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Confronting Covid-19 by exploring the possibility of vaccinating with live SARS-CoV-2 virus itself, via a route that would reduce the incidence of pulmonary complications
This article proposes that one should explore whether the pulmonary complications of Covid-19 can be reduced or avoided by bypassing the airway entry of the SARS-CoV-2 virus. This could possibly be achieved by injecting live SARS-CoV-2 virus intradermal (ID), subcutaneous, intra-muscular (IM) or intra-peritoneal (IP), or by targeting the virus to the digestive tract. The effectiveness and innocuity of using those various routes could be tested very rapidly in animal models, such as Macaques, Hamsters, Ferrets or Cats. The hope is that these experiments will reveal a route of inoculation that can reliably lead to bona-fide infections, resulting in strong immune responses, with both cellular and serological components, but with much less viral replication in the lungs. This would not only hopefully reduce the incidence of pulmonary complications in the infected subjects, but would also probably reduce the amount of virus released by them via aerosols, and thus reduce the vector of contagiosity that is hardest to control, and that probably leads most effectively to viral replication in the lungs. If those experiments in animal models reveal that one or several routes can be used effectively to reduce pulmonary pathology, a clinical trial could be conducted in human volunteers with very low risk profiles. The ID route should probably be considered as a priority, since it could double-up as a skin test to reveal the immune status of the recipients towards the SARS-CoV-2 virus. The course of action proposed here may possibly provide a way of taking a step ahead of the virus, and if it works as hoped, could help to end the need for confinement within a matter of months, if not weeks.
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Review on Dynamics of Offshore Floating Wind Turbine Platforms
This paper presents a literature review of the dynamics of offshore floating wind turbine platforms. When moving further offshore, there is an increase in the capacity of wind power. Generating power from renewable resources is enhanced through the extraction of wind energy from an offshore deep-water wind resource. Mounting the turbine on a platform that is not stable brings another difficulty to wind turbine modeling. There is a need to introduce platforms that are more effective to capture this energy, because of the complex dynamics and control of these platforms. This paper highlights the historical developments and progresses in the design of different types of offshore floating wind turbine platforms needed for harvesting the energy from offshore winds. The relative advantages and disadvantages of the platform types with the design challenges are discussed. The major types of floating platforms included in this study are tension leg platform (TLP) type, spar type, and semisubmersible type. This study reviews the previous work on the dynamics of the floating platforms for a single turbine and multiple turbines under various operating environmental conditions. The numerical methods to analyze the aerodynamics of the wind turbine and hydrodynamics of floating platforms are discussed in this paper. This paper also investigates the performance of analytical wake loss models of Jensen, Larsen, and Frandsen that can provide guidelines for using these wake models in future applications. There are still a lot of challenges that need to be addressed to study the accurate behavior of floating platforms operating under combined wind–wave environmental conditions. With the current technological advancements, the offshore floating multi-turbine platform can be a potential solution to harness the abundant offshore wind resource. Based on this literature review, recommendations for future work are suggested.
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A rare case of macroprolactinoma in a patient with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.
Summary A 17-year-old lady presented with primary amenorrhoea, headache, nausea and lethargy. She had delayed pubertal development that also includes under-developed breast (Tanner Stage 2). Hormonal investigations showed a high serum prolactin level of 1 680 000 mIU/L (normal value: 45-375 mIU/L), with low oestradiol, progesterone, follicular-stimulating hormone and luteinizing hormone. Early morning cortisol level was 206 nmol/L (normal value: >450 nmol/L), thyroxine was 7.5 pmol/L (normal value: 9.0-24.0 pmol/L) with TSH 5.091 mIU/L (normal value: 0.4-4.5 mlU/L). A pituitary MRI showed a 2.7 (AP) × 3.7 (W) × 4.6 cm (CC) macroadenoma, with invasion into the left cavernous sinus and encasement of cavernous portion of the left internal carotid artery. MRI pelvis showed absent uterus, cervix and 2/3 upper vagina confirming Mullerian hypoplasia. Cytogenetics showed 46XX. These findings were suggestive of Mayer-Rokitansky-Kauser-Hauser (MRKH) syndrome with the presence of a pituitary macroprolactinoma and panhypopituitarism. She was treated with hydrocortisone, levothyroxine and cabergoline. Repeated MRI showed a reduction in tumour size by approximately 50%. This case illustrated a rare coexistence of these two conditions, being only the third reported case in the world. In addition, this would be the first case of a functioning pituitary adenoma in a patient with MRKH syndrome. Learning points Comprehensive hormonal and radiological investigations are important in the management of a young patient with primary amenorrhoea. Coexistence pathology of two separate pathologies should be considered in patient presenting with primary amenorrhoea. Early diagnosis of MRKH or any disorders of sex development should be treated early, providing pharmacological, surgical, psychological and emotional support to the patient and reducing risk of associated complications. Abnormal pituitary hormones, particularly panhypopituitarism, would impose greater impact not only psychologically but also metabolically leading to cardiovascular, morbidity and mortality risks in this patient if not treated early. A multidisciplinary approach is necessary for patients presenting with MRKH to ensure appropriate treatments and follow-up across the lifespan of the patient.
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Distinct Immune Response at 1 Year Post-COVID-19 According to Disease Severity
BACKGROUND: Despite the fact of ongoing worldwide vaccination programs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), understanding longevity, breadth, and type of immune response to coronavirus disease-19 (COVID-19) is still important to optimize the vaccination strategy and estimate the risk of reinfection. Therefore, we performed thorough immunological assessments 1 year post-COVID-19 with different severity. METHODS: We analyzed peripheral blood mononuclear cells and plasma samples at 1 year post-COVID-19 in patients who experienced asymptomatic, mild, and severe illness to assess titers of various isotypes of antibodies (Abs) against SARS-CoV-2 antigens, phagocytic capability, and memory B- and T-cell responses. FINDINGS: A total of 24 patients (7, 9, and 8 asymptomatic, mild, and severe patients, respectively) and eight healthy volunteers were included in this study. We firstly showed that disease severity is correlated with parameters of immune responses at 1 year post-COVID-19 that play an important role in protecting against reinfection with SARS-CoV-2, namely, the phagocytic capacity of Abs and memory B-cell responses. INTERPRETATION: Various immune responses at 1 year post-COVID-19, particularly the phagocytic capacity and memory B-cell responses, were dependent on the severity of the prior COVID-19. Our data could provide a clue for a tailored vaccination strategy after natural infection according to the severity of COVID-19.
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Critically Ill Patients with Middle East Respiratory Syndrome Coronavirus Infection
The Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging virus that may lead to severe acute respiratory illness frequently associated with multiorgan failure and death. The objective of this chapter is to summarize the current state of knowledge regarding the pathogenesis, clinical manifestations, diagnosis, management and outcomes of MERS-CoV infection focusing on the critically ill.
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Design Performance and Frequency Response Analysis of SAW-Based Sensor for Dichloromethane Gas Sensing Amidst the COVID-19
BACKGROUND: To avoid the risk of increase in the rate of human infection is a big challenge for healthcare staffs during the treatment of patients affected from corona virus disease-2019 (COVID-19). This work is intended to save COVID-19-infected patients from conveyed hazardous volatile gases (VOCs) by the gas stream. The VOCs are generally generated from the pathways of medical respiratory devices. METHOD: Here, we present a surface acoustic wave-based sensor device for sensing dichloromethane (DCM) gas that can be connected with a gas pathway system used in medical devices. Dichloromethane is a volatile organic compound. Single- (polyisobutylene, PIB) and multi- (polyisobutylene/silicon nitride, PIB/Si(3)N(4)) surface acoustic wave-based sensors are designed on LiNbO(3) piezoelectric substrate. The designed models patterned with interdigitated transducer (IDT) aluminum (Al) electrodes are used to analyze gas sensing behavior for dichloromethane (CH(2)Cl(2), DCM) gas. RESULTS: The studies for DCM gas sensing are carried out for single- and multi-layer models using COMSOL Multi-physics software. The resonant frequency and displacement are also observed for 100 ppm gas concentration of DCM at room temperature. It has been found that multi-layer designed model shows higher sensitivity as compared to single layer (PIB/LiNbO(3)) model on exposing DCM gas. CONCLUSION: The estimation of various parameters observed by the proposed module is also explained. It is observed that the sensitivity of sensor for detection of VOCs (generated in gas pathways in medical devices) is best suited in the present crisis of COVID-19 pandemic.
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A60 Revealing the evolution of virulence in RNA viruses
A combination of high rates of mutation and replication, coupled with strong natural selection, ensures that RNA viruses experience rapid genotypic and phenotypic evolution. Such a ‘fast-forward’ evolution enables viruses to rapidly adapt to new host species, evade host immune responses, and to develop resistance to anti-viral drugs. Similarly, rapid evolution allows viruses to attain new levels of virulence, defined as the ability to cause severe disease in hosts. We hypothesize that distinct viral groups share genetic determinants that modulate virulence that have been acquired through convergent evolution. Thus, common patterns reflecting changing virulence-related specific viral groups could be detected. The main goals for this project are (1) to understand how genetic and phenotypic diversity can be generated among different viral groups by analyzing the variation patterns and determining the selective forces behind them (impact in viral fitness) and (2) to understand how fixed mutations can modulate virulence within different viral groups by performing comparison of strains with differing virulence within a longitudinal timescale. The subject of the study is key emerging and re-emerging virus families of medical importance. Such groups include: Coronaviridae (severe acute respiratory syndrome and Middle East respiratory syndrome-associated coronaviruses), Picornaviridae (Hepatitis A virus), Flaviviridae (Yellow fever, West Nile, Hepatitis C, Dengue, and Zika viruses), Togaviridae (Rubella and Chikungunya virus), Bornaviridae (Borna-disease virus), Filoviridae (Ebola and Marburg viruses), Paramyxoviridae (Measles, Nipah, and Hendra viruses), Rhabdoviridae (Lyssaviruses), Arenaviridae (Lassa virus), Bunyaviridae (Hanta- and Crimean-Congo hemorrhagic fever viruses), and Orthomyxoviridae (Influenza A viruses). Viral genomes collected at different time points, different hosts (human and their most closely related animal reservoirs) and different locations will be compiled. Extensive molecular evolutionary analyses will be carried out to infer gene expansion/contraction within groups, rates of evolution, and changes in selection pressure, including the detection of positive selected genes and sites (adaptive evolution). Positively selected sites will be mapped onto the viral protein structures to reveal their impact on function, and hence the location of potential virulence determinants. Virulence changes among particular viral strains and types will be defined and measured according to definitions based on an increase in: (1) transmissibility, (2) host tropism, (3) immune evasion, (4) morbidity and mortality, (5) drug resistance, and by the incorporation of epidemiological data to determine whether high or low virulence strains within different hosts and localities are spreading most efficiently in nature.
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It's a (vital) Sign: How Post-covidien Interagency Collaboration Can Prevent Future Medical Device Shortages
I feel like I'm trying to ventilate bricks instead of lungs," remarked one intensive care unit physician who has been treating COVID-19 patients for the last several months. The change in lung texture encountered by practitioners handling severe COVID-19 cases is caused by a potentially lethal presentation of acute respiratory distress syndrome (ARDS), in which "breathing becomes impossible without a ventilator. Ventilators are not curative, but they are essential in some cases: they keep the body alive while it fights infection. The US Food and Drug Administration (FDA) endorses innovative solutions, often devised by nurses tinkering with old machine parts. While adapting simple machines is preferable to using a pseudo-ethical algorithm to ration available ventilators, it is a risky endeavor. Provisional devices--like those that siphon air into multiple tubes to service two patients at once--and emergency triage techniques, are suboptimal fixes employed against a lifethreatening ventilator shortage.
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COVID-19 Lockdown Measures: Impact On Older Adults With Dementia And Their Caregivers In Singapore
Family caregivers typically rely on community-based services and social support networks to supplement their caregiving of older adults with dementia (OAwD). In April 2020, the Singapore government implemented a partial lockdown to contain the spread of COVID-19. We assessed the policy's impact on the physical and mental health of caregivers and their OAwD. As part of a larger study, 30 caregivers were interviewed and rated the stress they experienced when caring for an OAwD during the partial lockdown. Qualitative analyses found significant behavioral changes in OAwD such as irritability, aggression and hallucinations, which led some caregivers to believe their dependents’ condition had deteriorated, as well as heightened levels of caregiving stress. Overall, our preliminary results suggested that although social distancing measures may be effective in containing the spread of COVID-19, these measures could lead to negative outcomes on vulnerable populations such as OAwD and their caregivers.
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Taking a Health Perspective on Roller Derby: A Qualitative Exploration of Women’s Experiences
Although far fewer women exercise regularly than men, one women-dominated sport growing in popularity internationally is roller derby. A limited number of predominantly US-based and qualitative studies have explored roller derby. This Scotland-based qualitative study explored reasons for women starting, continuing, and stopping participation in roller derby in order to inform people involved in promoting physical activity for health benefits. Semi-structured interviews with six participants from a Scottish women’s roller derby league were recorded and transcribed verbatim. Data analysis using Interpretative Phenomenological Analysis generated five super-ordinate themes. Most participants learned about roller derby from watching the sport on film, attending a bout (game), or word of mouth. The main motivators and benefits of participating in this sport were found to be challenge, enjoyment, increased confidence, health benefits, and motivation to exercise. Participants were empowered by involvement and motivated by community, team spirit, and support to develop. Despite high commitment, some women could not sustain team involvement due to barriers such as injury, changing life roles, and conflicting commitments—a lack of support was described when this happened. Greater inclusivity is needed to enable changing levels of participation as women’s commitments change, to facilitate ongoing health benefits and inspire others.
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Central Nervous System Manifestations of COVID-19: A Critical Review and Proposed Research Agenda.
OBJECTIVE On March 11, 2020, the World Health Organization declared an outbreak of a new viral entity, coronavirus 2019 (COVID-19), to be a worldwide pandemic. The characteristics of this virus, as well as its short- and long-term implications, are not yet well understood. The objective of the current paper was to provide a critical review of the emerging literature on COVID-19 and its implications for neurological, neuropsychiatric, and cognitive functioning. METHOD A critical review of recently published empirical research, case studies, and reviews pertaining to central nervous system (CNS) complications of COVID-19 was conducted by searching PubMed, PubMed Central, Google Scholar, and bioRxiv. RESULTS After considering the available literature, areas thought to be most pertinent to clinical and research neuropsychologists, including CNS manifestations, neurologic symptoms/syndromes, neuroimaging, and potential long-term implications of COVID-19 infection, were reviewed. CONCLUSION Once thought to be merely a respiratory virus, the scientific and medical communities have realized COVID-19 to have broader effects on renal, vascular, and neurological body systems. The question of cognitive deficits is not yet well studied, but neuropsychologists will undoubtedly play an important role in the years to come.
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Teachers in COVID-19 period: Psychological effects, practices and career needs
The purpose of the current study was to examine teachers' career needs and psychosocial experience during the COVID-19 pandemic within the phenomenological pattern of qualitative research methods. The data collection process included individual interviews and an online survey form. As a result of the research, four main themes were obtained. The first of these themes concerned the effects of the COVID-19 process on teachers. These effects were divided into both positive and negative effects. The second main theme focused on the needs of teachers. In this process, teachers felt the need for psychological support, in-service training and support for infrastructure. The third main theme was the professional life of teachers and school counselors. In this process, teachers and school counselors continued their education, teaching and support processes by adapting them to the online environment. The last main theme was the problems experienced in this process and the proposed solutions. Participants highlighted problems in this period, particularly the access of students to education. Recommendations were made as part of the research results to strengthen the educational training activities offered by teachers in the COVID-19 period.
