BACKGROUND: In response to several high profile public health crises, public health renewal is underway in Canada. In the province of British Columbia, the Ministry of Health initiated a collaborative evidence-informed process involving a steering committee of representatives from the six health authorities. A Core Functions (CF) Framework was developed, identifying 21 core public health programs. For each core program, an evidence review was conducted and a model core program paper developed. These documents were distributed to health authorities to guide development of their own renewed public health services. The CF implementation was conceptualized as an embedded knowledge translation process. A CF coordinator in each health authority was to facilitate a gap analysis and development of a performance improvement plan for each core program, and post these publically on the health authority website. METHODS: Interviews (n = 19) and focus groups (n = 8) were conducted with a total of 56 managers and front line staff from five health authorities working in the Healthy Living and Sexually Transmitted Infection Prevention core programs. All interviews and focus groups were digitally recorded, transcribed and verified by the project coordinator. Five members of the research team used NVivo 9 to manage data and conducted a thematic analysis. RESULTS: Four main themes emerged concerning implementation of the CF Framework generally, and the two programs specifically. The themes were: youve told me what, now tell me how; the double bind; but we already do that; and the selling game. Findings demonstrate the original vision of the CF process was lost in the implementation process and many participants were unaware of the CF framework or process. CONCLUSIONS: Results are discussed with respect to a well-known framework on the adoption, assimilation, and implementation of innovations in health services organizations. Despite attempts of the Ministry of Health and the Steering Committee to develop and implement a collaborative, evidence-informed policy intervention, there were several barriers to the realization of the vision for core public health functions implementation, at least in the early stages. In neglecting the implementation process, it seems unlikely that the expected benefits of the public health renewal process will be realized.

Melasma is a common, difficult to treat hyperpigmentary disorder. Recently, ablative fractional lasers were utilized to enhance topical agents delivery to treat different skin conditions. This work was designed to evaluate the efficacy of fractional Er:YAG laser in enhancing the effect of topical kojic acid in patients with facial melasma. The patients were randomly treated in a split-face mode, by simple randomization, either with kojic acid alone on one side or combined with fractional Er:YAG laser on the other side. Twenty five patients completed six laser sessions at 2 week interval. The severity of melasma was assessed before and after treatment in addition to 3 months follow up after the last treatment session. The response to the treatment was evaluated by Melasma Area and Severity Index Score, physician global assessment of photographs and patient satisfaction. The side treated with fractional Er:YAG laser and kojic acid cream was found to have a statistically significant better improvement than the side treated with kojic acid alone. The patients were reported mild tingling sensation and mild erythema on both sides. Using combination of fractional Er:YAG laser and topical kojic acid was effective in the treatment of melasma.

We describe a case of coronavirus disease 2019 (COVID-19) in a patient with mixed cellularity classical Hodgkin lymphoma (cHL) undergoing brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) therapy. A 43-year-old man presented to our hospital with a complaint of fever, for which he was diagnosed with COVID-19 after a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and antiviral therapy with favipiravir and ciclesonide was started subsequently. The fever persisted for the first few days of treatment, but his respiratory status was stable, and he became asymptomatic and afebrile on day 9. Although the PCR tests remained positive, he met the updated discharge criteria of the World Health Organization (WHO) on day 12. However, his fever recurred, and his condition worsened on day 16. A chest X-ray showed a new opacity. It is likely that favipiravir and ciclesonide treatment probably did not completely eliminate the virus in the patient, and therefore the infection persisted. We added remdesivir from day 21, and the improvement was remarkable. He was discharged on day 29 after two consecutive PCR test results were negative. PCR tests are not mandatory for the updated WHO discharge criteria. However, even after antiviral therapy, COVID-19 patients with hematologic malignancies may have prolonged active infection with impaired viral excretion. Depending on the background disease and comorbidities, there may be some patient populations for whom it is not appropriate to simply comply with the current discharge criteria. Therefore, more emphasis may be needed on PCR examinations.

