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SIMPLE SUMMARY: This paper proposes a deep learning model for prognosis estimation and an attention mechanism for gene expression. In the prognosis estimation of low-grade glioma (LGG), the proposed model, Gene Attention Ensemble NETwork (GAENET), demonstrated superior performance compared to conventional models, where GAENET exhibited an improvement of 7.2% compared to the second-best model. By the proposed gene attention, HILS1 was discovered as the most significant prognostic gene for LGG. While HILS1 is classified as a pseudogene, it functions as a biomarker for predicting the prognosis of LGG and has been shown to have the ability to regulate the expression of other prognostic genes. ABSTRACT: While estimating the prognosis of low-grade glioma (LGG) is a crucial problem, it has not been extensively studied to introduce recent improvements in deep learning to address the problem. The attention mechanism is one of the significant advances; however, it is still unclear how attention mechanisms are used in gene expression data to estimate prognosis because they were designed for convolutional layers and word embeddings. This paper proposes an attention mechanism called gene attention for gene expression data. Additionally, a deep learning model for prognosis estimation of LGG is proposed using gene attention. The proposed Gene Attention Ensemble NETwork (GAENET) outperformed other conventional methods, including survival support vector machine and random survival forest. When evaluated by C-Index, the GAENET exhibited an improvement of 7.2% compared to the second-best model. In addition, taking advantage of the gene attention mechanism, HILS1 was discovered as the most significant prognostic gene in terms of deep learning training. While HILS1 is known as a pseudogene, HILS1 is a biomarker estimating the prognosis of LGG and has demonstrated a possibility of regulating the expression of other prognostic genes.

An Ensemble Deep Learning Model with a Gene Attention Mechanism for Estimating the Prognosis of Low-Grade Glioma

The COVID-19 pandemic has forced changes in production and especially in human interaction, with"social distancing"a standard prescription for slowing transmission of the disease. This paper examines the economic effects of social distancing at the aggregate level, weighing both the benefits and costs to prolonged distancing. Specifically we fashion a model of economic recovery when the productive capacity of factors of production is restricted by social distancing, building a system of equations where output growth and social distance changes are interdependent. The model attempts to show the complex interactions between output levels and social distancing, developing cycle paths for both variables. Ultimately, however, defying gravity via prolonged social distancing shows that a lower growth path is inevitable as a result.

Defying Gravity: The Economic Effects of Social Distancing

Despite clinical and laboratory screening of potential donors for transmissible disease, unexpected transmission of disease from donor to recipient remains an inherent risk of organ transplantation. The Disease Transmission Advisory Committee was created to review and classify reports of potential disease transmission and use this information to inform national policy and improve patient safety. From January 1, 2008 to December 31, 2017, the DTAC received 2185 reports; 335 (15%) were classified as a proven/probable donor transmission event. Infections were transmitted most commonly (67%), followed by malignancies (29%), and other disease processes (6%). Forty-six percent of recipients receiving organs from a donor that transmitted disease to at least one recipient developed a donor derived disease (DDD). Sixty-seven percent of recipients developed symptoms of DDD within 30 days of transplantation, and all bacterial infections were recognized within 45 days. Graft loss or death occurred in about one-third of recipients with DDD, with higher rates associated with malignancy transmission and parasitic and fungal diseases. Unexpected DDD was rare, occurring in 0.18% of all transplant recipients. These findings will help focus future efforts to recognize and prevent DDD.

Ten years of donor derived disease: a report of the disease transmission advisory committee.

Background The enormous health impact of the COVID-19 pandemic has refocused attention on measures to optimize immune function and vaccine response. Dietary deficiencies of micronutrients can weaken adaptive immunity. The aim of this review was to examine links between micronutrients, immune function and COVID-19 infection, with a focus on nutritional risks in subgroups of the Swiss population. Methods Scoping review on the associations between selected micronutrients (vitamins D and C, iron, selenium, zinc, and n-3 PUFAs) and immunity, with particular reference to the Swiss population. These nutrients were chosen because previous EFSA reviews have concluded they play a key role in immunity. Results The review discusses the available knowledge on links between sufficient nutrient status, optimal immune function, and prevention of respiratory tract infections. Because of the rapid spread of the COVID-19 pandemic, controlled intervention studies of micronutrients in the context of CIOVIUD-19 infection are now underway, but evidence is not yet available to draw conclusions. The anti-inflammatory properties of n-3 PUFAs are well established. In Switzerland, several subgroups of the population are at clear risk of nutrient deficiencies; e.g., older adults, multiple comorbidities, obesity, pregnancy, and institutionalized. Low intakes of n-3 PUFA are present in a large proportion of the population. Conclusion There are clear and strong relationships between micronutrient and n-3 PUFA status and immune function, and subgroups of the Swiss population are at risk for deficient intakes. Therefore, during the COVID-19 pandemic, as a complement to a healthy and balanced diet, it may be prudent to consider supplementation with moderate doses of Vitamins C and D, as well as of Se, Zn and n-3 PUFA, in risk groups.

Strengthening the immunity of the Swiss population with micronutrients: a narrative review and call for action

The COVID-19 pandemic has brought unprecedented disruptions to people’s everyday life and induced wide-ranging impacts on people’s physical health, mental health and well-being. This research investigated the relationship between risk perception, mental health distress, and flourishing during the peak period of the COVID-19 pandemic in China. Three hundred and ninety Chinese completed measures on risk perception, mental health distress, positive and negative affect, flourishing, and demographic information. The results revealed that 27.2% of participants experienced some level of mental health distress, but they also experienced a relatively high level of flourishing. Higher level of risk perception and negative affect were risk factors, whereas positive affect was a protective factor, of mental illness and flourishing. Experiences of positive and negative affect mediated the relationship between risk perception and level of mental health distress and flourishing, respectively. Although the COVID-19 pandemic led to a higher level of mental distress among the general public in China, most people were also resilient during the pandemic. The results have implications for improving mental health and enhancing resiliency during public health crises such as the COVID-19 pandemic.

Risk perception, mental health distress, and flourishing during the COVID-19 pandemic in China: The role of positive and negative affect

These authors reflect on how covid-19 has impacted on patient participation in policy and decision making in the Netherlands

Turning patient engagement into the “new normal”

The COVID-19 Pandemic is associated with many radical changes in the lives of young adults. Their developmental and generational characteristics would likely affect their experiences of Pandemic. This study explores their experiences in the context of school, family, and friendship during the Pandemic. The sample consisted of 23 college students. Qualitative data were collected online and analyzed with the thematic analysis method. The results showed that their experiences in the school context resulted in seven themes: difficulties with online classes, benefits, negative mood, coping strategies, loss of socialization opportunities at school, return to daily life, and physical conditions. The themes in the family context were the need for autonomy, increasing conflict, improved family relationships, and no change. Finally, in the friendship context, the themes of losses, coping strategies, emotions, no change, and gains emerged. Results were discussed in terms of the self-determination perspective and generational characteristics of the sample. [ FROM AUTHOR] Copyright of Child & Youth Services is the property of Taylor & Francis Ltd 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.)

Emerging Adults during the Pandemic: The Experiences of Generation Z in the Context of Self-Determination Theory

La expansión de la pandemia producida por el nuevo coronavirus SARS-CoV-2 ha obligado a focalizar casi toda la asistencia sanitaria en pacientes con enfermedad COVID-19, obligando a suspender la mayoría de intervenciones quirúrgicas electivas programadas. La cirugía torácica es eminentemente oncológica, por lo que resulta obligada una adecuada priorización de los pacientes para ser intervenidos lo antes posible y en condiciones de máxima seguridad. Por otra parte, la afectación pulmonar grave COVID-19 presenta complicaciones que con frecuencia requieren procedimientos quirúrgicos torácicos urgentes en un contexto nuevo. La Sociedad Española de Cirugía Torácica (SECT) ha desarrollado este documento para establecer unas recomendaciones básicas tanto para mantener la actividad quirúrgica electiva imprescindible como para orientar a los cirujanos que deban afrontar urgencias torácicas en este nuevo y desconocido entorno. Expansion of the pandemic produced by new coronavirus SATS-CoV-2 has made healthcare focused on patients with COVID-19 disease, leading to discontinue most of elective surgical procedures. Being Thoracic surgery eminently oncological, an optimal triage of patients amenable to be safely operated on is mandatory. Moreover, severe pulmonary involvement by COVID-19 causes complications frequently needing urgent thoracic surgical procedures under a new context. The Spanish Society of Thoracic Surgery (SECT) has developed this document to establish basic recommendations to keep up essential elective surgical activity and to guide surgeons facing thoracic urgencies in this new and unknown environment.

Recomendaciones de actuación en cirugía torácica electiva y urgente en contexto de pandemia por SARS-CoV-2 de la Sociedad Española de Cirugía Torácica (SECT)

The Spike protein (S protein) is a critical component in the infection of the new coronavirus (SARS-CoV-2). The objective of this work was to evaluate whether peptides from S protein could cause negative impact in the aquatic animals. The aquatic toxicity of SARS-CoV-2 Spike protein peptides derivatives has been evaluated in tadpoles (n = 50 tadpoles/5 replicates of 10 animals) from species Physalaemus cuvieri (Leptodactylidae). After synthesis, purification, and characterization of peptides (PSDP2001, PSDP2002, PSDP2003) an aquatic contamination has been simulated with these peptides during 24 h of exposure in two concentrations (100 and 500 ng/mL). The control group ("C") was composed of tadpoles kept in polyethylene containers containing de-chlorinated water. Oxidative stress, antioxidant biomarkers and AChE activity were assessed. In both concentrations, PSPD2002 and PSPD2003 increased catalase and superoxide dismutase antioxidants enzymes activities, as well as oxidative stress (nitrite levels, hydrogen peroxide and reactive oxygen species). All three peptides also increased acetylcholinesterase activity in the highest concentration. These peptides showed molecular interactions in silico with acetylcholinesterase and antioxidant enzymes. Aquatic particle contamination of SARS-CoV-2 has cholinesterasic effect in P. cuvieri tadpoles. These findings indicate that the COVID-19 can constitute environmental impact or biological damage potential.

Toxicological insights of Spike fragments SARS-CoV-2 by exposure environment: A threat to aquatic health?

Major changes in the organisation of the teaching process at universities in Poland had to be introduced in response to the current pandemic situation and threat of further spread of SARS-CoV-2 virus. This article presents the results of the research conducted at the Faculty of Architecture, Poznan University of Technology in view of the pilot, experimental entrance exam that excludes the evaluation of drawing skills of candidates for architectural studies in the 2020/21 recruitment process. The purpose of the research was to find a correlation between the quality of candidates accepted for the BSc (engineer) programme studies, evaluated on the basis of their drawing skills demonstrated during the entrance exam and the learning outcomes of graduates. For that purpose, the authors hereof have carried out an analysis with the use of the Spearman Rank Correlation formula. The comparative analysis has shown that candidates whose drawing skills were evaluated highly during the entrance exam did not necessarily rank as the top grade scoring graduates of the first degree study programme, and thus, it has further been shown that good drawing skills at the beginning of the study programme do not guarantee top learning results at the end of the studies. In effect, the research should become a starting point for a discussion in Poland on whether there are any justified grounds for entrance exams in drawing or whether a portfolio of works may replace it and be an effective recruitment criterion.

Drawing Skills of Candidates for Architectural Studies vs. Learning Outcomes of Graduates. Comparative Research Based on the Example of The Faculty of Architecture, Poznan University of Technology

Mechanistic modeling of SARS-CoV-2 transmission dynamics and frequently estimating model parameters using streaming surveillance data are important components of the pandemic response toolbox. However, transmission model parameter estimation can be imprecise, and sometimes even impossible, because surveillance data are noisy and not informative about all aspects of the mechanistic model. To partially overcome this obstacle, we propose a Bayesian modeling framework that integrates multiple surveillance data streams. Our model uses both SARS-CoV-2 diagnostics test and mortality time series to estimate our model parameters, while also explicitly integrating seroprevalence data from cross-sectional studies. Importantly, our data generating model for incidence data takes into account changes in the total number of tests performed. We model transmission rate, infection-to-fatality ratio, and a parameter controlling a functional relationship between the true case incidence and the fraction of positive tests as time-varying quantities and estimate changes of these parameters nonparameterically. We apply our Bayesian data integration method to COVID-19 surveillance data collected in Orange County, California between March, 2020 and March, 2021 and find that 33-62% of the Orange County residents experienced SARS-CoV-2 infection by the end of February, 2021. Despite this high number of infections, our results show that the abrupt end of the winter surge in January, 2021, was due to both behavioral changes and a high level of accumulated natural immunity.

Semi-parametric modeling of SARS-CoV-2 transmission in Orange County, California using tests, cases, deaths, and seroprevalence data (preprint)

OBJECTIVES: The aim was to investigate if there is synergy in HIV infection and COVID-19 in their influence on human immunity, if there is an exacerbation of HIV patients' immune status caused by SARS-CoV-2; and if HIV infection without antiretroviral therapy (ART) leads to a more serious COVID-19 course than HIV infection with ART. DESIGN: Anonymised blood samples and clinical data were collected in 47 hospitals, clinics and medical centres in six Russian cities/regions in the period from 20 March to 15 June 2020. Three hundred and seventy-six HIV/COVID-19 patients were studied (171 without ART and 205 with ART). The control group consisted of 382 SARS-CoV-2-positive patients without HIV infection. Lymphocyte and cytokine amounts were measured by flow cytometry and ELISA. This work is a retrospective study. RESULTS: COVID-19 led to rapid augmentation of the process of T-cell exhaustion initially caused by HIV, and this T cell degradation was most pronounced in patients without ART. A rise in IL-10 and TGFß serum concentrations was observed. Diminishing CD4+/CD8+ cell and Th1/Th2 cell ratios characteristic for HIV progression were accompanied by a surge in exhausted T cell count with simultaneous exacerbation of COVID-19-related respiratory distress. CONCLUSIONS: HIV infection without ART may be a very serious comorbidity of COVID-19, whereas immunity of HIV/COVID-19 patients with proper ART is not generally affected by SARS-CoV-2. HIV-1 and SARS-CoV-2 are likely to exhibit a synergic effect, and exhausted T lymphocyte dynamics may be its effective marker.

HIV/SARS-CoV-2 co-infection: T cell profile, cytokine dynamics and role of exhausted lymphocytes

Objective: Due to the prohibition of face-to-face courses during the Corona pandemic, the seminar "Written Examinations" of the Frankfurter Arbeitsstelle für Medizindidaktik (FAM) was converted into an asynchronous online seminar. This pilot project investigated how such a format is accepted and evaluated by the participants. Methodology: A forum-based online format with group and individual tasks was chosen, which was didactically designed according to the problem-oriented design by Reinmann and Mandl. Results: The seminar was attended by 14 people, 13 of whom took part in the evaluation. The overall evaluation was, with one exception, a grade of 2 (and better). The three items "practical relevance", "subjective learning success" and the question of recommendation also received very high approval ratings. The weekly workload reported by the participants was very heterogeneous (mean=2.4 hours; SD=1.1). For some participants, the use of the learning platform was not intuitive and group collaboration was somewhat faltering. Conclusion: The experiences made show that courses on medical didactics can be implemented online and are gladly accepted by the participants. Based on the experience gained, online seminars or blended learning formats will certainly continue to be part of the FAM course program in the future.

