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159,100 |
Impact of sex and gender on COVID-19 outcomes in Europe
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BACKGROUND: Emerging evidence from China suggests that coronavirus disease 2019 (COVID-19) is deadlier for infected men than women with a 2.8% fatality rate being reported in Chinese men versus 1.7% in women. Further, sex-disaggregated data for COVID-19 in several European countries show a similar number of cases between the sexes, but more severe outcomes in aged men. Case fatality is highest in men with pre-existing cardiovascular conditions. The mechanisms accounting for the reduced case fatality rate in women are currently unclear but may offer potential to develop novel risk stratification tools and therapeutic options for women and men. CONTENT: The present review summarizes latest clinical and epidemiological evidence for gender and sex differences in COVID-19 from Europe and China. We discuss potential sex-specific mechanisms modulating the course of disease, such as hormone-regulated expression of genes encoding for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) entry receptors angiotensin converting enzyme (ACE) 2 receptor and TMPRSS2 as well as sex hormone-driven innate and adaptive immune responses and immunoaging. Finally, we elucidate the impact of gender-specific lifestyle, health behavior, psychological stress, and socioeconomic conditions on COVID-19 and discuss sex specific aspects of antiviral therapies. CONCLUSION: The sex and gender disparities observed in COVID-19 vulnerability emphasize the need to better understand the impact of sex and gender on incidence and case fatality of the disease and to tailor treatment according to sex and gender. The ongoing and planned prophylactic and therapeutic treatment studies must include prospective sex- and gender-sensitive analyses.
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159,101 |
Covid-19 in a Patient with Cvid and Contraindications to Several Potential Treatments
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Introduction: Despite nearly 18 million cases of SARS-CoV-2 thus far, there is minimal information regarding treatment in patients with common variable immunodeficiency (CVID), such as presented here Case Description: A 59-year-old male with CVID was receiving IVIG infusion when RN noted lethargy, fever, and cough Chest Xray showed bilateral lower lobe opacities Labs significant for lymphopenia to 0 5, CRP 4 9, CK 23, ESR 22 SARS-CoV-2 testing positive Given history of atrial fibrillation, hypertension, severe back pain, and 10 5-pack-year smoking history, patient requested to be DNR/DNI Patient eventually required high flow oxygen with 70% FiO2 at 35L/min Hydroxychloroquine initiated, but Qtc became prolonged He received vitamin C and enrolled in convalescent plasma trial Patient’s respiratory status worsened with increasing hypoxia D-dimer increased to 7 63, ferritin to 2862, and LDH to 533 Prone position poorly tolerated BiPAP recommended, but patient increasingly anxious and declined, requesting to go home to die Within 2 days of receiving plasma, mentation improved;within 9 days oxygen requirements decreased;discharge occurred after 24 days in the hospital Patient subsequently admitted for severe back pain and found to be still SARS-CoV-2 positive, 8 5 weeks from initial test However, he continued asymptomatic on room air with improved chest xray Discussion: This patient had contraindications to several potential medications, physical limitations with proning, and slow recovery after receiving convalescent plasma, though he did not require ventilator support There was evidence of hyperinflammation secondary to COVID-19, and it is unknown to what degree immunodeficiency may have been protective against a severe cytokine storm Further investigation necessary
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159,102 |
Comparative Performance of Private Equity-Owned US Nursing Homes During the COVID-19 Pandemic
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Importance: It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes. Design, Setting, and Participants: This cross-sectional study of 11â¯470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics. Exposure: Nursing home ownership status. Main Outcomes and Measures: Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages. Results: Of 11â¯470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, -69.2 to -1.8; P = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points; P = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points; P < .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points; P < .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points; P < .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points; P < .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points; P < .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points; P = .049) than PE-owned nursing homes. Conclusions and Relevance: In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.
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159,103 |
Changes in alcohol use as a function of psychological distress and social support following COVID-19 related University closings
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Amidst the coronavirus pandemic, universities across the country abruptly closed campuses and transitioned to remote learning. The effects of these unprecedented closures are unknown. The current study examined reported alcohol consumption during the week prior to and after campus closure at a public university in Northeast Ohio. Analysis of data from 1,958 students, who endorsed using alcohol in the past 30 days, demonstrates that alcohol consumption (amount and frequency) increased as time progressed. Those with more symptoms of depression and anxiety reported greater increases in alcohol consumption (assessed via retrospective timeline follow-back) compared to students with fewer symptoms. Furthermore, students with greater perceived social support reported less alcohol consumption. Together, these findings highlight the need for universities to offer services and programs to students that will minimize risk factors and maximize protective factors in order to reduce or prevent alcohol abuse during the coronavirus pandemic.
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159,104 |
SARS-CoV-2 / COVID-19 and its transmission, prevention, treatment and control - An update
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Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Virus-2 (SARSCoV-2), pandemic has caused huge panic, havoc and global threats worldwide. The origin of this virus has been linked to animals, intermediate host is still to be identified, and studies are being carried out that how it got transmitted to humans and acquired rapid human-to-human transmission. Within a short time period of only 05 months, SARS-CoV-2 has spread to 213 countries, and till 28th May, 2020, nearly 5.8 million confirmed cases have been reported while taking lives of 0.36 million persons. Seeing the current situation of rapid increase in COVID-19 cases daily in many countries, this seems to be the deadliest pandemic after the 1918 Spanish Flu. There is currently no specific effective treatment for COVID-19 and also in absence of vaccine the radical cure of the disease is far away. Researchers are pacing high to design and develop effective vaccines, drugs and therapeutics to counter COVID-19, however such efforts, clinical trials, necessary approvals and then to reach the level of bulk production of many millions of doses may still take much time. Prevention and control of COVID-19 outbreaks requires an evidence-based, multi-factorial and effective mitigation strategy to be adopted. The current review discusses on the research advancements, challenges and opportunities in COVID 19 management with a focus on its transmission, prevention, treatment and control.
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159,105 |
Innovative anatomy assessment methods in COVID-19 pandemic: Statistical observations and students viewpoints
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Background: Currently anatomy training and assessment is seriously disrupted in COVID-19 Pandemic lockdown. New challenges of anatomy curriculum and assessment method development are being attempted based upon resources, expertise and technical skills of educators. This study aims at creating a standard operation procedure (SOP) for conducting gross anatomy assessment, finding statistical relevance and discusses viewpoints of students reflected in feedback. Materials and methods: a retrospective cross sectional study was conducted on 250 first year students at GSVM Medical College Kanpur India. Students were briefed about SOP and were given choice to opt for either of three interview modalities of assessment tool [Viz. Telephonic Interview (GROUP T), Whatsapp©video call (GROUP W) and Zoom©meetings (GROUP Z)] and submit subjective feedbacks to assessor regarding new assessment format. The marks obtained as response distribution were subjected to descriptive statistics. One way ANOVA was applied to test any difference in means at (P<0.05) followed by post-hoc pair wise test amongst groups corrected to Bonferroni adjusted alpha level of [P<0.0167] per test. Results: Among 97.2% respondent ANOVA test result pointed that the types of interview pattern preferred had no significant impact on obtained score [F (2,240) = 2.80, p =.062], post-hoc test further confirmed that there was no significant difference between groups. Conclusion: the assessor and students both need to evolve and adapt to paradigm changes. Student’s feedback will serve to tailor the assessment tool by refining validity, consistency, reliability and interaction dynamics of assessment designs. Alternative evidence based futuristic assessment methods exploration are call of the hour.
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159,106 |
Training During a Pandemic: Successes, Challenges, and Practical Guidance From a Virtual Facilitated Learning Collaborative Training Program for Written Exposure Therapy
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In response to COVID-19, continued workforce training is essential to ensure that evidence-based treatments are available on the frontline to meet communities' ongoing and emerging mental health needs However, training during a pandemic imposes many new challenges This paper describes a multisite training and implementation pilot program, facets of which allowed for continued training despite the onset of the COVID-19 pandemic and subsequent social distancing guidelines This virtual facilitated learning collaborative in Written Exposure Therapy, an evidence-based treatment for posttraumatic stress disorder, included virtual workshop training, phone-based clinical consultation, implementation-focused video calls for program leadership, and program evaluation Data are presented about program enrollees and patient impact following the onset of COVID-19-related social distancing restrictions Challenges, successes, and practical guidance are discussed to inform the field regarding training strategies likely to be durable in an uncertain, dynamic healthcare landscape
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159,107 |
Need to Amplify Health Security? Fuse Academia and Practice
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In December 2007, we traveled to Springfield, Illinois, to engage more than 150 physicians, state and local public health officials, university officials, judges, and attorneys in a scenario exercise to prepare for a future influenza pandemic The event was organized by the Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention (CDC) It was just one of the numerous workshops and stakeholder meetings on pandemic influenza that we would facilitate and/or participate in both domestically and internationally that year as part of the University of North Carolina Center for Public Health Preparedness (UNC CPHP) A primary mission of centers such as the UNC CPHP, which opened in 2003, was to link university faculty members and public health practitioners by bringing academic rigor to state and local health departments, adding qualified state and local public health professionals to the faculty, and influencing scholarly research and its translation to real-world action These partnerships provided students a window into health security, thereby inspiring them to devote their careers to threats such as COVID-19 through government service 1 The UNC CPHP was one of a network of 27 Centers for Public Health Preparedness that grew from the events after 9/11, when health emerged as a national security concern 2 Consequently, substantial federal investment in domestic health security transformed and modernized public health, especially after passage of the Pandemic and All-Hazards Preparedness Act in 2006 mandated research to improve federal, state, local, and tribal public health preparedness and response systems
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159,108 |
Blind-sided by privacy? Digital contact tracing, the Apple/Google API and big tech's newfound role as global health policy makers
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Since the outbreak of COVID-19, governments have turned their attention to digital contact tracing. In many countries, public debate has focused on the risks this technology poses to privacy, with advocates and experts sounding alarm bells about surveillance and mission creep reminiscent of the post 9/11 era. Yet, when Apple and Google launched their contact tracing API in April 2020, some of the world's leading privacy experts applauded this initiative for its privacy-preserving technical specifications. In an interesting twist, the tech giants came to be portrayed as greater champions of privacy than some democratic governments. This article proposes to view the Apple/Google API in terms of a broader phenomenon whereby tech corporations are encroaching into ever new spheres of social life. From this perspective, the (legitimate) advantage these actors have accrued in the sphere of the production of digital goods provides them with (illegitimate) access to the spheres of health and medicine, and more worrisome, to the sphere of politics. These sphere transgressions raise numerous risks that are not captured by the focus on privacy harms. Namely, a crowding out of essential spherical expertise, new dependencies on corporate actors for the delivery of essential, public goods, the shaping of (global) public policy by non-representative, private actors and ultimately, the accumulation of decision-making power across multiple spheres. While privacy is certainly an important value, its centrality in the debate on digital contact tracing may blind us to these broader societal harms and unwittingly pave the way for ever more sphere transgressions.
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159,109 |
SARS-CoV-2 vaccines in development
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in late 2019 in China and is the causative agent of the coronavirus disease 2019 (COVID-19) pandemic. To mitigate the effects of the virus on public health, the economy and society, a vaccine is urgently needed. Here I review the development of vaccines against SARS-CoV-2. Development was initiated when the genetic sequence of the virus became available in early January 2020, and has moved at an unprecedented speed: a phase I trial started in March 2020 and there are currently more than 180 vaccines at various stages of development. Data from phase I and phase II trials are already available for several vaccine candidates, and many have moved into phase III trials. The data available so far suggest that effective and safe vaccines might become available within months, rather than years.
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159,110 |
Fear and Psychopathology During the COVID-19 Crisis: Neuroticism, Hypochondriasis, Reassurance-Seeking, and Coronaphobia as Fear Factors
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The COVID-19 pandemic has generated a rise in psychological distress worldwide. Although fear appears to be a major contributing factor, there has been no systematic research to determine which specific facets of fear predict psychopathology during the coronavirus crisis. The present study is the first to examine which fear factors uniquely predict clinical levels of depressive symptoms and generalized anxiety. Data were collected from 256 adults in the United States recruited from Amazon's Mechanical Turk (MTurk) during the coronavirus pandemic. The results from logistic regression analyses demonstrated that neuroticism, coronaphobia, and hypochondriasis were fear factors that predicted pandemic-related psychopathology in adults. These findings suggest that mental health professionals should screen individuals for this set of fear factors when choosing appropriate assessments and interventions for treating people who are suffering during the crisis.
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159,111 |
Graph Neural Networks with Haar Transform-Based Convolution and Pooling: A Complete Guide
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Graph Neural Networks (GNNs) have recently caught great attention and achieved significant progress in graph-level applications. In order to handle graphs with different features and sizes, we propose a novel graph neural network, which we call HaarNet, to predict graph labels with interrelated convolution and pooling strategies. Similar to some existing routines, the model assembles unified graph-level representations from samples by first adopting graph convolutional layers to extract mutual information followed by graph pooling layers to downsample graph resolution. By a sequence of clusterings, we embed the intrinsic topological information of each graph into the GNN. Through the fast Haar transformation, we made our contribution to forming a smooth workflow that learns multi-scale graph representation with redundancy removed. As a result, our proposed framework obtains notable accuracy gains without sacrificing performance stability. Extensive experiments validate the superiority on graph classification and regression tasks, where our proposed HaarNet outperforms various existing GNN models, especially on big data sets.
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159,112 |
Auswirkungen der SARS-CoV-2-Pandemie auf die universitäre Hals-Nasen-Ohrenheilkunde im Bereich der Krankenversorgung./ [Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]
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INTRODUCTION: Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS: An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS: All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8â% to 26.2â±â14.2â% and in surgical treatments by 65.9â% to 34.1â±â13.9â%. In contrast, emergency treatment remained unchanged or even increased in 80â% of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90â%. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35â000 outpatients and about 12â000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION: The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY: This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.
