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Mood Sensitive Stocks and Sustainable Cross-Sectional Returns During the COVID-19 Pandemic: An Analysis of Day of the Week Effect in the Chinese A-Share Market

This study examines two stock market anomalies and provides strong evidence of the day-of-the-week effect in the Chinese A-share market during the COVID-19 pandemic. Specifically, we examined the Quality minus Junk (QMJ) strategy return on Monday and FridayQuality stocks mean portfolio deciles that earn higher excess returns. As historical evidences suggest that less distressed/safe stocks earn higher excess returns (Dichev, 1998).. The QMJ factor is similar to the division of speculative and non-speculative stocks described by Birru (2018). Our findings provide evidence that the QMJ strategy gains negative returns on Fridays for both anomalies because the junk side is sensitive to an elevated mood and, thus, performs better than the quality side of portfolios on Friday. Our findings are also consistent with the theory of investor sentiment which asserts that investors are more optimistic when their mood is elevated, and generally individual mood is better on Friday than on other days of the week. Therefore, the speculative stocks earned higher sustainable stock returns during higher volatility in Chinese market due to COVID-19. Intrinsically, new evidence emerges on an inclined strategy to invest in speculative stocks on Fridays during the COVID-19 pandemic to gain sustainable excess returns in the Chinese A-share market.

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Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team.

A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.

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Teachers’ Perspectives on Cyberbullying: A Cross-Cultural Study

The aim of this work is to analyze the perceptions of Colombian, Spanish, and Ecuadorian teachers regarding cyberbullying from a cross-cultural perspective. A descriptive and analytical method was used with a quantitative approach and 240 teachers answered an ad hoc questionnaire. Most teachers in the three countries say that they do not know how to deal with this type of bullying and have not received training in this respect, with the percentages in the three countries being very similar. Spanish teachers have the highest percentage of lack of concern about cyberbullying and Colombian teachers are the ones who admit to having had the most cases of cyberbullying. In terms of reaction, the majority acted, but among those who did not, Ecuadorian teachers did not due to lack of knowledge. Forced by the pandemic to teach their classes online, teachers are increasingly concerned about cyberbullying. For the three countries, it is considered necessary to take measures in terms of legislating specific protocols to deal with cyberbullying at school and that the training plans for the degrees that give access to this profession include the competencies that allow teachers to develop appropriate strategies to respond to cyberbullying.

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WHOOP, Inc.: Digital Entrepreneurship During the Covid-19 Pandemic

This case is about WHOOP, Inc , a digital startup in the fitness technology space, how it responded to the Covid-19 pandemic, and its evolving business model and opportunities in the competitive wearables industry WHOOP launched as a wearable device company Its business model evolved from selling a device to providing software as a service (SaaS) Industry competitors included large digital organizations like Apple and Google, sportswear companies such as Under Armour and Nike, and global wearable device startups like Oura, a health technology firm in Finland In early 2020, as a response to the Covid-19 pandemic, WHOOP launched research initiatives to track user wellbeing in the social-distancing conditions imposed worldwide The company responded to disruptions to its supply chain, developed and evaluated algorithms to detect Covid-19 infection, and created partnerships with research organizations Going forward, WHOOP proposed to define a strategic response to business disruptions and the new digital platform competitors

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Primary sigmoidectomy and appendicostomy for chronic idiopathic constipation.

PURPOSE To present our experience in patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence who underwent a primary sigmoidectomy and appendicostomy. METHODS We reviewed eight patients referred to the Colorectal Center from 2014 to 2016 with chronic idiopathic constipation and undergoing a sigmoidectomy and appendicostomy. We analyzed the previous medical treatment, indications for the surgical procedure, and outcomes. RESULTS Age at operation was 5-19 years. Time with constipation was 4-15 years. All patients received multiple laxatives, mainly polyethylene glycol, and all had severe social problems. Four patients have autism. The indication for surgery was an unsuccessful laxative trial, refusal to continue with rectal enemas or both, and social fear of continued fecal incontinence. Post-operatively, all patients were having daily bowel movements without fecal accidents. CONCLUSION Selected patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence can obtain great benefit from primary sigmoidectomy and appendicostomy.

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Changes In Mental Health, Social Engagement, and Physical Activities During the COVID-19 Pandemic

The current COVID-19 pandemic has profoundly changed our behaviors and health, especially vulnerable community-dwelling older adults. This symposium includes three presentations that evaluated the pandemic’s impacts on mental health, social engagement and physical activity in healthy community-living older adults and those with dementia. Dr. Wenjun Li and his team examined the pandemic impact on mental health and social engagement among relatively healthy older adults residing in suburban and rural neighborhoods in Central Massachusetts, USA. The study reported significant variations in pandemic impacts by sex, age, race, income, living arrangement, and neighborhood housing density, suggesting the pandemic has had disproportionally negative impacts on socially and economically disadvantaged vulnerable older adults. Dr. W. Quin Yow and her team evaluated the impacts of government mandated social distancing and lockdowns on older adults with dementia and their caregivers in Singapore. The study found significant increases in irritability, aggression and hallucinations among older adults with dementia, and possible deterioration of health conditions and heightened moderate level of stress. The results suggest that social distancing may have resulted in negative outcomes in this vulnerable population with dementia and their caregivers. Dr. Ladda Thiamwong reported her team’s efforts on forming an international aging research collaborative to mitigate heath consequences of COVID-19 crisis from the international perspective. The team consists of ten scholars from five countries, including Hong Kong, Nepal, Singapore, Thailand, and the United States. They collect data using combinations of online and face-to-face surveys. Their important findings will be discussed in detail in this symposium.

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Lipid-lowering therapy in high cardiovascular risk patients during COVID-19 pandemic: keep focused on the target.

To the Editor COVID-19 (COrona VIrus Disease) patients with cardiovascular (CV) disease, multiple CV risk factors or comorbidities (i.e., arterial hypertension and diabetes) were shown to be more prone to a worse prognosis. SARS-CoV-2 is a still unknown enemy and the role of concomitant cardiovascular therapies has been controversial in the early stages, particularly with regard to Angiotensin-Converting Enzyme inhibitors...

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Evaluation of a new simultaneous anti-SARS-CoV-2 IgA, IgM and IgG screening automated assay based on native inactivated virus

In addition to molecular testing, there is evolving interest for anti-SARS-CoV-2 antibodies serologic assays. Majority of them focus on IgM/IgG despite IgA important role in mucosal immunity. A simultaneous anti-SARS-CoV-2 IgA/IgG/IgM immunoassay, performed on an automated instrument by ELISA kit coated with native inactivated SARS-CoV-2, was detected on two control groups (negative swab healthcare workers; pre-pandemic healthy or with other viral infections individuals) and on two COVID-19 patient groups (early and late infection). Specificities were 100% in all groups, indicating no cross-reactivity with other infectious or pre-pandemic sera. Sensitivities were 94% in early infection group and 97% in total positive patient group, reaching 100% in late infection group. To our knowledge, this is the first technique based on native SARS-CoV-2. It is able to identify more positive samples than kits using recombinant antigens, therefore virus native epitopes as well as simultaneous anti-SARS-CoV-2 IgA/IgM/IgG detection could help to contain COVID-19 spreading.

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Surveillance of COVID-19 Pandemic using Hidden Markov Model

COVID-19 pandemic has brought the whole world to a stand-still over the last few months. In particular the pace at which pandemic has spread has taken everybody off-guard. The Governments across the world have responded by imposing lock-downs, stopping/restricting travel and mandating social distancing. On the positive side there is wide availability of information on active cases, recoveries and deaths collected daily across regions. However, what has been particularly challenging is to track the spread of the disease by asymptomatic carriers termed as super-spreaders. In this paper we look at applying Hidden Markov Model to get a better assessment of extent of spread. The outcome of such analysis can be useful to Governments to design the required interventions/responses in a calibrated manner. The data we have chosen to analyze pertains to Indian scenario.

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When a nightmare comes true: Change in obsessive-compulsive disorder over the first months of the COVID-19 pandemic

The outbreak of the COVID-19 pandemic has particularly affected people with obsessive-compulsive disorder (OCD). Exacerbation of obsessive-compulsive symptoms (OCS) has been suspected for those with contamination-related OCD (C-OCD). However, the course of OCS over the ongoing pandemic remains unclear. We assessed 268 participants with OCD (n = 184 with C-OCD) in an online survey at the beginning of the pandemic in Germany, reassessing 179 participants (66.8%, 104 C-OCD) three months later. We assessed severity of OCD (OCI-R), depression (PHQ-9), experiential avoidance, as well as functional and dysfunctional beliefs. Overall, OCS and depressive symptoms did not substantially change over time. However, when people with and without C-OCD were compared, symptoms improved in patients without C-OCD (nC-OCD) but remained stable in patients with C-OCD over time. Symptom improvement was associated with male gender, higher initial OCI-R, and nC-OCD. Experiential avoidance and beliefs at the beginning of the pandemic did not generally predict change in OCS. People with OCD, particularly those with nC-OCD, showed tentative signs for signs of adapting, whereas distress in those with C-OCD remained at a high level, underlining the burden for these patients. Clinicians should be informed about how to maintain effective treatment for C-OCD during a pandemic.

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Americans’ Perspectives on Online Media Warning Labels

Americans are pervasively exposed to social media, news, and online content. Some of this content is designed to be deliberately deceptive and manipulative. However, it is interspersed amongst other content from friends and family, advertising, and legitimate news. Filtering content violates key societal values of freedom of expression and inquiry. Taking no action, though, leaves users at the mercy of individuals and groups who seek to use both single articles and complex patterns of content to manipulate how Americans consume, act, work, and even think. Warning labels, which do not block content but instead aid the user in making informed consumption decisions, have been proposed as a potential solution to this dilemma. Ideally, they would respect the autonomy of users to determine what media they consume while combating intentional deception and manipulation through its identification to the user. This paper considers the perception of Americans regarding the use of warning labels to alert users to potentially deceptive content. It presents the results of a population representative national study and analysis of perceptions in terms of key demographics.

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Racial and Ethnic Disparities in the Prevalence of Stress and Worry, Mental Health Conditions, and Increased Substance Use Among Adults During the COVID-19 Pandemic — United States, April and May 2020

In 2019, approximately 51 million U.S. adults aged ≥18 years reported any mental illness,* and 7.7% reported a past-year substance use disorder† (1). Although reported prevalence estimates of certain mental disorders, substance use, or substance use disorders are not generally higher among racial and ethnic minority groups, persons in these groups are often less likely to receive treatment services (1). Persistent systemic social inequities and discrimination related to living conditions and work environments, which contribute to disparities in underlying medical conditions, can further compound health problems faced by members of racial and ethnic minority groups during the coronavirus disease 2019 (COVID-19) pandemic and worsen stress and associated mental health concerns (2,3). In April and May 2020, opt-in Internet panel surveys of English-speaking U.S. adults aged ≥18 years were conducted to assess the prevalence of self-reported mental health conditions and initiation of or increases in substance use to cope with stress, psychosocial stressors, and social determinants of health. Combined prevalence estimates of current depression, initiating or increasing substance use, and suicidal thoughts/ideation were 28.6%, 18.2%, and 8.4%, respectively. Hispanic/Latino (Hispanic) adults reported a higher prevalence of psychosocial stress related to not having enough food or stable housing than did adults in other racial and ethnic groups. These estimates highlight the importance of population-level and tailored interventions for mental health promotion and mental illness prevention, substance use prevention, screening and treatment services, and increased provision of resources to address social determinants of health. How Right Now (Qué Hacer Ahora) is an evidence-based and culturally appropriate communications campaign designed to promote and strengthen the emotional well-being and resiliency of populations adversely affected by COVID-19-related stress, grief, and loss (4).

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Clinically oriented Alzheimer's biosensors: expanding the horizons towards point-of-care diagnostics and beyond

The development of minimally invasive and easy-to-use sensor devices is of current interest for ultrasensitive detection and signal recognition of Alzheimer's disease (AD) biomarkers. Over the years, tremendous effort has been made on diagnostic platforms specifically targeting neurological markers for AD in order to replace the conventional, laborious, and invasive sampling-based approaches. However, the sophistication of analytical outcomes, marker inaccessibility, and material validity strongly limit the current strategies towards effectively predicting AD. Recently, with the promising progress in biosensor technology, the realization of a clinically applicable sensing platform has become a potential option to enable early diagnosis of AD and other neurodegenerative diseases. In this review, various types of biosensors, which include electrochemical, fluorescent, plasmonic, photoelectrochemical, and field-effect transistor (FET)-based sensor configurations, with better clinical applicability and analytical performance towards AD are highlighted. Moreover, the feasibility of these sensors to achieve point-of-care (POC) diagnosis is also discussed. Furthermore, by grafting nanoscale materials into biosensor architecture, the remarkable enhancement in durability, functionality, and analytical outcome of sensor devices is presented. Finally, future perspectives on further translational and commercialization pathways of clinically driven biosensor devices for AD are discussed and summarized.