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ADHD symptoms in relation to depressive and sleep-related symptoms among university students during the COVID-19 outbreak in Japan
Background: The COVID-19 pandemic and its associated societal response are anticipated to have wide-ranging effects on youth development and mental health. The three most common mental health problems among university students are depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). Many factors that can threaten the mental health during the outbreak affect these three conditions as well as the sleep conditions of the undergraduate students. Thus, determining how these abrupt changes in students’ circumstances will impact their mental health is very important from a public health perspective. Objective: We investigated both usual conditions and changes during the outbreak in sleep, depression, and ADHD symptoms among undergraduate students. Methods: : A total of 252 students, primarily juniors answered the online survey. Results: : As a result, 12% of the students exceeded the cutoff score of the ADHD questionnaire before the pandemic and approximately 6-21 % of the students especially with ADHD traits rated their ADHD behaviors as worse during the outbreak. Additionally, changes in circadian rhythm, depression, and ADHD symptoms are intertwined and often create a vicious cycle. Conclusion: This study suggested that students with ADHD-trait is more susceptible to further deterioration in their daily lives during the pandemic. In case it is difficult to intervene with ADHD symptoms, approaching circadian rhythm or depression will be of clinical use.
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Influence of recent administration and type of oncological treatment (T) in survival of oncological patients (p) with COVID-19: Experience of Vall d'Hebron University Hospital
Background: SARS-CoV-2 outbreak has impacted on the management of oncological p, leading to treatment delays in a considerable number of cases The aim of this study was to evaluate if oncological T affected negatively COVID-19 outcome Methods: We retrospectively analyzed clinical data from p with solid tumors under active systemic T (received in the last 6 months) that were diagnosed with SARS-CoV-2 infection (defined as positive PCR) between March and 11th May 2020 in our center Study endpoint was death due to COVID-19 We divided the patients in two groups;those who had received treatment in the last 4 weeks and those who had not Descriptive and univariate analysis were performed to detect the effect of T type and other variables on COVID-19 related mortality Results: A total of 70 p were included with a median follow-up of 28 days (10-47) and active oncological T had been administered in the past 4 weeks to 44 p Median age was 66 (IQR 56-74), 23 p (52 27%) were female and 41 (93 2%) had a baseline ECOG≤1 The most frequent primary site was lung tumor (12 p [27 3%]), followed by breast (11 p [25%]) and gastrointestinal (5 p [11 4%]) Thirty-one p (70 5%) had metastatic disease and 13 (29 5%) were included in clinical trials Twenty-four p (54 5%) received chemotherapy (CT), 14 (31 8%) targeted therapies, 9 (20 4%) immunotherapy (IT), 5 (11 4%) radiotherapy and 6 (13 6%) hormonotherapy A total of 13 p (29 5%) received different combinations of oncological T Death due to COVID-19 occurred in 5/22 (22 7%) p receiving CT and 6/21 (28 5%) p in the non-CT (p>0 05) Only 1/9 (11 1%) p treated with IT died compared to 11/35 (31 4%) p in the rest of the cohort (p>0 05) Age>71, comorbidities such as chronic obstructive pulmonary disease and ECOG status>2 were associated to a higher mortality The distribution of these variables between the anticancer T groups was not different Conclusions: Our results suggest that CT and other anticancer T might not worsen COVID-19 related mortality;nevertheless, the number of patients was small and decision making has to be individualized Our findings may warrant further investigation in larger studies Legal entity responsible for the study: The authors Funding: Has not received any funding Disclosure: E Felip: Advisory/Consultancy, Speaker Bureau/Expert testimony: AbbVie;AstraZeneca;Blueprint medicines;Boehringer Ingelheim;Bristol-Myers Squibb;Celgene;Eli Lilly;Guardant Health;Janssen;Medscape;Merck KGaA;Novartis;Pfizer;Roche;Takeda;Touchtime;Research grant/Funding (self), Research grant/Funding (institution): Fundación Merck Salud;Oncology Innovation EMD Serono J Carles: Advisory/Consultancy, Speaker Bureau/Expert testimony: Johnson & Johnson;Bayer;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (self): Astellas Pharma;Advisory/Consultancy: Pfizer;Sanofi;MSD Oncology;Advisory/Consultancy, Research grant/Funding (self): Roche;Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: AstraZéneca;Speaker Bureau/Expert testimony: Asofarma;Research grant/Funding (self), Travel/Accommodation/Expenses: BMS;ravel/Accommodation/Expenses: Ipsen;Roche;Research grant/Funding (self): AB Science;Aragon Pharmaceuticals;Pharmaceuticals;INC;Blueprint Medicines Corporation;N Immunotherapeutics INC;Boehringer Ingelheim España, S A ;Clovis Oncology;Cougar Biotechnology INC;Deciphera Pharmaceuticals LLC;Exelixis INC;F Hoffmann-La Roche LTD;Genentech INC;Glaxosmithkline;Incyte Corporation;Janssen-Cilag International NV;Karyopharm Therapeutics INC;Laboratoires Leurquin Mediolanum SAS J Tabernero: Honoraria (self): Array Biopharma;AstraZeneca;Bayer;BeiGene;Boehringer Ingelheim;Chugai;Genentech;Genmab A/S;Halozyme;Imugene Limited;Inflection Biosciences Limited;Ipsen;Kura Oncology;Lilly;MSD;Merck Serono;Menarini;Merrimack;Merus;Molecular Partners;Novartis;Peptomyc;Pfizer;Pharmacyclics;ProteoDesign SL;Rafael Pharmaceuticals;F Hoffmann-La Roche Ltd;): Sanofi;eaGen;Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS and Roche Diagnostics All other authors have declared no conflicts of interest
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COVID-19: Fear of pandemic and short-term IPO performance
This study analyzes the relationship between COVID-19 related fear and short-term IPO performance. Though the average market-adjusted initial return of IPOs in the year 2020 is higher than that of the last four decades, it decreases if fear of pandemic increases. The evidence is robust when we use matching firm-adjusted initial returns. Next, we analyze the persistence of performance after the IPO date. The results show that the performance of IPO firms is more sensitive to the fear of the pandemic than the performance of similar existing firms.
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A New Assessment of Bicycle Helmets: The Brain Injury Mitigation Effects of New Technologies in Oblique Impacts
New helmet technologies have been developed to improve the mitigation of traumatic brain injury (TBI) in bicycle accidents. However, their effectiveness under oblique impacts, which produce more strains in the brain in comparison with vertical impacts adopted by helmet standards, is still unclear. Here we used a new method to assess the brain injury prevention effects of 27 bicycle helmets in oblique impacts, including helmets fitted with a friction-reducing layer (MIPS), a shearing pad (SPIN), a wavy cellular liner (WaveCel), an airbag helmet (Hövding) and a number of conventional helmets. We tested whether helmets fitted with the new technologies can provide better brain protection than conventional helmets. Each helmeted headform was dropped onto a 45° inclined anvil at 6.3 m/s at three locations, with each impact location producing a dominant head rotation about one anatomical axes of the head. A detailed computational model of TBI was used to determine strain distribution across the brain and in key anatomical regions, the corpus callosum and sulci. Our results show that, in comparison with conventional helmets, the majority of helmets incorporating new technologies significantly reduced peak rotational acceleration and velocity and maximal strain in corpus callosum and sulci. Only one helmet with MIPS significantly increased strain in the corpus collosum. The helmets fitted with MIPS and WaveCel were more effective in reducing strain in impacts producing sagittal rotations and a helmet fitted with SPIN in coronal rotations. The airbag helmet was effective in reducing brain strain in all impacts, however, peak rotational velocity and brain strain heavily depended on the analysis time. These results suggest that incorporating different impact locations in future oblique impact test methods and designing helmet technologies for the mitigation of head rotation in different planes are key to reducing brain injuries in bicycle accidents.
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A Study of Dignity as a Principle of Service Design
This paper upholds the premise that dignity is a fundamental principle of human-centered design. I argue that consideration of dignity is particularly important in service design, as service concerns the collective participation of people with diverse backgrounds and needs. Service often starts with situations in which strangers meet for the first time and must collaborate to co-produce a service, which can sometimes lead to conflicts. This paper explores four perspectives of dignity that are grounded in utilitarian, humanistic, individual, and collective bases: dignity as merit, autonomy, universal rights, and interpersonal care. Key philosophical interpretations, social backgrounds, and historical shifts related to the concept of dignity are introduced, with design examples that reflect each of its dimensions. I then present research questions based on each concept of dignity and propose a research agenda to utilize the pluralistic framework of dignity in service design.
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Does healthcare system device volume correlate with price paid for spinal implants: a cross-sectional analysis of a national purchasing database
OBJECTIVES: Amid continuously rising US healthcare costs, particularly for inpatient and surgical services, strategies to more effectively manage supply chain expenses are urgently necessary. Across industries, the ‘economy of scale’ principle indicates that larger purchasing volumes should correspond to lower prices due to ‘bulk discounts’. Even as such advantages of scale have driven health system mergers in the USA, it is not clear whether they are being achieved, including for specialised products like surgical implants which may be more vulnerable to cost inefficiency. The objective of this observational cross-sectional study was to investigate whether purchasing volumes for spinal implants was correlated with price paid. SETTING: USA. PARTICIPANTS: Market data based on pricing levels for spine implants were reviewed from industry implant price databases. Filters were applied to narrow the sample to include comparable institutions based on procedural volume, patient characteristics and geographical considerations. Information on the attributes of 619 health systems representing 12 471 provider locations was derived from national databases and analytics platforms. PRIMARY OUTCOME MEASURE: Institution-specific price index paid for spinal implants, normalised to the national average price point achieved. RESULTS: A Spearman’s correlation test indicated a weak relationship between purchasing volume and price index paid (ρ=−0.35, p<0.001). Multivariable linear regression adjusting for institutional characteristics including type of hospital, accountable care organisation status, payer-mix, geography, number of staffed beds, number of affiliated physicians and volume of patient throughput also did not exhibit a statistically significant relationship between purchasing volume and price index performance (p=0.085). CONCLUSIONS: National supply chain data revealed that there was no significant relationship between purchasing volume and price paid by health systems for spinal implants. These findings suggest that factors other than purchasing or patient volume are responsible for setting prices paid by health systems to surgical vendors and/or larger healthcare systems are not negotiating in a way to consistently achieve optimal pricing.
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Identification and prediction of time-varying parameters of COVID-19 model: a data-driven deep learning approach
Data-driven deep learning provides efficient algorithms for parameter identification of epidemiology models. Unlike the constant parameters, the complexity of identifying time-varying parameters is largely increased. In this paper, a variant of physics-informed neural network is adopted to identify the time-varying parameters of the Susceptible-Infectious-Recovered-Deceased model for the spread of COVID-19 by fitting daily reported cases. The learned parameters are verified by utilizing an ordinary differential equation solver to compute the corresponding solutions of this compartmental model. The effective reproduction number based on these parameters is calculated. Long Short-Term Memory neural network is employed to predict the future weekly time-varying parameters. The numerical simulations demonstrate that PINN combined with LSTM yields accurate and effective results. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Computer Mathematics is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Aspiration thrombectomy in ST-Elevation myocardial infarction: Further insights from a network meta-analysis of randomized trials
BACKGROUND: The initial enthusiasm for thrombectomy during percutaneous coronary intervention (PCI) of ST-elevation myocardial infarction (STEMI) patients has given way to restraint. There has been some limited interest whether it is beneficial in a few selected subgroups. Hence, we performed a network meta-analysis to compare conventional PCI (cPCI), Aspiration or manual thrombectomy (AT) and Mechanical thrombectomy (McT) for clarification. METHODS: Electronic databases were searched for randomized studies that compared AT, McT, or cPCI. A network meta-analysis was performed and odd’s ratio (OR) with 95% confidence intervals was generated for major adverse cardiac events (MACE), mortality, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), stroke, left ventricular ejection fraction (LVEF), myocardial blush grade (MBG) and ST segment resolution (STR). RESULTS: A total of 43 randomized trials (n = 26,682) were included. The risk of MACE (OR 0.86 95% CI 0.73–1.00), Mortality (OR 0.85 95% CI 0.73–0.99), MI (OR 0.65, 95% CI: 0.44–0.95) and TVR (OR 0.86, 95% CI: 0.74–1.00) were lower with AT compared to cPCI. The risk of ST and stroke was no different with the use of adjunctive AT. MBG, STR, and LVEF improved with the use of AT while the infarct size was no different in the two groups. CONCLUSIONS: Our comprehensive network meta-analysis suggests conflicting outcomes with AT. While Mortality, MACE, MI seem better, there is a suggestion that, Stroke and ST might be worse. Whether AT can still be pursued in any select cases should be further scrutinized.
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Creating healthful cultures through Critical Creativity: Working with the body senses, reflection, connection with Nature, ancient wisdom & creative imagination
During Covid lockdown in 2021, I was invited to offer a masterclass to masters students at Queen Margaret University, Edinburgh: 'In the leadership module we have a masterclass, groupwork, study time and a plenary that ties together. We even have a book club!!! The aim is to be generic, not nursing/health focused. The learners make space to consider application in their own areas/specialisms. 'We were wondering if you would like to/could do a masterclass within the strand of healthfulness. We really value your storytelling and know you are really passionate about healthfulness from an ecological perspective. We would love it if you could draw on your experiences of politics, environment... The more creative the better. 'We would want learners to consider their role in creating healthful cultures and ways that they might go about it.' How could I resist, given my decades-long passion for transformational practice development and inquiry within a critical creativity landscape in health and social care? In my retirement, I have continued to work successfully in this way in a variety of contexts, including political activism. I responded: 'I would love to show how healthful cultures can be created, with stories from my person-centred community engagement work in creating a neighbourhood plan [for 21st century local housing development] and campaigning for positive personal and community political responses to the climate and ecological emergency. Stories that show up something of how conditions can be created to enable the ecology of human flourishing to be embodied in action. Also, how I am seeing the stirrings of transformative change in local politics that have previously been very traditional in the way they work with people.' [ FROM AUTHOR] Copyright of International Practice Development Journal is the property of Foundation of Nursing Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Staphylococcus aureus Bacteremia in Patients Infected With COVID-19: A Case Series
Background: Previous viral pandemics have shown that secondary bacterial infections result in higher morbidity and mortality, with Staphylococcus aureus being the primary causative pathogen. The impact of secondary S. aureus bacteremia on mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Methods: This was a retrospective observational case series of patients with coronavirus disease 2019 (COVID-19) who developed secondary S. aureus bacteremia across 2 New York City hospitals. The primary end point was to describe 14-day and 30-day hospital mortality rates of patients with COVID-19 and S. aureus bacteremia. Secondary end points included predictors of 14-day and 30-day hospital mortality in patients with COVID-19 and S. aureus bacteremia. Results: A total of 42 patients hospitalized for COVID-19 with secondary S. aureus bacteremia were identified. Of these patients, 23 (54.8%) and 28 (66.7%) died at 14 days and 30 days, respectively, from their first positive blood culture. Multivariate analysis identified hospital-onset bacteremia (&#8805;4 days from date of admission) and age as significant predictors of 14-day hospital mortality and Pitt bacteremia score as a significant predictor of 30-day hospital mortality (odds ratio [OR], 11.9; 95% CI, 2.03-114.7; P = .01; OR, 1.10; 95% CI, 1.03-1.20; P = .02; and OR, 1.56; 95% CI, 1.19-2.18; P = .003, respectively). Conclusions: Bacteremia with S. aureus is associated with high mortality rates in patients hospitalized with COVID-19. Further investigation is warranted to understand the impact of COVID-19 and secondary S. aureus bacteremia.
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Targeting the CCL2/CCR2 Axis in Cancer Immunotherapy: One Stone, Three Birds?
CCR2 is predominantly expressed by monocytes/macrophages with strong proinflammatory functions, prompting the development of CCR2 antagonists to dampen unwanted immune responses in inflammatory and autoimmune diseases. Paradoxically, CCR2-expressing monocytes/macrophages, particularly in tumor microenvironments, can be strongly immunosuppressive. Thus, targeting the recruitment of immunosuppressive monocytes/macrophages to tumors by CCR2 antagonism has recently been investigated as a strategy to modify the tumor microenvironment and enhance anti-tumor immunity. We present here that beneficial effects of CCR2 antagonism in the tumor setting extend beyond blocking chemotaxis of suppressive myeloid cells. Signaling within the CCL2/CCR2 axis shows underappreciated effects on myeloid cell survival and function polarization. Apart from myeloid cells, T cells are also known to express CCR2. Nevertheless, tissue homing of Treg cells among T cell populations is preferentially affected by CCR2 deficiency. Further, CCR2 signaling also directly enhances Treg functional potency. Thus, although Tregs are not the sole type of T cells expressing CCR2, the net outcome of CCR2 antagonism in T cells favors the anti-tumor arm of immune responses. Finally, the CCL2/CCR2 axis directly contributes to survival/growth and invasion/metastasis of many types of tumors bearing CCR2. Together, CCR2 links to two main types of suppressive immune cells by multiple mechanisms. Such a CCR2-assoicated immunosuppressive network is further entangled with paracrine and autocrine CCR2 signaling of tumor cells. Strategies to target CCL2/CCR2 axis as cancer therapy in the view of three types of CCR2-expessing cells in tumor microenvironment are discussed.
