title: Cardiovascular comorbidities and complications associated with coronavirus disease 2019

text: Coronavirus disease 2019 (COVID-19) has caused a devastating global pandemic and continues to overwhelm the health-care facilities and shatter the economies of countries worldwide. Although it primarily affects the lungs, it shares a strong interplay with the cardiovascular system. The presence of underlying cardiovascular disease and its risk factors (diabetes, hypertension) predispose the patients to increased severity and mortality associated with COVID-19. On the other hand, COVID-19 itself leads to various cardiovascular complications, which increase its associated morbidity and mortality in affected patients. It is, therefore, prudent to review the rapidly evolving data in this field and understand the mechanisms behind the cardiovascular involvement of this lethal disease.


title: Public pensions and unmet medical need among older people: cross-national analysis of 16 European countries, 2004–2010

text: BACKGROUND: Since the onset of the Great Recession in Europe, unmet need for medical care has been increasing, especially in persons aged 65 or older. It is possible that public pensions buffer access to healthcare in older persons during times of economic crisis, but to our knowledge, this has not been tested empirically in Europe. METHODS: We integrated panel data on 16 European countries for years 2004–2010 with indicators of public pension, unemployment insurance and sickness insurance entitlement from the Comparative Welfare Entitlements Dataset and unmet need (due to cost) prevalence rates from EuroStat 2014 edition. Using country-level fixed-effects regression models, we evaluate whether greater public pension entitlement, which helps reduce old-age poverty, reduces the prevalence of unmet medical need in older persons and whether it reduces inequalities in unmet medical need across the income distribution. RESULTS: We found that each 1-unit increase in public pension entitlement is associated with a 1.11 percentage-point decline in unmet medical need due to cost among over 65s (95% CI −0.55 to −1.66). This association is strongest for the lowest income quintile (1.65 percentage points, 95% CI −1.19 to −2.10). Importantly, we found consistent evidence that out-of-pocket payments were linked with greater unmet needs, but that this association was mitigated by greater public pension entitlement (β=−1.21 percentage points, 95% CI −0.37 to −2.06). CONCLUSIONS: Greater public pension entitlement plays a crucial role in reducing inequalities in unmet medical need among older persons, especially in healthcare systems which rely heavily on out-of-pocket payments.


title: Endocytosis unplugged: multiple ways to enter the cell

text: Endocytosis occurs at the cell surface and involves internalization of the plasma membrane (PM) along with its constituent membrane proteins and lipids. Endocytosis is involved in sampling of the extracellular milieu and also serves to regulate various processes initiated at the cell surface. These include nutrient uptake, signaling from cell-surface receptors, and many other processes essential for cell and tissue functioning in metazoans. It is also central to the maintenance of PM lipid and protein homeostasis. There are multiple means of internalization that operate concurrently, at the cell surface. With advancement in high-resolution visualization techniques, it is now possible to track multiple endocytic cargo at the same time, revealing a remarkable diversity of endocytic processes in a single cell. A combination of live cell imaging and efficient genetic manipulations has also aided in understanding the functional hierarchy of molecular players in these mechanisms of internalization. Here we provide an account of various endocytic routes, their mechanisms of operation and occurrence across phyla.


title: Is the use of RAS inhibitors safe in the current era of COVID-19 pandemic?

text: Antihypertensive drugs are one of the most widely used pharmacologic agent in the world and it is predominantly used in the elderly subjects. Pneumonia is the most common cause of death in the extremely old subject. During infection and its complication such as sepsis, hypotension could be exacerbated by antihypertensive drugs because homeostasis mechanisms such as sodium balance, renin angiotensin aldosterone system and/or sympathetic nervous system can be mitigated by antihypertensive drug therapy. Severe Acute Respiratory Syndrome-Coronavirus-1 and 2 viral surface protein is known to attach angiotensin converting enzyme 2 (ACE2) on the cell membrane to facilitate viral entry into the cytoplasm. Despite the theoretical concerns of increased ACE2 expression by Renin-Angiotensin-Aldosterone system (RAS) blockade, there is no evidence that RAS inhibitors are harmful during COVID-19 infection and have in fact been shown to be beneficial in animal studies. Therefore, it is recommended to maintain RAS blockade during the current corona virus pandemic.


title: Oligonucleotide-based microarray for detection of plant viruses employing sequence-independent amplification of targets

text: Abstract The potential of DNA microarrays for detection of plant viruses is hampered by underutilization of sequence-independent amplification methods for target nucleic acid enrichment. A microarray system is described for an unbiased detection of plant viruses using both short (30nt) and long (50 and 70nt) oligonucleotide probes. The assay involves amplification of target nucleic acid using random primers followed by in vitro transcription whose cRNA product is labeled chemically, fragmented and used as target for hybridization. Initial optimization tests with Turnip vein clearing virus and Cauliflower mosaic virus showed increased hybridization efficiency with shorter cDNA targets (100bp) and longer probes (50 and 70nt). The system was validated in pure and mixed samples by detection of three Tymovirus species: Asclepias asymptomatic virus, Kennedya yellow mosaic virus and Turnip yellow mosaic virus. The method could detect sequence variants with 70–75% or higher sequence identity, indicating the possible utility of the approach for virus discovery. Array performance comparison of long probes demonstrated the competence of 50-mers to provide a satisfactory balance between detection sensitivity and specificity. The work described is a significant step towards a method to assess, in one assay, the presence of a large diversity of relatives of known viruses of plants.


title: Anti‐cardiolipin IgG autoantibodies are an independent risk factor of COVID‐19 severity

text: A growing body of evidence indicates that patients with cardiovascular complications are at a higher risk for developing severe Coronavirus Disease 2019 (COVID‐19) (1). In addition, the high incidence of thromboembolic events suggests an important role of COVID‐19‐induced coagulopathy (2). Antiphospholipid autoantibodies (aPL), that are essential markers for antiphospholipid syndrome, are considered as a cardiovascular risk factor.


title: The re-direction of small deposit mining: technological solutions for raw materials supply security in a whole systems context

text: Large-scale mining of low-grade ores is energy-intensive and generates vast wastes. It has limited suitability for production of specialist metals that are required in relatively small quantities. An approach that limits environmental impact by restricting mining to high-grade deposits requires the investigation of small ore deposits as alternative sources of metals. The return on investment from small deposits is incompatible with the expensive surveys needed to secure investment and the high costs of managing risk. But increasing energy and transport costs may create space in the market for small-deposit mining with highly-competitive technological solutions. It can be argued that small-deposit mining is ethical because it must involve cooperation between mining companies and local residents who share a collective expectation and responsibility for their quality of life. However, small-deposit mining tends to be a limited, short-term initiative, which requires consideration of the extended ‘afterlife’ of mines. This manuscript is the culmination of five years of cross-sector dialogue and stakeholder engagement activities. It debates what constitutes a small deposit and describes the interactions between mining and manufacturing, investment, environment and society. It reaches the conclusion that technological innovations will support the re-emergence of small deposit mining as an important part of a diverse raw materials production sector. We do not suggest a return to past approaches, to mining of small, high-grade deposits, but a consideration of alternative narratives of localised, community-oriented mining processes, thus giving social, economic and environmental context to the needs of the present day.


title: Viruses in Bovine Respiratory Disease in North America: Knowledge Advances Using Genomic Testing

text: Advances in viral detection in bovine respiratory disease (BRD) have resulted from advances in viral sequencing of respiratory tract samples. New viruses detected include influenza D virus, bovine coronavirus, bovine rhinitis A, bovine rhinitis B virus, and others. Serosurveys demonstrate widespread presence of some of these viruses in North American cattle. These viruses sometimes cause disease after animal challenge, and some have been found in BRD cases more frequently than in healthy cattle. Continued work is needed to develop reagents for identification of new viruses, to confirm their pathogenicity, and to determine whether vaccines have a place in their control.


title: COVID-19 model-based practice changes in managing a large prostate cancer practice: following the trends during a month-long ordeal

text: Coronavirus (COVID-19) has been a life-changing experience for both individuals and institutions. We describe changes in our practice based on real-time assessment of various national and international trends of COVID-19 and its effectiveness in the management of our resources. Initial risk assessment and peak resource requirement using the COVID-19 Hospital Impact Model for Epidemics (CHIME) and McKinsey models. Strengths, weaknesses, opportunities, and threats (SWOT) analysis of our practice’s approach during the pandemic. Based on CHIME the community followed 60% social distancing, the number of expected new patients hospitalized at maximum surge would be 401, with 100 patients requiring ventilator support. In contrast, when the community followed 15% social distancing, the maximum surge of hospitalized new patients would be 1823 and 455 patients would require a ventilator. on April 15, the expected May requirement of ICU beds at peak would be 68, with 61 patients needing ventilators. The estimated surge numbers improved throughout April, and on April 22 the expected ICU bed peak in May would be 11.7, and those requiring ventilator would be 10.5. Simultaneously, within a month, our surgical waitlist grew from 585 to over 723 patients. Our SWOT analysis revealed our internal strengths and inherent weakness, relevant to the pandemic. A graded and a guarded response to this type of situation is crucial in managing patients in a large practice.


title: Liu Shen capsule shows antiviral and anti-inflammatory abilities against novel coronavirus SARS-CoV-2 via suppression of NF-κB signaling pathway

text: Abstract Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide through person-to-person contact, causing a public health emergency of international concern. At present, there is no specific antiviral treatment recommended for SARS-CoV-2 infection. Liu Shen capsule (LS), a traditional Chinese medicine, has been proven to have a wide spectrum of pharmacological properties, such as anti-inflammatory, antiviral and immunomodulatory activities. However, little is known about the antiviral effect of LS against SARS-CoV-2. Herein, the study was designed to investigate the antiviral activity of SARS-CoV-2 and its potential effect in regulating the host’s immune response. The inhibitory effect of LS against SARS-CoV-2 replication in Vero E6 cells was evaluated by using the cytopathic effect (CPE) and plaque reduction assay. The number of virions of SARS-CoV-2 was observed under transmission electron microscope after treatment with LS. Proinflammatory cytokine expression levels upon SARS-CoV-2 infection in Huh-7 cells were measured by real-time quantitative PCR assays. The results showed that LS could significantly inhibit SARS-CoV-2 replication in Vero E6 cells, and reduce the number of virus particles and it could markedly reduce pro-inflammatory cytokines (TNF-α, IL-6, IL-1β, IL-8, CCL-2/MCP-1 and CXCL-10/IP-10) production at the mRNA levels. Moreover, the expression of the key proteins in the NF-κB/MAPK signaling pathway was detected by western blot and it was found that LS could inhibit the expression of p-NF-κB p65, p-IκBα and p-p38 MAPK, while increasing the expression of IκBα. These findings indicate that LS could inhibit SARS-CoV-2 virus infection via downregulating the expression of inflammatory cytokines induced virus and regulating the activity of NF-κB/MAPK signaling pathway in vitro, making its promising candidate treatment for controlling COVID-19 disease.