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159,113 |
Economics of Coding, Coverage, and Reimbursement for Molecular Diagnostics
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This editorial highlights the article from the Association for Molecular Pathology's Economic Affairs Committee that appears in this issue.
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159,114 |
Using the internet search data to investigate symptom characteristics of COVID-19: A big data study
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Objective: Analyzing the symptom characteristics of Coronavirus Disease 2019(COVID-19) to improve control and prevention. Methods: Using the Baidu Index Platform (http://index.baidu.com) and the website of Chinese Center for Disease Control and Prevention as data resources to obtain the search volume (SV) of keywords for symptoms associated with COVID-19 from January 1 to February 20 in each year from 2017 to 2020 and the epidemic data in Hubei province and the other top 9 impacted provinces in China. Data of 2020 were compared with those of the previous three years. Data of Hubei province were compared with those of the other 9 provinces. The differences and characteristics of the SV of COVID-19-related symptoms, and the correlations between the SV of COVID-19 and the number of newly confirmed/suspected cases were analyzed. The lag effects were discussed. Results: Comparing the SV from January 1, 2020 to February 20, 2020 with those for the same period of the previous three years, Hubei's SV for cough, fever, diarrhea, chest tightness, dyspnea, and other symptoms were significantly increased. The total SV of lower respiratory symptoms was significantly higher than that of upper respiratory symptoms (Pï¼0.001). The SV of COVID-19 in Hubei province was significantly correlated with the number of newly confirmed/suspected cases (r confirmed = 0.723, r suspected = 0.863, both p < 0.001). The results of the distributed lag model suggested that the patients who searched relevant symptoms on the Internet may begin to see doctors in 2-3 days later and be confirmed in 3-4 days later. Conclusion: The total SV of lower respiratory symptoms was higher than that of upper respiratory symptoms, and the SV of diarrhea also increased significantly. It warned us to pay attention to not only the symptoms of the lower respiratory tract but also the gastrointestinal symptoms, especially diarrhea in patients with COVID-19. Internet search behavior had a positive correlation with the number of newly confirmed/suspected cases, suggesting that big data has an important role in the early warning of infectious diseases.
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159,115 |
Holding a Conference Online and Live due to COVID-19
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The joint EDBT/ICDT conference (International Conference on Extending Database Technology/International Conference on Database Theory) is a well established conference series on data management, with annual meetings in the second half of March that attract 250 to 300 delegates. Three weeks before EDBT/ICDT 2020 was planned to take place in Copenhagen, the rapidly developing Covid-19 pandemic led to the decision to cancel the face-to-face event. In the interest of the research community, it was decided to move the conference online while trying to preserve as much of the real-life experience as possible. As far as we know, we are one of the first conferences that moved to a fully synchronous online experience due to the COVID-19 outbreak. With fully synchronous, we mean that participants jointly listened to presentations, had live Q&A, and attended other live events associated with the conference. In this report, we share our decisions, experiences, and lessons learned.
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159,116 |
Outcomes and biomarker analyses among patients with COVID-19 treated with interleukin 6 (IL-6) receptor antagonist sarilumab at a single institution in Italy
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BACKGROUND: The inflammatory pathology observed in severe COVID-19 disease caused by the 2019 novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by elevated serum levels of C reactive protein (CRP) and cytokines, including interferon gamma, interleukin 8 (IL-8), and interleukin 6 (IL-6). Initial reports from the outbreak in Italy, China and the USA have provided anecdotal evidence of improved outcomes with the administration of anti-IL-6 agents, and large-scale trials evaluating these therapies are ongoing. STUDY DESCRIPTION: In this retrospective case series, clinical outcomes and correlates of response to treatment with the IL-6 receptor antagonist sarilumab are described for 15 patients with COVID-19 from a single institution in Southern Italy. Among 10 patients whose symptoms improved after sarilumab treatment, rapid decreases in CRP levels corresponded with clinical improvement. Lower levels of IL-6 at baseline as well as lower neutrophil to lymphocyte ratio as compared with patients whose COVID-19 did not improve with treatment were associated with sarilumab-responsive disease. CONCLUSIONS: This observation may reflect a possible clinical benefit regarding early intervention with IL-6-modulatory therapies for COVID-19 and that CRP could be a potential biomarker of response to treatment.
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159,117 |
Genomic and phylogenetic characterisation of an imported case of SARS-CoV-2 in Amazonas State, Brazil
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A new coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] is currently causing a life-threatening pandemic. In this study, we report the complete genome sequencing and genetic characterisation of a SARS-CoV-2 detected in Manaus, Amazonas, Brazil, and the protocol we designed to generate high-quality SARS-CoV-2 full genome data. The isolate was obtained from an asymptomatic carrier returning from Madrid, Spain. Nucleotide sequence analysis showed a total of nine mutations in comparison with the original human case in Wuhan, China, and support this case as belonging to the recently proposed lineage A.2. Phylogeographic analysis further confirmed the likely European origin of this case. To our knowledge, this is the first SARS-CoV-2 genome obtained from the North Brazilian Region. We believe that the information generated in this study may contribute to the ongoing efforts toward the SARS-CoV-2 emergence.
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159,118 |
Stress, Anxiety, and Depression in People Aged Over 60 in the COVID-19 Outbreak in a Sample Collected in Northern Spain
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OBJECTIVE: This study examines the levels of stress, anxiety, and depression in people over 60 years of age at the time of the COVID-19 outbreak. DESIGN: The study used an exploratory-descriptive cross-sectional methodology. The resulting responses were analyzed using SPSS v.25 PARTICIPANTS: Participants (Nâ¯=â¯290) were aged 60 years and above. SETTING: The study was carried out in the Basque Country (North of Spain). MEASUREMENTS: Stress, anxiety, and depression were measured using the Anxiety and Stress Scale - 21 (DASS-21) RESULTS: Most of the participants did not report levels of stress, anxiety, and depression. Among participants age 66 and above and those with chronic illness, a proportion reported experiencing one, two or all three of these symptoms.
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159,119 |
COVID-19 in Nepal: Times of Anxiety and Fear
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As of 30 June 2020, 14,046 COVID-19 positive cases have been confirmed in Nepal out of around 233,000 tests administered since January So far, only 30 people have died of the coronavirus - a small number compared to worldwide trends After the lockdown was eased on 14 June, the number of positive cases has spiked An atmosphere of anxiety looms large over a spike in COVID-19 infections and possible deaths, and along with the pandemic, people fear hunger, inefficient government response, and the possibility of dystopia in the long run Amidst this challenging time, popular protest and community solidarity have worked together with local government to provide some hope
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159,120 |
Acute oxygen therapy: a cross-sectional study of prescribing practices at an English hospital immediately before COVID-19 pandemic
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BACKGROUND: Approximately 14% of UK hospital in-patients receive supplemental oxygen therapy, only 57% have valid prescriptions. Oxygen must be optimally prescribed to ensure maximal therapeutic response whilst minimizing adverse outcomes (including fatality). This study investigates prescription compliance. METHODS: All adults admitted to medical wards (18 February to 3 March 2020) were included. Analyses present proportions, descriptive statistics, and hypothesis testing. Ethical approval was unnecessary for this audit. RESULTS: Of the 636 patients admitted, 66 (10%) were receiving oxygen therapy. Ages ranged from 34 to 100 years with 36 (54.5%) males and 30 (45.5%) females. The prescription was not documented in the oxygen section of the drug chart (n = 37, 56.1%, p = 0.389), nor did it have the physicians signature (n = 40, 60.6%, p = 0.110) nor date (n = 46, 69.7%, p = 0.002). Thirteen chronic obstructive pulmonary disease (COPD) patients (19.7%) were at risk of hypercapnic failure (p = 1.582x10-6). Target oxygen saturation (SpO2) range had been documented for 30 (45.5%) patients. A target SpO2 range of 88-92% was documented for 9 patients (13.6%), a 94-98% range documented for 11 patients (16.7%). All patients had an invalid prescription. CONCLUSION: We present real-world practice in naturalistic settings, immediately before pandemic-lockdown. Enhanced compliance is advocated to reduce risks of harm and mortality.
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159,121 |
Epidemic analysis and trend prediction of COVID-19 in Japan and Korea
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To provide a theoretical basis for China, Japan and South Korea for effective joint defense and control the COVID-19 epidemic in Japan and South Korea is analyzed and the trend of development is predicted Statistics and calculation of new cases per day, cumulative number of confirmed cases and mortality the epidemic in Japan and South Korea were made, and the line chart was drawn The SEIR model of infectious disease dynamics was constructed to predict the development trend of epidemic situation The newly diagnosed cases of COVID-19 in Japan are likely to increase in the near future and the newly diagnosed cases in South Korea are generally decreasing The results of the SEIR model are in good agreement with the real data of the current epidemic situation in Japan and South Korea The epidemic in Japan and South Korea will have inflection points in May 3rd and March 12th, 2020 respectively The time when the epidemic is expected to be basically controlled is approximately September 16th and June 11th, 2020 respectively South Korea has reached the inflection point of the epidemic, but it will be difficult to achieve the zero state of new cases in the future However, the epidemic in Japan is still in the early and middle stages of the transmission stage, and the number of confirmed cases may continue to rise At present, the two governments should continue to strengthen epidemic prevention and control, and China, Japan and South Korea should effectively carry out joint prevention and control, especially to strengthen the management of asymptomatic infection and the control of imported cases
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159,122 |
A Moroccan plastic surgery department approach during COVID-19 pandemic
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COVID-19 pandemic is an obstacle for all health systems, especially in African countries. This paper shows how plastic surgery teams can adapt human resources and an efficient approach to provide the best care to our patients in this troubled time.
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159,123 |
Pathogenesis of COVID-19
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The coronavirus disease 2019 (COVID-19) is a very contagious infectious disease which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) The virus is first identified in Wuhan city of China in December 2019 and in a short time dispersed to rest of the World Animal to human transmission of the virus happened by eating of an infected animal and then the virus is transmitted to healthy persons by close contact Coronaviruses attach and enter to the host cells by means of the spikes on the cell membrane The type 2 pneumocytes are the primary target of the virus The aim of this report is to review the immunopathogenesis of COVID-19 in the light of current literature
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159,124 |
Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators
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BACKGROUND: Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity. METHODS: Prospective study of COVID-19 patients undergoing tracheotomy (n = 12) over a 4-week period (March-April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined. RESULTS: Patients who sustained FiO2 ≤ 50% and PEEP ≤ 8 cm H2 O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48 hours. CONCLUSION: Sustained FiO2 ≤ 50% and PEEP ≤ 8 cm H2 O in the 48 hours post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.
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159,125 |
Route guidance ranking procedures with human perception consideration for personalized public transport service
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The use of smartphone applications (apps) to acquire real time and readily available journey planning information is becoming instinctive behavior by public transport (PT) users. Through the apps, a passenger not only seeks a path from origin to destination, but a satisfactory path that caters to the passenger's preferences at the desired time of travel. Essentially, apps attempt to provide a means of personalized PT service. As the implications of the Covid-19 pandemic take form and infiltrate human and environmental interactions, passenger preference personalization will likely include avoiding risks of infection or contagious contact. The personal preferences are enabled by multiple attributes associated with alternative PT routes. For instance, preferences can be connected to attributes of time, cost, and convenience. This work establishes a personalized PT service, as an adjustment to current design frameworks, by integrating user app experience with operators’ data sources and operations modeling. The work proceeds to focus on its key component: the personalized route guidance methodology. In addition to using the existing shortest path or k-weighted shortest path method, this study develops a novel, lexicographical shortest path method, considering a just noticeable difference (JND). The method adopts lexicographical ordering to capture passenger preferences for different PT attributes following Ernst Weber's law of human perception threshold. However, a direct application of Weber's law violates the axiom of transitivity required for an implementable algorithm, and thus, a revised method is developed with proven algorithms for ranking different paths. The differences between the three route-guidance methods and the effects of the JND perception threshold on the order of the alternative PT routes are demonstrated with an example. The developments were examined in a case study by simulation on the Copenhagen PT network. The results show that using the JND method reduces the value/cost of the most important attributes. Identical robust results are attained when JND parameters are not specified and default values are used. The latter may apply for the future with a mixture of specified and default preference input values. Finally, the computation time indicates a favorable potential for real-life applications. It is believed that the consideration of human threshold perception will encourage decision makers to establish new criteria to comply with this.
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159,126 |
Protecting Labor and Delivery Personnel from COVID-19 during the Second Stage of Labor
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The novel coronavirus disease 2019 (COVID-19) is spreading fast and is affecting the clinical workers at much higher risk than the general population. Little is known about COVID-19 effect on pregnant women; however, the emerging evidence suggests they may be at high risk of asymptomatic disease. In light of projected shortage of personal protective equipment (PPE), there is an aggressive attempt at conservation. In obstetrics, the guidelines on PPE use are controversial and differ among hospitals, globally, as well as nationally. The centers for disease control and prevention (CDC) recommend using N95 respirators, which are respirators that offer a higher level of protection instead of a facemask for when performing or present for an aerosol-generating procedures (AGP). However, the second stage of labor is not considered an AGP. The second stage of labor can last up to 4 hours. During that time, labor and delivery personnel is in close contact to patients, who are exerting extreme effort during and frequently blow out their breath, cough, shout, and vomit, all of which put the health care team at risk, considering that COVID-19 transmission occurs through aerosol generated by coughing and sneezing. The CDC and the American College of Obstetricians and Gynecologists (ACOG) do not provide clarification on the use of N95 during the second stage. We recommend that labor and delivery personnel have the utmost caution and be granted the protection they need to protect themselves and other patients. This includes providing labor and delivery personnel full PPE including N95 for the second stage of labor. This is critical to ensure the adequate protection for health care workers and to prevent spread to other health care workers and patients. KEY POINTS: · Second stage of labor exposes providers to aerosol.. · COVID-19 risk during second stage of labor is high.. · N95 should be used during second stage of labor..
