. The rate of deterioration from moderate to severe disease was high: 9% necessitated non-invasive oxygenation and 15% were intubated and mechanically ventilated. The mortality rate was 3.1. CONCLUSIONS: COVID-19 patients present a challenge for healthcare professionals and the whole medical system. We hope our findings will assist other providers and institutions in their care for these patients.


title: ADL-dependency, D-Dimers, LDH and absence of anticoagulation are independently associated with one-month mortality in older inpatients with Covid-19

text: BACKGROUND: To assess factors associated with one-month mortality among older inpatients with Covid-19. RESULTS: The mean age was 78 ± 7.8 years, 55.5% were men, CT scan lung damage was observed in 76% of the patients (mild 23%, moderate 38%, extensive 22%, and severe 7%). The mortality rate was 26%. Dependency/Activities of Daily Living (ADL) score ≤ 5/6, D-Dimers, LDH, and no anticoagulation by reference for curative were independently associated with one-month mortality. A score derived from the multivariate model showed good calibration and very good discrimination (Harrell's C index [95%CI] = 0.83 [0.79-0.87]). CONCLUSION: ADL-dependency, high serum levels of D-Dimers and LDH and the absence of anticoagulation were independently associated with one-month mortality among older inpatients with Covid-19. METHODS: 108 consecutive older inpatients aged 65 and over with Covid-19 confirmed by RT-PCR and/or typical CT chest scan were prospectively included in a French single-centre cohort study from March to April 2020. A systematic geriatric assessment was performed. Covariates were lymphocyte count, serum levels of albumin, C-Reactive Protein, D-Dimers and Lactate Dehydrogenase (LDH), anticoagulation level, and exposure to the hydroxychloroquine and azithromycin combined therapy. Cox uni- and multivariate proportional-hazard regressions were performed to identify predictors of one-month mortality.


title: "We're Not Ready, But I Don't Think You're Ever Ready." Clinician Perspectives on Implementation of Crisis Standards of Care

text: Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.


Responding to health emergencies in the Eastern Mediterranean region in times of conflict


Infección por coronavirus (COVID-19) en Anales de Pediatría./ [Coronavirus infection (COVID-19) in Anales de Pediatría]


title: Analysis of a SARS-CoV-2-Infected Individual Reveals Development of Potent Neutralizing Antibodies with Limited Somatic Mutation

text: Antibody responses develop following SARS-CoV-2 infection, but little is known about their epitope specificities, clonality, binding affinities, epitopes, and neutralizing activity. We isolated B cells specific for the SARS-CoV-2 envelope glycoprotein spike (S) from a COVID-19-infected subject 21 days after the onset of clinical disease. 45 S-specific monoclonal antibodies were generated. They had undergone minimal somatic mutation with limited clonal expansion, and three bound the receptor-binding domain (RBD). Two antibodies neutralized SARS-CoV-2. The most potent antibody bound the RBD and prevented binding to the ACE2 receptor, while the other bound outside the RBD. Thus, most anti-S antibodies that were generated in this patient during the first weeks of COVID-19 infection were non-neutralizing and target epitopes outside the RBD. Antibodies that disrupt the SARS-CoV-2 S-ACE2 interaction can potently neutralize the virus without undergoing extensive maturation. Such antibodies have potential preventive and/or therapeutic potential and can serve as templates for vaccine design.


title: Les grands exclus face à la pandémie

text: Faced with the corona virus pandemic, those leaving in total exclusion of our modern societies express various needs other than food: needs of reference points, communication, care and recognition of human dignity. It is our responsibility to consider these needs as essential.


title: Information Sharing in the School Setting During a Public Health Emergency

text: The Family Educational Rights and Privacy Act of 1974 is the federal law that protects the privacy of personally identifiable information from student education records and applies to all education entities that receive funding under any program administered by the U.S. Department of Education. The Health Insurance Portability and Accountability Act of 1996 is the federal law that establishes privacy requirements for patients' protected health information. Together these privacy laws establish rules that guide school nurses in the sharing of student information, even in times of public health emergencies. The U.S. Department of Education and the U.S. Department of Health and Human Services have issued special updates to privacy laws in response to the Novel Coronavirus Disease providing certain waivers of typical privacy requirements and direction to allow the sharing of information during this public health emergency. The purpose of this article is to briefly review the privacy laws as they relate to schools, as well as to provide an overview of the recent waivers to assist school nurses, school administrators, healthcare professionals, and public health agencies in protecting the health and safety of students during this current public health emergency.