Medical didactics during the pandemic: the asynchronous online seminar "Written Examinations" of the Frankfurter Arbeitsstelle für Medizindidaktik

Respiratory tract infections (RTI) are the leading cause of death in low-income countries and the second leading cause of death worldwide in children less than 5 years old. Most RTI are viral. Human metapneumovirus (hMPV) was discovered in 2001 in routine viral cultures of respiratory specimens from children with RTI and has been implicated as a common cause of RTI in children and adults and a cause of severe disease in immunocompromised hosts. This article describes the microbiology, epidemiology, clinical presentation, pathogenesis, diagnosis, treatment, prognosis, long-term outcome, immunity and reinfection of hMPV.

Human Metapneumovirus

In this paper, we describe the experience of setting up a computational infrastructure based on BOINC middleware and running a volunteer computing project on its basis. We characterize the first series of computational experiments and review the project’s development in its first six months. The gathered experience shows that BOINC-based Desktop Grids allow to efficiently aid drug discovery at its early stages. © 2021, Springer Nature Switzerland AG.

Toward Crowdsourced Drug Discovery: Start-Up of the Volunteer Computing Project SiDock@home

Attention is a powerful concept in computer vision. End-to-end networks that learn to focus selectively on regions of an image or video often perform strongly. However, other image regions, while not necessarily containing the signal of interest, may contain useful context. We present an approach that exploits the idea that statistics of noise may be shared between the regions that contain the signal of interest and those that do not. Our technique uses the inverse of an attention mask to generate a noise estimate that is then used to denoise temporal observations. We apply this to the task of camera-based physiological measurement. A convolutional attention network is used to learn which regions of a video contain the physiological signal and generate a preliminary estimate. A noise estimate is obtained by using the pixel intensities in the inverse regions of the learned attention mask, this in turn is used to refine the estimate of the physiological signal. We perform experiments on two large benchmark datasets and show that this approach produces state-of-the-art results, increasing the signal-to-noise ratio by up to 5.8 dB, reducing heart rate and breathing rate estimation error by as much as 30%, recovering subtle pulse waveform dynamics, and generalizing from RGB to NIR videos without retraining.

The Benefit of Distraction: Denoising Remote Vitals Measurements using Inverse Attention

Medical ethics that becomes more and more consolidated and important underwent modifications because of experiences with animals. This humanitarian movement initiated some time ago is now picking the best results, with permanent attention an care regarding this aspect at the Brazilian Medical Universities. The animal involuntarily involved, contribute with medical and surgical research and should be respected. The results should benefit both

Ética e experimentação animal

Factors that regulate mitotic spindle positioning have been elucidated in vitro, however it remains unclear how a spindle is placed within the confines of extremely large cells. Our studies identified a uniquely large centrosome structure in the early zebrafish embryo (246.44±11.93μm2 mitotic centrosome in a 126.86±0.35μm diameter cell), whereas C. elegans centrosomes are notably smaller (6.75±0.28μm2 mitotic centrosome in a 55.83±1.04μm diameter cell). During early embryonic cell divisions, cell size changes rapidly in C. elegans and zebrafish embryos. Notably, mitotic centrosome area scales closely with changing cell size compared to changes in spindle length for both organisms. One interesting difference between the two is that mitotic centrosomes are asymmetric in size across embryonic zebrafish spindles, with the larger mitotic centrosome being 2.14±0.13-fold larger in size than the smaller. The largest mitotic centrosome is placed towards the embryo center in a Polo-Like Kinase (PLK) 1 and PLK4 dependent manner 87.14±4.16% of the time. We propose a model in which uniquely large centrosomes direct spindle placement within the disproportionately large zebrafish embryo cells to orchestrate cell divisions during early embryogenesis.

PLK1- and PLK4-mediated asymmetric mitotic centrosome size and positioning in the early zebrafish embryo

PURPOSE OF REVIEW: To provide an update on the consequences of severe acute respiratory syndrome (SARS)-CoV-2 infection on the health and perinatal outcomes of pregnant women and their infants. RECENT FINDINGS: The severity of SARS-CoV-2 infection is greater in pregnant compared to nonpregnant women as measured by rates of admission to intensive care units, mechanical ventilation, mortality, and morbidities including myocardial infarction, venous thromboembolic and other thrombotic events, preeclampsia, preterm labor, and preterm birth. The risk of transmission from mother-to-infant is relatively low (1.5-5%) as quantitated by neonatal SARS-CoV-2 testing. Infants appear to be at higher risk of testing positive for SARS-CoV-2 if the mother has tested positive within 1 week of delivery or is herself symptomatic at the time of maternity admission. The rate of positivity is not higher in infants who room in with the mother compared to infants who are initially separated and cared for in a SARS-CoV-2-free environment. Infants who test positive in the hospital have no or mild signs of disease, most of which may be attributable to prematurity, and rarely require readmission for clinical signs consistent with COVID-19. SUMMARY: Pregnant women should take precautions to avoid infection with SARS-CoV-2. Infants born to mothers who test positive for SARS-CoV-2 can receive normal neonatal care in-hospital with their mothers if mother and staff adhere to recommended infection control practices.

Consequences of the SARS-CoV-2 pandemic in the perinatal period

BACKGROUND: Glutamine (GLN) has been reported to improve clinical and experimental sepsis outcomes. However, the mechanisms underlying the actions of GLN remain unclear, and may depend upon the route of GLN administration and the model of acute lung injury (ALI) used. The aim of this study was to investigate whether short-term GLN supplementation had an ameliorative effect on the inflammation induced by direct acid and lipopolysaccharide (LPS) challenge in mice. METHODS: Female BALB/c mice were divided into two groups, a control group and a GLN group (4.17% GLN supplementation). After a 10-day feeding period, ALI was induced by intratracheal administration of hydrochloric acid (pH 1.0; 2 mL/kg of body weight [BW]) and LPS (5 mg/kg BW). Mice were sacrificed 3 h after ALI challenge. In this early phase of ALI, serum, lungs, and bronchoalveolar lavage fluid (BALF) from the mice were collected for further analysis. RESULTS: The results of this study showed that ALI-challenged mice had a significant increase in myeloperoxidase activity and expression of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α in the lung compared with unchallenged mice. Compared with the control group, GLN pretreatment in ALI-challenged mice reduced the levels of receptor for advanced glycation end-products (RAGE) and IL-1β production in BALF, with a corresponding decrease in their mRNA expression. The GLN group also had markedly lower in mRNA expression of cyclooxygenase-2 and NADPH oxidase-1. CONCLUSIONS: These results suggest that the benefit of dietary GLN may be partly contributed to an inhibitory effect on RAGE expression and pro-inflammatory cytokines production at an early stage in direct acid and LPS-induced ALI in mice.

Short-term glutamine supplementation decreases lung inflammation and the receptor for advanced glycation end-products expression in direct acute lung injury in mice

In the early months of the pandemic, SARS-CoV-2 infected nursing home residents in explosive and deadly outbreaks. Nursing home residents disproportionately accounted for over 40% of COVID-19 mortality nationally. This national emergency drove scientific and public health experts to develop and implement administrative, clinical, and research programs to limit the pandemic’s impact, especially for high-risk individuals, such as those hospitalized or living in nursing homes. Nursing home policies, prompted by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) guidance, severely restricted access beginning in March 2020 in an effort to limit disease exposure. In July 2020 we began the process to conduct an investigational SARS-CoV-2 post exposure prophylaxis study of nursing home residents, incorporating FDA guidance developed for conducting investigational drug trials in the context of COVID-19. Our research teams adapted our nursing home engagement, resident consenting and research data collection strategies accordingly. We remotely screened residents living in any of 28 nursing homes for eligibility to participate, ultimately consenting and randomizing individuals in 11 facilities. Of the 2,683 nursing home residents 65 years or older we screened, 48 (1.8%) agreed to consent individually or through proxy, most often a legally authorized representative. We will describe our research methods, with emphasis on how we addressed challenges presented due to performing all research tasks remotely and identify strategies that can qualitatively improve the remote nursing home research experience.

Challenges with Conducting an Investigational Drug Study in Older Adults in Nursing Homes During a Pandemic

Background and study aims The need for hospital beds during the COVID-19 pandemic almost overwhelmed the health care systems all over the world. Therefore, elective non-life-saving procedures were postponed. We decided to perform all colorectal endoscopic mucosal dissections (ESDs) for challenging lesions as outpatient procedures, organizing an ad hoc path to management of any delayed post-procedural complications. The aim of the present study was to retrospectively evaluate the feasibility and safety of outpatient ESD for colorectal tumors. Patients and methods From March 2020 to May 2020, outpatient colorectal ESDs were performed for 15 challenging lesions. We retrospectively investigated feasibility and safety of the procedures, rates of en bloc resection, and complications rates. Results The mean age of the patients was 66.5 years and 40 % of the them were on antiplatelet/anticoagulation therapy. Median size of removed lesions was 45 mm (range 32–77) and 38 mm (range 24 to 55) Five patients (33 %) had rectal tumors extending to the dentate line and four (26.6 %) were recurrences on a scar of previous endoscopic or surgical local resections. All complications, such as bleeding or visible microperforation, were managed endoscopically and no delayed perforations occurred. One patient had fever (37.5 °C), while three patients complained of anal pain after ESD for a rectal tumor that extended to the dentate line (RTDL); all patients were managed conservatively. Conclusion Outpatient colorectal ESD is feasible and safe for challenging lesions. It reduces costs of hospitalization but direct access to the endoscopy service to manage potential post-ESD complications should always be guaranteed.

Outpatient ESD for challenging colorectal lesions: Is it feasible and safe for western countries?

Since the onset of the COVID-19 pandemic, several small cohorts have reported the recurrent occurrence of venous thromboembolic disease (VTE), particulary pulmonary embolism, in serious patients hospitalized in intensive care units. We report the case of a patient who presented a minor COVID-19 infection treated on an outpatient basis with good clinical resolution. She developed a pulmonary embolism three weeks after the onset of symptoms. When she was admitted to the emergency room, the two real time reverse transcription polymerase chain reactions (RT-PCRs) performed were negative, moreover the anti-SARS-CoV-2 Immunoglobulin Gs (IgGs) serological test was positive and the chest scanner without and with injection of contrast product showed specific images of COVID-19 with intermediate pulmonary embolism according to the classification of the European society of cardiology (ESC). This observation is interesting since there are not many studies which address the question of the occurrence of late pulmonary embolism in patients with non-severe COVID-19 and raises the discussion on the criteria for the initiation of thromboembolic prophylaxis treatment at the first diagnosis of the disease and duration of that treatment.

Late pulmonary embolism in a patient with non-severe COVID-19: case report, value of antithrombotic prophylaxis and literature review

Background: During the last few decades the prevalence of lumbar disc herniation has been increasing constantly, thereby imposing a significant socioeconomic burden. Physiotherapy plays a crucial role in both surgical and conservative treatment of lumbar disc herniation, consequently the current COVID-19 pandemic with concomitant lockdowns has led to a shortage of physiotherapeutical care. In the light of these recent events publicly available physiotherapy tutorials may be a useful tool to address this problem. Aim: The main aim of this study was to assess the quality of online physiotherapy exercise tutorials for lumbar disc herniation. Materials & Methods: With YouTube being a widely known and used platform we screened 240 of the most viewed videos. A total of 76 videos met the inclusion criteria and were statistically analyzed. The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Results: They displayed a wide range of views (44,969 to 5,448,717), likes (66 to 155,079) and dislikes (6 to 2339). The videos were assessed using Global Quality Score, DISCERN Score and JAMA benchmark criteria and in regard to their applicability. Neither the number of "Views", "Likes", nor "Dislikes" was found to have a significant association with any of the quality measures used in this study. Conclusion: Overall quality grade was determined as "moderate". Based on the data examined in this study, the use of YouTube videos as a source of therapy advice for lumbar spine disc herniation cannot be recommended universally.

Online Videos as a Source of Physiotherapy Exercise Tutorials for Patients with Lumbar Disc Herniation-A Quality Assessment

Background: In December 2019, an ongoing outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan, China While COVID-19 has become a global pandemic

Potential Predictors for Early Invasive Ventilation in Critically Ill Patients with COVID-19 in Wuhan, China: A Single-Centered, Retrospective, Observational Study

A prospective study was conducted from November 2013 to February 2014 to estimate the spatial clustering; cumulative incidence and risk factors associated with avian influenza (AI) subtype H9 infection on commercial poultry farms of Pakistan. A total of 400 farms were enrolled and followed during the study period. Among these, 109 farms submitted samples suspected for AI to the laboratory, and only 47 farms were confirmed positive by hemagglutinin inhibition (HI) test. Data was collected from these 109 farms about their demography, management, and biosecurity practices. The cumulative incidence of H9N2 was 11.75 % (95 % confidence interval (CI) 8.76–15.23). The highest number of cases (40.42 %) was reported in January. One most likely cluster (p = 0.009, radius = 4.61 km) occurred in the Kasur district. Multivariable logistic regression analyses showed that the presence of wild birds on the farms (odds ratio (OR) = 16.18; 95 % CI 3.94–66.45) was independently associated with H9N2 infection. Cleaning of cages before delivery on farm (OR = 0.16; 95 % CI = 0.06–0.47), presence of a footbath at the entrance of farm (OR = 0.24; 95 % CI 0.08–0.79), and changing of gloves (OR = 0.33; 95 % CI 0.11–0.99) were protective factors against H9N2 infection. Reducing the exposure to risk factors and adapting biosecurity measures may reduce the risk of AI H9N2 infection on commercial poultry farms in Pakistan.

Prospective study of avian influenza H9 infection in commercial poultry farms of Punjab Province and Islamabad Capital Territory, Pakistan

OBJECTIVES: The purpose of this study was to investigate the effects that the use of protective face mask has over the voice and to search for associations between the self-reported voice changes and the levels of discomfort experienced by the participants. Also, to detect any change it the phonatory patterns while speaking with face mask. METHODS: This was a cross-sectional, observational study, conducted by distributing an online questionnaire. From a total of 155 people who participated in the study, 143 of them wore protective face mask during their working hours and qualified. Five groups of questions were used to measure the Speech Difficulties, the Mask Related Behaviors caused by the use of face mask, alterations in the Voice Perceptual Features, the Vocal Tract Discomfort levels and the Greek version of the Voice Handicap Index. The participants self-evaluated their voice and stated the frequency and severity of the symptoms they experienced during the mask usage period. RESULTS: The results showed that the use of protective face mask increases the self-perception of changes in the voice, especially in the voice-breathing coordination and has great effect on the intelligibility and overall communication. The majority of people stated that they have to speak louder and that they have noticed alterations in the perceptual features of their voice, with hoarseness, and volume being the most frequently affected. Almost every symptom on the Vocal Tract Discomfort Group was present with Dry, Lump in Throat, Tight, and Short Breath being the most severe, and Dry and Short breath being the most common among them. Physical, Functional, and Emotional affectations were also observed through the Voice Handicap Index. CONCLUSION: The use of protective face mask increases the vocal effort of the speaker, affects the voice-breathing coordination, limits the overall communication, alters the perceptual features of the voice, increases vocal track discomfort levels and results in psychosocial and socioemotional difficulties. All these affectations may result to the establishment of a voice disorder, especially in high-risk population.