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Score-Level Fusion of 3D Face and 3D Ear for Multimodal Biometric Human Recognition
A novel multimodal biometric system is proposed using three-dimensional (3D) face and ear for human recognition. The proposed model overcomes the drawbacks of unimodal biometric systems and solves the 2D biometric problems such as occlusion and illumination. In the proposed model, initially, the principal component analysis (PCA) is utilized for 3D face recognition. Thereafter, the iterative closest point (ICP) is utilized for 3D ear recognition. Finally, the 3D face is fused with a 3D ear using score-level fusion. The simulations are performed on the Face Recognition Grand Challenge database and the University of Notre Dame Collection F database for 3D face and 3D ear datasets, respectively. Experimental results reveal that the proposed model achieves an accuracy of 99.25% using the proposed score-level fusion. Comparative analyses show that the proposed method performs better than other state-of-the-art biometric algorithms in terms of accuracy.
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Factors Related to Non-compliance With Non-pharmaceutical Interventions to Mitigate the Spread of SARS-CoV-2: Results From a Survey in the Swiss General Adult Population
BACKGROUND: Non-pharmaceutical interventions (NPI) play an important role in national efforts to control and contain the spread of SARS-CoV-2, but some people do not comply with these public health measures. The aim of this study was thus to describe this group of noncompliant people. METHODS: A random sample of 1,157 people was drawn from the adult general population of Switzerland based on a three-stepped quota scheme considering the variables age (18–31, 32–45, 46–59, and ≥60 years), sex (male and female), and language region (German-, French-, and Italian-speaking Switzerland). We assessed a global scale of non-compliance with NPI based on several individual measures such as wearing face masks and social distancing. As predictor variables we included objective sociodemographic variables (e.g., age, sex) and easy measurable constructs (e.g., fears and worries about COVID-19, trust in medical experts). RESULTS: Out of 14 predictor variables tested, seven were statistically significantly associated with increased non-compliance with NPI: male sex, younger age, self-identification as low-risk group, judging the consequences of an infection with SARS-CoV-2 as non-serious, less worries and fears about the pandemic, not obtaining regular information from health authorities, and not trusting in medical experts. The most parsimonious multivariable prediction model included the variables younger age, low appraisal of negative consequences, less fear and worries, not obtaining regular information from health authorities, and not trusting in medical experts. The model accounted for 27.9% of variance explained in non-compliance with NPI. CONCLUSION: Young adults who perceive COVID-19 as mostly harmless/inconsequential and who ignore and/or mistrust information from health authorities and medical experts, are the population most likely to be noncompliant with NPI. These findings may help to target a group of people at high risk of infection and to efficiently concentrate educational and interventional public health measures.
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COVID-19 gender susceptibility and outcomes: A systematic review
BACKGROUND: Epidemiological differences between men and women have been reported with regards to sepsis, influenza and severe coronavirus infections including SARS-CoV and MERS-CoV. AIM: To systematically review the literature relating to men versus women on SARS-CoV-2 in order to seek differences in disease characteristics (e.g. infectivity, severity) and outcomes (e.g. mortality). METHODS: We searched 3 electronic databases up or observational studies reporting differences between men and women in the SARS-CoV-2 disease characteristics stated. We identified and included 47 studies, reporting data for 21,454 patients mainly from China. RESULTS: The unadjusted mortality rates of men were higher than those of women, with a mortality OR 0.51 [0.42, 0.61] (p<0.001) for women. The proportion of men presenting with severe disease and admitted to the intensive care unit (ICU) was also higher than that of women (OR 0.75 [0.60-0.93] p<0.001 and OR 0.45 [0.40-0.52] p<0.001 respectively). Adjusted analyses could not be conducted due to lack of data. CONCLUSION: COVID-19 may be associated with worse outcomes in males than in females. However, until more detailed data are provided in further studies enabling adjusted analysis, this remains an unproven assumption.
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COVID-19 Stress and Mental Health of Students in Locked-Down Colleges
The impact of the COVID-19 pandemic on the mental health of students in locked-down colleges remains obscure. This study aimed to explore influencing factors for the psychological impact of COVID-19 on Wuhan college students, post-traumatic stress symptoms in particular, so as to inform evidence-based strategy development to ameliorate such adverse impacts. An online survey was conducted from 26 to 29 April 2020, and 4355 students enrolled in Wuhan universities and colleges participated. Post-Traumatic Stress Disorder via the Impact of Event-Scale-Revised was assessed. COVID-19 disproportionately affected older male Master's and doctoral students living in Wuhan. The overall prevalence of PTSD was 16.3%. The three-level socio-interpersonal model of PTSD was empirically validated, and college students faced individual level risks such as infection with COVID-19, close relationship level risks such as family support (infection suspicion of family members, the loss of loved ones, and the family income decrease) and online course difficulties (little interaction, disturbing learning environment, and difficulty in adaption), and distant level risks such as excessive collection of personal information, estrangement of family relatives, and harassment and insult from strangers. The findings suggest the severity of the psychological impact of COVID-19. Mental health services reducing PTSD should be provided. Students who have lost loved ones and suffered family financial loss should be given particular care.
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Mask use among pedestrians during the Covid-19 pandemic in Southwest Iran: an observational study on 10,440 people
BACKGROUND: Many countries have recommended the use of face masks for general population in public places to reduce the risk of COVID-19 transmission. This study aims to estimate the prevalence of face mask usage and investigate about different types of face mask and their distribution among pedestrians in southwest Iran during the Covid-19 pandemic. METHODS: This cross-sectional study was conducted in August 2020 in Ahvaz, southwest Iran. Using a multistage sampling method, a total of 10,440 pedestrians selected from 8 urban districts and 92 neighborhoods of the city. The data gathered by observation method. Percentage, mean and standard deviation were used to describe the variables. Chi-square test, fisher exact test and Chi-square for trend used to assess relationship between two categorical variables. We used unconditional logistic regression model to control confounders. RESULTS: The most common age group was 10 to 39 years and 67.9% of the participants were male. The overall prevalence of face mask usage was 45.6% (95% CI, 44.6-46.5). In general, as the age increased, the prevalence of face mask use significantly increased (p for trend < 0.001). Women used face masks significantly higher than men (60.2% vs. 38.7%, p < 0.001). Among the pedestrians who used the mask, 75.6% wore facemask correctly. The most common type of facemask used by the pedestrians were surgical (medical) masks (63.8%). In total, the prevalence of facemask usage was significantly higher during a.m. (49.4%) compared to p.m. (43.9%), (p < 0.001). Besides, in our study, 1.7 and 0.3% of Pedestrians had worn gloves and shielded respectively. Women used shields and gloves significantly higher than men (3.6% vs. 0.7%, p < 0.001). Also, women used shields more than men (0.5% vs. 0.3%, p = 0.036). CONCLUSION: We concluded that the prevalence rate of face mask use in Ahvaz was fairly low especially in men and younger people. Hence, the observed rates probably cannot protect the community against COVID-19 spread. Therefore, it is important to implement educational programs as well as to establish laws and regulations governing the use of face masks in public places.
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Covid-19: Do Medical Students Know, Bother About, and Practise Preventive Measures in Malaysia?
Since December 2019, a novel coronavirus disease (COVID-19) creates a global threat Medical students are more susceptible to be infected by the virus This study aimed to assess COVID-19 related knowledge, attitude towards COVID-19, and preventive behaviours against COVID-19 among medical students within the first month of the onset of the outbreak in Malaysia We collect data from medical students using an online Google survey form Out of 696 students, 467 responded to the questionnaire The analysis revealed that the mean percentage of knowledge was (85 04), attitude (84 12), and preventive practice (77 75) respectively Hierarchical multiple linear regression analysis revealed that living with family (p0 05) We found a high level of COVID-19 related knowledge, attitude, and preventive practice against COVID-19 among medical students A sustained knowledge, attitude, and preventive behavioural strategy could play an ingredient in upholding the student’s learning and practice against any disease like COVID-19 © 2020
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Clinical Characteristics and Short-Term Outcomes of Chronic Dialysis Patients Admitted for COVID-19 in Metro Manila, Philippines
AIM: Data published on COVID-19 in the Filipino population, particularly those with end stage kidney disease (ESKD) are still lacking. METHODS: We performed a retrospective, observational study of 68 ESKD patients admitted with COVID-19 infection at a tertiary hospital in Metro Manila, Philippines from April 1, 2020 to July 31, 2020. We compared the clinical features, baseline laboratory data, treatment strategies and short-term outcomes between those who survived and those who died. We also determined the risk factors associated with mortality from COVID-19. RESULTS: Mean age was 54.5 years old, 66% were male. All patients admitted were on maintenance hemodialysis (HD). The most common presenting symptoms were dyspnea (57%), fever (47%) and cough (38%). There was an equal number of patients on high flow nasal cannula (17.7%) and invasive mechanical ventilation (17.7%). ICU admission was required in 17.7% of the cohort. In-hospital death occurred in 25% of the patients. Admission PaO(2)/FiO(2) (PF) ratios (162 ± 134 versus 356 ± 181; p=0.0009) were lower, and procalcitonin (6.07 ± 10.5ng/mL versus 0.73 ± 3.61 ng/mL; p=0.02), lactate dehydrogenase (396 ± 274U/L versus 282 ± 148 U/L; p=0.03), and white blood cell counts (10 ± 7.3 x 10(9)/L versus 6.3 ± 4.2 x 10(9)/L; p= 0.0039) were significantly higher among those who died compared to those who survived. After adjusting for confounders, only low PF ratio (HR 1.01 for every unit decrease, 95% CI 1–1.01) and need for ventilation (HR 6.45, 95% CI 1.16–35.97) conferred a significant risk for in-hospital mortality. CONCLUSION: Short-term, in-hospital mortality is high among patients on chronic hemodialysis admitted for COVID-19 infection. They present similarly with the general population. Low PF ratio on admission and need for ventilation are independent risk factors for in-hospital mortality.
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Differences between COVID-19 and suspected then confirmed SARS-CoV-2-negative pneumonia: A retrospective study from a single center
Coronavirus disease 2019 (COVID-19) broke out in Wuhan, Hubei, China in December 2019. Tens thousands of people have been infected with the disease. Our aim was to distinguish severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients from SARS-CoV-2-negative patients. We retrospectively compared the data of COVID-19 patients with those of suspected and confirmed SARS-CoV-2-negative patients (control patients). There were 78 COVID-19 patients and 26 control patients, whose median ages were significantly different (P = .001). The percentage of COVID-19 patients admitting exposure to Wuhan was obviously higher than that of control patients (X2 = 29.130; P < .001). Fever and cough appeared more frequently in COVID-19 patients than in the control patients. The routine blood workup parameters of COVID-19 patients did not change much and their mean counts were in the normal range. There were 38.5% of control patients had higher procalcitonin (PCT) levels than 0.5 ng/mL, which was significantly higher than that percentage of COVID-19 patients (X2 = 22.636; P < .05), and COVID-19 patients were also more likely to have decreased or normal urea and creatinine levels than control patients (X2 = 24.930, 8.480; P < .05).Younger age, exposure to Wuhan, fever, cough, and slight changes in routine blood workup parameters, urea and creatinine were important features discriminating COVID-19 from control patients. Slightly increased, but far less than 0.5 ng/mL, PCT levels also differentiated COVID-19 patients from control patients.
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Challenges Faced by Nursing Home Direct Care Workers During the COVID-19 Pandemic: A Comparison Across Care Settings
The COVID-19 pandemic has generated awareness of the value of the direct care workforce to provide care in settings serving those most at risk from the disease. However, few studies have gauged the impact of COVID-19 on this workforce and their pandemic-related challenges. The purpose of this study was to examine the challenges and stress experienced by direct care workers (N=1,414) and their perceptions of preparation and quality of employer communication during this health crisis. Nursing home (NH) workers reported separation from family members and understaffing as the top external and work-related challenges. They felt adequately prepared and gave their employers high marks for communicating with them during the pandemic. NH direct care workers were more likely to report increased workload and understaffing as a challenge compared to workers in home and community-based settings. They also experienced a significantly higher number of work-related challenges compared to workers in assisted living.
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The two-year deadline to complete the International Seabed Authority’s Mining Code: Key outstanding matters that still need to be resolved
The International Seabed Authority (ISA) is an autonomous international organization established under the UN Convention on the Law of the Sea 1982 (UNCLOS) to organize and control the exploration for and exploitation of seabed mineral resources in areas beyond the limits of national jurisdiction. A system for exploration of mineral resources have been in existence for some time now and the ISA is currently in the midst of developing regulations for exploitation activities. Between 2014 and 2020, the ISA has made considerable progress in respect of the latter. However, with the COVID-19 pandemic, most of the work of the ISA, including the development of regulations for exploitation, have been on hiatus since March 2020. In late June 2021, the Republic of Nauru invoked a legal provision that essentially compels the ISA to accelerate the completion of the exploitation regulations. If the ISA fails to complete this within the prescribed time of two years, i.e. by July 2023, the ISA would have to consider and decide upon applications for mining contracts notwithstanding the absence of the exploitation regulations. Two years is not a long period, especially given that the COVID-19 pandemic continues to prevent member States from meeting in person at the ISA to continue negotiations on the exploitation regulations. Moreover, apart from having to resolve outstanding matters in relation to the exploitation regulations, the ISA would also need to address numerous other matters that intrinsically connect to the design of a functional system of exploitation. This paper reflects upon the key outstanding matters, both within and outside the exploitation regulations, which the ISA would need to urgently address and resolve within the two-year deadline.
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The future of non-financial businesses reporting: Learning from the Covid-19 pandemic
Abstract In this paper we conceptually identify the gap in the literature about lack of business's awareness in non -financial activities, especially biodiversity, which can be responsible for crisis like Covid-19 which can adversely affect the global economy We recommend approaches to existing business about how to enhance the quality of reporting by considering non-human element in reporting and making it more comprehensive for the stakeholders We adopt Actor Network Theory (ANT) and the Natural Inventory Model to support our argument that nature consists of both human and non-human From our observation about the Covid-19 crisis and by consulting the existing relevant literature on CSR, Covid-19, non-financial reporting and integrated reports (IR), we propose the implication of non-financial reporting by companies based on a theoretical framework We recommend that companies should implement/adopt Circular Economy concept for sustainable business model and report on biodiversity and extinction accounting in more structured and mandatory way via producing IR to create value on short, medium and long terms This is the first paper to tackle the Covid-19 crisis and offer solution for future reporting The findings will add value in the academia and society
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The Gravitational Bending of Acoustic Schwarzschild Black Hole
Acoustic black hole is becoming an attractive topic in recent years, for it open-up new direction for experimental explorations of black holes. In this work, the gravitational bending of acoustic Schwarzschild black hole is investigated. The gravitational deflection angle of particles traveling along null geodesics, weak gravitational lensing and Einstein ring for acoustic Schwarzschild black hole are carefully studied and analyzed. Particularly, in the calculation of gravitational deflection angle, we resort to two approaches -- the Gauss-Bonnet theorem and the geodesic method. The results show that the gravitational bending effect in acoustic Schwarzschild black hole is enhanced, compared with those in conventional Schwarzschild black hole. This result indicates that the acoustic black holes may be more easily detectable in gravitational bending and weak gravitational lensing observations.