title: [The preliminary analysis on the characteristics of the cluster for the COVID-19]

text: Since December 2019, COVID-19, a new emerging infection disease, has spread in 27 countries and regions. The clusters of many cases were reported with the epidemic progresses. We collected currently available information for 377 COVID-19 clusters (1 719 cases), excluded the hospital clusters and Hubei cases, during the period from January 1 to February 20, 2020. There were 297 family clusters (79%), case median was 4; 39 clusters of dining (10%), case median was 5; 23 clusters of shopping malls or supermarkets (6%), case median was 13; 12 clusters of work units (3%), case median was 6, and 6 clusters of transportation. We selected 325 cases to estimate the incubation period and its range was 1 to 20 days, median was 7 days, and mode was 4 days. The analysis of the epidemic situation in a department store in China indicated that there was a possibility of patients as the source of infection during the incubation period of the epidemic. From February 5 to 21, 2020, 634 persons were infected on the Diamond Princess Liner. All persons are susceptible to the 2019 coronavirus. Age, patients during the incubation period and the worse environment might be the cause of the cases rising. The progress of the two typical outbreaks clearly demonstrated the spread of the early cases in Wuhan. In conclusion, screening and isolating close contacts remained essential other than clinical treatment during the epidemic. Especially for the healthy people in the epidemic area, isolation was the key.


Thoughts during a COVID nightmare


Favorable outcome after COVID-19 infection in a multiple sclerosis patient initiated on ocrelizumab during the pandemic


A message from the trench: A day in the hospital during the COVID-19 pandemic


Stress-induced cardiac arrest with mitral annulus disjunction in a physician amid the COVID-19 pandemic fight


title: Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

text: We argue that enhanced Traffic Control Bundling (eTCB) can interrupt the community-hospital-community transmission cycle, thereby limiting COVID-19's impact. Enhanced TCB is an expansion of the traditional TCB that proved highly effective during Taiwan's 2003 SARS outbreak. TCB's success derived from ensuring that Health Care Workers (HCWs) and patients were protected from fomite, contact and droplet transmission within hospitals. Although TCB proved successful during SARS, achieving a similar level of success with the COVID-19 outbreak requires adapting TCB to the unique manifestations of this new disease. These manifestations include asymptomatic infection, a hyper-affinity to ACE2 receptors resulting in high transmissibility, false negatives, and an incubation period of up to 22 days. Enhanced TCB incorporates the necessary adaptations. In particular, eTCB includes expanding the TCB transition zone to incorporate a new sector - the quarantine ward. This ward houses patients exhibiting atypical manifestations or awaiting definitive diagnosis. A second adaptation involves enhancing the checkpoint hand disinfection and gowning up with Personal Protective Equipment deployed in traditional TCB. Under eTCB, checkpoint hand disinfection and donning of face masks are now required of all visitors who seek to enter hospitals. These enhancements ensure that transmissions by droplets, fomites and contact are disrupted both within hospitals and between hospitals and the broader community. Evidencing eTCB effectiveness is Taiwan's success to date in containing and controlling the community-hospital-community transmission cycle.


Nasal endoscopy protocols in the era of COVID-19


Perspectives on the recommendations for skin cancer management during the COVID-19 pandemic


docid: ucgfvfhi

title: Add to your learning experience as a histopathology professional: dealing with the SARS-Cov-2 pandemic and publications in this issue


Covid-19: Delaying school reopening by two weeks would halve risks to children, says iSAGE


Prescribing COVID-19 treatments: what we should never forget


Phenomenology and outcomes of in-patients with Parkinson's disease during COVID-19 pandemic


title: Donación de órganos y trasplante en la era COVID-19: ¿Realmente se deben parar los programas?