The Effects of the Use of Protective Face Mask on the Voice and Its Relation to Self-Perceived Voice Changes

Pulmonary fibrosis is a chronic debilitating condition characterized by progressive deposition of connective tissue, leading to a steady restriction of lung elasticity, a decline in lung function, and a median survival of 4.5 years. The leading causes of pulmonary fibrosis are inhalation of foreign particles (such as silicosis and pneumoconiosis), infections (such as post COVID-19), autoimmune diseases (such as systemic autoimmune diseases of the connective tissue), and idiopathic pulmonary fibrosis. The therapeutics currently available for pulmonary fibrosis only modestly slow the progression of the disease. This review is centered on the interplay of damage-associated molecular pattern (DAMP) molecules, Toll-like receptor 4 (TLR4), and inflammatory cytokines (such as TNF-α, IL-1β, and IL-17) as they contribute to the pathogenesis of pulmonary fibrosis, and the possible avenues to develop effective therapeutics that disrupt this interplay.

The interplay of DAMPs, TLR4, and proinflammatory cytokines in pulmonary fibrosis

Abstract Background Solid organ transplant recipients (SOTRs) are at increased risk for adverse outcomes with COVID-19. Early data shows a lower SARS-CoV-2 spike antibody immune response among SOTRs leading to patient concerns about vaccine efficacy. Public health messaging has largely left out immunocompromised individuals leading to a higher risk of vaccine misinformation. The American Society of Transplantation recommends COVID-19 vaccination for all SOTRs, however, patient concerns and beliefs about vaccination are largely unknown. Methods We conducted a transplant-center-based, pragmatic pilot trial to encourage COVID-19 vaccination among 103 unvaccinated SOTRs. We assessed vaccine concerns, barriers to vaccination, answered questions about efficacy, side effects, and clinical recommendations. Results A total of 24% (n = 25) of SOTRs reported that they will schedule COVID-19 vaccination after the study call, 46% reported that they will consider vaccination in the future, and 30% said they will not consider vaccination. Older age and White race were associated with lower willingness to schedule the vaccine, whereas Black race and longer time from transplant were associated with higher willingness. Common vaccine concerns included lack of long-term data, inconsistent messaging from providers, scheduling inconvenience, and insufficient resources. Follow-up approximately one month after the initial outreach found 52% (n = 13) of liver transplant recipients (LTRs) and 10% (n = 3) of kidney transplant recipients (KTRs) subsequently received COVID-19 vaccines for a vaccination rate of 29% among respondents. Conclusion Transplant center-based vaccine outreach efforts can decrease misinformation and increase vaccination uptake;however, vaccine-related mistrust remains high. This article is protected by copyright. All rights reserved

A pragmatic outreach pilot to understand and overcome barriers to COVID-19 vaccination in abdominal organ transplant

Infants, children, and adolescents who do not get sufficient sleep are at increased risk for injuries, obesity, type 2 diabetes, poor mental health, attention and behavior problems, and poor cognitive development (1). The American Academy of Sleep Medicine (AASM) provides age-specific sleep duration recommendations to promote optimal health (1). CDC analyzed data from the 2016-2018 National Survey of Children's Health (NSCH) to assess the prevalence of short sleep duration among persons in the United States aged 4 months-17 years. Overall, on the basis of parent report, 34.9% of persons aged 4 months-17 years slept less than recommended for their age. The prevalence of short sleep duration was higher in southeastern states and among racial and ethnic minority groups, persons with low socioeconomic status, and those with special health care needs. The prevalence of short sleep duration ranged from 31.2% among adolescents aged 13-17 years to 40.3% among infants aged 4-11 months. Persons aged 4 months-17 years with a regular bedtime were more likely to get enough sleep. Public health practitioners, educators, and clinicians might advise parents on the importance of meeting recommended sleep duration and implementing a consistent bedtime for healthy development.

Short Sleep Duration Among Infants, Children, and Adolescents Aged 4 Months-17 Years - United States, 2016-2018.

BACKGROUND Beta thalassemia patients, post-bone marrow transplant, and leukemia patients require long term therapy with an intense care follow-up especially for pediatric hematology-oncology origin. Emergence of side effects and noncompliance to therapy lead to reduced efficacy of medicines resulting in relapse of diseases. There is an increasing fact to support the incorporation of a pharmacist into clinical team due to their distinctive skills. Clinical oncology pharmacist with experience and specialized training in hematological cancers and bone marrow transplantation (BMT) patient care has in-depth knowledge and skills of chemotherapy regimens including drug information, monitoring parameters of cancer treatment, dose adjustment, drug-drug interactions, adverse effects, and patient counseling skills. AIM AND OBJECTIVES The main objective of our study was to assess the significance of incorporation of clinical oncology pharmacist in ambulatory care in pediatric hematology-oncology and transplant clinic. MATERIAL AND METHOD This study was conducted at National Institute of Blood Diseases and Bone Marrow Transplantation hospital with duration of five months from 17 March 2019 to 16 July 2019. In this study the clinical oncology pharmacist was made available at ambulatory clinic of hematology-oncology and transplantation. The activities performed by a clinical oncology pharmacist were observed by resident BMT clinical pharmacist during the visits of patients and their families in a clinic. The BMT pharmacist is a clinical oncology pharmacist with experience and specialized training in hematological cancers and BMT patient care. Only pediatrics patients with beta thalassemia major and those who were on chemotherapy treatment and post-transplant patient were included in this study. RESULTS During the five months' tenure, there were 1820 pediatric patients' visits in total. The clinical oncology pharmacist performed 980 direct patient interviews and documented 1665 pharmacist interventions. The majority of the documented clinical oncology pharmacist interventions were review of medication histories (n: 404, 24%) and "deferiprone" dose adjustments (n:400, 24%). Genomic profiling interventions were also among the commonly reported activities by the clinical oncology pharmacist. For beta thalassemia patients undergoing hydroxyurea therapy, the genomic profiling was performed to assess whether the hydroxyurea treatment is clinically effective or not (n:396, 23%). CONCLUSION The involvement of clinical oncology pharmacist into a specialized outpatient clinic of hematology-oncology and transplant clinic plays an integral role in minimizing the adverse effect and reduction in readmission into the hospital. This is new expansion of pharmacist's role especially in underdeveloped country, considering the relevant clinical participation of clinical oncology pharmacist into specialized clinic revealing through optimized therapy and future prospect of clinical oncology pharmacist in pediatric hematology.

Incorporating a clinical oncology pharmacist into an ambulatory care pharmacy in pediatric hematology-oncology and transplant clinic: Assessment and significance.

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Unexpected situation of coronavirus disease-2019 pandemic could increase the incidence of mental health problems such as psychotic disorders and other mental health problems. Psychotic disorders can occur as a result of quarantine social isolation. Herewith, we present a case of 30-year-old male with onset of brief psychotic disorder after quarantine. The patient was treated with risperidone and had rapid improvement. Quarantine leads to stress and social isolation in individuals, which can result in psychosis. There is a need of early detection and intervention services to improve the outcome of psychosis due to quarantine.

A case report on acute and transient psychotic disorder due to coronavirus disease 2019 quarantine

The purpose of the article is to identify the main socio-economic causes and consequences of the COVID-19 coronavirus pandemic in indicative planning of the innovative development of a federal state, as well as the ways to overcome the negative consequences as a new and substantial example of impact of unforeseen factors of a radical nature to a federal state The main fundamental consequences of the COVID-19 coronavirus pandemic appear to be two interrelated innovation processes (coronavirus' affects): accelerated digitalization of all aspects of socioeconomic activity, as well as socio-economic innovation, namely "zeroing", i e gradual displacement of a person from many processes where he is currently carrying out labor activities In order to overcome the negative consequences of the coronavirus pandemic COVID-19 and other unforeseen factors of a radical nature federal states of the countries and region governments are apt use the tools of innovation and indicative planning © The Authors, published by EDP Sciences, 2020

Indicative planning of the innovative development of a federal state in the context of the activation of unforeseen factors of a radical nature (at example of the COVID-19 pandemic)

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

Correction to: The use of intravenous immunoglobulin gamma for the treatment of severe coronavirus disease 2019: a randomized placebo-controlled double-blind clinical trial

Coronavirus disease 2019 (COVID-19) has resulted in an ongoing pandemic. Since COVID-19 spreads mainly via close contact among people, social distancing has become an effective manner to slow down the spread. However, completely forbidding close contact can also lead to unacceptable damage to the society. Thus, a system that can effectively monitor people's social distance and generate corresponding alerts when a high infection probability is detected is in urgent need. In this paper, we propose SmartDistance, a smartphone based software framework that monitors people's interaction in an effective manner, and generates a reminder whenever the infection probability is high. Specifically, SmartDistance dynamically senses both the relative distance and orientation during social interaction with a well-designed relative positioning system. In addition, it recognizes different events (e.g., speaking, coughing) and determines the infection space through a droplet transmission model. With event recognition and relative positioning, SmartDistance effectively detects risky social interaction, generates an alert immediately, and records the relevant data for close contact reporting. We prototype SmartDistance on different Android smartphones, and the evaluation shows it reduces the false positive rate from 33% to 1% and the false negative rate from 5% to 3% in infection risk detection.

SmartDistance: A Mobile-based Positioning System for Automatically Monitoring Social Distance

BACKGROUND: Increased vitamin D levels, as reflected by 25-hydroxy vitamin D (25OHD) measurements, have been proposed to protect against COVID-19 based on in vitro, observational, and ecological studies. However, vitamin D levels are associated with many confounding variables, and thus associations described to date may not be causal. Vitamin D Mendelian randomization (MR) studies have provided results that are concordant with large-scale vitamin D randomized trials. Here, we used 2-sample MR to assess evidence supporting a causal effect of circulating 25OHD levels on COVID-19 susceptibility and severity. METHODS AND FINDINGS: Genetic variants strongly associated with 25OHD levels in a genome-wide association study (GWAS) of 443,734 participants of European ancestry (including 401,460 from the UK Biobank) were used as instrumental variables. GWASs of COVID-19 susceptibility, hospitalization, and severe disease from the COVID-19 Host Genetics Initiative were used as outcome GWASs. These included up to 14,134 individuals with COVID-19, and up to 1,284,876 without COVID-19, from up to 11 countries. SARS-CoV-2 positivity was determined by laboratory testing or medical chart review. Population controls without COVID-19 were also included in the control groups for all outcomes, including hospitalization and severe disease. Analyses were restricted to individuals of European descent when possible. Using inverse-weighted MR, genetically increased 25OHD levels by 1 standard deviation on the logarithmic scale had no significant association with COVID-19 susceptibility (odds ratio [OR] = 0.95; 95% CI 0.84, 1.08; p = 0.44), hospitalization (OR = 1.09; 95% CI: 0.89, 1.33; p = 0.41), and severe disease (OR = 0.97; 95% CI: 0.77, 1.22; p = 0.77). We used an additional 6 meta-analytic methods, as well as conducting sensitivity analyses after removal of variants at risk of horizontal pleiotropy, and obtained similar results. These results may be limited by weak instrument bias in some analyses. Further, our results do not apply to individuals with vitamin D deficiency. CONCLUSIONS: In this 2-sample MR study, we did not observe evidence to support an association between 25OHD levels and COVID-19 susceptibility, severity, or hospitalization. Hence, vitamin D supplementation as a means of protecting against worsened COVID-19 outcomes is not supported by genetic evidence. Other therapeutic or preventative avenues should be given higher priority for COVID-19 randomized controlled trials.

Vitamin D and COVID-19 susceptibility and severity in the COVID-19 Host Genetics Initiative: A Mendelian randomization study

Introduction: Coronaviruses are zoonotic viruses that include human epidemic pathogens such as the Middle East Respiratory Syndrome virus (MERS-CoV), and the Severe Acute Respiratory Syndrome virus (SARS-CoV), among others (e.g., COVID-19, the recently emerging coronavirus disease). The role of animals as potential reservoirs for such pathogens remains an unanswered question. No systematic reviews have been published on this topic to date. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess MERS-CoV and SARS-CoV infection in animals and its diagnosis by serological and molecular tests. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Results: 6,493articles were retrieved (1960-2019). After screening by abstract/title, 50 articles were selected for full-text assessment. Of them, 42 were finally included for qualitative and quantitative analyses. From a total of 34 studies (n=20,896 animals), the pool prevalence by RT-PCR for MERS-CoV was 7.2% (95%CI 5.6-8.7%), with 97.3% occurring in camels, in which pool prevalence was 10.3% (95%CI 8.3-12.3). Qatar was the country with the highest MERS-CoV RT-PCR pool prevalence, 32.6% (95%CI 4.8-60.4%). From 5 studies and 2,618 animals, for SARS-CoV, the RT-PCR pool prevalence was 2.3% (95%CI 1.3-3.3). Of those, 38.35% were reported on bats, in which the pool prevalence was 14.1% (95%CI0.0-44.6%). Discussion: A considerable proportion of infected animals tested positive, particularly by nucleic acid amplification tests (NAAT). This essential condition highlights the relevance of individual animals as reservoirs of MERS-CoV and SARS-CoV. In this meta-analysis, camels and bats were found to be positive by RT-PCR in over 10% of the cases for both;thus, suggesting their relevance in the maintenance of wild zoonotic transmission.

MERS-CoV and SARS-CoV Infections in Animals: A Systematic Review and Meta-Analysis of Prevalence Studies

INTRODUCTION: Stroke is a common cause of epilepsy that may be mediated via glutamate dysregulation. There is currently no evidence to support the use of antiseizure medications as primary prevention against poststroke epilepsy. Perampanel has a unique antiglutamatergic mechanism of action and may have antiepileptogenic properties. This study aims to evaluate the efficacy and safety of perampanel as an antiepileptogenic treatment in patients at high risk of poststroke epilepsy. METHODS AND ANALYSIS: Up to 328 patients with cortical ischaemic stroke or lobar haemorrhage will be enrolled, and receive their first treatment within 7 days of stroke onset. Patients will be randomised (1:1) to receive perampanel (titrated to 6 mg daily over 4 weeks) or matching placebo, stratified by stroke subtype (ischaemic or haemorrhagic). Treatment will be continued for 12 weeks after titration. 7T MRI will be performed at baseline for quantification of cerebral glutamate by magnetic resonance spectroscopy and glutamate chemical exchange saturation transfer imaging. Blood will be collected for measurement of plasma glutamate levels. Participants will be followed up for 52 weeks after randomisation.The primary study outcome will be the proportion of participants in each group free of late (more than 7 days after stroke onset) poststroke seizures by the end of the 12-month study period, analysed by Fisher's exact test. Secondary outcomes will include time to first seizure, time to treatment withdrawal and 3-month modified Rankin Scale score. Quality of life, cognitive function, mood and adverse events will be assessed by standardised questionnaires. Exploratory outcomes will include correlation between cerebral and plasma glutamate concentration and stroke and seizure outcomes. ETHICS AND DISSEMINATION: This study was approved by the Alfred Health Human Research Ethics Committee (HREC No 44366, Reference 287/18). TRIAL REGISTRATION NUMBER: ACTRN12618001984280; Pre-results.

