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State-of-the-art, continuous personal monitoring is a reference point for assessing exposure to air pollution. European air-quality standards for particulate matter (PM) use mass concentration of PM (PM with aerodynamic diameters ≤ 10 μm (PM10) or ≤2.5 μm (PM2.5)) as the metric. It would be desirable to determine whether black carbon (BC) can be used as a better, newer indicator than PM10 and PM2.5. This article discusses the preliminary results of one of the three living laboratories developed in the project “Combination of traditional air quality indicators with an additional traffic proxy: Black Carbon (BC)”. The Living Lab#1 (LL#1) involved 15 users in the city of Turin, Italy. Three portable aethalometers (AE51) were used to detect personal equivalent black carbon (eBC) concentrations in the respiratory area of volunteers at 10-s intervals as they went about their normal daily activities. The Geo-Tracker App and a longitudinal temporal activity diary were used to track users’ movements. The sampling campaign was performed in November for one week. and each user was investigated for 24 h. A total of 8640 eBC measurements were obtained with an average daily personal exposure of 3.1 µg/m(3) (±SD 1.3). The change in movement patterns and the variability of microenvironments were decisive determinants of exposure. Preliminary results highlight the potential utility of Living Labs to promote innovative approaches to design an urban-scale air-quality management plan which also includes BC as a new indicator.

Living Lab Experience in Turin: Lifestyles and Exposure to Black Carbon

COVID-19 is a disease that manifests itself in a multitude of ways across a wide range of tissues. Many factors are involved, and though impressive strides have been made in studying this novel disease in a very short time, there is still a great deal that is unknown about how the virus functions. Clinical data has been crucial for providing information on COVID-19 progression and determining risk factors. However, the mechanisms leading to the multi-tissue pathology are yet to be fully established. Although insights from SARS-CoV-1 and MERS-CoV have been valuable, it is clear that SARS-CoV-2 is different and merits its own extensive studies. In this review, we highlight unresolved questions surrounding this virus including the temporal immune dynamics, infection of non-pulmonary tissue, early life exposure, and the role of circadian rhythms. Risk factors such as sex and exposure to pollutants are also explored followed by a discussion of ways in which bioengineering approaches can be employed to help understand COVID-19. The use of sophisticated in vitro models can be employed to interrogate intercellular interactions and also to tease apart effects of the virus itself from the resulting immune response. Additionally, spatiotemporal information can be gleaned from these models to learn more about the dynamics of the virus and COVID-19 progression. Application of advanced tissue and organ system models into COVID-19 research can result in more nuanced insight into the mechanisms underlying this condition and elucidate strategies to combat its effects.

Significant Unresolved Questions and Opportunities for Bioengineering in Understanding and Treating COVID-19 Disease Progression

BACKGROUND: The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease Very little is known about the impact of these restrictions on trauma centers Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient's demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital METHODS: An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 - June 15, 2020) with a control period (same period in 2017-2019) Comparisons were done using the Pearson's chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods Statistical significance was set at p 15 (37 3% vs 26 8%;p = 0 014);while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0 41;95% CI 0 31-0 54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS CONCLUSIONS: Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances

The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico

BACKGROUND: Location-based augmented reality (AR) games, such as Pokémon GO (PGO) and Harry Potter: Wizards Unite (HPWU), are shown to have beneficial impacts on physical activity, social connectedness, and mental-health for their players. In March 2020, global social distancing measures related to COVID-19 prompted the AR games developer Niantic to implement several changes to ensure continued player engagement with PGO and HPWU. We sought to examine how physical and mental well-being of PGO and HPWU players were affected during the unprecedented COVID-19 restriction period, as well as how video game engagement was affected. OBJECTIVE: (1) To examine the impact of COVID-19 social restrictions on the physical and mental well-being of AR game players; (2) to examine the impact of COVID-19 social restrictions on usage of video games and motivations for use; and (3) to explore the potential role of AR games (and video games in general) in supporting well-being during COVID-19 social restrictions. METHODS: A mixed-method, online, self-reported survey was conducted in May 2020, during which COVID-19 social restrictions were enforced in many countries. Participants were recruited online via four subreddit forums dedicated to PGO or HPWU. Data collected contained quantitative data on demographics, time spent playing video games, physical activity, and mental health, as well as qualitative data on motivations to play and video game impact on mental health during COVID-19 restrictions. RESULTS: We report results for 2,004 participants (58.8% male, average age=30.5 years). Self-reported physical activity during COVID-19 social restrictions significantly decreased from 7.50 hours per week on average (SD=11.12) to 6.50 (SD=7.81) (p<.001). Over half of the participants reported poor mental health (n=925/1766, 52.4%; WHO-Five Well-Being Index (WHO-5<13)). Being female, younger age, and reduced exercise were significant predictors of poor mental health. Participants reported a significant increase in video game play from 16.38 hours per week on average (SD=19.12) to 20.82 (SD=17.49) (p<.001). Three in four participants (n=1102/1427, 77.2%) reported that playing video games had been beneficial to their mental health. The changes made to PGO and HPWU were very well received by players, and players continued to use these games while exercising and to maintain social connection. In addition to providing an escape during the pandemic and as a form of entertainment, participants reported that they also used video games for emotional coping, to lower stress, relax, and alleviate mental health conditions. CONCLUSIONS: AR games have the potential to promote physical and mental-health during the COVID-19 pandemic. Used by populations under isolation and distress, such games can potentially improve physical and mental health by providing virtual socialization, sustained exercise, temporal routine, and mental structure. Further research is needed to explore the potential of AR games as digital behavioral interventions to maintain human wellbeing in the wider population.

COVID-19 as 'Game changer': Use and impact of augmented reality games on physical activity and mental well-being during the pandemic

A new coronavirus strain has wreaked havoc on human lives so the WHO was declared as a pandemic since 20th March 2020. The Membrane glycoprotein MP spans the viral envelope and it has a highly conserved glycosylation sequence. AIM: Our study goal was to find out the N-glycosylation, ligand binding sites, and antigenic variations between COVID-19 and other associated viruses. METHODS: We performed In silico methodologies for serial analysis at both an operational and result/output level is assessed and compared study factors. RESULTS: We detected high similarity in sequence alignment for > 89% between COVID-19 MP and other MP of CoVs. Prediction of N-glycosylation and cytotoxic T-cell epitopes, we identified precisely sites between SARS-CoV-2 MP and Pangolin CoV MP 100%. We also didn't obtain any similarity in ligand binding site residues between MP sequences. Our study didn't reveal any similarity in CTL epitope predication between coronaviruses under study using the CTLPred server. CONCLUSIONS: Our results exhibit that the membrane glycoprotein of SARS-CoV-2 is closely associated with predecessor SARS-CoVs specifically Pngolin CoV. Prediction of novel CTL epitopes may substantial scopes for the expansion of a peptide-based vaccine for the inhibition virion assembly of SARS-CoV-2.

Glicosilación, sitios de unión de ligandos y variaciones antigénicas entre la glicoproteína de membrana del COVID-19 y los coronavirus asociados./ [Glycosylation, Ligand Binding Sites and Antigenic Variations Between Membrane Glycoprotein of COVID-19 and Related Coronaviruses]

This article investigated the influence of risk aversion and the perception of risk associated with dining inside a restaurant on restaurant utilization and expenditures in the initial re-opening phase of the COVID-19 pandemic. Consistent with economic theory, risk aversion and perception decreased the use of in-person restaurant services and increased the probability of using take-out and delivery, but had no influence on total restaurant expenditures. Risk perception had a larger effect on indoor dining compared to outdoor dining, suggesting risk averting behavior within the utilization of in-person restaurant services. These findings suggest COVID-19 concerns may influence restaurant use even after states relax their policies restricting restaurant operations. Our results also highlight the importance of developing policies to support the restaurant industry as consumers adjust to the re-opening phase of the pandemic.

COVID-19 risk perception and restaurant utilization after easing in-person restrictions

Background: Stunting in children is one of the most significant barriers to human development, globally affecting approximately 162 million children under 5 years of age. During the Covid-19 pandemic, the development of communication and information media such as smartphones has encouraged the creation of various kinds of application-based health innovations known as mobile health. The purpose of this study was to analyze the utilization of android-based applications as a stunting prevention e-counseling program innovation in the Covid-19 pandemic era. Subjects and Method: This research was a systematic review. The articles were selected from Google Scholar, PubMed, ScienceDirect, and Elsevier. The keywords for this review are: prevention, education, stunting counseling, Covid-19, android-based stunting prevention application, stunting counseling application during the Covid-19 pandemic, application for stunting, android application for stunting. The search process to exclude the articles used for this literature review using the PRISMA method.

The utilization of android-based application as a stunting prevention e-counseling program innovation during COVID-19 pandemic

Referring to H. E. Bock’s famous lectures on differential diagnostics, some recent developments are discussed. Topical remarks are given concerning modern differential diagnostics. In general, they have changed from the diagnostic of the phenotype to the detection of the pathogenesis.

Gedanken zur Differentialdiagnostik*

Due to the limited number of critical care providers in the United States, even well-staffed hospitals are at risk of exhausting both physical and human resources during the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). One potential response to this problem is redeployment of non–critical care providers to increase the supply of available clinicians. To support efforts to increase capacity as part of surge preparation for the coronavirus disease (COVID-19) outbreak, we created an online educational resource for nonintensivist providers to learn basic critical care content. Among those materials, we created a series of one-page learning guides for the management of common problems encountered in the intensive care unit (ICU). These guides were meant to be used as just-in-time tools to guide problem-solving during the provision of ICU care. This article presents five guides related to the evaluation and management of patients with hypoxemic respiratory failure and the basics of invasive mechanical ventilation.

Just-In-Time Tools for Training Non–Critical Care Providers. Basics of Respiratory Failure

Type 2 diabetes mellitus (T2DM) is a known independent risk factor for atherosclerotic cardiovascular disease (CVD) and solid epidemiological evidence points to heart failure (HF) as one of the most common complications of diabetes. For this reason, it is imperative to consider the prevention of CV outcomes as an effective goal for the management of diabetic patients, as important as lowering blood glucose. Endothelial dysfunction (ED) is an early event of atherosclerosis involving adhesion molecules, chemokines, and leucocytes to enhance low-density lipoprotein oxidation, platelet activation, and vascular smooth muscle cell proliferation and migration. This abnormal vascular phenotype represents an important risk factor for the genesis of any complication of diabetes, contributing to the pathogenesis of not only macrovascular disease but also microvascular damage. Gliflozins are a novel class of anti-hyperglycemic agents used for the treatment of Type 2 diabetes mellitus (T2DM) that selectively inhibit the sodium glucose transporter 2 (SGLT2) in the kidneys and have provoked large interest in scientific community due to their cardiovascular beneficial effects, whose underlying pathophysiology is still not fully understood. This review aimed to analyze the cardiovascular protective mechanisms of SGLT2 inhibition in patients T2DM and their impact on endothelial function.

Cardiovascular Benefits from Gliflozins: Effects on Endothelial Function

BACKGROUND: The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations. METHODS: Cardiovascular procedures performed at 30 hospitals across six Western states in two large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression. RESULTS: Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in two distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15 to April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (p=0.0003), older (p<0.0001), Asian or Black (p=0.02), or Medicare insured (p<0.0001), and COVID I procedures were higher acuity (p<0.0001), but not higher complexity. In COVID II, there was a trend towards more procedural deferral in regions with a higher COVID-19 burden (p=0.05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases. CONCLUSIONS: Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.

Cardiovascular Procedural Deferral and Outcomes over COVID-19 Pandemic Phases: A Multi-Center Study

This paper describes a case study of a novel teaching method where the “Teaching with Industry” (TWI) model–industry practitioners incorporated as co-instructors in a semester-long classroom setting–is enhanced by using new videoconferencing technologies such as Zoom and Meeting Owl Pro, and innovative classroom setups. This enhanced model was developed with the intent to bridge the gap between information acquired in the classroom and the skills and competencies required in the industry. The different teaching platforms not only facilitated the teaching when industry practitioners were/are not able to be physically present in the classroom, but also led to efficient organization of the different activities carried out in class. Results obtained from end-course surveys showed that students had a positive experience using Zoom and Meeting Owl Pro welcoming the opportunity to engage with industry practitioners and gain better understanding of the practical usefulness of the course.

Case Study: Teaching with Industry (TWI) Using New Videoconferencing Technology and Innovative Classroom Setups

A series of aromatic helix-sheet-helix oligoamide foldamers composed of several different photosensitive diazaanthracene units have been designed and synthesized. Molecular objects up to 7 kDa were straightforwardly produced on a 100 mg scale. Nuclear magnetic resonance and crystallographic investigations revealed that helix-sheet-helix architectures can adopt one or two distinct conformations. Sequences composed of an even number of turn units were found to fold in a canonical symmetrical conformation with two helices of identical handedness stacked above and below the sheet segment. Sequences composed of an odd number of turns revealed a coexistence between a canonical fold with helices of opposite handedness and an alternate fold with a twist within the sheet and two helices of identical handedness. The proportions between these species could be manipulated, in some cases quantitatively, being dependent on solvent, temperature, and absolute control of helix handedness. Diazaanthracene units were shown to display distinct reactivity toward [4 + 4] photocycloadditions according to the substituent in position 9. Their organization within the sequences was programmed to allow photoreactions to take place in a specific order. Reaction pathways and kinetics were deciphered and product characterized, demonstrating the possibility to orchestrate successive photoreactions so as to avoid orphan units or to deliberately produce orphan units at precise locations. Strong cooperative effects were observed in which the photoreaction rate was influenced by the presence (or absence) of photoadducts in the structure. Multiple photoreactions within the aromatic sheet eventually lead to structure lengthening and stiffening, locking conformational equilibria. Photoproducts could be thermally reverted.

