title: A Phase 3 Open-label, Randomized, Controlled Study to Evaluate the Efficacy and Safety of Intravenously Administered Ravulizumab Compared with Best Supportive Care in Patients with COVID-19 Severe Pneumonia, Acute Lung Injury, or Acute Respiratory Distress Syndrome: A structured summary of a study protocol for a randomised controlled trial

text: OBJECTIVES: Primary Objective • To evaluate the effect of ravulizumab, a long-acting complement (C5) inhibitor plus best supportive care (BSC) compared with BSC alone on the survival of patients with COVID-19. Secondary Objectives • Number of days free of mechanical ventilation at Day 29 • Duration of intensive care unit stay at Day 29 • Change from baseline in Sequential Organ Failure Assessment (SOFA) score at Day 29 • Change from baseline in peripheral capillary oxygen saturation/ fraction of inspired oxygen (SpO2 /FiO2) at Day 29 • Duration of hospitalization at Day 29 • Survival (based on all-cause mortality) at Day 60 and Day 90 Safety • Incidence of treatment-emergent adverse events and treatment-emergent serious adverse events. PK/PD/Immunogenicity • Change in serum ravulizumab concentrations over time • Change in serum free and total C5 concentrations over time • Incidence and titer of anti-ALXN1210 antibodies Biomarkers • Change in absolute level of soluble biomarkers in blood associated with complement activation, inflammatory processes, and hypercoagulable states over time Exploratory • Incidence of progression to renal failure requiring dialysis at Day 29 • Time to clinical improvement (based on a modified 6-point ordinal scale) over 29 days • SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores at Day 29 (or discharge), Day 60, and Day 90 • EuroQol 5-dimension 5-level (EQ-5D-5L) scores at Day 29 (or discharge), Day 60, and Day 90 TRIAL DESIGN: This is a multicenter Phase 3, open-label, randomized, controlled, study. The study is being conducted in acute care hospital settings in the United States, United Kingdom, Spain, France, Germany, and Japan. PARTICIPANTS: Male or female patients at least 18 years of age, weighing ≥ 40 kg, admitted to a designated hospital facility for treatment will be screened for eligibility in this study. Key Inclusion criteria • Confirmed diagnosis of SARS-CoV-2 infection (eg, via polymerase chain reaction [PCR] and/or antibody test) presenting as severe COVID-19 requiring hospitalization • Severe pneumonia, acute lung injury, or ARDS confirmed by computed tomography (CT) or X-ray at Screening or within the 3 days prior to Screening, as part of the patient’s routine clinical care • Respiratory distress requiring mechanical ventilation, which can be either invasive (requiring endotracheal intubation) or non-invasive (with continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) Key Exclusion criteria • Patient is not expected to survive for more than 24 hours • Patient is on invasive mechanical ventilation with intubation for more than 48 hours prior to Screening • Severe pre-existing cardiac disease (ie, NYHA Class 3 or Class 4, acute coronary syndrome, or persistent ventricular tachyarrhythmias) • Patient has an unresolved Neisseria meningitidis infection Excluded medications and therapies • Current treatment with a complement inhibitor • Intravenous immunoglobulin (IVIg) within 4 weeks prior to randomization on Day 1 Excluded prior/concurrent clinical study experience • Treatment with investigational therapy in a clinical study within 30 days before randomization, or within 5 half-lives of that investigational therapy, whichever is greater • Exceptions a. Investigational therapies will be allowed if received as part of best supportive care through an expanded access protocol or emergency approval for the treatment of COVID-19. b. Investigational antiviral therapies (such as remdesivir) will be allowed even if received as part of a clinical study. INTERVENTION AND COMPARATOR: The study consists of a Screening Period of up to 3 days, a Primary Evaluation Period of 4 weeks, a final assessment at Day 29, and a Follow-up Period of 8 weeks. For patients randomized to ravulizumab plus BSC, a weight-based dose of ravulizumab (≥40 to < 60 kg/2400 mg, 60 to < 100 kg/2700 mg, ≥ 100 kg/3000 mg) will be administered on Day 1. On Day 5 and Day 10, additional doses of 600 mg (≥40 to <60 kg) or 900 mg (>60 kg) ravulizumab will be administered and on Day 15 patients will receive 900 mg ravulizumab. There is no active or placebo comparator in this open-label clinical trial. The total duration of each patient’s participation is anticipated to be approximately 3 months. MAIN OUTCOMES: The primary efficacy outcome of this study is survival (based on all-cause mortality) at Day 29. RANDOMISATION: Patients will be randomized in a 2:1 ratio (ravulizumab plus BSC:BSC alone). Randomization will be stratified by intubated or not intubated on Day 1. Computer-generated randomization lists will be prepared by a third party under the direction of the sponsor. Investigators, or designees, will enrol patients and then obtain randomization codes using an interactive voice/web response system. The block size will be kept concealed so that investigators cannot select patients for a particular treatment assignment. Blinding (masking): This is an open-label study. Numbers to be randomised (sample size): Approximately 270 patients will be randomly assigned in a 2:1 ratio to ravulizumab plus BSC (n=180) or BSC alone (n=90). TRIAL STATUS: Protocol Number: ALXN1210-COV-305 Original Protocol: 09 Apr 2020 Protocol Amendment 1 (Global): 13 Apr 2020 Protocol Amendment 2 (Global): 17 Apr 2020 Protocol Amendment 3 (Global): 09 Jun 2020 Recruitment is currently ongoing. Recruitment was initiated on 11 May 2020. We expect recruitment to be completed by 30 Nov 2020. TRIAL REGISTRATION: Clinicaltrials.gov: Protocol Registry Number: NCT04369469; First posted; 30 Apr 2020 EU Clinical Trials Register: EudraCT Number: https://www.clinicaltrialsregister.eu/ctr-search/search?query=ALXN1210-COV-305, Start date: 07 May 2020 FULL PROTOCOL: The full redacted protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


title: Comparing Artificial Neural Network Architectures for Brazilian Stock Market Prediction

text: Prediction of financial time series is a great challenge for statistical models. In general, the stock market times series present high volatility due to its sensitivity to economic and political factors. Furthermore, recently, the covid-19 pandemic has caused a drastic change in the stock exchange times series. In this challenging context, several computational techniques have been proposed to improve the performance of predicting such times series. The main goal of this article is to compare the prediction performance of five neural network architectures in predicting the six most traded stocks of the official Brazilian stock exchange B3 from March 2019 to April 2020. We trained the models to predict the closing price of the next day using as inputs its own previous values. We compared the predictive performance of multiple linear regression, Elman, Jordan, radial basis function, and multilayer perceptron architectures based on the root of the mean square error. We trained all models using the training set while hyper-parameters such as the number of input variables and hidden layers were selected using the testing set. Moreover, we used the trimmed average of 100 bootstrap samples as our prediction. Thus, our approach allows us to measure the uncertainty associate with the predicted values. The results showed that for all times series, considered all architectures, except the radial basis function, the networks tunning provide suitable fit, reasonable predictions, and confidence intervals.


'Ons past bescheidenheid en trots': Noord-Nederland koos eigen weg in coronacrisis


Overmacht door corona


Gedwongen het schip verlaten


KORT


Impact of the Covid-19 Pandemic on Early Childhood Care and Education


docid: axqbszwd

title: A novel control set-valued approach with application to epidemic models

text: This work is considered in the framework of studies dedicated to the control problems, especially in epidemiology where the scientist are concerned to develop effective control strategies to minimize the number of infected individuals. In this paper, we set this problem as an asymptotic target control problem under mixed state-control constraints, for a general class of ordinary differential equations that model the temporal evolution of disease spread. The set of initial data, from which the number of infected people decrease to zero, is generated by a new type of Lyapunov functions defined in the sense of viability theory. The associated controls are provided via selections of adequately designed feedback map. The existence of such selections is improved by using Micheal selection theorem. Finally, an application to the SIRS epidemic model, with numerical simulations, is given to show the efficiency of our approach. To the best of our knowledge, our work is the first one that used a set-valued approach based on the viability theory to deal with an epidemic control problem.


title: Kompetenznetz Public Health zu COVID-19

text: Das „Kompetenznetz Public Health zu COVID-19“ ist ein Ad hoc-Zusammenschluss mehrerer wissenschaftlicher Fachgesellschaften und Verbände aus dem Bereich Public Health, die somit ihre methodische, epidemiologische, statistische, sozialwissenschaftliche und (bevölkerungs-) medizinische Fachkenntnis bündeln. Wissenschaftler aus Deutschland, Österreich und der Schweiz arbeiten daran, schnell interdisziplinäre Expertise zu COVID-19 für die aktuelle Diskussion und Entscheidungsfindung zur Verfügung zu stellen. Dafür werden wissenschaftliche Erkenntnisse zusammengestellt, aufbereitet und in möglichst leicht verständlicher Form verbreitet.