title: A CASE REPORT OF COVID-19 ASSOCIATED HYPERACTIVE ICU DELIRIUM WITH PROPOSED PATHOPHYSIOLOGY AND TREATMENT

text: There have been increasing reports of neuropsychiatric presentations and symptoms of COVID-19, more commonly seen in severely ill patients. Delirium, which is highly prevalent in general intensive care unit (ICU) populations, is expected to be frequent and prominent in COVID-19 patients hospitalized with acute respiratory distress syndrome (ARDS) in ICU. In this case report with associated review, we present a case of a critically ill patient with COVID-19 managed in ICU for ARDS. Psychiatry was consulted for management of her hyperactive delirium, likely complicated by environmental factors inherent in management of COVID-19 patients as well as the use of multiple sedatives. Patient was successfully managed by psychiatry with a combination of high-dose melatonin, suvorexant, guanfacine, intravenous haloperidol, and intravenous valproic acid. In addition to case presentation, we discuss a proposed delirium pathophysiology in COVID-19 associated delirium and a systematized approach to evaluation and management of such patients.


title: Risk factors associated with diarrhea in Danish commercial mink (Neovison vison) during the pre-weaning period

text: BACKGROUND: Pre-weaning diarrhea in mink, also known as “sticky kits”, is a syndrome and outbreaks occur every year on commercial mink farms in all mink producing countries. Morbidity and mortality can be considerable on a farm with huge economic consequences for the farmer as well as compromised welfare for the mink kits. Although efforts have been taken to identify etiologic agents involved in outbreaks, the syndrome is still regarded as multifactorial and recurring problems on the same farms draw attention to management and environmental risk factors. In the pre-weaning period from May to June 2015, a case control study was carried out on 30 Danish mink farms. Data concerning management, biosecurity, hygiene, feed consumption, antibacterial prescription and production efficiency were analyzed. RESULTS: The proportion of 1-year old females, farm size (total number of females), energy supply per female in the late gestation period, and dogs accessing the farm area were significantly associated with being a case farm. Case farms were prescribed almost twice the amount of antibacterials per gestational unit (female and litter) as in control farms. Farmers on case farms spent significantly more time nursing and treating the animals and experienced more females with mastitis compared to farmers on control farms. No significant differences in cleaning practices or hygienic measures between case and control farms were found and there were no differences in drinking water quality, bedding material, composition neither of color types nor in management regarding litter equalization. CONCLUSIONS: Results from this study showed an association between the occurrence of pre-weaning diarrhea on mink farms and parity profile, farm size and feeding intensity in the gestational period. The access of dogs to the farm area was a significant risk factor, but needs further clarification. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13028-017-0312-1) contains supplementary material, which is available to authorized users.


title: Viroporins, Examples of the Two-Stage Membrane Protein Folding Model

text: Viroporins are small, α-helical, hydrophobic virus encoded proteins, engineered to form homo-oligomeric hydrophilic pores in the host membrane. Viroporins participate in multiple steps of the viral life cycle, from entry to budding. As any other membrane protein, viroporins have to find the way to bury their hydrophobic regions into the lipid bilayer. Once within the membrane, the hydrophobic helices of viroporins interact with each other to form higher ordered structures required to correctly perform their porating activities. This two-step process resembles the two-stage model proposed for membrane protein folding by Engelman and Poppot. In this review we use the membrane protein folding model as a leading thread to analyze the mechanism and forces behind the membrane insertion and folding of viroporins. We start by describing the transmembrane segment architecture of viroporins, including the number and sequence characteristics of their membrane-spanning domains. Next, we connect the differences found among viroporin families to their viral genome organization, and finalize focusing on the pathways used by viroporins in their way to the membrane and on the transmembrane helix-helix interactions required to achieve proper folding and assembly.


title: Review of bioaerosols in indoor environment with special reference to sampling, analysis and control mechanisms

text: Abstract Several tiny organisms of various size ranges present in air are called airborne particles or bioaerosol which mainly includes live or dead fungi and bacteria, their secondary metabolites, viruses, pollens, etc. which have been related to health issues of human beings and other life stocks. Bio-terror attacks in 2001 as well as pandemic outbreak of flue due to influenza A H1N1 virus in 2009 have alarmed us about the importance of bioaerosol research. Hence characterization i.e. identification and quantification of different airborne microorganisms in various indoor environments is necessary to identify the associated risks and to establish exposure threshold. Along with the bioaerosol sampling and their analytical techniques, various literatures revealing the concentration levels of bioaerosol have been mentioned in this review thereby contributing to the knowledge of identification and quantification of bioaerosols and their different constituents in various indoor environments (both occupational and non-occupational sections). Apart from recognition of bioaerosol, developments of their control mechanisms also play an important role. Hence several control methods have also been briefly reviewed. However, several individual levels of efforts such as periodic cleaning operations, maintenance activities and proper ventilation system also serve in their best way to improve indoor air quality.


The appropriate position of radiology in COVID-19 diagnosis and treatment—current status and opinion from China


Climate Change, Covid-19, Preparedness, and Consciousness


title: Chemical Composition, Antioxidant and Antimicrobial Activities of Sanguisorba officinalis L. Extracts

text: Sanquisorba officinalis has been used internally for the treatment of intestinal infections and duodenal ulcers, as well as hemorrhoids, phlebitis and varicose veins and female disorders, and topically to heal wounds, burns, and ulcers. In our study, the antioxidant and antimicrobial activities, as well as quantitative analysis of polyphenols (phenolic acids, flavonoids and total polyphenols) in methanol and aqueous extracts from S. officinalis herbs are presented. A correlation between the antioxidant activity and composition of tested extracts indicates that flavonoids are the major compounds causing scavenging of free radicals. Higher content of flavonoids was found in the methanol extract, while the content of total phenolics was higher in the aqueous extract. Both extracts from S. officinalis herbs showed antioxidant activity and high antimicrobial activity in a wide spectrum of test strains.


title: Risk Factors for Pandemic (H1N1) 2009 Virus Seroconversion among Hospital Staff, Singapore

text: We describe incidence and risk factors for pandemic (H1N1) 2009 virus infection in healthcare personnel during the June–September 2009 epidemic in Singapore. Personnel contributed 3 serologic samples during June–October 2009, with seroconversion defined as a >4-fold increase in hemagglutination inhibition titers to pandemic (H1N1) 2009. Of 531 participants, 35 showed evidence of seroconversion. Seroconversion rates were highest in nurses (28/290) and lowest in allied health staff (2/116). Significant risk factors on multivariate analysis were being a nurse (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] 1.0–19.6) and working in pandemic (H1N1) 2009 isolation wards (aOR 4.5, 95% CI 1.3–15.6). Contact with pandemic (H1N1) 2009–infected colleagues (aOR 2.5, 95% CI 0.9–6.6) and larger household size (aOR 1.2, 95% CI 1.0–1.4) were of borderline significance. Our study suggests that seroconversion was associated with occupational and nonoccupational risk factors.


title: Medical Vulnerability of Young Adults to Severe COVID-19 Illness—Data From the National Health Interview Survey

text: PURPOSE: COVID-19 morbidity and mortality reports in the U.S. have not included findings specific to young adults. The Centers for Disease Control and Prevention provides a list of conditions and associated behaviors, including smoking, conferring risk of severe COVID-19 illness regardless of age. This study examines young adults' medical vulnerability to severe COVID-19 illness, focusing on smoking-related behavior. METHODS: A young adult subsample (aged 18–25 years) was developed from the National Health Interview Survey, a nationally representative data set, pooling years 2016–2108. The medical vulnerability measure (yes vs. no) was developed, guided by the Centers for Disease Control and Prevention risk indicators. The estimates of medical vulnerability were developed for the full sample, the nonsmoking sample, and the individual risk indicators. Logistic regressions were conducted to examine differences by sex, race/ethnicity, income, and insurance. RESULTS: Medical vulnerability was 32% for the full sample and half that (16%) for the nonsmoking sample. Patterns and significance of some subgroup differences differed between the full and the nonsmoking sample. Male vulnerability was (33%) higher than female (30%; 95% CI: .7–.9) in the full sample, but lower in nonsmokers: male (14%) versus female (19%; 95% CI: 1.2–1.7). The white subgroup had higher vulnerability than Hispanic and Asian subgroups in both samples—full sample: white (31%) versus Hispanic (24%; 95% CI: .6–.9) and Asian (18%; 95% CI: .4–.5); nonsmokers: white (17%) versus Hispanic (13%; 95% CI: .06–.9) and Asian (10%; 95% CI: .3–.8). CONCLUSIONS: Notably, lower young adult medical vulnerability within nonsmokers versus the full sample underscores the importance of smoking prevention and mitigation.