Selective and Cooperative Photocycloadditions within Multistranded Aromatic Sheets

Purpose: The purpose of this study is to examine the attitudes of students in higher educational institutions in Jordan towards the use of online design studios during coronavirus disease 2019 (COVID-19) lockdown and discusses how their use could enhance the learning process Design/methodology/approach: 615 undergraduate students studying architecture in Jordanian universities were recruited to explore the factors that constituted and affected their perceptions of online design studios Findings: The findings of this study highlight that many of the participants felt uncertain about aspects of their online learning experience and wanted more guidance and support Reasons of this disengagement include technical factors, such as poor network quality and lack of familiarity with the new applications Students and tutors' personal situations when working and studying from home are also relevant due to the tutors' lack of expertise in online teaching, and the limitations of peer interaction Together, these factors can make the experience of the online design studio more challenging Research limitations/implications: The sample was nationally representative of architecture students from various institutions However, the study was limited to an exploration of students' opinions, and it did not include the points of view of tutors and decision-makers Originality/value: This research was conceived during the period of the COVID-19 lockdown, whilst both tutors and students were experiencing dramatic changes in their modes of teaching and learning due to the sudden move from on-campus design studios to a virtual alternative, with only the bare minimum of resources and relevant experience Learners' perspectives can enhance understanding of online design studios to assess their quality and effectiveness © 2020, Emerald Publishing Limited

Architecture students' satisfaction with and perceptions of online design studios during COVID-19 lockdown: the case of Jordan universities

Introduction/Background*Some studies have highlighted the imaging finding of vaccine-associated lymphadenopathies post-Covid19 vaccines. That may have a direct impact on the diagnostic accuracy of oncologic patients. Therefore, imaging experts suggest postponing imaging explorations to 6 weeks away from vaccination. Nevertheless to postpone imaging can interfere in assessment of disease extent or clinical response of these patients. We aimed to emphasize the relevance of these findings in ovarian cancer (OC) patients.MethodologyWe report three cases of asymptomatic OC patients that presented enlarged lymphadenopathies in CT scans and who have received at least one dose of mRNA Covid-19 vaccine at 6, 8 and 28days prior to the CT examination, respectively.Result(s)*Two of them were considered as having benign vaccine-associated lymphadenopathies as they presented right supraclavicular and intrapulmonary lymphadenopathies with no other clinical findings, nevertheless a new CT scan was performed 3 months later to reassure diagnostic. The third patient, one year after being diagnosed by EOC, was diagnosed by Lymphoma. After finishing treatment, a PET/CT SCAN to response evaluation was performed, 6 days after of COVID-19 vaccination. All tumoral nodes except one hypermetabolic lymph located at the lateral side of left Iliac Artery disappeared. This lymph node was considered as either no responsive or relapsed from OC, and less likely vaccine-associated. After being resected a high grade carcinoma was found.Conclusion*The incidence of lymphadenopathies in vaccinated patients raises a challenge in the interpretation of imaging of OC patients. Present cases emphasize the need for an accurate clinical evaluation encompassing the type and timing of Covid-19 vaccination. This would also allow avoiding imaging misinterpretations and unnecessary further assessment. Evidence-based guidelines are needed as postponing imaging controls to 6 weeks away from vaccination may be problematic in assessment of clinical response in treated OC patients or newly diagnosed patients.The authors declare no conflicts of interest. None received grant support for this study neither for related clinical or research activity

Covid-19 vaccination-associated pitfalls on treatment response evaluation with CT Scans ovarian cancer patients

Background There is no specific antiviral therapy recommended for the disease caused by SARS-CoV-2 (COVID-19). Recent publications have drawn attention to the possible benefit of chloroquine (CQ). Our study aimed to comprehensively evaluate the safety and efficacy of two different CQ dosages in patients with established severe COVID-19. Methods We performed a parallel, double-blinded, randomized, phase IIb clinical trial, aiming to assess safety and efficacy of two different CQ dosages as adjunctive therapy of hospitalized patients with SARS in Manaus, Brazilian Amazon. Eligible participants were allocated to receive orally or via nasogastric tube high dose CQ (600mg CQ twice daily for 10 days or total dose 12g); or low dose CQ (450mg for 5 days, twice daily only on the first day, or total dose 2.7g). In addition, all patients received ceftriaxone and azithromycin. This study was registered with ClinicalTrials.gov, number NCT04323527. Findings Out of a pre-defined 440 patients sample size, 81 patients were enrolled. The high dose CQ arm presented more QTc>500ms (25%), and a trend toward higher lethality (17%) than the lower dosage. Fatality rate was 13.5% (95%CI=6.9-23.0%), overlapping with the CI of historical data from similar patients not using CQ (95%CI=14.5-19.2%). In 14 patients with paired samples, respiratory secretion at day 4 was negative in only one patient. Interpretation Preliminary findings suggest that the higher CQ dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards. Such results forced us to prematurely halt patient recruitment to this arm. Given the enormous global push for the use of CQ for COVID-19, results such as the ones found in this trial can provide robust evidence for updated COVID-19 patient management recommendations.

Chloroquine diphosphate in two different dosages as adjunctive therapy of hospitalized patients with severe respiratory syndrome in the context of coronavirus (SARS-CoV-2) infection: Preliminary safety results of a randomized, double-blinded, phase IIb clinical trial (CloroCovid-19 Study)

AIM: Depression is a frequent outcome of long‐term stress, but no studies have examined depression rates among Japanese healthcare workers fighting the COVID‐19 pandemic. Therefore, we conducted a web‐based interview of hospital employees to assess depression prevalence and factors. METHODS: This observational cohort study was conducted from July to August, 2020, as part of a mandatory health checkup of Juntendo University Hospital employees (Tokyo, Japan). A total of 4239 participants completed a web‐based questionnaire on medical history and current health status. The Center for Epidemiologic Studies Depression Scale (CES‐D) was used for self‐assessment, with a score of ≥16 considered to indicate depression. RESULTS: Among all employees, the proportion of depression was 31.3% in 2020, the highest measured in the last 10 years and substantially greater than the pre‐pandemic value in 2019 (27.5%). The proportion of depression for 2020 was significantly higher in new recruits than in employees with more than 2 years of experience (47.0% vs 29.9%, respectively, P < .0001) and in new recruits in 2019 (26.4%, P < .0001). When subdivided by occupation, nurses demonstrated the highest depression rate (43.2%), followed by paramedics (35.1%) and clerks (31.6%), whereas residents (22.9%), doctors (20.4%), teaching staff (18.0%), and part‐time staff (15.3%) reported lower depression rates. The positive CES‐D score significantly correlated with age (P < .0001). CONCLUSIONS: Younger and newer employees demonstrated the highest rates of depression independent of occupation. Therefore, mental healthcare programs focusing on these vulnerable groups need to be established.

Elevated depressive symptoms among newer and younger healthcare workers in Japan during the COVID‐19 pandemic

Digital contact tracing of an infected person, testing the possible infection for the contacted persons, and isolation play a crucial role in alleviating the outbreak. Here, we design a dynamic graph streaming algorithm that can trace the contacts under the control of the Public Health Authorities (PHA). Our algorithm receives proximity data from the mobile devices as contact data streams and uses a sliding window model to construct a dynamic contact graph sketch. Prominently, we introduce the edge label of the contact graph as a binary contact vector, which acts like a sliding window and holds the latest D days (incubation period) of temporal social interactions. Notably, the algorithm prepares the direct and indirect (multilevel) contact list from the contact graph sketch for a given set of infected persons. Finally, the algorithm also uses a disjoint set data structure to construct the infection pathways for the trace list. The present study offers the design of algorithms with underlying data structures for digital contact trace relevant to the proximity data produced by Bluetooth enabled mobile devices. Our analysis reveals that for COVID-19 close contact parameters, the storage space requires maintaining the contact graph of ten million users;having 14 days of close contact data in the PHA server takes 55 Gigabytes of memory and preparation of the contact list for a given set of the infected person depends on the size of the infected list. Our centralized digital contact tracing framework can also be applicable for other relevant diseases parameterized by an incubation period and proximity duration of contacts.

Dynamic Graph Streaming Algorithm for Digital Contact Tracing

Sentiment contagion is similar to an infectious disease that spreads in a crowd In this study, we explore the law of emotional infection under sudden public events by SIR model The paper adds an emotionally stable node and establishes a group emotional infection model of U-SOSPa-SPSOa model Simulation results show that our model is reasonable and can better explain the entire contagion process by considering four groups (unsusceptible-susceptible-optimistic-pessimistic) of people Our theoretical results show: When the pessimists were below the critical value of 0 34, the number of negative emotional groups first increased and then decreased As the proportion increases, the emotional peak of pessimists increases The cure probability &theta;o has the least influence on the P(t), and at the same time, under the action of &theta;p, the P(t) reaches the stable state first The increase of the risk coefficient can promote the pessimist infection When the degree of risk is low, the rate of emotional infection is increased When the degree of risk is high, the rate of infection is slowed Therefore, system customizers and related managers can improve the efficiency of stable groups, adjust the proportion of initial negative emotions, control the infection of the spontaneous infection process, and directly deal with negative emotions They can carry out treatment and other means to stabilize group emotions and maintain social stability

Addition of an Emotionally Stable Node in the SOSa-SPSa Model for Group Emotional Contagion of Panic in Public Health Emergency: Implications for Epidemic Emergency Responses

Background: Social attitudes and context have a fundamental impact on the COVID-19 vaccine acceptance. This issue will be challenging the existing Polish public health infrastructure during the planned immunisation program. Material and methods: We attempt to exemplify Poland-specific social background via causal diagram and regional factor analysis based on dimensions (epidemiological potential, ability to act, magical thinking, koronascepticism, information needs etc.) by December 2020 – shortly before vaccination started. Results: We identified several potential target subpopulations and provide possible regional classification. We distinguish clusters of regions where communication strategies should be taken into consideration: 1) extending campaign reach, common social goods and conformism;2) individual’s profits and misinformation blocking. Conclusions: We are signalling the need for profiling and regionalization in campaigns and propose possible starting points for protocols for various voivodeships when safe and effective vaccines are available in Poland. Copyright © Medical University of Gdańsk.

Attempt at profiling and regionalisation of COVID-19 vaccine campaigns in Poland – Preliminary results

BACKGROUND Shared decision-making aims to combine what matters most to a patient with clinician expertise to develop a personalized health strategy. It is a dialogue between patient and clinician in which preferences are expressed, misconceptions reoriented, and available options are considered. To improve patient involvement, it would help to know more about specific barriers and facilitators of patient-clinician communication. Health literacy, the ability to obtain, process, and understand health information, may affect patient participation in decision-making. If the patient is quiet, deferential, and asks few questions, the clinician may assume a more paternalistic style. A patient with greater agency and engagement could be the catalyst for shared decisions. QUESTIONS/PURPOSES We assessed (1) whether effective clinician communication and effort is related to patient health literacy, and (2) if there are other factors associated with effective clinician communication and effort. METHODS We combined a prospective, cross-sectional cohort of 86 audio-recorded visits of adult patients seeking specialist hand care for a new problem at an urban community hospital in the Netherlands with a cohort of 72 audio-recorded hand surgery visits from a tertiary hospital in the United States collected for a prior study. The American cohort represents a secondary use of data from a set of patients from a separate study using audio-recorded visits and administering similar questionnaires that assessed different endpoints. In both cohorts, adult patients seeking specialist hand care for a new problem were screened. In total, 165 patients were initially screened, of which 96% (158) participated. Eight percent (13) of visits were excluded since the final diagnosis remained unclear, 8% (12) since it was not the first consultation for the current problem, 5% (8) in which only one treatment option was available, and < 1% (1) since there was a language barrier. A total of 123 patients were analyzed, 68 from the Netherlands and 55 from the United States. The Newest Vital Sign (NVS) health literacy test, validated in both English and Dutch, measures the ability to use health information and is based on a nutrition label from an ice cream container. It was used to assess patient health literacy on a scale ranging from 0 (low) to 6 (high). The 5-item Observing Patient Involvement (OPTION5) instrument is commonly used to assess the quality of patient-clinician discussion of options. Scores may be influenced by clinician effort to involve patients in decision making-as well as patient engagement and agency. Each item is scored from 0 (no effort) to 4 (maximum effort), with a total maximum score of 20. Two independent raters reached agreement (kappa value 0.8; strong agreement), after which all recordings were scored by one investigator. Visit duration and patient questions were assessed using the audio recordings. Patients had a median (interquartile range) age of 54 (38 to 66) years, 50% were men, 89% were white, 66% had a nontraumatic diagnosis, median (IRQ) years of education was 16 (12 to 18) years, and median (IQR) health literacy score was 5 (2 to 6). Median (IQR) visit duration was 9 (7 to 12) minutes. Cohorts did not differ in important ways. The number of visits per clinician ranged from 14 to 29, and the mean overall communication effectiveness and effort score for the visits was low (8.5 ± 4.2 points of 20 points). A multivariate linear regression model was used to assess factors associated with communication effectiveness and effort. RESULTS There was no correlation between health literacy and clinician communication effectiveness and effort (r = 0.087 [95% CI -0.09 to 0.26]; p = 0.34), nor was there a difference in means (SD) when categorizing health literacy as inadequate (7.8 ± 3.8 points) and adequate (8.9 ± 4.5 points; mean difference 1.0 [95% CI-2.6 to 0.54]; p = 0.20). After controlling for potential confounding variables such as gender, patient questions, and health literacy, we found that longer visit duration (per 1 minute increase: r2 = 0.31 [95% CI -0.14 to 0.48]; p < 0.001), clinician 3 (compared with clinician 1: OR 33 [95% CI 4.8 to 229]; p < 0.001) and clinician 5 (compared with clinician 1: OR 11 [95% CI 1.5 to 80]; p = < 0.02) were independently associated with more effective communication and effort, whereas clinician 6 was associated with less effective communication and effort (compared with clinician 1: OR 0.08 [95% CI 0.01 to 0.75]; p = 0.03). Clinicians' communication strategies (the clinician variable on its own) accounted for 29% of the variation in communication effectiveness and effort, longer visit duration accounted for 11%, and the full model accounted for 47% of the variation (p < 0.001). CONCLUSION The finding that the overall low mean communication effectiveness and effort differed between clinicians and was not influenced by patient factors including health literacy suggests clinicians may benefit from training that moves them away from a teaching or lecturing style where patients receive rote directives regarding their health. Clinicians can learn to adapt their communication to specific patient values and needs using a guiding rather than directing communication style (motivational interviewing).Level of Evidence Level II, prognostic study.

Clinician Factors Rather Than Patient Factors Affect Discussion of Treatment Options.

This is a Brighton Collaboration Case Definition of the term "Acute Respiratory Distress Syndrome - ARDS" to be utilized in the evaluation of adverse events following immunization. The Case Definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for SARS-CoV-2 vaccines and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected Expert Reviewers prior to submission. The comments of the reviewers were taken into consideration and edits incorporated in this final manuscript.

Acute respiratory distress syndrome (ARDS) as an adverse event following immunization: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data

WHAT IS KNOWN ON THE SUBJECT?: Coronavirus disease 2019 (COVID-19) is a new infectious disease that has spread across the world and infected a large number of people many of whom have died. People with moderate to severe dementia are at very high risk of becoming infected as the disease mainly impacts on older people with other health problems and once infected the person with dementia is more likely to become seriously ill than other people. To prevent infection, people are required to wear masks and isolate from contact with others. It is believed that these measures can reduce the quality of life and general well-being of people with moderate to severe dementia in hospital or social care. This belief has not yet been demonstrated by research. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: We show that people with moderate to severe dementia receiving care on mental health hospital wards and subject to strict infection prevention measures can still achieve high levels of well-being. We show that mental health nurses alter the focus of their care to deliberately overcome the challenges and particularly the restrictions on visiting by families. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We believe that the changes in practice we observed can occur in other healthcare and social care settings and that whilst restrictions remain in place care staff can protect and possibly enhance well-being for people with moderate to severe dementia. ABSTRACT: Introduction The effect of coronavirus (COVID-19) on people living with dementia is potentially severe in its clinical impacts. More widely, for this vulnerable group, the social restrictions to limit the spread of infection may be emotionally and psychologically damaging. Aim To explore the impact of restrictions on well-being for people with moderate to severe dementia in acute mental health hospital care. Method "Dementia Care Mapping" was the observational tool used to determine well- or ill-being. Observations were undertaken in two mental health hospital wards during a time of restrictions and the use of personal protective equipment. Results We report levels of well-being that are higher than might be expected alongside a change in the focus of psychological care delivered through mental health nursing interventions aimed at enhancing well-being. Discussion-We postulate that mental health nurses faced with an unprecedented challenge respond by changing practice to mitigate for infection prevention measures and to compensate for family absence. Implications for practice We suggest that the desirable enhancing actions by nursing staff which raise well-being in these hospital settings are readily transferable to other settings that are aiming to maintain well-being but also practising under COVID-19 restrictions.