Objective: To determine the diagnostic yield of repeat testing for SARS-CoV-2

The coronavirus disease 2019 (COVID-19) coronavirus is a new strain of coronavirus that had not been previously detected in humans. As its severe pathogenicity is concerned, it is important to study it thoroughly to aid in the discovery of a cure. In this study, the microRNAs (miRNAs) of COVID-19 were annotated to provide a powerful tool for the study of this novel coronavirus. We obtained 16 novel coronavirus genome sequences and the mature sequences of all viruses in the microRNA database (miRbase), and then used the miRNA matures sequences of the virus to perform the Basic Local Alignment Search Tool (BLAST) analysis in the coronavirus genome, extending the matched regions of approximately 20 bp to two segments by 200 bp. Six sequences were obtained after deleting redundant sequences. Then, the hairpin structures of the mature miRNAs were determined using RNAfold. The mature sequence on one hairpin arm was selected into a total of 4 sequences, and finally the relevant miRNA precursor prediction tools were used to verify whether the selected sequences are miRNA precursor sequences of the novel coronavirus. The miRNAs of the novel coronavirus were annotated by our newly developed method, which will lay the foundation for further study of this virus. ? 2021. All Rights Reserved.

The purpose of this research is to analyze the monthly energy consumption by the users of the PEC program (Energy Efficiency Program for induction cooking and electric water heating) of ELEPCO SA (Empresa Elctrica Provincial Cotopaxi Sociedad Annima) before and after the curfew measures dictated by the national COE (Emergency Operations Center) in response to the global pandemic caused by COVID-19 disease. Carried out by taking into account four strata distributed according the energy consumption levels, its variance in relation to the year 2019 and applying the linear regression method to estimate the average monthly demand in relation to the curfew time, resulting in that the rate The increase in the period April-May 2019 versus April-May 2020 is 5.17% and analyzing only stratum B in the period March-July 2019 in relation to March-July 2020 is 8.02%, estimating that for the month of August 2020 the will have an average monthly consumption of 215,441 KWh in stratum A. ? The author;licensee Universidad Nacional de Colombia.

The SARS-CoV-2 infection is a highly contagious viral infection, which has claimed millions of lives in the last two years. The infection can cause acute respiratory distress, myocarditis, and systemic inflammatory response in severe cases. The interaction of the viral spike protein with the angiotensin-converting enzyme in various tissues causes damage to vital organs and tissues, leading to complications in the post-infection period. Vaccines and antiviral drugs have improved patient response to the infection, but the long-term effect on vital organs is still unknown. Investigations are now focused on supportive nutrient therapies, which can mitigate the susceptibility as well as the long-term complications of COVID-19. Selenium is one such micronutrient that plays a vital role in preventing oxidative stress induced by the virus. Further, selenium is important for effective immune response, controlling systemic inflammation, and maintain overall health of humans. We examine the role of selenium in various aspects of SARS-CoV-2 infection and address the importance of selenium supplementation in reducing the susceptibility and severity of infection in this review.

Facing the novel coronavirus disease (COVID-19) pandemic, evidence to inform decision-making at all care levels is essential. Based on the results of a study by Petrilli et al., we have developed a calculator using patient data at admission to predict critical illness (intensive care, mechanical ventilation, hospice care, or death). We report a retrospective validation of the calculator on 145 consecutive patients admitted with COVID-19 to a single hospital in Israel. Despite considerable differences between the original and validation study populations, of 18 patients with critical illness, 17 were correctly identified (sensitivity: 94.4%, 95% CI, 72.7%C99.9%; specificity: 81.9%, 95% CI, 74.1%C88.2%). Of 127 patients with non-critical illness, 104 were correctly identified. Our results indicate that published knowledge can be reliably applied to assess patient risk, potentially reducing the cognitive burden on physicians, and helping policymakers better prepare for future needs.

