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Migration is a constant phenomenon in human history of conquests, conflicts and integration; when migrating, people interact with a different society with factors that condition their adaptability and insertion in the host country's system. This work aims to show intra-regional migration and the evolution of migration in Ecuador, which from issuer has become receiver and transit of migrants, within an established legal context; Special attention deserves the emergence of the covid19 pandemic that has affected the entire humanity, part of which is made up of a significant number of people who as migrants are in many countries. According to the WHO for at least a year, the health situation will not stabilize, and the macroeconomic forecast for Ecuador in 2020 foresees a fall in GDP, between −7.3% and −9.6%, which at the time of massive unemployment will notably affect the migrant sector.

An Approach to Latin American Reality, Its Significance and Scope in Ecuador

We study the driving forces behind COVID-19 vaccination in German counties using a cross-sectional and a panel approach. We identify several factors that have a significant impact on vaccination rates. Our results are robust to different model specifications.

What Determines COVID-19 Vaccination Rates in Germany?

The pandemic caused by the coronavirus disease of 2019 (COVID-19) challenged primary care providers (PCPs) to continue to deliver care for their patients, while also remaining financially stable. Most practices have experienced declining revenue due to fewer in-person patient visits. To help offset this and to continue to provide safe patient care, practices have shifted toward using remote options. Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) are benefits available to Medicare fee-for-service patients, which allow a medical practice to deliver expanded care and generate much-needed revenue. These services can be delivered by clinical staff called care managers. A top health priority for most seniors is to effectively self-isolate to reduce risk of COVID-19, while maintaining mental and physical health. We developed a Safe at Home program, designed to be run by care managers through CCM and RPM, with the use of a remote monitoring technology. Safe at Home tracks signs and symptoms of COVID-19, mental and physical health, and lifestyle behaviors that can affect immune function. We project that this service can complement regular telehealth PCP visits and deliver population health monitoring services, while generating substantial revenue for the practice.

A Primary Care Answer to a Pandemic: Keeping a Population of Patients Safe at Home through Chronic Care Management and Remote Patient Monitoring

This article on global health reviews the environment surrounding health strategies and plans, as well as lessons learned from the first 15 years of the 21st century, followed by a discussion on the quest for a new paradigm for disease control efforts and challenges and opportunities for Japan.

Global Strategies for the Prevention and Control of Infectious Diseases and Non-Communicable Diseases

BACKGROUND: The COVID-19 pandemic is affecting people with dementia in numerous ways. Nevertheless, there is a paucity of research on the COVID-19 impact on people with dementia and their care partners. OBJECTIVE: Using Twitter, the purpose of this study is to understand the experiences of COVID-19 for people with dementia and their care partners. METHODS: We collected tweets on COVID-19 and dementia using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. RESULTS: From the 5063 tweets analyzed with line-by-line coding, we identified 4 main themes including (1) separation and loss; (2) COVID-19 confusion, despair, and abandonment; (3) stress and exhaustion exacerbation; and (4) unpaid sacrifices by formal care providers. CONCLUSIONS: There is an imminent need for governments to rethink using a one-size-fits-all response to COVID-19 policy and use a collaborative approach to support people with dementia. Collaboration and more evidence-informed research are essential to reducing COVID-19 mortality and improving the quality of life for people with dementia and their care partners.

Using Twitter to Understand the COVID-19 Experiences of People With Dementia: Infodemiology Study

Coix seed is an important food and traditional Chinese medicine in China and other Asian countries. Notably, coix seed is currently being used as a traditional medicine for the treatment of COVID-19 in China. However, coix seeds are generally contaminated by mycotoxins, and this risk cannot be ignored. In this paper, we developed a method that involves direct extraction and UHPLC-HRMS analysis for the simultaneous detection of 24 mycotoxins in coix seeds. UHPLC-HRMS instrument and data acquisition parameters, and the sample pretreatment were optimised. One-step extraction showed several advantages compared to the three commercial solid-phase extraction clean-up methods, including ease of use, reduced time of sample preparation, low cost, good recovery, and acceptable matrix effect. The method validation results indicate that all mycotoxins have good linearity and sensitivity. Recoveries were between 74.2-101.1%, and RSD ranged from 0.1-5.8%. The LOQs for 24 mycotoxins were in the range of 0.5-100 µg/kg. To survey the contamination levels of these mycotoxins in commercial coix seeds, more than 70 samples were collected from Chinese markets and were analysed using the newly developed method. Zearalenone (positive ratio: 98.7%, range:1.1-1562 µg/kg), deoxynivalenol (positive ratio: 87%, range: 8.4-382.5 µg/kg), nivalenol (positive ratio: 85.7%, range: 26.8-828.2 µg/kg), fumonisin B1 (positive ratio: 84.4%, range:2.5-314.5 µg/kg), fumonisin B2 (positive ratio: 75.3%, range:1.6-72.8 µg/kg), fumonisin B3 (positive ratio: 48%, range:1.0-203.6 µg/kg), aflatoxin B1 (positive ratio: 29.9%, range: 0.39-14.7 µg/kg), sterigmatocystin (positive ratio: 29.9%, range: 1.4-51.6 µg/kg), and tenuazonic acid (positive ratio: 19.5%, range 36.1-105.7 µg/kg) were the most frequent mycotoxin contaminants. These results highlight the importance of routine monitoring and control of mycotoxins in coix seeds.

Development and validation of a rapid and efficient method for simultaneous determination of mycotoxins in coix seed using one-step extraction and UHPLC-HRMS

BACKGROUND The use of tacks for mesh fixation may induce pain after surgery for ventral hernia. The aim of this study was to compare postoperative pain after laparoscopic ventral hernia repair (LVHR) with conventional mesh fixation using titanium tacks versus fibrin sealant (FS). METHODS This randomized clinical trial included patients with an umbilical hernia defect ranging from 1·5 to 5 cm at three Danish hernia centres. Participants were assigned randomly to FS or titanium tack fixation. The primary outcome was acute pain, defined as the mean pain score on days 0-2 after surgery, measured on a 0-100-mm visual analogue scale (VAS). RESULTS Forty patients were included, of whom 38 were available for intention-to-treat analysis after 1 month. Patients in the FS group reported less pain than those in the tack group on days 0-2, both at rest (median 19 versus 47 mm; P = 0·025) and during activity (38 versus 60 mm; P = 0·014). The absolute difference in pain score between groups was 19 (95 per cent confidence interval 3 to 34) and 20 (4 to 35) mm at rest and during activity respectively. Patients in the FS group resumed normal daily activity earlier (after median 7 versus 18 days; P = 0·027) and reported significantly less discomfort. No recurrences were observed. CONCLUSION Mesh fixation with FS in LVHR was associated with less acute postoperative pain, discomfort and a shorter convalescence than tack fixation. Long-term follow-up is needed to show whether the effect of FS fixation persists in terms of chronic pain and recurrence. REGISTRATION NUMBER NCT00842842 (http://www.clinicaltrials.gov).

Randomized clinical trial of fibrin sealant versus titanium tacks for mesh fixation in laparoscopic umbilical hernia repair.

Abstract Pathological findings of coronavirus disease (COVID-19) have rarely been reported owing to its contagious nature Here, we treated an 82-year-old man whose condition was diagnosed as COVID-19 pneumonia, which exacerbated approximately 25?days after the initial onset The patient died despite receiving intensive care Post-mortem percutaneous needle biopsy of the lungs and liver tissue was performed, including genomic analysis, immunochemical tests, and pathological studies Histopathology of the lungs showed both exudative and organizing diffuse alveolar damage Supposedly, the organizing phase of acute respiratory distress syndrome (ARDS) induced COVID-19 Polymerase chain reaction (PCR) test and immunostaining of biopsy specimens showed negative results for COVID-19 Post-mortem percutaneous needle biopsy was more effective in reducing the risk of contagiousness than autopsy

Post-mortem biopsy of a patient with late exacerbation of COVID-19 pneumonia

Recent approaches using nanoparticles engineered for immune regulation have yielded promising results in preclinical models of disease. The number of nanoparticle therapies is growing, fueled by innovations in nanotechnology and advances in understanding of the underlying pathogenesis of immune-mediated diseases. In particular, recent mechanistic insight into the ways in which nanoparticles interact with the mononuclear phagocyte system and impact its function during homeostasis and inflammation have highlighted the potential of nanoparticle-based therapies for controlling severe inflammation while concurrently restoring peripheral immune tolerance in autoimmune disease. Here we review recent advances in nanoparticle-based approaches aimed at immune-modulation, and discuss these in the context of concepts in polymeric nanoparticle development, including particle modification, delivery and the factors associated with successful clinical deployment.

Harnessing nanoparticles for immune modulation

A global effort is underway to distribute coronavirus disease 2019 (COVID-19) vaccines to limit the crisis. Although adverse events related to vaccination are rare, there have been cases of new-onset neurologic symptoms following vaccination. We present two cases of new-onset neurologic symptoms post-vaccination that, upon further workup, revealed two different neuro-oncologic processes requiring neurosurgical intervention and further treatment. We hypothesize that despite these processes being unrelated to vaccination, the COVID-19 vaccines may induce an inflammatory cascade with the ability to uncover underlying sinister pathology. Our report therefore emphasizes the need for careful evaluation in the setting of new-onset neurologic symptoms after COVID-19 vaccination.

New-Onset Neurologic Symptoms and Related Neuro-Oncologic Lesions Discovered After COVID-19 Vaccination: Two Neurosurgical Cases and Review of Post-Vaccine Inflammatory Responses

The COVID-19 pandemic has profoundly influenced the practice of medicine in Australia over the last 24 months. Recently, the development of several vaccines to COVID-19 has been accompanied by reports of an associated rare syndrome of thrombosis and thrombocytopaenia (VITTS). The possibility of this rare disorder confronts all clinicians who deal with acute thrombosis, particularly given the prevalence of patients who have recently been immunised. However, VITTS remains rare, and we believe unnecessary focus on its potential diagnosis may distract from other more common causes of acute thrombosis. We discuss this with reference to a recent case at our institution.

Occam's Razor and Managing Acute Thrombosis in the COVID-19 Era

Objectives: The use of headgear is a controversial issue in girls' lacrosse. We compared concussion rates among high school lacrosse players wearing versus not wearing lacrosse headgear. Methods: Study participants included a sample of convenience of high schools with girls' lacrosse from across the United States. Certified athletic trainers reported athlete exposure and injury data via the National Athletic Treatment, Injury and Outcomes Network during the 2019 through 2021 seasons. The Headgear cohort was inclusive of high schools from the state of Florida, which mandate the use of ASTM standard F3137 headgear, while the Non-Headgear cohort was inclusive of the remaining states, none of which have headgear mandates. Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI) were calculated. IRRs with corresponding CIs that excluded 1.00 were deemed statistically significant. Results: 141 concussions (Headgear: 25; Non-Headgear: 116) and 357,225 Athlete Exposures (AE) were reported (Headgear: 91,074AE; Non-Headgear: 266,151AE) across all games and practices. Overall, the concussion injury rate per 1000AE was significantly higher in the Non-Headgear cohort (0.44) than the Headgear Cohort (0.27) (IRR=1.59, 95% CI:1.03 - 2.45). The IRR was significantly higher for the Non-Headgear cohort during games (1.74, 95% CI: 1.00, 3.02) but not for practices (1.42, 95% CI: 0.71, 2.83). Conclusions: These findings indicate that concussion rates among high school girls' lacrosse players not wearing headgear were 59% higher than those wearing headgear. These data support the use of protective headgear to reduce the risk of concussion among high school female lacrosse athletes.

The Effect of Headgear Use on Concussion Injury Rates in Girls' High School Lacrosse

The plastic capability of species to cope with the new conditions created by climate change is poorly understood. This is particularly relevant for organisms restricted to high elevations because they are adapted to cold temperatures and low oxygen availability. Therefore, evaluating trait plasticity of mountain specialists is fundamental to understand their vulnerability to environmental change. We transplanted mountain lizards, Iberolacerta cyreni, 800 m downhill to evaluate the plastic response in body condition, thermoregulation traits, haemoglobin level, and haemoparasite load. Initial measurements of body mass, total haemoglobin concentration ([Hb]), hematic parasite intensities, dorsal luminance, and thermoregulatory behaviour were resampled after two and four weeks of acclimation. We also tested whether an anti-parasitic drug reduced haemoparasite intensity. After only two weeks of acclimation to a lower elevation, lizards decreased 42% in [Hb], had 17% less parasite intensities, increased body condition by 25%, and raised by ~3% their mean preferred temperatures and their voluntary thermal maximum. The anti-parasitic treatment had no significant effect on the intensity of hematic parasites, but our results suggest that negative effects of haemoparasites on [Hb] are relaxed at lower elevation. The rapid plastic changes observed in thermal preferences, body condition, [Hb], and parasite intensity of I. cyreni demonstrate a potential plastic response of a mountain specialist. This may be adaptive under the climatic extremes typical of mountain habitats. However, there is uncertainty in whether the observed plasticity can also help overcome long term environmental changes.

Plasticity of haemoglobin concentration and thermoregulation in a mountain lizard

The coronavirus disease (COVID-19) has led to an rush to repurpose existing drugs, although the underlying evidence base is of variable quality. Drug repurposing is a technique by taking advantage of existing known drugs or drug combinations to be explored in an unexpected medical scenario. Drug repurposing, hence, plays a vital role in accelerating the pre-clinical process of designing novel drugs by saving time and cost compared to the traditional de novo drug discovery processes. Since drug repurposing depends on massive observed data from existing drugs and diseases, the tremendous growth of publicly available large-scale machine learning methods supplies the state-of-the-art application of data science to signaling disease, medicine, therapeutics, and identifying targets with the least error. In this article, we introduce guidelines on strategies and options of utilizing machine learning approaches for accelerating drug repurposing. We discuss how to employ machine learning methods in studying precision medicine, and as an instance, how machine learning approaches can accelerate COVID-19 drug repurposing by developing Chinese traditional medicine therapy. This article provides a strong reasonableness for employing machine learning methods for drug repurposing, including during fighting for COVID-19 pandemic.

Machine Learning Applications in Drug Repurposing

Ferrets (Mustela putorius furo) have been used as small animal models to investigate severe acute respiratory syndrome coronaviruses (SARS-CoV and SARS-CoV-2) infections. Pathological analyses of these tissue samples, including those of the lung, are, therefore, essential to understand the pathogenesis of SARS-CoVs and evaluate the action of therapeutic monoclonal antibodies (mAbs) against this disease. However, mAbs that recognize ferret-derived proteins and distinguish between specific cell types, such as lung epithelial cells, are limited. Podoplanin (PDPN) has been identified as an essential marker in lung type I alveolar epithelial cells, kidney podocytes, and lymphatic endothelial cells. In this study, an anti-ferret PDPN (ferPDPN) mAb PMab-292 (mouse IgG1, kappa) was established using the Cell-Based Immunization and Screening (CBIS) method. PMab-292 recognized ferPDPN-overexpressed Chinese hamster ovary-K1 (CHO/ferPDPN) cells by flow cytometry and Western blotting. The kinetic analysis using flow cytometry showed that the KD of PMab-292 for CHO/ferPDPN was 3.4 × 10-8 M. Furthermore, PMab-292 detected lung type I alveolar epithelial cells, lymphatic endothelial cells, and glomerular/Bowman's capsule in the kidney using immunohistochemistry. Hence, these results propose the usefulness of PMab-292 in analyzing ferret-derived tissues for SARS-CoV-2 research.

Development of a Monoclonal Antibody PMab-292 Against Ferret Podoplanin

OBJECTIVE: To evaluate the impact of an e-learning online event, created for supporting resident's training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue. METHODS: An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30-500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents. RESULTS AND LIMITATIONS: Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents' general perception towards web-based learning programs. CONCLUSIONS: The paper confirms residents' satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists.

COVID-19 and slowdown of residents' activity: Feedback from a novel e-learning event and overview of the literature

While debate over the appropriate scope and goals of COVID‐19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas‐Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline.