Evolución mortal de la enfermedad COVID-19 en un lactante de 5 meses con comorbilidad


title: Immunogenicity of a killed Leishmania vaccine with saponin adjuvant in dogs

text: Cellular and humoral immune responses of dogs to a candidate vaccine, composed of Leishmania braziliensis promastigote protein plus saponin as adjuvant, have been investigated as a pre-requisite to understanding the mechanisms of immunogenicity against canine visceral leishmaniasis (CVL). The candidate vaccine elicited strong antigenicity related to the increases of anti-Leishmania IgG isotypes, together with higher levels of lymphocytes, particularly of circulating CD8(+) T-lymphocytes and Leishmania chagasi antigen-specific CD8(+) T-lymphocytes. As indicated by the intense cell proliferation and increased nitric oxide production during in vitro stimulation by L. chagasi soluble antigens, the candidate vaccine elicited an immune activation status potentially compatible with effective control of the etiological agent of CVL.


title: Phenotypic switch of CD8(+) T cells reactivated under hypoxia toward IL‐10 secreting, poorly proliferative effector cells

text: CD8(+) T cells controlling pathogens or tumors must function at sites where oxygen tension is frequently low, and never as high as under atmospheric culture conditions. However, T‐cell function in vivo is generally analyzed indirectly, or is extrapolated from in vitro studies under nonphysiologic oxygen tensions. In this study, we delineate the role of physiologic and pathologic oxygen tension in vitro during reactivation and differentiation of tumor‐specific CD8(+) T cells. Using CD8(+) T cells from pmel‐1 mice, we observed that the generation of CTLs under 5% O(2), which corresponds to physioxia in lymph nodes, gave rise to a higher effector signature than those generated under atmospheric oxygen fractions (21% O(2)). Hypoxia (1% O(2)) did not modify cytotoxicity, but decreasing O(2) tensions during CTL and CD8(+) tumor‐infiltrating lymphocyte reactivation dose‐dependently decreased proliferation, induced secretion of the immunosuppressive cytokine IL‐10, and upregulated the expression of CD137 (4‐1BB) and CD25. Overall, our data indicate that oxygen tension is a key regulator of CD8(+) T‐cell function and fate and suggest that IL‐10 release may be an unanticipated component of CD8(+) T cell‐mediated immune responses in most in vivo microenvironments.


title: COVID-19 is rapidly changing: Examining public perceptions and behaviors in response to this evolving pandemic

text: BACKGROUND: Since the emergence of SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) in late 2019, communities have been required to rapidly adopt community mitigation strategies rarely used before, or only in limited settings. This study aimed to examine the attitudes and beliefs of Australian adults towards the COVID-19 pandemic, and willingness and capacity to engage with these mitigation measures. In addition, we aimed to explore the psychosocial and demographic factors that are associated with adoption of recommended hygiene-related and avoidance-related behaviors. METHODS: A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between the 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariate logistic regression analysis. FINDINGS: The survey of 1420 respondents found 50% (710) of respondents felt COVID-19 would ‘somewhat’ affect their health if infected and 19% perceived their level of risk as high or very high. 84·9% had performed ≥1 of the three recommended hygiene-related behaviors and 93·4% performed ≥1 of six avoidance-related behaviors over the last one month. Adopting avoidance behaviors was associated with trust in government/authorities (aOR: 6.0, 95% CI 2.6–11·0), higher perceived rating of effectiveness of behaviors (aOR: 4·0, 95% CI: 1·8–8·7), higher levels of perceived ability to adopt social distancing strategies (aOR: 5.0, 95% CI: 1·5–9.3), higher trust in government (aOR: 6.0, 95% CI: 2.6–11.0) and higher level of concern if self-isolated (aOR: 1.8, 95% CI: 1.1–3.0). INTERPRETATION: In the last two months, members of the public have been inundated with messages about hygiene and social (physical) distancing. However, our results indicate that a continued focus on supporting community understanding of the rationale for these strategies, as well as instilling community confidence in their ability to adopt or sustain the recommendations is needed.


title: Facile preparation of magnetic porous carbon monolith from waste corrugated cardboard box for solar steam generation and adsorption

text: Porous carbon monoliths (PCMs) were prepared from waste corrugated cardboard box (WCCB) via slurrying in FeCl(3) solution followed by molding and thermal treatment. The thermal process was analyzed by a thermogravimetric analyzer coupled with a Fourier transform infrared spectrometer. The evolution of physicochemical characteristics of PCMs was studied. The photothermal conversion and solar steam generation performances of the optimal sample (PCM(Fe/600)) were evaluated. The adsorption properties of PCM(Fe/600) for methylene blue (MB) were investigated. Results showed that Fe(3+) promoted the breaking of cellulose chains in WCCB, leading to the occurrence of pyrolysis of WCCB at lower temperatures and the reduction of activation energy by 76.63 kJ mol(−1). Char yield raised because volatile radicals were captured by FeCl(3)-derived amorphous Fe(III) species, then involved in char formation. Amorphous Fe(III) continuously converted into Fe(3)O(4) crystallites with carbonization temperature increasing from 400 to 700 °C, then α-Fe was formed at 800 °C via the carbothermal reduction of Fe(3)O(4). FeCl(3) was favorable to the formation of a developed microporous structure. Surface area significantly increased with carbonization temperature increasing from 400 to 600 °C due to the removal of volatiles. The etching of carbon by Fe(3)O(4) above 700 °C also led to the increase of surface area. PCM(Fe/600) exhibited higher optical absorption than other samples due to its high graphite degree and porosity. It also had excellent photothermal performance; thus, solar steam yield was 1.46 times that of the pure water with the assistance of PCM(Fe/600). PCM(Fe/600) in floating state was effective in adsorption of MB from water. Besides, the adsorption behavior fitted Langmuir model with a monolayer adsorption capacity reached up to 70.9 mg g(−1).


title: Prevalence of anti-Toxoplasma gondii antibodies in serum and aqueous humor samples from cats with uveitis or systemic diseases in France

text: Abstract Anti-Toxoplasma gondii antibodies were determined in serum and aqueous humor of two groups of cats in France: cats with uveitis (group 1, n =26) and cats with systemic disease (group 2, n =24) using an agglutination test. Titres above 1:64 were considered positive. IgG antibodies to T. gondii were detected in 10 serum samples from group 1 and in 10 serum samples from group 2, and in 2 aqueous humor samples from group 1 and in 1 aqueous humor samples from group 2. The distribution of ocular lesions according to the serological status of the animals indicated that lens luxation and buphthalmia were more frequent in T. gondii seropositive cats than in seronegative ones. The study reports a similar prevalence of anti-T. gondii antibodies in cats with uveitis and in cats without uveitis in France. Serological results must be analysed carefully and additional diagnostic tools is required.


title: Arteriviruses

text: The family Arteriviridae, which consists of four small, enveloped, positive-strand RNA viruses, was established in 1996. The current members are Equine arteritis virus (EAV), Lactate dehydrogenase-elevating virus (LDV), Porcine reproductive and respiratory syndrome virus (PRRSV), and Simian hemorrhagic fever virus (SHFV). Because arteriviruses share with coronaviruses a similar genome organization, conserved replicase motifs, and a common genome expression strategy, which includes a mechanism of discontinuous RNA synthesis to generate multiple subgenomic RNAs, they have been joined in the order Nidovirales. However, arteriviruses differ from coronaviruses in the smaller size of their genomes, the smaller size and morphology of their virions, and the properties of their structural proteins. The arteriviruses each have distinct narrow host ranges but are widely distributed geographically. Transmission of arteriviruses occurs via the respiratory route or via bodily fluids and in all cases their primary target cells are macrophages. The outcomes of infections with the different arteriviruses range from asymptomatic infections that can be either persistent or acute, to abortion, respiratory disease, arteritis, fatal hemorrhagic fever, and poliomyelitis. Mechanisms that are thought to contribute to persistence include masking of the primary neutralization epitope by glycosylation, the generation of neutralization escape variants, infection of macrophages by immune complexes via Fc receptors, and the presence of an immunodominant decoy epitope near the primary neutralizing epitope.


title: Coronavirus mRNA synthesis involves fusion of non-contiguous sequences.

text: Positive-stranded genomic RNA of coronavirus MHV and its six subgenomic mRNAs are synthesized in the cytoplasm of the host cell. The mRNAs are composed of leader and body sequences which are non-contiguous on the genome and are fused together in the cytoplasm by a mechanism which appears to involve an unusual and specific 'polymerase jumping' event.


title: Maintaining dental education and specialist dental care during an outbreak of a new coronavirus infection. Part 2:Control of the disease, then elimination

text: On Thursday 27th March 2003 the decision had been made to stop all clinical teaching and all non-elective patient care at the Prince Philip Dental Hospital, the teaching hospital of the Faculty of Dentistry of the University of Hong Kong. A lethal respiratory disease of unknown aetiology was spreading through the community but also in medical hospitals where it was infecting healthcare workers with apparent ease. Infections in an apartment block called Amoy Gardens seemed to have taken place by the deadly long distance airborne transmission route. The daily numbers of new cases of Severe Acute Respiratory Syndrome were rising exponentially. Normally bustling streets and public buildings of Hong Kong had fallen silent.


title: Cloning, Assembly, and Modification of the Primary Human Cytomegalovirus Isolate Toledo by Yeast-Based Transformation-Associated Recombination

text: Genetic engineering of cytomegalovirus (CMV) currently relies on generating a bacterial artificial chromosome (BAC) by introducing a bacterial origin of replication into the viral genome using in vivo recombination in virally infected tissue culture cells. However, this process is inefficient, results in adaptive mutations, and involves deletion of viral genes to avoid oversized genomes when inserting the BAC cassette. Moreover, BAC technology does not permit the simultaneous manipulation of multiple genome loci and cannot be used to construct synthetic genomes. To overcome these limitations, we adapted synthetic biology tools to clone CMV genomes in Saccharomyces cerevisiae. Using an early passage of the human CMV isolate Toledo, we first applied transformation-associated recombination (TAR) to clone 16 overlapping fragments covering the entire Toledo genome in Saccharomyces cerevisiae. Then, we assembled these fragments by TAR in a stepwise process until the entire genome was reconstituted in yeast. Since next-generation sequence analysis revealed that the low-passage-number isolate represented a mixture of parental and fibroblast-adapted genomes, we selectively modified individual DNA fragments of fibroblast-adapted Toledo (Toledo-F) and again used TAR assembly to recreate parental Toledo (Toledo-P). Linear, full-length HCMV genomes were transfected into human fibroblasts to recover virus. Unlike Toledo-F, Toledo-P displayed characteristics of primary isolates, including broad cellular tropism in vitro and the ability to establish latency and reactivation in humanized mice. Our novel strategy thus enables de novo cloning of CMV genomes, more-efficient genome-wide engineering, and the generation of viral genomes that are partially or completely derived from synthetic DNA. IMPORTANCE The genomes of large DNA viruses, such as human cytomegalovirus (HCMV), are difficult to manipulate using current genetic tools, and at this time, it is not possible to obtain, molecular clones of CMV without extensive tissue culture. To overcome these limitations, we used synthetic biology tools to capture genomic fragments from viral DNA and assemble full-length genomes in yeast. Using an early passage of the HCMV isolate Toledo containing a mixture of wild-type and tissue culture-adapted virus. we directly cloned the majority sequence and recreated the minority sequence by simultaneous modification of multiple genomic regions. Thus, our novel approach provides a paradigm to not only efficiently engineer HCMV and other large DNA viruses on a genome-wide scale but also facilitates the cloning and genetic manipulation of primary isolates and provides a pathway to generating entirely synthetic genomes.