Dementia care from behind the mask? Maintaining well-being during COVID-19 pandemic restrictions: Observations from Dementia Care Mapping on NHS mental health hospital wards in Wales

Abstract Bovine coronavirus (BCoV) is an important viral pathogen associated with neonatal calf diarrhea. Our aim was to investigate the incidence of BCoV in diarrhea outbreaks in beef and dairy herds from Argentina during 1994–2010. A total of 5.365 fecal samples from diarrheic calves were screened for BCoV diagnosis by ELISA. The virus was detected in 1.71% (92/5365) of the samples corresponding to 5.95% (63/1058) of the diarrhea cases in 239 beef and 324 dairy farms. The detection rate of BCoV was significantly higher in dairy than in beef herds: 12.13% (29/239) vs. 4.32% (14/324) respectively. Phylogenetic analysis of the hypervariable S1 region of seven representative samples (from different husbandry systems, farm locations and years of sampling) indicated that BCoV strains circulating in Argentinean beef and dairy herds formed a cluster distinct from other geographical regions. Interestingly, Argentinean strains are distantly related (at both the nucleotide and amino acid levels) with the Mebus historic reference BCoV strain included in the vaccines currently available in Argentina. However, Mebus-induced antibodies were capable of neutralizing the BCoV Arg95, a field strain adapted to grow in vitro, and vice versa, indicating that both strains belong to the same CoV serotype reported in cattle. This work represents the first large survey describing BCoV circulation in Argentinean cattle.

Molecular and antigenic characterization of bovine Coronavirus circulating in Argentinean cattle during 1994–2010

BACKGROUND: Substance use disorders are a highly prevalent group of chronic diseases with devastating individual and public health consequences. Current treatment strategies suffer from high rates of relapse, or return to drug use, and novel solutions are desperately needed. Realize Analyze Engage (RAE) is a digital, mHealth intervention that focusses on real time, objective detection of high-risk events (stress and drug craving) to deploy just-in-time supportive interventions. The present study aims to (1) evaluate the accuracy and usability of the RAE system and (2) evaluate the impact of RAE on patient centered outcomes. METHODS: The first phase of the study will be an observational trial of N = 50 participants in outpatient treatment for SUD using the RAE system for 30 days. Accuracy of craving and stress detection algorithms will be evaluated, and usability of RAE will be explored via semi-structured interviews with participants and focus groups with SUD treatment clinicians. The second phase of the study will be a randomized controlled trial of RAE vs usual care to evaluate rates of return to use, retention in treatment, and quality of life. ANTICIPATED FINDINGS AND FUTURE DIRECTIONS: The RAE platform is a potentially powerful tool to de-escalate stress and craving outside of the clinical milieu, and to connect with a support system needed most. RAE also aims to provide clinicians with actionable insight to understand patients’ level of risk, and contextual clues for their triggers in order to provide more personalized recovery support.

Realize, Analyze, Engage (RAE): A Digital Tool to Support Recovery from Substance Use Disorder

The purpose of this study is to recognize the important factors that influence the adoption of M-banking in gulf region by its users. IT is quantitative research-based the Unified Theory of Acceptance and the Use of Technology that is also known as UTAUT model. With the help of Partial Least-Squares Structure Equation Modeling, the conceptual framework has been tested and designed. The correlation and multiple linear regression analysis have been functioned to obtained results. In gulf region, the adoption of the customers has decreased because ofsome factors that have been identified in this paper. These factors also decrease the social influence, financial growth and facilitating conditions. The main contribution of this study is to provide a deep understanding of the factors that help to promote the use of mobile banking in some developing countries. Finally, the research recommends several determinants to use the M-banking in the gulf region setting.

The Technology of Mobile Banking and Its Impact on the Financial Growth during the Covid-19 Pandemic in the Gulf Region

BACKGROUND: Coronavirus disease (COVID-19) is a new infection with three pandemic waves up till now. CT plays an important role in diagnosis with multiple reporting systems that can be used during CT analysis. We aimed to compare reporting using the recommendations of the radiological society of North America (RSNA) versus the coronavirus disease reporting and data system (CO-RADS) and to assess the performance of CT if used in asymptomatic patients as a screening. Two hundred and fifty-one patients who underwent chest CT scanning either due to clinical suspicion or as screening before hospital admission were included in this retrospective observational cross-sectional study. This was followed by RT-PCR for confirmation. Three radiologists with different years of experience interpreted the CT findings using the RSNA recommendations and the CO-RADS reporting. The data were collected and compared. RESULTS: There was no statistically significant difference noted in the diagnostic accuracy obtained while using the RSNA recommendations and the CO-RADS reporting system. Also, a good inter-rater agreement was noticed while using the two reporting systems. The CT showed a highly significant value while used in the assessment of symptomatic patients in controversy to the screening of asymptomatic patients. CONCLUSION: Both reporting systems show similar diagnostic accuracy with a good almost similar inter-rater agreement. Both can be used while interpreting the CT images of cases with suspected COVID-19 infection. CT can be used effectively in the detection of COVID-19 infection between symptomatic patients while it is of a lower value in the screening of asymptomatic patients.

Comparison of the RSNA chest CT classification system and CO-RADS system in reporting COVID-19 pneumonia in symptomatic and asymptomatic patients

The purpose of this ecological study was to explore the association of weather with severity indicators of coronavirus disease 2019 (COVID-19). Daily COVID-19-related intensive care unit (ICU) admissions and in-hospital deaths in the Paris region and the daily weather characteristics of Paris midtown were correlated with a time lag. We assessed different study periods (41, 45, 50, 55, and 62 days) beginning from 31 March 2020. Daily ICU admissions and in-hospital deaths were strongly and negatively correlated to ambient temperatures (minimal, average, and maximal). The highest Pearson correlation coefficients and statistically significant p values were found 8 days before the occurrence of ICU admissions and 15 days before deaths. Partial correlations with adjustment on days since lockdown showed similar significant results. The study findings show a negative correlation of previously observed ambient temperature with severity indicators of COVID-19 that could partly explain the death toll discrepancies between and within countries.

ICU admissions and in-hospital deaths linked to COVID-19 in the Paris region are correlated with previously observed ambient temperature

Herd immunity or herd effect is a phenomenon that occurs in groups of people who are resistant to disease. The purpose of conducting this research is to predict the number of cumulative cases of COVID-19 in Indonesia. COVID-19 cases in Indonesia on April 6, 2020, were 2235 cases spread in 34 Provinces. As many as 2491 cases in Indonesia, there were 192 patients recovered (including those treated, so they have natural antibodies in the end) while the total who died was 209 people. It is assumed that around 13% of the total cases have natural antibodies. This is also the case with SARS-CoV-2 and may explain why some individuals (perhaps those most recently able to recover from seasonal coronavirus infections) have asymptomatic infections. Finally, the theoretical concept of increasing herd immunity in pandemic and epidemic cases in Indonesia which aims to control COVID-19 still needs to be reviewed because it is seen from the mortality data that CFR COVID-19 is predicted to be around 8.39% of the population in Indonesia where the risk of death still available. The best alternative is to do a healthy lifestyle, social distancing, and waiting for the vaccine to be found.

Herd Immunity And COVID-19 In Indonesia

Burnout in health care employees and leaders is at an all-time high. Strategies to address burnout can fall short of addressing the broad range of underlying causes, including both organizational culture and personal factors. The National Academies of Medicine has set forth recommendations to address health care burnout from a leadership-based systems level that focuses on the whole employee, body, mind, and spirit. Across generations and societies, there is a growing trend toward spirituality and meaning as a critical component of both personal life and work. Among the working-age millennials, values of purpose and greater societal good take precedent and impact work choices and behaviors. Spiritually based values such as a sense of purpose, the transcendence of the self and ego, and the acknowledgment of something greater than our collective selves, are present in both popular culture and research on transcendental models of leadership. This article presents a model of holistic transcendental leadership that can be leveraged in the health care workplace to enhance innovation and creativity, while placing a novel emphasis on the physical, emotional, and spiritual well-being at the individual, group, and organizational level.

A Holistic Transcendental Leadership Model for Enhancing Innovation, Creativity and Well-Being in Health Care.

Background and Objectives: Two community studies outside the US showed asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults, but not in children <10 years of age. In this study, we assessed the prevalence of asymptomatic SARS-CoV-2 infection in children and adults in Marion County, Indiana. Methods: Individuals living in Marion County with no symptoms of coronavirus 2019 disease (COVID-19) within seven days of enrollment were eligible for this cross-sectional household study. Study kits were delivered to the participant’s residence for self-swabbing, picked up by the study team, and tested by polymerase chain reaction (PCR) for SAR-CoV-2 infection. Results: Five hundred eleven nasal swabs were collected from 119 children and 392 adults ≥18 years of age. One participant (seven years of age) tested positive, for an overall study prevalence of 0.2% (95% CI 0, 0.6%). The participant had no known contact with a person with SARS-CoV-2 infection, and five family members tested negative for infection. The child and family members all tested negative for infection 10 and 20 days after the first test, and none developed symptoms of COVID-19 for 20 days after testing. Conclusions: Asymptomatic SARS-CoV-2 infection can occur in children <10 years with no known COVID-19 exposure. Large cohort studies should be conducted to determine prevalence of asymptomatic infection and risk of transmission from asymptomatic infection in children and adults over time.

Prevalence of Asymptomatic SARS-CoV-2 Infection in Children and Adults in Marion County, Indiana

Educational systems across the globe were disrupted by the COVID-19 pandemic, and faculty, staff, and students had to rapidly transition to e-learning platforms. These groups had little preparation to cope with the challenges of this newly adopted system. However, as we begin to emerge from the COVID-19 era, efforts are being made to assess the impact of this transition and develop a framework of best practices to help educators prepare for possible future disruptions. This commentary aims to discuss some of the challenges associated with the rapid transition to the new academic environment, including the modes of instruction employed, technical obstacles encountered, student responses to change and efforts made to evaluate didactic and practical aspects of the curriculum in the contexts of premedical and medical education, at the newly established College of Medicine at Khalifa University of Science and Technology in the United Arab Emirates.

Lessons Learned Transitioning from Traditional Premedical and Medical Education to E-learning Platforms during the COVID-19 Pandemic within the United Arab Emirates

The current emergency of the novel coronavirus SARS-CoV2 urged the need for broad-spectrum antiviral drugs as the first line of treatment. Coronaviruses are a large family of viruses that already challenged humanity in at least two other previous outbreaks and are likely to be a constant threat for the future. In this work we developed a pipeline based on in silico docking of known drugs on SARS-CoV1/2 RNA-dependent RNA polymerase combined with in vitro antiviral assays on both SARS-CoV2 and the common cold human coronavirus HCoV-OC43. Results showed that certain drugs displayed activity for both viruses at a similar inhibitory concentration, while others were specific. In particular, the antipsychotic drug lurasidone and the antiviral drug elbasvir showed promising activity in the low micromolar range against both viruses with good selectivity index.

Combined in silico and in vitro approaches identified the antipsychotic drug lurasidone and the antiviral drug elbasvir as SARS-CoV2 and HCoV-OC43 inhibitors

The rapid progression of Coronavirus disease 2019 (COVID-19) and its increasing burden on health systems necessitate the identification of parameters of severe infection to help in monitoring, prognoses and development of treatment algorithms. This review aims to investigate the association of lymphocyte count, CRP, LDH, and D-Dimer with the severe form of COVID-19. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), and ScienceDirect were used for the systematic search. Random effects model was used to estimate the pooled standardized mean differences (SMD) with the corresponding 95% confidence interval (CI), using OpenMeta Analyst software. A total of 11 studies, with 2437 COVID-19 patients, which fulfilled the eligibility criteria were included in the meta-analysis. The analysis revealed that lymphocyte count was significantly lower in patients with the severe form of COVID-19 (SMD = - 1.025, P value <.001). Also, the analysis of SMD showed that patients with severe COVID-19 have a significantly higher serum levels of CRP (SMD = 3.363, P value <.001), D-Dimer (SMD = 1.073, P value <.001), and LDH (SMD = 3.345, P value <.001). Low lymphocyte count and high levels of CRP, LDH, and D-Dimer are associated with severe COVID-19. These laboratory markers could be used as clinical indicators of worsening illness and poor prognosis of COVID-19.

The Association of Lymphocyte count and levels of CRP, D-Dimer, and LDH with severe coronavirus disease 2019 (COVID-19): A Meta-Analysis

Based on the Fama-French 5-factor model (FF5), this paper analyzes the market changes of the American steel industry before and after the epidemic In this paper, the Data from Kennethr French-Data Library were used to make multiple regression analysis of the U S steel industry before and after the epidemic The Fama-French 5-factor model was also used for analysis According to the results of multiple linear regression, due to the influence of COVID-19, the coefficient of market risk (Betam) decreased;Robust minus Week (RMW) changed from significant to insignificant;Small minus Big (SMB) and High minus Low (HML) were significant and the change of epidemic situation was not significant, while Conservative minus Aggressive (CMA) was not significant The impact of the outbreak on the U S steel industry has been dramatic and has led to a huge decline in the entire industry

Research on the application of Fama-French 5-factor model in the steel industry during COVID-19

Cancers are serious life-threatening diseases which annually are responsible for millions of deaths across the world. Despite many developments in therapeutic approaches for affected individuals, the rate of morbidity and mortality is high. The survival rate and life quality of cancer patients is still low. In addition, the poor prognosis of patients and side effects of the present treatments underscores that finding novel and effective complementary and alternative therapies is a critical issue. Melatonin is a powerful anticancer agent and its efficiency has been widely documented up to now. Melatonin applies its anticancer abilities through affecting various mechanisms including angiogenesis, apoptosis, autophagy, endoplasmic reticulum stress and oxidative stress. Regarding the implication of mentioned cellular processes in cancer pathogenesis, we aimed to further evaluate the anticancer effects of melatonin via these mechanisms.

An updated review of mechanistic potentials of melatonin against cancer: pivotal roles in angiogenesis, apoptosis, autophagy, endoplasmic reticulum stress and oxidative stress

INTRODUCTION: With increasing survival rates, intestinal transplantation (ITx) and multivisceral transplantation have reached the mainstream of medical care. Pediatric candidates for ITx often suffer from severe multisystem impairments that pose challenges to the medical team. These patients frequently require intensive care preoperatively and have unique intensive care needs postoperatively. METHODS: We reviewed the literature on intensive care of pediatric intestinal transplantation as well as our own experience. This review is not aimed only at pediatric intensivists from ITx centers; these patients frequently require ICU care at other institutions. RESULTS: Preoperative management focuses on optimization of organ function, minimizing ventilator-induced lung injury, preventing excessive edema yet maintaining adequate organ perfusion, preventing and controlling sepsis and bleeding from varices at enterocutaneous interfaces, and optimizing nutritional support. The goal is to extend life in stable condition to the point of transplantation. Postoperative care focuses on optimizing perfusion of the mesenteric circulation by maintaining intravascular volume, minimizing hypercoagulability, and providing adequate oxygen delivery. Careful monitoring of the stoma and its output and correction of electrolyte imbalances that may require renal replacement therapy is critical, as are monitoring for and aggressively treating infections, which often present with only subtle clinical clues. Signs of intestinal rejection may be non-specific, and early differentiation from other causes of intestinal dysfunction is important. Understanding of the expanding armamentarium of immunosuppressive agents and their side-effects is required. CONCLUSIONS: As outcomes of ITx improve, transplant teams accept patients with higher pre-operative morbidity and at higher risk for complications. Many ITx patients would benefit from earlier referral for transplant evaluation before severe liver disease, recurrent central venous catheter-related sepsis and venous thromboses develop.

