Datasets:

mystic-leung

/

medical_cord19

like 4

ACE2 is a type I membrane protein with extracellular carboxypeptidase activity displaying a broad tissue distribution with highest expression levels at the brush border membrane (BBM) of small intestine enterocytes and a lower expression in stomach and colon. In small intestinal mucosa, ACE2 mRNA expression appears to increase with age and to display higher levels in patients taking ACE-inhibitors (ACE-I). There, ACE2 protein heterodimerizes with the neutral amino acid transporter Broad neutral Amino acid Transporter 1 (B0AT1) (SLC6A19) or the imino acid transporter Sodium-dependent Imino Transporter 1 (SIT1) (SLC6A20), associations that are required for the surface expression of these transport proteins. These heterodimers can form quaternary structures able to function as binding sites for SARS-CoV-2 spike glycoproteins. The heterodimerization of the carboxypeptidase ACE2 with B0AT1 is suggested to favor the direct supply of substrate amino acids to the transporter, but whether this association impacts the ability of ACE2 to mediate viral infection is not known. B0AT1 mutations cause Hartnup disorder, a condition characterized by neutral aminoaciduria and, in some cases, pellagra-like symptoms, such as photosensitive rash, diarrhea, and cerebellar ataxia. Correspondingly, the lack of ACE2 and the concurrent absence of B0AT1 expression in small intestine causes a decrease in l-tryptophan absorption, niacin deficiency, decreased intestinal antimicrobial peptide production, and increased susceptibility to inflammatory bowel disease (IBD) in mice. Thus, the abundant expression of ACE2 in small intestine and its association with amino acid transporters appears to play a crucial role for the digestion of peptides and the absorption of amino acids and, thereby, for the maintenance of structural and functional gut integrity.

ACE2 and gut amino acid transport

To examine the feasibility and acceptability of a remote-based nutrition education program during COVID-19 for adolescents with autism spectrum disorder (ASD). Ten adolescents with ASD participated in a 4-week nutrition education program utilizing Zoom software during COVID-19. Topics included shopping for healthy food, and food preparation safety measures. Attendance was collected for each session. Participants, parents, and the classroom teacher completed post-program surveys and interviews. The course attendance rate was 97%. Every adolescent reported they would participate in similar future programs, and the teacher/parents felt the program was a positive experience for the participants. The remote-based nutrition education program appeared to be feasible and acceptable to participants. Future research should focus on program efficacy.

Brief Report: Feasibility and Acceptability of a Remote-Based Nutrition Education Program for Adolescents with Autism Spectrum Disorder: A COVID-19 Pilot Study

The coronavirus disease 2019 (COVID-19) has outbreak since early December 2019, and COVID-19 has caused over 100 million cases and 2 million deaths around the world. After one year of the COVID-19 outbreak, there is no certain and approve medicine against it. Drug repositioning has become one line of scientific research that is being pursued to develop an effective drug. However, due to the lack of COVID-19 data, there is still no specific drug repositioning targeting the COVID-19. In this paper, we propose a framework for COVID-19 drug repositioning. This framework has several advantages that can be exploited: one is that a local graph aggregating representation is used across a heterogeneous network to address the data sparsity problem; another is the multi-hop neighbors of the heterogeneous graph are aggregated to recall as many COVID-19 potential drugs as possible. Our experimental results show that our COVDR framework performs significantly better thanbaseline methods, and the docking simulation verifies that our three potential drugs have the ability to against COVID-19 disease.

A Network Representation Approach for COVID-19 Drug Recommendation

Severe acute respiratory syndrome (SARS) coronavirus (CoV)-2 (SARS-CoV-2) is a novel coronavirus identified as the cause of coronavirus disease-2019 (COVID-19) that began in Wuhan, China in late 2019 and spread now in 210 countries and territories around the world. Many people are asymptomatic or with mild symptoms. However, in some cases (usually the elderly and those with comorbidities) the disease may progress to pneumonia, acute respiratory distress syndrome and multi-organ dysfunction that can lead to death. Such wide interindividual differences in response to SARS-CoV-2 infection may relate to several pathogen- and host-related factors. These include the different levels of the ubiquitously present human angiotensin I converting enzyme 2 (ACE2) receptors gene expression and its variant alleles, the different binding affinities of ACE2 to the virus spike (S) protein given its L- and S-subtypes and the subsequent extent of innate immunity-related hypercytokinemia. The extensive synthesis of cytokines and chemokines in coronavirus diseases was suggested as a major factor in exacerbating lung damage and other fatal complications. The polymorphisms in genes coding for pro-inflammatory cytokines and chemokines have been associated with mediating the response and susceptibility to a wide range of infections and their severe outcomes. Understanding the nature of pathogen-host interaction in COVID-19 symptomatology together with the role of hypercytokinemia in disease severity may permit developing new avenues of approach for prevention and treatment and can delineate public health measures to control the spread of the disease.

Hypercytokinemia and Pathogen-Host Interaction in COVID-19

Homocystinuria, a disorder originating in defects in the methionine metabolism, is characterized by an elevated plasma concentration of homocysteine. Most patients have a defect in the cystathionine-beta-synthase, the key enzyme in the conversion of homocysteine to cysteine. Many abnormalities in the connective tissue of patients with homocystinuria resemble those seen in Marfan syndrome, caused by mutations in fibrillin-1. These observations led to the hypothesis that the structure and function of fibrillin-1 is compromised in patients with homocystinuria. To test this hypothesis we produced recombinant human fibrillin-1 fragments spanning the central portion of the molecule (8-Cys/transforming growth factor-beta binding domain 3 to calcium binding EGF domain 22) and extensively analyzed the potential of homocysteine to modify structural and functional properties of these proteins. Circular dichroism spectroscopy revealed moderate changes of their secondary structures after incubation with homocysteine. Equilibrium dialysis demonstrated a number of high affinity calcium binding sites in the tandemly repeated calcium binding epidermal growth factor-like domains 11-22. Calcium binding of homocysteine-modified fragments was completely abolished. Incubation of the recombinant proteins with homocysteine rendered the analyzed calcium binding EGF domains as well as the 8-Cys/transforming growth factor-beta binding domain 3 significantly more susceptible to proteolytic degradation. Furthermore, data were obtained demonstrating that homocysteine can covalently modify fibrillin-1 via disulfide bonds. These data strongly suggest that structural and functional modifications as well as degradation processes of fibrillin-1 in the connective tissues of patients with homocystinuria play a major role in the pathogenesis of this disorder.

Modification of the structure and function of fibrillin-1 by homocysteine suggests a potential pathogenetic mechanism in homocystinuria.

Background: Emerging reports suggest that continuation of clinical trials is feasible and safe even in hospitals admitting COVID-19 patients-given the appropriate safety procedures However, to our knowledge no studies have yet addressed how to again engage patients in cancer research C-CRES was developed to identify factors that may be affecting participation in cancer research during the COVID-19 pandemic We aimed to examine patientspecific concerns around research participation This information will help inform future strategies for mitigating the impact of COVID-19 on cancer research Methods: Between 5-13 June 2020, we advertised an anonymous survey using our research group's Twitter account and tagged a variety of cancer patient organisations/charities Patients aged 18 with a current cancer diagnosis were eligible to participate and asked about their diagnosis/treatment, experience in cancer research, and beliefs about future cancer research participation given the COVID-19 pandemic We specifically asked about potential concerns relating to research engagement Results: A total of 75 patients filled out our questionnaire, of whom 89% were UK-based 65% of respondents were male and the majority was of a white background (89%) The median age category was 60-69 years 47% of patients had prostate cancer, 15% breast, 12% bladder, and 9% kidney cancer-a reflection of the cancer types our research team focuses on Interestingly, 49% of participants had never participated previously in research We therefore set out to make comparisons of patient concerns with regards to research participation during the COVID-19 outbreak between those with and without research experience Those who had never taken part in research before were more likely to have concerns about currently being on cancer treatment (p=0 02) and about the type of cancer they had been diagnosed with (p≤0 05), with regards to taking part in cancer research during the current COVID-19 outbreak Conclusions:Those with no prior experience of taking part in cancer research may be more likely to have concerns related to their cancer type and current treatment, in terms of participation during COVID-19 Efforts should be made to reassure potential cancer research participants about safety of participating during the COVID-19 pandemic

C-CRES: COVID-19 and cancer research engagement study

RATIONALE AND OBJECTIVE: While COVID-19 infection has been associated with acute kidney injury (AKI), it is unclear whether this association is independent of traditional risk factors such as hypotension, nephrotoxin exposure, and inflammation. We tested the independent association of COVID-19 with AKI. STUDY DESIGN: Multicenter, observational, cohort study. SETTING AND PARTICIPANTS: Patients admitted to one of six hospitals within the Yale-New Haven Health System between 3/10/2020 and 8/31/2020 and tested for SARS-CoV-2 via nasopharyngeal PCR test. EXPOSURE: Positive test for SARS-CoV-2. OUTCOME: AKI by Kidney Disease: Improving Global Outcomes criteria. ANALYTIC APPROACH: Evaluated the association of COVID-19 with AKI after controlling for time-invariant factors at admission (e.g., demographics, comorbidities) and time-varying factors updated continuously during hospitalization (e.g., vital signs, medications, laboratory results, respiratory failure) using time-updated Cox proportional hazard models. RESULTS: Of the 22,122 patients hospitalized between, 2,600 tested positive and 19,522 tested negative for SARS-CoV-2. Compared to patients who tested negative, patients with COVID-19 had more AKI [30.6% vs. 18.2%, absolute risk difference 12.5 (95% CI, 10.6, 14.3)%] and dialysis-requiring AKI (8.5% vs. 3.6%) and lower recovery from AKI (58% vs. 69.8%]. Compared to patients who tested negative, patients with COVID-19 had higher inflammatory markers (C-reactive protein, ferritin), and greater use of vasopressors and diuretics. Compared to patients who tested negative, patients with COVID-19 had higher rate of AKI in univariable analysis (HR, 1.84 [1.73, 1.95]). In fully adjusted model controlling for demographics, comorbidities, vital signs, medications, and laboratory results, COVID-19 remained associated with a high rate of AKI (adjusted HR, 1.40 [1.29-1.53]). LIMITATIONS: Possibility of residual confounding. CONCLUSIONS: COVID-19 is associated with high rates of AKI not fully explained by adjustment for known risk factors. This suggests the presence of mechanisms of AKI not accounted for in this analysis, which may include a direct effect of COVID-19 on the kidney or other unmeasured mediators. Future studies should evaluate the possible unique pathways by which COVID-19 may cause AKI.

The Association of COVID-19 With Acute Kidney Injury Independent of Severity of Illness: A Multicenter Cohort Study

INTRODUCTION: In breast cancer, local tumour control is thought to be optimised by administering higher local levels of cytotoxic chemotherapy, in particular doxorubicin. However, systemic administration of higher dosages of doxorubicin is hampered by its toxic side effects. In this study, we aim to increase doxorubicin deposition in the primary breast tumour without changing systemic doxorubicin concentration and thus without interfering with systemic efficacy and toxicity. This is to be achieved by combining Lyso-Thermosensitive Liposomal Doxorubicin (LTLD, ThermoDox, Celsion Corporation, Lawrenceville, NJ, USA) with mild local hyperthermia, induced by Magnetic Resonance guided High Intensity Focused Ultrasound (MR-HIFU). When heated above 39.5°C, LTLD releases a high concentration of doxorubicin intravascularly within seconds. In the absence of hyperthermia, LTLD leads to a similar biodistribution and antitumour efficacy compared with conventional doxorubicin. METHODS AND ANALYSIS: This is a single-arm phase I study in 12 chemotherapy-naïve patients with de novo stage IV HER2-negative breast cancer. Previous endocrine treatment is allowed. Study treatment consists of up to six cycles of LTLD at 21-day intervals, administered during MR-HIFU-induced hyperthermia to the primary tumour. We will aim for 60 min of hyperthermia at 40°C–42°C using a dedicated MR-HIFU breast system (Profound Medical, Mississauga, Canada). Afterwards, intravenous cyclophosphamide will be administered. Primary endpoints are safety, tolerability and feasibility. The secondary endpoint is efficacy, assessed by radiological response. This approach could lead to optimal loco-regional control with less extensive or even no surgery, in de novo stage IV patients and in stage II/III patients allocated to receive neoadjuvant chemotherapy. ETHICS AND DISSEMINATION: This study has obtained ethical approval by the Medical Research Ethics Committee Utrecht (Protocol NL67422.041.18, METC number 18-702). Informed consent will be obtained from all patients before study participation. Results will be published in an academic peer-reviewed journal. TRIAL REGISTRATION NUMBERS: NCT03749850, EudraCT 2015-005582-23.

Phase I feasibility study of Magnetic Resonance guided High Intensity Focused Ultrasound-induced hyperthermia, Lyso-Thermosensitive Liposomal Doxorubicin and cyclophosphamide in de novo stage IV breast cancer patients: study protocol of the i-GO study

In this paper, terahertz (THz) pulsed spectroscopy and solid immersion microscopy were applied to study interactions between water vapor and tissue scaffolds-the decellularized bovine pericardium (DBP) collagen matrices, in intact form, cross-linked with the glutaraldehyde or treated by plasma. The water-absorbing properties of biomaterials are prognostic for future cell-mediated reactions of the recipient tissue with the scaffold. Complex dielectric permittivity of DBPs was measured in the 0.4-2.0 THz frequency range, while the samples were first dehydrated and then exposed to water vapor atmosphere with 80.0 ± 5.0% relative humidity. These THz dielectric measurements of DBPs and the results of their weighting allowed to estimate the adsorption time constants, an increase of tissue mass, as well as dispersion of these parameters. During the adsorption process, changes in the DBPs' dielectric permittivity feature an exponential character, with the typical time constant of =8-10 min, the transient process saturation at =30 min, and the tissue mass improvement by =1-3%. No statistically-relevant differences between the measured properties of the intact and treated DBPs were observed. Then, contact angles of wettability were measured for the considered DBPs using a recumbent drop method, while the observed results showed that treatments of DBP somewhat affects their surface energies, polarity, and hydrophilicity. Thus, our studies revealed that glutaraldehyde and plasma treatment overall impact the DBP-water interactions, but the resultant effects appear to be quite complex and comparable to the natural variability of the tissue properties. Such a variability was attributed to the natural heterogeneity of tissues, which was confirmed by the THz microscopy data. Our findings are important for further optimization of the scaffolds' preparation and treatment technologies. They pave the way for THz technology use as a non-invasive diagnosis tool in tissue engineering and regenerative medicine.

Moisture adsorption by decellularized bovine pericardium collagen matrices studied by terahertz pulsed spectroscopy and solid immersion microscopy.

The D614G mutation of the Spike protein is thought to be relevant for SARS-CoV-2 infection. Here we report biological and epidemiological aspects of this mutation. Using pseudotyped lentivectors, we were able to confirm that the G614 variant of the Spike protein is markedly more infectious than the ancestral D614 variant. We demonstrate by molecular modelling that the replacement of aspartate by glycine in position 614 facilitates the transition towards an open state of the Spike protein. To understand whether the increased infectivity of the D614 variant explains its epidemiological success, we analysed the evolution of 27,086 high-quality SARS-CoV-2 genome sequences from GISAID. We observed striking coevolution of D614G with the P323L mutation in the viral polymerase. Importantly, exclusive presence of G614 or L323 did not become epidemiologically relevant. In contrast, the combination of the two mutations gave rise to a viral G/L variant that has all but replaced the initial D/P variant. There was no significant correlation between reported COVID mortality in different countries and the prevalence of the Wuhan versus G/L variant. However, when comparing the speed of emergence and the ultimate predominance in individual countries, the G/L variant displays major epidemiological supremacy. Our results suggest that the P323L mutation, located in the interface domain of the RNA-dependent RNA polymerase (RdRp), is a necessary alteration that led to the epidemiological success of the present variant of SARS-CoV-2.