title: Strategies to Optimize Protein Expression in E. coli

text: Recombinant protein expression in Escherichia coli ( E. coli ) is simple, fast, inexpensive, and robust, with the expressed protein comprising up to 50 percent of the total cellular protein. However, it also has disadvantages. For example, the rapidity of bacterial protein expression often results in unfolded/misfolded proteins, especially for heterologous proteins that require longer times and/or molecular chaperones to fold correctly. In addition, the highly reductive environment of the bacterial cytosol and the inability of E. coli to perform several eukaryotic post‐translational modifications results in the insoluble expression of proteins that require these modifications for folding and activity. Fortunately, multiple, novel reagents and techniques have been developed that allow for the efficient, soluble production of a diverse range of heterologous proteins in E. coli . This overview describes variables at each stage of a protein expression experiment that can influence solubility and offers a summary of strategies used to optimize soluble expression in E. coli . Curr. Protoc. Protein Sci. 61:5.24.1‐5.24.29. © 2010 by John Wiley & Sons, Inc.


Appropriate use of self-directed learning at medical school prepares students for future clinical practice


Covid‐19 guidance algorithm for advanced head and neck cancer reconstruction


title: Influence of age, severity of infection, and co-infection on the duration of respiratory syncytial virus (RSV) shedding

text: RSV is the most important viral cause of pneumonia and bronchiolitis in children worldwide and has been associated with significant disease burden. With the renewed interest in RSV vaccines, we provide realistic estimates on duration, and influencing factors on RSV shedding which are required to better understand the impact of vaccination on the virus transmission dynamics. The data arise from a prospective study of 47 households (493 individuals) in rural Kenya, followed through a 6-month period of an RSV seasonal outbreak. Deep nasopharyngeal swabs were collected twice each week from all household members, irrespective of symptoms, and tested for RSV by multiplex PCR. The RSV G gene was sequenced. A total of 205 RSV infection episodes were detected in 179 individuals from 40 different households. The infection data were interval censored and assuming a random event time between observations, the average duration of virus shedding was 11·2 (95% confidence interval 10·1–12·3) days. The shedding durations were longer than previous estimates (3·9–7·4 days) based on immunofluorescence antigen detection or viral culture, and were shown to be strongly associated with age, severity of infection, and revealed potential interaction with other respiratory viruses. These findings are key to our understanding of the spread of this important virus and are relevant in the design of control programmes.


title: Genome-wide analysis on the maize genome reveals weak selection on synonymous mutations

text: BACKGROUND: Synonymous mutations are able to change the tAI (tRNA adaptation index) of a codon and consequently affect the local translation rate. Intuitively, one may hypothesize that those synonymous mutations which increase the tAI values are favored by natural selection. RESULTS: We use the maize (Zea mays) genome to test our assumption. The first supporting evidence is that the tAI-increasing synonymous mutations have higher fixed-to-polymorphic ratios than the tAI-decreasing ones. Next, the DAF (derived allele frequency) or MAF (minor allele frequency) of the former is significantly higher than the latter. Moreover, similar results are obtained when we investigate CAI (codon adaptation index) instead of tAI. CONCLUSION: The synonymous mutations in the maize genome are not strictly neutral. The tAI-increasing mutations are positively selected while those tAI-decreasing ones undergo purifying selection. This selection force might be weak but should not be automatically ignored.


title: Time series modelling to forecast the confirmed and recovered cases of COVID-19

text: Coronaviruses are enveloped RNA viruses from the Coronaviridae family affecting neurological, gastrointestinal, hepatic and respiratory systems. In late 2019 a new member of this family belonging to the Betacoronavirus genera (referred to as COVID-19) originated and spread quickly across the world calling for strict containment plans and policies. In most countries in the world, the outbreak of the disease has been serious and the number of confirmed COVID-19 cases has increased daily, while, fortunately the recovered COVID-19 cases have also increased. Clearly, forecasting the “confirmed” and “recovered” COVID-19 cases helps planning to control the disease and plan for utilization of health care resources. Time series models based on statistical methodology are useful to model time-indexed data and for forecasting. Autoregressive time series models based on two-piece scale mixture normal distributions, called TP–SMN–AR models, is a flexible family of models involving many classical symmetric/asymmetric and light/heavy tailed autoregressive models. In this paper, we use this family of models to analyze the real world time series data of confirmed and recovered COVID-19 cases.


title: Emergency management of 2019 novel coronavirus: implications for the dermatology department

text: Since cases first emerged in December 2019, COVID‐19 (a type of coronavirus) has rapidly become pandemic. This fast‐tracked paper (published quickly) from China on COVID‐19 is written by dermatologists at the epicentre of the outbreak in Wuhan. Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks. Online consultation for non‐urgent patients reduces the numbers of patients attending clinics. Nurse‐led triage, to identify patients with possible COVID‐19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID‐19 area and a dermatologist is consulted if the fever might be related to skin disease. Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID‐19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on‐call expert team to discuss inpatients suspected or diagnosed with COVID‐19 and refer them to radiology, respiratory or intensive care colleagues as required. Confirmed cases are managed following local policies. Skin disorders in COVID‐19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time. With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department. This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department


The hunt to find the coronavirus pandemic's patient zero


title: COVID-19 Infection: Strategies on When to Discontinue Isolation, a retrospective study

text: OBJECTIVE: : Add to available understanding of COVID-19 to help decrease further spread of SARS-CoV-2 by providing protocol providers can consider when giving patients recommendations to retest as well as length of time for self-isolation. METHODS: : We retrospectively collected data from the electronic medical record of patients in the Mayo Clinic Florida's COVID Virtual Clinic. 118 patients with detectable results for the virus were followed. Data reviewed in this study included: 1) length of time from detectable to undetectable results; 2) length of time from onset of symptoms to undetectable result; 3) length of time from resolution of fever to undetectable result. RESULTS: : 53% of studied patients eligible for discontinuation of self-isolation had detectable viral RNA and therefore underwent repeat testing. In these patients, the mean from the date of their first detectable result to attaining an undetectable result was 14.89 days. The mean time for onset of symptoms to undetectable testing was 21.5 days. CONCLUSION: : 118 patients with detectable results for SARS-CoV-2 were followed in the Mayo Clinic Florida COVID Virtual Clinic; 53% of patients still showed detectable viral RNA despite meeting CDC guidelines for discontinuation of self-isolation, prompting us to propose following a more cautious guideline that other providers could consider as a strategy to discontinue self-isolation, including increasing length of days since symptom onset.


title: Comparison of heated humidiﬁed high‐flow nasal cannula flow rates (1‐L·kg·min(−1) vs 2‐L·kg·min (−1)) in the management of acute bronchiolitis

text: OBJECTIVE: We aimed to compare the heated humidiﬁed high‐ﬂow nasal cannula (HHHFNC) flow rate of 1‐L·kg·min(−1) (1 L) with 2‐L·kg·min (−1) (2 L) in patients with severe bronchiolitis presenting to the pediatric emergency department. STUDY DESIGN: We performed a study in which all patients were allocated to receive these two flow rates. The primary outcome was admitted as treatment failure, which was defined as a clinical escalation in respiratory status. Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), the clinical respiratory score (CRS), rise of peripheral capillary oxygen saturation (SpO(2)), and rates of weaning, intubation, and intensive care unit (ICU) admission. RESULTS: One hundred and sixty‐eight cases (88 received the 1‐L flow rate and 80, the 2‐L flow rate) were included in the analyses. Treatment failure was 11.4% (10 of 88) in the 1‐L group, and 10% (8 of 80) in the 2‐L group (P = .775). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the rate of weaning (53.4% vs 35%; P = .017), the falling down of the CRS (−2.1 vs −1.5; P < .001), RR (−15.2 vs −11.8; P < .001), and HR (− 24.8 vs − 21.2; P < .001), and the increase of SpO (2) (4.8 vs 3.6; P < .001) were significantly more evident in the 1‐L group. CONCLUSION: HHHFNC with the 1‐L·kg·min(−1) flow rate, which provides a more frequent earlier effect, reached therapy success as high as the 2‐L·kg·min (−1) flow rate in patients with severe acute bronchiolitis.


title: Flexible Nanoporous Template for the Design and Development of Reusable Anti-COVID-19 Hydrophobic Face Masks

text: [Image: see text] Since the outbreak of the severe respiratory disease caused by the novel coronavirus (COVID-19), the use of face masks has become ubiquitous worldwide to control the rapid spread of this pandemic. As a result, the world is currently facing a face mask shortage, and some countries have placed limits on the number of masks that can be bought by each person. Although the surgical grade N95 mask provides the highest level of protection currently available, its filtration efficiency for sub-300 nm particles is around 85% due to its wider pore size (∼300 nm). Because the COVID-19 virus shows a diameter of around 65–125 nm, there is a need for developing more efficient masks. To overcome these issues, we demonstrate the development of a flexible, nanoporous membrane to achieve a reusable N95 mask with a replaceable membrane and enhanced filtration efficiency. We first developed a flexible nanoporous Si-based template on a silicon-on-insulator wafer using KOH etching and then used the template as a hard mask during a reactive ion etching process to transfer the patterns onto a flexible and lightweight (<0.12 g) polymeric membrane. Pores with sizes down to 5 nm were achieved with a narrow distribution. Theoretical calculations show that airflow rates above 85 L/min are possible through the mask, which confirms its breathability over a wide range of pore sizes, densities, membrane thicknesses, and pressure drops. Finally, the membrane is intrinsically hydrophobic, which contributes to antifouling and self-cleaning as a result of droplets rolling and sliding on the inclined mask area.