Pediatric intestinal and multivisceral transplantation: a new challenge for the pediatric intensivist

OBJECTIVE: We aim to explore and compare the effect of global travel restrictions and public health countermeasures in response to COVID-19 outbreak. DESIGN: A data-driven spatio-temporal modelling to simulate the spread of COVID-19 worldwide for 150 days since 1 January 2020 under different scenarios. SETTING: Worldwide. INTERVENTIONS: Travel restrictions and public health countermeasures. MAIN OUTCOME: The cumulative number of COVID-19 cases. RESULTS: The cumulative number of COVID-19 cases could reach more than 420 million around the world without any countermeasures taken. Under timely and intensive global interventions, 99.97% of infections could be avoided comparing with non-interventions. The scenario of carrying out domestic travel restriction and public health countermeasures in China only could contribute to a significant decrease of the cumulative number of infected cases worldwide. Without global travel restriction in the study setting, 98.62% of COVID-19 cases could be avoided by public health countermeasures in China only compared with non-interventions at all. CONCLUSIONS: Public health countermeasures were generally more effective than travel restrictions in many countries, suggesting multinational collaborations in the public health communities in response to this novel global health challenge.

Could COVID-19 pandemic be stopped with joint efforts of travel restrictions and public health countermeasures? A modelling study

BACKGROUND: Solid transplant patients are susceptible to Pneumocystis jirovecii pneumonia (PJP). While the vast majority of PJP cases occur within the first 6 months after transplantation, very few PJP cases are seen beyond 1 year post-transplantation (late-onset PJP). PJP and coronavirus disease 2019 (COVID-19, caused by infection with SARS-CoV-2) share quite a few common clinical manifestations and imaging findings, making the diagnosis of PJP often underappreciated during the current COVID-19 pandemic. To date, only 1 case of kidney transplantation who developed COVID-19 and late-onset PJP has been reported, but this patient also suffered from many other infections and died from respiratory failure and multiple organ dysfunction syndrome. A successful treatment of kidney patients with COVID-19 and late-onset PJP has not been reported. CASE PRESENTATION: We present a case of a 55-year-old male kidney transplant patient with COVID-19 who also developed late-onset PJP. He received a combined treatment strategy, including specific anti-pneumocystis therapy, symptomatic supportive therapy, adjusted immunosuppressive therapy, and use of antiviral drugs/antibiotics, ending with a favorable outcome. CONCLUSIONS: This case highlights the importance of prompt and differential diagnosis of PJP in kidney transplant patients with SARS-CoV-2 infection. Further studies are required to clarify if kidney transplant patients with COVID-19 could be prone to develop late-onset PJP and how these patients should be treated.

Successful treatment of a kidney transplant patient with COVID-19 and late-onset Pneumocystis jirovecii pneumonia

PURPOSE We investigated the usefulness of transscrotal near infrared spectroscopy that measures testicular oxygen saturation (StO2%) in the diagnosis of testicular torsion vs other causes of the acute scrotum in adults. MATERIALS AND METHODS Between January and May 2009, 16 adult males presenting with acute scrotum underwent StO2% measurement of the affected and unaffected testis using near infrared spectroscopy followed by color Doppler ultrasound. If surgically explored, near infrared spectroscopy was performed at surgery and on postoperative day 1. Data were presented as means ± SD and/or normalized to the internal control. Cutoff value was generated for the StO2% difference between the affected testis and control side. RESULTS Sixteen males with acute scrotum of mean duration 12 hours were enrolled. Of 11 patients with abnormal Doppler undergoing surgical exploration, mean StO2% of the affected testis at presentation and at surgery decreased from 40.09 ± 2.66 (range 36 to 44) to 37.18 ± 3.31 (range 32 to 42), respectively, while StO2% of the unaffected testis remained 63.09 (range 55 to 69) both at presentation (SD 4.72) and at surgery (SD 4.98). Of the 11 surgically explored, 4 had orchiectomy and 7 patients underwent surgical detorsion. At presentation and at surgical exploration of the detorsed group, the mean normalized difference between the StO2% values of the affected and unaffected sides was -16.12 and -25.9, respectively. A cutoff value of -11.5 was measured for the StO2% difference between the affected testis and control side at presentation in patients who underwent surgery. CONCLUSIONS Near infrared spectroscopy identified all surgically confirmed cases of testicular torsion when affected testis StO2% was more than 11.5 units lower than the contralateral testis. In pilot testing, near infrared spectroscopy is a rapid, noninvasive, easy and safe method for the differential diagnosis of adult human testicular torsion.

Pilot feasibility study of transscrotal near infrared spectroscopy in the evaluation of adult acute scrotum.

Recently, a few animals have been frequently reported to have been diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Whether they are SARS-CoV-2 intermediate hosts is worthy of great attention The interaction of SARS-CoV-2 spike protein and its acceptor protein ACE2 is an important issue in determining viral host range and cross-species infection, while the binding capacity of Spike protein to ACE2 of different species is unknown Here, we used the atomic structure model of SARS-CoV-2 and human ACE2 to assess the receptor utilization capacity of ACE2s from 10 kinds of animals Results show that chimpanzees, domestic cats and cattles are more susceptible to infection by SARS-CoV-2 Cats in particular, such as pet cats and stray cats, interact very closely with humans, implying the necessity to carefully evaluate the risk of cats during the current COVID-19 pandemic Furthermore, based on ACE2(cats)-SARS-CoV-2-RBD model, through high-throughput screening methods using a pool of 30,000 small molecules, eight compounds were selected for binding free energy calculations All the eight compounds can effectively interfere with the binding of ACE2 and Spike protein, especially Nelfinavir, providing drug candidates for the treatment and prevention of SARS-CoV-2, suggesting further assessment of the anti-SARS-CoV-2 activity of these compounds in cell culture Although we only reported the results of the simulation, and more laboratory and epidemiological investigation are required Like cats are a risk factor, we can further detect SARS-CoV-2 according to the susceptibility of different animals, find the potential host of infection, and completely cut off the living space of the virus Especially, cats could be a choice of animal model for screening antiviral drugs or vaccine candidates against SARS-CoV-2

Predicting the Animal Susceptibility and Therapeutic Drugs to SARS-CoV-2 Based on Spike Glycoprotein Combined With ACE2

Infectious bronchitis virus (IBV) poses massive economic losses in the global poultry industry. Here, we firstly report the construction and immunogenicity comparison of virus-like particles (VLPs) carrying the S, M and E proteins (SME-VLPs); VLPs carrying the S and M proteins (SM-VLPs); and VLPs carrying the M and E proteins (ME-VLPs) from the dominant serotype representative strain GX-YL5 in China. The neutralizing antibody response induced by the SME-VLPs was similar to that induced by the inactivated oil vaccine (OEV) of GX-YL5, and higher than those induced by the SM-VLPs, ME-VLPs and commercial live vaccine H120. More importantly, the SME-VLPs elicited higher percentages of CD4+ and CD8+ T lymphocytes than the SM-VLPs, ME-VLPs and OEV of GX-YL5. Compared with the OEV of GX-YL5, higher levels of IL-4 and IFN-γ were also induced by the SME-VLPs. Moreover, the mucosal immune response (sIgA) induced by the SME-VLPs in the tear and oral swabs was comparable to that induced by the H120 vaccine and higher than that induced by the OEV of GX-YL5. In the challenge experiment, the SME-VLPs resulted in significantly lower viral RNA levels in the trachea and higher protection scores than the OEV of GX-YL5 and H120 vaccines, and induced comparable viral RNA levels in the kidneys, and tear and oral swabs to the OEV of GX-YL5. In summary, among the three VLPs, the SME-VLPs carrying the S, M and E proteins of IBV could stimulate the strongest humoral, cellular and mucosal immune responses and provide effective protection, indicating that it would be an attractive vaccine candidate for IB.

Construction and Immunogenicity Comparison of Three Virus-Like Particles Carrying Different Combinations of Structural Proteins of Avian Coronavirus Infectious Bronchitis Virus

These abstracts form the collection of papers that were presented at the 4th UQ Symposium on Organisational Psychology held at Emmanuel College, University of Queensland, Brisbane on Saturday 24th July, 2004. The UQ Symposium on Organisational Psychology is an annual even organised by the Centre for Organisational Psychology at the University of Queensland. The aim of the symposium is for academic psychologists to present their latest research to fellow academics and practitioners. Papers were accepted for either paper presentation or poster presentation following a peer‐review process. The 100 delegates who attended consisted of practitioners and academics. The invited speaker was Dr Sally Carless (Monash University, Melbourne) who presented her latest research on selection procedures. The 5th Symposium will take place on Saturday 4th June, 2005. For more information about the UQ Symposium on Organisational Psychology series please contact Robin Martin ([email protected]).

The Abstracts of the 4th UQ Symposium on Organisational Psychology: Emmanuel College, University of Queensland

Background: Coronavirus disease 2019 (COVID-19) is a worldwide public health pandemic with a high mortality rate, among severe cases. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. It is important to ensure early detection of the virus to curb disease progression to severe COVID-19. This study aimed to establish a clinical-nomogram model to predict the progression to severe COVID-19 in a timely, efficient manner. Methods This retrospective study included 202 patients with COVID-19 who were admitted to the Fifth Affiliated Hospital of Sun Yat-sen University and Shiyan Taihe Hospital from January 17 to April 30, 2020. The patients were randomly assigned to the training dataset (n = 163, with 43 progressing to severe COVID-19) or the validation dataset (n = 39, with 10 progressing to severe COVID-19) at a ratio of 8:2. The optimal subset algorithm was applied to filter for the clinical factors most relevant to the disease progression. Based on these factors, the logistic regression model was fit to distinguish severe (including severe and critical cases) from non-severe (including mild and moderate cases) COVID-19. Sensitivity, specificity, and area under the curve (AUC) were calculated using the R software package to evaluate prediction performance. A clinical nomogram was established and performance assessed with the discrimination curve. Results Risk factors, including demographics data, symptoms, laboratory and image findings were recorded for the 202 patients. Eight of the 52 variables that were entered into the selection process were selected via the best subset algorithm to establish the predictive model;they included gender, age, BMI, CRP, D-dimer, TP, ALB, and involved-lobe. Sensitivity, specificity and AUC were 0.91, 0.84 and 0.86 for the training dataset, and 0.87, 0.66, and 0.80 for the validation dataset. Conclusions We established an efficient and reliable clinical nomogram model which showed that gender, age, and initial indexes including BMI, CRP, D-dimer, involved-lobe, TP, and ALB could predict the risk of progression to severe COVID-19.

Establishment of a clinical nomogram model to predict the progression of COVID-19 to severe disease

The COVID-19 pandemic has shuttered many university research labs because campuses are closed, and faculty and students lack productive ways of working remotely This presents major difficulties for students who need research opportunities to fulfill their intellectual growth potential and their undergraduate research and thesis requirements Without research experiences, undergraduates may be less competitive for future jobs and graduate programs Similarly, faculty need research avenues to advance their academic careers while maintaining physically distant protocols We outline here a budget-friendly, COVID-friendly, adaptable protocol that aims to introduce students to the wildlife research opportunities surrounding their campus or home through observation and literature research Student researchers learn the scientific method by getting first-hand experience with an original research project The pedagogical goals include designing a study: defining a question or proposing a hypothesis, collecting, organizing, and analyzing data, and sharing results in the form of posters, theses, informal educational materials, and scientific publications This protocol is flexible to allow for different budgets, opportunities, and constraints The researchers monitor different locations using trail cameras to determine which species are present around campus or even students' homes During the COVID-19 pandemic, when it is likely there will be few in-person meetings, this protocol offers students the opportunity to carry out research with limited or no in-person meetings, and it can be run remotely by sharing the data collected In this paper, we provide instructions, details, and student handouts for instructors to help implement this research project

Undergraduate Research in the Time of COVID-19: A Remote Imaging Protocol for Physically Distanced Students Studying Wildlife

Telework has drawn attentions as an “option for new labor method using ICT” for longtime Japanese Association of Telework consisting of researchers from various sectors for studying telework which had been difficult for recognition in the existing fields was established in June 1999 For last 20 years, the technologies have been greatly enhanced and ICT is indispensible from the contemporary era According to the enhancement in the technologies, humankind in the 21st Century have new tools such as smart-phone as well as computer and people in the streets hold phone on their hands and present various contents on screen freely and work with their notebook computer in cafe and was it possible to imagine these scene in the contemporary society 20 years ago? It might be the scenes of the “society wherever people work depending on their situations” and “wherever workers can choose freely for their workplace” which have been pursued by many telework researchers Telework is already available in the perspective of technical environment and the technologies have pervaded sufficiently in the society However, the people in society have no sufficient consciousness of the ‘freedom of work place’ and even there are not sufficient organization cultures, laws, and systems for supporting it This article, firstly, studies about the changes in telework and its definition and categorization Next, merits and demerits of telework are studied And then, focusing on the recent telework guidelines, the methods for introducing telework are reviewed It is expected that this article will be helpful to introduce strategically telework available for work in place where it is an office due to the current Covid 19 outbreak

A Basic Issue of Labor Law in Japanese Telework Environment – Focusing on Reviewing Telework Guidelines –

Kidney transplant recipients (KTRs) are prone to develop severe coronavirus disease 2019 (Covid-19) and are less well protected by vaccine than immunocompetent subjects. Thus, the use of neutralizing monoclonal anti-SARS-CoV-2 antibody (MoAb) to confer a passive immunity appears attractive in KTRs. Methods. We performed a French nation-wide study to compare Covid-19-related hospitalization, 30-days-admission to intensive care unit (ICU) and 30-days-death between KTRs who received an early infusion of MoAb (MoAb group) and KTRs who did not (control group). Controls were identified from the COVID-SFT registry (NCT04360707) using a propensity score matching with the following covariates: age, sex, delay between transplantation and infection, induction and maintenance immunosuppressive therapy, initial symptoms and comorbidities. Results. Eighty KTRs received MoAb between February and June 2021. They were matched to 155 controls. Covid-19-related hospitalization, 30-days-admission to intensive care unit (ICU) and 30-days-death were less frequently observed in MoAb group (35.0% vs 49.7%, p=0.032; 2.5% vs 15.5%, p=0.002, 1.25% vs 11.6%, p=0.005, respectively). No patients required mechanical ventilation in MoAb group. The number of patients to treat to prevent one death was 9.7. Conclusion. The early use of MoAb in KTRs with a mild form of Covid-19 largely improved outcomes in KTRs.