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Rates of Acute Myocardial Infarction During the COVID-19 Pandemic
BACKGROUND: During the early phases of the COVID-19 pandemic pandemic, stay-at-home orders and fear of acquiring COVID-19 may have led to an avoidance of care for medical emergencies, including acute myocardial infarction (AMI). We evaluated whether a decline in rates of AMI occurred during the COVID-19 stay-at-home order. METHODS: Rates of AMI per 100,000 member-weeks were calculated for Kaiser Permanente Southern California patients from January 1 to March 3, 2020 (prepandemic period) and from March 20 to July 31, 2020 (pandemic period), and during the same periods in 2019. Rate ratios (RRs) were calculated comparing the time periods using Poisson regression. Case fatality rates (CFRs) were also compared. RESULTS: Rates of AMI were lower during the pandemic period of 2020 compared to the same period of 2019 [3.20 vs 3.76/100,000 member-weeks; RR, 0.85; 95% confidence interval (CI) 0.80-0.90]. There was no evidence that rates of AMI differed during the 2020 prepandemic period compared to the same period in 2019 (4.45 vs 4.24/100,000 member-weeks; RR, 0.95; 95% CI, 0.88-1.03). AMI rates were lower during the early pandemic period (March 20-May 7: RR, 0.70; 95% CI, 0.66-0.77), but not during the later pandemic period (May 8-July 31: RR, 0.95; 95% CI, 0.88-1.02) compared to 2019. In-hospital and 30-day case fatality rates were higher during the pandemic period of 2020 compared to 2019 (8.8% vs 6.1% and 6.5% vs 5.0%, respectively). CONCLUSION: AMI rates were lower during the COVID-19 pandemic compared to the same period in 2019. During stay-at-home orders, public health campaigns that encourage people to seek care for medical emergencies are warranted.
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A Review of the Current Status of Clinical Management of COVID-19 in the Elderly
The high infectivity and severity of SARS-CoV-2 infection (COVID-19), and our limited understanding of the biology of the novel coronavirus, as well as the lack of an effective treatment for COVID-19, have created a global pandemic. Those most likely to become seriously ill with COVID-19 are adults, especially the elderly and those who are already weak or sick. At present, a specific drug for treatment of COVID-19 has not been developed. This, combined with the typical coexistence of a variety of chronic diseases in elderly patients, makes treatment challenging at present. In addition, for elderly patients, COVID-19 isolation measures during the epidemic can easily lead to psychological problems. Thus, how to manage elderly patients has become a focus of social attention in the current circumstances. This article reviews the effects of COVID-19 and makes management suggestions for elderly patients during this epidemic period. In addition to the elderly, critically ill people are also highly susceptible to this novel coronavirus. For elderly COVID-19 patients, antiviral therapy, immune regulation, and even auxiliary respiratory therapy can be given after a comprehensive evaluation of the disease. With the approval and use of COVID-19 vaccines, it is reasonable to expect that we can conquer SARS-CoV-2.
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Stay-at-home orders, social distancing, and trust
A clear understanding of community response to government decisions is crucial for policy makers and health officials during the COVID-19 pandemic. In this study, we document the determinants of implementation and compliance with stay-at-home orders in the USA, focusing on trust and social capital. Using cell phone data measuring changes in non-essential trips and average distance traveled, we find that mobility decreases significantly more in high-trust counties than in low-trust counties after the stay-at-home orders are implemented, with larger effects for more stringent orders. We also provide evidence that the estimated effect on post-order compliance is especially large for confidence in the press and governmental institutions, and relatively smaller for confidence in medicine and in science.
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Monitoring Re-Growth of Invasive Plants Using an Autonomous Surface Vessel
Invasive aquatic plant species, and in particular Eurasian Water-Milfoil (EWM), pose a major threat to domestic flora and fauna and can in turn negatively impact local economies. Numerous strategies have been developed to harvest and remove these plant species from the environment. However it is still an open question as to which method is best suited to removing a particular invasive species and the impact of different lake conditions on the choice. One problem common to all harvesting methods is the need to assess the location and degree of infestation on an ongoing manner. This is a difficult and error prone problem given that the plants grow underwater and significant infestation at depth may not be visible at the surface. Here we detail efforts to monitor EWM infestation and evaluate harvesting methods using an autonomous surface vessel (ASV). This novel ASV is based around a mono-hull design with two outriggers. Powered by a differential pair of underwater thrusters, the ASV is outfitted with RTK GPS for position estimation and a set of submerged environmental sensors that are used to capture imagery and depth information including the presence of material suspended in the water column. The ASV is capable of both autonomous and tele-operation.
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Heart Angiotensin-Converting Enzyme and Angiotensin-Converting Enzyme 2 Gene Expression Associated With Male Sex and Salt-Sensitive Hypertension in the Dahl Rat
Angiotensin-converting enzyme 2 (ACE 2) in the heart including its sex dependency in the hypertensive heart, has not been much studied compared to ACE. In the present study, we used the Dahl salt-sensitive rat exposed to fructose and salt to model a hypertensive phenotype in males, females, and ovariectomized females. Blood pressure was measured by the tale-cuff technique in the conscious state. Expression of RAS-related genes ACE, ACE2, angiotensin II receptor type 1, Mas1, and CMA1 in the heart were quantified. The results revealed small but significant differences between male and female groups. The main results indicate the presence of a male preponderance for an increase in ACE and ACE2 gene expression. The results are in accordance with the role of androgens or male chromosomal complement in controlling the expression of the two ACE genes.
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Optimal Control of a SIR Epidemic With ICU Constraints and Target Objectives
The aim of this paper is to provide a rigorous mathematical analysis of an optimal control problem with SIR dynamics. The main feature of our study is the presence of state constraints (related to intensive care units ICU capacity) and strict target objectives (related to the immunity threshold). The first class of results provides a comprehensive description of different zones of interest using viability tools. The second achievement is a thorough mathematical analysis of Pontryagin extremals for the aforementioned problem allowing to obtain an explicit closed-loop feedback optimal control. All our theoretical results are numerically illustrated for a further understanding of the geometrical features and scenarios.
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Proven COVID‐19—associated pulmonary aspergillosis in patients with severe respiratory failure
BACKGROUND: An increasing number of reports have described the COVID‐19–associated pulmonary aspergillosis (CAPA) as being a further contributing factor to mortality. Based on a recent consensus statement supported by international medical mycology societies, it has been proposed to define CAPA as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Considering current challenges associated with proven diagnoses, there is pressing need to study the epidemiology of proven CAPA. METHODS: We report the incidence of histologically diagnosed CAPA in a series of 45 consecutive COVID‐19 laboratory‐confirmed autopsies, performed at Padova University Hospital during the first and second wave of the pandemic. Clinical data, laboratory data and radiological features were also collected for each case. RESULTS: Proven CAPA was detected in 9 (20%) cases, mainly in the second wave of the pandemic (7/17 vs. 2/28 of the first wave). The population of CAPA patients consisted of seven males and two females, with a median age of 74 years. Seven patients were admitted to the intensive care unit. All patients had at least two comorbidities, and concomitant lung diseases were detected in three cases. CONCLUSION: We found a high frequency of proven CAPA among patients with severe COVID‐19 thus confirming at least in part the alarming epidemiological data of this important complication recently reported as probable CAPA.
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Causal Associations Between Blood Lipids and COVID-19 Risk: A Two-Sample Mendelian Randomization Study
OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome coronavirus 2. It has been reported that dyslipidemia is correlated with COVID-19, and blood lipids levels, including total cholesterol, HDL-C (high-density lipoprotein cholesterol), and LDL-C (low-density lipoprotein cholesterol) levels, were significantly associated with disease severity. However, the causalities of blood lipids on COVID-19 are not clear. APPROACH AND RESULTS: We performed 2-sample Mendelian randomization (MR) analyses to explore the causal effects of blood lipids on COVID-19 susceptibility and severity. Using the outcome data from the UK Biobank (1221 cases and 4117 controls), we observed potential positive causal effects of dyslipidemia (odds ratio [OR], 1.27 [95% CI, 1.08–1.49], P=3.18×10(−3)), total cholesterol (OR, 1.19 [95% CI, 1.07–1.32], P=8.54×10(−4)), and ApoB (apolipoprotein B; OR, 1.18 [95% CI, 1.07–1.29], P=1.01×10(−3)) on COVID-19 susceptibility after Bonferroni correction. In addition, the effects of total cholesterol (OR, 1.01 [95% CI, 1.00–1.02], P=2.29×10(−2)) and ApoB (OR, 1.01 [95% CI, 1.00–1.02], P=2.22×10(−2)) on COVID-19 susceptibility were also identified using outcome data from the host genetics initiative (14 134 cases and 1 284 876 controls). CONCLUSIONS: In conclusion, we found that higher total cholesterol and ApoB levels might increase the risk of COVID-19 infection.
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Uniting for adolescents in covid-19 and beyond
Adolescents and young adults are also experiencing a crisis of connection to family, community, and society, with increasing numbers living on the streets or dropping out of school 34 Between 2003 and 2015, development assistance for adolescent health accounted for only 1 6% of total development assistance for health,5 despite a third of the total global burden of disease estimated to have roots in adolescence 6 Mental health problems affect 10-20% of adolescents, and many more experience symptoms that diminish wellbeing 7 Furthermore, this is the age at which the gender inequalities that underlie and pose major barriers to wellbeing emerge clearly and is when programmes can transform these inequalities In 2017, 34% of young women and 10% of young men aged 15-24 years were not in employment, education, or training, with more pronounced disparities in northern Africa and southern Asia 68 Even among employed adolescents and young adults, an increasing proportion have poor job security, variable weekly earnings, and minimal or no health or social security coverage 8 These examples show that, as a global community, we have paid insufficient attention to the multidimensional and intersectional nature of adolescent wellbeing and the importance of the transition to young adulthood In 2019, for a more concerted and collaborative approach to adolescents’ wellbeing, an unprecedented coalition of governments, United Nations agencies, non-governmental organisations, and academic institutions—working closely with adolescents and young people—committed to a call to action for adolescent wellbeing 9 Underpinning this call to action is a new agreed definition and conceptual framework for adolescent wellbeing to inform policies and programming 10 The framework emphasises the importance of integrating five interconnected domains in adolescent programming: good health and optimum nutrition;connectedness, positive values, and contribution to society;safety and a supportive environment;learning, competence, education, skills, and employability;and agency and resilience
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Augmented reality is human-like: How the humanizing experience inspires destination brand love
Drawing on humanizing experience theory, we examined the antecedents and consequences of humanizing the digital experience in a virtual tourism context. Using a scenario survey approach, we designed dynamic 360° augmented reality (AR) panorama and 360° spin-of-the-mouse environments to examine the research model and hypotheses. Data from 263 subjects were collected and analyzed with AMOS 20. The empirical results elucidate the psychological mechanism behind the formation of humanizing digital experiences, showing that a 360° AR panorama shapes three features of a humanizing experience—anthropomorphism, self-representation, and intimacy—significantly better than a spin of the mouse, resulting in a stronger effect on green destination brand love. Furthermore, the technology readiness of online tourists significantly moderates the effects of a humanizing digital experience on green destination brand love. This study demonstrates how an emerging disruptive technology, AR, may help meet the need for contactless services in unique situations, such as the unexpected COVID-19 pandemic. The study helps researchers of green destination brand love and AR better understand what a humanizing digital experience in contactless service journeys can offer, paving the way for further research and practical development in this area. Because AR can be used to process big data, ethical compliance is also addressed.
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Childhood Immunization and COVID-19: An Early Narrative Review
The COVID-19 pandemic has evolved into arguably the largest global public health crisis in recent history—especially in the absence of a safe and effective vaccine or an effective anti-viral treatment. As reported, the virus seems to less commonly infect children and causing less severe symptoms among infected children. This narrative review provides an inclusive view of scientific hypotheses, logical derivation, and early analyses that substantiate or refute such conjectures. At the completion of a relatively less restrictive search of this evolving topic, 13 articles—all published in 2020, were included in this early narrative review. Directional themes arising from the identified literature imply the potential relationship between childhood vaccination and COVID-19—either based on the potential genomic and immunological protective effects of heterologous immunity, or based on observational associations of cross-immunity among vaccines and other prior endemic diseases. Our review suggests that immune response to the SARS-CoV-2 virus in children is different than in adults, resulting in differences in the levels of severity of symptoms and outcomes of the disease in different age groups. Further clinical investigations are warranted of at least three childhood vaccines: BCG, MMR, and HEP-A for their potential protective role against the SARS-CoV-2 virus.
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COVID-19 induced ischemic stroke and mechanisms of viral entry in brain and clot formation: a systematic review and current update
Background: Coronavirus disease 2019, caused by SARS-CoV-2 (SCV-2) was stated as a pandemic on March 11 2020 by World Health Organization (WHO), and since then, it has become a major health issue worldwide. It mainly attacks the respiratory system with various accompanying complications, including cardiac injury, renal failure, encephalitis and Stroke.Materials and Methods: The current systematic review has been compiled to summarize the available literature on SCV-2 induced ischemic Stroke and its subtypes. Further, the mechanisms by which the virus crosses the blood-brain barrier (BBB) to enter the brain have also been explored. The role of CRP and D-dimer as potent prognostic markers was also explored. The literature search was carried out comprehensively on Google scholar, PubMed, SCOP US, Embase and Cochrane databases by following guidelines.Results: All the studies were reviewed thoroughly by authors and disagreements were resolved by consensus and help of the senior authors. The most common subtype of the IS was found to be large artery atherosclerosis in SCV-2 induced IS. Hypertension emerged as the most significant risk factor. The mechanism resulting in elevated levels of CRP and D-dimer have also been discussed. However, there is a scarcity of definitive evidence on how SCV-2 enters the human brain. The available literature based on various studies demonstrated that SCV-2 enters through the nasopharyngeal tract via olfactory cells to olfactory neurons, astrocytes and via choroid plexus through endothelial cells. Further, disruption of gut-brain axis has been also discussed.Conclusion: Data available in the literature is not adequate to come to a conclusion. Therefore, there is a need to carry out further studies to delineate the possible association between SCV-2 induced IS.
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Depressive symptoms in helping professions: a systematic review of prevalence rates and work-related risk factors
OBJECTIVE: The aim of this study is twofold. Our first aim is to provide an overview of the prevalence rate of depression in a wide array of helping professions. Our second aim is to identify work organization conditions that seem to be associated with this depression risk. METHODS: Four databases were searched (CINAHL, PsycInfo, PubMed, and Web of Science) yielding 87,626 records in total. We were interested in identifying depression prevalence rates and work-related variables that have been found to contribute to depression in helping professions. RESULTS: In total, this systematic review included 17,437 workers in more than 29 countries. Depression prevalence rate varied between 2.5% and 91.30%. The two most frequently reported professions were nurses and doctors with 73.83% and 30.84% of studies including nurses and doctors in their sample. Work factors contributing to depression included: skill utilization, decision authority, psychological demands, physical demands, number of hours worked, work schedule (irregular or regular), work schedule (daytime or night time), social support from coworkers, social support from supervisor and the family, job insecurity, recognition, job promotion, and bullying. CONCLUSION: The results of this study highlight alarmingly high rates of depression in helping professions and should serve as a reminder to pay close attention to the mental health of those workers. Investing in employees’ mental health by preventing and reducing depression risk could prove to be a valuable investment from an employer’s point of view, as it is likely to increase productivity and reduce absenteeism among a host of other positive outcomes.
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How leaders can manage the disruption caused by the pandemic (preprint)/ en
Organisations have over time adopted conservative, structured and controlled processes to manage and achieve goals set with their stakeholders. Contrary to that, an environment of disruption has emerged, that being a faster, less predictable and less certain environment than the previous fifty or more years. This environmental difference has emerged due to the interconnectivity of trade formed out of globalisation, technology, internet and social media. The historical organisational decision models and structures are perhaps too slow and conservative for a faster less certain new age. Whilst pandemic was considered but one disruption to consider for the new age, more guidance is required for those leading and managing organisations through the current specific Covid-19 pandemic, into the pending recovery and beyond. Whilst wide-scale jobs may be lost in this new future, new opportunities for entrepreneurs, creativity and skills will likely emerge. This article will research how disruption, pandemic in particular, is changing leadership and management practices. Additionally, this article recognises that many of the organisational structures and processes of today were originally designed over thirty to forty years ago, so may no longer be appropriate. The design aspects or organisations, decision models and dealing with stakeholders will likely need to change in a pandemic, so this paper will recommend new and modified ways for organisations to operate. This research will offer a theoretical solution to assist management and leaders adjust their business and decision models in a pandemic. The past operating organisational models may lack the creativity and flexibility necessary for a world that has locked down, works from home or have closed without notice at once. Leading and managing is so different in a pandemic, especially when so much has changed so quickly, so this article will contribute by recommending new organisational principles to work to.
