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Prior research has shown that energy sector stock prices are impacted by uncertainty. The coronavirus (COVID-19) pandemic has given rise to widespread health and economic-related uncertainty. In this study, we investigate the magnitude and the timing of the impact of COVID-19 related uncertainty on returns and volatility for 20 national energy indices and a global energy index using ARCH/GARCH models. We propose a novel “overall impact of uncertainty” (OIU) measure, explained using a natural phenomenon analogy of the overall impact of a rainstorm, to gauge the magnitude and intensity of the impact of uncertainty on energy sector returns. Drawing upon economic psychology, COVID-19 related uncertainty is measured in terms of searches for information relating to COVID-19 as captured by Google search trends. Our results show that the energy sectors of countries further west from the outbreak of the virus in China are impacted to a greater extent by COVID-19 related uncertainty. A similar observation is made for net energy and oil exporters relative to importers. We also find that the impact of uncertainty on most national energy sectors intensified and then weakened as the pandemic evolved. Additional analysis confirms that COVID-19 uncertainty is part of the composite set of factors that drive energy sector returns over the COVID-19 period although its importance has declined over time.

The COVID-19 storm and the energy sector: The impact and role of uncertainty

BACKGROUND: In 2020, the COVID-19 pandemic caused an acute risk of deterioration and dying for many, and an urgent need to start advance care planning. AIM: To explore how general practitioners (GPs) experienced discussing values, goals and preferences with patients during COVID-19. DESIGN AND SETTING: Qualitative research in general practice. METHODS: Semi-structured interviews for which Dutch GPs were recruited via purposive sampling. Content analysis was used. RESULTS: Fifteen GPs were interviewed. Six themes were identified: (i) urge of advance care planning, (ii) the GP's perceived role in it, (iii) preparations for it, (iv) (proactively) discussing it, (v) essentials for good communication and (vi) advance care planning in the (near) future. Calls for proactively discussing advance care planning in the media and in COVID-guidelines caused awareness of it's importance. GPs envisaged an important role for themselves in initiating it, especially with patients at risk to deteriorate or die from COVID-19. Timing advance care planning appeared difficult but crucial. The recommended digital way of communication was considered problematic due to missing nonverbal communication and difficulties in involving relatives. It was noted that admission to the ICU, which was hardly discussed before the COVID-19 pandemic, should remain a topic during advance care planning. CONCLUSION: The COVID-19 pandemic brought advance care planning into a new light, GPs were more experienced with discussing it and patients were more aware of their frailty. Because of the nearing 'grey wave', advance care planning should remain top priority. Therefore, it should be central in GP and post-academic training.

The COVID-19 pandemic: A tipping point for advance care planning? Experiences of general practitioners

Diabetes is a life-long condition that is well-known in the 21st century Once known as a disease of the West, the rise of diabetes has been fed by a nutrition shift, rapid urbanization and increasingly sedentary lifestyles In late 2019, a new public health concern was emerging (COVID-19), with a particular hazard concerning people living with diabetes Medical institutes have been collecting data for years We expect to achieve predictions for pathological complications, which hopefully will prevent the loss of lives and improve the quality of life using data mining processes This work proposes a comparative study of data mining techniques for early diagnosis of diabetes We use a publicly accessible data set containing 520 instances, each with 17 attributes Naive Bayes, Neural Network, AdaBoost, k-Nearest Neighbors, Random Forest and Support Vector Machine methods have been tested The results suggest that Neural Networks should be used for diabetes prediction The proposed model presents an AUC of 98 3% and 98 1% accuracy, an F1-Score, Precision and Sensitivity of 98 4% and a Specificity of 97 5% © 2021 by the authors Licensee MDPI, Basel, Switzerland

Data mining techniques for early diagnosis of diabetes: A comparative study

The COVID-19 pandemic is proving to be a multiplier of inequalities Especially toward the elderly population A voiceless scream that comes from geriatrics, nursing homes, hospices from all over Italy They call it the silent massacre: from North to South, the bulletin of coronavirus positive—or already deceased—elderly people continues to grow exponentially without a chance to counter it Population aging and chronicity are a question that needs to be addressed Frailty is the most challenging expression of population aging, with major consequences for public health and clinical practice It is a geriatric syndrome which consists in a state of higher vulnerability to stressors attributed to a lower homeostatic reserve due to an age-related multisystem physiological change People over 60, and especially over 80, are particularly vulnerable to severe or fatal infection Moreover, the age-related dysregulation of the immune system in the elderly (i e , immunosenescence and inflammaging) results in poorer responses to vaccination Physical frailty is an effective health indicator and it has previously shown to predict the response to the seasonal flu vaccine These findings suggest that assessing frailty in the elderly may identify those who are less likely to respond to immunization and be at higher risk for COVID-19 and its complications Moreover, cognitive frailty and neurocognitive disorders, mental health and reduced awareness of illness negatively impact on adherence to complex medication regimens among elderly patients A worldwide research and development blueprint have been initiated to accelerate the development of vaccines and therapeutics for the COVID-19 outbreak Considered the above, I suggest the importance to consider aging in thinking about future Civud-19 vaccination and treatment, focusing on the possible impact of physical and cognitive frailty

Covid-19 Pandemic: Maximizing Future Vaccination Treatments Considering Aging and Frailty

Objective: To investigate the safety and effectiveness of extraluminal placement of a bronchial blocker compared with carbon dioxide (CO(2)) artificial pneumothorax in infants undergoing video-assisted thoracoscopic surgery (VATS). Methods: The study involved 33 infants (group A) who underwent one-lung ventilation (OLV) with extraluminal placement of a bronchial blocker and 35 other infants (group B) who underwent CO(2) artificial pneumothorax. Clinical characteristics, the degree of lung collapse, and complications were compared. Results: The degree of lung collapse in group A was significantly higher than that in group B at T2 and T3. The mean arterial pressure (MAP) of group B was significantly lower than that of group A at 10 min and 30 min after OLV. The partial pressure of carbon dioxide (PaCO(2)) of group B was significantly higher than that of group A at 30 min after OLV. The incidence of hypotension in group B was higher than that in group A. Conclusion: Compared with CO(2) artificial pneumothorax, extraluminal placement of a bronchial blocker is associated with a better degree of lung collapse, fewer episodes of hypotension, and lower PaCO(2) accumulation during OLV in infants undergoing VATS.

Extraluminal Placement of a Bronchial Blocker Compared with Carbon Dioxide Artificial Pneumothorax in Infants Undergoing Video-Assisted Thoracoscopic Surgery

Despite the COVID pandemic, worsening global conditions, and populations surviving with less than a dollar a day or a couple of days due to deliberately constructed dispossessions and disadvantages, it is consoling to hear about positive human capabilities and resilience in many parts of the world Moreover, while many communities around the world struggle to experience the touch of justice and peace, the obstacles that trim these efforts step up their assaults on civility Please extend a warm welcome to Dr Bernard and her team [Extracted from the article] Copyright of Contemporary Justice Review is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This 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 )

Positive capabilities, resilience, and the future

Synaptic plasticity is a key mechanism of learning and memory. Synaptic plasticity mechanisms within the nucleus accumbens (NAc) mediate differential behavioral adaptations. Feedforward inhibition in the NAc occurs when glutamatergic afferents onto medium spiny neurons (MSNs) collateralize onto fast-spiking parvalbumin (PV)-expressing interneurons (PV-INs), which exert GABAergic control over MSN action potential generation. Here, we find that feedforward glutamatergic synapses onto PV-INs in the NAc core selectively express Ca2+-permeable AMPA receptors (CP-AMPARs). Ca2+ influx by CP-AMPARs on PV-INs triggers long-term depression (LTD) mediated by endocannabinoid (eCB) signaling at presynaptic cannabinoid type-1 (CB1) receptors (CB1Rs). Moreover, CP-AMPARs authorize tonic eCB signaling to negatively regulate glutamate release probability. Blockade of CP-AMPARs in the NAc core in vivo is sufficient to disinhibit locomotor output. These findings elucidate mechanisms by which PV-IN-embedded microcircuits in the NAc undergo activity-dependent shifts in synaptic strength.

Calcium-Permeable AMPA Receptors Promote Endocannabinoid Signaling at Parvalbumin Interneuron Synapses in the Nucleus Accumbens Core

In this section of the journal, in the midst of a pandemic crisis it seemed incongruous to publish on any topic except Coronavirus At the time of writing, many health professionals who are members of CoramBAAF are at the frontline of the fight with the virus and some medical advisers and health professionals working with looked after children have been redeployed from their substantive roles to work in other areas of health care provision Health service interventions and assessments are critical components of adoption and fostering work These assessments are usually reliant on face-to-face, clinical contacts with children, carers and families How can these tasks be completed in a world where direct contact is not advised? What happens now that health staff who are normally involved in these services are not available? Reflecting on the past few months, I realise that at the onset of the pandemic I felt as if I were facing a huge jigsaw puzzle The pieces of the world in which I work and which once slotted neatly together were now in a jumbled heap and I had no idea how they would fit back together to make the familiar picture Initially it felt as if surely someone would take charge and direct the sector, making sure that normal processes could proceed But it quickly became obvious that in an area of work where accountability for systems and provision of services is so complex and multifaceted, this was not going to be the immediate scenario

Responding to Covid-19: some personal reflections

In the event of a pandemic that poses widespread infection and high death rates, the utilitarian mandate to ‘reduce harm’ is the relevant moral value that trumps other ethical considerations. The primacy of a utilitarian approach dictates that those who are in a position to assist the cessation of the most serious outbreaks in whatever role they may have, must be present to provide their services, and those who administer health care must also be present to ensure that all responders are supported and protected to the highest degree.

In the name of the greater good?

Due to the usage of social distancing as a means to control the spread of the novel coronavirus disease COVID-19, there has been a large amount of research into the dynamics of epidemiological models with time-varying transmission rates. Such studies attempt to capture population responses to differing levels of social distancing, and are used for designing policies which both inhibit disease spread but also allow for limited economic activity. One common criterion utilized for the recent pandemic is the peak of the infected population, a measure of the strain placed upon the health care system; protocols which reduce this peak are commonly said to `flatten the curve." In this work, we consider a very specialized distancing mandate, which consists of one period of fixed length of distancing, and addresses the question of optimal initiation time. We prove rigorously that this time is characterized by an equal peaks phenomenon: the optimal protocol will experience a rebound in the infected peak after distancing is relaxed, which is equal in size to the peak when distancing is commenced. In the case of a non-perfect lockdown (i.e. disease transmission is not completely suppressed), explicit formulas for the initiation time cannot be computed, but implicit relations are provided which can be pre-computed given the current state of the epidemic. Expected extensions to more general distancing policies are also hypothesized, which suggest designs for the optimal timing of non-overlapping lockdowns.

Minimizing the infected peak utilizing a single lockdown: a technical result regarding equal peaks

India, acclaimed the world’s largest noble coronavirus vaccine manufacturer, found struggling with social, legal and moral issues with the ongoing coronavirus vaccination program. The greatest challenge for protection of its citizens against serious infectious disease through vaccination remains access to vaccines and associated inequity in access. Besides, improving infrastructure, developing novel delivery platforms that eliminate the need for a cold chain, continuing education and enhancing community engagement will be essential. There is a notable subset of the population who are skeptical about vaccination;and this requires a response from the scientific community to provide transparency about the existing knowledge gaps and strategies to overcome these. This paper, through integrative review of articles, published reports and interviews attempts to briefly discuss some unprecedented ethical issues raised regarding the vaccination programme against novel coronavirus spread in India. The study observed that systematic methodical rigor to improve coverage with all antigens in the diverse country has been wanting;and for the same efforts are needed to generate evidence for planning to (or not to) introduce new antigens in the programme and to prove the impact of vaccine introduction on disease.

Ethical Issues Concerning Ongoing Mass Vaccination in India (preprint)

The world continues to face an ongoing viral pandemic that presents a serious threat to human health. The virus underlying the COVID-19 disease, SARS-CoV-2, caused over 29 million confirmed cases and 925,000 deaths since January 2020. Although the last pandemic occurred only a decade ago, the way science operates and responds to current events has experienced a paradigm shift in the interim. The scientific community responded rapidly to the COVID-19 pandemic, releasing over 16,000 COVID-19 scientific articles within 4 months of the first confirmed case, of which 6,753 were hosted by preprint servers. Focussing on bioRxiv and medRxiv, two growing preprint servers for biomedical research, we investigated the attributes of COVID-19 preprints, their access and usage rates and characteristics of sharing across online platforms. Our results highlight the unprecedented role of preprint servers in the dissemination of COVID-19 science, and the impact of the pandemic on the scientific communication landscape.

Preprinting the COVID-19 pandemic

Abstract COVID-19 has given rise to a myriad of social, psychological, and health-related complications. The specific mental health implications of COVID-19 are still being uncovered, but we know that there are likely to be negative outcomes for many people. This is particularly the case for vulnerable members of the community, such as those with high health anxiety, and under conditions where individuals feel isolated or disconnected from others. The objective of this study was to examine whether the level of socially motivated Internet use acts as a buffer of the relationship between health anxiety, isolation behaviors, and depression. Participants (N = 473; 67.3 percent female; Mage = 23.03, SD = 7.50) from Australia completed self-report measures during the height of the national pandemic restrictions (April-May 2020). A regression analysis revealed positive relationships between health anxiety and isolation behaviors on depression and highlighted a three-way interaction effect. Specifically, health anxiety was significantly negatively associated with depression when participants engaged in fewer isolation behaviors. However, at higher levels of isolation behaviors, the relationship between health anxiety and depression was attenuated for participants with greater levels of online social connection. The findings suggest that online social connection buffered the negative effects of health anxiety under conditions of isolation. These results offer promising avenues to mitigate against vulnerabilities during the pandemic and highlight the need to promote alternate social support mechanisms in the absence of face-to-face connection.

Online Social Connection as a Buffer of Health Anxiety and Isolation During COVID-19

Future healthcare systems will rely heavily on clinical decision support systems (CDSS) to improve the decision-making processes of clinicians. To explore the design of future CDSS, we developed a research-focused CDSS for the management of patients in the intensive care unit that leverages Internet of Things (IoT) devices capable of collecting streaming physiologic data from ventilators and other medical devices. We then created machine learning (ML) models that could analyze the collected physiologic data to determine if the ventilator was delivering potentially harmful therapy and if a deadly respiratory condition, acute respiratory distress syndrome (ARDS), was present. We also present work to aggregate these models into a mobile application that can provide responsive, real-time alerts of changes in ventilation to providers. As illustrated in the recent COVID-19 pandemic, being able to accurately predict ARDS in newly infected patients can assist in prioritizing care. We show that CDSS may be used to analyze physiologic data for clinical event recognition and automated diagnosis, and we also highlight future research avenues for hospital CDSS.