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Perceived Effectiveness, Restrictiveness, and Compliance with Containment Measures against the Covid-19 Pandemic: An International Comparative Study in 11 Countries

National governments took action to delay the transmission of the coronavirus (SARS-CoV-2) by implementing different containment measures. We developed an online survey that included 44 different containment measures. We aimed to assess how effective citizens perceive these measures, which measures are perceived as violation of citizens’ personal freedoms, which opinions and demographic factors have an effect on compliance with the measures, and what governments can do to most effectively improve citizens’ compliance. The survey was disseminated in 11 countries: UK, Belgium, Netherlands, Bulgaria, Czech Republic, Finland, India, Latvia, Poland, Romania, and Sweden. We acquired 9543 unique responses. Our findings show significant differences across countries in perceived effectiveness, restrictiveness, and compliance. Governments that suffer low levels of trust should put more effort into persuading citizens, especially men, in the effectiveness of the proposed measures. They should provide financial compensation to citizens who have lost their job or income due to the containment measures to improve measure compliance. Policymakers should implement the least restrictive and most effective public health measures first during pandemic emergencies instead of implementing a combination of many restrictive measures, which has the opposite effect on citizens’ adherence and undermines human rights.

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Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

OBJECTIVES: To understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales. DESIGN AND SETTING: A qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents. RESULTS: We interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial. CONCLUSIONS: Vertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

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Challenges for the Future and the Role of Industrial Policy

The chapter summarizes the key ideas and issues described in previous chapters. The chapter offers a description of the kind of future we can envisage in the world healthcare industry, based on China’s growing role. Challenges and issues to be solved by China are considered. Key aspects discussed include: accessibility of services and imbalances/disparities affecting the Chinese healthcare system; pollution; innovation; the trade war with the US. Considerations are also inspired by the recent coronavirus diffusion, which has highlighted pitfalls and strengths of the Chinese healthcare system.

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Treatment Outcomes of IL-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review.

The IL-17 pathway is a potential therapeutic target shown to be implicated in hidradenitis suppurativa (HS), however, it remains unclear whether evidence from mechanistic studies may translate into clinical practice. This systematic review summarizes available treatment outcomes of IL-17 inhibitors in patients with HS. Embase, MEDLINE, PubMed, and clinicaltrials.gov were comprehensively searched on February 26, 2021 to include 16 original studies representing 128 patients with HS (mean age: 36.5 years; age range: 21-47 years; male: 50.0%). Treatment outcomes were reported for the following biologics: secukinumab (n = 105), brodalumab (n = 22), and ixekizumab (n = 1). Patients were classified as responders or non-responders according to achievement of a positive response/improvement based on criteria established for each included study. For secukinumab 57.1% (n = 60/105) of patients were responders in a mean response period of 16.2 weeks and 42.9% (n = 45/105) were non-responders; for brodalumab, 100.0% (n = 22/22) of patients were responders within 4.4 weeks; and the one patient treated with ixekizumab was a responder within 10 weeks. In conclusion, IL-17 inhibitors may serve as an effective therapeutic target in approximately two-thirds of patients with HS and can be considered in those who are refractory to other treatment modalities. We also stress the importance of consistent outcome measures to enhance evidence synthesis, decrease reporting bias, provide potential for future meta-analysis, and ultimately improve clinical outcomes for patients with HS.

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Robotically-assisted laparoscopic biliopancreatic diversion with duodenal switch: the utility of the robotic system in bariatric surgery.

Biliopancreatic diversion with duodenal switch (BPD/DS) is considered the most effective surgical option for morbidly obese patients. Several techniques have been described: open, laparoscopic, and the combination of open and laparoscopic. Only a few centers in the world perform robotically-assisted laparoscopic BPD/DS and the published literature is limited. We describe our experience using this technique as a safe alternative for treatment of morbid obesity. A review of a prospectively maintained database from 2008 to 2011 was conducted. A total of 107 consecutive patients (F:M = 83:24) were included in this series. Average age was 44.76 years (range 20-67), body mass index 49.97 kg/m(2) (range 37-70), and the number of preoperative comorbidities was 6.24 (range 3-11). The mean operative time for a typical BPD/DS with or without an appendectomy was 264 min (range 192-413), which increased to 298 min (range 210-463) when lysis of adhesion or additional procedures were performed. All study cases were completed using a minimally invasive approach. There were no intraoperative or 30-day major postoperative complications. Two patients returned to the operating room: one for endoscopic release of an inadvertently-sutured nasogastric tube during creation of the duodeno-ileal anastomosis and another patient for a port-site infection. Minor postoperative complications included carpal tunnel syndrome exacerbation (n = 1), which did not require surgical intervention. The median length of stay was 3.0 days (range 2-13). Two patients were readmitted within 30 day due to fluid retention and incarcerated umbilical hernia. The percentages of excess body weight loss (EBWL) at 1, 3, 6, 9, 12, and 18 months were 18.9, 36.4, 54.5, 67.4, 73.9, and 82.42 %, respectively. No mortality occurred in this study. Robotically-assisted laparoscopic technique for BPD/DS is a feasible, safe, and effective alternative for weight loss surgery with excellent outcomes.

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Reposition of Montelukast either alone or in combination with Levocetirizine against SARS-CoV-2

It has been hypothesised that antiallergic medications (AAMs) like montelukast and levocetirizine both the two bitter chloro compounds could be repurposed either alone or combinedly as an antiviral against SARS-CoV-2, like chloroquine/hydroxychloroquine (CQ/HCQ), anorher two bitter chloro compounds. Both AAMs and CQ/HCQ are bitter tasted chloro compounds. Depending on their these two similar physical properties and the safety and efficacy of AAMs by controlling over post viral episodes as comparing with viral inhibitory activities including SARS-CoV-2 by CQ/HCQ, a reposition of AAMs either alone/combinedly could be rationalised as an antiviral approach to nCoV.

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Assessment of Somatosensory Function and Self-harm in Adolescents

IMPORTANCE: Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated. OBJECTIVE: To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm. DESIGN, SETTING, AND PARTICIPANTS: Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]). EXPOSURES: Participants were tested using a standardized QST protocol to establish baseline somatosensory function. MAIN OUTCOMES AND MEASURES: Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful). RESULTS: A total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: −1.03 [95% CI, −1.47 to −0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: −1.73; 95% CI, −2.62 to −0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001). CONCLUSIONS AND RELEVANCE: The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.

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Emergently planned exclusive hub-and-spoke system in the epicenter of the first wave of COVID-19 pandemic in Italy: the experience of the largest COVID-19-free ICU hub for time-dependent diseases

BACKGROUND: Lombardy was the epicenter in Italy of the first wave of COVID-19 pandemic. To face the contagion growth, from March 8 to May 8 2020, a regional law re-designed the hub-and-spoke system for time-dependent diseases to better allocate resources for COVID-19 patients. METHODS: We report the reorganization of the major hospital in Lombardy during COVID-19 pandemic, including the rearrangement of its ICU beds to face COVID-19 pandemic and fulfill its role as extended hub for time-dependent diseases while preserving transplant activity. To highlight the impact of the emergently planned hub-and-spoke system, all patients admitted to a COVID-19-free ICU hub for trauma, neurosurgical emergencies and stroke during the two-month period were retrospectively collected and compared to 2019 cohort. Regional data on organ procurement was retrieved. Observed-to-expected (OE) in-ICU mortality ratios were computed to test the impact of the pandemic on patients affected by time-dependent diseases. RESULTS: Dynamic changes in ICU resource allocation occurred according to local COVID-19 epidemiology/trends of patients referred for time-dependent diseases. The absolute increase of admissions for trauma, neurosurgical emergencies and stroke was roughly two-fold. Patients referred to the hub were older and characterized by more severe conditions. An increase in crude mortality was observed, though OE ratios for in-ICU mortality were not statistically different when comparing 2020 vs. 2019. An increase in local organ procurement was observed, limiting the debacle of regional transplant activity. CONCLUSIONS: We described the effects of a regional emergently planned hub-and-spoke system for time-dependent diseases settled in the epicenter of COVID-19 pandemic in Italy.

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The geographic spread of infectious diseases Lisa Sattenspiel

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A systematic review and meta-analysis of the safety and efficacy of remifentanil and dexmedetomidine for awake fiberoptic endoscope intubation

BACKGROUND: Awake fiberoptic endoscope intubation (AFOI) is the primary strategy for managing anticipated difficult airways. Adequate sedation, most commonly being achieved with remifentanil and dexmedetomidine, is integral to this procedure. This meta-analysis aimed to compare the safety and efficacy of these 2 sedatives. METHODS: We conducted electronic searches in Embase, Web of Science, PubMed, Google Scholar, Medline, Springer, and Web of Science with no language restrictions. Studies comparing safety and efficacy between the sole use of remifentanil and dexmedetomidine among patients who underwent AFOI were included. Eight randomized controlled trials, comprising 412 patients, met the inclusion criteria. The primary outcomes were first attempt intubation success rate and incidence of hypoxia. The secondary outcomes were the Ramsay Sedation Scale score at intubation, memory recall of endoscopy, and unstable hemodynamic parameters during intubation. RESULTS: Dexmedetomidine significantly reduced the incidence of hypoxemia during AFOI (risk ratio: 2.47; 95% confidence [CI]: 1.32–4.64]) compared with remifentanil; however, the first intubation success rates were equivalent (risk ratio: 1.12; 95% CI: 0.87–1.46]. No significant differences between the 2 sedatives were found for the Ramsay Sedation Scale score at intubation (mean difference: −0.14; 95% CI: −0.66–0.38) or unstable hemodynamic parameters during intubation (risk ratio: 0.83; 95% CI: 0.59–1.17). Dexmedetomidine reduced memory recall of endoscopy (risk ratio: 1.39; 95% CI: 1.13–1.72). CONCLUSIONS: While both remifentanil and dexmedetomidine are effective for AFOI and well-tolerated, dexmedetomidine may be more effective in reducing the incidence of hypoxemia and memory recall of endoscopy. PROSPERP REGISTRATION NUMBER: CRD42020169612.

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Communicable disease outbreaks: What is a case?

This second article in a series on communicable disease outbreaks focuses on case definitions, testing and early phases of a public health response.

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Association of In-Ear Device Use With Communication Quality Among Individuals Wearing Personal Protective Equipment in a Simulated Operating Room

Importance: The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators. Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date. Objective: To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR]) in the operating room. Design, Setting, and Participants: This quality improvement study was conducted in June 2020. Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited. All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital. Exposures: All participants performed the speech intelligibility tasks with and without an in-ear communication device. Main Outcomes and Measures: Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100%) was obtained for each speech intelligibility test. Listening effort was assessed using the NASA Task Load Index. An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained. Results: A total of 12 participants were included (mean [SD] age, 31.2 [1.9] years; 8 women [66.7%]). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8%) without the in-ear device vs 94.3% (7.4%) with the device. While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4%) without the in-ear device vs 90.8% (8.9%) with the device. While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8%) without the in-ear device vs 94.5% (5.5%) with the device. Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3%; 95% CI, 23.8%-40.7%; P < .001) and the PAPR (9.9%; 95% CI, 1.4%-18.3%; P = .01). Furthermore, use of the device was associated with decreased listening effort. The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device. While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device. While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device. Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI, 23.5-53.3; P < .001) and the PAPR (18.4; 95% CI, 0.4-36.4; P = .04). Conclusions and Relevance: This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort. Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.

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Coevolution spreading in complex networks

Abstract The propagations of diseases, behaviors and information in real systems are rarely independent of each other, but they are coevolving with strong interactions. To uncover the dynamical mechanisms, the evolving spatiotemporal patterns and critical phenomena of networked coevolution spreading are extremely important, which provide theoretical foundations for us to control epidemic spreading, predict collective behaviors in social systems, and so on. The coevolution spreading dynamics in complex networks has thus attracted much attention in many disciplines. In this review, we introduce recent progress in the study of coevolution spreading dynamics, emphasizing the contributions from the perspectives of statistical mechanics and network science. The theoretical methods, critical phenomena, phase transitions, interacting mechanisms, and effects of network topology for four representative types of coevolution spreading mechanisms, including the coevolution of biological contagions, social contagions, epidemic–awareness, and epidemic–resources, are presented in detail, and the challenges in this field as well as open issues for future studies are also discussed.

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Immunosuppression practices during the COVID-19 pandemic: A multinational survey study of transplant programs

During the COVID-19 pandemic, there has been wide heterogeneity in the medical management of transplant recipients. We aimed to pragmatically capture immunosuppression practices globally following the early months of the pandemic. From June to September 2020, we surveyed 1267 physicians; 40.5% from 71 countries participated. Management decisions were made on a case-by-case basis by the majority (69.6%) of the programs. Overall, 76.8% performed &#8805;1 transplantation and many commented on avoiding high-risk transplantations. For induction, 26.5% were less likely to give T-cell depletion and 14.8% were more likely to give non-depleting agents. These practices varied by program-level factors more so than the COVID-19 burden. In patients with mild, moderate and severe COVID-19 symptoms 59.7%, 76.0%, and 79.5% decreased/stopped anti-metabolites, 23.2%, 45.4%, and 68.2% decreased/stopped calcineurin inhibitors, and 25.7%, 43.9%, and 57.7% decreased/stopped mTOR inhibitors, respectively. Also, 2.1%, 30.6%, and 46.0% increased steroids in patients with mild, moderate, and severe COVID-19 symptoms. For prevalent transplant recipients, some programs also reported decreasing/stopping steroids (1.8%), anti-metabolites (10.3%), calcineurin inhibitors (4.1%), and mTOR inhibitors (5.5%). Transplant programs changed immunosuppression practices but also avoided high-risk transplants and increased maintenance steroids. The long-term ramifications of these practices remain to be seen as programs face the aftermath of the pandemic.

