The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderationoverseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face\to\face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers. Findings identified that local BSF groups are widely used and highly valued for their connection with local face\to\face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self\efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well\being, motivation and breastfeeding duration. As such, they have the potential to add value to local face\to\face services and improve breastfeeding experiences and knowledge in communities. The findings have important implications to support the development of integrated online interventions to improve public health.

INTRODUCTION AND IMPORTANCE: Deep brain stimulation (DBS) implantation is a neurosurgical procedure in which electrodes are implanted in the brain. Complications that may occur include wound infection, issues with the DBS hardware, and others. This case report presents a patient who suffered ear numbness following DBS implantation. CASE PRESENTATION: A 50-year-old man presented with resting tremors in both hands. He reported that his handwriting had worsened and his movements had slowed. Physical examination revealed rigidity and postural instability. The patient was diagnosed with Parkinson's disease and a bilateral subthalamic nucleus DBS implantation was scheduled combined with the patient's medication all this time. Patient's symptoms showed improvement after the procedure. However, the patient complained of ear numbness and occasional pain in the area around his ear. We observed the patient over the next 3 months and the symptoms eventually resolved without any medication and intervention. CLINICAL DISCUSSION: Ear numbness is a rare complication that occasionally occurs after DBS implantation. This complication occurs because the tunneling track's proximity to the great auricular nerve and the lesser occipital nerve can result in accidental damage to either one or both of these nerves during subcutaneous tunneling. CONCLUSION: We suggest a simple procedure to avoid neural injury while maintaining the course of the tunneling in which the tunnel is created below the periosteum rather than at the subcutaneous level.

In this systematic umbrella review we aggregate the current knowledge of how virtual and augmented reality technologies are applicable to and impact remote learning in higher education;specifically, how they impact such learning outcomes as performance and engagement in all stages of higher education from course preparation to student evaluation and grading This review was done as part of a state wide research effort of Latvia, to mitigate the impact of COVID-19 and specifically to provide a framework for a technological transformation of education in this context In this work we search the Scopus and Web of Science databases for articles describing the use of virtual and/or augmented reality technologies in remote learning for higher education and their impact on learning outcomes We identified 68 articles from which, after multiple screening and eligibility phases, nine review articles were left for extraction phase in which 30 structural elements with corresponding interventions and measured effects were extracted Of these, 24 interventions had a measured effect on student performance (11 positive, seven negative, six no impact) and six interventions had a measured effect on student engagement (all six positive)

COVID-19 is an emerging infectious disease with widespread transmission of the coronavirus SARS-CoV-2 in the Netherlands. Some of those infected become seriously ill. Others do not show any symptoms, but can still contribute to the transmission of the virus. SARS-CoV-2 is excreted in the oral cavity and can be spread via aerosols. Therefore, there is an increased risk of its spread during aerosol-producing treatments in dental care clinics. Due to the risk of infection of dental care workers and patients, and based on the evidence currently available, additional infection control measures for all patients are strongly recommended when providing emergency dental care in this phase of the pandemic. Other treatments should be postponed. Based on guidance in scientific literature and advice from the Dutch National Institute for Public Health and the Environment (RIVM), consideration should be given to what infection control measures are necessary when providing emergency and regular dental care in both the current situation and in the future.