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Epidemiological And Clinical Characteristics of The First 18 Patients with COVID-19 in Taiwan
To understand the epidemiological and clinical characteristics of patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in Taiwan, we analyzed data from the National Notifiable Disease Surveillance System and epidemiological case investigation reports We included all real-time reverse-transcription polymerase chain reaction (real-time RT-PCR) confirmed cases of coronavirus disease-2019 (COVID-19) from Jan 21 to Feb 14, 2020, and followed up until Feb 27, 2020 Eighteen cases were confirmed and all survived Median follow-up period was 24 5 days (range: 14-35) Of them, 16 (88 9%) were imported cases, and 2 (11 1%) were infected by imported cases within household Their median age was 52 years (range: 21-74);8 (44 4%) were men, and 9 (50%) had comorbidities Symptoms included cough (72 2%), fever (66 7%), rhinorrhea (22 2%) and diarrhea (11 1%);one patient (5 5%) was asymptomatic According to the WHO definition of clinical syndromes associated with SARS-CoV-2, there were 8 (44 4%), 9 (50 0%), and 1 (5 6%) categorized as mild, moderate, and severe illness, respectively At the end of follow-up, 9 cases met the criteria of discontinuation of isolation and 8 of them were discharged The median time from admission to discontinuation of isolation was 21 days (range: 13-31) and the median duration of persistent RT-PCR positivity was 14 days (range: 4- 22) and 15 days (range: 4-24) for upper and lower respiratory samples, respectively The first 18 cases of COVID-19 in Taiwan were all imported or importation related, which were related to the early phase of COVID-19 epidemic Because viral clearance may take more than 2 weeks, management plans for patients with mild illness is necessary to ensure the best use of medical care capacities during the ongoing COVID-19 pandemic
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Performance of Three Measures of Comorbidity in Predicting Critical COVID-19: A Retrospective Analysis of 4607 Hospitalized Patients
BACKGROUND: Comorbidity burden has been identified as a relevant predictor of critical illness in patients hospitalized with coronavirus disease 2019 (COVID-19). However, comorbidity burden is often represented by a simple count of few conditions that may not fully capture patients’ complexity. PURPOSE: To evaluate the performance of a comprehensive index of the comorbidity burden (Queralt DxS), which includes all chronic conditions present on admission, as an adjustment variable in models for predicting critical illness in hospitalized COVID-19 patients and compare it with two broadly used measures of comorbidity. MATERIALS AND METHODS: We analyzed data from all COVID-19 hospitalizations reported in eight public hospitals in Catalonia (North-East Spain) between June 15 and December 8 2020. The primary outcome was a composite of critical illness that included the need for invasive mechanical ventilation, transfer to ICU, or in-hospital death. Predictors including age, sex, and comorbidities present on admission measured using three indices: the Charlson index, the Elixhauser index, and the Queralt DxS index for comorbidities on admission. The performance of different fitted models was compared using various indicators, including the area under the receiver operating characteristics curve (AUROCC). RESULTS: Our analysis included 4607 hospitalized COVID-19 patients. Of them, 1315 experienced critical illness. Comorbidities significantly contributed to predicting the outcome in all summary indices used. AUC (95% CI) for prediction of critical illness was 0.641 (0.624–0.660) for the Charlson index, 0.665 (0.645–0.681) for the Elixhauser index, and 0.787 (0.773–0.801) for the Queralt DxS index. Other metrics of model performance also showed Queralt DxS being consistently superior to the other indices. CONCLUSION: In our analysis, the ability of comorbidity indices to predict critical illness in hospitalized COVID-19 patients increased with their exhaustivity. The comprehensive Queralt DxS index may improve the accuracy of predictive models for resource allocation and clinical decision-making in the hospital setting.
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Pre-vaccination frequency of circulatory Tfh is associated with robust immune response to TV003 dengue vaccine
It has been estimated that more than 390 million people are infected with Dengue virus every year; around 96 millions of these infections result in clinical pathologies. To date, there is only one licensed viral vector-based Dengue virus vaccine CYD-TDV approved for use in dengue endemic areas. While initially approved for administration independent of serostatus, the current guidance only recommends the use of this vaccine for seropositive individuals. Therefore, there is a critical need for investigating the influence of Dengue virus serostatus and immunological mechanisms that influence vaccine outcome. Here, we provide comprehensive evaluation of sero-status and host immune factors that correlate with robust immune responses to a Dengue virus vector based tetravalent vaccine (TV003) in a Phase II clinical cohort of human participants. We observed that sero-positive individuals demonstrate a much stronger immune response to the TV003 vaccine. Our multi-layered immune profiling revealed that sero-positive subjects have increased baseline/pre-vaccination frequencies of circulating T follicular helper (cTfh) cells and the Tfh related chemokine CXCL13/BLC. Importantly, this baseline/pre-vaccination cTfh profile correlated with the vaccinees’ ability to launch neutralizing antibody response against all four sero-types of Dengue virus, an important endpoint for Dengue vaccine clinical trials. Overall, we provide novel insights into the favorable cTfh related immune status that persists in Dengue virus sero-positive individuals that correlate with their ability to mount robust vaccine specific immune responses. Such detailed interrogation of cTfh cell biology in the context of clinical vaccinology will help uncover mechanisms and targets for favorable immuno-modulatory agents.
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The xenophobia virus and the COVID-19 pandemic
Summary The text addresses the risks involving xenophobia against the Chinese on the internet, and social networks, from the COVID-19 pandemic, in addition to demonstrating how irrational this manifestation is, especially the idea of virus creation in a laboratory For this purpose, historical examples of how xenophobic prejudice is meaningless and have damaged humanity's trajectory in all world regions are addressed Finally, I warn about the need to use science to confront the new coronavirus and abandon conspiracy theories
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Case Report: Importance of MRI Examination in the Diagnosis and Evaluation of COVID-19 mRNA Vaccination Induced Myocarditis: Our Experience and Literature Review
Acute myocarditis is a rare but serious complication associated with mRNA-based coronavirus disease 2019 (COVID-19) vaccination. In this article, four COVID-19 mRNA vaccination induced myocarditis cases managed at our tertiary Medical Center have been discussed. Three patients had typical myocarditis. One patient suffered from atrioventricular block and heart failure, which required more intensive treatment, but eventually improved. Additionally, a review of cardiac magnetic resonance imaging (MRI) features related to the diagnosis of myocarditis showed that COVID-19 mRNA vaccine-associated myocarditis tend to have more late-gadolinium enhancement (LGE) accumulation in the inferior lateral wall direction. According to a report by the U.S. Centers for Disease Control and Prevention (CDC), the diagnosis of COVID-19 mRNA vaccine-associated myocarditis is based on clinical symptoms, altered myocardial enzymes, cardiac MRI finding, or histopathology. Cardiac MRI is relatively less invasive than myocardial biopsy and plays an important role in the diagnosis of myocarditis. This review may aid in the diagnosis of COVID-19 mRNA vaccine-associated myocarditis.
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Psychological reactance and beliefs in conspiracy theories during the COVID-19 pandemic: Overview of the extended parallel process model (EPPM)
Compliance with health protocols plays an important role in minimizing the spread of COVID-19. However, Indonesia is still facing a robust challenge including non-compliance to persuasive recommendations or messages (psychological reactance) and belief in conspiracy theories. Issues related to conspiracy theories and theories had obscured the message for the people to keep their behavior safe from the virus. The Extended Parallel Process Model (EPPM) is a theory that explains how people would obey the messages they received particularly health messages. Perception of threats and efficacy contribute significantly to the effectiveness of the message people received. In this article we discussed four psychological conditions that possess the chance to affect society’s threats and efficacy to comply with health protocols. These conditions were viewed from social clinical and industrial-organizational psychology perspectives. Four solutions to cope with non-compliance tendencies were also proposed. We suggest that these solutions should be applied to strengthen the tendency for people to obey health protocols.
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Clinical and economic benefits of lenzilumab plus standard of care compared with standard of care alone for the treatment of hospitalized patients with Coronavirus Disease 19 (COVID-19) from the perspective of National Health Service England
Purpose: Estimate the clinical and economic benefits of lenzilumab plus standard of care (SOC) compared with SOC alone in the treatment of hospitalized COVID-19 patients from the National Health Service (NHS) England perspective. Methods: A cost calculator was developed to estimate the clinical benefits and costs of adding lenzilumab to SOC in newly hospitalized COVID-19 patients over 28 days. The LIVE-AIR trial results informed the clinical inputs: failure to achieve survival without ventilation (SWOV), mortality, time to recovery, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) use. Base case costs included drug acquisition and administration for lenzilumab and remdesivir and hospital resource costs based on level of care required. Clinical and economic benefits per weekly cohort of newly hospitalized patients were also estimated. Results: In all populations examined, specified clinical outcomes were improved with lenzilumab plus SOC over SOC treatment alone. In a base case population aged <85 years with C-reactive protein (CRP) <150 mg/L, with or without remdesivir, adding lenzilumab to SOC was estimated to result in per patient cost savings of 1,162 British Pounds (GBP). In a weekly cohort of 4,754 newly hospitalized patients, addition of lenzilumab to SOC could result in 599 IMV uses avoided, 352 additional lives saved, and over 5.5 million GBP in cost savings. Scenario results for per-patient cost savings included: 1) aged <85 years, CRP <150 mg/L, and receiving remdesivir (3,127 GBP); 2) Black patients with CRP <150 mg/L (9,977 GBP); and 3) Black patients from the full population (2,369 GBP). Conversely, in the full mITT population, results estimated additional cost of 4,005 GBP per patient. Conclusion: Findings support clinical benefits for SWOV, mortality, time to recovery, time in ICU, time on IMV, and ventilator use, and an economic benefit from the NHS England perspective when adding lenzilumab to SOC for hospitalized COVID-19 patients.
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What strategies are countries using to expand health workforce surge capacity during the COVID-19 pandemic? (Special Issue: COVID-19 health system response.)
Finding ways to increase the surge capacity and flexibility of the health workforce has been fundamental to delivering an effective COVID-19 response This article explores the strategies that 44 countries in Europe plus Canada have taken to maintain and increase the availability of health workers using data from the COVID-19 Health System and Response Monitor We show that all countries have used a variety of strategies to repurpose and mobilise the existing health workforce, while some have also augmented capacity by utilising foreign-trained or previously retired or inactive health professionals, medical and nursing students and volunteers
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Feasibility of community health workers as teleaudiology patient-site facilitators: a multilevel training study.
OBJECTIVE We evaluated the feasibility of a multi-level teleaudiology patient-site facilitator training program for Community Health Workers (CHWs) at a partnering health centre in southern Arizona. DESIGN Three levels were offered: Introductory, with basic information on hearing loss and teleaudiology; Intermediate, on technology, team roles, and access issues; and Facilitator, on further knowledge and hands-on skills to serve as patient-site facilitators in synchronous hearing aid service delivery. Six domains of feasibility were addressed using a mixed-methods design. Quantitative data included survey responses and observation of hands-on skills. Qualitative data included field notes from group discussion and open-ended survey questions, and were analysed using CHW core competencies. STUDY SAMPLE Twelve CHWs participated in the introductory training, ten moved on to intermediate, and three continued to the facilitator. RESULTS Quantitative outcomes indicated that the trainings were feasible according to each of the six domains. CHWs in the facilitator training passed the practical hands-on skill assessment. Qualitative analyses revealed CHWs comments addressed eight of the ten possible CHW core competencies, and focussed on service coordination/navigation, and capacity building. CONCLUSIONS Teleaudiology trainings for CHWs were feasible, increasing service capacity for a potential pathway to improve access to hearing health care in low-resource areas.
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American Frontline Healthcare Personnel's Access to and Use of Personal Protective Equipment Early in the COVID-19 Pandemic
To quantify adequacy of personal protective equipment (PPE) for U.S. healthcare personnel (HCP) at the outset of the COVID-19 pandemic and its association with infection risk. METHODS: March–May 2020 survey of the national Nurses’ Health Studies and the Growing Up Today study regarding self-reported PPE access, use, and reuse. COVID-19 endpoints included SARS-CoV-2 tests and COVID-19 status predicted from symptoms. RESULTS: Nearly 22% of 22,232 frontline HCP interacting with COVID-19 patients reported sometimes or always lacking PPE. Fifty percent of HCP reported not needing respirators, including 13% of those working in COVID-19 units. Lack of PPE was cross-sectionally associated with two-fold or greater odds of COVID-19 among those who interacted with infected patients. CONCLUSION: These data show the need to improve the U.S. infection prevention culture of safety when confronting a novel pathogen.
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Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study
BACKGROUND: Little is known about the practice of ventilation management in patients with COVID-19. We aimed to describe the practice of ventilation management and to establish outcomes in invasively ventilated patients with COVID-19 in a single country during the first month of the outbreak. METHODS: PRoVENT-COVID is a national, multicentre, retrospective observational study done at 18 intensive care units (ICUs) in the Netherlands. Consecutive patients aged at least 18 years were eligible for participation if they had received invasive ventilation for COVID-19 at a participating ICU during the first month of the national outbreak in the Netherlands. The primary outcome was a combination of ventilator variables and parameters over the first 4 calendar days of ventilation: tidal volume, positive end-expiratory pressure (PEEP), respiratory system compliance, and driving pressure. Secondary outcomes included the use of adjunctive treatments for refractory hypoxaemia and ICU complications. Patient-centred outcomes were ventilator-free days at day 28, duration of ventilation, duration of ICU and hospital stay, and mortality. PRoVENT-COVID is registered at ClinicalTrials.gov (NCT04346342). FINDINGS: Between March 1 and April 1, 2020, 553 patients were included in the study. Median tidal volume was 6·3 mL/kg predicted bodyweight (IQR 5·7-7·1), PEEP was 14·0 cm H2O (IQR 11·0-15·0), and driving pressure was 14·0 cm H2O (11·2-16·0). Median respiratory system compliance was 31·9 mL/cm H2O (26·0-39·9). Of the adjunctive treatments for refractory hypoxaemia, prone positioning was most often used in the first 4 days of ventilation (283 [53%] of 530 patients). The median number of ventilator-free days at day 28 was 0 (IQR 0-15); 186 (35%) of 530 patients had died by day 28. Predictors of 28-day mortality were gender, age, tidal volume, respiratory system compliance, arterial pH, and heart rate on the first day of invasive ventilation. INTERPRETATION: In patients with COVID-19 who were invasively ventilated during the first month of the outbreak in the Netherlands, lung-protective ventilation with low tidal volume and low driving pressure was broadly applied and prone positioning was often used. The applied PEEP varied widely, despite an invariably low respiratory system compliance. The findings of this national study provide a basis for new hypotheses and sample size calculations for future trials of invasive ventilation for COVID-19. These data could also help in the interpretation of findings from other studies of ventilation practice and outcomes in invasively ventilated patients with COVID-19. FUNDING: Amsterdam University Medical Centers, location Academic Medical Center.
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Development of new SNP genotyping assays to discriminate the Omicron variant of SARS-CoV-2.
The World Health Organization (WHO) designated Omicron (B.1.1.529 lineage) of SARS-CoV-2 as a new variant of concern (VOC) on 26th of November 2021. The risk to public health conferred by the Omicron variant is still not completely clear, although its numerous gene mutations raise concern about its potential for increased transmissibility and immune escape. In this study, we describe our development of two single nucleotide polymorphism (SNP) genotyping assays targeting the G339D or T547K mutation of the spike protein for screening of the Omicron variant. A specificity test revealed that the two assays successfully discriminated the Omicron variant from the Delta variant and Alpha variant each with one nucleotide mismatch. In addition, a sensitivity test showed that the G339D and T547K assays detected at least 2.60 and 3.36 RNA copies of the Omicron variant, respectively, and 1.59 RNA copies of the Delta variant. These results demonstrated that both assays could be useful for detecting and discriminating the Omicron variant from other strains. In addition, because of the rapid and unpredictable evolution of SARS-CoV-2, combining our assays with previously developed assays for detecting other mutations may lead to a more accurate diagnosis system.