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Kinetics of single and dual simultaneous infection of pigs with swine influenza A virus and porcine reproductive and respiratory syndrome virus

BACKGROUND: Simultaneous viral infections exhibit the phenomenon of viral interference, but understanding of the effect of one virus on another is limited. OBJECTIVE: Evaluate and compare clinical characteristics, immune and acute phase response, viral shedding and viral load in pigs singly and doubly inoculated with swine influenza A virus (swIAV) and porcine reproductive and respiratory syndrome virus (PRRSV). ANIMALS: Fifty‐four 7‐week‐old piglets. METHODS: Clinical status and gross lung lesions were scored. Titration of swIAV was carried out in Madin‐Darby canine kidney cells. The PRRSV RNA was quantified using a commercial qPCR kit. Antibodies were detected by hemagglutination inhibition assay and commercial ELISA. A lymphocyte proliferation assay was used to measure antigen‐specific T‐cell responses. Acute phase proteins were determined using ELISA. RESULTS: No differences were found between mean clinical scores, swIAV and PRRSV shedding, and magnitude of the humoral and T‐cell response between single‐inoculated and dual‐inoculated groups. Concentrations of C‐reactive protein and haptoglobin increased in PRRSV‐inoculated and coinoculated groups, whereas serum amyloid A concentration was increased in groups inoculated or coinoculated with swIAV. Mean swIAV TCID(50) titers in the lungs did not differ significantly between coinoculated and swIAV single‐inoculated pigs. A significantly higher mean copy number of PRRSV was found in the lungs of PRRSV only‐inoculated pigs at 2 day postinoculation (DPI). From 4 DPI, no significant differences in PRRSV load were identified. CONCLUSIONS AND CLINICAL IMPORTANCE: Coinfection of pigs with swIAV and PRRSV did not potentiate clinical signs, lung lesions, immune response, and replication of the viruses in the respiratory tract.

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Comparative performance of fully-automated and semi-automated artificial intelligence methods for the detection of clinically significant prostate cancer on MRI: a systematic review

OBJECTIVES: We systematically reviewed the current literature evaluating the ability of fully-automated deep learning (DL) and semi-automated traditional machine learning (TML) MRI-based artificial intelligence (AI) methods to differentiate clinically significant prostate cancer (csPCa) from indolent PCa (iPCa) and benign conditions. METHODS: We performed a computerised bibliographic search of studies indexed in MEDLINE/PubMed, arXiv, medRxiv, and bioRxiv between 1 January 2016 and 31 July 2021. Two reviewers performed the title/abstract and full-text screening. The remaining papers were screened by four reviewers using the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) for DL studies and Radiomics Quality Score (RQS) for TML studies. Papers that fulfilled the pre-defined screening requirements underwent full CLAIM/RQS evaluation alongside the risk of bias assessment using QUADAS-2, both conducted by the same four reviewers. Standard measures of discrimination were extracted for the developed predictive models. RESULTS: 17/28 papers (five DL and twelve TML) passed the quality screening and were subject to a full CLAIM/RQS/QUADAS-2 assessment, which revealed a substantial study heterogeneity that precluded us from performing quantitative analysis as part of this review. The mean RQS of TML papers was 11/36, and a total of five papers had a high risk of bias. AUCs of DL and TML papers with low risk of bias ranged between 0.80–0.89 and 0.75–0.88, respectively. CONCLUSION: We observed comparable performance of the two classes of AI methods and identified a number of common methodological limitations and biases that future studies will need to address to ensure the generalisability of the developed models. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13244-022-01199-3.

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Low risk of COVID-19 infection in an ambulatory gastrointestinal endoscopy center in Argentina

Background and Objectives. Since the onset of the COVID-19 pandemic, concerns have been raised regarding the risk of infection to both healthcare staff and patients during gastrointestinal endoscopy procedures. Given the im-portance of performing routine endoscopic procedures to an individual’s future health, we sought to estimate the risk of COVID-19 infection for healthcare staff and patients undergoing endoscopic studies at an ambulatory endoscopy center during the pandemic. Material and Methods. This is a prospective(and) analytical cohort study conducted in an ambulatory gastroenterology center located in the Au-tonomous City of Buenos Aires, Argentina. Patients undergoing different endoscopic procedures were evaluated for COVID-19 between April 14 and August 31, 2020. COVID-19 was also evaluated in all healthcare and associated staff during the same time period. The risk (cumu-lative incidence) of acquiring COVID-19 in all patients and staff was calculated. Results. Between April 14 and August 31, 2020, procedures were performed in 3,745 patients with a mean age of 51.12 years;2,102 (56.18%) were male and 1,643 (43.82%) were female. Follow-up was completed in 3,492 patients, 18 of whom tested positive for COVID-19 standing for an incidence of 0.52% (95%CI 0.31 – 0.81%). Six (5.45%) out of 110 staff members were infected with COVID-19 (1 endoscopist, 4 endoscopy assistants and 1 administrative staff member). In this group, the incidence of positive tests for COVID-19 was 5.45% (95%CI: 2.03 – 11.50%). The increased rates of positive cases among our patients and healthcare professionals were respectively 7.9 and 23.6 times lower than in general pop-ulation. Conclusion. During the study period, the propor-tion of COVID-19 infections in our ambulatory specialized in gastrointestinal endoscopy was low and much lower than that in the general population for both patients and health-care professionals. Endoscopic procedures undertaken at this center were low risk, likely due to strict compliance with es-tablished pandemic protocols. Future studies should compare the risk of infection in the hospital setting.

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An Intelligent Multicriteria Model for Diagnosing Dementia in People Infected with Human Immunodeficiency Virus

Hybrid models to detect dementia based on Machine Learning can provide accurate diagnoses in individuals with neurological disorders and cognitive complications caused by Human Immunodeficiency Virus (HIV) infection. This study proposes a hybrid approach, using Machine Learning algorithms associated with the multicriteria method of Verbal Decision Analysis (VDA). Dementia, which affects many HIV-infected individuals, refers to neurodevelopmental and mental disorders. Some manuals standardize the information used in the correct detection of neurological disorders with cognitive complications. Among the most common manuals used are the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) of the American Psychiatric Association and the International Classification of Diseases, 10th edition (ICD-10)—both published by World Health Organization (WHO). The model is designed to explore the predictive of specific data. Furthermore, a well-defined database data set improves and optimizes the diagnostic models sought in the research.

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Impact of the first COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center

PURPOSE: In Dec 2019, COVID-19 was first recognized and led to a worldwide pandemic. The German government implemented a shutdown in Mar 2020, affecting outpatient and hospital care. The aim of the present article was to evaluate the impact of the COVID-19 shutdown on patient volumes and surgical procedures of a Level I trauma center in Germany. METHODS: All emergency patients were recorded retrospectively during the shutdown and compared to a calendar-matched control period (CTRL). Total emergency patient contacts including trauma mechanisms, injury patterns and operation numbers were recorded including absolute numbers, incidence proportions and risk ratios. RESULTS: During the shutdown period, we observed a decrease of emergency patient cases (417) compared to CTRL (575), a decrease of elective cases (42 vs. 13) and of the total number of operations (397 vs. 325). Incidence proportions of emergency operations increased from 8.2 to 12.2% (shutdown) and elective surgical cases decreased (11.1 vs. 4.3%). As we observed a decrease for most trauma mechanisms and injury patterns, we found an increasing incidence proportion for severe open fractures. Household-related injuries were reported with an increasing incidence proportion from 26.8 to 47.5% (shutdown). We found an increasing tendency of trauma and injuries related to psychological disorders. CONCLUSION: This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma center and a decrease of the total number of operations during the shutdown period. Concurrently, we observed an increase of severe open fractures and emergency operations. Furthermore, trauma mechanism changed with less traffic, work and sports-related accidents.

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Inferring the true number of SARS-CoV-2 infections in Japan

IntroductionIn Japan, as of December 31, 2021, more than 1.73 million laboratory-confirmed cases have been reported. However, the actual number of infections is likely to be under-ascertained due to the epidemiological characteristics such as mild and subclinical infections and limited testing availability in the early days of the pandemic. In this study, we infer the true number of infections in Japan between January 16, 2020, and December 31, 2021, using a statistical modelling framework that combines data on reported cases and fatalities. MethodsWe used reported daily COVID-19 deaths stratified into 8 distinct age-groups and age-specific infection fatality ratios (IFR) to impute the true number of infections. Estimates of IFR were informed from published studies as well seroprevalence studies conducted in Japan. To account for the uncertainty in IFR estimates, we sampled values from relevant distributions. ResultsWe estimated that as of December 31, 2021, 2.90 million (CrI: 1.77 to 4.27 million) people had been infected in Japan, which is 1.68 times higher than the 1.73 million reported cases. Our meta-analysis confirmed that these findings were consistent with the intermittent seroprevalence studies conducted in Japan. ConclusionsWe have estimated that a substantial number of COVID-19 infections in the country were unreported, particularly in adults. Our approach provides a more realistic assessment of the true underlying burden of COVID-19. The results of this study can be used as fundamental components to strengthen population health control and surveillance measures.

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The impact of lower strength alcohol products on alcohol purchases: ARIMA analyses based on 4 million purchases by 69 803 households, 2015-2019.

BACKGROUND Lowering the strength of alcohol products could lead to less alcohol being bought and drunk. In its prevention White Paper, the UK Government aims to promote a significant increase in the availability of alcohol-free and low-alcohol products by 2025. METHODS Through descriptive analysis and ARIMA modelling of >4 million alcohol purchases from 69 803 British households, we study the potential impact of lower strength alcohol products in reducing household purchases of grams of alcohol over 2015-2019. Households are divided into predominantly beer, wine or spirits purchasers. RESULTS Over 5 years, there were decreases in purchases of grams of alcohol within beer amongst beer-purchasing households and increases in purchases of grams of alcohol within wine and spirits amongst, respectively, wine- and spirits-purchasing households. Almost all the changes were due to beer-purchasing households buying less regular strength beer, and wine and spirits-purchasing households buying, respectively, more regular strength wine and spirits, rather than increases in purchases of no- and low-alcohol products. CONCLUSIONS In general, lower strength alcohol products have not contributed to British households buying fewer grams of alcohol over the 5-year follow-up period during 2015-2019.

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The effect of increasing operator experience on procedure-related characteristics in patients undergoing carotid artery stenting.

Objectives To evaluate the efficacy and safety of carotid artery stenting for the treatment of severe carotid artery disease in our department and to investigate the effect of increasing operator experience on perioperative and procedure-related characteristics. Methods From January 2007 to February 2015 200 patients underwent 207 endovascular procedures for carotid artery stenosis. Of all, 113 arteries (56.5%) were symptomatic. Significant changes across time were calculated with the use of Change Point analysis using bootstrap and mean squared error estimates. Results The technical success was 98.6% (204/207 cases). Thirty-day neurological events included stroke in four patients (2%) and transient ischemic attack in two (1%). None of the patients died during the first 30 days. The most significant change of radiation duration occurred after the 33rd patient with a decrease from 25.31 min to 12.31 min, while for the total operative time that change occurred between the 31st and 33rd patient where mean operation time decreased from 88.89 min to 49.22 min. The most significant change of contrast media used occurred at the 40th patient with a decrease from 91.58 ml to 62 ml. During a mean follow-up period of 42 ± 20.02 months none of the patients experienced any cerebrovascular event. There was one case of significant recurrent stenosis, which was successfully treated by endovascular means. Conclusions Endovascular treatment of carotid artery stenosis performed in a single center with the use of a cerebral protection device seems to consist a safe therapeutic choice with acceptable results, within the referenced benchmarks proposed in the latest guidelines. Certain perioperative parameters such as the amount of contrast media used, the fluoroscopy and operation time, seem to decline overtime indicating increasing operator's experience. A number of performed cases above 40 was related to the significant decrease of those parameters and may represent the learning curve of the procedure.

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Narrowband-Internet of Things Device-to-Device Simulation: An Open-Sourced Framework

Narrowband-Internet of Things (NB-IoT) displays high-quality connectivity underpinned by fifth-generation (5G) networks to cover a wide array of IoT applications. The devices’ development and integration into different smart systems require permanent control, supervision, and the study of power consumption models to determine the performance of the network topology and allow for the measurement of the efficiency of the network topology’s application. This paper reports on an architecture and open-sourced simulation that was developed to study NB-IoT in Device-to-Device (D2D) mode, which includes the Physical (PHY), network, and application layers, as well as a queuing model, the model for uplink and downlink delays, the throughput, the overall NB-IoT D2D network performance, and the energy consumption based on the Low Energy Adaptive Clustering Hierarchy (LEACH) protocol. Our results prove that the suggested framework contributes to a reduction in power consumption, a minimization of queuing delays, a decrease in communication cost, a reduction in inter-cluster collisions, and the prevention of attacks from malicious nodes. Consequently, the framework manages the battery’s State of Charge (SOC), improves the battery’s State of Health (SOH), and maximizes the whole network lifetime. The proposed framework, the code of which has been open-sourced, can be effectively used for scientific research and development purposes to evaluate different parameters and improve the planning of NB-IoT networks.

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Reducing contacts to stop SARS-CoV-2 transmission during the second pandemic wave in Brussels, Belgium, August to November 2020

To evaluate the effect of physical distancing and school reopening in Brussels between August and November 2020, we monitored changes in the number of reported contacts per SARS-CoV-2 case and associated SARS-CoV-2 transmission. The second COVID-19 pandemic wave in Brussels was the result of increased social contact across all ages following school reopening. Physical distancing measures including closure of bars and restaurants, and limiting close contacts, while primary and secondary schools remained open, reduced social mixing and controlled SARS-CoV-2 transmission.

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How do community pharmacies in Ontario manage drug shortage problems? Results of an exploratory qualitative study.