Leveraging IoTs and Machine Learning for Patient Diagnosis and Ventilation Management in the Intensive Care Unit.

Clinical methods are used for diagnosing COVID-19 infected patients, but reports posit that, several people who were initially tested positive of COVID-19, and who had some underlying diseases, turned out having negative results, after further tests. Therefore, the performance of clinical methods is not always guaranteed. Moreover, chest X-ray image data of COVID-19 infected patients are mostly used in the computational models for COVI-19 diagnosis while the use of common symptoms such as “Fever, Cough, Fatigue, Muscle aches, Headache etc”, in computational models is not yet reported. In this study, we employ seven classification algorithms to empirically test and verify their efficacy when applied to diagnose COVID-19 using the aforementioned symptoms. We experimented with logistic regression (LR), support vector machine (SVM), naïve Byes (NB), decision tree (DT), multilayer perceptron (MLP), fuzzy cognitive map (FCM) and Deep neural network (DNN) algorithms. The techniques were subjected to random under-sampling and over-sampling. Our results showed that with class imbalance, MLP and DNN outperform others but without class imbalance MLP, FCM and DNN outperform others with the use of random under-sampling but DNN has the best performance with the use random oversampling. This study identified MLP, FCM and DNN as better classifiers over LR, NB, DT and SVM, that healthcare software system developers can adopt to develop intelligence-based expert systems which both medical personnel and patients can use for differential diagnosis of COVID-19 based on the aforementioned symptoms however, the test of performance must not be limited to the traditional performance metrics.

Application of intelligence-based computational techniques for classification and early differential diagnosis of COVID-19 disease

OBJECTIVES: To develop a population-based risk stratification model (COVID-19 Vulnerability Score) for predicting severe/fatal clinical manifestations of SARS-CoV-2 infection, using the multiple source information provided by the healthcare utilisation databases of the Italian National Health Service. DESIGN: Retrospective observational cohort study. SETTING: Population-based study using the healthcare utilisation database from five Italian regions. PARTICIPANTS: Beneficiaries of the National Health Service, aged 18–79 years, who had the residentship in the five participating regions. Residents in a nursing home were not included. The model was built from the 7 655 502 residents of Lombardy region. MAIN OUTCOME MEASURE: The score included gender, age and 29 conditions/diseases selected from a list of 61 conditions which independently predicted the primary outcome, that is, severe (intensive care unit admission) or fatal manifestation of COVID-19 experienced during the first epidemic wave (until June 2020). The score performance was validated by applying the model to several validation sets, that is, Lombardy population (second epidemic wave), and the other four Italian regions (entire 2020) for a total of about 15.4 million individuals and 7031 outcomes. Predictive performance was assessed by discrimination (areas under the receiver operating characteristic curve) and calibration (plot of observed vs predicted outcomes). RESULTS: We observed a clear positive trend towards increasing outcome incidence as the score increased. The areas under the receiver operating characteristic curve of the COVID-19 Vulnerability Score ranged from 0.85 to 0.88, which compared favourably with the areas of generic scores such as the Charlson Comorbidity Score (0.60). A remarkable performance of the score on the calibration of observed and predicted outcome probability was also observed. CONCLUSIONS: A score based on data used for public health management accurately predicted the occurrence of severe/fatal manifestations of COVID-19. Use of this score may help health decision-makers to more accurately identify high-risk citizens who need early preventive or treatment interventions.

Stratification of the risk of developing severe or lethal Covid-19 using a new score from a large Italian population: a population-based cohort study

Coronavirus disease 2019 (COVID-19) has been devastating to the elderly population, especially due to a lack of clear guidelines for treatment. Corticosteroids have been the mainstay in treating the cytokine storm caused by the virus. In the past, prolonged viral shedding of Middle East Respiratory Syndrome (MERS) was noted in patients treated with high-dose corticosteroids. It is unclear whether this also holds true for severe acute respiratory syndrome coronavirus (SARS-CoV2). To our knowledge, this case report highlights the longest reported disease course of SARS-CoV2, lasting approximately 210 days.

Prolonged SARS-CoV2 Viral Shedding in an Elderly Patient

We present a mathematical model for the simulation of the development of an outbreak of coronavirus disease 2019 (COVID-19) in a slum area under different interventions. Instead of representing interventions as modulations of the parameters of a free-running epidemic, we introduce a model structure that accounts for the actions but does not assume the results. The disease is modelled in terms of the progression of viraemia reported in scientific studies. The emergence of symptoms in the model reflects the statistics of a nation-wide highly detailed database consisting of more than 62 000 cases (about a half of them confirmed by reverse transcription-polymerase chain reaction tests) with recorded symptoms in Argentina. The stochastic model displays several of the characteristics of COVID-19 such as a high variability in the evolution of the outbreaks, including long periods in which they run undetected, spontaneous extinction followed by a late outbreak and unimodal as well as bimodal progressions of daily counts of cases (second waves without ad-hoc hypothesis). We show how the relation between undetected cases (including the ‘asymptomatic’ cases) and detected cases changes as a function of the public policies, the efficiency of the implementation and the timing with respect to the development of the outbreak. We show also that the relation between detected cases and total cases strongly depends on the implemented policies and that detected cases cannot be regarded as a measure of the outbreak, being the dependency between total cases and detected cases in general not monotonic as a function of the efficiency in the intervention method. According to the model, it is possible to control an outbreak with interventions based on the detection of symptoms only in the case when the presence of just one symptom prompts isolation and the detection efficiency reaches about 80% of the cases. Requesting two symptoms to trigger intervention can be enough to fail in the goals.

Stochastic model for COVID-19 in slums: interaction between biology and public policies

BACKGROUND: Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust. OBJECTIVE: We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis. METHODS: We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records. RESULTS: Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, P=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007). CONCLUSIONS: Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics.

Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey

This article aims to present methodological aspects on the collection, analyses, coverage, challenges, and the lessons learned from laboratory assessment of micronutrients on the Brazilian National Survey on Child Nutrition (ENANI-2019). This is a household survey on a probability sample of children under five years of age from 123 Brazilian municipalities in all 26 states and the Federal District. Blood samples were drawn by venipuncture at the homes of children 6 to 59 months of age. This procedure was performed by experienced phlebotomists from the laboratories located in the selected municipalities and scheduled in advance. Blood and serum levels were measured for biomarkers of nutritional status, using the services of a clinical test laboratory with nationwide coverage, for the following micronutrients: iron (hemoglobin and ferritin), zinc, selenium, folic acid, and vitamins A, B1, B6, B12, D, and E. C-reactive protein was analyzed as a marker of inflammation. A barcode identifier was used to track the blood samples and to link the biochemical test results to the other data collected in the survey. A total of 14,558 children were studied. Of the 12,598 eligible children, 8,829 (70.1%) had blood samples drawn. Of the total number of children who had samples drawn, 91.8% (n = 8,025) have results for at least nine of the 12 analyses performed. Coverage of the analysis varied from 95% (for vitamins A and E) to 84.2% (for folic acid). Aliquots of whole blood and serum were stored in a biorepository for future analyses. The results of this pioneering study in the country will back the formulation and, when necessary, the reorientation of public policies in food and nutrition.

Methodological aspects of the micronutrient assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey.

The use of chatbots in news media platforms, although relatively recent, offers many advantages to journalists and media professionals and, at the same time, facilitates users' interaction with useful and timely information This study shows the usability of a news chatbot during a crisis situation, employing the 2020 COVID-19 pandemic as a case study The basic targets of the research are to design and implement a chatbot in a news media platform with a two-fold aim in regard to evaluation: first, the technical effort of creating a functional and robust news chatbot in a crisis situation both from the AI perspective and interoperability with other platforms, which constitutes the novelty of the approach;and second, users' perception regarding the appropriation of this news chatbot as an alternative means of accessing existing information during a crisis situation The chatbot designed was evaluated in terms of effectively fulfilling the social responsibility function of crisis reporting, to deliver timely and accurate information on the COVID-19 pandemic to a wide audience In this light, this study shows the advantages of implementing chatbots in news platforms during a crisis situation, when the audience's needs for timely and accurate information rapidly increase © 2020 by the authors Licensee MDPI, Basel, Switzerland

Employing a chatbot for news dissemination during crisis: Design, implementation and evaluation

INTRODUCTION: The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) or novel corona virus disease (COVID-19) pandemic is sweeping the globe. Latest information on the outbreak of the corona virus epidemic in 2019, which was caused by the extreme acute respiratory syndrome corona virus 2 strains, has begun to shed light on the disease's effects on the liver. However, no studies have systematically to date, there have been no impaired liver tests in COVID-19 patients. In patients with irregular liver test results, we looked at the clinical features of COVID-19. The goal of this research was to explain the clinical outcomes of COVID-19 in patients with irregular liver tests and CLD. AIM:We performed an observational study to see how irregular liver tests and patients' clinical outcomes were influenced by chronic liver disease admitted to SMHRC Nagpur. MATERIAL AND METHODS: The research included 200 people aged 25 to 65 years old who had been diagnosed with corona positive and were admitted to Shalinitai Meghe Hospital in Nagpur. They were split up into different parties. One group had chronic liver disease, and the other did not, but both groups had patients that were corona positive. We included patients who had liver defects as a result of corona viruses in this study. During the research phase, we gathered information from this patient. As a research group and a control group, we test SGOT, SGPT, ALP, Protein, Total bilirubin, and GGT levels. RESULTS: The findings show that corona positive patients with liver disease had elevated liver function tests, such as increased levels of SGOT, SGPT, Total billirubin, Alkaline phosphates, and GGT, when compared to those who did not have any liver abnormalities but were corona positive. A history of irregular liver tests and liver damage was related to the development of serious pneumonia. The detrimental impacts on liver injury were linked to some drugs taken during hospitalization, implying that these patients should be monitored and evaluated on a regular basis. CONCLUSION: Patients who had irregular liver tests were more likely to develop serious disease. The negative effects on liver damage were mostly due to some drugs taken during hospitalization, which should be closely monitored and evaluated. © 2021, Annals of R.S.C.B. All rights reserved.

Impact of liver test abnormalities and chronic liver disease on the clinical outcomes of patients hospitalized with covid-19 in Vidharbha region of central India

BACKGROUND: The American Heart Association/ American Stroke Association and the Chinese Stroke Association guidelines are recommending intravenous alteplase intervention before endovascular thrombectomy if patients are eligible to do so but the benefits of endovascular thrombectomy are different in Chinese patients with stroke than those of the white patients. The objective of the study was to compare outcomes of patients with acute ischemic stroke treated with endovascular thrombectomy with intravenous alteplase against those treated with endovascular thrombectomy alone. METHODS: A report is a retrospective analysis of comparing demographics, imaging, clinical and adverse outcomes in the Han Chinese patient who underwent mechanical thrombectomy for acute ischemic stroke with large vessel occlusion, with or without preceding intravenous alteplase administration. Patients with terminus and non-terminus intracranial occlusions and ≤ 2 points neurologic deficit underwent endovascular thrombectomy preceded by 0.9 mg/ kg intravenous alteplase (ET cohort, n = 184) and those who had contra-indication for intravenous alteplase were treated with endovascular thrombectomy alone (EA cohort, n = 141). RESULTS: The most common procedural complications were embolization into new territory (p = 0.866) and uneventful artery vasospasm (p = 0.712). Insignificant differences were reported for any procedural complications (p = 0.991), imaging outcomes, the modified Rankin scale score (p = 0.663), and death (28 vs. 24, p = 0.761) within 90 days between patients of both cohorts. At the discharge of the hospital, the National Institutes of Health Stroke Scale scores of patients of the ET cohort were lower than those of the EA cohort (8.58 ± 3.79 vs. 10.23 ± 4.97, p = 0.003). The Barthel Index of survivors at 90 days after endovascular thrombectomy was higher for patients of the ET cohort than those of the EA cohort (87.47 ± 12.58 vs. 84.01 ± 13.47, p = 0.032). The most common adverse effect was asymptomatic intracranial hemorrhage (p = 0.297). Insignificant differences were reported for adverse effects after thrombectomy between survivors of both cohorts. CONCLUSIONS: Outcome measures in Han Chinese patients with acute ischemic stroke treated with endovascular thrombectomy alone were statistically the same as those treated with endovascular thrombectomy plus intravenous alteplase. LEVEL OF EVIDENCE: Iii TECHNICAL EFFICACY STAGE: 4.

Endovascular Thrombectomy preceded by intravenous Alteplase versus endovascular Thrombectomy alone in Han Chinese patients treated for acute ischemic stroke with large vessel occlusion: a single-center retrospective analysis

The aim of this study was to evaluate the number of primary and revision total joint arthroplasties (TJA/rTJA) in 2020 compared to 2019. Specifically, the first and the second waves of the COVID-19 pandemic were evaluated as well as the pre-operative COVID-19 test. A cross-sectional single-center study of our prospectively maintained institutional arthroplasty registry was performed. The first COVID-19 wave and the second COVID-19 wave led to a socioeconomic lockdown in 2020. Performed surgeries, cause of revision, age, gender, and American Society of Anesthesiologists-level were analyzed. Preoperative COVID-19 testing was evaluated and nationwide COVID-19 data were compared to other countries. In 2020, there was a decrease by 16.2% in primary and revision TJAs of the hip and knee compared to 2019. We observed a reduction of 15.8% in primary TJAs and a reduction of 18.6% on rTJAs in 2020 compared to 2019. There is an incline in total hip arthroplasties (THAs) and a decline in total knee arthroplasties (TKAs) comparing 2019 to 2020. During the first wave, there was a reduction in performed primary TJAs of 86%. During the second wave, no changes were observed. This is the first study quantifying the impact of the COVID-19 pandemic on primary and revision TJAs regarding the first and second wave.

