Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
Medication adherence in cardiovascular medicine.
Novel coronavirus disease 2019 (COVID-19) continues to affect pregnant women with concerns for adverse maternal and fetal outcomes and is rapidly spreading throughout many countries since it was first reported in China on 31 December 2019 The aim of this study is to describe characteristics, maternal and fetal outcomes among mothers with confirmed maternal SARS-CoV-2 infection This study presents a retrospective observational cohort study of 62 test-positive cases of coronavirus disease 2019 that presented at an affiliated tertiary university medical city from March 2020 to May 2020 A total of 14 patients (22 5%) presented with obvious typical symptoms of coronavirus disease 2019 associated viremia and were identified after they developed symptoms during admission or after the implementation of universal testing for all obstetric admissions A total of 62 mothers were screened positive for the SARS-CoV-2 infection Length of stay was higher in the symptomatic group The median length of stay was 4 days for the asymptomatic cases while it was 6 days for the symptomatic cases Amniotic fluid was meconium stained in (12 5%) of the asymptomatic group and in 30 8% in the symptomatic group Post discharge mothers with asymptomatic SARS-CoV-2 infection were more likely to breastfeed their infants OR (95% CI) was 1 4 (1 02-1 90) and P-value was 0 0327 There was non-statistically significant absence of perinatal morbidities or mortalities among symptomatic and asymptomatic mothers
Consequences of SARS-CoV-2 disease on maternal, perinatal and neonatal outcomes: A retrospective observational cohort study
ETHNOPHARMACOLOGICAL RELEVANCE: The subtribe Hyptidinae contains approximately 400 accepted species distributed in 19 genera (Hyptis, Eriope, Condea, Cantinoa, Mesosphaerum, Cyanocephalus, Hypenia, Hyptidendron, Oocephalus, Medusantha, Gymneia, Marsypianthes, Leptohyptis, Martianthus, Asterohyptis, Eplingiella, Physominthe, Eriopidion and Rhaphiodon). This is the Lamiaceae clade with the largest number of species in Brazil and high rates of endemism. Some species have been used in different parts of the world mainly as insecticides/pest repellents, wound healing and pain-relief agents, as well as for the treatment of respiratory and gastrointestinal disorders. AIM OF THE REVIEW: This review aims to discuss the current status concerning the taxonomy, ethnobotanical uses, phytochemistry and biological properties of species which compose the subtribe Hyptidinae. MATERIALS AND METHODS: The available information was collected from scientific databases (ScienceDirect, Pubmed, Web of Science, Scopus, Google Scholar, ChemSpider, SciFinder ACS Publications, Wiley Online Library), as well as other literature sources (e.g. books, theses). RESULTS: The phytochemical investigations of plants of this subtribe have led to the identification of almost 300 chemical constituents of different classes such as diterpenes, triterpenes, lignans, α-pyrones, flavonoids, phenolic acids and monoterpenes and sesquiterpenes, as components of essential oils. Extracts, essential oils and isolated compounds showed a series of biological activities such as insecticide/repellent, antimicrobial and antinociceptive, justifying some of the popular uses of the plants. In addition, a very relevant fact is that several species produce podophyllotoxin and related lignans. CONCLUSION: Several species of Hyptidinae are used in folk medicine for treating many diseases but only a small fraction of the species has been explored and most of the traditional uses have not been validated by current investigations. In addition, the species of the subtribe appears to be very promising, as alternative sources of podophyllotoxin-like lignans which are the lead compounds for the semi-synthesis of teniposide and etoposide, important antineoplastic agents. Thus, there is a wide-open door for future studies, both to support the popular uses of the plants and to find new biologically active compounds in this large number of species not yet explored.
Subtribe Hyptidinae: a promising source of bioactive metabolites
We estimate the short- to medium term impact of six major past pandemic crises on the CO2 emissions and energy transition to renewable electricity. The results show that the previous pandemics led on average to a 3.4-3.7% fall in the CO2 emissions in the short-run (1-2 years since the start of the pandemic). The effect is present only in the rich countries, as well as in countries with the highest pandemic death toll (where it disappears only after 8 years) and in countries that were hit by the pandemic during economic recessions. We found that the past pandemics increased the share of electricity generated from renewable sources within the fiveyear horizon by 1.9-2.3 percentage points in the OECD countries and by 3.2-3.9 percentage points in countries experiencing economic recessions. We discuss the implications of our findings in the context of CO2 emissions and the transition to renewable energy in the post-COVID-19 era.
The impact of past pandemics on CO$_2$ emissions and transition to renewable energy
OBJECTIVES: To report epidemiological features, clinical characteristics, and outcomes of human rhinovirus (HRV) infections in comparison with other community acquired respiratory virus (CRV) infections in patients hospitalized for two consecutive years. METHODS: This was a cross‐sectional study. Clinical, epidemiological, and laboratory data of patients hospitalized with acute respiratory syndrome in a tertiary care hospital from 2012 to 2013 were reviewed. RESULTS: HRV was the most common CRV observed (36%, 162/444) and was present in the majority of viral co‐detections (69%, 88/128), mainly in association with human enterovirus (45%). Most HRV‐infected patients were younger than 2 years (57%). Overall, patients infected with HRV had a lower frequency of severe acute respiratory infection than those infected with other CRVs (60% and 84%, respectively, p = 0.006), but had more comorbidities (40% and 27%, respectively; p = 0.043). However, in the adjusted analysis this association was not significant. The mortality rate within the HRV group was 3%. Detection of HRV was more prevalent during autumn and winter, with a moderately negative correlation between viral infection frequency and temperature (r = −0.636, p < 0.001) but no correlation with rainfall (r = −0.036, p = 0.866). CONCLUSION: HRV is usually detected in hospitalized children with respiratory infections and is often present in viral co‐detections. Comorbidities are closely associated with HRV infections. These infections show seasonal variation, with predominance during colder seasons.
Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years()
Initial reports suggest that mental health problems were elevated early in the COVID-19 pandemic. However, few studies have followed-up participants as the pandemic evolved and examined both between and within person predictors of symptom trajectories. In the current study, adolescents and young adults (N=532) in New York were surveyed monthly between March 27th and July 14th, 2020, a period spanning the first peak and subsequent decline in COVID-19 infection rates in the region. Surveys assessed symptoms of depression and anxiety using the Child Depression Inventory and the Screen for Child Anxiety Related Disorders, as well as experiences related to the pandemic. Multilevel growth modeling indicated that symptoms of depression and anxiety peaked around late April/early May and then decreased through May-July. Some pandemic experiences followed a similar quadratic trajectory, while others decreased linearly across the study. Specific relationships emerged between some types of pandemic experiences and depression and anxiety symptoms. While symptoms of depression and anxiety in youth may have been elevated early in the pandemic, these findings suggest they subsided across Spring-Summer of 2020, with higher levels of both corresponding to a period of peak infection rates and decreases paralleling the decline in pandemic experiences and COVID-19 infection rates.
Trajectories of depression, anxiety and pandemic experiences; A longitudinal study of youth in New York during the Spring-Summer of 2020.
BACKGROUND: Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic. METHODS: Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO's Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes. RESULTS: Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as "critically low". Identified symptoms of COVID-19 were (range values of point estimates): fever (82-95%), cough with or without sputum (58-72%), dyspnea (26-59%), myalgia or muscle fatigue (29-51%), sore throat (10-13%), headache (8-12%) and gastrointestinal complaints (5-9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%. CONCLUSIONS: In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was "critically low". Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.
Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews
BACKGROUND: Psychiatric disorders increase risk of neuropsychiatric disease and poor outcomes, yet little is known about the neuropsychiatric manifestations of COVID-19 in the psychiatric population. The primary objective is to synthesize neuropsychiatric outcomes of COVID-19 in people with preexisting psychiatric disorders. METHODS: Data were collected during an ongoing review of the impact of pandemics on people with existing psychiatric disorders. All study designs and gray literature were included. Medline, PsychInfo, CINAHL, EMBASE, and MedRx were searched from inception to September 1 2020. Risk of bias was assessed using a published tool that can accommodate all study types. Two independent authors screened the studies and extracted data. Data were narratively synthesized, as there were insufficient data to meta-analyze. Evidence was appraised according to GRADE. RESULTS: Four case reports were included, comprising 13 participants from three countries. Many large-sample, relevant papers were omitted for not reporting psychiatric history, despite reporting other comorbidities. Included participants (n = 13) were hospitalized with COVID-19 and appeared to meet criteria for delirium. Myoclonus, rigidity, and alogia were also reported. The most commonly reported preexisting psychiatric diagnoses were mood disorders, schizophrenia, and alcohol use disorder. CONCLUSIONS: People with preexisting psychiatric disorders may experience delirium, rigidity, myoclonus, and alogia during COVID-19 infection; although higher quality and longitudinal data are needed to better understand these phenomena. Relevant COVID-19 literature does not always report psychiatric history, despite heightened neuropsychiatric vulnerability within this population. Trial Registration: PROSPERO (CRD42020179611). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13256-021-03140-6.
Delirium and other neuropsychiatric manifestations of COVID-19 infection in people with preexisting psychiatric disorders: a systematic review
OBJECTIVE: to describe scientific evidence regarding the use of prone positioning in the care provided to patients with acute respiratory failure caused by COVID-19. METHOD: this is a scoping review. PRISMA Extension for Scoping Reviews was used to support the writing of this study. The search was conducted in seven databases and resulted in 2,441 studies, 12 of which compose the sample. Descriptive statistics, such as relative and absolute frequencies, was used to analyze data. RESULTS: prone positioning was mainly adopted in Intensive Care Units, lasted from a minimum of 12 up to 16 hours, and its prescription was based on specific criteria, such as PaO2/FiO2 ratio, oxygen saturation, and respiratory rate. The most prevalent complications were: accidental extubation, pressure ulcer, and facial edema. Decreased hypoxemia and mortality rates were the main outcomes reported. CONCLUSION: positive outcomes outweighed complications. Various cycles of prone positioning are needed, which may cause potential work overload for the health staff. Therefore, an appropriate number of trained workers is necessary, in addition to specific institutional protocols to ensure patient safety in this context.
Prone positioning as an emerging tool in the care provided to patients infected with COVID-19: a scoping review
De eerste verdedigingslinie, gevormd door het intacte oppervlak van huid en slijmvliezen, is van groot belang voor de afweer tegen micro-organismen. De kwaliteit van deze verdedigingslinie kan worden aangetast door een fysisch of chemisch trauma, waardoor micro-organismen hun kans schoon zien. Ook de processen die bijdragen tot de kwaliteit van deze verdedigingslinie, zoals secretie (o.a. talg, zweet, mucus, maagzuur) en beweging (trilhaaractiviteit, darmmotiliteit en blaaslediging) kunnen worden aangetast. Iatrogene schade aan de eerste verdedigingslinie is niet zeldzaam: injecties, operaties, katheterisaties en medicamenteuze interventies (o.a. antacida, parasympathicolytica, morfinomimetica) kunnen de afweer in negatieve zin beïnvloeden. Hoewel de eerste verdedigingslinie van groot belang is, zal dit hoofdstuk zich vooral richten op een aantal stoornissen in de overige verdedigingslinies, namelijk de humorale en de cellulaire afweer. Afhankelijk van de soort afweerstoornis komen bepaalde infecties voor; omgekeerd kan men aan de hand van de soort infecties die men ziet dikwijls een voorspelling doen over de aard van de afweerstoornis.
Infecties bij patiënten met een gestoorde afweer
As the United States' original epicenter of the COVID-19 pandemic and one of the leading national paediatric heart failure/cardiomyopathy programs, we describe our experience with the spectrum of COVID-19 in the paediatric heart failure population.
Spectrum of clinical presentation of COVID-19 in paediatric patients with cardiomyopathy and heart failure
BACKGROUND: The Kingdom of Saudi Arabia (KSA), as part of its 2030 National Transformation Program, set a goal of transforming the healthcare sector to increase access to, and improve the quality and efficiency of, health services. To assist with the workforce planning component, we projected the needed number of physicians and nurses into 2030. We developed a new needs-based methodology since previous global benchmarks of health worker concentration may not apply to the KSA. METHODS: We constructed an epidemiologic “needs-based” model that takes into account the health needs of the KSA population, cost-effective treatment service delivery models, and worker productivity. This model relied heavily on up-to-date epidemiologic and workforce surveys in the KSA. We used demographic population projections to estimate the number of nurses and physicians needed to provide this core set of services into 2030. We also assessed several alternative scenarios and policy decisions related to scaling, task-shifting, and enhanced public health campaigns. RESULTS: When projected to 2030, the baseline needs-based estimate is approximately 75,000 workers (5788 physicians and 69,399 nurses). This workforce equates to 2.05 physicians and nurses per 1000 population. Alternative models based on different scenarios and policy decisions indicate that the actual needs for physicians and nurses may range from 1.64 to 3.05 per 1000 population in 2030. CONCLUSIONS: Based on our projections, the KSA will not face a needs-based health worker shortage in 2030. However, alternative model projections raise important policy and planning issues regarding various strategies the KSA may pursue in improving quality and efficiency of the existing workforce. More broadly, where country-level data are available, our needs-based strategy can serve as a useful step-by-step workforce planning tool to complement more economic demand-based workforce projections. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-021-00597-w.