Competing Crises: COVID‐19 Countermeasures and Social Isolation among Older Adults in Long Term Care

Rotavirus infection is a major cause of severe dehydrating diarrhea in infants younger than 5 y old and in particular cases of immunocompromised patients irrespective to the age of the patients. Although vaccines have been developed, antiviral therapy is an important complement that cannot be substituted. Because of the lack of specific approved treatment, it is urgent to facilitate the cascade of further understanding of the infection biology, identification of druggable targets and the final development of effective antiviral therapies. PI3K-Akt-mTOR signaling pathway plays a vital role in regulating the infection course of many viruses. In this study, we have dissected the effects of PI3K-Akt-mTOR signaling pathway on rotavirus infection using both conventional cell culture models and a 3D model of human primary intestinal organoids. We found that PI3K-Akt-mTOR signaling is essential in sustaining rotavirus infection. Thus, blocking the key elements of this pathway, including PI3K, mTOR and 4E-BP1, has resulted in potent anti-rotavirus activity. Importantly, a clinically used mTOR inhibitor, rapamycin, potently inhibited both experimental and patient-derived rotavirus strains. This effect involves 4E-BP1 mediated induction of autophagy, which in turn exerts anti-rotavirus effects. These results revealed new insights on rotavirus-host interactions and provided new avenues for antiviral drug development.

PI3K-Akt-mTOR axis sustains rotavirus infection via the 4E-BP1 mediated autophagy pathway and represents an antiviral target

Introduction Considérés comme à risque de contracter la COVID-19, tous les personnels hospitaliers ont été invités à porter un masque chirurgical systématiquement pendant l’épidémie Des précautions renforcées ont été recommandées dans les services prenant en charge des cas confirmés Nous rapportons les résultats de l’étude de séroprévalence réalisée dans des services cibles dès la levée du confinement Matériels et méthodes Le personnel des services ayant pris en charge les cas confirmés de COVID-19 (maladies infectieuses : 158 patients, 1347 journées d’hospitalisation [JDH] ;pneumologie : 66 patients, 493 JDH ;réanimation, 74 patients, 652 JDH), ainsi que d’oncohématologie (0 cas confirmé), du laboratoire et de services administratifs ayant consulté en médecine du travail entre le 18 et le 29/05/2020 pour évaluation du risque d’exposition au COVID-19, ont été inclus dans une cohorte rétrospective Le taux de séropositivité, déterminé par ELISA, a été décrit selon le risque d’exposition (questionnaire standardisé), le service de rattachement, et le statut déclaratif vis-à-vis du COVID-19 : confirmé par RT-PCR, symptômes évocateurs et RT-PCR négative ou non réalisée, ou sujets asymptomatiques Résultats Le port du masque chirurgical pour tout le personnel a été effectif le 18/03/2020 Les précautions renforcées ont été appliquées, avec port du masque FFP2 systématique en réanimation et pneumologie devant les hauts débits d’oxygénothérapie utilisés Seul le masque chirurgical a été préconisé en maladies infectieuses sauf pour les gestes à risque d’aérosolisation Quatre cent douze membres du personnel ont été dépistés (85 % des services sollicités) Seize étaient séropositifs pour le SARS-CoV-2, soit une prévalence de 3,9 % [IC95 % : 1,9–5,9] La séroprévalence était de 12,5 % chez les personnels déclarant avoir été symptomatique (n=104, 25,2 %), alors que seuls 3 (1 %) des 308 (74,8 %) asymptomatiques étaient séropositifs (p<10−3) Les 9 cas confirmés par RT-PCR avaient une sérologie positive Parmi les 26 RT-PCR négatives, 2 avaient une sérologie positive (7,7 %) La séroprévalence était plus élevée en maladies infectieuses (n=10/63, 15,9 %, OR ajusté sur l’âge de 9,7 [3,4–28,2], p<10−3) qu’en pneumologie (n=0/31, 0 %), réanimation (n=2/110, 1,8 %), oncohématologie (n=2/50, 4,0 %), laboratoire (n=2/116, 1,7 %) et administration (n=0/42, 0 %) Seuls les personnels directement en contact avec les patients (IDE, médecins, AS) ou de laboratoire étaient séropositifs, sans différence significative selon ces professions, le temps de travail ou la notion de contact extérieur avec un sujet suspect de COVID-19 Conclusion La séroprévalence est signicativement plus élevée dans le service de maladies infectieuses La précocité de l’étude à la sortie du confinement fournit un reflet de l’exposition professionnelle pendant la période où le risque extérieur pouvait être considéré comme moindre, comme l’illustre la faible séroprévalence chez les personnels non exposés Ce résultat peut s’expliquer par l’exposition plus élevée aux patients, la prise en charge de patients plus précocement dans l’histoire de la maladie, probablement plus excréteurs et les moyens de protection différents (masque chirurgical vs masque FFP2)

Y a t-il une différence de séroprévalence à l’infection à SARS-CoV-2 (COVID-19) chez le personnel hospitalier selon le risque d’exposition ?

In animal gonads, transposable elements (TEs) are actively repressed to preserve genome integrity through the Piwi-interacting RNA (piRNA) pathway. In mice, piRNAs are most abundantly expressed in male germ cells, and form effector complexes with three distinct PIWI proteins. The depletion of individual Piwi genes causes male-specific sterility owing to severe defects in spermatogenesis with no discernible phenotype in female mice. Unlike mice, most other mammals have four PIWI genes, some of which are expressed in the ovary. Here, purification of PIWI complexes from oocytes of the golden hamster revealed that the size of the piRNAs loaded onto PIWIL1 changed during oocyte maturation. In contrast, PIWIL3, an ovary-specific PIWI in most mammals, associates with short piRNAs only in metaphase II oocytes, which coincides with intense phosphorylation of the protein. An improved high-quality genome assembly and annotation revealed that PIWIL1- and PIWIL3-associated piRNAs appear to share the 5′- ends of common piRNA precursors and are mostly derived from unannotated sequences with a diminished contribution from TE-derived sequences, most of which correspond to endogenous retroviruses (ERVs). Although binding sites for the transcription factor A-Myb are identified in the transcription start site regions of the testis piRNA clusters, the piRNA clusters in the ovary show no well-defined binding motifs in their upstream regions. These results show that hamster piRNA clusters are transcribed by different transcriptional factors in the ovary and testis, resulting in the generation of sex-specific piRNAs. Our findings show the complex and dynamic nature of biogenesis of piRNAs in hamster oocytes, and together with the new genome sequence generated, serve as the foundation for developing useful models to study the piRNA pathway in mammalian oocytes. Highlights - The size of PIWIL1-associated piRNAs changes during oocyte maturation - Phosphorylation of PIWIL3 in MII oocytes coincides with its association with small 19-nt piRNAs - Improved high-quality genome assembly and annotation identifies young endogenous retroviruses as major targets of piRNAs in hamster oocytes - PIWIL1- and PIWIL3-associated piRNAs share the 5′-ends of the common piRNA precursors in oocytes

Hamster PIWI proteins bind to piRNAs with stage-specific size variations during oocyte maturation

This study investigates the Covid-19 driven indiscriminate disposal of PPE wastes (mostly face mask and medical wastes) in Chittagong metropolitan area (CMA), Bangladesh. Based on the field monitoring, the mean PPE density (PPE/m(2)± SD) was calculated to be 0.0226 ± 0.0145, 0.0164 ± 0.0122, and 0.0110 ± 0.00863 for July, August, and September 2021, respectively (during the peak time of Covid-19 in Bangladesh). Moreover, gross information on PPE waste generation in the city was calculated using several parameters such as population density, face mask acceptance rate by urban population, total Covid-19 confirmed cases, quarantined and isolated patients, corresponding medical waste generation rate (kg/bed/day), etc. Moreover, the waste generated due to face mask and other PPEs in the CMA during the whole Covid-19 period (April 4, 2020 to September 5, 2021) were calculated to be 64183.03 and 128695.75 tons, respectively. It has been observed that the negligence of general people, lack of awareness about environmental pollution, and poor municipal waste management practices are the root causes for the contamination of the dwelling environment by PPE wastes. As a result, new challenges have emerged in solid waste management, which necessitates the development of an appropriate waste management strategy. The ultimate policies and strategies may help to achieve the SDG goals 3, 6, 11, 12, 13, and 15, and increase public perception on the use and subsequent disposal of PPEs, especially face masks.

Amassing the Covid-19 driven PPE wastes in the dwelling environment of Chittagong Metropolis and associated implications

This study aimed to understand how the anti-Asian attitude due to the COVID-19 affected Asian American communities in Alabama. We asked whether Asian Americans were worried about going out due to the anti-Asian attitude due to COVID-19. This study conducted online surveys to Cambodians or Laotians, who were 18 years and older, were living in Coastal Alabama, in May 2020. To avoid in-person contact, respondents answered questions online. A total of 353 respondents participated in the survey. In the Cambodian community, more younger adults participated in the survey, while more middle-aged adults participated from the Laotian community. Laotians had longer educational attainment and watched multiple media to obtain COVID-19 related information. Cambodians (72%) were afraid of COVID-19 infection more than Laotians (53%). More Cambodians (73%) were afraid to go out because of the anti-Asian attitude than Laotians (52%). The logistic regression analysis presented that people worried more about the COVID-19 infection were less likely to go out due to anti-Asian attitudes. Educational attainment did not have a protective effect. Watching multiple media sources decreased the worry about the anti-Asian attitude for Laotians. The age cohort showed both a protective and exacerbate the effect. Cambodians, who were in their thirties, were worried about going out. However, Laotian fifties and over did not worry about going out. This difference might be related to the length of the stay in the U.S. Hanks et al. found that Cambodians, compared to Laotians, had more new immigrants who recently came to the community to marry.

Psychological Effect of Anti-Asian Attitudes by COVID-19 on Asian Americans in Coastal Alabama

Background: On March 29th, 2021, Canada's National Advisory Committee on Immunization (NACI) recommended against using the AstraZeneca COVID-19 vaccine in younger adults pending further review of the risk for Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT). As a result, the province of British Columbia halted its front-line workers vaccination program which used the AstraZeneca vaccine. The province is expected to receive an additional 246,700 doses of AstraZeneca vaccine through US and COVAX until April 11th, enough to provide the first dose of vaccine to all unvaccinated front-line workers. It is unclear whether the alternative, mRNA vaccines can be immediately made available to front-line workers. We evaluated the harms and benefits of delaying vaccination of front-line workers in BC. Methods: We reviewed the latest available evidence and used compartmental modelling to *1)* compare the expected number of deaths due to COVID-19 and VIPIT under the scenarios of immediately continuing vaccination of front-line workers with the AstraZeneca vaccine or delaying it in favour of mRNA vaccines, and *2)* compare the individual mortality risk of immediately receiving the AstraZeneca vaccine with waiting to receive an mRNA vaccine later for different age groups. Results: We estimate that if British Columbia continues the front-line worker vaccination program with the AstraZeneca vaccine, we expect to see approximately 27,000 fewer cases of COVID-19, 500 fewer hospitalizations, 80 fewer COVID-related deaths, and 1,400 fewer cases of Long COVID from April 1st to October 1st, 2021, for an expected number of VIPIT-related deaths of 0.674 [95% CI 0.414-0.997]. In the same period and in areas of high transmission, the projected excess risk of mortality due to COVID-19 and VIPIT was significantly higher in the delayed vaccination with the mRNA vaccine scenario (3.23 to 4.44 times higher risk) than that of immediate vaccination with the AstraZeneca vaccine for those between 30 and 69 years of age. For those under 30, immediate vaccination with the AstraZeneca vaccine posed a higher risk than delayed vaccination with an mRNA vaccine. Conclusions: The benefits of immediately continuing immunization of front-line workers with the AstraZeneca vaccine far outweigh the risk both at a societal level and at an individual risk level for those over 40, and those over 30 in high-risk areas.

Continuing COVID-19 Vaccination of Front-Line Workers in British Columbia with the AstraZeneca Vaccine: Benefits in the Face of Increased Risk for Prothrombotic Thrombocytopenia

Dengue virus (DENV) is the causative agent of dengue fever and dengue hemorrhagic fever. The virus is endemic in over 120 countries, causing over 350 million infections per year. Dengue vaccine development is challenging because of the need to induce simultaneous protection against four antigenically distinct DENV serotypes and evidence that, under some conditions, vaccination can enhance disease due to specific immunity to the virus. While several live-attenuated tetravalent dengue virus vaccines display partial efficacy, it has been challenging to induce balanced protective immunity to all 4 serotypes. Instead of using whole-virus formulations, we are exploring the potentials for a particulate subunit vaccine, based on DENV E-protein displayed on nanoparticles that have been precisely molded using Particle Replication in Non-wetting Template (PRINT) technology. Here we describe immunization studies with a DENV2-nanoparticle vaccine candidate. The ectodomain of DENV2-E protein was expressed as a secreted recombinant protein (sRecE), purified and adsorbed to poly (lactic-co-glycolic acid) (PLGA) nanoparticles of different sizes and shape. We show that PRINT nanoparticle adsorbed sRecE without any adjuvant induces higher IgG titers and a more potent DENV2-specific neutralizing antibody response compared to the soluble sRecE protein alone. Antigen trafficking indicate that PRINT nanoparticle display of sRecE prolongs the bio-availability of the antigen in the draining lymph nodes by creating an antigen depot. Our results demonstrate that PRINT nanoparticles are a promising platform for delivering subunit vaccines against flaviviruses such as dengue and Zika.

Precisely Molded Nanoparticle Displaying DENV-E Proteins Induces Robust Serotype-Specific Neutralizing Antibody Responses

Abstract The plague is an infectious bacterial disease having a high fatality rate without treatment. It has occurred in three huge pandemics since the 6th century with millions of deaths and numerous smaller epidemics and sporadic cases. Referring to specific clinical symptoms of pulmonary plague the disease became known as the Black Death. This pandemic probably originated in central Asia and began spreading westward along major trade routes. Upon the arrival in the eastern Mediterranean the disease quickly spread especially by sea traffic to Italy, Greece and France and later throughout Europe by land. Until the 18th century many European cities were frequently affected by other great plague epidemics. The worldwide spread of the third pandemic began when the plague reached Hong Kong and Canton in the year 1894. The gram-negative coccobacillus now designated as Yersinia pestis has been discovered as the causative agent of plague in this Hong Kong outbreak. In the following years the role of rats and fleas and their detailed role in the transmission of plague has been discovered and experimentally verified. Today the plague is still endemic in many countries of the world.

The history of the plague and the research on the causative agent Yersinia pestis

The COVID-19 pandemic led to development of mRNA vaccines, which became a leading anti-SARS-CoV-2 immunization platform. Preclinical studies are limited to infection-prone animals such as hamsters and monkeys in which protective efficacy of vaccines cannot be fully appreciated. We recently reported a SARS-CoV-2 human Fc-conjugated receptor-binding domain (RBD-hFc) mRNA vaccine delivered via lipid nanoparticles (LNPs). BALB/c mice demonstrated specific immunologic responses following RBD-hFc mRNA vaccination. Now, we evaluated the protective effect of this RBD-hFc mRNA vaccine by employing the K18 human angiotensin-converting enzyme 2 (K18-hACE2) mouse model. Administration of an RBD-hFc mRNA vaccine to K18-hACE2 mice resulted in robust humoral responses comprising binding and neutralizing antibodies. In correlation with this response, 70% of vaccinated mice withstood a lethal SARS-CoV-2 dose, while all control animals succumbed to infection. To the best of our knowledge, this is the first nonreplicating mRNA vaccine study reporting protection of K18-hACE2 against a lethal SARS-CoV-2 infection.

Lipid Nanoparticle RBD-hFc mRNA Vaccine Protects hACE2 Transgenic Mice against a Lethal SARS-CoV-2 Infection.

Numerous reports of vascular events after an initial recovery from COVID-19 form our impetus to investigate the impact of COVID-19 on vascular health of recovered patients. We found elevated levels of circulating endothelial cells (CECs), a biomarker of vascular injury, in COVID-19 convalescents compared to healthy controls. In particular, those with pre-existing conditions (e.g., hypertension, diabetes) had more pronounced endothelial activation hallmarks than non-COVID-19 patients with matched cardiovascular risk. Several proinflammatory and activated T lymphocyte-associated cytokines sustained from acute infection to recovery phase, which correlated positively with CEC measures, implicating cytokine-driven endothelial dysfunction. Notably, we found higher frequency of effector T cells in our COVID-19 convalescents compared to healthy controls. The activation markers detected on CECs mapped to counter receptors found primarily on cytotoxic CD8+ T cells, raising the possibility of cytotoxic effector cells targeting activated endothelial cells. Clinical trials in preventive therapy for post-COVID-19 vascular complications may be needed.

Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation

Chronic and recurrent infections occur commonly in both type 1 and type 2 diabetes (T1D, T2D) and increase patient morbidity and mortality. Neutrophils are professional phagocytes of the innate immune system that are critical in pathogen handling. Neutrophil responses to infection are dysregulated in diabetes, predominantly mediated by persistent hyperglycaemia; the chief biochemical abnormality in T1D and T2D. Therapeutically enhancing host immunity in diabetes to improve infection resolution is an expanding area of research. Individuals with diabetes are also at an increased risk of severe coronavirus disease 2019 (COVID-19), highlighting the need for re-invigorated and urgent focus on this field. The aim of this review is to explore the breadth of previous literature investigating neutrophil function in both T1D and T2D, in order to understand the complex neutrophil phenotype present in this disease and also to focus on the development of new therapies to improve aberrant neutrophil function in diabetes. Existing literature illustrates a dual neutrophil dysfunction in diabetes. Key pathogen handling mechanisms of neutrophil recruitment, chemotaxis, phagocytosis and intracellular reactive oxygen species (ROS) production are decreased in diabetes, weakening the immune response to infection. However, pro-inflammatory neutrophil pathways, mainly neutrophil extracellular trap (NET) formation, extracellular ROS generation and pro-inflammatory cytokine generation, are significantly upregulated, causing damage to the host and perpetuating inflammation. Reducing these proinflammatory outputs therapeutically is emerging as a credible strategy to improve infection resolution in diabetes, and also more recently COVID-19. Future research needs to drive forward the exploration of novel treatments to improve infection resolution in T1D and T2D to improve patient morbidity and mortality.

A Bittersweet Response to Infection in Diabetes; Targeting Neutrophils to Modify Inflammation and Improve Host Immunity

Coronavirus disease 2019 (COVID-19) currently has few effective treatments. Given the uncertainty surrounding the effectiveness and uptake of a vaccine, it is important that the search for treatments continue. An exaggerated inflammatory state is likely responsible for much of the morbidity and mortality in COVID-19. Elevated levels of tumor necrosis factor (TNF), a key pro-inflammatory cytokine, have been shown to be associated with increased COVID-19 mortality. In patients with rheumatoid arthritis, TNF blockade reduces not only biologically active TNF but other pro-inflammatory cytokines important in COVID-19 hyperinflammation. Observational data from patients already on anti-TNF therapy show a reduced rate of COVID-19 poor outcomes and death compared with other immune-suppressing therapies. Anti-TNF has a long history of safe use, including in special at-risk populations, and is widely available. The case to adequately assess anti-TNF as a treatment for COVID-19 is compelling.

The Potential for Repurposing Anti-TNF as a Therapy for the Treatment of COVID-19

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time

Optimization of critical care pharmacy clinical services: A gap analysis approach

This work investigated the interaction of indole with SARS-CoV-2. Indole is widely used as a medical material owing to its astounding biological activities. Indole and its derivatives belong to a significant category of heterocyclic compounds that have been used as a crucial component for several syntheses of medicine. A straightforward one-pot three-component synthesis of indole, coupled with Mannich base derivatives 1a-1j, was synthesized without a catalyst. The products were confirmed by IR, 1H-NMR, 13C-NMR, mass spectra, and elemental analysis. The indole derivatives were tested for cytotoxic activity, using three cancer cell lines and normal cell lines of Human embryonic kidney cell (HEK293), liver cell (LO2), and lung cell (MRC5) by MTT assay using doxorubicin as the standard drug. The result of cytotoxicity indole compound 1c (HepG2, LC50-0.9 mum, MCF-7, LC50-0.55 mum, HeLa, LC50-0.50 mum) was found to have high activity compared with other compounds used for the same purpose. The synthesized derivatives have revealed their safety by exhibiting significantly less cytotoxicity against the normal cell line (HEK-293), (LO2), and (MRC5) with IC50 > 100 mug/ml. Besides, we report an in silico study with spike glycoprotein (SARS-CoV-2-S). The selective molecules of compound 1c exhibited the highest docking score -2.808 (kcal/mol) compared to other compounds. This research work was successful in synthesizing a few compounds with potential as anticancer agents. Furthermore, we have tried to emphasize the anticipated role of indole scaffolds in designing and discovering the much-awaited anti-SARS CoV-2 therapy by exploring the research articles depicting indole moieties as targeting SARS CoV-2 coronavirus.

Synthesis and Cytotoxic Activity of Novel Indole Derivatives and Their in silico Screening on Spike Glycoprotein of SARS-CoV-2

Host factors render cells susceptible to viral infection. One family of susceptibility factors, the tetraspanin proteins, facilitate enveloped virus entry by promoting virus-cell membrane fusion. They also facilitate viral egress from infected cells. In this Gem, we discuss recent insights into how tetraspanins assemble viral entry and exit platforms on cell membranes, and we speculate that tetraspanins contribute to nonviral membrane fusions by similar mechanisms.

Tetraspanins: Architects of Viral Entry and Exit Platforms

The aims of this study were to evaluate the situation of sleep quality among Chinese medical staff during the coronavirus disease 2019 (COVID-19) pandemic. We used the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality among medical staff from 8 May 2020 to 22 May 2020 in People's Republic of China. A total of 101 (25%) participants were poor sleepers, while 303 (75%) were good sleepers, as defined by PSQI. The PSQI scores were higher in high age, married, master/doctor, nurse, and frequent night shifts groups when compared with those in middle and low age, unmarried and divorced/widowed, bachelor or below, clinician and other job, low frequency night shifts, respectively (all p < 0.01). Multiple linear regression analysis showed that higher PSQI score was positively associated with higher educational background, age, and more frequent night shifts (all p < 0.001). Sleep quality of medical staff should be improved, especially for high age, married, master/doctor, nurse, and frequent night shifts groups.

Investigation on sleep quality in Chinese medical staff during the COVID-19 pandemic

INTRODUCTION Evidence suggests that older Black adults are frequent victims of financial fraud and exploitation. This study aims to identify the factors associated with scam susceptibility in older Black adults. METHODS Participants were 383 older Black adults living in the Chicago metropolitan area (mean age = 78 years and 82% female). A scam susceptibility measure assessed perceptions and behaviors that predispose older adults to fraud and scams. Categories of age-associated factors, including cognition, physical health, psychosocial factors, personality, and behavioral economics, were measured using uniform systematic assessments. For each category separately, measures associated with scam susceptibility were identified via stepwise variable selection. RESULTS Older age was associated with greater scam susceptibility. Further, the analysis revealed a robust association of cognitive health with scam susceptibility, particularly the domains of semantic and working memory. Psychological well-being was associated with susceptibility, as was neuroticism. Behavioral economic measures including financial and health literacy and financial and health decision-making ability were also implicated. In a final model that included all the measures initially retained by variable selection, semantic memory, psychological well-being, and financial and health literacy were independently associated with scam susceptibility. Moreover, the association of age was attenuated and no longer significant after adjusting for these correlates. DISCUSSION Age-associated vulnerabilities, rather than age itself, predispose older Black adults to financial fraud and scams. The correlates of scam susceptibility in community-living older Black adults primarily involve cognitive health, psychological, and behavioral economic factors.

Correlates of Susceptibility to Scams in Community-Dwelling Older Black Adults.

Women's Health Centers (WHC) have evolved over the last few decades as comprehensive centers for women's health care. This article reviews the history and evaluation of WHC, as well as opportunities for women's health training. Prior studies comparing WHC with traditional primary care and obstetrics/gynecology clinics have found that WHC offer at least similar levels of preventative care, may increase access to care for a more diverse patient population, and improve patient/provider relationship satisfaction. WHC also increase women's health providers' education and research opportunities. There is still a gap in women's health education and training, although residency and fellowship programs have aimed to address this through women's health tracks and fellowships. The coronavirus disease 2019 (COVID-19) pandemic and its negative impact on women's access to care have further highlighted the potential of WHC to meet women's health care demands. WHC can provide comprehensive, convenient, and single-site care for women. The increased opportunities for women's health training through WHC give rise to more representation in leadership and investment in women's health. New research is needed to reassess and further evaluate health outcomes of WHC compared with traditional care models.

A Closer Look at Women's Health Centers: Historical Lessons and Future Aims.

Since 2020, the world is still facing a global economic and health crisis due to the COVID-19 pandemic. One approach to fighting this global crisis is to track COVID-19 cases by wireless technologies, which requires receiving reliable, efficient, and accurate data. Consequently, this article proposes a model based on Lagrange optimization and a distributed deep learning model to assure that all required data for tracking any suspected COVID-19 patient is received efficiently and reliably. Finding the optimum location of the Radio Frequency Identifier (RFID) reader relevant to the base station results in the reliable transmission of data. The proposed deep learning model, developed using the one-dimensional convolutional neural network and a fully connected network, resulted in lower mean absolute squared errors when compared to state-of-the-art regression benchmarks. The proposed model based on Lagrange optimization and deep learning algorithms is evaluated when changing different network parameters, such as requiring signal-to-interference-plus-noise-ratio, reader transmission power, and the required system quality-of-service. The analysis of the obtained results, which indicates the appropriate transmission distance between an RFID reader and a base station, shows the effectiveness and the accuracy of the proposed approach, which leads to an easy and efficient tracking system.

A Reliable and Efficient Tracking System Based on Deep Learning for Monitoring the Spread of COVID-19 in Closed Areas

BackgroundTelemedicine has been used increasingly as an alternative care model in the Coronavirus 2019 pandemic. The practice of Developmental and Behavioural Paediatrics (DBP) relies heavily on direct child observations and building trust and rapport with caregivers over time and telemedicine was not routinely used in the Singapore setting.ObjectivesWe aimed to describe the initial experiences of caregivers and providers with telemedicine in a DBP service in Singapore during this pandemic.MethodsThis cross-sectional survey included caregivers who accessed telemedicine (through telephone or video-based platforms) and healthcare providers at a tertiary DBP clinic between 8 April and 14 May 2020, coinciding with the Circuit Breaker (similar to a lockdown) period in Singapore. Participants completed a questionnaire on experiences, perceived benefits and limitations of teleconsultation. Descriptive statistics and tests of comparison were conducted.ResultsAround half of the patients (N = 216, 47.3%) who were offered a teleconsultation agreed to it, of which 105 caregivers (48.6%) participated. Caregivers had children with diagnosis including autism spectrum disorder (33.3%), language delay (28.6%), and attention deficit hyperactivity disorder (12.4%). Most caregivers felt that their concerns were adequately addressed (98.1%), with good technological connectivity (95.2%). Majority had no difficulty preparing for the teleconsultation (61.0%) and 44.8% reported ease of follow-up with plans after. Perceived benefits included safety (47.6%) and reduced need to take time off work (24.8%). Perceived benefits included safety (47.6%) and reduced time off work (24.8%). Caregivers who had video-based teleconsultation (compared to telephone-based) had more difficulties preparing for the teleconsultation (52.3% vs 27.4, p=0.03). These caregivers were also more likely to have difficulties with remembering and following up with plans discussed during the consultation, compared to those who had a telephone-based consultation (52.3% vs 25.0%, p value = 0.02).Twenty-five providers participated. Providers included paediatricians, allied health therapists e.g. psychologists, speech and occupational therapists and social workers. Fifty-two percent of providers were as satisfied with teleconsultation compared to in person consults. Only 28.0% of providers rated technology infrastructure to be good. Most providers (92.0%) felt safer with teleconsultation. The most common difficulty perceived by providers was incompleteness of consultation without assessing the child physically. The two main perceived benefits of teleconsultation by providers included feeling safer as they were able to minimize physical interaction with patients and being able to provide similarly good care with less inconvenience to patients.Overall 63.8% of caregivers and 56.0% of providers would continue teleconsultation services post-pandemic. Amongst providers, paediatricians were more likely to continue teleconsultation services after current restrictions were lifted, compared to non-physician providers (100% vs 38.9%, p=0.008).ConclusionsTelemedicine was generally well received by caregiver and physician providers. Teleconsultation in a DBP practice setting is a viable option in a pandemic situation and can be considered even beyond this pandemic for continued care.

Use of telemedicine in a developmental and behavioural paediatric service during the COVID-19 pandemic:initial experiences of caregivers & providers, singapore

BACKGROUND: Evidence-based needs assessments for novel antibiotics against highly-resistant Gram-negative infections (GNIs) are scarce. We aimed to use real-world data from an electronic health record repository to identify treatment opportunities in US hospitals for GNIs resistant to all first-line drugs. METHODS: For this retrospective cohort study, population estimates with an unmet need for novel Gram-negative antibiotics were quantified using the Cerner Health Facts database (2009–15), aggregating episodes of infection in US hospitals with pathogens displaying difficult-to-treat resistance (DTR; resistance to carbapenems, other β-lactams, and fluoroquinolones) and episodes involving empirical coverage with reserve drugs (colistin or polymyxin B and aminoglycosides). Episodes displaying extended-spectrum cephalosporin resistance (ECR) were also estimated. Episodes were multiplied by site-specific and fixed 14-day treatment durations for conservative and liberal days-of-therapy (DOT) estimates and stratified by site and taxon. Hospital type-specific DOT rates were reliability adjusted to account for random variation; cluster analyses quantified contribution from outbreaks. FINDINGS: Across 2 996 271 inpatient encounters and 134 hospitals, there were 1352 DTR-GNI episodes, 1765 episodes involving empirical therapy with colistin or polymyxin B, and 16 632 episodes involving aminoglycosides. Collectively, these yielded 39·0 (conservative estimate) to 138·2 (liberal estimate) DOT per 10 000 encounters for a novel DTR-GNI-targeted drug, whereas greater treatment opportunities were identified for ECR (six times greater) and β-lactam susceptible GNIs (70 times greater). The most common DTR-GNI site and pathogen was lower respiratory (14·3 [43·3%] of 33 DOT per 10 000 encounters) and Pseudomonas aeruginosa (522 [38·1%] of 1371 episodes), whereas Enterobacteriaceae urinary-tract infections dominated the ECR or carbapenem-sparing niche (59·0% [5589 of 9535 episodes]) equating to 210·7 DOT per 10 000 encounters. DTR Stenotrophomonas maltophilia, Burkholderia spp, and Achromobacter spp represented less than 1 DOT per 10 000 encounters each. The estimated need for DTR-GNI-targeted antibiotics saw minor contributions by outbreaks and varied from 0·5 to 73·1 DOT per 10 000 encounters by hospital type. INTERPRETATION: Suspected or documented GNIs with no or suboptimal treatment options are relatively infrequent. Non-revenue-based strategies and innovative trial designs are probably essential to the development of antibiotics with improved effectiveness for these GNIs. FUNDING: Center for Drug Evaluation and Research, US Food and Drug Administration; Intramural Research Program, National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Diseases and the National Cancer Institute.