Impact of the 1st and 2nd Wave of the COVID-19 Pandemic on Primary or Revision Total Hip and Knee Arthroplasty-A Cross-Sectional Single Center Study

In an attempt to control the mosquito-borne diseases yellow fever, dengue, chikungunya, and Zika fevers, a strain of transgenically modified Aedes aegypti mosquitoes containing a dominant lethal gene has been developed by a commercial company, Oxitec Ltd. If lethality is complete, releasing this strain should only reduce population size and not affect the genetics of the target populations. Approximately 450 thousand males of this strain were released each week for 27 months in Jacobina, Bahia, Brazil. We genotyped the release strain and the target Jacobina population before releases began for >21,000 single nucleotide polymorphisms (SNPs). Genetic sampling from the target population six, 12, and 27–30 months after releases commenced provides clear evidence that portions of the transgenic strain genome have been incorporated into the target population. Evidently, rare viable hybrid offspring between the release strain and the Jacobina population are sufficiently robust to be able to reproduce in nature. The release strain was developed using a strain originally from Cuba, then outcrossed to a Mexican population. Thus, Jacobina Ae. aegypti are now a mix of three populations. It is unclear how this may affect disease transmission or affect other efforts to control these dangerous vectors. These results highlight the importance of having in place a genetic monitoring program during such releases to detect un-anticipated outcomes.

Transgenic Aedes aegypti Mosquitoes Transfer Genes into a Natural Population

The novel coronavirus Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) or COVID‐19 has caused a worldwide pandemic. The fatal virus has affected the health of human beings as well as the socio‐economic situation all over the world. To date, no concrete medicinal solution has been proposed to combat the viral infection, calling for an urgent, strategic, and cost‐effective drug development approach that may be achievable by applying targeted computational and virtual screening protocols. Immunity is the body's natural defense against disease‐causing pathogens, which can be boosted by consuming plant‐based or natural food products. Active constituents derived from natural sources also scavenge the free radicals and have anti‐inflammatory activities. Herbs and spices have been used for various medicinal purposes. In this study, 2,96 365 natural and synthetic derivatives (ligands) belonging to 102 classes of compounds were obtained from PubChem and assessed on Lipinski's parameters for their potential bioavailability. Out of all the derivatives, 3254 obeyed Lipinski's rule and were virtually screened. The 115 top derivatives were docked against SARS‐CoV‐2, SARS‐CoV, MERS‐CoV, and HCoV‐HKV1 main proteases (M(pro)s) as receptors using AutoDock Vina, AutoDock, and iGEMDOCK 2.1. The lowest binding energy was exhibited by ligands 2 and 6 against all the four M(pro)s. The molecular dynamic simulation was also performed with ligand 6 using the GROMACS package. Good bioactivity scores, absorption, distribution, metabolism, excretion, and toxicity profile and drug‐like pharmacokinetic parameters were also obtained. Hydroxychloroquine was used as the control drug.

Identification of Severe Acute Respiratory Syndrome Coronavirus‐2 inhibitors through in silico structure‐based virtual screening and molecular interaction studies

Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (>18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups-non-critically ill, critically ill, and death groups-in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52-71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.

Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases

As countries look towards re-opening of economic activities amidst the ongoing COVID-19 pandemic, ensuring public health has been challenging. While contact tracing only aims to track past activities of infected users, one path to safe reopening is to develop reliable spatiotemporal risk scores to indicate the propensity of the disease. Existing works which aim to develop risk scores either rely on compartmental model-based reproduction numbers (which assume uniform population mixing) or develop coarse-grain spatial scores based on reproduction number (R0) and macro-level density-based mobility statistics. Instead, in this paper, we develop a Hawkes process-based technique to assign relatively fine-grain spatial and temporal risk scores by leveraging high-resolution mobility data based on cell-phone originated location signals. While COVID-19 risk scores also depend on a number of factors specific to an individual, including demography and existing medical conditions, the primary mode of disease transmission is via physical proximity and contact. Therefore, we focus on developing risk scores based on location density and mobility behaviour. We demonstrate the efficacy of the developed risk scores via simulation based on real-world mobility data. Our results show that fine-grain spatiotemporal risk scores based on high-resolution mobility data can provide useful insights and facilitate safe re-opening.

Towards Accurate Spatiotemporal COVID-19 Risk Scores using High Resolution Real-World Mobility Data

We developed a novel approximate Bayesian computation (ABC) framework, ABCDP, which produces differentially private (DP) and approximate posterior samples. Our framework takes advantage of the sparse vector technique (SVT), widely studied in the differential privacy literature. SVT incurs the privacy cost only when a condition (whether a quantity of interest is above/below a threshold) is met. If the condition is sparsely met during the repeated queries, SVT can drastically reduce the cumulative privacy loss, unlike the usual case where every query incurs the privacy loss. In ABC, the quantity of interest is the distance between observed and simulated data, and only when the distance is below a threshold can we take the corresponding prior sample as a posterior sample. Hence, applying SVT to ABC is an organic way to transform an ABC algorithm to a privacy-preserving variant with minimal modification, but yields the posterior samples with a high privacy level. We theoretically analyzed the interplay between the noise added for privacy and the accuracy of the posterior samples. We apply ABCDP to several data simulators and show the efficacy of the proposed framework.

ABCDP: Approximate Bayesian Computation with Differential Privacy

Clinicians and researchers are rapidly adapting to working in the midst of a pandemic. Herein, we share our initial thoughts of the consequences of COVID-19 for the oncology community.

Managing cancer during a pandemic

Rising to the challenge: Pictured from left to right: Salma L. Nuñez, Albert Reyes and Lisandra Santiago-Capeles, Ph.D. The challenges that young scientists face in academia and industry in the United States are discussed. Prof. Joseph Clark provides insight about how social media, funding, diversity, natural disasters, COVID-19 and student loan debt are impacting young scientists. A discussion of strategies to meet these challenges and support young scientists are presented.

Challenges Facing Young Scientists in Academia and Industry in the United States from the Lens of a Millennial Academic

BACKGROUND: In locations where few people have received COVID-19 vaccines, health systems remain vulnerable to surges in SARS-CoV-2 infections. Tools to identify patients suitable for community-based management are urgently needed. METHODS: We prospectively recruited adults presenting to two hospitals in India with moderate symptoms of laboratory-confirmed COVID-19 in order to develop and validate a clinical prediction model to rule-out progression to supplemental oxygen requirement. The primary outcome was defined as any of the following: SpO(2) < 94%; respiratory rate > 30 bpm; SpO(2)/FiO(2) < 400; or death. We specified a priori that each model would contain three clinical parameters (age, sex and SpO(2)) and one of seven shortlisted biochemical biomarkers measurable using commercially-available rapid tests (CRP, D-dimer, IL-6, NLR, PCT, sTREM-1 or suPAR), to ensure the models would be suitable for resource-limited settings. We evaluated discrimination, calibration and clinical utility of the models in a held-out temporal external validation cohort. RESULTS: 426 participants were recruited, of whom 89 (21.0%) met the primary outcome. 257 participants comprised the development cohort and 166 comprised the validation cohort. The three models containing NLR, suPAR or IL-6 demonstrated promising discrimination (c-statistics: 0.72 to 0.74) and calibration (calibration slopes: 1.01 to 1.05) in the validation cohort, and provided greater utility than a model containing the clinical parameters alone. CONCLUSIONS: We present three clinical prediction models that could help clinicians identify patients with moderate COVID-19 suitable for community-based management. The models are readily implementable and of particular relevance for locations with limited resources.

Facilitating safe discharge through predicting disease progression in moderate COVID-19: a prospective cohort study to develop and validate a clinical prediction model in resource-limited settings

BACKGROUND Owing to the government's effective epidemic control measures, universities in some areas of China gradually resumed offline teaching six months after the COVID-19 outbreak. Although attention should now be paid to the experiences of students after they returned to campus, few studies have explored the factors and mechanisms that have influenced these students' school adaptation. The present study investigated the multiple roles of social support and resilience in mediating associations the relationship between Chinese university students' interpersonal relationships and their school adaptation during COVID-19 control period. METHODS A cross-sectional survey was conducted with 4534 Chinese university students (Mage = 19.70, SD = 1.14) at two universities in Jiangxi provinces. The independent variable was interpersonal relationships; mediating variables were social support and resilience; and the dependent variable was school adaptation. Multiple mediation analysis was performed using the MPlus software. RESULTS Controlling for demographic variables, the quality of students' interpersonal relationships was significantly and positively related to their school adaptation, with students' ratings of social support and resilience mediating these associations. More interestingly, social support and resilience played multiple mediating roles in the relationship between interpersonal relationships and school adaptation. LIMITATIONS The age stage of the sample and the methods in which the data were collected may affect the generalizability of the results. CONCLUSIONS During COVID-19 control period, interpersonal relationships can influence school adaptation either directly or indirectly by enhancing social support or resilience (parallel mediation) or by activating resilience via the experience of social support (serial mediation). This study's results emphasize the role of interpersonal relationships, as well as the contributions of positive external and internal factors on students' school adaptation during the epidemic control period. Accordingly, these findings may have implications for the mental health education of college students in the post-epidemic era.

The influence of interpersonal relationships on school adaptation among Chinese university students during COVID-19 control period: Multiple mediating roles of social support and resilience.

United States Army soldiers must meet physical fitness test standards. Criticisms of the Army Physical Fitness Test (APFT) include limited testing of only aerobic and muscular endurance activity domains; yet, it is unclear what levels of aerobic and muscle strengthening activity may help predict performance in aspects of the new Army Combat Fitness Test (ACFT). This study explored relationships between baseline self-reported aerobic and muscle strengthening activities and APFT- and ACFT-related performance. Baseline participant data (N = 123) were from a cluster-randomized clinical trial that recruited active-duty military personnel (mean age 33.7 ± 5.7 years, 72.4% White, 87.0% college-educated, 81.5% Officers). An online survey was used for self-report of socio-demographic characteristics and weekly aerobic and muscle-strengthening physical activity behaviors. Participants also completed the APFT (2 min push-ups, 2 min sit-ups, 2-mile run) and ACFT-related measures (1-repetition maximum deadlift, pull-up repetitions or timed flexed arm hang, horizontal jump, and dummy drag). Bivariate logistic regression found greater aerobic and muscle-strengthening activity predicted better APFT performance, while better ACFT-related performance was predicted by greater muscle-strengthening activity. Although our data are mostly from mid-career officers, command policies should emphasize the new Holistic Health and Fitness initiative that encourages regular aerobic and muscle-strengthening physical activity for soldiers.

Baseline Physical Activity Behaviors and Relationships with Fitness in the Army Training at High Intensity Study

BACKGROUND: We report hereby a severe case of Hantavirus Pulmonary Syndrome” (HPS) induced by Maripa virus in French Guiana and describe the mechanism of severity of the human disease. CASE PRESENTATION: A 47-year- old patient started presenting a prodromic period with fever, dyspnea, cough and head ache. This clinical presentation was followed by a rapid respiratory, hemodynamic and renal failure leading to admission in the ICU. Biological exams revealed an increased haematocrit level with a paradoxical low protein level. Echocardiographic and hemodynamic monitoring showed a normal left ventricular function with low filling pressures, an elevated extravascular lung water index and pulmonary vascular permeability index. These findings were compatible with a capillary leak-syndrome (CLS). CONCLUSIONS: The severity of HPS caused by the virus Maripa in French Guiana can be explained by the tropism of hantavirus for the microvascular endothelial cell leading to a CLS.

Capillary leak-syndrome triggered by Maripa virus in French Guiana: case report and implication for pathogenesis

Pityriasis rosea (PR) has been manifested in patients suffering from COVID‐19 as well as after vaccine protocols against SARS‐CoV‐2. It has a possible association with the HHV‐6B virus (roseola infantum) and can be controlled by antivirals such as acyclovir as well as by the amino acid l‐Lysine that showed a positive result in reducing the number of lesions and healing time. The aim of this study was to report a case of PR after a second dose of Oxford‐AstraZeneca, the adopted therapy and a brief literature review. A 53‐year‐old woman, phototype II, presented an erythematous lesion in the posterior right thigh 15 days after the second dose of Oxford‐AstraZeneca vaccine. Eight days after the initial injury, new injuries appeared in the calf, buttocks and thighs. The diagnosis was PR with a 5‐week eruption cycle. The treatment consisted of the use of l‐Lysine, 3 grams loading dose and 500 mg for 30 days and moisturizing/healing lotion, starting 14 days after the herald patch. After the 5th week of the disease cycle, there were no new eruptions and the repair cycle continued for up to 8 weeks leaving some residual skin spots. It is concluded that the patient may be a carrier a latent virus, HHV‐6, and the vaccine administration with immune system stimulation, would have activated the possible virus causing PR. l‐Lysine helped to control the manifestation by limiting the number of lesions and their location, which were restricted to the legs, thighs and buttocks.

Pityriasis rosea‐like cutaneous eruption as a possible dermatological manifestation after Oxford‐AstraZeneca vaccine: Case report and brief literature review

Purpose A videolaryngoscope has been recommended for intubation in the COVID-19 scenario but the videolaryngoscope providing optimal intubation conditions is not ascertained We compared KingVision channelled blade with a non-Channelled videolaryngoscope for intubation times in a simulated COVID-19 intubation scenario by both anaesthesiologists and non-anaesthesiologists Methods This prospective randomised cross over mannequin study was conducted in a skill training lab 25 anaesthesiologists and 25 non-anaesthesiologists donned in standard personal protective equipment performed 100 intubations with KingVision and Tuoren videolaryngoscopes in a mannequin covered with a transparent plastic sheet The total intubation time, percentage of glottic opening scores, first attempt success rates were assessed Results The mean difference in intubation times in anaesthesiologists and non-anaesthesiologist less with KingVision videolaryngoscope (21 1s;95% CI 9 6 to 32 6s vs 35 9s;95% CI 24 4 to 47 4 s;P=0 001) Percentage of glottic opening score was significantly better with KingVision by non-anaesthesiologists (60;IQR 42 5 to 75 vs 70;IQR 50 to 100;P=0 019) KingVision provided superior first attempt success rate in non-anaesthesiologists (84% vs 61 9%;P=0 02) and anaesthesiologists (96% vs 76%;P=0 12) Conclusion KingVision channelled videolaryngoscope provided faster intubation times, glottic views and first attempt success rates in a simulated COVID-19 scenario in manikins and might be preferred over videolaryngoscopes with non-channelled blade The findings need to be further verified in humans

Comparison of KingVision Videolaryngoscope channelled blade with Tuoren Videolaryngoscope non-channelled blade in a simulated COVID-19 intubation scenario by non-anaesthesiologists and experienced anaesthesiologists: a prospective randomised crossover mannequin study

COVID has stirred up an information deluge that challenges our capacity to absorb and make sense of data. In this unrelenting flow of information, Africa has been largely off the radar, escaping the attention of the scientific literature and the media. International agencies have been the exception: despite the still low numbers of cases and deaths, they have voiced concerns, often in catastrophic terms, on the health, economic and social impacts of COVID in African countries. These concerns contrast sharply with the optimistic view that Africa may be spared the worst consequences of the pandemic.This paper provides a snapshot of a crisis in evolution: its features could change as new data become available and our understanding improves. The paper examines the epidemic trends, the health impact, the containment measures and their possible side effects. Africa has a long experience of responding to epidemics: relevant lessons learned are outlined. The picture of the epidemic and its narrative are heterogenous, given the differing vulnerabilities of African countries and the diverse contexts within their borders. The paper, therefore, singles out selected countries as illustrative of specific situations and advocates for a transnational and subnational approach to future analyses.The virus has shown a strong capacity to adapt; therefore, a response strategy, in order to be effective, needs to be flexible and able to adapt to changes. The paper concludes with the recommendation that affected communities should be engaged in the response, to maintain or build trust. A lesson from the Ebola outbreak of a few years ago was that epidemiologists and community leaders learned, after initial difficulties, how to dialogue and work together.A summary update of the pandemic has been added, in view of its fast evolution.