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Resumption of Otolaryngology Surgical Practice in the Setting of Regionally Receding COVID-19
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The practice of otolaryngology has been drastically altered as a consequence of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Geographic heterogeneity in COVID-19 burden has meant different regions have experienced the pandemic at different stages. Regional dynamics of COVID-19 incidence has dictated the available resources for the provision of surgical care. As regions navigate their own COVID-19 dynamics, illustrative examples of areas affected early by the COVID-19 pandemic may provide anticipatory guidance. In this commentary, we discuss our experience with performed and canceled surgical procedures across the various otolaryngology specialties at our institution over the course of regionally rising and falling incident COVID-19 cases.
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Laboratory practice in the face of Covid-19
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In December 2019, the COVID-19 outbreak began in Wuhan and quickly spread over the world. Hospitals have had to make drastic changes to normal workflows and practices to handle the current pandemic. Laboratories face unique challenges in the management of the investigation of COVID-19. Not only must we consider the safe collection and delivery of samples, but we must also observe the latest guidelines in testing for the virus. We have introduced several new measures in our laboratory to accommodate the collection and testing of samples for COVID-19 from both within the hospital and external screening sites. These changes encompass the pre-analytical (sample collection, packaging, and delivery), analytical (evaluation, handling and preparation of samples) and post-analytical (result reporting within the hospital and to external bodies) aspects of both routine (biochemistry, haematology, transfusion and urine, stool and body fluid testing) and COVID-19 testing, to ensure the safe and efficient testing of any patient samples. In addition, more practical matters, such as laboratory staffing and continuing staff education, have also been changed to ensure the safety and well-being of laboratory staff. With the implementation of new rules and regulations, we seek to safeguard the health of all healthcare workers while streamlining the workflow for the large amount of testing required during this period. As the pandemic continues, new tests (e.g. COVID-19 serology and IL6 testing for prognosis or monitoring) are being requested, requiring even more changes and assay evaluation before implementation. All laboratories must be ready to adapt to these new challenges during the COVID-19 pandemic.
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Effect of Pokémon Go on Self-Harm Using Population-Based Interrupted Time-Series Analysis: Quasi-Experimental Study
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BACKGROUND: Pokémon Go is a very popular location-based augmented reality game with widespread influences over the world. An emerging body of research demonstrates that playing Pokémon Go can lead to improvements in physical activity and psychosocial well-being; however, whether Pokémon Go reduces self-harm incidence at the population-level is still questionable. OBJECTIVE: This study aimed to quantify how the launch of Pokémon Go in Hong Kong affected the incidence of self-harm using a quasi-experimental design. METHODS: An interrupted time-series design with Poisson segmented regression adjusted for time and seasonality trends was used on data from 2012 to 2018 to detect any changes in the number of accident and emergency attendances due to self-harm, after Pokémon Go was launched. The findings were validated using a baseline control period and using other intentional injuries and minor noninjuries as control outcomes. We also assessed intervention effects by age group. RESULTS: From January 1, 2012 to July 31, 2018, there were 13,463 accident and emergency attendances due to self-harm in Hong Kong. During the period after launching Pokémon Go, self-harm attendances dropped by 34% (adjusted incidence rate ratio: 0.66, 95% CI 0.61-0.73). When analyzed by age group, a reduction in self-harm incidence was only apparent in adults (18 to 24 years of age: adjusted incidence rate ratio: 0.78, P=.02; 25 to 39 years of age: adjusted incidence rate ratio: 0.75, P<.001; 40 years of age and older: adjusted incidence rate ratio: 0.57, P<.001). CONCLUSIONS: Self-harm incidence in the population, particularly in adults, showed a significant decline in the period after Pokémon Go was launched. Augmented reality games such as Pokémon Go show great promise as a tool to enhance psychosocial well-being and improve mental health.
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Construction of benchmark retinal image database for diabetic retinopathy analysis
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Diabetic retinopathy, a symptomless medical condition of diabetes, is one of the significant reasons of vision impairment all over the world. The prior detection and diagnosis can decrease the occurrence of acute vision loss and enhance efficiency of treatment. Fundus imaging, a non-invasive diagnostic technique, is the most frequently used mode for analyzing retinal abnormalities related to diabetic retinopathy. Computer-aided methods based on retinal fundus images support quick diagnosis, impart an additional perspective during decision-making, and behave as an efficient means to assess response of treatment on retinal abnormalities. However, in order to evaluate computer-aided systems, a benchmark database of clinical retinal fundus images is required. Therefore, a representative database comprising of 2942 clinical retinal fundus images is developed and presented in this work. This clinical database, having varying attributes such as position, dimensions, shapes, and color, is formed to evaluate the generalization capability of computer-aided systems for diabetic retinopathy diagnosis. A framework for the development of benchmark retinal fundus images database is also proposed. The developed database comprises of medical image annotations for each image from expert ophthalmologists corresponding to anatomical structures, retinal lesions and stage of diabetic retinopathy. In addition, the substantial performance comparison capability of the proposed database aids in analyzing candidature of different methods, and subsequently its usage in medical practice for real-time applications.
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Evaluation of the Knowledge of Operating Room Nurses on Preventive Practices for Protection Against COVID-19
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Purpose The purpose of this study is to evaluate the knowledge of operating room nurses (ORNs) on preventive practices in terms of protection against coronavirus disease 2019 (COVID-19) Design This research is a descriptive study Methods 279 ORNs from 17 provinces of Turkey included in this research The data were collected online, using Google Form ORNs were communicated via WhatsApp or via other social media platforms and were asked to answer the questionnaire In the questionnaire, there were 12 questions on descriptive characteristics and 20 statements regarding the knowledge of ORNs on preventive practices for protection against COVID-19 Findings The rate of "yes" responses provided by ORNs to statements on preventive practices for protection against COVID-19 was found between 10% and 98 6% while the rate of "no" responses was found between 0% and 25 8% The rate of those stating that they did not have an opinion on statements was found between 1 8% and 48 4% Conclusion The level of knowledge of ORNs on protective measures against COVID-19 is quite high However, there are important issues to consider such as the fact that the majority of the ORs do not employ an algorithm or a guideline for protective practices and that almost half of ORNs has not received a training on protection against COVID-19
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Psychosocial aspects of COVID-19 in the context of palliative care - A quick review
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In a resource-poor country like India, where the health-care systems are difficult to access, overburdened, and unaffordable to many, the impact of the coronavirus disease 2019 (COVID-19) pandemic can be devastating. The increased burden of serious health-related suffering can impact the well-being of health-care workers, patients, and their families alike. The elderly, the frail, the vulnerable, and those with multiple comorbidities are disproportionately affected. Palliative care, with its comprehensive and inclusive approach, has much to offer in terms of alleviating the suffering, particularly those caused by the distressing physical and psycho-socio-spiritual symptoms, the complex medical decision-making, end-of-life care issues, and grief and bereavement, and needs to be integrated into the pathway of care provision in COVID-19. Psychosocial issues contribute to and amplify suffering and are often underestimated and undertreated and not accessible to many. Empowering frontline professionals in the core concepts of psychosocial support and palliative care thus becomes an absolute necessity. This quick review was done by a group of palliative care physicians and mental health experts from India to develop recommendations for physical and psychosocial care in the context of COVID-19. This review was done as part of that process and highlights the role and challenges of the psychosocial domain of palliative care in the context of COVID-19 situation in India.
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How COVID-19 Pandemics Influences Chinese Economic Sustainability
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China was the first country to face the COVID-19 coronavirus pandemic Owing to the prompt and decisive actions of the authorities, and the consolidation of society, the country has passed the peak of infection and economic activity is gradually recovering The paper shows how COVID-19 affects key industries and the work of supply and transportation networks Using input-output spatial data, migration index indicators, and pandemic spread statistics, we modeled different scenarios for changes in Chinese provinces' production and consumption following the COVID-19 pandemic Calculations were made for 31 provinces and 42 sectors of the Chinese economy We obtained a model that shows how the coronavirus outbreak influences carbon dioxide emission, levels of hazardous waste, and the Energy-Resource Efficiency Rating Based on the financial and migration flows between Chinese provinces, we chose the most effective post-outbreak model Our main recommendation is that one does not need to segregate consumers It is necessary to distribute the damage as evenly as possible between all provinces equally We believe that such an approach will allow the Chinese economy to suffer the least possible amount of damage and facilitate a faster recovery Finally, we analyze the development of bilateral post-epidemic financial flows between China and Russia until 2025 In all scenarios, a temporary decline is expected The results of the study may be useful for other countries in developing policies to overcome the post-epidemic crisis
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Laparoscopic Cervical Cerclage: Don't Catch the Wrong Needle, or What to Do next If It Happens!
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OBJECTIVE: To present a technique to correct mis-placement of the tape during laparoscopic cervical cerclage. Catching and introducing the wrong needle resulted in a knot formed around the right adnexa. DESIGN: A step-by-step demonstration of the mistake and technique to correct it. SETTING: A Para 0+V patient with cervical insufficiency was managed with laparoscopic interval cerclage [1,2,3]. The patient's two most recent pregnancies had been managed with emergency transvaginal cerclage, which failed to prolong her gestation beyond 24 weeks. INTERVENTIONS: Prior to the cerclage procedure a 2.0â¯×â¯0.8cm deep endometriotic nodule was excised. Both curved needles were straightened extracorporeally, and the tape was dropped inside the peritoneal cavity. The 1st needle was introduced successfully through the right side. After insertion of - what was believed to be - the same needle through the left side following the opposite direction, it was discovered that a tight knot had been formed around the right adnexa (Figure 1). To avoid complete removal, the needles-less tape was pulled back completely from the right side (Supplemental Figure 1), and this end was stitched to a straight needle 2-0 polyglactin suture. The much thinner needle passed easily through the already created path, along with the tape (Supplemental Figure 2), and the procedure was completed as planned (Supplemental Figure 3). CONCLUSION: When performing laparoscopic cervical cerclage with the tape and needles inside the abdomen it is important to keep both under constant view. In the event of mis-placement, no need to completely remove the tape. The tape's cut end can still be re-introduced successfully, stitched to a straight needle suture.
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So You Need Datasets for Your COVID-19 Detection Research Using Machine Learning?
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Millions of people are infected by the coronavirus disease 2019 (COVID19) around the world. Machine Learning (ML) techniques are being used for COVID19 detection research from the beginning of the epidemic. This article represents the detailed information on frequently used datasets in COVID19 detection using Machine Learning (ML). We investigated 96 papers on COVID19 detection between January 2020 and June 2020. We extracted the information about used datasets from the articles and represented them here simultaneously. This investigation will help future researchers to find the COVID19 datasets without difficulty.
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Preventing the development of severe COVID-19 by modifying immunothrombosis
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BACKGROUND: COVID-19-associated acute respiratory distress syndrome (ARDS) is associated with significant morbidity and high levels of mortality. This paper describes the processes involved in the pathophysiology of COVID-19 from the initial infection and subsequent destruction of type II alveolar epithelial cells by SARS-CoV-2 and culminating in the development of ARDS. MAIN BODY: The activation of alveolar cells and alveolar macrophages leads to the release of large quantities of proinflammatory cytokines and chemokines and their translocation into the pulmonary vasculature. The presence of these inflammatory mediators in the vascular compartment leads to the activation of vascular endothelial cells platelets and neutrophils and the subsequent formation of platelet neutrophil complexes. These complexes in concert with activated endothelial cells interact to create a state of immunothrombosis. The consequence of immunothrombosis include hypercoagulation, accelerating inflammation, fibrin deposition, migration of neutrophil extracellular traps (NETs) producing neutrophils into the alveolar apace, activation of the NLRP3 inflammazome, increased alveolar macrophage destruction and massive tissue damage by pyroptosis and necroptosis Therapeutic combinations aimed at ameliorating immunothrombosis and preventing the development of severe COVID-19 are discussed in detail.
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A Study of Opacity Ranges for Transparent Overlays in 3D Landscapes
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{When visualizing data in a realistically rendered 3D virtual environment, it is often important to represent not only the 3D scene but also overlaid information about additional, abstract data. These overlays must be usefully visible, i.e. be readable enough to convey the information they represent, but remain unobtrusive to avoid cluttering the view. We take a step toward establishing guidelines for designing such overlays by studying the relationship between three different patterns (filled, striped and dotted patterns), two pattern densities, the presence or not of a solid outline, two types of background (blank and with trees), and the opacity of the overlay. For each combination of factors, participants set the faintest and the strongest acceptable opacity values. Results from this first study suggest that i) ranges of acceptable opacities are around 20-70%, that ii) ranges can be extended by 5% by using an outline, and that iii) ranges shift based on features like pattern and density.
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Cyanoamidine Cyclization Approach to Remdesivir's Nucleobase
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We report an alternative approach to the unnatural nucleobase fragment seen in remdesivir (Veklury). Remdesivir displays broad-spectrum antiviral activity and is currently being evaluated in Phase III clinical trials to treat patients with COVID-19. Our route relies on the formation of a cyanoamidine intermediate, which undergoes Lewis acid-mediated cyclization to yield the desired nucleobase. The approach is strategically distinct from prior routes and could further enable the synthesis of remdesivir and other small-molecule therapeutics.