Study protocol for a phase II randomised, double-blind, placebo-controlled trial of perampanel as an antiepileptogenic treatment following acute stroke

This study investigates students’ social networks and mental health before and at the time of the COVID-19 pandemic in April 2020, using longitudinal data collected since 2018. We analyze change on multiple dimensions of social networks (interaction, friendship, social support, co-studying) and mental health indicators (depression, anxiety, stress, loneliness) within two cohorts of Swiss undergraduate students experiencing the crisis (N = 212), and make additional comparisons to an earlier cohort which did not experience the crisis (N = 54). In within-person comparisons we find that interaction and co-studying networks had become sparser, and more students were studying alone. Furthermore, students’ levels of stress, anxiety, loneliness, and depressive symptoms got worse, compared to measures before the crisis. Stressors shifted from fears of missing out on social life to worries about health, family, friends, and their future. Exploratory analyses suggest that COVID-19 specific worries, isolation in social networks, lack of interaction and emotional support, and physical isolation were associated with negative mental health trajectories. Female students appeared to have worse mental health trajectories when controlling for different levels of social integration and COVID-19 related stressors. As universities and researchers discuss future strategies on how to combine on-site teaching with online courses, our results indicate the importance of considering social contacts in students’ mental health and offer starting points to identify and support students at higher risk of social isolation and negative psychological effects during the COVID-19 pandemic.

Students under lockdown: Comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland

BACKGROUND: Pediatric LRTI hospitalizations are a significant burden on patients, families, and healthcare systems. This study determined the burden of pediatric LRTIs on hospital settings in British Columbia and the benefits of prevention strategies as they relate to healthcare resource demand. METHODS: LRTI inpatient episodes for patients <19 years of age during 2008–2010 were extracted from the BC Discharge Abstract Database. The annual number of acute care beds required to treat pediatric LRTIs was estimated. Sub-analyses determined the burden due to infants <1 year of age and high-risk infants. Population projections were used to forecast LRTI hospitalizations and the effectiveness of public health initiatives to reduce the incidence of LRTIs to 2020 and 2030. RESULTS: During 2008–2010, LRTI as the primary diagnosis accounted for 32.0 and 75.9% hospitalizations for diseases of the respiratory system in children <19 years of age and infants <1 year of age, respectively. Infants <1 year of age accounted for 47 and 77% hospitalizations due to pediatric LRTIs and pediatric LRTI hospitalizations specifically due to respiratory syncytial virus (RSV), respectively. The average length of stay was 3.1 days for otherwise healthy infants <1 year of age and 9.1 days for high-risk infants (P <0.0001). 73.1% pediatric LRTI hospitalizations occurred between November and April. Over the study timeframe, 19.6 acute care beds were required on average to care for pediatric LRTIs which increased to 64.0 beds at the peak of LRTI hospitalizations. Increases in LRTI bed-days of 5.5 and 16.2% among <19 year olds by 2020 and 2030, respectively, were predicted. Implementation of appropriate prevention strategies could cause 307 and 338 less LRTI hospitalizations in <19 year olds in 2020 and 2030, respectively. CONCLUSION: Pediatric LRTI hospitalizations require significant use of acute care infrastructure particularly between November and April. Population projections show the burden may increase in the next 20 years, but implementation of effective public health prevention strategies may contribute to reducing the acute care demand and to supporting efforts for overall pediatric healthcare sustainability.

Acute care utilization due to hospitalizations for pediatric lower respiratory tract infections in British Columbia, Canada

Ethnopharmacological relevance Traditional Chinese medicines (TCMs) have made great contributions to the prevention and treatment of human diseases in China, and especially in cases of COVID-19. However, due to quality problems, the lack of standards, and the diversity of dosage forms, adverse reactions to TCMs often occur. Moreover, the composition of TCMs makes them extremely challenging to extract and isolate, complicating studies of toxicity mechanisms. Aim of the review: The aim of this paper is therefore to summarize the advanced applications of mass spectrometry imaging (MSI) technology in the quality control, safety evaluations, and determination of toxicity mechanisms of TCMs. Materials and methods Relevant studies from the literature have been collected from scientific databases, such as “PubMed”, “Scifinder”, “Elsevier”, “Google Scholar” using the keywords “MSI”, “traditional Chinese medicines”, “quality control”, “metabolomics”, and “mechanism”. Results MSI is a new analytical imaging technology that can detect and image the metabolic changes of multiple components of TCMs in plants and animals in a high throughput manner. Compared to other chemical analysis methods, such as liquid chromatography-mass spectrometry (LC-MS), this method does not require the complex extraction and separation of TCMs, and is fast, has high sensitivity, is label-free, and can be performed in high-throughput. Combined with chemometrics methods, MSI can be quickly and easily used for quality screening of TCMs. In addition, this technology can be used to further focus on potential biomarkers and explore the therapeutic/toxic mechanisms of TCMs. Conclusions As a new type of analysis method, MSI has unique advantages to metabolic analysis, quality control, and mechanisms of action explorations of TCMs, and contributes to the establishment of quality standards to explore the safety and toxicology of TCMs.

Advanced applications of mass spectrometry imaging technology in quality control and safety assessments of traditional Chinese medicines

Learning curves play a central role in power sector planning. We improve upon past learning curves for utility-scale wind and solar through a combination of approaches. First, we generate plant-level estimates of the levelized cost of energy (LCOE) in the United States, and then use LCOE, rather than capital costs, as the dependent variable. Second, we normalize LCOE to control for exogenous influences unrelated to learning. Third, we use segmented regression to identify change points in LCOE learning. We find full-period LCOE-based learning rates of 15% for wind and 24% for solar, and conclude that (normalized) LCOE-based learning provides a more complete view of technology advancement than afforded by much of the existing literature—particularly that which focuses solely on capital cost learning. Models that do not account for endogenous LCOE-based learning, or that focus narrowly on capital cost learning, may underestimate future LCOE reductions.

Levelized cost-based learning analysis of utility-scale wind and solar in the United States

Methods for the diagnosis of infectious diseases have stagnated in the last 20–30 years. Few major advances in clinical diagnostic testing have been made since the introduction of PCR, although new technologies are being investigated. Many tests that form the backbone of the “modern” microbiology laboratory are based on very old and labour-intensive technologies such as microscopy for malaria. Pressing needs include more rapid tests without sacrificing sensitivity, value-added tests, and point-of-care tests for both high- and low-resource settings. In recent years, research has been focused on alternative methods to improve the diagnosis of parasitic diseases. These include immunoassays, molecular-based approaches, and proteomics using mass spectrometry platforms technology. This review summarizes the progress in new approaches in parasite diagnosis and discusses some of the merits and disadvantages of these tests.

Diagnosis of Parasitic Diseases: Old and New Approaches

Abstract In the midst of the coronavirus pandemic, this article endeavors to offer expeditious insights into the impact of the global humanitarian crisis on the tourism industry from a consumer behavior perspective. To do so, this article employs the theory of crowding as an overarching theoretical lens, the coronavirus disease 2019 (COVID-19) as a context to represent a global humanitarian crisis, and the rapid review approach as a method to source maiden evidence. In doing so, this article sheds light on instances of undercrowding (undertourism) and overcrowding (overtourism) in tourism as a result of COVID-19, with interpretations enriched by agency theory and reactance theory?thereby resulting in the emergence of a new theory called the agency and reactance theory of crowding. The article concludes with pragmatic implications in light of the global humanitarian crisis.

Toward an agency and reactance theory of crowding: Insights from COVID-19 and the tourism industry

In his second week of severe acute respiratory syndrome (SARS) illness, a patient developed an unusually complicated course of acute coronary syndrome. One day after initial stabilization of a non-ST-elevated anterior myocardial infarction (MI), he sustained an ST-elevated anterior MI. Eight hours after emergency coronary intervention to the culprit lesion, he developed another ST-elevated MI in the inferior territory. Acute inflammation and cytokine storm in the immunopathological phase of SARS may play a role in coronary plague instability. Physicians should be alert to this potentially fatal complication and adopt appropriate vigilant and aggressive management strategies.

Coronary plague instability in severe acute respiratory syndrome

Abstract La certificación de la defunción es un acto médico en el que el profesional debe poner el mismo esfuerzo y dedicación que en el resto de los informes elaborados en vida del paciente. Para su correcta cumplimentación el facultativo debe seguir las instrucciones básicas, poniendo especial cuidado en rellenar adecuadamente la secuencia de causas de muerte. En casos de pandemia, la cumplimentación del certificado de defunción corresponde a la medicina asistencial y para poder hacerlo, los organismos oficiales deben publicar instrucciones basadas en recomendaciones internacionales. Debe establecerse, cuanto antes, la posibilidad de comunicación telemática de las defunciones. Mientras eso no sea posible tienen que establecerse procedimientos que permitan en situación de pandemia, comunicar de forma inmediata la mortalidad a las autoridades sanitarias. Abstract Death certification requires the same effort and dedication as all reports by doctors during their patients’ lifetimes. The physician must follow the basic instructions to complete a death certificate correctly, taking special care to fill in the sequence of causes of death. In the case of a pandemic, completion of the death certificate falls to the primary care physician and therefore the official bodies must publish instructions based on international recommendations. It should be established as soon as possible whether it is possible to report deaths telematically. While this is not possible, in a pandemic procedures should be put in place to enable the immediate reporting of deaths to the health authorities.

La certificacion de la defuncion de casos de covid-19 en españa

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exhibits high levels of mortality and morbidity and has dramatic consequences on human life, sociality and global economy. Neutralizing antibodies constitute a highly promising approach for treating and preventing infection by this novel pathogen. In the present study, we characterize and further evaluate the recently identified human monoclonal MD65 antibody for its ability to provide protection against a lethal SARS-CoV-2 infection of K18-hACE2 transgenic mice. Eighty percent of the untreated mice succumbed 6-9 days post-infection, while administration of the MD65 antibody as late as 3 days after exposure rescued all infected animals. In addition, the efficiency of the treatment is supported by prevention of morbidity and ablation of the load of infective virions in the lungs of treated animals. The data demonstrate the therapeutic value of human monoclonal antibodies as a life-saving treatment for severe COVID-19 infection.

Post-exposure protection of SARS-CoV-2 lethal infected K18-hACE2 transgenic mice by neutralizing human monoclonal antibody

(1) Objective: We aimed to report an update of the systematic review and meta-analysis by Baekelandt et al. (2016). (2) Method: We followed PRISMA guidelines to perform this systematic review. We searched MEDLINE, EMBASE, CENTRAL and additional sources and aimed to retrieve randomised controlled trials (RCTs), controlled clinical trials (CCTs) and prospective/retrospective cohort studies in human subjects that allowed direct comparison of vNOTES to laparoscopy. (3) Results: Our search yielded one RCT and five retrospective cohort trials. Pooled analysis of two subgroups showed that, compared to conventional laparoscopy, vNOTES is equally effective to successfully remove the uterus in individuals meeting the inclusion criteria. vNOTES had significantly lower values for operation time, length of stay and estimated blood loss. There was no significant difference in intra- and postoperative complications, readmission, pain scores at 24 h postoperative and change in hemoglobin (Hb) on day 1 postoperative.

Systematic Review and Meta-Analysis on Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Compared to Laparoscopic Hysterectomy for Benign Indications.

The SARS CoV-2 (COVID-19) pandemic and the enforced lockdown have reduced the use of surface and air transportation. This study investigates the impact of the lockdown restrictions in India on atmospheric composition, using Sentinel-5Ps retrievals of tropospheric NO2 concentration and ground-station measurements of NO2 and PM2.5 between March-May in 2019 and 2020. Detailed analysis of the changes to atmospheric composition are carried out over six major urban areas (i.e. Delhi, Mumbai, Kolkata, Chennai, Bangalore, and Hyderabad) by comparing Moderate Resolution Imaging Spectroradiometer (MODIS) Aerosol Optical Depth (AOD) and land surface temperature (LST) measurements in the lockdown year 2020 and pre-lockdown (2015-2019). Satellite-based data showed that NO2 concentration reduced by 18% (Kolkata), 29% (Hyderabad), 32-34% (Chennai, Mumbai, and Bangalore), and 43% (Delhi). Surface-based concentrations of NO2, PM2.5, and AOD also substantially dropped by 32-74%, 10-42%, and 8-34%, respectively over these major cities during the lockdown period and co-located with the intensity of anthropogenic activity. Only a smaller fraction of the reduction of pollutants was associated with meteorological variability. A substantial negative anomaly was found for LST both in the day (-0.16 °C to -1 °C) and night (-0.63 °C to -2.1 °C) across select all cities, which was also consistent with air temperature measurements. The decreases in LST could be associated with a reduction in pollutants, greenhouse gases and water vapor content. Improvement in air quality with lower urban temperatures due to lockdown may be a temporary effect, but it provides a crucial connection among human activities, air pollution, aerosols, radiative flux, and temperature. The lockdown for a shorter-period showed a significant improvement in environmental quality and provides a strong evidence base for larger scale policy implementation to improve air quality.

Improvement in air quality and its impact on land surface temperature in major urban areas across India during the first lockdown of the pandemic.

The commonly methods used to teach courses in majority of African Universities Tanzania included is face to face mode. This creates difficulty for most of universities to change dramatically to offer online courses in responses to COVID-19. Thus, this study has been conducted to determine the perceived obstacles that will hinder the universities to shift to online courses teaching.A mixed methods dominated with quantitative approach was used to answer the research questions. A total of 173 respondents participated in this study whereby descriptive statistics and binary logistic regression were applied to determine the factors that influence the academic staff to have online course or not. This was followed by content analysis to analyses the proposed adaptation to online courses by the academic staff.The findings indicated that the main hindrances to online teaching is lack of capacity;knowledge on how to conduct online course;knowledge and technological factors;environmental factors;staff attitudes towards delivering online courses and year spent in using E-learning. The academic staff proposed improvement of ICT infrastructure and strengthening the capacity of academic staff to deliver online courses.The study concludes that most of academic staff are will to adopt online teaching. Improving the organizational and individual factors will enhance staff to adopt online teaching. The paper recommends that the university may start with online teaching for postgraduate student and gradually to bachelor students using free available online teaching tools and platform such as Zoom, WeChat, Webinar and alike.