Background Pharmacists report spending a considerable amount of time dealing with drug shortages. There is no research in Canada identifying and describing the strategies and resources that pharmacists use to minimize disruption and continuity of care for patients. Methods An exploratory qualitative methodology was used. Community pharmacists and technicians in Ontario were interviewed using a semi-structured protocol. Verbatim transcripts were generated and coded by at least 2 independent reviewers using content analysis methods to identify management strategies. Results and Discussion A total of 14 pharmacists and 7 regulated pharmacy technicians participated in this study. The following 5 main strategies for managing drug shortages were identified: (1) using the supplier, (2) generic options, (3) brand options, (4) contacting other pharmacies and (5) switching to a different medication. Conclusion The strategies identified through this research can provide pharmacists with some guidance in approaching the real-world problem of drug shortages. It also highlights opportunities for organizations, government and manufacturers to provide additional support for pharmacists to minimize disruptions for patients and to ensure current ad hoc practices do not further compound shortage issues. Can Pharm J (Ott) 2020;153:xx-xx.

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The impact of COVID-19 on the operations and management of NGOs: resilience and recommendations

Purpose The COVID-19 pandemic has made humanity contend with the negative footprint of its activities in which social justice, ecological integrity and economic stability are compromised. This study aims to investigate the impact of COVID-19 on the operation and management of non-governmental organisations (NGOs) in Nigeria. Design/methodology/approach Multiple case study research design was used in the study with interviews from 25 senior-level management staff of NGOs. Findings The analysis revealed that COVID-19 impacts NGOs both negatively and positively. Dominant among the negative impacts are a decline in health-seeking behaviours, low programme implementation, increased cost and wastages resulting from PPE, transition to virtual meetings, a decline in capacity building and staff burnout/pressure. However, some positive impacts include increased efficiency through the use of virtual innovations, peer-to-peer intervention through the establishment of networks, flexibility and prompt adaptation to the crisis, prudent management of available resources, etc. This research contributes to theory and practice. Research limitations/implications Conducting this research and recruiting participants at the height of COVID-19 in Nigeria, in adherence to the prevention guidelines, constituted a considerable limitation to the study. Practical implications Although the identified impact could be useful in framing operational policies and guidelines, the study highlights a salient future outlook with policy implications for both the governance of NGOs and the facilitation of sustainable development goals by the government. Originality/value Although researchers continue to explore the impact of COVID-19, none has considered the NGO sector, especially in developing countries, and with a focus on providing evidence-backed resilience practices for the future.

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Forty years with coronaviruses

I have been researching coronaviruses for more than forty years. This viewpoint summarizes some of the major findings in coronavirus research made before the SARS epidemic and how they inform current research on the newly emerged SARS-CoV-2.

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Application of Deep Learning for Fast Detection of COVID-19 in X-Rays using nCOVnet

Presently, COVID-19 has posed a serious threat to researchers, scientists, health professionals, and administrations around the globe from its detection to its treatment. The whole world is witnessing a lockdown like situation because of COVID-19 pandemic. Persistent efforts are being made by the researchers to obtain the possible solutions to control this pandemic in their respective areas. One of the most common and effective methods applied by the researchers is the use of CT-Scans and X-rays to analyze the images of lungs for COVID-19. However, it requires several radiology specialists and time to manually inspect each report which is one of the challenging tasks in a pandemic. In this paper, we have proposed a deep learning neural network-based method nCOVnet, an alternative fast screening method that can be used for detecting the COVID-19 by analyzing the X-rays of patients which will look for visual indicators found in the chest radiography imaging of COVID-19 patients.

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Photocatalytic Degradation of Plastic Waste: A Mini Review

Plastic waste becomes an immediate threat to our society with ever-increasing negative impacts on our environment and health by entering our food chain. Sunlight is known to be the natural energy source that degrades plastic waste at a very slow rate. Mimicking the role of sunlight, the photocatalytic degradation process could significantly accelerate the degradation rate thanks to the photocatalyst that drastically facilitates the photochemical reactions involved in the degradation process. This mini review begins with an introduction to the chemical compositions of the common plastic waste. The mechanisms of photodegradation of polymers in general were then revisited. Afterwards, a few photocatalysts were introduced with an emphasis on titanium dioxide (TiO(2)), which is the most frequently used photocatalyst. The roles of TiO(2) photocatalyst in the photodegradation process were then elaborated, followed by the recent advances of photocatalytic degradation of various plastic waste. Lastly, our perspectives on the future research directions of photocatalytic plastic degradation are present. Herein, the importance of catalytic photodegradation is emphasized to inspire research on developing new photocatalysts and new processes for decomposition of plastic waste, and then to increase its recycling rate particularly in the current pandemic with the ever-increasing generation of plastic waste.

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Cervical Cancer Screening with HPV Testing: Updates on the Recommendation.

The present update is a reassessment of the 2018 'Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil' (Zeferino et al.)9, according to the changes observed in new international guidelines and knowledge updates. The most relevant and recent guidelines were assessed. Questions regarding the clinical practice were formulated, and the answers considered the perspective of the public and private sectors of the Brazilian health system. The review addressed risk-based strategies regarding age to start and stop screening, the use of cytology and colposcopy to support management decisions, treatment, follow-up strategies, and screening in specific groups, including vaccinated women. The update aims to improve the prevention of cervical cancer and to reduce overtreatment and the misuse of HPV testing.

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Hydroxychloroquine and chloroquine in COVID-19: should they be used as standard therapy?

The pandemic of the new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has urged the nations to an unprecedented world-wide reaction, including an accelerated exploration of therapeutic options. In the absence of a vaccine and specifically designed antivirals, the medical community has proposed the use of various previously available medications in order to reduce the number of patients requiring prolonged hospitalizations, oxygen therapy, and mechanical ventilation and to decrease mortality from coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine are among the proposed drugs and are the most widely used so far, despite the lack of robust evidence on their usefulness. The objective of this article is to review and discuss the possible role of these drugs in the therapy of COVID-19.

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Symptomatic Carotid Artery Thrombosis in a Patient Recently Recovered From a COVID-19 Infection

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), was initially discovered in December 2019 in China and rapidly spread all over the world to become a pandemic. The most common symptoms of a disease are fever, cough, generalized body ache, weakness, dyspnoea, nausea, vomiting, and diarrhea. Among vascular complications of COVID-19, the venous thrombotic complications, like pulmonary embolism and lower limb deep veins thrombosis, are not uncommon. But data about arterial thrombotic complications of COVID-19, especially carotid thrombosis, are still limited. We are describing a case of stroke due to thrombosis of the right carotid arteries, in a patient who had recovered from asymptomatic COVID-19. A 66-year-old male with arterial hypertension presented to the emergency department with a history of repeated collapse, dysarthria, weakness in the left extremities, and a drop in the left angle of his mouth (National Institutes of Health Stroke Scale [NIHSS]-4). The patient was swabbed for COVID-19 which was negative. A computed tomography angiography (CTA) was obtained which showed thrombosis in the branching point of the brachiocephalic trunk (BCT) continuing into the right subclavian artery (SA) and also into the right common carotid artery (CCA), with a subtotal occlusion of the right CCA, extending into the internal carotid artery (ICA) as well. From the apical lung tissue caught during the CT scan, bilateral, irregular widespread ground-glass opacifications, as well as consolidations and small reticular changes were seen in the lungs, which is typical for COVID-19 infection. A quantitative antibody test for COVID-19 infection was performed with the results showing a strong positivity for IgG antibodies, indicating previous COVID-19 infection. The patient was indicated for a standard carotid thrombectomy, which was performed without complications. It seems that one of the important factors that led to the formation of the thrombus in the carotid arteries was COVID-19 infection-induced inflammation in the atherosclerotic carotid vessels and generalized hypercoagulability as well as hyperviscosity. COVID-19 infection is an independent and important risk factor for the formation of an arterial thrombus during the acute illness and in the early post-COVID-19 period also, regardless of the severity of its course. Prophylactic anticoagulation is needed not only at the time of acute illness but also at the early post-COVID-19 time.

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Is Gut Involvement a Cause or Effect of COVID-19?

Digestive disorder symptoms in COVID-19 may be similar in form to post-infectious functional gastrointestinal disorder (PI-FGID). To cause clinical effects, SARS-CoV-2 must reach the bowels and gastric hypochlorhydria may facilitate such transit. Asian elderly are predisposed to greater infection rate and severity of COVID-19, and the high prevalence of gastric atrophy and intake of proton-pump inhibitor in this aged group might explain the risk. Persistence shedding of SARS-CoV-2 in stools indicates that faecal transmission should not be disregarded. Gut involvement in COVID-19 is mediated by angiotensin-converting enzyme 2 (ACE2) receptor, which serves as the entry point for SARS-CoV-2 in the small bowel. ACE2 dysregulation has an impact on the homeostasis of gut microbiota and altered inflammatory response. Liver injury is variable in COVID-19 and is likely a result of by-stander effects rather than actual viropathic process. Further research is needed to understand if gut involvement is a cause or effect of SARS-CoV-2.

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NCI Workshop on Artificial Intelligence in Radiation Oncology: Training the Next Generation

Abstract Artificial intelligence (AI) is about to touch every aspect of radiotherapy from consultation, treatment planning, quality assurance, therapy delivery, to outcomes modeling. There is an urgent need to train radiation oncologists and medical physicists in data science to help shepherd AI solutions into clinical practice. Poorly trained personnel may do more harm than good when attempting to apply rapidly developing and complex technologies. As the amount of AI research expands in our field, the radiation oncology community needs to discuss how to educate future generations in this area. The National Cancer Institute (NCI) Workshop on AI in Radiation Oncology (Shady Grove, MD, April 4-5, 2019) was the first (https://dctd.cancer.gov/NewsEvents/20190523_ai_in_radiation_oncology.htm) of two data science workshops in radiation oncology hosted by the NCI in 2019. During this workshop, the Training and Education Working Group was formed by volunteers among the invited attendees. Its members represent radiation oncology, medical physics, radiology, computer science, industry, and the NCI. In this perspective article written by members of the Training and Education Working Group, we provide and discuss Action Points relevant for future trainees interested in radiation oncology AI: (1) creating AI awareness and responsible conduct; (2) implementing a practical didactic curriculum; (3) creating a publicly available database of training resources; and (4) accelerate learning and funding opportunities. Together, these Action Points can facilitate the translation of AI into clinical practice.

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ProReal®: The ‘good enough’ online alternative to face-to-face Dramatherapy

The Covid-19 restrictions have limited the access of face-to face therapies for many people and continues to effect how Dramatherapists operate. The following article offers reflections around adapting to an on-line medium, focusing more specifically around the software of ProReal. Limitations and considerations are acknowledged, including technological difficulties, computer efficacy, ambiguity tolerance and the need for careful contracting and reassurance of autonomy and control when using on-line platforms. The article ends with a short selection of vignettes from ProReal sessions.

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Mitochondrial RNA, a new trigger of the innate immune system.

Mitochondria play a pivotal role in numerous cellular processes. One of them is regulation of the innate immune pathway. In this instance, mitochondria function in two different aspects of regulatory mechanisms. First, mitochondria are part of the antiviral signaling cascade that is triggered in the cytoplasm and transmitted to effector proteins through mitochondria-localized proteins. Second, mitochondria can become an endogenous source of innate immune stimuli. Under some pathophysiological conditions, mitochondria release to the cytoplasm immunogenic factors, such as mitochondrial nucleic acids. Here, we focus on immunogenic mitochondrial double-stranded RNA (mt-dsRNA) and its origin and metabolism. We discuss factors that are responsible for regulating mt-dsRNA and its escape from mitochondria, emphasizing the contribution of polynucleotide phosphorylase (PNPase, PNPT1). Finally, we review current knowledge of the role of PNPase in human health and disease. This article is categorized under: RNA in Disease and Development > RNA in Disease.

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Screening for Dental Infections Achieves 6-Fold Reduction in Dental Emergencies During Induction Chemotherapy for Acute Myeloid Leukemia

PURPOSE: Patients with newly diagnosed acute myeloid leukemia (AML) are at risk of infection, including odontogenic infections, during induction chemotherapy. It is unknown whether clinical dental screening to diagnose and treat odontogenic disease in these patients can reduce the incidence of dental emergencies. METHODS: Between November 1, 2014, and December 31, 2016, we screened 147 patients with newly diagnosed AML before their admission for induction chemotherapy (n1 = 147, "screened" group). The patients not screened acted as controls (n2 = 190, "unscreened" group), as did patients diagnosed with AML in the 26 months before the initiation of the screening program (n3 = 304, "prescreening" group). The number of patients in each group who presented for emergency dental assessment during admission for induction chemotherapy was determined by 2 independent reviewers. RESULTS: Among the 147 patients in the screened group, only 1 patient presented with an infectious odontogenic emergency (0.68% [95% CI, -0.64% to 1.98%]). In the unscreened group, 8 developed an infectious odontogenic emergency during induction chemotherapy (4.21% [95% CI, 1.37% to 7.15%]), a statistically significant difference (P = .046, a = 0.05). A similar rate of infectious dental emergencies was observed in the prescreening group (4.28% [95% CI, 2.0% to 7.2%]). CONCLUSION: Clinical dental screening before induction chemotherapy in patients with AML resulted in a 6-fold reduction in infectious dental emergencies during the induction period.