A needs-based methodology to project physicians and nurses to 2030: the case of the Kingdom of Saudi Arabia
The article discusses the first-year results of Ukraine's NAQA work -- the agency, whose activity is aimed at ensuring higher education quality The results of the accreditation evaluation of the educational programs of Ukrainian universities are presented More than 60% of the programs have been accredited, about 34% received conditional accreditation with the possibility to rectify the noted shortcomings within 1 year, and in more than 2% of cases HEIs have been refused in accreditation The most changes in the accreditation process because of coronavirus pandemic began in March 2020 It was decided to use the provisional accreditation procedures using information technology tools and videoconferencing to respond to COVID-19 quarantine challenges The current situation forces interview with stakeholders, discussions within the expert group, meetings with HEIs and NAQAs representatives to be done using videoconferencing and other IT tools (distance format) Given the uncertain situation in the world, it is argued that quality assurance agencies should be prepared to address these challenges and should develop alternative approaches and suggestions to pursue the same high quality of the accreditation procedures [ABSTRACT FROM AUTHOR] Copyright of Romanian Journal for Multidimensional Education / Revista Romaneasca pentru Educatie Multidimensionala is the property of Lumen Publishing House 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 )
Educational Programs Accreditation in Pandemic Times: Challenges for NAQA (Ukraine)
This article aims to examine the experiences of human resource professionals (HRPs) in managing crises posed by the COVID-19 pandemic Employing qualitative research methodology, in-depth interviews with 24 HRPs of different industries were carried out The findings indicate how the HRPs have navigated through five phases of the crisis as (a) anticipatory;(b) crisis;(c) adjustment;(d) rebounding;(e) continuance or reverting to old ways, struggling with many decisions and actions The periods that companies took to navigate these different stages and the success of how they faced the crises posed by the pandemic mainly depend on factors such as the level of preparedness, nature of the industry, availability of resources, and role of the HRPs The learning from the experiences of the HRPs and the phases they have navigated through will help to successfully manage similar crises in the future
Navigating the Crises of COVID-19: Human Resource Professionals Battle Against the Pandemic
We analyzed first-dose coronavirus disease vaccination coverage among US children 5–11 years of age during November–December 2021. Pediatric vaccination coverage varied widely by jurisdiction, age group, and race/ethnicity, and lagged behind vaccination coverage for adolescents aged 12–15 years during the first 2 months of vaccine rollout.
Disparities in First Dose COVID-19 Vaccination Coverage among Children 5–11 Years of Age, United States
Recent advances in large-scale pre-training such as GPT-3 allow seemingly high quality text to be generated from a given prompt. However, such generation systems often suffer from problems of hallucinated facts, and are not inherently designed to incorporate useful external information. Grounded generation models appear to offer remedies, but their training typically relies on rarely-available parallel data where information-relevant documents are provided for context. We propose a framework that alleviates this data constraint by jointly training a grounded generator and document retriever on the language model signal. The model learns to reward retrieval of the documents with the highest utility in generation, and attentively combines them using a Mixture-of-Experts (MoE) ensemble to generate follow-on text. We demonstrate that both generator and retriever can take advantage of this joint training and work synergistically to produce more informative and relevant text in both prose and dialogue generation.
RetGen: A Joint framework for Retrieval and Grounded Text Generation Modeling
Sub-Saharan Africa has generally experienced few cases and deaths of coronavirus disease 2019 (COVID-19). In addition to other potential explanations for the few cases and deaths of COVID-19 such as the population socio-demographics, early lockdown measures and the possibility of under reporting, we hypothesize in this mini review that individuals with a recent history of malaria infection may be protected against infection or severe form of COVID-19. Given that both the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Plasmodium falciparum (P. falciparum) merozoites bind to the cluster of differentiation 147 (CD147) immunoglobulin, we hypothesize that the immunological memory against P. falciparum merozoites primes SARS-CoV-2 infected cells for early phagocytosis, hence protecting individuals with a recent P. falciparum infection against COVID-19 infection or severity. This mini review therefore discusses the potential biological link between P. falciparum infection and COVID-19 infection or severity and further highlights the importance of CD147 immunoglobulin as an entry point for both SARS-CoV-2 and P. falciparum into host cells.
Less Severe Cases of COVID-19 in Sub-Saharan Africa: Could Co-infection or a Recent History of Plasmodium falciparum Infection Be Protective?
Science and health journalists have incorporated digital media as a source for their daily news production process, but little is known about the potential impacts of using digital media data to inform the news production process in the context of a global pandemic, where information is rapidly changing During the COVID-19 pandemic, families have struggled to ensure economic stability and good health as well as their children?s learning and development The Child Trends News Service sought to broaden access to science-based information to support families during the pandemic through television news, testing whether digital media can be used to understand parents? concerns, misconceptions, and needs in real time This article presents that digital media data can supplement traditional ways of conducting audience research and help tailor relevant content for families to garner an average of 90 million views per report
An Analysis of Digital Media Data to Understand Parents’ Concerns During the COVID-19 Pandemic to Enhance Effective Science Communication
Background In late December 2019, an outbreak of a novel coronavirus disease (COVID-19; previously known as 2019-nCoV) was epidemiologically linked to seafood and wet animal wholesale market in Wuhan, Hubei, China. This has instigated stigma among the general population as the wet market is viewed as a high-risk location for getting infected with coronavirus. Objective This study investigated the prevalence of facemask use among general population visiting the wet market. This study also investigated the demographic factors contributing to unacceptable facemask practice. Setting This prospective observational study was done among visitor to a district wet market selling range of live or freshly slaughtered animals during COVID-19 pandemic outbreak. Methods Individuals entering through dedicated entry point were observed for the type, category and practice of wearing personal protective equipment. Inclusion criteria for this study were any individuals entering the wet market. Subjects were categorized into two groups of acceptable and unacceptable facemask practice. The Pearson chi-square was used to test for differences in investigated variables in the univariate setting and Binary Logistic regression model was used in the multivariate setting. Main outcome measure Prevalence, acceptance practice and odds ratio of unacceptance of facemask use. Results Among 1697 individuals included in the final analysis, 1687 (99.7%) was observed wearing facemask with 1338 (78.8%) using medical-grade facemask. Among them, 1615 (95.7%) individuals facemask practice was acceptable while the reaming 72 (4.3%) individuals were observed with unacceptable facemask practice. Individuals using medical-grade facemask and high-risk age group are 6.4 times (OR=6.40; 95% CI, 2.00-20.43; p=.002) and 2.06 times practice (OR=2.06; 95% CI, 1.08-3.94; p=.028). More likely to practice unacceptable facemask use respectively. Conclusion High saturation of facemask among the general population is an adequate indicator of public hygiene measures strategy which can help to mitigate the COVID-19 epidemic impact. Alarmingly, the unacceptable facemask practice among high-risk population raises the need for a targeted approach by healthcare authorities to ensure satisfactory facemask use.
Prevalence of facemask use among general public when visiting wet market during Covid-19 pandemic: An observational study.
Background: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China in December 2019 has led to a pandemic. Influenza and coronaviruses are known to show cross-reactive immunity. Therefore, we hypothesized that influenza vaccination may provide a protective effect against SARS-CoV-2.Methods: We investigated the presence of SARS-CoV-2 in flu vaccinated and unvaccinated ILI cases by real time PCR, followed by confirmation of evolutionary and spatial relationships using next generation sequencing (NGS).Results: Out of 739 nasopharyngeal specimens collected from November 2019 to March 2020, we found 37 samples were positive for SARS-CoV-2 RNA mostly during February 2020. We observed that the overall incidence of ILI cases during 2019-2020 influenza season was considerably higher than previous years and was gradually replaced with SARS-CoV-2 which indicated a slow transmission among ambulatory patients. NGS data confirmed independent introductions and transmission earlier than previously thought. Phylogenetic reconstruction of representative isolates showed clustering in the GH clade which is characterized by two amino acid changes in spike gene (D614G) and NS3 (Q57H). Shortness of breath was significantly lower (p = 0.04) in the ILI cases with the history of influenza vaccination suggesting a protective effect of the influenza vaccine, at least in part, on COVID-19 disease outcomes.Conclusions: The detection of SARS-CoV-2 among ILI patients shows the importance of flu vaccination and ILI surveillance system and warrants their further strengthening to mitigate the ongoing transmission of SARS-CoV-2 and to guide policy makers to optimize public health interventions.Funding Statement: This work was supported by the Research Center at King Fahad Medical city (Grant No 20- 066).Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Ethics Approval Statement: The study was approved by the Institutional Review Board at King Fahad Medical City (IRB Log No. 19-477 approved on 25 September 2019) for influenza vaccine effectiveness study, started from 7 November 2019. When COVID-19 pandemic started, the collection of samples stopped on the 2nd of March 2020. To screen those samples for SARS-CoV-2, we applied for another IRB (Log No. 20-161 approved on 23 March 2020).
Silent Transmission of SARS-CoV-2 Among Ambulatory Influenza Like Illness (ILI) Patients
Objectives: In this unprecedented era of conducting clinical research during a global pandemic a Patient-Reported Outcomes (PRO) tool is required to (1) provide a comprehensive epidemiological understanding of SARS-COV-2 (COVID-19) symptoms, clustering and resolution;(2) provide data on the impact of both infection and the pandemic on people’s lives;and (3) offer a full understanding of treatment benefit in studies designed to treat or vaccinate against COVID-19 Methods: A review of the literature (March 2020) used COVID-19 and signs, symptoms and impacts search terms A preliminary conceptual model was developed and novel PRO items were drafted A review of social media (June 2020) informed an updated conceptual model and PRO items Joint concept elicitation-cognitive interviews were completed with people who had experienced COVID-19 (June-July 2020) Results: The literature (25 articles), social media (&gt;200 million mentions) and interviews (n=10) highlighted a heterogenous list of signs, symptoms and impacts of COVID-19 infections, and a broad list of impacts of the pandemic in general Novel PROs are intended to be comprehensive, so the incidence and severity of 42 signs and symptoms are measured Fifteen additional items ask about the impact of infection (physical, emotional and social) and 18 about the impact of the pandemic The PRO is adaptive (modular) to allow administration to people with and without COVID-19 infection Weekly- and daily-recall versions were tested in cognitive interviews resulting in adjustments to ensure understandability Conclusions: Novel content-valid PROs have been developed to measure the signs, symptoms and impacts of COVID-19 pandemic and infection These are currently being employed in a large longitudinal study to evaluate their psychometric measurement properties
PIN167 Patient-Reported Outcomes to Capture the Signs, Symptoms and Impacts of COVID-19 and the IMPACT of the Pandemic on People with and without Infection
INTRODUCTION Fast and accurate detection of SARS-CoV-2 is essential in limiting the COVID-19 pandemic. Rapid antigen (AG) tests provide results within minutes; however, their accuracy has been questioned. The study aims to determine the accuracy and cost of the STANDARD Q COVID-19 AG test compared with RT-PCR. METHODS Individuals 18 years or older with an appointment for a RT-PCR test on 26-31 December 2020 at a public test centre in Copenhagen, Denmark were invited to participate. An oropharyngeal swab was collected for RT-PCR analysis, followed by a nasopharyngeal swab examined by the AG test (SD Biosensor). The diagnostic accuracy of the AG test was calculated with RT-PCR as reference. Costs were evaluated for both tests. RESULTS A total of 4,811 paired conclusive test results were collected (median age: 45 years, female: 53%). The RT-PCR test revealed 221 (4.6%) positive tests. The overall sensitivity and specificity of the AG test were 69.7% and 99.5%, respectively. Viral cycle threshold values were significantly higher in individuals with false negative AG tests than in individuals who were true positives. The RT-PCR test and AG test costs were 67.0 DKK (10.8 USD) and 35.0 DKK (5.7 USD), respectively, per positive case detected at 100,000 daily tests. CONCLUSIONS The AG test enables mass testing and provides immediate results, which is important in SARS-CoV-2 screening. The AG test is a good and relevant supplement to RT-PCR testing in public SARS-CoV-2 screenings. FUNDING This project received no external funding. Copenhagen Medical A/S delivering the rapid AG tests and provided test personnel but were not otherwise involved. TRIAL REGISTRATION NCT04716088.
Accuracy and cost description of rapid antigen test compared with reverse transcriptase-polymerase chain reaction for SARS-CoV-2 detection.
Immune checkpoint inhibitors (ICIs) harness the immune system and are the therapy of choice for multiple cancers. Although immunosuppressive agents such as steroids are also used in many cancers, it is unknown how their timing affects treatment outcomes. Thus, we investigated the relationship between the timing of steroid exposure preceding ICI administration and subsequent treatment outcomes in melanoma. This population-based study utilized the SEER-Medicare-linked database to identify patients diagnosed with melanoma between 1991 and 2015 and receiving ICIs between 2010 and 2016, examining last steroid exposure in the 12 months preceding ICI. The main outcome was all-cause mortality (ACM) after ICIs. Modifications of the Cox proportional hazards model were used to calculate time-dependent hazards. Of 1671 patients with melanoma receiving ICIs, 907 received steroids. Compared with no steroids, last steroid exposures ≤1 month and 1-3 months prior to ICIs were associated with a 126% and 51% higher ACM within 3 months post ICI initiation, respectively (hazard ratio (HR): 2.26, 95% CI: 1.65-3.08; and HR: 1.51, 95% CI: 1.01-2.27). Steroid exposure within 3 months of initiating ICIs was associated with increased mortality up to 6 months after ICI. Further investigation is warranted to elucidate mechanisms affecting outcomes due to steroids.