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Reliability in Extreme Isolation: A Natural Language Processing Tool for Stress Self-assessment
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Life in isolation is a condition that affects more people every day From isolation of people in case of an epidemic (Ebola, Coronavirus, ) to mineworkers or scientist in the Antarctic environment, it is currently well established that extreme isolation is a stressor element which negatively affects human creating stress and social conflict Living in outer space is one of the most extreme forms of isolation that can be used as a test bench for isolation research Crews in space are expected to be able to manage independently stress and social conflict problems to be highly reliable and autonomous Human natural language (NL) has the potential of being a valuable source of information on crew-members stress and reliability in isolation Based on the use of NL, the PSI (Performance and Stress in Isolation) research group is developing an Artificial Intelligent tool for the autonomous monitoring of stress and reliability In order to develop this tool, the first step (here presented) is to investigate the correlation of NL with stress and reliability within the PSI experiment The experiment consisted of three tasks to be performed periodically during the isolation: 1 Analysis of free written communication (NL);2 Short self-reference questionnaire;and 3 Detection of heart rate and blood pressure values In this paper we present the preliminary data collected from 29 participants (17 males and 12 females) to 6 space analogue missions accomplished in Europe, the USA and Israel in the 2016 – 2019 time frames That is, so far, the largest database ever analyzed of this kind The results are coherent with what is described in the literature about NLP content and style analysis, with the novelty of the correlations found with the cardiovascular parameters, thus reinforcing the perspective of applying a NLP AI system for supporting stress management in extreme isolation contexts from Space to Earth spin off
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Effect of sulfated polysaccharides from the Rodophyta Kappaphycus alvarezii in post larva of Nile tilapia (Oreochromis niloticus) submitted to a stress situation - doi: 10.4025/actascianimsci.v34i3.13213/ Efeito dos polissacarídeos sulfatados da rodofícea Kappaphycus alvarezii em pós-larvas de tilápia do Nilo (Oreochromis niloticus) submetidas a situações de estresse - doi: 10.4025/actascianimsci.v34i3.13213
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The study evaluated the effect of oral administration of sulfated polysaccharides (SP) extracted from the marine macroalga Kappaphycus alvarezii on survival and weight gain of Nile tilapia post larvae during sex reversal in a stress situation. SP were extracted from the seaweed by enzymatic digestion and incorporated into the diet before the addition of the hormone 17--methyltestosterone, and administered at the doses of 0.05, 0.1 and 0.2 mg g-1 of body weight and a control (without SP), for 28 days. In the last week of sex reversal a stress situation was established by removing the aeration and water renewal. Survival and weight gains data were subjected to a variance analysis (ANOVA) and Tukey"s test for averages differentiation at significance levels of 1 and 5%. Weight gains were greater in animals that received SP, regardless of the used dose and better survivals were obtained when SP were administered at the doses of 0.05 and 0.1 mg g-1, with values of 79.90 ± 5.68 and 77.60 ± 1.80%, respectively. The study revealed that small doses of the SP were able to improve survival, daily weight gain and final average weight of tilapias submitted to a stress situation.
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Suction mitigation of airborne particulate generated during sinonasal drilling and cautery
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BACKGROUND: Coronavirus disease 2019 (COVID-19) has significantly impacted endonasal surgery, and recent experimentation has demonstrated that sinonasal drilling and cautery have significant propensity for airborne particulate generation immediately adjacent to the surgical field. In the present investigation, we assessed nasopharyngeal suctioning as a mitigation strategy to decrease particulate spread during simulated endonasal surgical activity. METHODS: Airborne particulate generation in the 1-µm to 10-µm range was quantified with an optical particle sizer in real-time during cadaveric-simulated anterior and posterior endonasal drilling and cautery conditions. To test suction mitigation, experiments were performed both with and without a rigid suction placed in the contralateral nostril, terminating in the nasopharynx. RESULTS: Both anterior (medial maxillary wall and nasal septum) and posterior (sphenoid rostrum) drilling produced significant particulate generation in the 1-µm to 10-µm range throughout the duration of drilling (p < 0.001) without the use of suction, whereas nasopharyngeal suction use eliminated the detection of generated airborne particulate. A similar effect was seen with nasal cautery, with significant particle generation (p < 0.001) that was reduced to undetectable levels with the use of nasopharyngeal suction. CONCLUSION: The use of nasopharyngeal suctioning via the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery. In the era of COVID-19, this technique offers an immediately available measure that may increase surgical safety.
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Design of nickel cobalt molybdate regulated by boronizing for high-performance supercapacitor applications
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Nickel-cobalt-based molybdates have been intensively investigated because of their high theoretical specific capacitance and multifarious oxidation states. Here, we have successfully synthesized hierarchical structures (Ni3B/Ni(BO2)2@NixCoyMoO4) by boronizing NixCoyMoO4 nanosheets on flexible carbon cloth substrates. Benefitting from the synergistic effect among Ni3B, Ni(BO2)2 and NixCoyMoO4 in hybrid architectures, the electrode material possesses higher capacity of 394.7 mA h g-1 at 1 A g-1 and a good rate performance (309.5 mA h g-1 maintained at 20 A g-1). Then, a hybrid supercapacitor assembled with Ni3B/Ni(BO2)2@NixCoyMoO4 and activated carbon as the positive and the negative electrode, displays a high specific capacitance of 370.7 F g-1 at 1 A g-1 (210 F g-1 at 10 A g-1), a high voltage of 1.7 V, and a high energy density of 131.8 W h kg-1 at the power density of 800 W kg-1 (still 74.7 W h kg-1 maintained at 8000 W kg-1). This study widens the research scope of boronizing pseudocapacitance materials and reveals a high application potential of Ni3B/Ni(BO2)2@NixCoyMoO4 for energy storage devices in the future.
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[The role of multimodality imaging in COVID-19 patients: from diagnosis to clinical monitoring and prognosis]
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The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, monitoring and evaluation of the patient's therapy in COVID-19 pneumonia The ideal imaging strategy in this setting is not yet well defined Bedside pulmonary ultrasound presents an undeniable series of advantages in patients at high risk of infection, and can provide incremental data in the respiratory intensive care for the serial control of the individual patient, as well as for home delivery of stabilized patients Chest X-ray is characterized by low sensitivity in identifying earlier lung changes Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative, and in the late phase imaging findings may not change the therapeutic approach Echocardiography should be limited to patients with hemodynamic instability
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L'imaging integrato nel percorso del paziente con COVID-19: dalla diagnosi, al monitoraggio clinico, alla prognosi./ [The role of multimodality imaging in COVID-19 patients: from diagnosis to clinical monitoring and prognosis]
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The integrated clinical, laboratory and ultrasound approach is essential for the diagnosis, monitoring and evaluation of the patient's therapy in COVID-19 pneumonia. The ideal imaging strategy in this setting is not yet well defined. Bedside pulmonary ultrasound presents an undeniable series of advantages in patients at high risk of infection, and can provide incremental data in the respiratory intensive care for the serial control of the individual patient, as well as for home delivery of stabilized patients. Chest X-ray is characterized by low sensitivity in identifying earlier lung changes. Pulmonary computed tomography shows high sensitivity but should not be routinely performed in all patients, because in the first 48 h it can be absolutely negative, and in the late phase imaging findings may not change the therapeutic approach. Echocardiography should be limited to patients with hemodynamic instability.
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159,145 |
Comparison of hospital worker anxiety in COVID-19 treating and non-treating hospitals in the same city during the COVID-19 pandemic
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BACKGROUND: The Hadassah Medical Organization operates two hospitals in Jerusalem. During the COVID-19 pandemic it made an administrative decision to operate one hospital as a COVID-19 treatment hospital (CTH) and to have the second function as a non-COVID-19 treating hospital (NCTH) offering general medical services. The purpose of this study was to assess how this decision affected hospital worker anxiety. METHODS: From April 27 to May 1, during the COVID-19 pandemic in Israel, while the country was under lock-down, an electronic questionnaire survey was carried out among hospital workers of the CTH and NCTH. The questionnaire includes personal demographics and attitudes about COVID-19 and assesses present anxiety state using the State-Trait Anxiety Inventory for Adults (STAI-S) validated questionnaire. A STAI-S score of ≥45 was considered to represent clinical anxiety. RESULTS: Completed questionnaires were received from 1570 hospital employees (24%). 33.5% of responders had STAI-S scores ≥45. Multivariable regression analysis showed that being a resident doctor (odds ration [OR] 2.13; 95% CL, 1.41-3.23; P = 0.0003), age ≤ 50 (OR, 2.08; 95% Cl, 1.62-2.67; P < .0001), being a nurse (OR, 1.29; 95% CL, 1.01-1.64; P = 0.039), female gender (OR, 1.63; 95% CL, 1.25-2.13; P = 0.0003) and having risk factors for COVID-19 (OR, 1.51; 95% CL, 1.19-1.91; P = 0.0007), but not hospital workplace (p = 0.08), were associated with the presence of clinical anxiety. 69% of the responders had been tested for COVID-19, but only nine were positive. CTH workers estimated that the likelihood of their already being infected with COVID-19 to be 21.5 ± 24.7% as compared to the 15.3 ± 19.5% estimate of NCTH workers (p = 0.0001). 50% (545/1099) of the CTH workers and 51% (168/330) of the NCTH workers responded that the most important cause of their stress was a fear of infecting their families (p = 0.7). CONCLUSIONS: By multivariable analysis the creation of a NCTH during the COVID-19 pandemic was not found to be associated with a decrease in the number of hospital workers with clinical anxiety. Hospital worker support resources can be focused on the at-risk groups identified in this study.
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159,146 |
Knowledge of general dentists, endodontists and pediatric dentists about the management on dental traumas: a survey in turkey/ Conhecimento de dentistas clínicos-gerais, endodontistas e pediatras sobre o manejo de traumas dentários: uma pesquisa na Turquia
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Objective: The purpose of this study was to determine endodontists, pedodontists and general dentists' knowledge of management of dental trauma. Material and methods: A web-based survey including 13 questions was prepared using Google forms, and a link to the survey was sent to the general dentists, endodontists and paediatric dentists via social media. The questionnaire asked for information regarding the age, gender, state of education, type of institution and knowledge levels about dental traumas. A total of 258 questionnaires were returned, and the One-Way Anova for practitioners' knowledge and the statistical analysis of the relationship between gender, vocational training and training by using Mann-Whitney U tests for participants. Results: As a result of statistical analysis, although there was no statistical difference between pedodontists and endodontists in their knowledge levels, it was found that both occupational groups had higher knowledge level than general dentists (p = 0,0001). While there was a significant difference between practitioners at university and oral and dental health hospital (p = 0.0001), there was no difference between practitioners in university hospital and private office (p = 0.065). Conclusions:In conclusion, general dentists had knowledge of inadequate dental trauma management and the knowledge level of dentists working at oral and dental hospital was lowe (AU)
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Facing COVID-19: Early Recognition and Triage Tool for Medical Treatment Facilities With Limited Resources
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INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is spreading all over the world. Health systems around the globe have to deal with decreased capabilities and exhausted resources because of the surge of patients. The need to identify COVID-19 patients to achieve a timely opportunity to treat and isolate them is an ongoing challenge for health care professionals everywhere. A lack of testing capabilities forces clinicians to make the crucial initial decision on the basis of clinical findings and routine diagnostic laboratory test. This article reviews the current literature and presents a new adapted protocol for diagnosing and triaging COVID-19 patients. A special emphasis lies on the stepwise approach guiding the medical provider to a triage decision that is suitable for the individual patient and the situation of the local medical treatment facility. MATERIALS AND METHODS: On March 30, 2020, a PubMed based literature research on COVID-19 following the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A diagnostic and triage tool for COVID-19 was designed based on the major findings in the reviewed literature. RESULTS: After a selection process, focusing on the topics "epidemiology," "clinical characteristics," and "diagnostic tools," 119 out of a total amount of 1,241 publications were selected to get an overview of the growing evidence. CONCLUSIONS: The designed Early Recognition and Triage Tool enables the medical provider to use the applicable modules of the protocol for capabilities of the local setting to get the most appropriate diagnostic and triage done. The tool should give guidance for the initial approach until specific testing for the COVID-19 virus is available.