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SARS-CoV-2 RNA detection and persistence in wastewater samples: An experimental network for COVID-19 environmental surveillance in Padua, Veneto Region (NE Italy)

Background Clinical detection of SARS-CoV-2 RNA in stools supports the idea of wastewater-based epidemiology (WBE) as a precious tool for COVID-19 environmental surveillance. Successful detection of SARS-CoV-2 RNA in untreated wastewaters has been reported in several countries. This study investigated the presence and persistence of viral RNA in treated and untreated wastewaters in Padua, Italy. An urban experimental network of sampling sites was tested for prospective surveillance activities. Methods Seven sampling sites (i.e. wastewater pumping stations, plant inlets and outlets) were selected from the two main municipal wastewater treatment plant systems. Eleven grab samples (9 untreated, 2 treated wastewaters) were collected on 2 dates. All samples were tested at t0 for SARS-CoV-2 RNA and t1 = 24 h to investigate its persistence, at room temperature and under refrigerated conditions. Overall, 33 sub-samples were concentrated by ultrafiltration and tested for molecular detection of viral RNA with two RT-qPCR assays. Results At t0, positivity for at least one RT-qPCR assay was achieved by 4/9 untreated wastewater samples and 2/2 tertiary treated samples. A minimum SARS-CoV-2 titer of 4.8–4.9 log10 gc/L was estimated. At t1, three refrigerated subsamples were positive as well. The two RT-qPCR assays showed differential sensitivity, with the N assay detecting 90% of successful amplifications. Conclusions SARS-CoV-2 RNA was detected in untreated and treated wastewaters. Its persistence after 24 h was demonstrated in subsamples kept at 4 °C. Hospitalization data suggested an approximate WBE detection power of 1 COVID-19 case per 531 inhabitants. The possible role of WBE in COVID-19 environmental surveillance is strongly supported by our findings. WBE can also provide precious support in the decision-making process of restriction policies during the epidemic remission phase. Optimization and standardization of laboratory methods should be sought in the short term, so that results from different studies can be compared with reliability.

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Healthcare-acquired clusters of COVID-19 across multiple wards in a Scottish health board

BACKGROUND: Healthcare-acquired COVID-19 has been an additional burden on hospitals managing increasing numbers of patients with SARS-CoV-2. One acute hospital (W) among three in a Scottish healthboard experienced an unexpected surge of COVID-19 clusters. AIM: To investigate possible causes of COVID-19 clusters at Hospital W. METHODS: Daily surveillance provided total numbers of patients and staff involved in clusters in three acute hospitals (H, M and W) and care homes across the healthboard. All clusters were investigated and documented, along with patient boarding, community infection rates and outdoor temperatures from October 2020 to March 2021. Selected SARS-CoV-2 strains were genotyped. FINDINGS: There were 19 COVID-19 clusters on 14 wards at Hospital W during the six-month study period, lasting from 2-42 days (average: 5 days, median: 14 days) and involving an average of 9 patients (range 1-24) and 7 staff (range 0-17). COVID-19 clusters in Hospitals H and M reflected community infection rates. An outbreak management team implemented a control package including daily surveillance; ward closures; universal masking; screening; restricting staff and patient movement; enhanced cleaning; and improved ventilation. Forty clusters occurred across all three hospitals before a January window opening policy, after which there were three during the remainder of the study. CONCLUSION: The winter surge of COVID-19 clusters was multifactorial, but clearly exacerbated by moving trauma patients around the hospital. An extended infection prevention and control package including enhanced natural ventilation helped reduce COVID-19 clusters in acute hospitals.

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Lung-resident memory B cells established after pulmonary influenza infection display distinct transcriptional and phenotypic profiles.

Recent studies have established that memory B cells, largely thought to be circulatory in the blood, can take up long-term residency in inflamed tissues, analogous to widely described tissue-resident T cells. The dynamics of recruitment and retention of memory B cells to tissues and their immunological purpose remains unclear. Here, we characterized tissue-resident memory B cells (BRM) that are stably maintained in the lungs of mice after pulmonary influenza infection. Influenza-specific BRM were localized within inducible bronchus-associated lymphoid tissues (iBALTs) and displayed transcriptional signatures distinct from classical memory B cells in the blood or spleen while showing partial overlap with memory B cells in lung-draining lymph nodes. We identified lung-resident markers, including elevated expression of CXCR3, CCR6, and CD69, on hemagglutinin (HA)- and nucleoprotein (NP)-specific lung BRM. We found that CCR6 facilitates increased recruitment and/or retention of BRM in lungs and differentiation into antibody-secreting cells upon recall. Although expression of CXCR3 and CCR6 was comparable in total and influenza-specific memory B cells isolated across tissues of human donors, CD69 expression was higher in memory B cells from lung and draining lymph nodes of human organ donors relative to splenic and PBMC-derived populations, indicating that mechanisms underpinning BRM localization may be evolutionarily conserved. Last, we demonstrate that human memory B cells in lungs are transcriptionally distinct to populations in lung-draining lymph nodes or PBMCs. These data suggest that BRM may constitute a discrete component of B cell immunity, positioned at the lung mucosa for rapid humoral response against respiratory viral infections.

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False sense of safety by daily QTc interval monitoring during methadone IVPCA titration in a patient with chronic pain.

It has been proposed that some deaths attributed to methadone are related to prolongation of the QTc interval; however, there are no clear recommendations on electrocardiogram (ECG) monitoring in patients undergoing intravenous methadone infusion. This is a report on a patient receiving methadone intravenous patient-controlled analgesia titration for the treatment of chronic pain. Initially, her daily ECGs showed QTc intervals within normal limits; however, she experienced a rapid increase in QTc interval from 317 ms to 784 ms within a 24-hour period after methadone had been discontinued for excessive sedation. QTc interval greater than 500 ms is considered to be high risk for the fatal arrhythmia Torsades de Pointes. Daily ECGs did not detect a gradual increase in the QTc interval that would have alerted the medical staff of the need to decrease or stop the methadone before reaching a prolonged QTc interval associated with cardiotoxicity. In selected cases where aggressive methadone titration is required, more intensive monitoring, such as telemetry or ECG determinations every 12 hours, might help detect changes in QTc interval duration that might otherwise be missed by daily ECG determinations.

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View Point (Editorial)

Agile helps teams focus on developing team-oriented goals, reflecting on their work and making needed adaptations at regular intervals and using agile practices to have authentic group interactions which lead to improved team dynamics and fostering innovation (Smith and Sidky, 2009). According to a recent survey (VersionOne, 2019), the top three reasons organizations adopt the agile way of working are to accelerate software delivery (74%), enhance ability to manage changing priorities (62%) and increase productivity (51%). To help mitigate the chaos, stress and anxiety, an agile mindset that welcomes uncertainty, embraces challenges and views failure as a learning opportunity can help us survive, and perhaps even thrive, in our new environment.

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Covid-19 telescreening in SUS users with risk conditions: case report

ABSTRACT This case report aims to describe the conception and preliminary data of the implementation of a telescreening and telemonitoring program of covid-19 for users of the Unified Health System with risk conditions A system of telerscreening was implemented through which undergraduate students in the health area contact patients by telephone, according to periodicity and predefined criteria, to monitor the evolution of the condition In eight weeks, 2,190 attempts at remote contact were made with individuals from five health units The effective number of individuals monitored at the time this writing is 802 RESUMO O presente relato de experiência tem como objetivo descrever a concepção e os dados preliminares da implementação de um programa de telerrastreio e telemonitoramento da covid-19 para usuários do Sistema Único de Saúde com condições de risco para agravamento Foi implantado um sistema de telerrastreio por meio do qual estudantes de graduação na área da saúde contactam os pacientes via telefone, conforme periodicidade e critérios predefinidos, para monitorar a evolução do quadro Em oito semanas, foram realizadas 2 190 tentativas de contato remoto com indivíduos de cinco unidades de saúde O número efetivo de indivíduos monitorados no momento da escrita deste artigo é de 802

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Power Distance Belief and Workplace Communication: The Mediating Role of Fear of Authority

Power distance is the degree of acceptance of unequal distribution of power in societies. In a high power distance context, the acceptance of inequality conflicts with the operation of modern organizations, which causes obstacles to workplace communication or even triggers workplace accidents due to ineffective communication. We conducted four studies (N = 1063) to explore the relations between and mechanisms of power distance belief and workplace communication. In Study 1, the participants with high power distance belief had ineffective workplace communication—specifically ineffective communication with superiors—but no difference in communication with subordinates and colleagues. We further focused on the mechanism underlying the relationship between power distance belief and communication with superiors. A questionnaire study (Study 2) was conducted in three stages over a three-month period, and an experimental study (Study 3) indicated that fear of authority mediated the negative effect of high power distance on communication with superiors. A cross-culture study (Study 4) re-tested the hypotheses among Chinese and U.S. participants. This research provides insight into the mechanisms that explain the relationship between power distance belief and workplace communication, indicating that fear of authority is significant. Organizations should pay attention to power distance belief and fear of authority, as they may lead to workplace accidents due to communication disasters.

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Peptidyl Fluoromethyl Ketones and Their Applications in Medicinal Chemistry

Peptidyl fluoromethyl ketones occupy a pivotal role in the current scenario of synthetic chemistry, thanks to their numerous applications as inhibitors of hydrolytic enzymes. The insertion of one or more fluorine atoms adjacent to a C-terminal ketone moiety greatly modifies the physicochemical properties of the overall substrate, especially by increasing the reactivity of this functionalized carbonyl group toward nucleophiles. The main application of these peptidyl &#945;-fluorinated ketones in medicinal chemistry relies in their ability to strongly and selectively inhibit serine and cysteine proteases. These compounds can be used as probes to study the proteolytic activity of the aforementioned proteases and to elucidate their role in the insurgence and progress on several diseases. Likewise, if the fluorinated methyl ketone moiety is suitably connected to a peptidic backbone, it may confer to the resulting structure an excellent substrate peculiarity and the possibility of being recognized by a specific subclass of human or pathogenic proteases. Therefore, peptidyl fluoromethyl ketones are also currently highly exploited for the target-based design of compounds for the treatment of topical diseases such as various types of cancer and viral infections.

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An 11-Year-Old Saudi Arabian Girl Who Presented with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection with Coronary Artery Aneurysm and Cardiac Involvement: A Case Report

Patient: Female, 11-year-old Final Diagnosis: Pediatrics multisystem inflammatory syndrome Symptoms: Cough • fever • shortness of breath Medication: — Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Early in the COVID-19 pandemic, children who were infected with severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) with vascular inflammation were described as having a vasculitis similar to Kawasaki’s disease. There are now consensus clinical guidelines that have described the presentation and diagnosis of multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection. This report aims to describe a case of MIS-C in an 11-year-old Saudi Arabian girl who presented with coronary artery aneurysm and cardiac involvement. CASE REPORT: We describe an 11-year-old Saudi girl who was asymptomatic for 3 weeks after contracting SARS-CoV-2. Three weeks after suffering a mild flulike illness, she developed a high fever, cough, and severe clinical deterioration within 12 h of admission, including shock, rash, pleural effusion, high inflammatory markers, and a coronary aneurysm. As per current practice, the diagnosis was confirmed as multisystem inflammatory syndrome based on a SARS-CoV-2 test with reverse transcription polymerase chain reaction (RT-PCR) from 2 nasopharyngeal aspirates. Her condition was successfully treated with antibiotics, inotropes, IVIG, aspirin, and Tocilizumab, in addition to high-flow oxygen therapy. Eventually, she was able to return home after fully recovering. CONCLUSIONS: The findings in this report suggest that children with MIS-C due to SARS-CoV-2 infection can have a good prognosis, even when they suffer from coronary artery and cardiac involvement. The increasing number of emerging SARS-CoV-2 variants that affect children supports the importance of RT-PCR for the COVID-19 diagnostic test for children with multisystem or cardiovascular inflammation, which may guide the most appropriate clinical management of the variants of MIS-C.

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Physical Activity and Depression in Adolescents: Evidence from China Family Panel Studies

Depression in adolescents is a major public health disorder. The relationship between physical activity and risk of depression in adolescents was examined using three waves of data from the China Family Panel Studies in 2020. The risk of depression was significantly higher among adolescents who reported lower frequency and shorter duration of physical exercise than those who reported physical exercise more frequently and for a longer duration. The risk of depression was significantly higher among adolescents who reported intense physical exercise than those who reported little or no intense physical exercise. The amount of time spent on housework by adolescents is inversely associated with depression. These results provide somewhat stronger evidence for an activity–depression link than previous studies and suggest a differential role for different types of physical activity, such as exercise and housework. The overall model predicting depression in adolescents (LR chi-squared = 95.974, p < 0.001, Nagelkerke R-square = 0.183) was statistically significant. To effectively control depression in adolescents, the government, schools and parents need to act together to guide adolescents towards participation in appropriate physical activities. The appropriate level of physical activity is for adolescents to experience breathing, rapid heartbeat, and slight perspiration.

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The relation between knowledge and concern: A global study of children and COVID-19

COVID-19 messages vary around the world, and populations receive these messages in different ways. Children are a vulnerable audience, especially in terms of risk communication. As messages are being developed, communicated, and disseminated about this pandemic, it is important to know the relation between COVID-19 knowledge and concern among preadolescents. In Spring 2020, children (N= 4,249) from 8 global regions completed an online survey (Mage= 11.0, 54% female, 46% male). We assessed children’s COVID-19 knowledge by asking about prevention and symptoms, as well as myths about the virus. We also assessed children’s concerns by asking about worries about self and others getting sick, missing school, and interruption of activities. Our analyses revealed different relations between knowledge and concern by region. Among children from Sub-Saharan Africa, the Arabian region, Asia, and North America, there was a positive relation between knowledge and concern. For those from Latin America, Oceania, Europe, and Southeast Asia, the relation was flat or negative. When producing messages for children during a public health crisis, health communicators must know that more knowledge is not always associated with less concern.