title: Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice

text: Abstract Outbreaks of emerging and re-emerging infectious diseases are global threats to society. Planning for, and responses to, such events must include healthcare and other measures based on current evidence. An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. Appropriate mask use during routine care is a forerunner to best practice in the event of an outbreak. However, little is known about the influences on decisions and behaviours of HCWs with respect to protective mask use when providing routine care. In this paper we argue that there is a need for more research to provide a better understanding of the decision-making and risk-taking behaviours of HCWs in respect of their use of masks for infectious disease prevention. Our argument is based on the ongoing threat of emerging infectious diseases; a need to strengthen workforce capability, capacity and education; the financial costs of healthcare and outbreaks; and the importance of social responsibility and supportive legislation in planning for global security. Future research should examine HCWs' practices and constructs of risk to provide new information to inform policy and pandemic planning.


title: Chapter Twelve China–Africa Cooperation Initiatives in Malaria Control and Elimination

text: Abstract Malaria has affected human health globally with a significant burden of disease, and also has impeded social and economic development in the areas where it is present. In Africa, many countries have faced serious challenges in controlling malaria, in part due to major limitations in public health systems and primary health care infrastructure. Although China is a developing country, a set of control strategies and measures in different local settings have been implemented successfully by the National Malaria Control Programme over the last 60 years, with a low cost of investment. It is expected that Chinese experience may benefit malaria control in Africa. This review will address the importance and possibility of China–Africa collaboration in control of malaria in targeted African countries, as well as how to proceed toward the goal of elimination where this is technically feasible.


title: Direct carbon dioxide emissions from civil aircraft

text: Abstract Global airlines consume over 5 million barrels of oil per day, and the resulting carbon dioxide (CO2) emitted by aircraft engines is of concern. This article provides a contemporary review of the literature associated with the measures available to the civil aviation industry for mitigating CO2 emissions from aircraft. The measures are addressed under two categories – policy and legal-related measures, and technological and operational measures. Results of the review are used to develop several insights into the challenges faced. The analysis shows that forecasts for strong growth in air-traffic will result in civil aviation becoming an increasingly significant contributor to anthropogenic CO2 emissions. Some mitigation-measures can be left to market-forces as the key-driver for implementation because they directly reduce airlines' fuel consumption, and their impact on reducing fuel-costs will be welcomed by the industry. Other mitigation-measures cannot be left to market-forces. Speed of implementation and stringency of these measures will not be satisfactorily resolved unattended, and the current global regulatory-framework does not provide the necessary strength of stewardship. A global regulator with ‘teeth’ needs to be established, but investing such a body with the appropriate level of authority requires securing an international agreement which history would suggest is going to be very difficult. If all mitigation-measures are successfully implemented, it is still likely that traffic growth-rates will continue to out-pace emissions reduction-rates. Therefore, to achieve an overall reduction in CO2 emissions, behaviour change will be necessary to reduce demand for air-travel. However, reducing demand will be strongly resisted by all stakeholders in the industry; and the ticket price-increases necessary to induce the required reduction in traffic growth-rates place a monetary-value on CO2 emissions of approximately 7–100 times greater than other common valuations. It is clear that, whilst aviation must remain one piece of the transport-jigsaw, environmentally a global regulator with ‘teeth’ is urgently required.


title: Pharyngitis and Epiglottitis

text: Acute pharyngitis is one of the most common illnesses for which patients visit primary care physicians. Most cases are of viral origin, and with few exceptions these illnesses are both benign and self-limited. The most important bacterial cause is the beta-hemolytic group A streptococcus. There are other uncommon or rare types of pharyngitis. For some of these treatment is required or available, and some may be life threatening. Among those discussed in this article are diphtheria, gonorrhea, HIV infection, peritonsillar abscess, and epiglottitis.


title: Design, synthesis and biological evaluation of 2′-deoxy-2′,2′-difluoro-5-halouridine phosphoramidate ProTides

text: Abstract We report the synthesis of a series of novel 2′-deoxy-2′,2′-difluoro-5-halouridines and their corresponding phosphoramidate ProTides. All compounds were evaluated for antiviral activity and for cellular toxicity. Interestingly, 2′-deoxy-2′,2′-difluoro-5-iodo- and -5-bromo-uridines showed selective activity against feline herpes virus replication in cell culture due to a specific recognition (activation) by the virus-encoded thymidine kinase.


title: Chapter 4 Virus Replication

text: Abstract To continue the chain of infection, a virus must undergo the process of replication to create new, infectious virions that are able to infect other cells of the body or subsequent hosts. After gaining entry into the body, a virus makes physical contact with and crosses the plasma membrane of a target cell. Inside, it releases and replicates its genome while facilitating the manufacture of its proteins by host ribosomes. How this is carried out depends upon the type of viral nucleic acid. Virus particles are assembled from these newly synthesized biological molecules and become infectious virions. Finally, the virions are released from the cell to continue the process of infection.


title: Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database

text: BACKGROUND: To meet the future challenges of infectious diseases and limit the spread of multidrug resistant microorganisms, a better understanding of published studies in the field of infectious diseases is needed. The objective of this study was to analyze the quantity and quality of research activity in the field of infectious diseases in Arab countries and compare it with that in non-Arab countries. METHODS: Documents published in Arab countries within the research category of “infectious diseases” were extracted and analyzed using the Web of Science database. The data analyzed represent research productivity during the time interval between 1900 – 2012. RESULTS: Worldwide, the total number of documents published in the field of infectious diseases up to 2012 was 227,188. A total of 2,408 documents in the field of infectious diseases were published in Arab countries, which represents 1.06% of worldwide research output. Research output from Arab countries in the field of infectious diseases was low for decades. However, approximately a five-fold increase was observed in the past decade. Arab countries ranked 56(th) to 218(th) on the standard competition ranking (SCR) in worldwide publications in the field of infectious diseases. Egypt, with a total publication of 464 (19.27%) documents ranked first among Arab countries, while Kuwait University was the most productive institution with a total of 158 (6.56%) documents. Average citation per document published in Arab countries was 13.25 and the h-index was 64. Tuberculosis (230; 9.55%), malaria (223; 9.26%), and hepatitis (189; 7.8%) were the top three infectious diseases studied as according to the retrieved documents. CONCLUSION: The present data reveals that some Arab countries contribute significantly to the field of infectious diseases. However, Arab countries need to work harder to bridge the gap in this field. Compared with non-Arab countries in the Middle East, research output from Arab countries was high, but more efforts are needed to enhance the quality of this output. Future research in the field should be encouraged and correctly directed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/2049-9957-4-2) contains supplementary material, which is available to authorized users.


title: Classical Swine Fever Virus Infection Induces Endoplasmic Reticulum Stress-Mediated Autophagy to Sustain Viral Replication in vivo and in vitro

text: Endoplasmic reticulum (ER) stress-mediated autophagy plays significant roles in replication and pathogenesis of many animal viruses. However, the relationship between ER stress, autophagy, and viral replication during in vivo and in vitro infection of classical swine fever virus (CSFV) remains unclear. In this study, we established a pig model for CSFV infection and found that viral loads of CSFV differed in 10 kinds of infected organs, and that the degree of tissue lesions was to some extent positively correlated with CSFV replication in vivo. Next, we found that CSFV infection not only induced ER stress and subsequently activated three unfolded protein responses (UPR) pathways including protein kinase R-like ER kinase (PERK), inositol requiring enzyme 1 (IRE1), and activating transcription factor-6 (ATF-6) pathways, but also triggered complete autophagy in main immune organs and partial nonimmune organs exhibiting severer pathological injuries and higher viral loads. However, only the IRE1 pathway and no autophagy were activated in some other nonimmune organs with slighter pathologies and lower viral loads. These results indicate a potential link between CSFV-induced ER stress and autophagy, both of which are associated with the CSFV replication in vivo. We further performed in vitro experiments and found that CSFV infection activates the PERK and IRE1 pathways and autophagy in cultured porcine kidney cell lines (PK-15) and macrophage cell lines (3D4/2), and pharmacological regulation of ER stress remarkably changed autophagic activities induced by CSFV, suggesting that CSFV-induced autophagy can be mediated by ER stress possibly via the PERK and IRE1 pathway. Furthermore, treatment with ER stress regulators significantly altered copy numbers of NS5B genes, expression of Npro proteins, and viral titers in CSFV-infected cells or in cells treated with autophagy regulators prior to CSFV infection, suggesting the requirement of ER stress-mediated autophagy for CSFV replication in vitro. Collectively, our data demonstrate that CSFV induces ER stress-mediated autophagy to sustain its replication in vivo and in vitro, which may be one of the potential strategies exploited by CSFV for immune evasion. This finding will provide new insights into mechanisms of replication and pathogenesis of CSFV, and development of new strategies for controlling CSF.


title: Discovery of Human Zinc Deficiency: Its Impact on Human Health and Disease(1)(2)(3)

text: The essentiality of zinc in humans was established in 1963. During the past 50 y, tremendous advances in both clinical and basic sciences of zinc metabolism in humans have been observed. The major factor contributing to zinc deficiency is high phytate-containing cereal protein intake in the developing world, and nearly 2 billion subjects may be zinc deficient. Conditioned deficiency of zinc has been observed in patients with malabsorption syndrome, liver disease, chronic renal disease, sickle cell disease, and other chronic illnesses. Major clinical problems resulting from zinc deficiency in humans include growth retardation; cell-mediated immune dysfunction, and cognitive impairment. In the Middle East, zinc-deficient dwarfs did not live beyond the age of 25 y, and they died because of intercurrent infections. In 1963, we knew of only 3 enzymes that required zinc for their activities, but now we know of >300 enzymes and >1000 transcription factors that are known to require zinc for their activities. Zinc is a second messenger of immune cells, and intracellular free zinc in these cells participate in signaling events. Zinc has been very successfully used as a therapeutic modality for the management of acute diarrhea in children, Wilson’s disease, the common cold and for the prevention of blindness in patients with age-related dry type of macular degeneration and is very effective in decreasing the incidence of infection in the elderly. Zinc not only modulates cell-mediated immunity but is also an antioxidant and anti-inflammatory agent.