Introduction Since the appearance of SARS-CoV-2 in December 2019 in the Chinese city of Wuhan, we have experienced a reduction in admissions in our Service and a decrease in urgent surgical activity Therefore, this study aimed to assess the incidence of potentially surgical abdominal emergency in our center during the epidemic of COVID-19 Methods A retrospective study was designed It included all patients admitted for urgent abdominal pathology with potential surgical treatment in our General and Digestive Surgery Department from February 24, 2020 to April 19, 2020 Results Eighty-nine patients with a mean age of 58 8522 2 were included The median time from symptom onset to the Emergency Department (ED) visit was 48 (P25-P75 = 24-96) hours On arrival at the ED, 18 (20%) patients presented with systemic inflammatory response syndrome criteria Fifty-one (57%) surgical procedures were performed The rate of post-surgical complications at 30 days was 31% and the mortality rate was 2% Concerning the same period from 2017 to 2019, the mean number of admissions from the ED to our Department decreased by 14% during the epidemic period Conclusion There has been a decrease in the number of patients admitted for urgent, potentially surgical, abdominal pathology during the period of the COVID-19 epidemic in our center Resumen Introduccin Desde la aparicin en diciembre de 2019 del SARS-CoV-2 en la ciudad de Wuhan, China, hemos experimentado un descenso en los ingresos en nuestro Servicio y disminucin de la actividad quirrgica urgente Por ello, el objetivo de este estudio fue analizar la incidencia de la patologa abdominal urgente potencialmente quirrgica en nuestro centro durante la epidemia por COVID-19 Mtodos Se dise? un estudio retrospectivo que incluy a todos los pacientes ingresados por patologa abdominal urgente potencialmente quirrgica en nuestro Servicio de Ciruga General y del Aparato Digestivo desde el 24 de febrero de 2020 hasta el 19 de abril de 2020 Resultados Se incluyeron 89 pacientes con una edad media de 58,85 22,2 La mediana de tiempo transcurrido desde el inicio de los sntomas hasta la consulta en el Servicio de Urgencias fue de 48 (P25-P75 = 24-96) horas A su llegada a Urgencias 18 (20%) pacientes presentaban criterios de sndrome de respuesta inflamatoria sistmica (SRIS) Se realizaron 51 (57%) intervenciones quirrgicas La tasa de complicaciones postquirrgicas a los 30 das fue del 31% y la tasa de mortalidad de 2% Con respecto al mismo perodo de los a?os 2017 a 2019, la media de ingresos desde Urgencias en nuestro Servicio descendi un 14% durante el perodo de epidemia Conclusiones Se ha producido un descenso en el nmero de pacientes que son ingresados por patologa abdominal urgente potencialmente quirrgica durante la epidemia por COVID-19 en nuestro centro

BACKGROUND: Pathology education provides information on pathology and guides students to become pathologists. Recently, the Ministry of Education of the Peoples Republic of China required the establishment of the system of High-quality Online and Offline Courses, which indicates that online courses will play an important role in higher education. Furthermore, the number of pathologists currently cannot satisfy clinical needs. To solve this health issue and implement the policy from the Ministry of Education, it is necessary to improve the current state of pathology education. First, we need to know students opinions of the current courses and their professional choices. METHODS: Online questionnaires covering the quality of traditional courses, attitudes towards online courses, and suggestions for optimizing courses were designed and applied. Whether students want to become pathologists and the underlying reasons for this interest are also included in this survey. Participants are medical students from certain colleges in Nanjing. The collected data were assessed by statistical analyses, and p-values less than 0.05 were considered significant. RESULTS: Of the 342 valid responses, 60.94% of undergraduate students showed their interest in pathology courses, and among them, 48.72% expressed that they may become pathologists. However, the corresponding percentage is only 29.59% in the group without interest. To optimize curricula, the top two suggestions are introducing more clinical cases (undergraduate students, 64.45%; graduate students, 79.09%) and making the classes lively and interesting (undergraduate students, 59.77%; graduate students, 62.79%). Approximately 80.00% of students consider online courses to be good supplementary materials to traditional courses, and approximately half prefer an online-offline mixed learning model. Salary, interest, and employment status are the main factors influencing students professional choices. CONCLUSIONS: Students are generally satisfied with traditional pathology courses, and online courses are good supplementary materials in their opinions. It has been suggested that clinical cases be introduced in classes. It is more likely that students who have an interest in pathology will become pathologists. The data from this survey also show that the main causes of the shortage of pathologists are a lack of engaging work and an unsatisfactory salary.

