The COVID-19 pandemic will not be easily forgotten as its contagious impact has penetrated education. In response to this, educational practices have moved online within various forms and terms, and Emergency Distance Education (EDE) is one of them. Within this frame, this qualitative study aimed to investigate the recommendations of 118 English Language Teaching (ELT) Department students for their teachers and for students themselves in developing four language skills-reading, writing, listening, and speaking-during EDE settings to improve the efficiency of the online courses. In doing so, Framework Method via NVivo 11 Plus was utilized. The participants' recommendations for EDE included a total of 152 comments for reading, 141 for writing, 131 for listening, and 147 for speaking skills. The participants' recommendations for four skills centered on a total of seven themes: for teachers, for students, for online platforms, for eliminating technical issues, satisfactory, no recommendation, and no answer. The data analysis demonstrated that the majority of the recommendations for each skill were given for teachers under two sub-themes: content and implementation. While content had the highest frequency for reading, writing, and listening skills, implementation was found to be the top concern for speaking skills. The results of the study presented valuable insights not only for ELT contexts but also for all language education settings.

Background: Health chatbots are rising in popularity and capability for fighting the novel SARS-CoV-2 coronavirus (COVID-19) Objectives: This study aims to review the current literature on COVID-19 related chatbots in healthcare, identify and characterize these emerging technologies and their applications for combating COVID-19, and describe related challenges Methods: The authors conducted a scoping review of peer-reviewed literature on COVID-19, guided by the Arksey and O'Malley framework PubMed/MEDLINE and Google Scholar were searched over a period between January and September 2020 by using the keywords COVID* chatbot, virtual assistant, AI enabled platform COVID and associated synonyms Relevant studies' references were checked for further articles The content of these studies was screened and thematically analyzed by the two authors Results: Out of 543 articles initially identified, 9 were eligible for inclusion Studies describing chatbots' development and architecture (n=6) were the most common, and only 3 empirical studies on the user experience were identified Our scoping review identified five key applications of the current health chatbots, which were: disseminating health information and knowledge;self-triage and personal risk assessment;monitoring exposure and notifications;tracking COVID-19 symptoms and health aspects;and combating misinformation and fake news Furthermore, these technologies can accomplish the following tasks: ask and answer questions;create health records and history of use;complete forms and generate reports;and take simple actions Nonetheless, the use of health chatbots poses many challenges both at the level of the social system (i e , consumers' acceptability) as well as the technical system (i e , design and usability) Conclusion: Using health chatbots to combat COVID-19 is a practice still in its infancy We believe that our work will help researchers in this domain gain better understanding of this novel technology's design and applications, which are needed for continuous improvement in the health chatbots' functionalities and their usefulness to fight COVID-19 ? 2020 Manal Almalki, Fahad Azeez This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License (http://creativecommons org/licenses/by-nc/4 0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited

Possibility theory is particularly efficient in combining multiple information sources providing incomplete, imprecise, and conflictive knowledge. In this work, we focus on the improvement of the accuracy rate of a person re-identification system by combining multiple Deep learning classifiers based on global and local representations. In addition to the original image, we explicitly leverages background subtracted image, middle and down body parts to alleviate the pose and background variations. The proposed combination approach takes place in the framework of possibility theory, since it enables us to deal with imprecision and uncertainty factor which can be presented in the predictions of poor classifiers. This combination method can take advantage of the complementary information given by each classifier, even the weak ones. Experimental results on Market1501 publicly available dataset confirm that the proposed combination method is interesting as it can easily be generalized to different deep learning re-identification architectures and it improves the results with respect to individual classifiers.

The World Health Organization (WHO) targets for eliminating HCV by 2030 may be over-ambitious for many high-income countries. Recent analyses (i.e., data from 2017-2019) show that only 11 countries are on track for meeting WHO's elimination targets. For a country to be truly on track, it is important that the majority of infected individuals be identified and treated. There is still a need for country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and support an evidence-based policy for HCV elimination. Any health policy model is affected by the diversity and quality of the available data and by gaps in data. Given the differences among countries, comparing progress based on fixed global targets will not necessarily be suitable in the same measure for each country. In a recent document, the European Collaborators of Polaris Observatory provide insight into the limitations of the current WHO targets. The absolute targets identified by each country in accordance with the measures set by WHO would be essential in reaching the HCV elimination. All analytic models to assess the progress toward HCV elimination are based on projections to 2030 not including the impact of the COVID-19 pandemic on hepatitis-related services. With specific regard to the achievement of WHO hepatitis elimination goals, all measures that will be put in place during and after COVID-19 pandemic could be transferred in increasing diagnosis and linkage to care of people with hepatitis.

