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Octreotide acetate (octreotide) is the most prescribed and most studied somatostatin congener, or analog, for gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and carcinoid syndrome, the latter of which may be characterized by debilitating diarrhea and flushing. Approved in the U.S. more than 30 years ago, octreotide is widely used to control the symptoms of carcinoid syndrome and has been shown to demonstrate antiproliferative activity. The two formulations available in the U.S. include a subcutaneous immediate-release (IR) injection introduced in 1989 and a long-acting repeatable (LAR) intramuscular injection approved in 1999. Lanreotide depot (lanreotide), a more recent somatostatin congener, has been available in the U.S. since 2014. Despite widespread use of octreotide LAR, several key challenges exist with the current depot-based treatment paradigm. Studies indicate that LAR formulations are associated with continued unmet patient needs, owing in part to a loss of bioactivity over time that may necessitate progressive supplemental treatment with IR octreotide to adequately control symptoms. Clinicians should understand the key differences in the pharmacokinetic profiles of the LAR and IR formulations that may contribute to bioactivity loss and somatostatin receptor desensitization. In addition, there is a need to re-evaluate the role of IR octreotide in combination with depot therapy to provide consistent bioavailability and better control of carcinoid syndrome symptoms. The purpose of this review is to explore all these issues and to re-establish a rationale for the IR formulation, particularly with respect to novel use cases and its use during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: There is a need to re-evaluate the role of immediate-release octreotide in combination with depot therapy to provide consistent bioavailability and better control of carcinoid syndrome symptoms.

Opportunities to Improve Symptom Control with Somatostatin Congeners in GEP-NETs: A Review of Key Issues

A common consequence of moderate to extreme periodontitis is pathologic migration. This denotes tooth movement when the periodontal disease interjects the equilibrium among the elements that preserve physiological tooth position. The balancing factors can migrate the teeth in any direction. The etiology of pathological migration tends to be multifactorial, thus achieving early diagnosis is imperative, which will ultimately lead to the prompt removal of the etiological factors while avoiding severe bone destruction. In this case maxillary central incisors had diastema due to pathological migration with mobility grade I in maxillary left central incisor. Many cases of moderate to severe pathological migration need a suitable, interdisciplinary approach. Nevertheless, since it is possible to detect mild cases of Pathological tooth migration (PTM) at an early stage, spontaneous correction of migrated teeth can be accomplished by periodontal therapy alone. Regardless of the treatment selected, maintenance of stable results should be considered as an aim of treatment.

Pathological tooth migration-spontaneous correction of diastema after surgical periodontal therapy: a case report

Mask ventilation is lifesaving, especially in cases of difficult intubation. Many publications have offered distinct techniques for optimizing mask ventilation. This article reviews currently available difficult mask ventilation literature and theory. We divide difficult mask ventilation into 3 broad categories based on etiology: inadequate mask seal, increased airway resistance, and decreased respiratory compliance. Published strategies for overcoming difficulty are presented and organized by etiology.

Optimizing Mask Ventilation: Literature Review and Development of a Conceptual Framework.

Current research endeavors in the application of artificial intelligence (AI) methods in the diagnosis of the COVID-19 disease has proven indispensable with very promising results. Despite these promising results, there are still limitations in real-time detection of COVID-19 using reverse transcription polymerase chain reaction (RT-PCR) test data, such as limited datasets, imbalance classes, a high misclassification rate of models, and the need for specialized research in identifying the best features and thus improving prediction rates. This study aims to investigate and apply the ensemble learning approach to develop prediction models for effective detection of COVID-19 using routine laboratory blood test results. Hence, an ensemble machine learning-based COVID-19 detection system is presented, aiming to aid clinicians to diagnose this virus effectively. The experiment was conducted using custom convolutional neural network (CNN) models as a first-stage classifier and 15 supervised machine learning algorithms as a second-stage classifier: K-Nearest Neighbors, Support Vector Machine (Linear and RBF), Naive Bayes, Decision Tree, Random Forest, MultiLayer Perceptron, AdaBoost, ExtraTrees, Logistic Regression, Linear and Quadratic Discriminant Analysis (LDA/QDA), Passive, Ridge, and Stochastic Gradient Descent Classifier. Our findings show that an ensemble learning model based on DNN and ExtraTrees achieved a mean accuracy of 99.28% and area under curve (AUC) of 99.4%, while AdaBoost gave a mean accuracy of 99.28% and AUC of 98.8% on the San Raffaele Hospital dataset, respectively. The comparison of the proposed COVID-19 detection approach with other state-of-the-art approaches using the same dataset shows that the proposed method outperforms several other COVID-19 diagnostics methods.

An Ensemble Learning Model for COVID-19 Detection from Blood Test Samples

Transitioning into the university environment can be both exciting and stressful for new and returning students alike The pressure to perform well academically in an increasingly competitive environment, coupled with a vast array of lifestyle changes, can contribute to suboptimal wellbeing Over recent years, uptake to wellbeing services within universities in the United Kingdom has grown given the concurrent rise in mental health difficulties reported Higher education students now have to contend with a drastically altered learning landscape, owing to the discovery of novel coronavirus, Sars-Cov-2, otherwise referred to as COVID-19 In the United Kingdom, universities have moved to close their campuses to both students and non-essential staff in an effort to protect them from contracting the virus The repercussions of these decisions have been monumental for the delivery of teaching, relationships and, importantly, the provision of student services Ambiguity remains as to how teaching will be delivered for the forthcoming academic year The uncertainty caused by the pandemic has yet to be considered in terms of student wellbeing and the new, mostly online, environments that students will be expected to navigate without their typical support networks For the purpose of this paper, the concept of student wellbeing, a population-level term concerned with positive emotions rather than diagnosed mental health conditions, will be considered in relation to the COVID-19 outbreak The current paper performs a conceptual analysis on student wellbeing in United Kingdom universities with a specific lens on the psychosocial impact of the global COVID-19 outbreak Given the unprecedented world that students now learn in, considering the impact of the pandemic on psychosocial outcomes delineates the novel challenges that researchers and practitioners must consider when implementing student wellbeing initiatives moving forward © Copyright © 2020 Burns, Dagnall and Holt

Assessing the Impact of the COVID-19 Pandemic on Student Wellbeing at Universities in the United Kingdom: A Conceptual Analysis

The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mostly affects adults with limited information on possible vertical transmission from pregnant mothers. We present here two very preterm infants born to mothers with COVID-19, whose respiratory course was significant for initial mild respiratory distress syndrome who developed acute onset severe air leak syndrome at approximately 24 to 36 hours of age requiring thoracentesis. Their respiratory status improved gradually with resolution of air leak and respiratory failure by 2 weeks of age. Both infants tested negative for SARS-CoV-2 by reverse transcriptase–polymerase chain reaction of multiple respiratory specimens collected beyond 24 hours after birth. As the incidence of severe air leak syndrome is relatively low in preterm infants without risk factors, this presentation in two very preterm infants born to mothers with COVID-19 is intriguing and needs to be further evaluated in larger cohorts. If confirmed, this data could potentially be the first step toward generating hypotheses for mechanisms of lung injury, intrauterine transmission, or how to detect COVID-19 in preterm infants. In addition, these data will be critical for developing evidence-based guidelines for perinatal management of these infants as we continue to battle against the COVID-19 pandemic for the foreseeable future.

Air Leak Syndrome in Two Very Preterm Infants Born to Mothers with Coronavirus Disease 2019: An Association or a Coincidence?

The effect of vaccination coupled with the behavioral response of the population is not well understood. Our model incorporates two important dynamically varying population behaviors: level of caution and sense of safety. Level of caution increases with infectious cases, while an increasing sense of safety with increased vaccination lowers precautions. Our model accurately reproduces the complete time history of COVID-19 infections for various regions of the United States. We propose a parameter d_I as a direct measure of a population’s caution against an infectious disease that can be obtained from the infectious cases. The model provides quantitative measures of highest disease transmission rate, effective transmission rate, and cautionary behavior. We predict future COVID-19 trends in the United States accounting for vaccine rollout and behavior. Although a high rate of vaccination is critical to quickly ending the pandemic, a return towards pre-pandemic social behavior due to increased sense of safety during vaccine deployment can cause an alarming surge in infections. Our results predict that at the current rate of vaccination, the new infection cases for COVID-19 in the United States will approach zero by August 2021. This model can be used for other regions and for future epidemics and pandemics.

A model and predictions for COVID-19 considering population behavior and vaccination

INTRODUCTION The identification of more efficient gene delivery vehicles (GDVs) is essential to fulfill the expectations of clinical gene therapy. Bacteriophages, due to their excellent safety profile, extreme stability under a variety of harsh environmental conditions and the capability for being genetically manipulated, have drawn a flurry of interest to be applied as a newly arisen category of gene delivery platforms. AREAS COVERED The incessant evolutionary interaction of bacteriophages with human cells has turned them into a part of our body's natural ecosystem. However, these carriers represent several barriers to gene transduction of mammalian cells. The lack of evolvement of specialized machinery for targeted cellular internalization, endosomal, lysosomal and proteasomal escape, cytoplasmic entry, nuclear localization and intranuclear transcription poses major challenges to the expression of the phage-carried gene. In this review, we describe pros and cons of bacteriophages as GDVs, provide an insight into numerous barriers that bacteriophages face for entry into and subsequent trafficking inside mammalian cells and elaborate on the strategies used to bypass these barriers. EXPERT OPINION Tremendous genetic flexibility of bacteriophages to undergo numerous surface modifications through phage display technology has proven to be a turning point in the uncompromising efforts to surmount the limitations of phage-mediated gene expression. The revelatory outcomes of the studies undertaken within the recent years have been promising for phage-mediated gene delivery to move from concept to reality.

Bacteriophages as vehicles for gene delivery into mammalian cells: prospects and problems.

There is an urgent need to address the devastating pandemic, COVID-19, caused by SARS-CoV-2 The efforts to understand the details of this disease in hope of providing effective treatments are commendable It is clear now that the virus can cause far more damage in patients with comorbid conditions-particularly in those with respiratory, cardiovascular, or immune-compromised system-than in patients without such comorbidities Drug use can further exacerbate the condition In this regard, the ill effects of smoking are amply documented, and no doubt can be a confounding factor in COVID-19 progression Although conflicting hypotheses on the potential role of nicotine in COVID-19 pathology have recently been offered, we believe that nicotine itself, through its interaction with the nicotinic cholinergic system, as well as ACE2, may not only be of use in a variety of neuropsychiatric and neurodegenerative diseases, but may also be of potential use in COVID-19 Thus, on one hand, while we strongly support smoking cessation as a means of harm reduction associated with COVID-19, on the other hand, we support a potential therapeutic role for nicotine, nicotinic agonists, or positive allosteric modulators of nicotinic cholinergic receptors in COVID-19, owing to their varied effects including mood regulation, anti-inflammatory, and purported interference with SARS-CoV-2 entry and/or replication

Nicotine and the nicotinic cholinergic system in COVID-19. (Special Issue: COVID-19.)

PurposeFacility location and re-location decisions are critical managerial decisions in modern supply chains Such decisions are difficult in this environment as managers encounter uncertainty and risks The study investigates establishing or moving distribution facilities in the global supply chain by considering costs, fulfilment, trade uncertainties, risks under environmental trade-offs and disruptive technologies Design/methodology/approachThis paper combines the possibilities and probabilistic scenarios for a supply chain network by proposing the novel Robust Optimisation and Mixed Integer Linear Programming (ROMILP) method developed under the potential uncertainty of demand while considering the costs associated with a four-tier supply chain network ROMILP has been solved in a real-time logistics environment by applying a case study approach FindingsThe solution is obtained using an exact solution approach and provides optimality in all tested market scenarios along the proposed global logistics corridor A sensitivity analysis examines potential facility location scenarios in a global supply chain context Research limitations/implicationsLogistics managers can apply the ROMILP model to test the cost-benefit trade-offs against their facility location and relocation decisions while operating under uncertainty Future research is proposed to extend the literature by applying data from the OBOR logistics corridor Originality/valueThis study is the first to examine sustainable dimensions along the global logistics corridor and investigate the global container traffic perspective The study also adds value to the Middle East logistics corridor regarding facility location decisions

Robust facility location decisions for resilient sustainable supply chain performance in the face of disruptions

Coronavirus disease 2019 (COVID-19) is a recently emerged pandemic caused by a novel virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease is communicable and mainly affects the respiratory tract. The outbreak of this disease has greatly influenced human health and economic activities worldwide. The absence of any medication for this infection highlights the urgent need for the development of alternative methods for managing the spread of the disease. Our immune system operates based on a complex array of cells, processes, and chemicals that continuously protect our body from invading pathogens, including viruses, toxins, and bacteria. The present study was conducted to perform a comprehensive review of all dietary treatments for boosting immunity against viral infections. No study was found to explicitly support the use of any healthy foods or supplements to protect against COVID-19. However, this study offers details on well-researched functional foods and supplements that typically improve the immune response, which could be helpful against this newly emerged pandemic.

Time to Enhance Immunity via Functional Foods and Supplements: Hope for SARS-CoV-2 Outbreak

(1) Background: Mozambique has an average population age of 17 years and adolescents and youths have a pivotal role in SARS-CoV-2 pandemic control. (2) Methods: We conducted a cross-sectional study in order to assess the awareness and information needs with regard to COVID-19 among a sample of adolescents and youths from two different Mozambican provinces. (3) Results: Only 25% of adolescents and youths had a high level of awareness and only 543/2170 participants reported a high level of knowledge regarding COVID-19. In our multivariate model, significant predictors of reporting a high level of knowledge about COVID-19 include female sex (O.R. = 1.47; 95% confidence interval (CI) 1.23-2.89), having a house without a thatched roof (O.R. = 1.85; 95% CI 1.02-2.95) and HIV-positive status (O.R. = 1.56; 95% CI 1.36-2.87). (4) Conclusions: Our study highlights an important and relevant knowledge gap in adolescents and youths with respect to the COVID-19 pandemic. Involving young people and adolescents in the fight against SARS-CoV-2 is an essential strategy, especially in countries where the national average age is young, such as Mozambique, and where this epidemic can aggravate an already fragile health system.