text: Durante los primeros meses de la pandemia por SARS-CoV 2 (Coronavirus 2 del Síndrome Respiratorio Agudo y Grave), el agente etiológico de la Enfermedad Infecciosa por Coronavirus de 2019 (COVID-19), la actividad de donación y trasplante de órganos en todo el mundo se ha visto claramente afectada Las principales razones que en este momento motivan el cese parcial o total de los trasplantes son: 1) la carga asistencial que genera el manejo de un potencial donante en la Unidad de Cuidado Intensivo (UCI), 2) el alto riesgo de contagio entre donante y receptor, 3) el riesgo de inmunosuprimir a un paciente en medio de la pandemia y 4) la escasez de camas de UCI A pesar de que el mundo está enfrentando a una enfermedad emergente que merece especial atención, al mismo tiempo continúan prevaleciendo las complicaciones asociadas a las demás enfermedades, incluyendo las complicaciones de patologías crónicas en estado terminal La decisión de continuar con los programas de trasplante se debe basar en el comportamiento local del virus y en la capacidad asistencial de cada una de las instituciones En Colombia, el comportamiento epidemiológico del SARS-CoV 2 varía significativamente entre las diferentes regionales, permitiendo a las instituciones que hasta el momento presentan poca carga de atención del COVID-19 retomar sus actividades de trasplante De esta manera se propone un balance entre mantener las medidas de prevención y atención del COVID-19 y continuar ofreciendo los servicios de trasplante, principalmente a los pacientes con alto riesgo de morbi-mortalidad en lista de esperaThe SARS-CoV2 (Severe Acute Respiratory Syndromerelated to Coronavirus 2) pandemic, which is the etiological agent of the Coronavirus Infectious Disease 2019 (COVID-19), organ donation and transplantation activity throughout the world has been clearly affected The main reasons that currently motivate the partial or total cessation of transplants are: 1) the burden of care burden generated by the management of a potential donor in the Intensive Care Unit (ICU), 2) the high risk of donor/recipient viral transmission, 3) the risk of using immuno-suppressing a patient in the midst of the pandemic, and 4) the shortage of ICU beds Despite the fact that the world is facing an emerging disease that deserves special attention, at the same time the complications associated with other diseases continue to prevail, including complications of end-stage chronic diseases The decision to continue with the transplant programs should be based on the local behavior of the virus and the healthcare capacity of each of the institutions In Colombia, the epidemiological behavior of SARS-CoV2 varies significantly between different regions, allowing institutions that, until now, have little burden of attention from COVID-19, to resume their transplant activities In this way, a balance is proposed between maintaining the prevention and care measures of COVID-19 and continuing to offer transplant services mainly to patients with a high risk of morbidity and mortality on the waiting list


title: Genomic characterization and phylogenetic analysis of SARS-COV-2 in Italy

text: This report describes the isolation, molecular characterization, and phylogenetic analysis of the first three complete genomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolated from three patients involved in the first outbreak of COVID-19 in Lombardy, Italy. Early molecular epidemiological tracing suggests that SARS-CoV-2 was present in Italy weeks before the first reported cases of infection.


docid: zdokfqhu

title: Preparedness and proactive infection control measures of Pakistan during COVID-19 pandemic outbreak


title: "Masking" our emotions: Botulinum toxin, facial expression, and well-being in the age of COVID-19

text: BACKGROUND: The globally devastating effects of COVID-19 breach not only the realm of public health, but of psychosocial interaction and communication as well, particularly with the advent of mask-wearing. METHODS: A review of the literature and understanding of facial anatomy and expressions as well as the effect of botulinum toxin on emotions and nonverbal communication. RESULTS: Today, the mask has become a semi-permanent accessory to the face, blocking our ability to express and perceive each other's facial expressions by dividing it into a visible top half and invisible bottom half. This significantly restricts our ability to accurately interpret emotions based on facial expressions and strengthens our perceptions of negative emotions produced by frowning. The addition of botulinum toxin (BTX)-induced facial muscle paralysis to target the muscles of the top (visible) half of the face, especially the corrugator and procerus muscles, may act as a therapeutic solution by its suppression of glabellar lines and our ability to frown. The treatment of the glabella complex not only has been shown to inhibit the negative emotions of the treated individual but also can reduce the negative emotions in those who come in contact with the treated individual. CONCLUSIONS: Mask-wearing in the wake of COVID-19 brings new challenges to our ability to communicate and perceive emotion through full facial expression, our most effective and universally shared form of communication, and BTX may offer a positive solution to decrease negative emotions and promote well-being for both the mask-wearer and all who come in contact with that individual.