Early administration of Anti-SARS-CoV-2 Monoclonal Antibodies prevents severe Covid-19 in Kidney Transplant Patients

A full-length genome sequence of 27 739 nt was determined for the only known European turkey coronavirus (TCoV) isolate. In general, the order, number and size of ORFs were consistent with other gammacoronaviruses. Three points of recombination were predicted, one towards the end of 1a, a second in 1b just upstream of S and a third in 3b. Phylogenetic analysis of the four regions defined by these three points supported the previous notion that European and American viruses do indeed have different evolutionary pathways. Very close relationships were revealed between the European TCoV and the European guinea fowl coronavirus in all regions except one, and both were shown to be closely related to the European infectious bronchitis virus (IBV) Italy 2005. None of these regions of sequence grouped European and American TCoVs. The region of sequence containing the S gene was unique in grouping all turkey and guinea fowl coronaviruses together, separating them from IBVs. Interestingly the French guinea fowl virus was more closely related to the North American viruses. These data demonstrate that European turkey and guinea fowl coronaviruses share a common genetic backbone (most likely an ancestor of IBV Italy 2005) and suggest that this recombined in two separate events with different, yet related, unknown avian coronaviruses, acquiring their S-3a genes. The data also showed that the North American viruses do not share a common backbone with European turkey and guinea fowl viruses; however, they do share similar S-3a genes with guinea fowl virus.

First complete genome sequence of European turkey coronavirus suggests complex recombination history related with US turkey and guinea fowl coronaviruses

COVID19 is a bolt from the blue, to the already ailing world economy Lockdowns, and disruptions of global supply chains, have impacted growth prospects of economies in various countries Reshuffling of portfolios by global investors, declining oil prices, medium term uncertainity, and "exit China" motivations have increased volatility in currency markets Indian Rupee is relatively stable, yet there is no room for complacency It is not appropriate to assume that central banks might protect currency volatility, and historical assumptions of currency forecasting models need to be revisited While natural hedging, currency invoicing and risk sharing contracts could be still effective, other currency risk management approaches, like medium term, anticipatory, and selective hedging, focussing on budgeted exchange rates, revenue and cost volatility, need to be changed Post COVID19, firms need to focus more on short term, actual, and full hedging of currency risks, focussing on liquidity, and cashflow volatility

Currency Risk Management and Covid 19

The emergence of the SARS-CoV-2 virus at the end of 2019 has led to unprecedented demand on healthcare systems around the world. Healthcare workers, including doctors, have found themselves having to work in unfamiliar environments in the effort to control this pandemic. This article gives the hospital physician an overview of the radiological manifestations of COVID-19 disease, to improve knowledge and increase familiarity when reviewing radiographic images.

Radiological manifestations of COVID-19: key points for the physician

IntroductionThe mental health care system in Ukraine is centralized and largely focuses on capacity for inpatient psychiatric treatment with 90% of funding allocated to inpatient psychiatric care at hospitals, much higher than countries who already have more decentralized care. Community-based mental health care options, including mental health provided at the primary health care level are currently limited or absent in the mental health system. Psychosocial support, as well as self-care and mental health promotion are also insufficiently developed. Covid-19 pandemic is serious challenge for health care system, especially for consultation liaison psychiatry.ObjectivesMental health monitoring and psychological support in University Clinic of Kharkiv National Medical University, Ukraine during COVID-19 epidemic.MethodsHADS, SCL-90, HDRS, HARSResultsDuring COVID-19 epidemic, implemented combination of off-line and eye-to-eye methods of mental health monitoring and psychological counselling for patients and medical staff in University clinic of Kharkiv National Medical University. Model of early detection and management of mental disorders based on multidisciplinary teamwork principles, сombination of off-line and eye-to-eye methods of screening, monitoring and psychological counselling for patients and medical staff. The online format proved beneficial because many patients of University clinic have trust issues and preferred not to deal with psychiatric services locally when it comes to mental health problems and it was accessible on epidemic conditions. An important part of the outreach work by the project was to destigmatize mental health problems.ConclusionsCombined model (off-line and eye-to-eye services) of mental health care is preferred compare to traditional approach in modern conditions.

Experience of organization of mental health monitoring in university clinic of Kharkiv national medical university

BACKGROUND: Fast, reliable and easy to handle methods are required to facilitate urgently needed point-of-care testing (POCT) in the current coronavirus pandemic. Life-threatening severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread all over the world, infecting more than 33,500,000 people and killing over 1 million of them as of October 2020. Infected individuals without any symptoms might still transfer the virus to others underlining the extraordinary transmissibility of this new coronavirus. In order to identify early infections effectively, treat patients on time and control disease spreading, rapid, accurate and onsite testing methods are urgently required. RESULTS: Here we report the development of a loop-mediated isothermal amplification (LAMP) based method to detect SARS-CoV-2 genes ORF8 and N directly from pharyngeal swab samples. The established reverse transcription LAMP (RT-LAMP) assay detects SARS-CoV-2 directly from pharyngeal swab samples without previous time-consuming and laborious RNA extraction. The assay is sensitive and highly specific for SARS-CoV-2 detection, showing no cross reactivity when tested on 20 other respiratory pathogens. The assay is 12 times faster and 10 times cheaper than routine reverse transcription real-time polymerase chain reaction, depending on the assay used. CONCLUSION: The fast and easy to handle RT-LAMP assay amplifying specifically the genomic regions ORF8 and N of SARS-CoV-2 is ideally suited for POCT at e.g. railway stations, airports or hospitals. Given the current pandemic situation, rapid, cost efficient and onsite methods like the here presented RT-LAMP assay are urgently needed to contain the viral spread.

Rapid point-of-care detection of SARS-CoV-2 using reverse transcription loop-mediated isothermal amplification (RT-LAMP)

E-health applications can support continuing care for persons with chronic diseases such as multiple sclerosis (MS). We have developed a web-based mobile app called VIOLA to be used at home by persons with MS (pwMS) who previously participated in an innovative multidisciplinary rehab program. The purpose of VIOLA is to reinforce what participants have learned about a healthy lifestyle and to keep them motivated to adhere to rehabilitation programs. As the outbreak of the Covid-19 pandemic has severely curtailed pwMS contact with their usual health providers, we quickly updated VIOLA to grant continuity of care to our home-bound patients.By monitoring pwMS subscriptions to individual modules, we found a definite increase after the national lockdown was declared. Subscribers rated the app very positively.Encouraged by the positive feedbacks, we are planning to extend the access to our app also to pwMS with no prior specific learning experience. This would limit the psychophysical consequences of the lockdown. Furthermore, VIOLA could be effective in maintaining a proper lifestyle, contributing to improve the quality of life of pwMS.VIOLA has the potential of increasing the adherence of pwMS to the rehabilitation confirming that digital communication tools are a valuable solution for those home-bound.].

Managing chronic disease in the COVID-19 pandemic: an e-learning application to promote a healthy lifestyle for persons with multiple sclerosis

To find the association between CAM and diabetes and correlate the severity of glycemic status,and clinical features and morbidity associated with them. MATERIAL This descriptive study was conducted at a COVID Ward in govt kilpauk med college from Apr 10, 2021 to Aug 1 0, 2021. All laboratory confirmed COVID-19 cases by RTPCR (Real Time Reverse Transcription Polymerse Chain Reaction) nasopharyngeal & throat swab were admitted at this centre. Severe COVID-19 infection was defined bySp02<90%orRespiratory rate >30/min at admi during hospital stay. Post COVID 19 cases were defined who had either clinical recovery from respiratory symptoms or had passed 28 days since the onset of symptoms of COVID 19. Lymphocytopenia was defined by absolute lymphocyte count<1000/mm3.Data compiled in Ms-excel sheet and studied. OBSERVATION In Patients with CAM30/32(93.8%) hadheadache,20/32(62.5%) had nasal symptoms in form of rhinorrhoea & nasal stuffiness and 19/32(59.4%) had eyes symptoms in form of red nessoreye pain. O n admission, 18/32 (56.2%) patients had history or presented with Severe COVID-19 pneumonia. At the time of diagnosis of CAM, 22/ 32 (68.8%) had hypoxemia and required supplemental oxygen. The mean duration from onset of COVID-19 to diagnosis of CAM was 17.28 (±11.76) days. In patients with CAM, none of them were fully vaccinated against COVID-19. Two patients had received a single dose of (Covishield) COVID-19 vaccine. Both the patients are still admitted at our centre and are on antifungal therapy. Among 822 hospitalized patients with COVID 19 infection, 36 patients had CAM with an incidence of 3.9%. In patients with CAM, 84.5% had Diabetes Mellitus as the most common co-morbidity. The majority of the patients had poor glycemic control with a mean HbA1c of 8.06%. Out of the total population, 88% had prior exposure to high dose corticosteroids.surgical debridement done for 65%of patients and others treated withantifungals. During the study period, 36% patients of CAM did not survive. CONCLUSION Mucormycosis is a formidable angioinvasive opportunistic infection in an immunocompromised host. The spectrum of mucormycosis involves rhino-orbital-cerebral, pulmonary, disseminated, cutaneous, gastrointestinal and disseminated form of disease. The major risk factors for the disease are diabetes, neutropenia, iron overload, malignancy and organ transplant. Diabetes is the most common metabolic disorder and is an independent risk factor for Severe COVID-19 and Mucormycosis. In patients with diabetes affected with COVID-19 superinfection with Mucormycosis will lead to adverse clinical outcome and prolonged hospital stay.

Diabetes and Covid Associated Mucormucormycosis-A Cross Sectional Study in Kilpauk Medical College.

We propose the design of a ventilator which can be easily manufactured and integrated into the hospital environment to support COVID-19 patients. The unit is designed to support standard ventilator modes of operation, most importantly PRVC (Pressure Regulated Volume Control) and SIMV-PC (Synchronised Intermittent Mandatory Ventilation) modes. The unit is not yet an approved medical device and is in the concept and prototyping stage. It is presented here to invite fast feedback for development and deployment in the face of the COVID-19 pandemic.

The HEV Ventilator Proposal

This work presents a watermarking algorithm applied to medical images of COVID-19 patients The principal objective is to protect the information of the patient using an imperceptible watermarking and to preserve its diagnose Our technique is based on a perceptive approach to insert the watermark by decomposing the medical image using the Hermite transform We use as watermark two image logos, including text strings to demonstrate that the watermark can contain relevant information of the patient Some metrics were applied to evaluate the performance of the algorithm Finally, we present some results about robustness with some attacks applied to watermark images © 2020 SPIE

A perceptive watermarking approach applied to covid-19 imaging data

Objective. Although coronavirus disease 2019 (COVID-19) typically presents as a respiratory illness, co-existent cardiovascular symptomatology associated with an elevated serum troponin level has been identified as a risk factor for adverse outcomes. Our study addressed the need to correlate serum cardiovascular biomarkers with tissue pathology based on autopsy. Materials and Methods. In 13 patients, we reviewed the clinical history and measurements of serum troponin and other biomarkers and correlated them with autopsy findings. Results. At autopsy, the 13 COVID-19 patients exhibited evidence of diffuse alveolar damage (DAD) and cardiomegaly (heart weights ranged from 380 to 1170 grams). Of the 13 patients, three had elevated troponin I and evidence of severe coronary artery disease (CAD) (cases 4, 5, and 11), while six had elevated troponin I without evidence of severe CAD (cases 1, 3, 6, 7, 8, and 9), and four had no clinical or pathological evidence of CAD. Of note, cases 7 and 9 had significantly elevated troponin I levels (8.84 ng/mL and 4.94 ng/mL, respectively). Several cases showed focal degenerative change or damage of cardiomyocytes. However, none of the cases had evidence of lymphocytic myocarditis. Conclusion. Although we observed elevated biomarkers of heart failure in some cases, it was not a consistent finding and did not correlate with evidence of myocarditis. The elevated biomarkers may reflect non-ischemic heart damage as a consequence of COVID-19 infection.

COVID-19 Cardiac Injury: An Important Cause of COVID-19 Related Morbidity and Mortality

This study highlights the importance of community pharmacists' strategic role in hindering the progression of the SARS-CoV-2 virus in the community setting and innovative measures to protect themselves. This article focuses on the features, control, and prevention of COVID-19 and social awareness measures of the pandemic. The means employed by the community pharmacist to safeguard his health while providing pharmaceutical services during COVID-19 is compiled and presented to benefit health-care professionals around the world. As per the US Center for Disease Control and Prevention, community pharmacists play a crucial role in providing essential drugs to patients without knowing their current COVID-19 status. They also work in conditions that make them susceptible to COVID-19 exposure. Despite the availability of guidelines, community pharmacists need to be trained in personal protective equipment for efficient protection and prevention of spread. Community pharmacists are essential frontline warriors against transmission of the SARS-CoV-2 virus in the community and act as frontline workers to educate the public on COVID-19. They are at high risk and need to observe necessary precautions to mitigate the spread of the virus.

Strategic role and challenges of community pharmacists in SARS-CoV-2 outbreak

COVID 19 pandemic has brought about a sea change in health care practices across the globe. All specialities have changed their way of working during the pandemic. In this study, we evaluated the impact of COVID-19 on the practice of interventional pulmonology at our centre. All interventional pulmonology procedures done during the three months after implementation of lockdown were evaluated retrospectively for patient demographics, clinical diagnosis, indication for procedure and diagnostic accuracy. The changes in practices, additional human resources requirement, the additional cost per procedure and impact on resident training were also assessed. Procedures done during the month of January 2020 were used as controls for comparison. Twenty-two flexible bronchoscopies (75.8%), four semirigid thoracoscopies (13.7%) and three EBUS-TBNAs (10.3%) were carried out during three month lockdown period as compared to 174 during January 2020. Twenty-three of the procedures were for the diagnostic indication (79%), and six were therapeutic (20.6%). The diagnostic yield in suspected neoplasm was 100% while for suspected infections was 58.3%. The percentage of independent procedures being done by residents reduced from 45.4% to 0%. The workforce required per procedure increased from 0.75 to 4-8, and the additional cost per procedure came out to be 135 USD. To conclude, COVID 19 has impacted the interventional pulmonology services in various ways and brought about a need to reorganize the services, while also thinking of innovative ideas to reduce cost without compromising patient safety.

Assessment of the impact and reorganization of interventional pulmonology services at a tertiary care centre during nationwide lockdown for COVID-19 pandemic.

BACKGROUND: People on ships are at high risk for outbreaks of infectious diseases including coronavirus disease 2019 (COVID-19). A rapid and well-coordinated response is important to curb transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We studied an outbreak on an industrial ship to improve outbreak control for ships and coordination between participating harbour partners. MATERIALS AND METHODS: Public Health Service (PHS) Rotterdam-Rijnmond performed an epidemiological investigation during the outbreak of COVID-19 among 77 seafarers on a ship in their port. The captain was interviewed about ship details and his experiences during the outbreak. The seafarers were asked to fill in questionnaires about symptoms suspicious of COVID-19 and date of symptom onset. Information about stakeholders involved in outbreak control was registered. RESULTS: The captain first contacted PHS about probable cases on March 31st 2020 via a physician ashore. One crewmember was hospitalised on April 8th and another died unexpectedly aboard on April 10th. Questionnaires distributed mid-April to the 75 remaining seafarers showed that 38 of 60 responders (63%) had had suspicious symptoms between February 15th and April 13th. None of them were tested but a total of 8 other crewmembers tested positive for COVID-19 after leaving the ship, including the hospitalised crewmember and the one who died aboard. On May 5th, the last case left isolation and the quarantine ended. Many different stakeholders were involved in the outbreak response and responsibilities were not always fully clear beforehand, causing coordination issues. CONCLUSIONS: Testing crew with COVID-19 symptoms underpins control measures and clarifies communication between stakeholders. Building a network beforehand to develop outbreak guidelines tailored to ships and local circumstances is essential to control future outbreaks on ships.