Is Timing of Steroid Exposure Prior to Immune Checkpoint Inhibitor Initiation Associated with Treatment Outcomes in Melanoma? A Population-Based Study
Storms of this magnitude coupled with floodwater inundation reveal how complex the sources and types of chemical and elemental hazards can be, hazards that include pollutants mobilized from hazardous waste sites, oil spills, and formaldehyde off-gassing in temporary housing units 1 Adverse respiratory outcomes associated with both acute and chronic exposures to particulate matter, including biological and chemical hazards, were prevalent in Katrina disaster victims, first responders, and the workforce, including transient volunteers, who are typically involved in remediation, demolition, and cleanup of affected residential and industrial areas 2 Noise exposure and heat stress associated with heavy equipment use and physical labor during summer months in hurricane-prone regions are consistent sources of disaster-related injury Duration and frequency of exposures must be considered in addition to the levels or concentrations of the pollutants Because proper and accurate exposure assessments were and continue to be poorly documented before and after disasters, it remains a public health challenge to clearly associate exposures with particular chemicals or toxins with adverse health outcomes Excessive standing floodwaters, flooded swimming pools, and warmer temperatures after Katrina provided optimal conditions for mosquito larvae, including the vector of West Nile virus;cases of West Nile fever nearly doubled compared with previous years but have since stabilized to average ranges 4 The crowding of infected and susceptible hosts, interruptions of ongoing control programs, and a weakened public health infrastructure further increased risk factors for the transmission of vector-borne diseases Correspondence should be sent to Stephen A Murphy, Assistant Professor, Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2100, New Orleans, LA 70112 (e-mail: smurphy1@ tulane edu)
The Environmental Health and Emergency Preparedness Impacts of Hurricane Katrina
Penelitian ini dilakukan untuk mengetahui dampak pandemi COVID-19 terhadap perusahaan yang ada di Tangerang Selatan apa yang dilakukan oleh perusahaan terhadap dirinya dan karyawan yang ada untuk mengetahui stres kerja yang dihadapai oleh karyawan dan langkah-langkah apa saja yang diambil oleh karyawan untuk mengelola stres kerja dan dapat menyesuaikan sistem kerja dengan kondisi yang ada saat ini. Penelitian ini menggunakan metode studi pustaka dengan mengkaji buku-buku peraturan pemerintah yang berlaku saat pandemi COVID-19 observasi ke perusahaan yang berada di daerah Tangrang Selatan dan wawancara kepada beberapa karyawan sebagai sampel mengenai dampak dari pandemi COVID-19 dan langkah-langkah apa yang bisa dilakukan oleh karyawan untuk menanggulangi stres kerja yang ada. Hasil dari penelitian ini adalah perusahaan melakukan: tetap beroperasi tes rapid dan PCR protokol kesehatan karyawan panas tinggi dan sakit tidak diperkenankan masuk shift kerja pemutusan karyawan magang dan kontrak yang habis waktunya dan pengurangan upah yang diterima bulanan dan tunjangan-tunjangan. Karyawan kerja dari rumah dan bergilir ke kantor untuk proses produksi pemasaran dan pelayanan pelanggan dan untuk menanggulangi stres kerja hal yang dilakukan karyawan adalah berdoa olah raga wfh hindari kerumunan dan alat transportasi publik konsumsi makanan sehat dan vitamin bisnis dari rumah dan menekuni hobi yang bermanfaat. Kata kunci: Stres kerja covid karyawan perusahaan
Pengelolaan stres kerja karyawan saat pandemi COVID-19 pada perusahaan di Tangerang selatan
(1) Background: Persistent olfactory (POD) and gustatory (PGD) dysfunctions are one of the most frequent symptoms of long-Coronavirus Disease 2019 but their effect on the quality of life (QoL) of patients is still largely unexplored. (2) Methods: An online survey was administered to individuals who reported to have had SARS-CoV-2 infection at least 6 months prior with persisting COVID-19 symptoms (using the COVID symptom index), including ratings of POD and PGD, and their physical (PCS) and mental (MCS) components of quality of life were assessed using the standardized short form 12 questionnaire (SF-12). (3) Results: Responses from 431 unique individuals were included in the analyses. The most frequent persistent symptoms were: fatigue (185 cases, 42.9%), olfactory dysfunction (127 cases, 29.5%), gustatory dysfunction (96 cases, 22.3%) and muscle pain (83 cases, 19.3%). Respondents who reported persisting muscle pain, joint pain, fatigue, headache, gastrointestinal disturbances, and dyspnea had significantly worse PCS. Those experiencing persistent fatigue and dyspnea also showed significantly lower MCS. Respondents reporting POD or PGD showed significantly worse QoL, but only pertaining to the MCS. Multiple regressions predicted MCS based on olfactory and marginally on gustatory ratings, but not PCS. Age significantly affected the prediction of PCS but not MCS, and gender and temporal distance from the COVID-19 diagnosis had no effect. (4) Conclusions: POD and PGD are frequent symptoms of the long-COVID-19 syndrome and significantly reduce QoL, specifically in the mental health component. This evidence should stimulate the establishment of appropriate infrastructure to support individuals with persistent CD, while research on effective therapies scales up.
The Effects of Persistent Olfactory and Gustatory Dysfunctions on Quality of Life in Long-COVID-19 Patients
Tocilizumab is a humanized monoclonal antibody to the interleukin-6 (IL-6) receptor which was first approved for use in refractory rheumatoid arthritis almost a decade ago. Since then, its use has expanded to a number of rheumatological and inflammatory conditions. In dermatology, off-label use of tocilizumab has been reported to be efficacious in morphoea, systemic sclerosis, psoriasis, atopic dermatitis, vitiligo, graft-versus-host disease, pyoderma gangrenosum, Behcet's disease, Schnitzler's syndrome, sarcoidosis, and cutaneous adverse reactions. That being said, the evidence demonstrating tocilizumab's efficacy in dermatology is predominantly low-level case-based evidence, and one must consider the potential for publication bias. In this review we will discuss the reported clinical applications of tocilizumab in dermatology, mechanisms of action, and the range of associated adverse effects (both cutaneous and non-cutaneous) that can occur. Additionally, we will discuss the role of tocilizumab in the management of COVID-19.
Does tocilizumab have a role in dermatology? A review of clinical applications, its adverse side effects and practical considerations
The previous outbreaks of SARS-CoV and MERS-CoV have led researchers to study the role of diagnostics in impediment of further spread and transmission. With the recent emergence of the novel SARS-CoV-2, the availability of rapid, sensitive, and reliable diagnostic methods is essential for disease control. Hence, we have developed a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay for the specific detection of SARS-CoV-2. The primer sets for RT-LAMP assay were designed to target the nucleocapsid gene of the viral RNA, and displayed a detection limit of 10(2) RNA copies close to that of qRT-PCR. Notably, the assay has exhibited a rapid detection span of 30 min combined with the colorimetric visualization. This test can detect specifically viral RNAs of the SARS-CoV-2 with no cross-reactivity to related coronaviruses, such as HCoV-229E, HCoV-NL63, HCoV-OC43, and MERS-CoV as well as human infectious influenza viruses (type B, H1N1pdm, H3N2, H5N1, H5N6, H5N8, and H7N9), and other respiratory disease-causing viruses (RSVA, RSVB, ADV, PIV, MPV, and HRV). Furthermore, the developed RT-LAMP assay has been evaluated using specimens collected from COVID-19 patients that exhibited high agreement to the qRT-PCR. Our RT-LAMP assay is simple to perform, less expensive, time-efficient, and can be used in clinical laboratories for preliminary detection of SARS-CoV-2 in suspected patients. In addition to the high sensitivity and specificity, this isothermal amplification conjugated with a single-tube colorimetric detection method may contribute to the public health responses and disease control, especially in the areas with limited laboratory capacities.
Development of a reverse transcription-loop-mediated isothermal amplification as a rapid early-detection method for novel SARS-CoV-2
Background: Since December 2019, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first spread quickly in Wuhan, China, then globally Based on previously published evidence, ACE2 and TMPRSS2 are both pivotal entry molecules that enable cellular infection by SARS-CoV-2 Also, increased expression of pro-inflammatory cytokines, or a "cytokine storm," is associated with multiple organ dysfunction syndrome often observed in critically ill patients Methods: We investigated the expression pattern of ACE2 and TMPRSS2 in major organs in the human body, especially in specific disease conditions Multiple sequence alignment of ACE2 in different species was used to explain animal susceptibility Moreover, the cell-specific expression patterns of ACE2 and cytokine receptors in the urinary tract were assessed using single-cell RNA sequencing (scRNA-seq) Additional biological relevance was determined through Gene Set Enrichment Analysis (GSEA) using an ACE2-specific signature Results: Our results revealed that ACE2 and TMPRSS2 were highly expressed in genitourinary organs ACE2 was highly and significantly expressed in the kidney among individuals with chronic kidney diseases or diabetic nephropathy In single cells, ACE2 was primarily enriched in gametocytes in the testis and renal proximal tubules The receptors for pro-inflammatory cytokines, especially IL6ST, were notably concentrated in endothelial cells, macrophages, spermatogonial stem cells in the testis, and renal endothelial cells, which suggested the occurrence of alternative damaging autoimmune mechanisms Conclusion: This study provided new insights into the pathogenic mechanisms of SARS-CoV-2 that underlie the clinical manifestations observed in the human testis and kidney These observations might substantially facilitate the development of effective treatments for this rapidly spreading disease
Multiple Expression Assessments of ACE2 and TMPRSS2 SARS-CoV-2 Entry Molecules in the Urinary Tract and Their Associations with Clinical Manifestations of COVID-19
The aim of the study is to evaluate the effect of Aronia melanocarpa fruit juice (AMJ) supplementation on age-related coronary arteries remodeled in aged rat hearts. Male Wistar rats (n = 24) were divided into three groups: (1) young controls (CY), aged 2 months, without AMJ supplementation; (2) old controls (CO), aged 27 months, without AMJ supplementation; and (3) the AMJ group (A), which used 27-month old animals, supplemented orally with AMJ for 105 days. AMJ supplementation did not influence the wall-to-diameter parameter (Kernohan index) of the coronary arteries of test animals. Aged rats supplemented with AMJ showed a significant decrease in the amount of collagen fibers in their coronary tunica media, as compared with the old controls. The intensity of the immunoreaction for alpha smooth muscle actin (αSMA) in the coronary tunica media was significantly lower in the supplemented group than in the old controls. The intensity of the angiotensin-converting enzyme 2 (ACE2) immunoreaction in the coronary tunica media of the supplemented group was significantly higher than the one observed in the old controls. These results indicate the positive effects of AMJ supplementation on the age-dependent remodeling of coronary arteries and support for the preventive potential of antioxidant-rich functional food supplementation in age-related diseases.
Aronia melanocarpa Fruit Juice Modulates ACE2 Immunoexpression and Diminishes Age-Related Remodeling of Coronary Arteries in Rats
BACKGROUND: Observation status (OBS) stays incur similar costs to low-acuity, short-stay inpatient (IP) hospitalizations. Despite this, payment for OBS is likely less and may represent a financial liability for children's hospitals. Thus, we described the financial outcomes associated with OBS stays compared to similar IP stays by hospital and payer. METHODS: We conducted a retrospective cohort study of clinically similar pediatric OBS and IP encounters at 15 hospitals contributing to the revenue management program in 2017. Clinical and demographic characteristics were described. For each hospitalization, the cost coverage ratio (CCR) was calculated by dividing revenue by estimated cost of hospitalization. Differences in CCR were evaluated using Wilcoxon rank sum tests and results were stratified by billing designation and payer. CCR for OBS and IP stays were compared by institution, and the estimated increase in revenue by billing OBS stays as IP was calculated. RESULTS: OBS was assigned to 70 981 (56.9%) of 124 789 hospitalizations. Use of OBS varied across hospitals (8%-86%). For included hospitalizations, OBS stays were more likely than IP stays to result in financial loss (57.0% vs 35.7%). OBS stays paid by public payer had the lowest median CCR (0.6; interquartile range [IQR], 0.2-0.9). Paying OBS stays at the median IP rates would have increased revenue by $167 million across the 15 hospitals. CONCLUSIONS: OBS stays were significantly more likely to result in poor financial outcomes than similar IP stays. Costs of hospitalization and billing designations are poorly aligned and represent an opportunity for children's hospitals and payers to restructure payment models.
Financial Implications of Short Stay Pediatric Hospitalizations
BACKGROUND: Infectious diseases remain a major public health problem worldwide. Hence, their surveillance is critical. Currently, many surveillance strategies and systems are in use around the world. An inventory of the data, surveillance strategies, and surveillance systems developed worldwide for the surveillance of infectious diseases is presented herein, with emphasis on the role of the microbiology laboratory in surveillance. METHODS: The data, strategies, and systems used around the world for the surveillance of infectious diseases and pathogens, along with current issues and trends, were reviewed. RESULTS: Twelve major classes of data were identified on the basis of their timing relative to infection, resources available, and type of surveillance. Two primary strategies were compared: disease-specific surveillance and syndromic surveillance. Finally, 262 systems implemented worldwide for the surveillance of infections were registered and briefly described, with a focus on those based on microbiological data from laboratories. CONCLUSIONS: There is currently a wealth of available data on infections, which has been growing with the recent emergence of new technologies. Concurrently with the expansion of computer resources and networks, these data will allow the optimization of real-time detection and notification of infections.
Traditional and syndromic surveillance of infectious diseases and pathogens
Ixodes pacificus ticks can harbor a wide range of human and animal pathogens. To survey the prevalence of tick-borne known and putative pathogens, we tested 982 individual adult and nymphal I. pacificus ticks collected throughout California between 2007 and 2009 using a broad-range PCR and electrospray ionization mass spectrometry (PCR/ESI-MS) assay designed to detect a wide range of tick-borne microorganisms. Overall, 1.4% of the ticks were found to be infected with Borrelia burgdorferi, 2.0% were infected with Borrelia miyamotoi and 0.3% were infected with Anaplasma phagocytophilum. In addition, 3.0% were infected with Babesia odocoilei. About 1.2% of the ticks were co-infected with more than one pathogen or putative pathogen. In addition, we identified a novel Anaplasmataceae species that we characterized by sequencing of its 16S rRNA, groEL, gltA, and rpoB genes. Sequence analysis indicated that this organism is phylogenetically distinct from known Anaplasma species with its closest genetic near neighbors coming from Asia. The prevalence of this novel Anaplasmataceae species was as high as 21% at one site, and it was detected in 4.9% of ticks tested statewide. Based upon this genetic characterization we propose that this organism be called ‘Candidatus Cryptoplasma californiense’. Knowledge of this novel microbe will provide awareness for the community about the breadth of the I. pacificus microbiome, the concept that this bacterium could be more widely spread; and an opportunity to explore whether this bacterium also contributes to human or animal disease burden.