Epidemiologically most successful SARS-CoV-2 variant: concurrent mutations in RNA-dependent RNA polymerase and spike protein

SIMPLE SUMMARY: Since neuroendocrine tumor patients require a highly specialized and interdisciplinary infrastructure for diagnostic and therapy, medical care has been very challenging during the COVID-19 pandemic. In cooperation with the patient organization NETZWERK NeT we were able to distribute a comprehensive survey, which has profoundly investigated the healthcare structure and patient-specific concerns during the crisis. In addition to regular medical care, there is a considerable need to measure patient-reported outcomes such as social and emotional distress in a structured way to optimize individual therapy for NET patients. ABSTRACT: The assessment of cancer patient care during the COVID-19 pandemic has been mainly reported from a physician’s perspective. Patients with rare tumor entities such as neuroendocrine tumors (NET), which require a complex and specialized care infrastructure, were highly affected by the COVID-19 crisis. Using a structured questionnaire consisting of a general section on the disease and a special COVID-19 section to record medical care, vaccination behavior as well as social and psycho-emotional parameters were collected from NET patients. The survey was distributed via direct medical contact and via the patient organization NETZWERK NeT. A total of 684 patients participated in the survey and 79.2% (n = 542) of the participants answered the questionnaire completely (54 questions). Patient characteristics were comparable to those in large NET registries. The majority of participants were patients with pancreatic and small bowel NET on somatostatin analogue (SSA) therapy. Medical care under COVID-19 was adequate and appointment cancellations and postponements were not common. Nevertheless, the majority of patients were worried about adequate treatment for their tumor disease during the crisis. Most of the participants considered themselves to be at risk of severe COVID-19 infection and were therefore very concerned. This was accompanied by an extremely high vaccination readiness rate of 90%. Increased distress in the social and psycho-emotional domains in the course of the crisis reflected a need for optimization in the medical care of NET patients, although the rate of COVID-19 positive participants was low (3.7%). Therefore, patient-reported measurements are required to identify and address all areas of medical care. Overall, our survey provides an essential contribution to the care of NET patients during the COVID-19 pandemic from the patient’s perspective.

The Patient’s Point of View: COVID-19 and Neuroendocrine Tumor Disease

As telecommunications technology progresses, telehealth frameworks are becoming more widely adopted in the context of long-term care (LTC) for older adults, both in care facilities and in homes. Today, robots could assist healthcare workers when they provide care to elderly patients, who constitute a particularly vulnerable population during the COVID-19 pandemic. Previous work on user-centered design of assistive technologies in LTC facilities for seniors has identified positive impacts. The need to deal with the effects of the COVID-19 pandemic emphasizes the benefits of this approach, but also highlights some new challenges for which robots could be interesting solutions to be deployed in LTC facilities. This requires customization of telecommunication and audio/video/data processing to address specific clinical requirements and needs. This paper presents OpenTera, an open source telehealth framework, aiming to facilitate prototyping of such solutions by software and robotic designers. Designed as a microservice-oriented platform, OpenTera is an end-to-end solution that employs a series of independent modules for tasks such as data and session management, telehealth, daily assistive tasks/actions, together with smart devices and environments, all connected through the framework. After explaining the framework, we illustrate how OpenTera can be used to implement robotic solutions for different applications identified in LTC facilities and homes, and we describe how we plan to validate them through field trials.

OpenTera: A microservice architecture solution for rapid prototyping of robotic solutions to COVID-19 challenges in care facilities

OBJECTIVE: During the COVID-19 era, a reliable method for tracing aerosols and droplets generated during otolaryngology procedures is needed to accurately assess contamination risk and to develop mitigation measures. Prior studies have not investigated the reliability of different fluorescent tracers for the purpose of studying aerosols and small droplets. Objectives include (1) comparing vitamin B2, fluorescein, and a commercial fluorescent green dye in terms of particle dispersion pattern, suspension into aerosols and small droplets, and fluorescence in aerosolized form and (2) determining the utility of vitamin B2 as a fluorescent tracer coating the aerodigestive tract mucosa in otolaryngology contamination models. METHODS: Vitamin B2, fluorescein, and a commercial fluorescent dye were aerosolized using a nebulizer and passed through the nasal cavity from the trachea in a retrograde-intubated cadaveric head. In another scenario, vitamin B2 was irrigated to coat the nasal cavity and nasopharyngeal mucosa of a cadaveric head for assessment of aerosol and droplet generation from endonasal drilling. A cascade impactor was used to collect aerosols and small droplets ≤14.1 µm based on average aerodynamic diameter, and the collection chambers were visualized under UV light. RESULTS: When vitamin B2 was nebulized, aerosols ≤5.4 µm were generated and the collected particles were fluorescent. When fluorescein and the commercial water tracer dye were nebulized, aerosols ≤8.61 µm and ≤2.08 µm respectively were generated, but the collected aerosols did not appear visibly fluorescent. Endonasal drilling in the nasopharynx coated with vitamin B2 irrigation yielded aerosols ≤3.30 µm that were fluorescent under UV light. CONCLUSION: Vitamin B2’s reliability as a fluorescent tracer when suspended in aerosols and small droplets ≤14.1 µm and known mucosal safety profile make it an ideal compound compared to fluorescein and commercial water-based fluorescent dyes for use as a safe fluorescent tracer in healthcare contamination models especially with human subjects.

Novel Use of Vitamin B2 as a Fluorescent Tracer in Aerosol and Droplet Contamination Models in Otolaryngology

Serological investigations were performed between 1977-1978 with 972 serum samples from 243 subjects having either direct (group A) or sporadic (group B) occupational contact with wastewater or sludge. the control group (C) was represented by 100 persons having no contact with such material. The sera were tested against influenza, parainfluenza, adeno-, herpes, coronavirus, rickettsial and chlamydial antigens, as well as for the presence of HBsAg and anti-HBs. Statistically significant differences between group A and groups B and C were found as regards the prevalence of antibodies to adenovirus and parainfluenza virus type 1 antigens.

Prevalence of antiviral antibodies in workers handling wastewater and sludge.

AIM To assess the time to obtain reliable oxygen saturation readings by different pulse oximeters during neonatal resuscitation in the delivery room or NICU. METHODS Prospective study comparing three different pulse oximeters: Masimo Radical-7 compared simultaneously with Ohmeda Biox 3700 or with Nellcor N395, in newborn infants who required resuscitation. Members of the research team placed the sensors for each of the pulse oximeters being compared simultaneously, one sensor on each foot of the same baby. Care provided routinely, without interference by the research team. The time elapsed until a reliable SpO2 was obtained was recorded using a digital chronometer. Statistical comparisons included chi-square and student's T-test. RESULTS Thirty-two infants were enrolled; median gestational age 32 weeks. Seventeen paired measurements were made with the Radical-7 and Biox 3700; mean time to a stable reading was 20.2±7 sec for the Radical-7 and 74.2±12 sec for the Biox 3700 (p=0.02). The Radical-7 and the N- 395 were paired on 15 infants; the times to obtain a stable reading were 20.9±4 sec and 67.3±12 sec, respectively (p=0.03). CONCLUSION The time to a reliable reading obtained simultaneously in neonatal critical situations differs by the type of the pulse oximeter used, being significantly faster with Masimo Signal Extraction Technology. This may permit for better adjustments of inspired oxygen, aiding in the prevention of damage caused by unnecessary exposure to high or low oxygen.

Avoiding hyperoxemia during neonatal resuscitation: time to response of different SpO2 monitors.

Although antibody response to SARS-CoV-2 can be detected early during the infection, several outstanding questions remain to be addressed regarding the magnitude and persistence of antibody titer against different viral proteins and their correlation with the strength of the immune response An ELISA assay has been developed by expressing and purifying the recombinant SARS-CoV-2 Spike Receptor Binding Domain (RBD), Soluble Ectodomain (Spike), and full length Nucleocapsid protein (N) Sera from healthcare workers affected by non-severe COVID-19 were longitudinally collected over four weeks, and compared to sera from patients hospitalized in Intensive Care Units (ICU) and SARS-CoV-2-negative subjects for the presence of IgM, IgG and IgA antibodies as well as soluble pro-inflammatory mediators in the sera Non-hospitalized subjects showed lower antibody titers and blood pro-inflammatory cytokine profiles as compared to patients in Intensive Care Units (ICU), irrespective of the antibodies tested Noteworthy, in non-severe COVID-19 infections, antibody titers against RBD and Spike, but not against the N protein, as well as pro-inflammatory cytokines decreased within a month after viral clearance Thus, rapid decline in antibody titers and in pro-inflammatory cytokines may be a common feature of non-severe SARS-CoV-2 infection, suggesting that antibody-mediated protection against re-infection with SARS-CoV-2 is of short duration These results suggest caution in using serological testing to estimate the prevalence of SARS-CoV-2 infection in the general population

Persistence of Anti-SARS-CoV-2 Antibodies in Non-Hospitalized COVID-19 Convalescent Health Care Workers

Being satisfied in marriage provides protective stress buffering benefits to various health complications but the causal mechanisms and speed at which this is accomplished is less well understood. Much of the research on health and marriage has conceptualized marital quality in a unidimensional way, with high levels of either positivity or negativity. This conceptualization may not fully capture the nuanced benefits of marital relationships. Pupillometry is an innovative method which captures the effects of marital stress buffering on the body’s autonomic nervous system in real time; pupil dilation occurs within 200ms to stress exposure. Additionally, this method records hundreds of readings per second, providing precision and sensitivity. This preregistered experiment aimed to conceptually replicate previous pupillometry stress buffering results and extend the previous findings by including a generalizable, real-life stressor—viewing a horror movie—and multidimensional relationship quality effects. Eighty-three couples (166 participants) were quasi-grouped, based on a self-reported multidimensional relationship quality scale, to either supportive or ambivalent marital relationship conditions. They were then randomly assigned to either a spousal support (i.e., handholding) or non-support (spousal absence) condition and watched clips from both horror and nature movies while pupil dilation was measured. Tonic pupillary response results revealed that the horror video clips elicited a stress response and there were significant differences between the support and non-support conditions, as well as marital relationship quality conditions. These results frame the precision, speed, and sensitivity of pupillometry as a potentially fruitful method to investigate the causal mechanisms linking stress buffering and supportive marital relationships.

Spousal emotional support and relationship quality buffers pupillary response to horror movies

BACKGROUND There is pressing need to improve hospital-based addiction care. Various models for integrating substance use disorder care into hospital settings exist, but there is no framework for describing, selecting, or comparing models. We sought to fill that gap by constructing a taxonomy of hospital-based addiction care models based on scoping literature review and key informant interviews. METHODS Methods included a scoping review of the literature on US hospital-based addiction care models and interventions for adults, published between January 2000 and July 2021. We conducted semi-structured interviews with 15 key informants experienced in leading, implementing, evaluating, andpracticing hospital-based addiction care to explore model characteristics, including their perceived strengths, limitations, and implementation considerations. We synthesized findings from the literature review and interviews to construct a taxonomy of model types. RESULTS Searches identified 2,849 unique abstracts. Of these, we reviewed 280 full text articles, of which 76 were included in the final review. We added 8 references from reference lists and informant interviews, and 4 gray literature sources. We identified six distinct hospital-based addiction care models. Those classified as addiction consult models include (1) interprofessional addiction consult services, (2) psychiatry consult liaison services, and (3) individual consultant models. Those classified as practice-based models, wherein general hospital staff integrate addiction care into usual practice, include (4) hospital-based opioid treatment and (5) hospital-based alcohol treatment. The final type was (6) community-based in-reach, wherein community providers deliver care. Models vary in their target patient population, staffing, and core clinical and systems change activities. Limitations include that some models have overlapping characteristics and variable ways of delivering core components. DISCUSSION A taxonomy provides hospital clinicians and administrators, researchers, and policy-makers with a framework to describe, compare, and select models for implementing hospital-based addiction care and measure outcomes.

A Taxonomy of Hospital-Based Addiction Care Models: a Scoping Review and Key Informant Interviews.

INTRODUCTION: Health care systems have faced unprecedented challenges due to the COVID-19 pandemic. Access to timely population-based data has been vital to informing public health policy and practice. METHODS: We describe how ICES, an independent not-for-profit research and analytic institute in Ontario, Canada, pivoted existing research infrastructure and engaged health system stakeholders to provide near real-time population-based data and analytics to support Ontario’s COVID-19 pandemic response. RESULTS: Since April 2020, ICES provided the Ontario COVID-19 Provincial Command Table and public health partners with regular and ad hoc reports on SARS-CoV-2 testing and COVID-19 vaccine coverage. These reports: 1) helped identify congregate care/shared living settings that needed testing and prevention efforts early in the pandemic; 2) provided early indications of inequities in testing and infection in marginalized neighbourhoods, including areas with higher proportions of immigrants and visible minorities; 3) identified areas with high test positivity, which helped Public Health Units target and evaluate prevention efforts; and 4) contributed to altering the province’s COVID-19 vaccine roll-out strategy to target high-risk neighbourhoods and helping Public Health Units and community organizations plan local vaccination programs. In addition, ICES is a key component of the Ontario Health Data Platform, which provides scientists with data access to conduct COVID-19 research and analyses. DISCUSSION AND CONCLUSION: ICES was well-positioned to provide rapid analyses for decision-makers to respond to the evolving public health emergency, and continues to contribute to Ontario’s pandemic response by providing timely, relevant reports to health system stakeholders and facilitating data access for externally-funded COVID-19 research.

Pivoting data and analytic capacity to support Ontario’s COVID-19 response

The negative impact of infectious diseases like COVID-19 on public health and the global economy is evident. This pandemic represents a significant challenge for the scientific community to develop new practical analytical methods for accurately diagnosing emerging cases. Due to their selectivity and sensitivity, new methodologies based on antigen/antibody interactions to detect COVID-19 biomarkers are necessary. In this context, the theoretical, computational modeling reduces experimental efforts and saves resources for rational biosensor design. This study proposes using molecular dynamics to predict the interactions between the Receptor Binding Domain (RBD) of the SARS-CoV-2 spike protein simplified model and a set of highly characterized antibodies. The binding free energy of the antigen/antibody complexes was calculated for the simplified models and compared against the complete SARS-CoV-2 ectodomain to validate the methodology. The structural data derived from our molecular dynamics and end-point free energy calculations showed a positive correlation between both approximations, with a 0.82 Pearson correlation coefficient; t = 3.661, df = 3, p-value = 0.03522, with a 95% confident interval. Furthermore, we identified the interfacial residues that could generate covalent bonds with a specific chemical surface without perturbing the binding dynamics to develop highly sensitive and specific diagnostic devices. Communicated by Ramaswamy H. Sarma.

Use of simplified models for theoretical prediction of the interactions between available antibodies and the receptor-binding domain of SARS-CoV-2 spike protein

BACKGROUND: The COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU. METHODS: This is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents’ review, and calculation of online examination’s psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes. RESULTS: Quantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach’s alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students’ responses and review of documents. The examination was found to be feasible and of reasonable cost. CONCLUSION: Online OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students’ physical examination skills.