Mozambican Adolescents and Youths during the COVID-19 Pandemic: Knowledge and Awareness Gaps in the Provinces of Sofala and Tete

Since being identified in China in December 2019, coronavirus disease 2019 (Covid‐19) has rapidly evolved into a global pandemic with over 4 million cases and more than 270,000 deaths.(1) Following the first reported cases in the United Kingdom (UK) in late January 2020, numbers have continued to rise with 223,060 cases and 32,065 deaths reported as of 11(th) May 2020.(2) Initial reports from China have indicated that Covid‐19 has an overall mortality rate of 1.4%. However, the prognosis varies widely between groups, with age over 60 years and underlying conditions including hypertension, diabetes, cardiovascular disease and cancer identified as risk factors for severe disease and death.(3) The initial reports from China show that patients with cancer are over‐represented among individuals who develop severe Covid‐19 after contracting the virus.(4) Patients with haematological malignancies are expected to be at increased risk of adverse outcomes from this viral infection, due being immunosuppressed as a consequence of the underlying cancer, and from the effects of therapy.

Clinical Outcome of Coronavirus Disease 2019 in Haemato‐oncology Patients

Disease outbreaks in the form of epidemics and pandemics are known to destabilise the existing global public health infrastructure and to put nation-states in an alarming set of circumstances, thereby posing quite a few questions before us, including: can there be a solution to such problem in international law? In light of this question, the present essay tries to discern the role of international law in handling disease outbreaks. It wants to know whether there are sufficient international legal safeguards to address disease outbreaks and whether liability can be fastened on nation-states (including their people), international organisations, etc., if they are found to be directly and substantially responsible for such outbreaks. It dissects theoretical frameworks, analyses and interprets the existing literature to conclude that a 'one-size-fits-all' international legal approach is required to control disease outbreaks. It eventually recommends the need to have a Pandemic Convention. Copyright © 2021 Inderscience Enterprises Ltd.

The role of international law in controlling disease Outbreaks

An increased incidence of HFE gene mutations has been described in hematologic malignancies. In the present study, we investigated the allelic frequency of HFE gene mutations in 154 adult patients with acute leukemia (AL) [107 acute myeloid leukemia (AML), 20 acute promyelocytic leukemia (APL) and 27 acute lymphoblastic leukemia (ALL)]. The allelic frequency of the H63D mutation was 29% in AL patients and 25% in the healthy controls [P = 0.41; odds ratio (OR) = 1.20; 95% confidence interval (CI) = 0.77 - 1.93]. No difference was found between controls and AML or APL patients, whereas the H63D mutation was significantly more frequent in ALL than controls (44% vs. 25%, P = 0.04; OR = 2.37; 95% CI = 1.05 - 5.36). The overall comparison of the mutation among the three subtypes of AL demonstrated a higher allelic frequency in ALL (P = 0.02). In conclusion, our data demonstrate a correlation between the presence of the H63D mutation and the occurrence of ALL in adult patients.

HFE gene mutations in patients with acute leukemia.

The purpose of this study is to determine how mathematics instruction is carried out at the higher level of education in COVID-19 pandemic and what are the effects of these teaching activities. In the study, the case study model was used in which 30 lecturers with expertise in mathematics from 20 different universities in Turkey participated. In the study, the opinion form was used as a data collection tool. Descriptive analysis and content analysis methods were used in analyzing the data. It was found that before the pandemic, the use of technology in mathematics education by the lecturers was quite rare and at a basic level. In the pandemic process, it was observed that lecturers conducted their teaching synchronously or asynchronously with the traditional teaching approach, as before the pandemic, with distance education as the teacher-centered approach. It was understood that the main problems encountered during distance education were the difficulties encountered in teacher-student interaction and the inability to carry out assessment and evaluation activities in a healthy manner. It has been observed that the problems encountered especially in assessment and evaluation make it difficult to understand the actual impact of teaching mathematics during the pandemic on student learning. In fact, it was found that at the beginning of the pandemic, universities gave various instructions to their lecturers various trainings on distance education. However, these instructions were usually technical in scope and insufficient to overcome the difficulties encountered in the process, so that mathematics instruction was carried out with an understanding of 'emergency distance education" rather than formal distance education. On the other hand, the experience of distance education gained during the pandemic process had a positive influence on the views of a significant proportion of the lecturers on the integration of technology in mathematics education.

Instruction of Mathematics in Higher Education in the COVID-19 Pandemic: The Case of Turkey

COVID-19 is caused by a novel coronavirus (2019-nCoV), which was declared as a pandemic after it emerged in China 2019. A vast international effort has been conducted to prevent and treat COVID-19 due to its high transmissibility and severe morbidity and mortality rates, particularly in individuals with chronic co-morbidities. In addition, polymorphic variants increased the need for proper vaccination to overcome the infectivity of new variants that are emerging across the globe. Many treatment options have been proposed and more than 25 vaccines are in various stages of development; however, the infection peaks are oscillating periodically, which raises a significant question about the effectiveness of the prevention measures and the persistence of this pandemic disease. In this review, we are exploring the most recent knowledge and advances in the treatment and vaccination options as well as the new emerging variants of 2019-nCoV and the possible mitigation of one of the most aggressive pandemics in the last centuries.

SARS-CoV-2 and Coronavirus Disease Mitigation: Treatment Options, Vaccinations and Variants

Purpose We report a case of a patient with a known hereditary spherocytosis who developed a bilateral macular hemorrhage in concurrence with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related respiratory syndrome Observations Blood tests showed severe hemolytic anemia Interestingly, the peripheral blood smear demonstrated a mixed pathogenesis of the hemolytic process (cold-agglutinin-mediated and non-immune-mediated due to spherocytosis) Conclusions and Importance: We argue that SARS-CoV-2 could have triggered the hemolytic process, which led to retinal hemorrhages due to endothelial anoxia from the low oxygen carrying capacity

Bilateral macular hemorrhage in a patient with COVID-19

In the face of a pandemic, social media have found to be vital information channels that might exert a positive influence on people's preventive behaviors. However, little is known about the underlying processes that may mediate or moderate the relationship. The present study examined the relation between novel coronavirus disease (COVID-19) information consumption on social media and preventive behaviors, as well as the mediation role of personal responsibility and moderation role of health orientation. A sample of 511 online participants (mean age = 32.47 years) responded to anonymous questionnaires regarding COVID-19 information consumption on social media, health orientation, personal responsibility, and preventive behaviors. Bias-corrected bootstrap method was used to test the moderated mediation model. Results indicated that after controlling for participants' age, gender, education, income, and insurance, personal responsibility mediated the relationship between COVID-19 information consumption on social media and preventive behaviors. Meanwhile, the direct relation between COVID-19 information consumption on social media and preventive behaviors, and the mediation effect of personal responsibility were moderated by health orientation. The present study can extend our knowledge about how risk information consumption on social media is related to one's behavioral outcomes. Implications and limitations about the present study are also discussed.

COVID-19 information on social media and preventive behaviors: Managing the pandemic through personal responsibility

It is essential to consider challenges previously faced and addressed while developing a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Considering the severity of the health crisis that SARS-CoV-2 has caused worldwide, and with so little known about the virus, our focus should be drawn towards approaches that can bring better development outcomes in a relatively short period of time. This commentary discusses the use of nucleic acid (deoxyribonucleic acid and ribonucleic acid) vaccines against viral infections and pandemic-like settings. The potential advantages of the nucleic acid vaccines over conventional vaccines are presented, and the nucleic acid vaccines currently in development against viral infections and the challenges these vaccines face entering clinical trial are discussed.

Vaccine against SARS-CoV-2: Challenges and considerations.

Lockdowns during the COVID-19 pandemic provide an unprecedented opportunity to examine the effects of human activity on air quality. The effects on fine particulate matter (PM(2.5)) are of particular interest, as PM(2.5) is the leading environmental risk factor for mortality globally. We map global PM(2.5) concentrations for January to April 2020 with a focus on China, Europe, and North America using a combination of satellite data, simulation, and ground-based observations. We examine PM(2.5) concentrations during lockdown periods in 2020 compared to the same periods in 2018 to 2019. We find changes in population-weighted mean PM(2.5) concentrations during the lockdowns of −11 to −15 μg/m(3) across China, +1 to −2 μg/m(3) across Europe, and 0 to −2 μg/m(3) across North America. We explain these changes through a combination of meteorology and emission reductions, mostly due to transportation. This work demonstrates regional differences in the sensitivity of PM(2.5) to emission sources.

Effects of COVID-19 lockdowns on fine particulate matter concentrations

BACKGROUND: Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. METHODS: Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. RESULTS: After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. CONCLUSIONS: PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.

Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities

The worldwide COVID-19 pandemic caused by the SARS-CoV-2 betacoronavirus has highlighted the need for a synthetic biology approach to create reliable and scalable sources of viral antigen for uses in diagnostics, therapeutics and basic biomedical research. Here, we adapt plasmid-based systems in the eukaryotic microalgae Phaeodactylum tricornutum to develop an inducible overexpression system for SARS-CoV-2 proteins. Limiting phosphate and iron in growth media induced expression of the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein from the P. tricornutum HASP1 promoter in the wild-type strain and in a histidine auxotrophic strain that alleviates the requirement for antibiotic selection of expression plasmids. The RBD was purified from whole cell extracts (algae-RBD) with yield compromised by the finding that 90–95% of expressed RBD lacked the genetically encoded C-terminal 6X-histidine tag. Constructs that lacked the TEV protease site between the RBD and C-terminal 6X-histidine tag retained the tag, increasing yield. Purified algae-RBD was found to be N-linked glycosylated by treatment with endoglycosidases, was cross-reactive with anti-RBD polyclonal antibodies, and inhibited binding of recombinant RBD purified from mammalian cell lines to the human ACE2 receptor. We also show that the algae-RBD can be used in a lateral flow assay device to detect SARS-CoV-2 specific IgG antibodies from donor serum at sensitivity equivalent to assays performed with RBD made in mammalian cell lines. Our study shows that P. tricornutum is a scalable system with minimal biocontainment requirements for the inducible production of SARS-CoV-2 or other coronavirus antigens for pandemic diagnostics.

Phosphate-regulated expression of the SARS-CoV-2 receptor-binding domain in the diatom Phaeodactylum tricornutum for pandemic diagnostics

The coronavirus disease 2019 (COVID-19) pandemic has led to a large increase in mortality in the United States and around the world, leaving many grieving the sudden loss of family members. We created an indicator—the COVID-19 bereavement multiplier—that estimates the average number of individuals who will experience the death of a close relative (defined as a grandparent, parent, sibling, spouse, or child) for each COVID-19 death. Using demographic microsimulation-based estimates of kinship networks in the United States, the clear age gradient in COVID-19 mortality seen across contexts, and several hypothetical infection prevalence scenarios, we estimate COVID-19 bereavement multipliers for White and Black individuals in the United States. Our analysis shows that for every COVID-19 death, approximately nine surviving Americans will lose a grandparent, parent, sibling, spouse, or child. These estimates imply, for example, that if 190,000 Americans die from COVID-19, as some models project, then ∼1.7 million will experience the death of a close relative. We demonstrate that our estimates of the bereavement multiplier are stable across epidemiological realities, including infection scenarios, total number of deaths, and the distribution of deaths, which means researchers can estimate the bereavement burden over the course of the epidemic in lockstep with rising death tolls. In addition, we provide estimates of bereavement multipliers by age group, types of kin loss, and race to illuminate prospective disparities. The bereavement multiplier is a useful indicator for tracking COVID-19’s multiplicative impact as it reverberates across American families and can be tailored to other causes of death.

Tracking the reach of COVID-19 kin loss with a bereavement multiplier applied to the United States

Radiotherapy is being performed in many situations as a curative approach for head and neck cancer instead of surgery due to the current novel coronavirus disease (COVID-19) pandemic. A recent publication reported that even hypofractionation was being conducted in order to reduce the daily exposure of both patients and the medical staff involved in cancer therapies. As a result, dental teams may be requested more frequently than usual to fabricate intraoral stents (IOS). Given that IOS may be a potential source of COVID-19 contagion, the main purpose of the present correspondence is to offer a guide on how health professionals may be safely presented in the room, on the management of the IOS and also how to sanitize the stents.

Management of intraoral stents for radiotherapy during COVID-19 pandemic.

PURPOSE To evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS Thirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9-83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5-6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6-36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135-0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography. RESULTS In 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2-47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization. CONCLUSIONS Hydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations.

In the last few years, Earth Observation sensors received a large development, offering, therefore, various types of data with different temporal, spatial, spectral, and radiometric resolutions. However, due to physical and budget limitations, the acquisition of images with the best characteristics is not feasible. Image fusion becomes a valuable technique to deal with some specific applications. In particular, the vegetation area, which needs a high spectral resolution and frequent coverage. In this paper, we present a novel fusion technique based on Convolutional Neural Networks (CNN) to combine two kinds of remote sensing data with different but complement spectral and temporal characteristics, to produce one high spectral and temporal resolution product. To the best of our knowledge, this is the first attempt to deal with the spectral-temporal fusion problem. The feasibility of the proposed method is evaluated via Sentinel-2 data. The experimental results show that the proposed technique can achieve substantial gains in terms of fusion performance.

End-to-End Spectral-Temporal Fusion Using Convolutional Neural Network

The Delta variant raised concern regarding its ability to evade SARS-CoV-2 vaccines. We evaluated a serum neutralizing response of 172 Italian healthcare workers, three months after complete Comirnaty (BNT162b2 mRNA, BioNTech-Pfizer) vaccination, testing their sera against viral isolates of Alpha, Gamma and Delta variants, including 36 subjects with a previous SARS-CoV-2 infection. We assessed whether IgG anti-spike TRIM levels and serum neutralizing activity by seroneutralization assay were associated. Concerning Gamma variant, a two-fold reduction in neutralizing titres compared to the Alpha variant was observed, while a four-fold reduction of Delta virus compared to Alpha was found. A gender difference was observed in neutralizing titres only for the Gamma variant. The serum samples of 36 previously infected SARS-CoV-2 individuals neutralized Alpha, Gamma and Delta variants, demonstrating respectively a nearly three-fold and a five-fold reduction in neutralizing titres compared to Alpha variant. IgG anti-spike TRIM levels were positively correlated with serum neutralizing titres against the three variants. The Comirnaty vaccine provides sustained neutralizing antibody activity towards the Alpha variant, but it is less effective against Gamma and even less against Delta variants.

SARS-CoV-2 Gamma and Delta Variants of Concern Might Undermine Neutralizing Activity Generated in Response to BNT162b2 mRNA Vaccination

This study with a quantitative, descriptive and trend approach aims to determine the situation of technological resources that kindergarten teachers had in Peru, just before the transition to e-teaching due to covid-19. To do this, three Surveys to Peruvian Teachers (ENDO) carried out by Ministerio de Educacion del Peru before the pandemic, in 2014, 2016 and 2018 were analyzed. The total of kindergarten teachers who participated in each year, respectively, were: 1593 (74.2 % = urban, 25.8 % = rural), 1759 (76.8 % = urban, 23.2 % = rural) and 2935 (82.2 % = urban, 17.8 % = rural). After analyzing the three variables that make up the technological context dimension (electricity access, technological devices access and internet access) it can be concluded that the trends, in general, were positive, but insufficient, especially in terms of internet access, and especially in the rural areas of the Peruvian jungle. © 2021 IEEE.