Survey of Ixodes pacificus Ticks in California Reveals a Diversity of Microorganisms and a Novel and Widespread Anaplasmataceae Species
BACKGROUND: Emotional Intelligence (EI) and mindfulness can impact the level of anxiety and depression that an individual experiences These symptoms have been exacerbated in college students during the COVID-19 pandemic AjivarTM is an application that utilizes artificial intelligence (AI) and machine learning (ML) to deliver personalized mindfulness and EI training OBJECTIVE: The main objective of this research study was to determine the effectiveness of delivering an EI curriculum and mindfulness techniques using an AI conversation platform, AjivarTM to improve symptoms of anxiety and depression during this pandemic METHODS: 95 subjects ages 18-29 years were recruited from a second semester freshmen of students All participants completed the online TestWell inventory at the start and at the end of the 14 week semester The comparison group (n=45) was given routine mental wellness instruction The intervention group (n=50) were required to complete AjivarTM activities in addition to routine mental wellness instruction during the semester, which coincided with the onset of the COVID-19 pandemic This group also completed assessments to evaluate for anxiety (Generalized Anxiety Disorder scale, GAD-7) and depression (Patient Health Questionnaire, PHQ-9) RESULTS: Study participants were 19 81 9 years old, 28% males (27/95), and 60% Caucasian No significant demographic differences existed between the comparison and intervention groups Subjects in the intervention group interacted with AjivarTM for a mean of 14241168 minutes There was a significant decrease in anxiety as measured by GAD-7 (11 471 85 at the start of the study compared to 6 271 44, P&lt;0 01, at the end) There was a significant reduction in the symptoms of depression measured by PHQ-9 (10 692 04 vs 6 692 41, P&lt;0 01) Both the intervention and the comparison groups independently had significant improvements in pre-post TestWell inventory The subgroups in the inventory for social awareness and spirituality showed significant improvement in the intervention group In a group of participants (n=11) where GAD-7 was available during the onset of the COVID-19 pandemic, it showed an increase in anxiety (11 012 16 at the start to 13 031 34, P=0 23) in mid-March (onset of pandemic) to a significant decrease at the end of the study period (6 31 44, P&lt;0 01) CONCLUSIONS: It is possible to deliver EI and mindfulness training in a scalable way using the AjivarTM app during the COVID-19 pandemic resulting in improvements in anxiety, depression, and EI in the college population
Study of the Novel AI-Powered Emotional Intelligence and Mindfulness App (Ajivar) for the College population during the COVID-19 Pandemic
Idiopathic pulmonary fibrosis (IPF) is a specific clinicopathologic ­syndrome presenting in older adults with the predominant features: dyspnea, dry cough, restrictive defect on pulmonary function tests (PFTs), hypoxemia, characteristic abnormalities on high-resolution thin section computed tomographic (HRCT) scans, usual interstitial pneumonitis (UIP) pattern on lung biopsy. Surgical lung biopsy is the gold standard of diagnosis, but the diagnosis can be established in some cases by HRCT, provided the clinical features are consistent. The cause of IPF is unknown. However, IPF is more common in adults >60 years old, smokers (current or ex), and patients with specific occupational or noxious exposures. Familial IPF, associated with several distinct genetic mutations, accounts for 1.5–3% of cases. Unfortunately, the prognosis is poor, and most patients die of respiratory failure within 3–6 years of diagnosis. However, the course is highly variable. In some patients, the disease is fulminant, progressing to lethal respiratory failure within months, whereas the course may be indolent, spanning >5 years in some patients. Therapy has not been proven to alter the course of the disease or influence mortality, but recent studies with pirfenidone and tyrosine kinase inhibitors are promising. Lung transplantation is the best therapeutic option, but is limited to selected patients with severe, life-threatening disease and no contraindications to transplant.
Idiopathic Pulmonary Fibrosis
From here, Burnham abides to a relatively normal format, and through a visual circus of discreet sketches and musical numbers, with increasingly impressive choreography and lighting, he comments on and satirises the current state of society or “the way the world works”. From this point, the template for the special fades and we find ourselves watching a conflicted and overly self-aware creator, at odds with himself, struggling to piece together a special that he cannot help but over-analyse. The song's descent into madness and the non-sensical mirrors the truly strange and surreal experience of life in lockdown.
The truth inside the comedy
The escape from a potential well is an archetypal problem in the study of stochastic dynamical systems, representing real-world situations from chemical reactions to leaving an established home range in movement ecology. Concurrently, L{\'e}vy noise is a well-established approach to model systems characterized by statistical outliers and diverging higher-order moments, ranging from gene expression control to the movement patterns of animals and humans. Here, we study the problem of L\'evy noise-driven escape from an almost rectangular, arctan potential well restricted by two absorbing boundaries. We unveil analogies of the observed transient dynamics to the general properties of stationary states of L{\'e}vy processes in single-well potentials. The first escape dynamics is shown to exhibit exponential tails. We examine the dependence of the escape on the shape parameters, steepness and height, of the arctan potential. Finally, we explore in detail the behavior of the probability densities of the first-escape time and the last-hitting point.
L\'evy noise-driven escape from arctan potential wells
Amidst a global pandemic, outrage and anger over the death of a Black man at the hands of a White police officer spread globally. The protests exposed generations of institutional racism and socio-economic inequities in many countries. This editorial explores the socio-economic inequities that have left those in racially segregated marginalized communities most at risk from COVID 19. It offers a cyclical view of the relationship between socio-economic inequities and health outcomes, suggesting that once these inequities are addressed, then health outcomes can improve. There is an important role to be played by ICTs in enabling a positive cycle to take place. The papers in this issue reflect the ways in which the socio-economic indicators can be increased to support better health outcomes for people in low SES communities. They uncover the key issues facing communities offering healthcare service to their constituents and move the field forward by showing the ways in which ICTs may support a positive cycle of development and health outcomes.
Outrage and anger in a global pandemic: flipping the script on healthcare
This research aims at investigating the response of the stock market to the WHO announcement on 11th of March 2020 which officially declares the spread of the COVID-19 virus as a global pandemic A total of 77 countries’ major indices have been examined by this research The results show that (1) the pandemic announcement provides considerable negative shock on the global stock market;(2) country with different income presents a different response to the announcement In general, the stock market in higher-income country tends to be overreacted at the beginning and bounds back more rapidly than lower-income country
The Response of the Stock Market to the Announcement of Global Pandemic
Real-time reverse transcription-PCR (RT-PCR) is currently the most sensitive method to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). However, the correlation between detectable viral RNA and culturable virus in clinical specimens remains unclear. Here, we performed virus culture for 60 specimens that were confirmed to be positive for SARS-CoV-2 RNA by real-time RT-PCR. The virus could be successfully isolated from 12 throat and nine nasopharyngeal swabs and two sputum specimens. The lowest copy number required for virus isolation was determined to be 5.4, 6.0, and 5.7 log(10) genome copies/ml sample for detecting the nsp12, E, and N genes, respectively. We further examined the correlation of genome copy number and virus isolation in different regions of the viral genome, demonstrating that culturable specimens are characterized by high copy numbers with a linear correlation observed between copy numbers of amplicons targeting structural and nonstructural regions. Overall, these results indicate that in addition to the copy number, the integrity of the viral genome should be considered when evaluating the infectivity of clinical SARS-CoV-2 specimens.
Culture-Based Virus Isolation To Evaluate Potential Infectivity of Clinical Specimens Tested for COVID-19
The presence of CD4+ T cells in the healthy brain parenchyma remains controversial due to the barrier function of the glia limitans. Pasciuto, Burton, Roca et al. in Cell describe the dynamic recruitment of CD4+ T cells within the brain parenchyma, their unexpected contribution to microglial maturation, and, ultimately, their influence on behavior.
Microglia Get a Little Help from "Th"-eir Friends.
PURPOSE: To evaluate the effects of early combination therapy with intravenous vitamin C and thiamine on recovery from organ failure in patients with septic shock. METHODS: The ascorbic acid and thiamine effect in septic shock (ATESS) trial was a multi-centre, double-blind, randomized, controlled trial conducted in four academic emergency departments, enrolling adult patients with septic shock from December 2018 through January 2020. Patients were randomly assigned in a 1:1 ratio to either the treatment group [intravenous vitamin C (50 mg/kg, maximum single dose 3 g) and thiamine (200 mg) administration every 12 h for a total of 48 h] or the placebo group (identical volume of 0.9% saline with the same protocol). The primary outcome was Δ Sequential Organ Failure Assessment (SOFA) score (SOFA score at enrolment–SOFA score after 72 h). Eighteen secondary outcomes were predefined, including shock reversal and 28-day mortality. RESULTS: A total of 111 patients were enrolled, of which 53 were assigned to the treatment group and 58 were assigned to the placebo group. There was no significant difference in ΔSOFA scores between the treatment group and the placebo group [3, interquartile range (IQR) − 1 to 5 vs. 3, IQR 0–4, respectively, p = 0.96]. Predefined secondary outcomes were also not significantly different between the groups. CONCLUSION: In this study, vitamin C and thiamine administration in the early phase of septic shock did not improve organ function compared with placebo, despite improvements in vitamin C and thiamine levels. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06191-3) contains supplementary material, which is available to authorized users.
Combination therapy of vitamin C and thiamine for septic shock: a multi-centre, double-blinded randomized, controlled study
The COVID-19 pandemic has seriously impacted the management and trajectory of same-sex relationships This study considered the mediational role of same-sex partners? conflict avoidance and the moderating roles of individual and contextual vulnerability factors in the face of the pandemic Results showed that greater adverse daily life impacts and higher perceived threat of COVID-19 predicted more complaint avoidance, which in turn predicted lower relationship satisfaction and higher anxiety, depression, and substance use Being a person of color and having higher internalized homophobia exacerbated the pandemic?s negative effects on relationship satisfaction While moving in with partners during the pandemic was related to more complaint avoidance, lower relational satisfaction, higher relationship termination intentions, and greater mental health risks, it also buffered the negative effects of the pandemic on relational well-being Same-sex couples are encouraged to constructively solve relational issues and actively discuss moving in decisions More efforts should be devoted to understanding multiple pandemic-related stressors facing same-sex couples
The impact of the COVID-19 pandemic on same-sex couples’ conflict avoidance, relational quality, and mental health
IMPORTANCE: Respiratory syncytial virus (RSV) is a leading cause of hospitalizations in young children. RSV largely disappeared in 2020 owing to precautions taken because of the COVID-19 pandemic. Estimating the timing and intensity of the reemergence of RSV and the age groups affected is crucial for planning for the administration of prophylactic antibodies and anticipating hospital capacity. OBJECTIVE: To examine the association of different factors, including mitigation strategies, duration of maternal-derived immunity, and importation of external infections, with the dynamics of reemergent RSV epidemics. DESIGN, SETTING, AND PARTICIPANTS: This simulation modeling study used mathematical models to reproduce the annual epidemics of RSV before the COVID-19 pandemic in New York and California. These models were modified to project the trajectory of RSV epidemics from 2020 to 2025 under different scenarios with varying stringency of mitigation measures for SARS-CoV-2. Simulations also evaluated factors likely to affect the reemergence of RSV epidemics, including introduction of the virus from out-of-state sources and decreased transplacentally acquired immunity in infants. Models using parameters fitted to similar inpatient data sets from Colorado and Florida were used to illustrate these associations in populations with biennial RSV epidemics and year-round RSV circulation, respectively. Statistical analysis was performed from February to October 2021. MAIN OUTCOMES AND MEASURES: The primary outcome of this study was defined as the estimated number of RSV hospitalizations each month in the entire population. Secondary outcomes included the age distribution of hospitalizations among children less than 5 years of age, incidence of any RSV infection, and incidence of RSV lower respiratory tract infection. RESULTS: Among a simulated population of 19.45 million people, virus introduction from external sources was associated with the emergence of the spring and summer epidemic in 2021. There was a tradeoff between the intensity of the spring and summer epidemic in 2021 and the intensity of the epidemic in the subsequent winter. Among children 1 year of age, the estimated incidence of RSV hospitalizations was 707 per 100 000 children per year in the 2021 and 2022 RSV season, compared with 355 per 100 000 children per year in a typical RSV season. CONCLUSIONS AND RELEVANCE: This simulation modeling study found that virus introduction from external sources was associated with the spring and summer epidemics in 2021. These findings suggest that pediatric departments should be alert to large RSV outbreaks in the coming seasons, the intensity of which could depend on the size of the spring and summer epidemic in that location. Enhanced surveillance is recommended for both prophylaxis administration and hospital capacity management.
Estimation of the Timing and Intensity of Reemergence of Respiratory Syncytial Virus Following the COVID-19 Pandemic in the US
BACKGROUND: The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. OBJECTIVE: This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. METHODS: This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. RESULTS: This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. CONCLUSIONS: If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. TRIAL REGISTRATION: NCT04476667; INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/24913
Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program
The home-based learning strategy is a useful control measure to decrease the spread of COVID-19 among students A sudden alteration of offline learning to online learning impacted the effectiveness of learning activities During the COVID-19 pandemic, the Faculty of Engineering, Darma Cendika Catholic University needed to assess the level of student satisfaction of online-based learning so that the quality of service was maintained The purpose of this study was to measure the level of student satisfaction during online-based learning during the COVID-19 pandemic using the Service Quality (Servqual) and Importance Performance Analysis (IPA) methods Servqual and IPA are methods for measuring the level of satisfaction and quality of service The result of Servqual shows all the measurements of 17 attributes have negative gap value This shows that there is a difference between students perception and expectation of online-based learning The Matrix of IPA indicates the priority of improvement of online-based learning that encompasses the lecturers consistency in providing a good lecture, the capability of using learning platform, the prompt and efficient response to students needs in online-based learning, the encouragement of students motivation throughout the learning process, and the understanding of students impediments during the process of online-based learning
Evaluasi Kualitas Pembelajaran Online Selama Pandemi COVID-19: Studi Kasus Di Fakultas Teknik, Universitas Katolik Darma Cendika
Feline enteric coronaviruses have three open reading frames (ORFs) in region 3 (3a, 3b, and 3c). All three ORFs were expressed with C-terminal eGFP and 3xFLAG tags in different cell lines and their localisation was determined. ORF 3a is predicted to contain DNA-binding and transcription activator domains, and it is localised in the nucleus and in the cytoplasm. ORF 3b is also predicted to contain DNA-binding and activator domains, and was found to localise in the mitochondrion. Besides that, in some of the non-infected and FIPV-infected cells nucleolar, perinuclear or nuclear membrane accumulation of the eGFP-tagged 3b was observed. The exact compartmental localisation of ORF 3c is yet to be determined. However, based on our co-localisation studies 3c does not seem to be localised in the ER-Golgi network, ERGIC or peroxisomes. The expression of 3c-eGFP is clearly cell type dependent, it is more stable in MARC 145 cells than in Fcwf-4 or CrFK cells, which might reflect in vivo stability differences of 3c in natural target cells (enterocytes vs. monocytes/macrophages).
Cellular localisation of the proteins of region 3 of feline enteric coronavirus.