Evaluation of the Utility of Online Objective Structured Clinical Examination Conducted During the COVID-19 Pandemic

The pandemia of coronavirus disease 2019 (COVID-19) has caused more than 355,000 confirmed deaths worldwide. However, publications on postmortem findings are scarce. We present the pulmonary findings in four cases of fatal COVID-19 with a spectrum of lung pathology reflecting disease course and duration, invasive therapies, and laboratory features. Early disease is characterized by neutrophilic, exudative capillaritis with microthrombosis and high levels of IL-1beta and IL-6. Later stages are associated with diffuse alveolar damage and ongoing intravascular thrombosis in small to medium-sized pulmonary vessels, occasionally with areas of infarction equivalents, accompanied by laboratory features of disseminated intravascular coagulation. In late stages, organizing pneumonia with extensive intra-alveolar proliferation of fibroblasts and marked metaplasia of alveolar epithelium can be observed. Viral RNA is encountered in the lung, with virus particles in endothelial cells and pneumocytes. In many patients, multi-organ failure with severe liver damage sets in finally, possibly as consequence of an early-onset pro-inflammatory cytokine storm and/or thrombotic microangiopathy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00428-020-02881-x) contains supplementary material, which is available to authorized users.

The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation

Promoting hope was identified in our prior work as the top priority research question among patients and caregivers with diverse childhood-onset chronic conditions. Here, we aimed to construct a conceptual model to guide future research studies of interventions to improve hope. We conducted eight monthly virtual focus groups and one virtual workshop with patients, caregivers, and researchers to explore key constructs to inform the model. Discussions were facilitated by Patient Co-Investigators. Participants developed a definition of hope and identified promotors and inhibitors that influence the experience of hope. We utilized qualitative methods to analyze findings and organize the promotors and inhibitors of hope within three strata of the socio-ecologic framework: structural, interpersonal, and intrapersonal. Participants identified three types of interventions to promote hope: resources, navigation, and activities to promote social connection. The hope conceptual model can be used to inform the selection of interventions to assess in future research studies aimed at improving hope and the specification of outcome measures to include in hope research studies. Inclusion of the health care system in the model provides direction for identifying strategies for improving the system and places responsibility on the system to do better to promote hope among young patients with chronic illness and their caregivers.

Getting to Hope: Perspectives from Patients and Caregivers Living with Chronic Childhood Illness

Due to the global alert about the risk of contagion and propagation of Covid-19, a situation that has changed in the educational processes, this has forced the system to migrate towards a more dynamic and connected model of teaching and learning, which has allowed not to interrupt and to continue with the training processes, in a remote and assisted way In this research, the profile of the engineering and science student is analyzed, and its relationship with the learning of physics in this crisis For this purpose, the technique of simple random sampling of a certain population was applied, a research instrument was designed and validated by pairs of experts, its reliability was established based on Cronbach's Alpha test, and the instrument was applied to 354 students of the faculty of engineering and basic sciences, of the Universidad Francisco de Paula Santander, located in the city of Cúcuta, Colombia, during a 15-day time window, the analysis of the data and variables is carried out from the design of a mathematical model of logistic regression, where the dependent variable represents the feeling of emotional affect by the obligatory social isolation The results indicated that the students feel emotionally affected in 88 56% generating implications in the learning of physics and in their academic performance, especially those who comply the profile: being female, single, not having received training in the use of digital platforms, without academic difficulties but who feel that their academic performance has been affected © Published under licence by IOP Publishing Ltd

Influence of COVID-19 confinement on physics learning in engineering and science students

The standard methodology for the assessment of cultural heritage significance relies on hindsight, with a passage of time elapsed between the creation of the site or object and its assessment. There are, however, cases where heritage significance is instant (e.g., sites associated with the first Moon landing). This paper argues that hindsight will not be required to determine that the COVID-19 pandemic will come to be considered as a significant historic event, as COVID-19 has already manifested itself as a social, cultural and economic disruptor on a global scale with a mortality in the millions. Heritage professionals have the unique opportunity to assess and document places and structures associated with the pandemic, that are poised to be worthy of a heritage listing in the near future, while they are still in use and function as intended. This paper discusses the nature of the sites and structures and explores possible management approaches to safeguard evidence of the pandemic for future generations.

COVID-19 on the Ground: Managing the Heritage Sites of a Pandemic

In April 2020, close to the start of the first U.K. COVID-19 lockdown, the U.K. government announced the development of a COVID-19 contact tracing app, which was later trialled on the U.K. island, the Isle of Wight, in May/June 2020. United Kingdom surveys found general support for the development of such an app, which seemed strongly influenced by public trust. Institutions developing the app were called upon to fulfil the commitment to public trust by acting with trustworthiness. Such calls presuppose that public trust associated with the app can emerge if the conditions for trustworthiness are met and that public trust is simplistic, i.e., linearly the sum of each member of the publics’ individual – U.K. government trust relationship. Drawing on a synthesis of the trust literature and fifteen interviews with members of the public trialling the app on the Isle of Wight, this paper aims to explore what trust mechanisms and relationships are at play when thinking about public trust in the context of the U.K. COVID-19 app. We argue that public trust is a complex social phenomenon and not linearly correlated with institutional trustworthiness. As such, attention needs to widen from calls for trustworthy infrastructures as a way to build public trust, to a deeper understanding of those doing the trusting; in particular, what or whom do people place their trust in (or not) when considering whether using the app and why. An understanding of this will help when trying to secure public trust during the implementation of necessary public health measures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11673-021-10127-x.

Ecologies of Public Trust: The NHS COVID-19 Contact Tracing App

Objective: To identify risk factors associated with mortality in COVID-19. Study Design: Retrospective Cross Sectional Study. Setting: Nishtar Hospital Multan. Period: April 2020 to September 2020. Material & Methods: Charts of all PCR confirmed COVID-19 cases expired during the study period. Results: Out of 96 cases, 62(64.6%) were male and 34(35.4%) were female. Sixty five (67.7%) were from urban areas. Niney two (95.8%) patients had a comorbid condition. Fifty two (54.2%) had diabetes, 42(43.8%) had hypertension, 29(30.20%) had heart disease, 21(21.9%) had chronic kidney disease, 14(14.5%) had chronic lung disease and 5(5.2%) had chronic liver disease. Mean respiratory rate was 25.01±7.80, mean SaO2 was73.99±17.53 and 57(59.37%) had bilateral infiltrates on chest X-ray. Mean CRP was 59.95±46.28, mean S/LDH was 765.92 ±266.61, mean S/Ferritin was 1446.00±1261.69 and mean D-dimer was 1.26±0.45µg/ml. Thirty five (36.45%) had sepsis, 26(27.08%) had cytokine storm, 17(17.7%) had respiratory failure and 13(13.5%) had hypotension. Conclusion: Male gender, old age, diabetes, hypertension, ischemic heart disease and chronic kidney disease were associated with increased mortality in COVID 19. Tachypnea, hypoxia, bilateral infiltrates on chest X-ray and raised inflammatory markers also had poor prognosis. Sepsis, cytokine release syndrome, shock, and respiratory failure were common complications. These high risk patients with COVID 19 should be timely admitted and managed aggressively to improve outcome. [ FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Risk factors associated with mortality in COVID-19 patients in Nishtar Hospital Multan

In early 2020 the world was struck by the epidemic of novel SARS-CoV-2 virus. Like many others, German government has introduced severe contact restrictions to limit the spread of infection. This paper analyses effects of weather on the spread of the disease under the described circumstances. We demonstrate that regions reported lower growth rates of the number of the infection cases after days with higher temperatures, no rain and low humidity. We argue that this effect is channelled through human behaviour. The evidence suggests that "good" weather attracts individuals to outdoor (safer) environments, thus, deterring people from indoor (less safe) environments. Understanding this relationship is important for improving the measures aiming at combating the spread of the virus.

Home alone? Effect of weather-induced behaviour on spread of SARS-CoV-2 in Germany

English Abstract: Major advanced economies have taken policy measures to strengthen the resilience of the financial system since the 2008 global financial crisis. On that basis, the G20 Coherent Conclusions for the Management of Capital Flows Drawing on Country Experiences was established in 2011, followed by discussions among policy circles including the OECD and IMF. Emerging economies have also taken various policy measures to manage systemic risks associated with cross-border capital flows. In 2010, the Korean government and central bank announced foreign exchange-related macroprudential measures (MPMs) aimed at building resilience against external financial shocks. These measures have greatly contributed to limiting systemic risk by curbing excessive capital inflows. Twelve years have passed since the global financial crisis started, and ten years after the introduction of FX-related macroprudential policy measures in Korea. It is now an opportune time to check the performance and effectiveness of these policies. Given the newly heightened risky environment, it is urgent to discuss how to improve macroprudential measures in response to emerging external risks. Chapter 2 reviews trends in macroprudential policies from a global perspective, and approaches by several international organizations to cross-border capital flow management measures. The IMF and OECD take different approaches to capital flow management measures to mitigate volatility in capital flows in emerging counties. Such conflicting signals from the OECD and IMF regarding those macroprudential measures make it difficult for emerging counties to implement tools relevant for themselves. Cooperation between the IMF and OECD is essential to enhance the consistency between the IMF’s institutional view and OECD approaches for the management of capital flows. Chapter 3 analyzes the determinants of macroprudential policy measures in the external sectors and examines the empirical effects of these measures. As determinants of capital flows, pull factors (private credit, foreign exchange reserves, and economic size) as well as push factors (the VIX index) were significantly associated with cross-border capital flows. An analysis reveals that reinforcement of capital inflow regulations and deregulation of capital outflows were significantly related with a depreciation of domestic currency. We also find that the strengthening regulations on capital inflows had a large effect on scaling down capital inflows, and deregulation on capital outflows also lowered the accumulation of net capital inflows. Further analysis also reveals that deregulation of capital outflows is significantly associated with lower volatility of portfolio investment. In Chapter 4, we check the performance and effectiveness of FX-related macroprudential measures in Korea. In 2010, Korea’s authorities introduced three-pronged macroprudenti l policies ‒ a regulation on the ratio of FX derivatives position, an FX stability levy, and a tax on bond investment by foreigners ‒ in order to mitigate volatility from capital flows. These measures are considered to have contributed greatly to easing vulnerabilities in the FX sector through curtailment of external debt in the banking sector and improvements in maturity structures. In particular, the short-term portion out of total external debt in foreign bank branches has declined greatly. In March 2020, the authorities relaxed FX macroprudential regulations in a flexible manner to cope with external shocks triggered by the Covid-19 pandemic. In Chapter 5, we make an effort to identify new types of risks unanticipated by policy authorities and to recognize thin markets usually ignored due to their relatively small business sizes. The Covid-19 pandemic led to globally tighter US dollar funding conditions as the US dollar money market became severely strained. Under these circumstances, it also tightened the local financial conditions in Korea, which remain heavily exposed to US dollar funding risks. Finally, based on the analysis outcome, we suggest the following policy implications. Korea’s FX-related macroprudential policies greatly contributed to stabilizing systemic risk by curbing excessive capital inflows to Korea since its 2010 introduction of macroprudential measures. However, it is necessary to note that financial stability is threatened by potential risks not comparable with risks in the past. In particular, the global financial market is now grappling with difficulties in funding the US dollar. This indicates that the Korean authorities should strengthen monitoring of changing trends in the international financial market, while prioritizing to secure enough US dollar liquidity during a crisis. As a result, it is critical to sustain a resilient framework for curbing excessive capital inflow, but to respond with caution to the trend of decreasing capital inflow. In this regard the current macroprudential system in the external sector – introduced to mainly curb excessive capital inflow – should be overhauled.

Korea's Macroprudential Policies for Cross-Border Capital Flows: Accomplishments and Road to Improvement

The purpose of this study is to predict the short-term trend of the COVID-19 pandemic and give insights into effective response strategies. Based on the basic SIR model, a compartment method for modeling the course of an epidemic, the short-term infection change ratio md, is derived. The number of infected people can be predicted using this ratio. We calculated different md values on a weekly basis. As we tested different combinations of md, the prediction from the combination of md based on a week and md based on 4 weeks was found to be statistically reliable. According to our regression analysis, our approach has an explanatory power of 96%. However, this method could only predict 1 week ahead of current data. Thus, we use LSTM, a deep learning method applied for time series data, to forecast the trend 4 weeks ahead. The forecasted trends show that the number of infected people in South Korea will reach its peak a week after the writing of this work and start to gradually decline after that.

Short-Term Prediction Methodology of COVID-19 Infection in South Korea

Digital health interventions (DHIs) have the potential to improve the accessibility and effectiveness of palliative care but heterogeneity amongst existing systematic reviews presents a challenge for evidence synthesis. This meta-review applied a structured search of ten databases from 2006 to 2020, revealing 21 relevant systematic reviews, encompassing 332 publications. Interventions delivered via videoconferencing (17%), electronic healthcare records (16%) and phone (13%) were most frequently described in studies within reviews. DHIs were typically used in palliative care for education (20%), symptom management (15%), decision-making (13%), information provision or management (13%) and communication (9%). Across all reviews, mostly positive impacts were reported on education, information sharing, decision-making, communication and costs. Impacts on quality of life and physical and psychological symptoms were inconclusive. Applying AMSTAR 2 criteria, most reviews were judged as low quality as they lacked a protocol or did not consider risk of bias, so findings need to be interpreted with caution.

Digital health interventions in palliative care: a systematic meta-review

There are many examples of hybrid simulation models in healthcare education which are designed to simulate specific scenarios. However, there appears to be a need for a cost effective and configurable hybrid simulation platform which can be used by educators of various healthcare disciplines to simulate different scenarios. The purpose of this paper is to develop a proof-of-concept platform that can be easily implemented at little cost and provide flexibility to healthcare instructors to develop a variety of simulation scenarios, and to determine the effectiveness of this platform. Using a standardized patient, a person acting as a patient in a scripted manner, along with wearable and web-based technologies, a congestive heart failure simulation was used as an evaluative exercise for a group of personal support worker students at a Canadian Community College. Personal support workers typically provide care to any person who may require personal assistance with activities of daily living such as feeding, lifting, bathing, skin care and oral hygiene to name a few. Standardized patients are typically used in healthcare education to educate and evaluate soft skills, such as caregiver to patient communication, professionalism, as well as hard skills, such as history taking, examination and diagnostic skills (Rosen in J Crit Care 23:157–166, 2008). Instructor feedback indicated that the platform was easy to use and capable of simulating a large variety of scenarios. Pre and post test results are evidence of initial findings of promise indicating that the platform seemed to be effective in enabling students to meet learning outcomes. Focus group results seem to indicate an increase in student confidence as it relates to their ability to handle a similar scenario in the workplace.

Implementing a cost effective and configurable hybrid simulation platform in healthcare education, using wearable and web-based technologies

The Care4PD study examined the impact of the COVID-19 pandemic on the care situation of people (PwP) with Parkinson’s disease in Germany. A comprehensive, nationwide, anonymous questionnaire for PwP was distributed by the members’ journal of the German Parkinson’s Disease Association and in several PD specialized in- and outpatient institutions. PwP subjectively evaluated their general care situation and individual impairments during the pandemic. We analyzed 1269 eligible out of 1437 returned questionnaires (88.3%) and compared PwP with (p-LTC) and without (np-LTC) professional long-term care. Both groups rated the general pandemic-related consequences as being rather mild to moderate (e.g., worsening of symptom or concerns). However, familial/social contact restrictions were indicated as most compromising, whereas access to outpatient professional health care providers was less affected. PwP with professional LTC reported more impairment than those without. COVID-19 vaccination rates and acceptance were generally high (p-LTC: 64.3%, np-LTC: 52.3%) at the time of the study, but realization of sanitary measures—especially wearing masks as a patient during care sessions—still needs to be improved. Technical options for telemedicine were principally available but only rarely used. Altogether, during the COVID-19 pandemic, PwP in Germany seemed to have a relatively stable health care access, at least in outpatient settings, while mainly social isolation compromised them. The p-LTC group was more impaired in everyday live compared with the np-LTC group.