title: "Masking" our Emotions: Botulinum Toxin, Facial Expression and Well-Being in the Age of COVID-19

text: The globally devastating effects of COVID-19 breach not only the realm of public health, but of psychosocial interaction and communication as well, particularly with the advent of mask-wearing. Today, the mask has become a semi-permanent accessory to the face, blocking our ability to express and perceive each other's facial expressions by dividing it into a visible top-half and invisible bottom-half. This significantly restricts our ability to accurately interpret emotions based on facial expressions and strengthens our perceptions of negative emotions produced by frowning. The addition of botulinum toxin (BTX) induced facial muscle paralysis to target the muscles of the top (visible) half of the face, especially the corrugator and procerus muscles, may act as a therapeutic solution by its suppression of glabellar lines and our ability to frown. The treatment of the glabella complex not only has been shown to inhibit the negative emotions of the treated individual but also can reduce the negative in those who come in contact with the treated individual. Mask-wearing in the wake of COVID-19 brings new challenges to our ability to communicate and perceive emotion through full facial expression, our most effective and universally-shared form of communication, and BTX may offer a positive solution to decrease negative emotions and promote well-being for both the mask wearer as well as all who come in contact with that individual.


Hydroxychloroquine: small effects in mild disease


title: Identification and validation of a novel clinical signature to predict the prognosis in confirmed COVID-19 patients

text: BACKGROUND: This study aims to identify a prognostic biomarker to predict the disease prognosis and reduce the mortality rate of COVID-19, which has caused a worldwide pandemic. METHODS: COVID-19 patients were randomly divided into training and test groups. Univariate and multivariate Cox regression analyses were performed to identify the disease prognosis signature, which was selected to establish a risk model in the training group. Furthermore, the disease prognosis signature of COVID-19 was validated in the test group. RESULTS: The signature of COVID-19 was combined with five indicators, namely neutrophil count, lymphocyte count, procalcitonin, older age, and C-reactive protein. The signature stratified patients into high- and low-risk groups with significantly relevant disease prognosis (log-rank test, P<0.001) in the training group. The survival analysis indicated that the high-risk group displayed substantially lower survival probability than the low-risk group (log-rank test P<0.001). The area under ROC curve (AUC) showed that the signature of COVID-19 displayed the highest predictive accuracy regarding disease prognosis, which was 0.955 in the training group and 0.945 in the test group. The ROC analysis of both groups demonstrated that the predictive ability of the signature surpassed the use of each of the five indicators alone. CONCLUSION: The signature of COVID-19 presents a novel predictor and prognostic biomarker for closely monitoring patients and providing timely treatment for those who are severely or critically ill.


title: Seroprävalenz und SARS-CoV-2-Testung in Gesundheitsberufen./ [Seroprevalence and SARS-CoV-2 testing in healthcare occupations]

text: The SARS-CoV2 causes a disease spectrum that includes asymptomatic and mildly symptomatic infections with subclinical manifestations but which can nevertheless still be potentially contagious. Evidence from SARS-CoV2 infected macaque monkeys and from studies with seasonal coronaviruses suggests that the infection is likely to produce an immunity that is protective for a certain period of time. Available test methods enable a high degree of reliability, e.g. if high-quality serological methods are combined. Although individual test results have to be interpreted with caution, serosurveillance in a tertiary eye care center and large eye research institute can reduce anxiety and provide clarity regarding the actual number of (unreported) SARS-CoV2 infections.


Study on the cleaning effect of medical protective positive pressure air supply respirator during COVID-19


title: Reducing dexamethasone antiemetic prophylaxis during the COVID-19 pandemic: recommendations from Ontario, Canada