title: Research trends and scientific analysis of publications on burnout and compassion fatigue among healthcare providers

text: BACKGROUND: Burnout and compassion fatigue are closely related concepts. Burnout is thought to develop from occupational stress while compassion fatigue results from being in a caregiver role leading to inability to get engaged in a caring relation. The objective of the current study was to investigate research trends, themes, citations, and key players of publications on burnout and compassion fatigue among healthcare providers. METHODS: A validated search query was developed and implemented in the Scopus database. The study period was all times up to 2019. RESULTS: Research query found 4416 publications. Publications started in 1978. Steep growth in the number of publications was observed in the last decade. There were seven research themes in the retrieved publications; six for burnout and one for compassion fatigue. Approximately 36% of the retrieved publications were about nurses; 36% were about physicians, 10% were about medical residents and the remaining did not include a specific profession. The retrieved publications received an average of 22.2 citations per article. Four of the top 10 active journals were in the field of nursing and two in the field of general medicine, one in public health, one in neurology, one in psychology, and one was multidisciplinary. The USA ranked first with 1292 (29.3%) articles followed by Spain (n = 248; 5.6%) and the UK (n = 247; 5.6%). Mayo Clinic was the most active institution (n = 93; 2.1%) followed by Harvard University (n = 46; 1.0%) and University of Washington, Seattle (n = 45; 1.0%). A total of 16,108 authors participated in publishing the retrieved documents, an average of 3.6 authors per article. Shanafelt, T.D. was the most active author (n = 78; 1.8%) followed by Dyrbye, L.N. (n = 43; 1.0%), and West, C.P. (n = 37; 0.8%). A total of 472 (10.7%) articles declared funding. CONCLUSION: The current study was carried out to draw attention to the wellbeing of healthcare providers. Retrieved literature was dominated by high-income countries. Lack of information from low- and middle-income countries will hinder planning for interventional strategies and will negatively affect the health system and the patients. Health researchers in low- and middle-income countries need to focus on burn out and compassion fatigue.


title: Meeting report of the third annual Tri-Service Microbiome Consortium symposium

text: The Tri-Service Microbiome Consortium (TSMC) was founded to enhance collaboration, coordination, and communication of microbiome research among U.S. Department of Defense (DoD) organizations and to facilitate resource, material and information sharing among consortium members. The 2019 annual symposium was held 22–24 October 2019 at Wright-Patterson Air Force Base in Dayton, OH. Presentations and discussions centered on microbiome-related topics within five broad thematic areas: 1) human microbiomes; 2) transitioning products into Warfighter solutions; 3) environmental microbiomes; 4) engineering microbiomes; and 5) microbiome simulation and characterization. Collectively, the symposium provided an update on the scope of current DoD microbiome research efforts, highlighted innovative research being done in academia and industry that can be leveraged by the DoD, and fostered collaborative opportunities. This report summarizes the presentations and outcomes of the 3rd annual TSMC symposium.


title: Recommendations for the surveillance of multidrug-resistant bacteria in Italian long-term care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI)

text: Long-term care facilities (LTCFs) are an important reservoir of multidrug-resistant organisms (MDROs). Colonization of LTCF residents by MDROs is generally higher in Italy compared to other European countries. The present review by the working group for the study of infections in LTCFs (GLISTer) of the Italian Association of Clinical Microbiologists (AMCLI) aims to propose criteria for a laboratory-based surveillance of MDROs in Italian LTCFs. We recommend the adhesion to three levels of laboratory-based MDROs surveillance in LTCFs: i) mandatory MDRO surveillance by cumulative retrospective analysis of antimicrobial susceptibility data, obtained as part of routine care of clinical specimens. ii) strongly recommended surveillance by active rectal swab cultures or molecular screening to determine colonization with carbapenemase-producing Enterobacterales, should a resident be proven infected. iii) voluntary surveillance by prospective MDRO surveys, mainly based on point prevalence colonization studies, allowing to determine the MDROs baseline prevalence in the facility. Laboratory-based surveillance of MDROs in LTCFs is aimed at providing useful epidemiological information to healthcare providers operating in the facility, but it is only effective if the collected data are used for infection prevention and control purposes, targeting the peculiar aspects of LTCFs.


title: Transcription Factor Nrf2 as a Potential Therapeutic Target for Prevention of Cytokine Storm in COVID-19 Patients

text: Nrf2 is a key transcription factor responsible for antioxidant defense in many tissues and cells, including alveolar epithelium, endothelium, and macrophages. Furthermore, Nrf2 functions as a transcriptional repressor that inhibits expression of the inflammatory cytokines in macrophages. Critically ill patients with COVID-19 infection often present signs of high oxidative stress and systemic inflammation – the leading causes of mortality. This article suggests rationale for the use of Nrf2 inducers to prevent development of an excessive inflammatory response in COVID-19 patients.


title: Führung virtueller Teams

text: Eine gute Führungskraft zeichnet sich durch den souveränen und den konstruktiven Umgang mit gesellschaftlichen und unternehmerischen Herausforderungen sowie ein hohes Maß an Selbstreflexion aus. Dennoch nehmen die Anforderungen an die Führung zahlenmäßig und an Komplexität konstant zu. Dies kann einen Manager im digitalen Zeitalter schnell überfordern. Die Abb. 5.1 zeigt nur einen Ausschnitt der zahlreichen Herausforderungen, mit denen sich Führungskräfte konfrontiert sehen. Dazu zählt die Führung virtueller Teams, für die neben neuen Vorgehensweisen auch ein hohes Maß an Selbstreflexion erforderlich ist. Selbst Bundeskanzlerin Angela Merkel reagiert aktuell (04/2020) aufgrund von COVID-19 das Land aus dem Homeoffice und steht vor der gleichen Herausforderung.


title: Zusammenfassung

text: Seit mittlerweile fünf Jahren arbeite ich fast ausschließlich im Homeoffice bzw. in virtuellen Teams und habe auch eine wissenschaftliche Arbeit zu diesem Themenbereich geschrieben. Ich war viel unterwegs und habe von allen Ecken der Welt aus gearbeitet, bis mich COVID-19 gezwungen hat, meine Reisen zu unterbrechen. Dies gab mir Zeit, die praktischen wie auch die wissenschaftlichen Erfahrungen zusammenzufassen.


title: Einleitung

text: Unter einem virtuellen Team wird im Allgemeinen die Zusammenarbeit einer Gruppe von Personen auf Distanz mithilfe von Technologie verstanden. Anfang der 2000er Jahre wurde dies zumeist nur temporär praktiziert als Zusammenschluss mehrerer Fachkräfte für ein bestimmtes Projekt oder für einen entsprechenden Zeitraum zur Erarbeitung und zur Durchführung bestimmter Projekte. Vor allem in den letzten fünf Jahren kommt es zunehmend häufig vor, dass ganze Abteilungen dauerhaft durch virtuelle Teams repräsentiert werden oder dass diese von zwei Standorten des Unternehmens aus zusammenarbeiten.


title: Technologische Ausstattung virtueller Teams

text: In diesem Kapitel sollen die benötigte technologische Ausstattung in Form von Software sowie die notwendige Technologie für Videokonferenzen im Homeoffice behandelt werden. Das Kapitel schließt mit Empfehlungen zur Einrichtung des Homeoffice und einem Exkurs zu VR-Meetings.


title: Traditional Chinese Medicine and Clinical Pharmacology

text: Traditional Chinese Medicine (TCM) represents thousands of years in treatment protocols for health, healing, and longevity and has evolved into a complex healthcare system. The following chapter is designed to give a basic concise overview of TCM principles and practices, in relation to clinical pharmacology, and focuses on mutually relevant areas of interest. Much as society learned to harness electrical currents to empower machinery, TCM theories of energetic patterns help to empower the functionality of the human body. The major theories include the vital life force, known as Qi, Yin and Yang, Five Elements, herbal medicine, multivariate diagnostics, syndrome differentiation, and acupuncture, among others. In TCM, there is a direct relationship to the energy of nature and the energetic patterns within the human body and the human consciousness. This comprehensive approach is gaining momentum in clinical and network pharmacology, as new technologies emerge regarding TCM collaborative compounds versus singular chemical constituents in treatment modalities. Of major importance to clinical pharmacology are recent TCM evidenced-based empirical studies, correlations, and interactions between herbs and pharmaceuticals, updated data on toxicity, adverse reactions, quality assurance, and herbal medicine standardization. Global concerns over antimicrobial resistance to drugs have put a spotlight on TCM herbal medicines as alternatives with greatly reduced resistance factors. From ancient archives to the Nobel Prize to a formal endorsement by the World Health Organization as a global healthcare system, TCM has widened the lens of modern science. It offers the wisdom and experience of millennia to inspire the think tank of today’s medicine and pharmacology and tomorrow’s generations of integrative healthcare advancements.


title: Techniques of Gastrointestinal Endoscopy—Do We Need to Change Anything?

text: Novel coronavirus disease 2019 (COVID-19) has spread to different parts of the world and was declared a pandemic by World Health Organization (WHO). Health care workers are at increased risk of contracting the disease due to their nature of work and close contact with the patients. Staff in endoscopy need to be aware of this risk due to the aerosol-generating nature of procedures and the presence of virus particles in stool samples of infected persons. The risk of asymptomatic patients spreading the disease is also a cause for concern. This article intends to provide guidance and recommendations for techniques and practice of gastrointestinal (GI) endoscopy to prevent infection in endoscopy unit.