BACKGROUND: The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid. OBJECTIVE: Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients. DESIGN: Cross-sectional. SETTING: Tertiary care center in Turkey. PATIENTS AND METHODS: Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups. MAIN OUTCOME MEASURE: Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules. SAMPLE SIZE AND CHARACTERISTICS: Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals. RESULTS: The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively). CONCLUSION: These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules. LIMITATION: Single-center and possible information bias. CONFLICTS OF INTEREST: None.

Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers' attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned.

Purpose: This study aims to determine the political commitment of the Enrekang District Government in overcoming the problem of stunting during the COVID-19 period Method: This study uses a qualitative research method with a type of case study research This research was conducted in Enrekang District in May-July 2020 The informants in this study were 13 people who were selected by purposive sampling technique Data collection was carried out by in-depth interviews, document review, and observation Results: The results of this study indicate that the COVID-19 pandemic has an impact on the political commitment of the Enrekang local government in handling stunting The enactment of Large Scale Social Restriction (LSSR) and refocusing on the budget caused several programs to experience budget cuts On the other hand, the provision of latrines for sanitation and hygiene absorbs the largest amount of funds Conclusions: The COVID-19 pandemic has an impact on the political commitment to handling stunting due to the enactment of Large Scale Social Restriction (LSSR) and budget refocusing

AIM Pregnancy- and lactation-related osteoporosis (PLRO) is a rare transient osteoporosis causing severe low back pain and morbidity in the last trimester of pregnancy and in the postpartum period. The etiology of PLRO is still unclear. We aimed to share our experience regarding management and follow-up of patients with PLRO who were effectively treated. MATERIAL AND METHODS In this case series, we presented 10 patients who were diagnosed with PLRO and treated from January 2010 to December 2020. VAS scale and laboratory findings were evaluated. Spinal and extremity magnetic resonance imaging (MRI) was obtained for patients with spinal and extremity pains. Dual energy X-ray absorptiometry was used for the measurement of bone mineral density. Values assessed on dual energy X-ray absorptiometry were L1-L4 T score, L2-L4 T score and femoral neck T score. RESULTS In the first-month follow-ups, all patients had meaningful pain relief and symptom resolution. The mean duration of pain control during the treatment period was 2.4 months. Two patients who continued breastfeeding were also the patients whose pain control was achieved at the latest. One patient required vertebroplasty surgery. CONCLUSION Patients with PLRO should be promptly treated and followed-up. Discontinuation of breastfeeding will provide rapid advantage and should be the first step of the management. Early diagnosis and treatment of Calcium and Vitamin D with conservative procedures with spinal braces are very important for the treatment of PLRO patients. Additionally, bisphosphonates or teriparatide can improved the bone mineral density in patients with PLRO.

Managerial preparedness is a constant concern for firm stakeholders. This concern is exacerbated during times of immense stress brought about by exogenous shocks. In this paper, we analyze the preparedness of U.S. commercial airline management teams to the largest systematic exogenous shock to date, namely the COVID-19 pandemic in 2019 and 2020. We do this by underpinning the paper with theory on environmental scanning and managerial dysfunction and then documenting the signals and actions of management around multiple public health scares. These include the SARS outbreak, the Swine Flu outbreak and the COVID-19 outbreak. Our results, based off of corporate filings with the SEC, is that airline management had multiple dry runs before the COVID-19 outbreak that should have lead them to prepare for financially catastrophic scenarios such as the one observed in 2020. Instead, management teams failed to learn from these, and other, prior shocks. Instead, they focused on other, less serious threats while diffusing their financial buffers through dividends and share buybacks.

The spectrum of coenzyme Q10 (CoQ10) deficiency syndromes comprises a variety of disorders, including a form of autosomal recessive cerebellar ataxia (ARCA2) caused by mutations in the AarF domain-containing kinase 3 gene (ADCK3). Due to the potential response to CoQ10 supplementation, a timely diagnosis is crucial. Herein, we describe two siblings with a novel homozygous ADCK3 variant and an unusual presentation consisting of isolated writer's cramp with adult-onset. Cerebellar ataxia developed later in the disease course and remained stable during the follow-up. This report highlights that ARCA2 should be considered in the differential diagnosis of familial writer's cramp.