Needs assessment for novel Gram-negative antibiotics in US hospitals: a retrospective cohort study

The global pandemic caused by the 2019 coronavirus (COVID-19) has led to a dramatic increase in medical waste worldwide This tremendous increase in medical waste is an important transmission medium for the virus and thus poses new and serious challenges to urban medical waste management This study investigates the response of medical waste management to the COVID-19 pandemic and subsequent changes in Wuhan City based on the most detailed data available, including waste generation, storage, transportation, and disposal The results show that despite a 5-fold increase in the demand for daily medical waste disposal in the peak period, the quick responses in the storage, transportation, and disposal sectors during the pandemic ensured that all medical waste was disposed of within 24 hours of generation Furthermore, this paper discusses medical waste management during future emergencies in Wuhan The ability of the medical waste management system in Wuhan to successfully cope with the rapid increase in medical waste caused by major public health emergencies has important implications for other cities suffering from the pandemic and demonstrates the need to establish resilient medical emergency systems in urban areas

What medical waste management system may cope With COVID-19 pandemic: Lessons from Wuhan

Contemporary organizations function in a complex business and operational environment composed of closely interdependent systems They are also complex by their internal structure, management and deployed modern technologies This complexity is not always well understood, and cannot be efficiently controlled As the complexity and interdependencies increase, man-made systems become more unstable creating conditions for cascading, system-level failures causing serious threats to both themselves and society in general Such breakdowns may consist of a) serious physical damages and destruction of their physical assets (caused by natural disasters, extreme weather phenomena and climate change, malicious human actions, etc ), and/or b) large functional disruptions with no physical damages of assets (caused by major organization’s internal disturbances, market crashes, pandemics, disruptions of supply chains, etc ) Those sources of risks are basically external to organizations They are unable to control them, but are deeply affected by those risks The latest case of the COVID-19 pandemic demonstrates the above It is affecting both all sectors of life and businesses worldwide It convincingly shows that we need to think, plan and act globally in order to deal with such situations that will also take place in the future Thus, organizations have to find ways of coping with this reality to remain economically viable We are of opinion that the concepts of structured Asset Management (AM) and resilience put together may provide an efficient framework in this regard Two case studies in a major North American electrical utility demonstrate the applicability of this approach: i) during an exceptional ice storm with significant damages of its physical assets, and ii) coping with challenges of COVID-19 with no destruction of its physical assets © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG

Engineering Asset Management at Times of Major, Large-Scale Instabilities and Disruptions

The coronavirus disease-2019 (COVID-19) pandemic has created a sense of fear and raised major concerns over the preparedness of the national public health authorities to respond to infectious disease outbreaks Even though, a lot of dimensions pertaining to the disease prevention, control and treatment need to be strengthened to mount an effective response plan against the novel infection, it is extremely essential to invest and make rapid progress in the research and development field to enhance our understanding about the disease In-fact, multiple number of such projects have been funded in China to gain significant insights about the genomics of the causative virus, antiviral drugs, utility of traditional Chinese therapy, clinical trials, potential vaccines, better diagnostic tools and various animal models In conclusion, in the global battle against the novel COVID 19 outbreak, the domain of research and development for coming out with better diagnostic tools, potential therapeutic agents, and vaccines need to be strengthened immensely It is worth realizing that any advancements made in this regard will shape the way the infection will be tackled in the coming days © Biomedical and Biotechnology Research Journal

Coronavirus disease 2019 pandemic: Envisaging capacity building in the field of research to accomplish effective control

Introduction As in many other countries, healthcare workers (HCWs) have been identified as the priority group for vaccination in Turkey for they are in close contact with not only patients with COVID-19 to whom they provide treatment but also asymptomatic individuals with COVID-19 infection while inoculating COVID-19 vaccines. As a result of this prioritization, they will always be in the limelight and regarded as role models for personal and parental acceptance of COVID-19 vaccines. Methods Turkish healthcare workers (n=1,808) were contacted and invited to fill out an online questionnaire between December 27, 2020, and January 14, 2021, in order to reveal their approaches to COVID-19 vaccines and vaccination. Results Most of the participants had moderate concerns of having severe COVID-19. Anxiety on the adverse effects of COVID-19 vaccines was more prevalent in females and among 36- to 50-year-old healthcare workers and less frequent in physicians, nurses, and midwives and in those with a higher level of knowledge about COVID-19 vaccines. Strict anti-vaccination tendency was higher in professional categories other than physicians, nurses, and midwives. Females, physicians, nurses, midwives, healthcare workers aged 51 and over, healthcare workers having children, married healthcare workers, and healthcare workers who use scientific journals and World Health Organization (WHO) announcements as sources of information were more inclined to accept COVID-19 vaccines. The elimination of COVID-19 vaccine hesitancy in healthcare workers would be possible if people around them, physicians, and ministers or high officials get vaccinated but will persist in 19% of the healthcare workers. More than half of the healthcare workers thought vaccination against COVID-19 should not be mandatory. The Pfizer-BioNTech vaccine was the most preferred COVID-19 vaccine (37.3%). The reasons for this preference were the trustworthiness of the country of origin, the manufacturer company, the Turkish origin of its developers, the vaccine’s being the first to receive emergency validation, and its non-Indian, non-Russian, and non-Chinese origin. Parental vaccine refusal and hesitancy were present in 15.6% and 31.9% of the healthcare workers, respectively. The mistrust in COVID-19 vaccines among Turkish healthcare workers was directed toward not only pharmaceutical companies but also health authorities and academicians because of their unconvincing, conflicting, or vague statements and toward certain countries known for their production of low-quality merchandise in the past. Conclusion The parental COVID-19 vaccine hesitancy of 32% of the healthcare workers is unacceptably high for role modeling against anti-vaccine movement and should be diminished by implementing necessary measures as soon as possible.

Turkish Healthcare Workers’ Personal and Parental Attitudes to COVID-19 Vaccination From a Role Modeling Perspective

PURPOSE: The development of blood biomarkers that reflect Alzheimer’s disease (AD) pathophysiology (phosphorylated tau and amyloid-β) has offered potential as scalable tests for dementia differential diagnosis and early detection. In 2019, the Geneva AD Biomarker Roadmap Initiative included blood biomarkers in the systematic validation of AD biomarkers. METHODS: A panel of experts convened in November 2019 at a two-day workshop in Geneva. The level of maturity (fully achieved, partly achieved, preliminary evidence, not achieved, unsuccessful) of blood biomarkers was assessed based on the Biomarker Roadmap methodology and discussed fully during the workshop which also evaluated cerebrospinal fluid (CSF) and positron emission tomography (PET) biomarkers. RESULTS: Plasma p-tau has shown analytical validity (phase 2 primary aim 1) and first evidence of clinical validity (phase 3 primary aim 1), whereas the maturity level for Aβ remains to be partially achieved. Full and partial achievement has been assigned to p-tau and Aβ, respectively, in their associations to ante-mortem measures (phase 2 secondary aim 2). However, only preliminary evidence exists for the influence of covariates, assay comparison and cut-off criteria. CONCLUSIONS: Despite the relative infancy of blood biomarkers, in comparison to CSF biomarkers, much has already been achieved for phases 1 through 3 – with p-tau having greater success in detecting AD and predicting disease progression. However, sufficient data about the effect of covariates on the biomarker measurement is lacking. No phase 4 (real-world performance) or phase 5 (assessment of impact/cost) aim has been tested, thus not achieved.

The validation status of blood biomarkers of amyloid and phospho-tau assessed with the 5-phase development framework for AD biomarkers

The inflammatory/anti‐inflammatory balance has an important role in the clinical course of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (coronavirus disease [COVID‐19]) infection, which has affected over 200 million people since it first appeared in China in December 2019. This study aimed to determine the effectiveness of montelukast, which has known anti‐inflammatory and bronchodilatory effects, in these patients. The prospective randomized controlled study included 180 patients who were hospitalized in the infectious diseases department of our hospital between May and July 2021 and were diagnosed with the delta variant of SARS‐CoV‐2 by real‐time polymerase chain reaction of nasopharyngeal swabs. The patients were divided into three groups and received only standard treatment according to national guidelines (Group 1) or standard treatment plus 10 mg/day montelukast (Group 2) or 20 mg/day montelukast (Group 3). Laboratory parameters and pulmonary function tests (PFTs) at admission and on Day 5 of treatment were compared. Comparison of laboratory parameters on Day 5 showed that Groups 2 and 3 had significantly lower levels of lactate dehydrogenase, fibrinogen, D‐dimer, C‐reactive protein, and procalcitonin compared with Group 1 (p = 0.04, 0.002, 0.05, 0.03, and 0.04, respectively). In the comparison between Groups 2 and 3, only fibrinogen was significantly lower in Group 3 (p = 0.02). PFT results did not differ between the groups at admission, while on Day 5, only Group 3 showed significant improvements in forced expiratory volume in 1 s, forced vital capacity, and peak expiratory flow 25–75 compared with admission (p = 0.001 for all). Montelukast may be beneficial in COVID‐19 patients to maintain the inflammatory/anti‐inflammatory balance, prevent respiratory failure through its bronchodilator activity, and reduce mortality.

Effect of montelukast therapy on clinical course, pulmonary function, and mortality in patients with COVID‐19

Theoretically, human testes are highly expressive organs for angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 receptor. This study aimed to investigate whether the causative agent of COVID-19 is found in semen. The databases of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched using a combination of related keywords. All studies with original data, involving detection of SARS-CoV-2 in semen of male patients with COVID-19 or in those who have recovered from it, were included in the study. Six articles, including 136 samples, entered the systematic review. Most of the studies were performed in the recovery phase of COVID-19. In four articles, SARS-CoV-2 was not detected in semen, while in the other two articles semen testing showed the presence of the virus in some samples. Testicular discomfort, testicular cell damage, and spermogram disruption were also reported in some studies. We conclude that the study question cannot be answered with this number of studies. Since most of the samples were mild to moderate forms of COVID-19, it is not yet clear what the presence of the virus in semen will be in severe cases. The long-term effects are also vague. More original articles with better design and in different phases of the disease are needed to draw robust conclusions.

A Systematic Review of the Assessment of the Presence of SARS-CoV-2 in Human Semen.

PURPOSE: Spine surgeons around the world have been universally impacted by COVID-19. The current study addressed whether prior experience with disease epidemics among the spine surgeon community had an impact on preparedness and response toward COVID-19. METHODS: A 73-item survey was distributed to spine surgeons worldwide via AO Spine. Questions focused on: demographics, COVID-19 preparedness, response, and impact. Respondents with and without prior epidemic experience (e.g., SARS, H1NI, MERS) were assessed on preparedness and response via univariate and multivariate modeling. Results of the survey were compared against the Global Health Security Index. RESULTS: Totally, 902 surgeons from 7 global regions completed the survey. 24.2% of respondents had prior experience with global health crises. Only 49.6% reported adequate access to personal protective equipment. There were no differences in preparedness reported by respondents with prior epidemic exposure. Government and hospital responses were fairly consistent around the world. Prior epidemic experience did not impact the presence of preparedness guidelines. There were subtle differences in sources of stress, coping strategies, performance of elective surgeries, and impact on income driven by prior epidemic exposure. 94.7% expressed a need for formal, international guidelines to help mitigate the impact of the current and future pandemics. CONCLUSIONS: This is the first study to note that prior experience with infectious disease crises did not appear to help spine surgeons prepare for the current COVID-19 pandemic. Based on survey results, the GHSI was not an effective measure of COVID-19 preparedness. Formal international guidelines for crisis preparedness are needed to mitigate future pandemics.

Learning from the past: did experience with previous epidemics help mitigate the impact of COVID-19 among spine surgeons worldwide?

Foot ulceration is the most common complication of diabetes and represents a major health problem all over the world. If these ulcers are not adequately treated in an early stage, they may lead to lower limb amputation. Considering the low-cost and prevalence of smartphones with a high-resolution camera, Diabetic Foot Ulcer (DFU) healing assessment by image analysis became an attractive option to help clinicians for a more accurate and objective management of the ulcer. In this work, we performed DFU segmentation using Deep Learning methods for semantic segmentation. Our aim was to find an accurate fully convolutional neural network suitable to our small database. Three different fully convolutional networks have been tested to perform the ulcer area segmentation. The U-Net network obtained a Dice Similarity Coefficient of 97.25% and an intersection over union index of 94.86%. These preliminary results demonstrate the power of fully convolutional neural networks in diabetic foot ulcer segmentation using a limited number of training samples.

Semantic Segmentation of Diabetic Foot Ulcer Images: Dealing with Small Dataset in DL Approaches

Background and Objectives Olfactory and gustatory dysfunctions have been known as characteristic symptoms of coronavirus disease 2019 (COVID-19). However, the study of the clinical features of olfactory and gustatory dysfunctions in COVID-19 is still insufficient. Subjects and Method Mild COVID-19 patients who complained of olfactory or gustatory dysfunctions in the telephone monitoring from March 8 to April 8, 2020 were included in this study. Patient information was collected using a Google questionnaire. COVID-19 symptoms, severity and improvement of olfactory and gustatory dysfunctions of patients were investigated. Results A total of 228 patients participated in this study. The number of male and female were 76 and 152, and the average age was 32.1±11.5 years. There were 210 patients (92.1%) of olfactory dysfunction, 179 patients (78.5%) of gustatory dysfunction, and 165 patients (71.4%) who complained of both symptoms. The 18.4% of patients complained only olfactory or gustatory dysfunction without other symptoms of COVID-19, and 51.1% of patients presented olfactory and gustatory dysfunctions as the first symptoms. Most of the patients (95.6%) improved olfactory and gustatory dysfunctions within several months, but only 79.8% of patients were normalized. Conclusion Since olfactory and gustatory dysfunctions are the first symptoms in the numerous COVID-19 patients, and continued research on these patients play an important role in the screening and prevention of COVID-19. Long-term observation and further studies of treatment are needed for 20.2% of patients who have not fully recovered. Copyright © 2021 Korean Society of Otorhinolaryngology-Head and Neck Surgery.

Characteristics and prognosis of COVID-19 induced olfactory and gustatory dysfunction in Daegu

: Little is known about surgical practice in the initial phase of coronavirus disease 2019 (COVID-19) global crisis. This is a retrospective case series of 4 surgical patients (cholecystectomy, hernia repair, gastric bypass, and hysterectomy) who developed perioperative complications in the first few weeks of COVID-19 outbreak in Tehran, Iran in the month of February 2020. COVID-19 can complicate the perioperative course with diagnostic challenge and a high potential fatality rate. In locations with widespread infections and limited resources, the risk of elective surgical procedures for index patient and community may outweigh the benefit.

COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period

Proxima Centauri is the closest star to the Sun. This small, low-mass, mid M dwarf is known to host an Earth-mass exoplanet with an orbital period of 11.2 days within the habitable zone, as well as a long-period planet candidate with an orbital period of close to 5 years. We report on the analysis of a large set of observations taken with the ESPRESSO spectrograph at the VLT aimed at a thorough evaluation of the presence of a third low-mass planetary companion, which started emerging during a previous campaign. Radial velocities (RVs) were calculated using both a cross-correlation function (CCF) and a template matching approach. The RV analysis includes a component to model Proxima's activity using a Gaussian process (GP). We use the CCF's full width at half maximum to help constrain the GP, and we study other simultaneous observables as activity indicators in order to assess the nature of any potential RV signals. We detect a signal at 5.12 $\pm$ 0.04 days with a semi-amplitude of 39 $\pm$ 7 cm/s. The analysis of subsets of the ESPRESSO data, the activity indicators, and chromatic RVs suggest that this signal is not caused by stellar variability but instead by a planetary companion with a minimum mass of 0.26 $\pm$ 0.05 $M_\oplus$ (about twice the mass of Mars) orbiting at 0.029 au from the star. The orbital eccentricity is well constrained and compatible with a circular orbit.

A candidate short-period sub-Earth orbiting Proxima Centauri

Background: The associated risk factors, co-morbid conditions and biological variations varying with gender and age might be the cause of higher COVID-19 infection and deaths among males and older persons. The objective of this study was to predict and specify the biological attributes of variation in age and gender-based on COVID-19 status (deceased/recovered). Methods: In this retrospective study, the data was extracted from a recognised web-based portal. A total of 112,860 patients record was filtered out and an additional 9,131 records were separately analyzed to examine age and gender relationship with patient`s COVID-19 status (recovered/deceased). Chi-square, t-test, binary logistic regression, and longitudinal regression analysis were conducted. Results: The male COVID-19 cases (65.39%) were more than females (34.61%) and mean age of infected and recovered patients was 39.47{+/-}17.59 years and 36.85{+/-}18.51 years respectively. The odds for infection was significantly higher among females for lower age categories, which declines with age. The age-adjusted odds for recovery were significantly higher among females (O.R.=1.779) and odds for recovery was highest in 5-17 years age category (O.R.=88.286) independent of gender. Conclusion: The chances of being COVID-19 infected was higher for females of lower age categories (<35 years) which decreases with age. The odds for recovery among females was significantly higher than males. The chances of recovery declines with increasing age and the variation could be attributed to the biological differences between age categories and gender.