Infection Control Practices in Endoscopy Room in COVID-19 Era


Kickstarting the Endoscopy Unit after Lockdown Period: Why, When, and How?


title: Risk of COVID-19 Transmission During Gastrointestinal Endoscopy

text: COVID-19 is a viral illness caused by a novel severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). It is highly contagious virus with human-to-human transmission being primarily attributed to direct contact or air droplets. It is highly infectious and contagious due to high-viable viral loads in the upper respiratory tract secretions of infected patients and also similar viral load being detected in both asymptomatic and symptomatic patients. The virus stability characteristics and modes of transmission via fomites and air droplets make gastrointestinal (GI) endoscopy a high-risk procedure for COVID-19 transmission. This review discusses the currently available literature on risk of transmission of SARS-CoV-2 during GI endoscopy.


title: Personal Protective Equipment during Endoscopy

text: The novel coronavirus disease 2019 (COVID-19) which originated in China has been declared a pandemic by the World Health Organization (WHO). This virus gets transmitted through air droplets and direct contact. Health care workers doing aerosol-generating procedures are at a higher risk of acquiring the infection. Many procedures done by the gastrointestinal endoscopists are classified as aerosol-generating procedures, which in turn underline the need for proper safety precautions during these procedures. Apart from general safety measures advised by various organizations, proper use of personal protective equipment (PPE) is a pivotal factor in safeguarding health care personnel during endoscopy. This article provides a short overview of the different PPEs available and their proper use in endoscopy.


title: Triaging Patients Undergoing Endoscopy During COVID-19 Pandemic

text: "Triaging for endoscopy" is the process to determine the most deserving patients after careful scrutiny amongst a pool of patients who report for Gastrointestinal (GI) Endoscopy diagnostic or interventional procedures that include Esophago-gastro-duodenoscopy (OGD), Colonoscopy, ERCP, EUS and Enteroscopy. The purpose of triaging at endoscopy is to prevent transmission of SARS-COV2 infection from suspected patient to the health care workers involved at endoscopy. The three professional Indian Gastroenterology bodies namely Society of Gastrointestinal Endoscopy of India (SGEI), Indian Society of Gastroenterology (ISG) & Indian Association for the study of the liver (INASL) have recently provided guidance of scheduling of endoscopic procedures in the current Covid-9 pandemic. Similar suggestions have been promulgated by other international bodies.


title: Way Forward: Gastrointestinal Tract Endoscopy Work Flow Postlockdown Era

text: Gastrointestinal tract endoscopy being an aerosol generating procedure increases the risk to staff and uninfected patients from a coronavirus disease 2019 patient. Social and physical distancing through “lockdown” has suppressed the spread of disease but will not eradicate it. Various endoscopy societies formulated guidelines to triage the patients and limit the work to only emergency and urgent cases and postpone “routine” endoscopies. Postlockdown infected vector pool will persist till an effective vaccine is widely available. Nonurgent cases cannot be postponed indefinitely. We need to identify infected symptomatic and asymptomatic individuals and create a safe environment for uninfected patients. Endoscopy staff protection through education, optimized manpower flow, and personal protective equipment usage and hand hygiene needs urgent attention. Proper environment sanitization, endoscope, and device reprocessing will remain important.


COVID-19 Pandemic Brings Gastrointestinal Endoscopy Practice to Its Knees—Financially!


title: Pharmacokinetics of high-dose tigecycline in critically ill patients with severe infections

text: BACKGROUND: In critically ill patients, the use of high tigecycline dosages (HD TGC) (200 mg/day) has been recently increasing but few pharmacokinetic/pharmacodynamic (PK/PD) data are available. We designed a prospective observational study to describe the pharmacokinetic/pharmacodynamic (PK/PD) profile of HD TGC in a cohort of critically ill patients with severe infections. RESULTS: This was a single centre, prospective, observational study that was conducted in the 20-bed mixed ICU of a 1500-bed teaching hospital in Rome, Italy. In all patients admitted to the ICU between 2015 and 2018, who received TGC (200 mg loading dose, then 100 mg q12) for the treatment of documented infections, serial blood samples were collected to measure steady-state TGC concentrations. Moreover, epithelial lining fluid (ELF) concentrations were determined in patients with nosocomial pneumonia. Amongst the 32 non-obese patients included, 11 had a treatment failure, whilst the other 21 subjects successfully eradicated the infection. There were no between-group differences in terms of demographic aspects and main comorbidities. In nosocomial pneumonia, for a target AUC(0-24)/MIC of 4.5, 75% of the patients would be successfully treated in presence of 0.5 mcg/mL MIC value and all the patients obtained the PK target with MIC ≤ 0.12 mcg/mL. In intra-abdominal infections (IAI), for a target AUC(0-24)/MIC of 6.96, at least 50% of the patients would be adequately treated against bacteria with MIC ≤ 0.5 mcg/mL. Finally, in skin and soft-tissue infections (SSTI), for a target AUC(0-24)/MIC of 17.9 only 25% of the patients obtained the PK target at MIC values of 0.5 mcg/mL and less than 10% were adequately treated against germs with MIC value ≥ 1 mcg/mL. HD TGC showed a relevant pulmonary penetration with a median and IQR ELF/plasma ratio (%) of 152.9 [73.5–386.8]. CONCLUSIONS: The use of HD TGC is associated with satisfactory plasmatic and pulmonary concentrations for the treatment of severe infections due to fully susceptible bacteria (MIC < 0.5 mcg/mL). Even higher dosages and combination strategies may be suggested in presence of difficult to treat pathogens, especially in case of SSTI and IAI.


title: Tigecycline Therapy for Multi-drug-Resistant Pseudomonas aeruginosa Sepsis Associated with Multi-organ Failure in an Infant with Persistent Arterial Duct. Case Report

text: Sepsis is the leading cause of death in infants and children worldwide. The growing drug resistance in nosocomial gram-negative bacteria has resulted in treatment challenges. One of the most common multi-drug-resistant bacteria is Pseudomonas aeruginosa. Resistance to antibiotics used in Pseudomonas aeruginosa infections limits the therapeutic options. We present a tigecycline administration in a 5-month-old infant with patent arterial duct, heart failure, and respiratory failure due to respiratory syncytial virus bronchiolitis with subsequent respiratory distress syndrome and severe sepsis caused by multi-drug-resistant Pseudomonas aeruginosa. Despite combined antibiotic therapy with meropenem, amikacin, and colistin, inflammatory markers increased. Because of life-threatening condition, tigecycline was added to the therapy and was administered intravenously twice daily. Within 48 h, inflammatory markers started to decrease and tigecycline therapy continued for 13 days without adverse effects. Tigecycline used in combination with other antibiotics might be a valuable therapeutic approach in the management of multi-drug-resistant bacteria infections in pediatric patients when conventional antibiotics have failed. Further studies are needed to evaluate the efficacy and safety of tigecycline administration in critically ill pediatric patients.


title: The Changing Landscapes in DCD Liver Transplantation

text: PURPOSE OF REVIEW: The transplant community continues to look for ways to help address the discordance between donor liver graft availability and patients on the liver transplant waiting list. Donation after circulatory death (DCD) donor livers represents one potential means to help address this discordance. The present review describes the changing landscape of DCD liver transplantation (LT). RECENT FINDINGS: The number of DCD LTs performed annually within the USA has continued to grow on an annual basis. Importantly, national data has demonstrated that outcomes with DCD LT have been improving. This improvement has been driven by better understanding of how to successfully utilize these organs through better donor and recipient matching and careful evaluation of both hemodynamics during withdrawal of life support and the refinement of the procurement operation. SUMMARY: Despite these improvements in outcome, ischemic cholangiopathy (IC) continues to be the Achilles heel of DCD LT. Emerging technologies such as various forms of machine perfusion may allow for reduction of complications and better prognostication of the risk associated with DCD liver grafts.


title: Feeding the food insecure in Britain: learning from the 2020 COVID-19 crisis

text: The lockdown in Britain has rendered a large proportion of the population economically vulnerable and has at least quadrupled demand for emergency food relief. This paper looks critically at response to the crisis from the government and the voluntary sector with respect to provision of emergency food. In doing so, it has exposed gaps in understanding of the vagaries of the food supply for certain population groups and systemic weaknesses in the current system of emergency food aid. We make recommendations for healthier governmental capacity to react to a food security crisis, better relationships between the government and the voluntary sector, and further research into the dietary constraints of the precariate. Importantly, the social system needs to be responsive to short-term changes in people’s income if people are not to fall into food insecurity.


title: The Internet of Things: Enabling Opportunities and Challenges

text: There is much market hype about the potential of IoT to transform firms and industries. Taking perspective of actors in the quadruple helix—industry, government, universities and end users—we consider the enabling opportunities and challenges that IoT brings. Enabling opportunities for firms include firm purpose reconfiguration, competitive disruption and market dominance, value reconfiguration, value creation and business models environmental and customer insights and ecosystem integration. Regulation, infrastructural investment and capacity, societal awareness and adoption, entrepreneurial ecosystem development are challenges that IoT brings to quadruple helix actors. The chapter concludes by discussing the implications of IoT for these actors.


docid: fyqcwlpc

title: Disrupting the Electrical Circuit: New Onset Atrial Fibrillation in a Patient With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

text: In December 2019, an outbreak of pneumonia cases in Wuhan, China was attributed to a novel coronavirus that was eventually recognized as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently identified as coronavirus disease 2019 (COVID-19), it has been declared a pandemic by the World Health Organization given its rapid global transmission. Various cardiovascular complications have been reported, including heart failure, myocarditis, acute coronary syndrome and arrhythmias, both atrial and ventricular. Regarding arrhythmias, onset from time of infection is variable but usually ranges from several days to a week. We hereby present a case of a COVID-19 positive patient presenting with new onset atrial fibrillation.


title: Outcomes of an Online Virtual Boot Camp to Prepare Fourth-Year Medical Students for a Successful Transition to Internship

text: Introduction Changes in medical education and health care delivery have limited the ability of fourth-year medical students to perform the role of an intern prior to graduating from medical school. To address this issue, many schools have instituted residency preparation courses (sometimes referred to as boot camps) particularly for students entering surgical fields. Courses for students entering nonprocedural fields are less common and most assess increases in self-reported confidence without providing objective evidence of a gain in knowledge or skills improvement. Materials and Methods We used a Plan, Do, Study, Act (PDSA) model to develop and pilot cycle 1 of a nonprocedural internship preparation elective in 2019. Feedback was used to refine the course and map sessions to core competencies outlined by the Accreditation Council of Graduate Medical Education (ACGME) for PDSA cycle 2. The curriculum was adapted for remote synchronous delivery due to the coronavirus pandemic in spring 2020 using a combination of didactic lectures containing embedded polls and case-based role play responses using a chat box. Students completed anonymous surveys assessing self-perceived levels of confidence, as well as an objective comprehensive assessment after course completion. Results A total of 89 students participated in the course. Pre-session confidence was lowest for transfusion medicine, handling pages from nursing while on call, and knowledge of the role of a chief resident. A statistically significant increase in median scores for self-reported knowledge or confidence was seen in all sessions. The percentage of students reporting that they were either confident or extremely confident also increased significantly after each session (p<0.001 for all). All sessions analyzed were rated as useful or extremely useful by more than half of the students, and 94% of the students scored 70% or higher on the comprehensive course assessment. Conclusions An online virtual synchronous boot camp increased students’ confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. We were able to adapt our curriculum to a remote model and will likely keep several sessions in an online format in the future.