Organoids emulate many aspects of their parental tissue and are therefore used to study pathogen-host interactions and other complex biological processes. Here, we report a robust protocol for the isolation, maintenance and differentiation of rabbit small intestinal organoids and organoid-derived cell monolayers. Our rabbit intestinal spheroid and monolayer cultures grew most efficiently in L-WRN-conditioned medium that contained Wnt, R-spondin and Noggin, and that had been supplemented with ROCK and TGF-β inhibitors. Organoid and monolayer differentiation was initiated by reducing the concentration of the L-WRN-conditioned medium and by adding ROCK and Notch signalling inhibitors. Immunofluorescence staining and RT-qPCR demonstrated that our organoids contained enterocytes, enteroendocrine cells, goblet cells and Paneth cells. Finally, we infected rabbit organoids with Rabbit calicivirus Australia-1, an enterotropic lagovirus that—like many other caliciviruses—does not grow in conventional cell culture. Despite testing various conditions for inoculation, we did not detect any evidence of virus replication, suggesting either that our organoids do not contain suitable host cell types or that additional co-factors are required for a productive infection of rabbit organoids with Rabbit calicivirus Australia-1.
Culture and differentiation of rabbit intestinal organoids and organoid-derived cell monolayers
BACKGROUND: Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose. METHODS: This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from 12th March to 29th June 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48 h of ICU admission) with those who did not receive early corticosteroids (delayed group) or any corticosteroids at all (never group). Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications. RESULTS: A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n = 485) had lower ICU mortality (30.3% vs. never 36.6% and delayed 44.2%) and lower 7-day mortality (7.2% vs. never 15.2%) compared to non-early treated patients. They also had higher number of ventilator-free days, less length of ICU stay, and less secondary infections than delayed treated patients. There were no differences in medical complications between groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens. CONCLUSION: Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality than no or delayed use, and fewer complications than delayed use.
Early corticosteroids are associated with lower mortality in critically ill patients with COVID-19: a cohort study
An infectious disease COVID-19 is caused by virus called coronavirus. The corona virus transmitted from individual to individual through droplets / contact. The first conformed case of India was on 30 January 2020 occurred in Kerala. As still no vaccine is available for controlling it so from initial stage government of India started different initiatives like lockdown, work from home, suspension of train services and international flights, implemented rules and regulation such as limiting the number of passengers in the vehicle, banning on social gathering to control on this virus. Ministry of Health and Family Welfare (MoHFW) was launched a nationwide training for front line health worker on COVID19. Hence the implication of the study becomes very crucial. In this paper the special case of India is considered from the initial period to October 2020. Based on available data, the analysis of this viruses is studied also the different cases of stability is checked by considering logistic growth in prey population. The parameter which used to study this case are predators, prey, time, prey’s growth rate, attack rate, predator or consumer mortality rate, conversion efficiency and maximum curing capacitive rate.
Analysis of Covid-19 in India using mathematical modeling
The concept of "double jeopardy"-being both older and Black-describes how racism and ageism together shape higher risks for coronavirus exposure, COVID-19 disease, and poor health outcomes for older Black adults. Black people and older adults are the two groups most affected by COVID-19 morbidity and mortality. Double jeopardy, as a race- and age-informed analysis, demonstrates how Black race and older age are associated with practices and policies that shape key life circumstances (e.g., racial residential segregation, family and household composition) and resources in ways that embody elevated risk for COVID-19. The concept of double jeopardy underscores long-standing race- and age-based inequities and social vulnerabilities that produce devastating COVID-19 related deaths and injuries for older Black adults. Developing policies and actions that address race- and age-based inequities and social vulnerabilities can lower risks and enhance protective factors to ensure the health of older Black Americans during the COVID-19 pandemic.
Older Black Americans During COVID-19: Race and Age Double Jeopardy
Background: The SARS‐CoV‐2 (COVID‐19) virus has wide community spread. The aim of this study was to describe patient characteristics and to identify factors associated with COVID‐19 among emergency department patients under investigation for COVID‐19 who were admitted to the hospital. Methods: This was a retrospective observational study from eight emergency departments within a nine‐hospital health system. Patients with COVID‐19 testing around the time of hospital admission were included. The primary outcome measure was COVID‐19 test result. Patient characteristics were described and a multivariable logistic regression model was used to identify factors associated with a positive COVID‐19 test. Results: During the study period from March 1, 2020 to April 8, 2020, 2,182 admitted patients had a test resulted for COVID‐19. Of these patients, 786 (36%) had a positive test result. For COVID positive patients, 63 (8.1%) died during hospitalization. COVID‐19 positive patients had lower pulse oximetry (0.91 [95%CI], [0.88‐0.94]), higher temperatures (1.36 [1.26‐1.47]), and lower leukocyte counts than negative patients (0.78 [0.75‐0.82]). Chronic lung disease (OR 0.68, [0.52‐0.90]) and histories of alcohol (0.64 [0.42‐0.99]) or substance abuse (0.39 [0.25‐0.62]) were less likely to be associated with a positive COVID‐19 result. Conclusion: We observed a high percentage of positive results among an admitted emergency department cohort under investigation for COVID‐19. Patient factors may be useful in early differentiation of patients with COVID‐19 from similarly presenting respiratory illnesses although no single factor will serve this purpose. This article is protected by copyright. All rights reserved
Patient factors associated with SARS‐CoV‐2 in an admitted emergency department population
OBJECTIVE: This exploratory study estimates the economic value of the current vaccination program and increased coverage against four preventable diseases in older adults in the United States (US). METHODS: A population-based, age-structured economic model was used to conduct a cost-benefit analysis of vaccination against influenza, pertussis, herpes zoster, and pneumococcal disease among US adults aged 50 years and older, accounting for aging of the population. The model used separate decision trees for each disease to project the discounted number of vaccinated individuals, number of disease cases, and direct medical and indirect costs (2018 US$) over a 30-year period. Benefit-cost ratios (BCRs) and net present values were calculated for two primary analyses comparing current vaccination coverage versus no vaccination and comparing increased coverage versus current coverage. Key parameter values were varied in deterministic sensitivity analyses. RESULTS: Current adult vaccination coverage (vs. no vaccination) is estimated to result in nearly 65 million averted disease cases, $185 billion averted costs of cases, and $136 billion in incremental vaccination costs over a 30-year period from a societal perspective (BCR = 1.4). Increased vaccination coverage (vs. current coverage) is associated with over 33 million additional averted disease cases, $96 billion additional averted costs of cases, and nearly $83 billion in incremental vaccination costs, resulting in a societal BCR of 1.2 over 30 years. Deterministic sensitivity analyses demonstrated that results were most sensitive to disease incidence, vaccine efficacy, and productivity costs for time required for vaccination. CONCLUSIONS: Study results highlight the economic value of vaccination programs for older adults in the US and indicate that efforts to further increase vaccination coverage may be warranted and economically justifiable.
Cost-benefit analysis of vaccination against four preventable diseases in older adults: Impact of an aging population
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, in late December 2019 and has since spread rapidly around the world. Severe coronavirus disease 2019 (COVID-19) pneumonia patients have abnormal blood coagulation function, but their thromboembolism prevalence is still unknown. We reported a case of a 49-year-old man infected with COVID-19, presenting with fever, chest pain, limb weakness, myalgia, and dyspnea. The patient was diagnosed with severe COVID-19 pneumonia, pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and cerebral infarction. He received supportive and empirical treatment including anticoagulant treatment, anti-inflammatory treatment, oxygen supply, and inhalation therapy. The patient's symptoms, CT images, and laboratory results improved after treatment, and a throat swab was reported to be negative for SARS-CoV-2 virus by polymerase chain reaction (PCR) test. However, on day 51 of illness onset, CT reexamination demonstrated hemorrhagic infarction. Anticoagulant therapy was discontinued temporarily. After the patient tested negative for SARS-CoV-2 virus by PCR test six more times, he was discharged and remained in home quarantine. This case highlights the importance of clinician attentiveness to the appearance of multiple thromboembolism, especially in patients with severe pulmonary damage. It also emphasizes the diagnostic value of early CT imaging and the need for effective treatment once thrombotic events occur.
Case Report: The Coronavirus Disease 2019 (COVID-19) Pneumonia With Multiple Thromboembolism
Megalocytivirus is a DNA virus with a broad host range among farmed fish including tongue sole (Cynoglossus semilaevis). In this study, label-free proteomics was performed to examine protein expression in tongue sole spleen induced by megalocytivirus at 8 and 12 days post infection (dpi). Compared to uninfected control fish, virus-infected fish displayed 315 up-regulated proteins and 111 down-regulated proteins at 8 dpi, and 48 up-regulated proteins and 43 down-regulated proteins at 12 dpi. The expressions of five differentially expressed proteins were confirmed by Western blot. The differentially expressed proteins were enriched in the pathways and processes associated with innate immune response and viral infection. Interference with the expression of two up-regulated proteins of the ubiquitin proteasome system (UPS), i.e. proteasome assembly chaperone 2 and proteasome maturation protein, significantly reduced viral propagation in fish, whereas overexpression of these two proteins significantly enhanced viral propagation. Consistently, inhibition of the functioning of proteasome significantly impaired viral replication in vivo. This study provided the first global protein profile responsive to megalocytivirus in tongue sole, and revealed an essential role of UPS in viral infection.
Global profiling of megalocytivirus-induced proteins in tongue sole (Cynoglossus semilaevis) spleen identifies cellular processes essential to viral infection
As emerging and re-emerging infectious diseases like dengue, Ebola, chikungunya, and Zika threaten new populations worldwide, officials scramble to assess local severity and transmissibility, with little to no epidemiological history to draw upon. Standard methods for assessing autochthonous (local) transmission risk make either indirect estimates based on ecological suitability or direct estimates only after local cases accumulate. However, an overlooked source of epidemiological data that can meaningfully inform risk assessments prior to outbreak emergence is the absence of transmission by imported cases. Here, we present a method for updating a priori ecological estimates of transmission risk using real-time importation data. We demonstrate our method using Zika importation and transmission data from Texas in 2016, a high-risk region in the southern United States. Our updated risk estimates are lower than previously reported, with only six counties in Texas likely to sustain a Zika epidemic, and consistent with the number of autochthonous cases detected in 2017. Importation events can thereby provide critical, early insight into local transmission risks as infectious diseases expand their global reach.
Downgrading disease transmission risk estimates using terminal importations
The use of real-time techniques to evaluate the global mixing performance of co-rotating twin-screw extruders is well consolidated, but much less is reported on the specific contribution of individual screw zones. This work uses on-line flow turbidity and birefringence to ascertain the mixing performance of kneading blocks with different geometries. For this purpose, one of the barrel segments of the extruder was modified in order to incorporate four sampling devices and slit dies containing optical windows were attached to them. The experiments consisted in reaching steady extrusion and then adding a small amount of tracer. Upon opening each sampling device, material was laterally detoured from the local screw channel, and its turbidity and birefringence were measured by the optical detector. Residence time distribution curves (RTD) were obtained at various axial positions along three different kneading blocks and under a range of screw speeds. It is hypothesized that K, a parameter related to the area under each RTD curve, is a good indicator of dispersive mixing, whereas variance can be used to assess distributive mixing. The experimental data confirmed that these mixing indices are sensitive to changes in processing conditions, and that they translate the expected behavior of each kneading block geometry.
On-Line Optical Monitoring of the Mixing Performance in Co-Rotating Twin-Screw Extruders
INTRODUCTION Early detection and monitoring of mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) patients are key to tackling dementia and providing benefits to patients, caregivers, healthcare providers and society. We developed the Integrated Cognitive Assessment (ICA); a 5-minute, language independent computerised cognitive test that employs an Artificial Intelligence (AI) model to improve its accuracy in detecting cognitive impairment. In this study, we aimed to evaluate the generalisability of the ICA in detecting cognitive impairment in MCI and mild AD patients. METHODS We studied the ICA in a total of 230 participants. 95 healthy volunteers, 80 MCI, and 55 participants with mild AD completed the ICA, the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination (ACE) cognitive tests. RESULTS The ICA demonstrated convergent validity with MoCA (Pearson r = 0.58, p<0.0001) and ACE (r = 0.62, p<0.0001). The ICA AI model was able to detect cognitive impairment with an AUC of 81% for MCI patients, and 88% for mild AD patients. The AI model demonstrated improved performance with increased training data and showed generalisability in performance from one population to another. The ICA correlation of 0.17 (p=0.01) with education years is considerably smaller than that of MoCA (r=0.34, p<0.0001) and ACE (r=0.41, p<0.0001) which displayed significant correlations. In a separate study the ICA demonstrated no significant practice effect observed over the duration of the study. DISCUSSION The ICA can support clinicians by aiding accurate diagnosis of MCI and AD and is appropriate for large-scale screening of cognitive impairment. The ICA is unbiased by differences in language, culture and education.
Validity and cultural generalisability of a 5-minute AI-based, computerised cognitive assessment in Mild Cognitive Impairment and Alzheimer’s Dementia
Screening for total pain and sharing of patient information including adverse events for patients receiving chemotherapy by medical staff is needed in clinical practice. We introduced a sharing system for patient-oriented outcome sheets via a touch panel at an outpatient chemotherapy clinic. This study aimed to assess whether the system contributes to the improved management of treatment-related adverse events. We retrospectively analyzed data from a total of 215 patients at Ehime University Hospital using their electronic medical records from April to August 2015. Forty of these patients had received interventions relating to treatment-related adverse events. The proportion of a total number of interventions before and after the sharing system was 42/282(14.9%)and 45/215(20.9%), respectively. The proportion of a total number of interventions at the first course of outpatient chemotherapy also increased from 9/40(22.5%)to 14/40(35%)compared with before the sharing system. The purpose of interventions were for insomnia, anorexia, and cancer-related pain, etc., listed in order of degree of frequency. These results suggest that a sharing system of patient-reported interview sheets contributes to tracking treatment -related adverse events and aids in ensuring interventions can be efficiently performed by multidisciplinary team members.
[Assessment of Chemotherapy-Induced Adverse Events Using a Sharing System of Patient-Reported Information via a Touch Panel].