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COVID-19 and gynecological cancers: Asia and Oceania Federation of Obstetrics and Gynecology oncology committee opinion

Since the outbreak of COVID-19, there have already been over 26 million people being infected and it is expected that the pandemic will not end in near future. Not only the daily activities and lifestyles of individuals have been affected, the medical practice has also been modified to cope with this emergency catastrophe. In particular, the cancer services have faced an unprecedented challenge. While the services may have been cut by the national authorities or hospitals due to shortage of manpower and resources, the medical need of cancer patients has increased. Cancer patients who are receiving active treatment may develop various kinds of complications especially immunosuppression from chemotherapy, and they and their carers will need additional protection against COVID-19. Besides, there is also evidence that cancer patients are more prone to deteriorate from COVID-19 if they contract the viral infection. Therefore, it is crucial to establish guidelines so that healthcare providers can triage their resources to take care of the most needed patients, reduce less important hospitalization and visit, and to avoid potential complications from treatment. The Asia and Oceania Federation of Obstetrics and Gynecology (AOFOG) hereby issued this opinion statement on the management of gynecological cancer patients during the COVID-19.

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Oral Health Conditions and COVID-19: A Systematic Review and Meta-analysis of the Current Evidence

BACKGROUND: : The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of understanding the underlying conditions that lead to COVID-19. Oral health has systemic implications in the maintenance of a healthy state. This study aimed to summarize evidence on the prevalence of oral health conditions in participants with COVID-19 and assess the associations between oral health conditions and COVID-19 related outcomes. METHODS: : Article searches were conducted in five databases and the gray literature from December 1, 2019 to March 1, 2021. Studies that reported oral health conditions for participants with COVID-19 and/or examined associations between oral health and COVID-19 were included. RESULTS: : We identified 15 articles that encompassed 5,377 participants with COVID-19 from 10 countries. Dry mouth was the most common oral health condition reported (41.0%), followed by oral lesions (38.8%), orofacial pain (18.3%), and periodontal symptoms (11.7%). Based on the pooled odds ratios (ORs), periodontal symptoms were not associated with COVID-19 positivity (OR = 1.1; 95% confidence intervals [CI], 0.73-1.65) or mortality (OR = 2.71; 95% CI, 0.64-11.51), but were associated with COVID-19 severity (OR = 3.18; 95% CI, 1.81-5.58). CONCLUSIONS: : Oral health conditions are common in participants with COVID-19 and should be considered in both the onset and progression of this disease. Knowledge in this area is still limited, and the quality of the data extracted was low. Further longitudinal studies are needed to ascertain whether oral health conditions are a consequence of infection with SARS-CoV-2 or whether they predate infection and are risk factors for COVID-19.

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Evaluating the contribution of synthetic fungicides to cereal plant health and CO2 reduction targets against the backdrop of the increasingly complex regulatory environment in Europe

The global COVID pandemic has impacted the world in ways and at a scale that few could have predicted, with many industries severely disrupted. Despite this, crops were sown and harvested, food was produced and agriculture continued to function, albeit it with many logistical challenges. Plant health lies at the heart of preventing crop losses through a combination of varietal resistance and agronomic practices. In the case of foliar plant diseases in wheat, varietal resistance plays a key role, but the use of synthetic fungicides is essential to minimize crop losses. European arable production faces a dilemma: how to contribute and maintain global food supplies but at the same time decrease emissions of greenhouse gases (GHGs), reduce inputs potentially harmful to biodiversity, society and the environment while ensuring no more land is brought into production. Throughout history, major disruptions in society have led to big steps in agricultural innovation. Presently, the major disruptive forces in Europe are not just a result of the COVID pandemic but the increasingly urgent need to address climate change. Within the European Green Deal, the Farm‐to‐Fork strategy is in place to help achieve climate neutrality by 2050, aiming for a reduction of GHG emissions of 55% by 2030. To achieve this, there will need to be a major adjustment to how food is produced, a realignment in plant health strategies and accelerated innovation across the agricultural sector. This paper aims to evaluate how synthetic fungicides presently contribute to plant health (mainly wheat) and food production as well as the management of GHG emissions. In addition, it explores the future challenges and prospects for their positive contribution in achieving global food security alongside emerging innovative technologies. [ABSTRACT FROM AUTHOR] Copyright of Plant Pathology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Who is watching? Refugee protection during a pandemic - responses from Uganda and South Africa

Both Uganda and South Africa were quick to respond to the global pandemic – Uganda for example imposing quarantine on foreign travellers after only a handful of cases before shutting off all international flights, and South Africa imposing one of the first lockdowns on the continent. Reflecting on the first 6 months of the pandemic responses in terms of refugee protection, the two countries have taken diverging pathways. South Africa used the pandemic to start building a border fence on the border with Zimbabwe, initially curtailed all foreign shop owners from opening under lockdown and excluded asylum seekers from emergency relief grants. In contrast, Uganda opened its borders to refugees from the DRC in June, when border closures were still the global norm. Whilst both responses are not unusual in light of their standard governance approaches, they highlight the own self-image the countries espouse – with Uganda positioning itself as the world’s premier refugee protector at a time when it is desperately in need of more funds and South Africa looking to politically capitalize internally from reiterating a division between migrant communities as a threat to poor and disenfranchised South Africans. Even during a pandemic, the practice of refugee protection does not happen in a political vacuum. This paper is based on over 50 in-person and digital interviews conducted in Uganda and South Africa in 2020, as well as nine focus groups with refugee and host communities.

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Development of Learning Media for Android-Based during the COVID-19 Pandemic

Android-based learning media is expected to be the precise choice during the pandemic outbreak. Learning and teaching activity can still be conducted even if only through online learning. In accordance with the development of information technology which is growing rapidly around the world, especially among vocational students which makes the learning and teaching activity can be done anywhere and anytime. Teachers and learning media play an important role during learning and teaching activity which both cannot be separated because qualified teachers and also proper and innovative learning media are able to enhance students' enthusiasm to learning and teaching activity. In this study, an Android-based learning media without coding was designed, the result of which was an Android application that could be installed on students' smartphone so they could learn anywhere and anytime. This learning medium which is in the form of Android application is expected to help and encourage students to learn anywhere and anytime. From the results of the assessment that has been given by the application users, the interpretation value of 87.5% and percentage of interpretation assessment of the criteria value is in the excellent category. © 2021 IEEE.

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Time of Bariatric Surgery and Hospitalization for SARS-CoV-2: a Nationwide Study

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Scientometrics analysis of recent trends in Global Corona virus Research

Background: The worldwide pandemic COVID-19 has produced a wealth of research more rapidly after the outbreak. In just a couple of months, there is a rise in several studies on Coronavirus, adding up to the scholarly literature. Method: The current study attempts to Scientometric analyze very recent literature on Coronaviruses just before and after the outbreak. Besides, the objective of this exploration was to assess the global research progress on Coronavirus in recent times. The current research is an analytical descriptive study using Scientometrics. The study sample includes research papers about the Coronavirus indexed in Web of Science (WoS) database from January 1, 2019 to May 14, 2020. The records with topic search (includes Title, Abstract, Keywords and Keywords Plus) “coronavirus” were extracted. These data were analyzed by MS Excel and the visualizations were created using Tableau Result: The results showed that 2551 scientific literature about the Coronavirus was indexed in WoS. A considerable number of these articles were published in journals such as the Journal of Medical Virology, Viruses, Nature, and Lancet. Authors from China, USA and Italy were the most prolific authors. About 47.51% articles received total of 11435 citations with an average of 9 citations, which indicates that nearly half articles were cited in another publication. The highest and lowest citations for these articles were 737 and 1, respectively. Conclusion: These results show a high rate of research on Coronavirus.

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Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection

In this retrospective study, chest CTs of 121 symptomatic patients infected with coronavirus disease-19 (COVID-19) from four centers in China from January 18, 2020 to February 2, 2020 were reviewed for common CT findings in relationship to the time between symptom onset and the initial CT scan (i.e. early, 0-2 days (36 patients), intermediate 3-5 days (33 patients), late 6-12 days (25 patients)). The hallmarks of COVID-19 infection on imaging were bilateral and peripheral ground-glass and consolidative pulmonary opacities. Notably, 20/36 (56%) of early patients had a normal CT. With a longer time after the onset of symptoms, CT findings were more frequent, including consolidation, bilateral and peripheral disease, greater total lung involvement, linear opacities, "crazy-paving" pattern and the "reverse halo" sign. Bilateral lung involvement was observed in 10/36 early patients (28%), 25/33 intermediate patients (76%), and 22/25 late patients (88%).

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Insights into financial technology (FinTech): a bibliometric and visual study

This paper conducted a comprehensive analysis based on bibliometrics and science mapping analysis. First, 848 publications were obtained from Web of Science. Their fundamental characteristics were analyzed, including the types, annual publications, hot research directions, and foci (by theme analysis, co-occurrence analysis, and timeline analysis of author keywords). Next, the prolific objects (at the level of countries/regions, institutions, journals, and authors) and corresponding pivotal cooperative relationship networks were used to highlight who pays attention to FinTech. Furthermore, the citation structures of authors and journals were investigated, including citation and co-citation. Additionally, this paper presents the burst detection analysis of cited authors, journals, and references. Finally, combining the analysis results with the current financial environment, the challenges and future development opportunities are discussed further. Accordingly, a comprehensive study of the FinTech documents not only reviews the current research characteristics and trajectories but also helps scholars find the appropriate research entry point and conduct in-depth research.

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The impact of COVID-19 news, panic and media coverage on the oil and gold prices: An ARDL approach

This study investigates whether COVID-19 news, panic and media coverage affect oil and gold prices Using the ARDL approach over the period January 23, 2020 to June 23, 2020, we find that COVID-19 deaths and panic have negative effects on crude oil price However, the propaganda created by the media in the long term has a negative impact on oil price The empirical results show that the COVID-19 new infections, deaths and media coverage have positive effects on the gold price Our findings prove that oil price is sensitive to bad news unlike gold price According to our study, gold, which is a hedge against economic and geopolitical crises, is additionally a safe haven during COVID-19 health crisis Overall, our results also demonstrate that the economic and financial uncertainty affect oil and gold prices negatively during the COVID-19 pandemic We conclude that the impact of the COVID-19 new infections on oil and gold prices is depending on whether the disease is an epidemic or a pandemic

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[the Attitude of Young People to the New Coronavirus Infection: the Dynamics of Ideas and Practices of Health-saving Behavior]

The article examines the dynamics of the attitude of young people about the new coronavirus infection. The attitude of young people to the new coronavirus infection is formed in two types of reality: «online¼ and «offline¼. The views, assessments and knowledge of young people about the new coronavirus infection were significantly influenced by the flow of information (often fake) from various sources and, above all, the information posted on social networks. The authors conclude that the attitude to coronavirus infection from the first to the second wave has undergone significant changes and generally influenced the practices of self-preservation behavior of young people. With the expansion of knowledge and experience, understanding them from the point of view of the components of the image of health, there was a clarification of the own behavioral attitudes of young people.

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Vaccination as a possible trigger for immune-mediated necrotising myopathy.

Immune-mediated necrotising myopathy is a rare autoimmune myopathy characterised by severe progressive muscle weakness, elevated levels of creatine kinase (CK), and necrosis with minimal inflammatory cell infiltration on muscle biopsy. We report a case of a previously healthy 42-year-old woman who presented with progressive muscle weakness 2 weeks after immunisation for yellow fever, tetanus/diphtheria and hepatitis B. Her symptoms started from the lower limbs and progressed to the upper limbs and cervical region associated with dysphagia, making her wheelchair bound. Electromyography showed a myopathic pattern, with a CK level of 12.177 U/L (reference value: 26-190 U/L), and biceps brachial muscle biopsy confirmed necrosis and regeneration fibres. The immunoblot test was positive for antisignal recognition particle. She was successfully treated with prednisone (1 mg/kg/day). Although considered safe, vaccines may cause allergic reactions or trigger autoimmune disorders. Currently, a causal relationship between them cannot be established.

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A Veterinary Vaccine for SARS-CoV-2: The First COVID-19 Vaccine for Animals

As coronaviruses have a wide range of host species, many animals harbor these pathogens, however only a handful of them become severely infected [...].

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Effect of hepatitis C antiviral therapy on oral lichen planus and hyposalivation in inmates

BACKGROUND: Oral lichen planus (OLP) and hyposalivation have been reported as extrahepatic manifestations of hepatitis C virus (HCV) infection. Our study evaluated the effect of direct antiviral agents (DAAs) on OLP and hyposalivation in convicts with chronic hepatitis C, examining patients before, during and after the antiviral treatment period with direct acting antiviral agents (DAAs). METHODS: We screened 198 inmates for the presence of the HCV antibody. Patients found to be positive underwent a quantitative HCV-RNA test and HCV genotype typing, as well as an oral cavity examination using a scoring system for OLP (REU score) and the clinical oral dryness score (CODS). Subsequently, all patients underwent DAA therapy and a systematic physical examination of the oral cavity at 1, 3 and 6 months from the beginning of treatment. RESULTS: Fifty patients (25.25%) had a positive HCV-RNA test. At baseline, OLP was detected in 4 patients (8%), with a mean REU score of 10.13±4, and different degrees of hyposalivation were seen in 17 patients (34%), with a mean CODS score of 4.71±1.72. Six months after the start of DAA therapy, we observed resolution of OLP in 3 patients (75%) and improvement in the remaining subject with a significantly lower mean REU score (2±4). Hyposalivation disappeared in 5 patients, improved in 10, and remained unchanged in 2 patients with a significantly lower mean CODS score (0.06±0.24). CONCLUSION: This study demonstrated the effectiveness of DAAs in the treatment of OLP and hyposalivation.