Impact of COVID-19 Pandemic on (Health) Care Situation of People with Parkinson’s Disease in Germany (Care4PD)

When the Philippine government eased the community quarantine restrictions on June 2020, the healthcare system was overwhelmed by the surge in coronavirus disease 2019 (COVID-19) cases. In this study, we developed an SEIQR model considering behavior change and unreported cases to examine their impact on the COVID-19 case reports in Metro Manila during the early phase of the pandemic. We found that if behavior was changed one to four weeks earlier, then the cumulative number of cases can be reduced by up to 74% and the peak delayed by up to four weeks. Moreover, a two- or threefold increase in the reporting ratio can decrease the cumulative number of cases by 29% or 47%, respectively, at the end of September 2020. Results of our finding are expected to guide healthcare professionals to mitigate disease spread and minimize socioeconomic burden of strict lockdown policies during the start of an epidemic.

Modeling behavior change and underreporting in the early phase of COVID-19 pandemic in Metro Manila, Philippines

Background: The COVID-19 epidemic has taken a fearsome toll on individuals residing in long-term care facilities (LTC). As of April 10, 2020 half COVID-19 deaths in Canada had occurred in LTC. We sought to better understand trends and risk factors for COVID-19 death in LTC in Ontario. Methods: We analyzed a COVID-19 outbreak database created by the Ontario Ministry of Health, for the period March 29-April 7, 2020. Mortality incidence rate ratios for LTC were calculated with community living Ontarians aged > 69 used as the comparator group. Count-based regression methods were used to model temporal trends and identify associations between infection risk in staff and residents, and subsequent LTC resident death. Results: Confirmed or suspected cases of COVID-19 were identified in 272/627 LTC by April 7, 2020. The incidence rate ratio for COVID-19 death was 13.1 (9.9-17.3) relative to community living adults over 69. Incidence rate ratio increased over time and was 87.28 (90% CrI 9.98 to 557.08) by April 7, 2020. Lagged infection in staff was a strong predictor of death in residents (e.g., adjusted IRR for death per infected staff member 1.17, 95% CI 1.11 to 1.26 at a 6-day lag). Interpretation: Mortality risk in elders in Ontario is currently concentrated in LTC, and this risk has increased sharply over a short period of time. Early identification of risk requires a focus on testing and provision of personal protective equipment to staff, and restructuring the LTC workforce to prevent movement of COVID-19 between LTC.

Failing our Most Vulnerable: COVID-19 and Long-Term Care Facilities in Ontario

BACKGROUND: Surgical delays are associated with invasive cancer for patients with ductal carcinoma in situ (DCIS). During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, neoadjuvant endocrine therapy (NET) was used as a bridge until postponed surgeries resumed. This study sought to determine the impact of NET on the rate of invasive cancer for patients with a diagnosis of DCIS who have a surgical delay compared with those not treated with NET. METHODS: Using the National Cancer Database, the study identified women with hormone receptor-positive (HR+) DCIS. The presence of invasion on final pathology was evaluated after stratifying by receipt of NET and by intervals based on time from diagnosis to surgery (≤30, 31–60, 61–90, 91–120, or 121–365 days). RESULTS: Of 109,990 women identified with HR+ DCIS, 276 (0.3%) underwent NET. The mean duration of NET was 74.4 days. The overall unadjusted rate of invasive cancer was similar between those who received NET ((15.6%) and those who did not (12.3%) (p = 0.10). In the multivariable analysis, neither the use nor the duration of NET were independently associated with invasion, but the trend across time-to-surgery categories demonstrated a higher rate of upgrade to invasive cancer in the no-NET group (p < 0.001), but not in the NET group (p = 0.97). CONCLUSIONS: This analysis of a pre-COVID cohort showed evidence for a protective effect of NET in HR+ DCIS against the development of invasive cancer as the preoperative delay increased, although an appropriately powered prospective trial is needed for a definitive answer. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-021-10883-5.

Neoadjuvant Endocrine Therapy and Delays in Surgery for Ductal Carcinoma in Situ: Implications for the Coronavirus Pandemic

Germaphobia –– a pathological aversion to microorganisms –– could be contributing to an explosion in human immune-related disorders via mass sterilisation of surfaces and reduced exposure to biodiversity. Loss of biodiversity and our connectedness to nature, along with poor microbial literacy may be augmenting the negative consequences of germaphobia on ecosystem health. In this study, we created an online questionnaire to acquire data on attitudes towards, and knowledge of microbes. We collected data on nature connectedness and interactions with nature and explored the relationships between these variables. We found a significant association between attitudes towards microbes and both duration and frequency of visits to natural environments. A higher frequency of visits to nature per week, and a longer duration spent in nature per visit, significantly associated with positive attitudes towards microbes. We found no association between nature connectedness and attitudes towards microbes. We found a significant relationship between knowledge of ‘lesser known’ microbial groups (e.g., identifying that fungi, algae, protozoa, and archaea are microbes) and positive attitudes towards microbes. However, we also found that people who correctly identified viruses as being microbes expressed less positive views of microbes overall –– this could potentially be attributed to a ‘COVID-19 effect’. Our results suggest that basic microbial literacy and nature engagement may be important in reducing/preventing germaphobia. The results also suggest that a virus-centric phenomenon (e.g., COVID-19) could increase broader germaphobia. As the rise of immune-related disorders and mental health conditions have been linked to germaphobia, reduced biodiversity, and non-targeted sterilisation, our findings point to a feasible strategy to potentially help ameliorate these negative consequences. A greater emphasis on microbial literacy and promoting time spent in nature could be useful in promoting resilience in human health and more positive/constructive attitudes towards the foundations of our ecosystems – the microorganisms.

Germaphobia! Does our Relationship with, and Knowledge of Biodiversity Affect our Attitudes Towards Microbes?

This paper aims to shed light on work-life balance in Latvia during the state of emergency. The COVID-19 outbreak has led many governments to introduce lockdowns. While the restrictions imposed may help to contain the spread of the virus, they may also result in substantial damage to the well-being of the population. The COVID-19 outbreak in Latvia demonstrates the extent and ways in which socio-demographics has determined different patterns of behaviour, attitudes, employment changes and harmonised work and life balance. The study describes the development of COVID-19 in the country chronologically. It shows labour migration to and from Latvia before the COVID-19 outbreak, and then discusses geographical features of the distribution of confirmed COVID-19 cases. The extent of the COVID-19 threat is assessed focusing on the global, national, regional and intra-family levels. Finally, types of employment and work-life balance are analysed according to the geography and age groups.

Work-life balance during the COVID-19 outbreak: the case of Latvia

Introduction Concussion is a clinical diagnosis, based on self-reported patient symptoms supported by clinical assessments across many domains including postural control, ocular/vestibular dysfunction, and neurocognition. Concussion incidence may be rising in motorsport which, combined with unresolved challenges to accurate diagnosis and lack of guidance on the optimal return-to-race timeframe, creates a difficult environment for healthcare practitioners. Methods and analysis Research Evaluating Sports ConcUssion Events-Rapid Assessment of Concussion and Evidence for Return (RESCUE-RACER) evaluates motorsports competitors at baseline (Competitor Assessment at Baseline; Ocular, Neuroscientific (CArBON) study) and post-injury (Concussion Assessment and Return to motorSport (CARS) study), including longitudinal data. CArBON collects pre-injury neuroscientific data; CARS repeats the CArBON battery sequentially during recovery for competitors involved in a potentially concussive event. As its primary outcome, RESCUE-RACER will develop the evidence base for an accurate trackside diagnostic tool. Baseline objective clinical scoring (Sport Concussion Assessment Tool-5th edition (SCAT5)) and neurocognitive data (Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)) will be assessed for specificity to motorsport and relationship to existing examinations. Changes to SCAT5 and ocular, vestibular, and reaction time function (Dx 100) will be estimated by the reliability change index as a practical tool for trackside diagnosis. Neuropsychological (Cambridge Neuropsychological Test Automated Battery (CANTAB)) assessments, brain MRI (7 Tesla) and salivary biomarkers will be compared with the new tool to establish utility in diagnosing and monitoring concussive injuries. Ethics and dissemination Ethical approval was received from East of England-Cambridge Central Research Ethics Committee (18/EE/0141). Participants will be notified of study outcomes via publications (to administrators) and summary reports (funder communications). Ideally, all publications will be open access. Trial registration number February 2019 nationally (Central Portfolio Management System 38259) and internationally (ClinicalTrials.gov NCT03844282).

Research Evaluating Sports ConcUssion Events-Rapid Assessment of Concussion and Evidence for Return (RESCUE-RACER): a two-year longitudinal observational study of concussion in motorsport.

Biomedical waste (BMW) is an emerging occupational and environmental health hazard in the health care platform. BMW in any form generated from hospitals during diagnosis, surgery, management of patients, antibiotics, radioactive isotope needs proper handling and disposal. In the field of dentistry, mercury waste, waste from dental amalgam, lead, and silver-containing waste were often found and have severe risks for health and are also environmental hazards. This also has an impact and risk of airborne pathogens if its improperly handled and disposed of. All these contaminated waste-like syringes, needles, sharps, blood-soaked gauze, which leads to infections, must be properly disposed of in various color codes indicated for a certain category of biomedical waste as per the guidelines from the government for the disposal. This article throws light on the categories of biomedical waste and extensive literature review on the research performed, waste generated from dental Clinics and hospitals. Environmental audit guidelines in the health care sector and its importance, alternative waste handling methods like the robotic model, which is an artificial intelligence employed to handle biomedical waste at a large scale, are discussed.

Biomedical waste management in dental practice and its significant environmental impact: A perspective

The mitogenome of the South American parthenogenetic lizard Loxopholis percarinatum Müller, 1923 (Squamata: Gymnophthalmidae), a uni-bisexual species complex, was recovered for three individuals from Rio Negro region, Amazonas, Brazil. The content and order of genes are typical for vertebrate mitochondrial genomes, and we recovered 13 protein-coding genes, 22 tRNA, and two rRNA (12S and 16S), in addition to partial fragments of the Control Region. A maximum likelihood phylogenetic analysis with mitogenomes of selected lizard families recovered L. percarinatum with Iphisa elegans Gray, 1851, the only other Gymnophthalmidae species available in GenBank.

The first mitochondrial genome of a South America parthenogenetic lizard (Squamata: Gymnophthalmidae)

COVID-19, resulting from the SARS-CoV-2 virus, is a major pandemic that the world is fighting. SARS-CoV-2 primarily causes lung infection by attaching to the ACE2 receptor on the alveolar epithelial cells. However, the ACE2 receptor is also present in intestinal epithelial cells, suggesting a link between nutrition, virulence and clinical outcomes of COVID-19. Respiratory viral infections perturb the gut microbiota. The gut microbiota is shaped by our diet; therefore, a healthy gut is important for optimal metabolism, immunology and protection of the host. Malnutrition causes diverse changes in the immune system by repressing immune responses and enhancing viral vulnerability. Thus, improving gut health with a high-quality, nutrient-filled diet will improve immunity against infections and diseases. This review emphasizes the significance of dietary choices and its subsequent effects on the immune system, which may potentially impact SARS-CoV-2 vulnerability.

Malnutrition and Dietary Habits Alter the Immune System Which May Consequently Influence SARS-CoV-2 Virulence: A Review

BACKGROUND Despite its preventable nature, poisoning remains one of the leading causes of morbidity and mortality in the pediatric population. In Lebanon, this population is poorly studied and there is no poison center to which healthcare providers and the public can refer in case of toxicological exposure, leading to unnecessary Emergency Department (ED) visits. This study describes the pediatric toxicological exposures seen at the largest tertiary care center in Lebanon. It also evaluates the appropriateness of ED visits among confirmed or suspected toxicological exposures in children, in order to assess the role of a national poison center in reducing unnecessary ED visits. METHODS This is a secondary analysis of a database for a telephonic medical toxicology service at the American University of Beirut Medical Center, the largest tertiary care center in Lebanon. Data relating to all pediatric patients aged 0-19 years of age were entered into the database by the medical toxicology team. The cases were independently reviewed by 2 medical toxicologists for the adequacy of referral to the ED and performance of invasive procedures. RESULTS Two hundred and nine exposures were recorded between 15 April 2015 and 31 December 2019, of which 53.1% were females. Children aged less than 5 years were involved in 67.0% of cases while adolescents aged 13-19 years were involved in 21.1%. The most commonly involved substances were analgesics (14.8%) and cardiovascular drugs (10.0%). The majority had no (59.3%) or minor (26.3%) effects and were treated and discharged home (67.5%). More than a third of ED visits were deemed unnecessary by the toxicologists (Kappa = 0.705), and when including only unintentional cases, around 45% of the ED visits were deemed unnecessary (Kappa = 0.677). CONCLUSION Our data show that 37% of all pediatric poisoning ED visits and 45% of ED visits due to unintentional pediatric poisonings were unnecessary. Additionally, more often than not lavage suctions were done unnecessarily. Future research investigating the possibility of preventing unnecessary visits by establishing a national poison center is needed.

Toxicological exposures among the pediatric patients at a tertiary care center in Lebanon: the case for establishing a national poison center.

P[3] rotavirus (RV) has been identified in many species, including human, simian, dog, and bat. Several glycans, including sialic acid, histo-blood group antigens (HBGAs) are reported as RV attachment factors. The glycan binding specificity of different P[3] RV VP8*s were investigated in this study. Human HCR3A and dog P[3] RV VP8*s recognized glycans with terminal sialic acid and hemagglutinated the red blood cells, while bat P[3] VP8* showed neither binding to glycans nor hemagglutination. However, the bat P[3] VP8* mutant of C189Y obtained the ability to hemagglutinate the red blood cells, while human P[3] HCR3A/M2-102 mutants of Y189C lost the ability. Sequence alignment and structural analysis indicated that residue 189 played an important role in the ligand recognition and may contribute to the cross-species transmission. Structural superimposition exhibited that bat P[3] VP8* model was quite different from the simian P[3] Rhesus rotavirus (RRV) P[3] VP8*, indicating that bat P[3] RV was relatively distinct and partially contributed to the no binding to tested glycans. These results promote our understanding of P[3] VP8*/glycans interactions and the potential transmission of bat/human P[3] RVs, offering more insight into the RV infection and prevalence.

The Functional Characterization of Bat and Human P[3] Rotavirus VP8*s

IMPORTANCE: There are concerns regarding the side effects of the new COVID-19 mRNA-1273 vaccine among healthcare workers (HCWs) in the United States OBJECTIVE: To investigate the side effects of the mRNA-1273 vaccine with detailed review of organ systems METHODS: A randomized, cross-sectional study using an independent online survey questionnaire with responses from HCWs RESULTS: Of all participants, 87.8% (1116/1271) provided complete responses. Of them, 38.7 % (432/1116) received the mRNA-1273 vaccine, among which, 89.35% were females. 425 of these 432 mRNA-1273 vaccine recipients (98.34%) reported at least one or more symptoms. The results were classified based on the frequency of symptoms reported post vaccination. Of these, 254/432 (58.8%) were able to continue their daily routine activities. 108/432 (25%) were temporarily unable to perform daily activities, 120/432 (27.78%) required transient time off from work, 17/432 (3.94%) required help from an outpatient provider, 1/432 (0.23%) required help from emergency department, and none of them were hospitalized. Despite the wide array of self-reported symptoms, 97.02% of the HCWs did not intend to skip the second dose of vaccine CONCLUSIONS: Among all the symptoms reported, localized pain, generalized weakness, headache, myalgia, chills, fever, nausea, joint pains, sweating, localized swelling at the injection site, dizziness, itching, rash, decreased appetite, muscle spasm, decreased sleep quality, and brain fogging/confusion are the most commonly reported symptoms (in descending order of occurrence). Most of the symptoms reported were non-life threatening. Despite the wide array of self-reported symptoms, there appears to be a higher acceptance for the vaccine This article is protected by copyright. All rights reserved.