title: Cardiac Rehabilitation during quarantine in COVID-19 Pandemic: Challenges for Center based programs

text: Abstract Due to the COVID-19 epidemic, many cardiac rehabilitation (CR) services and programs are stopped. Because CR is a Class I level A recommendation with clinical benefits that are now well documented, the cessation of CR programs can lead to dramatic consequences in terms of public health. We proposed here a viewpoint of significant interest about the sudden need to develop remote home-based CR programs both in clinical research and in clinical care routine. This last decade, the literature on remote home-based cardiac rehabilitation programs has been increasing but to date only clinical research experiences have been implemented. Benefits are numerous and the relevance of this approach has obviously increased with the actual health emergency. The COVID-19 crisis, the important prevalence of smartphones and high speed internet during confinement should be viewed as an opportunity to promote a major shift in CR programs with the use of telemedicine to advance the health of a larger number of individuals with cardiac disease.


title: Gamma and Deltacoronaviruses in quail and pheasants from Northern Italy(1)

text: In view of the restricted knowledge on the diversity of coronaviruses in poultry other than chicken, this study aimed to investigate the genetic diversity of coronaviruses in quail, pheasant, and partridge from two regions of Northern Italy. To this end, pools of tracheal and cloacal swabs from European quail (Coturnix Coturnix) and intestinal tract from pheasants (Phasianus Colchicus) and partridge (Perdix Perdix) flocks, with or without enteric signs, were collected during 2015. Avian coronavirus (Gammacoronavirus) was detected in quail not vaccinated against Infectious Bronchitis Virus (IBV) and in pheasants vaccinated with an IBV Massachusetts serotype. Based on DNA sequences for the gene encoding the S protein, the avian coronaviruses detected in the quail and pheasant are related to the IBV 793B and Massachusetts types, respectively. However, RNA-dependent RNA polymerase (RdRp) analyses showed the susceptibility of quail also to Deltacoronaviruses, suggesting that quail and pheasant avian coronaviruses share spike genes identical to chicken IBV spike genes and quail might host Deltacoronavirus.


What All We Should Know About Masks in COVID-19 Pandemic


title: Sampling methods for recovery of human enteric viruses from environmental surfaces

text: Abstract Acute gastroenteritis causes the second highest infectious disease burden worldwide. Human enteric viruses have been identified as leading causative agents of acute gastroenteritis as well as foodborne illnesses in the U.S. and are generally transmitted by fecal-oral contamination. There is growing evidence of transmission occurring via contaminated fomite including food contact surfaces. Additionally, human enteric viruses have been shown to remain infectious on fomites over prolonged periods of time. To better understand viral persistence, there is a need for more studies to investigate this phenomenon. Therefore, optimization of surface sampling methods is essential to aid in understanding environmental contamination to ensure proper preventative measures are being applied. In general, surface sampling studies are limited and highly variable among recovery efficiencies and research parameters used (e.g., virus type/density, surface type, elution buffers, tools). This review aims to discuss the various factors impacting surface sampling of viruses from fomites and to explore how researchers could move towards a more sensitive and standard sampling method.


title: Nucleolar localization of non-structural protein 3b, a protein specifically encoded by the severe acute respiratory syndrome coronavirus

text: Abstract The open reading frame 3 (ORF3) of the severe acute respiratory syndrome coronavirus (SARS-CoV) genome encodes a predicted 154-amino acid protein, which lacks similarities to any known protein, and is named 3b. In this study, it was shown that 3b protein was predominately localized to nucleus with EGFP tag at its N- or C-terminus. The localization patterns were similar in different transfected cells. Immuno-fluorescence assay revealed that 3b protein was co-localized well with C23 in nucleolus. C23, B23 and fibrillarin all are important nucleolar proteins, which localize in the region of the nucleolus. Co-transfection of p3b-EGFP with pC23-DsRed, pB23-DsRed and pfibrillarin-DsRed further confirmed 3b's nucleolus localization. With construction of serial truncated mutants of 3b, a region (residues 134–154 aa) responsible for nucleolar localization was determinated in 3b protein. These results provide a new insight for further functional studies of SARS-CoV 3b protein.


title: Antibodies against viruses: passive and active immunization

text: Antibodies, through passive or active immunization, play a central role in prophylaxis against many infectious agents. While neutralization is a primary function of antibodies in protection against most viruses, the relative contribution of Fc-dependent and complement-dependent antiviral activities of antibodies was found to vary between different viruses in recent studies. The multiple hit model explains how antibodies neutralize viruses and recent data on the stoichiometry of antibody neutralization suggest that the organization of viral surface proteins on viruses, in addition to virus size, influences the level of antibody occupancy required for neutralization. These new findings will improve our strategies in therapeutic antibody engineering and rational vaccine design.


title: Effect of weather on COVID-19 spread in the US: A prediction model for India in 2020

text: Abstract The effect of weather on COVID-19 spread is poorly understood. Recently, few studies have claimed that warm weather can possibly slowdown the global pandemic, which has already affected over 1.6 million people worldwide. Clarification of such relationships in the worst affected country, the US, can be immensely beneficial to understand the role of weather in transmission of the disease in the highly populated countries, such as India. We collected the daily data of new cases in 50 US states between Jan 1–Apr 9, 2020 and also the corresponding weather information (i.e., temperature (T) and absolute humidity (AH)). Distribution modeling of new cases across AH and T, helped identify the narrow and vulnerable AH range. We validated the results for 10-day intervals against monthly observations, and also worldwide trends. The results were used to predict Indian regions which would be vulnerable to weather based spread in upcoming months of 2020. COVID-19 spread in the US is significant for states with 4 < AH < 6 g/m3 and number of new cases > 10,000, irrespective of the chosen time intervals for study parameters. These trends are consistent with worldwide observations, but do not correlate well with India so far possibly due the total cases reported per interval < 10,000. The results clarify the relationship between weather parameters and COVID-19 spread. The vulnerable weather parameters will help classify the risky geographic areas in different countries. Specifically, with further reporting of new cases in India, prediction of states with high risk of weather based spread will be apparent.


title: Lung infections and aging

text: Abstract Respiratory tract infections are the leading cause of death due to infectious disease in the elderly. Many factors, especially waning immune responses and the onset of age-associated organ dysfunction, likely account for an increase in susceptibility to respiratory tract infection in the elderly, and morbidity and mortality rates are substantially greater for the elderly when outcomes are compared to that of younger individuals. The presence of underlying disease states such as chronic obstructive pulmonary disease (COPD) or other organ system disease further increases the likelihood of developing severe pneumonia in the elderly population, and the frail elderly, particularly when institutionalized in chronic care facilities, are at high risk for developing severe and recurrent pneumonia. This article will discuss various factors associated with advanced age that predispose the elderly to respiratory infections and summarize current approaches to treatment and prevention.


title: Mechanisms of HIV non-progression; robust and sustained CD4+ T-cell proliferative responses to p24 antigen correlate with control of viraemia and lack of disease progression after long-term transfusion-acquired HIV-1 infection

text: BACKGROUND: Elite non-progressors (plasma viral load <50 copies/ml while antiretroviral naive) constitute a tiny fraction of HIV-infected individuals. After 12 years follow-up of a cohort of 13 long-term non-progressors (LTNP) identified from 135 individuals with transfusion-acquired HIV infection, 5 remained LTNP after 23 to 26 years infection, but only 3 retained elite LTNP status. We examined the mechanisms that differentiated delayed progressors from LTNP in this cohort. RESULTS: A survival advantage was conferred on 12 of 13 subjects, who had at least one host genetic factor (HLA, chemokine receptor or TLR polymorphisms) or viral attenuating factor (defective nef) associated with slow progression. However, antiviral immune responses differentiated the course of disease into and beyond the second decade of infection. A stable p24-specific proliferative response was associated with control of viraemia and retention of non-progressor status, but this p24 response was absent or declined in viraemic subjects. Strong Gag-dominant cytotoxic T lymphocyte (CTL) responses were identified in most LTNP, or Pol dominant-CTL in those with nef-defective HIV infection. CTL were associated with control of viraemia when combined with p24 proliferative responses. However, CTL did not prevent late disease progression. Individuals with sustained viral suppression had CTL recognising numerous Gag epitopes, while strong but restricted responses to one or two immunodominant epitopes was effective for some time, but failed to contain viraemia over the course of this study. Viral escape mutants at a HLA B27-restricted Gag-p24 epitope were detected in only 1 of 3 individuals, whereas declining or negative p24 proliferative responses occurred in all 3 concurrent with an increase in viraemia. CONCLUSION: Detectable viraemia at study entry was predictive of loss of LTNP status and/or disease progression in 6 of 8, and differentiated slow progressors from elite LTNP who retained potent virological control. Sustained immunological suppression of viraemia was independently associated with preserved p24 proliferative responses, regardless of the strength and breadth of the CTL response. A decline in this protective p24 response preceded or correlated with loss of non-progressor status and/or signs of disease progression.


title: Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans

text: BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly across the USA, causing extensive morbidity and mortality, particularly in the African American community. Autopsy can considerably contribute to our understanding of many disease processes and could provide crucial information to guide management of patients with coronavirus disease 2019 (COVID-19). We report on the relevant cardiopulmonary findings in, to our knowledge, the first autopsy series of ten African American decedents, with the cause of death attributed to COVID-19. METHODS: Autopsies were performed on ten African American decedents aged 44–78 years with cause of death attributed to COVID-19, reflective of the dominant demographic of deaths following COVID-19 diagnosis in New Orleans. Autopsies were done with consent of the decedents' next of kin. Pulmonary and cardiac features were examined, with relevant immunostains to characterise the inflammatory response, and RNA labelling and electron microscopy on representative sections. FINDINGS: Important findings include the presence of thrombosis and microangiopathy in the small vessels and capillaries of the lungs, with associated haemorrhage, that significantly contributed to death. Features of diffuse alveolar damage, including hyaline membranes, were present, even in patients who had not been ventilated. Cardiac findings included individual cell necrosis without lymphocytic myocarditis. There was no evidence of secondary pulmonary infection by microorganisms. INTERPRETATION: We identify key pathological states, including thrombotic and microangiopathic pathology in the lungs, that contributed to death in patients with severe COVID-19 and decompensation in this demographic. Management of these patients should include treatment to target these pathological mechanisms. FUNDING: None.