title: Zwischen Asthma und COPD differenzieren — mehr Mut zur probatorischen Therapie!: Seminar / Atemwegserkrankungen

text: Bei Patienten mit obstruktiver Atemwegserkrankung muss zwischen einem Asthma bronchiale und einer COPD differenziert werden. Die Unterscheidung ist wegweisend für die Therapie — in der Praxis aber oft nicht einfach. Sind die Zusammenhänge nicht ganz klar, kann im individuellen Fall eine probatorische Therapie weiterhelfen.


title: Well-Being and the Good Death

text: The philosophical literature on well-being and the good life contains very little explicit discussion of what makes for a better or worse death. The purpose of this essay is to highlight some commonly held views about the good death and investigate whether these views are recognized by the leading theories of well-being. While the most widely discussed theories do have implications about what constitutes a good death, they seem unable to fully accommodate these popular good death views. I offer two partial explanations for why these views have been neglected in discussions of well-being and make two corresponding recommendations for future work in the philosophy of well-being.


Das Stethoskop bleibt wichtig — auch in COVID-19-Zeiten: Kein Auslaufmodell


Wie Dampfen den Gefäßen schadet: Shisha und E-Zigarette


title: Allgemeinärztliche Sonografie — Teil 2: Schilddrüse, Thorax, Gefäße, Lymphknoten: Bildgebende Diagnostik

text: Nicht nur das Abdomen, sondern auch Schilddrüse, Thorax, Gefäße und Lymph- knoten können in der Hausarztpraxis sonografiert werden. Durch eine strukturierte und fundierte Diagnostik werden Doppeluntersuchungen vermieden sowie Befunde an einer Stelle erfasst und dokumentiert. In einigen Fällen sollte der Patient jedoch an einen Teilgebietsarzt überwiesen werden.


title: Complex Networks: a Mini-review

text: Network analysis is a powerful tool that provides us a fruitful framework to describe phenomena related to social, technological, and many other real-world complex systems. In this paper, we present a brief review about complex networks including fundamental quantities, examples of network models, and the essential role of network topology in the investigation of dynamical processes as epidemics, rumor spreading, and synchronization. A quite of advances have been provided in this field, and many other authors also review the main contributions in this area over the years. However, we show an overview from a different perspective. Our aim is to provide basic information to a broad audience and more detailed references for those who would like to learn deeper the topic.


docid: kguhgpjp

title: COVID-19: the impetus for change—sustaining healthcare team communication in times of social distancing

text: The COVID-19 pandemic has challenged existing healthcare systems and has made prevention of healthcare personnel exposure a high priority. Essential healthcare services, including multi-disciplinary team (MDT) meetings that make medical decisions, are expected to continue uninterrupted in this time of social distancing. There are a multitude of virtual platforms available to enable remote MDT meetings, and the pandemic has accelerated their arrival into daily healthcare practice. While we deal with a pandemic crisis, we have comprehensively reviewed and reported on the popular platforms and services available for this purpose. While each platform has its own unique features and drawbacks, it is essential to liaise with information technology departments and data governance teams to understand the optimal platforms for use within each healthcare setting. Level of evidence: Not ratable


title: Praxis-Digitalisierung: So zieht die Karawane weiter: Telematik-Infrastruktur

text: Alle Praxen in Deutschland sollen sich an die Telematik-Infrastruktur (TI) anschließen. Konnektoren und Lesegeräte sind inzwischen weit verbreitet. Doch ausruhen sollte sich niemand, denn der Marsch in die Zukunft geht weiter, von Oase zu Oase. Ein Ausblick.


The Neuropsychological Impact of E-learning on Children


Single-Cell Analyses in the Multi-omics Era


title: Antiviral immunity and nucleic acid sensing in haematopoietic stem cell gene engineering

text: The low gene manipulation efficiency of human hematopoietic stem and progenitor cells (HSPC) remains a major hurdle for sustainable and broad clinical application of innovative therapies for a wide range of disorders. Given that all current and emerging gene transfer and editing technologies are bound to expose HSPC to exogenous nucleic acids and most often also to viral vectors, we reason that host antiviral factors and nucleic acid sensors play a pivotal role in the efficacy of HSPC genetic manipulation. Here, we review recent progress in our understanding of vector–host interactions and innate immunity in HSPC upon gene engineering and discuss how dissecting this crosstalk can guide the development of more stealth and efficient gene therapy approaches in the future.


Reflecting on the challenges of sustaining emergency care research during the Covid-19 pandemic


Directions & Connections


Emotional state should not be used to differentiate IBD from IBS – Authors' reply


Tackling cervical cancer in Europe amidst the COVID-19 pandemic


HIV, tuberculosis, and malaria: how can the impact of COVID-19 be minimised?


Emotional state should not be used to differentiate IBD from IBS


Going Virtual: Redesigning the Interview Experience


title: False-Negative Nasopharyngeal Swab RT-PCR Assays in Typical COVID-19: Role of Ultra-low-dose Chest CT and Bronchoscopy in Diagnosis

text: On 11 March 2020, the WHO declared COVID-19 a pandemic and global health emergency. We describe the clinical features and role of ultra-low-dose chest computed tomography (CT) and bronchoscopy in the diagnosis of coronavirus disease (COVID-19). In our patient, who was highly suggestive clinically and radiologically for COVID-19, we had two false-negative results for nasopharyngeal and oral swab reverse-transcriptase polymerase chain reaction (RT-PCR) assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eventually, we confirmed the diagnosis using bronchoscopy and bronchoalveolar lavage (BAL). LEARNING POINTS: Clinical and laboratory findings in COVID-19 are unspecific. Chest CT has a diagnostic sensitivity comparable to nasopharyngeal swab RT-PCR assay but lacks specificity. RT-PCR assays on biological specimens, particularly nasopharyngeal swabs, are considered the diagnostic gold standard. Bronchoscopy and bronchoalveolar lavage can help confirm the diagnosis and should be performed in patients in whom diagnostic-driven treatment for COVID-19, such as tocilizumab or remdesivir, is being considered.


title: Prevalence and correlates of physical activity in a sample of UK adults observing social distancing during the COVID-19 pandemic

text: OBJECTIVE: To investigate the levels and correlates of physical activity during COVID-19 social distancing in a sample of the UK public. METHODS: This paper presents analyses of data from a cross-sectional study. Levels of physical activity during COVID-19 social distancing were self-reported. Participants also reported on sociodemographic and clinical data. The association between several factors and physical activity was studied using regression models. RESULTS: Nine hundred and eleven adults were included (64.0% were women and 50.4% of the participants were aged 35–64 years). 75.0% of the participants met the physical activity guidelines during social distancing. Meeting these guidelines during social distancing was significantly associated with sex (reference: male; female: OR=1.60, 95% CI 1.10 to 2.33), age (reference: 18–34 years; ≥65 years: OR=4.11, 95% CI 2.01 to 8.92), annual household income (reference: <£15 000; £15 000–<£25 000: OR=2.03, 95% CI 1.11 to 3.76; £25 000–<£40 000: OR=3.16, 95% CI 1.68 to 6.04; £40 000–<£60 000: OR=2.27, 95% CI 1.19 to 4.34; ≥£60 000: OR=2.11, 95% CI 1.09 to 4.09), level of physical activity per day when not observing social distancing (OR=1.00 (per 1 min increase), 95% CI 1.00 to 1.01), and any physical symptom experienced during social distancing (reference: no; yes: OR=0.31, 95% CI 0.21 to 0.46). CONCLUSION: During COVID-19, social distancing interventions should focus on increasing physical activity levels among younger adults, men and those with low annual household income. It should be noted in the present sample that women and younger adults are over-represented.


Expert consensus on the prevention and treatment of substance use and addictive behaviour-related disorders during the COVID-19 pandemic


title: Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data

text: OBJECTIVES: To compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D. DESIGN: Population-based cohort study. SETTING: Primary and secondary care, England, UK. PARTICIPANTS: 108 588 people with T2D and 528 667 comparators registered in 391 English general practices. Each patient with T2D aged ≥16 years between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D. RESULTS: Overall, 77% of patients with T2D had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women and those most socially deprived. Conditional logistic regression models fitted to estimate (OR, 95% CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR 2.13, 95% CI 1.85 to 2.46); heart failure (OR 2.12, 1.84 to 2.43); depression (OR 1.75, 1.62 to 1.89), but non-significant for cancer (OR 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions as highly prevalent comorbidities in people with T2D. CONCLUSIONS: T2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and under-reported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.


This summer, not all flu-like symptoms will be COVID-19s…


Cet été, les syndromes pseudo-grippaux ne seront pas tous des COVID-19


Quels symptômes inhabituels doivent faire rechercher une COVID-19 ?


Suivi des soignants impliqués dans la prise en charge de la COVID-19


Dépistage des porteurs du SARS-CoV-2 : et les tests salivaires ?


Artemisia et COVID-19


Comment maintenir une activité chirurgicale vitale en cas de crise sanitaire grave ? L’exemple de la transplantation chez l’adulte


Comment gérer, après confinement, les malades porteurs d’une affection chronique à risque ?


