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Convalescent plasma (CP) therapy is one of the promising therapies being tried for COVID-19 patients. This passive immunity mode involves separating preformed antibodies against SARS-CoV-2 from a recently recovered COVID-19 patient and infusing it into a patient with active disease or an exposed individual for prophylaxis. Its advantages include ease of production, rapid deployment, specificity against the target infectious agent, and scalability. In the current pandemic, it has been used on a large scale across the globe and also in India. However, unequivocal proof of efficacy and effectiveness in COVID-19 is still not available. Various CP therapy parameters such as donor selection, antibody quantification, timing of use, and dosing need to be considered before its use. The current review attempts to summarize the available evidence and provide recommendations for setting up CP protocols in clinical and research settings.

Use of convalescent plasma for COVID-19 in India: A review & practical guidelines

BACKGROUND: Medical humanities courses that incorporate the visual arts traditionally require in-person instruction and visits to museums. The COVID-19 pandemic afforded medical educators a unique opportunity to implement and evaluate virtual visual arts programming. METHODS: A two-week, 7-module visual arts and medicine elective course for third and fourth-year medical students was conducted virtually in the Spring of 2021. The course included traditional didactic components as well as a range of hands-on creative art activities including painting, graphic medicine, photovoice, and Kintsugi (Japanese craft). Digital tools including Canvas, Google Jamboard, and Zoom facilitated student engagement. Student feedback was collected through anonymous post-course surveys. RESULTS: We successfully conducted a virtual visual arts and medicine elective which integrated hands-on creative art activities. Most students “strongly agreed” that remote instruction was sufficient to meet course objectives. However, all students also “agreed” that in-person instruction may promote more in-depth engagement with the visual arts. The hands-on creative art activities were appreciated by all students. CONCLUSION: Visual arts-based medical humanities courses can be delivered virtually and can include hands-on creative art activities such as painting. Future visual arts and medicine courses may benefit from incorporating a range of pedagogical methodologies, digital tools, control groups, and pre−/post-course assessments.

Design, implementation, and reflections on a two-week virtual visual arts and medicine course for third- and fourth-year medical students

Comparing median outcomes to gauge treatment effectiveness is widespread practice in clinical and other investigations. While common, such difference-in-median characterizations of effectiveness are but one way to summarize how outcome distributions compare. This paper explores properties of median treatment effects as indicators of treatment effectiveness. The paper's main focus is on decisionmaking based on median treatment effects and it proceeds by considering two paths a decisionmaker might follow. Along one, decisions are based on point-identified differences in medians alongside partially identified median differences;along the other decisions are based on point-identified differences in medians in conjunction with other point-identified parameters. On both paths familiar difference-in-median measures play some role yet in both the traditional standards are augmented with information that will often be relevant in assessing treatments' effectiveness. Implementing both approaches is shown to be straightforward. In addition to its analytical results the paper considers several policy contexts in which such considerations arise. While the paper is framed by recently reported findings on treatments for COVID-19 and uses several such studies to explore empirically some properties of median-treatment-effect measures of effectiveness, its results should be broadly applicable.

Discovering Treatment Effectiveness via Median Treatment Effects—Applications to COVID-19 Clinical Trials

Obesity is a major risk factor for SARS-CoV-2 infection and COVID-19 severity. The underlying basis of this association is likely complex in nature. The host-cell receptor angiotensin converting enzyme 2 (ACE2) and the type II transmembrane serine protease (TMPRSS2) are important for viral cell entry. It is unclear whether obesity alters expression of Ace2 and Tmprss2 in the lower respiratory tract. Here, we show that: 1) Ace2 expression is elevated in the lung and trachea of diet-induced obese male mice and reduced in the esophagus of obese female mice relative to lean controls; 2) Tmprss2 expression is increased in the trachea of obese male mice but reduced in the lung and elevated in the trachea of obese female mice relative to lean controls; 3) in chow-fed lean mice, females have higher expression of Ace2 in the lung and esophagus as well as higher Tmprss2 expression in the lung but lower expression in the trachea compared to males; and 4) in diet-induced obese mice, males have higher expression of Ace2 in the trachea and higher expression of Tmprss2 in the lung compared to females, whereas females have higher expression of Tmprss2 in the trachea relative to males. Our data indicate diet- and sex-dependent modulation of Ace2 and Tmprss2 expression in the lower respiratory tract and esophagus. Given the high prevalence of obesity worldwide and a sex-biased mortality rate, we discuss the implications and relevance of our results for COVID-19.

Obesity alters Ace2 and Tmprss2 expression in lung, trachea, and esophagus in a sex-dependent manner: Implications for COVID-19

Die aktuelle Corona-Pandemie betrifft nahezu alle Bereiche der Medizin und des täglichen Lebens. Dementsprechend häufig tauchen Fragen zum Stellenwert der Ernährung auf, z. B. welche Ernährung einen Schutz vor der Corona-Infektion bieten kann und welche Bedeutung die Ernährung im Krankheitsverlauf hat.

Wie ernähre ich mich am besten in Zeiten der Corona-Pandemie?: COVID-19 und Ernährungsmedizin

Today, the world is struggling with a coronavirus epidemic. People explain differently the causes and sense of this disease. Old Polish literature about diseases is representative for European thought in the modern era. The problem of the disease appears in old Polish literature in various discourses. The three most important are religious, medical-astrological and social discourse. In this article, I discuss basic paradigms of thinking connected with these discourses and the relationship between them. In the religious discourse, it is God who decides about health and illness. The pathological state of the organism can be both a trial and a punishment for the sinner. The medical and astrological discourse is based on ancient medicine, medieval medicine and astrology. It assumes a close dependence of human health on the balance of the fluids in the body and on the planetary system. The social discourse is dominated by epidemics of infectious diseases. It is a collection of advices for organizing a society during a pandemic.

The Image of Disease in Religious, Medical-Astrological and Social Discourses: Old Polish Literature as an Example of Early Modern European Mentality

Coronavirus disease 2019 (COVID-19), currently a worldwide pandemic, is a viral illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The suspected contribution of thrombotic events to morbidity and mortality in COVID-19 patients has prompted a search for novel potential options for preventing COVID-19-associated thrombotic disease. In this article by the Global COVID-19 Thrombosis Collaborative Group, we describe novel dosing approaches for commonly used antithrombotic agents (especially heparin-based regimens) and the potential use of less widely used antithrombotic drugs in the absence of confirmed thrombosis. Although these therapies may have direct antithrombotic effects, other mechanisms of action, including anti-inflammatory or antiviral effects, have been postulated. Based on survey results from this group of authors, we suggest research priorities for specific agents and subgroups of patients with COVID-19. Further, we review other agents, including immunomodulators, that may have antithrombotic properties. It is our hope that the present document will encourage and stimulate future prospective studies and randomized trials to study the safety, efficacy, and optimal use of these agents for prevention or management of thrombosis in COVID-19.

Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research

Background/Aims: We reviewed demographic and clinical profiles, along with measures of hospital-based clinical practice to identify temporal changes in clinical practice that may have affected in-hospital outcomes of patients with COVID-19. Methods: Data consisted of sociodemographic and clinical data captured in University of Pittsburgh Medical Center (UPMC) electronic medical record (EMR) systems, linked by common variables (deidentified). The analysis population included hospitalized patients (across 21 hospitals) with a primary diagnosis of COVID-19 infection during the period March 14-August 31, 2020. The primary outcome was a composite of in-hospital mechanical ventilation/mortality. We compared temporal trends in patient characteristics, clinical practice, and hospital outcomes using 4 time-defined epochs for calendar year 2020: March 14-March 31 (epoch 1); April 1-May 15, (epoch 2), May 16-June 28 (epoch 3); and June 29-August 31 (epoch 4). We report unadjusted survival estimates, followed by propensity score analyses to adjust for differences in patient characteristics, to compare in-hospital outcomes of epoch 4 patients (recently treated) to epoch 1-3 patients (earlier treated). Results: Mean number of hospital admissions was 9.9 per day during epoch 4, which was ~2- to 3-fold higher than the earlier epochs. Presenting characteristics of the 1,076 COVID-19 hospitalized patients were similar across the 4 epochs, including mean age. The crude rate of mechanical ventilation/mortality was lower in epoch 4 patients (17%) than in epoch 1-3 patients (23% to 35%). When censoring for incomplete patient follow-up, the rate of mechanical ventilation/mortality was lower in epoch 4 patients (p<0.0001), as was the individual component of mechanical ventilation (p=0.0002) and mortality (p=0.02). In propensity score adjusted analyses, the in-hospital relative risk (RR) of mechanical ventilation/mortality was lower in epoch 4 patients (RR=0.67, 95% CI: 0.48, 0.93). For the outcome being discharged alive within 3, 5, or 7 days of admission, adjusted odds ranged from 1.6- to 1.7-fold higher among epoch 4 patients compared to earlier treated patients. The better outcomes in epoch 4 patients were principally observed in patients under the age of 75 years. Patient level dexamethasone use was 55.6% in epoch 4 compared to 15% or less of patients in the earlier epochs. Most patients across epochs received anticoagulation drugs (principally heparin). Overall steroid (81.7% vs. 54.3%, p<0.0001) and anticoagulation use (90.4% vs. 80.7%, p=0.0001) was more frequent on the day or day after hospitalization in epoch 4 patients compared to earlier treated patients. Conclusions: In our large system, recently treated hospitalized COVID-19 patients had lower rates of in-hospital mechanical ventilation/mortality and shorter length of hospital stay. Alongside of this was a change to early initiation of glucocorticoid therapy and anticoagulation. The extent to which the improvement in patient outcomes was related to changes in clinical practice remains to be established.

Temporal Changes in Clinical Practice with COVID-19 Hospitalized Patients: Potential Explanations for Better In-Hospital Outcomes

Electric mobility has become increasingly prominent, not only because of the potential to reduce greenhouse gas emissions but also because of the proven implementations in the electric and transport sector. This paper, considering the smart grid perspective, focuses on the financial and economic benefits related to Electric Vehicle (EV) management in Vehicle-to-Building (V2B), Vehicle-to-Home (V2H), and Vehicle-to-Grid (V2G) technologies. Vehicle-to-Everything is also approached. The owners of EVs, through these technologies, can obtain revenue from their participation in the various ancillary and other services. Similarly, providing these services makes it possible to increase the electric grid’s service quality, reliability, and sustainability. This paper also highlights the different technologies mentioned above, giving an explanation and some examples of their application. Likewise, it is presented the most common ancillary services verified today, such as frequency and voltage regulation, valley filling, peak shaving, and renewable energy supporting and balancing. Furthermore, it is highlighted the different opportunities that EVs can bring to energy management in smart grids. Finally, the SWOT analysis is highlighted for V2G technology.

Electric Mobility: An Overview of the Main Aspects Related to the Smart Grid

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

Coronavirus disease-19 (COVID-19) is an acute resolved disease, with estimated 3.4% case fatality rate. Due to insufficient data and short onset time of the disease, researchers have to change the strategy against its associated virus, SARS-CoV-2. One of these strategies is the use of computational methods in the field of drug and vaccine design, which can greatly reduce the time and cost of the therapeutic or immunogenic development projects. In this study, we employed various immunoinformatics tools to design a multi-epitope vaccine polypeptide with the highest potential for activating the human immune system against SARS-CoV-2. The initial epitope set was extracted from the whole set of viral structural proteins. Their potential non-toxic and non-allergenic T- cell and B-cell binding and cytokine inducing epitopes were then identified through a priori immunoinformatic prediction. Selected epitopes were bonded to each other with appropriate links. A suitable adjuvant was added to the N-terminus of the vaccine polypeptide sequence to increase its immunogenicity. Molecular modelling of the 3D structure of the vaccine polypeptide, docking, molecular dynamics simulations and free energy calculations confirmed that the designed vaccine had high affinity for Toll-like receptor 3 binding, and that the vaccine-receptor complex was highly stable. Therefore, the designed polypeptide is promising for antigenicity and inducing an effective and safe immune response against SARS-CoV-2 inside the human body.

Immunoinformatic design of a COVID-19 subunit vaccine using entire structural immunogenic epitopes of SARS-CoV-2

Aging of hematopoiesis is associated with increased frequency and clonality of hematopoietic stem cells (HSCs), along with functional compromise and myeloid bias, with donor age being a significant variable in survival after HSC transplantation. No clinical methods currently exist to enhance aged HSC function, and little is known regarding how aging affects molecular responses of HSCs to biological stimuli. Exposure of HSCs from young fish, mice, nonhuman primates, and humans to 16,16-dimethyl prostaglandin E2 (dmPGE2) enhances transplantation, but the effect of dmPGE2 on aged HSCs is unknown. Here we show that ex vivo pulse of bone marrow cells from young adult (3 mo) and aged (25 mo) mice with dmPGE2 prior to serial competitive transplantation significantly enhanced long-term repopulation from aged grafts in primary and secondary transplantation (27 % increase in chimerism) to a similar degree as young grafts (21 % increase in chimerism; both p < 0.05). RNA sequencing of phenotypically-isolated HSCs indicated that the molecular responses to dmPGE2 are similar in young and old, including CREB1 activation and increased cell survival and homeostasis. Common genes within these pathways identified likely key mediators of HSC enhancement by dmPGE2 and age-related signaling differences. HSC expression of the PGE2 receptor EP4, implicated in HSC function, increased with age in both mRNA and surface protein. This work suggests that aging does not alter the major dmPGE2 response pathways in HSCs which mediate enhancement of both young and old HSC function, with significant implications for expanding the therapeutic potential of elderly HSC transplantation.

Prostaglandin E2 Enhances Aged Hematopoietic Stem Cell Function

The coronavirus SARS-CoV-2 has created a global pandemic that has killed more than a quarter million people since December 2019, halted commerce, and disrupted our ability to research cancer in the laboratory and clinic and care for our patients. A return toward a functioning society can be facilitated by the active participation of cancer researchers to diagnose and treat SARS-CoV-2 infected patients, and the direct and indirect benefits of our involvement cannot be overstated.

The Era of COVID-19 and the Rise of Science Collectivism in Cancer Research.