Technological Context of Kindergarten Education Teachers in Peru before E-teaching due to covid-19. Prepandemic Diagnosis

BACKGROUND: Several COVID-19 vaccines have been authorized, and the need for rapid, further modification is anticipated. This work uses a Model-Based Meta-Analysis (MBMA) to relate, across species, immunogenicity to peak viral load (VL) after challenge and to clinical efficacy. Together with non-clinical and/or early clinical immunogenicity data (ECID), this enables prediction of a candidate vaccine’s clinical efficacy. The goal of this work was to enable the accelerated development of vaccine candidates by supporting Go/No-Go and study design decisions, and the resulting MBMA can be instrumental in decisions not to progress candidates to late stage development. METHODS: A literature review with pre-specified inclusion/exclusion criteria enabled creation of a database including nonclinical serum neutralizing titers (SN), peak VL after challenge with SARS-CoV-2 (VL), along with data from several clinical vaccine candidates. Rhesus Macaque (RM) and golden hamster (GH) were selected (due to availability and consistency of data) for MBMA modeling. For both RM and GH, peak post-challenge VL in lung and nasal tissues were used as surrogates for clinical disease and were related to pre-challenge SN via the MBMA. The VL predictions from the RM MBMA were scaled to incidence rates in humans, with a scaling factor between RM and human SN estimated using early Phase 3 efficacy data. This enabled clinical efficacy predictions based on ECID. To qualify the model’s predictive power, efficacies of COVID-19 vaccine candidates were compared to those predicted from the MBMA and their respective Ph1/2 SN data. More recently available clinical data enable building a clinical MBMA; comparing this to the RM MBMA further supports SN as predictive. RESULTS: The MBMA analyses identified a sigmoidal decrease in VL (increasing protection) with increase in SN in all three species, with more SN needed (in both RM and GH) for protection in nasal swabs than in BAL (see figure). The comparison between predicted and reported clinical efficacies demonstrated the model’s predictive power across vaccine platforms. RM and GH MBMA Protection Models and Translational Prediction with Observed Efficacies [Image: see text] Sizes of circles indicate relative weight of the data in the respective quantitative model. Model and data visualizations have been harmonized (across tissue-types) separately for each of RM and GH using VACHER (Lommerse, et al., CPT:PSP, in press). CONCLUSION: By quantifying adjustments needed between species and assays, translational MBMA can inform development decisions by using nonclinical SN and VL, and ECID to predict protection from COVID-19. DISCLOSURES: Anna Largajolli, PhD, Certara (Employee) Nele Plock, PhD, Certara (Employee, Shareholder)Merck & Co., Inc. (Independent Contractor) Bhargava Kandala, PhD, Merck & Co., Inc. (Employee, Shareholder) Akshita Chawla, PhD, Merck & Co., Inc. (Employee, Shareholder) Seth H. Robey, PhD, Merck & Co., Inc. (Employee, Shareholder) Kenny Watson, PhD, Certara (Employee, Shareholder) Raj Thatavarti, MS, Certara (Employee, Shareholder) Sheri Dubey, PhD, Merck & Co., Inc. (Employee, Shareholder) S. Y. Amy Cheung, PhD, Certara (Employee, Shareholder) Rik de Greef, MSc, Certara (Employee, Shareholder) Jeffrey R. Sachs, PhD, Merck & Co., Inc. (Employee, Shareholder)

1010. Cross-Species Translation of Correlates of Protection for COVID-19 Vaccine Candidates Using Quantitative Tools

In response to the global expansion of COVID-19, governments around the world have implemented social distancing measures resulting in an unprecedented fall in economic activity Consequently, the economic growth forecasts for 2020 have been adjusted downward in most countries, yet the magnitude of the decline has been different In this article, we examine the economic vulnerability to COVID-19-measured as the change in GDP growth forecasts for 2020-and its determinants for a sample of 194 countries We identify the characteristics of the external sector and macroeconomic policy stance that are associated with an increase in economic vulnerability during the pandemic © 2020, Universidad de Huelva All rights reserved

Tracking the characteristics of economic growth vulnerability to covid-19: A preliminary analysis

BACKGROUND: Decisions about treatments for extremely preterm infants (EPIs) born in the ‘grey zone’ of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine. METHODS: The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents’ views based on profession and neonatal unit designation. Further questions explored respondents’ conceptual understanding of viability. RESULTS: 336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22(+1) and 24(+0) weeks’ gestation. Registrars/fellows were more likely to select a lower threshold at 22(+0) weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22(+0) weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be ‘viable’ if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team. CONCLUSION: Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks’ gestation.

Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals

BACKGROUND: Slowing the spread of the novel coronavirus (COVID-19) requires behavioral changes such as physical distancing (e.g., staying a 6-foot distance from others, avoiding mass gatherings, reducing houseguests), wearing masks, reducing trips to nonessential business establishments, and increasing hand washing. Like other health behaviors, COVID-19 related behaviors may be related to risk representations. Risk representations are the cognitive responses a person holds about illness risk such as, identity (i.e., label/characteristics of risk), cause (i.e., factors causing condition), timeline (i.e., onset/duration of risk), consequences (i.e., intrapersonal/interpersonal outcomes), behavioral efficacy (i.e., if and how the condition can be controlled/treated), and illness risk coherence (i.e., extent to which representations, behaviors, and beliefs are congruent). The current study applies the Common-Sense Model of Self-Regulation (CSM-SR) to evaluate how risk representations may relate to COVID-19 protective and risk behaviors. METHODS: Participants include 400 workers from Amazon's Mechanical Turk aged &#8805; 18 years and US residents. Participants completed an online survey measuring risk representations (B-IPQ) and COVID-19 related behaviors, specifically, physical distancing, hand washing, and shopping frequency. RESULTS: Risk coherence, consequences, timeline, emotional representation, and behavioral efficacy were related to risk and protective behaviors. CONCLUSIONS: Risk representations vary in their relationship to COVID-19 risk and protective behaviors. Implications include the importance of coherent, targeted, consistent health communication, and effective health policy in mitigating the spread of COVID-19.

The Role of Risk Perceptions and Affective Consequences in COVID-19 Protective Behaviors

This paper proposes a new approach to estimating investor sentiments and their implications for the global financial markets. Contextualising the COVID-19 pandemic, we draw on the six behavioural indicators (media coverage, fake news, panic, sentiment, media hype and infodemic) of the 17 largest economies and data from [Formula: see text] January 2020 to [Formula: see text] February 2021. Our key findings, obtained using a time-varying parameter-vector auto-regression (TVP-VAR) model, indicate the total and net connectedness for the new index, entitled ‘feverish sentiment’. This index provides us insight into economies that send or receive the sentiment shocks. The construction of the network structures indicates that the United Kingdom, China, the United States and Germany became the epicentres of the sentimental shocks that were transmitted to other economies. Furthermore, we also explore the predictive power of the newly constructed index on stock returns and volatility. It turns out that investor sentiment positively (negatively) predicts the stock volatility (return) at the onset of COVID-19. This is the first study of its kind to assess international feverish sentiments by proposing a novel approach and its impacts on the equity market. Based on empirical findings, the study also offers some policy directions to mitigate the fear and panic during the pandemic.

Feverish sentiment and global equity markets during the COVID-19 pandemic

PURPOSE: There is no universal consensus on second-line agents for the treatment of moderate/severe to sight-threatening thyroid eye disease (TED) to maintain remission after first-line intravenous methylprednisolone (IVMP). This study investigates the efficacy and safety of mycophenolate mofetil (MMF) in TED patients in a real-world setting and over a longer period than previous randomized controlled trials. METHODS: A retrospective cohort study of TED patients with active moderate/severe to sight-threatening TED seen over a 4-year period. Data collected were visual acuity (VA), Clinical Activity Score (CAS), Gorman Diplopia scores, MMF dosing and side effects at 24, 52 and 78 weeks. Clinical efficacy was defined as an absence of relapse: no decline in best corrected LogMAR VA, no need for further steroids, no increase in CAS of ≥2. RESULTS: Out of 23 patients, 20 patients were included in this study. 10% (2/20) stopped MMF before 24 weeks. Median duration of MMF treatment was 76 weeks (1–140 weeks). 55% (11/20) had dysthyroid optic neuropathy (DON). In those with active moderate-severe TED without DON, clinical efficacy was seen in 100% (8/8) at 24 weeks, 87.5% (7/8) at 52 weeks, and 83.3% (5/6) at 78 weeks, with CAS decreasing from a baseline of 2.78±1.99 to 0.50±0.58 at 24 weeks, 0.50±0.82 at 52 weeks and 1.00±1.30 at 78 weeks. In DON, improvements were seen in 90% (9/10) at 24 weeks, 100% (7/7) at 52 weeks and 100% (4/4) at 78 weeks, with significantly reduced CAS scores from 2.55±1.54 to 0.83±1.27, 1.00±1.17 and 0.63±0.95 at 24, 52 and 78 weeks, respectively. Gorman score, VA and soft tissue inflammation parameters also improved throughout. There were two significant side effects over the treatment period. CONCLUSION: MMF appears to be an effective and safe second-line immunosuppressive agent. Further studies aimed at elucidating optimal dosing regimens and ideal treatment duration will prove helpful.

Real-World Efficacy and Safety of Mycophenolate Mofetil in Active Moderate-to-Sight-Threatening Thyroid Eye Disease

BACKGROUND: A major limitation of current predictive prognostic models in patients with COVID-19 is the heterogeneity of population in terms of disease stage and duration. This study aims at identifying a panel of clinical and laboratory parameters that at day-5 of symptoms onset could predict disease progression in hospitalized patients with COVID-19. METHODS: Prospective cohort study on hospitalized adult patients with COVID-19. Patient-level epidemiological, clinical, and laboratory data were collected at fixed time-points: day 5, 10, and 15 from symptoms onset. COVID-19 progression was defined as in-hospital death and/or transfer to ICU and/or respiratory failure (PaO(2)/FiO(2) ratio < 200) within day-11 of symptoms onset. Multivariate regression was performed to identify predictors of COVID-19 progression. A model assessed at day-5 of symptoms onset including male sex, age > 65 years, dyspnoea, cardiovascular disease, and at least three abnormal laboratory parameters among CRP (> 80 U/L), ALT (> 40 U/L), NLR (> 4.5), LDH (> 250 U/L), and CK (> 80 U/L) was proposed. Discrimination power was assessed by computing area under the receiver operating characteristic (AUC) values. RESULTS: A total of 235 patients with COVID-19 were prospectively included in a 3-month period. The majority of patients were male (148, 63%) and the mean age was 71 (SD 15.9). One hundred and ninety patients (81%) suffered from at least one underlying illness, most frequently cardiovascular disease (47%), neurological/psychiatric disorders (35%), and diabetes (21%). Among them 88 (37%) experienced COVID-19 progression. The proposed model showed an AUC of 0.73 (95% CI 0.66–0.81) for predicting disease progression by day-11. CONCLUSION: An easy-to-use panel of laboratory/clinical parameters computed at day-5 of symptoms onset predicts, with fair discrimination ability, COVID-19 progression. Assessment of these features at day-5 of symptoms onset could facilitate clinicians’ decision making. The model can also play a role as a tool to increase homogeneity of population in clinical trials on COVID-19 treatment in hospitalized patients.

Assessment of COVID-19 progression on day 5 from symptoms onset

In murine 17 Cl 1 cells persistently infected with murine coronavirus mouse hepatitis virus strain A59 (MHV-A59), expression of the virus receptor glycoprotein MHVR was markedly reduced (S. G. Sawicki, J. H. Lu, and K. V. Holmes, J. Virol. 69:5535-5543, 1995). Virus isolated from passage 600 of the persistently infected cells made smaller plaques on 17 Cl 1 cells than did MHV-A59. Unlike the parental MHV-A59, this variant virus also infected the BHK-21 (BHK) line of hamster cells. Virus plaque purified on BHK cells (MHV/BHK) grew more slowly in murine cells than did MHV-A59, and the rate of viral RNA synthesis was lower and the development of the viral nucleocapsid (N) protein was slower than those of MHV-A59. MHV/BHK was 100-fold more resistant to neutralization with the purified soluble recombinant MHV receptor glycoprotein (sMHVR) than was MHV-A59. Pretreatment of 17 Cl 1 cells with anti-MHVR monoclonal antibody CC1 protected the cells from infection with MHV-A59 but only partially protected them from infection with MHV/BHK. Thus, although MHV/BHK could still utilize MHVR as a receptor, its interactions with the receptor were significantly different from those of MHV-A59. To determine whether a hemagglutinin esterase (HE) glycoprotein that could bind the virions to 9-O-acetylated neuraminic acid moieties on the cell surface was expressed by MHV/BHK, an in situ esterase assay was used. No expression of HE activity was detected in 17 Cl 1 cells infected with MHV/BHK, suggesting that this virus, like MHV-A59, bound to cell membranes via its S glycoprotein. MHV/BHK was able to infect cell lines from many mammalian species, including murine (17 Cl 1), hamster (BHK), feline (Fcwf), bovine (MDBK), rat (RIE), monkey (Vero), and human (L132 and HeLa) cell lines. MHV/BHK could not infect dog kidney (MDCK I) or swine testis (ST) cell lines. Thus, in persistently infected murine cell lines that express very low levels of virus receptor MHVR and which also have and may express alternative virus receptors of lesser efficiency, there is a strong selective advantage for virus with altered interactions with receptor (D. S. Chen, M. Asanaka, F. S. Chen, J. E. Shively, and M. M. C. Lai, J. Virol. 71:1688-1691, 1997; D. S. Chen, M. Asanaka, K. Yokomori, F.-I. Wang, S. B. Hwang, H.-P. Li, and M. M. C. Lai, Proc. Natl. Acad. Sci. USA 92:12095-12099, 1995; P. Nedellec, G. S. Dveksler, E. Daniels, C. Turbide, B. Chow, A. A. Basile, K. V. Holmes, and N. Beauchemin, J. Virol. 68:4525-4537, 1994). Possibly, in coronavirus-infected animals, replication of the virus in tissues that express low levels of receptor might also select viruses with altered receptor recognition and extended host range.

The murine coronavirus mouse hepatitis virus strain A59 from persistently infected murine cells exhibits an extended host range.

Von der Prävention zur Preparedness: Kulturanthropologen werfen einen neuen Blick auf Pandemien als globalisierte und globalisierende Erkrankungen. Virusinfektionen wie SARS sollen über die medizinische Dimension hinaus umfassend verstanden und bekämpft werden.

