Litter was collected from 12 roadside ditches in the Finger lakes Region of New York State over two sampling periods: pre-COVID-19 pandemic and during COVID-19 pandemic. Litter pieces were washed in DI water, oven dried, massed and plastic-type visually determined. Macroplastic data was analysed to assess the impact of land use, traffic, and COVID-19 variables on macroplastic accumulation on a piece, mass, and plastic-type basis. These data are all litter pieces collected, including both plastics categorized as 1 through 7 in the RIC resin classification codes as well as non-plastic litter. These data have wide-ranging reuse potential, as terrestrial microplastic accumulation is not well documented. These data could be compared with other litter accumulation across regions, specifically to assess total environmental macroplastic loading and enable contaminant mitigation strategies. These data also have direct application to modelling and transport of macroplastics into surface water bodies as a result of road ditch sampling locations. Macroplastic accumulation data across varying land uses, traffic, and COVID-19 conditions has been published [1].

BACKGROUND: Large mortality rates have been reported in the Mexican public health system, however in the experiences of private hospitals that have resources and infrastructure this is lower compared to the national average. METHODS: Descriptive and retrospective study. Adult patients treated for pneumonia due COVID-19 from April to December 2020 are entered into the study. Its general characteristics such as gender and age, comorbidities, influenza vaccination history, clinical characterization, laboratory and tomographic diagnosis of sars cov2 pneumonia are studied, as well as the drug and oxygen therapy treatments received and finally, its evolution and clinical outcome. RESULTS: 132 patients were studied, of which 51% were female. The main age groups affected were 65 and over (43.9%), 50-59 years (20.4%) and 25-44 years (16.6%). The main comorbidities found were: arterial hypertension (43.9%), Diabetes mellitus 2 (33.3%), heart disease (11.3%) and obesity (10.6%). 95.4% of the patients were not vaccinated against influenza. The main symptoms reported were: fever (92%), cough (87%), dyspnea (76%) and headache (52%). The diagnosis was confirmed with RT-PCR in 63%, reporting negative RT-PCR in 36%; the antigen test was positive in 1%. Regarding the findings of the chest computed tomography, CORADS 5 was reported in 30%, CORADS 6 in 3% and CORADS 4 in 20%. The main treatments used in patients with severe inflammatory pneumonia were: steroids (98%), enoxaparin (100%), tocilizumab (20%), baricitinib (60%), direct oral anticoagulants (10%), fibroquel (5%). 60% were treated with a combination of two or more drugs. The main oxygenation contributions were: 20% nasal tips - mask/reservoir, 60% high flow nasal cannula, 20% mechanical ventilation. In 95% the prone position was indicated. Regarding the clinical evolution, 65.1% were towards improvement, 17.4% died, 12.1% requested transfer to another unit and 5.3% requested voluntary discharge. Overall mortality was 17%. Medications in ICU [Image: see text] Ventilation strategies [Image: see text] CONCLUSION: A hospital strategy that has the necessary resources and infrastructure as well as openness to the use of medication with emergency approvals for its use or off-label indications, can help limit morbidity and mortality in vulnerable populations and manifest risk factors such as Mexican population DISCLOSURES: All Authors: No reported disclosures

Since independence, African governments have been criticized for either their slow, ineffective, or lack of homegrown solutions when addressing challenges in their respective countries. From economic and development models to dealing with conflicts, governance practices, and planning, overreliance and dependence on external practices which sometimes fail to take into consideration the unique domestic challenges have characterized the response of many African governments. This has, in turn, tainted the image of the continent over their ability to adequately deal with disasters. As the rest of the world is struggling to deal with their share of challenges as a result of the pandemic, it is becoming increasingly important that every country adopts measures that will effectively deal with the spread of the disease. This essay seeks to step back from the seemingly crowded debate over where the next epicentre of COVID 19 will be in Africa and focus on what lessons and measures governments in Africa can adopt during and after the pandemic.