text: PURPOSE: People with cancer face an elevated risk of infection and severe sequelae from COVID-19. Dexamethasone is commonly used for antiemetic prophylaxis with systemic therapy for cancer. However, dexamethasone is associated with increased risk of viral and respiratory infections, and causes lymphopenia, which is associated with worse outcomes during COVID-19 infections. Our purpose was to minimize dexamethasone exposure during antiemetic prophylaxis for systemic therapy for solid tumors during the COVID-19 pandemic, while maintaining control of nausea and emesis. METHODS: We convened an expert panel to systematically review the literature and formulate consensus recommendations. RESULTS: No studies considered the impact of dexamethasone-based antiemetic regimens on the risk and severity of COVID-19 infection. Expert consensus recommended modifications to the 2019 Cancer Care Ontario Antiemetic Recommendations. CONCLUSION: Clinicians should prescribe the minimally effective dose of dexamethasone for antiemetic prophylaxis. Single-day dexamethasone dosing is recommended over multi-day dosing for regimens with high emetogenic risk excluding high-dose cisplatin, preferably in combination with palonosetron, netupitant, and olanzapine. For regimens with low emetogenic risk, 5-HT3 antagonists are recommended over dexamethasone.


Experiences and lesson strategies for cardiology from the COVID-19 outbreak in Wuhan, China, by 'on the scene' cardiologists


Novel coronavirus: Australian GPs raise concerns about shortage of face masks


Clinical features and outcomes of COVID-19 patients with gastrointestinal symptoms


Parálisis facial periférica aislada en un paciente con COVID-19./ [Isolated peripheral facial paralysis in a patient with COVID-19]


title: SARS-CoV-2 nsp13, nsp14, nsp15 and orf6 function as potent interferon antagonists

text: The Coronavirus disease 2019 (COVID-19), which is caused by the novel SARS-CoV-2 virus, is now causing a tremendous global health concern. Since its first appearance in December 2019, the outbreak has already caused over 5.8 million infections worldwide (till 29 May 2020), with more than 0.35 million deaths. Early virus-mediated immune suppression is believed to be one of the unique characteristics of SARS-CoV-2 infection and contributes at least partially to the viral pathogenesis. In this study, we identified the key viral interferon antagonists of SARS-CoV-2 and compared them with two well-characterized SARS-CoV interferon antagonists, PLpro and orf6. Here we demonstrated that the SARS-CoV-2 nsp13, nsp14, nsp15 and orf6, but not the unique orf8, could potently suppress primary interferon production and interferon signalling. Although SARS-CoV PLpro has been well-characterized for its potent interferon-antagonizing, deubiquitinase and protease activities, SARS-CoV-2 PLpro, despite sharing high amino acid sequence similarity with SARS-CoV, loses both interferon-antagonising and deubiquitinase activities. Among the 27 viral proteins, SARS-CoV-2 orf6 demonstrated the strongest suppression on both primary interferon production and interferon signalling. Orf6-deleted SARS-CoV-2 may be considered for the development of intranasal live-but-attenuated vaccine against COVID-19.


title: Statistical Explorations and Univariate Timeseries Analysis on COVID-19 Datasets to Understand the Trend of Disease Spreading and Death

text: "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)", the novel coronavirus, is responsible for the ongoing worldwide pandemic. "World Health Organization (WHO)" assigned an "International Classification of Diseases (ICD)" code-"COVID-19"-as the name of the new disease. Coronaviruses are generally transferred by people and many diverse species of animals, including birds and mammals such as cattle, camels, cats, and bats. Infrequently, the coronavirus can be transferred from animals to humans, and then propagate among people, such as with "Middle East Respiratory Syndrome (MERS-CoV)", "Severe Acute Respiratory Syndrome (SARS-CoV)", and now with this new virus, namely "SARS-CoV-2", or human coronavirus. Its rapid spreading has sent billions of people into lockdown as health services struggle to cope up. The COVID-19 outbreak comes along with an exponential growth of new infections, as well as a growing death count. A major goal to limit the further exponential spreading is to slow down the transmission rate, which is denoted by a "spread factor (f)", and we proposed an algorithm in this study for analyzing the same. This paper addresses the potential of data science to assess the risk factors correlated with COVID-19, after analyzing existing datasets available in "ourworldindata.org (Oxford University database)", and newly simulated datasets, following the analysis of different univariate "Long Short Term Memory (LSTM)" models for forecasting new cases and resulting deaths. The result shows that vanilla, stacked, and bidirectional LSTM models outperformed multilayer LSTM models. Besides, we discuss the findings related to the statistical analysis on simulated datasets. For correlation analysis, we included features, such as external temperature, rainfall, sunshine, population, infected cases, death, country, population, area, and population density of the past three months - January, February, and March in 2020. For univariate timeseries forecasting using LSTM, we used datasets from 1 January 2020, to 22 April 2020.