The Mediterranean diet is considered an example of sustainable diets and an intangible cultural heritage of the whole humanity. However, attention to the Mediterranean diet changes from a country to another even within the Euro-Mediterranean region. In this context, this paper analyses the state of research on the Mediterranean diet in the Western Balkans (viz. Albania, Bosnia and Herzegovina, Croatia, Kosovo, North Macedonia, Montenegro, and Serbia). In particular, it explores whether and how environmental, economic, sociocultural, and nutrition-health aspects related to the sustainability of the Mediterranean diet are addressed. A search performed in June 2021 on the Web of Science returned 68 documents, and 41 of them were included in the systematic review. Most of the selected documents deal with Croatia, especially island regions, and focus on health-nutrition aspects while other sustainability dimensions are generally overlooked. The scholarly literature shows that higher adherence to the Mediterranean diet is associated with reduced risk of obesity, different non-communicable diseases (e.g. diabetes, cardiovascular diseases, cancers, metabolic syndrome) as well as mental illnesses. However, it also highlights a decrease in the Mediterranean diet adherence even in Mediterranean/Adriatic territories. Interestingly, some recent studies showed a shift towards the Mediterranean diet during the COVID-19 lockdown even among adolescents. The analysis suggests the need to adopt a holistic approach in studies on the Mediterranean diet to better understand the relationships between the sustainability dimensions and operationalize its contribution to the transformation of food systems and the achievement of the Sustainable Development Goals in the Mediterranean region.
Mediterranean diet in the Western Balkans
Psychodynamic group psychotherapy in Daily Hospital for non-psychotic disorders was held through Hangouts program during CoViD-19 pandemic lockdown. In our pilot study we compared patients' impressions and their satisfaction with online program vs. usual, in-person setting program. We analyzed the impressions of group therapists as well. Our conclusion is that according to our patients' impressions and satisfaction, online psychodynamic group psychotherapy is good enough option in extreme situations such as infectious disease pandemic, although it cannot completely replace all the aspects of usual "live" setting.
How to Square a Circle?
The aim of the present study was to explore the impact of school year's extension due to the coronavirus pandemic (COVID-19) by addressing test anxiety and by studying the coping strategies adolescents used to overcome it For the majority of the adolescents the final exams can be a powerful source of stress, since the entrance examinations are required for admission into higher education and further reflect the transition to adulthood The sample consisted of 67 High School students and the data collection was conducted online due to the imposed measures by the Greek government Results showed normal or average levels of test anxiety with low self-esteem and fear of a family member contracting the virus identified as significant predictors Students who participated in the research pointed teachers as the main source of pressure in school exams Gender differences regarding social media engagement and online video gaming were also detected Resilience was equally as high among genders [t(63) = 858, p = 324] and the correlation between test anxiety and resilience did not produce a statistically significant result (r = - 178, p = 155)
Assessing test anxiety and resilience among Greek adolescents during COVID-19 pandemic
We have yet to realise the full capability of social media as an innovative information platform during emergencies and crisis response and management. Sentiment analysis can systematically identify, extract, and scrutinise emotional states and subjective information in social media data. Exploring reactions and perceptions to response messaging is invaluable and proved especially useful for a pandemic response as it can demonstrate general population reaction to the pandemic and governments response actions. This can be further analysed to identify the gap between government response actions and communications and citizens' perceptions. In this paper, an analysis of Twitter data explores population reaction towards COVID-19 health messaging. A Natural Language Processing Python tool is known as TextBlob was used to discover general data sentiment. Data were divided into three sentiments and text extraction of health messages was conducted to explore subsequent tweets in predefined categories. Our findings show the outcome of Tweets analysis could help us to identify the general population concerns and their reactions to COVID-19 to give a better understanding of the situation to governments and support them in implementing appropriate policies. © 2021 IEEE.
Twitter Sentiment Analysis in Covid-19 Pandemic
The rooting of the SARS-CoV-2 phylogeny is important for understanding the origin and early spread of the virus. Previously published phylogenies have used different rootings that do not always provide consistent results. We investigate several different strategies for rooting the SARS-CoV-2 tree and provide measures of statistical uncertainty for all methods. We show that methods based on the molecular clock tend to place the root in the B clade, whereas methods based on outgroup rooting tend to place the root in the A clade. The results from the two approaches are statistically incompatible, possibly as a consequence of deviations from a molecular clock or excess back-mutations. We also show that none of the methods provide strong statistical support for the placement of the root in any particular edge of the tree. These results suggest that phylogenetic evidence alone is unlikely to identify the origin of the SARS-CoV-2 virus and we caution against strong inferences regarding the early spread of the virus based solely on such evidence.
Assessing Uncertainty in the Rooting of the SARS-CoV-2 Phylogeny
From the outset of the Covid-19 pandemic, diabetes has been identified as attracting higher rates of severe infection and associated mortality. Our understanding of the mechanisms behind these observations continue to develop but it is clear that the comorbidities associated with diabetes play a key role. Here we provide a brief overview of the clinical implications relevant to Covid-19 infection in diabetes and outline the changes we have instituted to adapt the management of both acute hyperglycaemic emergencies and routine diabetes care during the current pandemic.
Diabetes and Covid-19: Clinical implications and novel management strategies
An amendment to this paper has been published and can be accessed via the original article.
Correction to: Pakistan Randomized and Observational Trial to Evaluate Coronavirus Treatment (PROTECT) of Hydroxychloroquine, Oseltamivir and Azithromycin to treat newly diagnosed patients with COVID-19 infection: A structured summary of a study protocol for a randomized controlled trial
The use of face masks or respirators (N95/KN95) is recommended to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1). Well-fitting face masks and respirators effectively filter virus-sized particles in laboratory conditions (2,3), though few studies have assessed their real-world effectiveness in preventing acquisition of SARS-CoV-2 infection (4). A test-negative design case-control study enrolled randomly selected California residents who had received a test result for SARS-CoV-2 during February 18-December 1, 2021. Face mask or respirator use was assessed among 652 case-participants (residents who had received positive test results for SARS-CoV-2) and 1,176 matched control-participants (residents who had received negative test results for SARS-CoV-2) who self-reported being in indoor public settings during the 2 weeks preceding testing and who reported no known contact with anyone with confirmed or suspected SARS-CoV-2 infection during this time. Always using a face mask or respirator in indoor public settings was associated with lower adjusted odds of a positive test result compared with never wearing a face mask or respirator in these settings (adjusted odds ratio [aOR] = 0.44;95% CI = 0.24-0.82). Among 534 participants who specified the type of face covering they typically used, wearing N95/KN95 respirators (aOR = 0.17;95% CI = 0.05-0.64) or surgical masks (aOR = 0.34;95% CI = 0.13-0.90) was associated with significantly lower adjusted odds of a positive test result compared with not wearing any face mask or respirator. These findings reinforce that in addition to being up to date with recommended COVID-19 vaccinations, consistently wearing a face mask or respirator in indoor public settings reduces the risk of acquiring SARS-CoV-2 infection. Using a respirator offers the highest level of personal protection against acquiring infection, although it is most important to wear a mask or respirator that is comfortable and can be used consistently.
Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021
During the coronavirus pandemic, policy makers need to interpret available public health data to make decisions affecting public health. However, the United States’ coronavirus response faced data gaps, inadequate and inconsistent definitions of data across different governmental jurisdictions, ambiguous timing in reporting, problems in accessing data, and changing interpretations from scientific institutions. These present numerous problems for the decision makers relying on this information. This paper documents some of the data pitfalls in coronavirus public health data reporting, as identified by the authors in the course of supporting data management for New England’s coronavirus response. We provide recommendations for individuals to collect data more effectively during emergency situations such as a COVID-19 surge, as well as recommendations for institutions to provide more meaningful data for various users to access. Through this, we hope to motivate action to avoid data pitfalls during public health responses in the future.
The challenges of data usage for the United States’ COVID-19 response
Many real world applications can be formulated as event forecasting on Continuous Time Dynamic Graphs (CTDGs) where the occurrence of a timed event between two entities is represented as an edge along with its occurrence timestamp in the graphs.However, most previous works approach the problem in compromised settings, either formulating it as a link prediction task on the graph given the event time or a time prediction problem given which event will happen next. In this paper, we propose a novel model combining Graph Neural Networks and Marked Temporal Point Process (MTPP) that jointly forecasts multiple link events and their timestamps on communities over a CTDG. Moreover, to scale our model to large graphs, we factorize the jointly event prediction problem into three easier conditional probability modeling problems.To evaluate the effectiveness of our model and the rationale behind such a decomposition, we establish a set of benchmarks and evaluation metrics for this event forecasting task. Our experiments demonstrate the superior performance of our model in terms of both model accuracy and training efficiency.
CEP3: Community Event Prediction with Neural Point Process on Graph
The COVID-19 pandemic demonstrates once again that hybrid threats are increasingly challenging European countries. Although there is international cooperation on the conceptual level, individual countries are responsible for the actual implementation of counter hybrid measures. This article compares the approaches of Finland, Germany and the Netherlands to counter hybrid threats, while taking into consideration their strategic culture. It shows that the countries differ in their approach to counter hybrid threats in terms of their organisation of security and the scope of measures taken to deter adversaries. These differences are mainly rooted in historical, institutional and political processes. The countries are rather similar in detecting hybrid threats and responding to hybrid attacks, which can be explained by the nature of hybrid threats. Consequently, strategic culture is a context that shapes but not ultimately determines how Finland, Germany and the Netherlands counter hybrid threats. The results of this article suggest that our current understanding of strategic culture is insufficient to describe and explain an actor's security policy in the contemporary security environment. It is recommended that the concept of strategic culture should be revised and has to be examined more broadly by including national security issues and a broad spectrum of instruments of power. [ FROM AUTHOR] Copyright of Defence Studies is the property of Routledge 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 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 . (Copyright applies to all s.)
Countering hybrid threats: does strategic culture matter?: Defence Studies
This article reviews the association between diabetes mellitus (DM) and COVID-19. We report on the convergence of infectious diseases such as coronavirus infections and non-communicable diseases including DM. The mechanisms for the interaction between COVID-19 and DM are explored, and suggestions for the management of DM in patients with COVID-19 in South Africa are offered.
Diabetes mellitus and COVID-19: A review and management guidance for South Africa
Alpine field research often involves travel and hiking to steep but gorgeous mountain ranges where days are spent outdoors, and in our case, in botanical/ecological/sensor research Under the usual conditions, alpine field researchers in Montana need to consider integral hazards such as cliffs, snow, stormy weather, the alpine sun, and bears But what influence ds a pandemic have on alpine field research?
On the impact of the COVID-19 pandemic on alpine research projects in Montana
The aim of the research is on the uneven distribution of aid during this pandemic and what are the requirements for the community to receive such assistance. Using empirical research methods that are based on the results of interviews from informants. Through this research, the researcher suggests that the government must review the data of people who need assistance during this pandemic in their respective areas of residence. Since the COVID-19 period, it has spread widely in Indonesia, causing a drastic economic downturn due to the large number of unemployed, layoff victims, few opportunities for workers and much more. So in this case, daily life feels very heavy, even to eat. Finally, in this matter, the government helps the people to start living again. This government assistance is in the form of basic food assistance, cash social assistance, village fund BLT, free electricity, pre-employment cards, employee salary subsidies, and BLT for small and micro enterprises. However, this assistance that should have been conveyed to people in need was not conveyed to people in need. A lot of help is received by people who are well off. Therefore, the researcher suggests whether the community has included the criteria for getting assistance during this COVID-19 period, and people who have received or received assistance can check directly through the web that has been provided by the government in the form of Pansos. Keywords: Corona;government;social assistance Tujuan penelitian adalah dalam bantuan selama pandemi ini tidak merata dan bagaimana persyaratan untuk masyarakat mendapatkan bantuan tersebut. Menggunakan metode penelitian empiris yang bersumber pada hasil wawancara dari informan. Melalui penelitian ini peneliti menawarkan bahwa pemerintah harus meninjau kembali data-data masyarakat yang membutuhkan bantuan dalam masa pandemi ini terdapat di wilayah tempat tinggal masing-masing. Sejak masa COVID-19 ini menyebar luas di Indonesia hingga menyebabkan penurunan ekonomi secara drastis dikarenakan banyaknya pengangguran, korban PHK, peluang pekerja juga sedikit dan masih banyak lagi. Sehingga, dalam hal ini kehidupan sehari-hari terasa berat sekali, untuk makan pun tidak bisa. Akhirnya dalam masalah ini, pemerintah membantu masyarakatnya untuk memulai kehidupan lagi. Bantuan pemerintah ini berupa bantuan sembako, bantuan sosial tunai, BLT dana desa, listrik gratis, kartu pra kerja, subsidi gaji karyawan, dan BLT usaha mikro kecil. Akan tetapi bantuan ini yang seharusnya disampaikan kepada masyarakat yang membutuhkan tidak disampaikan kepada masyarakat yang membutuhkan. Banyak bantuan yang diterima dengan orang-orang yang berkecukupan. Oleh karena itu, peneliti menyarankan apa masyarakat itu sudah termasuk kriteria yang mendapatkan bantuan dalam masa COVID-19 ini, dan masyarakat yang mendapatkan atau menerima bantuan bisa cek langsung lewat web yang sudah disediakan oleh pemerintah berupa Pansos. Kata kunci: Bantuan sosial;Corona;pemerintah
Ketidakmerataan bantuan pemerintah kepada masyarakat selama pandemi COVID-19
BACKGROUND: It is of interest to explore the variability in how the COVID-19 pandemic evolved geographically during the first twelve months. To this end, we apply inequality indices over regions to incidences, infection related mortality, and infection fatality rates. If avoiding of inequality in health is an important political goal, a metric must be implemented to track geographical inequality over time. METHODS: The relative and absolute Gini index as well as the Theil index are used to quantify inequality. Data are taken from international data bases. Absolute counts are transformed to rates adjusted for population size. RESULTS: Comparing continents, the absolute Gini index shows an unfavorable development in four continents since February 2020. In contrast, the relative Gini as well as the Theil index support the interpretation of less inequality between European countries compared to other continents. Infection fatality rates within the EU as well as within the U.S. express comparable improvement towards more equality (as measured by both Gini indices). CONCLUSIONS: The use of inequality indices to monitor changes in geographic inequality over time for key health indicators is a valuable tool to inform public health policies. The absolute and relative Gini index behave complementary and should be reported simultaneously in order to gain a meta-perspective on very complex dynamics.
Inequality indices to monitor geographic differences in incidence, mortality and fatality rates over time during the COVID-19 pandemic
Photo-eradication of microorganisms with UV and blue light has been around since the 1870s. Research to further the development and deployment of germicidal UV and violet-blue light has been on the rise since COVID-19 pandemic. This paper traces the evolution of UV and violet-blue light, presents suggested ways to exploit two leading germicidal light technologies—far UV and pulsed blue light (PBL)—in the ongoing quest to effectively stem the spread of pandemic diseases. An effective way to overcome or minimize the spread of disease is to inactivate and reduce the number of viral particles both in the environment and in accessible parts of patients. This can be achieved by irradiating spaces, infected air, and the general environment with PBL or far UV, and by similarly disinfecting supplies, tools, and equipment. Irradiating the oronasal cavity of infected patients with PBL could clear the virus and kill oral opportunistic bacteria that worsen coronavirus infections. The advantages and disadvantages of the two-leading photo-disinfection light technologies are discussed.