Biological attributes of age and gender variations in Indian COVID-19 cases: A retrospective data analysis

In India, the second wave of coronavirus disease (COVID -19) was associated with a distinct surge in cases of invasive fungal infection with mucormycosis. This disease was seen typically in the sinonasal form in COVID-19 patients. Uncontrolled diabetes, steroid use in COVID-19 treatment, etc. were some of the postulated risk factors for the association of COVID 19 and Mucormycosis. The management plan of these cases included surgical debridement, systemic antifungal therapy, sugar control, and management of antifungal related systemic adverse effects. In this retrospective case record review, we aimed to evaluate the airway management plan, demographics, and overall outcomes in patients undergoing surgical resection for COVID-19 associated mucormycosis. Forty-one (71.9 %) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) had a diagnosis of rhino-orbital mucormycosis, and 2 patients (3.5%) were diagnosed with palatal mucormycosis. Total 44 (77.19 %) patients had co-morbidities. The most common co-morbidity was Diabetes Mellitus 42 (73.6%), followed by hypertension 21 (36.84%) and Acute kidney injury 14 (28.07%). We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 out of 57 patients. In our study, mortality occurred in 7 (12.28 %) patients. The median mortality time was 60 (range, 27-74) days. The median time to hospital discharge was 53.5 (range,10-85) days. Managing COVID-19 on its own is challenging and additional mucormycosis can lead to increased morbidity and mortality. Despite challenges and risks, timely and meticulous interventions can reduce complications.

Coronavirus disease (COVID-19) associated Mucormycosis: An Anaesthesiologist's Perspective

Le monde entier est touché par un bouleversement sans précédent, crée par un virus incontrôlable et qui a pris le pas sur les théories scientifiques les plus élaborées. Les grandes puissances peinent à empêcher l’hécatombe dans les effectifs de leurs citoyens infectés, en dépit de toutes les avancées scientifiques et technologiques. Les pays à ressources limitées et dans lesquels vivent des populations parmi les plus vulnérables apparaissent comme les cibles sur lesquelles le virus est susceptible de faire le maximum de dégâts. Cette note discute des approches stratégiques, propose des mesures politiques et suggère des recommandations. La capacité de dépistage/diagnostic, les mesures de protection et d’assainissement, la communication et l’implication de la communauté seraient des priorités de riposte.

Comment prendre le pas sur le coronavirus dans un pays en développement: questions et actions au Burkina Faso

INTRODUCTION: Neuropilin-1(NRP1) is a cofactor that enhances SARS-CoV-2 coronavirus cell infectivity when co-expressed with angiotensin-converting enzyme 2(ACE2). The Renin-Angiotensin System (RAS) is activated in type 2 diabetes (T2D); therefore, the aim of this study was to determine if hypoglycaemia-induced stress in T2D would potentiate serum NRP1(sNRP1) levels, reflecting an increased risk for SARS-CoV-2 infection. METHODS: A case-control study of aged-matched T2D (n = 23) and control (n = 23) subjects who underwent a hyperinsulinemic clamp over 1-hour to hypoglycemia(<40mg/dl) with subsequent timecourse of 4-hours and 24-hours. Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement determined RAS-related proteins: renin (REN), angiotensinogen (AGT), ACE2, soluble NRP1(sNRP1), NRP1 ligands (Vascular endothelial growth factor, VEGF and Class 3 Semaphorins, SEM3A) and NRP1 proteolytic enzyme (A Disintegrin and Metalloproteinase 9, ADAM9). RESULTS: Baseline RAS overactivity was present with REN elevated and AGT decreased in T2D (p<0.05); ACE2 was unchanged. Baseline sNRP1, VEGF and ADAM9 did not differ between T2D and controls and remained unchanged in response to hypoglycaemia. However, 4-hours post-hypoglycemia, sNRP1, VEGF and ADAM9 were elevated in T2D(p<0.05). SEMA3A was not different at baseline; at hypoglycemia, SEMA3A decreased in controls only. Post-hypoglycemia, SEMA3A levels were higher in T2D versus controls. sNRP1 did not correlate with ACE2, REN or AGT. T2D subjects stratified according to ACE inhibitor (ACEi) therapies showed no difference in sNRP1 levels at either glucose normalization or hypoglycaemia. CONCLUSION: Hypoglycemia potentiated both plasma sNRP1 level elevation and its ligands VEGF and SEMA3A, likely through an ADAM9-mediated mechanism that was not associated with RAS overactivity or ACEi therapy; however, whether this is protective or promotes increased risk for SARS-CoV-2 infection in T2D is unclear. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov, identifier NCT03102801.

Soluble Neuropilin-1 Response to Hypoglycemia in Type 2 Diabetes: Increased Risk or Protection in SARS-CoV-2 Infection?

Repurposing the large arsenal of existing non-cancer drugs is an attractive proposition to expand the clinical pipelines for cancer therapeutics. The earlier successes in repurposing resulted primarily from serendipitous findings but more recently, drug or target-centric systematic identification of repurposing opportunities continues to rise. Kinases are one of the most sought-after cancer drug targets over the last three decades. There are many non-cancer approved drugs that can inhibit kinases as "off-targets" as well as many existing kinase inhibitors that can target new additional kinases in cancer. Identifying cancer-associated kinase inhibitors through mining commercial drug databases or new kinase targets for existing inhibitors through comprehensive kinome profiling can offer more effective trial-ready options to rapidly advance drugs for clinical validation. In this review, we argue that drug repurposing is an important approach in modern drug development for cancer therapeutics. We have summarized the advantages of repurposing, the rationale behind this approach together with key barriers and opportunities in cancer drug development. We have also included examples of non-cancer drugs that inhibit kinases or are associated with kinase signalling as a basis for their anti-cancer action.

Repurposing existing therapeutics, its importance in oncology drug development: kinases as a potential target.

Background: Rheumatic heart disease (RHD) has declined dramatically in wealthier countries in the past three decades, but it remains endemic in many lower-resourced regions and can have significant costs to households. The objective of this study was to quantify the economic burden of RHD among Ugandans affected by RHD. Methods: This was a cross-sectional cost-of-illness study that randomly sampled 87 participants and their households from the Uganda National RHD registry between December 2018 and February 2020. Using a standardized survey instrument, we asked participants and household members about outpatient and inpatient RHD costs and financial coping mechanisms incurred over the past 12 months. We used descriptive statistics to analyze levels and distributions of costs and the frequency of coping strategies. Multivariate Poisson regression models were used to assess relationships between socioeconomic characteristics and utilization of financial coping mechanisms. Results: Most participants were young or women, demonstrating a wide variation in socioeconomic status. Outpatient and inpatient costs were primarily driven by transportation, medications, and laboratory tests, with overall RHD direct and indirect costs of $78 per person-year. Between 20 and 35 percent of households experienced catastrophic healthcare expenditure, with participants in the Northern and Western Regions 5–10 times more likely to experience such hardship and utilize financial coping mechanisms than counterparts in the Central Region, a wealthier area. Increases in total RHD costs were positively correlated with increasing use of coping behaviors. Conclusion: Ugandan households affected by RHD, particularly in lower-income areas, incur out-of-pocket costs that are very high relative to income, exacerbating the poverty trap. Universal health coverage policy reforms in Uganda should include mechanisms to reduce or eliminate out-of-pocket expenditures for RHD and other chronic diseases.

Household Economic Consequences of Rheumatic Heart Disease in Uganda

The response to the novel coronavirus outbreak in China suggests that many of the lessons from the 2003 SARS epidemic have been implemented and the response improved as a consequence. Nevertheless some questions remain and not all lessons have been successful. The national and international response demonstrates the complex link between public health, science and politics when an outbreak threatens to impact on global economies and reputations. The unprecedented measures implemented in China are a bold attempt to control the outbreak - we need to understand their effectiveness to balance costs and benefits for similar events in the future.

SARS to novel coronavirus - old lessons and new lessons

Introduction: Diffuse nodular lung opacities can be caused by several processes including infection, autoimmune diseases, idiopathic interstitial pneumonia, or malignancy and can be a considerable diagnostic challenge. We present a patient with a suspicion of autoimmune bullous disease - associated interstitial lung disease who underwent a transbronchial cryobiopsy was eventually diagnosed with lepidic predominant adenocarcinoma. Case report: Our patient is a 73-year-old male with multiple co-morbidities including coronary artery disease, atrial fibrillation, type 2 diabetes mellitus, chronic obstructive pulmonary disease, 40 pack year tobacco use, hypothyroidism and pemphigus foliaceous which was diagnosed 3 years ago by skin biopsy and responded well to azathioprine which was later weaned off. He was doing well until 6 months ago when he noted worsening generalized rash and was started on azathioprine and mycophenolate mofetil by his dermatologist with mild improvement of rash. 4 months ago, he developed exertional dyspnea, fatigue, 40 lbs unintentional weight loss which finally brought him to the ED for further evaluation. CT chest was done which showed multiple, diffuse bilateral nodular lesions and focal opacities which were concerning for infectious process, inflammatory process, collagen vascular disease, amyloidosis, and malignancy. These findings were thought to be from autoimmune bullous disease - associated interstitial lung disease. Prior to escalation of his immunosuppression medication, flexible bronchoscopy with bronchoalveolar lavage and transbronchial cryobiopsy was performed. Histopathology of the specimen demonstrated well differentiated pulmonary adenocarcinoma growing in a lepidic pattern. The cells were found to be KRAS positive but PDL-1 negative. Patient was planned for further evaluation and staging but became critically ill in the interim with respiratory failure secondary to COVID-19 pneumonia. Discussion: An accurate and timely diagnosis is of the utmost importance in the workup of diffuse nodular lung opacities as it can drastically change management. Although surgical biopsy is the gold standard, cryobiopsy can also provide an adequately sized specimen with good architectural and morphological review while avoiding crush artifact. Our case highlights the importance of obtaining tissue biopsy to confirm definite diagnosis as well as safety and efficacy of diagnostic bronchoscopy with transbronchial cryobiopsy in the diagnosis of lepidic pattern adenocarcinoma.

The Great Mimicker: Lepidic Pattern Pulmonary Adenocarcinoma Presenting as Interstitial Lung Disease

Acute cardiac injury has been observed in a subset of COVID-19 patients, but the molecular basis for this clinical phenotype is unknown. It has been hypothesized that molecular mimicry may play a role in triggering an autoimmune inflammatory reaction in some individuals after SARS-CoV-2 infection. Here we investigate if linear peptides contained in proteins that are primarily expressed in the heart also occur in the SARS-CoV-2 proteome. Specifically, we compared the library of 136,704 8-mer peptides from 144 human proteins (including splicing variants) to 9,926 8-mers from all 17 viral proteins in the reference SARS-CoV-2 proteome. No 8-mers were exactly identical between the reference human proteome and the reference SARS-CoV-2 proteome. However, there were 45 8-mers that differed by only one amino acid when compared to the reference SARS-CoV-2 proteome. Interestingly, analysis of protein-coding mutations from 141,456 individuals showed that one of these 8-mers from the SARS-CoV-2 Replicase polyprotein 1a/1ab (KIALKGGK) is identical to a MYH6 peptide encoded by the c.5410C>A (Q1804K) genetic variation, which has been observed at low prevalence in Africans/African Americans (0.08%), East Asians (0.3%), South Asians (0.06%) and Latino/Admixed Americans (0.003%). Furthermore, analysis of 4.85 million SARS-CoV-2 genomes from over 200 countries shows that viral evolution has already resulted in 20 additional 8-mer peptides that are identical to human heart-enriched proteins encoded by reference sequences or genetic variants. Whether such mimicry contributes to cardiac inflammation during or after COVID-19 illness warrants further experimental evaluation. We suggest that SARS-CoV-2 variants harboring peptides identical to human cardiac proteins should be investigated as viral variants of cardiac interest.

Genetic alteration of human MYH6 is mimicked by SARS-CoV-2 polyprotein: mapping viral variants of cardiac interest

Fire smoke reduces the visibility of emergency direction signs, rendering them ineffective for providing appropriate guidance along evacuation routes in a fire situation. This is problematic because civilians may select evacuation routes that expose them to smoke or fire in a burning building. This study proposed using a smartphone voice-guided evacuation system (SVGES) to provide alternative evacuation routes for civilians trapped at a fire scene. To verify the efficacy of the SVGES, experiments were conducted with 26 participants in a simulated fire scenario. The experimental results showed that when using the SVGES, the participants chose the safest evacuation route with a 100% successful evacuation rate.

Using Smartphones for Indoor Fire Evacuation

pWe performed molecular dynamics simulation of the dimeric SARS-CoV-2 (severe acute respiratory syndrome corona virus 2) main protease (Mpro) to examine the binding dynamics of small molecular ligands Seven HIV inhibitors, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, and tipranavir, were used as the potential lead drugs to investigate access to the drug binding sites in Mpro The frequently accessed sites on Mpro were classified based on contacts between the ligands and the protein, and the differences in site distributions of the encounter complex were observed among the ligands All seven ligands showed binding to the active site at least twice in 28 simulations of 200 ns each We further investigated the variations in the complex structure of the active site with the ligands, using microsecond order simulations Results revealed a wide variation in the shapes of the binding sites and binding poses of the ligands Additionally, the C-terminal region of the other chain often interacted with the ligands and the active site Collectively, these findings indicate the importance of dynamic sampling of protein- ligand complexes and suggest the possibilities of further drug optimisations brrr pRaw trajectory data analysed in this paper and movie examples are available at the zenodo repository br/ / / / / / /div

Drug Binding Dynamics of the Dimeric SARS-CoV-2 Main Protease, Determined by Molecular Dynamics Simulation

BACKGROUND: A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. METHODS: This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. RESULTS: Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO(2)/FiO(2) ratio during the first 5 days of MV, respiratory system compliance (C(RS)) lower than 40 mL/cmH(2)O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. CONCLUSIONS: Age, SOFA score at ICU admission, C(RS), PaO(2)/FiO(2), renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. TRIAL REGISTRATION: NCT04411459

Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

During the COVID-19 outbreak, universities, teachers and students were required to transform their teaching and learning to online to maintain social distancing and reduce the spread of COVID-19 through the use of many online communication applications and platforms. However, in practical- oriented subjects such as web programming, the transition from laboratory instruction to online learning could not be seamless with a variety of communication applications and online programming websites. As a result, this research proposed a prototype of a support system for a web programming subject that teachers and students can use for studying, reviewing, doing exercises, monitoring progress, and collecting portfolios that have been done throughout the semester. In addition, a preliminary evaluation was carried out with 30 students to initially estimate the feeling and usability of the software from students' perspectives. The preliminary result was positive and acceptable among the students. © 2021 IEEE.

Designing an interactive online learning platform to support a practical subject during COVID-19 outbreak

BACKGROUND: Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. METHODS: We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. FINDINGS: CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. INTERPRETATION: CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.

Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study

OBJECTIVES: To investigate the potential impact of the syndromic multiplex FilmArray(®) Pneumonia plus Panel (FAPP) on the antimicrobial treatment guidance of patients with ventilated hospital-acquired pneumonia (VHAP). METHODS: Respiratory fluids from 100 adult patients with VHAP, receiving invasive mechanical ventilation in three intensive care units from one French university hospital, were tested prospectively using FAPP. Conventional cultures were performed in parallel as routine practice. Clinicians were left blinded to the FAPP results. Antimicrobial therapies based on FAPP results were simulated by independent blinded experts according to a predefined algorithm and compared to 1) those prescribed in practice according to local guidelines (real-life), and 2) those that complied with the international ERS/ESICM/ESCMID/ALAT recommendations. The primary endpoint was the number of days of broad-spectrum antimicrobial therapy. Secondary endpoints were the rates of microbiological treatment failure and cost-effectiveness ratio. RESULTS: The predicted median duration of broad-spectrum antibiotics was 0 [0-1.25] day in the FAPP-based simulation, versus 2 [0-6] days in real-life (p<0.0001) and 2 [2-3.25] days in the recommendations-based simulation (p<0.0001). Treatment failure was predicted in 3% of cases with FAPP results versus observed in 11% in real-life (p=0.08) and 6% with recommendations-based simulation (p=0.37). The incremental cost-effectiveness ratio was 1 121 € [-7021; 6794] to avoid one day of non-optimized antimicrobial therapy. CONCLUSIONS: Our results suggest that using FAPP in patients with VHAP has the potential to reduce the use of broad-spectrum antimicrobial therapy without increasing the risk of microbial treatment failure.