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Staffing and Capacity Planning for SARS-CoV-2 Monoclonal Antibody Infusion Facilities: A Performance Estimation Calculator Based on Discrete-Event Simulations

BACKGROUND: The COVID-19 pandemic has significantly stressed healthcare systems. The addition of monoclonal antibody (mAb) infusions, which prevent severe disease and reduce hospitalizations, to the repertoire of COVID-19 countermeasures offers the opportunity to reduce system stress but requires strategic planning and use of novel approaches. Our objective was to develop a web-based decision-support tool to help existing and future mAb infusion facilities make better and more informed staffing and capacity decisions. MATERIALS AND METHODS: Using real-world observations from three medical centers operating with federal field team support, we developed a discrete-event simulation model and performed simulation experiments to assess performance of mAb infusion sites under different conditions. RESULTS: 162,000 scenarios were evaluated by simulations. Our analyses revealed that it was more effective to add check-in staff than to add additional nurses for middle-to-large size sites with ≥2 infusion nurses; that scheduled appointments performed better than walk-ins when patient load was not high; and that reducing infusion time was particularly impactful when load on resources was only slightly above manageable levels. DISCUSSION: Physical capacity, check-in staff, and infusion time were as important as nurses for mAb sites. Health systems can effectively operate an infusion center under different conditions to provide mAb therapeutics even with relatively low investments in physical resources and staff. CONCLUSION: Simulations of mAb infusion sites were used to create a capacity planning tool to optimize resource utility and allocation in constrained pandemic conditions, and more efficiently treat COVID-19 patients at existing and future mAb infusion sites.

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The SARS-CoV-2 spike protein primes inflammasome-mediated interleukin-1- beta secretion in COVID-19 patient-derived macrophages

Innate immunity triggers responsible for viral control or hyperinflammation in COVID- 19 are largely unknown. Here we show that the SARS-CoV-2 spike protein primes inflammasome activation and interleukin 1-beta (IL-1β) secretion in macrophages derived from COVID-19 patients but not in macrophages from healthy SARS-CoV-2 naïve controls. Chemical NLRP3 inhibition blocks spike protein-induced IL-1β secretion ex vivo . These findings can accelerate research on COVID-19 vaccine design and drug treatment.

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Temporal associations of B and T cell immunity with robust vaccine responsiveness in a 16-week interval BNT162b2 regimen

Spacing of the BNT162b2 mRNA doses beyond 3 weeks raised concerns about vaccine efficacy. We longitudinally analyzed B cell, T cell and humoral responses to two BNT162b2 mRNA doses administered 16 weeks apart in 53 SARS-CoV-2 naïve and previously-infected donors. This regimen elicited robust RBD-specific B cell responses whose kinetics differed between cohorts, the second dose leading to increased magnitude in naïve participants only. While boosting did not increase magnitude of CD4(+) T cell responses further compared to the first dose, unsupervised clustering analyses of single-cell features revealed phenotypic and functional shifts over time and between cohorts. Integrated analysis showed longitudinal immune component-specific associations, with early Thelper responses post-first dose correlating with B cell responses after the second dose, and memory Thelper generated between doses correlating with CD8 T cell responses after boosting. Therefore, boosting elicits a robust cellular recall response after the 16-week interval, indicating functional immune memory.

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Variations In Spectrum Of Covid-19 Ct Findings And Its Severity Scoring In A Tertiary Care Hospital Of Bahawalpur, Southern Punjab Pakistan

BACKGROUND: Recently the Coronavirus pandemic presented with different manifestations in different parts of the world, both on clinical examinations and on imaging CT Scanning (CT Scan) chest is used for detailed evaluation of the different characteristic patterns determining the depth of disease The study is aimed to assess the variations in spectrum of Covid-19 CT findings and relating severity (CT Severity Score) with the Clinical Symptoms in Bahawal Victoria Hospital, Bahawalpur METHODS: In this cross-sectional study, patients referred to radiology department from outdoor for COVID screening were included from 1st May to 30th June 2020 Mean age range of patients was calculated, while presenting complaints and co-morbidities were tabulated in frequencies and percentages after analysis Severity of symptoms and CT findings were correlated with biochemical and haematological tests RESULTS: Patients' age range from 25 to 85 years with 62% males and 38% females Statistically no significant difference was observed in CTSS on gender basis As sensitivity of RT PCR is about 70%, negative cases cannot be considered disease free and this is seen in this study as CT findings suggestive of COVID are seen in these patients Using 40-point CT-SS, 11 patients had a score of &gt;19 with severe diseases, while 14 patients had common disease with a score range of 11-18 and 35 patients had &lt;10 score with mild or no symptoms CONCLUSIONS: In this study, a spectrum of patchy ground glass opacities, bilateral peripheral predominantly lower lung consolidations were observed Quantitative analysis of inflammatory process as occurring in lungs in Coronavirus Disease 2019, using 40-point CTSS scoring on Imaging could provide a timely and objective approach towards identifying patients requiring intensive care and hospitalisation

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Predicting the Kidney Graft Survival Using Optimized African Buffalo-Based Artificial Neural Network

A variety of receptor and donor characteristics influence long-and short-term kidney graft survival. It is critical to predict the effectiveness of kidney transplantation to optimise organ allocation. This would allow patients to choose the best accessible kidney donor and the optimal immunosuppressive medication. Several studies have attempted to identify factors that predispose to graft rejection, but the results have been contradictory. As a result, the goal of this paper is to use the African buffalo-based artificial neural network (AB-ANN) approach to uncover predictive risk variables related to kidney graft. These two feature selection approaches combine to provide a novel hybrid feature selection technique that could select the most important elements to improve prediction accuracy. The feature analysis revealed that clinical features have varied effects on transplant survival. The collected data is processed in both training and testing methods. The prediction model's performance, in terms of accuracy, precision, recall, and F-measure, was examined, and the results were compared with those of other existing systems, including naive Bayesian, random forest, and J48 classifier. The results suggest that the proposed approach can forecast graft survival in kidney recipients' next visits in a creative manner and with more accuracy compared with other classifiers. This proposed method is more efficient for predicting kidney graft survival. Incorporating those clinical tools into outpatient clinics' everyday workflows could help physicians make better and more personalised decisions.

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Genetic Manipulation of Human Intestinal Enteroids Demonstrates the Necessity of a Functional Fucosyltransferase 2 Gene for Secretor-Dependent Human Norovirus Infection

Human noroviruses (HuNoVs) are the leading cause of nonbacterial gastroenteritis worldwide. Histo-blood group antigen (HBGA) expression is an important susceptibility factor for HuNoV infection based on controlled human infection models and epidemiologic studies that show an association of secretor status with infection caused by several genotypes. The fucosyltransferase 2 gene (FUT2) affects HBGA expression in intestinal epithelial cells; secretors express a functional FUT2 enzyme, while nonsecretors lack this enzyme and are highly resistant to infection and gastroenteritis caused by many HuNoV strains. These epidemiologic associations are confirmed by infections in stem cell-derived human intestinal enteroid (HIE) cultures. GII.4 HuNoV does not replicate in HIE cultures derived from nonsecretor individuals, while HIEs from secretors are permissive to infection. However, whether FUT2 expression alone is critical for infection remains unproven, since routinely used secretor-positive transformed cell lines are resistant to HuNoV replication. To evaluate the role of FUT2 in HuNoV replication, we used CRISPR or overexpression to genetically manipulate FUT2 gene function to produce isogenic HIE lines with or without FUT2 expression. We show that FUT2 expression alone affects both HuNoV binding to the HIE cell surface and susceptibility to HuNoV infection. These findings indicate that initial binding to a molecule(s) glycosylated by FUT2 is critical for HuNoV infection and that the HuNoV receptor is present in nonsecretor HIEs. In addition to HuNoV studies, these isogenic HIE lines will be useful tools to study other enteric microbes where infection and/or disease outcome is associated with secretor status.

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Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.

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COVID-19: Vaccine Delivery System, Drug Repurposing and Application of Molecular Modeling Approach

The acute respiratory syndrome coronavirus (SARS-CoV-2) has spread across the world, resulting in a pandemic COVID-19 which is a human zoonotic disease that is caused by a novel coronavirus (CoV) strain thought to have originated in wild or captive bats in the initial COVID outbreak region. The global COVID-19 outbreak started in Guangdong Province, China’s southernmost province. The global response to the COVID-19 pandemic has been hampered by the sheer number of infected people, many of whom need intensive care before succumbing to the disease. The epidemic is being handled by a combination of disease control by public health interventions and compassionate treatment for those who have been impacted. There is no clear anti-COVID-19 medication available at this time. However, the need to find medications that can turn the tide has led to the development of a number of investigational drugs as potential candidates for improving outcomes, especially in the severely and critically ill. Although many of these adjunctive medications are still being studied in clinical trials, professional organizations have attempted to define the circumstances in which their use is deemed off-label or compassionate. It is important to remind readers that new information about COVID-19’s clinical features, treatment options, and outcomes is released on a regular basis. The mainstay of treatment remains optimized supportive care, and the therapeutic effectiveness of the subsequent agents is still being studied.

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Emergent and urgent otologic surgeries during the SARS-CoV-2 pandemic: a protocol and review of literature

OBJECTIVE: To review guidelines for otologic procedures during the SARS-CoV-2 pandemic and to present a protocol for emergent or urgent mastoidectomy at our institution. DATA SOURCES: Guidelines regarding emergent and urgent otologic procedures from otolaryngologic societies are reviewed. We described a protocol for emergent or urgent mastoidectomy at our institution. CONCLUSION: Patients requiring urgent or emergent mastoidectomy during the COVID-19 pandemic require prompt treatment. We make the following recommendations: Emergent or urgent otologic procedures should be performed in a contained environment, such as a tent created by the microscope drape. The surgical team should practice using instruments in the tent setup to prepare for real cases. Otologic procedures should adhere to guidelines set for high-risk procedures.

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Recomendaciones sobre reanimación cardiopulmonar en pacientes con sospecha o infección confirmada por SARS-CoV-2 (COVID-19). Resumen ejecutivo

Resumen La pandemia por SARS-CoV-2 ha generado nuevos escenarios que requieren modificaciones de los protocolos habituales de reanimación cardiopulmonar. Las guías clínicas vigentes sobre el manejo de la parada cardiorrespiratoria no incluyen recomendaciones para situaciones aplicables a este contexto. Por ello, el Plan Nacional de Reanimación Cardiopulmonar de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias, en colaboración con el Grupo Español de RCP Pediátrica y Neonatal y con el programa de Enseñanza de Soporte Vital en Atención Primaria de la Sociedad Española de Medicina Familiar y Comunitaria, ha redactado las siguientes recomendaciones, que están divididas en cinco partes que tratan los principales aspectos para cada entorno asistencial. En este artículo se presenta un resumen ejecutivo de las mismas. Abstract The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into five parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.

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Correction to: Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia

An amendment to this paper has been published and can be accessed via the original article.

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Preoperative Noninvasive Mapping Allowed Targeted Concomitant Surgical Ablation and Revealed COVID-19 Infection

In March 2020, a 64-year-old female with mitral valve insufficiency and persistent atrial fibrillation underwent preoperative noninvasive mapping for developing an ablation strategy. In the computed tomography (CT) scan, typical signs of COVID-19 were described. Since the consecutive polymerase chain reaction (PCR) test was negative, the severely symptomatic patient was planned for urgent surgery. Noninvasive mapping showed that atrial fibrillation was maintained by left atrial structures and pulmonary veins only. On admission day, the preoperative routine COVID-19 PCR test was positive, and after recovery, uneventful mitral valve repair with cryoablation of the left atrium and pulmonary veins was performed. Our case describes the potential benefit of preoperative noninvasive mapping for the development of a surgical ablation strategy, as well as the challenges in managing urgent surgical patients during the COVID-19 pandemic and the corresponding diagnostic relevance of CT.

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An atypical case of COVID-19 and renal amyloidosis presenting with brash syndrome

INTRODUCTION: The syndrome of bradycardia, renal failure, atrioventricular nodal blockade (AVNB), shock and hyperkalemia (BRASH) represents a persistent cycle of pre-existing renal disease and hyperkalemia worsened by bradycardia, hypoperfusion and an AVNB agent We report a continuous cycle of BRASH triggered by COVID-19 that led to diagnosis of renal amyloidosis METHODS: 58-year-old male recently hospitalized for COVID pneumonia with secondary multiorgan failure, requiring temporary mechanical ventilation and continuous renal replacement therapy (CRRT), presented to the emergency department for worsening chills and dyspnea His workup revealed persistent bradycardia (HR 40- 50s bpm), hypotension (MAPs50-70s mmHg), elevated creatinine (2 4 mg/dL), and hyperkalemia (5 2-6 1 mmol/L), thereby raising concern for BRASH Given severity, patient was transferred to ICU for monitoring via arterial line and anticipation of vasopressors, CRRT, and mechanical ventilation His home amiodarone and enalapril were held and hyperkalemia was treated with stabilizing therapies, patiromer and bumetanide Hypotension was addressed with fluids and intermittent albumin Blood pressure, bradycardia, creatinine and hyperkalemia finally improved on third day of admission In the interim, further workup revealed SARS-CoV-2 positive, anasarca and bilateral pleural effusions without evidence of systolic or diastolic dysfunction on echocardiogram He underwent diagnostic and therapeutic thoracentesis that showed transudative fluid, likely sequela of nephrotic syndrome given nephrotic range proteinuria Given M-spike on serum electrophoresis, he underwent kidney biopsy which showed AL amyloid He was discharged to long-term facility for continued diuresis without AVNB or other antihypertensive agents RESULTS: Patient likely had decompensation of preexisting renal amyloidosis due to systemic hypotension from COVID that resulted in a persistent cycle of BRASH While initially critically ill, he became hemodynamically stable by ending the BRASH cycle through appropriate management of hyperkalemia and discontinuation of precipitating medications This case highlights how early recognition and management of BRASH syndrome and its precipitant, such as COVID, can lead to clinical stability in critically ill patients

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COVID-19 response in South-East Asia: promoting healthcare quality through political engagement

Coronavirus disease-2019 (COVID-19), a disease caused by coronavirus severe acute respiratory syndrome coronavirus 2, led to a pandemic that affected every region of the world. The World Health Organization South-East Asia Region (SEARO) is composed of 11 countries: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste. Each of these countries faced different challenges in tackling COVID-19 depending upon their resources and health system. However, in general it was evidenced that no country was prepared to handle such a pandemic. Two strategies were adopted globally: closing the international borders and restricting movement within countries. These measures were adopted throughout the SEARO.