The Role of UV and Blue Light in Photo-Eradication of Microorganisms
Coronavirus disease 2019 (COVID-19), the disease resulting from infection by a novel coronavirus, SARS-Cov2, has rapidly spread since November 2019 leading to a global pandemic. SARS-Cov2 has infected over four million people and caused over 290,000 deaths worldwide. Although most cases are mild, a subset of patients develop a severe and atypical presentation of acute respiratory distress syndrome (ARDS) that is characterised by a cytokine release storm (CRS). Paradoxically, treatment with anti-inflammatory agents and immune regulators has been associated with worsening of ARDS. We hypothesize that the intrinsic circadian clock of the lung and the immune system may regulate individual components of CRS, and thus, chronotherapy may be used to effectively manage ARDS in COVID-19 patients. LINKED ARTICLES: This article is part of a themed issue on The Pharmacology of COVID-19. To view the other articles in this section visit
The case for chronotherapy in Covid-19-induced acute respiratory distress syndrome
Secondary methicillin‐resistant Staphylococcus aureus (MRSA) infection is a cause of severe pneumonia with high mortality during influenza A virus (IAV) pandemics. Alveolar macrophages (AMs) mount cellular defenses against IAV and MRSA infection, which occurs via the nucleotide‐binding domain‐like receptor protein 3 (NLRP3) inflammasome. However, the activity and function of the NLRP3 inflammasome in MRSA pneumonia secondary to IAV infection remain unclear. To clarify this, we studied MRSA infection secondary to IAV both in vitro and in mouse model. The expression of the NLRP3 inflammasome was evaluated by quantitative reverse transcription polymerase chain reaction, immunofluorescence, Western blot, and enzyme‐linked immunosorbent assay. The lung pathology and the rate of weight change were observed. We found that IAV infection for 1 week activated NLRP3 inflammasome. The enhanced expression of NLRP3, caspase‐1, and cleaved caspase‐1 was associated with MRSA infection secondary to IAV, but the expression of interleukin (IL)‐1β decreased in superinfection with MRSA both in vitro and in vivo. The aggravated inflammatory pathology in MRSA pneumonia secondary to IAV infection was associated with decreased expression of IL‐1β. And increased weight loss in MRSA pneumonia secondary to IAV infection was related to decreased concentration of IL‐1β in serum. It infers that superinfection with MRSA reduces expression of IL‐1β someway, and decreased expression of IL‐1β impairs the host immunity and leads to aggravated pneumonia. These results contributed to our understanding of the detailed activity of the NLRP3 inflammasome, IL‐1β, and their relationship with aggravation of MRSA pneumonia secondary to IAV infection. Immunotherapy targeting the IL‐1β signaling pathway could be possible therapeutic strategy for secondary MRSA pneumonia.
Aggravated MRSA pneumonia secondary to influenza A virus infection is derived from decreased expression of IL‐1β
The event of the Diamond Princess, with a total of 712 (as of 17 March 2020) persons infected on the cruise ship, attracted global attention as the largest disease cluster outside China for the period 7 to 24 February 2020 Representing the Ministry of Health, Labour and Welfare, the authors were heavily engaged in the quarantine operation on the cruise ship ourselves During the quarantine period from 5 to 23 February 2020, when the last group of the quarantined passengers left the ship, a series of measures have been conducted under the principles of i) zero deaths among all on board, ii) rapid establishment and thorough implementation of an infection control system, and iii) maintenance of health conditions and relief of anxieties among passengers and crew members The case of Diamond Princess has implications of more than a cruise ship but deserves full scientific analysis to learn lessons from this operation as well as to study the characteristics, particularly the transmission of COVID-19
Challenges of COVID-19 outbreak on the cruise ship Diamond Princess docked at Yokohama, Japan: a real-world story
Black populations in the U.S. South are disproportionally affected by HIV and COVID-19 due to longstanding inequalities. We conducted 20 in-depth interviews-12 with Black same-gender-loving men and 8 with Black cisgender women-to explore the impact of the initial phase of the COVID-19 pandemic on sexual activities and PrEP use. Almost all participants reduced the frequency of sex and number of partners. Women described little interest in sex, whereas men began to connect with some sexual partners after stay-at-home orders were lifted. Both populations were concerned about contracting COVID-19 through sexual partners, and men described selecting partners based on perceived COVID-19 risk. Participants valued PrEP and could access it, although several men who were not having sex stopped taking it. Risk of acquiring HIV during this time was likely limited. Future qualitative research is needed to understand how sexual behaviors and PrEP use changed as the pandemic continued.
HIV Prevention During the COVID-19 Pandemic: Sexual Activity and PrEP Use Among Black Same-Gender-Loving Men and Black Cisgender Women
Several medications are used to treat the patients and to control the spread of the disease. Some of these drugs proved to be harmful besides drug-drug interactions can be occurred particularly in old-age groups or patients with chronic diseases. This study aimed to investigate the effects of several drugs on the survival outcome of COVID19 patients hospitalized in a single medical center in Erbil, Iraq. 204 patients (128 men and 76 women) with COVID-19 were recruited from the West Erbil Emergency hospital between August 10 and November 20, 2020. The primary outcome measures were the survival rate during the course of illness taking into consideration the number and the generic name of prescribed drugs, the percentage of saturated blood oxygen (sPO2), and the age. A total number of sixty-four patients died. Non-survivors are characterized by having a significantly lower percentage of sPO2 and used a significantly high mean value of a number (4-5) of drugs during the course of treatment. The percentage of non survivors who used fluoroquinolones was significantly higher than the corresponding percentage of survivors (37.5 vs 21.4, p=0.016). The cumulative odds ratio (> 1.0) was observed significantly (chi 2=6.286, p=0.012) in patients who used five-drug items despite the sPO2 >= 90%. We conclude that drug combinations of more than three drugs are harmful in old-age group patients, and dexamethasone, carbapenems, and fluoroquinolones should be not prescribed as empiric therapy.
Assessment of some prescribed drugs in the management of COVID-19 on the survival function: A preliminary report from a single center in Iraq
Acute respiratory distress syndrome is considered the most severe form of acute lung injury resulting in high morbidity and mortality. This syndrome is characterized by noncardiogenic pulmonary edema, diffuse pulmonary infiltrates, and hypoxemia refractory to oxygen delivery. Critical care nurses should be aware of newer treatment modalities available for patients with acute respiratory distress syndrome.
Trends in caring for adult respiratory distress syndrome patients.
This paper presents an optimization strategy based on mathematical programming to solve resource management problems regarding hospitalization of sick patients, considering emergency scenarios, such as those that can occur in a pandemic. This optimization strategy is based on the use of efficient optimization tools in solving complex problems in which other strategies are not efficient. The mathematical modeling of epidemiological phenomena is a useful tool to predict the direction of a disease, as well as to adequately and timely manage the available resources and thus save as many lives as possible. This work uses a mathematical model formulation based on deterministic optimization developed in general algebraic modeling system (GAMS) environment. The main user interface has been developed in a Microsoft™ (MS) Excel worksheet, which is familiar to many users. The linking code to send values from MS Excel to GAMS has been programmed in visual basic for applications (VBA) and it uses GAMS data exchange (GDX) files. The proposed optimization methodology is applied to case studies based on data obtained from affected people by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus that causes coronavirus disease 2019 (COVID-19). The distances were taken as example from severely affected cities in the USA. The obtained results offer attractive alternatives for the specified objective function in an acceptable computation time.
Multi-objective Optimization Approach Based on Deterministic and Metaheuristic Techniques to Resource Management in Health Crisis Scenarios Under Uncertainty
BACKGROUND: Spinal cord injury (SCI) is associated with autonomic imbalance and significant secondary conditions, including cardiac and brain dysfunction that adversely impact health and wellbeing. This study will investigate the effectiveness (intention-to-treat) of a neuro-cardiac self-regulation therapy to improve autonomic and neural/brain activity in adults with SCI living in the community. METHODS: A two-arm parallel, randomised controlled trial in which adults with SCI living in the community post-rehabilitation will be randomly assigned to a treatment or control group. The treatment group (N = 60) aged 18–70 years with a chronic traumatic or non-traumatic SCI, will receive intervention sessions once per week for 10 weeks, designed to regulate autonomic activity using computer-based feedback of heart rate variability and controlled breathing (called HRV-F). Comprehensive neurophysiological and psychological assessment will occur at baseline, immediate post-treatment, and 6 and 12-months post-treatment. Primary outcome measures include electrocardiography/heart rate variability (to assess autonomic nervous system function) and transcranial doppler sonography (to assess cerebral blood circulation in basal cerebral arteries). Secondary outcomes measures include continuous blood pressure, electroencephalography, functional near-infrared spectroscopy, respiration/breath rate, electrooculography, cognitive capacity, psychological status, pain, fatigue, sleep and quality of life. Controls (N = 60) will receive usual community care, reading material and a brief telephone call once per week for 10 weeks and be similarly assessed over the same time period as the HRV-F group. Linear mixed model analysis with repeated measures will determine effectiveness of HRV-F and latent class mixture modelling used to determine trajectories for primary and selected secondary outcomes of interest. DISCUSSION: Treatments for improving autonomic function after SCI are limited. It is therefore important to establish whether a neuro-cardiac self-regulation therapy can result in improved autonomic functioning post-SCI, as well as whether HRV-F is associated with better outcomes for secondary conditions such as cardiovascular health, cognitive capacity and mental health. TRIAL REGISTRATION: The study has been prospectively registered with the Australian and New Zealand Clinical Trial Registry (ACTRN12621000870853.aspx). Date of Registration: 6th July 2021. Trial Sponsor: The University of Sydney, NSW 2006. Protocol version: 22/07/2021.
A neuro-cardiac self-regulation therapy to improve autonomic and neural function after SCI: a randomized controlled trial protocol
Inhibition of interleukin 6 (IL‐6) signalling has been proposed as a potential cardioprotective strategy for patients with chronic kidney disease (CKD), but the direct effects of IL‐6 inhibition on renal function are not known. A Mendelian randomization (MR) study was performed to investigate the association of genetically proxied inhibition of IL‐6 signalling with estimated glomerular filtration rate (eGFR), CKD and blood urea nitrogen (BUN). Inverse‐variance weighted MR was used as the main analysis, with sensitivity analyses performed using simple median, weighted median and MR‐Egger methods. There was no evidence for an association of genetically proxied inhibition of IL‐6 signalling (scaled per standard deviation unit decrease in C‐reactive protein) with log eGFR (0.001, 95% confidence interval −0.004‐0.007), BUN (0.009, 95% confidence interval −0.003‐0.021) and CKD (odds ratio 0.948, 95% confidence interval 0.822‐1.094). These findings do not raise concerns for IL‐6 signalling having large adverse effects on renal function.
Inhibition of interleukin 6 signalling and renal function: A Mendelian randomization study
INTRODUCTION: Telemedicine has bridged the distance gap between patients and pediatric urologists for over a decade, yet many pediatric urologists have not embraced it as a major part of their practice. The purpose of this systematic review is to evaluate and clarify the optimal role of telemedicine in pediatric urology, as well as the benefits, barriers, risks, and other important considerations that must be accounted for in its optimal adoption. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review utilized Medical Subject Headings (MeSH) to search PubMed through April 29, 2021 as follows: (Humans [MeSH]) AND ((Child [MeSH]) OR (Infant [MeSH])) AND ((Remote Consultation [MAJR]) OR (Telemedicine [MAJR]) OR (Videoconferencing [MAJR]) OR (Health Services Accessibility [MAJR])) AND ((Urology [MAJR]) OR (Postoperative Care [MAJR]) OR (Urologic Surgical Procedures [MAJR])). 73 resulting articles, plus 21 from manual searches (e.g. papers too recent to have MeSH terms), were screened. 17 met inclusion criteria by discussing telemedicine in context of pediatric urology in a full manuscript. Non-complete manuscripts and papers not specifically considering pediatric urology, or in which telemedicine was not a major focus, were excluded. RESULTS: 17 papers met inclusion criteria. Varied approaches to the topic included surveys, controlled studies, retrospective studies, and descriptive opinion pieces. Quality of evidence varied, representing at least 1851 virtual encounters, 409 in-person encounters, and 68 clinician opinions. Four papers included a comparison or control group, and none utilized randomization. All 17 papers support expanded application of telemedicine in pediatric urology with varied evidence that telemedicine improves patient access to pediatric urologic care, satisfies both patient families and clinicians, is safe, provides equivalent outcomes, and is practicable. CONCLUSIONS: Implementation of telemedicine in pediatric urology should be expanded as it can practicably and safely improve patient access to pediatric urologic care, satisfy both patient families and clinicians, and maintain outcomes.
Systematic review of telemedicine in pediatric urology
Carotid artery aneurysms account for 4% of peripheral aneurysms and may present as a neck mass, with hemispheric ischaemic symptoms, or with symptoms secondary to local compression. This case explores the presentation, investigations and management of a presumed mycotic common carotid artery aneurysm in a 77-year-old male, which was repaired using end-to-end interposition vein graft using long saphenous vein. This report discusses the aetiology, presentation and surgical management for carotid artery aneurysms, as well as focusing on that of the rare mycotic carotid artery aneurysm.
Giant Carotid Artery Aneurysm.
The Enhanced Recovery After Surgery (ERAS) protocol affected traditional cardiac surgery processes and COVID-19 is expected to accelerate its scalability. The aim of this study was to assess the impact of an ERAS-based protocol on the length of hospital stay after cardiac surgery. From January 2019 to June 2020, 664 patients underwent consecutive cardiac surgery at a Latin American center. Here, 46 patients were prepared for a rapid recovery through a multidisciplinary institutional protocol based on the ERAS concept, the "TotalCor protocol". After the propensity score matching, 46 patients from the entire population were adjusted for 12 variables. Patients operated on the TotalCor protocol had reduced intensive care unit time (P < 0.025), postoperative stay (P &#8804; 0.001) and length of hospital stay (P &#8804; 0.001). In addition, there were no significant differences in the occurrence of complications and death between the two groups. Of the 10-central metrics of TotalCor protocol, 6 had > 70% adherences. In conclusion, the TotalCor protocol was safe and effective for a 3-day discharge after cardiac surgery. Postoperative atrial fibrillation and renal failure were predictors of postoperative stay > 5 days.