Adverse effects of COVID-19 mRNA-1273 vaccine: A randomized, cross-sectional study on healthcare workers with detailed self-reported symptoms

It is possible that bromhexine hydrochloride, by inhibiting TMPRSS2, can prevent the priming of COVID-19 and abort the cell entry of the SARS-CoV-2.

Controversy with bromhexine in COVID-19;where we stand

The year 2021 is devoted, in Italy and around the world, to the vaccination campaign against SARS-CoV-2 epidemic event activated by the outbreak in China. In December 2020 we proposed a model prediction for the vaccination effects: after more than 9 months of vaccinations the comparison of those predictions with data is mandatory. Surprising evidences emerge suggesting new strategies to look at the diffusion of the virus and to preserve frail people. After months of immunization campaign in Italy, we estimate explicitly a save of (roughly) 20000 deaths during the year 2021.

Modelling SARS-CoV-2 vaccination campaign in Italy: the fundamental rôle of unreported cases

The global COVID-19 pandemic caused by the virus SARS-CoV-2 has led to over 10 million confirmed cases, half a million deaths, and is challenging healthcare systems worldwide. With limited medical resources, early identification of patients with a high risk of progression to severe disease or a critical state is crucial. We present a prognostic model predicting critical state within 28 days following COVID-19 diagnosis trained on data from US electronic health records (EHR) within IBM Explorys, including demographics, comorbidities, symptoms, laboratory test results, insurance types, and hospitalization. Our entire cohort included 20152 COVID-19 cases, of which 3160 patients went into critical state or died. Random, stratified train-test splits were repeated 100 times to obtain a distribution of performance. The median and interquartile range of the areas under the receiver operating characteristic curve (ROC AUC) and the precision recall curve (PR AUC) were 0.863 [0.857, 0.866] and 0.539 [0.526, 0.550], respectively. Optimizing the decision threshold lead to a sensitivity of 0.796 [0.775, 0.821] and a specificity of 0.784 [0.769, 0.805]. Good model calibration was achieved, showing only minor tendency to over-forecast probabilities above 0.6. The validity of the model was demonstrated by the interpretability analysis confirming existing evidence on major risk factors (e.g., higher age and weight, male gender, diabetes, cardiovascular disease, and chronic kidney disease). The analysis also revealed higher risk for African Americans and "self-pay patients". To the best of our knowledge, this is the largest dataset based on EHR used to create a prognosis model for COVID-19. In contrast to large-scale statistics computing odds ratios for individual risk factors, the present model combining a rich set of covariates can provide accurate personalized predictions enabling early treatment to prevent patients from progressing to a severe or critical state.

Predicting Critical State after COVID-19 Diagnosis Using Real-World Data from 20152 Confirmed US Cases

OBJECTIVE: To examine recent vaccination trends among Brazilian children during their first year of life, and the impact of the coronavirus disease 2019 (COVID-19) pandemic on these trends. METHODS: Monthly vaccination and birth data from the DATASUS (Department of Informatics of the Unified Health System) database of the Ministry of Health of Brazil were obtained from January 2017 to December 2020. Interrupted time series analysis was used to compare vaccination trends before and after March 2020, when isolation measures were first implemented in Brazil. RESULTS: There was no strong evidence of a significant change in trends during the study period, or before and during the pandemic at national level. However, the mean number of vaccinations per child was 10.6, which is lower than the 13 doses expected under the immunization schedule. CONCLUSIONS: Although the pandemic did not appreciably impact on vaccinations, incomplete immunization among children aged <1 year in Brazil is cause for concern. A potential impact of the COVID-19 pandemic on specific antigens or regional and sociodemographic disparities in vaccinations cannot be ruled out without further research.

Impact of COVID-19 on immunization of Brazilian infants

We convey responses from migrant-sending households in western Odisha from interviews on migration conducted during the lockdown. The majority of migrants are indigenous (referred to as Scheduled Tribes or STs in India), come from very poor households and have little or no education. Prior to the lockdown, the majority of migrants engaged in seasonal, temporary migration—working in dangerous, informal, low-skilled odd jobs for low wages for a few months to supplement incomes at home the rest of the year. Lack of local employment alternatives is cited as the primary reason behind migration. After the lockdown, in the absence of income from migration, households with former migrants hope to earn a livelihood locally—with assistance from National Rural Employment Guarantee Act (NREGA), India’s public works program. Besides providing employment, NREGA works can include physical and health infrastructure which improve connectivity of health workers. NREGA works can also include community assets, such as facilities for irrigation, rainwater harvesting and plantations as well as child-care centers under India’s Integrated Child Development Services (ICDS) program. We posit that in the long run, this can improve health, education levels and livelihoods of the local communities, addressing not only the immediate need for local employment but also distress migration in the future.

Distress migration and employment in indigenous Odisha, India: Evidence from migrant-sending households

BACKGROUND For decades, concurrent chemo-radiotherapy with cisplatin-based regimen has been a standard therapy for locally advanced stage III non-small-cell lung cancer (NSCLC). We conducted individual-participant-data (IPD) meta-analyses to compare S-1/cisplatin versus other third-generation anti-cancer medications plus cisplatin regimens with the goal of determining whether or not S-1/cisplatin was the ideal choice for treatment accompanied by radiotherapy (RT). METHODS A thorough search was performed using multiple electronic databases. We integrated the IPD of each trial and analyzed the resulting meta-database. The primary endpoint was the overall survival (OS), and the secondary endpoints included the progression-free survival (PFS), objective response rate (ORR), toxicities, and treatment delivery. Subgroup analyses were conducted based on baseline characteristics. Statistical analyses were stratified by trials. RESULTS Three randomized control trials (WJOG5008L study, SPECTRA study, and TORG1018 study) were found. Of the 316 patients enrolled in those studies, 159 received S-1/cisplatin (SP), and 157 were assigned to other combination chemotherapy. The median OS for the SP arm was 48.2 months, and that of the non-SP arm was 42.4 months. The combined hazard ratio (HR) for the OS was 0.895 (95% confidence interval [CI] 0.638-1.256), and no heterogeneity was noted among the trials (test for heterogeneity, p = 0.87; I2 = 0). The median PFS for the SP and non-SP arms was 12.8 and 14.0 months, respectively. The corresponding HR for the PFS was 1.022 (95% CI 0.776-1.347), and there was evidence of moderate heterogeneity among the trials (test for heterogeneity, p = 0.16; I2 = 0.46). The ORRs were 69.7% (95% CI 62.1-76.7%) and 70.9% (95% CI 63.7-78.1%) in the SP and non-SP arms, respectively. The toxicity profile showed that SP caused significantly fewer instances of grade 3-4 leukopenia and neutropenia than non-SP regimens. CONCLUSION No marked differences were detected in the OS, PFS, or ORR between the SP and non-SP arms. SP had significantly less myelosuppression and better treatment compliance as a chemotherapy regimen for concurrent chemoradiation in locally advanced NSCLC than non-SP regimens.

Concurrent chemoradiotherapy with cisplatin + S-1 versus cisplatin + other third-generation agents for locally advanced non-small-cell lung cancer: a meta-analysis of individual participant data.

The purpose of this research is to discover how early literacy activities are implemented during Covid-19 pandemic in Pekanbaru, Riau, Indonesia. Since the offline meeting at school has been discontinued, the research sample consists of 400 parents in Pekanbaru who were recruited online. This research method is descriptive in quantitative terms and provides an overview of the performance of literacy activities in Pekanbaru Riau. A questionnaire with A Likert Scale Model was used to collect data. The percentage descriptive technique was used for data analysis with IBM SPSS for Windows Version 23. The results showed that the implementation of literacy activities in Pekanbaru kindergarten was carried out through the parent participation in early childhood literacy development. According to the findings, four indicators that children must have in order to develop early literacy well (vocabulary, narrative, print awareness, and print motivation) are in the high category or more than 65%. Meanwhile, the Letter Knowledge and Phonological Awareness skills are sufficient, at around 60%. Overall, the results of this study are in the high category (64.5%), indicating that literacy activities in Pekanbaru, Riau, Indonesia, have involved parents in the advancement of early childhood literacy skills. © 2022 Eskisehir Osmangazi University. All rights reserved.

Implementation of Early Literacy Activities during Covid-19: A Parents Involvement Analysis

Randomized controlled trials are the preferred design for the analysis of health-related interventions. In this Viewpoint, Nigel Paneth and Michael Joyner discuss circumstances when randomized controlled trials might not be feasible and the criteria that should be used when considering applying observational data medicine.

The use of observational research to inform clinical practice.

The SARS-CoV-2 pandemic led to a huge increase in global pathogen genome sequencing efforts, and the resulting data are becoming increasingly important to detect variants of concern, monitor outbreaks, and quantify transmission dynamics. However, this rapid up-scaling in data generation brought with it many IT infrastructure challenges. In this paper, we report about developing an improved system for genomic epidemiology. We (i) highlight key challenges that were exacerbated by the pandemic situation, (ii) provide data infrastructure design principles to address them, and (iii) give an implementation example developed by the Swiss SARS-CoV-2 Sequencing Consortium (S3C) in response to the COVID-19 pandemic. Finally, we discuss remaining challenges to data infrastructure for genomic epidemiology. Improving these infrastructures will help better detect, monitor, and respond to future public health threats.

Advancing genomic epidemiology by addressing the bioinformatics bottleneck: Challenges, design principles, and a Swiss example

In the Plasmodium berghei ANKA mouse model of malaria, accumulation of CD8+ T cells and infected RBCs in the brain promotes the development of experimental cerebral malaria (ECM). In this study, we used malaria-specific transgenic CD4+ and CD8+ T cells to track evolution of T cell immunity during the acute and memory phases of P. berghei ANKA infection. Using a combination of techniques, including intravital multiphoton and confocal microscopy and flow cytometric analysis, we showed that, shortly before onset of ECM, both CD4+ and CD8+ T cell populations exit the spleen and begin infiltrating the brain blood vessels. Although dominated by CD8+ T cells, a proportion of both T cell subsets enter the brain parenchyma, where they are largely associated with blood vessels. Intravital imaging shows these cells moving freely within the brain parenchyma. Near the onset of ECM, leakage of RBCs into areas of the brain can be seen, implicating severe damage. If mice are cured before ECM onset, brain infiltration by T cells still occurs, but ECM is prevented, allowing development of long-term resident memory T cell populations within the brain. This study shows that infiltration of malaria-specific T cells into the brain parenchyma is associated with cerebral immunopathology and the formation of brain-resident memory T cells. The consequences of these resident memory populations is unclear but raises concerns about pathology upon secondary infection.

CD8+ and CD4+ T Cells Infiltrate into the Brain during Plasmodium berghei ANKA Infection and Form Long-Term Resident Memory

Background: Arrhythmias are common cardiovascular complications in multiple myeloma (MM) patients and are related to a poor prognosis. Objective: This study aimed to assess the burden of arrhythmias and their prognostic value in patients with MM. Methods: This was a retrospective study of patients with MM between January 2015 and April 2020 at the First Affiliated Hospital of Xi'an Jiaotong University. The incidence of arrhythmia and associated risk factors were evaluated. The relationship between the type of arrhythmia and survival was analyzed. Results: A total of 319 patients with MM were identified, and 48.0% (153/319) had arrhythmias. The most common type of arrhythmia was sinus tachycardia (ST) (15.0%, 48/319), followed by sinus bradycardia (SB) (14.4%, 46/319), premature atrial contractions (PACs) (6.3%, 20/319), conduction disorders (CDs) (6.0%, 19/319), atrial fibrillation (AF) (6.0%, 19/319), premature ventricular contractions (PVCs) (4.4%, 14/319) and paroxysmal supraventricular tachycardia (PSVT) (0.6%, 2/319). The patients with arrhythmias had higher levels of log NT-proBNP and creatinine, greater bortezomib use, and a higher incidence of diabetes than those without arrhythmias (P < 0.05). The all-cause mortality rates of patients without arrhythmias and those with AF, ST, PACs, CDs, SB, and PVCs were 50.6% (84/166), 73.7% (14/19), 60.4% (29/48), 60.0% (12/20), 52.6% (10/19), 34.8% (16/46), and 28.6% (4/14), respectively. In a subgroup analysis of patients experiencing different types of arrhythmias, patients with SB had lower all-cause mortality than patients with AF (P < 0.01). Univariate and multivariate Cox analyses showed that there was a positive statistically significant association between SB and survival (HR: 0.592 [0.352–0.998], P = 0.049) in a subgroup analysis of different arrhythmias. Conclusions: Patients with MM had a heavy arrhythmia burden, and in this study, approximately half of MM patients had arrhythmias. MM patients with SB were associated with lower all-cause mortality than those with AF. SB might be an independent positive factor for prognosis.

Incidence of Arrhythmias and Their Prognostic Value in Patients With Multiple Myeloma

Women entrepreneurs have been facing various challenges in the sustenance of their enterprises. During the COVID-19 lockdown in India, their vulnerability doubled due to the financial distress. In the backdrop of this, the paper measures the direct and indirect impact via forward and backward linkages of women entrepreneurs during the COVID-19 lockdown. Further, it examines their sustainability and the challenges they faced during the lockdown. The paper is based on primary data using a pre-structured questionnaire from 50 women entrepreneurs in Rishikesh, Uttarakhand. Analyses have been performed using principal components analysis, Kruskal?Wallis H test, Mann?Whitney U test and Chi-square test. The paper exhibits that both the direct and indirect impacts via forward and backward linkages have been more significant on women entrepreneurs. However, women entrepreneurs tried to sustain their business by switching towards online conduct of business, changing their promotional strategy and doing work from home. A major challenge faced by them is the lack of finance, and they relied on their previous savings to finance the expenditure.JEL Codes: L25, L26

Collision of the COVID 19 Lockdown on Women Entrepreneurship in Uttarakhand: A Micro-level Analysis

We have previously shown that exposure to particulate air pollution, both from natural and anthropogenic sources, alters gene expression in the airways and increases susceptibility to respiratory viral infection. Additionally, we have shown that woodsmoke particulates (WSP) affect responses to influenza in a sex-dependent manner. In the present study, we used human nasal epithelial cells (hNECs) from both sexes to investigate how particulate exposure could modulate gene expression in the context of SARS-CoV-2 infection. We used diesel exhaust particulate (DEP) as well as WSP derived from eucalyptus or red oak wood. HNECs were exposed to particulates at a concentration of 22 μg/cm2 for 2 h then immediately infected with SARS-CoV-2 at a MOI (multiplicity of infection) of 0.5. Exposure to particulates had no significant effects on viral load recovered from infected cells. Without particulate exposure, hNECs from both sexes displayed a robust upregulation of antiviral host response genes, though the response was greater in males. However, WSP exposure before infection dampened expression of genes related to the antiviral host response by 72 h post infection. Specifically, red oak WSP downregulated IFIT1, IFITM3, IFNB1, MX1, CCL3, CCL5, CXCL11, CXCL10, and DDX58, among others. After sex stratification of these results, we found that exposure to WSP prior to SARS-CoV-2 infection downregulated anti-viral gene expression in hNECs from females more so than males. These data indicate that WSP, specifically from red oak, alter virus-induced gene expression in a sex-dependent manner and potentially suppress antiviral host defense responses following SARS-CoV-2 infection.