Do facemasks protect against COVID‐19?


title: Prescription Surveillance and Polymerase Chain Reaction Testing to Identify Pathogens during Outbreaks of Infection

text: Syndromic surveillance, including prescription surveillance, offers a rapid method for the early detection of agents of bioterrorism and emerging infectious diseases. However, it has the disadvantage of not considering definitive diagnoses. Here, we attempted to definitively diagnose pathogens using polymerase chain reaction (PCR) immediately after the prescription surveillance system detected an outbreak. Specimens were collected from 50 patients with respiratory infections. PCR was used to identify the pathogens, which included 14 types of common respiratory viruses and Mycoplasma pneumoniae. Infectious agents including M. pneumoniae, respiratory syncytial virus (RSV), rhinovirus, enterovirus, and parainfluenza virus were detected in 54% of patients. For the rapid RSV diagnosis kit, sensitivity was 80% and specificity was 85%. For the rapid adenovirus diagnosis kit, no positive results were obtained; therefore, sensitivity could not be calculated and specificity was 100%. Many patients were found to be treated for upper respiratory tract infections without the diagnosis of a specific pathogen. In Japan, an outbreak of M. pneumoniae infection began in 2011, and our results suggested that this outbreak may have included false-positive cases. By combining syndromic surveillance and PCR, we were able to rapidly and accurately identify causative pathogens during a recent respiratory infection outbreak.


title: Crystal structures of a bacterial dipeptidyl peptidase IV reveal a novel substrate recognition mechanism distinct from that of mammalian orthologues

text: Dipeptidyl peptidase IV (DPP IV, DPP4, or DAP IV) preferentially cleaves substrate peptides with Pro or Ala at the P1 position. The substrate recognition mechanism has been fully elucidated for mammalian DPP IV by crystal structure analyses but not for bacterial orthologues. Here, we report the crystal structures of a bacterial DPP IV (PmDAP IV) in its free form and in complexes with two kinds of dipeptides as well as with a non-peptidyl inhibitor at 1.90 to 2.47 Å resolution. Acyl-enzyme intermediates were observed for the dipeptide complexes of PmDAP IV, whereas tetrahedral intermediates were reported for the oligopeptide complexes of mammalian DPP IVs. This variation reflects the different structural environments of the active site Arg residues, which are involved in the recognition of a substrate carbonyl group, of mammalian and bacterial enzymes. A phylogenetic analysis revealed that PmDAP IV is a closer relative of dipeptidyl peptidases 8 and 9 (DPP8 and DPP9, DPP IV-family enzymes) than DPP IV. These results provide new insights into the substrate recognition mechanism of bacterial DAP IVs and may assist in the development of selective inhibitors for DAP IVs from pathogenic asaccharolytic bacteria, which utilise proteins or peptides as an energy source.


Transmission of Severe Acute Respiratory Syndrome


title: Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study

text: Summary Background The model of infectious disease prevention and control changed significantly in China after the outbreak in 2003 of severe acute respiratory syndrome (SARS), but trends and epidemiological features of infectious diseases are rarely studied. In this study, we aimed to assess specific incidence and mortality trends of 45 notifiable infectious diseases from 2004 to 2013 in China and to investigate the overall effectiveness of current prevention and control strategies. Methods Incidence and mortality data for 45 notifiable infectious diseases were extracted from a WChinese public health science data centre from 2004 to 2013, which covers 31 provinces in mainland China. We estimated the annual percentage change in incidence of each infectious disease using joinpoint regression. Findings Between January, 2004, and December, 2013, 54 984 661 cases of 45 infectious diseases were reported (average yearly incidence 417·98 per 100 000). The infectious diseases with the highest yearly incidence were hand, foot, and mouth disease (114·48 per 100 000), hepatitis B (81·57 per 100 000), and tuberculosis (80·33 per 100 000). 132 681 deaths were reported among the 54 984 661 cases (average yearly mortality 1·01 deaths per 100 000; average case fatality 2·4 per 1000). Overall yearly incidence of infectious disease was higher among males than females and was highest among children younger than 10 years. Overall yearly mortality was higher among males than females older than 20 years and highest among individuals older than 80 years. Average yearly incidence rose from 300·54 per 100 000 in 2004 to 483·63 per 100 000 in 2013 (annual percentage change 5·9%); hydatid disease (echinococcosis), hepatitis C, and syphilis showed the fastest growth. The overall increasing trend changed after 2009, and the annual percentage change in incidence of infectious disease in 2009–13 (2·3%) was significantly lower than in 2004–08 (6·2%). Interpretation Although the overall incidence of infectious diseases was increasing from 2004, the rate levelled off after 2009. Effective prevention and control strategies are needed for diseases with the highest incidence—including hand, foot, and mouth disease, hepatitis B, and tuberculosis—and those with the fastest rates of increase (including hydatid disease, hepatitis C, and syphilis). Funding Chinese Ministry of Science and Technology, National Natural Science Foundation (China).


title: INDA launches new portal to meet Covid-19 need

text: INDA, the Association of the Nonwoven Fabrics Industry, has a new portal on its website which connects suppliers with buyers and increases awareness of actions by nonwoven and engineered fabric producers in the fight against Covid-19.


title: A large-scale study of a poultry trading network in Bangladesh: implications for control and surveillance of avian influenza viruses

text: BACKGROUND: Since its first report in 2007, avian influenza (AI) has been endemic in Bangladesh. While live poultry marketing is widespread throughout the country and known to influence AI dissemination and persistence, trading patterns have not been described. The aim of this study is to assess poultry trading practices and features of the poultry trading networks which could promote AI spread, and their potential implications for disease control and surveillance. Data on poultry trading practices was collected from 849 poultry traders during a cross-sectional survey in 138 live bird markets (LBMs) across 17 different districts of Bangladesh. The quantity and origins of traded poultry were assessed for each poultry type in surveyed LBMs. The network of contacts between farms and LBMs resulting from commercial movements of live poultry was constructed to assess its connectivity and to identify the key premises influencing it. RESULTS: Poultry trading practices varied according to the size of the LBMs and to the type of poultry traded. Industrial broiler chickens, the most commonly traded poultry, were generally sold in LBMs close to their production areas, whereas ducks and backyard chickens were moved over longer distances, and their transport involved several intermediates. The poultry trading network composed of 445 nodes (73.2% were LBMs) was highly connected and disassortative. However, the removal of only 5.6% of the nodes (25 LBMs with the highest betweenness scores), reduced the network’s connectedness, and the maximum size of output and input domains by more than 50%. CONCLUSIONS: Poultry types need to be discriminated in order to understand the way in which poultry trading networks are shaped, and the level of risk of disease spread that these networks may promote. Knowledge of the network structure could be used to target control and surveillance interventions to a small number of LBMs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12917-018-1331-5) contains supplementary material, which is available to authorized users.


title: A DNA microarray for the versatile diagnosis of infectious diarrhea

text: Several bacteria, viruses, and parasites cause diarrhea as coinfecting pathogens. We designed a DNA microarray comprising 60‐bp probes spotted 194 times for the multiplex detection of 33 enteropathogenic bacteria and seven enteropathogenic viruses, and the archaeon Methanobrevibacter smithii was used as an internal positive control. Nine pathogen‐free stool specimens were used as negative controls. One of these control specimens was further spiked with Salmonella enterica as a positive control. The microarray was then tested with 40 pathological stool specimens, comprising S. enterica (n = 30), Campylobacter jejuni (n = 4), pathogenic Escherichia coli (n = 2), and adenovirus (n = 4). M. smithii was detected in 47/49 (95.9%) specimens, no pathogen was detected in negative controls and S. enterica was identified in the S. enterica‐spiked positive control. The overall specificity was 100% and the overall sensitivity was 97.5% because one S. enterica sample was missed by the microarray. The multiplexed detection of C. jejuni spiked into an adenovirus‐positive stool sample gave positive results, with fluorescence values of 14.3 and 9.1, respectively. These data indicate that using the protocol developed in this article, the DNA array allows for the multiplexed detection of some enteropathogens in stool samples.


title: Antiserum from mice vaccinated with modified vaccinia Ankara virus expressing African horse sickness virus (AHSV) VP2 provides protection when it is administered 48h before, or 48h after challenge

text: Abstract Previous studies show that a recombinant modified vaccinia Ankara (MVA) virus expressing VP2 of AHSV serotype 4 (MVA-VP2) induced virus neutralising antibodies in horses and protected interferon alpha receptor gene knock-out mice (IFNAR −/−) against challenge. Follow up experiments indicated that passive transfer of antiserum, from MVA-VP2 immune donors to recipient mice 1h before challenge, conferred complete clinical protection and significantly reduced viraemia. These studies have been extended to determine the protective effect of MVA-VP2 vaccine-induced antiserum, when administered 48h before, or 48h after challenge. In addition, passive transfer of splenocytes was undertaken to assess if they confer any degree of immunity to immunologically naïve recipient mice. Thus, antisera and splenocytes were collected from groups of mice that had been vaccinated with MVA-VP2, or wild type MVA (MVA-wt), for passive immunisation of recipient mice. The latter were subsequently challenged with AHSV-4 (together with appropriate vaccinated or unvaccinated control animals) and protection was assessed by comparing clinical signs, lethality and viraemia between treated and control groups. All antiserum recipients showed high protection against disease (100% survival rates even in mice that were immunised 48h after challenge) and statistically significant reduction or viraemia in comparison with the control groups. The mouse group receiving splenocytes from MVA-VP2 vaccinates, showed only a 40% survival rate, with a small reduction in viraemia, compared to those mice that had received splenocytes from MVA-wt vaccinates. These results confirm the primarily humoral nature of protective immunity conferred by MVA-VP2 vaccination and show the potential of administering MVA-VP2 specific antiserum as an emergency treatment for AHSV.