Artificial intelligence (AI) has become one of the core driving forces for the future development of the medical industry, but patients are skeptical about the use of AI in medical care. Based on the intergroup threat theory (ITT), this study verified that patients would regard AI as an external group, triggering the perceived threat of the external group, which results in avoidance behaviors in the treatment (experiment 1: n = 446) and diagnosis (experiment 2: n = 330) scenarios. The results show that despite AI can provide expert-level accuracy in medical care, patients are still more likely to rely on human doctors and experience more negative emotions as AI is more involved in medical care (experiment 1). Furthermore, patients pay more attention to threats at the individual level related to themselves, such as realistic threats related to privacy issues and symbolic threats related to the neglect of personal characteristics. In contrast, realistic threats and symbolic threats at the group level had less effect on patients in the medical scenario (experiment 2).

A long duration sympathomimetic agent, alfa-I, beta-l and beta-2 agonist, etilephrine was studied in 40 dogs, males and females, divided into four groups. The cardiorespiratory function was evaluated under thiopental and halothane anesthesia, with or without etilephrine administration and with or without methotrirneprazine pretreatment. It was found that heart rate (HR), systolic blood pressure (SBP), average blood pressure (ABP), diastolic blood pressure (DBP) and central venous pressure (CVP) were significantly increased (p O.OS) in the group that was not pretreated with methotrimeprazine but received etilephrine (Group II) when compared to their control (Group I). On the other hand, the group of animals pretreated with methotrimeprazine that also received etilephrine (Group IV) displayed increased heart rate but SBP, ABP, DBP and CVP were considerably reduced when compared to their control (Group li). Regarding its arrhythmogenic effect, it was observed that some animals in Group II had ventricular extrasystole after treatment with etilephrine. This was not observed in Group IV. Besides the hemodynamic properties, some analeptic action was detected through the minute volume increase, although it was not significant (p O.OS).

Background: The novel coronavirus (2019-nCoV) causes a severe respiratory illness that was unknown in the human before. Its alarmingly quick transmission to many countries across the world resulted in a worldwide health emergency. It has caused a notable percentage of morbidity and mortality. Therefore, an imminent need for drugs to combat this disease has been increased. Global collaborative efforts from scientists are underway to find a therapy to treat infections and reduce death cases. Herbal medicines and purified natural products have been reported to have antiviral activity against Coronaviruses (CoVs). Methods: : In this study, a High Throughput Virtual Screening (HTVS) protocol was used as a fast method on the discovery of novel drug candidates as the COVID-19 main protease inhibitors. Over 180,000 natural product-based compounds were obtained from the ZINC database and virtually screened against the COVID-19 main protease. In this study, the Glide docking program was applied for high throughput virtual screening. Extra precision (XP) and in a combination of Prime module, induced-fit docking (IFD) approach was also used. Additionally, the ADME properties of all compounds were analyzed, and the final selection was carried out based on the Lipinski rule of five. Results: : The nineteen compounds were selected and introduced as new potential inhibitors. The compound ZINC08765174 (1-[3-(1H-indol-3-yl) propanoyl]-N-(4-phenylbutan-2-yl)piperidine-3-carboxamide) showed a strong binding affinity (-11.5 kcal/mol) to the crucial residues of COVID-19 main protease comparing to peramivir (-9.8 kcal/mol) as a positive control. Conclusions: : The excellent ADME properties proposed the opportunity of this compound to be a promising candidate for the treatment of COVID-19.