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Infektionen
Die Meldung und Erfassung von Infektionskrankheiten ist in Deutschland durch das Infektionsschutzgesetz (IfSG) geregelt. In §6 sind meldepflichtige Krankheiten nach gewissen Vorgaben geregelt.
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The COVID-19 pandemic and paradigm change in global scientific research
The current pandemic has rocked the lives of human beings everywhere in ways never imagined, forcing us to question where our civilization is headed. In this article, we explore and discuss scientific evidence that helps explain recent events in the context of the COVID-19 pandemic. COVID-19 is caused by infection with a zoonotic-origin novel virus, SARS-CoV-2, that is genetically close to two coronavirus types isolated in bats. The transmission dynamics to humans from the original and intermediary hosts remain poorly understood, but it is highly likely that the SARS-CoV-2 virus infected humans after undergoing an interspecies transfer from bats to an intermediate species, and from there to human beings. Crossing the species barrier is largely fostered by industrial-scale agricultural practices that simplify original ecosystem connections by reducing biodiversity, facilitating the emergence of new infectious diseases. The scientific community has played an exemplary role in responding to this global emergency, working to find timely, relevant solutions for governments and society as a whole. We need to take this opportunity to promote a global and open science that delves into the interrelationships of the biological, environmental, social and economic dimensions of this and other diseases while questioning current modes of production and their impact on the environment, and thus on human health worldwide.
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Targeting S1PR1 May Result in Enhanced Migration of Cancer Cells in Bladder Carcinoma
SIMPLE SUMMARY: Metastasis is critical to the prognosis of patients with bladder cancer, and it is important to understand the mechanism of its occurrence. S1PR1 expression is thought to be associated with poor prognosis, but it is unknown whether it is associated with tumor metastasis. Analysis of clinical gene expression data suggests that endothelial or immune cells in tumor tissue may be the source of S1PR1 expression. Comparative analysis of clinical tumor tissues with bladder cancer cells suggests that S1PR1 expression is associated with cellular adhesion. In vitro experiments demonstrated that S1PR1 expression was negatively correlated with cancer cell motility, and that S1PR1 inhibition by FTY-720 may cause an increase in cancer cell motility, suggesting that the use of S1PR1 inhibition as a synergistic therapy requires additional observations and considerations. ABSTRACT: Clinical bladder tumor histological analysis shows that high expression of S1PR1 is associated with poor patient prognosis. However, there are no studies that describe the underlying mechanism. To investigate the relative distribution and actual function of S1PR1 in bladder tumors, we analyzed multiple clinical databases in combination with tumor purity and immune cell infiltration simulations, as well as databases of well-defined histological phenotypes of bladder cancer, and single-cell sequencing of adjacent normal tissues and bladder tumors, and further compared them with bladder cancer cell lines. The results showed that S1PR1 expression was generally higher in normal tissues than in bladder cancer tissues, and its distribution was mainly in endothelial cells or immune cells. The association between high S1PR1 expression and poor prognosis may be due to tumor invasion of adjacent normal tissues, where highly expressed S1PR1 may affect prognostic interpretation. The effect of S1PR1 itself on cancer cells was associated with cell adhesion, and in bladder cancer cells, S1PR1 expression was negatively correlated with cell motility. Moreover, the use of FTY-720 will cause an increased metastatic ability of bladder cancer cells. In conclusion, we suggest that the use of S1PR1-specific inhibition as a synergistic treatment requires more observation and consideration.
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Infection, Sepsis and the Inflammatory Response: Mechanisms and Therapy
Sepsis secondary to bacterial infection remains a significant cause of morbidity and mortality globally. Recent decades have seen the evolution of international collaborations to improve care for these patients and identify areas for research. In this article we discuss the pathophysiology underlying the condition, review the current recommended management strategies, discuss areas of controversy, and highlight the need for ongoing research, particularly in diagnostics.
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Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities
Of all the late complications of diabetes, those involving the foot have traditionally required more face-to-face patient visits to clinics to treat wounds by debridement, offloading, and many other treatment modalities. The advent of the coronavirus disease 2019 (COVID-19) pandemic has resulted not only in the closing of most outpatient clinics for face-to-face consultations but also in the inability to perform most laboratory and imaging investigations. This has resulted in a paradigm shift in the delivery of care for those with diabetic foot ulcers. The approaches to this challenge in two centers with an interest in diabetic foot disease, including virtual consultations using physician-to-patient and physician-to-home nurse telemedicine as well as home podiatry visits, are described in this review and are illustrated by several case vignettes. The outcomes from these two centers suggest that we may be witnessing new possibilities in models of care for the diabetic foot.
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Radiological Findings of COVID-19 in Children: A Systematic Review and Meta-Analysis
BACKGROUND: The majority of the children with SARS-CoV-2 infection present with respiratory symptoms, hence various chest imaging modalities have been used in the management. Knowledge about the radiological findings of coronavirus disease (COVID-19) in children is limited. Hence, we systematically synthesized the available data that will help in better management of COVID-19 in children. METHODS: Four different electronic databases (MEDLINE, EMBASE, Web of Science and CENTRAL) were searched for articles reporting radiological findings in children with COVID-19. Studies reporting thoracic radiological findings of COVID-19 in patients aged <19 years were included. A random-effect meta-analysis (wherever feasible) was performed to provide pooled estimates of various findings. RESULTS: A total of 1984 records were screened of which forty-six studies (923 patients) fulfilled the eligibility criteria and were included in this systematic review. A chest computed tomography (CT) scan was the most frequently used imaging modality. While one-third of the patients had normal scans, a significant proportion (19%) of clinically asymptomatic children had radiological abnormalities too. Unilateral lung involvement (55%) was frequent when compared with bilateral and ground-glass opacities were the most frequent (40%) definitive radiological findings. Other common radiological findings were non-specific patchy shadows (44%), consolidation (23%), halo sign (26%), pulmonary nodules and prominent bronchovascular marking. Interstitial infiltration being the most frequent lung ultrasound finding. CONCLUSION: CT scan is the most frequently used imaging modality for COVID-19 in children and can detect pneumonia before the appearance of clinical symptoms. Undefined patchy shadows, grand-glass opacities and consolidation are commonly observed imaging findings in COVID-19 pneumonia.
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Targeting Neutrophils Extracellular Traps (NETs) reduces multiple organ injury in a COVID-19 mouse model
COVID-19 is characterized by severe acute lung injury, which is associated with neutrophils infiltration and release of neutrophil extracellular traps (NETs). COVID-19 treatment options are scarce. Previous work has shown an increase in NETs release in the lung and plasma of COVID-19 patients suggesting that drugs that prevent NETs formation or release could be potential therapeutic approaches for COVID-19 treatment. Here, we report the efficacy of NET-degrading DNase I treatment in a murine model of COVID-19. DNase I decreased detectable levels of NETs, improved clinical disease, and reduced lung, heart, and kidney injuries in SARS-CoV-2-infected K18-hACE2 mice. Furthermore, our findings indicate a potential deleterious role for NETs lung tissue in vivo and lung epithelial (A549) cells in vitro, which might explain part of the pathophysiology of severe COVID-19. This deleterious effect was diminished by the treatment with DNase I. Together, our results support the role of NETs in COVID-19 immunopathology and highlight NETs disruption pharmacological approaches as a potential strategy to ameliorate COVID-19 clinical outcomes.
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Avoidance of oxidative‐stress perturbation in yeast bioprocesses by proteomic and genomic biostrategies?
Aims: Bioprocess oxidative stress caused by many reactive oxygen species (ROS) can lead to largely irreversible perturbation of yeast bioprocesses. These include the production of proteins derived from recombinant DNA yeast technology (aerobically grown Saccharomyces cerevisiae). These proteins include rennin, amyloglucosidases (glucamylases), interferons, interleukins, insulin, monoclonal antibodies, tissue plasminogen activators (t‐PA), sexually transmitted disease antigens, and measles, mumps and rubella antigens, growth hormones, somatotropin, blood clotting factors VIII and XIII. In addition, there may be a demand for severe acute respiratory syndrome–coronavirus antigens, hepatitis A, B and C viral‐selected antigens, HIV retroviral antigens, influenza antigens, trypanosomal antigens, and foot and mouth disease antigens. Prevention of oxidative stress has been achieved by application of antioxidant redox metalloenzymes such as superoxide dismutases (containing Cu/Zn cytosolic, Mn mitochondrial and Fe bacterial) glutathione peroxidases (and other Se‐containing proteins and enzymes such as the thioredoxins), catalases (Fe‐containing), cytochrome c peroxidases (Fe‐containing), ceruloplasmins (Cu‐containing), metallothionines (these cysteine thiol‐rich proteins bind ions of cadmium and mercury) and tyrosinases(Cu‐containing). Methods and Results: ROS are generated inadvertently by single metal valency couples such as FeII/FeIII and by FeIII/FeV present in 2700 (including 57 human) isoforms in cytochromes P450 mixed‐function oxidases (EC 1·14·14·1; O(2) : mono‐oxygenase NADPH/NADH requiring). In addition, mixed‐metal couples such as valency unmatched forms in CuI/FeII and FeIII/MnIV can recycle electrons. Moreover, proteins/protein chaperone couples can recycle electrons, often where futile‐recycling systems have been instigated. Furthermore, oxidized membrane phospholipids (R) can form ROOH (lipid hydroperoxides) and ROH (lipid alkoxides) that can generate ROS through Fenton chemistry (iron‐catalysed) chain reactions. Utilization of chain‐breaking antioxidants such as vitamin E (α‐tocopherol) in the lipid phase and vitamin C (ascorbate) in the aqueous phase can terminate these ROS‐producing reactions. Conclusions: The main significance of the study is that proteomic strategies of relief from bioprocess perturbation by ROS of yeast fermentations (used to manufacture proteins required in the food and therapeutic bioindustries) may become possible through addition of selected proteins (including metalloenzymes). The main impact of the study is that the utilization of genetically modified (GM) yeast produced by recombinant DNA technology genomic strategies could circumvent the bioprocessing problems that otherwise result from the bioprocess perturbations: this is as a result of oxidative stress caused by ROS, which is avoidable by deployment of appropriate antioxidants such as vitamins E, C and D (and antioxidant proteins and enzymes often of microbial origin via recombinant DNA technology).
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Nitrogen dioxide reductions from satellite and surface observations during COVID-19 mitigation in Rome (Italy)
Lockdown restrictions were implemented in Italy from 10 March 2020 to contain the COVID-19 pandemic. Our study aims to evaluate air pollution changes, with focus on nitrogen dioxide (NO2), before and during the lockdown in Rome and in the surroundings. Significant NO2 declines were observed during the COVID-19 pandemic with reductions of - 50%, - 34%, and - 20% at urban traffic, urban background, and rural background stations, respectively. Tropospheric NO2 vertical column density (VCD) from the TROPOspheric Monitoring Instrument (TROPOMI) was used to evaluate the spatial-temporal variations of the NO2 before and during the lockdown for the entire area where the surface stations are located. The evaluation is concerned with the pixels including one or more air quality stations to explore the capability of the unprecedented high spatial resolution to monitor urban and rural sites from space with relation to the surface measurements. Good agreement between surface concentration and TROPOMI VCD was obtained in Rome (R = 0.64 in 2019, R = 0.77 in 2020) and in rural sites (R = 0.71 in 2019). Inversely, a slight correlation (R = 0.20) was observed in rural areas during the lockdown due to very low levels of NO2. Finally, the TROPOMI VCD showed a sharp decline in NO2, larger in urban (- 43%) than in rural sites (- 17%) as retrieved with the concurrent surface measurements averaging all the traffic and urban background (- 44%) and all the rural background stations (- 20%). These results suggest air pollution improvement in Rome gained from implementing lockdown restrictions.
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Condiciones médicas, síntomas de ansiedad y depresión durante la pandemia por COVID-19 en una muestra poblacional de Lima, Perú
Introducción: El objetivo de este estudio es determinar diferencias entre el número de condiciones médicas subyacentes, depresión y ansiedad, al controlar por las covariables edad, sexo y educación completa. Métodos: Los participantes (n = 484) indicaron el número de condiciones médicas presentes durante la encuesta, incluyendo también el PHQ-9 y GAD-7 para evaluar la depresión y la ansiedad respectivamente. Resultados: Se hallaron diferencias entre los grupos de afecciones médicas y los valores combinados de PHQ-9 y GAD-7 después de controlar por las covariables mencionadas (F4,954 = 5,78; Wilks’ Λ = 0,95; p < 0,0005). Las pruebas univariadas mostraron diferencias para PHQ-9 (F2,478 = 8,70; p < 0,0005) y GAD-7 (F2,478 = 11,16; p < 0,0005) entre los 3 grupos. Finalmente, el análisis post-hoc mostró diferencias entre los participantes con una condición médica y sin ninguna condición médica (PHQ-9: MD = 1,82; IC95%, 0,25-3,40; GAD-7: MD = 1,73; IC95%, 0,55-2,91) y entre participantes con más de 1 afección médica y participantes sin afección médica (PHQ-9: MD = 3,10; IC95%, 1,11-5,10; GAD-7: MD = 2,46; IC95%, 0,97-3,95). Conclusiones: Nuestros resultados indican que las personas que tuvieron una afección médica durante la pandemia de COVID-19 son más propensas a desarrollar síntomas graves de ansiedad y depresión. Introduction: This study aims to determine differences between the number of underlying medical conditions, depression, and anxiety, when controlling for the covariates of age, sex, and completed education. Methods: Participants (n=484) indicated the number of medical conditions present during the survey, also including the PHQ-9 and GAD-7, to assess depression and anxiety, respectively. Results: Differences were found between groups of medical conditions and the combined values of PHQ-9 and GAD-7 after controlling for the covariates mentioned above (F4,954=5.78; Wilks’ Λ=0.95; P<0.0005). The univariate tests showed differences for PHQ-9 (F2,478=8.70; P<0.0005) and GAD-7 (F2,478=11.16; P<0.0005) between the 3 groups. Finally, post-hoc analysis showed differences between participants with one medical condition and with no medical condition (PHQ-9: MD=1.82; 95%CI, 0.25-3.40; GAD-7: MD=1.73; 95%CI, 0.55-2.91), and between participants with more than one medical condition and participants with no medical condition (PHQ-9: MD=3.10; 95%CI, 1.11-5.10; GAD-7: MD=2.46; 95%CI, 0.97-3.95). Conclusions: Our results suggest that people who had a medical condition during the COVID-19 pandemic were more prone to developing severe symptoms of anxiety and depression.
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The Art of Prevention: COVID-19 Vaccine Preparedness for the Dermatologist
As COVID-19 vaccinations begin, dermatologists must be aware of the cutaneous adverse events reported in the clinical trials, including injection site and hypersensitivity reactions, and emerging evidence of dermal filler injection reactions following vaccination. The filler reaction may represent development of a delayed-type hypersensitivity in the setting of another immunologic trigger, i.e. the vaccine. Upon literature review of similar reactions, their pathophysiology and management, we present a set of timely clinical considerations for counseling, prevention and management of the possible cutaneous sequelae of the COVID-19 vaccine, and encourage documentation of vaccine-related reactions to aid the safety-data collection in the Vaccine Adverse Event Reporting System and the American Academy of Dermatology COVID-19 Registry.
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Preterm Infant Outcomes Following COVID-19 Lockdowns in Melbourne, Australia
Background Community lockdowns during the coronavirus disease 2019 (COVID-19) pandemic may influence preterm birth rates, but mechanisms are unclear. Methods We compared neonatal outcomes of preterm infants born to mothers exposed to community lockdowns in 2020 (exposed group) to those born in 2019 (control group). Main outcome studied was composite of significant neonatal morbidity or death. Results Median gestational age was 35 + 4 weeks (295 infants, exposed group) vs. 35 + 0 weeks (347 infants, control group) (p = 0.108). The main outcome occurred in 36/295 (12.2%) infants in exposed group vs. 46/347 (13.3%) in control group (p = 0.69). Continuous positive airway pressure (CPAP) use, jaundice requiring phototherapy, hypoglycaemia requiring treatment, early neonatal white cell and neutrophil counts were significantly reduced in the exposed group. Conclusions COVID-19 community lockdowns did not alter composite neonatal outcomes in preterm infants, but reduced rates of some common outcomes as well as early neonatal inflammatory markers.