COVID-19 in Africa: the little we know and the lot we ignore

BACKGROUND The study assesses the perspective of doctors working in government hospitals of Nepal regarding hospital preparedness for infection prevention measures, isolation services provisions, critical care service readiness, and training of staff for COVID-19 pandemic management. METHODS This cross-sectional study was done in central, provincial, and local level health centers of the Government of Nepal to assess the perspective of medical doctors regarding COVID-19 pandemic readiness in their facility. Nonprobability sampling was used to collect 56 responses from doctors working in different hospitals of Nepal. An online survey was performed using a questionnaire tool, which was adapted from the guidelines of the World Health Organization and the Centers for Disease Control and Prevention. RESULTS Most of the participants were medical officers with an MBBS degree (32) followed by anesthesiologists (10). Thirteen participants worked in central hospitals (23.2%), 24 in provincial hospitals (42.8%) and 19 in local health centers (33.92%). The availability of adequate facemask was 84% in central hospitals, which was higher than provincial hospitals (66.7%), and local level health centers (77.8%). There were only 53.8% trained critical care providers in central hospitals and 29.2% in provincial hospitals. Nearly 38.5% (5) of central hospitals had measures for airborne isolation in place, whereas this was only found in 8.3% (2) of provincial hospitals surveyed for critical care facilities. Overall, only 2 hospitals had the provision of a negative pressure room with air exchanges. Only 8 participants working in central hospitals (61.5%) and 14 working in provincial hospitals (58.3%) had performed hands-on training for donning and doffing personal protective equipment. CONCLUSIONS The majority of medical doctors working in government hospitals of Nepal perceive that provision of facemask distribution, airborne isolation rooms, critical care preparedness, and hands-on training to staff were not adequate.

Perspective of Doctors for COVID-19 Pandemic Readiness in Government Hospitals of Nepal.

The fast and untraceable virus mutations take lives of thousands of people before the immune system can produce the inhibitory antibody. The recent outbreak of COVID-19 infected and killed thousands of people in the world. Rapid methods in finding peptides or antibody sequences that can inhibit the viral epitopes of SARS-CoV-2 will save the life of thousands. To predict neutralizing antibodies for SARS-CoV-2 in a high-throughput manner, in this paper, we use different machine learning (ML) model to predict the possible inhibitory synthetic antibodies for SARS-CoV-2. We collected 1933 virus-antibody sequences and their clinical patient neutralization response and trained an ML model to predict the antibody response. Using graph featurization with variety of ML methods, like XGBoost, Random Forest, Multilayered Perceptron, Support Vector Machine and Logistic Regression, we screened thousands of hypothetical antibody sequences and found nine stable antibodies that potentially inhibit SARS-CoV-2. We combined bioinformatics, structural biology, and Molecular Dynamics (MD) simulations to verify the stability of the candidate antibodies that can inhibit SARS-CoV-2.

Potential neutralizing antibodies discovered for novel corona virus using machine learning

BACKGROUND: This study was designed to prospectively evaluate the efficacy of extracorporeal photopheresis (ECP) to attenuate the rate of decline of FEV(1) in lung transplant recipients with refractory bronchiolitis obliterans. Due to an observed higher than expected early mortality, a preliminary analysis was performed. STUDY DESIGN AND METHODS: Subjects from 10 lung transplant centres were assigned to ECP treatment or to observation based on spirometric criteria, with potential crossover for those under observation. The primary endpoint of this study was to assess response to ECP (i.e., greater than a 50% decrease in the rate of FEV(1) decline) before and 6 months after initiation of ECP. Mortality was also evaluated 6 and 12 months after enrolment as a secondary endpoint. RESULTS: Of 44 enrolled subjects, 31 were assigned to ECP treatment while 13 were initially assigned to observation on a non‐random basis using specific spirometric inclusion criteria (seven of the observation patients subsequently crossed over to receive ECP). Of evaluable patients, 95% of patients initially assigned to treatment responded to ECP with rates of FEV(1) decline that were reduced by 93% in evaluable ECP‐treated patients. Mortality rates (percentages) at 6 and 12 months after enrolment was 32% and 41%, respectively. The most common (92%) primary cause of death was respiratory or graft failure. Significantly (p = 0.002) higher rates of FEV(1) decline were observed in the non‐survivors (−212 ± 177 ml/month) when compared to the survivors (−95 ± 117 ml/month) 12 months after enrolment. In addition, 18 patients with bronchiolitis obliterans syndrome (BOS) diagnosis within 6 months of enrolment had lost 38% of their baseline lung function at BOS diagnosis and 50% of their lung function at enrolment. CONCLUSIONS: These analyses suggest that earlier detection and treatment of BOS should be considered to appreciate improved outcomes with ECP.

Extracorporeal photopheresis to attenuate decline in lung function due to refractory obstructive allograft dysfunction

The coronavirus pandemic has undoubtedly challenged the nursing professional development community to adeptly navigate unchartered territory to meet the needs of frontline staff. To ease the struggles of its membership, the Association for Nursing Professional Development conducted, summarized, and provided meaningful environmental scanning and just-in-time resources. Numerous resources were created to ensure nursing professional development practitioners were equipped to navigate the challenges presented throughout 2020.

2020: Association for Nursing Professional Development's Year of Resources and Resilience

Middle East respiratory syndrome is a viral respiratory illness caused by a novel human beta-coronavirus. Based on the first case of Middle East respiratory syndrome found in China, a clinical research in combination with radiological findings was studied. Fever was the main clinical manifestation of this patient, and the primary imaging findings were basically the same as viral pneumonia. Differential imaging diagnosis on the basis of epidemiological and experimental pathogen detection is helpful for clinical diagnosis of MERS, even in distinguishing from SARS and pneumonia caused by H7N9 avian influenza.

Clinical imaging research of the first Middle East respiratory syndrome in China

BACKGROUND: The prone position (PP) is increasingly used in mechanically ventilated coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. However, studies investigating the influence of the PP are currently lacking in these patients. This is the first study to investigate the influence of the PP on the oxygenation and decarboxylation in COVID-19 patients. METHODS: A prospective bicentric study design was used, and in mechanically ventilated COVID-19 patients, PP was indicated from a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FIO2) ratio of <200. Patients were left prone for 16 h each. Pressure levels, FIO2, were adjusted to ensure a PaO2 greater than 60 mmHg. Blood gas analyses were performed before (baseline 0.5 h), during (1/2/5.5/9.5/13 h), and after being in the PP (1 h), the circulatory/ventilation parameters were continuously monitored, and lung compliance (LC) was roughly calculated. Responders were defined compared to the baseline value (PaO2/FIO2 ratio increase of &#8805;15%; partial pressure of carbon dioxide (PaCO2) decrease of &#8805;2%). RESULTS: 13 patients were included and 36 PP sessions were conducted. Overall, PaO2/FIO2 increased significantly in the PP (p < 0.001). Most PaO2/FIO2 responders (29/36 PP sessions, 77%) were identified 9.5 h after turning prone (14% slow responders), while most PaCO2 responders (15/36 PP sessions, 42%) were identified 13 h after turning prone. A subgroup of patients (interval intubation to PP &#8805;3 days) showed less PaO2/FIO2 responders (16% vs. 77%). An increase in PaCO2 and minute ventilation in the PP showed a significant negative correlation (p < 0.001). LC (median before the PP = 38 mL/cm H2O; two patients with LC >80 mL/cm H2O) showed a significant positive correlation with the 28 day survival of patients (p = 0.01). CONCLUSION: The PP significantly improves oxygenation in COVID-19 ARDS patients. The data suggest that they also benefit most from an early PP. A decrease in minute ventilation may result in fewer PaCO2 responders. LC may be a predictive outcome parameter in COVID-19 patients. TRIAL REGISTRATION: Retrospectively registered.

Prone Position in Mechanically Ventilated COVID-19 Patients: A Multicenter Study

Hypertrophic hypersecretory gastropathy with protein loss (HHGP) is a rare form of acquired gastropathy characterized by giant gastric rugal folds and hypoalbuminemia. It is often misdiagnosed as Ménétrier's disease. We report the case of a 45-year-old man with HHGP who presented with nausea and anorexia. The patient had no underlying disease and was not on medication. Esophagogastroduodenoscopy and CT showed a thickening of the gastric folds in the stomach. As cancer cells were not detected on endoscopic biopsies, the patient was diagnosed with Ménétrier's disease. He was managed with a high-protein diet and annual follow-up by esophagogastroduodenoscopy. Five years after the diagnosis, the patient underwent laparoscopy-assisted total gastrectomy for refractory abdominal pain, diarrhea, and protein loss. A pathological diagnosis of HHGP was made and he was discharged without any surgical complications. The patient was relieved of anorexia, abdominal pain, and diarrhea. Laparoscopy-assisted total gastrectomy could be regarded as a treatment option for HHGP.

Laparoscopic management of hypertrophic hypersecretory gastropathy with protein loss: a case report.

For a non-technical audience, new concepts from computer science and engineering are often hard to grasp. In order to introduce a general audience to topics related to Industry 4.0, we designed and developed a demonstrator game. The Who-wants-to-be-a-millionaire?-style quiz game lets the player experience indoor positioning based on Bluetooth signal strength firsthand. We found that such an interactive game demonstrator can function as a conversation-opener and is useful in helping introduce concepts relevant for many future jobs.

Demonstrator Game Showcasing Indoor Positioning via BLE Signal Strength

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of COVID-19 , is considered a pathogen with animal origin, mainly transmitted human to human. It has been experimentally and naturally demonstrated that several animals can be infected by SARS-CoV-2. There are strong evidences that minks are highly susceptible to SARS-CoV-2 infection, since several cases of human to mink infection have been reported, and it has been suggested mink to human infection exists, which so far it is the most reliable example of a zoonotic event of COVID-19 . However, all these cases reported are form mink farms, with the exception of one case in the USA in which the virus was detected in a mink located in the wild, but it was demonstrated that the animal was infected on a fur farm. In the present work, we have detected SARS-CoV-2 RNA in two wild American minks (Neovison vison) in Valencian Community (Eastern Spain) during invasive species trapping campaigns. The animals were trapped from areas known for harbouring self-sustained populations, far away from the nearest fur farm. SARS-CoV-2 RNA was detected in mesenteric lymph nodes samples by RT-PCR. A partial region of the Spike protein gene was amplified and sequence obtaining a 397 nt size sequence. Phylogenetic analysis shown that both sequences were identical to the consensus variant SARS CoV-2 sequence (from Wuhan). This research describes the first infection report of a true wild American mink not related to infected fur farms or direct contact with humans, which is believed to be the first example of wild animals in which SARS-CoV-2 has been detected.

First Description of Natural SARS-CoV-2 Infection in Two Wild American Minks (Neovison vison)

In this issue of Blood, Hegerova et al report on a study of 20 hospitalized patients with severe or critical coronavirus disease 2019 (COVID-19) who were transfused with convalescent plasma (CP); the authors suggest a favorable, albeit modest, benefit as compared with 20 matched (ie, nontransfused) controls, particularly when transfusion was undertaken within the first 7 days of hospitalization.(1)

Convalescent plasma to treat COVID-19

This dissertation is committed to pinpoint the current different dynamics of State interventionism in three different countries. Notwithstanding privatisations decreased the impact of the States in the economy, they kept on being interventionist even if with relevant differences. This is proved in two different fields. Firstly, they pursued the aim of defending their national champions through the creation of a network of companies in order to impede foreign companies to reach their control. Secondly, by resorting to their legislative powers in order to solve a problem that concerns the economic sphere. This is the case of short-termism, a problem that is putting in trouble both managers and investors. Some States decided to intervene by law to end the problem, even if this was risky and indeed ineffective. At last, 2020 has been a critical year. In January, the UK ultimately left the EU. From the beginning of March, European countries have been dealing with Coronavirus. Both these two crises challenged the European economies, hence, they allow to pinpoint the latest declination of State interventionism in the three different systems.

State Interventionism in the UK, France and Italy: a Constant Temptation

AIMS: A service review of specialist child and adolescent intellectual disability provision in South Wales was conducted between March and May 2020. The purpose was to explore the impact of the first COVID-19 pandemic lockdown on children with intellectual disability and their families. The review aimed to explore if the disruption to the systems involved in their care would impact their wellbeing and behavioural presentations. We also measured if there had been an increase in the use of medication. Our focus was on the distress calls, which are requests for urgent clinical review to prevent a crisis.A service review of specialist child and adolescent intellectual disability provision in South Wales was conducted between March and May 2020. The purpose was to explore the impact of the first COVID-19 pandemic lockdown on children with intellectual disability and their families. The review aimed to explore if the disruption to the systems involved in their care would impact their wellbeing and behavioural presentations. We also measured if there had been an increase in the use of medication. Our focus was on the distress calls, which are requests for urgent clinical review to prevent a crisis. METHOD: Six clinical areas across three Welsh health boards under the same specialist team were surveyed. Case notes and email correspondence were reviewed to obtain the number and content of crisis calls made to specialist CAMHS across an eight week period during the first UK COVID-19 lockdown. Data were gathered on frequency, purpose, and outcome of calls. Comparison data were also collected for the period October 2019 to March 2020. RESULT: Pre-COVID-19: Two crisis calls were identified in two different areas during the pre-COVID period surveyed. Increases in medication and increases in respite care packages were made as a result. During COVID-19 restrictions: 20 different initial distress calls made (children age 9 and 17 years old (M = 13.2); 75% were boys) across five of the six clinical areas. Of these 20 calls, 17 were active cases and 3 were new referrals. 95% of calls resulted in medication increases and there were few other interventions used due to COVID-19 constraints. Changes to the child's support system were discussed across all cases and return to school was highlighted as a key protective factor in improved well-being. Differences between clinical areas were also identified. CONCLUSION: There was a clear increase in distress calls and requests to prescribe or increase psychotropic medication to calm the distress during the ‘lockdown’. Changes in behavioural presentation may have occurred partly due to the disruption to the complex systems that typically support a child and the shift away from community support. Children with intellectual disability and their families are unique and embedded in complex systems comprising schools, respite, and healthcare provision which work together to deliver optimal mental healthcare with psychosocial interventions with medication for higher-risk situations. Any shifts in these systems may lead to an imbalance and a higher likelihood of medication use.