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Preliminary Study on Environmental and Climatic Characteristics of Historical Infectious Diseases and Some Thoughts of COVID-19
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The outbreak and pandemic of COVID-19 pose a serious threat to the safety of human society and examine the ability of public health care resources around the world to deal with the large sudden infectious diseases A review on the environmental and climatic characteristics related to historical infectious diseases will shed immediate light on the scientific research and control of COVID-19 Our results show that: (1) Historically, outbreaks of human-to-human coronavirus and orthomyxoviridae infectious diseases mainly occurred in the subtropical monsoon climate of the northern hemisphere in the winter and spring, while the outbreaks of flaviridae infectious diseases mostly occurred in tropical regions in hot and rainy summer and autumn (2) Global warming and extreme weather may exacerbate the outbreak and spread of infectious diseases (3) The impact of human activities on the ecosystem balance forces the habitat migration of virus hosts and the aggregation of different virus hosts, increasing the probability of virus mutation and the risk of infectious disease outbreaks The lessons from historical outbreak of infectious diseases suggest that suitable climate factors might be conducive to the outbreak and epidemics, while the outbreaks in tropical countries also indicate that it is necessary to scrutinize the roles of climate, environmental conditions and ecological factors in the global wave of COVID-19 Our study provides some useful insights for the prevention and control of COVID-19 plague and other potential pandemics in the future © 2020, Editorial Board, Research of Environmental Sciences All right reserved
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Comparison of the severity of psychological distress among four groups of an Iranian population regarding COVID-19 pandemic
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BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has caused serious psychological problems, including panic attack, anxiety, stress, and depression. The main objective of this study was to measure the prevalence and compare the severity of this psychological distress among four groups of an Iranian population. METHOD: In a cross-sectional survey, the mental health status of four groups of an Iranian society including community population, patients with COVID-19, medical staff, and medical students were investigated by the self-report questionnaire of Depression, Anxiety, and Stress Scale (DASS). DASS-21 questionnaire and the demographic data sheet were filled out by the participants. All statistical analyses were done using R version 3.6.1 software. P-values less than 0.05 were considered as statistically significant. ANOVA test was used to compare the severity of stress, anxiety, and depression between the four study groups. RESULTS: Of the 886 participants in this survey, 554 (62.5%) were men and 332 (37.5%) were women, and the mean ± standard division of age was 40.91 ± 10.7 years. Among these participants, 241 (27.2%) were selected from community population, 221 (24.9%) were patients with COVID-19, 217 (24.5%) were medical staff, and 207 (23.4%) were medical students. The mean score of stress, anxiety, and depression in medical students and patients with COVID-19 was significantly higher than in medical staff and community population (P < 0.05). Overall, the anxiety score in men was higher than that in women (27.4 ± 4.6 vs. 26.48 ± 4.8, P = 0.006), and unmarried participants had a significantly higher depression score compared with the married group (27.5 ± 4.8 vs. 26.7 ± 4.6, P = 0.023). In addition, the score of depression was higher in female medical staff (27.08 ± 4.6 vs. 25.33 ± 4.3, P = 0.011) and community population (26.6 ± 4.3 vs. 25.3 ± 4.3, P = 0.02) than in male. CONCLUSION: COVID-19 patients and medical students in contact with these patients were at a high risk for mental illness due to lower experience compared with professional medical staff and community population. Continuous surveillance and monitoring of psychological distress for outbreaks should become a routine part of preparedness efforts worldwide.
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Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden
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The Public Health Agency of Sweden has analyzed how many pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been treated in intensive care units (ICU) in Sweden between 19 March and 20 April 2020 compared with non-pregnant women of similar age. Cases were identified in a special reporting module within the Swedish Intensive Care Registry (SIR). Fifty-three women aged 20-45 years with SARS-CoV-2 were reported in SIR, and 13 of these women were either pregnant or postpartum (<1 week). The results indicate that the risk of being admitted to ICU may be higher in pregnant and postpartum women with laboratory-confirmed SARS-CoV-2 in Sweden, compared with non-pregnant women of similar age.
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Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden
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The Public Health Agency of Sweden has analyzed how many pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been treated in intensive care units (ICU) in Sweden between 19 March and 20 April 2020 compared with non-pregnant women of similar age. Cases were identified in a special reporting module within the Swedish Intensive Care Registry (SIR). Fifty-three women aged 20-45 years with SARS-CoV-2 were reported in SIR, and 13 of these women were either pregnant or postpartum (<1 week). The results indicate that the risk of being admitted to ICU may be higher in pregnant and postpartum women with laboratory-confirmed SARS-CoV-2 in Sweden, compared with non-pregnant women of similar age.
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Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden
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The Public Health Agency of Sweden has analyzed how many pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been treated in intensive care units (ICU) in Sweden between 19 March and 20 April 2020 compared with non-pregnant women of similar age. Cases were identified in a special reporting module within the Swedish Intensive Care Registry (SIR). Fifty-three women aged 20-45 years with SARS-CoV-2 were reported in SIR, and 13 of these women were either pregnant or postpartum (<1 week). The results indicate that the risk of being admitted to ICU may be higher in pregnant and postpartum women with laboratory-confirmed SARS-CoV-2 in Sweden, compared with non-pregnant women of similar age.
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The Creation of a Psychiatry-Palliative Care Liaison Team: Using Psychiatrists to Extend Palliative Care Delivery and Access During the COVID-19 Crisis
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CONTEXT: During the course of March and April 2020, New York City experienced a surge of a 170,000 coronavirus disease 2019 (COVID-19) cases, overwhelming hospital systems and leading to an unprecedented need for palliative care services. OBJECTIVES: To present a model for rapid palliative care workforce expansion under crisis conditions, using supervised advanced psychiatry trainees to provide primary palliative services in the acute care and emergency setting. METHODS: In response to the New York City COVID-19 surge, advanced psychiatry trainees at New York-Presbyterian Columbia University Irving Medical Center were rapidly trained and redeployed to a newly formed psychiatry-palliative care liaison team. Under the supervision of consultation-liaison psychiatrists (who also served as team coordinators), these trainees provided circumscribed palliative care services to patients and/or their families, including goals-of-care discussions and psychosocial support. Palliative care attendings remained available to all team members for more advanced and specialized supervision. RESULTS: The psychiatry-palliative care liaison team effectively provided palliative care services during the early phase and peak of New York City's COVID-19 crisis, managing up to 16 new cases per day and provided longitudinal follow-up, thereby enabling palliative care specialists to focus on providing services requiring specialist-level palliative care expertise. CONCLUSION: By training and supervising psychiatrists and advanced psychiatry trainees in specific palliative care roles, palliative care teams could more effectively meet markedly increased service needs of varying complexity during the COVID-19 crisis. As new geographic regions experience possible COVID-19 surges in the coming months, this may serve as a model for rapidly increasing palliative care workforce.
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Mesenchymal Stem Cells in COVID-19: A Journey from Bench to Bedside
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The COVID-19 pandemic has led to a major setback in both the health and economic sectors across the globe. The scale of the problem is enormous because we still do not have any specific anti-SARS-CoV-2 antiviral agent or vaccine. The human immune system has never been exposed to this novel virus, so the viral interactions with the human immune system are completely naive. New approaches are being studied at various levels, including animal in vitro models and human-based studies, to contain the COVID-19 pandemic as soon as possible. Many drugs are being tested for repurposing, but so far only remdesivir has shown some positive benefits based on preliminary reports, but these results also need further confirmation via ongoing trials. Otherwise, no other agents have shown an impactful response against COVID-19. Recently, research exploring the therapeutic application of mesenchymal stem cells (MSCs) in critically ill patients suffering from COVID-19 has gained momentum. The patients belonging to this subset are most likely beyond the point where they could benefit from an antiviral therapy because most of their illness at this stage of disease is driven by inflammatory (over)response of the immune system. In this review, we discuss the potential of MSCs as a therapeutic option for patients with COVID-19, based on the encouraging results from the preliminary data showing improved outcomes in the progression of COVID-19 disease.
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Type I and Type III Interferons Restrict SARS-CoV-2 Infection of Human Airway Epithelial Cultures
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The newly emerged human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a pandemic of respiratory illness. Current evidence suggests that severe cases of SARS-CoV-2 are associated with a dysregulated immune response. However, little is known about how the innate immune system responds to SARS-CoV-2. In this study, we modeled SARS-CoV-2 infection using primary human airway epithelial (pHAE) cultures, which are maintained in an air-liquid interface. We found that SARS-CoV-2 infects and replicates in pHAE cultures and is directionally released on the apical, but not basolateral, surface. Transcriptional profiling studies found that infected pHAE cultures had a molecular signature dominated by proinflammatory cytokines and chemokine induction, including interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and CXCL8, and identified NF-κB and ATF-4 as key drivers of this proinflammatory cytokine response. Surprisingly, we observed a complete lack of a type I or III interferon (IFN) response to SARS-CoV-2 infection. However, pretreatment and posttreatment with type I and III IFNs significantly reduced virus replication in pHAE cultures that correlated with upregulation of antiviral effector genes. Combined, our findings demonstrate that SARS-CoV-2 does not trigger an IFN response but is sensitive to the effects of type I and III IFNs. Our studies demonstrate the utility of pHAE cultures to model SARS-CoV-2 infection and that both type I and III IFNs can serve as therapeutic options to treat COVID-19 patients.IMPORTANCE The current pandemic of respiratory illness, COVID-19, is caused by a recently emerged coronavirus named SARS-CoV-2. This virus infects airway and lung cells causing fever, dry cough, and shortness of breath. Severe cases of COVID-19 can result in lung damage, low blood oxygen levels, and even death. As there are currently no vaccines approved for use in humans, studies of the mechanisms of SARS-CoV-2 infection are urgently needed. Our research identifies an excellent system to model SARS-CoV-2 infection of the human airways that can be used to test various treatments. Analysis of infection in this model system found that human airway epithelial cell cultures induce a strong proinflammatory cytokine response yet block the production of type I and III IFNs to SARS-CoV-2. However, treatment of airway cultures with the immune molecules type I or type III interferon (IFN) was able to inhibit SARS-CoV-2 infection. Thus, our model system identified type I or type III IFN as potential antiviral treatments for COVID-19 patients.
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Necrotizing Enterocolitis-like Pneumatosis Intestinalis in an Infant With COVID-19
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We report an infant with COVID-19 who presented with bloody stools, lethargy and imaging findings significant for pneumatosis intestinalis. The infant was treated with conservative therapy, including resuscitation, bowel rest and intravenous antibiotics, successfully avoiding surgical intervention.
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Beyond COVID-19: Network science and sustainable exit strategies
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On May $28^{th}$ and $29^{th}$, a two day workshop was held virtually, facilitated by the Beyond Center at ASU and Moogsoft Inc. The aim was to bring together leading scientists with an interest in Network Science and Epidemiology to attempt to inform public policy in response to the COVID-19 pandemic. Epidemics are at their core a process that progresses dynamically upon a network, and are a key area of study in Network Science. In the course of the workshop a wide survey of the state of the subject was conducted. We summarize in this paper a series of perspectives of the subject, and where the authors believe fruitful areas for future research are to be found.
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Medidas de distanciamento social e mobilidade na Am\'erica do Sul durante a pandemia por COVID-19: Condi\c{c}\~oes necess\'arias e suficientes?
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In a scenario where there is no vaccine for COVID-19, non-pharmaceutical interventions are necessary to contain the spread of the virus and the collapse of the health system in the affected regions. One of these measures is social distancing, which aims to reduce interactions in the community by closing public and private establishments that involve crowds of people. The lockdown presupposes a drastic reduction in community interactions, representing a more extreme measure of social distancing. Based on geolocation data provided by Google for six categories of physical spaces, this article identifies the variations in the circulation of people in South America for different types of social distancing measures adopted during the COVID-19 pandemic. In this study, population mobility trends for a group of countries between February 15, 2020 and May 16, 2020 were analyzed. To summarize these trends in a single metric, a general circulation index was created, and to identify regional mobility patterns, descriptive analyzes of spatial autocorrelation (global and local Moran index) were used. The first hypothesis of this study is that countries with a lockdown decree can achieve greater success in reducing the mobility of the population, and the second hypothesis is that Argentina, Brazil and Colombia have regional mobility patterns. The first hypothesis was partially confirmed (considering 10 countries in South America), and the results obtained in the spatial analyzes confirmed the second hypothesis. In general, the observed data shows that less rigid lockdown or social distancing measures are necessary, however, they are not sufficient to achieve a significant reduction in the circulation of people during the pandemic.
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Pore-Scale Transport and Two-Phase Fluid Structures in Fibrous Porous Layers: Application to Fuel Cells and Beyond
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We present pore-scale simulations of two-phase flows in a reconstructed fibrous porous layer. The three dimensional microstructure of the material, a fuel cell gas diffusion layer, is acquired via X-ray computed tomography and used as input for lattice Boltzmann simulations. We perform a quantitative analysis of the multiphase pore-scale dynamics and we identify the dominant fluid structures governing mass transport. The results show the existence of three different regimes of transport: a fast inertial dynamics at short times, characterised by a compact uniform front, a viscous-capillary regime at intermediate times, where liquid is transported along a gradually increasing number of preferential flow paths of the size of one-two pores, and a third regime at longer times, where liquid, after having reached the outlet, is exclusively flowing along such flow paths and the two-phase fluid structures are stabilised. We observe that the fibrous layer presents significant variations in its microscopic morphology, which have an important effect on the pore invasion dynamics, and counteract the stabilising viscous force. Liquid transport is indeed affected by the presence of microstructure-induced capillary pressures acting adversely to the flow, leading to capillary fingering transport mechanism and unstable front displacement, even in the absence of hydrophobic treatments of the porous material. We propose a macroscopic model based on an effective contact angle that mimics the effects of the such a dynamic capillary pressure. Finally, we underline the significance of the results for the optimal design of face masks in an effort to mitigate the current COVID-19 pandemic.
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Does meaning protect against loneliness? Exploring empirical studies and theory
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Research indicates that meaning in life is a protective factor for physical and mental health. Although loneliness is increasingly recognized as an important public health concern, no studies have investigated the potential of meaning in life to protect against loneliness. Based on an explorative interdisciplinary research strategy that comprises data from a cohort study, a strategic review of empirical literature and a conceptual analysis of the concept of meaning in life we explore the support for potential links between meaning in life and the protection against loneliness. We propose three different explanatory mechanisms; (i) that meaning in life promotes a positive orientation toward others, (ii) that meaning in life enhances interpersonal appeal and (iii) that meaning in life promotes a better ability to cope with loneliness. Theoretically, we explore the idea that the value of meaning in life ultimately concerns a social need to contribute to the realization of value that, at least in principle, can be shared and recognized by others. When people realize the value of meaning in life, they partake in a community of shared values, which links them to a social world in a way that may protect against the feeling of loneliness. Jointly the analyses point to the need for prospective studies on the role of meaning in life as a protective factor against loneliness and a potential novel focus for loneliness interventions.