A protocol for a retrospective cohort study and interrupted time series analysis to investigate the effect of successive COVID related lockdown restrictions on major trauma presentations and patient outcomes in English hospitals. The study specifically aims to assess: 1) The impact of successive lockdowns on the volume, demographics, injury mechanism, severity, treatment and outcomes of major trauma in England. 2) If the implementation of lockdowns affected major trauma related mortality. A patient cohort will be derived from the Trauma and Audit Research Network (TARN) database, for all trauma receiving hospitals in England, between 1st of January 2017 to 1st of September 2021. This period encompasses two national lockdown periods (23rd March 2020 to 29th June 2020 and 2nd Nov 2020 to 16th May 2021) in England. A time series will be used to illustrate changes in the volume and mechanism of injury associated with successive lockdowns. Demographic characteristics and features of the clinical care pathways will be compared during the lockdown and equivalent pre-COVID periods. To specifically assess if there were any changes in risk adjusted mortality associated with the lockdowns interrupted time series analysis will be conducted.

OBJECTIVE To analyze the view of nurses from the Family Health Strategy on the health care of rural populations. METHOD A qualitative and exploratory research conducted with eleven nurses working in rural areas, conducted from January to March 2017, in Campina Grande-PB. Data was collected through semi-structured interviews and analyzed by the Content Analysis technique. RESULTS Nurses associate the health context of the rural population with the living conditions of the community, with the lack of access to health services, and with the peculiarities of work resulting from this context. The satisfaction of rural PHC nurses is associated with professional identification and bond with the population. CONCLUSIONS Nurses perceive the particularities that involve the rural context requiring differentiated health care that positively impacts their work.

Introduction Peritoneal tear (PT) is a frequent intraoperative event during totally extraperitoneal repair (TEP). We aimed to introduce our surgical technique for PT during TEP to avoid the more difficult TEP procedure.MethodsOne surgeon with 10 years of experience performed our TEP method in 147 TEP cases from January 2012 to June 2019. We investigated the repair time of each repair technique using endoscopic suturing (suturing group, SG) and endoscopic Hem-o-lok stapling (CG). Results Twenty-three (15.6%) PT cases occurred as TEP complication. The mean repair times (with standard deviation) of the PT were 16.2 13 and 7.6 7.0 min in the SG and CG, respectively, indicating a significant difference (P = 0.043). The repair time of the PT using Hem-o-lok (Teleflex, Wayne, PA, USA) stapling was shorter than that using endoscopic suturing, which was significantly different despite the length of the PT. Conclusion Hem-o-lok stapling is feasible in case of PT during TEP.

INTRODUCTION: : The effect of toothpastes on viruses, such as SARS-CoV-2, is unknown. This study investigated the short-term effect of toothpastes containing antimicrobial properties in patients with COVID-19 to determine if they could reduce the SARS-CoV-2 salivary viral load. METHODS: : Hospitalized patients with COVID-19 (n = 83) were instructed to perform tooth brushing with one of three arms: a toothpaste containing 0.96% zinc (zinc oxide, zinc citrate) in a silica base (Test 1); toothpaste containing 0.454% SnF(2) in a silica base (Test 2), and a nonantibacterial toothpaste (control). Saliva was collected before intervention (T0), immediately after intervention (T1), and 30 (T2) and 60 min (T3) after intervention. The SARS-CoV-2 salivary viral load was measured using quantitative real-time polymerase chain reaction (qRT-PCR) assays. For Test 1 and Test 2 toothpastes, the fold reductions were normalized to baseline and to the control toothpaste at each time point after brushing. A fold change of 2 is considered clinically effective. RESULTS: : Brushing with the Test 1 toothpaste reduced the SARS-CoV-2 salivary viral load by 4.06-fold at T1, by 2.36-fold at T2, and by 1.42-fold at T3. Similarly, brushing with a Test 2 toothpaste reduced the SARS-CoV-2 salivary viral load by 2.33-fold at T1, by 2.38-fold at T2, and by 0.77-fold at T3. CONCLUSION: : Immediately after brushing, the use of antimicrobial toothpastes reduced the salivary viral load of patients with COVID-19. The trial was registered on https://clinicaltrials.gov/ (NCT04537962).