In the ongoing COVID‐19 pandemic situation, exposure assessment and control strategies for aerosol transmission path are feebly understood. A recent study pointed out that Poissonian fluctuations in viral loading of airborne droplets significantly modifies the size spectrum of the virus‐laden droplets (termed as “virusol”) (Anand and Mayya, 2020). Herein we develop the theory of residence time of the virusols, as contrasted with complete droplet system in indoor air using a comprehensive “Falling‐to‐Mixing‐Plate‐out” model that considers all the important processes namely, indoor dispersion of the emitted puff, droplet evaporation, gravitational settling, and plate out mechanisms at indoor surfaces. This model fills the existing gap between Wells falling drop model (Wells, 1934) and the stirred chamber models (Lai and Nazarofff, 2000). The analytical solutions are obtained for both 1‐D and 3‐D problems for non‐evaporating falling droplets, used mainly for benchmarking the numerical formulation. The effect of various parameters is examined in detail. Significantly, the mean residence time of virusols is found to increase nonlinearly with the viral load in the ejecta, ranging from about 100 to 150 s at low viral loads (<10(4)/ml) to about 1100–1250 s at high viral loads (>10(11)/ml). The implications are discussed.

Modeling the viral load dependence of residence times of virus‐laden droplets from COVID‐19‐infected subjects in indoor environments

Supplementation of cancer cells exposed to 5-fluorouracil (FUra) and folinic acid (FA) with high concentration pyridoxal 5′-phosphate, the cofactor of vitamin B6, potentiates the cytotoxicity of FUra in a synergistic interaction mode. We report a pilot study in 13 patients with previously untreated advanced carcinoma of the digestive tract to assess the impact of high-dose pyridoxine (PN) on the antitumor activity of regimens comprising FUra and FA. Five patients had colorectal adenocarcinoma (CRC); 5 had pancreas adenocarcinoma (PC); and 3 had squamous cell carcinoma of the esophagus (EC). Patients with CRC and with PC received oxaliplatin, irinotecan, FUra and FA, and patients with EC had paclitaxel, carboplatin, FUra and FA. PN iv from 1000 to 3000 mg/day preceded each administration of FA and FUra. Eleven patients responded. Two patients with CRC attained CRs and 3 had PRs with reduction rates ≥ 78%. Two patients with PC attained CRs, and 2 had PRs with reduction rates ≥ 79%. Responders experienced disappearance of most metastases. Of 3 patients with EC, 2 attained CRs. Median time to attain a response was 3 months. Unexpected toxicity did not occur. Results suggest that high-dose vitamin B6 enhances antitumor potency of regimens comprising FUra and FA.

Pharmacologic modulation of 5-fluorouracil by folinic acid and high-dose pyridoxine for treatment of patients with digestive tract carcinomas

Due to their need for living cells, viruses have developed adaptive evolutionary strategies to survive and perpetuate in reservoir hosts that play a crucial role in the ecology of emerging pathogens. Pathogenic and potentially pandemic betacoronaviruses arose in humans in 2002 (SARS-CoV, disappeared in July 2003), 2012 (MERS-CoV, still circulating in Middle East areas), and 2019 (SARS-CoV-2, causing the current global pandemic). As universally recognized, bats host ancestors of the above-mentioned zoonotic viruses. However, hedgehogs have been recently identified in Europe and Asia as possible reservoirs of MERS-CoV-like strains classified as Erinaceus coronavirus (EriCoV). To elucidate the evolution and genetics of EriCoVs, NGS (next generation sequencing) and Sanger sequencing were used to examine fecal samples collected in Northern Italy in 2018/2019 from 12 hedgehogs previously found EriCoV-positive by RT-PCR. By sequence analysis, eight complete EriCoV genomes, obtained by NGS, showed a high phylogenetic correlation with EriCoV strains previously reported in Eurasia. Interestingly, eight viral strains presented an additional ORF encoding for the CD200 ortholog located between the genes encoding for the Spike and the ORF3a proteins. The CD200 ortholog sequences were closely similar to the host CD200 protein but varying among EriCoVs. The result, confirmed by Sanger sequencing, demonstrates for the first time that CoVs can acquire host genes potentially involved in the immune-modulatory cascade and possibly enabling the virus to escape the host defence.

Can Coronaviruses Steal Genes from the Host as Evidenced in Western European Hedgehogs by EriCoV Genetic Characterization?

The primary objective of the study is to find out the student's perception towards online learning during this pandemic situation since the educational platform has taken a sudden shift to a new platform from the traditional classroom learning methods, thus the study focuses on how students have perceived it and to identify the difficulties associated with this transition.

A Study On Students' Perception On Online Learning During Covid-19 Pandemic

BACKGROUND: A national policy focus in England to address general practice workforce issues has led to a commitment to employ significant numbers of non-general practitioner (GP) roles to redistribute workload. This paper focuses on two such roles: the care navigation (CN) and social prescribing link worker (SPLW) roles, which both aim to introduce ‘active signposting’ into primary care, to direct patients to the right professional/services at the right time and free up GP time. There is a lack of research exploring staff views of how these roles are being planned and operationalised into general practice and how signposting is being integrated into primary care. METHODS: The design uses in-depth qualitative methods to explore a wide range of stakeholder staff views. We generated a purposive sample of 34 respondents who took part in 17 semi-structured interviews and one focus group (service leads, role holders and host general practice staff). We analysed data using a Template Analysis approach. RESULTS: Three key themes highlight the challenges of operationalising signposting into general practice: 1) role perception – signposting was made challenging by the way both roles were perceived by others (e.g. among the public, patients and general practice staff) and highlighted inherent tensions in the expressed aims of the policy of active signposting; 2) role preparedness – a lack of training meant that some receptionist staff felt unprepared to take on the CN role as expected and raised patient safety issues; for SPLW staff, training affected the consistency of service offer across an area; 3) integration and co-ordination of roles – a lack of planning and co-ordination across components of the health and care system challenged the success of integrating signposting into general practice. CONCLUSIONS: This study provides new insights from staff stakeholder perspectives into the challenges of integrating signposting into general practice, and highlights key factors affecting the success of signposting in practice. Clarity of role purpose and remit (including resolving tensions inherent the dual aims of ‘active signposting’), appropriate training and skill development for role holders and adequate communication and engagement between stakeholders/partnership working across services, are required to enable successful integration of signposting into general practice. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-022-01669-z.

The challenges of integrating signposting into general practice: qualitative stakeholder perspectives on care navigation and social prescribing in primary care

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) causes severe acute respiratory failure and considerable extrapumonary organ dysfuction with substantial high mortality. For the limited number of autopsy reports, small animal models are urgently needed to study the mechanisms of MERS-CoV infection and pathogenesis of the disease and to evaluate the efficacy of therapeutics against MERS-CoV infection. In this study, we developed a transgenic mouse model globally expressing codon-optimized human dipeptidyl peptidase 4 (hDPP4), the receptor for MERS-CoV. After intranasal inoculation with MERS-CoV, the mice rapidly developed severe pneumonia and multi-organ damage, with viral replication being detected in the lungs on day 5 and in the lungs, kidneys and brains on day 9 post-infection. In addition, the mice exhibited systemic inflammation with mild to severe pneumonia accompanied by the injury of liver, kidney and spleen with neutrophil and macrophage infiltration. Importantly, the mice exhibited symptoms of paralysis with high viral burden and viral positive neurons on day 9. Taken together, this study characterizes the tropism of MERS-CoV upon infection. Importantly, this hDPP4-expressing transgenic mouse model will be applicable for studying the pathogenesis of MERS-CoV infection and investigating the efficacy of vaccines and antiviral agents designed to combat MERS-CoV infection.

Multi-Organ Damage in Human Dipeptidyl Peptidase 4 Transgenic Mice Infected with Middle East Respiratory Syndrome-Coronavirus

Abstract Influenza virus infection is characterized by symptoms ranging from mild congestion and body aches to severe pulmonary edema and respiratory failure. While the majority of those exposed have minor symptoms and recover with little morbidity, an estimated 500,000 people succumb to IAV-related complications each year worldwide. In these severe cases, an exaggerated inflammatory response, known as “cytokine storm”, occurs which results in damage to the respiratory epithelial barrier and development of acute respiratory distress syndrome (ARDS). Data from retrospective human studies as well as experimental animal models of influenza virus infection highlight the fine line between an excessive and an inadequate immune response, where the host response must balance viral clearance with exuberant inflammation. Current pharmacological modulators of inflammation, including corticosteroids and statins, have not been successful in improving outcomes during influenza virus infection. We have reported that the amplitude of the inflammatory response is regulated by Linear Ubiquitin Assembly Complex (LUBAC) activity and that dampening of LUBAC activity is protective during severe influenza virus infection. Therapeutic modulation of LUBAC activity may be crucial to improve outcomes during severe influenza virus infection, as it functions as a molecular rheostat of the host response. Here we review the evidence for modulating inflammation to ameliorate influenza virus infection-induced lung injury, data on current anti-inflammatory strategies, and potential new avenues to target viral inflammation and improve outcomes.

Targeting the Linear Ubiquitin Assembly Complex to Modulate the Host Response and Improve Influenza A Virus Induced Lung Injury

OBJECTIVES: The novel Coronavirus Disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus, was officially recognised in the KSA in March 2020. Registered nurses (RNs) play a frontline role in the delivery of healthcare services to the COVID-19 patients. This role has potentially exposed RNs to infection with its associated consequences. We conducted this study to assess the psychological effects of fear and stress, and level of resilience to the COVID-19 outbreak by RNs in KSA. METHODS: In this cross-sectional study, we recruited all RNs working with patients with the COVID-19 in KSA during the outbreak. All participants completed an anonymous questionnaire, which included items about their sociodemographic details, job stress related to the COVID-19, and fear of infection. Data were analysed with descriptive correlation statistics and multiple regression tests. RESULTS: In total, 314 RNs responded to our survey. The results showed that the RNs had high levels of anxiety and stress during the COVID-19 outbreak. RNs were fearful about their safety and the well-being of their families. However, RNs felt more responsible for providing care to the COVID-19 patients. Moreover, our results signalled some predictive factors that increased RNs' level of fear, such as social media (β = 0.76, p = 0.03), exposure to trauma prior to the outbreak (β = −0.95, p = 0.003), and readiness to care for infected patients (β = −0.21, p = 0.001). CONCLUSION: This study reports high levels of perceived stress and fear among RNs in KSA while caring for patients with the COVID-19. Furthermore, certain factors have a significant impact on RNs' psychological status, which may affect the quality of patient care and safety.

Measuring the extent of stress and fear among Registered Nurses in KSA during the COVID-19 Outbreak

The COVID-19 pandemic has exacted an extraordinarily high human toll throughout the country, imposing an almost unfathomable strain on its healthcare infrastruc

The Way Forward in the Post-COVID World

AIMS & OBJECTIVES: A key measure to mitigate COVID-19 has been social distancing Incorporating videoconferencing Apps in patients' handover process between HCWs can enhance social distancing while maintaining handover elements This research aimed to describe PICU physicians' experience in using online videoconferencing App for handover during the pandemic METHODS: This is a qualitative content analysis at a university hospital in Riyadh, KSA Since May 15th, 2020, due to the pandemic, our PICU utilized Zoom® as a remote conferencing App, instead of face-to-face handover After the IRB approval, data were collected over two weeks (July 1-14th, 2020) through an online structured questionnaire Demographic data and open-ended questions about the perceived efficacy of the remote handover were collected The analysis process included open coding, creating categories, and abstraction RESULTS: From the 36 PICU physicians who participated, 30 (83 3%) completed the survey Participants included 6 attendings, 9 specialists, and 21 residents They had variable previous teleconferencing experience (Table) Most physicians (75%) were comfortable conducting a remote endorsement The majority found that SBAR handover elements were achieved through this remote handover process (Fig) The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing Perceived disadvantages were the paucity of non-verbal communication and teaching during virtual meetings CONCLUSIONS: Videoconferencing Apps utilized for online handover could supplement traditional face-to-face ICU patients' endorsement during infectious disease outbreaks Some changes should be implemented to optimize the users' experience

Perceived quality of remote handover process during COVID-19 crisis in pediatric intensive care setting: A mixed-method with content analysis

BACKGROUND: Low skeletal muscle mass (LSMM) and visceral fat areas can be assessed by cross‐sectional images. These parameters are associated with several clinically relevant factors in various disorders with predictive and prognostic implications. Our aim was to establish the effect of computed tomography (CT)‐defined LSMM and fat areas on unfavourable outcomes and in‐hospital mortality in coronavirus disease 2019 (COVID‐19) patients based on a large patient sample. METHODS: MEDLINE library, Cochrane, and Scopus databases were screened for the associations between CT‐defined LSMM as well as fat areas and in‐hospital mortality in COVID‐19 patients up to September 2021. In total, six studies were suitable for the analysis and included into the present analysis. RESULTS: The included studies comprised 1059 patients, 591 men (55.8%) and 468 women (44.2%), with a mean age of 60.1 years ranging from 48 to 66 years. The pooled prevalence of LSMM was 33.6%. The pooled odds ratio for the effect of LSMM on in‐hospital mortality in univariate analysis was 5.84 [95% confidence interval (CI) 1.07–31.83]. It was 2.73 (95% CI 0.54–13.70) in multivariate analysis. The pooled odds ratio of high visceral fat area on unfavourable outcome in univariate analysis was 2.65 (95% CI 1.57–4.47). CONCLUSIONS: Computed tomography‐defined LSMM and high visceral fat area have a relevant association with in‐hospital mortality in COVID‐19 patients and should be included as relevant prognostic biomarkers into clinical routine.

Computed tomography‐defined body composition as prognostic markers for unfavourable outcomes and in‐hospital mortality in coronavirus disease 2019

Placing contact tracing tool in the hands of all is certain to enhance contact identification-as individuals can perform self-tests to discover in real-time, frequently associated contacts, ultimately instilling caution and adherence to recommended local and international guidelines It can also assist epidemiologists and policymakers to formulate appropriate policies as well as proffer cost-effective solution for containing disease outbreaks A Spatio-GraphNet model for real-time contact tracing of CoVID-19 infection is proposed in this paper for real-time crowd source of contacts-using a WiFi-like soft-robot enabled on mobile phones Once enabled, useful contact tracing parameters can be captured and stored Using knowledge of Graph Theory, production traces of stored contacts are filtered for efficient contact tracing, practical disease surveillance and prompt medical/healthcare intervention Simulation results reveal the contact tracing dashboard with appropriate parameters thresholds, application and evaluation of various statistical kernels as well as practical implications of the study © 2020 ACM

A spatio-graphnet model for real-time contact tracing of CoVID-19 infection in resource limited settings

Three monoclonal antibodies?natalizumab (NTZ), ocrelizumab (OCR), and alemtuzumab (ALM)?are the mainstays for the treatment of both relapsing and progressive forms of multiple sclerosis (MS). Here, their safety in patients with MS is analyzed and compared for rational use, especially during the COVID-19 pandemic. All clinical studies published between 2016 and 2020 with the primary outcome of the occurrence of adverse events (AEs) with the use of NTZ, OCR, and ALM in the treatment of MS were systematically searched in the PubMed database. In this review, the percentage of patients reporting AEs was calculated and compared. The most common AEs associated with the use of NTZ, OCR, and ALM were infection and infestation. The percentage of patients reporting urinary tract infection, upper respiratory tract infection, and herpes was 16% using natalizumab, 7% using natalizumab and ocrelizumab, and 2% with ocrelizumab, respectively. The most common AEs, such as rashes, pyrexia, and influenza, were reported with ocrelizumab and alemtuzumab. Additionally, alemtuzumab was associated with immune thrombocytopenia (2%), respiratory infections (7%), and thyroid dysfunction (43%). All these data outcomes show that of the three monoclonal antibodies, natalizumab and ocrelizumab were associated with a reduced incidence of adverse events, making them a safer choice for MS.