Introduction: Italy, since the end of February 2020, is experiencing the corona virus disease 2019 (COVID-19) pandemic that may present as an acute respiratory infection. We report on COVID-19 pneumonia in the context of a complex case of Cushing's disease (CD). Case Report: A 67-year-old man with CD, who was admitted to our hospital, presented with signs and symptoms of adrenal insufficiency with persistent hypotension and glycemia toward the lower limits. We progressively withdrew almost all treatments for diabetes and CD (pasireotide and metyrapone), and i.v. hydrocortisone was necessary. A tendency to hyperkalemia was probably associated to enoxaparin. We summarized the many possible interactions between medications of Cushing's syndrome (CS) and COVID-19. Conclusion: Adrenal insufficiency might be a clinical challenge that needs a prompt treatment also in CS patients during COVID-19 infection. We should consider the possibility to titrate or temporary halt medical therapies of CS in the context of COVID-19 infection. Unexpected hyperkalemia in CS patients under treatment with heparin might be the signal of aldosterone suppression.

BACKGROUND: Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their childs health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their childs health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. OBJECTIVE: The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. METHODS: This research is part of a broader study to explore caregivers perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. RESULTS: We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their childs status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their childrens educators. Beyond the scope of managing their childs health information, family caregivers also navigated bureaucratic processes for their childs home care. CONCLUSIONS: Family caregivers experiences of caring for CSHCN differ contextually and evolve as their childs condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their childs health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings.

Powered flight has evolved several times in vertebrates and constrains morphology and physiology in ways that likely have shaped how organisms cope with infections. Some of these constraints likely have impacts on aspects of immunology, such that larger fliers might prioritize risk reduction and safety. Addressing how the evolution of flight may have driven relationships between body size and immunity could be particularly informative for understanding the propensity of some taxa to harbor many virulent and sometimes zoonotic pathogens without showing clinical disease. Here, we used a scaling framework to quantify scaling relationships between body mass and the proportions of two types of white blood cells--lymphocytes, and granulocytes (neutr-/heterophils)--across 60 bat species, 414 bird species, and 256 non-volant mammal species. By using phylogenetically-informed statistical models on field-collected data from wild Neotropical bats, data gleaned from other wild bats available in the literature, and data from captive non-volant mammals and birds, we show that lymphocyte and neutrophil proportions do not vary systematically with body mass among bats. In contrast, larger birds and non-volant mammals have disproportionately higher granulocyte proportions than expected for their body size. Future comparative studies of wild bats, birds, and non-volant mammals of similar body mass should aim to further differentiate evolutionary effects and other aspects of life history on immune defense. Summary statement Powered flight might constrain morphology such that certain immunological features are prioritized. We show that bats largely have similar cell proportions across body mass compared to strong allometric scaling relationships in birds and non-flying mammals.

Introduction: The COVID-19 pandemic has prompted researchers to conduct non-randomized studies in an effort to find an off-label drug that can effectively combat the virus and its effects. While these studies can expedite the drug approval process, researchers must carefully design and analyze such studies in order to perform rigorous science that is reproducible and credible. This article focuses on several key design and analysis considerations that can improve the scientific rigor of non-randomized studies of off-label drugs. Areas covered: The aim of this article is to provide an overview of best approaches that should be considered for non-randomized studies on off-label drugs. We discuss these approaches in detail and use a non-randomized study by Rivera et al. in Cancer Discovery as an example of methods that have been undertaken for COVID-19. Expert opinion: While non-randomized studies are inherently biased, they may be unavoidable in situations such as the COVID-19 pandemic, where researchers need to find an effective treatment quickly. We believe that a well-formed experimental design, high-quality data collection, and a well-thought-out statistical and data analysis plan are sufficient to produce rigorous and credible results for making an optimal decision.