BACKGROUND: Measures for effective control of the coronavirus disease 2019 (COVID-19) pandemic include identifying the causal organisms, applying appropriate therapies, and developing vaccines, as well as improving understanding among the general public. AIM: To evaluate the knowledge, awareness, perception, and response of the general public to COVID-19 in China. METHODS: A detailed questionnaire comprising 47 questions designed in both English and Chinese was developed. The survey was conducted via WeChat, a multipurpose messaging, social media, and mobile payment app that is widely used by the Chinese population. In total, 1006 participants responded, and most of them were from different provinces of mainland China. RESULTS: Overall, this comprehensive survey revealed that the general public in China is highly aware of the basic information concerning COVID-19 and its precautions. Interestingly, more respondents (99.3%) were aware of the term severe acute respiratory syndrome (SARS) than COVID-19 (97.2%) and Middle East respiratory syndrome (MERS) (73.4%). Among them, 2.4%, 1.6%, and 0.9% said that they or their family members or friends were affected by COVID-19, SARS, and MERS, respectively. The majority of the respondents (91.2%) indicated that knowledge about COVID-19 was received mainly from WeChat, followed by TV (89%), friends (76.1%), and QQ (a Chinese instant messaging software service) (57.7%). CONCLUSION: The general public in China is highly aware of COVID-19 and the necessary precautions. Unexpectedly, 2.8% of the participants were unaware of the current epidemic. The remaining information gaps highlight the necessity of further enhancing awareness and preparedness.

Introduction: There is limited research on how the COVD-19 pandemic will affect countries with weakened health systems and particularly those in conflict. Syria protracted conflict has strained its health systems and caused fragmentation. In this study, we focus on northwest (NW) Syria, where recent violence has driven almost one million civilians (of the 4.17 million in the area) from their homes between December 2019 and March 2020. The area is challenged by overcrowding, inadequate WASH, shelter and insufficient healthcare services. Internationally promoted measures (social distancing, self-isolation, quarantine, lockdown) are not impossible. We model outcomes, according to three scenarios, should there be a COVD-19 outbreak. We aim to: 1. Predict the numbers of cases, including severe and critical ones, and deaths. 2. Identify critical time points when the health system capacity is overwhelmed due to COVID-19. Methodology: using the WHO COVD-19 Essential Supplies Forecasting Tool (COVID-ESFT) and data from the Health Information System Unit on population and health facility capacity and utilization in northwest Syria, we generate predicted numbers of cases, deaths and health care needs according to three scenarios. Scenario One assumes a medium doubling rate (every 4 days) and a medium clinical attack rate (20% of the population). Scenario Two assumes a fast doubling rate (every 3.2 days) and a medium clinical attack rate (20% of the population). Camp-population Scenario assumes a very fast doubling rate (every 2.3 days) and a medium clinical attack rate (20% of the population). Scenarios One and Two apply to the total population of 4.17 million and for 8 weeks from the first case while Camp-population Scenario applies only to the 1.2 million internally displaced persons (IDPs) in camps and tented settlements and for 6 weeks from the first case. For each scenario, we identify critical time-points when the health system capacity is overwhelmed assuming a highly conservative estimate that 50% of regular hospital (ward) and ICU beds can be occupied by COVID-19 patients. Results: Scenario One predicts 16,384 cases (0.4% of the total population), of which 2,458 are severe and 819 are critical, and 978 deaths in the first 8 weeks. Scenario Two predicts 185,364 cases (4.4% of the population), of which 27805 are severe and 9268 are critical, and 11,066 deaths in the first 8 weeks. Camp-population Scenario predicts 240,000 cases (20% of the IDP population) of which 36,000 are severe and 12,000 are critical and 14,328 deaths in the first 6 weeks. With only 2,429 inpatient beds and 240 ICU beds (98 with adult ventilators, 62 with paediatric ventilators) in northwest Syria, ward and ICU bed capacities will be overwhelmed within 4-7 weeks. The Camp-population Scenario will see the earliest critical time-points. Conclusion and recommendations: Should a COVID-19 outbreak occur in NW Syria, projected cases and deaths will be particularly severe among IDPs. Health system capacity will be overwhelmed within a short period after the first case in camp settings. There is need for further research to account for additional variables that can impact projections. However, it is urgent for international community to mobilize efforts and resources to support community-based measures, increase testing, strengthen health system capacity.