Woodsmoke particulates alter expression of antiviral host response genes in human nasal epithelial cells infected with SARS-CoV-2 in a sex-dependent manner

Abstract Group A rotavirus (RVA) is a major cause of diarrhea in children worldwide. Although RVA infects many animals, little is known about RVA in bats. The present study investigated the genetic diversity of RVA in Zambian bats. We identified RVA from two straw-colored fruit bats (Eidolon helvum) and an Egyptian fruit bat (Rousettus aegyptiacus), and analyzed the genome sequences of these strains. Genome segments of the RVA strains from Zambian E. helvum showed 97%–99% nucleotide sequence identity with those of other RVA strains from E. helvum in Cameroon, which is 2800 km from the sampling locations. These findings suggest that migratory straw-colored fruit bat species, distributed across sub-Saharan Africa, have the potential to disseminate RVA across long distances. By contrast, the RVA strain from Zambian R. aegyptiacus carried highly divergent NSP2 and NSP4 genes, leading us to propose novel genotypes N21 and E27, respectively. Notably, this RVA strain also shared the same genotype for VP6 and NSP3 with the RVA strains from Zambian E. helvum, suggesting interspecies transmission and genetic reassortment may have occurred between these two bat species in the past. Our study has important implications for RVA dispersal in bat populations, and expands our knowledge of the ecology, diversity and evolutionary relationships of RVA.

Identification of group A rotaviruses from Zambian fruit bats provides evidence for long-distance dispersal events in Africa

The effects of the COVID-19 pandemic on mental health have not been fully inspected among the young adults’ population. The objectives of the present study were: (1) to examine differences in emotional reactivity and emotion regulation between, both gender and sports engagement level during the first 2 weeks of the lockdown; and (2) to examine the possible impact of emotion regulation on emotional reactivity, and possible significant roles of gender and sports engagement level as moderators. This cross-sectional study included 315 Serbian young adults (aged 18–26 years old) during COVID-19 lockdown. Respondents answered socio-demographic questions and the Serbian version of the Multidimensional Emotion Questionnaire (MEQ). The results of confirmatory factor analysis indicated good fit for both positive and negative reactivity scales (SRMR = 0.037; CFI = 0.984, RMSEA = 0.046, and SRMR = 0.055; CFI = 0.964, RMSEA = 0.064, respectively). Gender differences were found in both positive (p = 0.039; d = 0.28) and negative emotional reactivity scales (p < 0.001; d = 0.60), with females reported lower and higher values, respectively. Professional athletes presented higher scores in positive reactivity scale in comparison to non-athletes (p < 0.001; d = 0.78) and recreational athletes (p = 0.034; d = 0.34) during 2 weeks of COVID-19 lockdown. Conversely, professional athletes scored lower in negative emotional reactivity scale in comparison to non-athletes (p < 0.001; d = 0.85) and recreational athletes (p = 0.006; d = 0.42). Both gender and sports engagement level differences were found for negative, but not for positive emotion regulation scale. Furthermore, results showed that engagement in sports level plays a significant role as moderator in relationship between negative regulation and negative reactivity, where professional athletes presented significant interaction effect and predicted lower negative reactivity scores compared to non-athletes and recreational athletes. However, gender does not moderate the influence of emotion regulation on emotional reactivity either positive or negative. Engagement in sports as a lifestyle may contribute to better emotional harmony especially in the crisis situation as COVID-19 lockdown.

Emotional Reactivity and Emotion Regulation Among Young Adults During COVID-19 Lockdown: The Moderating Role of Gender and Engagement in Sports

Over the last two decades, fragment-based drug discovery (FBDD) has emerged as an effective and efficient method to identify new chemical scaffolds for the development of lead compounds. X-ray crystallography can be used in FBDD as a tool to validate and develop fragments identified as binders by other methods. However, it is also often used with great success as a primary screening technique. In recent years, technological advances at macromolecular crystallo­graphy beamlines in terms of instrumentation, beam intensity and robotics have enabled the development of dedicated platforms at synchrotron sources for FBDD using X-ray crystallography. Here, the development of the Fast Fragment and Compound Screening (FFCS) platform, an integrated next-generation pipeline for crystal soaking, handling and data collection which allows crystallography-based screening of protein crystals against hundreds of fragments and compounds, at the Swiss Light Source is reported.

Fast fragment- and compound-screening pipeline at the Swiss Light Source

To mitigate the spread of COVID-19, countries worldwide enacted quarantines, particularly for older adults, as mortality from COVID-19 is inequitably distributed among this group. Notably, social isolation in older adults is associated with a heightened risk of cardiovascular, autoimmune, and mental health problems (e.g., depression, anxiety). Furthermore, the mental health of women in particular has been greatly impacted by the pandemic. Although previous research indicates that social isolation among older adults is a “serious public health concern”, less is known about the extent to which the COVID-19 pandemic has exacerbated this issue. The primary objective is to investigate the effects of social isolation on mental health indices and health-related quality of life (HRQOL) in older women in the context of the COVID-19 pandemic. Participants include 77 postmenopausal women (aged 60+) who completed self-report measures online during the COVID-19 pandemic. Controlling for education and annual household income in all analyses, we used linear regression models to investigate the effects of social isolation on depression, anxiety, alcohol use, binge eating, and the 8 domains of the SF-36. Results indicate that, when controlling for education and income, social isolation significantly predicted depression, binge eating, and poorer HRQOL in all 8 domains of the SF-36 (all p’s < .01) Social isolation did not predict anxiety and alcohol consumption when controlling for these sociodemographic variables. Enrollment is ongoing; this poster will report updated results. Results indicate the continued need for creative avenues to improve social connectedness during the COVID-19 pandemic.

Social Isolation in Older Women during the COVID-19 Pandemic: The impact on Quality of Life and Mental health

This study aims to explore the influence mechanism of COVID-19 risk perception on anxiety in emerging adulthood in the context of public health events of the second round of COVID-19 outbreaks and provide support for exploring the path of mental health after the normalization of the epidemic situation. An online questionnaire, combined with community social work, was used in this study, and data of 522 emerging adults were collected in February 2021. The Perceived Risk of COVID-19 pandemic scale (PRCPS), the generalized anxiety disorder 7-item (GAD-7) scale, the scale of affect balance, and the connor-davidson resilience scale (CD-RISC) were used to investigate. The results showed that: first, the risk perception of COVID-19 in early adulthood was positively predictive of anxiety symptoms [B = 0.110, p < 0.05, 95%CI = (0.042, 0.176)]. Second, the affective quality of life plays a mediating role between the risk perception of COVID-19 and anxiety [B = 0.108, 95%CI = (0.060, 0.161)]. Thirdly, resilience plays a moderating role between the risk perception of COVID-19 and anxiety, the higher the resilience of emerging adulthood, the weaker effects of the risk perception of COVID-19 negative prediction of anxiety [B = −0.110, p < 0.001, 95%CI = (−0.170, −0.049)]. Therefore, to control the anxiety of emerging adulthood in public health events, we should pay attention to the propaganda and management of epidemic information, improve the quality of life, and attention should be paid to the emerging adulthood with low resilience.

The Effect of Risk Perception on Anxiety in Emerging Adulthood Under the Local Outbreak of COVID-19: A Conditional Process Analysis

LESS, or laparo-endoscopic single site surgery, is a promising new method in minimally invasive surgery. An increasing number of surgical procedures are being performed using this technique; however, its large-scale adoption awaits results of prospective randomized controlled studies confirming potential benefits. Theoretically, cosmetic outcomes, postoperative pain and complication rates could be improved with use of single site surgery. This study describes introduction of the method in a private hospital in Denmark in which 40 women were treated for benign gynecologic conditions. Although the operations described are the first of their kind reported in Denmark, favorable operating times and very low complication rates are seen. It is the authors' opinion that in addition to being feasible for hysterectomy, single port laparoscopy may become the preferred method for many simple gynecological procedures.

Single port laparoscopic surgery: concept and controversies of a new technique.

As the world focuses on containing the spread of the coronavirus disease 2019 (COVID-19) and limiting the effects of the pandemic on the global population, care must be taken not to lose sight of existing individual health issues. There is a real risk of creating a ‘post-pandemic double burden of disease’– where the pressures of having to manage acute COVID-19-related impacts on the health system are added to the existing burden of chronic non-communicable diseases or long-term conditions in developed countries. This could create a post-pandemic health crisis by devoting less attention to existing health conditions. A growing evidence base from other epidemics and health emergencies highlight the potential negative impact of short-term health crises on long-term public health. The significant disruptions to the usual healthcare systems and society can lead to increased morbidity and mortality in the long-term if not managed appropriately. This viewpoint provides an overview of the evidence to support the management of long-term conditions during, and after, health emergencies, to limit the impact of COVID-19 on public health in the short- and long-term.

Preventing a Post-Pandemic Double Burden of Disease in the COVID-19 Pandemic

Although animal models have been extensively used to evaluate human topical therapeutics, they exhibit marked physiological differences to human skin. Our objective was to develop a human ex vivo skin culture model to explore the pathophysiology of inflammatory dermatoses and for preclinical testing of potential therapeutic treatments. Ex vivo skin barrier integrity and metabolic activity was retained for 5 days and stimulation of T-helper cells (Th1), which produce proinflammatory cytokines, provided inflammatory responses similar to those reported from in vivo biopsy. Tissue responses to established therapies of pimecrolimus (Elidel) and clobetasol propionate (Dermovate) were evaluated using the human ex vivo skin culture, assessing pharmacodynamic changes in gene expression alongside the pharmacokinetics of drug penetration with both products showing time dependent efficacies. The translational utility of the human ex vivo skin culture model of inflammatory dermatoses was demonstrated through comparison with an in vivo clinical study, with similar reductions in inflammatory gene expression recorded for both drug treatments. Thus, this model can reduce, replace or refine animal testing and also mitigate the risk of failure in costly and time-consuming clinical trials associated with novel topical therapeutic development.

Accelerating topical formulation development for inflammatory dermatoses; an ex vivo human skin culture model consistent with clinical therapeutics.

Ipsilateral avid axillary lymph node uptake at FDG PET/CT persists in 29% (49 of 169) of patients between 7 to 10 weeks after the second dose of the mRNA-based BNT162b2 COVID-19 vaccination.

Prevalence of Increased FDG PET/CT Axillary Lymph Node Uptake Beyond 6 Weeks after mRNA COVID-19 Vaccination

We evaluate the impact of the Federal Reserve corporate credit facilities (PMCCF and SMCCF). A third of the positive effect on prices and liquidity occurred on the announcement date. We document immediate pass through into primary markets, particularly for eligible issuers. Improvements continue as additional information is shared and purchases begin, with the impact of bond purchases larger than the impact of purchases of ETFs. Exploiting cross-sectional evidence, we see the greatest impact on investment grade bonds and in industries less affected by COVID, concluding that the improvement in corporate credit markets can be attributed both to announcement effects of Federal Reserve interventions on the economy and to the specific differential impact of the facilities on eligible issues.

It's What You Say and What You Buy: A Holistic Evaluation of the Corporate Credit Facilities

The preparation of an integrated biosensor for the easy, fast, and sensitive determination of miRNAs is described based on a direct hybridization format and a label-free voltammetric detection. The biosensor involves a disposable carbon electrode substrate doubly nanostructured with reduced graphene oxide (rGO) and AuNPs modified with pyrene carboxylic acid (PCA) and 6-ferrocenylhexanethiol (Fc-SH), respectively. A synthetic amino terminated DNA capture probe was covalently immobilized on the CO2H moieties of PCA/rGO, while Fc-SH was used as a signaling molecule. Differential pulse voltammetry was employed to record the decrease in the oxidation peak current of Fc after the hybridization due to the hindering of the electron transfer upon the formation of the DNA-RNA duplex on the electrode surface. The stepwise biosensor preparation was characterized by surface and electrochemical techniques showing the role played by each biosensor component as well as the reliability of the target miRNA determination. The determination of the oncogene miRNA-21 synthetic target allowed quantification in the low femtomolar range (LOD of 5 fM) with a high discrimination of single-base mismatched sequences in a single 30-min incubation step. The bioplatform allowed the determination of the target miRNA in a small amount of total RNA extracted from breast cancer (BC) cells or directly in serum samples collected from BC patients without the need for prior extraction, purification, amplification, or reverse transcription of the genetic material and with no matrix effect. Graphical abstract.

Determination of miRNAs in serum of cancer patients with a label- and enzyme-free voltammetric biosensor in a single 30-min step.

We previously demonstrated that the typical mitochondrial uncoupler carbonyl cyanide m-chlorophenylhydrazone (CCCP) inhibited artery constriction, but CCCP was used only as a pharmacological tool. Niclosamide is an anthelmintic drug approved by FDA. Niclosamide ethanolamine (NEN) is a salt form of niclosamide and has been demonstrated to uncouple mitochondrial oxidative phosphorylation. The aim of the present study was to elucidate the vasoactivity of NEN and the potential mechanisms. Isometric tension of rat mesenteric artery and thoracic aorta was recorded by using multi-wire myograph system. The protein levels were measured by using western blot techniques. Niclosamide ethanolamine (NEN) treatment relaxed phenylephrine (PE)- and high K+ (KPSS)-induced constriction, and pre-treatment with NEN inhibited PE- and KPSS-induced constriction of rat mesenteric arteries. In rat thoracic aorta, NEN also showed antagonism against PE- and KPSS-induced constriction. NEN induced increase of cellular ADP/ATP ratio in vascular smooth muscle cells (A10) and activated AMP-activated protein kinase (AMPK) in A10 cells and rat thoracic aorta. NEN-induced aorta relaxation was attenuated in AMPKα1 knockout (-/-) mice. SERCA inhibitors cyclopiazonic acid and thapsigargin, but not KATP channel blockers glibenclamide and 5-hydroxydecanoic acid, attenuated NEN-induced vasorelaxation in rat mesenteric arteries. NEN treatment increased cytosolic [Ca2+]i and depolarized mitochondrial membrane potential in vascular smooth muscle cells (A10). Niclosamide in non-salt form showed the similar vasoactivity as NEN in rat mesenteric arteries. Niclosamide ethanolamine inhibits artery constriction, indicating that it would be promising to be developed as an anti-hypertensive drug or it would induce vasodilation-related side effects when absorbed in vivo.

Niclosamide ethanolamine inhibits artery constriction.

A lot has changed over the las t two year s in how engineering faculty teach and how their students learn. Engineering educators were contemplating imminent changes in 2019/2020 when the COVID pandemic struck. The discussion wa s almost two decades old. Social, economic, and developmental factors coupled with advances in technology paved the way for more mult idisciplinary engineering. Engineer s have been tackling new problems to solve and more sophisticated systems to design. Globalization meant that they should acquire certain personal, social, and cultural skills. They have to be more aware of the impac t of their work on society and on the environment. Experiential learning, project- based lear ning, and research-based learning became themes of a new engineering education paradigm, the signs of which were emerging on the horizon. Changes in the philosophy, disciplines, and pedagogy of engineering education were under discussion. The demand for these changes varied, however, in terms of their motivation, scope, scale, and implementation from one country to another.