Systematic Review and Meta-Analysis Comparing the Safety of Natalizumab, Ocrelizumab, and Alemtuzumab in Treating Relapsing–Remitting, Primary Progressive, and Secondary Progressive Multiple Sclerosis

BACKGROUND: Mycobacterium tuberculosis (Mtb) strains resistant to isoniazid and rifampin (multidrug-resistant tuberculosis [MDR-TB]) are increasingly reported worldwide, requiring renewed focus on the nuances of drug resistance. Patients with low-level moxifloxacin resistance may benefit from higher doses, but limited clinical data on this strategy are available. METHODS: We conducted a 5-year observational cohort study of MDR-TB patients at a tertiary care center in India. Participants with Mtb isolates resistant to isoniazid, rifampin, and moxifloxacin (at the 0.5 µg/mL threshold) were analyzed according to receipt of high-dose moxifloxacin (600 mg daily) as part of a susceptibility-guided treatment regimen. Univariable and multivariable Cox proportional hazard models assessed the relationship between high-dose moxifloxacin and unfavorable treatment outcomes. RESULTS: Of 354 participants with MDR-TB resistant to moxifloxacin, 291 (82.2%) received high-dose moxifloxacin. The majority experienced good treatment outcomes (200 [56.5%]), which was similar between groups (56.7% vs 54.0%, P = .74). Unfavorable outcomes were associated with greater extent of radiographic disease, lower initial body mass index, and concurrent treatment with fewer drugs with confirmed phenotypic susceptibility. Treatment with high-dose moxifloxacin was not associated with improved outcomes in either unadjusted (hazard ratio [HR], 1.2 [95% confidence interval {CI}, .6–2.4]) or adjusted (HR, 0.8 [95% CI, .5–1.4]) models but was associated with joint pain (HR, 3.2 [95% CI, 1.2–8.8]). CONCLUSIONS: In a large observational cohort, adding high-dose (600 mg) moxifloxacin to a drug susceptibility test–based treatment regimen for MDR-TB was associated with increased treatment-associated side effects without improving overall outcomes and should be avoided for empiric treatment of moxifloxacin-resistant MDR-TB.

Increased Moxifloxacin Dosing Among Patients With Multidrug-Resistant Tuberculosis With Low-Level Resistance to Moxifloxacin Did Not Improve Treatment Outcomes in a Tertiary Care Center in Mumbai, India

We describe the third edition of the CheckThat! Lab, which is part of the 2020 Cross-Language Evaluation Forum (CLEF). CheckThat! proposes four complementary tasks and a related task from previous lab editions, offered in English, Arabic, and Spanish. Task 1 asks to predict which tweets in a Twitter stream are worth fact-checking. Task 2 asks to determine whether a claim posted in a tweet can be verified using a set of previously fact-checked claims. Task 3 asks to retrieve text snippets from a given set of Web pages that would be useful for verifying a target tweet’s claim. Task 4 asks to predict the veracity of a target tweet’s claim using a set of potentially-relevant Web pages. Finally, the lab offers a fifth task that asks to predict the check-worthiness of the claims made in English political debates and speeches. CheckThat! features a full evaluation framework. The evaluation is carried out using mean average precision or precision at rank k for ranking tasks, and F[Formula: see text] for classification tasks.

CheckThat! at CLEF 2020: Enabling the Automatic Identification and Verification of Claims in Social Media

OBJECTIVE: To develop a predictive analytics tool that would help evaluate different scenarios and multiple variables for clearance of surgical patient backlog during the COVID-19 pandemic MATERIALS AND METHODS: Using data from 27 866 cases (May 1 2018-May 1 2020) stored in the Johns Hopkins All Children's data warehouse and inputs from 30 operations-based variables, we built mathematical models for (1) time to clear the case backlog (2), utilization of personal protective equipment (PPE), and (3) assessment of overtime needs RESULTS: The tool enabled us to predict desired variables, including number of days to clear the patient backlog, PPE needed, staff/overtime needed, and cost for different backlog reduction scenarios CONCLUSIONS: Predictive analytics, machine learning, and multiple variable inputs coupled with nimble scenario-creation and a user-friendly visualization helped us to determine the most effective deployment of operating room personnel Operating rooms worldwide can use this tool to overcome patient backlog safely

"P(3)": an adaptive modeling tool for post-COVID-19 restart of surgical services

The goal of this mini-review is to summarize the collective experience of the authors for how modeling and simulation approaches have been used to inform various decision points from discovery to First-In-Human clinical trials. The article is divided into a high-level overview of the types of problems that are being aided by modeling and simulation approaches, followed by detailed case studies around drug design (Nektar Therapeutics, Genentech), feasibility analysis (Novartis Pharmaceuticals), improvement of preclinical drug design (Pfizer), and preclinical to clinical extrapolation (Merck, Takeda, and Amgen).

Navigating Between Right, Wrong, and Relevant: The Use of Mathematical Modeling in Preclinical Decision Making

O objetivo deste trabalho foi medir a ocorrência de multimorbidade e estimar o número de indivíduos na população brasileira com 50 anos ou mais em risco para COVID-19 grave. Estudo transversal de base nacional com dados do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), conduzido em 2015-2016, com 9.412 indivíduos com 50 anos ou mais. A multimorbidade foi caracterizada como &#8805; 2 condições crônicas com base em uma lista de 15 morbidades consideradas de risco para COVID-19 grave. As análises incluíram cálculo de prevalência e estimativa do número absoluto de pessoas na população em risco. Autoavaliação do estado de saúde, fragilidade e atividades básicas da vida diária foram utilizadas como marcadores da situação de saúde. Sexo, idade, região geopolítica e escolaridade foram usados como covariáveis. Cerca de 80% dos indivíduos da amostra apresentaram pelo menos alguma das morbidades avaliadas, o que representa cerca de 34 milhões de indivíduos; a multimorbidade foi referida por 52% da população em estudo, com maior proporção nas regiões Centro-oeste, Sudeste e Sul. Doenças cardiovasculares e obesidade foram as condições crônicas mais frequentes. Estima-se que 2,4 milhões de brasileiros estejam em risco grave de saúde. Desigualdades segundo a escolaridade foram observadas. O número de pessoas com 50 anos ou mais que apresentam morbidades de risco para COVID-19 grave é elevado tanto em termos relativos quanto absolutos. A estimativa apresentada é importante para planejar as estratégias de monitoramento das pessoas com morbidades crônicas e de prevenção no enfrentamento do novo coronavírus.

Multimorbidity and population at risk for severe COVID-19 in the Brazilian Longitudinal Study of Aging/ Multimorbidade e população em risco para COVID-19 grave no Estudo Longitudinal da Saúde dos Idosos Brasileiros/ Multimorbilidad y población en riesgo para la COVID-19 grave en el Estudio Brasileño Longitudinal del Envejecimiento

This paper reviews how the Additive Manufacturing (AM) industry played a key role in stopping the spread of the Coronavirus by providing customized parts on-demand quickly and locally, reducing waste and eliminating the need for an extensive manufacturer. The AM technology uses digital files for the production of crucial medical parts, which has been proven essential during the COVID-19 crisis. Going ahead, the 3D printable clinical model resources described here will probably be extended in various centralized model storehouses with new inventive open-source models. Government agencies, individuals, corporations and universities are working together to quickly development of various 3D-printed products especially when established supply chains are under distress, and supply cannot keep up with demand.

Role of Additive Manufacturing in Medical Application COVID-19 Scenario: INDIA Case study

INTRODUCTION: Social media connects people globally and may enhance access to radiation oncology information. We characterized the global growth of the radiation oncology Twitter community using the hashtag #radonc. MATERIALS AND METHODS: We analyzed all public tweets bearing the hashtag #radonc from 2014 to 2019 using Symplur Signals. We collected data on #radonc activity and growth, stakeholder distribution, user geolocation, and languages. We obtained global Twitter user data and calculated average annual growth rates for users and tweets. We analyzed growth rates by stakeholder. We conducted thematic analysis on a sample of tweets in each three-year period using frequently occurring two-word combinations. RESULTS: We identified 193,115 tweets including #radonc composed by 16,645 Twitter users. Globally, users wrote in 35 languages and came from 122 countries, with the known highest users from the United States, United Kingdom, and Spain. Use of #radonc expanded from 23 countries in 2014 to 116 in 2019. The average annual growth rate in #radonc users and tweets was 70.5% and 69.2%, respectively. The annual growth rate of #radonc users was significantly higher than for all Twitter users (p = 0.004). While doctors were the source of 46.9% of all tweets, research and government organizations had annual increases in tweet volume of 84.6% and 211.4%, respectively. From 2014 to 2016, promotion of the radiation oncology community was the most active theme, though this dropped to 7th in 2017–2019 as discussion increased regarding aspects of radiation and treated disease sites. CONCLUSION: Use of #radonc has grown rapidly into a global community. Focused discussion related to radiation oncology has outpaced the growth of general Twitter use, both among physicians and non-physicians. #radonc has grown into a self-sustaining community. Further research is necessary to define the risks and benefits of social media in medicine and to determine whether it adds value to oncology practice.

#radonc: Growth of the global radiation oncology Twitter network

Abstract Early evidence suggests that Canadian farmland values increased in 2020 Farming returns were not negatively impacted by COVID-19 and it appears as though farming returns will be strong into 2021 Low interest rates in 2020 contributed to substantial farmland value increases in the last half of 2020 There is some evidence that the development component of farmland values increased in 2020 The future consequences of COVID-19 on farmland values are unclear Some economists suggest that future inflationary risks have increased A return to inflation rates comparable to those experienced in the 1970s is unlikely, but if increased inflation does materialize it will put upward pressure on farmland values, while increases in nominal and real interest rates will push farmland values down

COVID-19 and Canadian farmland markets in 2020

The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.

Nasal Cavity and Paranasal Sinuses

BACKGROUND Physical activity (PA) is associated with physical and cognitive benefits among people living with dementia or mild cognitive impairment (PLWD/MCI) and is a meaningful activity that can improve their confidence in everyday life. Exercising in virtual reality environments (VR Exergame) is becoming an increasingly feasible and enjoyable way to promote PA and well-being in PLWD/MCI. Although co-design can significantly improve the design of technology, it is rarely done with PLWD/MCI. This study uses participatory design methods and collaborative approaches to involve key stakeholders to develop and test a VR Exergame "Seas the Day", a novel solution targeting PLWD/MCI well-being. METHODS A multi-stage, user-centered co-design approach was used to custom-build VR Exergames tailored to the unique needs and abilities of PLWD/MCI based on a first generation of the prototype that was previously developed and tested with PLWD/MCI. This paper describes the next iteration of the prototype. Processes included concept ideation and brainstorming activities, iterative prototyping, and playtesting/input/feedback sessions with key stakeholders (PLWD/MCI, exercise professionals, engineers, VR game designers, content developers). RESULTS The multidisciplinary and collaborative design process occurred over 15 months (overlapping with COVID-19 pandemic) with 7 PLWD/MCI (6 females; M=81.3 years) and 9 exercise professionals (7 females; M=38.1 years) to date. The game was designed to target movements identified by exercise professionals and researchers (aerobic exercises, range of motion, seated-balance, quick response to stimuli) and is structured in three exercise stages (warm-up, conditioning, cool-down). To ensure safety of participants while using VR headsets, only seated upper-limb exercises were targeted. Stakeholder feedback regarding game mechanics, aesthetics, and visual/auditory cues were gathered during brainstorming and playtesting sessions and implemented into specific game-related scenarios (tai-chi, rowing, fishing). CONCLUSION We presented the process, outcomes, and challenges of adopting a participatory/collaborative approach with multiple stakeholder groups to co-design VR Exergames tailored to PLWD/MCI. Next steps will include a mixed-method evaluation of the VR Exergames among community-dwelling older adults and PLWD/MCI in retirement communities and long-term care to evaluate: i) feasibility and acceptability of use, ii) game user experience, iii) barriers/facilitators to uptake of VR Exergames; and iv) inform/validate VR Exergames gameplay metrics reflective of cognitive and motor performance.

Seas the day: Co-designing immersive virtual reality exergames with exercise professionals and people living with dementia.

Picornaviruses are small naked icosahedral viruses with a single-stranded RNA genome of positive polarity. According to current taxonomy, the family includes four genera: Enterouirus (polioviruses, coxsackieviruses, echoviruses, and other enteroviruses), Rhinovirus, Curdiouirus [encephalomyocarditis virus (EMCV), mengovirus, Theiler's murine encephalomyelitis virus (TMEV)], and Aphthouirus [foot-and-mouth disease viruses (FMDV)]. There are also some, as yet, unclassified picornaviruses [e.g., hepatitis A virus (HAW] that should certainly be assessed as a separate genus. Studies on the molecular biology of picornaviruses might be divided into two periods: those before and after the first sequencing of the poliovirus genome. The 5'-untranslated region (5-UTR) of the viral genome was one of the unexpected problems. This segment proved to be immensely long: about 750 nucleotides or ∼10% of the genome length. There were also other unusual features (e.g., multiple AUG triplets preceding the single open reading frame (ORF) that encodes the viral polyprotein). This chapter shows that the picornaviral 5-UTRs are not only involved in such essential events as the synthesis of viral proteins and RNAs that could be expected to some extent, although some of the underlying mechanisms appeared to be quite a surprise, but also may determine diverse biological phenotypes from the plaque size or thermosensitivity of reproduction to attenuation of neurovirulence. Furthermore, a close inspection of the 5-UTR structure unravels certain hidden facets of the evolution of the picornaviral genome. Finally, the conclusions drawn from the experiments with the picornaviral5-UTRs provide important clues for understanding the functional capabilities of the eukaryotic ribosomes.