COVID-19 and young people with intellectual disability: a service review

Background: The unprecedented development of Artificial Intelligence has revolutionised the healthcare industry. In the next generation of healthcare systems, self-diagnosis will be pivotal to personalised healthcare services. During the COVID-19 pandemic, new screening and diagnostic approaches like mobile health are well-positioned to reduce disease spread and overcome geographical barriers. This paper presents a non-invasive screening approach to predict the health of a person from visually observable features using machine learning techniques. Images like face and skin surface of the patients are acquired using camera or mobile devices and analysed to derive clinical reasoning and prediction of the person’s health. Methods: In specific, a two-level classification approach is presented. The proposed hierarchical model chooses a class by training a binary classifier at the node of the hierarchy. Prediction is then made using a set of class-specific reduced feature set. Results: Testing accuracies of 86.87% and 76.84% are reported for the first and second-level classification. Empirical results demonstrate that the proposed approach yields favourable prediction results while greatly reduces the computational time. Conclusions: The study suggests that it is possible to predict the health condition of a person based on his/her face appearance using cost-effective machine learning approaches.

Non-invasive health prediction from visually observable features

We examine how Canadians living in the East York section of Toronto exchange social support. Just as we have had to deconstruct social support to understand its component parts, we now deconstruct how different types of communication technologies play socially supportive roles. We draw on 101 in-depth interviews conducted in 2013-2014 to shed light on the support networks of a sample of East York residents and discern the role of communication technologies in the exchange of different types of social support across age groups. Our findings show that not much has changed since the 1960s in terms of the social ties that our sample of East Yorkers have, and the types of support mobilized via social networks: companionship, small and large services, emotional aid, and financial support. What has changed is how communication technologies interweave in complex ways with different types of social ties (partners, siblings, friends, etc.) to mobilize social support. We found that with siblings and extended kin communication technologies could boost the frequency of interaction and help exchange support at a distance. With friendship ties, communication technologies provide a continuous, constant flow of interaction. We draw implications for theories of social support and for social policy linked to interventions aimed at helping vulnerable groups during the COVID-19 pandemic.

The Role of Communication Technology Across the Life Course: A Field Guide to Social Support in East York

In the editorial by A'Court C, I et al i , COVID-19 and cardiac considerations in the community, I Br J Gen Pract i 2021;DOI: https://bjgp org/content/70/700/524;the Figure 1 caption incorrectly stated: 'COVID-19 is defined by an acute rise and fall in cardiac troponin' It should be 'Acute myocardial injury in COVID-19 (defined by an acute rise and fall in cardiac troponin)', as shown within the body of the Figure Figure 1 caption now reads 'Possible mechanisms and clinical manifestations of acute myocardial injury in COVID-19

Corrections

Point-of-care (POC) or near patient testing for infectious diseases is a rapidly expanding space that is part of an ongoing effort to bring care closer to the patient. Traditional POC tests were known for their limited utility, but advances in technology have seen significant improvements in performance of these assays. The increasing promise of these tests is also coupled with their increasing complexity, which requires the oversight of qualified laboratory-trained personnel.

Point-of-Care Testing in Microbiology

Isothermal nucleic acid amplification tests (iNATs), such as loop-mediated isothermal amplification (LAMP), are good alternatives to PCR-based amplification assays, especially for point-of-care and low-resource use, in part because they can be carried out with relatively simple instrumentation. However, iNATs can often generate spurious amplicons, especially in the absence of target sequences, resulting in false-positive results. This is especially true if signals are based on non-sequence-specific probes, such as intercalating dyes or pH changes. In addition, pathogens often prove to be moving, evolving targets and can accumulate mutations that will lead to inefficient primer binding and thus false-negative results. Multiplex assays targeting different regions of the analyte and logical signal readout using sequence-specific probes can help to reduce both false negatives and false positives. Here, we describe rapid conversion of three previously described SARS-CoV-2 LAMP assays that relied on a non-sequence-specific readout into individual and multiplex one-pot assays that can be visually read using sequence-specific oligonucleotide strand exchange (OSD) probes. We describe both fluorescence-based and Boolean logic-gated colorimetric lateral flow readout methods and demonstrate detection of SARS-CoV-2 virions in crude human saliva.IMPORTANCE One of the key approaches to treatment and control of infectious diseases, such as COVID-19, is accurate and rapid diagnostics that is widely deployable in a timely and scalable manner. To achieve this, it is essential to go beyond the traditional gold standard of quantitative PCR (qPCR) that is often faced with difficulties in scaling due to the complexity of infrastructure and human resource requirements. Isothermal nucleic acid amplification methods, such as loop-mediated isothermal amplification (LAMP), have been long pursued as ideal, low-tech alternatives for rapid, portable testing. However, isothermal approaches often suffer from false signals due to employment of nonspecific readout methods. We describe general principles for rapidly converting nonspecifically read LAMP assays into assays that are read in a sequence-specific manner by using oligonucleotide strand displacement (OSD) probes. We also demonstrate that inclusion of OSD probes in LAMP assays maintains the simplicity of one-pot assays and a visual yes/no readout by using fluorescence or colorimetric lateral-flow dipsticks while providing accurate sequence-specific readout and the ability to logically query multiplex amplicons for redundancy or copresence. These principles not only yielded high-surety isothermal assays for SARS-CoV-2 but might also aid in the design of more sophisticated molecular assays for other analytes.

High-Surety Isothermal Amplification and Detection of SARS-CoV-2

We compared two E-assessment platforms and we evaluated the impact of online versus on-site examination by analysing students' outcomes and classifying them into performance groups Two groups of 480 (G1/2019) and 527 (G2/2020) 2nd year medical students were included G1 was assessed by using E-School Exam Module on-site, while G2 used FlexiQuiz assessment platform online G2 received 3 partial examinations during the semester while G1 was evaluated by o single final exam at the end of the semester Students were classified in four performance categories as high (8-10, HPG), medium (6-7 99, MPG), low (5-5 99, LPG) and fail (less than 4, FPG) based on final grade The analysis was applied for both theoretical and practical exams A significant increase of HPG (79% vs 4% for theory and 42% vs 16% for practice) was noted for G2 compared with G1 MPG remained relatively the same between groups while LPG decreased for G2 compared with G1 (22% vs 1% for theory, 25% vs 4% for practice) The G2-FPG significantly decreased but remained higher for practical exam HGP, LPG, FPG were strongly influenced by applying different assessment methods while MPG remained similar for G1 and G2 Factors influencing these variations will be discussed here © 2020 IEEE

Online versus On-site e-Assessment in Medical Education: Are we ready for the change?

Coronavirus disease 2019 (COVID-19) manifests with a range of severities, but immune signatures of mild and severe disease are still not fully understood. Excessive inflammation has been postulated to be a major factor in the pathogenesis of severe COVID-19 and innate immune mechanisms are likely to be central in the inflammatory response. We used 40-plex mass cytometry and targeted serum proteomics to profile innate immune cell populations from peripheral blood of patients with mild or severe COVID-19 and healthy controls. Sampling at different stages of COVID-19 allowed us to reconstruct a pseudo-temporal trajectory of the innate immune response. Despite the expected patient heterogeneity, we identified consistent changes during the course of the infection. A rapid and early surge of CD169+ monocytes associated with an IFNγ+MCP-2+ signature quickly followed symptom onset; at symptom onset, patients with mild and severe COVID-19 had a similar signature, but over the course of the disease, the differences between patients with mild and severe disease increased. Later in the disease course, we observed a more pronounced re-appearance of intermediate/non-classical monocytes and mounting systemic CCL3 and CCL4 levels in patients with severe disease. Our data provide new insights into the dynamic nature of the early inflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and identifies sustained pathological innate immune responses as a likely key mechanism in severe COVID-19, further supporting investigation of targeted anti-inflammatory interventions in severe COVID-19.

A distinct innate immune signature marks progression from mild to severe COVID-19

INTRODUCTION: Due to overcome the hardness of the vaccine design, computational vaccinology is emerging widely. Prediction of T cell and B cell epitopes, antigen processing analysis, antigenicity analysis, population coverage, conservancy analysis, allergenicity assessment, toxicity prediction, and protein-peptide docking are important steps in the process of designing and developing potent vaccines against various viruses and cancers. In order to perform all of the analyses, several bioinformatics tools and online web servers have been developed. Scientists must take the decision to apply more suitable and precise servers for each part based on their accuracy. AREAS COVERED: In this review, a wide-range list of different bioinformatics tools and online web servers has been provided. Moreover, some studies were proposed to show the importance of various bioinformatics tools for predicting and developing efficient vaccines against different pathogens including viruses, bacteria, parasites, and fungi as well as cancer. EXPERT OPINION: Immunoinformatics is the best way to find potential vaccine candidates against different pathogens. Thus, the selection of the most accurate tools is necessary to predict and develop potent preventive and therapeutic vaccines. To further evaluation of the computational and in silico vaccine design, in vitro/in vivo analyses are required to develop vaccine candidates.

An overview of in silico vaccine design against different pathogens and cancer

PURPOSE: The study was carried out to determine the perceived stress levels and health‐protective behaviors of nursing students during the COVID‐19 pandemic. DESIGN AND METHODS: This study used a descriptive design. The sample consisted of a total of 372 students. FINDINGS: The examination of the protective measures adopted by the students against COVID‐19 indicated that the mean perceived stress subscale scores of the students who did not use a mask and disposable wipes when coughing/sneezing were statistically significantly higher (p < .005). PRACTICE IMPLICATIONS: The stress levels of students should be determined at certain intervals, and interventional studies on coping methods that will reduce stress levels should be planned.

The determination of the perceived stress levels and health‐protective behaviors of nursing students during the COVID‐19 pandemic

Listen to the podcast associated with this article, which can also be found at ESC CardioTalk https://www.escardio.org/The-ESC/Whatwe-do/news/ESC-Cardio-Talk This editorial refers to ‘C-reactive protein and clinical outcomes in patients with COVID-19’, by N.R. Smilowitz et al., doi: 10.1093/eurheartj/ehaa1103.

C-reactive protein predicts outcome in COVID-19: is it also a therapeutic target?

In this paper, we investigate the fractional epidemic mathematical model and dynamics of COVID-19. The Wuhan city of China is considered as the origin of the corona virus. The novel corona virus is continuously spread its range of effectiveness in nearly all corners of the world. Here we analyze that under what parameters and conditions it is possible to slow the speed of spreading of corona virus. We formulate a transmission dynamical model where it is assumed that some portion of the people generates the infections, which is affected by the quarantine and latent time. We study the effect of various parameters of corona virus through the fractional mathematical model. The Laguerre collocation technique is used to deal with the concerned mathematical model numerically. In order to deal with the dynamics of the novel corona virus we collect the experimental data from 15th–21st April, 2020 of Maharashtra state, India. We analyze the effect of various parameters on the numerical solutions by graphical comparison for fractional order as well as integer order. The pictorial presentation of the variation of different parameters used in model are depicted for upper and lower solution both.

A novel fractional mathematical model of COVID-19 epidemic considering quarantine and latent time

The article presents modern methods of surgical treatment of chronic dacryocystitis, a brief historical review of various options for endonasal endoscopic dacryocystorhinostomy is carried out. The method of plastic seamless formation of dacryocystostomy, which does not require intubation of the lacrimal passages and/or using of silicone stoma dilators, is described. Between 2010 and 2019 at The State Budgetary Healthcare Institution of Moscow Area Moscow regional research clinical institute n.a. M.F. Vladimirskiy, according to the developed technique, 32 patients (32 eyes) with chronic dacryocystitis were operated on. According to the results of observation 1 year after surgical treatment, all 100% of patients recorded a positive result (absence or significant decrease in lacrimation, good anatomical visualization of dacryocystostomy with a good tear passage, both passive and during washing the lacrimal passages).

[Method of endonasal endoscopic dacryocystorhinostomy with plastic stoma formation].

We investigated age related synaptic plasticity in thalamic reticular nucleus (TRN) as a part of visual information processing system in the brain. Simulation experiments were performed using a hierarchical spike timing neural network model in NEST simulator. The model consists of multiple layers starting with retinal photoreceptors through thalamic relay, primary visual cortex layers up to the lateral intraparietal cortex (LIP) responsible for decision making and preparation of motor response. All synaptic inter- and intra-layer connections of our model are structured according to the literature information. The present work extends the model with spike timing dependent plastic (STDP) synapses within TRN as well as from visual cortex to LIP area. Synaptic strength changes were forced by teaching signal typical for three different age groups (young, middle and elderly) determined experimentally from eye movement data collected by eye tracking device from human subjects preforming a simplified simulated visual navigation task.

STDP Plasticity in TRN Within Hierarchical Spike Timing Model of Visual Information Processing

Since the recent COVID-19 outbreak, several researchers have begun to focus on various difficulties to data mining of social data to study people's reactions to the outbreak. Recent approaches have mostly concentrated on the analysis of social data in the English language. In this study, we present an in-depth social data mining approach to extract Spatio-temporal and semantic insights about the COVID-19 pandemic from the Arabic social data. We developed sentiment-based categorization methods to extract major topics at various location granularities (regions/cities). Besides, we used topic ion levels (subtopics and main topics). A correlation-based analysis of Arabic tweets and official health provider data will also be presented. Furthermore, we used occurrence-based and statistical correlation methodologies to create many topic-based analysis mechanisms. Our findings demonstrate a positive association between top subjects (for example, lockdown and vaccine) and the increasing number of COVID-19 new cases, but unfavorable attitudes among Arab Twitter users were generally heightened during this pandemic, on issues such as lockdown, closure, and law enforcement. © 2021 ACM.