Pathway to a New Engineering Education Paradigm: The COVID-19 Factor

The COVID-19 pandemic and its consequences, such as contact restrictions, pose new challenges to psychiatric-psychotherapeutic care in many parts of the world. This article provides an overview of digital methods for treating mental disorders under pandemic conditions and for reducing pandemic- related psychological distress (e.g., due to social isolation). Current challenges and limitations in the use of digital treatment options and their long-term perspectives in psychiatric-psychotherapeutic care are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (German) Die COVID-19-Pandemie und ihre Folgen (z. B. Kontaktbeschrankungen) stellen die psychiatrisch-psychotherapeutische Versorgung national und international vor neue Herausforderungen. Dieser Beitrag gibt einen Uberblick uber digitale Verfahren zur Behandlung psychischer Storungen unter Pandemiebedingungen und zur Reduktion pandemiebedingter psychischer Belastung (z. B. aufgrund sozialer Isolation). Diskutiert werden auserdem aktuelle Herausforderungen und Grenzen beim Einsatz digitaler Behandlungsformen sowie Perspektiven fur deren langfristigen Einsatz in der psychiatrisch- psychotherapeutischen Versorgung. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Digital options for treating mental disorders during the COVID-19 pandemic

Transition to in vitro alternative methods to in vivo in vaccine release testing and characterization, the implementation of the consistency approach, and a drive towards international harmonization of regulatory requirements are most pressing needs in the field of vaccines. It is critical for global vaccine community to work together to secure effective progress towards animal welfare and to ensure that vaccines of ever higher quality can reach the populations in need in the shortest possible timeframe. Advancements in the field, case studies, and experiences from Low and Middle Income Countries (LMIC) were the topics discussed by an international gathering of experts during a recent conference titled “Animal Testing for Vaccines – Implementing Replacement, Reduction and Refinement: Challenges and Priorities”. This conference was organized by the International Alliance for Biological Standardization (IABS), and held in Bangkok, Thailand on December 3 and 4 2019. Participants comprised stakeholders from many parts of the world, including vaccine developers, manufacturers and regulators from Asia, Europe, North America, Australia and New Zealand. In interactive workshops and vibrant panel discussions, the attendees worked together to identify the remaining barriers to validation, acceptance and implementation of alternative methods, and how harmonization could be promoted, especially for LMICs.

Animal testing for vaccines. Implementing replacement, reduction and refinement: challenges and priorities

This is the protocol for a Campbell review. The objectives are as follows: To carry out a mixed methods review to summarise current evidence relating to the components of case‐management interventions for people experiencing homelessness.

PROTOCOL: Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta‐analysis and thematic synthesis

160 maternal deaths due to COVID‐19 have been reported worldwide, most of them in middle‐income countries, representing a barrier to reducing maternal mortality.

Worldwide maternal deaths due to COVID‐19: A brief review

Genomics, combined with population mobility data, used to map importation and spatial spread of SARS-CoV-2 in high-income countries has enabled the implementation of local control measures. Here, to track the spread of SARS-CoV-2 lineages in Bangladesh at the national level, we analysed outbreak trajectory and variant emergence using genomics, Facebook ‘Data for Good’ and data from three mobile phone operators. We sequenced the complete genomes of 67 SARS-CoV-2 samples (collected by the IEDCR in Bangladesh between March and July 2020) and combined these data with 324 publicly available Global Initiative on Sharing All Influenza Data (GISAID) SARS-CoV-2 genomes from Bangladesh at that time. We found that most (85%) of the sequenced isolates were Pango lineage B.1.1.25 (58%), B.1.1 (19%) or B.1.36 (8%) in early-mid 2020. Bayesian time-scaled phylogenetic analysis predicted that SARS-CoV-2 first emerged during mid-February in Bangladesh, from abroad, with the first case of coronavirus disease 2019 (COVID-19) reported on 8 March 2020. At the end of March 2020, three discrete lineages expanded and spread clonally across Bangladesh. The shifting pattern of viral diversity in Bangladesh, combined with the mobility data, revealed that the mass migration of people from cities to rural areas at the end of March, followed by frequent travel between Dhaka (the capital of Bangladesh) and the rest of the country, disseminated three dominant viral lineages. Further analysis of an additional 85 genomes (November 2020 to April 2021) found that importation of variant of concern Beta (B.1.351) had occurred and that Beta had become dominant in Dhaka. Our interpretation that population mobility out of Dhaka, and travel from urban hotspots to rural areas, disseminated lineages in Bangladesh in the first wave continues to inform government policies to control national case numbers by limiting within-country travel.

Genomics, social media and mobile phone data enable mapping of SARS-CoV-2 lineages to inform health policy in Bangladesh

Chest radiography is a relatively cheap, widely available medical procedure that conveys key information for making diagnostic decisions. Chest X-rays are almost always used in the diagnosis of respiratory diseases such as pneumonia or the recent COVID-19. In this paper, we propose a self-supervised deep neural network that is pretrained on an unlabeled chest X-ray dataset. The learned representations are transferred to downstream task - the classification of respiratory diseases. The results obtained on four public datasets show that our approach yields competitive results without requiring large amounts of labeled training data.

Self-supervised deep convolutional neural network for chest X-ray classification

The synchrony of patient-ventilator interaction affects the process of mechanical ventilation which is clinically applied for respiratory support The occurrence of patient-ventilator asynchrony (PVA) not only increases the risk of ventilator complications but also affects the comfort of patients To solve the problem of uncertain patient-ventilator interaction in the mechanical ventilation system, a novel method to evaluate patient-ventilator synchrony is proposed in this article Firstly, a pneumatic model is established to simulate the mechanical ventilation system, which is verified to be accurate by the experiments Then, the PVA phenomena are classified and detected based on the analysis of the ventilator waveforms On this basis, a novel synchrony index SIhao is established to evaluate the patient-ventilator synchrony It not only solves the defects of previous evaluation indexes but also can be used as the response parameter in the future research of ventilator control algorithms The accurate evaluation of patient-ventilator synchrony can be applied to the adjustment of clinical strategies and the pathological analyses of patients This research can also reduce the burden on clinicians and help to realize the adaptive control of the mechanical ventilation and weaning process in the future

A Novel Method to Evaluate Patient-Ventilator Synchrony during Mechanical Ventilation

Traditional herbal remedies have been attracting attention as prospective alternative resources of therapy for diverse diseases across many nations. In recent decades, medicinal plants have been gaining wider acceptance due to the perception that these plants, as natural products, have fewer side effects and improved efficacy compared to their synthetic counterparts. Glycyrrhiza glabra L. (Licorice) is a small perennial herb that has been traditionally used to treat many diseases, such as respiratory disorders, hyperdipsia, epilepsy, fever, sexual debility, paralysis, stomach ulcers, rheumatism, skin diseases, hemorrhagic diseases, and jaundice. Moreover, chemical analysis of the G. glabra extracts revealed the presence of several organic acids, liquirtin, rhamnoliquirilin, liquiritigenin, prenyllicoflavone A, glucoliquiritin apioside, 1-metho-xyphaseolin, shinpterocarpin, shinflavanone, licopyranocoumarin, glisoflavone, licoarylcoumarin, glycyrrhizin, isoangustone A, semilicoisoflavone B, licoriphenone, and 1-methoxyficifolinol, kanzonol R and several volatile components. Pharmacological activities of G. glabra have been evaluated against various microorganisms and parasites, including pathogenic bacteria, viruses, and Plasmodium falciparum, and completely eradicated P. yoelii parasites. Additionally, it shows antioxidant, antifungal, anticarcinogenic, anti-inflammatory, and cytotoxic activities. The current review examined the phytochemical composition, pharmacological activities, pharmacokinetics, and toxic activities of G. glabra extracts as well as its phytoconstituents.

Traditional Uses, Bioactive Chemical Constituents, and Pharmacological and Toxicological Activities of Glycyrrhiza glabra L. (Fabaceae)

In the performance of their duties, authorities and organisations with safety and security tasks face major challenges. As a result, the need to expand the knowledge and skills of security forces in a targeted manner through knowledge, systemic and technological solutions is increasing. Of particular importance for this inhomogeneous end user group is the time factor and thus in general also space, distance, and velocity. Authorities focus on people, goods, and infrastructure in the field of prevention, protection, and rescue. For purposive tactical, strategic, and operational planning, geodata and information about past and ongoing operations dispatched and archived at control centers can be used. For that reason, a rule-based process for the geovisual evaluation of massive spatio-temporal data is developed using geoinformation methods, techniques, and technologies by the example of operational emergency data of fire brigade and rescue services. This contribution to the extension of the KDE for hotspot analysis has the goal to put the professional and managerial personnel in a position to create well-founded geoprofiles based on the spatial-temporal location, distribution, and typology of emergency mission hotspots. In doing so, significant data is generated for the neighborhood of the operations in abstract spatial segments, and is used to calculate distance measures for the Kernel Density Estimation (KDE) process. At the end there is a completely derived rule-based kde process for the geovisual analysis of massive spatio-temporal mass data for hotspot geoprofiling.

Geoprofiling in the Context of Civil Security: KDE Process Optimisation for Hotspot Analysis of Massive Emergency Location Data

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging coronavirus causing respiratory disease commonly known as COVID-19. This novel coronavirus transmits from human to human and has caused profound morbidity and mortality worldwide leading to the ongoing pandemic. Moreover, disease severity differs considerably from individual to individual. Investigating the virology of COVID-19 and immunological pathways underlying its clinical manifestations will enable the identification and design of effective vaccines and potential therapies. In this review, we explore COVID-19 virology, the contribution of the immune system (innate and adaptive) during infection and control of the virus. Finally, we highlight vaccine development and implications of immune system modulation for potential therapeutic interventions to design better therapeutic strategies to guide future cure.

Investigating virological, immunological, and pathological avenues to identify potential targets for developing covid-19 treatment and prevention strategies

BACKGROUND: Bacteria and respiratory viruses co-occur in the nasopharynx, and their interactions may impact pathogenesis of invasive disease. Associations of viruses and bacteria in the nasopharynx may be affected by HIV. METHODS: We conducted a nested case-control study from a larger cohort study of banked nasopharyngeal swabs from families with and without HIV in West Bengal India, to look at the association of viruses and bacteria in the nasopharynx of parents and children when they are asymptomatic. Quantitative polymerase chain reaction for 4 bacteria and 21 respiratory viruses was run on 92 random nasopharyngeal swabs from children--49 from children living with HIV (CLH) and 43 from HIV uninfected children (HUC)-- and 77 swabs from their parents (44 parents of CLH and 33 parents of HUC). RESULTS: Bacteria was found in 67% of children, viruses in 45%, and both in 27% of child samples. Staphylococcus aureus (53%) was the most common bacteria, followed by Streptococcus pneumoniae (pneumococcus) (37%) in children and parents (53, 20%). Regardless of HIV status, viruses were detected in higher numbers (44%) in children than their parents (30%) (p = 0.049), particularly rhinovirus (p = 0.02). Human rhinovirus was the most frequently found virus in both CLH and HUC. Children with adenovirus were at six times increased risk of also having pneumococcus (Odds ratio OR 6, 95% CI 1.12–31.9) regardless of HIV status. In addition, the presence of rhinovirus in children was associated with increased pneumococcal density (Regression coeff 4.5, 1.14–7.9). In CLH the presence of rhinovirus increased the risk of pneumococcal colonization by nearly sixteen times (OR 15.6, 1.66–146.4), and, pneumococcus and S. aureus dual colonization by nearly nine times (OR 8.7). CONCLUSIONS: Children more frequently carried viruses regardless of HIV status. In CLH the presence of rhinovirus, the most frequently detected virus, significantly increased co-colonization with pneumococcus and S. aureus.

Association of nasopharyngeal viruses and pathogenic bacteria in children and their parents with and without HIV

Since the last COVID-19 outbreak, several approaches have been put forward to quickly tackle this global calamity. One of the strategies employed by a handful of researchers is the so-called drug repurposing, which consists in finding new therapeutic uses for approved drugs. Following the same paradigm, we report in the present study an investigation of the potential inhibitory activity of 5-FU and nineteen of its analogues against the SARS-CoV-2 main protease in the framework of molecular docking. This work also discusses the profile of druggability of the best binding candidates as well as their inherent reactivity using ADMET and quantum mechanics methods respectively. From the calculations performed, four candidates show promising results with respect to the binding affinity to the target protease, 3CLpro, the therapeutic profile of druggability and safety. Molecular electrostatic potential, Fukui functions and frontier molecular orbitals are scrutinized to discuss the global and local reactivity of these candidates. Further in-vitro and in-vivo investigations are needed to shed light on the possible mechanism of pharmacological action of the proposed ligands.

In silico drug repurposing of anticancer drug 5-FU and analogues against SARS-CoV-2 main protease: molecular docking, pharmacokinetics and chemical reactivity (preprint)

OBJECTIVE To examine contraceptive practices and conception rates after bariatric surgery. METHODS The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18-44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies. RESULTS Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30-39) years. In the first postsurgical year, 12.7% (95% CI 9.4-16.0) of women had no intercourse, 40.5% (95% CI 35.6-45.4) had protected intercourse only, 41.5% (95% CI 36.4-46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4-6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3-17.0; P<.001). The conception rate was 53.8 (95% CI 40.0-71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9-7.0] years); 42.3 (95% CI 30.2-57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19-0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02-11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92-24.75], P<.001) were associated with early conception. CONCLUSIONS Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00465829.

Contraception and Conception After Bariatric Surgery.

Mexico grew -0.1% in 2019. That rate is well below the average between 1980 and 2018, which is 2.4%. Our hypothesis is that the Mexican economy suffered a pre-COVIDfall in its trend growth. To validate the hypothesis we proceed as follows: i) analyze the dynamics of some macroeconomic variables in the first year of the current (2018-2024) and the three previous presidential terms;ii) measure the change in the trend in economic activity and estimate the probability of the economy being in a low growth regime (in a statistical sense) using a three-state Markov switching model;iii) estimate a multivariate regime Markov switching model with the growth of five variables. We summarize our findings into two main results: i) there is a common pattern in macro variables in the first year of a new administration. The main distinguishing feature of the current administration is the reversal of the trade balance in 2019;ii) Mexico moved towards a low growth regime at the end of 2018. We propose, without establishing causality, that the source of the fall in trend growth comes from large changes in economic policy in 2018 and 2019. These changes translated into a negative shock to trend growth. We list four alternative hypotheses. We propose a test for theories explaining the change in 2019: to explain simultaneously the fall in growth and the change of sign of the trade balance. Our theory could account for both facts.

Detecting a Pre-COVID Fall in the Trend Growth of the Mexican Economy: Extended Version (preprint)/ en

Object trackers are a tool to achieve accurate object state estimation over time Due to their complexity, a framework to experiment with different variations of trackers and their subcomponents is desired This drove the authors research and experimentation with object tracking using MathWorks toolsets In this paper, three object trackers - Point Target Tracker (PTT), Gamma Gaussian Inverse Wishart Probability Hypothesis Density (GGIW-PHD), and Gaussian Mixture Probability Hypothesis Density (GM-PHD) - are compared in simulation for track statistics and object/track accuracy The results show that a rectangular GM-PHD multi object tracker outperforms the other trackers A follow up is shown using real-world data and the process used to get the sensor data into the appropriate MathWorks format The impact of COVID-19 prevented the collection of ground truth data so the real-world data cannot be compared using the same metrics For this reason, the simulation portion of this paper will act as the detailed discussion of fusion and tracking while the real-world testing portion is an overview of the authors' process of converting real-world sensor data into a format compatible with MathWorks object tracking tools © 2021 SAE International All rights reserved

Object Tracking Comparison for Automated Vehicles Using MathWorks Toolsets

BACKGROUND: The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste—contaminated with EVD and other highly infectious pathogens—is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. METHODS: A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. RESULTS: Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. CONCLUSIONS: Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety.