BACKGROUND: The actual number of accidents in e?scooter drivers in Germany seems to be significantly higher than the current figures from the Statistisches Bundesamt suggest. This epidemiological study examines e?scooter injuries and compares them with e?bike and bicycle injuries. OBJECTIVE: In order to create a comparable database on the dangers of e?scooters, e?bikes and bicycles, the typical injury patterns were analyzed and prevention options derived from them. MATERIAL AND METHODS: All accidents involving e?scooters, e?bikes and bicycles that were presented via the university emergency room of a level 1 trauma center between 15 June 2019 and 31 October 2020 were prospectively investigated. RESULTS: In our study, 68 accidents in e?scooter drivers were included, of which only 11.8% (n = 8) were recorded by the police. Significantly more of them were male than female (p = 0.032) with a mean age of 31.1 (13) years. At the same time, we registered 34 accidents in e?bike riders and 356 in cyclists. In all three groups, most injuries occurred to the head, followed by injuries to the upper extremities. Significantly more e?scooter drivers had an ISS 16 than in the group of injured cyclists (p = 0.016). E?scooter riders who had an accident had a significantly longer length of stay in hospital, than e?bike riders (p = 0.003) and cyclists (p = 0.001), 52.9% (n = 18) of e?bike riders and 53.3% (n = 113) cyclists wore a helmet, compared to only 1.5% (n = 1) of e?scooter riders. The most common cause of accidents among e?bike riders (17.7%; n = 6) and cyclists (10.4%; n = 37) was slipping away on tram rails, while for e?scooter riders it was colliding with a curb (7.4%; n = 5). CONCLUSION: The three patient collectives examined showed different causes and profiles of injuries. The reasons for an increased proportion of seriously injured people compared to cyclists are electromobility, driving under the influence of alcohol and inadequate wearing of a helmet on e?scooters when head injuries dominate. 73.5% (n = 50) of the e?scooter accidents recorded by us were not registered by the police and therefore do not appear in the current statistics of the statistisches Bundesamt. As a result, a much higher number of e?scooter accidents can be assumed. Preventive measures could include the introduction of compulsory helmets, a higher number of traffic controls and the expansion of bike tracks.

Newborn animals, in the fetal-to-neonatal transition, usually face several challenges in their first 24 hours, including issues with acid-base balance, glycemic levels and oxygenation. Difficulties to overcome such issues have caused several deaths among newborns. Therefore, studies have been carried out in order to evaluate them. The main purpose of this study is to evaluate the correlation between the serum lactate level in the mother, in the placenta and in the newborn. Moreover, the study measured the lactate level, blood glucose level and blood gas level in the first 24 hours. Tests were carried out right after birth, and at 4, 8, 12 and 24 hours after. Lactate levels were quite similar to the placental levels (p=0.991) which, in turn, were significantly different from the mother's (p=0.011). Results showed that, shortly after birth, the production of lactate in the placenta is part of the issue. Along the first 24 hours, the study observed a reduction of the levels of lactate in newborns; the levels were closer to the normal index levels for the species. Regarding the blood gas test results, we observed mild metabolic acidosis at birth; acid-base balance was completely stable at the end of the period.(AU)

Long\chain fatty\acyl CoA dehydrogenase deficiency (LCHADD) is an inborn error of long chain fatty acid oxidation with various features including hypoketotic hypoglycemia, recurrent rhabdomyolysis, pigmentary retinopathy, peripheral neuropathy, cardiomyopathy, and arrhythmias. Various stresses trigger metabolic decompensation. Coronavirus disease 2019 (COVID\19) is a pandemic caused by the RNA virus SARS\CoV\2 with diverse presentations ranging from respiratory symptoms to myocarditis. We report a case of a patient with LCHADD who initially presented with typical metabolic decompensation symptoms including nausea, vomiting, and rhabdomyolysis in addition to mild cough, and was found to have COVID\19. She developed acute respiratory failure and refractory hypotension from severe cardiomyopathy which progressed to multiple organ failure and death. Our case illustrates the need for close monitoring of cardiac function in patients with a long\chain fatty acid oxidation disorder.

Nowadays, the increase in patient demand and the decline in resources are lengthening patient waiting times in many chemotherapy oncology departments. Therefore, enhancing healthcare services is necessary to reduce patient complaints. Reducing the patient waiting times in the oncology departments represents one of the main goals of healthcare manager. Simulation models are considered an effective tool for identifying potential ways to improve patient flow in oncology departments. This paper presents a new agent-based simulation model designed to be configurable and adaptable to the needs of oncology departments which have to interact with an external pharmacy. When external pharmacies are utilized, a courier service is needed to deliver the individual therapies from the pharmacy to the oncology department. An oncology department located in southern Italy was studied through the simulation model and different scenarios were compared with the aim of selecting the department configuration capable of reducing the patient waiting times.