The 5′-Untranslated Region of Picornaviral Genomes

Due to the current situation with Coronavirus (COVID-19) the attendance of students in the academic life has changed and the educational process has been driven towards smart educational environments Higher educational Institutes invest significant resources in reforming their educational programs so that it will support distance learning using asynchronous or synchronous methodologies and tools In this work, we propose the development of a student profile using data from both asynchronous and synchronous e-learning platforms, using a multi-layered neural network in order to classify students' performance A neural network is compared against Support Vector Machines, k-Nearest Neighbour and decision trees The results indicate that the Neural network achieves better accuracy than the others, so using our methodology the instructors or the policy makers of the institute will be able to keep informed about the performance of the students, or take the appropriate actions in order to prevent student failure or low participation © 2020 ACM

An integrated system for predicting students' academic performance in smart universities

Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18 months. Coronavirus disease 19 (COVID-19) causes mild-to-moderate symptoms in most individuals. However, rapid deterioration to severe disease with or without acute respiratory distress syndrome (ARDS) can occur within 1–2 weeks from the onset of symptoms in a proportion of patients. Early identification by risk stratifying such patients who are at risk of severe complications of COVID-19 is of great clinical importance. Computed tomography (CT) is widely available and offers the potential for fast triage, robust, rapid, and minimally invasive diagnosis: Ground glass opacities (GGO), crazy-paving pattern (GGO with superimposed septal thickening), and consolidation are the most common chest CT findings in COVID pneumonia. There is growing interest in the prognostic value of baseline chest CT since an early risk stratification of patients with COVID-19 would allow for better resource allocation and could help improve outcomes. Recent studies have demonstrated the utility of baseline chest CT to predict intensive care unit (ICU) admission in patients with COVID-19. Furthermore, developments and progress integrating artificial intelligence (AI) with computer-aided design (CAD) software for diagnostic imaging allow for objective, unbiased, and rapid assessment of CT images.

Prognostic findings for ICU admission in patients with COVID-19 pneumonia: baseline and follow-up chest CT and the added value of artificial intelligence

Purpose: The purpose of this study is to evaluate the effects of nasal steroid use on the loss of smell in patients diagnosed with Covid-19. Material: and Method: 211 patients diagnosed with Covid-19 with positive PCR tests between April 2020 and December 2020 and followed up and treated in the Elazig City Hospital Pandemic Clinic were included in this cross-sectional study. The demographic data, comorbidities and drug use histories of the patients were interviewed face-to-face and recorded. Findings: The average age of the patients was 53.55 ± 17.81 (129 men, 82 women). Regarding the age, gender and comorbidities of the patients, there was no difference between the groups with and without loss of smell in terms of average age and gender. Anosmia developed in 50 patients (23.5%) and hyposmia developed in 84 patients (40%). No decrease or loss of sense of smell was observed in 77 patients. 26 of these patients were using nasal steroids at the time of diagnosis, and none of them had a decrease or loss in sense of smell. Results: : With the results of the study, it has presented for the first time to the literature that the use of nasal steroids can prevent the loss of smell, which is one of the common neurological symptoms in Covid-19 . The results of our study suggest that the nasal steroid, which plays an immunomodulatory role, can be a shield against loss of smell by creating a local anti-inflammatory effect in the nasal mucosa and around the olfactory nerve.

Can Topical Nasal Steroid Prevent the Loss of Smell in Covid-19?

A variety of screening approaches have been proposed to diagnose epileptic seizures, using electroencephalography (EEG) and magnetic resonance imaging (MRI) modalities. Artificial intelligence encompasses a variety of areas, and one of its branches is deep learning (DL). Before the rise of DL, conventional machine learning algorithms involving feature extraction were performed. This limited their performance to the ability of those handcrafting the features. However, in DL, the extraction of features and classification are entirely automated. The advent of these techniques in many areas of medicine, such as in the diagnosis of epileptic seizures, has made significant advances. In this study, a comprehensive overview of works focused on automated epileptic seizure detection using DL techniques and neuroimaging modalities is presented. Various methods proposed to diagnose epileptic seizures automatically using EEG and MRI modalities are described. In addition, rehabilitation systems developed for epileptic seizures using DL have been analyzed, and a summary is provided. The rehabilitation tools include cloud computing techniques and hardware required for implementation of DL algorithms. The important challenges in accurate detection of automated epileptic seizures using DL with EEG and MRI modalities are discussed. The advantages and limitations in employing DL-based techniques for epileptic seizures diagnosis are presented. Finally, the most promising DL models proposed and possible future works on automated epileptic seizure detection are delineated.

Epileptic Seizures Detection Using Deep Learning Techniques: A Review

Electricity demand and its typical load pattern are usually affected by many endogenous and exogenous factors to which the generation system must accordingly respond through utility operators Lockdown measures to prevent the spread of COVID-19 imposed by many countries have led to sudden changes in socioeconomic habits which have had direct effects on the electricity systems Therefore, a detailed analysis of how confinement measures have modified the electricity consumption in Spain, one of the countries most affected by this pandemic, has been performed in this work Its electricity consumption has decreased by 13 49 % from March 14 to April 30, compared to the average value of five previous years Daily power demand profiles, especially morning and evening peaks, have been modified at homes, hospitals, and in the total power demand These changes generate a greater uncertainty for the System Operator when making demand forecasts, but production deviations have increased by only 0 1 %, thanks to the presence of a diversified generation mix, which has been modified during this period, increasing the proportion of renewable sources and decreasing CO2 emissions

Electricity demand during pandemic times: the case of the COVID-19 in Spain

INTRODUCTION Severe Acute Respiratory Syndrome Coronavirus 2, (SARS-CoV-2) was first identified by the Chinese Centers for Disease Control and Prevention on January 8, 2020 and was declared as a global pandemic on March 11, 2020 by WHO. SARS-CoV-2 uses the Angiotensin-converting enzyme 2 (ACE2) receptor as an entry route, associated with the transmembrane serine protease protein (TMPRSS2), which makes the testis and particularly spermatogenesis potentially vulnerable, since this tissue has high expression of ACE2. MATERIAL AND METHODS We performed a systematic literature review by electronic bibliographic databases in Pubmed, Scopus and ScienceDirect up to August 2020 about the effect of SARS-CoV-2 on male sexual function and its transmission, to assess possible repercussions on sex organs and the existence of a sexual transmission path. RESULTS Although SARS-CoV-2 presence has not been found in testicle samples, it has been demonstrated that it causes histological changes compatible with orchitis, and sex hormone disturbances. TMPRSS2 is up-regulated in prostate cancer where it supports tumor progression, thus these patients may have a higher risk of SARS-CoV-2 infection. TMPRSS2 inhibitors may be useful for the treatment or prevention of COVID-19. No viral material has been found in blood or semen, however it has been proven to be present in stool and saliva. CONCLUSION The male reproductive system would be highly vulnerable and susceptible to infection by SARS-CoV-2 given the expression of the ACE2 receptor in somatic and germ cells. The seminal fluid would remain free of viral presence in patients with COVID-19. Regardless, non-genital sex could be an important source of viral transmission. In assisted reproduction techniques all necessary tests must be carried out to ensure the donor is free of the virus at the time of collection and handling of the seminal sample.

Effects of COVID-19 on male sex function and its potential sexual transmission.

Multiplexed PCR amplicon sequencing (AmpSeq) is an increasingly popular application for cost-effective monitoring of threatened species and managed wildlife populations, and shows strong potential for genomic epidemiology of infectious disease. AmpSeq data for infectious microbes can inform disease control in multiple ways, including measuring drug resistance marker prevalence, distinguishing imported from local cases, and determining the effectiveness of therapeutics. We describe the design and comparative evaluation of two new AmpSeq assays for Plasmodium falciparum malaria parasites: a four-locus panel ('4CAST') composed of highly diverse antigens, and a 129-locus panel ('AMPLseq') composed of drug resistance markers, highly diverse loci for measuring relatedness, and a locus to detect Plasmodium vivax co-infections. We explore the performance of each panel in various public health use cases with in silico simulations as well as empirical experiments. We find that the smaller 4CAST panel performs reliably across a wide range of parasitemia levels without DNA pre-amplification, and could be highly informative for evaluating the number of distinct parasite strains within samples (complexity of infection) and distinguishing recrudescent infections from new infections in therapeutic efficacy studies. The AMPLseq panel performs similarly to two existing panels of comparable size for relatedness measurement, despite differences in the data and approach used for designing each panel. Finally, we describe an R package (paneljudge) that facilitates design and comparative evaluation of AmpSeq panels for relatedness estimation, and we provide general guidance on the design and implementation of AmpSeq panels for genomic epidemiology of infectious disease.

Design and implementation of multiplexed amplicon sequencing panels to serve genomic epidemiology of infectious disease: a malaria case study

This review explores the presence and functions of polyglutamine (polyQ) in viral proteins. In mammals, mutations in polyQ segments (and CAG repeats at the nucleotide level) have been linked to neural disorders and ataxias. PolyQ regions in normal human proteins have documented functional roles, in transcription factors and, more recently, in regulating autophagy. Despite the high frequency of polyQ repeats in eukaryotic genomes, little attention has been given to the presence or possible role of polyQ sequences in virus genomes. A survey described here revealed that polyQ repeats occur rarely in RNA viruses, suggesting that they have detrimental effects on virus replication at the nucleotide or protein level. However, there have been sporadic reports of polyQ segments in potyviruses and in reptilian nidoviruses (among the largest RNA viruses known). Conserved polyQ segments are found in the regulatory control proteins of many DNA viruses. Variable length polyQ tracts are found in proteins that contribute to transmissibility (cowpox A-type inclusion protein (ATI)) and control of latency (herpes viruses). New longer-read sequencing methods, using original biological samples, should reveal more details on the presence and functional role of polyQ in viruses, as well as the nucleotide regions that encode them. Given the known toxic effects of polyQ repeats, the role of these segments in neurovirulent and tumorigenic viruses should be further explored. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12035-018-1269-4) contains supplementary material, which is available to authorized users.

Polyglutamine Repeats in Viruses

One of the most precious values of the modern age is time. Despite the increasing life expectancy achieved by medicine and by the time-saving automation technologies, for most of us, time is never enough. Beside manifold upheavals and psychological consequences (1), the COVID-19 pandemic and the consequent quarantine have impacted on our subjective perception of "time", opening a frightening Pandora's box. The healthcare emergency has thrown the population into a surreal novel where the time perception may be shrunk and, simultaneously, expanded or suddenly frozen without control and full awareness. Individuals are waved by events like leaves lashed out by an unexpected wind which brings unpredictable changes. Thus, our existence is no more like before: the rhythm of our days has changed, and nothing could be the same in our next future as the pandemic has left indelible marks in habits and perspectives.

It's all a matter of time

The aim of the article is to give an overview of the first month of the novel coronavirus outbreak and of the public reactions to the news in media comments and social media environments in both local Estonian and global contexts The pandemic was still ongoing at the time the article was published and, with some modifications and new emphases, vernacular reactions in the media (incl social media) continued flourishing During the first month (January 2020), the growing flow of information and rapid escalation of the situation made the topic more noticeable in both the media and social media, and thus provided a fertile basis for jokes and internet memes, legends, fake news, misinformation, conspiracy theories, etc , as was the case with the former bigger epidemics and pandemics As it has also been observed previously, the consequences of some fake news, misinformation, and conspiracy theories may often be more harmful for society than the disease itself Several motifs and storylines are universal and surge as similar situations arise both in Estonia and all over the world The article also presents a selection of more prominent topics and examples of the outbreak from social media environments during the initial phase of international awareness of the novel coronavirus © 2021, FB and Media Group of Estonian Literary Museum All rights reserved

EArly days of the novel coronavirus: Public response in social media during the first month of the outbreak

Purpose: To report a novel, telemedicine-friendly, smartphone-based, wireless anterior segment device with instant photo-documentation ability in the COVID-19 era. Methods: Anterior Imaging Module (AIM) was constructed based on a 50/50 beam splitter design, to match the magnification drum optics of slit-lamps with a three-step or higher level of magnification. The design fills the smartphone sensor fully at the lowest magnification and matches the fixed focus of the slit-lamp. It comes with a smartphone for instant photo-documentation, an in-built software application for data-management and secure HIPAA compliant cloud storage, and a Bluetooth trigger for a one-tap image capture. The construction of the device is explained, and the optical resolution measured using U.S. air-force resolution test. AIM's performance was characterized with traceability to internationally relevant performance standards for digital slit-lamps after image quality assessment through a pilot study. Results: Clinically useful anterior segment images were obtained with both diffuse and slit illumination at different magnification settings with the highest magnification (40X) resolution of 359 lines per cm and the lowest magnification (16X) resolution of 113 lines per cm. Conclusion: AIM is a novel, wireless, telemedicine-enabled design that digitizes existing, analog slit lamps with at least three-step magnification. The settings ensure the focus is determined purely by the position of the slit-lamp. Hence, the image viewed and captured on the smartphone is exactly what the clinician sees through the eyepiece. This helps in maintaining distance from the patient in the ongoing COVID-19 pandemic, as well.

A novel approach to anterior segment imaging with smartphones in the COVID-19 era

Infants show impressive speech decoding abilities and detect acoustic regularities that highlight the syntactic relations of a language, often coded via non-adjacent dependencies (NADs, e.g., is singing). It has been claimed that infants learn NADs implicitly and associatively through passive listening and that there is a shift from effortless associative learning to a more controlled learning of NADs after the age of 2 years, potentially driven by the maturation of the prefrontal cortex. To investigate if older children are able to learn NADs, Lammertink et al. (2019) recently developed a word-monitoring serial reaction time (SRT) task and could show that 6–11-year-old children learned the NADs, as their reaction times (RTs) increased then they were presented with violated NADs. In the current study we adapted their experimental paradigm and tested NAD learning in a younger group of 52 children between the age of 4–8 years in a remote, web-based, game-like setting (whack-a-mole). Children were exposed to Italian phrases containing NADs and had to monitor the occurrence of a target syllable, which was the second element of the NAD. After exposure, children did a “Stem Completion” task in which they were presented with the first element of the NAD and had to choose the second element of the NAD to complete the stimuli. Our findings show that, despite large variability in the data, children aged 4–8 years are sensitive to NADs; they show the expected differences in r RTs in the SRT task and could transfer the NAD-rule in the Stem Completion task. We discuss these results with respect to the development of NAD dependency learning in childhood and the practical impact and limitations of collecting these data in a web-based setting.