Community-Based Epidemic Prevention in Taiwan: Combating the Coronavirus Disease-2019 Crisis


Clozapine treated patients and COVID-19: Ensuring continued care through collaboration


Evolution of COVID-19 infection in four psoriatic patients treated with biological drugs


title: Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum

text: We found that environmental conditions affect the stability of severe acute respiratory syndrome coronavirus 2 in nasal mucus and sputum. The virus is more stable at low-temperature and low-humidity conditions, whereas warmer temperature and higher humidity shortened half-life. Although infectious virus was undetectable after 48 hours, viral RNA remained detectable for 7 days.


title: Panton-Valentine Leukocidin-Secreting Staphylococcus aureus Pneumonia Complicating COVID-19

text: Necrotizing pneumonia induced by Panton-Valentine leukocidin-secreting Staphylococcus aureus is a rare but life-threatening infection that has been described in patients after they had influenza. We report a fatal case of this superinfection in a young adult who had coronavirus disease.


Biologics for psoriasis in COVID-19 era: What do we know?


The COVID-19 outbreak and rheumatologic skin diseases


title: Exploration on the emergency support mode of hospital medical supplies under the epidemic of NCP/ 中华医院管理杂志

text: Since the outbreak of Novel Coronavirus Pneumonia(NCP), hospitals have taken the fight against the virus as its own responsibility, and keep standing in the front line of epidemic prevention and control. The continuous input of anti-epidemic forces in hospitals also brings challenges to the medical supplies support, including the management of protective supplies and the maintenance of medical equipment. In the face of increasing security pressure, the medical materials support team broke the game on multiple fronts. Firstly, the team implements active material procurement strategy, sets material distribution priority according to risk level, releases materials uniformly based on stock and use, and implements traceability management of donated materials to ensure material supply. Secondly, centralized allocation management of equipment, emergency installation, advanced maintenance and emergency maintenance work is effectively completed. Thirdly, disinfection strategies for items and equipment are developed safely and effectively with the aid of disinfection equipment functions. At last, personnel management and training have been strengthened. These measures have provided strong support for the orderly prevention and control of the epidemic.


The COVID-19 information pandemic: how have we managed the surge?


title: New EEG parameters correlated with sevoflurane concentration in dogs: tau and burst

text: Background: Electroencephalographic (EEG) indicators for anaesthesia depth are being developed. Here, we propose novel EEG parameters created by using two kinds of waveforms discriminated by voltage thresholds from a new perspective. Methods: Six young-adult beagles and 6 senior beagles were anaesthetised with end-tidal sevoflurane (SEV) of 2.0%-4.0% in 0.5% intervals, and 2-channel EEG (256 Hz) was recorded. Two events were discriminated: a consecutive part ({\tau}) with a peak-to-peak potential difference (Vpp) within 1-6, 8, 12, or 20 mcrV, and another part (burst) with Vpp outside the threshold. Number of {\tau} (N{\tau}), mean {\tau} duration (M{\tau}), total percentage of {\tau} (SR{\tau}), mean burst duration (Mbst), and amplitude of burst (Abst) were evaluated as anaesthesia depth indicators using Pearsons correlation coefficients (r). Results: When Vpp was near the suppression wave threshold, N{\tau} had the highest correlation with SEV in both groups. As SEV was increased until onset of burst suppression, N{\tau} decreased, M{\tau} remained unchanged, and Mbst and Abst increased. In the young-adult group, mean |r| exceeded 0.95 for N{\tau} with Vpp of 4-6 mcrV, for Mbst with Vpp of 8-12 mcrV, and for Abst with Vpp of 4-12 mcrV. In the senior group, r exceeded 0.90 for N{\tau} with Vpp of 4 mcrV and for Abst with Vpp of 5-12 mcrV. Conclusion: We developed new EEG parameters that were almost perfectly correlated with volatile anaesthetic concentrations using traditional bipolar recording. This study suggests that the effect of anaesthetics on EEG can be investigated from two directions: pacemaker ({\tau}) and generator (burst).