Potential Impact of Rapid Multiplex PCR on Antimicrobial Therapy Guidance for Ventilated Hospital-Acquired Pneumonia in Critically Ill Patients, A Prospective Observational Clinical and Economic Study

BACKGROUND: In Canada, there is widespread agreement about the need for integrated models of team-based care. However, there is less agreement on how to support the scale-up and spread of successful models, and there is limited empirical evidence to support this process in chronic disease management. We studied the supporting and mitigating factors required to successfully implement and scale-up an integrated model of team-based care in primary care. METHODS: We conducted a collective case study using multiple methods of data collection including interviews, document analysis, living documents, and a focus group. Our study explored a team-based model of care for chronic obstructive pulmonary disease (COPD) known as Best Care COPD (BCC) that has been implemented in primary care settings across Southwestern Ontario. BCC is a quality improvement initiative that was developed to enhance the quality of care for patients with COPD. Participants included healthcare providers involved in the delivery of the BCC program. RESULTS: We identified several mechanisms influencing the scale-up and spread of BCC and categorized them as Foundational (e.g., evidence-based program, readiness to implement, peer-led implementation team), Transformative (adaptive process, empowerment and collaboration, embedded evaluation), and Enabling Mechanisms (provider training, administrative support, role clarity, patient outcomes). Based on these results, we developed a framework to inform the progressive implementation of integrated, team-based care for chronic disease management. Our framework builds off our empirical work and is framed by local contextual factors. CONCLUSIONS: This study explores the implementation and spread of integrated team-based care in a primary care setting. Despite the study’s focus on COPD, we believe the findings can be applied in other chronic disease contexts. We provide a framework to support the progressive implementation of integrated team-based care for chronic disease management.

A framework to support the progressive implementation of integrated team-based care for the management of COPD: a collective case study

The COVID-19 pandemic makes restaurants implement new safety rules. However, because of consumers’ and employees’ resistance, employees may break these rules to improve the service experience. This paper examines how employees’ prosocial safety-rule-breakings (PSRB) affect consumer satisfaction. We propose that PSRB has two competing effects on consumers’ (including both requesters and bystanders) satisfaction via the mediating roles of service performance and perceived safety. We tested our proposed model in two experiments, adopting a 2 (Consumer role: Requesters vs. Bystanders) × 2 (PSRB level: Low vs. High) between-subject experimental design. Our findings suggest that PSRB has a strong negative relationship with bystanders’ service performance rating. PSRB harms both requesters’ and bystanders’ perceived safety. PSRB reduces consumer satisfaction, and the relationship is stronger for bystanders (vs. requesters). This study demonstrates the importance for hospitality organizations to ensure safety rule compliance during and after the pandemic.

Safety or service? Effects of employee prosocial safety-rule-breaking on consumer satisfaction

Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico is a telementoring program that uses videoconferencing technology to connect health care providers in underserved communities with subject matter experts In March 2020, Project ECHO created 10 coronavirus disease 2019 (COVID-19) telementoring programs to meet the public health needs of clinicians and teachers living in underserved rural and urban regions of New Mexico The newly created COVID-19 programs include 7 weekly sessions (Community Health Worker [in English and Spanish], Critical Care, Education, First-Responder Resiliency, Infectious Disease Office Hours, and Multi-specialty) and 3 one-day special sessions We calculated the total number of attendees, along with the range and standard deviation, per session by program Certain programs (Critical Care, Infectious Disease Office Hours, Multi-specialty) recorded the profession of attendees when available The Project ECHO research team collected COVID-19 infection data by county from March 11 through May 31, 2020 During that same period, 9765 health care and general education professionals participated in the COVID-19 programs, and participants from 31 of 35 (89%) counties in New Mexico attended the sessions Our initial evaluation of these programs demonstrates that an interprofessional clinician group and teachers used the Project ECHO network to build a community of practice and social network while meeting their educational and professional needs Because of Project ECHO's large reach, the results of the New Mexico COVID-19 response suggest that the rapid use of ECHO telementoring could be used for other urgent national public health problems

Innovative COVID-19 Programs to Rapidly Serve New Mexico : Project ECHO

1. Human lymphocytes and monocytes are not permissive to productive SARS coronavirus (SARS-CoV) infection in vitro. 2. Challenge of lymphocytes and monocytes with infectious SARS-CoV, inactivated virions, and receptor-binding fragment of spike protein does not trigger apoptosis. 3. Direct infection/interaction between viruses and lymphocytes/monocytes is unlikely to be the cause of lymphopaenia in SARS patients. 4. Lymphopaenia in SARS patients is likely to result from indirect mechanisms secondary to the viral infection.

Mechanisms of lymphocyte loss in SARS coronavirus infection.

Social isolation and sedentary behaviour are common in residential aged care facilities (also known as nursing homes or long-term care). Use of new technologies such as virtual and augmented reality are currently under investigation for their potential to provide exciting and engaging activities for older people in residential aged care facilities. However, there is limited evidence on whether these technologies can promote physical activity in a small group setting for people with cognitive impairment. Using mixed methods, we examined the use of a virtual cycling experience in a sample of 10 participants with cognitive impairment living in residential aged care facilities. In a randomised crossover design, participants engaged in a 25-minute, self-paced, facilitated seated virtual cycling experience and a time-matched seated physical activity session in groups of five. All participants completed a brief pre- and post-intervention mood questionnaire. Video analysis was used for both conditions to compare levels of environmental stimulation, apathy and engagement using both the Person-Environment Apathy Rating Scale and the Engagement of a Person with Dementia Scale. A thematic analysis of semi-structured interviews following the virtual cycling experience was also performed. No differences were observed between conditions for all outcomes except for environmental stimulation, where there was a lower response in the intervention than the control condition (p = 0.032). This was primarily driven by lower scores for the virtual cycling experience than control in physical accessibility (p = 0.012). Participants reported the virtual cycling experience to be immersive and challenging and reminisced about cycling earlier in life. The activity manager observed that the virtual cycling experience was an overall positive experience and emphasised benefits of safety screening and preparation prior to the activities. The findings of this study support the use of the virtual cycling experience as an immersive and engaging alternative to usual activities, which might encourage higher levels of physical activity in residential aged care facilities.

Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study

Motivated numeracy refers to the idea that people with high reasoning capacity will use that capacity selectively to process information in a manner that protects their own valued beliefs. This concept was introduced in a now classic article by Kahan, Peters, Dawson, & Slovic [2017, Behavioral Public Policy 1, 54-86], who used numeracy to index reasoning capacity, and demonstrated that the tendency to engage in ideologically congruent interpretation of facts increased substantially with people's numeracy. Despite the importance of this finding, both from a theoretical and practical point of view, there is yet no consensus in the literature about the factual strength of motivated numeracy. We therefore conducted a large-scale replication of Kahan, Peters, Dawson, and Slovic (2017), using a pre-specified analysis plan with strict evaluation criteria. We did not find good evidence for motivated numeracy; there are distinct patterns in our data at odds with the core predictions of the theory, most notably (i) there is ideologically congruent responding that is not moderated by numeracy, and (ii) when there is moderation, ideologically congruent responding occurs only at the highest levels of numeracy. Our findings suggest that the cumulative evidence for motivated numeracy is weaker than previously thought, and that caution is warranted when this feature of human cognition is leveraged to improve science communication on contested topics such as climate change or immigration.

A preregistered replication of motivated numeracy.

Long noncoding RNAs (lncRNAs) have been reported to participate in regulating many biological processes, including immune response to influenza A virus (IAV). However, the association between lncRNA expression profiles and influenza infection susceptibility has not been well elucidated. Here, we analyzed the expression profiles of lncRNAs, miRNAs, and mRNAs among IAV-infected adult rat (IAR), normal adult rat (AR), IAV-infected junior rat (IJR), and normal junior rat (JR) by RNA sequencing. Compared with differently expressed lncRNAs (DElncRNAs) between AR and IAR, 24 specific DElncRNAs were found between IJR and JR. Then, based on the fold changes and P value, the top 5 DElncRNAs, including 3 upregulated and 2 downregulated lncRNAs, were chosen to establish a ceRNA network for further disclosing their regulatory mechanisms. To visualize the differentially expressed genes in the ceRNA network, GO and KEGG pathway analysis was performed to further explore their roles in influenza infection of junior rats. The results showed that the downregulated DElncRNA-target genes were mostly enriched in the IL-17 signaling pathway. It indicated that the downregulated lncRNAs conferred the susceptibility of junior rats to IAV via mediating the IL-17 signaling pathway.

A Biological Insight into the Susceptibility to Influenza Infection in Junior Rats by Comprehensive Analysis of lncRNA Profiles

Gegenqinlian decoction (GD) has been extensively used for the treatment of diarrhea with intestinal dampness-heat syndrome (IDHS) with a satisfying therapeutic effect. The purpose of this study is to clarify the active ingredients and mechanism of GD in the treatment of diarrhea with IDHS. The TCMSP database was used to screen out the active ingredients of the four Chinese herbal medicines in GD, and the targets of the active ingredients were predicted. We selected the targets related to diarrhea through the DisGeNET database, then used the NCBI database to screen out related targets of lactase and sucrase, and constructed the visual network to search for the active ingredients of GD in the treatment of diarrhea and related mechanisms of the targets. Combined with network pharmacology, we screened out 146 active ingredients in GD corresponding to 252 ingredient targets, combined with 328 disease targets in diarrhea, and obtained 12 lactase targets and 11 sucrase targets. The key active ingredients involved quercetin, formononetin, β-sitosterol kaempferol, and wogonin. Furthermore, molecular docking showed that these five potential active ingredients had good affinities with the core targets PTGS2. The active ingredients in GD (such as quercetin, formononetin, and β-sitosterol) may increase the microbial activity of the intestinal mucosa of mice and reduce the microbial activity of the intestinal contents through multiple targets, thereby achieving the effect of treating diarrhea.

Network Pharmacology-Based Analysis of Gegenqinlian Decoction Regulating Intestinal Microbial Activity for the Treatment of Diarrhea

Purpose: In early 2020, the world faced a rapid life-changing pandemic in the form of the Coronavirus Disease of 2019 (COVID-19) crisis. Citywide lockdowns with stay-at-home orders and mass closings quickly became the “new normal.” With these new mandates, routine activity, mental health and financial securities all began to experience major deviations, and it became clear that this could prove to be rather valuable in providing the opportunity for large-scale criminology experiments. This study aims to explore New York City's (NYC) crime patterns during this unique social situation. Specifically, has crime as a whole increased or decreased, and have particular crimes increased or decreased during these stressful fluid times? Design/methodology/approach: The authors briefly review previous crises and worldwide trends but focus on NYC crime as collected by the New York Police Department's statistics unit, “CompStat.” An analysis of 13 crime types from March 30 to July 5 was completed, including percent differences and individual weekly incidence rates in citywide crimes compared to the same time in 2019. Findings: The analysis demonstrated that all crimes analyzed, except for murder and burglary, exhibited a statistically significant difference during COVID-19 conditions compared to the same time the previous year. Grand larceny auto and gun violence crimes significantly increased during COVID-19 weeks, whereas rape, other sex crimes, robbery, felony assault, grand larceny, transit, housing, misdemeanor assault and petit larceny all significantly decreased. Originality/value: Due to the ongoing nature of the pandemic, this is amongst the first studies to examine trends in NYC crime during pandemic mandates. Expanding our knowledge in these situations can inform natural disaster responses, as well as criminal justice policy and practice to better protect the public in future crises. © 2021, Emerald Publishing Limited.

New York City: COVID-19 quarantine and crime

PURPOSE: To identify whether fluorodeoxyglucose (FDG) uptake in the Waldeyer ring (WR)/nasopharyngeal (NP) region by positron emission tomography-computed tomography (PET-CT) was physiologic or pathologic in the follow-up of lymphoma patients receiving postchemotherapy treatment. PATIENTS AND METHODS: We retrospectively examined FDG uptake in the WR/NP region in 534 patients with lymphoma as assessed by PET-CT used for both diagnosis and follow-up. RESULTS: Forty-nine patients had FDG uptake in the WR/NP region by PET-CT performed after completion of a chemotherapy regimen. Biopsy was performed for 11 of these patients in whom the uptake was considered to be pathologic, and results indicated the presence of reactive follicular hyperplasia. It was considered to be physiologic in 38 patients. PET-CT was repeated after 1 year, and no significant difference was identified between the standardized maximum uptake values (SUVmax; P = .107). The initial diagnosis of 20 patients was made via biopsy performed in the WR/NP region. The SUVmax for the FDG uptake in these patients, asymmetry, SUVmax of the coexisting lymphadenopathies in the neck, and FDG uptake with a counterpart finding by CT were significantly higher than other groups (P = .047, .001, and .005). CONCLUSION: When deciding whether to resample after treatment completion, it should be taken into account that, in addition to the SUVmax of the lesion, asymmetry, and the SUVmax of the coexisting lymphadenopathy in the neck, a crucial criterion is whether the FDG uptake has a counterpart finding by CT.

Clinical Significance of Increased FDG Uptake in the Waldeyer Ring and the Nasopharynx Region Identified by PET-CT in Postchemotherapy Follow-up in Patients With Lymphoma: When Should We Perform Biopsy?

Objective The autoimmune response in rheumatoid arthritis (RA) is marked by anti-citrullinated protein antibodies (ACPA). A remarkable feature of ACPA-IgG is the abundant expression of N-linked glycans in the variable domain. Nonetheless, the presence of ACPA variable domain glycans (VDG) across disease stages and its’ response to therapy is poorly described. To understand its dynamics, we investigated the abundance of ACPA-IgG VDG in 1574 samples from individuals in different clinical disease stages. Methods Using liquid chromatography, we analyzed ACPA-IgG VDG profiles of 7 different cohorts from Japan, Canada, the Netherlands and Sweden. We assessed 184 healthy, 228 pre-symptomatic, 277 arthralgia, 305 patients at RA-onset and 117 RA-patients 4, 8 and 12 months after disease onset. Additionally, we measured VDG of 234 samples from RA-patients that did or did not achieve long-term drug-free remission (DFR) during up to 16 years follow-up. Results Our data show that ACPA-IgG VDG significantly increases (p<0.0001) towards disease-onset and associates with ACPA-levels and epitope spreading pre-diagnosis. A slight increase in VDG was observed in established RA and a moderate influence of treatment. Individuals who later achieved DFR displayed reduced ACPA-IgG VDG already at RA-onset. Conclusion The abundance of ACPA-IgG VDG rises towards RA-onset and correlates with maturation of the ACPA-response. Although, ACPA-IgG VDG levels are rather stable in established disease, a lower degree at RA-onset correlates with DFR. Even though the underlying biological mechanisms are still elusive, our data support the concept that VDG relates to an expansion of the ACPA-response pre-disease and contributes to disease-development.

ACPA-IgG variable domain glycosylation increases before the onset of rheumatoid arthritis and stabilizes thereafter; a cross-sectional study encompassing over 1500 samples

Introduction: The 19th National Congress of the Communist Party of China in October 2017 and 1st Session of the 13th National People’s Congress in March 2018 play key role in promoting development of Chinese society. This article present updated information on reform of occupational health (OH) management. Methods: The related information were collected and current practices were introduced. Results: National Health Commission (NHC) of State Council, established on basis of National Health and Family Planning Commission, is responsible all management work related OH, except for supervision of coal mine safety work, still by newly established Ministry of Emergency Management (former SAWS). The State Council strives to implement the advancing reform to delegate power, streamline administration and optimize government services and has an inter-ministerial joint annual conference system for occupational disease prevention and control. New agency entitled with Division of Occupational Health within NHC was established. NHC has revised several regulations, e.g, OH management in workplaces, classification of occupational hazards，diagnosis of occupational diseases， OH services management. Against pneumoconiosis, NHC, jointly with other 9 Ministries and approved by State Council, announced Action plan for pneumoconiosis prevention and treatment in 2019 and has promoted construction of pneumoconiosis rehabilitation stations in some provinces. To prevent Covid-19 epidemic, NHC released several guidelines to instruct the enterprises how to do. Conclusion: The improvement of systematicness of OH management system is still expected.