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Needs and concerns of patients in isolation care units - learnings from COVID-19: A reflection
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With strict measures in place to contain the spread of coronavirus disease 2019, many have been isolated as suspected or confirmed cases. Being isolated causes much inconvenience for the patients and family. Patients' and next-of-kins' needs and concerns during isolation will be shared together with suggestions for key process improvements. Our hospital's Senior Patient Experience Managers contact all patients admitted to the isolation wards on a daily basis to provide some form of support. Common issues raised were gathered and strategies to help with their needs and concerns were discussed. Being in isolation is a challenging period for both patients and family. Nonetheless, we can implement measures to mitigate against the adverse effects of isolation. Patient education, effective and efficient means of communication, close monitoring for signs of distress and anxiety, and early intervention could help patients cope better with the whole isolation experience. Nursing management may want to consider implementing the measures shared in the article to manage patient's stress while not compromising on staff safety.
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Proto-fascism and State impunity in Majoritarian India: An Interview with Teesta Setalvad
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This interview with Teesta Setalvad was conducted in the wake of the February 2020 anti-Muslim violence in North East Delhi Drawing on her vast experience as a human rights activist, journalist, and peace educator, Setalvad's responses map the continuum-across years, anti-minority pogroms and ruling parties with divergent ideologies-of the cultures of hate, and the practices of state repression and impunity in a proto-fascist India Setalvad offers an interrogation of the ideology of the Hindu right, delves into the historical trajectories of the rise of the Rashtriya Sway-amsevak Sangh (RSS) and the Bharatiya Janata Party (BJP) She also charts the repeating patterns of police and media complicity in fomenting anti-minority hate and critically analyses the contradictory role of the criminal law and the Constitution of India in both enabling and resisting communal violence In conclusion, she offers hopeful strategies for keeping alive the promise of secularism
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Telemedicine in Neurosurgery: Lessons Learned from a Systematic Review of the Literature for the COVID-19 Era and Beyond
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BACKGROUND: Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era. OBJECTIVE: To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience. METHODS: A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty. RESULTS: A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes. CONCLUSION: Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.
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"Virtual" Boot Camp: Orthopaedic Intern Education in the Time of COVID-19 and Beyond
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The emergence of COVID-19 as a viral pandemic in early 2020 resulted in notable changes to the daily practice, workflow, and education of orthopaedic residencies internationally. In particular, social distancing, residency restructuring, and redeployment to other services has increased heterogeneity in schedules and made the in-person gathering of trainees for education increasingly challenging. These changes may last until 2024 based on some mathematical models, resulting in notable disruptions to orthopaedic education, especially for junior residents. Therefore, in this study, we describe how we converted our in-person PGY-1 skills course into a "virtual" boot camp based on validated training modules and existing American Board of Orthopaedic Surgeons guidelines. Lessons learned from the experience and potential areas for improvement in the use of newer technology to teach cognitive knowledge and skills modules are highlighted with the hope that this can be useful to other orthopaedic residency programs, during the pandemic and also beyond.
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Large-Scale Air Medical Operations in the Age of Coronavirus Disease 2019: Early Leadership Lessons From the Front Lines of British Columbia
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In late 2019, a novel coronavirus was identified as the cause of a cluster of atypical pneumonia cases in Wuhan, China. It subsequently spread throughout China and around the world, quickly becoming a public health emergency. In March 2020, the World Health Organization declared coronavirus disease 2019 a pandemic. This article explores the preparation and early experiences of a large Canadian critical care transport program during the coronavirus disease 2019 pandemic focused on 6 broad strategic objectives centered around staff welfare, regular and transparent communication, networking, evidenced-based approach to personal protective equipment, agile mission planning, and an expedited approach to clinical practice and policy updates and future state modeling.
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Bat predation by Phyllostomus hastatus
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Predation is well studied experimentally and empirically, even though it may be difficult to be observedin the field for nocturnal species, such as bats. We studied bat assemblages through mist-netting in four AtlanticForest sites in the states of Espírito Santo, Rio de Janeiro and Minas Gerais, Southeastern Brazil. Here we reportthe observation of four predation events of individuals of the species Glossophaga soricina, Carollia perspicillata and Myotis nigricans by Phyllostomus hastatus. Our observations suggest that P. hastatus may opportunistically prey upon smaller bats.
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Alterations in Fear Extinction Neural Circuitry and Fear-Related Behavior Linked to Trauma Exposure in Children
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Exposure to childhood trauma is extremely common (>60%) and is a leading risk factor for fear-based disorders, including anxiety and posttraumatic stress disorder. These disorders are characterized by deficits in fear extinction and dysfunction in underlying neural circuitry. Given the strong and pervasive link between childhood trauma and the development of psychopathology, fear extinction may be a key mechanism. The present study tests the impact of childhood trauma exposure on fear extinction and underlying neural circuitry. Children (N = 44, 45% trauma-exposed; 6-11 yrs) completed a novel two-day virtual reality fear extinction experiment. On day one, participants underwent fear conditioning and extinction. Twenty-four hours later, participants completed a test of extinction recall during fMRI. Conditioned fear was measured throughout the experiment using skin conductance and fear-related behavior, and activation in fear-related brain regions was estimated during recall. There were no group differences in conditioned fear during fear conditioning or extinction learning. During extinction recall, however, trauma-exposed children kept more distance from both the previously extinguished and the safety cue, suggesting poor differentiation between threat and safety cues. Trauma-exposed youth also failed to approach the previously extinguished cue over the course of extinction recall. The effects on fear-related behavior during extinction recall were accompanied by higher activation to the previously extinguished cue in fear-relevant brain regions, including the dorsal anterior cingulate cortex and anterior insula, in trauma-exposed relative to control children. Alterations in fear-related brain regions and fear-related behavior may be a core mechanism through which childhood trauma confers heightened vulnerability to psychopathology.
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A Survey on Computational Propaganda Detection
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Propaganda campaigns aim at influencing people's mindset with the purpose of advancing a specific agenda. They exploit the anonymity of the Internet, the micro-profiling ability of social networks, and the ease of automatically creating and managing coordinated networks of accounts, to reach millions of social network users with persuasive messages, specifically targeted to topics each individual user is sensitive to, and ultimately influencing the outcome on a targeted issue. In this survey, we review the state of the art on computational propaganda detection from the perspective of Natural Language Processing and Network Analysis, arguing about the need for combined efforts between these communities. We further discuss current challenges and future research directions.
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The spatiotemporal estimation of the risk and the international transmission of COVID-19: a global perspective
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An ongoing novel coronavirus outbreak (COVID-19) started in Wuhan, China, in December 2019. Currently, the spatiotemporal epidemic transmission, prediction, and risk are insufficient for COVID-19 but we urgently need relevant information globally. We have developed a novel two-stage simulation model to simulate the spatiotemporal changes in the number of cases and estimate the future worldwide risk. Simulation results show that if there is no specific medicine for it, it will form a global pandemic. Taiwan, South Korea, Hong Kong, Japan, Thailand, and the United States are the most vulnerable. The relationship between each country's vulnerability and days before the first imported case occurred shows an exponential decrease. We successfully predicted the outbreak of South Korea, Japan, and Italy in the early stages of the global pandemic based on the information before February 12, 2020. The development of the epidemic is now earlier than we expected. However, the trend of spread is similar to our estimation.
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Research Note: Governance Indicators Explain Discrepancies in COVID-19 Data
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is neutral. It does not discriminate: the outbreak affects all countries. Yet, countries with better governance detect and report COVID-19 cases an average of 34 days earlier than countries with low governance scores. They also report a significantly higher number of cases, and more deaths but lower death-per-case ratios. Analyzing the statistical relationship between the good governance indicators devised by the World Bank with data pertaining to COVID-19 (to May 10, 2020), we present some initial yet strong statistical evidence that countries with higher levels of good governance based on the Worldwide Governance Indicators report more (cases, deaths), report earlier, and are more effective at reducing fatalities. These findings remain robust after controlling for population size, population density, old-age population, and the number of tourist arrivals. Countries with better governance are more successful in treating the disease and in reducing its deadliness. Good governance matters.
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Estimation of incubation period and generation time based on observed length-biased epidemic cohort with censoring for COVID-19 outbreak in China
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The incubation period and generation time are key characteristics in the analysis of infectious diseases. The commonly used contact-tracing-based estimation of incubation distribution is highly influenced by the individuals' judgment on the possible date of exposure, and might lead to significant errors. On the other hand, interval censoring-based methods are able to utilize a much larger set of traveling data but may encounter biased sampling problems. The distribution of generation time is usually approximated by observed serial intervals. However, it may result in a biased estimation of generation time, especially when the disease is infectious during incubation. In this paper, the theory from renewal process is partially adopted by considering the incubation period as the interarrival time, and the duration between departure from Wuhan and onset of symptoms as the mixture of forward time and interarrival time with censored intervals. In addition, a consistent estimator for the distribution of generation time based on incubation period and serial interval is proposed for incubation-infectious diseases. A real case application to the current outbreak of COVID-19 is implemented. We find that the incubation period has a median of 8.50 days (95% confidence interval [CI] [7.22; 9.15]). The basic reproduction number in the early phase of COVID-19 outbreak based on the proposed generation time estimation is estimated to be 2.96 (95% CI [2.15; 3.86]).
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Virtual Urgent Care Quality and Safety in the Time of Coronavirus
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ABSTRACT Introduction Telemedicine use rapidly increased during the coronavirus disease 2019 pandemic We assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic Methods We performed a retrospective cohort analysis in a single hospital network of VUC patients from March 1, 2020 through April 20, 2020 We abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals, and ED visits, dispositions, intubations, and deaths We also reviewed incomplete visits For comparison, we evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths We separately analyzed the effects of enhanced callback system targeting higher risk patients with COVID-like illness during the last two weeks of the study period Results A total of 18,278 unique adult patients completed 22,413 VUC visits Separately, 718 patient-scheduled visits were incomplete;the majority were no-shows 50 9% of all patients and 74 0% of patients aged 60 years or older had comorbidities Of VUC visits, 6 8% had a subsequent VUC encounter within 72 hours;1 8% had a subsequent ED visit Of patients with enhanced follow-up, 4 3% were referred for ED evaluation Mortality was 0 20% overall;0 21% initially and 0 16% with enhanced follow-up (p = 0 59) Males and black patients were significantly overrepresented in decedents Conclusion Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality
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159,173 |
Evaluating John Theophilus Desaguliers' Newtonianism: the case of waterwheel knowledge in A course of experimental philosophy
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John Theophilus Desaguliers (1683-1744) was a French-born English Huguenot who made his name as a public lecturer in London and a demonstrator at the Royal Society, writing a very popular introduction to Isaac Newton's natural philosophy, the two-volume A course of experimental philosophy (1734-1744). This paper looks at the influence of three French natural philosophers, Edme Mariotte (1620-1684), Antoine Parent (1666-1716) and Bernard Forest de Bélidor (1698-1761), on the account of waterwheel functioning in the second volume of that work. The aim of the paper is to show that, although Desaguliers demonstrated a commitment to Newton's work, his own natural philosophical objectives also led him to borrow ideas from natural philosophers outside Newton's direct sphere of influence. To do this I shall give an account of what Desaguliers appropriated from Newton's Principia, how it fitted in with his own project and how he also made use of other natural philosophers' theories in his discussion of fluid mechanics. This will hopefully result in a more nuanced conception of Desaguliers' 'Newtonianism' that takes into account the diverse sources and influences in his work.
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159,174 |
'A chain only as strong as its weakest link': an up-to-date literature review on the bidirectional interaction of pulmonary fibrosis and COVID-19
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The COVID-19 pandemic rapidly became a worldwide healthcare emergency affecting millions of people, with poor outcomes for patients with chronic conditions and enormous pressure on healthcare systems Pulmonary fibrosis (PF) has been cited as a risk factor for a more severe evolution of COVID-19, primarily because its acute exacerbations were already associated with high mortality We reviewed the available literature on biochemical, pathophysiological, and pharmacological mechanisms of PF and COVID-19 in an attempt to foresee the particular risk of infection and possible evolution of PF patients if infected with SARS-COV-2 We also analyzed the possible role of medication and risk factors (such as smoking) in the disease's evolution and clinical course We found out that there is a complexity of interactions between coexisting IPF/ILD and COVID-19 disease Also, patients recovering from severe COVID-19 disease are at serious risk of developing PF Smokers seem to have, in theory, a chance to a better outcome if they develop a severe form of COVID-19 but statistically are at much higher risk of dying if they become critically ill
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159,175 |
Global Coronavirus Pandemic (SARS CoV-2): Past, Present, And Future Of Pediatric Dermatology
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Two months have passed since the World Health Organization (WHO) declared the pandemic of the Coronavirus Disease 19 (COVID-19), caused by the SARS CoV-2 virus, on March 11, 2020. Medical and healthcare workers have continued to be on the frontline to defeat this disease, however, continual changes are being made to their working habits which are proving to be difficult. Although the skin is not the main target of the SARS CoV-2 infection, it is strongly involved both directly and indirectly, in many aspects of dermatological disease management, and particularly in pediatric dermatology. In this manuscript, our goal was to provide a "up-to-date" account on this topic, through analysis of current literature and sharing our experiences during this pandemic. This article is protected by copyright. All rights reserved.
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159,176 |
Global coronavirus pandemic (SARS-CoV-2): Past, present, and future of pediatric dermatology
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Two months have passed since the World Health Organization (WHO) declared the pandemic of the Coronavirus Disease 19 (COVID-19), caused by the SARS-CoV-2 virus, on 11 March 2020. Medical and healthcare workers have continued to be on the frontline to defeat this disease, however, continual changes are being made to their working habits which are proving to be difficult. Although the skin is not the main target of the SARS-CoV-2 infection, it is strongly involved both directly and indirectly, in many aspects of dermatological disease management, and particularly in pediatric dermatology. In this manuscript, our goal was to provide a "up-to-date" account on this topic, through analysis of current literature and sharing our experiences during this pandemic.