Adoption of Online Courses Teaching in Tanzania's Universities after World Health Organization Declares the COVID-19 a Pandemic Disease: Opportunities and Barriers

Using a national survey of Generation Z conducted in late May 2020, we measure attitudes about the impact of the coronavirus on personal health, financial and job concerns, views about shelter-in-place laws, and 2020 voting intentions. Gen Z women express greater health and economic concerns and support for shelter-in-place measures than their male counterparts, but this gender gap is largely mitigated by party and other covariates. Party also mediates the differences between young male and female voters concerning the influence of the coronavirus on their vote choice in 2020. Notably, women have significantly greater concern about the impact of COVID-19 on their personal financial situation, while Gen Z men express more concern about their personal health amid COVID-19 in more fully specified statistical models. This research contributes to the growing literature that examines not only the sorting effect of party on the gender gap but also how different identities—in this case, generation—can help explain the persistent political divides between men and women.

Gen Z, Gender, and COVID-19

Artificial intelligence has recently been one of the most commonly discussed topics of discussion in the world. The need for efficient and reliable energy has been a growing fact in many sectors of the sciences. More importantly, the need for predictive analysis has become essential for most of the forecasting variables. On the other hand, there has been a notable relationship and overlaps between artificial intelligence and simulation due to the decrease in the use of hardware, while the sophistication of the software application increases. Algorithms used in simulation also allow expert systems to think in the direction and line of complex models and systems, which may always change dynamically or that may have an inclusion of the stochastic processes. The following paper begins with an introduction of artificial intelligence and its relationship to modeling and simulation. The study has involved a critical review of different pieces of literature on the value of artificial intelligence in modeling and simulation and also finds out the model of the relationship between the COVID-19 death rate and the number of handwashing materials. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Simulation of the Relation Between the Number of COVID-19 Death Cases as a Result of the Number of Handwashing Facilities by Using Artificial Intelligence

BACKGROUND: COVID-19 is an infectious disease that has killed more than 555,000 people in the US. During a time of social distancing measures and increasing social isolation, green spaces may be a crucial factor to maintain a physically and socially active lifestyle while not increasing risk of infection. OBJECTIVES: We evaluated whether greenness was related to COVID-19 incidence and mortality in the US. METHODS: We downloaded data on COVID-19 cases and deaths for each US county up through June 7, 2020, from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center. We used April–May 2020 Normalized Difference Vegetation Index (NDVI) data, to represent the greenness exposure during the initial COVID-19 outbreak in the US. We fitted negative binomial mixed models to evaluate associations of NDVI with COVID-19 incidence and mortality, adjusting for potential confounders such as county-level demographics, epidemic stage, and other environmental factors. We evaluated whether the associations were modified by population density, proportion of Black residents, median home value, and issuance of stay-at-home orders. RESULTS: An increase of 0.1 in NDVI was associated with a 6% (95% Confidence Interval: 3%, 10%) decrease in COVID-19 incidence rate after adjustment for potential confounders. Associations with COVID-19 incidence were stronger in counties with high population density and in counties with stay-at-home orders. Greenness was not associated with COVID-19 mortality in all counties; however, it was protective in counties with higher population density. DISCUSSION: Exposures to NDVI were associated with reduced county-level incidence of COVID-19 in the US as well as reduced county-level COVID-19 mortality rates in densely populated counties.

County-level exposures to greenness and associations with COVID-19 incidence and mortality in the United States

Over the past 16 months, Iranian children have had their schools closed. Prolonged COVID-19-related restrictions and limited play activities can have significant mental health consequences in children. Using a cross-sectional design, a sample of Iranian parents (n = 1182) of children aged between 5 and 11 years completed an online survey including: Children's Play Scale (CPS), Positive and Negative Affect Schedule Short Form (I-PANAS-SF), and the Strength and Difficulties Questionaries (SDQ). Parents reported that their child spent significantly longer time playing outside at home and inside at home than anywhere else. Children were also reported to spend the minimum number of hours at indoor play centres, near water, green spaces, and playgrounds. Compared to the pre-COVID-19 context, significant declines in outdoor play activities during the pandemic were reported for 83% of children. Findings revealed that there are significant but small negative correlation between mental health difficulties and total CPS scores (r = -.427, p < .0001). Correlations of CPS scores with Positive and Negative affect were weak but significant (r = .211, and r = -.294, respectively;p < .0001). Results indicate that it is necessary to find strategies to increase children's outdoor play activities, especially when they return to their schools with wider-spread social and emotional needs than before.

Children's indoor and outdoor play as potential correlates of mental health during the COVID-19 pandemic in Iran: a brief report on national survey

Individuals with chronic lung disease and their families were selected from the Tecumsch community along with similarly selected families as comparison groups and studied for 1-year periods. Occurence of acute respiratory illness was ascertained weekly by telephone and calculated as an annual rate. Persons with chronic bronchitis not only experienced more acute lower respiratory illness than healthy comparison subjects, but total illness rates were somewhat higher as well. Infection rates were determined from blood samples taken 3 times from each participant during the surveillance year. Antibody tests were performed for respiratory syncytial virus, para-influenza virus types 1, 2, and 3, influenza types A and B, coronavirus OC43, Mycoplasma pneumoniae, and Haemophilus influenzae. Differences in serologic infection rates among the subgroups of the population were similar to those seen in the clinical data, with more frequent infection among those with bronchitis than among the comparison subjects. This finding indicates that some degree of increased susceptibility to actual infection existed among those individuals with bronchitis. Influence of smoking on illness and infection rates was also examined. Infections were, in general, more frequent in smokers than in nonsmokers, but illness rates were reversed, suggesting that perception of disease differed in the 2 groups. Rates of illness and infection of other adults in the families of the index individuals with bronchitis were not influenced by the higher rates seen in the index individuals; however, it was of interest that children of persons with bronchitis did have somewhat higher rates of infection than children of comparison subjects.

The Tecumseh study of respiratory illness. VIII. Acute infection in chronic respiratory disease and comparison groups.

The COVID-19 pandemic changed our lives affecting all areas of living Education, teaching, our movement habits, including our hobbies and leisure time activities has been changed Changes occurs for everyday habits of university students and young people as well This study was designed with aim to determine changes that occurs in students sport activity during leisure in period of pandemic, compared with their previous movement habits as well as to determine differences in their opinions regarded their place of living The study sample was consisted from 119 students at Faculty of Educational Sciences at Goce Delcev University Stip, Republic of North Macedonia Specially designed questioner was applied and was administrated online The obtained results were analyzed using descriptive statistic parameters and non-parametric procedure: t-test Results suggest on maintaining the same level of physical activity before and during the pandemic, but changes in manner of its realization (home workouts, use of online video exercises, individual outdoor sports activities, etc) The same level of satisfaction of personal use of leisure time is also maintained but changes occurs in possibility for doing things and hobbies that can not be done before due to luck of time and other factors

Oppinions of Students for Their Sport Activity during Covid-19 Pandemic - Case of Students from Teaching Faculty in Stip

SARS-CoV-2 variants of concern (VOCs), especially the latest Omicron, have exhibited severe antibody evasion. Broadly neutralizing antibodies with high potency against Omicron are urgently needed for understanding working mechanisms and developing therapeutic agents. In this study, we characterized previously reported F61, which was isolated from convalescent patients infected with prototype SARS-CoV-2, as a broadly neutralizing antibody against all VOCs including Omicron BA.1, BA.1.1, BA.2, BA.3 and BA.4 sublineages by utilizing antigen binding and cell infection assays. We also identified and characterized another broadly neutralizing antibody D2 with epitope distinct from that of F61. More importantly, we showed that a combination of F61 with D2 exhibited synergy in neutralization and protecting mice from SARS-CoV-2 Delta and Omicron BA.1 variants. Cryo-EM structures of the spike-F61 and spike-D2 binary complexes revealed the distinct epitopes of F61 and D2 at atomic level and the structural basis for neutralization. Cryo-EM structure of the Omicron-spike-F61-D2 ternary complex provides further structural insights into the synergy between F61 and D2. These results collectively indicated F61 and F61-D2 cocktail as promising therapeutic antibodies for combating SARS-CoV-2 variants including diverse Omicron sublineages.

Structural basis of a two-antibody cocktail exhibiting highly potent and broadly neutralizing activities against SARS-CoV-2 variants including diverse Omicron sublineages

PURPOSE OF REVIEW: Told from the viewpoint of rheumatologists, this review tells the story of hydroxychloroquine and its swift ascent to become a household name as a therapeutic strategy against the novel SARS-CoV-2 virus. This review describes the history, mechanisms, pharmacokinetics, therapeutic applications, and safety profile of hydroxychloroquine as an immunomodulatory and antiviral agent. It also summarizes the major studies that launched and assessed the use of hydroxychloroquine against COVID-19 infection. RECENT FINDINGS: More recent literature calls into question the long-held dogma that endolysosomal alkalinization is the primary mode of action of hydroxychloroquine. Ongoing uncertainty about the multiple potential mechanisms contributing to the therapeutic effect of hydroxychloroquine in rheumatic and viral disease led to a natural avenue for exploration in the treatment of COVID-19. Taken as a whole, the literature does not support utilizing hydroxychloroquine to treat or prevent infection from the SARS-CoV-2 virus. This is, at least in part, due to the wide variability in hydroxychloroquine pharmacokinetics between patients and difficulty achieving adequate target tissue concentrations of hydroxychloroquine without encountering unacceptable toxicities. Hydroxychloroquine continues to be a routinely prescribed, well-tolerated, effective, and low-cost treatment for rheumatic disease. Its therapeutic versatility has led to frequent repurposing for other conditions, most recently as an investigative treatment against the SARS-CoV-2 virus. Despite overall negative findings, the intense study of hydroxychloroquine against COVID-19 infection has enhanced our overall understanding of how hydroxychloroquine operates in autoimmune disease and beyond.

Hydroxychloroquine and COVID-19: a Rheumatologist's Take on the Lessons Learned

Phishing is an online scam where criminals trick users with various strategies, with the goal of obtaining sensitive information or compromising accounts, systems, and/or other personal or organisational Information Technology resources. Multiple studies have shown that human factors influence the success of phishing attempts. However, these studies were conducted before the COVID-19 pandemic, which is significant because security reports show that the numbers of phishing attacks have been rapidly increasing since the start of COVID-19. This study investigates the extent to which users' fear, anxiety and stress levels regarding COVID-19, impact falling for common and COVID-19 themed phishing scams during the outbreak period. Prior studies have depicted the effects of human behaviour on phishing attacks before the pandemic, such as risk-taking preferences and users' demographic factors, hence this study also focuses on the effects of those factors on the likelihood of phishing victimisation. More concretely, we present the results of a scenario-based roleplay experiment to study the relationship between fear, anxiety, stress, risk-taking, and demographic factors and the success of phishing attacks during the pandemic. The findings indicate that fear of COVID-19 influences the success of COVID-19 specific themed phishing scams, while anxiety, stress, and risk-taking influences the success of both the COVID-19 themed and common phishing scams. Our findings also suggest that the users' education level impacts common phishing attacks during the pandemic.

COVID-19 and Phishing: Effects of Human Emotions, Behavior, and Demographics on the Success of Phishing Attempts During the Pandemic

The present study investigated the lasting effects of sickness presenteeism on well-being and innovative job performance in the demanding Chinese work context compounded with the precarities of the post-pandemic business environment Adopting the conservation of resources (COR) theory perspective, especially its proposition of compensation of resources, we incorporated social resources at work (supervisory support and collegial support) as joint moderators in the presenteeism-outcomes relationship We employed a panel design in which all variables were measured twice with 6 months in between Data were obtained from 323 Chinese employees working in diverse industries in Taiwan We found that after controlling for the baseline level of well-being, presenteeism did not have a lasting effect on employees' exhaustion However, presenteeism did have a negative lasting effect on employees' innovative behavior 6 months later Moreover, we found a significant three-way interaction of presenteeism, supervisory support, and collegial support on employees' innovative job performance, after controlling for the baseline level of performance Specifically, when working under illness, employees displayed the best innovative performance with high levels of both supervisory and collegial support, the worst performance with both support being low, and the intermediate when any one of the support being high This can be taken as the preliminary evidence to support the COR proposition of resource caravans, showing that supervisory support and collegial support compensated for each other as critical resources in alleviating the impact of working under sickness on employees' innovative performance Theoretical implications of the findings are discussed, taking into account the macro-cultural context of the East Asian Confucian societies We also reflected on the managerial implications of the lasting damages of sickness presenteeism and benefits of mobilizing social resources on employees' well-being and performance

The Compensatory Protective Effects of Social Support at Work in Presenteeism During the Coronavirus Disease Pandemic

We construct a stochastic SIR model for influenza spreading on a D-dimensional lattice, which represents the dynamic contact network of individuals. An age distributed population is placed on the lattice and moves on it. The displacement from a site to a nearest neighbor empty site, allows individuals to change the number and identities of their contacts. The dynamics on the lattice is governed by an attractive interaction between individuals belonging to the same age-class. The parameters, which regulate the pattern dynamics, are fixed fitting the data on the age-dependent daily contact numbers, furnished by the Polymod survey. A simple SIR transmission model with a nearest neighbors interaction and some very basic adaptive mobility restrictions complete the model. The model is validated against the age-distributed Italian epidemiological data for the influenza A(H1N1) during the [Image: see text] season, with sensible predictions for the epidemiological parameters. For an appropriate topology of the lattice, we find that, whenever the accordance between the contact patterns of the model and the Polymod data is satisfactory, there is a good agreement between the numerical and the experimental epidemiological data. This result shows how rich is the information encoded in the average contact patterns of individuals, with respect to the analysis of the epidemic spreading of an infectious disease.

A Lattice Model for Influenza Spreading

Telehealth is a growing field, its pertinence magnified by COVID-19 causing the accelerated digitalization of the world. Given the significant global demand to provide telehealth services, it is important to explore patient receptiveness toward this alternative service model, particularly from regions where it has yet to be implemented. We conducted a cross-sectional study to understand the views and willingness of patients toward the use of telehealth for cancer genetic counseling. A survey was completed by 160 patients of the National Cancer Centre Singapore, and descriptive statistics were used to analyze the data. The study found that 95.6% (n = 153/160) of participants did not have prior telehealth experience. Most participants were willing or neutral toward having genetic counseling by phone (n = 114/160, 71.3%) and video (n = 106/160, 66.3%). However, majority prefer in-person appointments for first (n = 127/160, 79.4%) and follow-up (n = 97/160, 60.6%) visits over telehealth. Majority agreed that a phone/video consultation would meet most of their needs but voiced concerns regarding privacy and sharing of information (n = 79/160, 49.4% for phone; n = 74/160, 46.3% for video) and whether their emotional needs could be met (n = 61/160, 38.1%). Participants' age, employment status, income, mode of transportation to the appointment, and whether special arrangements were made to attend the in-person appointment were associated with receptivity to telehealth genetic counseling (p ≤ .05 for all). This study adds diversity to existing literature and demonstrates that patients from Asia are generally willing and accepting of the use of telehealth in a cancer genetics service. This will help meet increasing global demand of telehealth consultations in the post-pandemic new norm. Furthermore, it will also provide services for underserved populations and patients requiring urgent testing in a timely manner. Further studies are needed to explore the cost-effectiveness and fair billing methods, as well as willingness and acceptability of telehealth genetic counseling in post-COVID times.