Correlation Analysis of Spatio-temporal Arabic COVID-19 Tweets

Influenza is a perennial problem affecting millions of people annually with the everpresent threat of devastating pandemics. Active prophylaxis by vaccination against influenza virus is currently the main countermeasure supplemented with antivirals. However, disadvantages of this strategy include the impact of antigenic drift, necessitating constant updating of vaccine strain composition, and emerging antiviral drug resistance. The development of other options for influenza prophylaxis, particularly with broad acting agents able to provide protection in the period between the onset of a pandemic and the development of a strain specific vaccine, is of great interest. Exploitation of broad-spectrum mediators could provide barricade protection in the early critical phase of influenza virus outbreaks. Passive immunity has the potential to provide immediate antiviral effects, inhibiting virus replication, reducing virus shedding, and thereby protecting vulnerable populations in the event of an impending influenza pandemic. Here, we review passive broad-spectrum influenza prophylaxis options with a focus on harnessing natural host defenses, including interferons and antibodies.

Passive Broad-Spectrum Influenza Immunoprophylaxis

This study aimed to analyze the proportion of household contacts that had detectable COVID-19 after a shortened quarantine period From April-September 2020, among 105 index patients, 185 household contacts were enrolled (median of one household contact per index patient, interquartile range [[]IQR]=1-2;45[%] of household contacts were male;median age of household contacts=27 years, IQR=15-45 years)in Nashville, Tennessee, and Marshfield, Wisconsin Enrollment occurred a median of 4 days (IQR = 2-4 days) after the index patient's illness onset and study follow-up concluded a median of 16 days (IQR=15-17 days) after the index patient's illness onset Overall, 109 (59[%]) household contacts had SARS-CoV-2 detected in respiratory specimens during the follow-up period, with the first positive specimen collected a median of 5 days (IQR=3-7 days) after the index patient's illness onset Among all infected household contacts, 76[%] had infection detected within 7 days after the index patient's illness onset and 86[%] within 10 days The probability that a household contact who was asymptomatic and had negative RT-PCR test results through day 7 would remain asymptomatic with negative RT-PCR test results through 14 days after the index patient's illness onset was 81[%] (95[%] CI = 67[%]-90[%]);increased to 93[%] (95[%] CI=78[%]-98[%]) if the household contact remained asymptomatic with negative test results through day 10 With consistent adherence, quarantine prevents transmission from persons who were exposed to the virus and who might become infectious, but who do not have symptoms or signs of infection A 14-day quarantine of all close contacts who are exposed to a person with COVID-19, such as in the household, is the most effective strategy to reduce the spread of COVID-19 Although persons might be more adherent to a shorter quarantine period, such a policy is not without risk for further spread

Implications of shortened quarantine among household contacts of index patients with confirmed SARS-CoV-2 infection - Tennessee and Wisconsin, April-September 2020

Introduction During the COVID-19 pandemic, the national transplant activity has been reduced due to the overload of the health system and concern for patient safety in this situation The aim of our work is to expose the activity of kidney transplantation in Cantabria during the state of alarm, as well as to assess the safety of the transplantation program Material and methods Retrospective study of kidney transplants performed in our Center from the beginning of the state of alarm until the beginning of the lockdown easing in Cantabria Descriptive analysis of the demographic data of recipients and their donors, intraoperative data and postoperative outcomes Comparative analysis with the data of the same period in 2017–2019, by means of the X2 for categorical variables, Student’s T and Mann-Whitney U tests in case of quantitative variables of normal and non-normal distribution, respectively Results Fifteen kidney transplants were performed in the period described Delayed renal function (DRF) was seen in 7 5% of patients, and 26 6% showed data of acute rejection;no patient presented COVID-19 disease Comparative analysis showed a remarkable increase in the number of transplants in comparison with previous periods (15 vs 5 6), at the expense of donors from outside Cantabria (93 3%) We found no statistically significant differences in terms of cold ischemia time (p 0 77), DRF (p 0 73), need for dialysis (p 0 54), or appearance of post-surgical complications (p 0 61) Conclusions The evolution of the pandemic in our region, and the adoption of strict protective measures has allowed the early and safe resumption of the renal transplantation program, increasing the number of transplants performed compared to previous years and maintaining comparable early post-operative results Resumen Introducción Durante la pandemia COVID-19, la actividad nacional de trasplante se ha visto reducida por la sobrecarga del sistema sanitario, y la preocupación por la seguridad de los pacientes en esta situación El objetivo de nuestro trabajo es exponer la actividad de trasplante renal en Cantabria durante el estado de Alarma, así como valorar la seguridad del programa de trasplante Material y métodos Estudio retrospectivo de los trasplantes renales realizados en nuestro Centro desde el inicio del estado de Alarma hasta el inicio del desconfinamiento en Cantabria Análisis descriptivo de los datos demográficos de receptores y sus donantes, datos intraoperatorios y resultados postoperatorios Análisis comparativo con los datos del mismo periodo de 2017–2019, mediante los estadísticos X2 para variables categóricas, T-Student y U de Mann-Whitney en caso de variables cuantitativas de distribución normal y no normal, respectivamente Resultados Se realizaron 15 trasplantes renales en el periodo descrito 7,5% de pacientes presentaron función renal retrasada (FRR), 26,6% mostró datos de rechazo agudo;ningún paciente presentó enfermedad por COVID-19 En el análisis comparativo, llamativo aumento del número de trasplantes frente a periodos anteriores (15 vs 5,6), a expensas de donantes de fuera de Cantabria (93,3%) No encontramos diferencias estadísticamente significativas en cuanto a tiempo de isquemia fría (p 0,77), FRR (p 0,73), necesidad de diálisis (p 0,54), o aparición de complicaciones postquirúrgicas (p 0,61) Conclusiones La evolución de la pandemia en nuestra región y la adopción de medidas de protección rigurosas ha permitido reiniciar el programa de trasplante renal de una forma temprana y segura, aumentando el número de trasplantes realizados frente a años anteriores y manteniendo unos resultados postoperatorios tempranos comparables

Activity and short-term outcomes of kidney transplantation during the COVID-19 pandemic

Optimizing the well-being of the oncology clinician has never been more important Well-being is a critical priority for the cancer organization because burnout adversely impacts the quality of care, patient satisfaction, the workforce, and overall practice success To date, 45% of U S ASCO member medical oncologists report experiencing burnout symptoms of emotional exhaustion and depersonalization As the COVID-19 pandemic remains widespread with periods of outbreaks, recovery, and response with substantial personal and professional consequences for the clinician, it is imperative that the oncologist, team, and organization gain direct access to resources addressing burnout In response, the Clinician Well-Being Task Force was created to improve the quality, safety, and value of cancer care by enhancing oncology clinician well-being and practice sustainability Well-being is an integrative concept that characterizes quality of life and encompasses an individual's work- and personal health-related environmental, organizational, and psychosocial factors These resources can be useful for the cancer organization to develop a well-being blueprint: a detailed start plan with recognized strategies and interventions targeting all oncology stakeholders to support a culture of community in oncology

Creating a Blueprint of Well-Being in Oncology: An Approach for Addressing Burnout From ASCO's Clinician Well-Being Taskforce

OBJECTIVE: The objective of this study was to determine the frequency of burnout, global, and by dimension, in resident physicians of Federal University of Piauí, and to identify possible factors associated with the presence of the syndrome. METHOD: This is a cross-sectional, observational, and descriptive study. Population: resident physicians in Federal University of Piauí's medical residency programs (136 individuals). The frequency of burnout was investigated using the Maslach Burnout Inventory. Sociodemographic variables were evaluated through a questionnaire and their associations with the presence of the syndrome were tested. RESULTS: A total of 67 (49.26%) residents answered the questionnaires. The burnout syndrome frequencies found were global=73.1%; EE=44.8%; DP=64.2%, and PA=47.8%. Statistically significant association was obtained between current year of residency and EE; between having children and PA; between current work routine and DP; and between the use of antidepressant/hypnotic medication and EE. Compared with residency programs, there was a difference in the EE dimension, which was higher among residents in internal medicine residents (88.9%) and pediatrics (83.3%). In the comparative analysis between global burnout levels and all variables evaluated, no associations were found. CONCLUSION: Burnout syndrome was found in the majority of participating residents. There was an association between sociodemographic variables and the presence of isolated burnout dimensions, but not between sociodemographic variables and global burnout.

Burnout syndrome in resident physicians of a Federal University

A proportion of patients surviving acute COVID-19 infection develop post-COVID syndrome (long COVID) encompassing physical and neuropsychiatric symptoms lasting longer than 12 weeks. Here we studied a prospective cohort of individuals with long COVID (the ADAPT study) compared to age/gender matched subjects without long COVID, healthy donors and individuals infected with other non-SARS CoV2 human coronaviruses (the ADAPT-C study). We found an elevated diffuse serum inflammatory cytokine profile in symptomatic long COVID subjects that was maintained at 8 months post-infection and was not observed in asymptomatic COVID-19 survivors. This inflammatory profile consisted of 15 cytokines that positively correlated; revealing an apparent diffuse, potentially coordinated, low level up regulation of a spectrum of immune and inflammatory mediators. In addition, we found an absence of subsets of un-activated naive T and B cells in peripheral blood of long COVID subjects, that did not reconstitute over time. In contrast, individual serum cytokines from the interferon I and III classes, T cell activation markers and plasma ACE2, while elevated in the serum of people previously infected with SARS-CoV-2 were not further elevated in subjects with long COVID symptoms. This work defines immunological parameters associated with long COVID and suggests future opportunities to prevention and treatment.

Immunological dysfunction persists for 8 months following initial mild-moderate SARS-CoV-2 infection

Monitoring of vitamin K antagonist treatment with the international normalized ratio (INR) is obligatory, whereas this only applies to direct oral anticoagulants (DOAC) or low molecular weight heparin in the context of selected clinical scenarios. For DOAC the focus is on the determination of trough and peak plasma levels of the drug but for low molecular weight heparins the focus is on anti-Xa activity. The timing of blood sampling in relation to drug intake is essential for the interpretation of the results. A new-onset thrombocytopenia during hospitalization is common. The cause can frequently be identified based on the classification of the underlying disease, the day of onset and documentation of the dynamics of thrombocytopenia as well as the medication history. The importance of thrombophilia testing following a venous thromboembolism has decreased in the absence of clear therapeutic consequences; however, antiphospholipid antibody syndrome must not be overlooked as both the duration of treatment and the choice of anticoagulant depend on this.

Gerinnungsdiagnostik im klinischen Alltag – Teil 2: Überwachung von Antikoagulanzientherapien, neu aufgetretene Thrombozytopenie und Thrombophilie

The COVID-19 pandemic has affected people’s lives and increased the banking solvency risk. This research aimed to build an early warning and early action simulation model to mitigate the solvency risk using the system dynamics methodology and the Powersim Studio 10©software. The addition of an early action simulation updates the existing early warning model. Through this model, the effect of policy design and options on potential solvency risks is known before implementation. The trials conducted at Bank BRI (BBRI) and Bank Mandiri (BMRI) showed that the model had the ability to provide an early warning of the potential increase in bank solvency risk when the loan restructuring policy is revoked. It also simulates the effectiveness of management’s policy options to mitigate these risks. This research used publicly accessible banking data and analysis. Bank management could also take advantage of this model through a self-stimulation facility developed in this study to accommodate their needs using the internal data.

Early Warning Early Action for the Banking Solvency Risk in the COVID-19 Pandemic Era: A Case Study of Indonesia

BACKGROUND: Acute lung injury is an important factor that leads to the death of patients with pneumonia. Previous studies have shown that nicotinamide (NAM) plays a role in reducing cell damage, so this study explored the mechanism by which NAM functions in acute lung injury. METHODS: We explored the mechanism by which NAM affects acute lung injury in vivo and in vitro by qRT-PCR, western blotting and ELISA. RESULTS: The results showed that NAM could significantly reduce lung injury and proinflammatory mediator accumulation. Further mechanistic studies showed that NAM could significantly inhibit the MAPK and AKT/NF-κB signaling pathways. CONCLUSION: These results suggested that NAM may reduce the release of proinflammatory mediators by inhibiting the MAPK and AKT/NF-κB signaling pathways and ultimately alleviate lung injury. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s10020-021-00376-2.

The mechanism of nicotinamide on reducing acute lung injury by inhibiting MAPK and NF-κB signal pathway

Respiratory tract infections caused by both viruses and/or atypical bacteria are involved in the pathogenesis of asthma. In particular, several viruses such as respiratory syncytial virus, rhinovirus and influenza/parainfluenza viruses may favour the expression of the asthmatic phenotype, being also implicated in the induction of disease exacerbations. Within this pathological context, a significant role can also be played by airway bacterial colonizations and infections due to Chlamydiae and Mycoplasms. All these microbial agents probably interfere with complex immunological pathways, thus contributing to induce and exacerbate asthma in genetically predisposed individuals.

Respiratory infections and asthma

BACKGROUND: An important feature of severe acute respiratory syndrome coronavirus 2 pathogenesis is COVID-19-associated coagulopathy, characterised by increased thrombotic and microvascular complications. Previous studies have suggested a role for endothelial cell injury in COVID-19-associated coagulopathy. To determine whether endotheliopathy is involved in COVID-19-associated coagulopathy pathogenesis, we assessed markers of endothelial cell and platelet activation in critically and non-critically ill patients admitted to the hospital with COVID-19. METHODS: In this single-centre cross-sectional study, hospitalised adult (≥18 years) patients with laboratory-confirmed COVID-19 were identified in the medical intensive care unit (ICU) or a specialised non-ICU COVID-19 floor in our hospital. Asymptomatic, non-hospitalised controls were recruited as a comparator group for biomarkers that did not have a reference range. We assessed markers of endothelial cell and platelet activation, including von Willebrand Factor (VWF) antigen, soluble thrombomodulin, soluble P-selectin, and soluble CD40 ligand, as well as coagulation factors, endogenous anticoagulants, and fibrinolytic enzymes. We compared the level of each marker in ICU patients, non-ICU patients, and controls, where applicable. We assessed correlations between these laboratory results with clinical outcomes, including hospital discharge and mortality. Kaplan–Meier analysis was used to further explore the association between biochemical markers and survival. FINDINGS: 68 patients with COVID-19 were included in the study from April 13 to April 24, 2020, including 48 ICU and 20 non-ICU patients, as well as 13 non-hospitalised, asymptomatic controls. Markers of endothelial cell and platelet activation were significantly elevated in ICU patients compared with non-ICU patients, including VWF antigen (mean 565% [SD 199] in ICU patients vs 278% [133] in non-ICU patients; p<0·0001) and soluble P-selectin (15·9 ng/mL [4·8] vs 11·2 ng/mL [3·1]; p=0·0014). VWF antigen concentrations were also elevated above the normal range in 16 (80%) of 20 non-ICU patients. We found mortality to be significantly correlated with VWF antigen (r = 0·38; p=0·0022) and soluble thrombomodulin (r = 0·38; p=0·0078) among all patients. In all patients, soluble thrombomodulin concentrations greater than 3·26 ng/mL were associated with lower rates of hospital discharge (22 [88%] of 25 patients with low concentrations vs 13 [52%] of 25 patients with high concentrations; p=0·0050) and lower likelihood of survival on Kaplan–Meier analysis (hazard ratio 5·9, 95% CI 1·9–18·4; p=0·0087). INTERPRETATION: Our findings show that endotheliopathy is present in COVID-19 and is likely to be associated with critical illness and death. Early identification of endotheliopathy and strategies to mitigate its progression might improve outcomes in COVID-19. FUNDING: This work was supported by a gift donation from Jack Levin to the Benign Hematology programme at Yale, and the National Institutes of Health.

Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study

Objectives Unavailability of potential drugs/vaccines in the outbreak of the pandemic severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) have devastated the human population globally. Several druggable targets have been analyzed against different viral proteins such as the spike protein. The study aims to explore the potential of natural compounds as an effective drug against a novel nsp10-nsp16 complex of SARS-CoV-2 using in silico approaches. Materials and Methods In silico screening (Docking analysis) was performed for 10 shortlisted natural compounds viz. allicin, ajoene, carvacrol, coumarin, curcumin, menthol, eugenol, theaflavin, ursolic acid, and catechin against a novel target of SARS-CoV-2, that has been anticipated to provide valuable lead molecules and potentially druggable compounds for the treatment of SARS-CoV-2. Results Theaflavin and catechin, the natural components of black tea and green tea, out of 10 shortlisted compounds have shown excellent performance in our docking studies with the minimum binding energy of -11.8 kcal/mol and -9.2 kcal/mol respectively, against a novel nsp10-nsp16 complex of SARS-CoV-2 that indicates their potential for inhibitory molecular interactions against the virus to assist rapid drug designing from natural products. Conclusion Either consumption of black tea and green tea or repurposing them as drug candidates may help individuals to fight against SARS-CoV-2, subject to their in vivo and in vitro further experimental validations.

Molecular Docking Studies to Identify Promising Natural Inhibitors Targeting SARS-CoV-2 Nsp10-Nsp16 Protein Complex

In recent yearsy coronavims infections have occurred frequently, causing huge losses to humans. The new coronavirus (SARS-CoV-Z) not only spread rapidly, but is also lethal. It has now constituted a global pandemic, resulting in the death of hundreds of thousands of people. Therefore, the timely diagnosis and treatment of new coronavirus is very important. Since coronavirus structural proteins play an important role in the process of Viral replication, infection and transmission. The research progress on diagnostic, therapeutic and prevention technologies based on this new coronavirus structural proteins S, E, M, and N is reviewed in this paper, in order to better understand the pathogenic mechanism of coronavirus as well as provide strong support for clinical detection, drug development, and vaccine preparation.

Research progress on diagnosis and treatment technology based on structural protein of SARS-CoV-2

The COVID-19 pandemic has led to widespread attention given to the notions of ”flattening the curve” during lockdowns, and successful contact tracing programs suppressing outbreaks. However a more nuanced picture of these interventions’ effects on epidemic trajectories is necessary. By mathematical modeling each as reactive quarantine measures, dependent on current infection rates, with different mechanisms of action, we analytically derive distinct nonlinear effects of these interventions on final and peak outbreak size. We simultaneously fit the model to provincial reported case and aggregated quarantined contact data from China. Lockdowns compressed the outbreak in China inversely proportional to population quarantine rates, revealing their critical dependence on timing. Contact tracing had significantly less impact on final outbreak size, but did lead to peak size reduction. Our analysis suggests that altering the cumulative cases in a rapidly spreading outbreak requires sustained interventions that decrease the reproduction number close to one, otherwise some type of swift lockdown measure may be needed.

Differential impacts of contact tracing and lockdowns on outbreak size in COVID-19 model applied to China

Endoplasmic reticulum (ER)-resident α-glucosidases I and II sequentially trim the three terminal glucose moieties on N-linked glycans attached to nascent glycoproteins. These reactions are the first steps of N-linked glycan processing and are essential for proper folding and function of many glycoproteins. Because most viral envelope glycoproteins contain N-linked glycans, inhibition of ER α-glucosidases with derivatives of 1-deoxynojirimycin (DNJ) or castanospermine (CAST), two well-studied pharmacophores of α-glucosidase inhibitors, efficiently disrupts the morphogenesis of a broad spectrum of enveloped viruses. Moreover, both DNJ and CAST derivatives have been demonstrated to prevent the death of mice infected with several distinct flaviviruses and filoviruses and suppress the multiplication of several other species of viruses in infected animals. N-Butyl derivative of DNJ (NB-DNJ) and 6 O-bytanoyl prodrug of CAST (Bu-CAST) have been evaluated in human clinical trials for their antiviral activities against human immunodeficiency virus and hepatitis C virus, and there is an ongoing trial of treating dengue patients with Bu-CAST. This article summarizes the current status of ER α-glucosidase-targeted antiviral therapy and proposes strategies for development of more efficacious and specific ER α-glucosidase inhibitors as broad-spectrum, drug resistance-refractory antiviral therapeutics. These host function-targeted, broad-spectrum antiviral agents do not rely on time-consuming etiologic diagnosis, and should therefore be particularly promising in the management of viral hemorrhagic fever and respiratory tract viral infections, medical conditions that can be caused by many different enveloped RNA viruses, with a short window for medical intervention.

Antiviral therapies targeting host ER alpha-glucosidases: Current status and future directions

COVID-19 patients represent a new and distinct population in home health care. Little is known about health care utilization and incremental improvements in health for recovering COVID-19 patients after admission to home health care. Using a retrospective observational cohort study of 5452 episodes of home health care admitted to a New Jersey Home Health Agency between March 15 and May 31, 2020, this study describes COVID-19 Home Health Care (HHC) patients (n = 842) and compare them to the general HHC population (n = 4610). COVID HHC patients differ in significant ways from the typical HHC population. COVID patients were more likely to be 65 years of age and younger (41% vs 26%), be from a racial/ethnic minority (60% vs 31%), live with another person (85% vs 76%), have private insurance (28% vs 16%), and began HHC with greater independence in activities-of-daily-living (ADL/IADLs). COVID patients received fewer overall visits than their non-COVID counterparts (11.7 vs 16.3), although they had significantly more remote visits (1.7 vs 0.3). Multivariate analyses show that COVID patients early in the pandemic were 34% (CI, 28%-40%) less likely to be hospitalized and demonstrated significantly greater improvement in all the outcome measures examined compared to the general home health population.

Description, Health Care Utilization, and Outcomes for Home Health Care (HHC) COVID-19 Patients Early in the Pandemic: A Comparison to the General HHC Population

In sepsis death follows an excessive inflammatory response involving cytokines and complement that is activated primarily via the amplifying C3/C5 convertase. Excessive stimulation of complement amplification requires IgG-containing or F(ab′)(2)-containing immune complexes (IC) that capture dimeric C3b on one of their heavy chains or heavy chain fragments. The ability of IgG-IC to capture dimeric C3b by the Fab portion is dependent on an affinity for C3 within the Fab portion, but outside the antigen-binding region. This property is rare among IgG NAbs. In contrast to this, the lack of the Fc portion renders the Fab regions of any F(ab′)(2)-IC accessible to nascent C3b, but dimeric C3b deposits only if F(ab′)(2)-IC form secondary IC with anti-hinge NAbs that rigidify the complex and thereby promote deposition of dimeric C3b. Both types of complexes, C3b(2)-IgG-IC and C3b(2)-F(ab′)(2)-IC/anti-hinge NAbs, are potent precursors of alternative C3 convertases and stimulate complement amplification along with properdin up to 750 times more effectively than C3b and properdin. F(ab′)(2) fragments are not normally generated, but are formed from NAbs by enzymes from pathogens and neutrophils in sepsis. Unlike IgG-IC F(ab′)(2)-IC are not cleared by Fc-receptor dependent processes and circulate long enough to form secondary IC with anti-hinge NAbs that rigidify the complexes such that they capture dimeric C3b and gain the potency to stimulate complement amplification.

How Immune Complexes from Certain IgG NAbs and Any F(ab′)(2) Can Mediate Excessive Complement Activation

Glycyrrhizin (GL) has been used in Japan to treat patients with chronic viral hepatitis, as an anti-inflammatory drug to reduce serum alanine aminotransferase levels. GL is also known to exhibit various biological activities, including anti-viral effects, but the anti-hepatitis C virus (HCV) effect of GL remains to be clarified. In this study, we demonstrated that GL treatment of HCV-infected Huh7 cells caused a reduction of infectious HCV production using cell culture-produced HCV (HCVcc). To determine the target step in the HCV lifecycle of GL, we used HCV pseudoparticles (HCVpp), replicon, and HCVcc systems. Significant suppressions of viral entry and replication steps were not observed. Interestingly, extracellular infectivity was decreased, and intracellular infectivity was increased. By immunofluorescence and electron microscopic analysis of GL treated cells, HCV core antigens and electron-dense particles had accumulated on endoplasmic reticulum attached to lipid droplet (LD), respectively, which is thought to act as platforms for HCV assembly. Furthermore, the amount of HCV core antigen in LD fraction increased. Taken together, these results suggest that GL inhibits release of infectious HCV particles. GL is known to have an inhibitory effect on phospholipase A2 (PLA2). We found that group 1B PLA2 (PLA2G1B) inhibitor also decreased HCV release, suggesting that suppression of virus release by GL treatment may be due to its inhibitory effect on PLA2G1B. Finally, we demonstrated that combination treatment with GL augmented IFN-induced reduction of virus in the HCVcc system. GL is identified as a novel anti-HCV agent that targets infectious virus particle release.

Antiviral Activity of Glycyrrhizin against Hepatitis C Virus In Vitro

An efficient and practical synthetic procedure for libraries of diversified 1,2-dihydrochromeno[2,3-c]pyrrole-3,9-diones using a multicomponent process is presented. A convenient synthetic procedure for obtaining functionalized 3-(2-hydroxyphenyl)-4,5-dihydropyrrolo[3,4-c]pyrazol-6(1H)-ones via ring-opening strategy has also been developed. This protocol was found to be compatible with a wide range of substituents and paves the way for the practical synthesis of title compounds with a broad range of substituents under mild condition. The products can be easily isolated by crystallization without the use of chromatography. [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11030-021-10234-2.

Rapid synthetic approaches to libraries of diversified 1,2-dihydrochromeno[2,3-c]pyrrole-3,9-diones and 3-(2-hydroxyphenyl)-4,5-dihydropyrrolo[3,4-c]pyrazol-6(1H)-ones

IntroductionWithdrawal of NIV in COVID-19 patients at end of life presents several challenges. Patients are often more alert and have a higher symptom burden than in other end of life situations where NIV is withdrawn. The NIV withdrawal guideline, created by the centre, was updated to reflect the requirement for higher doses of anticipatory medications required for some patients in this cohort after learning from the first wave of COVID-19. The aim of this study was to review staff response to the guideline and its efficacy. MethodA questionnaire was sent to physician associates, nursing staff and doctors of all grades who have worked on the Respiratory Support Unit during the COVID-19 pandemic. This collected several types of data on staff perception of NIV withdrawal in COVID-19 patients.ResultsThe questionnaire generated 39 responses from the multidisciplinary team (MDT).97% of respondents found the withdrawal of NIV in COVID-19 challenging, and 74% felt this was more difficult in patients with COVID-19 than with other pathologies. 87% were aware of the Trust guideline regarding NIV withdrawal and 82% used it in their practice. All respondents felt the guideline was useful. While the majority of healthcare workers felt that adequate symptom control was achieved, 20% of respondents did not. This unease was further evidenced as 64% of respondents had issues or concerns regarding the use of anticipatory medications. The predominant concerns were that medication doses were started too low (35%) or too late (46%). 71% of respondents found discussions with families regarding commencing palliation challenging. All members of the multidisciplinary team found an MDT approach, including the involvement of Palliative Care colleagues, a useful source of support. The team was united in finding debriefs useful.ConclusionsOverall, this study identified that timing and dosage of anticipatory medications are a particular challenge in withdrawal of NIV in patients with COVID-19. There is scope for additional learning regarding symptom management during withdrawal of NIV. Maintaining a close relationship with the Palliative Care team provides benefit to patients, their families and staff. Further work will also focus on supporting staff in difficult conversations.

Assessing the multi-disciplinary team response to NIV withdrawal guidelines in patients with COVID-19

The voices of West Indian writers in the 1950s changed the landscape for Literature emerging out of the West Indies. These powerful literary voices were a means of creating and recording a facet of West Indian history and cultural heritage. West Indian writers wrote their stories through their own eyes. John Hearne was one of the most eloquent voices among them. He became a known voice in the West Indian literary world, using his recognition to facilitate the indigenous West Indian Literature genre’s development. He was also a prominent Jamaican political and social commentator. The John Hearne archive not only produced an important historical picture of the development of the West Indian Literature genre, but West Indian political history, and changes in the cultural and social fabric of the West Indian society, with special emphasis on Jamaica. This paper aims to present this archive as a fundamental body of primary resources for historical research.

A Caribbean Visionary and His Literary Collection, Karlene Saundria Nelson

Polycystic kidney disease (PKD) caused by PKD2 mutation is an important type of autosomal dominant PKD. In this study, peripheral blood mononuclear cells from a patient with PKD2 polycystic kidney disease were reprogrammed to obtain induced pluripotent stem cells (iPSCs). After stable amplification, the pluripotency of the iPSCs was determined by identifying their cell-surface markers, their expression of pluripotency-related genes, and their ability to form teratomas with three germ layers in vivo. The establishment of the iPSC line could provide a basis for a kidney-like organ model of human PKD caused by PKD2 mutation for use in studying the pathogenesis of PKD along with relevant screening and testing intervention drugs.