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159,177 |
Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study
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AIM: To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D). METHODS: From the CORONAvirus-SARS-CoV-2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19-related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status. RESULTS: Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m2 , reference group), 726 (36.9%) overweight (25-29.9 kg/m2 ) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m2 ) and 314 (16.0%) with class II/III obesity (≥35 kg/m2 ). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years. CONCLUSIONS: Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.
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Incidence trend of 2019 novel coronavirus diseases (COVID-19) in China/ 上海预防医学
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Objective To investigate the epidemical characteristics and analyze the incidence trend of 2019 novel coronavirus diseases (COVID-19) in China. Methods The daily new confirmed cases of 2019 novel coronavirus diseases (COVID-19) in China from January 25 to February 8,2020 were collected for epidemiological descriptive analysis. Results During the period from January 25 to February 8, 2020, the number of daily new confirmed cases fell for five consecutive days, from 890 cases on February 3 to 509 cases on February 8. Conclusion The incidence of 2019 novel coronavirus diseases (COVID-19) slowed down in 30 provinces (autonomous regions and municipalities directly under the central government) except Hubei and Xinjiang production and construction corps , but the overall situation is still not optimistic. It is imperative to pay close attention to the origin and destination of migrant workers and the incidence of disease in various areas, and take targeted measures to strengthen prevention and control of the disease.
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159,179 |
Co-spread of Misinformation and Fact-Checking Content During the Covid-19 Pandemic
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In the context of the Covid-19 pandemic, the consequences of misinformation are a matter of life and death Correcting misconceptions and false beliefs are important for injecting reliable information about the outbreak Fact-checking organisations produce content with the aim of reducing misinformation spread, but our knowledge of its impact on misinformation is limited In this paper, we explore the relation between misinformation and fact-checking spread during the Covid-19 pandemic We specifically follow misinformation and fact-checks emerging from December 2019 to early May 2020 Through a combination of spread variance analysis, impulse response modelling and causal analysis, we show similarities in how misinformation and fact-checking information spread and that fact-checking information has a positive impact in reducing misinformation However, we observe that its efficacy can be reduced, due to the general amount of online misinformation and the short-term spread of fact-checking information compared to misinformation © 2020, Springer Nature Switzerland AG
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CTCF-mediated chromatin looping in EGR2 regulation and SUZ12 recruitment critical for peripheral myelination and repair
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Chromatin organization is critical for cell growth, differentiation, and disease development, however, its functions in peripheral myelination and myelin repair remain elusive. In this report, we demonstrate that the CCCTC-binding factor (CTCF), a crucial chromatin organizer, is essential for Schwann cell myelination and myelin regeneration after nerve injury. Inhibition of CTCF or its deletion blocks Schwann cell differentiation at the pro-myelinating stage, whereas overexpression of CTCF promotes the myelination program. We find that CTCF establishes chromatin interaction loops between enhancer and promoter regulatory elements and promotes expression of a key pro-myelinogenic factor EGR2. In addition, CTCF interacts with SUZ12, a component of polycomb-repressive-complex 2 (PRC2), to repress the transcriptional program associated with negative regulation of Schwann cell maturation. Together, our findings reveal a dual role of CTCF-dependent chromatin organization in promoting myelinogenic programs and recruiting chromatin-repressive complexes to block Schwann cell differentiation inhibitors to control peripheral myelination and repair.
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159,181 |
Stakeholders’ views regarding macro-environment impacts on commercial flight operations in South Africa
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Background: Worldwide, the aviation industry facilitates the efficient movement of passengers and goods across borders to support economic access to various local, regional and international markets As an indirect stimulus for other economies, the aviation industry is known for distinct economic competitiveness, low profit margins and vulnerability to macro-environment fluctuations Although many studies have focused specifically on scheduled airline’s operations, this study of commercial flight operations in South Africa encompasses both airline operations and charter/on-demand operations Objectives: The key research objective was to critically review stakeholders’ perceptions on the macro-environment’s influences on the flight operations subsector of South African aviation industry Method: As research methodology to explore manifest and latent meaning in dialogue, qualitative content analysis was employed in this study Data were collected through interviews with the stakeholders of South African aviation industry and analysed using qualitative content analysis Results: This study revealed stakeholders’ views on the effects of political, economic, sociocultural, technological, legal and ecological (PESTLE) framework embedded in the macro-environment of commercial flight operations in South Africa Conclusion: Although the macro-environment is uncontrollable by the industry, each of the PESTLE framework’s dimensions presents challenges as well as growth opportunities Continuous monitoring and a comprehensive understanding of the probable impacts of the macro-environment are necessary to remain competitive
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159,182 |
Long Survival and Prolonged Remission after Surgery and Chemotherapy in a Metastatic Mismatch Repair Deficient Pancreatic Neuroendocrine Carcinoma with MLH1/PMS2 Immunodeficiency and Minimal Microsatellite Shift
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Pancreatic neuroendocrine carcinomas (NECs) are rare and very aggressive neoplasms with dismal prognosis, especially when metastatic or with negative prognostic factors, such as vascular invasion. To the best of our knowledge, no case of pancreatic NEC with mismatch repair deficiency has been reported to date. We describe a 62-year-old patient who underwent pancreaticoduodenectomy for a NEC located in the pancreatic head, with peripancreatic lymph node metastases. Tumor necrosis was prominent and the Ki67 proliferative index was 60%. One year after the diagnosis, the patient experienced recurrence with a left supraclavicular lymph node metastasis, which was surgically removed, followed by standard cisplatin-etoposide chemotherapy. Neoplastic cells showed combined loss of expression of MLH1 and PMS2 in both primary tumor and lymph node metastasis. Microsatellite instability (MSI) test using a mononucleotide repeats pentaplex PCR (BAT-25, BAT-26, NR-21, NR-22, and NR-24) revealed minimal mononucleotide shifts showing deletion of less than 3 bp at NR-21, BAT-26, NR-24, and NR-22 loci. MLH1 methylation analysis revealed absence of the gene promoter methylation. BRAF and KRAS mutations were not detected. In gut, NECs' mismatch repair deficiency phenotype has been reported in about 10% of cases, and it represents an independent factor of more favorable outcome. Likewise, our patient is currently alive with a follow-up of more than 12 years after pancreaticoduodenectomy, by itself an unexpected finding for such an aggressive neoplasm.
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159,183 |
Blessings and Cursings: The Liberating Gift of Profanity in Clinical Pastoral Education
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Profanity, derived from the Latin for "not sacred," has long been seen as antithetical to spirituality Social norms around organized religion, respectability, race, gender, etc compound this perception In this article, I examine how the use of profanity in Clinical Pastoral Education can help students experience personal, social, and physical freedom Association of Clinical Pastoral Education outcomes, demographic data, and a student experience provide support for this assertion
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159,184 |
Tackling harmful cyanobacterial blooms with Chinese colleagues: We’re all in the same boat
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Harmful cyanobacterial blooms (CyanoHABs) are a rapidly proliferating global problem, threatening the use and sustainability of our freshwater resources In recent decades, the USA, China and other developed and developing countries threatened by CyanoHAB expansion have developed collaborative efforts aimed at mitigating and managing this environmental and human health problem However, an escalating negative political climate and restrictive policies on scientific exchange threaten these efforts In this Perspective, I point to progress that has been made to counter the CyanoHAB problem on US-Chinese fronts through our collaborations, which have been mutually-beneficial form research and academic perspectives Much like global efforts now needed to control pandemics, we are all ?in the same boat? when to comes to countering the threat CyanoHABs pose for drinkable, swimmable, and fishable freshwater supplies and human health
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159,185 |
COVID-19 and maternal, fetal and neonatal mortality: a systematic review
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OBJECTIVE: This is the first comprehensive review to focus on currently available evidence regarding maternal, fetal and neonatal mortality cases associated with Coronavirus Disease 2019 (COVID-19) infection, up to July 2020. METHODS: We systematically searched PubMed, Scopus, Google Scholar and Web of Science databases to identify any reported cases of maternal, fetal or neonatal mortality associated with COVID-19 infection. The references of relevant studies were also hand-searched. RESULTS: Of 2815 studies screened, 10 studies reporting 37 maternal and 12 perinatal mortality cases (7 fetal demise and 5 neonatal death) were finally eligible for inclusion to this review. All maternal deaths were seen in women with previous co-morbidities, of which the most common were obesity, diabetes, asthma and advanced maternal age. Acute respiratory distress syndrome (ARDS) and severity of pneumonia were considered as the leading causes of all maternal mortalities, except for one case who died of thromboembolism during postpartum period. Fetal and neonatal mortalities were suggested to be a result of the severity of maternal infection or the prematurity, respectively. Interestingly, there was no evidence of vertical transmission or positive COVID-19 test result among expired neonates. CONCLUSION: Current available evidence suggested that maternal mortality mostly happened among women with previous co-morbidities and neonatal mortality seems to be a result of prematurity rather than infection. However, further reports are needed so that the magnitude of the maternal and perinatal mortality could be determined more precisely.
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159,186 |
Causal analysis of Covid-19 spread in Germany
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In this work, we study the causal relations among German regions in terms of the spread of Covid-19 since the beginning of the pandemic, taking into account the restriction policies that were applied by the different federal states. We propose and prove a new theorem for a causal feature selection method for time series data, robust to latent confounders, which we subsequently apply on Covid-19 case numbers. We present findings about the spread of the virus in Germany and the causal impact of restriction measures, discussing the role of various policies in containing the spread. Since our results are based on rather limited target time series (only the numbers of reported cases), care should be exercised in interpreting them. However, it is encouraging that already such limited data seems to contain causal signals. This suggests that as more data becomes available, our causal approach may contribute towards meaningful causal analysis of political interventions on the development of Covid-19, and thus also towards the development of rational and data-driven methodologies for choosing interventions.
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159,187 |
Robust neutralization assay based on SARS-CoV-2 S-protein-bearing vesicular stomatitis virus (VSV) pseudovirus and ACE2-overexpressing BHK2121 cells
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The global pandemic of coronavirus disease 2019 (COVID-19) is a disaster for human society A convenient and reliable neutralization assay is very important for the development of vaccines and novel drugs In this study, a G protein-deficient vesicular stomatitis virus (VSVdG) bearing a truncated spike protein (S with C-terminal 18 amino acid truncation) was compared to that bearing the full-length spike protein of SARS-CoV-2 and showed much higher efficiency A neutralization assay was established based on VSV-SARS-CoV-2-Sdel18 pseudovirus and hACE2-overexpressing BHK21 cells (BHK21-hACE2 cells) The experimental results can be obtained by automatically counting the number of EGFP-positive cells at 12 h after infection, making the assay convenient and high-throughput The serum neutralizing titer measured by the VSV-SARS-CoV-2-Sdel18 pseudovirus assay has a good correlation with that measured by the wild type SARS-CoV-2 assay Seven neutralizing monoclonal antibodies targeting the receptor binding domain (RBD) of the SARS-CoV-2 S protein were obtained This efficient and reliable pseudovirus assay model could facilitate the development of new drugs and vaccines
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159,188 |
Robust neutralization assay based on SARS-CoV-2 S-protein-bearing vesicular stomatitis virus (VSV) pseudovirus and ACE2-overexpressing BHK21 cells
|
The global pandemic of coronavirus disease 2019 (COVID-19) is a disaster for human society. A convenient and reliable neutralization assay is very important for the development of vaccines and novel drugs. In this study, a G protein-deficient vesicular stomatitis virus (VSVdG) bearing a truncated spike protein (S with C-terminal 18 amino acid truncation) was compared to that bearing the full-length spike protein of SARS-CoV-2 and showed much higher efficiency. A neutralization assay was established based on VSV-SARS-CoV-2-Sdel18 pseudovirus and hACE2-overexpressing BHK21 cells (BHK21-hACE2 cells). The experimental results can be obtained by automatically counting the number of EGFP-positive cells at 12â h after infection, making the assay convenient and high-throughput. The serum neutralizing titer measured by the VSV-SARS-CoV-2-Sdel18 pseudovirus assay has a good correlation with that measured by the wild type SARS-CoV-2 assay. Seven neutralizing monoclonal antibodies targeting the receptor binding domain (RBD) of the SARS-CoV-2 S protein were obtained. This efficient and reliable pseudovirus assay model could facilitate the development of new drugs and vaccines.
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159,189 |
Lessons from being challenged by COVID-19
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We present results of different approaches to model the evolution of the COVID-19 epidemic in Argentina, with a special focus on the megacity conformed by the city of Buenos Aires and its metropolitan area, including a total of 41 districts with over 13 million inhabitants. We first highlight the relevance of interpreting the early stage of the epidemic in light of incoming infectious travelers from abroad. Next, we critically evaluate certain proposed solutions to contain the epidemic based on instantaneous modifications of the reproductive number. Finally, we build increasingly complex and realistic models, ranging from simple homogeneous models used to estimate local reproduction numbers, to fully coupled inhomogeneous (deterministic or stochastic) models incorporating mobility estimates from cell phone location data. The models are capable of producing forecasts highly consistent with the official number of cases with minimal parameter fitting and fine-tuning. We discuss the strengths and limitations of the proposed models, focusing on the validity of different necessary first approximations, and caution future modeling efforts to exercise great care in the interpretation of long-term forecasts, and in the adoption of non-pharmaceutical interventions backed by numerical simulations.