Auf alles gefasst sein

BACKGROUND AND OBJECTIVE: Community-based elderly studies concerning microbiology of acute respiratory infections are scarce. Data on subclinical infections are even totally absent, although asymptomatic persons might act as a source of respiratory infections. METHODS: In a 1-year community-based study, we prospectively investigated the possible virologic cause of acute respiratory infections in 107 symptomatic case episodes and 91 symptom-free control periods. Participants, persons ⩾60 years, reported daily the presence of respiratory symptoms in a diary. Virologic assessment was performed by polymerase chain reaction (PCR) and serology. RESULTS: In 58% of the case episodes a pathogen was demonstrated, the most common being rhinoviruses (32%), coronaviruses (17%), and influenzaviruses (7%). The odds ratio for demonstrating a virus in cases with symptoms vs. controls without symptoms was 30.0 (95% confidence interval 10.2–87.6). In 4% of the symptom-free control periods a virus was detected. CONCLUSION: This study supports the importance of rhinovirus infections in community-dwelling elderly persons, whereas asymptomatic elderly persons can also harbor pathogens as detected by PCR, and thus might be a source of infection for their environment.

A prospective, community-based study on virologic assessment among elderly people with and without symptoms of acute respiratory infection

BACKGROUND: During the initial wave of COVID-19 hospitalizations, care delivery and workforce adaptations were rapidly implemented. In response to subsequent surges of patients, institutions have deployed, modified, and/or discontinued their workforce plans. OBJECTIVE: Using rapid qualitative methods, we sought to explore hospitalists’ experiences with workforce deployment, types of clinicians deployed, and challenges encountered with subsequent iterations of surge planning during the COVID-19 pandemic across a collaborative of hospital medicine groups. APPROACH: Using rapid qualitative methods, focus groups were conducted in partnership with the Hospital Medicine Reengineering Network (HOMERuN). We interviewed physicians, advanced practice providers (APP), and physician researchers about (1) ongoing adaptations to the workforce as a result of the COVID-19 pandemic, (2) current struggles with workforce planning, and (3) evolution of workforce planning. KEY RESULTS: We conducted five focus groups with 33 individuals from 24 institutions, representing 52% of HOMERuN sites. A variety of adaptations was described by participants, some common across institutions and others specific to the institution’s location and context. Adaptations implemented shifted from the first waves of COVID patients to subsequent waves. Three global themes also emerged: (1) adaptability and comfort with dynamic change, (2) the importance of the unique hospitalist skillset for effective surge planning and redeployment, and (3) the lack of universal solutions. CONCLUSIONS: Hospital workforce adaptations to the COVID pandemic continued to evolve. While few approaches were universally effective in managing surges of patients, and successful adaptations were highly context dependent, the ability to navigate a complex system, adaptability, and comfort in a chaotic, dynamic environment were themes considered most critical to successful surge management. However, resource constraints and sustained high workload levels raised issues of burnout. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-022-07480-x.

Adaptability on Shifting Ground: a Rapid Qualitative Assessment of Multi-institutional Inpatient Surge Planning and Workforce Deployment During the COVID-19 Pandemic

Abstract Complementary and alternative medicine, including Traditional Chinese Medicine (TCM), has been used as therapy against acquired immune deficiency syndrome (AIDS) for almost 30 years. Based on evaluation indicators for AIDS treatment using TCM, we discuss why the survival rate (which has been used widely in Western Medicine) should be adopted as a new important indicator of TCM treatment for AIDS. We advise that further prospective or retrospective cohort studies should be carried out to confirm this hypothesis.

Survival rate: an indicator of the management of acquired immune deficiency syndrome using Traditional Chinese Medicine

Background In October 2020 SARS-CoV-2 seroprevalence among hospital healthcare workers (HCW) of two Irish hospitals was 15% and 4.1% respectively. We compare seroprevalence in the same HCW population six months later, assess changes in risk factors for seropositivity with progression of the pandemic and serological response to vaccination. Methods All staff of both hospitals (N=9038) were invited to participate in an online questionnaire and SARS-CoV-2 antibody testing in April 2021. We measured anti-nucleocapsid and anti-spike antibodies. Frequencies and percentages for positive SARS-CoV-2 antibodies were calculated and adjusted relative risks for participant characteristics were calculated using multivariable regression analysis. Results 5085 HCW participated. Seroprevalence increased to 21% and 13% respectively; 26% of infections were previously undiagnosed. Black ethnicity (aRR 1.7, 95% CI 1.3-2.2, p<.001), lower level of education (aRR 1.4 for secondary level education, 95% CI 1.1-1.8, p=0.002), living with other HCW (aRR 1.2, 95% CI 1.0-1.4, p=0.007) were significantly associated with seropositivity. Having direct patient contact also carried a significant risk (being a healthcare assistant (aRR 1.8, 95% CI 1.3-2.3, p<.001), being a nurse (aRR 1.4, 95% CI 1.0-1.8, p=0.022), daily contact with COVID-19 patients (aRR 1.4, 95% CI 1.1-1.7, p=0.002), daily contact with patients without suspected or confirmed COVID-19 (aRR 1.3, 95% CI 1.1-1.5, p=0.013) Breakthrough infection occurred in 23/4111(0.6%) of fully vaccinated participants; all had anti-S antibodies. Conclusion The increase in seroprevalence reflects the magnitude of the third wave of the pandemic in Ireland. Genomic sequencing is needed to apportion risk to the workplace versus the household/community. Concerted efforts are needed to mitigate risk factors due to ethnicity and lower level of education, even at this stage of the pandemic. The undiagnosed and breakthrough infections call for ongoing infection prevention and control measures and testing of HCW in the setting of close contact. Vaccinated HCW with confirmed infection should be actively assessed, including SARS-CoV-2 whole genome sequencing (WGS), serology testing and assessment of host determinants, to advance understanding of the reasons for breakthrough infection.

Prevalence of Antibodies to SARS-CoV-2 following natural infection and vaccination in Irish Hospital Healthcare Workers; changing epidemiology as the pandemic progresses

The COVID-19 pandemic poses a threat to global health and security inciting governments with the responsibility to respond with measures that ensure the health and safety of their communities We assessed public attitudes towards governmental actions to combat the COVID-19 pandemic in the G7 countries Data were collected during 19th–21st March 2020, from 7005 Kantar's online panelists aged &gt;16 years across the G7 countries: Canada, France, Great Britain, Germany, Italy, Japan, and the United States Data were post-stratified and weighted to match population distributions of the respective countries Descriptive and multivariable analyses were conducted Amongst the G7, Japan had the lowest level of approval of governmental response to the pandemic, rating governmental communication as good, and trusting governmental decisions (35 0%, 33 6%, and 38 0%, respectively), followed by the U S (52 9%, 64 6%, and 59 9%, respectively) Understanding of which measures one can personally take to help limit the spread of the coronavirus was significantly associated with approving governmental response (aOR = 2 88), rating government communication as good (aOR = 2 70) and trust in future governmental decisions (aOR = 2 73) Those who reported government/politicians and friends/family as their most trusted information source were more likely to report approval, higher rating, and/or trust toward governmental actions Public attitudes towards governmental actions against COVID-19 varied substantially across the G7 countries and were associated with the understanding of measures and source of information that respondents most trusted Timely and accurate communication is essential to enhance public engagement to control the COVID-19 pandemic

Public perspective on the governmental response, communication and trust in the governmental decisions in mitigating COVID-19 early in the pandemic across the G7 countries

Background: The first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rio Grande do Norte, northeast Brazil, was diagnosed on March 12, 2020; thereafter, the pattern of COVID-19 followed the multiple waves as seen elsewhere. The waves were mostly due to the SARS-CoV-2 virus mutations leading to emergence of variants of concern (VoC). The introduction of new VoCs in a population context of prior SARS-CoV-2 infections or after vaccination has been a challenge in understanding the kinetics of the protective immune response against SARS-CoV-2 . The aim of this study was to investigate the outbreak of SARS-CoV-2 reinfections observed in mid-January 2022 in Rio Grande do Norte state, Brazil when the omicron variant was introduced. Methodology/Principal findings: From a total of 172,965 individuals with mild to severe respiratory symptoms, 58,097 tested positive for SARS-CoV-2 between March 2020 through mid-February 2022. Of those previously infected, 444 had documented a second SARS-CoV-2 infection and 9 of these reinfection cases were selected for sequencing. Genomic analysis revealed that virus lineages diverged between primary and the reinfection, with the latter caused by the Omicron (BA.1) variant among individuals fully vaccinated against SARS-CoV-2. Conclusions/Significance: Once all subjects whose samples were sequenced had prior SARS-CoV-2 infection and were also fully vaccinated, our data suggest that the Omicron variant evades natural and vaccine-induced immunities, confirming the continuous need to decrease transmission and to develop effective blocking vaccines.

SARS-CoV-2 reinfections with BA.1 (Omicron) variant among fully vaccinated individuals in the northeast of Brazil

OBJECTIVE To study the serum vitamin D levels in neonatal seizures and vitamin D status of the mothers whose babies had vitamin D deficiency. METHODS For this case-control study, vitamin D levels were studied in term and late preterm neonates admitted to NICU with seizures in a tertiary care center in South India. Controls were term and late preterm healthy neonates admitted in the postnatal ward with the mothers in the same center. RESULT 30 cases and 30 controls were enrolled. The mean (SD) serum vitamin D was 19.33 (7.76) ng/mL among cases and 16.83 (6.74) ng/mL among controls (P=0.18). We tested maternal vitamin D levels in babies with seizures and low vitamin D levels. The mean (SD) serum vitamin D level among these mothers (n=11) was 13.25 (6.17) ng/mL. CONCLUSION There was no statistically significant association between serum vitamin D levels and seizures among neonates in our study. However, we found low vitamin D levels in lactating mothers and newborn population of this region.

Vitamin D Levels in Neonates With and Without Seizures: A Single Center Cross-Sectional Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) primarily causes lung infection, but recent studies have shown that cardiac involvement is associated with a worse prognosis. OBJECTIVES: We conducted a systematic review and meta-analysis to examine the prevalence of cardiac arrhythmias detected by the electrocardiogram and their relationships with adverse outcomes in patients with COVID-19. METHODS: PubMed and Google were searched for studies that reported on cardiac arrhythmias and/or examined the relationship between arrhythmias and adverse outcomes. RESULTS: Thirty studies with 12,713 participants were included in the systematic review, and 28 studies (n = 12,499) in the meta-analysis. The mean age was 61.3 ± 16.8 years; 39.3% were female. In 25 studies with 7578 patients, the overall prevalence of cardiac arrhythmias was 10.3% (95% confidence interval [CI]: 8.4%-12.3%). The most common arrhythmias documented during hospitalization were supraventricular arrhythmias (6.2%, 95% CI: 4.4%-8.1%) followed by ventricular arrhythmias (2.5%, 95% CI: 1.8%-3.1%). The incidence of cardiac arrhythmias was higher among critically ill patients (relative risk [RR]: 12.1, 95% CI: 8.5-17.3) and among non-survivors (RR: 3.8, 95%, CI: 1.7-8.7). Eight studies reported changes in the QT interval. The prevalence of QTc > 500 ms was 12.3% (95% CI: 6.9%-17.8%). ST-segment deviation was reported in eight studies, with a pooled estimate of 8.7% (95% CI: 7.3% to 10.0%). CONCLUSION: Our meta-analysis showed that QTc prolongation, ST-segment deviation, and various other cardiac arrhythmias were observed in patients hospitalized with COVID-19. The presence of cardiac arrhythmias was associated with a worse prognosis.

Arrhythmias and electrocardiographic findings in Coronavirus disease 2019: A systematic review and meta-analysis

INTRODUCTION In patients with atrial fibrillation (AF), oral anticoagulation with vitamin K antagonists (VKA) (warfarin, phenprocoumon) is effective both for primary and secondary stroke prevention with a 60-70% relative reduction in stroke risk compared with placebo. Mortality is reduced by 26%. VKA have a number of well-documented shortcomings which were overcome by non-vitamin-K oral anticoagulants (NOACs). Areas covered: Results of randomized trials for four NOACs (apixaban, dabigatran, edoxaban, rivaroxaban) have been published (ARISTOTLE, RE-LY, ENGAGE, ROCKET-AF). In this review, the authors discuss the results in subgroups of patients with prior transient ischemic attacks or ischemic stroke. In aggregate, the NOACs are superior to warfarin for secondary prevention and result in a 50% reduction in intracerebral hemorrhage. Apixaban was superior to aspirin in the AVERROES trial and had a similar rate of major bleeding complications. Expert opinion: NOACs add to the therapeutic options for secondary stroke prevention in patients with AF and offer advantages over warfarin including a favorable bleeding profile and convenience of use. Aspirin should no longer be used for secondary stroke prevention in patients with AF.

Non-vitamin-K oral anticoagulants (NOACs) for the prevention of secondary stroke.

BACKGROUND: Emerging evidence suggests many people have persistent symptoms after acute COVID-19 illness. Our objective was to estimate the prevalence and correlates of post-acute sequelae of SARS-CoV-2 infection (PASC). METHODS: We employed a population-based probability survey of adults with COVID-19 in Michigan. Living non-institutionalized adults aged 18+ in the Michigan Disease Surveillance System with COVID-19 onset through mid-April 2020 were eligible for selection (n=28,000). Among 2,000 selected, 629 completed the survey between June - December 2020. We estimated PASC prevalence, defined as persistent symptoms 30+ (30-day COVID-19) or 60+ days (60-day COVID-19) post COVID-19 onset, overall and by sociodemographic and clinical factors, including self-reported symptom severity and hospitalization status. We used modified Poisson regression to produce adjusted prevalence ratios (aPR) for potential risk factors. RESULTS: The analytic sample (n=593) was predominantly female (56.1%), aged 45 and older (68.2%), and Non-Hispanic White (46.3%) or Black (34.8%). 30- and 60-day COVID-19 were highly prevalent (52.5% and 35.0%), even among non-hospitalized respondents (43.7% and 26.9%) and respondents reporting mild symptoms (29.2% and 24.5%). Respondents reporting very severe (vs. mild) symptoms had 2.25 times higher prevalence of 30-day COVID-19 ([aPR] 2.25, 95% CI 1.46-3.46) and 1.71 times higher prevalence of 60-day COVID-19 (aPR 1.71, 95% 1.02-2.88). Hospitalized (vs. non-hospitalized) respondents had about 40% higher prevalence of both 30-day (aPR 1.37, 95% CI 1.12-1.69) and 60-day COVID-19 (aPR 1.40, 95% CI 1.02-1.93). CONCLUSIONS: PASC is highly prevalent among cases reporting severe initial symptoms, and, to a lesser extent, cases reporting mild and moderate symptoms.