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Etanercept Ameliorates Cardiac Fibrosis in Rats with Diet-Induced Obesity

Diet-induced obesity (DIO) is considered the main risk factor for cardiovascular diseases. Increases in the plasma levels of tumor necrosis factor alpha (TNF-α) is associated with DIO. Etanercept, a TNF-α inhibitor, has been shown to alleviate cardiac hypertrophy. To investigate the effect of etanercept on cardiac fibrosis in DIO model, rats on high fat diet (HFD) were subdivided into two groups: the etanercept group and vehicle group. Cardiac injury was identified by classic methods, while fibrosis was characterized by histological analysis of the hearts. Etanercept treatment at 0.8 mg/kg/week twice weekly by subcutaneous injection effectively alleviates the cardiac fibrosis in HFD-fed rats. STAT3 activation seems to be induced in parallel with fibrosis-related gene expression in the hearts of HFD-fed rats. Decreased STAT3 activation plays a role in the etanercept-treated animals. Moreover, fibrosis-related genes are activated by palmitate in parallel with STAT3 activation in H9c2 cells. Etanercept may inhibit the effects of palmitate, but it is less effective than a direct inhibitor of STAT3. Direct inhibition of STAT3 activation by etanercept seems unlikely. Etanercept has the ability to ameliorate cardiac fibrosis through reduction of STAT3 activation after the inhibition of TNF-α and/or its receptor.

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Covid-19 virus diffusion in Italy: Data quality and methodological challenges

In early 2020, it emerged in Italy a large outbreak of Covid-19, the infectious disease caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). In this context, producing as accurate as possible forecasting models was crucial both for the containment of the epidemic and for the planning of effective policy interventions. In this article I describe the main data sources which have been used to monitor the spread of the Covid-19 virus diffusion in Italy in the early stages of the epidemic (i.e. spring 2020);I focus on administrative records, Big Data from online search engines, and survey data, including data on contagion, fatalities, and Intensive Care Units admissions and exits. I discuss data quality issues associated with these sources of data, and I comment the main challenges faced in the dissemination of data and research findings in the first stages of the epidemic. © 2021 Societa Editrice il Mulino. All rights reserved.

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Crisis as a chance. A digital training of social competencies with simulated persons at the Medical Faculty of RWTH Aachen, due to the lack of attendance teaching in the SARS-Cov-2 pandemic

Objective: The AIXTRA Competence Center for Training and Patient Safety at RWTH Aachen University has developed a concept to enable learning of communication skills with simulated persons (SP) digitally. Methodology: Existing SP cases in curricular teaching were checked for digital applicability and modified. Digital seminars with the methodology of simulated conversations with SP, for planned 690 students for the courses "history taking", 6th semester, conversations in psychiatry, 8th semester, and in the clinical competence course, 10th semester, were conducted via video conferencing software. The structure is similar to SP-seminars in classroom teaching with a case presentation, a doctor/patient dialogue and a feedback session. In the 6th and 10th semester, the seminars were evaluated anonymously by the students using an online questionnaire. SP were asked by e-mail for their assessment. The lecturers were asked about their experience with the digital seminars by means of qualitative interviews. Results: The survey of students with 92 completed questionnaires indicates a high level of acceptance. Digital teaching with SP was rated "very good" by 63% of the students and "good" by 37% as an overall mark for the course. The digital implementation is well practicable, the retention and accessibility of all learning goals is rated as given. Conclusion: Digital teaching with SP can be well realized with appropriate preparation. Specific aspects of digital implementation (e.g. role and data protection) must be taken into account. The differentiated evaluation of the surveys will bring further results and deductive questions.

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Association between vitamin D level and prognostic factors among patients infected with SARS-CoV-2.

OBJECTIVES The present study aimed to evaluate the presence of any relationship between vitamin D and prognostic factors among patients infected with SARS-CoV-2. METHODS This retrospective cross-sectional study was conducted among patients admitted from March to August 2020 in a referral hospital, Tehran, Iran. All patients aged 18-65 who had not any comorbidity participated in the study. The diagnosis of COVID-19 was established using the rRT-PCR test for SARS-CoV-2 detection. Then the incidence of lung involvement and biochemical markers including vitamin D level, c-reactive protein, D-dimer, lymphocyte count, platelet count, white blood cell count, and lactic acid dehydrogenase, were extracted through medical records. RESULTS Altogether, 84 patients met our study criteria, and the information of 68 (80.9%) participants were collected. Among all 68 patients, 45 (66.2%) were male. The mean (SD) age of all participants was 52.4 (10.4) years old. Among 24 (35.2%) clients who died due to SARS-CoV-2, 20 (83.3%) patients were male (p=0.02). The mean (SD) of vitamin D level was 24.1 (13.6) ng/dL. No association between vitamin D level and prognostic factors, including CRP, lymphocyte count, D-dimer, LDH, and HRCT scan score, was observed. Also, the vitamin D level of the dead patients was not significantly different from that of the treated patients. CONCLUSIONS Our findings indicated no significant relationship between vitamin D level and prognostic factors or outcomes of patients infected with SARS-CoV-2.

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Polymeric surfaces with biocidal action: challenges imposed by the SARS-CoV-2, technologies employed, and future perspectives

The COVID-19 pandemic has demonstrated that hygiene habits reduce the spread of the SARS-CoV-2 virus on contaminated surfaces In this context, compounds with biocidal properties can act as surface coatings, especially in hospital environments, a source of pathogenic microorganisms Therefore, the purpose of this review was to report an overview of recent studies with biocidal agents, focusing on polymeric surface modification Methods such as direct incorporation, direct deposition, and chemical deposition of the microbial agent on the polymeric surface and surface modification without a microbial agent were discussed Despite several studies in the literature, antimicrobial materials still face challenges such as commercialization, material stability in post-processing, and guarantee of long cycles Moreover, effectiveness, toxicity, and final cost must be balanced We also discussed the concept of antiviral activity and the action mode of the materials Inorganic, organic materials, nanocomposites, and biopolymers have been addressed as viral inhibitors of several diseases Lastly, we explored the functional validation of polymeric surface through characterization techniques

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Review the safety of Covid-19 mRNA vaccines: a review

The novel coronavirus disease 2019 (COVID-19) has infected more than 100 million people globally within the first year of the pandemic. With a death toll surpassing 500,000 in the United States alone, containing the pandemic is predicated on achieving herd immunity on a global scale. This implies that at least 70-80 % of the population must achieve active immunity against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), either as a result of a previous COVID-19 infection or by vaccination against SARS-CoV-2. In December 2020, the first two vaccines were approved by the FDA through emergency use authorization in the United States. These vaccines are based on the mRNA vaccine platform and were developed by Pfizer/BioNTech and Moderna. Published safety and efficacy trials reported high efficacy rates of 94-95 % after two interval doses, in conjunction with limited side effects and a low rate of adverse reactions. The rapid pace of vaccine development and the uncertainty of potential long-term adverse effects raised some level of hesitation against mRNA vaccines in the global community. A successful vaccination campaign is contingent on widespread access to the vaccine under appropriate storage conditions, deployment of a sufficient number of vaccinators, and the willingness of the population to be vaccinated. Thus, it is important to clarify the objective data related to vaccine safety, including known side effects and potential adverse reactions. The present review was designed to provide an update on the current state of science related to the safety and efficacy of SARS-CoV-2 mRNA vaccines.

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Interest in dentistry in early months of the COVID‐19 global pandemic: A Google Trends approach

BACKGROUND: In early the COVID‐19 pandemic, routine dental treatments have been delayed due to the risk of disease transmission. This delay may lead public to search for information on the Internet for a solution. OBJECTIVES: This study aims to evaluate the public interest in dentistry in the early months of the COVID‐19 global pandemic in the selected countries. METHODS: The daily numbers of new COVID‐19 cases were recorded for China, South Korea, Italy, Germany, Russia, Ukraine and Turkey. For these countries, Internet search interest of the keyword ‘dentistry’, ‘coronavirus’, ‘COVID‐19’, ‘SARS‐CoV‐2’ and ‘pandemic’ in the early months of the COVID‐19 pandemic was evaluated by using Google Trends data. RESULTS: In most countries included the public Internet search interest in ‘dentistry+coronavirus+COVID‐19+SARS‐CoV‐2+pandemic’ peaked prior to the peak of new COVID‐19 cases. While a statistically significant positive correlation was observed between the number of new cases and Google Trends data in China, South Korea, Italy and Germany, a statistically significant negative correlation was observed in Turkey. CONCLUSION: The peak public interest in dentistry has been prior to the peak of COVID‐19 new cases in most countries. The use of Internet data can provide useful information about pandemics and many other diseases.

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Willingness to Vaccinate Children against Influenza after the Coronavirus Disease 2019 Pandemic

OBJECTIVES: To determine factors associated with parents who plan to vaccinate their children against influenza next year, especially those who did not vaccinate against influenza last year using a global survey. STUDY DESIGN: A survey of caregivers accompanying their children aged 1-19 years old in 17 pediatric emergency departments in 6 countries at the peak of the coronavirus disease 2019 (COVID-19) pandemic. Anonymous online survey included caregiver and child demographic information, vaccination history and future intentions, and concern about the child and caregiver having COVID-19 at the time of emergency department visit. RESULTS: Of 2422 surveys, 1314 (54.2%) caregivers stated they plan to vaccinate their child against influenza next year, an increase of 15.8% from the previous year. Of 1459 caregivers who did not vaccinate their children last year, 418 (28.6%) plan to do so next year. Factors predicting willingness to change and vaccinate included child's up-to-date vaccination status (aOR 2.03, 95% CI 1.29-3.32, P = .003); caregivers' influenza vaccine history (aOR 3.26, 95% CI 2.41-4.40, P < .010), and level of concern their child had COVID-19 (aOR 1.09, 95% CI 1.01-1.17, P = .022). CONCLUSIONS: Changes in risk perception due to COVID-19, and previous vaccination, may serve to influence decision-making among caregivers regarding influenza vaccination in the coming season. To promote influenza vaccination among children, public health programs can leverage this information.

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COVID-19 and liver transplantation

The effect of coronavirus disease 2019 (COVID-19) on liver transplantation programmes and recipients is still not completely understood but overall involves the risk of donor-derived transmission, the reliability of diagnostic tests, health-care resource utilization and the effect of immunosuppression. This Comment reviews the effect of COVID-19 on liver transplantation and summarizes recommendations for donor and recipient management.

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Effectiveness and satisfaction of technology‐mediated learning during global crisis: understanding the role of pre-developed videos

Purpose: In today’s dynamic situation, innumerable challenges are posited in the education sector because of the COVID-19 pandemic. Higher educational institutes (HEIs) are compelled to adopt digital technologies and technology-mediated learning in the teaching-learning processes. The purpose of this paper is to understand the factors affecting learning effectiveness, learning satisfaction and the mediating role of prerecorded videos from the learners’ perspective. Design/methodology/approach: A self-designed structured questionnaire based on previous similar studies is adopted as a survey instrument. It consists of 22 questions to address the five constructs of the proposed hypothesized conceptual model, developed for the study. Data of 311 students from HEIs of Maharashtra state in India were collected. Confirmatory factor analysis is carried out to test the model fitness, reliability and validity, and structural equation modeling is applied to conduct path analysis and hypotheses testing of the model. Findings: Hypotheses testing reveals that perceived usefulness (PU) significantly affects the perceived learning effectiveness, which again affects the learning satisfaction of the students. In addition, perceived ease of use affects the PU as suggested in the technology acceptance model. The prerecorded videos have a moderating role to play in the computer self-efficacy and the perceived learning effectiveness of the students. This research will provide meaningful acumen to enhance the overall learning process among students in urban as well as rural India. Originality/value: This study explores the technology-mediated learning during the unexpected and dynamic situations of the COVID-19 pandemic in the context of higher education in India. For sustainable use of technology-assisted learning, educators must understand the key factors that influence students’ learning effectiveness and satisfaction. The research outcomes will lead toward developing the human capacities, as the prerecorded videos at the HEIs of India will provide new approaches for effectively adopting digital technologies and technology-mediated learning. © 2022, Emerald Publishing Limited.

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Retinal microvascular signs in COVID-19

BACKGROUND/AIMS: To explore if retinal findings are associated with COVID-19 infection. METHODS: In this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records. RESULTS: 108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs—eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03). CONCLUSION: One in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.

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