Outbreak of COVID-19 on an industrial ship

The Paris Agreement and the United Nations Framework Convention on Climate Change outline mitigation goals by sector. However, this framing is likely to create climate justice issues as it does not explicitly address the contributions of individuals. High emissions from luxury activities like commercial air travel are addressed with voluntary and behavioral change approaches for mitigation while the global rural communities who are dependent on forestry-based livelihoods face carbon credit schemes as well as federal and international conservation interventions despite having a lower per capita carbon footprint. To illustrate this point, the emissions of the average air traveler and several international flights are compared to the average forest user in relation to land use change emissions. In many cases, a single round-trip international flight emits more CO(2) per person than the yearly national average of India, Mexico, and Tanzania; all countries with important forestry sectors and indigenous people that depend on forestry-based livelihoods. The disproportionate regulatory burden of forest users in the developing world contrasts their relative contribution to climate change and the unregulated individual behaviors of the global elite. It is time for mandatory offset charges on airline tickets and regulatory framing of mitigation by per capita contributions instead of sector-based approaches.

The Flyer’s dilemma and the Logger’s case for climate justice

Hypochlorous acid (HOCl) is the active oxidizing principle underlying drinking water disinfection, also delivered by numerous skin disinfectants and released by standard swimming pool chemicals used on a global scale, a topic of particular relevance in the context of the ongoing COVID-19 pandemic. However, the cutaneous consequences of human exposure to HOCl remain largely unknown, posing a major public health concern. Here, for the first time, we have profiled the HOCl-induced stress response in reconstructed human epidermis and SKH-1 hairless mouse skin. In addition, we have investigated the molecular consequences of solar simulated ultraviolet (UV) radiation and HOCl combinations, a procedure mimicking co-exposure experienced for example by recreational swimmers exposed to both HOCl (pool disinfectant) and UV (solar radiation). First, gene expression elicited by acute topical HOCl exposure was profiled in organotypic human reconstructed epidermis. Next, co-exposure studies (combining topical HOCl and UV) performed in SKH-1 hairless mouse skin revealed that the HOCl-induced cutaneous stress response blocks redox and inflammatory gene expression elicited by subsequent acute UV exposure (Nos2, Ptgs2, Hmox1, Srxn1), a finding consistent with emerging clinical evidence in support of a therapeutic role of topical HOCl formulations for the suppression of inflammatory skin conditions (e.g. atopic dermatitis, psoriasis). Likewise, in AP-1 transgenic SKH-1 luciferase-reporter mice, topical HOCl suppressed UV-induced inflammatory signaling assessed by bioluminescent imaging and gene expression analysis. In the SKH-1 high-risk mouse model of UV-induced human keratinocytic skin cancer, topical HOCl blocked tumorigenic progression and inflammatory gene expression (Ptgs2, Il19, Tlr4), confirmed by immunohistochemical analysis including 3-chloro-tyrosine-epitopes. These data illuminate the molecular consequences of HOCl-exposure in cutaneous organotypic and murine models assessing inflammatory gene expression and modulation of UV-induced carcinogenesis. If translatable to human skin these observations provide novel insights on molecular consequences of chlorination stress relevant to environmental exposure and therapeutic intervention.

Topical hypochlorous acid (HOCl) blocks inflammatory gene expression and tumorigenic progression in UV-exposed SKH-1 high risk mouse skin

Viral infections represent a serious threat to the world population and are becoming more frequent. The search and identification of broad-spectrum antiviral molecules is necessary to ensure new therapeutic options, since there is a limited availability of effective antiviral drugs able to eradicate viral infections, and consequently due to the increase of strains that are resistant to the most used drugs. Recently, several studies on antimicrobial peptides identified them as promising antiviral agents. In detail, amphibian skin secretions serve as a rich source of natural antimicrobial peptides. Their antibacterial and antifungal activities have been widely reported, but their exploitation as potential antiviral agents have yet to be fully investigated. In the present study, the antiviral activity of the peptide derived from the secretion of Rana tagoi, named AR-23, was evaluated against both DNA and RNA viruses, with or without envelope. Different assays were performed to identify in which step of the infectious cycle the peptide could act. AR-23 exhibited a greater inhibitory activity in the early stages of infection against both DNA (HSV-1) and RNA (MeV, HPIV-2, HCoV-229E, and SARS-CoV-2) enveloped viruses and, on the contrary, it was inactive against naked viruses (PV-1). Altogether, the results indicated AR-23 as a peptide with potential therapeutic effects against a wide variety of human viruses.

The Broad-Spectrum Antiviral Potential of the Amphibian Peptide AR-23

BACKGROUND Vagal nerve stimulation (VNS) is approved therapy for the treatment of intractable epilepsy. The stimulation of either nerve, left or right, is effective. However, due to the anatomic and physiological effects of cardiac innervation, the right vagus nerve is typically avoided in order to minimize the risk of cardiac bradyarrhythmias. The location of the VNS lead contacts on the nerve can also have an effect, namely, more distally placed contacts have been associated with lower risk of cardiac arrhythmias, presumably by avoiding vagal cervical cardiac branches; however, our case demonstrates reproducible asystole despite left sided, distal VNS lead placement. CASE PRESENTATION We report a 28-year-old male patient with pharmacoresistant generalized clonic-tonic seizures. The VNS therapy with 1.5 mA output and 16% duty cycle drastically reduced his seizure burden for several years. The breakthrough seizures along with stabbing pain episodes at the implantable pulse generator (IPG) site have prompted the VNS lead revision surgery with new lead contacts placed more caudally than the old contacts. However, the intraoperative device interrogation with 1 mA output resulted in immediate asystole for the duration of stimulation and it was reproducible until the output was decreased to 0.675 mA. CONCLUSIONS Our case highlights the possibility of new severe cardiac bradyarrhythmias following surgical VNS lead replacements even in patients without preoperatively known clinical side effects. We suggest preoperative electrocardiography and cardiology consultation for detected abnormalities for all patients undergoing new VNS implantations, as well as revision surgeries for VNS malfunctions. Intraoperatively, the surgeon and anesthesia team should be vigilant of cardiac rhythms and prepared for the immediate management.

Reproducible asystole following vagal nerve stimulator lead replacement: a case report.

The current COVID-19 pandemic affects the mental health of medical staff. Our objective was to evaluate the factors that are associated with the distress of physicians in two general hospitals in Lima, Peru. A cross-sectional correlational survey study was carried out. Physicians completed The Impact of Event Scale-Revised-22 (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). A total of 310 physicians completed the survey, 36.5% of whom reported distress symptoms. Higher levels of distress were reached by women, by those with a prior psychiatric diagnosis, by those who considered that the hospital does not provide adequate personal protective equipment, and by those who perceived stigma from family members. Multiple regression analysis showed that there is a correlation between distress symptoms and anxiety symptoms, (B = 0.509), depressive symptoms (B = 0.305), the total hours/week worked in the Emergency Department (B=−0.142), and the stigma perception (B = 0.096). Early intervention programs must be developed to support medical staff members exposed to severe distress situations such as the current viral pandemic.

Factors Associated with Distress Among Medical Staff During the Initial Phase of the COVID-19 Pandemic in Peru

From the Summary: In recent months, the Coronavirus Disease 2019 (COVID-19) pandemic has spread globally, with the United States now reporting the highest number of cases of any country in the world Currently, there are few treatment options available to lessen the health impact of the disease and no vaccines or other prophylactic treatments to curb the spread of the virus [ ] This report answers frequently asked questions about current efforts related to research and development of medical countermeasures, their regulation, and related policy issues Although several efforts are underway, medical product research, development, and approval is a difficult and high-risk endeavor that takes years in typical circumstances In response to COVID-19, this process has been expedited, including through several federal programs and mechanisms covered in this report However, expedited medical product development can carry certain risks, such as a more limited safety profile for new products upon approval COVID-19 (Disease);Vaccines;Health--Testing

Development and Regulation of Medical Countermeasures for COVID-19 (Vaccines, Diagnostics, and Treatments): Frequently Asked Questions [June 25, 2020]

PURPOSE: To investigate foveal morphologic parameters related to visual acuity and the stages classified in this study reflect the severity of the macular pseudohole (MPH). METHODS: Seventy-eight eyes of 78 consecutive patients diagnosed with MPH were studied. Quantitative optical coherence tomography (OCT) parameters including central foveal thickness, parafoveal thickness, parafoveal inner and outer retinal thickness (PIRT and PORT), pseudohole depth, pseudohole diameter, and inner nuclear layer (INL) angulation were measured and the morphologic features of the inner retina (disorganization of retinal inner layers (DRIL)) and the photoreceptor layer (external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and cotton ball sign) were determined. Associations between OCT parameters and best-corrected visual acuity (BCVA) were analyzed. Based on the location of the inner margin of INL, all patients were divided into three stages and the mean comparison between the three stages was analyzed. RESULTS: PIRT (r = 0.6489; p < 0.0001) and pseudohole depth (r = 0.5266; p < 0.0001) had a statistically significant correlation with BCVA. Statistically significant visual acuity differences were found in eyes with DRIL (p < 0.001) and IZ disruption (p = 0.018), but not in ELM disruption (p = 0.916), EZ disruption (p = 0.581), and cotton ball sign (p = 0.075). According to the univariate and multivariate regression analyses, PIRT was associated with BCVA in both univariate (p < 0.001) and multivariate (p = 0.002) regression analyses. Defect diameters of both ELM (p = 0.025) and IZ (p = 0.006) were associated with BCVA in univariate regression analysis, but not in multivariate regression analysis. INL angulation and the ratio of the IZ disruption was significantly different in the three groups. Stage 3 (95.8%) had significantly higher disrupted IZ ratio than stage 1 (40%) and stage 2 (65.5%). The BCVA of stages 1, 2, and 3 were identified as 0.06 ± 0.07 (20/23 Snellen equivalent), 0.23 ± 0.17 (20/34 Snellen equivalent), and 0.48 ± 0.23 (20/60 Snellen equivalent), respectively, and the differences in BCVA between the three groups were significant (p < 0.0001). CONCLUSION: The parameters related to visual acuity were PIRT, pseudohole depth, DRIL, and IZ. The stage classification proposed in this study included morphologic changes of the inner retina and photoreceptor layer and is likely to be clinically useful for showing the severity of the MPH.

Angulation of the inner nuclear layer as an indicator of the severity of macular pseudohole

Objective The present study aimed to determine the differences in outcomes between natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy (NAVH) and conventional laparoscopy-assisted vaginal hysterectomy (LAVH). Methods We retrospectively reviewed the charts of patients who between July 2012 and September 2015, were diagnosed as having benign uterine disease such as uterine myoma, endometriosis, or adenomyosis and managed via NAVH or LAVH in a single-center (Eulji University Hospital). Data such as age, body weight, height, parity, operation time, intra/post-operative complications, and uterus weight were obtained from the clinical charts. NAVH and LAVH recipients were matched 1:3 in terms of baseline characteristics, and the 2 groups were compared regarding surgical outcomes. Results Of the 160 patients with benign uterine disease included in the present study. Forty received NAVH and remaining 120 received LAVH. There were significant differences between the groups regarding operation time and hemoglobin change. Notably, although the operation time was shorter for LAVH, hemoglobin change was lower for NAVH. Additionally, although maximum hospitalization duration was shorter for LAVH, the average length of hospitalization was similar between NAVH and LAVH. There were no significant differences between the groups in terms of other variables. Conclusion NAVH may become a new alternative surgical method of choice for hysterectomy, as it represents a clinically feasible and safe approach; moreover is superior to LAVH in terms of bleeding loss.

Postoperative outcomes of natural orifice transluminal endoscopic surgery-assisted vaginal hysterectomy and conventional laparoscopic-assisted vaginal hysterectomy: a comparative study.

The emergence of complex global problems and related concerns about ‘sustainability’ are central pre-occupations of discourses concerning innovation and its pursuit. The pressing need to gain fresh insights into the nature of new ideas and collaborative endeavour that can be used to drive societal transitions, is increasingly acknowledged. The objective of this paper is to contribute to these insights by examining and enriching the conceptual foundations of sustainability focused innovation policy. It's comparative metatheoretical approach enables exploration of the epistemological and political dimensions of the geography of transitions and systems literatures and the implications for the way in which they inform transformational change. The potential for deeper engagement with systems theory to create more holistic representations of complex problems, and the issues which must be addressed to resolve them, is explored. Findings regarding theory development and its implications for sustainability focused policy making provide a vital contribution to the fields of economic geography and the geography of transitions as well as to transitions literature more generally. As such it augments the foundations of ongoing empirical study and discourses which address the diminishing returns associated with current growth trajectories.

Conceptualising the foundations of sustainability focused innovation policy: From constructivism to holism

Chemically and biologically safe storage of solutions for medical uses is a daily concern for industry since decades and it appeared even more dramatic during the last two years of pandemia. Biological safety is readily reached by sterilization using γ-irradiation process. However, such a type of irradiation induces the degradation and the release of chemicals able to spoil the biological solutions. Surprisingly, there are no investigations on multi-layer films combining multi-technique and multi-method approaches to unveil the events occurring during γ-irradiation. Furthermore, our investigations are focuses on properties/events occurring at product, macromolecular, and molecular levels.

Investigations at the Product, Macromolecular, and Molecular Level of the Physical and Chemical Properties of a γ-Irradiated Multilayer EVA/EVOH/EVA Film: Comprehensive Analysis and Mechanistic Insights

INTRODUCTION: Zoonotic diseases are the infectious diseases that can be transmitted to human beings and vice versa from animals either directly or indirectly. These diseases can be caused by a range of organisms including bacteria, parasites, viruses and fungi. Viral diseases are highly infectious and capable of causing pandemics as evidenced by outbreaks of diseases like Ebola, Middle East Respiratory Syndrome, West Nile, SARS-Corona, Nipah, Hendra, Avian influenza and Swine influenza. EXPALANTION: Many viruses affecting equines are also important human pathogens. Diseases like Eastern equine encephalitis (EEE), Western equine encephalitis (WEE), and Venezuelan-equine encephalitis (VEE) are highly infectious and can be disseminated as aerosols. A large number of horses and human cases of VEE with fatal encephalitis have continuously occurred in Venezuela and Colombia. Vesicular stomatitis (VS) is prevalent in horses in North America and has zoonotic potential causing encephalitis in children. Hendra virus (HeV) causes respiratory and neurological disease and death in man and horses. Since its first outbreak in 1994, 53 disease incidents have been reported in Australia. West Nile fever has spread to many newer territories across continents during recent years. It has been described in Africa, Europe, South Asia, Oceania and North America. Japanese encephalitis has expanded horizons from Asia to western Pacific region including the eastern Indonesian archipelago, Papua New Guinea and Australia. Rabies is rare in horses but still a public health concern being a fatal disease. Equine influenza is historically not known to affect humans but many scientists have mixed opinions. Equine viral diseases of zoonotic importance and their impact on animal and human health have been elaborated in this article. CONCLUSION: Equine viral diseases though restricted to certain geographical areas have huge impact on equine and human health. Diseases like West Nile fever, Hendra, VS, VEE, EEE, JE, Rabies have the potential for spread and ability to cause disease in human. Equine influenza is historically not known to affect humans but some experimental and observational evidence show that H3N8 influenza virus has infected man. Despite our pursuit of understanding the complexity of the vector-host-pathogen mediating disease transmission, it is not possible to make generalized predictions concerning the degree of impact of disease emergence. A targeted, multidisciplinary effort is required to understand the risk factors for zoonosis and apply the interventions necessary to control it.