Population-based estimates of post-acute sequelae of SARS-CoV-2 infection (PASC) prevalence and characteristics

OBJECTIVE: To understand how giving birth during the coronavirus disease 2019 (COVID-19) pandemic affected women based on birth parameters (gestational age, type of birth and body weight at birth), satisfaction with childbirth, and development of postpartum depression. METHODS: This is a cross-sectional study of 162 Spanish women. They were divided into two groups: those who gave birth before the pandemic (n = 82; from September 1, 2019 to March 1, 2020) and during the pandemic (n = 75; from April 1, 2020 to July 1, 2020). They were assessed using psychological instruments for postpartum childbirth satisfaction and postpartum depression. RESULTS: It was found that women who gave birth during the pandemic suffered higher levels of stress during childbirth (U = 2652.50; P = 0.040) and gave a worse rating of the quality of care received (U = 2703.50; P = 0.041). In addition, the percentage of postpartum depression was much higher in women who gave birth during the pandemic (&#967;2 = 4.31; P = 0.038). CONCLUSION: Giving birth during the COVID-19 pandemic could have an impact on greater dissatisfaction with childbirth, as well as increasing the risk of postpartum depression.

Giving birth during the COVID-19 pandemic: The impact on birth satisfaction and postpartum depression

There is no effective treatment for the COVID-19 disease that is still impacting the whole world. It considered that vaccines one of the effective means to prevent infectious diseases will play a significant role in protecting from the COVID-19 Disease. Vaccination’s generals performed before exposure. We aimed to follow the clinical and laboratory progress of patients who got COVID-19 after the first dose of the COVID-19 vaccine and to evaluate the changes that may occur in antibody formation. 13 patients who received the first dose of COVID-19 vaccine Coronovac as of 14.01.2021 when vaccination started in Adıyaman University Training and Research Hospital/Turkey who had symptoms after the vaccine and whose real-time PCR found to be positive were included in the study. After the first dose of the COVID-19 vaccine 13 patients’ exam. Three of our patients were female and 10 of them were male. The average age was 38.8. British variant detected in 4 of our patients;1 of them was female. Contact times differed between 3 and 5 days. The most common symptoms were muscle-joint pain (53.8) weakness-fatigue (46.2) fever (38.5) and headache (30.8). Three of our patients being one female received inpatient treatment. Furthermore, our five patients who checked regarding SARS cov-2 IgG became positive in the first month. No adverse changes in the course of the illness observed in the patients were RT-PCR positive after the first dose of the COVID-19 vaccine. Antibody response detected at the end of the first month. Vaccination is an effective method for taking infectious diseases under control but adhering to personal protective measures still maintains their importance.

Patients that are having COVID-19 disease after the first dose of COVID-vaccine

OBJECTIVE: The application of media on lifestyle-related risk factors (LRRFs) by healthcare providers to educate women may improve women's adherence, health literacy, and awareness of LRRFs, as well as offspring's health outcomes. This study investigated whether exposure to media-based education in gynecological and obstetric care is associated with LRRFs perceived levels of education received during pregnancy and lactation. METHODS: We conducted a cross-sectional, observational study across 14 randomly generated sample points in the 12 most populated cities in Baden-Württemberg, southwest Germany. Women were recruited from gynecological and obstetric institutions. Participants were 219 women who met our inclusion criteria and completed the quantitative questionnaire. We applied ordinal logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of women's perceived level of education received related to healthcare providers' exposure to media-based education. RESULTS: Media-based education on LRRFs during pregnancy through gynecologists and/or midwives were significantly associated with women's perceived level of education received (gynecologists: OR = 4.26 (95% CI: 2.04, 8.90; p < .001); midwives: OR = 3.86 (95% CI: 1.66, 8.98; p = .002)). Similar results were found for media-based education through gynecologists and/or midwives on LRRFs during lactation and its association with women's self-assessed level of perceived level of education received (gynecologists: OR = 4.76 (95% CI: 2.15, 10.56; p < .001); midwives: OR = 7.61 (95% CI: 3.13, 18.53; p < .001)). CONCLUSIONS: This study suggests that the exposure to media-based education in gynecological and obstetric care increases women's perceived level of education received of LRRFs during pregnancy and lactation. Therefore, it is recommendable to apply media in gynecological and obstetric care settings.

Media use in gynecological and obstetric care and women's perceived level of education received of lifestyle-related risks: A cross-sectional study

As of 22 April 2020, there are 6 countries with &gt;100,000 cases, 21 countries with 1000 to 10,000 confirmed cases and 53 countries with between 1000 and 10,000 confirmed cases of COVID‑19 Six articles (5 research articles and 1 review article) with a total of 159 cases delineating the equipment, protocol, techniques, indications and follow‑up management of COVID‑19 were identified in a PUBMED search evaluating the role of lung Ultrasound In the current review article, 55%‑60% of the patients with COVID‑19 were male;the median age has been reported between 34 and 59 years Lung Ultrasound features of COVID‑19 are related to the stage of the disease, the severity of lung injury, and comorbidities This review article provides a summary of lung Ultrasound findings in COVID‑19 and clinical guidance for the use and interpretation of lung ultrasound for patients with moderate, severe and critical COVID‑19‑related pulmonary syndrome [ABSTRACT FROM AUTHOR] Copyright of Saudi Journal of Anaesthesia is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Review of lung ultrasound findings in coronavirus disease 2019 (COVID-19): Effectiveness, applications and approach to lung ultrasound during times of a pandemic

Global health continues to face increasing challenges owing to a variety of reasons that include the almost constant changes in disease appearance and evolution. Most, but not all, of these changes affect low-income countries and are influenced by climate change. Tracking the recent and anticipated changes in the demographics and global distribution of these changes is essential for evolving effective new methods for dealing with the problems. The recent recognition by the United Nations of the importance of non-communicable diseases is a major positive step. For the sake of this paper, the following diseases were chosen: dengue and malaria, to highlight the role of climate change on vector-borne diseases. Drug-resistant tuberculosis illustrates the role of globalization and reduced resources on disease evolution. The continuing rise in cardiovascular mortality and morbidity, particularly in resource-poor countries is largely attributed to lack of preventive and therapeutic measures against such conditions as hypertension, diabetes, atherosclerosis and congenital heart disease as well as neglected diseases, of which Chagas and rheumatic heart disease will be discussed further.

Disease appearance and evolution against a background of climate change and reduced resources.

STUDY OBJECTIVES Like other medical branches, the practice of sleep medicine has been affected by the COVID-19 pandemic; however, the actual impact is not known. This study was planned to assess the status of the practice of sleep medicine in India during the COVID-19 pandemic and lockdown. METHODS This was an online questionnaire-based descriptive study. A 25-item questionnaire was developed to assess the functioning of sleep laboratories, use of telemedicine, and positive airway pressure therapy during the COVID-19 pandemic in India. The questionnaire was sent to the sleep physicians of two major sleep medicine societies of India. Responses were analyzed. RESULTS In this study, the response rate was 64.6%. During this pandemic, 72% of physicians reported that they had closed sleep laboratory while 24% reported shifting to home sleep apnea testing. Only half of the sleep physicians confirmed awareness of the disinfection guidelines proposed by AASM to prevent COVID-19 infection in the sleep laboratory. However, almost all of them reported taking preventive measures like the use of protective gear. 61% of physicians advised mitigating strategies as a temporary measure to their patients of obstructive sleep apnea (OSA). 58.6% opined that auto-PAP might be used for uncomplicated OSA without diagnostic polysomnography during the pandemic. 84% of physicians reported that they were continuing their services through telemedicine facility. Physicians reported that consultations for insomnia and circadian rhythm sleep disorders increased during the pandemic. CONCLUSIONS Sleep laboratories were reportedly closed during the COVID-19 pandemic, and most of the sleep physicians were providing services through telemedicine. The majority reported that auto-PAP without diagnostic polysomnography could be an effective option for uncomplicated OSA. Consultation for insomnia and circadian rhythm sleep disorders reportedly increased during the lockdown.

Status of the practice of sleep medicine in India during COVID-19 pandemic.

Abstract Objectives To investigate the role of ethnicity in COVID-19 outcome disparities in a cohort in Kuwait. Methods This is a retrospective analysis of 405 individuals infected with SARS-CoV2 in Kuwait. Outcomes such as symptoms severity and mortality were considered. Multivariate logistic regression models were used to report the odds ratios (OR) for ICU admission and dying from COVID-19. Results The cohort included 290 Arabs and 115 South Asians. South Asians recorded significantly higher COVID-19 death rates compared to Arabs (33% vs. 7.6%, P value<0.001). When compared to Arabs, South Asians also had higher odds of being admitted to the ICU (OR = 6.28, 95% CI: 3.34-11.80, p < 0.001). South Asian patients showed 7.62 (95% CI: 3.62-16.02, p < 0.001) times the odds of dying from COVID-19. Conclusion COVID-19 patients with South Asians ethnicity are more likely to have worse prognosis and outcome when compared to patients with Arab ethnicity. This suggest a possible role for ethnicity in COVID-19 outcome disparities and this role is likely to be multifactorial.

Outcomes of COVID-19: disparities by ethnicity

Importance: Research is needed to demonstrate the efficacy of nasal povidone-iodine (PVP-I) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To evaluate the in vitro efficacy of PVP-I nasal antiseptic for the inactivation of SARS-CoV-2 at clinically significant contact times of 15 and 30 seconds. Interventions: The SARS-CoV-2, USA-WA1/2020 strain, virus stock was tested against nasal antiseptic solutions consisting of aqueous PVP-I as the sole active ingredient. Povidone-iodine was tested at diluted concentrations of 0.5%, 1.25%, and 2.5% and compared with controls. The test solutions and virus were incubated at mean (SD) room temperature of 22 (2) °C for time periods of 15 and 30 seconds. Design and Setting: This controlled in vitro laboratory research study used 3 different concentrations of study solution and ethanol, 70%, as a positive control on test media infected with SARS-CoV-2. Test media without virus were added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol, 70%, was tested in parallel as a positive control and water only as a negative control. Main Outcomes and Measures: The primary study outcome measurement was the log reduction value after 15 seconds and 30 seconds of given treatment. Surviving virus from each sample was quantified by standard end point dilution assay, and the log reduction value of each compound was compared with the negative (water) control. Results: Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact as measured by log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus. The ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact. The nasal antiseptics tested performed better than the standard positive control routinely used for in vitro assessment of anti-SARS-CoV-2 agents at a contact time of 15 seconds. No cytotoxic effects on cells were observed after contact with each of the nasal antiseptics tested. Conclusions and Relevance: Povidone-iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 at contact times as short as 15 seconds. Intranasal use of PVP-I has demonstrated safety at concentrations of 1.25% and below and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2

BACKGROUND: The COVID-19 pandemic has caused a negative impact in every sector of life, especially in the health sector. Patients with different medical conditions are suffering delays in their surgical treatments. Cleft lip and palate is a common congenital disease that requires early interdisciplinary attention, and there is uncertainty about the safety of performing its surgical treatment during the COVID-19 pandemic. The objective of this study was to evaluate the safety of a surgical cleft protocol for cleft lip and palate used during the COVID-19 pandemic at a high volume cleft center in Lima, Peru. METHODS: This is a comparative study between two groups of patients with nonsyndromic cleft lip and palate who were operated on before and during the COVID-19 pandemic. Data collection was done by evaluation of presurgical condition, and surgical and nonsurgical postoperative outcomes and complications. RESULTS: Significant differences were observed regarding both the age of the patients at the time of the primary surgeries, and surgical times between the two groups. Nonstatistical significant differences were observed between the two groups regarding the presurgical conditions, postoperative outcomes, and complications. Rate of COVID-19 infection was 1.25%. CONCLUSIONS: The surgical protocol used for cleft lip and palate repair during the COVID-19 pandemic is a safe method based on the observed postoperative outcomes. However, the COVID-19 pandemic caused delays of the time of the primary cleft lip and palate repair, and its long-term impact should be well evaluated.

Cleft Lip and Palate Surgery during COVID-19 Pandemic

BACKGROUND: Coronavirus infection (COVID-19) spreading took place in the Russian Federation in recent 10 months. Russia has a reliable and effective governmental public health infrastructure that worked at an advanced level to control the situation since the first day of receiving reports about pneumonia ofunknown etiology cases in December 2019 and the registration of the first COVID-19 cases in Wuhan, China, in January 2020. Several measures were applied (administrative, organizational, technical, sanitary, and hygiene), nevertheless, creating an adequate response to the COVID-19 pandemic was 15 a challenge for the Russian national public health authorities. AREAS COVERED: We used official information of the Ministry of Health of the Russian Federation, Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), the Russian Federation Government, and Moscow Government, and the official World Health Organization (WHO);the analysis was conducted between 1 December 2019 and 31 March 2020. EXPERT OPINION: Rospotrebnadzor implemented a set of measures which comprised of three stages: 1. Stage 1 Preventive and sanitary measures; 2. Stage 2 Organizational and technical measures; 3. Stage 3 Organizational and preventive measures.

Organizational measures aiming to combat COVID-19 in the Russian Federation: the first experience

Although the COVID-19 pandemic affects predominantly the respiratory function, epidemiological studies show that multiple systems can be affected. The severe complications of SARS-CoV-2 infection seem to be induced by an inflammatory dysregulation ("cytokine storm"), which can also induce an immunodepression. Several studies highlight beneficial effects of osteopathic medicine on inflammation and immune regulation. A careful review of evidence-based literature brings to the fore significant improvements of osteopathic manipulative treatment (OMT) in adjunction to conventional care. OMT can improve the condition of infected patients by decreasing symptoms and boosting the efficiency of conventional care. OMT might also benefit surviving patients by reducing the long-lasting consequences of the infection as well as improving their quality of life during convalescence. This review should constitute an argument in favor of multidisciplinary care, although further biological and clinical research is essential to better assess the potential beneficial contributions of adjunct osteopathic medicine to conventional care in the fight against pandemics such as COVID-19.

Evidence-based assessment of potential therapeutic effects of adjunct osteopathic medicine for multidisciplinary care of acute and convalescent COVID-19 patients

This chapter studies the cotton rat, Sigmodon hispidus, which is a New World rodent with a stocky, robust stature. The average adult weight of a cotton rat is between 100 and 250 gm. The name Sigmodon comes from the sigmoid enamel loops on the grinding surface of the molar. Sexual dimorphism is not prominent, but males and females can be distinguished based on the size of the genital papilla and distance from the anus. The cotton rat is distinguished from the Norway rat by its smaller size, shorter tail, and longer grizzled fur. The lifespan of the hispid cotton rat is less than 6 months in the wild but in captivity animals have a survival span up to 23 months of age. The cotton rat (Sigmodon) species has been recognized as a significant animal model for diseases caused by a variety of human and rodent pathogens. The primary research use for cotton rats is for studies into infectious disease and immunology.