Understanding patients' views and willingness toward the use of telehealth in a cancer genetics service in Asia.

Systemic symptoms have often been observed in patients with coronavirus disease 2019 (COVID-19) in addition to pneumonia, however, the details are still unclear due to the lack of an appropriate animal model. In this study, we investigated and compared blood coagulation abnormalities and tissue damage between male Syrian hamsters of 9 (young) and over 36 (aged) weeks old after intranasal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite similar levels of viral replication and inflammatory responses in the lungs of both age groups, aged but not young hamsters showed significant prolongation of prothrombin time and prominent acute kidney damage. Moreover, aged hamsters demonstrated increased intravascular coagulation time-dependently in the lungs, suggesting that consumption of coagulation factors causes prothrombin time prolongation. Furthermore, proximal urinary tract damage and mesangial matrix expansion were observed in the kidneys of the aged hamsters at early and later disease stages, respectively. Given that the severity and mortality of COVID-19 are higher in elderly human patients, the effect of aging on pathogenesis needs to be understood and should be considered for the selection of animal models. We, thus, propose that the aged hamster is a good small animal model for COVID-19 research.

Abnormal Blood Coagulation and Kidney Damage in Aged Hamsters Infected with Severe Acute Respiratory Syndrome Coronavirus 2

Monoclonal antibodies (mAbs) are the basis of treatments and diagnostics for pathogens and other biological phenomena. We conducted a structural characterization of mAbs against the N-terminal domain of nucleocapsid protein (NPNTD) from SARS-CoV-2 using small-angle X-ray scattering and transmission electron microscopy. Our solution-based results distinguished the mAbs' flexibility and how this flexibility affects the assembly of multiple mAbs on an antigen. By pairing two mAbs that bind different epitopes on the NPNTD, we show that flexible mAbs form a closed sandwich-like complex. With rigid mAbs, a juxtaposition of the antigen-binding fragments is prevented, enforcing a linear arrangement of the mAb pair, which facilitates further mAb polymerization. In a modified sandwich enzyme-linked immunosorbent assay, we show that rigid mAb-pairings with linear polymerization led to increased NPNTD detection sensitivity. These enhancements can expedite the development of more sensitive and selective antigen-detecting point-of-care lateral flow devices, which are critical for early diagnosis and epidemiological studies of SARS-CoV-2 and other pathogens.

Rigid monoclonal antibodies improve detection of SARS-CoV-2 nucleocapsid protein

INTRODUCTION: At the start of the coronavirus disease 2019 (COVID-19) pandemic, Walter Reed Army Institute of Research (WRAIR) mobilized to rapidly conduct medical research to detect, prevent, and treat the disease in order to minimize the impact of the pandemic on the health and readiness of U.S. Forces. WRAIR’s major efforts included the development of the Department of Defense (DoD) COVID-19 vaccine candidate, researching novel drug therapies and monoclonal antibodies, refining and scaling-up diagnostic capabilities, evaluating the impact of viral diversity, assessing the behavioral health of Soldiers, supporting U.S. DoD operational forces overseas, and providing myriad assistance to allied nations. WRAIR personnel have also filled key roles within the whole of government response to the pandemic. WRAIR had to overcome major pandemic-related operational challenges in order to quickly execute a multimillion-dollar portfolio of COVID-19 research. Consequently, the organization learned lessons that could benefit other leaders of medical research organizations preparing for the next pandemic. MATERIALS AND METHODS: We identified lessons learned using a qualitative thematic analysis of 76 observation/recommendation pairs from across the organization. These lessons learned were organized under the Army’s four pillars of readiness (staffing, training, equipping, and leadership development). To this framework, we added organizing and leading to best capture our experiences within the context of pandemic response. RESULTS: The major lessons learned for organizing were: (1) the pandemic created a need to rapidly pivot to new scientific priorities; (2) necessary health and safety precautions disrupted the flow of normal science and put programs at risk of missing milestones; (3) relationships with partners and allies facilitated medical diplomacy and advancement of U.S. national military and economic goals; and (4) a successful response required interoperability within and across multiple organizations. For equipping: (1) existing infrastructure lacked sufficient capacity and technical capability to allow immediate countermeasure development; (2) critical supply chains were strained; and (3) critical information system function and capacity were suddenly insufficient under maximum remote work. For staffing and training: (1) successful telework required rapid shifts in management, engagement, and accountability methods; and (2) organizational policies and processes had to adapt quickly to support remote staffing. For leading and leadership development (1) engaged, hopeful, and empathetic leadership made a difference; and (2) the workforce benefitted from concerted leadership communication that created a shared understanding of shifting priorities as well as new processes and procedures. CONCLUSIONS: An effective pandemic response requires comprehensive institutional preparedness that facilitates flexibility and surge capacity. The single most important action leaders of medical research organizations can take to prepare for the next pandemic is to develop a quick-reaction force that would activate under prespecified criteria to manage reprioritization of all science and support activities to address pandemic response priorities at the velocity of relevance.

Cross-Cutting Lessons Learned During the COVID-19 Pandemic—the Walter Reed Army Institute of Research Experience

Background: Covid-19 seroprevalence rates and serological tests are important tools in understanding the epidemiology of the disease and help in the fight against it. Seroprevalence rates vary according to the population studied and the test employed and they range from 0.133 to 25.7%. The purpose of this study is to assess the seroprevalence rate in a population of healthy blood donors living under strict lockdown measures in Jordan which has in total 144 confirmed cases per million population. Methods: Left-over sera and plasma samples from 746 healthy blood donors were tested using a commercially available FDA approved kit having a sensitivity and specificity of 100% and 99.8% respectively. External positive controls were used for validation. Results: More than 80% of the donors were men 18-63 year old and residing in the capital city of Jordan, Amman. All tested specimens were negative yielding a zero seroprevalence rate in this healthy blood donor population. Conclusion: Strict lockdown measures effectively limit intracommunity spread of the infection, however at the cost of lack of any acquired community immunity. Additionally the use of highly specific test is recommended in low prevalence setting.

Covid-19 Seroprevalence rate in healthy blood donors from a community under strict lockdown measures

Fungi and viruses encode a variety of peptidases having a plethora of functions. Many fungal peptidases are extracellular and are likely used to degrade proteins in their environment. Viral peptidases are processing enzymes, intimately involved in the virus infectious cycle. The viral RNA genome is translated by the host-cell machinery into a large polyprotein that is cleaved by the viral peptidases into mature capsid proteins, non-structural proteins and enzymes. I review the structure and catalytic mechanism of scytalidoglutamic peptidase isolated from the wood-destroying fungus Scytalidium lignicolum. This enzyme has a unique beta-sandwich fold and a novel catalytic mechanism based on a glutamate, a glutamine and a nucleophilic water molecule. Hepatitis A virus (HAV) 3C peptidase was the first structure identified for a viral 3C enzyme that exhibited the three-dimensional fold of the chymotrypsin family of serine peptidases but had a cysteine sulfur atom instead of the serine oxygen as the nucleophile. The structure of HAV 3C was unusual in that the Asp residue expected as the third member of the catalytic triad did not interact with the general base His. The present structure is of a beta-lactone-inhibited version of HAV 3C that has a restored catalytic triad.

The peptidases from fungi and viruses.

In this innovative practice paper, we describe a project related to fitness trackers designed to cultivate sociotechnical awareness and practice among second-year undergraduate engineering students in Spring 2020. We identified four topics related to fitness trackers that intersected with broader sociotechnical themes including data privacy, the workplace, health insurance companies, and sustainability. In teams, students researched the social and environmental impacts of fitness trackers for their topic and gave a presentation to the class including leading a discussion. This project was designed to scaffold learning, encourage class participation, and enhance the quality of presentation. Survey responses revealed that all student respondents found the practice presentation with the instructors held over Zoom as helpful in completing their assignments and presentations. Other aspects that students rated as helpful included providing a list of resources to start their research and an example presentation to clarify expectations about depth required. The global COVID-19 pandemic necessitated the project presentations being conducted remotely, which gave students the opportunity to practice facilitating using Zoom, a skill that is directly relevant to current industrial practice. Students were creative in how they encouraged their classmates to participate including using Zoom polls, Kahoot, and breakout rooms. Students' responses to survey questions demonstrate that they learned about the sociotechnical nature of engineering, believed the project topics mattered to them as engineers, and these topics were relevant to their majors. Students cited the environmental, social, and legal aspects of the project as most interesting to them as engineers. Thus this can serve as an example for other engineering educators for how to approach teaching sociotechnical content in engineering. © 2021 IEEE.

On Track: Seeing Engineering as Sociotechnical using Fitness Trackers

CONTEXT: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG testing is used for serosurveillance and will be important to evaluate vaccination status. Given the urgency to release coronavirus disease 2019 (COVID-19) serology tests, most manufacturers have developed qualitative tests. OBJECTIVE: To evaluate clinical performance of six different SARS-CoV-2 IgG assays and their quantitative results to better elucidate the clinical role of serology testing in COVID-19. DESIGN: Six SARS-CoV-2 IgG assays were tested using remnant specimens from 190 patients. Sensitivity and specificity were evaluated for each assay with the current manufacturer's cutoff and a lower cutoff. A numeric result analysis and discrepancy analysis were performed Results: The specificity was >93% for all assays, and sensitivity was >80% for all assays (&#8805; 7 days post-polymerase chain reaction [PCR] testing). Inpatients with more severe disease had higher numeric values compared to health care workers with mild or moderate disease. Several discrepant serology results were those just below the manufacturers cutoff. CONCLUSIONS: SARS-CoV-2 IgG antibody testing can aid in the diagnosis of COVID-19 especially with negative PCR. Quantitative COVID-19 IgG results are important to better understand the immunological response and disease course of this novel virus and to assess immunity as part of future vaccination programs.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Qualitative IgG Assays: The Value of Numeric Reporting

The world evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov2 or simply COVID-19) led the World Health Organization to declare it a pandemic The disease appeared in China in December 2019, and it has spread fast around the world, especially in European countries like Italy and Spain The first reported case in Brazil was recorded in February 26, and after that the number of cases grew fast In order to slow down the initial growth of the disease through the country, confirmed positive cases were isolated to not transmit the disease To better understand the early evolution of COVID-19 in Brazil, we apply a Susceptible–Infectious–Quarantined–Recovered (SIQR) model to the analysis of data from the Brazilian Department of Health, obtained from February 26, 2020 through March 25, 2020 Based on analytical and numerical results, as well on the data, the basic reproduction number is estimated to R 0 = 5 2 5 In addition, we estimate that the ratio between unidentified infectious individuals and confirmed cases at the beginning of the epidemic is about 10, in agreement with previous studies We also estimated the epidemic doubling time to be 2 7 2 days [ABSTRACT FROM AUTHOR] Copyright of International Journal of Modern Physics C: Computational Physics & Physical Computation is the property of World Scientific Publishing Company 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 )

Modeling the early evolution of the COVID-19 in Brazil: Results from a Susceptible–Infectious–Quarantined–Recovered (SIQR) model

BACKGROUND Post-cesarean delivery (CD) surgical site infections can cause considerable maternal morbidity. We aimed to estimate the efficacy of a medical personnel education program in aseptic and scrub techniques on the rate of infectious morbidity after CD. METHODS A prospective, 2-period cohort intervention study was performed at a single institution. The first era, which included all CDs performed between September 2006 and August 2007, was used to obtain baseline infection rates. During this period, prophylactic antibiotics were given only to women undergoing elective CD. In era 2, July 2009 through June 2010, prophylactic antibiotics were given to all women. In addition, medical personnel underwent an education program, refresher course, and retraining in aseptic and scrub techniques. The study's primary outcome included any infectious morbidity related to the CD within 30 days from the operation. RESULTS The 1,616 CDs analyzed included 751 performed in era 1 and 865 performed in era 2. The incidence of any infectious morbidity dropped from 6.4% in era 1 to 2.5% in era 2 (P = .001). The incidence of any infectious morbidity in women undergoing elective CD fell from 5.3% to 0.9% (P = .001). Among women undergoing nonelective CD, the difference between the first and second eras was not statistically significant (7.5% vs. 4.5%; P = .09). However, the rate of incisional surgical site infection fell significantly, from 4% in era 1 to 1.5% in era 2 (P = .05). CONCLUSIONS The interventions implemented at our institution led to a considerable decline in post-CD infectious morbidity.

Effect of interventions in reducing the rate of infection after cesarean delivery.

Public health and social measures have been implemented around the world in a bid to prevent the spread of COVID-19. Public compliance with these measures is key in successfully controlling the pandemic. This online survey assessed the compliance and attitude of adults residing in the southern African Kingdom of Eswatini to government protection, activity and travel measures aimed at controlling the spread of COVID-19. A rapid online survey, comprising of 28 questions, was administered in May 2020. More than 90% of respondents knew the virus could kill anyone and most respondents (70%) reported to be compliant to public health and social measures. Females, those who did not use public transport and those aged 30 years and above were significantly (p<0.01) more compliant, particularly to protective and travel measures. Social media, television and official government websites were the primary source of ongoing COVID-19 information for respondents of this online survey, and these methods should continue to be employed to reach the public who regularly use the internet. More than half of essential workers who responded to the online survey reported to have their own personal protective equipment; however, 32% either did not have any protective equipment or shared their equipment with other staff members. Due to the survey being online, these results should not be generalised to populations of low socioeconomic status.

Assessment of early COVID-19 compliance to and challenges with public health and social prevention measures in the Kingdom of Eswatini, using an online survey

BACKGROUND: Despite the advantages of using active learning strategies in nursing education, researchers have rarely investigated how such pedagogic approaches can be used to assess students or how interactive examinations can be modified depending on circumstances of practice (e.g., in online education). AIMS: The aim was to compare three interactive examination designs, all based on active learning pedagogy, in terms of nursing students’ engagement and preparedness, their learning achievement, and instructional aspects. METHODS: A comparative research design was used including final-year undergraduate nursing students. All students were enrolled in a quality improvement course at a metropolitan university in Sweden. In this comparative study to evaluate three course layouts, participants (Cohort 1, n = 89; Cohort 2, n = 97; Cohort 3, n = 60) completed different examinations assessing the same course content and learning objectives, after which they evaluated the examinations on a questionnaire in numerical and free-text responses. Chi-squared tests were conducted to compare background variables between the cohorts and Kruskal–Wallis H tests to assess numerical differences in experiences between cohorts. Following the guidelines of the Good Reporting of a Mixed Methods Study (GRAMMS), a sequential mixed-methods analysis was performed on the quantitative findings, and the qualitative findings were used complementary to support the interpretation of the quantitative results. RESULTS: The 246 students who completed the questionnaire generally appreciated the interactive examination in active learning classrooms. Among significant differences in the results, Cohort 2 (e.g., conducted the examination on campus) scored highest for overall positive experience and engagement, whereas Cohort 3 (e.g., conducted the examination online) scored the lowest. Students in Cohort 3 generally commended the online examination’s chat function available for use during the examination. CONCLUSIONS: Interactive examinations for nursing students succeed when they are campus-based, focus on student preparation, and provide the necessary time to be completed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12912-021-00575-6.