Déconfinons avec prudence pour ne pas avoir à reconfiner dans l’urgence


Les abattoirs : une cible majeure pour la prévention de la COVID-19


COVID-19 : interprétation des données de morbidité et mortalité


Vacciner contre la COVID-19 : la quête du Graal ?


La précarité : un risque majoré de COVID-19


Successful spontaneous breathing trial, early reintubation and mechanisms of weaning failure


title: Thrombocytopenia: is it a prognostic factor for development of post-hemorrhagic hydrocephalus in neonates?

text: PURPOSE: Post-hemorrhagic hydrocephalus (PHH) is a rare but serious complication among premature babies in the neonatal intensive care unit. The causes of PHH are still not entirely understood, and its prevention and treatment are controversial. We tried to analyze the risk factors for such complication in our cohort. METHODS: We reviewed our neonatology data bank and included all preterms below 28 weeks who were born in the period between 1999 and 2014 and suffered from an intraventricular hemorrhage (IVH). We reviewed gestational age, gender, birth weight, type of birth, IVH degree, comorbidities, therapy, complications, time to event, protein content of cerebrospinal fluid, and clinical follow-up. RESULTS: We identified 180 patients, divided into two subgroups, “B1” with 37 cases (IVH + PHH) and “B2” with 143 cases (IVH − PHH). In group B1, the presence of IVH grades I, II, III, or IV was in 11%, 19%, and 70% respectively. Nineteen patients were treated with a ventricular access device (VAD) or external ventricular drain (EVD). A total of 20 shunts were implanted, with 11 revisions (55%). One patient suffered from thrombocytopenia. In subgroup B2, 51% showed IVH grade I, whereas severe IVH grades were only present in 22%. 25.9% suffered from thrombocytopenia. Thrombocytopenia was significantly higher in patients who did not develop PHH (p value: 0.002). CONCLUSION: According to our results, thrombocytopenia could play a decisive role in avoiding development of PHH as a sequel of IVH. We recommend a randomized controlled trial to assess the possible efficacy of antiplatelet drugs in avoiding PHH in this vulnerable group.


title: Inactivation effect and mechanisms of combined ultraviolet and metal-doped nano-TiO(2) on treating Escherichia coli and Enterococci in ballast water

text: The discharge of ship ballast water (containing large amounts of alien organisms) has caused severe ecological hazards to marine environments. In this study, three metal elements (Ag, Fe, and Gd) were doped to nano-TiO(2) material respectively (content: 0.4%, 0.7%, and 1.0%) to improve inactivation effect of Escherichia coli and Enterococci in ballast water. Experimental results indicate that compared with the sole ultraviolet (UV) and the UV and original nano-TiO(2), the UV and metal-doped nano-TiO(2) increased the bacterial inactivation rate to different extents. For each metal element, high external metal content (1.0%) corresponded to high inactivation effort. The doping of Ag resulted in optimal inactivation effort, and the addition of Fe and Gd caused unobvious effort. At the end of the inactivation process (20 s), the UV and 1% Ag-doped nano-TiO(2) reached the highest logarithmic sterilization rates (0.915 for Escherichia coli and 0.805 for Enterococcus). The doping of Ag, Fe, and Gd did not change the anatase phase TiO(2) crystal form, and 1% Ag-doped nano-TiO(2) had the smallest particle diameter and the evenest distribution of nanoparticles. Compared with the sole UV, the UV and Ag-doped nano-TiO(2) treatment resulted in higher malondialdehyde contents (0.0646 μmol/L for Escherichia coli and 0.0529 μmol/L for Enterococci) and lower superoxide dismutase activities (0.672 U/mL for Escherichia coli and 0.792 U/mL for Enterococci), which were in accordance with high inactivation rates in these cases.


title: Power and Message Framing: the Case of Comparative Advertising

text: Two studies tested the hypothesis that power affects an individual’s likelihood to be influenced by positively vs. negatively framed comparative messages. Experiment 1 showed that individuals with a higher personal sense of power are more persuaded by positively framed messages than negatively framed messages. Experiment 2 showed that this effect is partly attributable to higher power individuals being more suspicious of the negatively framed communicator’s motivation. Message frame did not have a significant influence on individuals with lower levels of power. These results have important implications for tailoring comparative messages aimed at persuasion toward targets with different levels of power.


docid: qhhhedhz

title: The Future of Infectious Diseases Education

text: The infectious diseases (ID) specialty continues to be in crisis due to a lack of interest by residents in the recruitment pool. It is possible that enhancing and innovating how microbiology is taught in medical school could increase the interest in ID. We need to improve teaching of preclinical medical microbiology and immunology by incorporating advancements in education and learning technologies to reignite the interest in the field. The shortage of ID specialists has important implications in our fight against ID threats such as the current COVID-19 global pandemic. In order to address this problem, we need to perform extensive research to identify the issues that medical learners and trainees are facing as they progress through their medical education towards the ID specialty.


title: Telepresence Mobile Robots Design and Control for Social Interaction

text: Human–robot interaction has extended its application horizon to simplify how human beings interact with each other through a remotely controlled telepresence robot. The fast growth of communication technologies such as 4G and 5G has elevated the potential to establish stable audio–video-data transmission. However, human–robot physical interactions are still challenging regarding maneuverability, controllability, stability, drive layout, and autonomy. Hence, this paper presents a systematic design and control approach based on the customer’s needs and expectations of telepresence mobile robots for social interactions. A system model and controller design are developed using the Lagrangian method and linear quadratic regulator, respectively, for different scenarios such as flat surface, inclined surface, and yaw (steering). The robot system is capable of traveling uphill (30[Formula: see text] ) and has a variable height (600–1200 mm). The robot is advantageous in developing countries to fill the skill gaps as well as for sharing knowledge and expertise using a virtual and mobile physical presence. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12369-020-00676-3) contains supplementary material, which is available to authorized users.


title: The Hopeless University: Intellectual Work at the End of the End of History

text: The University is being explicitly restructured for the production, circulation and accumulation of value, materialised in the form of rents and surpluses on operating activities. The pace of restructuring is affected by the interplay between financial crisis and Covid-19, through which the public value of the University is continually questioned. In this conjuncture of crises that affect the body of the institution and the bodies of its labourers, the desires of Capital trump human needs. The structural adjustment of sectoral and institutional structures as forms, cultures as pathologies, and activities as methodologies enacts scarring. However, the visibility of scars has led to a reawakening of politics inside and beyond the University. The idea that History had ended because there is no alternative to capitalism or its political horizon, is in question. Instead, the political content of the University has reasserted itself at the end of The End of History. In this article, the idea that the University at The End of History has become a hopeless space, unable both to fulfil the desires of those who labour within it for a good life and to contribute solutions to socio-economic and socio-environmental ruptures, is developed dialectically. This enables us to consider the potential for reimagining intellectual work as a movement of sensuous human activity in the world, rather than being commodified for value.


title: Functional and cognitive outcomes after COVID-19 delirium

text: PURPOSE: To ascertain delirium prevalence and outcomes in COVID-19. METHODS: We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. RESULTS: In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium − 50 out of 166 points (95% CI − 83 to − 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. CONCLUSIONS: Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s41999-020-00353-8) contains supplementary material, which is available to authorized users.


COVID-19 and macular edema: a necessarily blindness?


title: Food system disruption: initial livelihood and dietary effects of COVID-19 on vegetable producers in India

text: Disruption to food systems and impacts on livelihoods and diets have been brought into sharp focus by the COVID-19 pandemic. We aimed to investigate effects of this multi-layered shock on production, sales, prices, incomes and diets for vegetable farmers in India as both producers and consumers of nutrient-dense foods. We undertook a rapid telephone survey with 448 farmers in 4 states, in one of the first studies to document the early impacts of the pandemic and policy responses on farming households. We find that a majority of farmers report negative impacts on production, sales, prices and incomes. Over 80% of farms reported some decline in sales, and over 20% of farms reported devastating declines (sold almost nothing). Price reductions were reported by over 80% of farmers, and reductions by more than half for 50% of farmers. Similarly, farm income reportedly dropped for 90% of farms, and by more than half for 60%. Of surveyed households, 62% reported disruptions to their diets. A majority of farm households reported reduced ability to access the most nutrient-dense foods. Around 80% of households reported ability to protect their staple food consumption, and the largest falls in consumption were in fruit and animal source foods other than dairy, in around half of households. Reported vegetable consumption fell in almost 30% of households, but vegetables were also the only food group where consumption increased for some, in around 15% of households. Our data suggest higher vulnerability of female farmers in terms of both livelihoods and diet, and differential effects on smaller and larger farms, meaning different farms may require different types of support in order to continue to function. Farms reported diverse coping strategies to maintain sales, though often with negative implications for reported incomes. The ability to consume one’s own produce may be somewhat protective of diets when other routes to food access fail. The impacts of COVID-19 and subsequent policy responses on both livelihoods and diets in horticultural households risk rolling back the impressive economic and nutrition gains India has seen over the past decade. Food systems, and particularly those making available the most nutrient-dense foods, must be considered in ongoing and future government responses.


title: Epidemiology and short-term outcomes of acute kidney injury among patients in the intensive care unit in Laos: a nationwide multicenter, prospective, and observational study

text: BACKGROUND: Acute kidney injury (AKI) has become a global health issue. Little is known about the disease burden in Laos. We aimed to evaluate the burden and outcomes of AKI as well as assess the availability of AKI treatment in Laos. METHODS: We performed a multicentric prospective observational study in adult patients who had been admitted to 5 intensive care units (ICU) in Laos. The data was serially collected on the first 28 days of ICU admission. Patients were diagnosed by the KDIGO 2012 criteria for AKI. We used AKI occurrence as the primary outcome and explored risk factors on the development and outcomes of AKI. RESULTS: We enrolled 1480 patients from 5 ICU centers across Laos from January to December 2016. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 508 of the 1460 enrolled patients (34.8%). Overall, the rates of maximum AKI staging were 4% for stage 1, 10.3% for stage 2, and 20.5% for stage 3. Risk factors for AKI were older age, obesity, cardiovascular diseases, respiratory diseases, renal diseases, oncologic diseases, and chronic kidney diseases. Only 1.8% of all participants received RRT. The mortality rate was 28.4% in non-AKI patients compared to 44.5% in AKI patients, which increased according to the stage of AKI (stage 1, 4.9%; stage 2, 28.3%; stage 3 66.8%; P < 0.001). There were 13.6% who were discharged against medical advice. CONCLUSIONS: AKI is a huge burden in Laos with under-recognition and poor outcomes.