Cotton Rat

With a Coronavirus disease (COVID-19) case count exceeding 10 million worldwide, there is an increased need for a diagnostic capability. The main variables in increasing diagnostic capability are reduced cost, turnaround or diagnosis time, and upfront equipment cost and accessibility. Two candidates for machine learning COVID-19 diagnosis are Computed Tomography (CT) scans and plain chest X-rays. While CT scans score higher in sensitivity, they have a higher cost, maintenance requirement, and turnaround time as compared to plain chest X-rays. The use of portable chest X-radiograph (CXR) is recommended by the American College of Radiology (ACR) since using CT places a massive burden on radiology services. Therefore, X-ray imagery paired with machine learning techniques is proposed a first-line triage tool for COVID-19 diagnostics. In this paper we propose a computer-aided diagnosis (CAD) to accurately classify chest X-ray scans of COVID-19 and normal subjects by fine-tuning several neural networks (ResNet18, ResNet50, DenseNet201) pre-trained on the ImageNet dataset. These neural networks are fused in a parallel architecture and the voting criteria are applied in the final classification decision between the candidate object classes where the output of each neural network is representing a single vote. Several experiments are conducted on the weakly labeled COVID-19-CT-CXR dataset consisting of 263 COVID-19 CXR images extracted from PubMed Central Open Access subsets combined with 25 normal classification CXR images. These experiments show an optimistic result and a capability of the proposed model to outperforming many state-of-the-art algorithms on several measures. Using k-fold cross-validation and a bagging classifier ensemble, we achieve an accuracy of 99.7% and a sensitivity of 100%.

Fused Deep Convolutional Neural Network for Precision Diagnosis of COVID-19 Using Chest X-Ray Images

Edible sprouts are rich in flavonoids and other polyphenols, as well as proteins, minerals, and vitamins. Increasing sprout consumption necessitates improving their quality, palatability, and bioactivity. The purpose of this study was to test how KNO(3) priming affects the sprouting process species on three Medicago species (Medicago indicus, Medicago interexta, and Medicago polymorpha) and their nutritional values. Targeted species of Medicago were primed with KNO(3), and the levels of different primary and secondary metabolites were determined. KNO(3) induced biomass accumulation in the sprouts of the three species, accompanied by an increased content of total mineral nutrients, pigments, vitamins, and essential amino acids. Besides, our results showed that KNO(3) enhanced the activity of nitrate reductase (NR), glutamate dehydrogenase (GDH), and glutamine synthetase (GS) enzymes, which are involved in the nitrogen metabolism and GOGAT cycle, which, in turn, increase the nitrogen and protein production. KNO(3) treatment improved the bioactive compound activities of Medicago sprouts by increasing total phenolic and flavonoid contents and enhancing the antioxidant and antidiabetic activities. Furthermore, species-specific responses toward KNO(3) priming were noticeable, where Medicago interexta showed the highest antioxidant and antidiabetic activities, followed by Medicago polymorpha. Overall, this study sheds the light on the physiological and biochemical bases of growth, metabolism, and tissue quality improvement impact of KNO(3) on Medicago sprouts.

Impact of Sprouting under Potassium Nitrate Priming on Nitrogen Assimilation and Bioactivity of Three Medicago Species

ABSTRACT The crisis of coronavirus disease (COVID-19) is growing and has a potential impact on low-and-middle-income countries (LMICs), particularly in Asian regions, which, have reported less so far. The main purpose of this article is to discuss the challenges of COVID-19 management in Asian LMICs and propose some future guidelines to control the transmission and spread. Due to a highly dense population, low-resourced health system, lack of testing kit, and tracing, the ultimate impact could be lasting. It is highly likely that Asian LMICs were not in the center of receiving high priority by the international community in order to take effective prevention strategies. This might upsurge caseloads. Like the symptoms, mode of transmission varies largely due to a number of unknown clinical features of the virus, defining a risk group only based on some limited criteria such as age and disease with comorbidity could be risky. Recently some of the Asian LMICs launched contact tracing app. However, the study has identified several healthcare challenges in Asian LMICs such as shortage of supply of PPE, inadequate long-term care services, the socio-cultural differences which require utmost consideration. In addition, to control infection and enhance prevention, some pertinent problems need to be addressed. Based on that, some multifactorial approaches can be taken in line with international guidelines. Finally, this paper recommends developing a strong and resilient healthcare monitoring system.

COVID-19: challenges and viewpoints from low-and-middle-income Asian countries perspectives

Invasive aspergillosis (IA) may occur as a serious complication of hematological malignancy. Delays in antifungal therapy can lead to an invasive disease resulting in high mortality. Currently, there are no well-established blood circulating microRNA biomarkers or laboratory tests which can be used to diagnose IA. Therefore, we aimed to define dysregulated miRNAs in hematology and oncology (HO) patients to identify biomarkers predisposing disease. We performed an in-depth analysis of high-throughput small transcriptome sequencing data obtained from the whole blood samples of our study cohort of 50 participants including 26 high-risk HO patients and 24 controls. By integrating in silico bioinformatic analyses of small noncoding RNA data, 57 miRNAs exhibiting significant expression differences (P < 0.05) were identified between IA-infected patients and non-IA HO patients. Among these, we found 36 differentially expressed miRNAs (DEMs) irrespective of HO malignancy. Of the top ranked DEMs, we found 14 significantly deregulated miRNAs, whose expression levels were successfully quantified by qRT-PCR. MiRNA target prediction revealed the involvement of IA related miRNAs in the biological pathways of tumorigenesis, the cell cycle, the immune response, cell differentiation and apoptosis.

Circulating microRNA sequencing revealed miRNome patterns in hematology and oncology patients aiding the prognosis of invasive aspergillosis

BACKGROUND: The question to involve or restrict medical students' involvement in the coronavirus disease 2019 (COVID-19) pandemic response remains contentious. As their state of preparation and perceptions in volunteering during this pandemic have yet to be investigated, this study aims to evaluate Indonesian medical students' willingness to volunteer and readiness to practice during the COVID-19 pandemic. METHODS: A web-based survey was conducted among undergraduate medical students throughout Indonesia. Socio-demographic and social interaction information, in addition to willingness to volunteer and readiness to practice, were obtained using a self-reported questionnaire. The significance level was set at 5%. RESULTS: Among 4870 participants, 2374 (48.7%) expressed their willingness to volunteer, while only 906 (18.6%) had adequate readiness to practice. Male students, students with prior volunteering experience in health or non-health sectors, and students from public universities or living in Central Indonesia (vs Java) had higher scores of willingness and readiness to volunteer. Students from Sumatra also had better preparedness (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.15-2.12, p = 0.004), while the opposite occurred for students from Eastern Indonesia (OR 0.63, 95% CI: 0.44-0.89, p = 0.002)-when compared to students from Java. In addition, compared to students with high family income, students from lower-middle income families were less willing to volunteer (OR 0.76, 95% CI: 0.59-0.98, p = 0.034), though those with low family income had better readiness (OR 1.51, 95% CI: 1.10-2.08, p = 0.011). Shortage of medical personnel, sense of duty, and solicitation by stakeholders were the main reasons increasing the students' willingness to volunteer; whereas contrarily fear for own's health, absence of a cure, and fear of harming patients were the primary factors diminishing their willingness to volunteer. CONCLUSION: Our findings indicated that many Indonesian medical students are willing to volunteer, yet only few of them were ready to practice, indicating that further preparations are required to maximize their potentials and minimize their exposure to hazards. We suggest that their potentials as a firm support system during the pandemic should not be overlooked, and that the integration of relevant courses to the medical curricula are imperative to prepare for future public health emergencies.

Willingness to volunteer and readiness to practice of undergraduate medical students during the COVID-19 pandemic: a cross-sectional survey in Indonesia

The densely glycosylated spike (S) protein highly exposed on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) surface mediates host cell entry by binding to the receptor angiotensin-converting enzyme 2 (ACE2). However, the role of glycosylation has not been fully understood. In the present study, we investigated the effect of different N-glycosylation of S1 protein on its binding to ACE2. Using real-time surface plasmon resonance assay the negative effects were demonstrated by the considerable increase of binding affinities of de-N-glycosylated S1 proteins produced from three different expression systems including baculovirus-insect, Chinese hamster ovarian and two variants of human embryonic kidney 293 cells. Molecular dynamic simulations of the S1 protein-ACE2 receptor complex revealed the steric hinderance and Coulombic repulsion effects of the different types of N-glycans on the S1 protein interaction with ACE2. The results presented here should contribute to future pathological studies of SARS-CoV-2 and therapeutic development of Covid-19, particularly using recombinant S1 proteins as models.Funding Information: The authors declare that they have no conflict of interest.Declaration of Interests: The work was supported in part by the National Natural Science Foundation of China (31600650, 31671369, and 62072435), the March of Dimes Prematurity Research Center grant (22-FY18-82), and Wellcome Trust Biomedical Resource grant (218304/Z/19/Z).

The Effect of N-Glycosylation of SARS COV-2 Spike Protein on the Virus Interaction With the Host Cell ACE2 Receptor

While vaccines directed against the SARS-CoV-2 spike protein will have varying degrees of effectiveness in preventing SARS-CoV-2 infections, the severity of infection will be determined by multiple host factors including the ability of immune cells to lyse virus-infected cells. This review will discuss the complexity of both adaptive and innate immunomes and how a flow-based assay can detect up to 158 distinct cell subsets in the periphery. This assay has been employed to show the effect of age on differences in specific immune cell subsets, and the differences in the immunome between healthy donors and age-matched cancer patients. Also reviewed are the numerous soluble factors, in addition to cytokines, that may vary in the pathogenesis of SARS-CoV-2 infections and may also be employed to help define the effectiveness of a given vaccine or other antiviral agents. Various steroids have been employed in the management of autoimmune adverse events in cancer patients receiving immunotherapeutics and may be employed in the management of SARS-CoV-2 infections. The influence of steroids on multiple immune cells subsets will also be discussed.

Interrogation of the cellular immunome of cancer patients with regard to the COVID-19 pandemic

The variation of polar vortex intensity is a significant factor affecting the atmospheric conditions and weather in the Northern Hemisphere (NH) and even the world. However, previous studies on the prediction of polar vortex intensity are insufficient. This paper establishes a deep learning (DL) model for multi-day and long-time intensity prediction of the polar vortex. Focusing on the winter period with the strongest polar vortex intensity, geopotential height (GPH) data of NCEP from 1948 to 2020 at 50 hPa are used to construct the dataset of polar vortex anomaly distribution images and polar vortex intensity time series. Then, we propose a new convolution neural network with long short-term memory based on Gaussian smoothing (GSCNN-LSTM) model which can not only accurately predict the variation characteristics of polar vortex intensity from day to day, but also can produce a skillful forecast for lead times of up to 20 days. Moreover, the innovative GSCNN-LSTM model has better stability and skillful correlation prediction than the traditional and some advanced spatiotemporal sequence prediction models. The accuracy of the model suggests important implications that DL methods have good applicability in forecasting the nonlinear system and vortex spatial–temporal characteristics variation in the atmosphere.

Polar Vortex Multi-Day Intensity Prediction Relying on New Deep Learning Model: A Combined Convolution Neural Network with Long Short-Term Memory Based on Gaussian Smoothing Method

Kaposi's sarcoma associated herpesvirus (KSHV) has gained considerable attention as a type of carcinogenic pathogen. Recent research suggests that KSHV has participated in the pathogenesis of Kaposi's sarcoma-related malignant neoplastic diseases. Viral lytic infection might be pivotal for the etiopathogenesis of KSHV-induced diseases; however, most clinical KSHV lytic replication inhibitors like ganciclovir, nelfinavir, or cidofovir do not restrain virus replication effectively enough to achieve clinical efficacy. In our continued pharmaceutical studies on Chinese herbal medicines, new acylphloroglucinol-based meroterpenoid enantiomers have been discovered from Hypericum japonicum. Most of these metabolites have potential inhibitory activities that target KSHV lytic replication. Amongst these analogues, compounds 1a and 1b possess an unreported ring system cyclopenta[b]chromene. Compounds 1a with 4a exhibit stronger inhibitory activities towards the lytic replication of KSHV in Vero cells. In addition, 1a and 4a have IC50 values of 8.30 and 4.90 µM and selectivity indexes of 23.49 and 25.70, respectively. Qualitative and quantitative SAR and molecular docking studies for acylphloroglucinol-based meroterpenoids with regard to anti-KSHV activity were conducted. An explanation for the variation in the activity and selectivity indexes was proposed in accordance with the predicted binding pose found with molecular docking to a putative target, thymidylate synthase (kTS). Compounds 1a and 4a have potential for further development and optimization of their anti-KSHV activities which could lead to new candidate drugs.

Discovery of acylphloroglucinol-based meroterpenoid enantiomers as KSHV inhibitors from Hypericum japonicum

Success and impact metrics in science are based on a system that perpetuates sexist and racist “rewards” by prioritizing citations and impact factors. These metrics are flawed and biased against already marginalized groups and fail to accurately capture the breadth of individuals’ meaningful scientific impacts. We advocate shifting this outdated value system to advance science through principles of justice, equity, diversity, and inclusion. We outline pathways for a paradigm shift in scientific values based on multidimensional mentorship and promoting mentee well-being. These actions will require collective efforts supported by academic leaders and administrators to drive essential systemic change.

Promoting inclusive metrics of success and impact to dismantle a discriminatory reward system in science

BACKGROUND: Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI. RESULTS: Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall P for the dummy variable = 0.003). CONCLUSIONS: The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.