A comparison of three interactive examination designs in active learning classrooms for nursing students

The COVID‐19 pandemic has posed significant challenges for health science librarians. During this pandemic, librarians are playing an active role by increasing the public’s awareness of the virus, maintaining document delivery services and providing research support. This paper uses the method of desktop analysis of the websites of selected library associations to identify the responses of health science librarians to the COVID‐19 pandemic. The study highlights significant initiatives taken by some health science librarians which can be replicated by others to meet the needs of library users in the COVID‐19 health crisis. JM

Global responses of health science librarians to the COVID‐19 (Corona virus) pandemic: a desktop analysis

Background: There is uncertainty about the appropriate dosing regimen, safety, bleeding risk, and the predisposing factors for thrombosis/bleeding risk in critically ill COVID-19 patients. Also, the available evidence is limited and depends either on observational studies or randomized trials with small sample size. Thus, the aim of the study is to determine the optimal dosing of pharmacological VTE prophylaxis in critically ill patients with COVID-19 patients. Methods: : A multicenter, retrospective, cohort study conducted at two governmental tertiary hospitals in Saudi Arabia. All critically ill COVID 19 patients who received pharmacological VTE prophylaxis and were admitted to Intensive Care Units (ICUs) between March 1st, 2020 to January 31st, 2021 were included. Patients who received Standard dosing VTE prophylaxis were compared to patients who received high dosing pharmacological VTE prophylaxis. Results: : A total of 758 patients were screened;565 patients were included in the study. We matched 352 patients using propensity score matching (1:1) according to the baseline severity scores (i.e., APACHE II score, SOFA score), history of CKD, and AKI within 24 hours of ICU admission. The differences in venous thromboembolism (OR (95%CI): 0.75 (0.16–3.38), p-value = 0.70) and any case of thrombosis (OR (95%CI): 1.22 (0.52–2.86), p-value = 0.64) were not statistically significant between the two groups. In contrast, minor bleeding was associated with the use of high dosing regimen of VTE prophylaxis (OR (95%CI): 3.39 (1.08–10.61), p-value = 0.04). There was no difference in the 30-day ICU mortality nor in-hospital mortality between the two groups (OR (95%CI): 1.26 (0.77–2.05), p-value = 0.36 and OR (95%CI): 1.05 (0.66–1.68), p-value = 0.83 respectively). Conclusion: High dosing pharmacological VTE prophylaxis in critically ill COVID-19 patients was not associated with VTE, thrombosis, or mortality benefits but led to an increased risk of minor bleeding. Further randomized clinical and interventional studies are required to confirm our findings.

Comparison Between Standard Vs. High Dosing Venous Thromboembolism (VTE) Prophylaxis in COVID19 Critically Ill Patients: A Multicenter, Observational Study

The ongoing outbreak of SARS-CoV-2 Omicron BA.2 infections in Hong Kong, the world model city of universal masking, has resulted in a major public health crisis. In this study, we investigate public servants who had been vaccinated with two dose (82.7%) or three dose (14%) of either CoronaVac (CorV) or BNT162b2 (BNT). During the BA.2 outbreak, 29.3% vaccinees were infected. Three-dose vaccination provided protection with lower incidence rates of breakthrough infections (2xBNT 49.2% vs 3xBNT 16.6%, p<0.0001; 2xCorV 48.6% vs 3xCoV 20.6%, p=0.003). The third heterologous vaccination showed the lowest incidence (2xCorV+1xBNT 6.3%). Although BA.2 conferred the highest neutralization resistance compared with variants of concern tested, the third dose vaccination-activated spike-specific memory B and Omicron cross-reactive T cell responses contributed to reduced frequencies of breakthrough infection and disease severity. Our results have implications to timely boost vaccination and immune responses likely required for vaccine-mediated protection against Omicron BA.2 pandemic.

Three-dose vaccination-induced immune responses protect against SARS-CoV-2 Omicron-BA.2

The rapid evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergency involved Italy as the first European country. Meanwhile, China was the only other country to experience the emergency scenario, implementing public health recommendations and raising concerns about the mental health of the population. The Italian National Institute of Health [Istituto Superiore di Sanità (ISS)] reviewed relevant scientific literature in mental health to evaluate the best clinical practices and established the collaboration with the WHO, World Psychiatry Association, and China to support the public health system in a phase of acute emergency. This process permitted the definition of organizational and practical-operational Italian guidelines for the protection of the well-being of healthcare workers. These guidelines have been extensively disseminated within the Italian territory for maximum stakeholder utilization.

An Italy-China Collaboration for Promoting Public Mental Health Recommendations During the COVID-19 Pandemic

Real time reverse transcriptase-PCR (RT-PCR) is now used commonly for the detection of viral pathogens in respiratory samples. However, due to potential inhibition of the RT-PCR or inefficient extraction, this sample type can present significant challenges to accurate patient testing. The goal of this study was to create an internal control to be multiplexed in a real time RT-PCR assay for detecting a viral target in respiratory samples. This report describes an Armored RNA (aRNA) internal control developed originally to be multiplexed in a real time RT-PCR assay for detecting SARS-associated Coronavirus, but can be incorporated into any RT-PCR assay. The internal control primers and probe target a region in the coat protein gene of the E. coli F-specific bacteriophage ms2, which is contained within the aRNA.

The use of Armored RNA as a multi-purpose internal control for RT-PCR

In this special communication, a brief description is made of the main events of the new pathology (that WHO has named Covid-19) caused by coronavirus The cases of Covid-19 occurred in mainland China and the rest of the world are mentioned It is also emphasized the effort that China and other countries around the world are making to contain the epidemic Also, it highlights the role that WHO and other international organizations are playing to prevent and control the epidemic

[Covid-19: the new pathology caused by a coronavirus]

The furin cleavage site (FCS), an unusual feature in the SARS-CoV-2 spike protein, has been spotlighted as a factor key to facilitating infection and pathogenesis by increasing spike processing 1,2. Similarly, the QTQTN motif directly upstream of the FCS is also an unusual feature for group 2B coronaviruses (CoVs). The QTQTN deletion has consistently been observed in in vitro cultured virus stocks and some clinical isolates 3. To determine whether the QTQTN motif is critical to SARS-CoV-2 replication and pathogenesis, we generated a mutant deleting the QTQTN motif (ΔQTQTN). Here we report that the QTQTN deletion attenuates viral replication in respiratory cells in vitro and attenuates disease in vivo. The deletion results in a shortened, more rigid peptide loop that contains the FCS, and is less accessible to host proteases, such as TMPRSS2. Thus, the deletion reduced the efficiency of spike processing and attenuates SARS-CoV-2 infection. Importantly, the QTQTN motif also contains residues that are glycosylated4, and disruption its glycosylation also attenuates virus replication in a TMPRSS2-dependent manner. Together, our results reveal that three aspects of the S1/S2 cleavage site – the FCS, loop length, and glycosylation – are required for efficient SARS-CoV-2 replication and pathogenesis.

QTQTN motif upstream of the furin-cleavage site plays key role in SARS-CoV-2 infection and pathogenesis

STUDY DESIGN Experimental animal study. OBJECTIVE The current study aims to test whether the blood flow within the contused spinal cord can be assessed in a rodent model via the acoustic window of the laminectomy utilizing transcutaneous ultrasound. SETTING Department of Neurological Surgery, University of Washington, Seattle WA. METHODS Long-Evans rats (n = 12) were subjected to a traumatic thoracic spinal cord injury (SCI). Three days and 10 weeks after injury, animals underwent imaging of the contused spinal cord using ultrafast contrast-enhanced ultrasound with a Vantage ultrasound research system in combination with a 15 MHz transducer. Lesion size and signal-to-noise ratios were estimated via transcutaneous, subcutaneous, or epidural ultrasound acquisition through the acoustic window created by the original laminectomy. RESULTS Following laminectomy, transcutaneous and subcutaneous contrast-enhanced ultrasound imaging allowed for assessment of perfusion and vascular flow in the contused rodent spinal cord. An average loss of 7.2 dB from transcutaneous to subcutaneous and the loss of 5.1 dB from subcutaneous to epidural imaging in signal-to-noise ratio (SNR) was observed. The hypoperfused injury center was measured transcutaneously, subcutaneously and epidurally (5.78 ± 0.86, 5.91 ± 0.53, 5.65 ± 1.07 mm2) at 3 days post injury. The same animals were reimaged again at 10 weeks following SCI, and the area of hypoperfusion had decreased significantly compared with the 3-day measurements detected via transcutaneous, subcutaneous, and epidural imaging respectively (0.69 ± 0.05, 1.09 ± 0.11, 0.95 ± 0.11 mm2, p < 0.001). CONCLUSIONS Transcutaneous ultrasound allows for measurements and longitudinal monitoring of local hemodynamic changes in a rodent SCI model.

Transcutaneous contrast-enhanced ultrasound imaging of the posttraumatic spinal cord.

The Community Multi-Scale Air Quality (CMAQ) model was applied to evaluate the air quality in the coastal city of Kannur, India, during the 2020 COVID-19 lockdown. From the Pre1 (March 1–24, 2020) period to the Lock (March 25–April 19, 2020) and Tri (April 20–May 9, 2020) periods, the Kerala state government gradually imposed a strict lockdown policy. Both the simulations and observations showed a decline in the PM(2.5) concentrations and an enhancement in the O(3) concentrations during the Lock and Tri periods compared with that in the Pre1 period. Integrated process rate (IPR) analysis was employed to isolate the contributions of the individual atmospheric processes. The results revealed that the vertical transport from the upper layers dominated the surface O(3) formation, comprising 89.4%, 83.1%, and 88.9% of the O(3) sources during the Pre1, Lock, and Tri periods, respectively. Photochemistry contributed negatively to the O(3) concentrations at the surface layer. Compared with the Pre1 period, the O(3) enhancement during the Lock period was primarily attributable to the lower negative contribution of photochemistry and the lower O(3) removal rate by horizontal transport. During the Tri period, a slower consumption of O(3) by gas-phase chemistry and a stronger vertical import from the upper layers to the surface accounted for the increase in O(3). Emission and aerosol processes constituted the major positive contributions to the net surface PM(2.5), accounting for a total of 48.7%, 38.4%, and 42.5% of PM(2.5) sources during the Pre1, Lock, and Tri periods, respectively. The decreases in the PM(2.5) concentrations during the Lock and Tri periods were primarily explained by the weaker PM(2.5) production from emission and aerosol processes. The increased vertical transport rate of PM(2.5) from the surface layer to the upper layers was also a reason for the decrease in the PM(2.5) during the Lock periods.

Integrated process analysis retrieval of changes in ground-level ozone and fine particulate matter during the COVID-19 outbreak in the coastal city of Kannur, India()

Innovation has enabled organizations to highlight and engage during the COVID -19 pandemic. The use of virtual site visits to assess the organizations 's culture and sustainability of the Magnet components during initial designation and redesignation allows for ongoing support of nursing excellence.

Achieving American Nurses Credentialing Center Magnet® Designation With a Virtual Site Visit

Influenza A viruses, which are further subtyped on the basis of antigenic differences in external hemagglutinin and neuraminidase glycoproteins, and influenza B viruses are prominent among the viral causes of respiratory diseases and can cause a wide spectrum of illness. Each year these viruses are responsible for recurrent epidemics, frequently in association with genetic variation. There is a requirement for sensitive and rapid diagnostic techniques in order to improve both the diagnosis of infections and the quality of surveillance systems. A new three-dimensional biochip platform (Flow-Thru Chip; MetriGenix) was used to develop a rapid and reliable molecular method for the typing and subtyping of influenza viruses. Oligonucleotide probes immobilized in microchannels of a silicon wafer were selected to recognize multiple fragments of the influenza A virus matrix protein gene; the influenza B virus NS gene; the H1, H3, and H5 hemagglutinin genes; and the N1 and N2 neuraminidase genes. Biotinylated amplicons resulting from either multiplex or random reverse transcription-PCR were hybridized to arrayed oligonucleotides on the influenza virus chip before they were stained with horseradish peroxidase-streptavidin and were imaged by use of a chemiluminescent substrate. The chip analysis procedure, from the time of pipetting of the sample into the chip cartridge to the time of analysis of the results, was performed in less than 5 h. The random PCR exhibited a higher level of performance than the multiplex PCR in terms of the specificity of product hybridization to the influenza virus chip. Analysis of influenza A viruses (H1N1, H3N2, H1N2, and H5N1) and influenza B viruses showed that this microarray-based method is capable of the rapid and unambiguous identification of all types and subtypes of viruses by use of random PCR products. The redundancy of the probes designed for each gene selected yielded an additional criterion of confidence for the subtyping of viruses which are known for antigenic variations in some of their components.

Use of the DNA flow-thru chip, a three-dimensional biochip, for typing and subtyping of influenza viruses.

BACKGROUND AND PURPOSE: The developing nervous system is particularly vulnerable to late adverse effects of cranial radiation therapy, such as leukoencephalopathy, microbleeds, and cavernomas. Cystlike lesions have been rarely described and characterized in the literature. We aimed to characterize cystlike lesions, their risk factors, and association with other late adverse effects. MATERIALS AND METHODS: Children treated for brain tumors during a 30-year period (n = 139) were included. We documented imaging findings, focusing on cystlike lesion development and its relationship with clinical history and other imaging findings. Multivariable analysis was performed using logistic regression and negative binomial regression models. RESULTS: Cystlike lesions developed in 16.5% of patients treated with radiotherapy, with a median of 2 years until the development of the first lesion. For every 4-year age increase, there were 50% decreased odds of developing lesions and a 50% decrease in the average count of lesions. Females demonstrated a 4.00 rate ratio of developing a higher number of lesions. Patients who underwent chemoradiotherapy had 3.20 increased odds of developing cystlike lesions compared with patients with radiation therapy alone. A larger proportion of patients treated with methotrexate (25%) developed cystlike lesions, but this was not statistically significant. Cystlike lesions tended to develop in cerebral locations where leukoencephalopathy was worse. A strong relationship was found between the development of cystlike lesions and leukoencephalopathy severity. CONCLUSIONS: Cystlike lesions are frequent and under-reported late adverse effects of cranial radiation therapy in children. Younger age, chemoradiotherapy, and the severity of leukoencephalopathy represent risk factors for the development of cystlike lesions.