„Corona-Angst“ wegwischen?


title: Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy

text: OBJECTIVE: To assess sensitivity/specificity of CT vs RT-PCR for the diagnosis of COVID-19 pneumonia in a prospective Italian cohort of symptomatic patients during the outbreak peak. METHODS: In this cross-sectional study, we included all consecutive patients who presented to the ER between March 13 and 23 for suspected COVID-19 and underwent CT and RT-PCR within 3 days. Using a structured report, radiologists prospectively classified CTs in highly suggestive, suggestive, and non-suggestive of COVID-19 pneumonia. Ground-glass, consolidation, and visual extension of parenchymal changes were collected. Three different RT-PCR-based reference standard definitions were used. Oxygen saturation level, CRP, LDH, and blood cell counts were collected and compared between CT/RT-PCR classes. RESULTS: The study included 696 patients (41.4% women; age 59 ± 15.8 years): 423/454 (93%) patients with highly suggestive CT, 97/127 (76%) with suggestive CT, and 31/115 (27%) with non-suggestive CT had positive RT-PCR. CT sensitivity ranged from 73 to 77% and from 90 to 94% for high and low positivity threshold, respectively. Specificity ranged from 79 to 84% for high positivity threshold and was about 58% for low positivity threshold. PPV remained ≥ 90% in all cases. Ground-glass was more frequent in patients with positive RT-PCR in all CT classes. Blood tests were significantly associated with RT-PCR and CT classes. Leukocytes, lymphocytes, neutrophils, and platelets decreased, CRP and LDH increased from non-suggestive to suggestive CT classes. CONCLUSIONS: During the outbreak peak (in a high-prevalence setting), CT presented high PPV and may be considered a good reference to recognize COVID-19 patients while waiting for RT-PCR confirmation. KEY POINTS: • During the epidemic peak, CT showed high positive predictive value and sensitivity for COVID-19 pneumonia when compared with RT-PCR. • Blood tests were significantly associated with RT-PCR and CT classes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-020-07050-x) contains supplementary material, which is available to authorized users.


Ultrasonographic diagnosis of pancreatic diseases: this is all you need


Message from the Editor-in-Chief


title: In silico analysis of a chimeric fusion protein as a new vaccine candidate against Clostridium perfringens type A and Clostridium septicum alpha toxins

text: In silico analysis is the most important approach to understand protein structure and functions, and the most important problem for designing and producing a fusion construct is producing large amounts of functional protein. Clostridium perfringens type A and Clostridium septicum produce alpha (plc) and alpha toxins respectively. C. perfringens can cause gas gangrene and gastrointestinal diseases. C. septicum can cause traumatic and non-traumatic gas gangrene. The aim of current research was in silico analysis of a chimeric fusion protein against C. perfringens type A and C. septicum alpha toxins. Firstly, the chimeric fusion gene was designed according to nucleotide sequences of C. perfringens type A alpha (KY584046.1) and C. septicum alpha (JN793989.2) toxin genes and then its fusion protein is constructed by amino acid sequences of C. perfringens type A and C. septicum alpha toxins. Secondly, online software was used to determine prediction of secondary and tertiary structures and physicochemical characteristics of the fusion protein. Finally, the validation of the fusion protein was confirmed by Rampage and proSA program. The designed fusion protein has 777 amino acids in length. TASSER server and physicochemical parameters are showed: C-score = − 2.68 and molecular weight = 87.9 KD respectively. Rampage and proSA software revealed the fusion protein is valid. Deposited accession number for the sequence of the fusion gene in the GenBank is MK908396. The designed fusion protein is valid and functional. Thus, the fusion gene could be used for clone and expression in a proper prokaryotic cell and also as a recombinant vaccine candidate.


Correction to: ChemoPROphyLaxIs with hydroxychloroquine For covId-19 infeCtious disease (PROLIFIC) to prevent covid-19 infection in frontline healthcare workers: A structured summary of a study protocol for a randomised controlled trial


docid: hhrgwxwb

title: Prone positioning under VV-ECMO in SARS-CoV-2-induced acute respiratory distress syndrome


docid: tuijdbzs

title: Nurse-performed ultrasound: a new weapon against COVID-19


Atorvastatin associated with decreased hazard for death in COVID-19 patients admitted to an ICU: a retrospective cohort study


title: Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation

text: STUDY DESIGN: Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin-Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission. OBJECTIVES: Determine the implications of MRSA-related infection isolation on spinal cord injury patients’ anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls. SETTING: National Spinal Injuries Centre, England, UK. METHODS: Secondary analyses were conducted on pre-existing data based on patients’ first admission for primary rehabilitation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge. RESULTS: Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups. CONCLUSIONS: Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation.


title: Unleashing the mysterious link between COVID-19 and a famous childhood vasculitis: Kawasaki disease

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged as a small outbreak in Wuhan rapidly progressing into the deadliest pandemic since the Spanish flu of 1918. The disease was deemed trivial in children, until the reporting, few days ago, of an emerging pediatric multi-inflammatory syndrome mimicking Kawasaki disease (KD). MAIN BODY: This report reveals that coronaviridae were implicated in induction of several post-infectious vasculitides, namely, KD, AHEI, and HSP. This occurs in genetically susceptible individuals to vascular inflammation. Shared genetic susceptibilities between KD and CoV include genes encoding for CD 40, HLAB-15:03, and ACE. This leads to augmented inflammation with hypersecretion of cytokines especially IL-6. CONCLUSION: The revealed relationships between KD and CoV can help to predict the risk of KD in COVID-19 patients through screening levels of upregulated cytokines. It might also signify that classic treatment of KD with IVIG might need to be replaced with anti-cytokine therapy in COVID-19 patients.


title: Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

text: The objective of this study was to assess the predictive value of a lung ultrasound (LUS) score in the development of moderate–severe bronchopulmonary dysplasia (sBPD). This was a prospective observational diagnostic accuracy study in a third-level neonatal intensive care unit. Preterm infants with a gestational age below 32 weeks were included. A LUS score (range 0–24 points) was calculated by assessing aeration semiquantitatively (0–3 points) in eight lung zones on the 7th day of life (DOL) and repeated on the 28th DOL. ROC curves and logistic regression were used for analysis. Forty-two preterm infants were included. The LUS on the 7th DOL had an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI: 0.87–1) for the prediction of sBPD (optimal cutoff of ≥8 points: sensitivity 93%, specificity 91%). The LUS score was independently associated with sBPD [OR 2.1 (95% CI: 1.1–3.9), p = 0.022, for each additional point in the score]. Conclusions: Lung aeration as assessed by LUS on the 7th DOL may predict the development of sBPD.


Rheumatic disease management in the Campania region of Italy during the COVID-19 pandemic


title: Containing the Anxieties of Children, Parents and Families from a Distance During the Coronavirus Pandemic

text: The coronavirus pandemic and the move to teletherapy has created uncertainty among both clinicians and patients. As therapists who work with children, we have heard from parents who are desperate for support and advice about how to respond to their children’s behavioral changes, as well as those who feel too overwhelmed to continue their children’s sessions at the moment and want to take a break from treatment. We have had to rethink the frame in concrete ways, reimagine how to play, and renegotiate parameters around confidentiality. At a time when fear and uncertainty make mentalizing difficult, the hallmarks of a mentalizing approach—curiosity and flexibility—are most critical. This paper will describe how the Mentalization-Based Treatment for Children (MBT-C) model offers a framework for an integrative approach that can inform treatment via teletherapy, so that clinicians can continue supporting young people and their families through this period. We will begin by describing how the mentalizing stance, particularly an awareness of our own mentalizing capacities in the moment, has become more important than ever. Ways in which clinicians maintain their mentalizing in the face of the mentalizing breakdowns will be also discussed. Finally, we illustrate with clinical vignettes how the developmental levels of mentalizing—attention control, emotion regulation, and explicit mentalizing—can inform the structure, techniques and interventions in teletherapy with children and parents.


From economic crisis to the COVID-19 pandemic crisis: evidence from a mental health helpline in Greece


docid: xbxxtiju

title: The Role of the Patient-Centered Medical Home in Treating Depression

text: PURPOSE OF REVIEW: This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. RECENT FINDINGS: Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. SUMMARY: The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.


title: Fight Against COVID-19: ARCI’s Technologies for Disinfection

text: COVID-19 (SARS-CoV-2) is causing a huge concern to the global population due to its highly contagious properties. The SARS-CoV-2 is a new variant in the coronavirus family. The world is focussing on several methods to battle against this novel corona virus, including control of its spread. In this context, ARCI has quickly made efforts to develop disinfection systems including a UVC-based disinfection trolley, honeycomb air heater and a fogging chamber using UVC germicidal lamps, dry heat sterilization and HOCl-based chemical disinfectant to provide rapid and effective inactivation of microorganisms causing the pandemic. These systems have been successfully deployed at different hospitals for their validation.