Children’s Learning of Non-adjacent Dependencies Using a Web-Based Computer Game Setting

Proteins are made of atoms constantly fluctuating, but can occasionally undergo large-scale changes. Such transitions are of biological interest, linking the structure of a protein to its function with a cell. Atomic-level simulations, such as Molecular Dynamics (MD), are used to study these events. However, molecular dynamics simulations produce time series with multiple observables, while changes often only affect a few of them. Therefore, detecting conformational changes has proven to be challenging for most change-point detection algorithms. In this work, we focus on the identification of such events given many noisy observables. In particular, we show that the No-prior-Knowledge Exponential Weighted Moving Average (NEWMA) algorithm can be used along optical hardware to successfully identify these changes in real-time. Our method does not need to distinguish between the background of a protein and the protein itself. For larger simulations, it is faster than using traditional silicon hardware and has a lower memory footprint. This technique may enhance the sampling of the conformational space of molecules. It may also be used to detect change-points in other sequential data with a large number of features.

Online Change Point Detection in Molecular Dynamics With Optical Random Features

It has been recently discovered that the measles virus can damage pre-existing immunological memory, destroying B lymphocytes and reducing the diversity of non-specific B cells of the infected host. In particular, this implies that previously acquired immunization from vaccination or direct exposition to other pathogens could be partially erased in a phenomenon named ‘immune amnesia’, whose effects can become particularly worrisome given the actual rise of anti-vaccination movements. Here, we present the first attempt to incorporate immune amnesia into standard models of epidemic spreading by proposing a simple model for the spreading of two concurrent pathogens causing measles and another generic disease. Different analyses confirm that immune amnesia can have important consequences for epidemic spreading, significantly altering the vaccination coverage required to reach herd immunity. We also uncover the existence of novel propagating and endemic phases induced by immune amnesia. Finally, we discuss the meaning and consequences of our results and their relation with, e.g. immunization strategies, together with the possibility that explosive types of transitions may emerge, making immune-amnesia effects particularly dramatic. This work opens the door to further developments and analyses of immune-amnesia effects, contributing also to the theory of interacting epidemics on complex networks.

Immune amnesia induced by measles and its effects on concurrent epidemics

In the last two decades, multi (MDR), extensively (XDR), extremely (XXDR) and total (TDR) drug-resistant Mycobacterium tuberculosis (M tb) strains have emerged as a threat to public health worldwide, stressing the need to develop new tuberculosis (TB) prevention and treatment strategies It is estimated that in the next 35 years, drug-resistant TB will kill around 75 million people and cost the global economy $16 7 trillion Indeed, the COVID-19 pandemic alone may contribute with the development of 6 3 million new TB cases due to lack of resources and enforced confinement in TB endemic areas Evolution of drug-resistant M tb depends on numerous factors, such as bacterial fitness, strain's genetic background and its capacity to adapt to the surrounding environment, as well as host-specific and environmental factors Whole-genome transcriptomics and genome-wide association studies in recent years have shed some insights into the complexity of M tb drug resistance and have provided a better understanding of its underlying molecular mechanisms In this review, we will discuss M tb phenotypic and genotypic changes driving resistance, including changes in cell envelope components, as well as recently described intrinsic and extrinsic factors promoting resistance emergence and transmission We will further explore how drug-resistant M tb adapts differently than drug-susceptible strains to the lung environment at the cellular level, modulating M tb-host interactions and disease outcome, and novel next generation sequencing (NGS) strategies to study drug-resistant TB

Evolution of Drug-Resistant Mycobacterium tuberculosis Strains and Their Adaptation to the Human Lung Environment

The emergence of novel variants of concern of SARS-CoV-2 demands a fast and reliable detection of such variants in local populations. Here we present a cost-efficient and fast workflow combining a pre-screening of SARS-CoV-2 positive samples using RT-PCR melting curve analysis with multiplexed IP-RP-HPLC-based single nucleotide primer extensions (SIRPH). The entire workflow from positive SARS-CoV-2 testing to base-specific identification of variants requires about 24 h. We applied the sensitive method to monitor the local VOC outbreaks in a few hundred positive samples collected in a confined region of Germany.

Rapid base-specific calling of SARS-CoV-2 variants of concern using combined RT-PCR melting curve screening and SIRPH technology

BACKGROUND: The coronavirus disease of 2019 (COVID-19) pandemic led to the suspension and shortening of the 2020 Major League Baseball (MLB) season from 162 to 60 regular season games. The effect of this disruption on injury rates, specifically injury to the ulnar collateral ligament (UCL), has not been quantified. PURPOSE/HYPOTHESIS: The purpose of this study was to compare the rate of UCL reconstruction (UCLR), surgery timing, and pitching workload in MLB pitchers from before and after the COVID-19 pandemic lockdown. We hypothesized that UCLR rates relative to games played would be increased and pitching workload would be decreased in 2020 compared with previous seasons. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: An extensive online search using publicly available data was conducted to identify all MLB pitchers who underwent UCLR between January 1, 2017, and December 31, 2020. Only pitchers who were competing at the MLB level when undergoing reconstruction were included. Player characteristics and surgery date, as well as career and season of surgery pitching workload, were collected for all included pitchers. All data were compared as a pooled sample (2017-2019 vs 2020). RESULTS: A similar number of pitchers underwent UCLR during or after the 2020 regular season (n = 18) compared with the 2017-2019 seasons (n = 16, 20, and 16, respectively). However, after accounting for the decrease in games played during the 2020 regular season, an MLB pitcher was 2.9 times more likely to undergo surgery per game after the COVID-19 lockdown compared with the previous years (P < .001). MLB pitchers who underwent surgery in 2020 threw fewer preseason innings than did pitchers who underwent surgery between 2017 and 2019 (5.98 vs 9.39; P = .001). CONCLUSION: MLB pitchers were almost 3 times more likely to undergo UCLR per game after the COVID-19 lockdown. A decreased preseason pitching workload because of the COVID-19 lockdown may have had an effect on per game UCLR rates.

Effect of COVID-19 on Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

The 12th International Congress on Membranes & Membrane Processes (ICOM 2020) is now scheduled to be held on 6–11 December 2020 instead of 12–17 July 2020. It is still set to be held at the Excel Convention Centre in London, UK.

Postponed ICOM 2020 is now taking place in December

BACKGROUND: International professional bodies have been quick to disseminate initial guidance documents during the COVID-19 pandemic. In the absence of firm evidence, these have been developed by expert committees, limited in participant number. This study aimed to validate international COVID-19 surgical guidance using a rapid Delphi consensus exercise. METHODS: Delphi statements were directly mapped to guidance from surgical professional bodies in the US and Europe (SAGES/EAES), the UK (Joint RCS), and Australasia (RACS), to validate content against international consensus. Agreement from &#8805;70% participants was determined as consensus agreement. RESULTS: The Delphi exercise was completed by 339 individuals from 41 countries and 52 statements were mapped to the guidance, 47 (90.4%) reaching consensus agreement. Of these, 27 statements were mapped to SAGES/EAES guidance, 21 to the Joint RCS document, and 33 to the RACS document. Within the SAGES/EAES document, 92.9% of items reached consensus agreement (median 89.0%, range 60.5-99.2%), 90.4% within the Joint RCS document (87.6%, 63.4-97.9%), and 90.9% within the RACS document (85.5%, 18.7-98.8%). Statements lacking consensus related to the surgical approach (open vs. laparoscopic), dual consultant operating, separate instrument decontamination, and stoma formation rather than anastomosis. CONCLUSION: Initial surgical COVID-19 guidance from the US, Europe and Australasia was widely supported by an international expert community, although a small number of contentious areas emerged. These findings should be addressed in future guidance iterations, and should stimulate urgent investigation of non-consensus areas.

International surgical guidance for COVID-19: Validation using an international Delphi process - Cross-sectional study

Natural products are an excellent source of skeletons for medicinal seeds. Triterpenes and saponins are representative natural products that exhibit anti-herpes simplex virus type 1 (HSV-1) activity. However, there has been a lack of comprehensive information on the anti-HSV-1 activity of triterpenes. Therefore, expanding information on the anti-HSV-1 activity of triterpenes and improving the efficiency of their exploration are urgently required. To improve the efficiency of the development of anti-HSV-1 active compounds, we constructed a predictive model for the anti-HSV-1 activity of triterpenes by using the information obtained from previous studies using machine learning methods. In this study, we constructed a binary classification model (i.e., active or inactive) using a logistic regression algorithm. As a result of the evaluation of predictive model, the accuracy for the test data is 0.79, and the area under the curve (AUC) is 0.86. Additionally, to enrich the information on the anti-HSV-1 activity of triterpenes, a plaque reduction assay was performed on 20 triterpenes. As a result, chikusetsusaponin IVa (11: IC(50) = 13.06 μM) was found to have potent anti-HSV-1 with three potentially anti-HSV-1 active triterpenes. The assay result was further used for external validation of predictive model. The prediction of the test compounds in the activity test showed a high accuracy (0.83) and AUC (0.81). We also found that this predictive model was found to be able to successfully narrow down the active compounds. This study provides more information on the anti-HSV-1 activity of triterpenes. Moreover, the predictive model can improve the efficiency of the development of active triterpenes by integrating many previous studies to clarify potential relationships.

Effective Search of Triterpenes with Anti-HSV-1 Activity Using a Classification Model by Logistic Regression

This article examines emergency restrictions imposed by state-level public officials on firearms during the COVID-19 pandemic. It surveys the litigation challenging each of the relatively few restrictions that were imposed, considers when and whether courts should apply the deferential Jacobson standard, the Heller Second Amendment analysis, or both, and explores the possibility that the unsettled nature of Second Amendment jurisprudence makes it likely that challenges to emergency firearms restrictions could result in dramatic developments in what the Second Amendment protects.

COVID-19 Emergency Restrictions on Firearms.

BACKGROUND: Telocytes play key roles in maintenance of organ/tissue function and prevention of organ injury. However, there are great challenges to investigate telocytes functions using primary telocytes, due to the difficulties of isolation, identification, and stability. The present study aims at constructing continuous cell strain of mouse lung telocyte cell line with stable characters by gene modification and investigating biological behaviors and responses of gene-modified telocytes to inflammation. METHODS: Mouse primary lung telocytes were isolated and identified using immune-labeling markers and immunoelectron microscopy. Primary telocytes were transformed with Simian vacuolating virus 40 small and large T antigen (SV40). Biological characters, behaviors morphology, and proliferation of those gene-modified telocytes were defined and monitored dynamically for 50 generations, as compared with primary lung telocytes. Cell cycle of mouse primary lung telocytes or gene-modified telocytes was detected by flow cytometry. RESULTS: Gene modified telocytes of generations 5, 10, 30 and 50 were observed with telopodes and also showed CD34 and ckit positive. Multiple cellular morphology were also observed on telocyte cell-line under monitor of celliq and enhanced cell proliferation were showed. SV40 transduction was also reduced apoptosis and increased the ratio of S and G2 phases in telocyte cell-line. CONCLUSION: We successfully constructed mouse lung telocyte cell-line which maintained the biological properties and behaviors as primary telocytes and could responses to inflammation induced by LPS. Thus, gene-modified lung telocytes, Telocyte Line, would provide a cell tool for researchers exploring the roles and applications of telocytes involved in physiological and pathological states in future. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12967-019-1870-y) contains supplementary material, which is available to authorized users.

Influence of gene modification in biological behaviors and responses of mouse lung telocytes to inflammation

Background: The 2019 coronavirus (COVID-19) is a highly contagious disease associated with a high morbidity and mortality worldwide The accumulation of data through a prospective clinical registry enables public health authorities to make informed decisions based on real evidence obtained from surveillance of COVID-19 This registry is also fundamental to providing robust infrastructure for future research surveys The purpose of this study was to design a registry and its minimum data set (MDS), as a valid and reliable data source for reporting and benchmarking COVID-19 Methods: This cross sectional and descriptive study provides a template for the required MDS to be included in COVID-19 registry This was done by an extensive literature review and 2 round Delphi survey to validate the content, which resulted in a web-based registry created by Visual Studio 2019 and a database designed by Structured Query Language (SQL) Results: The MDS of COVID-19 registry was categorized into the administrative part with 3 sections, including 30 data elements, and the clinical part with 4 sections, including 26 data elements Furthermore, a web-based registry with modular and layered architecture was designed based on final data classes and elements Conclusion: To the best of our knowledge, COVID-19 registry is the first designed instrument from information management perspectives in Iran and can become a homogenous and reliable infrastructure for collecting data on COVID-19 We hope this approach will facilitate epidemiological surveys and support policymakers to better plan for monitoring patients with COVID-19

Design and development of a web-based registry for Coronavirus (COVID-19) disease

The recent emergence of novel neoadjuvant and/or adjuvant therapies for early stage (I-IIIA) non-small cell lung carcinoma (NSCLC), mainly tyrosine kinase inhibitors (TKIs) targeting EGFR mutations and immunotherapy or chemo-immunotherapy, has suddenly required the evaluation of biomarkers predictive of the efficacy of different treatments in these patients. Currently, the choice of one or another of these treatments mainly depends on the results of immunohistochemistry for PD-L1 and of the status of EGFR and ALK. This new development has led to the setup of different analyses for clinical and molecular pathology laboratories, which have had to rapidly integrate a number of new challenges into daily practice and to establish new organization for decision making. This review outlines the impact of the management of biological samples in laboratories and discusses perspectives for pathologists within the framework of EGFR TKIs in early stage NSCLC.

EGFR Status Assessment for Better Care of Early Stage Non-Small Cell Lung Carcinoma: What Is Changing in the Daily Practice of Pathologists?

INTRODUCTION: During the COVID-19 outbreak, many citizens were asked to stay at home in self-quarantine, which can pose a significant challenge with respect to remaining physically active and maintaining mental health. This study aimed to evaluate the prevalence of inadequate physical activity, anxiety, and depression and to explore the relationship of physical activity with anxiety and depression symptoms among Chinese college students during quarantine. METHOD: Using a web-based cross-sectional survey, we collected data from 1,396 Chinese college students. Anxiety and depression were assessed with the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS), respectively. The data on physical activity were collected by types of physical activity and the International Physical Activity Questionnaire (IPAQ-SF). RESULTS: During the COVID-19 outbreak, about 52.3% of Chinese college students had inadequate physical activity. The rates of anxiety and depression symptoms were 31.0 and 41.8%, respectively. A high level of physical activity (β = −0.121, P < 0.001) was significantly closely associated with low anxiety, while a moderate (β = −0.095, P = 0.001), or high (β = −0.179, P < 0.001) level of physical activity was significantly closely associated with reduced depression after adjusting confounding demographic factors. Moreover, specific types of physical activity, such as stretching and resistance training, were negatively correlated with both anxiety and depression; doing household chores was negatively correlated with depression. CONCLUSION: Our findings highlight specific levels and types of home-based physical activities that need to be taken into consideration to protect the mental health of college students during the COVID-19 epidemic.