Zoonotic Viral Diseases of Equines and Their Impact on Human and Animal Health

The detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in upper and lower respiratory specimens and coinfection with other respiratory pathogens in patients with coronavirus disease 2019 (COVID-19) was investigated. Study subjects (N = 342) were retrospectively enrolled after being confirmed as SARS-CoV-2 positive, and their nasopharyngeal swab (NPS), oropharyngeal swab (OPS), and sputum specimens were restored for SARS-CoV-2 retesting and respiratory pathogen detection. The majority of the subjects (96.5%, N = 330) were confirmed as SARS-CoV-2 positive using NPS/OPS specimens. Among the COVID-19 patients (N = 342), 7.9% (N = 27) and 0.9% (N = 3) were coinfected with respiratory viruses and Mycoplasma pneumoniae, respectively, yielding an 8.8% (N = 30) overall respiratory pathogen coinfection rate. Of the respiratory virus coinfection cases (N = 27), 92.6% (N = 25) were coinfected with a single respiratory virus and 7.4% (N = 2) with two viruses (metapneumovirus/adenovirus and rhinovirus/bocavirus). No triple coinfections of other respiratory viruses or bacteria with SARS-CoV-2 were detected. Respiratory viruses coinfected in the patients with COVID-19 were as follows: rhinovirus (N = 7, 2.1%), respiratory syncytial virus A and B (N = 6, 1.8%), non-SARS-CoV-2 coronaviruses (229E, NL63, and OC43, N = 5, 1.5%), metapneumovirus (N = 4, 1.2%), influenza A (N = 3, 0.9%), adenovirus (N = 3, 0.9%), and bocavirus (N = 1, 0.3%). In conclusion, the diagnostic value of utilizing NPS/OPS specimens is excellent, and, as the first report in Korea, coinfection with respiratory pathogens was detected at a rate of 8.8% in patients with COVID-19. [ABSTRACT FROM AUTHOR] Copyright of Canadian Journal of Infectious Diseases & Medical Microbiology is the property of Hindawi Limited 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.)

Coinfections with Respiratory Pathogens among COVID-19 Patients in Korea

BACKGROUND: Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. METHODS: This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. RESULTS: A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with &#8805; 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08-1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07-1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07-1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01-1.55; p = 0.03) in fully adjusted models. CONCLUSION: Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.

Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population

The SARS-CoV-2 outbreak and pandemic that began near the end of 2019 has posed a challenge to global health. At present, many candidate small-molecule therapeutics have been developed that can inhibit both the infection and replication of SARS-CoV-2 and even potentially relieve cytokine storms and other related complications. Meanwhile, host-targeted drugs that inhibit cellular transmembrane serine protease (TMPRSS2) can prevent SARS-CoV-2 from entering cells, and its combination with chloroquine and dihydroorotate dehydrogenase (DHODH) inhibitors can limit the spread of SARS-CoV-2 and reduce the morbidity and mortality of patients with COVID-19. The present article provides an overview of these small-molecule therapeutics based on insights from medicinal chemistry research and focuses on RNA-dependent RNA polymerase (RdRp) inhibitors, such as the nucleoside analogues remdesivir, favipiravir and ribavirin. This review also covers inhibitors of 3C-like protease (3CL(pro)), papain-like protease (PL(pro)) and other potentially innovative active ingredient molecules, describing their potential targets, activities, clinical status and side effects.

An update review of emerging small-molecule therapeutic options for COVID-19

Objective: To assess the feasibility of home antibody testing as part of large-scale study, the King's College London Coronavirus Health and Experiences of Colleagues at King's (KCL CHECK). Methods: Participants of the KCL CHECK study were sent a SureScreen Diagnostics COVID-19 IgG/IgM Rapid Test Cassette to complete at home in June 2020 (phase 1) and September 2020 (phase 2). Participants were asked to upload a test result image to a study website. Test result images and sociodemographic information were analysed by the research team. Results: A total of n=2716 participants enrolled in the KCL CHECK study, with n=2003 (73.7%) and n=1825 (69.3%) consenting and responding to phase 1 and 2. Of these, n=1882 (93.9%; phase 1) and n=1675 (91.8%; phase 2) returned a valid result. n=123 (6.5%; phase 1) and n=91 (5.4%; phase 2) tested positive for SARS-CoV-2 antibodies. A total of n=1488 participants provided a result in both phases, with n=57 (3.8%) testing positive for SARS-CoV-2 antibodies across both phases, suggesting a reduction in the number of positive antibody results over time. Initial comparisons showed variation by age group, gender and clinical role. Conclusions: Our study highlights the feasibility of rapid, repeated and low-cost SARS-CoV-2 serological testing without the need for face-to-face contact.

The King's College London Coronavirus Health and Experiences of Colleagues at King's Study: SARS-CoV-2 antibody response in a higher education sample

Since its initial approval, mifepristone has been regulated with a strictness out of proportion to its risks. This paper explores how the regulation of mifepristone, specifically the Risk Evaluation and Mitigation Strategies (REMS) requirements, are a manifestation of abortion exceptionalism-the phenomenon of abortion being treated differently under the law than other comparable health care. The weight of medical and public health evidence demonstrates that mifepristone is extremely safe and the REMS are unnecessary. In fact, the mifepristone REMS is neither justified by the absolute risk of the medication itself, nor comprehensible as a logical response to the risks actually posed by mifepristone. Nevertheless, the REMS remain in place. From July 2020 through January 2021, enforcement of the REMS elements requiring in-person distribution of mifepristone were enjoined by court order due the COVID-19 pandemic. In other words, COVID-19 created a context so exceptional as to temporarily outweigh abortion exceptionalism. However, the reprieve did not last-in January 2021, the Supreme Court ruled to dissolve the injunction, allowing FDA to resume enforcement of the in-person requirements. In response, advocates called on the incoming Biden administration to direct FDA to suspend enforcement once more. This regulatory whiplash is itself further evidence that the REMS flow from political, rather than scientific, concerns. Abortion exceptionalism is apparent in the specific requirements of the REMS, and it is also apparent in the precarity of the regulatory scheme itself.

Abortion exceptionalism and the mifepristone REMS

A situation when the citizen rights are being limited results in the society’s justified objection. The last year was unique due to the pandemic. Governments around the world introduced limitations of citizen rights to counteract the spread of the coronavirus and to maintain healthcare capacity. The society’s reaction to such limitations varied between countries, and democratic and authoritarian systems. In Poland, democratic state, at the beginning of the pandemic (March 2020) major restrictions were imposed. The society’s approach was responsible, and people complied with all the rules. However, the situation changed dramatically when the second wave of COVID-19 when the Constitutional Court in Poland passed a judgement on abortion. Restrictions for businesses imposed again, resulting in the protests of entrepreneurs. The situation arose in which on one hand restrictions related to the pandemic were in force, while many demonstrations were held in the name of freedom and democracy. Such situation gives rise to a conflict between responsibility and civil liberties. The study reveals conflicts between the government actions and citizens respond, in both governing their values. Research findings illustrate complexity of socio-political issues during the pandemic, highlighting possible danger of using the crisis for manipulation of public opinion. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Threats to Democracy During the Covid-19 Pandemic: The Case of Poland

BACKGROUND: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. OBJECTIVE: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. METHODS: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. RESULTS: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. CONCLUSIONS: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients.

A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review

This work aims to present an advanced prototype of cost-effective wearable air quality monitoring equipment suitable for different use cases due to its small size, easy handling, and smartphone compatibility In the paper, we present the chosen components and the system design The prototype development is also presented, with the initial measurements and the aspects encountered during development We used C and Arduino programming, Android software development The proposed system comprises of an Arduino based micro controller, a CCS811 sensor for volatile organic compound (VOC) measurement, a ZPH01 particulate matter (PM) detector, and an HC-O5 device for Bluetooth connection We investigated the prototype both in the laboratory and in a smart urban environment with different scenarios in Budapest, Hungary (street, campus, store, mall, underground) Also, the use of a smartphone connection for data loggings is presented The paper shows examples of measurement results and the relation to similar results from around the world The possible application in COVID-19 pandemic related questions is also discussed © 2020 IEEE

Wearable Smart Prototype for Personal Air Quality Monitoring

This study aimed to establish and validate the nomograms to predict the mortality risk of patients with coronavirus disease 2019 (COVID-19) using routine clinical indicators. This retrospective study included a development cohort enrolled 2,119 hospitalized patients with COVID-19 and a validation cohort included 1,504 patients with COVID-19. The demographics, clinical manifestations, vital signs, and laboratory tests of the patients at admission and outcome of in-hospital death were recorded. The independent factors associated with death were identified by a forward stepwise multivariate logistic regression analysis and used to construct the two prognostic nomograms. The nomogram 1 was a full model to include nine factors identified in the multivariate logistic regression and nomogram 2 was built by selecting four factors from nine to perform as a reduced model. The nomogram 1 and nomogram 2 showed better performance in discrimination and calibration than the Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age (MuLBSTA) score in training. In validation, nomogram 1 performed better than nomogram 2 for calibration. We recommend the application of nomogram 1 in general hospitals which provide robust prognostic performance though more cumbersome; nomogram 2 in the out-patient, emergency department, and mobile cabin hospitals, which depend on less laboratory examinations to make the assessment more convenient. Both the nomograms can help the clinicians to identify the patients at risk of death with routine clinical indicators at admission, which may reduce the overall mortality of COVID-19.

Establishment of Routine Clinical Indicators-Based Nomograms for Predicting the Mortality in Patients With COVID-19

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis. METHODS: We performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected. RESULTS: Of the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively. CONCLUSIONS: The COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.

Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic

AIMS To determine any relationship between ambient temperatures adjusted for humidity at conception and the occurrence of pre-eclampsia. METHODS The subjects were singleton primiparae delivered in a Teaching Hospital between 1995 and 2002. We studied the odds of developing pre-eclampsia across months and investigated the association between the pre-eclamptic rates based on the months of conception and the mean monthly heat index. RESULTS A total of 245 (1.6%) women were diagnosed pre-eclampsia and eclampsia during the study period. There was a significant association between the seasons of conception and rate of pre-eclampsia (logistic regression Wald chi(2) = 9.2, p = 0.03). Conceptions during summer had a higher risk of pre-eclampsia than those during autumn (2.3 vs. 1.6%, OR 1.7, 95% CI 1.2-2.5). Women who conceived in June had the highest risk of developing pre-eclampsia (OR 2.8, 95% CI 1.5-5.2) while women who conceived in October had the lowest after adjusting for age. A 2-month time lag was observed between the peak pre-eclamptic rate in women who conceived in June and the peak heat index in August. CONCLUSION Singleton primiparous women who conceived in summer and had a longer exposure to higher ambient temperature were at a greater risk of pre-eclampsia.

Seasonal variation in pre-eclamptic rate and its association with the ambient temperature and humidity in early pregnancy.

There is limited knowledge about the long-term effects on pulmonary function of COVID-19 in patients that required intensive care treatment. Spirometry and diffusing capacity for carbon monoxide (DLCO) were measured in 60 subjects at 3-6 months post discharge. Impaired lung function was found in 52% of the subjects, with reduced DLCO as the main finding. The risk increased with age above 60 years, need for mechanical ventilation and longer ICU stay as well as lower levels of C-reactive protein at admission. This suggests the need of follow-up with pulmonary function testing in intensive-care treated patients.

Impaired diffusing capacity for carbon monoxide is common in critically ill Covid-19 patients at four months post-discharge

Objective: To determine possible M-Pro enzyme inhibitors by using structure-based virtual screening methods, in the ZINC Biogenic Data Set containing natural products and natural product-like molecules Materials and Methods: QVina, an AutoDockVina derivative, was used in virtual screening operations, GROMACS in molecular dynamics studies and SwissAdme server in ADME (Absorption, Distribution, Metabolism, and Excretion) calculations KNIME (Konstanz Information Miner) and ChemAxon software were used for filtering data and creating three-dimensional structures of the molecules Results: Seven out of totally screened 51535 natural products or natural products like molecules were identified as possible candidate to be used as SARS-CoV-2 Main Protease (MPro) enzyme inhibitors based on the results obtained from structure based virtual screening and ADME models Conclusion: Among the seven potent molecules, two of them (ZINC000604382012 and ZINC000514288074) were selected as candidate molecules for further studies according to the results obtained from g_mmpbsa simulations and synthetic accessibility models In addition, a workflow has been established to identify novel or potent M-pro enzyme inhibitors

Screening of Natural Product and Natural Product like Molecules against SARS-CoV-2 Main Protease Using Molecular Modeling Methods

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first broke out in Wuhan, China and COVED-19 disease spread throughout the world by its highly contagious nature. High death numbers have caused a massive panic across the globe. Fast and early diagnosis is the key for preventing the virus from spreading. Besides PCR test, computed tomography (CT) of lungs is also used for diagnosis of COVID-19. Since the amount of testing kits for the diagnosis is insufficient and the conventional diagnosis methods are slow, developing AI-based fast diagnosis tools is not only an alternative way but also an urgent requirement for such alarming situations as those people faced with today. In this study, we employed three popular CNN models, VGG16, VGG19, and Xception, to classify CT scans of suspected patient cases as COVED-19 infected and non-COVID-19. VGG16 achieved 93% accuracy with the best parameters on the test set.

Diagnosis of COVID-19 with a Deep Learning Approach on Chest CT Slices

The cholecystokinin receptor system, specifically cholecystokinin 2 receptor (CCK2R) is a historic target for pain management that has shown limited success. However, new approaches to target CCK2R have incited fresh enthusiasm for this target. In this mini-review, we discuss what is known about CCK2R in peripheral and central circuits under naïve physiological conditions and under conditions of chronic pain, the interactions of CCK2Rs with opioids and briefly, recent efforts to develop new treatments targeting CCK2R for chronic pain.

CCK2 receptors in chronic pain.