Hydroxychloroquine and Potential Drug Interactions in Older Adults


Commentary: Are Thoracic Surgery Program Websites A Charming Vitrine to Attract?


Pneumomédiastin spontané : une complication rare du COVID-19 ?


docid: kxxnmjug

title: El cierre de Acta Pediátrica Española. La publicación pediátrica en España en peligro de extinción


Évacuation sanitaire et déploiement d’un hôpital militaire durant la crise COVID : le biomédical également sollicité


Commentary: Managing Thoracic Aortic Emergencies During A Pandemic


Commentary: Eliminating cervical anastomotic leak after esophagectomy: To supercharge or not to supercharge that’s the question.


title: Human Population and the Environment

text: One of the burning issues of the present world is the explosion of human population due to which shortage of resources in terms of food, space, employment and other basic needs has cropped up. The chapter discusses a comprehensive population policy, which is based not on the traditional foundation of family planning, but on the pillars of women’s access to education, health care, economic and political decisions. To solve the acute unemployment problem, a non-conventional alternative livelihood has also been presented as annexure to the chapter.


title: Herpes Zoster Co-Infection in an Immunocompetent Patient With COVID-19

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a broad spectrum of manifestations. A variety of dermatological manifestations were described. We present a case of an immunocompetent middle-aged man who presented with novel coronavirus disease 2019 (COVID-19) and later developed herpes zoster (HZ). The case highlights the possibility of COVID-19-related HZ. The highest infection control measures must be abided when managing patients with cutaneous complaints until COVID-19 is ruled out.


title: COVID-19 Trends and Forecast in the Eastern Mediterranean Region With a Particular Focus on Pakistan

text: First reported in China, the coronavirus responsible for coronavirus disease 2019 (COVID-19) has spread to 213 countries and territories around the world as of April 26, 2020. This study was designed to explore COVID-19 trends in the Eastern Mediterranean Region (EMR), with a particular focus on Pakistan. Daily reports and updates from the Ministry of National Health Services Regulations and Coordination COVID-19 Pakistan and the European Centre for Disease Prevention and Control were collected and study-specific data were extracted and analyzed. Our analysis revealed that, as of April 26, 2020, a total of 22 countries and territories in the EMR have reported COVID-19 cases. Iran had the highest number of cases (89,329) followed by Saudi Arabia (16,299), Pakistan (12,723), and the United Arab Emirates (9,813). Egypt (7.1%), Iran (6.3%), and Iraq (4.9%) had high case fatality rates; Lebanon (3.4%) and Pakistan (2.1%) had moderate case fatality rates; Saudi Arabia and the United Arab Emirates had low case fatality rates of 0.8% and 0.7%, respectively. Iran (76.3%) and Iraq (69.4 %) had the highest recovery rate followed by Pakistan (22.5%), the United Arab Emirates (19.2%), and Saudi Arabia (13.6%). If the current trend continues, based on the susceptible, infected, recovered (SIR) epidemiological model, we predict that EMR countries might experience a surge in the number of COVID-19 cases, resulting in as many as 2.12 million cases in Iran, 0.58 million in Saudi Arabia, and 0.51 million in Pakistan by June 20, 2020. Pakistan is the most populated country in the EMR and was the third most-affected country in terms of the number of cases with moderate case fatality and recovery rates. We predict that Pakistan’s weak healthcare system would not be able to sustain care if there is an explosive increase in the number of cases due to insufficient and inconsistent disease prevention and control policies. The best strategy for mitigating the COVID-19 pandemic is to strictly follow recommendations based on epidemiological principles.


title: Coronavirus Disease 2019 (COVID-19)-Associated Thromboembolic Disease: A Report of Three Patients With Pulmonary Embolism

text: Coagulopathy and thromboembolic disease, including pulmonary embolism (PE), are reported complications of coronavirus disease 2019 (COVID-19). The mechanism is not fully understood. We present three patients with COVID-19 and concurrent PE.


title: Effect of T-Piece Resuscitator versus Self Inflating Bag on Arterial CO(2) Levels in Preterm Neonates

text: OBJECTIVE: To compare the effect of self-inflating bag (SIB) vs. T-piece resuscitator (TPR) on PaCO(2) levels, when used for brief manual ventilation during administration of first dose of surfactant. METHODS: Preterm neonates were randomized to receive positive pressure ventilation with either self-inflating bag or T-piece resuscitator during administration of first dose of surfactant. Arterial blood gases were obtained at baseline and 1 h after the intervention. Primary outcome was the mean change in PaCO(2) levels 1 h after the intervention. RESULTS: Eighty neonates were enrolled (40 in each group). The drop in PaCO(2) at 1 h was significantly greater in the self inflating bag group as compared to the T-piece resuscitator group [8.96 ± 9.06 mmHg vs. 1.37 ± 9.06 mmHg, Mean difference = 7.58 mmHg, (95% CI: 3.78 to 11.4); P < 0.01]. The PaCO(2) change was also statistically significant in the subgroup of infants that required only non-invasive ventilation. The need for second dose of surfactant was higher in the self-inflating bag group [77% vs. 55%, RR - 1.41 (95% CI: 1.02 to 1.94); P = 0.03]. CONCLUSIONS: T-piece resuscitator results in smaller reduction in PaCO(2) levels compared to the self inflating bag, when used for brief manual ventilation during surfactant administration.


title: Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response

text: BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems’ decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.


title: Through thick and thin: Russia, China and the future of Eurasian International Society

text: Recent years have seen Moscow and Beijing driven closer together as their respective relations with Washington have deteriorated. While a normative convergence between Russia and China appears to be underway, there remains a legacy of historical mistrust in addition to potential irritants that could plague their bilateral relationship. Nonetheless, if Western sanctions against Russia and pressure on China continue unabated, they may have little option but to continue their rapprochement. Against this backdrop, this article will explore whether the two countries currently display a ‘thin’ or ‘thick’ bilateral relationship, making use of an English School theoretical framework. It will do so by exploring established English School concepts such as pluralism and solidarism and discussing notable literature within the School on contestation in order to derive conclusions regarding the potential future shape of international order in Eurasia.


title: Searching for the HERO in Youth: Does Psychological Capital (PsyCap) Predict Mental Health Symptoms and Subjective Wellbeing in Australian School-Aged Children and Adolescents?

text: Psychological capital (PsyCap) comprising the positive psychological resources of hope, efficacy, resilience, and optimism (HERO) has strong empirical associations with increased wellbeing and reduced mental health symptoms in adult samples. Emerging studies of PsyCap among school-age students have also shown preliminary, positive associations between PsyCap and student wellbeing. The present study is the first to examine PsyCap-HERO constructs and associations with both mental health symptoms and subjective wellbeing in school-aged children and adolescents (aged 9–14 years). A convenience sample of Australian school students (N = 456, Mage = 11.54, SD = 1.20, 47% female) completed an online survey during class time. Measures of hope, efficacy, resilience, optimism, flourishing, anxiety, and depression previously well-validated in school samples were used. Significant associations between each HERO construct and flourishing, anxiety and depression symptoms in the expected direction were found, and importantly, the combination of HERO constructs was shown to be a stronger predictor of increased levels of student flourishing, and decreased levels of anxiety and depression symptoms, than individual HERO constructs. Findings indicate that student PsyCap may be a promising area of further investigation for schools, policymakers, clinicians and researchers looking to identify positive psychological resources in youth that may buffer poor mental health and promote wellbeing.


title: Is it financially beneficial for hospitals to prevent nosocomial infections?

text: BACKGROUND: Financial incentives represent a potential mechanism to encourage infection prevention by hospitals. In order to characterize the place of financial incentives, we investigated resource utilization and cost associated with hospital-acquired infections (HAI) and assessed the relative financial burden for hospital and insurer according to reimbursement policies. METHODS: We conducted a prospective matched case-control study over 18 months in a tertiary university medical center. Patients with central-line associated blood-stream infections (CLABSI), Clostridium difficile infection (CDI) or surgical site infections (SSI) were each matched to three control patients. Resource utilization, costs and reimbursement (per diem for CLABSI and CDI, diagnosis related group (DRG) reimbursement for SSI) were compared between patients and controls, from both the hospital and insurer perspective. RESULTS: HAIs were associated with increased resource consumption (more blood tests, imaging, antibiotic days, hospital days etc.). Direct costs were higher for cases vs. controls (CLABSI: $6400 vs. $2376 (p < 0.001), CDI: $1357 vs $733 (p = 0.047) and SSI: $6761 vs. $5860 (p < 0.001)). However as admissions were longer following CLABSI and CDI, costs per-day were non-significantly different (USD/day, cases vs. controls: CLABSI, 601 vs. 719, (p = 0.63); CDI, 101 vs. 93 (p = 0.5)). For CLABSI and CDI, reimbursement was per-diem and thus the financial burden ($14,608 and $5430 respectively) rested on the insurer, not the hospital. For SSI, as reimbursement was per procedure, costs rested primarily on the hospital rather than the insurer. CONCLUSION: Nosocomial infections are associated with both increased resource utilization and increased length of stay. Reimbursement strategy (per diem vs DRG) is the principal parameter affecting financial incentives to prevent hospital acquired infections and depends on the payer perspective. In the Israeli health care system, financial incentives are unlikely to represent a significant consideration in the prevention of CLABSI and CDI.