title: Attachment of viruses to cell receptors and penetration of viruses into cells

text: This chapter describes the process of attachment of viruses to cell receptors and penetration of viruses into cells. Enveloped viruses contain a number of glycoprotein-type projections that are anchored in the membrane. Orthomyxoviruses, paramyxoviruses, rhabdoviruses, togaviruses, in addition to coronaviruses and arenaviruses, have such projections. The large poxviruses also have an envelope but peplomers have so far not been identified. Virus infection in cell cultures and in animals is to a large extent dependent upon the capacity of a virus to adsorb to the target cells, that is, upon the presence of receptors. When a virus is adsorbed irreversibly to the plasma membrane, parts of the virus or the whole virus is taken into the cytoplasm to initiate virus-specific protein and mRNA synthesis. The intake of adenovirus particles into cells requires a long sequence of events before mRNA synthesis can be initiated in the nucleus of the infected cell.


title: Deficient Incorporation of Spike Protein into Virions Contributes to the Lack of Infectivity Following Establishment of a Persistent, Non-Productive Infection in Oligodendroglial Cell Culture by Murine Coronavirus

text: Infection of mouse oligodendrocytes with a recombinant mouse hepatitis virus (MHV) expressing a green fluorescence protein facilitated specific selection of virus-infected cells and subsequent establishment of persistence. Interestingly, while viral genomic RNAs persisted in infected cells over 14 subsequent passages with concomitant synthesis of viral subgenomic mRNAs and structural proteins, no infectious virus was isolated beyond passage 2. Further biochemical and electron microscopic analyses revealed that virions, while assembled, contained little spike in the envelope, indicating that lack of infectivity during persistence was likely due to deficiency in spike incorporation. This type of non-lytic, non-productive persistence in oligodendrocytes is unique among animal viruses and resembles MHV persistence previously observed in the mouse central nervous system. Thus, establishment of such a culture system that can recapitulate the in vivo phenomenon will provide a powerful approach for elucidating the mechanisms of coronavirus persistence in glial cells at the cellular and molecular levels.


Clarifying the controversial risk-benefit profile of soluble ACE2 in COVID-19


title: Aetiology of lower respiratory tract infection in adults in primary care: a prospective study in 11 European countries

text: Abstract Objectives To describe the role of bacteria (including bacterial resistance), viruses (including those recently described) and mixed bacterial–viral infections in adults presenting to primary care with lower respiratory tract infection (LRTI). Methods In all, 3104 adults with LRTI were enrolled, of whom 141 (4.5%) had community-acquired pneumonia (CAP), and 2985 matched controls in a prospective study in 16 primary care networks in Europe, and followed patients up at 28–35 days. We detected Streptococcus pneumoniae and Haemophilus influenzae and assessed susceptibility, atypical bacteria and viruses. Results A potential pathogen was detected in 1844 (59%) (in 350 (11%) bacterial pathogens only, in 1190 (38%) viral pathogens only, and in 304 (10%) both bacterial and viral pathogens). The most common bacterial pathogens isolated were S. pneumoniae (5.5% overall, 9.2% in CAP patients) and H. influenzae (5.4% overall, 14.2% in CAP patients). Less than 1% of S. pneumoniae were highly resistant to penicillin and 12.6% of H. influenzae were β-lactamase positive. The most common viral pathogens detected were human rhinovirus (20.1%), influenza viruses (9.9%), and human coronavirus (7.4%). Influenza virus, human parainfluenza viruses and human respiratory syncytial virus as well as human rhinovirus, human coronavirus and human metapneumovirus were detected significantly more frequently in LRTI patients than in controls. Conclusions A bacterial pathogen is identified in approximately one in five adult patients with LRTI in primary care, and a viral pathogen in just under half, with mixed infections in one in ten. Penicillin-resistant pneumococci and β-lactamase-producing H. influenzae are uncommon. These new findings support a restrictive approach to antibiotic prescribing for LRTI and the use of first-line, narrow-spectrum agents in primary care.


title: Temperature Decreases Spread Parameters of the New Covid-19 Case Dynamics

text: (1) Background: The virulence of coronavirus diseases due to viruses like SARS-CoV or MERS-CoV decreases in humid and hot weather. The putative temperature dependence of infectivity by the new coronavirus SARS-CoV-2 or covid-19 has a high predictive medical interest. (2) Methods: External temperature and new covid-19 cases in 21 countries and in the French administrative regions were collected from public data. Associations between epidemiological parameters of the new case dynamics and temperature were examined using an ARIMA model. (3) Results: We show that, in the first stages of the epidemic, the velocity of contagion decreases with country- or region-wise temperature. (4) Conclusions: Results indicate that high temperatures diminish initial contagion rates, but seasonal temperature effects at later stages of the epidemy remain questionable. Confinement policies and other eviction rules should account for climatological heterogeneities, in order to adapt the public health decisions to possible geographic or seasonal gradients.


title: Under pressure: Factors shaping urban greenspace provision in a mid-sized city

text: Urban greenspaces provide diverse ecosystem functions, services and benefits to residents. Much commentary has been offered to date about citizens' demands for more urban greenspace. Less attention, however, has been given to the ‘supply side’ pressures experienced by local government in delivering urban greenspace, particularly in mid-sized cities. Greater attention to factors shaping supply is warranted, especially in the context of rapid population growth. By understanding how existing greenspace provision approaches can stymie the efforts of local government to meet citizens' needs, new approaches can be identified. This paper assesses several factors shaping urban greenspace provision in Surrey - a city within the Greater Vancouver area. Insights are derived from in-depth interviews with key stakeholders, public documents, and census and municipal data about parks and their context as a specific type of greenspace. Our findings suggest that governance tools, economy and property markets, and financial and natural resources manifest as core factors influencing urban greenspace provision in Surrey. A reliance on governance tools premised upon standards has created park provision paradoxes. Treating greenspace provision as a largely technocratic exercise may be limiting Surrey's ability to respond to changing politics, economics and population trends. We point to alternative approaches.


title: Save the ICU and save lives during the COVID-19 pandemic

text: Appropriate critical care delivery for Coronavirus disease 2019 (COVID-19) is a cornerstone in saving lives. Earlier publications worldwide demonstrate higher mortality among patients receiving mechanical ventilation in intensive care units during “surges” in the number of cases. In contrast, lower mortality outcomes are evident in Japan using CRISIS [CRoss Icu Searchable Information System] data by the national registry, Japan ECMOnet for COVID-19. This highlights the need for scientific analysis of the medical factors contributing to high survival rates and social factors associated with low case “surges,” to gain insight into protective strategies for possible coming waves in the COVID-19 pandemic.


title: Multiple viral etiologies in patients with influenza-like illness and severe acute respiratory infection in Qatar, 2013–2016

text: Presenter: Shazia Nadeem, Acting Head of Surveillance and Outbreak, Public Health Department, Ministry of Public Health, Doha, Qatar Background: Respiratory illnesses are a significant cause of morbidity and mortality. Qatar has a comprehensive surveillance system which includes influenza-like illness (ILI) and severe acute respiratory infection (SARI) and identification of the influenza and non-influenza viruses causing the infections. Purpose: The aim of this study was to determine the viruses causing acute respiratory illness in Qatar during 2013–2016. Methodology: Respiratory samples were collected from selected patients using WHO standard case definitions with ILI at the sentinel primary health care centre sites of the National Influenza Centre and patients with SARI admitted to sentinel hospitals. Nasopharyngeal and/or oropharyngeal swabs were collected from eligible patients (standardized case definitions) for the period 2013–2016. Samples were analysed by real-time polymerase chain reaction at the National Influenza Centre, which tests for 22 types and subtypes of virus. Findings: In the study period, 43 106 patients were included and tested, 29 626 (68.7%) of whom tested positive for infection. Out of these, 8 829 (29.8%) were influenza positive, 6 655 (75.4%) of whom were influenza A and 2 174 (24.6%) were influenza B. Sub-typing of influenza A showed 3 721 (55.9%) were influenza A(H1N1)pdm09. Other respiratory viruses isolated included rhinovirus 4 626 (15.6%), respiratory syncytial virus 3 259 (11.0%), coronaviruses 1 824 (6.2%), adenovirus 1 689 (5.7%), parainfluenza virus 1 645 (5.6%), human metapneumovirus 1 357 (4.6%) Mycoplasma pneumoniae 1 053 (3.6%), bocavirus 874 (3.0%) and parechovirus 178 (0.6%). Seasonal variation was observed for influenza with the peak season being from October to March with an unexpected surge of cases seen in October to December 2016. Conclusions: Influenza viruses A and B are responsible for the majority of the ILI and SARI cases reported in Qatar; however many other viruses also contribute to the burden of respiratory illness in the country. The findings indicate other viral etiologies besides influenza which may influence the clinical management and outcome of the patient. Keywords: Influenza; Influenza-like illness; Severe acute respiratory infection; Respiratory pathogens; Qatar


Technological developments driven by COVID


title: Antibióticos en las infecciones respiratorias

text: El correcto tratamiento de las infecciones respiratorias representa un reto continuo para el médico de atención primaria. La mayor parte de las veces el tratamiento es empírico, debiendo combinar diferentes aspectos, como un diagnóstico correcto, microorganismos causales más probables, espectro de acción del antibiótico elegido, aumento de resistencias a antibióticos, aparición de nuevos fármacos, expectativas de adecuado cumplimiento y, por último, valorar la relación coste-efectividad. En este artículo se hace una revisión del tratamiento antibiótico de las infecciones respiratorias más frecuentes, como otitis, rinosinusitis, faringoamigdalitis, neumonía extrahospitalaria y reagudización de EPOC.