The global Covid-19 pandemic has been a considerable concern worldwide. In Surabaya city, the government has taken particular measures to establish appropriate policies to overcome the Covid-19 pandemic. However, there has been no precise measure to verify the effectiveness of the policy in the future. This research aims to evaluate the Surabaya Government policy scenario using a dynamic system-based simulation with Vensim Ventana software the initial model was designed with adopting the Covid-19 model made by Tom Fiddaman, Ventana System in 2020 adjusted to real conditions in Surabaya the simulation results obtained from the initial validated model estimate that the Covid-19 pandemic would end on May 5, 2021, with total infected 15,876 people the model was then developed by simulating several policy scenarios: herd immunity, convalescent plasma therapy, and swab test to predict policy's impact the best-case scenario is gained by combining the convalescent plasma therapy policy and increasing the number of swab tests at Labkesda to 4,000 samples per day the simulation results' prediction shows the pandemic will end 52 days earlier, with the percentage of the infected population 23.77% smaller than the initial model. It can be concluded that the government's strategy of collaborating the two policies is effective to overcome the pandemic in Surabaya. Nevertheless, the implementation of policies to overcome this pandemic success with contributions from all elements of society. © 2021 IEEE.

A Policy Strategy Evaluation for Covid-19 Pandemic in the City of Surabaya using Vensim Ventana Dynamic System Simulation

The current study was aimed to introduce five new species of Cordyceps from Yunnan, with morphological descriptions, illustrations, color photographs, phylogenetic placement, associated host, and a comparison with allied taxa. The five new species were morphologically distinct from all other Cordyceps sensu lato species, and it was also suggested that they should differ from other species in the genus Cordyceps based on combined multigene analyses. Employing DNA nucleotide sequences of the nrLSU, nrSSU, tef-1α, rpb1, and rpb2, the five new species were recognized in the clade of Cordyceps by using molecular phylogenetic analyses, including five well-supported subclades: three new species, Cordyceps bullispora, Cordyceps longiphialis, and Cordyceps nabanheensis, were found in the subclade of C. pruinosa, and two new species, Cordyceps pseudotenuipes and Cordyceps simaoensis, were located in the subclade of C. tenuipes. The five novel species shared similar morphologies to other species in the genus Cordyceps, with fleshy and brightly pigmented stromata; perithecia superficial to completely immersed, ordinal in arrangement; and hyaline asci, with thickened cylindrical ascus apex. The morphological characteristics of 66 species in Cordyceps sensu stricto, namely, 5 novel species and 61 known taxa, were also compared.

Morphology and Phylogeny Reveal Five Novel Species in the Genus Cordyceps (Cordycipitaceae, Hypocreales) From Yunnan, China

Before a trip, a screening for SARS-CoV-2 infection by RT-PCR is often required and raises the problem of detection of residual viral RNA at distance from the acute infection (post-Covid) At the University Hospital of Geneva, we developed an expertise to distinguish acute from post-Covid infections Between October and December 2020, 30% of the people tested positive were able to travel because the result corresponded to post-Covid and 65% were put in isolation because of an acute infection with a risk of transmission To overcome the detection of residual viral RNA by RT-PCR, a rapid antigenic test would be an interesting and less expensive alternative It could also be performed a few hours before departure

[SARS-CoV-2 screening in travelers: what approach to assess transmission risk ?]

Social pediatric initiatives aim to improve health outcomes for vulnerable children by working in the community to empower families, to enhance protective factors that mitigate adverse childhood experiences (ACEs), and to deliver place-based health care. In 2012, pediatric dermatology was added as a component of the Responsive, Interdisciplinary Intersectoral Child and Community Health Education and Research (RICHER) social pediatric program in Vancouver, BC. We share our experience with inclusion of pediatric dermatology in a well-established social pediatric program as well as lessons we have learned in the first 8 years of our partnership. Partnership, bridging trust, knowledge sharing, empowerment, consistency, and flexibility were found to be central elements in the success of this endeavor.

Integrating dermatology services into a social pediatrics network: 8 years of experience in the RICHER (Responsive, Interdisciplinary/Intersectoral, Child/Community, Health, Education and Research) program.

BACKGROUND: Postgraduate entrance examination (the Unified National Graduate Entrance Examination) is the major way for Chinese medical undergraduate student to apply for postgraduate studies. It consists of two stages: the preliminary basic written test and the re-examination in form of both written tests and interviews. With the spread of COVID-19, the traditional on-site re-examination of postgraduates must be changed to online re-examination. By comparing the re-examination process and admission results of online and on-site re-examination, we studied the feasibility of online re-examination for postgraduates and measures to improve it. METHODS: This was a retrospective cohort study using data from the Unified National Graduate Entrance Examination. Our sample population was the applicants to Peking University Third Hospital (PUTH) who completed re-examinations. In total, 281 records were successively selected from March 2017 to May 2020. By comparing the re-examination process and admission results of the 2020 online re-examination with those of the 2017-2019 on-site re-examinations, we analyzed the process, difficulties and improvement of online re-examination. RESULTS: A total of 281 subjects were included, of whom 77.9% completed an on-site re-examination in 2017-2019 and 22.1% completed the 2020 online re-examination. In the on-site re-examinations, 70.8% of the students were admitted, and in the online re-examination, 74.2% of the students were admitted. There were no significant differences between the students who completed on-site and online re-examinations in terms of gender, recent graduation, cultivation type, graduate from a key university, and admission (P>0.05). The on-site and online re-examination results were very similar among the admitted students. The multivariable logistic regression analysis showed that online re-examination had no effect on student admissions. Students seeking professional degree were less likely to be admitted than those seeking academic degree, and those with a better standardized rank in medicine and a better standardized rank of re-examination score were more likely to be admitted. CONCLUSIONS: The online re-examination implemented in 2020 during the COVID-19 pandemic achieved the same selective effect as on-site re-examination. Effective time management, a standardized test question template, well-trained staff and effective technology are the keys to success.

Online re-examination of postgraduate medical students during the COVID-19 pandemic

The purpose of this investigation was to characterize the management and prognosis of severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV)-negative patients. An observational cohort study of HIV-negative adults with PJP documented by bronchoalveolar lavage (BAL) through Gomori–Grocott staining or immunofluorescence, admitted to one intensive care unit (ICU) for acute respiratory failure, was undertaken. From 1990 to 2010, 70 patients (24 females, 46 males) were included, with a mean age of 58.6 ± 18.3 years. The mean Simplified Acute Physiology Score (SAPS)-II was 36.9 ± 20.4. Underlying conditions included hematologic malignancies (n = 21), vasculitis (n = 13), and solid tumors (n = 13). Most patients were receiving systemic corticosteroids (n = 63) and cytotoxic drugs (n = 51). Not a single patient received trimethoprim–sulfamethoxazole as PJP prophylaxis. Endotracheal intubation (ETI) was required in 42 patients (60.0 %), including 38 with acute respiratory distress syndrome (ARDS). In-ICU mortality was 52.9 % overall, reaching 80.9 % and 86.8 %, respectively, for patients who required ETI and for patients with ARDS. In the univariate analysis, in-ICU mortality was associated with SAPS-II (p = 0.0131), ARDS (p < 0.0001), shock (p < 0.0001), and herpes simplex virus (HSV) or cytomegalovirus (CMV) on BAL (p = 0.0031). In the multivariate analysis, only ARDS was associated with in-ICU mortality (odds ratio [OR] 23.4 [4.5–121.9], p < 0.0001). PJP in non-HIV patients remains a serious disease with high in-hospital mortality. Pulmonary co-infection with HSV or CMV may contribute to fatal outcome.

Human herpes virus co-infection is associated with mortality in HIV-negative patients with Pneumocystis jirovecii pneumonia

Objectives: Oral potentially malignant disorders (OPMDs) are lesions that may undergo malignant transformation to oral cancer. The early diagnosis and surveillance of OPMDs reduce the morbidity and mortality of patients. Diagnostic techniques based on medical images analysis have been developed to diagnose clinical conditions. This systematic review and meta-analysis aimed to evaluate the efficacy of imaging-based techniques compared to the gold standard of histopathology to assess their ability to correctly identify the presence of OPMDs. Design: Literature searches of free text and MeSH terms were performed using MedLine (PubMed), Scopus, Google Scholar, and the Cochrane Library (from 2000 to 30 June 2020). The keywords used in the search strategy were: (“oral screening devices” or “autofluorescence” or “chemiluminescence” or “optical imaging” or “imaging technique”) and (“oral dysplasia” or “oral malignant lesions” or “oral precancerosis”). Results: The search strategy identified 1282 potential articles. After analyzing the results and applying the eligibility criteria, the remaining 43 papers were included in the qualitative synthesis, and 34 of these were included in the meta-analysis. Conclusions: None of the analyzed techniques based on assessing oral images can replace the biopsy. Further studies are needed to explore the role of techniques-based imaging analysis to identify an early noninvasive screening method.

In Vivo Imaging-Based Techniques for Early Diagnosis of Oral Potentially Malignant Disorders—Systematic Review and Meta-Analysis

Context: Home-based pulmonary rehabilitation (PR) can increase compliance in chronic obstructive pulmonary disorder (COPD). There is paucity of data on this in India. Aims: To study the effectiveness of home-based PR on lung function, health-related quality of life, exercise tolerance and dyspnea among patients with COPD. Setting: The Department of Pulmonary Medicine, Christian Medical College, Vellore. Subjects and Methods: This was a quasi-experimental study which included COPD patients who found hospital-based PR impractical. Those willing for home-based PR constituted the intervention group and those unwilling, constituted the control group. Both groups received standard of care otherwise. At 6 weeks, forced expiratory volume in 1 sec (FEV1), St. George Respiratory Questionnaire (SGRQ), six-minute walk test distance (6MWD), COPD assessment test (CAT) score and modified Borg dyspnea scale were compared with their baseline values. Statistical Analysis: Student paired t-test. Results: A total of 42 patients completed the study, 21 in each arm. The baseline characteristics were comparable. The improvement in FEV1 was 90 ml in the intervention group and 4 ml in the control group (P = 0.01). There was no significant difference in 6MWD change. SGRQ score, Borg scale and CAT score improved significantly by 10.4, 2.4, and 3.4, respectively, in the intervention group when compared to the control group (P = 0.01). Conclusions: Home-based PR effectively provides tangible benefits in FEV1, QOL, exercise tolerance and dyspnea. It should be offered to those who are unable to avail institution-based PR, especially in this era of COVID pandemic.

Effect of home-based pulmonary rehabilitation on health-related quality of life, lung function, exercise tolerance, and dyspnea in chronic obstructive pulmonary disorder patients in a tertiary care center in South India

The article presents the views of author approaching to ask whether providing a platform to discuss autism in engineering Topics include the article offering alarming insights on how people with autism are prone to being bullied in the workplace;and focus on topical and technical issues affecting the industries in which readers work, including biotech and the spread of coronavirus

Coming Forward, Speaking Up

PURPOSE: To assess the spectrum of computed tomography angiogram (CTA) abdominal and pelvic findings in critically ill COVID-19 patients and investigate correlation with CT chest scores. METHODS: An IRB approved retrospective study of CTA of the chest, abdomen and pelvis between dates March 1st to September 15th, 2020 was performed in the hospitalized COVID-19 positive patients. CTA studies of solely the chest were excluded. Medical record review was performed to note patient demographics, CTA scan details and coagulation profile. CTA findings were reviewed to record vascular and non-vascular findings. CT chest was reviewed to calculate CT chest score. Logistic regression analyses were performed to correlate CT chest scores with odds of vascular and other abdomen-pelvis findings. A p < 0.05 was considered statistically significant. RESULTS: A total of 45 consecutive hospitalized COVID-19 positive patients with 61 years mean age and M:F (2:1) gender ratio were evaluated, out of which majority 68.9% (n = 31) had CTA chest, abdomen and pelvis. The most common vascular findings were hematoma 46.7% (n = 21), active extravasation 24.4% (n = 11) and vascular occlusion 17.8% (n = 8). Higher CT chest scores were significantly associated with hematoma/extravasation (OR 1.19, 95% CI 1.07-1.34, p < 0.01). The most common non-vascular abdomen-pelvis findings were seen in organs gallbladder 20% (n = 9), liver 20% (n = 9) followed by kidney 15.6% (n = 7). Higher CT chest scores were significantly associated with bowel findings (OR 1.28, 95% CI 1.01-1.63, p < 0.05) and cholestasis (OR 13.3, 95% CI 1.28-138.9, p < 0.05). CONCLUSION: Patients with moderate to severe COVID-19 pneumonia have significantly higher rate of vascular complications in the abdomen and pelvis.

CT angiography of abdomen and pelvis in critically ill COVID-19 patients: imaging findings and correlation with the CT chest score

Life-saving interventions utilize endotracheal intubation to secure a patient's airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all.

Novel expandable architected breathing tube for improving airway securement in emergency care.

OBJECTIVE: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID‐19 during 2020, and to determine the predictors of in‐hospital death for SARS‐CoV‐2 positive patients. METHODS: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID‐19 and underwent testing for SARS‐CoV‐2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in‐hospital mortality. RESULTS: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS‐CoV‐2. During the ‘second wave’ from 1 July to 30 September 2020, 26 (6%) of 406 SARS‐CoV‐2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS‐CoV‐2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3–5.2, P < 0.001), and 41 (10%) SARS‐CoV‐2 positive patients died in hospital compared to 312 (3%) SARS‐CoV‐2 negative patients (OR 3.2; 95% CI 2.2–4.4, P = 0.001). For SARS‐CoV‐2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1–1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3–9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2–14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8–36.7, P = 0.006). CONCLUSIONS: ED patients who tested positive for SARS‐CoV‐2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.

Outcomes for emergency department patients with suspected and confirmed COVID‐19: An analysis of the Australian experience in 2020 (COVED‐5)

The haemostatic system acts in concert with inflammation, so that after inflammatory response various mediators activate the haemostatic system through endothelial dysfunction, platelet activation and coagulation promoting thrombosis, which is termed thromboinflammation. In this process, the inflammasome acquires special relevance;its stimulation promotes innate and adaptive immune responses. Inflamma some activation plays an important physiopathological role in several disorders with inflammatory and thrombotic phenomena. The role of thromboinflammation has become relevant in the COVID-19 pandemic, in which a cytokine storm has been described as one of the mechanisms responsible. (C) 2020 Elsevier Espaila, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.

Inflammatory response in relation to COVID-19 and other prothrombotic phenotypes

A novel coronavirus (2019-nCoV) responsible for a severe acute respiratory disorder (SARS-CoV-2) in humans, with its epicentre in Wuhan, China emerged in December 2019. This coronavirus, by far, has hit >200 countries, affecting 7 million worldwide accounting 11% death of the affected population. The transmission is majorly caused by human-to-human contact and, through fomite. In view of the increasing number of COVID-19 cases and the absence of definitive treatment or vaccinations, WHO has deemed the viral infection a pandemic of international concern. In such grave situations, there is a need for expanding the health sector workforce, government and police workforce, sanitation and prevention strategies. The current article describes the virology aspect, control of COVID-19 and revisits the various treatment options available at present this deadly infection. Epidemiology of COVID-19 is also discussed to further understand the pandemic status of India. The article also discusses implicating quarantine or social distancing, and in extreme cases, lockdown or alternative approaches such as herd or indirect immunity, as a measure to control the pandemic. Lockdown or social distancing will give rise to economic, emotional, political and social downfall in the country. It is estimated that a lockdown period will set back the country, possibly, by $240 billion, yet it stands unavoidable in the spread of control of infection. Thus, policymakers should strategize economic revival depending upon the best possible data and critical understanding.

A Comprehensive Review of the Cross-Disciplinary Impact of COVID-19 in India