The study of the respiratory microbiota has revealed that the lungs of healthy and diseased individuals harbour distinct microbial communities. Imbalances in these communities can contribute to the pathogenesis of lung disease. How these imbalances occur and establish is largely unknown. This review is focused on the genetically inherited condition of Cystic Fibrosis (CF). Understanding the microbial and host-related factors that govern the establishment of chronic CF lung inflammation and pathogen colonisation is essential. Specifically, dissecting the interplay in the inflammationCpathogenChost axis. Bile acids are important host derived and microbially modified signal molecules that have been detected in CF lungs. These bile acids are associated with inflammation and restructuring of the lung microbiota linked to chronicity. This community remodelling involves a switch in the lung microbiota from a high biodiversity/low pathogen state to a low biodiversity/pathogen-dominated state. Bile acids are particularly associated with the dominance of Proteobacterial pathogens. The ability of bile acids to impact directly on both the lung microbiota and the host response offers a unifying principle underpinning the pathogenesis of CF. The modulating role of bile acids in lung microbiota dysbiosis and inflammation could offer new potential targets for designing innovative therapeutic approaches for respiratory disease.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. METHODS: We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. RESULTS: A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8C11.1) in comparison to influenza A (11.4, 95% CI 7.9C14.8) and influenza B patients (10.4, 95% CI 7.1C13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3C1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9C6.1) and influenza B patients (3.0, 95% CI 1.2C4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9C31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3C9.9) and patients with influenza B (6.4, 95% CI 3.8C9.1). CONCLUSIONS: We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.

Picornaviruses form replication complexes in association with membranes in structures called replication organelles. Common themes to emerge from studies of picornavirus replication are the need for cholesterol and phosphatidylinositol 4-phosphate (PI4P). In infected cells, type III phosphatidylinositol 4-kinases (PI4KIIIs) generate elevated levels of PI4P, which is then exchanged for cholesterol at replication organelles. For the enteroviruses, replication organelles form at Golgi membranes in a process that utilizes PI4KIII. Other picornaviruses, for example the cardioviruses, are believed to initiate replication at the endoplasmic reticulum and subvert PI4KIII to generate PI4P. Here we investigated the role of PI4KIII in foot-and-mouth disease virus (FMDV) replication. Our results showed that, in contrast to the enteroviruses and the cardioviruses, FMDV replication does not require PI4KIII (PI4KIII and PI4KIII), and PI4P levels do not increase in FMDV-infected cells and PI4P is not seen at replication organelles. These results point to a unique requirement towards lipids at the FMDV replication membranes.

OBJECTIVES To identify healthcare worker (HCW) and work-site characteristics associated with HCWs' reported use of recommended respiratory-infection control practices in primary and emergency care settings. DESIGN A cross-sectional study using a self-administered questionnaire for HCWs during the summer and fall of 2005. SETTING Primary and emergency care clinics at 5 medical centers in King County, Seattle, Washington. RESULTS Nurse professionals who reported receiving training (odds ratio [OR], 2.5 [confidence interval {CI}, 1.1-5.9]; P=.029), instructional feedback from supervisors (OR, 3.0 [CI, 1.5-5.9]; P=.002), and management support for implementing safe work practices had a higher odds of also reporting adherence to recommended respiratory precautions, compared with nurses who did not. Training was the only important determinant for adherence to respiratory precaution measures among medical practitioners (OR, 5.5 [CI, 1.2-25.8]; P=.031). The reported rate of adherence to hand hygiene practices was higher among nurse professionals who were male (OR, 2.2 [CI, 1.0-4.9]; P=.045), had infants, small children, or older adults living at home (OR, 2.2 [CI, 1.2-3.9]; P=.007), reported cleanliness and orderliness of the establishment where they worked (OR, 2.0 [CI, 1.1-3.5]; P=.019), had received respiratory-infection control training (OR, 3.2 [CI, 1.8-6.0]; P<.001), and reported fears about catching a dangerous respiratory infection at work (OR, 2.3 [CI, 1.2-4.5]; P=.011). CONCLUSION A number of HCW and work-site characteristics associated with HCWs' use of recommended respiratory-infection control measures have been identified. These potentially influential characteristics should be considered as targets or guides for further investigation, which should include the evaluation of intervention strategies.