Bloodstream infections in critically ill patients with COVID-19

Healthcare workers (HCWs) have been recommended to receive first priority for limited COVID-19 vaccines. They have also been identified as potential ambassadors of COVID-19 vaccine acceptance, helping to ensure that sufficient members of a hesitant public accept COVID-19 vaccines to achieve population immunity. Yet HCWs themselves have shown vaccine hesitancy in other contexts and the few prior surveys of U.S. HCW intentions to receive a COVID-19 vaccine report acceptance rates of only 28% to 34%. However, it is unknown whether HCW acceptance remains low following mid-November announcements of the efficacy of the first COVID-19 vaccines and the issuance of two emergency use authorizations (EUA) in December. We report the results of a December 2020 survey (N = 16,158; response rate 61%) administered by a large Pennsylvania health system to determine the intentions of its employees to receive a vaccine when it is offered to them. In a mixed sample of individuals serving in patient-facing and other roles, 55% would decide to receive a COVID-19 vaccine when offered, 16.4% would not, and 28.5% reported being undecided. The distribution of responses varied little across hospital campuses, between those in patient-facing roles and other HCWs, or by area or department of work. The higher rate of COVID-19 vaccine acceptance we observe may reflect the framing and timing of our survey. Among hesitant respondents, an overwhelming majority (90.3%) reported concerns about unknown risks and insufficient data. Other commonly reported concerns included known side effects (57.4%) and wanting to wait until they see how it goes with others (44.4%). We observed a substantial increase in self-reported intent to receive a COVID-19 vaccine after an FDA advisory committee voted to recommend an EUA. Among respondents who completed the survey after that point in time, 79% intend to receive a COVID-19 vaccine (n = 1155). Although only suggestive, this trend offers hope that rates of COVID-19 vaccine acceptance may be higher among HCWs and, perhaps, the general public than more hypothetical survey results have indicated.

Healthcare worker intentions to receive a COVID-19 vaccine and reasons for hesitancy: A survey of 16,158 health system employees on the eve of vaccine distribution

OBJECTIVE: To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. MATERIALS AND METHODS: The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). RESULTS: The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. CONCLUSION: The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.

Tomographic findings in bronchial atresia

For patients with blood cancers, the COVID‐19 mortality rate is approximately 20% overall and 33% for those who require hospitalization, according to new data from the ASH Research Collaborative COVID‐19 Registry for Hematology.

ASH Registry Offers Insights on COVID‐19 in Patients with Hematologic Malignancies

This work aims to systematize a set of scientific evidence presented in international papers that identify the main problems affecting health professionals directly involved in coping with the COVID-19 pandemic and point out actions and strategies for the protection and healthcare of these professionals. The risk of infection is the main issue and has led to absence from work, illness, death, and intense psychological distress, expressed in generalized anxiety and sleep disorders, fear of becoming ill and infecting colleagues and relatives. In the Brazilian reality, this work revives the analysis of the chronic problems affecting health workers, resulting from the underfinancing of the Brazilian Unified Health System (SUS), the sector's spending freeze, the deterioration of services and workforce's insecurity, and points out the acute challenges of work management and staff training, given the expanded hospital bed infrastructure and reorganization of the work process in primary care to face the pandemic, emphasizing the necessary measures for the protection and promotion of the physical and mental health of health professionals and workers.

The health of healthcare professionals coping with the Covid-19 pandemic.

Background: Cancer patients are at increased risk of severe COVID-19 illness because of their systemic immunosuppressive state. The potential effects of cancer and/or anticancer treatments on COVID-19 vaccine response, adverse events and progression are unknown. Moreover, the impacts of financial, familial and societal stressors during the pandemic on health-related quality of life are unclear. To address these concerns, we report data from the ongoing U.S. NCI-funded SeroNet COVID-19 Risk Associations and Longitudinal Evaluation Study (CORALE) at a large health care system in Los Angeles. Methods: Cancer patients are invited to complete questionnaires, donate blood specimens and engage in long-term follow-up with repeat questionnaires and biosampling. Patient-reported outcomes are assessed at baseline, post-vaccination, 6, 12 and 24 months. Clinical information on cancer type, stage, treatment, dates, medications and outcomes (adverse events, SARS-CoV-2 infection, COVID-19 vaccination and cancer-related outcomes) are extracted from electronic medical records. Results: From December 2019-May 2020, we enrolled 317 patients with malignancies or hematologic disorders (70.0% response rate). The median age was 63 (interquartile range (IQR)=54-73) years, 47% were women, 30% self-identified as non-White minorities and 18% were unable to work due to health status. 3% were known to been infected with SARS-CoV-2. An overall COVID-19 vaccine acceptance rate of 80% was reported. Among unvaccinated patients, women expressed more hesitancy than men (p=0.045). Concerns about adverse events (56%), rushed vaccine development (44%), and insufficient knowledge (44%) were reported. Self-reported symptoms after the first dose included injection site pain (21%) and fatigue (11%). We observed low levels of depression and high emotional support. Enrollment is ongoing. Conclusions: Individuals with cancer are a complex and extremely diverse population with a multitude of considerations for both immediate clinical care and long-term survivorship. Updated results including findings on antibody response to vaccination across cancer types/treatment protocols will be presented. Legal entity responsible for the study: Cedars-Sinai Medical Center. Funding: U.S. National Cancer Institute. Disclosure: All authors have declared no conflicts of interest.

1611P Health-related quality of life, vaccine uptake and immune response among cancer patients undergoing treatment during the COVID-19 pandemic

RATIONALE Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare disease without standard treatments. Tripterygium wilfordii hook f (TwHF) is a traditional Chinese herb with anti-inflammatory effect, and 1.0 mg/(kg·d) dose of Tripterygium glycosides has been reported to significantly improve the disease activity of a SAPHO patient in a case report. However, the optimal dose of TwHF is still unclear. Here, we report the first case of SAPHO patient who achieved rapid remission in clinical symptoms after receiving 1.5 mg/(kg·d) dose of Tripterygium glycosides treatment. PATIENT CONCERNS A 67-year-old woman noted palmoplantar pustulosis and pain in the anterior chest wall and waist. Bone scintigraphy demonstrated the typical tracer accumulation feature and magnetic resonance images showed bone marrow edema in lumbosacral vertebra. DIAGNOSES The diagnosis was made by dermatological and osteoarticular manifestations and classical signs in bone scintigraphy in accordance with the diagnostic criteria proposed in 2012. INTERVENTIONS Tripterygium glycosides was given with a primary dose of 1.5 mg/(kg·d) for 1 month and then reduced at a rate of 10 mg every 2 weeks until 1.0 mg/(kg·d) for a long-term maintenance. OUTCOMES Fast-induced remission on clinical manifestations was achieved and magnetic resonance imaging abnormality was improved significantly. Additionally, no apparent side effects were observed. LESSONS 1.5 mg/(kg·d) dose of Tripterygium glycosides seems to have fast-induced remission than 1.0 mg/(kg·d) with reliable safety. Besides, Tripterygium glycosides may also have a pharmacological effect of inhibiting osteolysis and enhancing bone strength.

Rapid induction of clinical remission in SAPHO syndrome using high-dose Tripterygium glycosides: A case report.

SARS-CoV-2 is a disease known from a few months, caused by a recently arisen virus and, consequently, it is little known. The disease has a benign course in most infected subjects (children and young adults), is often symptomatic in adults over the age of 50 and often serious and life threatening in people with comorbidities and the elderly. The few data published on COVID-19 in the blood-oncology field report a serious clinical presentation, a serious course of the disease and a high mortality rate, as has also been reported for other cancer contexts. The current strategy for treating patients with SARS-CoV-2 includes antivirals that are effective against other viral infections and drugs that can moderate the cytokine storm. There is no specific vaccine and consequently all possible precautions must be taken to prevent SARS-CoV-2 infection in the areas of oncology, onco-hematology, and bone marrow transplantation. In this reviewer's article, we report the information currently available on SARS-CoV-2 infection to help young doctors and hematologists to successfully manage patients with COVID-19. This article is protected by copyright. All rights reserved.

The impact of the SARS-CoV-2 infection, with special reference to the haematological setting

BACKGROUND: The ongoing global coronavirus disease 2019 (COVID-19) pandemic is posing a serious public health threat to nations worldwide. Understanding the pathogenesis of the disease and host immune responses will facilitate the discovery of therapeutic targets and better management of infected patients. Metabolomics technology can provide an unbiased tool to explore metabolic perturbation. METHODS: Twenty-six healthy controls and 50 COVID-19 patients with mild, moderate, and severe symptoms in the Fifth Medical Center of PLA General Hospital from January 22 to February 16, 2020 were recruited into the study. Fasting blood samples were collected and subject to metabolomics analysis by liquid chromatography–mass spectrometry. Metabolite abundance was measured by peak area and was log-transformed before statistical analysis. The principal component analysis, different expression analysis, and metabolic pathway analysis were performed using R package. Co-regulated metabolites and their associations with clinical indices were identified by the weighted correlation network analysis and Spearman correlation coefficients. The potential metabolite biomarkers were analyzed using a random forest model. RESULTS: We uncovered over 100 metabolites that were associated with COVID-19 disease and many of them correlated with disease severity. Sets of highly correlated metabolites were identified and their correlations with clinical indices were presented. Further analyses linked the differential metabolites with biochemical reactions, metabolic pathways, and biomedical MeSH terms, offering contextual insights into disease pathogenesis and host responses. Finally, a panel of metabolites was discovered to be able to discriminate COVID-19 patients from healthy controls, and also another list for mild against more severe cases. Our findings showed that in COVID-19 patients, citrate cycle, sphingosine 1-phosphate in sphingolipid metabolism, and steroid hormone biosynthesis were downregulated, while purine metabolism and tryptophan metabolism were disturbed. CONCLUSION: This study discovered key metabolites as well as their related biological and medical concepts pertaining to COVID-19 pathogenesis and host immune response, which will facilitate the selection of potential biomarkers for prognosis and discovery of therapeutic targets.

Systematic Discovery and Pathway Analyses of Metabolic Disturbance in COVID-19

OBJECTIVE: To examine the effect of a change in the delivery mode of clinical neurology, a postgraduate subject at Macquarie University, following COVID-19 restrictions on face-to-face teaching. METHODS: Participants were master of chiropractic students (n = 212) who completed 2019 or 2020 clinical neurology. The main outcome measure was a comparison of objective structured clinical examination (OSCE) marks between the 2019 and 2020 cohorts. The 2019 group underwent traditional, face-to-face learning, whereas the 2020 group were taught and examined remotely in session 1 but returned to campus in session 2. Descriptive analyses, between-group differences, and generalized linear models were performed. RESULTS: Means for OSCE marks between the 2 groups were higher in the 2020 group in session 1 (p < .001). However, when students returned to campus in session 2, the means were significantly lower in the 2020 group compared with the 2019 group (p < .001). Generalized linear regression indicated that the web-based mode of delivery in 2020 might have had a significant impact on OSCE marks compared with their 2019 counterparts (p < .001). CONCLUSION: The sudden change in the mode of delivery from face-to-face to remote learning and the change in testing methods in response to the global COVID-19 pandemic had a significant effect on clinical neurology student performance scores. The OSCE marks in the 2020 cohort for session 1 were higher than those in 2019. However, when the 2020 cohort returned to on-campus tutorials in session 2, their marks were lower than those of their 2019 counterparts.

Effects of a sudden change in curriculum delivery mode in postgraduate clinical studies, following the COVID-19 pandemic

AIMS: Although the new coronavirus (SARS-CoV-2) may cause an acute multiorgan syndrome (COVID-19), data are emerging on mid- and long-term sequelae of COVID-19 pneumonia. Since no study has hitherto investigated the role of both cardiac and pulmonary ultrasound techniques in detecting such sequelae, this study aimed at evaluating these simple diagnostic tools to appraise the cardiopulmonary involvement occurring after COVID-19 pneumonia. METHODS AND RESULTS: Twenty-nine patients fully recovered from COVID-19 pneumonia were considered at our centre. On admission, all patients underwent 12-lead electrocardiogram (ECG) and transthoracic echocardiography (TTE) evaluation. Compression ultrasound (CUS) and lung ultrasound (LUS) were also performed. Finally, in each patient, pathological findings detected on LUS were correlated with the pulmonary involvement occurring after COVID-19 pneumonia as assessed on thoracic computed tomography (CT). Out of 29 patients (mean age 70 ± 10 years old; M 69%), prior cardiovascular and pulmonary comorbidities were recorded in 22 (76%). Twenty-seven patients (93%) were in sinus rhythm and two (7%) in atrial fibrillation. ECG repolarization abnormalities were extremely common (93%) and reflected the high prevalence of pericardial involvement on TTE (86%). Likewise, pleural abnormalities were frequently observed (66%). TTE signs of left and right ventricular dysfunction were reported in two patients only, but values of systolic pulmonary artery pressure were abnormal in 16 (55%) despite absence of prior comorbidities in 44% of them. Regarding LUS evaluation, most patients displayed abnormal values of diaphragmatic thickness and excursion (93%) which well correlated with the high prevalence (76%) of on pathological findings on CT scan. CUS ruled out deep vein thrombosis in all patients. CONCLUSIONS: Data on cardiopulmonary sequelae after COVID-19 pneumonia are scarce. In our study, simple diagnostic tools (TTE and LUS) proved clinically useful for detection of cardiopulmonary involvement after COVID-19 pneumonia.

264 Cardiac and pulmonary sequelae after COVID-19 pneumonia: a case series

BACKGROUND: COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020. AIM: To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools. METHOD: A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise. RESULTS: Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic. CONCLUSIONS: Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.

A review on the COVID-19-related psychological impact on older adults: vulnerable or not?

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BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a viral pandemic disease that may induce severe pneumonia in humans. In this paper, we investigated the putative implication of 12 vaccines, including BCG, OPV and MMR in the protection against COVID-19. Sequences of the main antigenic proteins in the investigated vaccines and SARS-CoV-2 proteins were compared to identify similar patterns. The immunogenic effect of identified segments was, then, assessed using a combination of structural and antigenicity prediction tools. RESULTS: A total of 14 highly similar segments were identified in the investigated vaccines. Structural and antigenicity prediction analysis showed that, among the identified patterns, three segments in Hepatitis B, Tetanus, and Measles proteins presented antigenic properties that can induce putative protective effect against COVID-19. CONCLUSIONS: Our results suggest a possible protective effect of HBV, Tetanus and Measles vaccines against COVID-19, which may explain the variation of the disease severity among regions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12859-021-04045-3.

In silico comparative study of SARS-CoV-2 proteins and antigenic proteins in BCG, OPV, MMR and other vaccines: evidence of a possible putative protective effect

The model organism Drosophila melanogaster was increasingly applied in nutrition research in recent years. A range of methods are available for the phenotyping of D. melanogaster, which are outlined in the first part of this review. The methods include determinations of body weight, body composition, food intake, lifespan, locomotor activity, reproductive capacity and stress tolerance. In the second part, the practical application of the phenotyping of flies is demonstrated via a discussion of obese phenotypes in response to high-sugar diet (HSD) and high-fat diet (HFD) feeding. HSD feeding and HFD feeding are dietary interventions that lead to an increase in fat storage and affect carbohydrate-insulin homeostasis, lifespan, locomotor activity, reproductive capacity and stress tolerance. Furthermore, studies regarding the impacts of HSD and HFD on the transcriptome and metabolome of D. melanogaster are important for relating phenotypic changes to underlying molecular mechanisms. Overall, D. melanogaster was demonstrated to be a valuable model organism with which to examine the pathogeneses and underlying molecular mechanisms of common chronic metabolic diseases in a nutritional context.