Novel coronavirus (2019-nCoV): Lessons of uncertainty and globalization


Adjusting to the COVID-19 pandemic: challenges and opportunities of frontline colorectal cancer teams in the UK


title: An Evasion Attack against ML-based Phishing URL Detectors

text: Background: Over the year, Machine Learning Phishing URL classification (MLPU) systems have gained tremendous popularity to detect phishing URLs proactively. Despite this vogue, the security vulnerabilities of MLPUs remain mostly unknown. Aim: To address this concern, we conduct a study to understand the test time security vulnerabilities of the state-of-the-art MLPU systems, aiming at providing guidelines for the future development of these systems. Method: In this paper, we propose an evasion attack framework against MLPU systems. To achieve this, we first develop an algorithm to generate adversarial phishing URLs. We then reproduce 41 MLPU systems and record their baseline performance. Finally, we simulate an evasion attack to evaluate these MLPU systems against our generated adversarial URLs. Results: In comparison to previous works, our attack is: (i) effective as it evades all the models with an average success rate of 66% and 85% for famous (such as Netflix, Google) and less popular phishing targets (e.g., Wish, JBHIFI, Officeworks) respectively; (ii) realistic as it requires only 23ms to produce a new adversarial URL variant that is available for registration with a median cost of only $11.99/year. We also found that popular online services such as Google SafeBrowsing and VirusTotal are unable to detect these URLs. (iii) We find that Adversarial training (successful defence against evasion attack) does not significantly improve the robustness of these systems as it decreases the success rate of our attack by only 6% on average for all the models. (iv) Further, we identify the security vulnerabilities of the considered MLPU systems. Our findings lead to promising directions for future research. Conclusion: Our study not only illustrate vulnerabilities in MLPU systems but also highlights implications for future study towards assessing and improving these systems.


Collateral consequences of COVID-19 epidemic in Greater Paris


title: Preying on Public Fears and Anxieties in a Pandemic: Businesses Selling Unproven and Unlicensed "Stem Cell Treatments" for COVID-19

text: In the midst of a global public health emergency, some businesses are taking advantage of widespread fears by marketing purported stem cell treatments for COVID-19. Such businesses target prospective clients with misleading claims, expose patients to potentially risky stem cell-based products, and undermine efforts to develop evidence-based treatments for COVID-19.


title: 'Policing' a pandemic: Garda wellbeing and COVID-19

text: In response to the global pandemic COVID-19, the Irish government has called upon the Garda Síochána to implement an unparalleled mode of policing to mitigate and contain the spread of the Coronavirus. Studies investigating smaller scale epidemics, such as Severe Acute Respiratory Syndrome (SARS), indicate that staff at the frontlines of an outbreak are exposed to an insuperable amount of stress and experience increased psychological morbidities as a result. Furthermore, research not only indicates that heighted levels of psychological distress are an occupational hazard associated with the law enforcement profession, but that members of the Garda Síochána feel their mental health needs are largely unmet by their organisation. Given the pandemic's propensity to expose officers to indeterminate echelons of physical and psychological threat; there has never been a more appropriate time to explore the potential burdens associated with 'policing' a pandemic, question the governments capacity to address the psychological support needs of frontline professionals, and plan future research for best practice.


title: Comparative computational analysis of SARS-CoV-2 nucleocapsid protein epitopes in taxonomically related coronaviruses

text: Several research lines are currently ongoing to address the multitude of facets of the pandemic COVID-19. In line with the One-Health concept, extending the target of the studies to the animals which humans are continuously interacting with may favor a better understanding of the SARS-CoV-2 biology and pathogenetic mechanisms; thus, helping to adopt the most suitable containment measures. The last two decades have already faced severe manifestations of the coronavirus infection in both humans and animals, thus, circulating epitopes from previous outbreaks might confer partial protection from SARS-CoV-2 infections. In the present study, we provide an in-silico survey of the major nucleocapsid protein epitopes and compare them with the homologues of taxonomically-related coronaviruses with tropism for animal species that are closely inter-related with the human beings population all over the world. Protein sequence alignment provides evidence of high sequence homology for some of the investigated proteins. Moreover, structural epitope mapping by homology modelling revealed a potential immunogenic value also for specific sequences scoring a lower identity with SARS-CoV-2 nucleocapsid proteins. These evidence provide a molecular structural rationale for a potential role in conferring protection from SARS-CoV-2 infection and identifying potential candidates for the development of diagnostic tools and prophylactic-oriented strategies.