Establishment of the induced pluripotent stem cell line PLAFMCi006-A from peripheral blood mononuclear cells of polycystic kidney disease patients with PKD2 gene mutation

A nurse as well as a midwife belong to independent professions which inherently involve performing numerous tasks and functions in various areas and in various positions, which simultaneously requires from these professions respecting the rules of law In health-threatening conditions, for example during a pandemic, especially when all social groups are exposed to danger and when danger arises unexpectedly, nurses become an important link in the process of providing health security to everybody who needs it In such situations nurses are obliged to perform their professional duties as well as possible and, at the same time, they have to tackle numerous family responsibilities No matter if they take direct care of patients infected with SARS-CoV-2 virus or those possibly suffering from COVID-19, work as university lecturers teaching prospective nurses or hold managerial positions, they always face professional difficulties and dilemmas or even real dangers Although the challenges which nurses face during the pandemic tend to change week by week, nurses, with time, learn to respond to them for the sake of other people's welfare

A Polish nurse during SARS-CoV-2 pandemic - various aspects of following a nursing profession

With the significant changes in the economy and the society occurring under neo-liberalism as a base, this paper analyzes the extent to which government policies, including federal, state, and local, and labor activism since the Great Recession constitute challenges to neo-liberalism in the United States It investigates the legacy of neo-liberalism including the ineffective federal governmental response to the COVID-19 economic and health crisis, and the emerging discourse within the Democratic Party calling for a major reorientation of government policy away from neo-liberalism It concludes by discussing the effects of the neo-liberal agenda on economic well-being and evaluating whether the neo-liberal agenda has been successful in its own terms © 2020 Informa UK Limited, trading as Taylor & Francis Group

Challenges to neo-liberalism in the United States

ABSTRACT Background Hochuekkito extract (HET) has multiple effects through the digestive and immune systems, including for acute viral infection and chronic inflammation We review basic pharmacological and clinical researches of HET and discuss the effects of HET against the pandemic COVID-19 Methods We reviewed pharmacological studies from 1996 to 30 April 2020 that used experimental animals orally treated with HET and randomized controlled trials (RCTs) from 2000 to 30 April 2020 Results Altogether, 64 pharmacological studies reported immuno-stimulatory effects against infection and cancer, immuno-modulative effects against allergy and some inflammatory diseases, and ameliorating effects against exhaustion and frailty Nine RCTs showed improvement of pulmonary Mycobacterium avium complex disease on chest X-ray;improved systemic inflammation, nutrition, and quality of life of patients with chronic obstructive pulmonary disease and a decrease in the number getting common cold and exacerbations;reduction of soluble interleukin-2 receptor and the serum cortisol concentration of postoperative patients;a reduction of the incidence of inflammatory complications and C-reactive protein elevation after cerebrovascular disease;a reduction of the volume of steroid and tacrolimus during the treatment of atopic dermatitis;a healing effect for intractable chronic wounds;improvement of the physical status of elderly weak patients;and improvement of the fatigue level of cancer patients Conclusion CODIV-19 is characterized by high risk for the aged and people with other disease complications, cytokine hyperactivity in the severe stage, and sequelae in the recovery stage Considering the immune-stimulative/modulative effects of HET on inflammatory conditions and against exhaustion and frailty, it may be useful for prevention, treatment, and recovery from COVID-19

Basic pharmacological mechanisms and clinical evidence of the efficacy of Hochuekkito against infectious diseases and its potential for use against COVID-19

Introduction: SARS-CoV-2 has fatally affected the whole world with millions of deaths. Amidst the dilemma of a breakthrough in vaccine development, hydroxychloroquine (HCQ) was looked upon as a prospective repurposed candidate. It has confronted numerous controversies in the past few months as a chemoprophylactic and treatment option for COVID-19. Recently, it has been withdrawn by the World Health Organization for its use in an ongoing pandemic. However, its benefit/risk ratio regarding its use in COVID-19 disease remains poorly justified. An extensive literature search was done using Scopus, PubMed, Google Scholar, www.cdc.gov, www.fda.gov, and who.int.Areas covered: It is an attempt to unravel the toxicity vexations of HCQ along with the pharmaceutical perspectives in the current scenario. This will be followed by brief discussions on new advances in drug delivery approaches and computational modelling (PBPK and PD modelling) overtures. Multipronged combination approaches for enhanced synergism with antiviral and anti-inflammatory agents, and immuno-boosting effects, have also been discussed.Expert opinion: Harnessing the multipronged pharmaceutical perspectives will optimistically help the researchers, scientists, biotech, and pharmaceutical companies to bring new horizons in the safe and efficacious utilization of HCQ alone or in combination with remdesivir and immunomodulatory molecules like bovine lactoferrin in a fight against COVID-19. These different combinational therapies with free forms or nanomedicine based targeted approaches can act synergistically to boost host immunity and stop SARS-CoV-2 replication and invasion to impede the infection.

Exploring the room for repurposed hydroxychloroquine to impede COVID-19: toxicities and multipronged combination approaches with pharmaceutical insights.

High-immersion virtual reality (VR) technology is often associated with gaming. Yet, it is increasingly popular in educational contexts due to its potential to engage and motivate learners. Prior to VR technology integration in the classroom, the acceptance or resistance toward VR needs to be explored. This paper reports the results obtained from a large-scale (N = 20,876) survey on teachers’ attitudes toward the use of VR for education. The survey explored the relationships between the teachers’ VR integration level and their instructional approaches, as well as the frequency of VR use. Furthermore, the survey yielded answers on the relationship between the availability of information technology (IT) personnel and the frequency of VR use. Overall, teachers had moderately positive perceptions of the use of VR in education. There was no strong correlation between instructional approaches and the level of VR integration, but lower levels of VR integration were associated with more traditional teaching approaches. The results revealed a positive correlation between the level of VR integration and the frequency of VR use. However, the VR frequency use had a weak correlation with the availability of IT personnel.

Teachers’ perceptions of using virtual reality technology in classrooms: A large-scale survey

The coronavirus disease 2019 (COVID-19) pandemic has clearly shown that major challenges and threats for humankind need to be addressed with global answers and shared decisions. Data and their analytics are crucial components of such decision-making activities. Rather interestingly, one of the most difficult aspects is reusing and sharing of accurate and detailed clinical data collected by Electronic Health Records (EHR), even if these data have a paramount importance. EHR data, in fact, are not only essential for supporting day-by-day activities, but also they can leverage research and support critical decisions about effectiveness of drugs and therapeutic strategies. In this paper, we will concentrate our attention on collaborative data infrastructures to support COVID-19 research and on the open issues of data sharing and data governance that COVID-19 had made emerge. Data interoperability, healthcare processes modelling and representation, shared procedures to deal with different data privacy regulations, and data stewardship and governance are seen as the most important aspects to boost collaborative research. Lessons learned from COVID-19 pandemic can be a strong element to improve international research and our future capability of dealing with fast developing emergencies and needs, which are likely to be more frequent in the future in our connected and intertwined world.

Health informatics and EHR to support clinical research in the COVID-19 pandemic: an overview

Coronavirus disease 2019 is a newly emerging infectious disease currently spreading across the world. It is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The spike (S) protein of SARS-CoV-2, which plays a key role in the receptor recognition and cell membrane fusion process, is composed of two subunits, S1 and S2. The S1 subunit contains a receptor-binding domain that recognizes and binds to the host receptor angiotensin-converting enzyme 2, while the S2 subunit mediates viral cell membrane fusion by forming a six-helical bundle via the two-heptad repeat domain. In this review, we highlight recent research advance in the structure, function and development of antivirus drugs targeting the S protein.

Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19

[ ]the visible rejection of Syrian refugees across many European countries, contemporary with the free circulation and consumption of the replica, undermines efforts to construct a global discourse that addresses the human scale of the Syrian conflict (Cunliffe 2016;Thompson 2017) [ ]the apparent applause that this replica has received across the world evokes the strong rejection of the reproduction of the Ishtar Gate in Babylon, Iraq, which was disassembled through excavation to be reassembled in Berlin in the 1930s [ ]calling for decolonizing practices in heritage preservation must revolve around an exploration of the channels of authority and expertise that give shape to specific safeguarding narratives, rather than focus on repackaging preservation strategies under new codifications and techniques that result in the same colonizing process of heritagization nonetheless

The second coming of Palmyra. A technological prison

In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.

Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan

Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.

Telemedicine for healthcare: Capabilities, features, barriers, and applications

Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.

Kissing Aneurysms at Fenestrated Proximal Basilar Artery: Double-barrel Stent-assisted Coiling Using Dual Closed-cell Stents.

BACKGROUND AND AIMSBACKGROUND: Currently there is limited knowledge on cancer and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of cancer on serious events including ICU admission rate and mortality in COVID 19. METHODS: PubMed, Cochrane Central Register of Clinical Trials were searched on April 16, 2020, to extract published articles that reported the outcomes of cancer in COVID-19 patients. The search terms were “coronavirus” and “clinical characteristics” with no language or time restrictions. We identified 512 published results and 13 studies were included in the analysis. RESULTS: There were 3775 patients, of whom 63 (1·66%) had a cancer. The pooled estimates of ICU admission in COVID 19 patients with and without cancer were 40% versus 8·42%.The odds ratio of ICU admission rates between the cancer and non-cancer groups was 2.88 with a 95% CI of 1·18 to 7·01 (p = 0·026). The pooled estimates of death rate in COVID -19 patients with and without cancer were 20·83% versus 7·82%. The odds ratio of death rates between the cancer and non-cancer groups was 2.25 with a 95% CI ranging from 0·71 to 7·10 with p value of 0·166. The pooled prevalence of cancer patients was 2% (95 CI 1–4). CONCLUSIONS: Presence of cancer in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical ventilation and mortality. The presence of cancer has a significant impact on mortality rate in COVID-19 patients.

Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis

COVID-19 pandemic is one of the biggest crises faced by health-care systems in the recent times The aim of this study was to assess the impact of the COVID-19 pandemic on radiology workflow, working pattern, training and continuing professional development (CPD) activities, as well as personal well-being of the radiologists during the pandemic Material and Methods: Questionnaire designed to gather the opinions regarding the impact of the COVID-19 pandemic was distributed to radiologists throughout the world in electronic format Anonymized responses were obtained and analyzed Two hundred radiologists, working in 17 different countries, responded to our questionnaire Majority of the respondents were from India (72 8%) and 70% of the them were in the age group of 25-45 years About 80% of respondents felt that they were well protected or moderately well protected in terms of the personal protective equipment (PPE), however, most of them felt that the use of PPE had affected their ability to work Similar number of radiologists felt that there was significant reduction in the radiology workload More than half of the respondents felt that their working patterns were altered by the pandemic with drastic impact on teaching, CPD activities, and personal well-being COVID-19 pandemic has had profound impact on the radiologists all over the world Learning from the experiences of the first wave should be used to provide innovative solutions to some of the challenges posed to provide better radiology services, training, and improve the well-being of radiologists if we encounter a similar situation in the future COVID-19 pandemic had significant impact on radiologists Radiologists felt that they were well or moderately well protected with PPEs;however, PPEs affected their ability to work Radiology workflow was significantly reduced in the pandemic with more radiologists working from home COVID-19 pandemic had deleterious effect on radiologist's well-being, education, and CPD activities

Impact of the COVID-19 pandemic on radiologists

The novel coronavirus (COVID-19), average size 100 nm, can be aerosolized by cough, sneeze, speech and breath of infected persons. The airborne carrier for the COVID-19 can be tiny droplets and particulates from infected person, fine suspended mists (humidity) in air, or ambient aerosols in air. To-date, unfortunately there are no test standards for nano-aerosols (≤100 nm). A goal in our study is to develop air filters (e.g. respirator, facemask, ventilator, medical breathing filter/system) with 90% capture on 100-nm airborne COVID-19 with pressure drop of less than 30 Pa (3.1 mm water). There are two challenges. First, this airborne bio-nanoaerosol (combined virus and carrier) is amorphous unlike cubic NaCl crystals. Second, unlike standard laboratory tests on NaCl and test oil (DOP) droplets, these polydispersed aerosols all challenge the filter simultaneously and they are of different sizes and can interact among themselves complicating the filtration process. For the first time, we have studied these two effects using ambient aerosols (simulating the bio-nanoaerosols of coronavirus plus carrier of different shapes and sizes) to challenge electrostatically charged multilayer/multimodule nanofiber filters. This problem is fundamentally complicated due to mechanical and electrostatic interactions among aerosols of different sizes with induced charges of different magnitudes. The test filters were arranged in 2, 4, and 6 multiple-modules stack-up with each module having 0.765 g/m 2of charged PVDF nanofibers (mean diameter 525 ± 191 nm). This configuration minimized electrical interference among neighboring charged nanofibers and reduced flow resistance in the filter. For ambient aerosol size&gt;80 nm (applicable to the smallest COVID-19), the electrostatic effect contributes 100–180% more efficiency to the existing mechanical efficiency (due to diffusion and interception) depending on the number of modules in the filter. By stacking-up modules to increase fiber basis weight in the filter, a 6-layer charged nanofiber filter achieved 88%, 88% and 96% filtration efficiency for, respectively, 55-nm, 100-nm and 300-nm ambient aerosol. This is very close to attaining our set goal of 90%-efficiency on the 100-nm ambient aerosol. The pressure drop for the 6-layer nanofiber filter was only 26 Pa (2.65 mm water column) which was below our limit of 30 Pa (3.1 mm water). For the test multi-module filters, a high ‘quality factor’ (efficiency-to-pressure-drop ratio) of about 0.1 to 0.13 Pa −1can be consistently maintained, which was far better than conventional filters. Using the same PVDF 6-layer charged nanofiber filter, laboratory tests results using monodispersed NaCl aerosols of 50, 100, and 300 nm yielded filtration efficiency, respectively, 92%, 94% and 98% (qualified for 'N98 standard') with same pressure drop of 26 Pa. The 2–6% discrepancy in efficiency for the NaCl aerosols was primarily attributed to the absence of interaction among aerosols of different sizes using monodispersed NaCl aerosols in the laboratory. This discrepancy can be further reduced with increasing number of modules in the filter and for larger 300-nm aerosol. The 6-layer charged nanofiber filter was qualified as a 'N98 respirator' (98% capture efficiency for 300-nm NaCl aerosols) but with pressure drop of only 2.65-mm water which was 1/10 below conventional N95 with 25-mm (exhaling) to 35-mm (inhaling) water column! The 6-layer charged PVDF nanofiber filter provides good personal protection against airborne COVID-19 virus and nano-aerosols from pollution based on the N98 standard, yet it is at least 10X more breathable than a conventional N95 respirator.

Charged PVDF multilayer nanofiber filter in filtering simulated airborne novel coronavirus (COVID-19) using ambient nano-aerosols