title: Automated detection and quantification of COVID-19 pneumonia: CT imaging analysis by a deep learning-based software

text: BACKGROUND: The novel coronavirus disease 2019 (COVID-19) is an emerging worldwide threat to public health. While chest computed tomography (CT) plays an indispensable role in its diagnosis, the quantification and localization of lesions cannot be accurately assessed manually. We employed deep learning-based software to aid in detection, localization and quantification of COVID-19 pneumonia. METHODS: A total of 2460 RT-PCR tested SARS-CoV-2-positive patients (1250 men and 1210 women; mean age, 57.7 ± 14.0 years (age range, 11–93 years) were retrospectively identified from Huoshenshan Hospital in Wuhan from February 11 to March 16, 2020. Basic clinical characteristics were reviewed. The uAI Intelligent Assistant Analysis System was used to assess the CT scans. RESULTS: CT scans of 2215 patients (90%) showed multiple lesions of which 36 (1%) and 50 patients (2%) had left and right lung infections, respectively (> 50% of each affected lung’s volume), while 27 (1%) had total lung infection (> 50% of the total volume of both lungs). Overall, 298 (12%), 778 (32%) and 1300 (53%) patients exhibited pure ground glass opacities (GGOs), GGOs with sub-solid lesions and GGOs with both sub-solid and solid lesions, respectively. Moreover, 2305 (94%) and 71 (3%) patients presented primarily with GGOs and sub-solid lesions, respectively. Elderly patients (≥ 60 years) were more likely to exhibit sub-solid lesions. The generalized linear mixed model showed that the dorsal segment of the right lower lobe was the favoured site of COVID-19 pneumonia. CONCLUSION: Chest CT combined with analysis by the uAI Intelligent Assistant Analysis System can accurately evaluate pneumonia in COVID-19 patients.


title: Comparison between volume-controlled ventilation and pressure-controlled volume-guaranteed ventilation in postoperative lung atelectasis using lung ultrasound following upper abdominal laparotomies: a prospective randomized study

text: BACKGROUND: Atelectasis is a common side effect of general anesthesia. Prevention of lung atelectasis, carbon dioxide retention, and chest infection would improve the quality of medical care and decrease hospital stay and costs. The aim of this study was to compare the effects of volume-controlled ventilation (VCV) and pressure-controlled volume-guaranteed ventilation (PCVG) on postoperative lung atelectasis using lung ultrasound (LUS) following upper abdominal laparotomies. RESULTS: Sixty patients (male and female) scheduled for upper abdominal laparotomies. They were randomly allocated into two equal groups: Group A (n = 30): received intraoperative volume-controlled ventilation (VCV) mode and group (n = 30): received intraoperative pressure-controlled ventilation volume-guaranteed (PCV-VG) mode. Arterial blood samples were obtained immediately after extubation, and 30, 120, 240, and 360 min postextubation. Lung ultrasound was done intraoperatively at 30 min from induction, immediate, and 120 and after 360 min postoperatively. There was difference between two groups favoring PCV-VG group but that difference failed to be statically significant regarding arterial partial pressure of oxygen (PaO(2)) and arterial carbon dioxide tension (PaCo(2)) between the two groups in preoperative, immediate postoperative, and 120, 240, and 360 min postoperative. Arterial oxygen saturation (SaO(2)) was significantly lower among patients in the VCV group immediate postextubation compared with patients in group PCV-VG (p value = 0.009*). Although signs of atelectasis were low in group B, 36.7% of the patients showed normal lung ultrasound, 63.3% showed various abnormalities, 46.7% showed the presence of lung pulse (vertical rhythmic movement synchronous with cardiac pulsation through motionless lung), and 46.7% showed B lines (vertical lines indicate abnormal lung aeration), while 30% of the patients showed the absence of A-lines (indicates the absence of lung sliding and abnormal lung aeration). Also, some patients demonstrated more than one sign. However, there was no a significant difference between the two groups both showed atelectasis immediate, 2 h and 6 h postoperatively. CONCLUSION: PCV-VG offered no significant advantage over VCV regarding the occurrence of the postoperative atelectasis. However, we prefer to use PCV-VG as postoperative hypoxia and atelectasis was much less in that mode. Further, large-scale studies are required to confirm these findings and to establish a definite conclusion.


title: Central venous pressure measurement is associated with improved outcomes in septic patients: an analysis of the MIMIC-III database

text: PURPOSE: Measurement of central venous pressure (CVP) can be a useful clinical tool. However, the formal utility of CVP measurement in preventing mortality in septic patients has never been proven. METHODS: The Medical Information Mart for Intensive Care III (MIMIC-III) database was searched to identify septic patients with and without CVP measurements. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between CVP measurement and 28-day mortality, and propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) were employed to validate our findings. RESULTS: A total of 10,275 patients were included in our study, of which 4516 patients (44%) underwent CVP measurement within 24 h of intensive care unit (ICU) admission. The risk of 28-day mortality was reduced in the CVP group (OR 0.60 (95% CI 0.51–0.70; p < 0.001)). Patients in the CVP group received more fluid on day 1 and had a shorter duration of mechanical ventilation and vasopressor use, and the reduction in serum lactate was greater than that in the no CVP group. The mediating effect of serum lactate reduction was significant for the whole cohort (p = 0.04 for the average causal mediation effect (ACME)) and patients in the CVP group with an initial CVP level below 8 mmHg (p = 0.04 for the ACME). CONCLUSION: CVP measurement was associated with decreased risk-adjusted 28-day mortality among patients with sepsis and was proportionally mediated through serum lactate reduction.


title: Japanese Animals in Calamity

text: This chapter provides a brief background of the empirical research in this volume by describing the position of companion animals in contemporary Japan and the context of the 3.11 earthquake and tsunami. Today, about 34.3% (Cabinet Office Government of Japan 2010) of Japanese households keep some kind of pet. It is evident from the multiple social surveys that a strong attachment to pets has emerged since the mid-1990s. On 11 March 2011, the Tohoku region in Japan was struck by a large earthquake and the tsunami that followed. This was the largest earthquake on record in Japan. The Fukushima No. 1 nuclear power plant was seriously damaged and released radiation which continues to be an ongoing issue for those living in that part of Japan. The serious damage to humans and other animals caused by the tsunami and the radioactive contamination is outlined. The author provides an overview of the study and shows research questions. Then, she reviews the relevant literature, noting that most of the studies are set in a Western context and pointing to the contributions that might be made by considering how one highly developed Asian society has responded to the plight of pet owners following a major disaster. The chapter ends by showing the structure of the book.


title: Avoiding or Co-Opting ATP Inhibition: Overview of Type III, IV, V, and VI Kinase Inhibitors

text: As described in the previous chapter, most kinase inhibitors that have been developed for use in the clinic act by blocking ATP binding; however, there is growing interest in identifying compounds that target kinase activities and functions without interfering with the conserved features of the ATP-binding site. This chapter will highlight alternative approaches that exploit unique kinase structural features that are being targeted to identify more selective and potent inhibitors. The figure below, adapted from (Sammons et al., Molecular Carcinogenesis 58:1551–1570, 2019), provides a graphical description of the various approaches to manipulate kinase activity. In addition to the type I and II inhibitors, type III kinase inhibitors have been identified to target sites adjacent to the ATP-binding site in the catalytic domain. New information on kinase structure and substrate-binding sites has enabled the identification of type IV kinase inhibitor compounds that target regions outside the catalytic domain. The combination of targeting unique allosteric sites outside the catalytic domain with ATP-targeted compounds has yielded a number of novel bivalent type V kinase inhibitors. Finally, emerging interest in the development of irreversible compounds that form selective covalent interactions with key amino acids involved in kinase functions comprise the class of type VI kinase inhibitors.


title: A comprehensive investigation of the mRNA and protein level of ACE2, the putative receptor of SARS-CoV-2, in human tissues and blood cells

text: The outbreak of pneumonia caused by SARS-CoV-2 posed a great threat to global human health, which urgently requires us to understand comprehensively the mechanism of SARS-CoV-2 infection. Angiotensin-converting enzyme 2 (ACE2) was identified as a functional receptor for SARS-CoV-2, distribution of which may indicate the risk of different human organs vulnerable to SARS-CoV-2 infection. Previous studies investigating the distribution of ACE2 mRNA in human tissues only involved a limited size of the samples and a lack of determination for ACE2 protein. Given the heterogeneity among humans, the datasets covering more tissues with a larger size of samples should be analyzed. Indeed, ACE2 is a membrane and secreted protein, while the expression of ACE2 in blood and common blood cells remains unknown. Herein, the proteomic data in HIPED and the antibody-based immunochemistry result in HPA were collected to analyze the distribution of ACE2 protein in human tissues. The bulk RNA-seq profiles from three separate public datasets including HPA tissue Atlas, GTEx, and FANTOM5 CAGE were also obtained to determine the expression of ACE2 in human tissues. Moreover, the abundance of ACE2 in human blood and blood cells was determined by analyzing the data in the PeptideAtlas and the HPA Blood Atlas. We found that the mRNA expression cannot reflect the abundance of ACE2 factor due to the strong differences between mRNA and protein quantities of ACE2 within and across tissues. Our results suggested that ACE2 protein is mainly expressed in the small intestine, kidney, gallbladder, and testis, while the abundance of which in brain-associated tissues and blood common cells is low. HIPED revealed enrichment of ACE2 protein in the placenta and ovary despite a low mRNA level. Further, human secretome shows that the average concentration of ACE2 protein in the plasma of males is higher than those in females. Our research will be beneficial for understanding the transmission routes and sex-based differences in susceptibility of SARS-CoV-2 infection.


title: Ageusia and anosmia, a common sign of COVID-19? A case series from four countries

text: Over the course of the pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), multiple new clinical manifestations, as the consequence of the tropism of the virus, have been recognized. That includes now the neurological manifestations and conditions, such as headache, encephalitis, as well as olfactory and taste disorders. We present a series of ten cases of RT-PCR-confirmed SARS-CoV-2-infected patients diagnosed with viral-associated olfactory and taste loss from four different countries.