Relationship of Physical Activity With Anxiety and Depression Symptoms in Chinese College Students During the COVID-19 Outbreak

Background: Health care workers are at increased risk of SARS-CoV-2 infection due to potential exposure to patients or staff in health care settings. Australian health care services and health care workers experienced intense pressure to prepare for and respond to SARS-CoV-2 infections. We summarise national data on health care worker infections and associated outbreaks during 2020. Methods: We collected aggregated data on infected health care workers and outbreaks in health care facilities from all jurisdictions. Health care workers working solely in residential aged care and outbreaks in residential aged care facilities were excluded. Jurisdictions provided data on the number of health care setting outbreaks, confirmed cases, hospitalisation, source of infection, and health care worker role. We analysed data for two periods that aligned with two distinct peaks in the epidemic relative to 1 June 2020, referred to here as the first wave (23 January - 31 May 2020) and the second wave (1 June - 18 September 2020). Results: Jurisdictions reported a total of 2,163 health care worker infections with SARS-CoV-2 during the surveillance period. Source of acquisition was known for 81.0% of cases (1,667/2,059). The majority of cases in the first wave were acquired overseas, shifting to locally-acquired cases in the second wave. The odds of infection in the second wave compared to the first wave were higher for nurses/midwives (odds ratio, OR: 1.61; 95% confidence interval (95% CI): 1.32-2.00), lower for medical practitioners (OR: 0.36; 95% CI: 0.28-0.47) and did not differ for 'other' health care workers (OR: 1.07; 95% CI: 0. 87-1.32). The odds of infection in the second wave were higher in a health care setting (OR: 1.76; 95% CI: 1.28-2.41) than in the community. There were 120 outbreaks in health care settings with 1,428 cases, of which 56.7% (809/1,428) were health care workers. The majority (88/120; 73.8%) of outbreaks in health care settings occurred in the second wave of the epidemic, with 90.9% of these (80/88) occurring in Victoria. Conclusions: In the second wave of the epidemic, when there was heightened community transmission, health care workers were more likely to be infected in the workplace. Throughout the epidemic, nurses were more likely to be infected than staff in other roles.

COVID-19 in health care workers, Australia 2020

The outbreak of coronavirus named COVID-19 has disrupted the Chinese economy and is spreading globally. The evolution of the disease and its economic impact is highly uncertain which makes it difficult for policymakers to formulate an appropriate macroeconomic policy response. In order to better understand possible economic outcomes, this paper explores seven different scenarios of how COVID-19 might evolve in the coming year using a modelling technique developed by Lee and McKibbin (2003) and extended by McKibbin and Sidorenko (2006). It examines the impacts of different scenarios on macroeconomic outcomes and financial markets in a global hybrid DSGE/CGE general equilibrium model. The scenarios in this paper demonstrate that even a contained outbreak could significantly impact the global economy in the short run. These scenarios demonstrate the scale of costs that might be avoided by greater investment in public health systems in all economies but particularly in less developed economies where health care systems are less developed and popultion density is high.

The Global Macroeconomic Impacts of COVID-19: Seven Scenarios

Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia.

Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak

OBJECTIVE To explore the impact of complexity and feedback on script training outcomes in aphasia DESIGN: Randomized balanced single-blind 2 × 2 factorial design SETTING: Freestanding urban rehabilitation hospital. PARTICIPANTS Adults with fluent and nonfluent aphasia (at least six months post-onset). INTERVENTIONS Experimental treatment was AphasiaScripts®, a computer-based script training program. Scripts were 10-turns long and developed at different complexity levels to allow for comparison of high versus low complexity. The program was modified to contrast high versus low feedback conditions during sentence practice. Participants were instructed to practice three 30-minute sessions per day, six days a week for three weeks. MAIN MEASURES Gains achieved from baseline in accuracy and rate of production of trained and untrained script sentences at post-treatment and at 3-, 6- and 12-weeks after the end of treatment. RESULTS Sixteen participants completed the intervention. On the trained script, gains were statistically significant for both accuracy and words per minute, at post-treatment and 3-, 6- and 12-week maintenance. Gains on the untrained script were smaller than on the trained script; they were statistically significant only for accuracy at post-treatment and 3-week maintenance. Complexity had an influence on accuracy at post-treatment (F(1) = 4.8391, p = 0.0501) and at maintenance (F(1) = 5.3391, p = 0.04125). Practicing scripts with high complexity increased accuracy by 11.33% at post-treatment and by 9.90% at maintenance compared to scripts with low complexity. Participants with nonfluent aphasia made greater gains than those with fluent aphasia. There was no significant effect of feedback. CONCLUSION This study reinforces script training as a treatment option for aphasia. Results highlight the use of more complex scripts to better promote acquisition and maintenance of script production skills. There is a need for further investigation of these variables with larger samples and with other types of aphasia treatments. CLINICALTRIALS gov identifier: NCT01597037.

Complexity and feedback during script training in aphasia: A feasibility study.

Understanding broadly neutralizing sarbecovirus antibody responses is key to developing countermeasures against SARS-CoV-2 variants and future zoonotic sarbecoviruses. We describe the isolation and characterization of a human monoclonal antibody, designated S2K146, that broadly neutralizes viruses belonging to SARS-CoV- and SARS-CoV-2-related sarbecovirus clades which use ACE2 as an entry receptor. Structural and functional studies show that most of the virus residues that directly bind S2K146 are also involved in binding to ACE2. This allows the antibody to potently inhibit receptor attachment. S2K146 protects against SARS-CoV-2 Beta challenge in hamsters and viral passaging experiments reveal a high barrier for emergence of escape mutants, making it a good candidate for clinical development. The conserved ACE2-binding residues present a site of vulnerability that might be leveraged for developing vaccines eliciting broad sarbecovirus immunity.

Antibody-mediated broad sarbecovirus neutralization through ACE2 molecular mimicry

The Poxvirus Bioinformatics Resource Center (PBRC) has been established to provide informational and analytical resources to the scientific community to aid research directed at providing a better understanding of the Poxviridae family of viruses. The PBRC was specifically established as the result of the concern that variola virus, the causative agent of smallpox, as well as related viruses, might be utilized as biological weapons. In addition, the PBRC supports research on poxviruses that might be considered new and emerging infectious agents such as monkeypox virus. The PBRC consists of a relational database and web application that supports the data storage, annotation, analysis and information exchange goals of the project. The current release consists of over 35 complete genomic sequences of various genera, species and strains of viruses from the Poxviridae family. Sequence and annotation information for these viruses has been obtained from sequences publicly available from GenBank as well as sequences not yet deposited in GenBank that have been obtained from ongoing sequencing projects. In addition to sequence data, the PBRC provides comprehensive annotation and curation of virus genes; analytical tools to aid in the understanding of the available sequence data, including tools for the comparative analysis of different virus isolates; and visualization tools to help better display the results of various analyses. The PBRC represents the initial development of what will become a more comprehensive Viral Bioinformatics Resource Center for Biodefense that will be one of the National Institute of Allergy and Infectious Diseases' ‘Bioinformatics Resource Centers for Biodefense and Emerging or Re-Emerging Infectious Diseases’. The PBRC website is available at http://www.poxvirus.org.

Poxvirus Bioinformatics Resource Center: a comprehensive Poxviridae informational and analytical resource

The article offers information on the ‘International Virtual Workshop on Global Seismology and Tectonics' was organized to bring national and international experts together and boost the morale of the students and researchers during the COVID- 19 pandemic Topic include providing opportunities to interact with eminent scientists in the domain of seismology and tectonics

Global seismology and tectonics

The disease caused by the new coronavirus COVID-19 is considered by the world community as an emergency of international importance Along with the huge social importance, the COVID-19 pandemic has highlighted a number of principally new clinical and fundamental problems of immunopathology of human diseases This problem is extremely urgent for patients suffering from immune-inflammatory rheumatic diseases (IIRD) due to their higher exposure to infectious complications Achieving and maintaining control over the activity of IIRD plays an important role in reducing the incidence of comorbid infections in these patients It has been shown that patients with IIRD undergoing active anti-rheumatic therapy are most likely not characterized by increased risk of respiratory or other life-threatening complications within COVID-19 compared to the general population Given the need for continued monitoring of patients receiving these therapy, unjustified “prophylactic” cancellation should nevertheless be avoided, thereby increasing the risk of relapse of major IIRD The article also discusses the issues related to the use of basic anti-rheumatic drugs in COVID-19 Currently there is no evidence to support the therapeutic and prophylactic efficacy of chloroquine or hydroxychloroquine in COVID-19 Tocilizumab can be considered as “lifesaving therapy” for patients with acute respiratory distress syndrome in COVID-19, if other treatments have failed or are unavailable The use of baricitinib in hospitalized pneumonia patients as part of COVID-19 should be considered with extreme caution The need for further research to assess the potential role of baricitinib for these patients is highlighted In the absence of a COVID-19 vaccine in a continuing pandemic, vaccination against influenza and pneumococcal infection should be strongly recommended to the absolute majority of patients with IIRD This is associated with a high risk of fatal respiratory infection in rheumatological patients, especially given the high respiratory tract involvement in COVID-19 © 2020, Remedium Group Ltd All rights reserved

Covid-19 and rheumatology: So far, so close

BACKGROUND Surgical jejunostomy tubes are a routine part of elective esophagectomies in patients with carcinomas and provide a route for nutritional support in those who experience complications. We wished to determine how frequently oral intake is delayed and the amount of nutrition delivered via the jejunostomy tube. METHODS We reviewed the charts of all adults undergoing esophagectomy for carcinoma between January 2000 and June 2008. We determined the proportion of patients unable to resume oral nutrition after 8 days and the amount of nutrition delivered in each of the 8 days. RESULTS In all, 111 patients underwent elective esophagectomy for carcinoma, and 103 had a jejunostomy tube placed. The mean age was 67 ± 10.8 years. The median time to oral intake was 7 (interquartile range 7-11) days. Seventy-four (67%) patients resumed oral intake within 8 days. The mean nutrition delivered by jejunostomy within the first 8 days as a percentage of the target was 45.6% (95% confidence interval 41.2%-49.9%). Six (5.4%) patients experienced complications attributable solely to the jejunostomy tube; 3 (2.9%) required surgery. Forty (38.8%) patients had abdominal issues serious enough to warrant delaying the progression of feeding. CONCLUSION Two-thirds of patients undergoing elective esophagectomy were tolerating oral intake by the end of the eighth postoperative day, and less than half of the target nutrition was delivered over the first 8 days. We now selectively place surgical jejunostomy tubes in patients undergoing elective esophagectomies.

Jejunostomy tube feeding in patients undergoing esophagectomy.

This study applied molecular‐based method to investigate the presence of porcine deltacoronavirus (PDCoV) in 59 commercial pig farms in South Korea. The results of RT‐PCR screening on a relatively large collection of faeces samples (n = 681) from January 2013 to March 2015 did not reveal the presence of PDCoV until the end of 2014. However, on March 2015, PDCoV‐positive samples (SL2, SL5) were detected from SL swine farm in Gyeongbuk province. The phylogenetic trees based on the complete spike‐ and nucleocapsid protein‐coding genes showed that SL2 and SL5 closely related to the US PDCoV strains rather than those in China. Thought Korean strains of PDCoV isolated in 2014 (KNU14.04) and in 2015 (SL2 and SL5) grouped within US PDCoV cluster, the reconstruction of ancestral amino acid changes suggested that they are different.

Detection and Phylogenetic Analysis of Porcine Deltacoronavirus in Korean Swine Farms, 2015

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate (CFR) between French districts. In theory, the hospital age-standardized CFR should not display significant differences between districts, since hospital lethality depends on the virulence of the pathogen (the SARS-CoV-2 virus), the vulnerability of the population (mainly age-related), the healthcare system quality, and cases and deaths definition and the recording accuracy. We analyzed hospital data on COVID-19 hospitalizations, severity (admission to intensive care units for reanimation or endotracheal intubation) and mortality, from March 19 to May 8 corresponding to the first French lockdown. All rates were age-standardized to eliminate differences in districts age structure. The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity. Time analysis shows that the case-fatality rate has decreased over time, globally and in almost all districts, showing an improvement in the management of severe patients during the epidemic. In conclusion, it appears that during the first critical phase of COVID-19 ramping epidemic in metropolitan France, the higher case-fatality rates were generally related to the higher level of hospitalization, then potentially related to the overload of healthcare system. Also, low hospitalization with high case-fatality rates were mostly found in districts with low population density, and could due to some limitation of the local healthcare access. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate, and this variation is small compared to much greater variation across countries reported in the literature.

COVID-19: Spatial analysis of hospital case-fatality rate in France

Worldwide neural tube defects, such as encephalocele and spina bifida (SB), remain a substantial cause of the global burden of disease; and in the US, Latinos consistently have a higher birth prevalence of SB compared with other ethnic groups. From limited access and fragmented care, to scarcely available adult services, many are the challenges that besiege those living with SB. Thus, to provide inclusion and active involvement of parents of children and adults with SB from all communities, innovative approaches will be required, such as community-based participatory research and culturally competent learning collaboratives. Promisingly, the Spina Bifida Community-Centered Research Agenda was developed by the community of people living with SB through the Spina Bifida Association (SBA). Additionally, the SBA will host the Fourth World Congress on Spina Bifida Research and Care in March of 2023. Just as the SBA is clearly committed to this population, the Journal of Pediatric Rehabilitation Medicine will continue to serve as a catalyst for SB care, education, and research across the SB population in a global context.

Spina bifida care, education, and research: A multidisciplinary community in a global context.

The teaching-learning process has undergone substantial changes since the onset of the pandemic due to a shift in the established mode of knowledge-sharing in educational institutions. In this paper, we present an overview of the changes that have happened in the knowledge dissemination process, with a focus on India, with respect to engineering education. We present results from a targeted survey of the students from different engineering disciplines and their experience of online education. The findings highlight the student’s point of view about the online education system. Further, we discuss the impact of using technology which is the backbone of this shift in the learning model. Furthermore, the paper discusses the digital divide, another consequence of the new development of next-generation telecommunication technologies, which is an important consideration in fulfilling this shift in education.