Interest in mindfulness meditation continues to grow as accumulating evidence suggests mindfulness training encourages more positive functioning. However, basic questions about the conditions best suited for realizing mindful states remain unanswered. Prominent among these is whether a group mindfulness practice setting is more effective for novice meditators than a solitary practice setting. Answering this question has assumed new urgency due to the imposition of physical distancing measures designed to stop the spread of COVID-19. In a time of limited social contact, is a simulated group practice setting better than practicing alone? This preliminary study investigated whether environmental setting impacted mindfulness practice experience by examining the effects of three simulated meditation practice environments (1. group practice, 2. nature practice, and 3. solitary practice) on state mindfulness and perceived social connectivity in a sample of novice meditators. Significant differences emerged across the three simulated practice settings. Findings suggest watching others meditate while meditating appears to most effectively induce a state of mindfulness and strengthen feelings of social connectivity. This study supports traditional beliefs about the benefits of group mindfulness practice. These findings also have implications for social workers struggling to stretch limited resources to address growing mental health demands, especially during times of heightened social isolation due to COVID-19. If a simulated group practice confers the same cognitive benefits as solitary practice while also conferring social benefits, simulated group instruction may be preferable for therapeutic and economic reasons.

Das Pankreas ist sowohl ein exokrines wie auch ein endokrines Organ (Tab. 21.1). Ihm kommt die zentrale Rolle in der Aufschlie?ung der Nahrungsbestandteile sowie in der Regulation des Blutzuckerspiegels zu.

We report on the development of minimal change disease (MCD) with nephrotic syndrome and acute kidney injury (AKI), shortly after first injection of the BNT162b2 COVID-19 vaccine (Pfizer-BioNTech). A 50-year-old previously healthy man was admitted to our hospital following the appearance of peripheral edema. Ten days earlier, he had received the first injection of the vaccine. Four days after injection, he developed lower leg edema, which rapidly progressed to anasarca. On admission, serum creatinine was 2.31 mg/dL and 24-hour urinary protein excretion was 6.9 grams. As kidney function continued to decline over the next days, empirical treatment was initiated with prednisone 80 mg/d. A kidney biopsy was performed and the findings were consistent with MCD. Ten days later, kidney function began to improve, gradually returning to normal. The clinical triad of MCD, nephrotic syndrome, and AKI has been previously described under a variety of circumstances, but not following the Pfizer-BioNTech COVID-19 vaccine. The association between the vaccination and MCD is at this time temporal and by exclusion, and by no means firmly established. We await further reports of similar cases to evaluate the true incidence of this possible vaccine side effect.

Hundreds of clinical trials of potential treatments and vaccines for the coronavirus 19 disease (COVID-19) have been set up in record time. This is a remarkable reaction to the global pandemic, but the absence of a global coordination of clinical research efforts raises serious ethical concerns. Some COVID-19 patients might carry the burden of clinical trial involvement even though their trial cannot be completed as researchers are competing for patients. A shortage of medicines can occur when existing drugs are diverted for clinical trials. Research ethics committees are overburdened with multiple applications. A multitude of trials can also overstretch medical staff and risk neglecting non-COVID-19 patients. And finally, conflicting conclusions from a multitude of heterogeneous trials might lead to delays in public health decisions about life-saving issues. These challenges are made worse by the unpredictable evolution of epidemics, the active involvement of political decision-makers in scientific issues and the pressure of social media globally. While freedom to conduct research must be safeguarded, global health emergency situations would greatly benefit from effective international coordination mechanisms for clinical research.

BACKGROUND: Pleural biopsies for investigating the causes of pleurisy are performed through modalities including needle biopsies, local anesthetic thoracoscopic procedures, and surgery (video\assisted thoracoscopic surgery and open thoracotomy). To date, there have been no large\scale nationwide epidemiological studies regarding pleurisy diagnosed via surgical pleural biopsy. This study examined the epidemiology of pleurisy diagnosed via surgical pleural biopsy in a Japanese nationwide administrative database. METHODS: We evaluated Japanese Diagnosis Procedure Combination data of 24 173 patients who underwent video\assisted thoracoscopic surgery or open thoracotomy and received a diagnosis of pleurisy between April 2014 and March 2020. In addition to pleurisy diagnoses, the patients' clinical information, including age, sex, smoking status (pack\years), dyspnea grade, length of in\hospital stay, and comorbidities, were extracted from the dataset. RESULTS: This study included data from 1699 patients. The most frequent causes of pleurisy were neoplastic diseases (55.9%; malignant mesothelioma 22.5%, lung cancer 15.7%, lymphoma 2.5%), followed by infectious diseases (24.0%; tuberculosis 16.2%, parapneumonic pleural effusion 3.6%, empyema 3.5%, nontuberculous mycobacteriosis 0.5%), collagen vascular diseases (2.8%; rheumatoid arthritis 1.3%, immunoglobulin G4\related diseases 0.7%, systemic lupus erythematosus 0.3%), and paragonimiasis (0.1%). CONCLUSIONS: Neoplastic diseases, including malignant mesothelioma and lung cancer, were frequently and accurately diagnosed as pleurisy via surgical pleural biopsy. The next leading cause was infectious diseases such as mycobacterial infections. Physicians should consider performing surgical biopsy in light of the knowledge regarding the etiology of pleurisy when a definitive diagnosis cannot be made via needle pleural biopsy.