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Internet-of-Things Devices and Assistive Technologies for Healthcare: Applications, Challenges, and Opportunities
Medical conditions and cases are growing at a rapid pace, where physical space is starting to be constrained. Hospitals and clinics no longer have the ability to accommodate large numbers of incoming patients. It is clear that the current state of the health industry needs to improve its valuable and limited resources. The evolution of the Internet of Things (IoT) devices along with assistive technologies can alleviate the problem in healthcare, by being a convenient and easy means of accessing healthcare services wirelessly. There is a plethora of IoT devices and potential applications that can take advantage of the unique characteristics that these technologies can offer. However, at the same time, these services pose novel challenges that need to be properly addressed. In this article, we review some popular categories of IoT-based applications for healthcare along with their devices. Then, we describe the challenges and discuss how research can properly address the open issues and improve the already existing implementations in healthcare. Further possible solutions are also discussed to show their potential in being viable solutions for future healthcare applications
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Psychological distress in healthcare workers during COVID-19 pandemic
With the sudden outbreak of coronavirus disease of 2019 (COVID-19) pandemic, the Health Care Workers (HCWs) have claimed varying echelons of stress, anxiety and insomnia This is the first write up ever reported describing the numerous studies conducted globally to determine the mental health issues in HCWs throughout in COVID-19 pandemic Herein we compile the studies conducted in different countries worldwide All these studies alleged high pervasiveness of stress, anxiety, depression, insomnia, somatization, obsessive-compulsive symptoms and other mental disorders in HCWs Female medical staff showed high occurrence of mental distress over male medical staff Transmission of infection from HCWs to their family members further increases fear and distress Ample education, training, psychosocial services and social support have improve mental health of HCWs © 2021 MEDIC SCIENTIFIC All rights reserved
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Japan's public health and culture, and the ongoing fight against COVID-19. (Special Issue: COVID-19: conventional therapies, fates, and mechanisms.)
The rising number of new cases or new waves of COVID-19 infections threaten to overwhelm or collapse the health care system in many countries The pandemic is likely to make the human sufferings worse However, unlike many other developed countries, the situation in Japan with respect to COVID-19 remains relatively very good, despite the existence of a number of unfavorable factors that could make the country more vulnerable to COVID-19 Therefore, it seems important to understand and clarify the factors that have helped hold down the number of COVID-19 cases and deaths in Japan The purpose of this narrative review was to provide some insights into the public health system and cultural factors that might have significantly contributed to the success of Japan in the fight against COVID-19 In light of the findings and discussion of this review, we suggest that Japan has achieved a remarkable success against COVID-19, by virtue of its strong and effective public health system, and also high standards of ingrained hygiene practices that are deeply influenced by local culture
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COVID-19: a qualitative chest CT model to identify severe form of the disease
Purpose – The purpose of this study was to identify clinical and chest computed tomography (CT) features associated with a severe form of coronavirus disease 2019 (COVID-19) and to propose a quick and easy to use model to identify patients at risk of a severe form. Materials and Methods – A total of 158 patients with biologically confirmed COVID-19 who underwent a chest CT after the onset of the symptoms were included. There were 84 men and 74 women with a mean age of 68 ± 14 (SD) years (range: 24–96 years). There were 100 non severe and 58 severe cases. Their clinical data were recorded and the first chest CT examination was reviewed using a computerized standardized report. Univariate and multivariate analyses were performed in order to identify the risk factors associated with disease severity. Two models were built: one was based only on qualitative CT features and the other one included a semi-quantitative total CT score to replace the variable representing the extent of the disease. Areas under the ROC curves (AUC) of the two models were compared with DeLong’s method. Results – Central involvement of lung parenchyma (P < 0.001), area of consolidation (P < 0.008), air bronchogram sign (P < 0.001), bronchiectasis (P < 0.001), traction bronchiectasis (P < 0.011), pleural effusion (P < 0.026), large involvement of either one of the upper lobes or of the middle lobe (P < 0.001) and total CT score ≥ 15 (P < 0.001) were more often observed in the severe group than in the non-severe group. No significant differences were found between the qualitative model (large involvement of either upper lobes or middle lobe [odd ratio (OR) = 2.473), central involvement [OR = 2.760], pleural effusion [OR = 2.699] and the semi-quantitative model (total CT score ≥ 15 [OR = 3.342], central involvement [OR = 2.344], pleural effusion [OR = 2.754]) with AUC of 0.722 (95% CI: 0.638–0.806) vs. 0.739 (95% CI: 0.656–0.823), respectively (P = 0.209). Conclusion – We have developed a new qualitative CT-based multivariate model (NEWS2) that provides independent risk factors associated with severe COVID-19 with performances similar to those of the total semi-quantitative CT score.
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Metformin therapy, severity and mortality of SARS-CoV-2 infection: A meta-analysis
Background. It has been postulated that metformin could have anti-SARS-CoV-2 action. This raises the hypothesis that people who take metformin may have lower SARS-CoV-2 severity and/or mortality. Objectives. To conduct a meta-analysis of the association between the use of Metformin and risk of severity and mortality in SARS-CoV-2 infection. Methods. we searched PubMed, EMbASE, google scholar, the Cochrane Database of Systematic Reviews and preprint servers (medRxiv and Research Square) for studies published between December 2019 and January 2021. Data was extracted on study location, year of publication, design, number of participants, sex, age at baseline, body mass index, and exposure and outcome definition. Effect statistics were pooled using random effects models with 95% confidence intervals (CI). The quality of included studies was assessed with the newcastle-Ottawa Scale (nOS). Results. Thirty-two observational studies were included, combining to a total sample of 44306 participants. The mean nOS score of included studies was 7.9. Results suggested that metformin use was associated with a reduced risk of SARS-CoV-2 mortality (OR = 0.56, 95% CI: 0.46–0.68, P < 0.001;22 studies) but not with disease severity (OR = 0.85, 95% CI: 0.71–1.02, P = 0.077;15 studies). In the subgroup analysis, metformin reduces the risk of mortality (OR = 0.69, 95% CI: 0.55–0.88;P = 0.002) and severity (OR = 0.83, 95% CI: 0.70–0.97, P = 0.023) in patients aged 70 and above. Conclusions. The use of metformin was associated to lower risk of mortality from SARS-CoV-2 infection. This association does not imply causation and further research is required to clarify potential mechanisms. © 2021 Via Medica. All rights reserved.
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Mechanism of the different metabolome responses between Plutella xylostella and Pieris rapae treated with the diamide insecticides.
Diamide insecticides, such as chlorantraniliprole, cyantraniliprole, and tetrachlorantraniliprole, are a new class of insecticides that selectively target insects by affecting calcium homeostasis. While this class of insecticides are effective on a wide range of insect pests, the toxicities of diamide insecticides vary among species and life stages. In this study, we addressed the mechanism underlying the different responses of Plutella xylostella and Pieris rapae to diamide insecticides. The susceptibility to insecticides of P. xylostella and P. rapae larvae was assessed 2 and 4 days after exposure to chlorantraniliprole, cyantraniliprole, and tetrachlorantraniliprole. P. xylostella larvae treated with distilled water (Group A), chlorantraniliprole (Group B), cyantraniliprole (Group C), and tetrachlorantraniliprole (Group D) and P. rapae larvae treated with distilled water (Group E), chlorantraniliprole (Group F), cyantraniliprole (Group G) and tetrachlorantraniliprole (Group H) were subjected to metabolomics analysis. The differential metabolites in the B vs. F, C vs. G, and D vs. H groups were analyzed, followed by pathway enrichment analysis. Chlorantraniliprole, cyantraniliprole, and tetrachlorantraniliprole all showed high toxicities for P. xylostella and P. rapae larvae. P. rapae larvae were more sensitive to the diamide insecticides than P. xylostella larvae. There were 65 overlapped differential metabolites between P. xylostella and P. rapae larvae treated with these three diamide insecticides. Pathway analysis showed that the differential metabolites were closely related with fatty acid biosynthesis and metabolism-related pathways. The differential regulation of fatty acid biosynthesis and metabolism may contribute to the different response to diamide insecticides in P. xylostella and P. rapae.
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A history of biological disasters of animal origin in North America.
This paper examines past occurrences in North America relevant to the possibility of biological disasters with animal origins. With respect to naturally occurring animal disease outbreaks, North America, while not as adversely affected by epizootics as other regions, has had its fair share of such outbreaks of both 'traditional' and emerging animal diseases. The traditional category includes such diseases as anthrax, classical swine fever, bluetongue, brucellosis, foot and mouth disease, and the family of equine encephalomyelitis viruses. The emerging diseases include relatively more recent culprits such as postweaning multisystemic wasting syndrome, poultry enteritis mortality syndrome, and newly discovered examples of the transmissible spongiform encephalopathies. Additionally, several serious diseases of human beings that involve animal vectors or reservoirs occur naturally in North America or have emerged in recent decades; these include plague, hantavirus, monkeypox, West Nile virus and avian-derived influenza. At the same time, there have been very few intentional attacks on livestock using biological agents and no recorded cases in North America of animals intentionally being used to transmit disease to humans. According to the historical record, therefore, naturally occurring emerging zoonoses probably constitute the greatest threat in terms of biological disasters with animal origins. However, some of the general trends in terrorist activity, such as the intensification of activities by animal rights extremists against facilities undertaking animal research, mean that the possibility of intentional animal-related biological disasters should not be discounted.
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Supratherapeutic lithium levels in COVID‐19 infection
Lithium levels are often checked in the inpatient setting when a patient has clear indications of acute kidney injury. Lithium levels can become supratherapeutic in COVID‐19 infection even after normalization of creatinine. Lithium levels should be checked routinely in patients with COVID‐19 infection in order to avoid supratherapeutic levels.
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COVID-19 pandemic and potential of artificial intelligence.
OBJECTIVE To evaluate the potential of artificial intelligence in combating COVID-19 pandemic. METHODS PubMed, Embase, Cochrane Library and Google Scholar were searched for the term "Artificial intelligence and COVID-19" up to March 31, 2021. RESULTS Artificial intelligence (AI) is a potential tool to contain the current pandemic. AI can be used in many fields such as early detection and respective diagnosis, supervision of treatment, projection of cases and mortality, contact tracing of individuals, development of drugs and vaccines, reduces workload on health workers, prevention of disease, analysis of mental health of people amid pandemic. CONCLUSIONS AI is being updated and being improved, second by second to be able to interpret like actual human minds. This advancement in AI may lead to a completely different future of COVID-19 pandemic where most of the simpler works may be done by AI and only essential works could be done by health workers in order to increase patient care in current scenario of COVID-19 outbreak. But again one of the main constraint is of limited trustworthy and noise free sources of information. So the need for the hour is to make a free data system where most of the analysed data could be available to feed AI, which could effectively halt the current pandemic.
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Conceptualizing Cybersecurity Management Impact on Performance: Agility and Information Technology Governance
It is inevitable that the era of Industrial Revolution 4.0 is here, businesses are digitalizing their processes especially under the uncertainty inflicted by the COVID-19 pandemic to stay competitive. However, businesses and governing agencies soon realizes the potential pitfall of excessive digitalization without addressing the security aspect of it with the sharp rise of cybersecurity incidents. Consequently, the area of cybersecurity management (CM) has been identified as one key area that can help businesses enjoy the full benefits of modern technology. Despite this, it is observed that not all business owners are convinced of the importance of cybersecurity management. This paper proposes a framework through the theoretical lens of Dynamic Capability View (DCV) and the Agency Theory to study what impact CM has on a firm's performance, providing a foundation for more in-depth study on the matter for practical and academic purpose. © 2021 IEEE.
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Symptoms and immunoglobulin development in hospital staff exposed to a SARS-CoV-2 outbreak
BACKGROUND: Worldwide, the number of SARS-CoV-2 infections is increasing. Serological immunoglobulin tests may help to better understand the development of immune mechanisms against SARS-CoV-2 in COVID-19 cases and exposed but asymptomatic individuals. The aim of this study was to investigate exposure to SARS-CoV-2, symptoms, and antibody responses in a large sample of healthcare workers following a COVID-19 outbreak. METHODS: A COVID-19 outbreak among staff members of a major German children's and women's hospital was followed by massive RT-PCR SARS-CoV-2 tests and provided the opportunity to study symptoms, chains of infection, and SARS-CoV-2-specific antibody responses (IgG and IgA) by ELISA. Study participants were classified as COVID-19 cases, and persons with close, moderate, or no exposure to SARS-CoV-2 in the clinical setting, respectively. RESULTS: Out of 201 study participants, 31 were COVID-19 cases. While most study participants experienced many symptoms indicative for SARS-CoV-2 infection, anosmia and coughing were remarkably more frequent in COVID-19 cases. Approximately 80% of COVID-19 cases developed some specific antibody response (IgA and IgG) approximately 3 weeks after onset of symptoms. Subjects in the non-COVID-19 groups had also elevated IgG (1.8%) and IgA values (7.6%) irrespective of contact history with cases. CONCLUSION: We found that a significant number of diseased did not develop relevant antibody responses three weeks after symptom onset. Our data also suggest that exposure to COVID-19 positive co-workers in a hospital setting is not leading to the development of measurable immune responses in a significant proportion of asymptomatic contact persons.
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An Exploration of Geo-temporal Characteristics of Users' Reactions on Social Media During the Pandemic
During the outbreak of the COVID-19 pandemic, social networks become the preeminent medium for communication, social discussion, and entertainment. Social network users are regularly expressing their opinions about the impacts of the coronavirus pandemic. Therefore, social networks serve as a reliable source for studying the topics, emotions, and attitudes of users that are discussed during the pandemic. In this paper, we investigate the reactions and attitudes of people towards topics raised on social media platforms. We collected data of two large-scale COVID-19 datasets from Twitter and Instagram for six and three months, respectively. The paper analyzes the reaction of social network users on different aspects including sentiment analysis, topics detection, emotions, and geo-temporal characteristics of our dataset. We show that the dominant sentiment reactions on social media are neutral while the most discussed topics by social network users are about health issues. The paper examines the countries that attracted more posts and reactions from people, as well as the distribution of health-related topics discussed in the most mentioned countries. We shed light on the temporal shift of topics over countries. Our results show that posts from the top-mentioned countries influence and attract more reaction worldwide than posts from other parts of the world.
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Impact of operator experience on transcranial magnetic stimulation
OBJECTIVE: To determine the impact of an operator’s experience on transcranial magnetic stimulation (TMS) measurement. METHODS: Operator B (beginner), operator E (expert), and 30 healthy participants joined the study consisting of two experiments. In each experiment, each operator performed a TMS protocol on each participant in a random order. RESULTS: Compared with operator E, operator B exhibited higher resting motor threshold (RMT) in experiment I (60.1 ± 13.0 vs. 57.4 ± 10.9% maximal stimulation output, p = 0.017) and the difference disappeared in experiment II (p = 0.816). In 1-mV motor evoked potential (MEP) measurement, operator B exhibited higher standard deviation indicating lower consistency in experiment I compared with experiment II (1.05 ± 0.40 vs. 1.05 ± 0.16 mV with unequal variances, p = 0.001) and had poor intrarater reliability between the experiments (intraclass correlation coefficient = −0.130). There was no difference in the results of active motor threshold, silent period, paired-pulse stimulation, or continuous theta burst stimulation between the operators. CONCLUSIONS: An operator’s experience in TMS may affect the results of RMT measurement. With practice, a beginner may choose a more precise stimulation location and have higher consistency in 1-mV MEP measurement. SIGNIFICANCE: We recommend that a beginner needs to practice for precise stimulation locations before conducting a trial or clinical practice.