Teaching, Technology and Pandemic: Experiences of a Teacher (preprint)/ en

BACKGROUND: There is a worldwide shortage of medical grade face masks. Donning masks can play an important role in curbing the spread of SARS-CoV-2. AIM: To conclude if there is an effective mask for the population to wear in public that could easily be made during a medical face mask shortage using readily available materials. METHODS: We determined the effectiveness of readily available materials and models for making a face mask. The outcomes were compared with N95/FFP2/KN95 masks that entered the Netherlands in April-May 2020. Masks were tested to see if they filter a minimum of 35% of 0.3É¥m particles, are hydrophobic, seal on the face, are breathable, and can be washed. FINDINGS: Fourteen of the 25 (combinations of) materials filtered at least 35% of 0.3É¥m particles. Four of the materials proved hydrophobic, all commercially manufactured filters. Two models sealed the face. Twenty-two of the 25 materials were breathable at <0.7 mbar. None of the hydrophobic materials stayed intact after washing. CONCLUSIONS: It would be possible to reduce the reproduction rate of SARS CoV-2 from 2.4 to below one if 39% of the population would wear a mask made from ePM1 85% commercially manufactured filter fabric and in a duckbill form. This mask performs better than 80% of the imported N95/FFP2/KN95 masks and provides a better fit than a surgical mask. Two layers of quilt fabric with a household paper towel as filter is also a viable choice for protecting the user and the environment.

Is there an adequate alternative for commercially manufactured face masks? A comparison of various materials and forms

A 45-year-old man presented with malaise, arthralgia, and dyspnea. The chest CT scan showed bilateral patchy consolidation in the lower lobes. A lung biopsy revealed intra-alveolar fibrin “balls” deposits and focal features of organizing pneumonia, both of which are typical pathological features of acute fibrinous and organizing pneumonia (AFOP). The patient had a good clinical course after treatment with prednisone. We report this case of idiopathic AFOP and review the published studies on this newly recognized clinicopathological entity that is still underdiagnosed and underreported.

Acute fibrinous and organizing pneumonia

The outcome of surgery in patients who have recovered from severe coronavirus disease 2019 (COVID-19) is unknown Herein, we present a case of an emergency operation for acute pan-peritonitis due to perforation of the descending colon diverticulum in a patient who recovered from severe COVID-19 pneumonia A 59-year-old man, who had recovered from severe COVID-19 pneumonia ~6 months previously, developed acute pan-peritonitis due to perforation of a diverticulum in the descending colon Emergency surgery was performed, and the perforation was sutured and closed He was discharged from the hospital 13 days postoperatively There was no relapse of COVID-19 during the perioperative period of peritonitis surgery General perioperative management may, therefore, be sufficient in patients who have recovered from COVID-19

Perforation of the descending colon diverticulum in a patient following recovery from severe COVID-19 pneumonia: a case report

Background As evidenced by the COVID-19 pandemic, rapid collection of data on clinical characterization, treatment, and diagnostics to inform rapid public health response is paramount in an outbreak of a novel infectious agent In 2018, The World Health Organization R&D Blueprint identified a list of priority diseases for accelerated research based on their potential to cause a public health emergency Among these diseases were Severe acute respiratory syndrome-coronavirus (SARS-CoV) and Middle East respiratory syndrome-coronavirus (MERS-CoV) To facilitate a rapid research response during an outbreak, standardized research protocols must be prepared before the outbreak occurs The aim of this systematic review is to identify the most common clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV to inform future clinical research protocol development for coronaviruses Methods Medline, Embase, and Global Health bibliographic databases were searched to identify clinical studies published on SARS-CoV and MERS-CoV in the outbreak setting Studies were grouped thematically according to the clinical research question addressed Results From the research questions and objectives, eleven themes in the literature were identified: Clinical characterisation, prognosis, diagnosis, clinical management, viral pathogenesis, epidemiological characterisation, infection prevention and control, transmission, susceptibility, psychosocial, and aetiology Case series made up the highest proportion of study designs, while clinical trials made up the lowest 83% of the SARS-CoV studies were published after the end of the outbreak Conclusion: The thematic analysis was used to identify the key clinical research questions asked during outbreaks of SARS-CoV and MERS-CoV and study designs were recommended to answer these questions By defining the key clinical research questions, this study provides a first step in creating standardized clinical research protocols and defining core data variables to be collected during future outbreaks of respiratory coronaviruses

Key clinical research questions asked during epidemic respiratory outbreaks: A systematic review of the literature published on severe acute respiratory syndrome and middle east respiratory syndrome

Background: The COVID-19 crisis has strained world health care systems. This study aimed to develop an innovative prediction score using clinical and biological parameters (PREDICT score) to anticipate the need of intensive care of COVID-19 patients already hospitalized in standard medical units. Methods: PREDICT score was based on a training cohort and a validation cohort retrospectively recruited in 2020 in the Marseille University Hospital. Multivariate analyses were performed, including clinical, and biological parameters, comparing a baseline group composed of COVID-19 patients exclusively treated in standard medical units to COVID-19 patients that needed intensive care during their hospitalization. Results: Independent variables included in the PREDICT score were: age, Body Mass Index, Respiratory Rate, oxygen saturation, C-reactive protein, neutrophil–lymphocyte ratio and lactate dehydrogenase. The PREDICT score was able to correctly identify more than 83% of patients that needed intensive care after at least 1 day of standard medical hospitalization. Conclusions: The PREDICT score is a powerful tool for anticipating the intensive care need for COVID-19 patients already hospitalized in a standard medical unit. It shows limitations for patients who immediately need intensive care, but it draws attention to patients who have an important risk of needing intensive care after at least one day of hospitalization.

Predict Score: A New Biological and Clinical Tool to Help Predict Risk of Intensive Care Transfer for COVID-19 Patients

Introduction: To investigate the characteristic of anxiety and depression among patients in general hospitals, and explore the degree of the clinical symptoms and correlated social economic factors. Methods: This is a cross-sectional survey of anxiety and depression in patients with physical diseases, who were suspected of depression and anxiety based on their clinical performance by their physicians and PHQ ≧ 8, from various clinical departments of 57 general hospitals in China. Data regarding demographic characteristics and clinical characteristics were collected. Social and psychological factors and the severity of anxiety or depression were collected through self-rating scales. Finally, we used multivariate logistic regression to identify the factors associated with anxiety and depression in patients with physical diseases. Results: A total of 2,105 (84.6%) valid and completed questionnaires were returned. The proportion of anxiety, depression, combined depression and anxiety, either anxiety or depression among the patients with physical diseases from all clinical departments was 63.3, 75.1, 57.1, and 81.2% respectively. Further regression analysis indicated that gender, monthly income, specific physical diseases, personality traits, social supports and life negative events were related factors of both anxiety and depression. Conclusions: Anxiety and depression were common in patients with physical diseases, with a high proportion of co-morbidity of anxiety and depression. Females, patients with cancer, poor social support and negative life events reported more severe anxiety and depression. The results may help to understand the present situation of anxiety and depression in general hospitals in china, and identify the patients with high risk of depression and anxiety.

Anxiety and Depression in Patients With Physical Diseases and Associated Factors: A Large-Scale Field Survey in General Hospitals in China

On March 20(th) 2020 the Federal Government of Nigeria ordered the closure of all educational institutions, this was inclusive of all medical schools in the country. During the initial phases of this closure, most institutions were at a loss on how to proceed with learning as universities in Nigeria use mainly the didactic lecturing model. As the lockdown progressed it became imperative to the institutions to set up e-learning media for continued instruction of students. It was found that in the institutions with e-learning facilities, the preclinical years remained mostly unaffected by the closure of medical schools due to the COVID-19 pandemic, while all institutions came to a standstill as regards providing a suitable alternative for clinical exposure. This therein has caused loss of valuable time and a change in the calendar of the school year, making it uncertain as to when the next set of qualified medical professionals will emerge in Nigeria. In this essay, we take a look at medical education in Nigeria, its challenges and progression in the COVID-19 era. We also take a look at the effect of the pandemic on learning and the subsequent interventions introduced to mitigate it.

Challenges with medical education in Nigeria in the COVID-19 era

Background: Pediatric migraine is among the most common primary or comorbid neurologic disorders in children Psychological stressors are widely acknowledged as potential triggers involved in recurring episodes of pediatric migraine As the COVID-19 emergency may have affected the levels of stress perceived by children and adolescents with migraine, the present study was aimed to understand the effect of COVID-19 emergency on symptoms intensity and frequency in pediatric patients Methods: A cohort of 142 child and adolescent patients with a diagnosis of migraine was enrolled at the Child Neurology and Psychiatry Unit of the IRCCS Mondino Foundation in Pavia (Italy) Socio-demographic and clinical characteristics were obtained from medical records An on-line survey was used to collect information on COVID-19 exposure, stress response to the lockdown period, anxious symptoms during COVID-19 emergency, as well as migraine symptoms intensity and frequency before and during the lockdown Results: The great majority were outpatients (n = 125, 88 0%), 52 (36 6%) had migraine with aura, whereas, 90 (63 4%) had migraine without aura All the patients reporting worsening symptoms progression before COVID-19, had reduced intensity during the lockdown (χ2 = 31 05, p &lt; 0 0001) Symptoms frequency reduction was observed in 50% of patients presenting worsening symptoms before the lockdown, 45% of those who were stable, and 12% of those who were already improving All patients who had resolved symptoms before COVID-19 were stable during the lockdown (χ2 = 38 66, p &lt; 0 0001) Anxious symptomatology was significantly associated with greater migraine symptoms frequency (χ2 = 19 69, p &lt; 0 001) Repeating the analysis separately for individuals with and without aura did not affect the findings and significant associations were confirmed for both the patients' subgroups Discussion: A significant reduction of migraine symptoms intensity and frequency was observed in pediatric patients during the COVID-19 lockdown phase in northern Italy The improvement in both intensity and frequency of the migraine symptoms was especially significant in patients who were stable or worsening before the lockdown The reduction of symptoms severity during a period of reduced environmental challenges and pressures further highlights the need of providing effective training in stress regulation and coping for these patients

Migraine Symptoms Improvement During the COVID-19 Lockdown in a Cohort of Children and Adolescents

This work discusses the educational and occupational challenges posed by the outbreak of the COVID-19 pandemic from the point of view of young high school teachers from Mexico City. We sought to identify and compare their teaching practices using the concept of asymmetric educational spaces (Villa Lever et al., 2017) to capture the influence of educational inequalities upon this sector’s response to the health crisis. For this purpose, 22 semi-structured interviews were conducted to an intentional selection of cases from private and public high schools, all from ages 22-30. Interviews were conducted remotely between June and August 2020, the moment of the first wave of COVID-19 infections in the Mexican capital. Drawing on Hochschild’s work (1983), we deploy the concept of “asymmetric educational labours” to show how different institutional resources and social contexts of action shaped the emotional experiences of our informants. Furthermore, this research provides significant insights into the multiple problems experienced by young early career teachers as a social group with little visibility in times of crisis.

Being a Young High School Teacher in Mexico City. Teachers’ Experiences in Times of Pandemic

BACKGROUND Outcomes after robotic distal pancreatectomy with spleen preservation (RDP-SP) by the Warshaw technique and with splenectomy (RDP-S) were compared. METHODS All the data for patients undergoing robotic distal pancreatectomy (RDP) were prospectively collected. RESULTS A total of 66 patients were included, with 33 in each group. The console time was significantly shorter in the RDP-SP group than in the RDP-S group (165 minutes vs. 220 minutes). The median blood loss was 50 cm3 in the RDP-SP group and 100 cm3 in the RDP-S group. The surgical morbidity was significantly lower in RDP-SP group (18% vs. 58%). Spleen infarction (15%), gastric varices (6%) and perigastric varices (45%) after RDP-SP were not associated with any subsequent complication. Postoperative platelet count and white blood cell (WBC) count were significantly higher in the RDP-S group. CONCLUSIONS Both RDP-SP and RDP-S are feasible in selected patients. RDP-SP is feasible and time-saving. Although gastric/perigastric varices and spleen infarction are not uncommon after RDP-SP, they appear to be clinically irrelevant.

Robotic distal pancreatectomy: Comparison of spleen-preservation by the Warshaw technique and splenectomy.

COVID-19 is affecting every social sector significantly, including human mobility and subsequently road traffic safety. In this study, we analyze the impact of the pandemic on traffic accidents using two cities, namely Los Angeles and New York City in the U.S., as examples. Specifically, we have analyzed traffic accidents associated with various demographic groups, how traffic accidents are distributed in time and space, and the severity level of traffic accidents that both involve and do not involve other transportation modes (e.g., pedestrians and motorists). We have made the following observations: 1) the pandemic has disproportionately affected certain age groups, races, and genders; 2) the"hotspots"of traffic accidents have been shifted in both time and space compared to time periods that are prior to the pandemic, demonstrating irregularity; and 3) the number of non-fatal accident cases has decreased but the number of severe and fatal cases of traffic accidents remains the same under the pandemic.

Assessing Road Traffic Safety During COVID-19: Inequality, Irregularity, and Severity

PURPOSE OF REVIEW: This review is meant to describe the genetic associations with pediatric severe COVID-19 pneumonia and the postinfectious complication of the multisystem inflammatory syndrome in children (MIS-C). Multiple genetic approaches have been carried out, primarily in adults with extrapolation to children, including genome-wide association studies (GWAS), whole exome and whole genome sequencing (WES/WGS), and target gene analyses. RECENT FINDINGS: Data from adults with severe COVID-19 have identified genomic regions (human leukocyte antigen locus and 3p21.31) as potential risk factors. Genes related to viral entry into cells (ABO blood group locus, ACE2, TMPRS22) have been linked to severe COVID-19 patients by GWAS and target gene approaches. Type I interferon (e.g. IFNAR2) and antiviral gene (e.g. TLR7) associations have been identified by several genetic approaches in severe COVID-19. WES has noted associations with several immune regulatory genes (e.g. SOCS1). Target gene approaches have identified mutations in perforin-mediated cytolytic pathway genes in children and adults with severe COVID-19 and children with MIS-C. SUMMARY: Several genetic associations have been identified in individuals with severe COVID-19 and MIS-C via various genetic approaches. Broadly speaking, COVID-19 genetic associations include genes involved with antiviral functions, viral cell entry, immune regulation, chemotaxis of white blood cells, and lymphocyte cytolytic function.