The issue currently permeating is how COVID- 19 affects our lives, including in terms of consumer behavior. For example, sales of men's suits have fallen sharply since March 2020, while there has been high demand for jogging pants. While German online retailing was able to increase sales by double digits in 2020, downtown retailers of non-food articles (e.g., textiles, shoes, etc.) had to accept a decrease of more than 20 % (HDE 2021). Our article focuses on the questions of whether consumer behavior has been fundamentally affected by the crisis, whether previously formed shopping patterns have dissipated and led to new shopping behavior, and whether old habits will return. Using two surveys at different timestamps of the pandemic, we analyze the impact on consumers' shopping styles and particularly discuss whether the pandemic has permanently changed online shopping tendencies and ethical behavior, and whether the desire for experience-oriented shopping has changed. ? 2021 C.H.BECK oHG. All rights reserved.

A widely used media narrative suggests that the environment benefitted from the Covid-19 lockdowns. Numerous publications which came out following the lockdowns only reinforced this view by seeing Covid-19 as an opportunity to think more about the environment. However, these narratives are largely anecdotal, assumptive and pay little attention to the question of what people actually think about the lockdowns in environmental terms. To fill this gap, this study provides the empirical basis needed to either support or reject the aforementioned dominant narrative on Covid-19 and environment. Survey data (eighty questionnaires per country) were collected from participants in Cameroon (Buea), Egypt (Cairo), Italy (several major cities) India (Mumbai and New Delhi), and The Netherlands (mainly Amsterdam). The findings of this study reveal that generally, Covid-19 has not changed the way most people think about the environment. This is either because people were already pro-environmental before Covid-19, or people see Covid-19 and the visible environmental changes as temporal phenomenon. One other major observation in this study is the regional differences in environmental attitudes in relation to Covid-19. The least change in environmental attitudes was observed in high-income countries and the most change in low-middle-income countries. Therefore, the paper concludes that the importance of Covid-19 on a more sustainable future should not be overplayed or overemphasised. It will take more than a two-year break from normal living to mitigate environmental degradation. Accordingly, pro-environmentalism should focus on other intervention points.

From 7 November 2020, Greece adopted a second nationwide lockdown policy to mitigate the transmission of SARS-CoV-2 (the first took place from 23 March to 4 May 2020), just as the second wave of COVID-19 was advancing, as did other European countries. To secure the full benefits of mass vaccination, which started in early January 2021, it is of utmost importance to complement it with mid-term non-pharmaceutical interventions (NPIs). The objective was to minimize human losses and to limit social and economic costs. In this paper a two-phase stochastic dynamic network compartmental model (a pre-vaccination SEIR until 15 February 2021 and a post-vaccination SVEIR from 15 February 2021 to 30 June 2021) is developed. Three scenarios are assessed for the first phase: (a) A baseline scenario, which lifts the national lockdown and all NPIs in January 2021; (b) a "semi-lockdown" scenario with school opening, partial retail sector operation, universal mask wearing, and social distancing/teleworking in January 2021; and (c) a "rolling lockdown" scenario combining a partial lifting of measures in January 2021 followed by a third nationwide lockdown in February 2021. In the second phase three scenarios with different vaccination rates are assessed. Publicly available data along with some first results of the SHARE COVID-19 survey conducted in Greece are used as input. The results regarding the first phase indicate that the "semi-lockdown" scenario clearly outperforms the third lockdown scenario (5.7% less expected fatalities); the second phase is extremely sensitive on the availability of sufficient vaccine supplies and high vaccination rates.