Updated Information On Administrative Regulation On Occupational Health In China Since 2018

Devices that monitor the depth of hypnosis based on the electroencephalogram (EEG) have long been commercialized, and clinicians use these to titrate the dosage of hypnotic agents. However, these have not yet been accepted as standard monitoring devices for anesthesiology. The primary reason is that the use of these monitoring devices does not completely prevent awareness during surgery, and the development of these devices has not taken into account the neurophysiological mechanisms of hypnotic agents, thus making it possible to show different levels of unconsciousness in the same brain status. An alternative is to monitor EEGs that are not signal processed with numerical values presented by these monitoring devices. Several studies have reported that power spectral analysis alone can distinguish the effects of different hypnotic agents on consciousness changes. This paper introduces the basic concept of power spectral analysis and introduces the EEG characteristics of various hypnotic agents that are used in sedation.

Characteristics of electroencephalogram signatures in sedated patients induced by various anesthetic agents.

The COVID-19 virus has swept the world and brought great impact to various fields, gaining wide attention from all walks of life since the end of 2019. At present, although the global epidemic situation is leveling off and vaccine doses have been administered in a large amount, confirmed cases are still emerging around the world. To make up for the missed diagnosis caused by the uncertainty of nucleic acid polymerase chain reaction (PCR) test, utilizing lung CT examination as a combined detection method to improve the diagnostic rate becomes a necessity. Our research considered the time-consuming and labor-intensive characteristics of the traditional CT analyzing process, and developed an efficient deep learning framework named CSGBBNet to solve the binary classification task of COVID-19 images based on a COVID-Seg model for image preprocessing and a GBBNet for classification. The five runs with random seed on the test set showed our novel framework can rapidly analyze CT scan images and give out effective results for assisting COVID-19 detection, with the mean accuracy of 98.49 ± 1.23%, the sensitivity of 99.00 ± 2.00%, the specificity of 97.95 ± 2.51%, the precision of 98.10 ± 2.61%, and the F1 score of 98.51 ± 1.22%. Moreover, our model CSGBBNet performs better when compared with seven previous state-of-the-art methods. In this research, the aim is to link together biomedical research and artificial intelligence and provide some insights into the field of COVID-19 detection.

CSGBBNet: An Explainable Deep Learning Framework for COVID-19 Detection

OBJECTIVES: The COVID-19 crisis has disrupted economies and health systems across the globe and has brought substantial challenges for food systems. Government responses key to minimizing disease spread have included a number of movement restriction policies (e.g., school closures, stay at home measures, etc.). Such policies have impacted food consumption and purchasing behaviours and have harmed much of the face-to-face type of labour required for food retailing, which in turn may have impacted the affordability of diets. We use evidence from 133 countries to investigate the association between stringency in movement restriction policies and retail price levels for food and other consumer goods. METHODS: We use the International Monetary Fund's monthly national consumer price index (CPI), and food and non-alcoholic beverage index (FCPI), as well as a ratio of FCPI to CPI—the food price index (FPI)—for 133 countries from January 2017 to November 2020. Data on stringency in movement restriction policies and COVID-19 cases and mortality per million were obtained from the Oxford COVID-19 Government Response Tracker and the European Centre for Disease Prevention and Control, respectively. Fixed effects regression models were used to estimate the association between stringency of COVID-19 movement restrictions and monthly differences in 2020 retail price levels (from average 2017–2019 levels) of foods and other consumer goods, while controlling for pandemic severity in each country and month. RESULTS: Regression models yielded a positive and significant relationship between stringency level and FCPI level (coeff. = 1.24–1.91; 95% CIs: 0.25–2.79) or FPI level (coeff. = 1.24–2.14; 95% CIs: 0.60–2.53). Alternatively, stringency level was either negatively associated with CPI level (coeff. = −0.57; 95% CI: −1.06 – −0.07) or not significantly associated with CPI level. CONCLUSIONS: Government response stringency in COVID-19 movement restriction policies is linked with higher retail food price levels. Governments could consider implementing these policies alongside other measures (e.g., food assistance) to mitigate negative spillovers into the domain of food security and nutrition. FUNDING SOURCES: This work was supported by the Bill & Melinda Gates Foundation and UKAid through the Foreign, Commonwealth & Development Office of the UK.

Stringency of Movement Restrictions Linked With Higher Retail Food Prices but Not Overall Prices for All Consumer Goods During COVID-19 Pandemic

During the epidemics in the Qing dynasty, many medical professionals, nonprofessionals, and social organizations collected and sorted medical prescriptions related to infectious diseases. These people also compiled, published, disseminated, and consulted related medical formularies. The above historical event can be viewed as the construction and dissemination of medical knowledge. They edited and published medical formularies on infectious diseases with lower cost and in flexible ways by taking the initiative and giving full scope to creativity. Diverse anti-epidemic medical prescriptions from these medical formularies can be used for infectious diseases in the event of the outbreaks. However, the therapeutic effects of classical prescriptions and folk recipes cannot be regarded as the same. The wide circulation of anti-epidemic medical prescriptions and medical formularies was essentially a process of epidemic prevention resource allocation. Not only did it enable many nonprofessionals to participate in epidemic prevention and control, but it also enhanced awareness, knowledge, and capacity for epidemic prevention at the individual level. At the same time, due to the uneven quality and individual differences in the physical fitness and condition of the prescriptions and formularies, they had the capacity of causing inconveniences to the readers or patients.

Acquisition and Dissemination of Anti-Epidemic Medical Prescriptions During the Outbreaks in the Qing Dynasty of China

The rapidly evolving pandemic of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection worldwide cost many lives. The angiotensin converting enzyme-2 (ACE-2) has been identified as the receptor for the SARS-CoV-2 viral entry. As such, it is now receiving renewed attention as a potential target for anti-viral therapeutics. We review the physiological functions of ACE2 in the cardiovascular system and the lungs, and how the activation of ACE2/MAS/G protein coupled receptor contributes in reducing acute injury and inhibiting fibrogenesis of the lungs and protecting the cardiovascular system. In this perspective, we predominantly focus on the impact of SARS-CoV-2 infection on ACE2 and dysregulation of the protective effect of ACE2/MAS/G protein pathway vs. the deleterious effect of Renin/Angiotensin/Aldosterone. We discuss the potential effect of invasion of SARS-CoV-2 on the function of ACE2 and the loss of the protective effect of the ACE2/MAS pathway in alveolar epithelial cells and how this may amplify systemic deleterious effect of renin-angiotensin aldosterone system (RAS) in the host. Furthermore, we speculate the potential of exploiting the modulation of ACE2/MAS pathway as a natural protection of lung injury by modulation of ACE2/MAS axis or by developing targeted drugs to inhibit proteases required for viral entry.

ACE2, Much More Than Just a Receptor for SARS-COV-2

Suicide is the 10th leading cause of death in the United States overall, and the second and fourth leading cause among persons aged 10-34 and 35-44 years, respectively (1). In just over 2 decades (1999-2019), approximately 800,000 deaths were attributed to suicide, with a 33% increase in the suicide rate over the period (1). In 2019, a total of 12 million adults reported serious thoughts of suicide during the past year, 3.5 million planned a suicide, and 1.4 million attempted suicide (2). Suicides and suicide attempts in 2019 led to a lifetime combined medical and work-loss cost (i.e., the costs that accrue from the time of the injury through the course of a person's expected lifetime) of approximately $70 billion (https://wisqars.cdc.gov:8443/costT/). From 2018 to 2019, the overall suicide rate declined for the first time in over a decade (1). To understand how the decline varied among different subpopulations by demographic and other characteristics, CDC analyzed changes in counts and age-adjusted suicide rates from 2018 to 2019 by demographic characteristics, county urbanicity, mechanism of injury, and state. Z-tests and 95% confidence intervals were used to assess statistical significance. Suicide rates declined by 2.1% overall, by 3.2% among females, and by 1.8% among males. Significant declines occurred, overall, in five states. Other significant declines were noted among subgroups defined by race/ethnicity, age, urbanicity, and suicide mechanism. These declines, although encouraging, were not uniform, and several states experienced significant rate increases. A comprehensive approach to prevention that uses data to drive decision-making, implements prevention strategies from CDC's Preventing Suicide: A Technical Package of Policy, Programs, and Practices with the best available evidence, and targets the multiple risk factors associated with suicide, especially in populations disproportionately affected, is needed to build on initial progress from 2018 to 2019 (3).

Changes in Suicide Rates — United States, 2018–2019

The supply chain disruption caused by the coronavirus disease 2019 (COVID-19) pandemic has forced many manufacturers to look for alternative suppliers. How to choose a suitable alternative supplier in the COVID-19 pandemic has become an important task. To fulfill this task, this research proposes a calibrated fuzzy geometric mean (cFGM)-fuzzy technique for order preference by similarity to ideal solution (FTOPSIS)-fuzzy weighted intersection (FWI) approach. In the proposed methodology, first, the cFGM method is proposed to accurately derive the priorities of criteria. Subsequently, each expert applies the FTOPSIS method to compare the overall performances of alternative suppliers in the COVID-19 pandemic. The sensitivity of an expert to any change in the overall performance of the alternative supplier is also considered. Finally, the FWI operator is used to aggregate the comparison results by all experts, for which an expert’s authority level is set to a value proportional to the consistency of his/her pairwise comparison results. The cFGM-FTOPSIS-FWI approach has been applied to select suitable alternative suppliers for a Taiwanese foundry in the COVID-19 pandemic.

Analyzing the Impact of Vaccine Availability on Alternative Supplier Selection Amid the COVID-19 Pandemic: A cFGM-FTOPSIS-FWI Approach

Due to the COVID-19 pandemic, multidisciplinary team (MDT) meetings have to switch from physical to digital meetings. However, the technology they currently use to facilitate these meetings can sometimes be lacking, therefore many software companies have developed new software to ease our new digital workspace. In this study, we propose a new method, a comparative participatory cognitive walkthrough, which can show mismatches in cognitive models. To test our method, we tested the compatibility of EPIC EMR (EPIC Care) and the NAVIFY Tumor Board for preparing MDT meetings. The identified mismatches are categorized in the HOT-fit model by Yusof et al, a common way to evaluate if a healthcare information system fits with the healthcare professionals and the organization. In total, 16 mismatches were identified. These mismatches were discussed in a feedback session with an implementation manager of the NAVIFY Tumor Board. The proposed method seems to be a fast and cheap method to gain useful insights in how well new software matches with the software currently in use, by comparing the cognitive models in place when performing tasks involved with specific scenarios. The identified aspects can be of use for the development and adaptation of the new software, as well as provide guidelines on which aspects to focus on when training healthcare professionals to use the new software to have a smooth transition of software.

Assessing the Usability of a Tumor Dashboard for Multidisciplinary Care Teams for First Time Users; First Exploration of a Comparative Participatory Cognitive Walkthrough to Show Mismatches in Cognitive Models

Prenatal screening to prevent congenital toxoplasmosis as performed in France for several decades has been questioned in view of the decreasing incidence of this infection and the cost of testing. The French College of Obstetrics and Gynecology mandated a multidisciplinary panel of experts to perform a reassessment of the screening program in accordance with international good practice. In France, about 70% of pregnant women are not immune to T. gondii, and 0.2-0.25% become infected during pregnancy. The risk of maternal-fetal transmission of infection is on average 25-29% and depends greatly on the gestational age at seroconversion. In case of fetal transmission, the outcome is livebirth in 95% of cases, with latent congenital toxoplasmosis in 90% of cases and symptomatic forms in 10% of cases, of which 1/3 are severe and 2/3 moderate. Biological techniques have satisfactory performance regarding serologies for the diagnosis of maternal infections and PCR on amniotic fluid for the prenatal diagnosis of congenital toxoplasmosis. Primary prevention of toxoplasmosis is based on hygiene measures that are relatively simple, but poorly implemented. In case of maternal seroconversion, there is a strong case for prenatal prophylactic treatment as soon as possible (ideally within 3 weeks of seroconversion), spiramycin before 14 weeks of gestation (WG), and with a tendency to superiority of the pyrimethamine/sulfadiazine association over spiramycin beyond 14 W G, in order to reduce the risk of symptomatic congenital toxoplasmosis. In case of congenital toxoplasmosis, prompt initiation of treatment reduces the occurrence of cerebral signs and symptoms, as well as retinal lesions. Several medico-economic evaluations of the French toxoplasmosis screening program have been conducted including an individual cost-effectiveness approach with decision analysis which concluded on the profitability of prenatal screening as carried out in France (monthly surveillance of seronegative women, prenatal treatment in case of seroconversion, termination of pregnancy in severe forms). Though most international societies do not recommend systematic screening for mainly financial reasons, if congenital toxoplasmosis appears benign in France today, it is probably thanks to screening and the possibility of early treatment of fetuses and/or newborns. Thus, the panel recommends continuing for now the program in France for prevention of congenital toxoplasmosis.

Toxoplasmosis screening during pregnancy in France: Opinion of an expert panel for the CNGOF.

As an art collective Cesar & Lois develops projects that examine sociotechnical systems, attempting to challenge anthropocentric technological pathways while linking to intelligences sourced in biological circuitry. As artists we imagine new configurations for what we understand as (social, economic, technological) networks and intelligences. With this ecosystemic approach we consider the possibility of an artificial intelligence (AI) that supports well-being in a broad sense, accommodating relationships across different layers of living worlds and involving local and global communities of all kinds. This thinking is grounded in research by theorists across disciplines, including communications and media theory, microbiology, anthropology, decolonial studies, social ecology, sociology and environmental psychology. At a time when human beings and their ecosystems face grave threats due to climate change and a global pandemic, we are rethinking the basis for our AIs, and for the resulting decision-making on behalf of societies and ecosystems. Creative projects by Cesar & Lois provide alternative conceptual models for thinking across networks, reframing the artists’ and potentially viewers’ understanding of what motivates and shapes societies. Referencing a series of artworks and the theories that underpin them, this article envisages a sociotechnical framework that takes into account ecosystems and challenges the philosophical orientations that guide society. Degenerative Cultures is an artwork in which the artists overlap microbiological organisms, AI and human systems as a speculative restructuring of networks across human and nonhuman entities. The push for ecosystemic technologies and intelligences is linked to the expansion of community to include planetary constituents, such as nonhuman beings and environments. The artists posit that such ecosystemic networks would be capable of taking into account the planet’s human societies as well as nonhuman species and their environments, broadening the concept of community well-being and shifting the technological architecture to meet the complex needs of the planet and its constituent parts. The experimental series, [ECO]nomic Revolution, layers Physarum polycephalum, or slime mold, over the mapped demographics of human cities. The species polycephalum references multi-brains, and implies a decentralized logic, which for the non-neurological microbiological network translates to the sharing of nutrients and regulated growth across a culture. Assuming a perspective based in the arts, this proposition imagines a shift from the dominant conceptions of AI as an individual intelligence and frames it as part of a network that necessarily includes ecosystems. We envision the creation of sociotechnical systems that could be modeled on networked lifeforms that have optimized themselves across millions of years, like the organism Physarum polycephalum, which occurs globally in moist environments, or like those microbial populations within and outside of human bodies, whose percussive biological processing interacts with and alters many layers of lifeforms. We argue that an environmentally responsive intelligence based on relationships across living systems potentially serves a broad community composed of diverse human populations, nonhuman beings and ecosystems.

An Argument for an Ecosystemic AI: Articulating Connections across Prehuman and Posthuman Intelligences

The clinical research we do to improve our understanding of disease and development of new therapies has temporarily been paused or delayed as the global healthcare enterprise has focused its attention on those impacted by COVID-19. While rates of SARS-CoV-2 infection are decreasing in many areas, many locations continue to have a high prevalence of infection. Nonetheless, research must continue and institutions are considering approaches to re-starting non-COVID related clinical investigation. Those restarting respiratory research must navigate the added planning challenges that take into account outcome measures that require aerosol generating procedures. Such procedures potentially increase risk of transmission of SARS-CoV-2 to research staff, utilize limited personal protective equipment, and require conduct in negative pressure rooms. One must also be prepared to address the potential for COVID-19 resurgence. With research subject and staff safety and maintenance of clinical trial data integrity as the guiding principles, here we review key considerations and suggest a step-wise approach for resuming respiratory clinical research.