A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste

Exclusive breastfeeding (EBF) during the first 6 months of life is crucial for optimizing child growth, development and survival, as well as the mother's wellbeing. Mother's employment may hinder optimal breastfeeding, especially in the first 6 months. We assessed the effectiveness of a baby‐friendly workplace support intervention on EBF in Kenya. This pre‐post intervention study was conducted between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/breastfeeding women residing on the farm and consisted of workplace support policies and programme interventions including providing breastfeeding flexi‐time and breaks for breastfeeding mothers; day‐care centres (crèches) for babies near the workplace and lactation centres with facilities for breast milk expression and storage at the crèches; creating awareness on available workplace support for breastfeeding policies; and home‐based nutritional counselling for pregnant and breastfeeding women. EBF was measured through 24‐h recall. The effect of the intervention on EBF was estimated using propensity score weighting. The study included 270 and 146 mother–child dyads in the nontreated (preintervention) group and treated (intervention) group, respectively. The prevalence of EBF was higher in the treated group (80.8%) than in the nontreated group (20.2%); corresponding to a fourfold increased probability of EBF [risk ratio (RR) 3.90; 95% confidence interval (CI) 2.95–5.15]. The effect of the intervention was stronger among children aged 3–5 months (RR 8.13; 95% CI 4.23–15.64) than among those aged <3 months (RR 2.79; 95% CI 2.09–3.73). The baby‐friendly workplace support intervention promoted EBF especially beyond 3 months in this setting.

Effect of a baby‐friendly workplace support intervention on exclusive breastfeeding in Kenya

After the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), research has highlighted several aspects of the pandemic, focusing on clinical features and risk factors associated with infection and disease severity. However, emerging results on the role of smoking in SARS-CoV-2 infection susceptibility or COVID-19 outcomes are conflicting, and their robustness remains uncertain. In this context, this project aims at quantifying the proportion of SARS-CoV-S antibody seroprevalence, studying the changes in antibody levels over time, and analyzing the association between smoking status and infection using seroprevalence data. The added value of this research is that the current smoking status of the population to be studied will be biochemically verified, in order to avoid the bias associated with self-reported smoking status. As such, the results from this survey may provide actionable metric to study the role of smoking in SARS-CoV-2 spread, and therefore implement the most appropriate public health measures to control the pandemic. The research design involves a 6-month prospective cohort study with serial sampling of the same individuals. Each participant will be surveyed about their demographics and COVID-19-related information, and blood sampling will be collected upon recruitment and at specified follow-up time points (namely, after 8 and 24 weeks). Blood samples will be screened for the presence of SARS-CoV-2 specific antibodies and serum cotinine. Overall, we expect to find a higher prevalence of antibodies in individuals at high-risk for viral exposure (i.e., healthcare or other essential workers), according to previous literature, and to refine current estimates on the association between smoking status and SARS-CoV-2/COVID-19. Our results may serve as a reference for future clinical research and the methodology could be exploited in public health sectors and policies.

POPULATION-BASED SERO-EPIDEMIOLOGICAL STUDY PROTOCOL FOR THE IMPACT OF SMOKING ON SARS-COV-2 INFECTION AND COVID-19 OUTCOMES - THE TROINA STUDY

New Energy Vehicles (NEVs), and especially electric cars, are rapidly changing the outlook of the car industry in China, the largest vehicle market in the world However, an adjustment in subsidy schemes and breakout of COVID-19 appear to slow down the uptake of NEVs in the Chinese market This raises the question of whether, other less costly, policy instruments can help the transformation towards cleaner vehicles With the understanding that public support and user acceptance play a key role, we ask whether NEVs as part of increasingly popular car-sharing mode can gain further support, the increased uptake of new energy vehicles To investigate this question, we perform an online survey, retrieving 1583 questionnaires, and scrutinize the perception of NEVs at the nexus with car-sharing Relying on the Theory of Planned Behavior and ordered logistic regression model, we demonstrate that attitudes towards environmental protection and perceived benefits (economic and safety) play a key role in accelerating the adoption of shared electric cars NEVs promotion policies need to specifically target groups by regions Municipal agencies can substantially support NEV uptake by providing on-street parking exclusively for shared NEVs in cities, and information on the economic and social benefits of NEVs in rural areas

Leverage points for accelerating adoption of shared electric cars: Perceived benefits and environmental impact of NEVs

In the present study, we report on the simple sol-gel preparation of a nanocomposite composed of chitosan/ polyoxometalate /graphene oxide, and its application in the headspace solid-phase microextraction combined with the ion mobility spectrometry for the analysis of methadone in biological matrices. The developed nanocomposite was characterized through the infrared spectroscopy and thermogravimetric analyses. The ternary nanocomposite coating offers the good mechanical and thermal stability and high extraction efficiency thanks to its large specific surface. A central composite statistical design was used to study the main variables affecting the extraction efficiency. Afterwards, to study the relationship between different input and output variables as well as to identify the optimal operating conditions, response surface methodology was used, whereby a second-order polynomial equation was fit to the experimental data. The optimized extraction conditions were as follows: temperature, 70°C; extraction time, 15 min; and concentration of NaCl, 5%w/v. Detection limit of 0.12 ng mL-1 was obtained at the optimized extraction conditions, and the calibration plot was linear in the concentration range of 0.30-200 ng mL-1 . With relatively low limit of detection and good precisions, the proposed method has the potential for the extraction and determination of methadone in biological samples. This article is protected by copyright. All rights reserved.

Solid-phase microextraction of methadone by using a chitosan nanocomposite incorporated with Polyoxomolibdate nanocluster/Graphene oxide.

OBJECTIVE: The present study aimed to describe the experience of, and factors associated with, disordered eating in a population-based sample of emerging adults during the COVID-19 outbreak. METHOD: Participants in the EAT 2010-2018 (Eating and Activity over Time) study were invited to complete the C-EAT (COVID-19 EAT) survey in April-May 2020. There were 720 respondents to the survey (age: 24.7 ± 2.0 years). Psychological distress, stress, stress management, financial difficulties, and food insecurity during the COVID-19 pandemic were examined as cross-sectional correlates of disordered eating in 2020. Open-ended questions assessed the perceived impact of the pandemic on eating behaviors. RESULTS: Low stress management was significantly associated with a higher count of extreme unhealthy weight control behaviors (UWCBs). Food insecurity, higher depressive symptoms, and financial difficulties were significantly associated with a higher count of less extreme UWCBs. Higher stress and depressive symptoms were significantly associated with greater odds of binge eating. Six themes pertaining to disordered eating during the pandemic emerged: (a) mindless eating and snacking; (b) increased food consumption; (c) generalized decrease in appetite or dietary intake; (d) eating to cope; (e) pandemic-related reductions in dietary intake; and (f) re-emergence or marked increase in eating disorder symptoms. DISCUSSION: Psychological distress, stress management, financial difficulties, and abrupt schedule changes may have contributed to disordered eating during the COVID-19 pandemic. Interventions that target stress management, depressive symptoms, and financial strain and provide tools to develop a routine may be particularly effective for emerging adults at risk of developing disordered eating during public health crises.

Disordered eating in a population-based sample of young adults during the COVID-19 outbreak

Severe acute respiratory syndrome coronavirus 2 is the causative agent of the ongoing coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6-7 days and a basic reproductive number (R0) of 2.2-2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period (4.2 days). We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3-3.3 days. Assuming a serial interval of 6-9 days, we calculated a median R0 value of 5.7 (95% CI 3.8-8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.

High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2

Over the past decades, a better understanding of the genetic and molecular alterations underlying several respiratory diseases has encouraged the development of new therapeutic strategies. Gene therapy offers new therapeutic alternatives for inherited and acquired diseases by delivering exogenous genetic materials into cells or tissues to restore physiological protein expression and/or activity. In this review, we review (1) different types of viral and non-viral vectors as well as gene-editing techniques; and (2) the application of gene therapy for the treatment of respiratory diseases and disorders, including pulmonary arterial hypertension, idiopathic pulmonary fibrosis, cystic fibrosis, asthma, alpha-1 antitrypsin deficiency, chronic obstructive pulmonary disease, non-small-cell lung cancer, and COVID-19. Further, we also provide specific examples of lung-targeted therapies and discuss the major limitations of gene therapy.

Novel Insights into the Therapeutic Potential of Lung-Targeted Gene Transfer in the Most Common Respiratory Diseases

BACKGROUND: COVID-19 is a lung disease, and there is medical evidence that air pollution is one of the external causes of lung diseases. Fine particulate matter is one of the air pollutants that damages pulmonary tissue. The combination of the coronavirus and fine particulate matter air pollution may exacerbate the coronavirus’ effect on human health. RESEARCH QUESTION: This paper considers whether the long-term concentration of fine particulate matter of different sizes changes the number of detected coronavirus infections and the number of COVID-19 fatalities in Germany. STUDY DESIGN: Data from 400 German counties for fine particulate air pollution from 2002 to 2020 are used to measure the long-term impact of air pollution. Kriging interpolation is applied to complement data gaps. With an ecological study, the correlation between average particulate matter air pollution and COVID-19 cases, as well as fatalities, are estimated with OLS regressions. Thereby, socioeconomic and demographic covariates are included. MAIN FINDINGS: An increase in the average long-term air pollution of 1 μg/m(3) particulate matter PM(2.5) is correlated with 199.46 (SD = 29.66) more COVID-19 cases per 100,000 inhabitants in Germany. For PM(10) the respective increase is 52.38 (SD = 12.99) more cases per 100,000 inhabitants. The number of COVID-19 deaths were also positively correlated with PM(2.5) and PM(10) (6.18, SD = 1.44, respectively 2.11, SD = 0.71, additional COVID-19 deaths per 100,000 inhabitants). CONCLUSION: Long-term fine particulate air pollution is suspected as causing higher numbers of COVID-19 cases. Higher long-term air pollution may even increase COVID-19 death rates. We find that the results of the correlation analysis without controls are retained in a regression analysis with controls for relevant confounding factors. Nevertheless, additional epidemiological investigations are required to test the causality of particulate matter air pollution for COVID-19 cases and the severity.

Long-term exposure to fine particulate matter air pollution: An ecological study of its effect on COVID-19 cases and fatality in Germany

OBJECTIVE We address the hypothesis that the extraordinary sandstorm occurred on 22-24 February 2020 might have a role in the different cumulated incidence of COVID-19 cases between the islands of Tenerife and Gran Canaria, since it obliged to reduce significantly air traffic and forced to suspend all major carnival street events in all most locations. METHOD We performed a retrospective analysis of COVID-19 cases as to 1 April 2020 according to symptoms onset, weather-related data and Carnival events in Tenerife and Gran Canaria. RESULTS The sandstorm occurred on February 22-24, 2020, forced air traffic to close, reducing the influx of tourists to the Canary Islands and suspending carnival events in most places, except in Santa Cruz de Tenerife. Cumulated incidence as to 1 April was 132.81/100,000 in Tenerife, and 56.04/100,000 in Gran Canaria. CONCLUSIONS The suspension of Carnival events due to the sandstorm in the Canary Islands contributed to reduce differently the SARS-CoV-2 spread in Tenerife and Gran Canaria.

Impact of sandstorm and carnival celebrations on SARS-CoV-2 spreading in Tenerife and Gran Canaria (Canary Islands, Spain).

Greece imposed a nationwide lockdown in March 2020 to mitigate transmission of severe acute respiratory syndrome coronavirus 2 during the first epidemic wave. We conducted a survey on age-specific social contact patterns to assess effects of physical distancing measures and used a susceptible-exposed-infectious-recovered model to simulate the epidemic. Because multiple distancing measures were implemented simultaneously, we assessed their overall effects and the contribution of each measure. Before measures were implemented, the estimated basic reproduction number (R(0)) was 2.38 (95% CI 2.01–2.80). During lockdown, daily contacts decreased by 86.9% and R(0) decreased by 81.0% (95% credible interval [CrI] 71.8%–86.0%); each distancing measure decreased R(0 )by 10%–24%. By April 26, the attack rate in Greece was 0.12% (95% CrI 0.06%–0.26%), one of the lowest in Europe, and the infection fatality ratio was 1.12% (95% CrI 0.55%–2.31%). Multiple social distancing measures contained the first epidemic wave in Greece.

Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the microorganism responsible for the aggressive Coronavirus Disease (COVID-19) pandemic. During the such pandemic, discharge and community reintegration of patients are critical phases in guaranteeing public health. A review of the international and Italian experiences that represent the best available evidence was carried out, mainly focusing on the precise allocation of tasks and related responsibilities. The report provides a proposal for a systematic management pathway dedicated to COVID-19 patients. The original result is a logigramme to guide health practitioners on discharge and community reintegration of COVID-19 patients. To standardize clinical attitudes helps in ensuring quality of care and patient safety, should be a core element even during a public health emergency. The logigramme suggests, after discharge, 14 days of further isolation with regular health monitoring and, finally, the execution of a nasopharyngeal swab for identification of SARS-CoV-2 viral RNA. Home-cared patients should be placed on 7 days of further isolation after at least 2 negative RT-PCR tests for respiratory tract samples (nasopharyngeal swab). The logigramme is already used in the Department of Prevention - Local Health Agency of Lecce (Apulia) but it will be updated according to the latest research findings.

An original logigramme to make safe discharge and community reintegration for COVID-19 patients

There appears to be a connection between COVID-19 infection and an airborne microscopic pollutant called particulate matter which has been suggested to act as vector for viral transmission. The highest human exposure to particulate matter occurs during smoking and to a lesser extent to 2(nd) hand smoking. This article offers a hypothetical proposition that particulate matter derived from tobacco smoking may act as COVID-19’s vector for infection transmission. With a background smoking Chinese male population of more than 66% and more than 70% of Chinese nonsmokers exposed to 2(nd) hand smoke, the potential of exhaled smoke acting as a viral vector is significant. If this hypothesis is proven, measures such as face protection to reduce coronavirus-laden particulate matter transmission, measures of social distancing and legislation to protect nonsmokers from contracting the infection through 2(nd) hand smoking should be implemented. (www.actabiomedica.it)

Could the COVID-19 Positive Asymptomatic Tobacco Smoker be a Silent Superspeader?

Abstract Despite the pioneering efforts to identify correlates of passive immunity to transmissible gastroenteritis virus (TGEV), effective vaccines for the control of TGE in suckling pigs have remained elusive. The initial concept of an enteromammary immunologic axis in monogastrics originated from studies of lactogenic immunity to TGEV in swine. These studies revealed that infection of pregnant swine with virulent TGEV stimulated high titers of SIgA antibodies in milk which correlated with protection of suckling pigs against TGE; parenteral or oral inoculation with live attenuated or killed TGEV vaccines induced mainly IgG antibodies in milk which generally provided poor protection to suckling pigs. The recent appearance of PRCV infections in swine and continuing studies of TGEV infections, present a unique model for further studies of mucosal immunity. Research using these viruses has increased our understanding of the various components of the common mucosal immune system and their interactions. Although the most important consideration in designing an effective vaccine for TGEV is the stimulation of GALT through intestinal virus replication, studies addressing the contribution of BALT to immunity to TGEV and PRCV may provide insights for alternative vaccine approaches. The mechanism by which exposure to PRCV elicits a variable degree of immunity to TGEV challenge is unknown. Virus replication in the gut or respiratory tract is a major factor affecting the magnitude of the immune response at the respective site and may be necessary for the recruitment of specific immune cells from other mucosal inductive sites, i.e., GALT to BALT and BALT to GALT migration. Further studies on the induction and immune regulation of specific responses to TGEV and PRCV that affect the distribution patterns of IgM-, IgG- and IgA-antibody-secreting cells (ASC) and T lymphocytes should provide valuable insights for optimizing vaccine regimens to elicit the highest mucosal immune responses and optimal protection against TGEV challenge.

Immunity to transmissible gastroenteritis virus and porcine respiratory coronavirus infections in swine