Safe and effective protocol for discharge 3 days after cardiac surgery
Global economic growth is noted to have been severely affected by the Great Recession in 2009, reaching its lowest level since the series began in 2019 This low was exceeded in 2020, in the sense that the level of economic growth in Q1 and Q2 2020 is well below 2009 due to countries&rsquo;efforts to stop the COVID-19 pandemic Cases of coronavirus that have occurred since February&ndash;March 2020 have started to produce significant effects on economic growth, and the evolution of the economic growth indicator is in decline for the countries analysed The article is aiming to develop two models (using Empirical Regression Model) that analyse the influence of macroeconomic indicators on economic growth Our study covers EU member countries in Central and Eastern Europe from 2001&ndash;2020 Q2 Using the same variables and coefficients for both models, six for the first model and seven for the second model with the addition of coronavirus cases, we see a change in the behaviour of independent variables The authors consider that this variable influences the economic situation in a country because it has caused the change in the unfavourable direction of certain macroeconomic indicators with a direct influence on economic growth By adding cases of coronavirus (Cc) the equation becomes broader and contains several variables that explain the evolution of economic growth Each of the indicators changes its value, but it is noted that variables with negative coefficients decrease further (e g , Cs, GvS) Our findings in this article confirm that of all the determinants analysed, CsGw, Ret, GvS, and Cc overwhelmingly influence economic growth
Major Crises of the XXIst Century and Impact on Economic Growth
We conducted a longitudinal study to clarify the changes in the sense of coherence (SOC); that is, the ability to cope with stress successfully, of 166 Japanese junior high school students and their mothers before and after the onset of the COVID-19 pandemic. First, we analyzed changes in SOC at three time points for all students and divided them into two groups: Group 1 included students with SOC scores that increased or maintained before and after the onset of the pandemic and Group 2 included students with decreased SOC scores after the onset of the pandemic. Second, we conducted a comparative analysis between the two groups. Overall, results indicated that student's SOC scores increased. Additionally, interpersonal stress scores were lower after the onset of the pandemic than before. There were almost no differences in family relationships, financial conditions, or personality tendencies between the two groups. However, Group 2 did not regain their sense of belonging to school. In this group, the frequency of stress experiences in club activities after the onset of the pandemic, troubles with the opposite gender, and inability to catch up with the contents of the subject lecture were high. The accumulation of small stressors may have hindered the maintenance of a sense of school affiliation. Mothers of students in Group 2 either were full-time employees at baseline or had started a new job after the onset of the pandemic. Their children may have been affected by the household's damaged financial budget and changes in mother's working styles. As COVID-19 reduced the number of days students went to school, students' SOC could have reduced had they not felt a sense of presence or belonging due to the lack of participation in club activities, school events, etc. Teachers and mothers should communicate carefully with their students and children, respectively, to develop a sense of belonging.
Changes in Japanese Junior High School Students' Sense of Coherence Before and After the Onset of the COVID-19 Pandemic: A Longitudinal Study of Children and Mothers
The first cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19) infections were recorded in China in November 2019. Since its appearance in China at the end of last year, the virus has spread to all continents causing a "global pandemic". To date, some aspects remain to be investigate about the pathophysiology of this viral infection. One of the aspects to be still clarified is the correlation between the renin-angiotensin system (RAS) and SARS-CoV-2 infection. RAS is a physiological system playing a key role in different human body functions regulation. SARS-CoV-2 uses the angiotensin-converting enzyme 2 (ACE-2), a component of RAS, as a potential factor of cell penetration and infectivity; in addition, in the different infection stages, a functional variation of the RAS has been noted. In this article, we discuss the correlation between the role of RAS and system-modifying agents, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and direct renin inhibitors (DRIs), with SARS-CoV-2 infection.
Correlation between renin-angiotensin system and Severe Acute Respiratory Syndrome Coronavirus 2 infection: What do we know?
We aim to understand the spatial inequality in Coronavirus disease 2019 (COVID-19) positivity rates across New York City (NYC) ZIP codes. Applying Bayesian spatial negative binomial models to a ZIP-code level dataset (N = 177) as of May 31st, 2020, we find that (1) the racial/ethnic minority groups are associated with COVID-19 positivity rates; (2) the percentages of remote workers are negatively associated with positivity rates, whereas older population and household size show a positive association; and (3) while ZIP codes in the Bronx and Queens have higher COVID-19 positivity rates, the strongest spatial effects are clustered in Brooklyn and Manhattan.
Examining spatial inequality in COVID-19 positivity rates across New York City ZIP codes
Background: Coronavirus disease 2019 (COVID-19) and Influenza A are common disease caused by viral infection. The clinical symptoms and transmission routes of the two diseases are similar. However, there are no relevant studies on laboratory diagnostic models to discriminate COVID-19 and influenza A. This study aims at establishing a signature of laboratory findings to tell patients with COVID-19 apart from those with influenza A perfectly. Materials: In this study, 56 COVID-19 patients and 54 influenza A patients were included. Laboratory findings, epidemiological characteristics and demographic data were obtained from electronic medical record databases. Elastic network models, followed by a stepwise logistic regression model were implemented to identify indicators capable of discriminating COVID-19 and influenza A. A nomogram is diagramed to show the resulting discriminative model. Results: The majority of hematological and biochemical parameters in COVID-19 patients were significantly different from those in influenza A patients. In the final model, albumin/globulin (A/G), total bilirubin (TBIL) and erythrocyte specific volume (HCT) were selected as predictors. Using an external dataset, the model was validated to perform well. Conclusion: A diagnostic model of laboratory findings was established, in which A/G, TBIL and HCT were included as highly relevant indicators for the segmentation of COVID-19 and influenza A, providing a complimentary means for the precise diagnosis of these two diseases.
Establishment of a diagnostic model to distinguish coronavirus disease 2019 from influenza A based on laboratory findings
Increasing health emergencies are driving unprecedented demand for effective supply chains to support emergency response. Andréia Azevedo Soares reports.
Supply chains in health emergency response
BACKGROUND: The effect of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) on the coronavirus disease 2019 (COVID-19) remains controversial from clinic evidence. OBJECTIVES: The objectives of this study were to report the major characteristics and clinical outcomes of COVID-19 patients treated with ACEIs and ARBs and compare the different effects of the two drugs for outcomes of COVID-19 patients. METHODS: This is a retrospective, two-center case series of 198 consecutive COVID-19 patients with a history of hypertension. RESULTS: Among 198 patients, 58 (29.3%) and 16 (8.1%) were on ARB and ACEI, respectively. Patients who were on ARB or ACEI/ARB had a significantly lower rate of severe illness and acute respiratory distress syndrome (ARDS) when compared with patients treated with ACEI alone or not receiving RAAS blocker (P < 0.05). The Kaplan–Meier survival curve showed that patients with ARB in their antihypertensive regimen had a trend toward a higher survival rate when compared with individuals without ARB (adjusted hazard ratio, 0.27; 95% confidence interval [CI], 0.07–1.02; P = 0.054). The occurrence rates of severe illness, ARDS, and death were similar in the two groups regardless of receiving ACEI. The Cox regression analyses showed a better survival in the ARB group than the ACEI group (adjusted hazard ratio, 0.03; 95% CI, 0.00–0.58; P = 0.02). CONCLUSIONS: Our data may provide that some evidence of using ARB, but not ACEI, was associated with a reduced rate of severe illness and ARDS, indicating their potential protective impact in COVID-19. Further large sample sizes and multiethnic populations are warranted to confirm our findings.
Differential Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on COVID-19
INTRODUCTION: Paediatric sepsis is a major contributor to morbidity and mortality worldwide. Assessing concern from parents and healthcare professionals to determine disease severity in a child evaluated for sepsis remains a field requiring further investigation. This study aims to determine the diagnostic accuracy of parental and healthcare professional concern in the diagnosis of children evaluated for sepsis. METHODS AND ANALYSIS: This prospective multicentre observational study will be conducted over a 24-month period in the paediatric emergency department (ED) at two tertiary Australian hospitals. A cross-sectional survey design will be used to assess the level of concern in parents, nurses and doctors for children presenting to ED and undergoing assessment for sepsis. The primary outcome is a diagnosis of sepsis, defined as suspected infection plus organ dysfunction at time of survey completion. Secondary outcomes include suspected or proven infection and development of organ dysfunction, defined as a Paediatric Sequential Organ Failure Assessment Score >0, within 48 hours of presentation, paediatric intensive care unit admission, confirmed or probable bacterial infection independent of organ dysfunction, and hospital length of stay. ETHICS AND DISSEMINATION: Ethics approval was obtained from Children’s Health Queensland’s Human Research Ethics Committee (HREC/17/QRCH/85). Findings will be shared with relevant stakeholders and disseminated via conferences and peer-reviewed journals TRIAL REGISTRATION NUMBER: WHO Universal Trial Number, U1111-1256-4537; ANZCTR number, ACTRN1262000134092.
Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study
This study aimed to elucidate how school employees caring for students with intellectual disabilities managed emergencies caused by the COVID-19 pandemic. It attended to decision-making by school managers as well as the engagement of local teachers in the outcome resolution process. A total of 10 teachers employed in different positions were purposefully selected from a school for students with intellectual disabilities in Osaka, Japan, and interviews were conducted with them via Zoom. The thematic analysis identified six significant premises: sensemaking, emergency responsive organization, high morale, planning through prioritization, risk management, and recovery from adverse incidents. The findings suggest distributed leadership functions to successfully sustain security in educational practices. Additionally, the empirical study consisting of interviews with staff in multiple positions reveals that all of the staff’s proactive participation in decision-making and the communication process enabled the school to cope with the pandemic crisis as a united organization.
One School’s Management of Students With Intellectual Disabilities During the COVID-19 Outbreak in Japan: A Study Based on Interviews With Teachers
PURPOSE This study examines disaster awareness and coping among college students to identify their influence on stress, anxiety, and depression. DESIGN AND METHODS Overall, 291 college students participated. A multiple regression analysis was conducted to analyze the influence of disaster awareness and coping on stress, anxiety, and depression. FINDINGS In the multiple regression model, anxiety, and depression were influenced by an awareness of natural and social disasters, level of perception of disaster response strategies, and level of information relating to disasters. PRACTICE IMPLICATIONS It is important to deliver effective information on disaster response and strategies to prevent disaster-related mental health issues.
Disaster awareness and coping: Impact on stress, anxiety, and depression.
Coronavirus disease 2019 (Covid-19) is highly contagious with limited treatment options Early and accurate diagnosis of Covid-19 is crucial in reducing the spread of the disease and its accompanied mortality Currently, detection by reverse transcriptase-polymerase chain reaction (RT-PCR) is the gold standard of outpatient and inpatient detection of Covid-19 RT-PCR is a rapid method;however, its accuracy in detection is only ~70-75% Another approved strategy is computed tomography (CT) imaging CT imaging has a much higher sensitivity of ~80-98%, but similar accuracy of 70% To enhance the accuracy of CT imaging detection, we developed an open-source framework, CovidCTNet, composed of a set of deep learning algorithms that accurately differentiates Covid-19 from community-acquired pneumonia (CAP) and other lung diseases CovidCTNet increases the accuracy of CT imaging detection to 95% compared to radiologists (70%) CovidCTNet is designed to work with heterogeneous and small sample sizes independent of the CT imaging hardware To facilitate the detection of Covid-19 globally and assist radiologists and physicians in the screening process, we are releasing all algorithms and model parameter details as open-source Open-source sharing of CovidCTNet enables developers to rapidly improve and optimize services while preserving user privacy and data ownership
CovidCTNet: an open-source deep learning approach to diagnose covid-19 using small cohort of CT images
The COVID-19 pandemic has aggravated existing problems associated with the high consumption of plastic products and their incorrect disposal, resulting in serious social, economic, and environmental problems The development of biodegradable packaging has been growing in recent years due to the demand for food safety and quality This work aimed to prepare PBAT active films loaded with cellulose nanofibers (CNF) embedded with cinnamon essential oil (EO) by the wire extension method The possible interactions between NC-EO-PBAT were investigated, and the results confirmed the EO presence that physically interacted with the PBAT matrix, altering the polymeric molecular conformations All films showed high thermal stability, being adequate for application in the food industry The films containing the modified-CNF showed a Fickian controlled diffusion, and the higher essential oil release was verified for lower filler contents The modified-CNF decreased the water vapor permeability due to the oil hydrophobic oil and good filler dispersion, which impacted the film's performance as packaging for strawberries The fruits packed in films with 0 5 wt% of modified-CNF have lower weight loss after 15 days of storage, better freshness preservation, and no fungal attack The results indicated that the developed films improved the strawberries' qualities and have antimicrobial properties against Salmonella and Listeria monocytogenes, offering a potential alternative to synthetic materials as food packaging
Nanocellulose functionalized with cinnamon essential oil: A potential application in active biodegradable packaging for strawberry
At the end of 2019, an outbreak of a new coronavirus infection was identified in the People's Republic of China centerd in the city of Wuhan The official name COVID-19 (COronaVIrus Disease 2019) was assigned to the infection caused by the novel coronavirus by the World Health Organization on February 11, 2020 The International Committee on Taxonomy of Viruses assigned the name to the causative agent of the infection - SARS-CoV-2 on February 11, 2020 The bilateral pneumonia is currently known to be the most common clinical manifestation of the variant of coronavirus infection The development of acute respiratory distress syndrome was found in 3 - 4% of patients As a result of pneumonia, patients develop ventilation and perfusion disorders, weakness of skeletal muscles To recover patients after viral pneumonia, methods of pulmonary rehabilitation should be applied This article represents the methods of pulmonary rehabilitation aimed to improve the blood circulation in the lungs, the ventilation-perfusion ratios, and to the restoration of the skeletal muscles © 2020 Medical Education All rights reserved
Pulmonary rehabilitation of patients with coronavirus infection COVID-19, clinical examples


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