IGPA developed several Pandemic Stress Indicators, designed to evaluate the social and economic effects of the COVID-19 pandemic on Illinois residents. The Pandemic Stress Indicators grew out of the work on IGPAs Task Force on the Impact of the COVID-19 Pandemic. One of these indicators has been a poll of three sets of experts about pandemic policies. Experts on economics, public health, and/or vulnerable populations from across Illinois have generously agreed to provide regular opinions on various pandemic policies.Primary article:Policy Spotlight: Ongoing Expert Advice on Pandemic Policies

Objective: To assess the risk of public health emergencies, both the indigenous ones and the imported ones, which might occur in the mainland of China in July 2021.

We employ the Google and Apple mobility data to identify, quantify and classify different degrees of social distancing and characterise their imprint on the first wave of the COVID-19 pandemic in Europe and in the United States. We identify the period of enacted social distancing via Google and Apple data, independently from the political decisions. Our analysis allows us to classify different shades of social distancing measures for the first wave of the pandemic. We observe a strong decrease in the infection rate occurring two to five weeks after the onset of mobility reduction. A universal time scale emerges, after which social distancing shows its impact. We further provide an actual measure of the impact of social distancing for each region, showing that the effect amounts to a reduction by 20-40% in the infection rate in Europe and 30-70% in the US.

BACKGROUND: In view of the current global coronavirus disease 2019 pandemic, mass drug administration interventions for neglected tropical diseases, including lymphatic filariasis (LF), have been halted. We used mathematical modelling to estimate the impact of delaying or cancelling treatment rounds and explore possible mitigation strategies. METHODS: We used three established LF transmission models to simulate infection trends in settings with annual treatment rounds and programme delays in 2020 of 6, 12, 18 or 24 months. We then evaluated the impact of various mitigation strategies upon resuming activities. RESULTS: The delay in achieving the elimination goals is on average similar to the number of years the treatment rounds are missed. Enhanced interventions implemented for as little as 1 y can allow catch-up on the progress lost and, if maintained throughout the programme, can lead to acceleration of up to 3 y. CONCLUSIONS: In general, a short delay in the programme does not cause a major delay in achieving the goals. Impact is strongest in high-endemicity areas. Mitigation strategies such as biannual treatment or increased coverage are key to minimizing the impact of the disruption once the programme resumes and lead to potential acceleration should these enhanced strategies be maintained.

As the US air cargo network (USACN) becomes a crucial part of the economy, it is pivotal to understand the structural evolution of the network and how it would be affected by unexpected events. We investigated the network structure, efficiency, and robustness of the USACN from 1990 to 2019 due to targeted attacks based on complex network theory from a dynamic and spatiotemporal perspective. Our results suggest that the USACN has enhanced robustness. Moreover, we find that attacks based on betweenness centrality are the most effective way to cause a collapse compared with attacks based on degree and closeness centrality. In addition, airports of the USACN have formed an increasing number of communities with geographical ties, and airports in the noncontiguous regions are more vulnerable than other communities in the lower 48 states. Further, we discover that the average path lengths have increased, and the overall efficiency has decreased from 0.7 to 0.4 due to the dependency of the hub-and-spoke structure. This paper complements previous studies on the dynamic structure evolution of air cargo networks through the lens of complex network theory with spatial-temporal data.

This article, one of 12 in a series on most commonly billed diagnoses in primary care, provides a comprehensive overview of the pathophysiologic processes related to urinary tract infections (UTIs). The clinical manifestations, diagnostic tests, treatments, and billing codes associated with UTIs will be described.