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159,190 |
Several features of inflammation at the patients with atopic bronchial asthma when exposed to respiratory viruses
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The modern interpretation of the pathogenesis bronchial asthma (ВА) emphasizes the role of systemic inflammation at the BA, since its development under the influence of specific (allergens) and non-specific factors leads to an imbalance of pro- and anti-inflammatory cytokines in the airways It has been established that most exacerbations of BA occur due to the influence of respiratory viral infection (RVI) The process of inflammation in the airways with virus-induced exacerbations of BA depends on the type of respiratory virus, and also phenotype and endotype of BA at the patient Based on in vitro and in vivo studies, the role of interleukin-33 (IL-33) in the pathogenesis exacerbation of atopic BA in the mouse model is described The aim of our work is to determine the IL33 gene expression and study its role during development of atopic BA and its virus-induced exacerbation in humans Material and methods All volunteers included in the study were divided into groups: «BA», «BA+RVI», «RVI», «healthy donors» All study participants underwent clinical, laboratory, instrumental (spirometry), allergological, immunological examination (determination the expression mRNA of the IL33 gene in peripheral venous blood and identification the mRNA of respiratory viruses (RSV, RV, coronaviruses, influenza virus type A and B, metapnevmovi-ruses, adenoviruses, bokaviruses, parainfluenza viruses type 1, 2, 3, 4) in smears from the nasal cavity by RT-PCR) Results In the «BA» and «BA+RVI» groups were observed the decrease FEV1, increased the ACQ-7 (more than 1 5 points), the blood eosinophilia (P = 0 000002), which characterizes the uncontrolled course and exacerbation of atopic BA from volunteers The highest level of the expression mRNA IL-33 was found at the «BA+RVI» group (P = 0 003), and in the absence of RVI in volunteers with exacerbation of atopic BA the level of IL-33 not differs from healthy donors According to the results of our study the more severe course of atopic BA was observed in the season with a predominance of RSV infection in 2017 compared to 2016 according to ACQ-7 (P = 0 00004 and P = 0 0002) and FEV1 (P = 0 006 and P = 0 008), respectively Conclusions The results of the study provide additional evidence of the role of pro-inflammatory IL-33 in the pathogenesis of RVI and virus-induced exacerbations of atopic BA (most often RSV and RV) Identification of new mechanisms of virus-induced exacerbations of atopic BA can be used in the selection and development of personalized basic therapy of asthma Введение Современная трактовка патогенеза бронхиальной астмы (БА) подчеркивает роль системного воспаления при БА, так как его развитие под воздействием специфических (аллергены) и неспецифических факторов приводит к нарушению баланса про- и противовоспалительных цитокинов в дыхательных путях Установлено, что большинство обострений БА возникают при влиянии респираторной вирусной инфекции (РВИ) Процесс воспаления в респираторном тракте при вирус-индуцированных обострениях БА зависит от вида респираторного вируса, а также от фенотипа и эндотипа БА у пациента На основании исследований in vitro и in vivo описана роль интерлейкина-33 (ИЛ-33) в патогенезе обострения атопической БА модели на мышах Цель исследования - определение экспрессии гена IL33 и изучение роли ИЛ-33 в развитии атопической БА и при ее вирус-индуцированном обострении у человека Материал и методы В исследование отобраны добровольцы, которые были распределены на группы: «БА», «БА+РВИ», «РВИ», здоровые доноры Всем участникам исследования проведено клиническое, лабораторное, инструментальное (спирометрия), аллергологическое, иммунологическое обследование (определение экспрессии мРНК гена IL33 в периферической венозной крови и детекция мРНК респираторных вирусов (РСВ, РВ, коронавирусы, вирусы гриппа типа А и В, метапневмовирусы, аденовирусы, бокавирусы, вирусы парагриппа 1, 2, 3, 4-го типа) в мазках из полости носа методом ПЦР в реальном времени (ПЦР-РВ) Результаты В группах «БА» и «БА+РВИ» отмечали уменьшение ОФВ1, увеличение показателя ACQ-7 (более 1,5 балла), эозинофилии крови (P = 0,000002), что характеризует неконтролируемое течение и обострение атопической БА у добровольцев Наиболее высокий уровень экспрессии мРНК IL33 детектировался в группе «БА+РВИ» (P = 0,003), а при отсутствии РВИ у пациентов с обострением атопической БА фиксировался уровень ИЛ-33, не отличающийся от здоровых доноров По результатам нашего исследования более тяжелое течение атопической БА отмечалось в сезон с преобладанием РСВ-инфекции в 2017 г по сравнению с 2016 г по данным ACQ-7 (P = 0,00004 и P = 0,0002) и ОФВ1 (P = 0,006 и P = 0,008) соответственно Заключение Результаты исследования представляют дополнительные доказательства роли провоспалительного ИЛ-33 в патогенезе РВИ и вирус-индуцированных обострениях атопической БА (чаще всего РСВ и РВ) Выявление новых механизмов вирус-индуцированных обострений атопической БА может быть использовано при подборе и разработке персонифицированной базисной противоастматической терапии
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159,191 |
Novel coronavirus infection in children outside of Wuhan, China
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BACKGROUND: Since December 8, 2019, an epidemic of coronavirus disease 2019 (COVID-19) has spread rapidly, but information about children with COVID-19 is limited. METHODS: This retrospective and the single-center study were done at the Public Health Clinic Center of Changsha, Hunan, China. We identified all hospitalized children diagnosed with COVID-19 between January 8, 2019 and February 19, 2020, in Changsha. Epidemiological and clinical data of these children were collected and analyzed. Outcomes were followed until February 26th, 2020. RESULTS: By February 19, 2020, nine pediatric patients were identified as having 2019-nCoV infection in Changsha. Six children had a family exposure and could provide the exact dates of close contact with someone who was confirmed to have 2019-nCoV infection, among whom the median incubation period was 7.5 days. The initial symptoms of the nine children were mild, including fever (3/9), diarrhea (2/9), cough (1/9), and sore throat (1/9), two had no symptoms. Two of the enrolled patients showed small ground-glass opacity of chest computed tomography scan. As of February 26, six patients had a negative RT-PCR for 2019-nCoV and were discharged. The median time from exposure to a negative RT-PCR was 14 days. CONCLUSIONS: The clinical symptoms of the new coronavirus infection in children were not typical and showed a less aggressive clinical course than teenage and adult patients. Children who have a familial clustering or have a family member with a definite diagnosis should be reported to ensure a timely diagnosis.
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159,192 |
Three health-related paradoxes in the COVID 19 pandemic
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Health is enigmatic in nature, in the sense that people pay attention to it when they have lost it This enigmatic nature of health is the context for expressing health-related paradoxes The paradoxes of digitalization, isolation, and prevention that have become prominent in the COVID 19 pandemic are elaborated in this article The digitalization paradox demonstrates that we have procrastinated in digitalizing daily life, but have the digital tools to communicate with others and share information in quarantine The isolation paradox means that "social distancing" is required to prevent infection, but loneliness can make us sick The "paradox of prevention” arises when reducing the risk of persons in medium-risk to low-risk groups has a greater impact on the overall risk in the population than only reducing the risk of persons in high-risk groups All three paradoxes reflect the complexity and uncertainty of circumstances in a pandemic and the need for medical humanities © 2020, Vesnu Publications All rights reserved
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159,193 |
The support needs of Australian primary health care nurses during the COVID-19 pandemic
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AIM: To identify Australian primary health care nurses' immediate support needs during the COVID-19 pandemic. BACKGROUND: COVID-19 has had widespread implications for primary health care nurses. Supporting these nurses' capacity to deliver quality care ensures that ongoing health needs can be met. METHODS: Primary health care nurses were recruited to an online survey via social media and professional organisations in April 2020. RESULTS: Six-hundred and thirty-seven responses were included in the analysis. Participants provided 1,213 statements about perceived supports required to provide quality clinical care. From these, seven key categories emerged, namely personal protective equipment, communication, funding, industrial issues, self-care, workplace factors and valuing nurses. CONCLUSION: A number of key issues relating to personal health and safety, care quality and job security need to be addressed to support primary health care nurses during the COVID-19 pandemic. Addressing these support issues can assist in retaining nurses and optimizing the role of primary health care nurses during a pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Responding to the needs of primary health care nurses has the potential to facilitate their role in providing community-based health care. This knowledge can guide the provision of support for primary health care nurses during the current pandemic, as well as informing planning for future health crises across the health service.
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159,194 |
Echocardiographic changes following active heat acclimation
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Heat adaption through acclimatisation or acclimation improves cardiovascular stability by maintaining cardiac output due to compensatory increases in stroke volume. The main aim of this study was to assess whether 2D transthoracic echocardiography (TTE) could be used to confirm differences in resting echocardiographic parameters, before and after active heat acclimation (HA). Thirteen male endurance trained cyclists underwent a resting blinded TTE before and after randomisation to either 5 consecutive daily exertional heat exposures of controlled hyperthermia at 32°C with 70% relative humidity (RH) (HOT) or 5-days of exercise in temperate (21°C with 36% RH) environmental conditions (TEMP). Measures of HA included heart rate, gastrointestinal temperature, skin temperature, sweat loss, total non-urinary fluid loss (TNUFL), plasma volume and participant's ratings of perceived exertion (RPE). Following HA, the HOT group demonstrated increased sweat loss (p = 0.01) and TNUFL (p = 0.01) in comparison to the TEMP group with a significantly decreased RPE (p = 0.01). On TTE, post exposure, there was a significant comparative increase in the HOT group in left ventricular end diastolic volume (p = 0.029), SV (p = 0.009), left atrial volume (p = 0.005), inferior vena cava diameter (p = 0.041), and a significant difference in mean peak diastolic mitral annular velocity (e') (p = 0.044). Cardiovascular adaptations to HA appear to be predominantly mediated by improvements in increased preload and ventricular compliance. TTE is a useful tool to demonstrate and quantify cardiac HA.
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159,195 |
Modern Methods for Text Generation
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Synthetic text generation is challenging and has limited success. Recently, a new architecture, called Transformers, allow machine learning models to understand better sequential data, such as translation or summarization. BERT and GPT-2, using Transformers in their cores, have shown a great performance in tasks such as text classification, translation and NLI tasks. In this article, we analyse both algorithms and compare their output quality in text generation tasks.
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159,196 |
Racism and healthcare disparities
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Laskowski-Jones discusses racism and health disparities in health care in the US The morbidity and mortality statistics for COVID-19 alone reveal striking racial disparities Black and Brown people are far more likely to contract COVID-19 and die from it than White people The literature is replete with data showing significant health outcome disparities in cancer, heart disease, diabetes, hypertension, and even infant mortality in people of color Yet scientific research focused on minority populations is lagging Although the concept of healthcare disparities related to race is now well established, its foundation remains widely unnamed It is racism The problem of racism is systemic Its tentacles are embedded in the fabric of our society, producing exactly the injustice and disparate healthcare outcomes that exist today The environment where a person lives impacts choices and opportunities
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159,197 |
Modeling the molecular impact of SARS-CoV-2 infection on the renin-angiotensin system
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SARS-CoV-2 coronavirus infection is mediated by the binding of its spike protein to the angiotensin-converting enzyme 2 (ACE2), which plays a pivotal role in the renin-angiotensin system (RAS). The study of RAS dysregulation due to SARS-CoV-2 infection is fundamentally important for a better understanding of the pathogenic mechanisms and risk factors associated with COVID-19 coronavirus disease, and to design effective therapeutic strategies. In this context, we developed a mathematical model of RAS based on data regarding protein and peptide concentrations; the model was tested on clinical data from healthy normotensive and hypertensive individuals. We then used our model to analyze the impact of SARS-CoV-2 infection on RAS, which we modeled through a down-regulation of ACE2 as a function of viral load. We also used it to predict the effect of RAS-targeting drugs, such as RAS-blockers, human recombinant ACE2, and angiotensin 1-7 peptide, on COVID-19 patients; the model predicted an improvement of the clinical outcome for some drugs and a worsening for others.
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159,198 |
From pedestrian area to urban and metropolitan project: assets and challenges for the centre of Brussels (new edition)
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The new pedestrian area has been one of the main urban projects designed for the centre of Brussels in recent decades In 2015, the transit route in the city centre - Boulevard Anspach - was closed to traffic The redevelopment of public space and the renovation of the main metro stations are now nearing completion The finalisation of this urban project and the challenges it has faced are, by definition, complex Experiences elsewhere in the country and abroad, as well as the data collected by BSI-BCO, show that it will have a significant impact at different levels: quality of public space, housing and facilities, local economy and employment, mobility, accessibility and logistics, social and cultural activities, etc This synopsis is an update of a previously published work (no 115) Part 1 sets out the general context of this project which has not been spared by several external crises (lockdown following the attacks in Paris, attacks in Brussels, the tunnel crisis and, of course, the covid crisis) Part 2 develops the challenges which remain In conclusion, this synopsis proposes some concrete ways to improve the quality and management of the project
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159,199 |
Kwame: A Bilingual AI Teaching Assistant for Online SuaCode Courses
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Introductory hands-on courses such as our smartphone-based coding courses, SuaCode require a lot of support for students to accomplish learning goals. Online environments make it even more difficult to get assistance especially more recently because of COVID-19. Given the multilingual context of our students (learners across 38 African countries), in this work, we developed an AI Teaching Assistant (Kwame) that provides answers to students' coding questions from our SuaCode courses in English and French. Kwame is a Sentence-BERT(SBERT)-based question-answering (QA) system that we trained and evaluated using question-answer pairs created from our course's quizzes and students' questions in past cohorts. It finds the paragraph most semantically similar to the question via cosine similarity. We compared the system with TF-IDF and Universal Sentence Encoder. Our results showed that SBERT performed the worst for the duration of 6 secs per question but the best for accuracy and fine-tuning on our course data improved the result.
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