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An mRNA-based vaccine candidate against SARS-CoV-2 elicits stable immuno-response with single dose
D614G genotype of SARS-CoV-2 virus is highly infectious and responsible for almost all infection for 2nd wave. However, there are currently no reports with D614G as vaccine candidate. Here we report the development of an mRNA-LNP vaccine with D614G variant and characterization in animal model. We have used special mRNA-architecture and formulation that provides suitable response of the product. The surface plasmon resonance (SPR) data with spike protein (S) revealed that immunization generated specific antibody pools against the whole extracellular domain (RBD and S2) of the spike protein. The anti-sera and purified IgGs from immunized mice neutralized SARS-CoV-2-pseudoviruses in ACE2-expressing HEK293 cells in a dose dependent manner. Importantly, single-dose immunization protected mice-lungs from homotypic-pseudovirus entry and cytopathy. The immunologic responses have been implicated by a balanced and stable population of CD4+ cells with a Th1 bias. The data suggested great promise for immediate translation of the technology to the clinic.
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Blood neurofilament light chain and total tau levels at admission predict death in COVID-19 patients
BACKGROUND AND AIMS: Patients infected with SARS-CoV-2 range from asymptomatic, to mild, moderate or severe disease evolution including fatal outcome. Thus, early predictors of clinical outcome are highly needed. We investigated markers of neural tissue damage as a possible early sign of multisystem involvement to assess their clinical prognostic value on survival or transfer to intensive care unit (ICU). METHODS: We collected blood from 104 patients infected with SARS-CoV-2 the day of admission to the emergency room and measured blood neurofilament light chair (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and total tau protein levels. RESULTS: We found that NfL, GFAP, and tau were significantly increased in patients with fatal outcome, while NfL and UCH-L1 in those needing ICU transfer. ROC and Kaplan-Meier curves indicated that total tau levels at admission accurately predict mortality. CONCLUSIONS: Blood neural markers may provide additional prognostic value to conventional biomarkers used to predict COVID-19 outcome.
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Machine learning to assist clinical decision-making during the COVID-19 pandemic
BACKGROUND: The number of cases from the coronavirus disease 2019 (COVID-19) global pandemic has overwhelmed existing medical facilities and forced clinicians, patients, and families to make pivotal decisions with limited time and information. MAIN BODY: While machine learning (ML) methods have been previously used to augment clinical decisions, there is now a demand for “Emergency ML.” Throughout the patient care pathway, there are opportunities for ML-supported decisions based on collected vitals, laboratory results, medication orders, and comorbidities. With rapidly growing datasets, there also remain important considerations when developing and validating ML models. CONCLUSION: This perspective highlights the utility of evidence-based prediction tools in a number of clinical settings, and how similar models can be deployed during the COVID-19 pandemic to guide hospital frontlines and healthcare administrators to make informed decisions about patient care and managing hospital volume.
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A Social Media Microinfluencer Intervention to Reduce COVID-19 Vaccine Hesitancy in Underserved Tennessee Communities: A Protocol Paper
Background Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the US. Recent data suggests that the trustworthiness of information about the COVID-19 vaccine was a larger concern than either vaccine side effects or risks. Objective This paper aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the social ecological model and social cognitive theory may address vaccine hesitancy using community pharmacies. Methods In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the State of Tennessee Department of Health and the University of Tennessee Health Science Center College of Pharmacy. The project involved a three-pronged, pharmacy-based COVID-19 vaccination outreach project, including: (a) social media messaging (i.e., microinfluencer approach), (b) community partner collaboration, and (c) in-pharmacy promotion. Quantitative and qualitative data will assess the quality and effectiveness of the program. Social media outcomes will also be assessed to measure the impact of the microinfluencer social media training. Results Project implementation is planned for six months (January 2021-June 2021), after an initial month of planning by the research team (December 2020) and preceding several months of assessment (July 2021 and beyond). Conclusions Novel, theory-based approaches will be necessary to improve vaccine confidence. One approach to promoting public health, derived from the Social Ecological Model, may be to use trusted microinfluencers on social media platforms, such as local community pharmacists and community leaders.
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Recognition and management of depression in early psychosis.
AIMS AND METHOD Depression in first-episode psychosis (FEP) is highly prevalent and associated with poor outcomes; it has become increasingly recognised and adopted in national and international guidelines for psychosis. Using a 26-item questionnaire, this study aimed to explore if this shift has led to greater recognition among UK psychiatrists, and more effective management of depression in FEP. RESULTS Of the 297 respondents, 54.4% observed depression occurring in chronic psychosis, with the least number of respondents (17.7%) identifying depression occurring frequently during FEP. Although there was reasonable agreement in the use of antidepressants as a first-line treatment for depression (70% prescribing antidepressants), there was uncertainty around assessing depression and delineating from psychosis symptoms, and particularly negative symptoms. CLINICAL IMPLICATIONS Evidence-based treatments for comorbid depression in psychosis will lead to clearer national guidelines, allowing for optimal management of depression in early psychosis, potentially leading to improved outcomes for these individuals.
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Modeling Reactive Species Metabolism in Colorectal Cancer for Identifying Metabolic Targets and Devising Therapeutics
Reactive species (RS) are known to play significant roles in cancer development as well as in treating or managing cancer. On the other hand, genome scale metabolic models are being used to understand cell metabolism in disease contexts including cancer, and also in planning strategies to handle diseases. Despite their crucial roles in cancers, the reactive species have not been adequately modeled in the genome scale metabolic models (GSMMs) when probing disease models for their metabolism or detection of drug targets. In this work, we have developed a module of reactive species reactions, which is scalable - it can be integrated with any human metabolic model as it is, or with any metabolic model with fine-tuning. When integrated with a cancer (colorectal cancer in this case) metabolic model, the RS module highlighted the deregulation occurring in important CRC pathways such as fatty acid metabolism, cholesterol metabolism, arachidonic acid and eicosanoid metabolism. We show that the RS module helps in better deciphering crucial metabolic targets for devising better therapeutics such as FDFT1, FADS2 and GUK1 by taking into account the effects mediated by reactive species during colorectal cancer progression. The results from this reactive species integrated CRC metabolic model reinforces ferroptosis as a potential target for colorectal cancer therapy.
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High-Throughput Activity Assay for Screening Inhibitors of the SARS-CoV-2 Mac1 Macrodomain
[Image: see text] Macrodomains are a class of conserved ADP-ribosylhydrolases expressed by viruses of pandemic concern, including coronaviruses and alphaviruses. Viral macrodomains are critical for replication and virus-induced pathogenesis; therefore, these enzymes are a promising target for antiviral therapy. However, no potent or selective viral macrodomain inhibitors currently exist, in part due to the lack of a high-throughput assay for this class of enzymes. Here we developed a high-throughput ADP-ribosylhydrolase assay using the SARS-CoV-2 macrodomain Mac1. We performed a pilot screen that identified dasatinib and dihydralazine as ADP-ribosylhydrolase inhibitors. Importantly, dasatinib inhibits SARS-CoV-2 and MERS-CoV Mac1 but not the closest human homologue, MacroD2. Our study demonstrates the feasibility of identifying selective inhibitors based on ADP-ribosylhydrolase activity, paving the way for the screening of large compound libraries to identify improved macrodomain inhibitors and to explore their potential as antiviral therapies for SARS-CoV-2 and future viral threats.
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Psychological and mental health impacts of COVID-19 pandemic on healthcare workers in China: A review
The coronavirus disease-19 (COVID-19) pandemic has put healthcare workers in an unprecedented situation, increasing their psychological and mental health distress. Much research has focused on the issues surrounding anxiety, depression, and stress among healthcare workers. The consequences of mental health problems on healthcare workers’ physical health, health-compromising behaviours, suicide ideation, family relationships, and job satisfaction during the COVID-19 pandemic are not well studied. Enhanced psychological stress has known effects on an individual’s physical health. In healthcare workers with pre-existing comorbidities, psychological stressors may exacerbate their current health problems. Healthcare professionals are known to have a high risk of substance use, hence they may be at risk of development of substance use addiction or vulnerable to addiction relapse. Frontline COVID-19 healthcare workers are being pushed above and beyond their limits, possibly resulting in suicidal tendencies. Furthermore, the burden of high workload and burnout may also have serious manifestations in relationships with family and an intention to quit their jobs. Future studies should explore the above-mentioned deleterious consequences to provide insight into the development of mental healthcare strategies to combat the psychological impact of COVID-19 on healthcare workers during the COVID-19 emergency. It is imperative to employ strategies to care for and policies to protect the psychological well-being of healthcare workers.
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Preferences for Medical Consultations from Online Providers: Evidence from a Discrete Choice Experiment in the United Kingdom
BACKGROUND: In the UK, consultations for prescription medicines are available via private providers such as online pharmacies. However, these providers may have lower thresholds for prescribing certain drugs. This is a particular concern for antibiotics, given the increasing burden of antimicrobial resistance. Public preferences for consultations with online providers are unknown, hence the impact of increased availability of online consultations on antibiotic use and population health is unclear. OBJECTIVE: To conduct a discrete choice experiment survey to understand UK public preferences for seeking online consultations, and the factors that influence these preferences, in the context of having symptoms for which antibiotics may be appropriate. METHODS: In a survey conducted between July and August 2018, general population respondents completed 16 questions in which they chose a primary care consultation via either their local medical centre or an online provider. Consultations were described in terms of five attributes, including cost and similarity to traditional ‘face-to-face’ appointments. Choices were modelled using regression analysis. RESULTS: Respondents (n = 734) placed a high value on having a consultation via their local medical centre rather than an online provider, and a low value on consultations by phone or video. However, respondents characterised as ‘busy young professionals’ showed a lower strength of preference for traditional consultations, with a higher concern for convenience. CONCLUSION: Before COVID-19, the UK public had limited appetite for consultations with online providers, or for consultations that were not face-to-face. Nevertheless, prescriptions from online providers should be monitored going forward, particularly for antibiotics, and in key patient groups. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40258-021-00642-8.
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Clinical and Epidemiological Characteristics of COVID-19 Mortality in Saudi Arabia: A Retrospective Multi-Center Study
Background: Coronavirus disease 2019 (COVID-19) has resulted in considerable morbidity and mortality worldwide since December 2019. This study highlights the significant burden of the COVID-19 outbreak, particularly in patients’ health and the healthcare system. This study's clinical implication provides insight into the significant death indicators among COVID-19 patients in Saudi Arabia. Exploring these indicators will help physicians triage patients, identify critically ill patients, and prioritize ICU admissions by identifying high-risk medical and clinical indicators. Methods: : A multi-center retrospective study conducted among all COVID-19 mortality cases, admitted to 15 of Armed forces hospitals across Saudi Arabia regions during March – July 2020. Demographic data, clinical presentation, laboratory investigations, and complications of COVID-19 mortality cases were collected and analyzed. According to the WHO, death due to COVID-19 was classified as a direct and indirect cause of death. Results: : A total of 224 COVID-19 mortality cases were included in the analysis. The mean age was 69.6614.68 years, and 142(63.4%) of the cases were male. 30% of overall COVID-19 mortalities occurred in the first 24 hours of hospital admission, while 50% of the mortalities occurred on day 10. There was a highly significant difference in the survival time (days) between cases admitted to the Intensive care unit (ICU) and general ward (p-values <.001), as well as a significant difference in the survival time (days) between the direct and indirect cause of death from COVID-19 cases (p-values 0.012). The most prevalent comorbidities were diabetes mellitus (DM) occurred in 165(73.7%), and hypertension (HTN) in 156(69.6%). Logistic regression for risk factors in all mortality cases revealed that direct mortality cases from COVID-19 are more likely to develop acute respiratory distress syndrome and acute kidney injury [OR 1.75 (CI 0.89-3.43);p=.102], [OR 1.01 (CI 0.54-1.90);p=.960]. Conclusions: : The prevalence of underlying diseases DM and HTN is high among COVID‐19 mortality cases in Saudi Arabia. Multiple organ dysfunction can be observed, the most common organ damage, lungs, heart, followed by the kidney. The rising of serum ferritin, Procalcitonin, CRP, and D-dimer levels can be used as indicators of disease progression.
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Dementia and Major Neurocognitive Disorders: Some Lessons Learned One Century after the first Alois Alzheimer’s Clinical Notes
Over 100 years ago, Alois Alzheimer presented the clinical signs and symptoms of what has been later called "Alzheimer Dementia" in a young woman whose name was Augustine Deter [...].
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How to strengthen a health research system: WHO's review, whose literature and who is providing leadership?
BACKGROUND: Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. MAIN TEXT: The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. CONCLUSIONS: The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches - conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.
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A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis.
BACKGROUND Antibiotic therapy has been proposed as an alternative to surgery for the treatment of appendicitis. METHODS We conducted a pragmatic, nonblinded, noninferiority, randomized trial comparing antibiotic therapy (10-day course) with appendectomy in patients with appendicitis at 25 U.S. centers. The primary outcome was 30-day health status, as assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire (scores range from 0 to 1, with higher scores indicating better health status; noninferiority margin, 0.05 points). Secondary outcomes included appendectomy in the antibiotics group and complications through 90 days; analyses were prespecified in subgroups defined according to the presence or absence of an appendicolith. RESULTS In total, 1552 adults (414 with an appendicolith) underwent randomization; 776 were assigned to receive antibiotics (47% of whom were not hospitalized for the index treatment) and 776 to undergo appendectomy (96% of whom underwent a laparoscopic procedure). Antibiotics were noninferior to appendectomy on the basis of 30-day EQ-5D scores (mean difference, 0.01 points; 95% confidence interval [CI], -0.001 to 0.03). In the antibiotics group, 29% had undergone appendectomy by 90 days, including 41% of those with an appendicolith and 25% of those without an appendicolith. Complications were more common in the antibiotics group than in the appendectomy group (8.1 vs. 3.5 per 100 participants; rate ratio, 2.28; 95% CI, 1.30 to 3.98); the higher rate in the antibiotics group could be attributed to those with an appendicolith (20.2 vs. 3.6 per 100 participants; rate ratio, 5.69; 95% CI, 2.11 to 15.38) and not to those without an appendicolith (3.7 vs. 3.5 per 100 participants; rate ratio, 1.05; 95% CI, 0.45 to 2.43). The rate of serious adverse events was 4.0 per 100 participants in the antibiotics group and 3.0 per 100 participants in the appendectomy group (rate ratio, 1.29; 95% CI, 0.67 to 2.50). CONCLUSIONS For the treatment of appendicitis, antibiotics were noninferior to appendectomy on the basis of results of a standard health-status measure. In the antibiotics group, nearly 3 in 10 participants had undergone appendectomy by 90 days. Participants with an appendicolith were at a higher risk for appendectomy and for complications than those without an appendicolith. (Funded by the Patient-Centered Outcomes Research Institute; CODA ClinicalTrials.gov number, NCT02800785.).
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SP2-3 The impact of the COVID-19 global pandemic on oncology drug development, clinical research and R&D in Japan
The challenges due to the impact of the coronavirus disease 2019 (COVID-19) pandemic and the unprecedented public health crisis are severely affecting oncology clinical trials, early to late phase drug development and clinical research. There has been a decrease in the numbers of new trial initiations, site activations, and patient enrollments, as well as negative impacts upon on-site monitoring, protocol compliance/deviations, and safety assurance for patients with cancer participating in oncology clinical trials. Further, clinical trials may be affected by the spread of COVID-19 owing to the implementation of extreme measures, such as local hospital and patient treatment facility closures, travel restrictions, and delays in the shipment of study treatment and trial supplies. This has been reported in many affected countries, including those in Asia. Currently, all pharmaceutical sponsors are supporting the safety and well-being of clinical trial patients, and investigator sites such as communities, hospitals, and government agencies are striving to regain control over public health and taking proactive steps to ensure regulatory compliance and the scientific integrity of clinical trial data. Similar to the situation in the United States and the European Union, vast majority of oncology clinical trial sites in Japan are still partially facing the challenges raised by this unprecedented event. This session will describe the various aspects including experiences, current situation of, and multiple challenges associated with, the impact of COVID-19 on oncology drug development/ clinical research in Japan, in addition to the experiences and perspectives of key oncology early phase drug development centers in Asia.
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