title: Identification of coronavirus sequences in carp cDNA from Wuhan, China

text: Severe acute respiratory syndrome (SARS)-like coronavirus sequences were identified in two separate complementary DNA (cDNA) pools. The first pool was from a Carassius auratus (crusian carp) cell line and the second was from Ctenopharyngodon idella (grass carp) head kidney tissue. BLAST analysis suggests that these sequences belong to SARS-like coronaviruses, and that they are not evolutionarily conserved in other species. Investigation of the submitting laboratories revealed that two laboratories from the Institute of Hydrobiology at the Chinese Academy of Sciences in Wuhan, China performed the research and submitted the cDNA libraries to GenBank. This institution is very close in proximity to the Wuhan South China Seafood Wholesale Market where SARS-CoV-2 first amplified in the human population. It is possible that these sequences are an artifact of the bioinformatics pipeline that was used. It is also possible that SARS-like coronaviruses are a common environmental pathogen in the region that may be in aquatic habitats.


COVID-19 Fatigue: Not So Fast


title: Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic

text: Novel Corona Virus Disease (COVID-19) originating from China has rapidly crossed borders, infecting people throughout the whole world. This phenomenon has led to a massive public reaction; the media has been reporting continuously across borders to keep all informed about the pandemic situation. All these things are creating a lot of concern for people leading to heightened levels of anxiety. Pandemics can lead to heightened levels of stress; Anxiety is a common response to any stressful situation. This study attempted to assess the knowledge, attitude, anxiety experience, and perceived mental healthcare need among adult Indian population during the COVID-19 pandemic. An online survey was conducted using a semi-structured questionnaire using a non-probability snowball sampling technique. A total of 662 responses were received. The responders had a moderate level of knowledge about the COVID-19 infection and adequate knowledge about its preventive aspects. The attitude towards COVID-19 showed peoples' willingness to follow government guidelines on quarantine and social distancing. The anxiety levels identified in the study were high. More than 80 % of the people were preoccupied with the thoughts of COVID-19 and 72 % reported the need to use gloves, and sanitizers. In this study, sleep difficulties, paranoia about acquiring COVID-19 infection and distress related social media were reported in 12.5 %, 37.8 %, and 36.4 % participants respectively. The perceived mental healthcare need was seen in more than 80 % of participants. There is a need to intensify the awareness and address the mental health issues of people during this COVID-19 pandemic.


Letter to the Editor Regarding "Implementation and Workflow of a Telehealth Clinic in Neurosurgery During the COVID-19 Pandemic"


The COVID-19 pandemic and the Tata Memorial Centre response


docid: dthnptnp

title: High COVID-19 testing rate in Portugal


COVID-19 and the treatment of acute appendicitis in Ireland: a new era or short-term pivot?


Will the status of infection prevention and control (IPC) professionals be improved in the context of COVID-19?


title: Rapidly evaluating lockdown strategies using spectral analysis: the cycles behind new daily COVID-19 cases and what happens after lockdown

text: Spectral analysis characterises oscillatory time series behaviours such as cycles, but accurate estimation requires reasonable numbers of observations. Current COVID-19 time series for many countries are short: pre- and post-lockdown series are shorter still. Accurate estimation of potentially interesting cycles within such series seems beyond reach. We solve the problem of obtaining accurate estimates from short time series by using recent Bayesian spectral fusion methods. Here we show that transformed new daily COVID-19 cases for many countries generally contain three cycles operating at wavelengths of around 2.7, 4.1 and 6.7 days (weekly). We show that the shorter cycles are suppressed after lockdown. The pre- and post lockdown differences suggest that the weekly effect is at least partly due to non-epidemic factors, whereas the two shorter cycles seem intrinsic to the epidemic. Unconstrained, new cases grow exponentially, but the internal cyclic structure causes periodic falls in cases. This suggests that lockdown success might only be indicated by four or more daily falls in cases. Spectral learning for epidemic time series contributes to the understanding of the epidemic process, helping evaluate interventions and assists with forecasting. Spectral fusion is a general technique that is able to fuse spectra recorded at different sampling rates, which can be applied to a wide range of time series from many disciplines.