Cystlike Lesions as a Late Sequela of Radiotherapy in Pediatric Patients

BACKGROUND: Recent reports suggest a higher incidence of COVID-19 infections among healthcare workers (HCW). However, information about the long-term complications affecting this population is lacking. AIMS: Investigation of long-term impact of COVID-19 in HCW. METHODS: Seropositivity for SARS-CoV-2 antibodies was evaluated for the majority of HCW in an English teaching hospital 2 months following the peak of COVID-19 first wave. A questionnaire investigating the long-term complications was sent through global e-mail to HCW 4 months following the peak of the wave enquiring about the persistent health issues still affecting them at that point. RESULTS: Out of 3759 subjects tested for SARS-CoV-2 antibodies, 932 were positive (24%). Forty-five per cent of 138 HCW responding to the questionnaire reported persistent symptoms with 32% struggling to cope 3–4 months following the peak of the wave. Moderate-to-severe fatigue stood out as the most disabling symptom (39%) but mild-to-moderate shortness of breath, anxiety and sleep disturbance were almost universal in the subjects still struggling with symptoms. Only 16% consulted their general practitioner (GP) about their symptoms with only 2% taking sick leave after recovering from the acute illness. CONCLUSIONS: Our data suggest that about a third of HCW who responded to the survey were still struggling to cope with the symptoms of what is now known as long covid several months after the acute COVID-19 infections. The overwhelming majority of this group seem to be reluctant to neither seek medical advice nor take sick leave.

Persistent post-covid symptoms in healthcare workers

We report considerations related with surgery through 2 cases of acute appendicitis (AA) with coronavirus disease 2019 (COVID-19) infection. In November and December 2020, AA occurred in 2 patients with COVID-19, who underwent emergency surgery. In case 1, an 84-year-old woman was asymptomatic and diagnosed with AA on the 20th day of infection. She was discharged after surgery without complication. In contrast, case 2 was that a 69-year-old man with pneumonia was treated with antibiotics, steroids, and remdesivir. After surgery, he was hospitalized for a long duration due to persistent pneumonia and wound complications. We should perform in well-established negative pressure operating rooms, personal protective equipment, and protocols. Since the physical examination and blood tests were limited, image examination like computed tomography scan should be considered if AA is suspected. If pneumonia is accompanied before surgery, pneumonia may worsen after surgery, or complications such as wound infection may occur.

Perioperative Considerations for Acute Appendicitis in Patients With Coronavirus Infection: Two Cases Report.

Investigating how counselors perceive technology as a tool for delivering counseling services is crucial to understand the usage and challenges that may have implications for training programs, policymaking, and allocation of resources. With the COVID-19 crisis and accompanying shelter-in-place and self-distancing guidelines, telemental health, including distance counseling, has become a satisfactory primary delivery system and is now expected to be part of routine counseling care. The present pre-COVID-19 study explored practicing counselors' perceptions of distance counseling regarding advantages and challenges. While noting benefits, results indicate continuing barriers to widespread telemental health use encompassing licensure, training, safety, privacy, evaluation, and regulatory policies. Also, attention is needed for therapeutic relationships and culturally alert digital interventions. In addition, counselors can take advantage of rapidly changing technologies to provide numerous innovative counseling services. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Counselors' perceptions of distance counseling: A national survey

This study emerged from the abrupt shift to online distance teaching due to the Covid-19 pandemic and reports of Mother Tongue Instruction (MTI) in Sweden, where online distance teaching was initially introduced in MTI only. In Sweden, MTI is offered to students whose parents/caregivers speak languages other than Swedish on a daily basis in the home. The focus is on how agentive space, as a body-space relationship, was created by students in a 9(th) grade class (ages 15-16 years) studying English MTI, in relation to both space and educational discourse. Despite the prescribed online distance teaching, many of the students collaboratively chose to assemble in a physical classroom without a supervisor on site. How the students created a new learning frame through their actions is discussed on the basis of video-recorded lessons, and two students' reflective follow-up talks. In this new - and in many respects difficult - learning space, educational discourse and educational ground rules were upheld through collaborative agency, which also facilitated expressions of identity and emotional space among the students. It is worth exploring further how schools can more efficiently draw on students' agency for language learning in similar and different contexts.

Student agency in relation to space and educational discourse. The case of English online mother tongue instruction

OBJECTIVE: To assess the impact of corticosteroids on inflammatory and respiratory parameters of patients with COVID-19 and acute respiratory distress syndrome (ARDS). METHODS: Longitudinal, retrospective, observational study conducted in an ICU of a second level hospital. Adult patients with COVID-19 were included. Baseline characteristics, data on SARS-CoV-2 infection, treatment received, evolution of respiratory and inflammatory parameters, and ICU and hospital stay and mortality were analyzed. RESULTS: A total of 27 patients were included, 63% men, median age: 68.4 (51.8, 72.2) years. All patients met ARDS criteria and received MV and corticosteroids. After corticosteroids treatment we observed a reduction in the O2 A-a gradient [day 0: 322 (249, 425); day 3: 169 (129.5, 239.5) p<0.001; day 5: 144 (127.5, 228.0) p<0.001; day 7: 192 (120, 261) p=0.002] and an increase in the pO2/FiO2 ratio on days 3 and 5, but not on day 7 [day 0: 129 (100, 168); day 3: 193 (140, 236) p=0.002; day 5: 183 (141, 255) p=0.004; day 7: 170 (116, 251) p=0.057]. CRP also decreased on days 3 and 5 and increased again on day 7 [day 0: 16 (8.6, 24); day 3: 3.4 (1.7, 10.2) p<0.001; day 5: 4.1 (1.4, 10.2) p<0.001; day 7: 13.5 (6.8, 17.3) p=0.063]. Persistence of moderate ARDS on day 7 was related to a greater risk of poor outcome (OR 6.417 [1.091-37.735], p=0.040). CONCLUSIONS: Corticosteroids appears to reduce the inflammation and temporarily improve the oxygenation in COVID-19 and ARDS patients. Persistence of ARDS after 7 days treatment is a predictor of poor outcome.

COVID-19 and Acute Respiratory Distress Syndrome. Impact of corticosteroid treatment and predictors of poor outcome

INTRODUCTION: Anesthetic management of parturients with COVID-19 is a big challenge to anesthesiologists. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with SARS and MERS might provide insights into COVID-19's effects during pregnancy. EVIDENCE ACQUISITION: Evidence from previous reports from SARS and MERS, and from COVID-19 cases were reviewed. Concepts from guidelines from the government and academic societies were collected as well. EVIDENCE SYNTHESIS: The evidences were described and summarized. CONCLUSIONS: Principles to minimize the risk of infection as well as optimize patients' safety during obstetric anesthesia were found to include careful evaluation, tight protection, and multi-discipline-based strategy. Though vertical transmission of COVID-19 still needs more definitive evidences, strict isolation is necessary for the newborn of COVID-19 mothers. Psychological support for the parturients is also an important issue during COVID-19 pandemic.

Pregnancy and COVID-19: what anesthesiologists should know?

Background: Multiple myeloma is a chronic progressive disease that calls for extended survivorship support post-diagnosis. Pre- COVID- 19, the AMPATH Multiple Myeloma Program had created support groups for myeloma survivors and their caregivers that regularly met for health education, emotional support, and social opportunities. With the enforcement COVID-19 prevention and control protocols physical support group meetings became impossible. The program shifted to the online platform to sustain peer to peer support for myeloma patients and caregivers. We aim to describe challenges faced with online patient support group meetings as this has not been well documented in a resource-constrained setting. Methods: Myeloma patients and caregivers at Moi Teaching and Referral Hospital were contacted and a meeting date and time agreed. Participants were briefed on how to download and operate the zoom application in preparation for online meetings. A meeting link was shared with the expected attendees and a reminder sent two days before a meeting. Support group meetings were held for different groups among them myeloma survivors and caregivers. The meeting sessions were led by healthcare professionals - hematology consultants, social workers, nutritionist and psychosocial counsellors. Peer-to-peer sessions were also held. Results: Six online meeting sessions were held between June 2020 and December 2020. A total of 199 participants were expected to join the six different meetings but a low meeting turn-out of 25.6% was experienced. Participants were later contacted to unravel the reasons for a low turn-out. A total of 129 participants were contacted of which 88 responded. Out of the 88 respondents, 29% reported a tight work schedule, 25% short time meeting alerts, 20% did not have access to smartphones, and 8% had poor internet connectivity and another 8% reported no internet data bundles to connect to the internet. Conclusions: Low attendance of online meetings was observed. Participants cited scheduling and internet access as major obstacles to attending online support group meetings. Improved access to the internet through smartphones, reliable internet connection, and affordable data are needed in underserved communities to fully unlock the benefits of virtual platforms namely cost savings and effective information sharing.

Patient-reported barriers to online meetings: The case of a myeloma support group in western Kenya in the era of COVID-19

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection causes Coronavirus Disease 2019 (COVID-19), a pandemic that seriously threatens global health. SARS-CoV-2 propagates by packaging its RNA genome into membrane enclosures in host cells. The packaging of the viral genome into the nascent virion is mediated by the nucleocapsid (N) protein, but the underlying mechanism remains unclear. Here, we show that the N protein forms biomolecular condensates with viral genomic RNA both in vitro and in mammalian cells. While the N protein forms spherical assemblies with homopolymeric RNA substrates that do not form base pairing interactions, it forms asymmetric condensates with viral RNA strands. Cross-linking mass spectrometry (CLMS) identified a region that drives interactions between N proteins in condensates, and deletion of this region disrupts phase separation. We also identified small molecules that alter the size and shape of N protein condensates and inhibit the proliferation of SARS-CoV-2 in infected cells. These results suggest that the N protein may utilize biomolecular condensation to package the SARS-CoV-2 RNA genome into a viral particle.

SARS-CoV-2 nucleocapsid protein forms condensates with viral genomic RNA

Most of the theoretical contributions on the relationship between economy and environment assume the environment as a good distributed homogeneously among agents. The aim of this work is to relax this hypothesis and to consider that the environment can have a local character even if conditioned through externalities by the choices made at the global level. In this article, we adapt the classical framework introduced in John and Pecchenino (Econ J 104(427):1393–1410, 1994) to analyze the dynamic relationship between environment and economic process, and we propose an OLG agent-based model where each agent perceives her own level of environmental quality determined by her own decisions, and by the decisions of those living around her. Despite the attention devoted to local environmental aspects, network externalities (determined through the scheme of Moore neighborhoods) play a fundamental role in defining environmental dynamics and they may induce the emergence of cyclical dynamics. The occurrence of oscillations in the local environmental quality is partially mitigated by the presence of heterogeneity in individuals’ preferences. Finally, when a centralized planner is introduced, the dynamics converge to stationary values regardless of the assumption on heterogeneity of agents.

Local environmental quality and heterogeneity in an OLG agent-based model with spatial externalities

BACKGROUND: During the outbreak, billions of people were eager to get information about COVID-19 through social media. Social media can not only deliver reliable information to the public but can in turn reflect changes in the public's psychological status. Insight into the public's hotspots of concern and mental status through media background tools contributes to the formulation of public health policies and the clarification of epidemic development mode. METHODS: WeChat is the largest social media in China. Taking the recovery period of COVID-19 in China, for example, we collected WeChat Index data and analyzed the public's concern about the course of COVID-19 and the restoration of emotional tendency through keywords search. RESULTS: With the gradual control of the COVID-19 in China, the public psychological status changes from negative to neutral, accompanied by a weakening of negative emotions and an increase in positive emotions. Every obvious inflection point of improvement in social operation is reflected in the increase of public attention and the relaxation of lifestyle. CONCLUSIONS: Social media can be used to monitor the public psychological status and the development mode and trend of infection in one country during a pandemic.

Using social media to analyze public psychological status during the recovery period of COVID-19 in China

Yan Li talks about spotting the novel swine flu virus at Canada's National Microbiology Laboratory.

The virus spy

BACKGROUND: There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. METHODS: This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores &#8805;5 and &#8805; 6, quick Sequential Organ Failure Assessment (qSOFA) score &#8805; 2, &#8805;2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score &#8805; 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong's test. RESULTS: In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score &#8805; 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690-0.953). NEWS2 was superior to qSOFA score &#8805; 2 (AUC 0.624, 95% CI 0.446-0.810, p < 0.05) and other clinical risk scores for this purpose. CONCLUSION: NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.

National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - a prospective cohort study

Background: Currently, there is a growing concern towards epidemiological and clinical research on functional gastrointestinal disorders. Irritable Bowel Syndrome is defined as a functional gastrointestinal disorder characterized by abdominal discomfort, abdominal pain, and altered bowel movements. It is the most common gastrointestinal disorder. It can be diarrhea-predominant IBS, constipation-predominant IBS, and mixed type IBS. Objective: The objective of this study was to determine the frequency of IBS among medical students of Allama lqbal Medical College and to determine conditions and lifestyle habits that may act as significant risk factors for developing IBS. Methods: A cross-sectional study was conducted for over 5 months. A sample of 323 individuals was studied whereas the sampled individuals were selected using a "stratified random sampling technique". The study was conducted by collecting data through an online questionnaire during the global COVID pandemic. The questionnaire consisted of three parts. The first section consisted of demographic information, the second section consisted of a standard questionnaire determining the risk factors of IBS i.e., personal food and lifestyle habits, and the last section was aimed at determining whether the person was a case of IBS or not using the widely accepted and used "Rome III Criteria" and determining the predominant pattern of IBS. Results: The frequency of IBS was found to be 15.5%. Analysis of collected data revealed that the predictors for IBS were stress and reduced hours of daily sleep. It was also observed that a positive family history of irritable bowel syndrome predisposed the development of IBS in a person. 30% of subjects with a positive family history of IBS had symptoms suggestive of IBS. Conclusion: The study concludes that there is a high incidence of IBS among medical students because they live under higher stress conditions, concerning their academics and professional duty than students and professionals from other educational fields.

Frequency of Irritable Bowel Syndrome (IBS) and its Risk Factors among MBBS Students of Allama Iqbal Medical College, Lahore

The prevalent respiratory viruses such as SARS-CoV-2 probably persist for a long time on fomites and environmental surfaces. Some recent studies have detected SARS-CoV-2 RNA on the surface of cell phones, door handles and other items in the inhabited sites of confirmed cases. For the aim of this study, a total of 50 environmental surface samples of SARS-CoV-2 was collected from Imam Khomeini Hospital in Ardabil. Forty-one environmental surface samples were proved negative for SARS-CoV-2 RNA while nine surface samples were positive. Our findings regarding surfaces contaminated with the virus are consistent with the results of recent similar researches as it was revealed that a number of different samples taken from hospital surfaces such as handles, cupboards, light switches, and door handles were positive for the presence of SARS-Cov-2.

Investigation of SARS CoV-2 virus in environmental surface