Phenotyping of Drosophila Melanogaster—A Nutritional Perspective

Following the coup in Myanmar, humanitarian assistance, including coronavirus disease 2019 (COVID-19) control, must be implemented on the Thai-Myanmar border in the framework of international cooperation. The actual number of refugees was expected to increase in the Karen state at the end of March 2021, and they are at risk of contracting COVID-19 as they live in overcrowded conditions without access to basic sanitation. The global community has been hesitant to provide direct support because of fearing that such support would benefit the military. To reach this most vulnerable population, further strengthening of support through the Thai-Myanmar border as an alternative channel that was used before Myanmar's democratic transition in 2011 is necessary.

COVID-19 control during a humanitarian crisis; the need for emergency response at the Thai-Myanmar border as an alternative channel

We present here a case of severe digital necrosis in a patient with long-standing rheumatoid arthritis (RA). The concomitant presence of two autoimmune conditions such as cryoglobulinemia and antiphospholipid syndrome (APS) were diagnosed. To best of our knowledge, this is the first case of the coexistence of RA, cryoglobulinemia, and APS in a single patient. An aggressive treatment was needed including hallux amputation, methylprednisolone pulses followed by rituximab with favorable outcome.

Coexistence of antiphospholipid syndrome and cryoglobulinemia in a patient with rheumatoid arthritis

Since the first report of SARS-CoV-2 infection in humans, the virus has mutated to develop new viral variants with higher infection rates and more resistance to neutralization by antibodies elicited after natural SARS-CoV-2 infection or by vaccines. Therefore, rapid identification of viral variants circulating in the population is crucial for epidemiological assessment and efforts to contain the resurgence of the pandemic. Between January and November 2021, we performed a large variant RT-qPCR-based screening of mutations in the spike protein of 1851 SARS-CoV-2-positive samples derived from outpatients from the UC-Christus Health Network in Chile. In a portion of samples (n = 636), we validated our RT-qPCR-pipeline by WGS, obtaining a 99.2% concordance. Our results indicate that from January to March 2021 there was a dominance of non-identifiable variants by the RT-qPCR-based screening; however, throughout WGS we were able to identify the Lambda (C.37) variant of interest (VOI). From March to July, we observed the rapid emergence of mutations associated with the Gamma variant (P.1), which was quickly replaced by the appearance of a combination of samples harboring mutations associated with the Delta variant (B.1.617.2), which predominated until the end of the study. Our results highlight the applicability of cost-effective RT-qPCR-based screening of mutations associated with known variants of concern (VOC), VOI and variants under monitoring (VUM) of SARS-CoV-2, being a rapid and reliable tool that complements WGS-based surveillance.

Assessment of Mutations Associated With Genomic Variants of SARS-CoV-2: RT-qPCR as a Rapid and Affordable Tool to Monitoring Known Circulating Variants in Chile, 2021

BACKGROUND: The risk factors that emerge with the onset and protraction of humanitarian crises leave populations at a heightened risk of excess morbidity and mortality from vaccine-preventable diseases (VPDs). There is currently little clarity on which vaccines are being used in crises throughout the world, and whether vaccination decisions correspond to local disease threats. This review aimed to collect and analyse such information. METHODS: We reviewed vaccination services from January 2015 to June 2019 across all 25 humanitarian responses that had an activated coordination mechanism during this period. A range of online sources and informants within the humanitarian sector were consulted to compile data on which vaccines were provided in each crisis, and the modality and timing of vaccine provision. The package of vaccination services since the start of each crisis was then compared with local disease burden (baseline + excess due to crisis-emergent risk factors). RESULTS: The range of vaccines used in humanitarian crises appears limited. When offered, vaccines were primarily delivered through the pre-existing routine schedule, with few supplementary actions taken in recognition of the need for rapidly enhancing population immunity. Vaccine packages mostly did not address the actual range of VPDs that likely accounted for substantial disease risk. CONCLUSIONS: This review suggests inconsistencies and inequities in vaccine provision to crisis-affected populations. A consistent, standardised and broader approach to vaccine use in crises is needed.

The utilisation of vaccines in humanitarian crises, 2015-2019: A review of practice

Amyloid fibril formation is associated with various amyloidoses, including neurodegenerative diseases such as Alzheimer's and Parkinson's diseases. Amyloid fibrils form above the solubility of amyloidogenic proteins or peptides upon breaking supersaturation, followed by a nucleation and elongation mechanism, which is similar to the crystallization of solutes. Many additives, including salts, detergents, and natural compounds, promote or inhibit amyloid formation. However, the underlying mechanisms of the opposing effects are unclear. We examined the effects of two polyphenols, i.e., epigallocatechin gallate (EGCG) and kaempferol-7-O-glycoside (KG), with high and low solubilities, respectively, on the amyloid formation of α-synuclein (αSN). EGCG and KG inhibited and promoted amyloid formation of αSN, respectively, when monitored by thioflavin T (ThT) fluorescence or transmission electron microscopy (TEM). Nuclear magnetic resonance (NMR) analysis revealed that, although interactions of αSN with soluble EGCG increased the solubility of αSN, thus inhibiting amyloid formation, interactions of αSN with insoluble KG reduced the solubility of αSN, thereby promoting amyloid formation. Our study suggests that opposing effects of polyphenols on amyloid formation of proteins and peptides can be interpreted based on the solubility of polyphenols. This article is protected by copyright. All rights reserved.

Polyphenol-solubility alters amyloid fibril formation of α-synuclein.

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by a coronavirus called SARS Coronavirus 2 (SARS-CoV-2). It has been observed that COVID-19 mainly spreads via respiratory tract, contact and digestive tract. Due to the particularity of profession, ophthalmic medical workers need to be in close contact with patients, so they have a higher risk of SARS-CoV-2 infection. In this paper, therefore, the self-protection of medical workers in ophthalmology clinic during COVID-19 epidemic was summarized, so as to improve the occupational protection measures for medical workers in ophthalmology clinic, strengthen the self-protection awareness, and protect the safety of such a special group.

Self-protection of medical workers in ophthalmology clinic during COVID-19 epidemic.

The coffee plant Coffea spp. offers much more than the well-known drink made from the roasted coffee bean. During its cultivation and production, a wide variety of by-products are accrued, most of which are currently unused, thermally recycled, or used as animal feed. The aim of this review is to provide an overview of novel coffee products in the food sector and their current legal classification in the European Union (EU). For this purpose, we have reviewed the literature on the composition and safety of coffee flowers, leaves, pulp, husk, parchment, green coffee, silver skin, and spent coffee grounds. Some of these products have a history of consumption in Europe (green coffee), while others have already been used as traditional food in non-EU-member countries (coffee leaves, notification currently pending), or an application for authorization as novel food has already been submitted (husks, flour from spent coffee grounds). For the other products, toxicity and/or safety data appear to be lacking, necessitating further studies to fulfill the requirements of novel food applications.

A Review of Coffee By-Products Including Leaf, Flower, Cherry, Husk, Silver Skin, and Spent Grounds as Novel Foods within the European Union

Several factors have ramifications on the development of adequate and efficient local content policies. Factors affecting local content design differ in developing countries compared to developed countries. The variation in factors leading to local content success has led to debates and development of several constructs within different theoretical and conceptual frameworks. Nevertheless, local content is an interdisciplinary phenomenon that navigates through different socio-legal and socio-economic schools of thought. The interdisciplinary nature of local content policies is what creates the ambiguity in local content implementation. This chapter addresses the theoretical debate, as well as clarity aspects of local content policy implementation. Though national content policies have been the primary typology of local content policies adopted by several oil and gas rich countries. This chapter argues the bottlenecks of different typologies of local content policies as well as makes suggestions on what type of local content policy best addresses the enclave nature of the oil and gas industry in developing countries.

The Different Aspect of Local Content

To evaluate contrast-enhanced dual-energy computed tomography (DECT) chest examinations regarding pulmonary perfusion patterns and pulmonary opacities in patients with confirmed COVID-19 disease. Fourteen patients with 24 DECT examinations performed between April and May 2020 were included in this retrospective study. DECT studies were assessed independently by two radiologists regarding pulmonary perfusion defects, using a Likert scale ranging from 1 to 4. Furthermore, in all imaging studies the extent of pulmonary opacities was quantified using the same rating system as for perfusion defects. The main pulmonary findings were ground glass opacities (GGO) in all 24 examinations and pulmonary consolidations in 22 examinations. The total lung scores after the addition of the scores of the single lobes showed significantly higher values of opacities compared to perfusion defects, with a median of 12 (9–18) for perfusion defects and a median of 17 (15–19) for pulmonary opacities (p = 0.002). Furthermore, mosaic perfusion patterns were found in 19 examinations in areas with and without GGO. Further studies will be necessary to investigate the pathophysiological background of GGO with maintained perfusion compared to GGO with reduced perfusion, especially regarding long-term lung damage and prognosis.

Dual-Energy Computed Tomography of the Lung in COVID-19 Patients: Mismatch of Perfusion Defects and Pulmonary Opacities

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has become a worldwide pandemic and created an utmost crisis across the globe. To mitigate the crisis, the design of vaccines is a crucial solution. The frequent mutation of the virus demands generalized vaccine candidates, which would be effective for all mutated strains at present and for the strains that would evolve due to further new mutations in the virus. OBJECTIVE: The objective of this study is to identify more frequently occurring mutated variants of SARS-CoV-2 and to suggest peptide vaccine candidates effective in common against the viral strains considered. METHOD: In this study, we have identified all currently prevailing mutated strains of SARS-CoV-2 through 2D Polar plot and Quotient Radius〖(q〗_R) characterization descriptor. Then, by considering the top eight mutation strains, which are significant due to their frequency of occurrence, peptide regions suitable for vaccine design have been identified with the help of a mathematical model - 2D Polygon Representation, followed by the evaluation of epitope potential and ensuring that there is no case of any autoimmune threat. Lastly, in order to verify whether this entire approach is applicable for vaccine design against any other virus in general, we have made a comparative study between the peptide vaccine candidates prescribed for the Zika virus using the current approach and a list of potential vaccine candidates for the same already established in the past. RESULTS: We have finally suggested three generalized peptide regions which would be suitable as sustainable peptide vaccine candidates against SARS-CoV-2 irrespective of its currently prevailing strains as well any other variant of the same that may appear in the future. We also observed that during the comparative study using the case of E protein of Zika virus, the peptide regions suggested using the new approach matched with the already established results. CONCLUSION: The study, therefore, illustrates an approach that would help in developing peptide vaccine against SARS-CoV-2 by suggesting those peptide regions which can be targeted irrespective of any mutated form of this virus. The consistency with which this entire approach was also able to figure out similar vaccine candidates for Zika virus with utmost accuracy proves that this protocol can be extended for peptide vaccine design against any other virus in the future.

Identification of Generalized Peptide Regions for Designing Vaccine Effective for All Significant Mutated Strains of SARS-CoV-2

As the world moves into a post COVID-19 mode of operation, organizational change practices must also move into a new paradigm Drawing on what is already known

Organizational Change Practices for a Post-Pandemic World

The unprecedented pandemic COVID-19 has impacted businesses across the globe. A significant jump in the credit default risk is expected. Credit default is an indicator of financial distress experienced by the business. Credit default often leads to bankruptcy filing against the defaulting company. In India, the Insolvency and Bankruptcy Code (IBC) is the law that governs insolvency and bankruptcy. As reported by the Insolvency and Bankruptcy Board of India (IBBI), the number of companies filing for bankruptcy under IBC is on a rise, and the industrial sector has witnessed the maximum number of bankruptcy filings. The present article attempts to develop a credit default prediction model for the Indian industrial sector based on a sample of 164 companies comprising an equal number of defaulting and nondefaulting companies. A total of 120 companies are used as training samples and 44 companies as the testing samples. Binary logistic regression analysis is employed to develop the model. The diagnostic ability of the model is tested using receiver operating characteristic curve, area under the curve and annual accuracy. According to the study, return on assets, current ratio, debt to total assets ratio, sales to working capital ratio and cash flow to total assets ratio is statistically significant in predicting default. The findings of the study have significant implications in lending and investment decisions.

Corporate Default Prediction Model: Evidence from the Indian Industrial Sector

COVID-19 pandemic has posed significant challenges globally. Countries have adopted different strategies with varying degrees of success. Epidemiologists are studying the impact of government actions using scenario analysis. However, the interactions between the government policy and the disease dynamics are not formally captured. We, for the first time, formally study the interaction between the disease dynamics, which is modeled as a physical process, and the government policy, which is modeled as the adjoining controller. Our approach enables compositionality, where either the plant or the controller could be replaced by an alternative model. Our work is inspired by the engineering approach for the design of Cyber-Physical Systems (CPSs). Consequently, we term the new framework Compositional Cyber-Physical Epidemiology (CCPE). We created different classes of controllers and applied these to control the disease in New Zealand and Italy. Our controllers closely follow government decisions based on their published data. We not only reproduce the pandemic progression faithfully in New Zealand and Italy but also show the tradeoffs produced by differing control actions.

Compositional Cyber-Physical Epidemiology of COVID-19

The epic Covid 2019 is likewise known as Coronavirus is a continuous infection that was spread rapidly around the world. It's the outbreak affects hundreds of thousands of people and it has a growing impact on daily lives. It affected the global economy and environment too. The main problem is that in the densely populated country it's very difficult to detect the positive cases earlier as much as possible and to prevent the rapid spread of this and to treat the patients quickly. This project is aimed at supplying healthcare providers with ways to use the 'Health Monitoring System' to reduce such viral flues. This project is mainly focused on android application development. It is mainly directed to the people in quarantine. Their information will be collected from these people themselves. By this application collecting the details of people in a questionnaire mode by using a QR code who has gone for the test of covid'19. This application provides physically contactless and wireless technology to help prevent the further spreading of this disease at the time of collecting the details of the people. Here the details and results of people are transferred to the applications are done by scanning the QR codes. The main advantages of this project are that there is no need of enquiring about health for health workers by contacting the patient's details directly. The significance and purpose of this project are to providing user-friendly support to reduce the number of infected people and helping to maintain social distance and also reduce physical contact and find the exact location of the patient. © 2021 IEEE.

A Covid 19: QR Code based Health Monitoring System

In addition to its impact on public health, COVID-19 has had a major impact on the economy To shed light on how COVID-19 is affecting small businesses – and on

How are Small Businesses Adjusting to COVID-19? Early Evidence from a Survey