Pandemi COVID-19 telah mendisrupsi berbagai aspek kehidupan masyarakat, tidak terkecuali proses penegakan hukum di lembaga peradilan. Ditutupnya lembaga peradilan sebagai respons atas kebijakan pemerintah untuk membatasi aktivitas masyarakat dalam rangka mengurangi kasus positif COVID-19 seolah menjadi hambatan bagi justitiabellen untuk mendapatkan keadilan substantif. Digitalisasi dan globalisasi yang berdampak pada disrupsi digital pada penegakan hukum di lembaga peradilan menjadi secercah harapan bagi masyarakat untuk mendapatkan keadilan. Beberapa negara di dunia, termasuk Indonesia, telah menerbitkan kebijakan disrupsi digital di lembaga peradilan agar proses penegakan hukum dapat terus berjalan. Penelitian ini mengkaji bagaimana disrupsi digital dilaksanakan dalam penegakan hukum di Indonesia pada masa pandemi COVID-19 dan memaparkan perbandingan pelaksanaan penegakan hukum dengan disrupsi digital dari beberapa negara pada masa pandemi COVID-19. Metode penelitian adalah yuridis normatif dengan pendekatan literatur dan komparatif. Hasil dari penelitian ini adalah terlepas dari telah cukup berhasilnya pelaksanaan persidangan virtual di masa pandemi COVID-19 sebagai bentuk disrupsi digital pada penegakan hukum di lembaga peradilan, pemerintah masih perlu untuk menyusun peraturan di level undang-undang sebagai payung hukum yang memberikan standardisasi dan pedoman yang sama untuk proses penegakan hukum di lembaga peradilan melalui persidangan virtual agar keadilan substantif benar-benar terwujud.

Background Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID. Methods Seventeen patients (mean age, 9.6 2.9 years) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed. Results The BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes. Conclusion BIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.

Introduction: This study aims to characterize attitudes towards COVID-19 vaccination and to evaluate factors associated with vaccine uptake amongst pregnant individuals. Methods: An anonymous survey was distributed to a convenience sample of pregnant individuals receiving prenatal care at two large urban academic hospitals in a single healthcare network in Massachusetts. Individual demographic variables were included in the survey along with questions assessing attitudes towards COVID-19 and vaccination in pregnancy. Results: Of 477 respondents, 233 (49.3%) had received or were scheduled to receive a COVID-19 vaccine. Age, White race, non-Hispanic/LatinX ethnicity, working from home, and typical receipt of the influenza vaccine were associated with COVID-19 vaccination. 276 respondents (58.4%) reported that their provider recommended the COVID-19 vaccine in pregnancy; these participants were more likely to have received a vaccine (OR 5.82, 95% confidence interval [CI] 3.68-9.26). Vaccinated individuals were less likely to be worried about the effects of the vaccine on themselves (OR 0.18, 95% CI 0.12-0.27) or their developing babies (OR 0.17, 95% CI 0.11-0.26). Unvaccinated individuals were less likely to report that it is easy to schedule a COVID-19 vaccine (OR 0.56, 95% CI 0.34-0.93), to travel to receive a vaccine (OR 0.19, 95% CI 0.10-0.36), and to miss work to receive a vaccine (OR 0.30, 95% CI 0.18-0.48). Conclusions: Strategies are needed to improve patient education regarding vaccine side effects and safety in pregnancy and to change policy to make it feasible for pregnant patients to schedule and miss work without loss of pay to get vaccinated.

BACKGROUND The objective of this study was to measure the recovery of routine pediatric immunization after a period of reduced vaccine administrations in the early weeks of the COVID-19 pandemic. METHODS We recorded data on vaccines administered in Children's Wisconsin primary care or urgent care clinics from January 2019 through December 2020 and aggregated data by date and insurance type. RESULTS During the gradual reopening period after week 21 in 2020, vaccine administration returned to prepandemic levels for children with commercial insurance but remained below baseline rates until the end of 2020 for children with Medicaid insurance. DISCUSSION The decline in pediatric vaccination in 2020 disproportionately affected children with Medicaid insurance.

Acute respiratory distress syndrome (ARDS) is a rapidly progressive condition that is caused by the disruption of the alveolarcapillary barrier About a quarter of all patients on mechanical ventilation develop ARDS, and although our understanding of the pathogenetic mechanisms of ARDS has evolved over time and mortality has since declined, the condition still poses a significant threat to this day Treatment principles include management of the underlying disease and a lung-protective mechanical ventilation strategy to avoid ventilator-induced lung injury Patients who have survived the condition often experience a loss of quality of life Furthermore, they have an increased risk of developing cognitive impairment and depression Thus, it should be concluded that ARDS is a serious and debilitating condition, for which it is important to find new treatment options Not to mention that it is crucial to implement the best current measures available to avoid complications and to improve patients' quality of life

Forced by the COVID-19 pandemic into lockdown during intercontinental travels, the author finds herself in limbo With help from literary precedents such as Dante, Boccaccio, and Defoe supported by a brief interrogation of contemporary utterances surrounding the master trope "virus," she claims a chiasmic relation between the concepts "consolation" and "control ? 2020 Penn State University Press All rights reserved