Host genetics of pediatric SARS-CoV-2 COVID-19 and multisystem inflammatory syndrome in children

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused great public concern worldwide due to its high rates of infectivity and pathogenicity. The Chinese government responded in a timely manner, alleviated the dilemma, achieved a huge victory and lockdown has now been lifted in Wuhan. However, the outbreak has occurred in more than 200 other countries. Globally, as of 9:56 am CEST on 19 May 2020, there have been 4,696,849 confirmed cases of COVID-19, including 315,131 deaths, reported to Word Health Organization (WHO). The spread of COVID-19 overwhelmed the healthcare systems of many countries and even crashed the fragile healthcare systems of some. Although the situation in each country is different, health workers play a critical role in the fight against COVID-19. In this review, we highlight the status of health worker infections in China and other countries, especially the causes of infection in China and the standardised protocol to protect health workers from the perspective of an anaesthesiologist, in the hope of providing references to reduce medical infections and contain the COVID-19 epidemic.

Avoiding health worker infection and containing the coronavirus disease 2019 pandemic: Perspectives from the frontline in Wuhan

Surgical proctoring requires increasing resources in growing healthcare systems. In addition, travel has become less safe in the era of COVID-19. This study demonstrates surgeon satisfaction and safety with tele-proctoring in robotic gynecologic surgery. This pilot study assesses surgeon satisfaction and operative outcomes with a novel operative tele-proctoring system with a continuous two-way video-audio feed that allows the off-site surgeon to see the operating room, surgical field, and hands of the robotic surgeon. After thorough system testing, two experienced surgeons underwent tele-proctoring for hospital credentialing, completing 7 total cases. Each completed pre- and post-surveys developed from the Michigan Standard Simulation Experience Scale. Surgical characteristics were compared between tele-proctored cases and 59 historical cases proctored in-person over the last 8 years. Surgeons reported unanimous high satisfaction with tele-proctoring (5 ± 0). There were no major technologic issues. Five of the tele-proctored cases and 35 of controls were hysterectomies. Mean age was 48.2 ± 1.4 years, mean BMI was 29.6 ± 0.9 kg/m(2), and mean uterine weight was 152 ± 112.3 g. Two-thirds had prior abdominal surgery (P > 0.1). Tele-proctored hysterectomies were 58 ± 6.5 min shorter than controls (P = 0.001). There were no differences in EBL or complication rates (P > 0.1). Tele-proctoring resulted in high surgeon satisfaction rates with no difference in EBL or complications. Tele-mentoring is a natural extension of tele-proctoring that could provide advanced surgical expertise far beyond where we can physically reach.

Surgeon satisfaction and outcomes of tele-proctoring for robotic gynecologic surgery

This article aims to describe the Vietnamese Government?s policy response to support disadvantaged groups affected by the COVID-19 pandemic through the relief package. The Vietnamese policy response is characterized by rapid response, priority for disadvantaged groups in communities, social work core values in the policy, openness, and transparency. We hope the experiences from Vietnam could be helpful for similar settings in the world.

Policy response for disadvantaged groups during the COVID-19 pandemic: Vietnam experiences

The sudden outbreak of the COVID-19 pandemic has profoundly altered the daily lives of the population with dramatic effects caused not only by the health risks of the coronavirus, but also by its psychological and social impact in large sectors of the worldwide population. The present study adapted the COVID-19 Peritraumatic Distress Index (CPDI) to the Spanish population, and 1094 Spanish adults (mean age 52.55 years, 241 males) completed the Spanish version in a cross-sectional online survey. To analyze the factorial structure and reliability of the CPDI, we performed an exploratory factor analysis (EFA) followed by a confirmatory factor analysis (CFA) on the Spanish sample. The effects of gender and age on the degree of distress were analyzed using the factorial scores of the CPDI as the dependent variables. Results showed that, after rotation, the first factor (Stress symptoms) accounted for 35% of the total variance and the second factor (COVID-19 information) for 15%. Around 25% (n = 279) of the participants experienced mild to moderate distress symptoms, 16% (n = 179) severe distress, and about 58% (n = 636) showed no distress symptoms. Women experienced more distress than men ([Formula: see text]), and distress decreased with age ([Formula: see text]). We conclude that the CPDI seems a promising screening tool for the rapid detection of potential peritraumatic stress caused by the COVID-19 pandemic.

COVID-19 Peritraumatic Distress as a Function of Age and Gender in a Spanish Sample

Novel variants continue to emerge in the SARS-CoV-2 pandemic. University testing programs may provide timely epidemiologic and genomic surveillance data to inform public health responses. We conducted testing from September 2021 to February 2022 in a university population under vaccination and indoor mask mandates. A total of 3,048 of 24,393 individuals tested positive for SARS-CoV-2 by RT-PCR; whole genome sequencing identified 209 Delta and 1,730 Omicron genomes of the 1,939 total sequenced. Compared to Delta, Omicron had a shorter median serial interval between genetically identical, symptomatic infections within households (2 versus 6 days, P=0.021). Omicron also demonstrated a greater peak reproductive number (2.4 versus 1.8) and a 1.07 (95% confidence interval: 0.58, 1.57; P<0.0001) higher mean cycle threshold value. Despite near universal vaccination and stringent mitigation measures, Omicron rapidly displaced the Delta variant to become the predominant viral strain and led to a surge in cases in a university population.

Mapping the emergence of SARS-CoV-2 Omicron variants on a university campus

The pandemic diffusion of the SARS-CoV-2 infection throughout the world required measures to prevent and strategies to control the infection, as well as the reallocation of the hospital structures in order to take care of an increased number of infected patients. Endoscopy Units should be able to perform endoscopic procedures on COVID-19 infected as well as on noninfected patients. The aim of this manuscript is to propose a model for a fast reorganization of the endoscopy department environment in order to safely perform endoscopic procedures in this Pandemic COVID-19 scenario, according to the current advices given by the Scientific Societies.

Redesign of a GI endoscopy unit during the COVID-19 emergency: A practical model

This article is a femin horizontal ellipsis manifesto for supporting and encouraging academic ecologies of care and cure: it is a collaborative assemblage created by six academics-laborers, white, native American, European, Caucasian, cisgender, neurodivergent, bisexual, gay, and horizontal ellipsis and horizontal ellipsis and horizontal ellipsis -who wrote these reflections during the pandemic events that affected their lives. The cultural artifact, the femin horizontal ellipsis manifesto, is organized around nine theses, each of which tries to highlight the multiplicity of cares and genders, the challenges, the productive vitality, and the enforced slowness experienced both during lockdown and after it. The paper uses different forms/styles-academic writing, pictures, poems, first-person narratives-which nurture the flow of the presentation of the nine theses. Each thesis ends with a call for action. The femin horizontal ellipsis manifesto is a performative text which, while opposing the constraints of the COVID-19 emergency, also sees the potential the event offers for caring and curing - both life and our academic lives. Femin horizontal ellipsis manifesto renders explicit the undecidability of cares and cures and is a call to unite with the aim of resisting the inequalities and vulnerabilities which COVID-19 has exacerbated.

A femin horizontal ellipsis manifesto: Academic ecologies of care and cure during a global health pandemic

The global COVID-19 pandemic and efforts to stem its transmission highlights the essential role of behavioral medicine in contemporary healthcare. As a result, the Annals of Behavioral Medicine instituted a COVID-19 rapid review process in mid-April to bring new knowledge to publication. This editorial describes the first two papers accepted through this mechanism and issues a broader call to recognize the human element in transmission and mitigation, and for behavioral medicine to play a central role in all phases of research, care, and public messaging.

Behavioral Medicine in the COVID-19 Era: Dawn of the Golden Age

Ready-to-use therapeutic food (RUTF) containing less dairy may be a lower-cost treatment option for severe acute malnutrition (SAM). The objective was to understand the effectiveness of RUTF containing alternative sources of protein (nondairy), or <50% of protein from dairy products, compared with standard RUTF in children with SAM. The Cochrane Library, MEDLINE, Embase, CINAHL, and Web of Science were searched using terms relating to RUTF. Studies were eligible if they included children with SAM and evaluated RUTF with <50% of protein from dairy products compared with standard RUTF. Meta-analysis and meta-regression were completed to assess the effectiveness of intervention RUTF on a range of child outcomes. The quality of the evidence across outcomes was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A total of 5868 studies were identified, of which 8 articles of 6 studies met the inclusion criteria evaluating 7 different intervention RUTF recipes. Nondairy or lower-dairy RUTF showed less weight gain (standardized mean difference: -0.20; 95% CI: -0.26, -0.15; P < 0.001), lower recovery (relative risk ratio: 0.93; 95% CI: 0.87, 1.00; P = 0.046), and lower weight-for-age z scores (WAZ) near program discharge (mean difference: -0.10; 95% CI: -0.20, 0.0; P = 0.047). Mortality, time to recovery, default (consecutive absences from outpatient therapeutic feeding program visits), nonresponse, and other anthropometric measures did not differ between groups. The certainty of evidence was high for weight gain and ranged from very low to moderate for other outcomes. RUTF with lower protein from dairy or dairy-free RUTF may not be as effective as standard RUTF for treatment of children with SAM based on weight gain, recovery, and WAZ evaluated using meta-analysis, although further research is required to explore the potential of alternative formulations. This review was registered at https://www.crd.york.ac.uk/prospero/ as CRD42020160762.

Ready-to-Use Therapeutic Food (RUTF) Containing Low or No Dairy Compared to Standard RUTF for Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis.

In the most recent 25–30 years, multiple novel mechanisms and applications of cell-penetrating peptides (CPP) have been demonstrated, leading to novel drug delivery systems. In this review, I present a brief introduction to the CPP area with selected recent achievements. This is followed by a nostalgic journey into the research in my own laboratories, which lead to multiple CPPs, starting from transportan and paving a way to CPP-based therapeutic developments in the delivery of bio-functional materials, such as peptides, proteins, vaccines, oligonucleotides and small molecules, etc.

Cell-Penetrating Peptides and Transportan

Background: Concerns have been raised that the response to the UK COVID-19 pandemic may have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We asked what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic? Methods: Using electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (2017-2020), we calculated weekly primary care contacts for selected acute physical and mental health conditions (including: anxiety, depression, acute alcohol-related events, asthma and chronic obstructive pulmonary disease [COPD] exacerbations, cardiovascular and diabetic emergencies). We used interrupted time series (ITS) analysis to formally quantify changes in conditions after the introduction of population-wide restrictions ('lockdown') compared to the period prior to their introduction in March 2020. Findings: The overall population included 9,863,903 individuals on 1st January 2017. Primary care contacts for all conditions dropped dramatically after introduction of population-wide restrictions. By July 2020, except for unstable angina and acute alcohol-related events, contacts for all conditions had not recovered to pre-lockdown levels. The largest reductions were for contacts for: diabetic emergencies (OR: 0.35, 95% CI: 0.25-0.50), depression (OR: 0.53, 95% CI: 0.52-0.53), and self-harm (OR: 0.56, 95% CI: 0.54-0.58). Interpretation: There were substantial reductions in primary care contacts for acute physical and mental conditions with restrictions, with limited recovery by July 2020. It is likely that much of the deficit in care represents unmet need, with implications for subsequent morbidity and premature mortality. The conditions we studied are sufficiently severe that any unmet need will have substantial ramifications for the people experiencing the conditions and healthcare provision. Maintaining access must be a key priority in future public health planning (including further restrictions). Funding: Wellcome Trust Senior Fellowship (SML), Health Data Research UK.

COVID-19 collateral: Indirect acute effects of the pandemic on physical and mental health in the UK

The emerging pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused social and economic disruption worldwide, infecting over 9.0 million people and killing over 469 000 by 24 June 2020. Unfortunately, no vaccine or antiviral drug that completely eliminates the transmissible disease coronavirus disease 2019 (COVID-19) has been developed to date. Given that coronavirus nonstructural protein 1 (nsp1) is a good target for attenuated vaccines, it is of great significance to explore the detailed characteristics of SARS-CoV-2 nsp1. Here, we first confirmed that SARS-CoV-2 nsp1 had a conserved function similar to that of SARS-CoV nsp1 in inhibiting host-protein synthesis and showed greater inhibition efficiency, as revealed by ribopuromycylation and Renilla luciferase (Rluc) reporter assays. Specifically, bioinformatics and biochemical experiments showed that by interacting with 40S ribosomal subunit, the lysine located at amino acid 164 (K164) was the key residue that enabled SARS-CoV-2 nsp1 to suppress host gene expression. Furthermore, as an inhibitor of host-protein expression, SARS-CoV-2 nsp1 contributed to cell-cycle arrest in G0/G1 phase, which might provide a favourable environment for virus production. Taken together, this research uncovered the detailed mechanism by which SARS-CoV-2 nsp1 K164 inhibited host gene expression, laying the foundation for the development of attenuated vaccines based on nsp1 modification.

Lysine 164 is critical for SARS-CoV-2 Nsp1 inhibition of host gene expression

BACKGROUND: Laboratory testing is a fundamental component of influenza surveillance for detecting novel strains with pandemic potential and informing biannual vaccine strain selection. The United States (U.S.) Centers for Disease Control and Prevention (CDC), under the auspices of its WHO Collaborating Center for Influenza, is one of the major public health agencies which provides support globally to build national capacity for influenza surveillance. Our main objective was to determine if laboratory assessments supported capacity building efforts for improved global influenza surveillance. METHODS: In 2010, 35 national influenza laboratories were assessed in 34 countries, using a standardized tool. Post-assessment, each laboratory received a report with a list of recommendations for improvement. Uptake of recommendations were reviewed 3.2 mean years after the initial assessments and categorized as complete, in-progress, no action or no update. This was a retrospective study; follow-up took place through routine project management rather than at a set time-point post-assessment. WHO data on National Influenza Centre (NIC) designation, External Quality Assessment Project (EQAP) participation and FluNet reporting was used to measure laboratory capacity longitudinally and independently of the assessments. All data was further stratified by World Bank country income category. RESULTS: At follow-up, 81 % of 614 recommendations were either complete (350) or in-progress (145) for 32 laboratories (91 % response rate). The number of countries reporting to FluNet and the number of specimens they reported annually increased between 2005, when they were first funded by CDC, and 2010, the assessment year (p < 0.01). Improvements were also seen in EQAP participation and NIC designation over time and more so for low and lower-middle income countries. CONCLUSIONS: Assessments using a standardized tool have been beneficial to improving laboratory-based influenza surveillance. Specific recommendations helped countries identify and prioritize areas for improvement. Data from assessments helped CDC focus its technical assistance by country and region. Low and lower-middle income countries made greater improvements in their laboratories compared with upper-middle income countries. Future research could include an analysis of annual funding and technical assistance by country. Our approach serves as an example for capacity building for other diseases.

Capacity building in national influenza laboratories – use of laboratory assessments to drive progress