How I Do It: Restarting Respiratory Clinical Research in the Era of the COVID19 Pandemic

An observational study was conducted in Ukraine to determine the independent mortality risks among adult inpatients with COVID-19. The results of treatment of COVID-19 inpatients (n = 367) are presented, and waist circumference (WC) was measured. Logistic regression analysis was applied to evaluate the effects of factors on the risk of mortality. Odds ratios and 95% CIs for the association were calculated. One hundred and three of 367 subjects had fasting plasma glucose level that met the diabetes mellitus criteria (≥7.0 mmol/L), in 53 patients, diabetes mellitus was previously known. Two hundred and eleven patients did not have diabetes or hyperglycemia. Diabetes mellitus/hyperglycemia odds ratio 2.5 (CI 1.0-6.1), p = 0.045 loses statistical significance after standardization by age, waist circumference or fasting plasma glucose. No effect on gender, body mass index-determined obesity, or hypertension was found. The fasting plasma glucose (>8.5 mmol/L), age (≥61 years), and waist circumference (>105 cm) categories were associated with ORs 6.34 (CI 2.60-15.4); 4.12 (CI 1.37-12.4); 8.93 (CI 3.26-24.5), respectively. The optimal model of mortality risk with AUC 0.86 (CI 0.81-0.91) included the diabetes/heperglycemia and age categories as well as waist circumference as a continued variable. Waist circumference is an independent risk factor for mortality of inpatients with COVID-19.

Relationship between hyperglycemia, waist circumference, and the course of COVID-19: Mortality risk assessment

BACKGROUND Three laparoscopic ports are traditionally required to complete a laparoscopic appendectomy. We describe a novel, innovative 2-port laparoscopic technique, in which intracorporeal appendectomy can be completed safely with standard instrumentation. MATERIALS AND METHODS Eight consecutive patients were prospectively assigned to undergo 2-port laparoscopic appendectomies for presumed appendicitis. The technique involves the placement of one 12-mm infraumbilical port for the working instruments and one 5-mm left lower quadrant port for the camera. A suture is tied in a loop to the anterior abdominal wall in the right lower quadrant, which is subsequently used as an axle. A pretied suture placed on the appendix is passed through the loop suture and then through the port to the outside of the abdomen. This technique allows exposure of the base of the appendix and compensates for the lack of the third port usually required for the retraction of the appendix. The mesoappendix and appendix are stapled and removed from the abdomen in an extrication bag. RESULTS All 8 laparoscopic procedures were completed without difficulty. The mean operative time was 64.1 min. Length of hospitalization was 1 d or less. No major complications were encountered. One minor postoperative complication occurred in which the patient developed periumbilical cellulitis, which was completely resolved at the 1-wk postoperative visit. CONCLUSION In times where surgeons are focusing on transluminal approaches to access the abdominal cavity, we favor laparoscopy for the enhanced exposure, instrument diversity, and overall patient safety. Two-port laparoscopic appendectomy is a safe, novel laparoscopic technique, which minimizes minimally invasive surgery even further to a new level of decreased invasiveness and improved cosmesis.

Two-port laparoscopic appendectomy: minimizing the minimally invasive approach.

Developing and strengthening systems for information sharing as well as detecting and addressing dis/misinformation can not only protect capacity for public health emergency preparedness and response, but potentially increase overall community resilience and social capital. More actively involving citizens in the government's collection and sharing of information can generate more public buy‐in so people will be more invested in making certain that such information is not arbitrarily dismissed or drowned out by conspiracy theories. Such an approach may have the added the benefit of creating stronger collaborative connections between government, individual citizens, and civic organizations to promote overall resilience. More community involvement in terms of the collection and dissemination of information can provide value in terms of preparation for a public health emergency by bolstering surveillance efforts to detect a threat early on. Getting the public more integrated into the public health information system can also be valuable in terms of diminishing the threat of mis/disinformation. Building up relationships between the public and the public health sector can advance the mission of improving community resilience through education, engagement, and collaboration. In this review, we will examine existing evidence for this approach and will then conclude with possible new approaches.

Information Sharing and Community Resilience: Toward a Whole Community Approach to Surveillance and Combatting the “Infodemic”

BACKGROUND & AIMS: The aim of this study was to evaluate the nutritional support management in mechanically ventilated coronavirus disease 2019 (COVID-19) patients and explore the association between early caloric deficit and mortality, taking possible confounders (i.e. obesity) into consideration. METHODS: This was a prospective study carried out during the first pandemic wave in the intensive care units (ICUs) of two referral University Hospitals in Lombardy, Italy. Two hundred twenty-two consecutive mechanically ventilated COVID-19 patients were evaluated during the ICU stay. In addition to major demographic and clinical data, we recorded information on the route and amount of nutritional support provided on a daily basis. RESULTS: Among patients still in the ICUs and alive on day 4 (N = 198), 129 (65.2%) and 72 (36.4%) reached a satisfactory caloric and protein intake, respectively, mainly by enteral route. In multivariable analysis, a satisfactory caloric intake on day 4 was associated with lower mortality (HR = 0.46 [95%CI, 0.42-0.50], P < 0.001). Mild obesity (body mass index [BMI] &#8805;30 and < 35 kg/m2) was associated with higher mortality (HR = 1.99 [95%CI, 1.07-3.68], P = 0.029), while patients with moderate-severe obesity (BMI&#8805;35 kg/m2) were less likely to be weaned from invasive mechanical ventilation (HR = 0.71 [95%CI, 0.62-0.82], P < 0.001). CONCLUSIONS: This study confirmed the negative prognostic and clinical role of obesity in mechanically ventilated COVID-19 patients and suggested that early caloric deficit may independently contribute to worsen survival in this patients' population. Therefore, any effort should be made to implement an adequate timely nutritional support in all COVID-19 patients during the ICU stay.

Early caloric deficit is associated with a higher risk of death in invasive ventilated COVID-19 patients

Le savon est un produit cosmétique d’usage courant, en cette période de pandémie, puisque son utilisation fait partie des gestes barrières. Capable de prévenir une maladie, la COVID-19, il devrait donc être commercialisé sous un statut de médicament. Si l’on considère l’histoire du savon, on se rend compte de la complexité de son statut. Selon les périodes, il a été considéré comme un produit d’hygiène et/ou comme un excipient ou encore comme une substance active, permettant la réalisation de médicaments ou de cosmétiques destinés à traiter aussi bien la gale que les brûlures, de réaliser des purges ou de mettre au point des préparations pour adoucir ou blanchir les mains ou pour allonger les cils. L’emploi du terme « savon » étant extrêmement galvaudé, l’établissement d’une réglementation visant à clarifier cette situation s’imposerait. Soap is a cosmetic product in common use during this pandemic period. It enables barrier gestures to be carried out. Capable of preventing pathology (COVID-19), it should, therefore, be marketed under a drug status. If we consider the history of soap, we realize the complexity of its status. Depending on the period, it has been considered as a hygiene product and/or as an excipient or an active ingredient allowing the production of a drug or cosmetic making it possible to treat both scabies and burns, to carry out purges or to put at the point of preparations to soften or whiten hands or to lengthen eyelashes. The use of the term “soap”, being extremely overused, the establishment of regulations to clarify this situation is essential.

Un produit de santé peut-il changer de statut au gré des circonstances ? Éléments de réflexion avec l’exemple précis du savon

INTRODUCTION: Human infection caused by the new Coronavirus is a public health emergency of international importance, whose clinical spectrum ranges from mild symptoms to severe acute respiratory syndrome However, there is weak information about the clinical presentations of Coronavirus in newborns and childrenOBJECTIVE: To describe the recommendations about breastfeeding during SARS-CoV-2 infectionMETHODS: Scope review studyRESULTS: The discussion on viral transmission through breastfeeding is controversial and the recommendations vary according to experts of different countriesCONCLUSION: The scientific knowledge currently available does not allow to accurately inform the best conduct in the breastfeeding process, making each country decide the strategy that best adapts to its reality Implications for the practice: It is important that the health team has a close eye to identify atypical signs and symptoms during this process to act preventively in the face of possible complications INTRODUÇÃO: A infecção humana causada pelo novo Coronavírus é uma emergência de saúde pública de importância internacional, cujo espectro clínico varia de sintomas leves à síndrome respiratória aguda grave Destaca-se que há informações fragilizadas sobre as apresentações clínicas do Coronavírus em recém-nascidos e criançasOBJETIVO: Descrever as recomendações acerca da amamentação durante a infecção por SARS-CoV-2MÉTODO: Estudo de revisão de escopoRESULTADOS: A discussão sobre a transmissão viral via amamentação é controversa e as recomendações variam de acordo com especialistas em diferentes países do mundoCONCLUSÃO: O conhecimento científico atualmente disponível não permite informar com precisão a melhor conduta no processo de amamentação, fazendo com que cada país decida a estratégia que melhor se adapta a sua realidade Implicações para a prática: É importante que a equipe de saúde tenha um olhar atento para identificação de sinais e sintomas atípicos durante esse processo para agir preventivamente frente às possíveis intercorrências

Overview on the recommendations for breastfeeding and COVID-19

The Annual Meeting of the International Society for Stem Cell Research (ISSCR) brought together experts from across the world in the field of stem cell therapy research and regenerative medicine. The sessions were organized around 5 main themes: clinical applications, cellular identity, modeling development & disease, new technologies, and tissue stem cell & regeneration. This report covers some of the highlights of the virtual meeting.

International society for stem cell research (ISSCR) – 19thannual meeting

The development of efficacious vaccines has made it possible to envision mass vaccination programs aimed at suppressing SARS-CoV-2 transmission around the world. Here we use a data-driven age-structured multilayer representation of the population of 34 countries to estimate the disease induced immunity threshold, accounting for the contact variability across individuals. We show that the herd immunization threshold of random (un-prioritized) mass vaccination programs is generally larger than the disease induced immunity threshold. We use the model to test two additional vaccine prioritization strategies, transmission-focused and age-based, in which individuals are inoculated either according to their behavior (number of contacts) or infection fatality risk, respectively. Our results show that in the case of a sterilizing vaccine the behavioral strategy achieves herd-immunity at a coverage comparable to the disease-induced immunity threshold, but it appears to have inferior performance in averting deaths than the risk vaccination strategy. The presented results have potential use in defining the effects that the heterogeneity of social mixing and contact patterns has on herd immunity levels and the deployment of vaccine prioritization strategies.

Data-driven estimate of SARS-CoV-2 herd immunity threshold in populations with individual contact pattern variations

ARDS is severe form of respiratory failure with significant impact on the morbidity and mortality of critical care patients. Epidemiological data are crucial for evaluating the efficacy of therapeutic interventions, designing studies, and optimizing resource distribution. The goal of this review is to present general aspects of mortality data published over the past decades. A systematic search of the MEDLINE/PubMed was performed. The articles were divided according to their methodology, type of reported mortality, and time. The main outcome was mortality. Extracted data included study duration, number of patients, and number of centers. The mortality trends and current mortality were calculated for subgroups consisting of in-hospital, ICU, 28/30-d, and 60-d mortality over 3 time periods (A, before 1995; B, 1995-2000; C, after 2000). The retrospectivity and prospectivity were also taken into account. Moreover, we present the most recent mortality rates since 2010. One hundred seventy-seven articles were included in the final analysis. General mortality rates ranged from 11 to 87% in studies including subjects with ARDS of all etiologies (mixed group). Linear regression revealed that the study design (28/30-d or 60-d) significantly influenced the mortality rate. Reported mortality rates were higher in prospective studies, such as randomized controlled trials and prospective observational studies compared with retrospective observational studies. Mortality rates exhibited a linear decrease in relation to time period (P < .001). The number of centers showed a significant negative correlation with mortality rates. The prospective observational studies did not have consistently higher mortality rates compared with randomized controlled trials. The mortality trends over 3 time periods (before 1995, 1995-2000, and after 2000) yielded variable results in general ARDS populations. However, a mortality decrease was present mostly in prospective studies. Since 2010, the overall rates of in-hospital, ICU, and 28/30-d and 60-d mortality were 45, 38, 30, and 32%, respectively.

Past and Present ARDS Mortality Rates: A Systematic Review.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with a poor prognosis. The current coronavirus disease 2019 (COVID-19) shares some similarities with IPF. SARS-CoV-2 related genes have been reported to be broadly regulated by N(6)-methyladenosine (m(6)A) RNA modification. Here, we identified the association between m(6)A methylation regulators, COVID-19 infection pathways, and immune responses in IPF. The characteristic gene expression networks and immune infiltration patterns of m(6)A-SARS-CoV-2 related genes in different tissues of IPF were revealed. We subsequently evaluated the influence of these related gene expression patterns and immune infiltration patterns on the prognosis/lung function of IPF patients. The IPF cohort was obtained from the Gene Expression Omnibus dataset. Pearson correlation analysis was performed to identify the correlations among genes or cells. The CIBERSORT algorithm was used to assess the infiltration of 22 types of immune cells. The least absolute shrinkage and selection operator (LASSO) and proportional hazards model (Cox model) were used to develop the prognosis prediction model. Our research is pivotal for further understanding of the cellular and genetic links between IPF and SARS-CoV-2 infection in the context of the COVID-19 pandemic, which may contribute to providing new ideas for prognosis assessment and treatment of both diseases.

The networks of m(6)A-SARS-CoV-2 related genes and immune infiltration patterns in idiopathic pulmonary fibrosis

BACKGROUND: The COVID-19 pandemic challenges societies in unknown ways, and individuals experience a substantial change in their daily lives and activities. Our study aims to describe these changes using population-based self-reported data about social and health behavior in a random sample of the Swiss population during the COVID-19 pandemic. The aim of the present article is two-fold: First, we want to describe the study methodology. Second, we want to report participant characteristics and study findings of the first survey wave to provide some baseline results for our study. METHODS: Our study design is a longitudinal online panel of a random sample of the Swiss population. We measure outcome indicators covering general well-being, physical and mental health, social support, healthcare use and working state over multiple survey waves. RESULTS: From 8,174 contacted individuals, 2,026 individuals participated in the first survey wave which corresponds to a response rate of 24.8%. Most survey participants reported a good to very good general life satisfaction (93.3%). 41.4% of the participants reported a worsened quality of life compared to before the COVID-19 emergency and 9.8% feelings of loneliness. DISCUSSION: The COVID-19 Social Monitor is a population-based online survey which informs the public, health authorities, and the scientific community about relevant aspects and potential changes in social and health behavior during the COVID-19 emergency and beyond. Future research will follow up on the described study population focusing on COVID-19 relevant topics such as subgroup differences in the impact of the pandemic on well-being and quality of life or different dynamics of perceived psychological distress.

The COVID-19 Social Monitor longitudinal online panel: Real-time monitoring of social and public health consequences of the COVID-19 emergency in Switzerland

The transmission of SARS-CoV-2 through contact with contaminated surfaces or objects is an important form of transmissibility. Thus, in this study, we evaluated the performance of a disinfection chamber designed for instantaneous dispersion of the biocidal agent solution, in order to characterize a new device that can be used to protect individuals by reducing the transmissibility of the disease through contaminated surfaces. We proposed the necessary adjustments in the configuration to improve the dispersion on surfaces and the effectiveness of the developed equipment. Computational Fluid Dynamics (CFD) simulations of the present technology with a chamber having six nebulizer nozzles were performed and validated through qualitative and quantitative comparisons, and experimental tests were conducted using the method Water-Sensitive Paper (WSP), with an exposure to the biocidal agent for 10 and 30 s. After evaluation, a new passage procedure for the chamber with six nozzles and a new configuration of the disinfection chamber were proposed. In the chamber with six nozzles, a deficiency was identified in its central region, where the suspended droplet concentration was close to zero. However, with the new passage procedure, there was a significant increase in wettability of the surface. With the proposition of the chamber with 12 nozzles, the suspended droplet concentration in different regions increased, with an average increase of 266%. The experimental results of the new configuration proved that there was an increase in wettability at all times of exposure, and it was more significant for an exposure of 30 s. Additionally, even in different passage procedures, there were no significant differences in the results for an exposure of 10 s, thereby showing the effectiveness of the new configuration or improved spraying and wettability by the biocidal agent, as well as in minimizing the impact caused by human factor in the performance of the disinfection technology.

Numerical and experimental analyses for the improvement of surface instant decontamination technology through biocidal agent dispersion: Potential of application during pandemic