Social distancing was planned as a preventive measure to control the extensive spread of COVID-19. COVID-19-related deaths in Brazil were analyzed during the period of social distancing measures. Mortality data for COVID-19 was obtained from the Worldometer website (www.worldometer.info). Deaths were estimated up to the 31st day after the occurrence of the 5th COVID-19-related death in Brazil. Social distance was measured using Google's community mobility reports (https://www.google.com/covid19/mobility/). The Brazilian epidemic curves were interconnected, and mathematical models were evaluated to fit the mortality estimation curves. The optimistic model was defined in the opening period of social distancing and, therefore, in the lower mobility (40-60%). The realistic model was calculated according to relaxed social distance measures (<40%) and the pessimistic model was calculated based on the transmission rate between 2-3. Thus, the equations of the mathematical models provided the outcomes for the date of June 9, 2020, as follows: realistic model with 40,623 deaths, pessimistic model with 64,310 deaths and the optimistic model with a projection of 31,384 deaths. As a result of these analyzes, on May 24, 2020, there were a total of 22,965 deaths related to COVID-19, and those deaths included within the proposed mathematical models were 17,452 for the optimistic model, 22,623 for the realistic model and 32,825 for the pessimistic model. Thus, it is concluded that social distancing measures promoted by the Brazilian public managers contributes to the reduction in approximately ten thousand deaths related to COVID-19 in the current pandemic scenario.

Amiodarone is a common antiarrhythmic drug that is utilised in clinical practice and is associated with pulmonary toxicity. The most common form of pulmonary complication is interstitial pneumonitis which is treated with discontinuation of amiodarone and initiation of corticosteroids. Amiodarone-induced pulmonary eosinophilia is a rare complication of amiodarone therapy, with blood and pulmonary eosinophilia the predominant features. During the COVID-19 era, the incidence of delay in treatment of pulmonary pathology is also delayed due to the effort of excluding COVID-19 infection. Here we report a case of a 64-year-old man who developed eosinophilic pneumonia after initiation of amiodarone therapy, and the investigations required to exclude other forms of pulmonary toxicity. We also reviewed the effect of COVID-19 testing in the management of patients presenting with respiratory distress.

PURPOSE OF REVIEW: Severe acute respiratory syndrome (SARS)Ccoronavirus disease 2019 (COVID-19) virus imposes a higher risk of complications and mortality among people with mental disorders. Until widely available vaccines, adherence to preventive behaviours remains the most crucial tool to prevent SARS/COVID-19 virus transmission. Our review focuses on the determinants of adherence behaviours. RECENT FINDINGS: Adherence behaviours include the use of a face mask and protective gloves, personal hygienic behaviours (handwashing or using hand sanitiser), and keeping physical distance and avoiding social gatherings. In almost all studies, males and younger people show less adherence. Risk perception and health beliefs (especially perceived severity of COVID-19 related conditions) can explain the sex and age differences in adherence. Studies covering the impact of mental disorders on adherence are surprisingly missing, with the exception of smoking. SUMMARY: Engaging men and young people in adopting preventive behaviours is crucial in protecting the whole community and specific vulnerable populations. There is a lack of studies investigating preventive behaviours among people living with mental disorders and addiction problems. Furthermore, descriptive and intervention studies are needed to understand and improve the adherence of this population to preventive behaviours.

AIMS AND OBJECTIVES: To document the level of frailty in sub-acute COVID-19 patients recovering from acute respiratory failure and investigate the associations between frailty, assessed by the nurse using the Blaylock Risk Assessment Screening Score (BRASS), and clinical and functional patient characteristics during hospitalisation. BACKGROUND: Frailty is a major problem in patients discharged from acute care, but no data are available on the frailty risk in survivors of COVID-19 infection. DESIGN: A descriptive cross-sectional study (STROBE checklist). METHODS: At admission to sub-acute care in 2020, 236 COVID-19 patients (median age 77 years - interquartile range 68-83) were administered BRASS and classified into 3 levels of frailty risk. The Short Physical Performance Battery (SPPB) was also administered to measure physical function and disability. Differences between BRASS levels and associations between BRASS index and clinical parameters were analysed. RESULTS: The median BRASS index was 14.0 (interquartile range 9.0-20.0) denoting intermediate frailty (32.2%, 41.1%, 26.7% of patients exhibited low, intermediate and high frailty, respectively). Significant differences emerged between the BRASS frailty classes regards to sex, comorbidities, history of cognitive deficits, previous mechanical ventilation support and SPPB score. Patients with no comorbidities (14%) exhibited low frailty (BRASS: median 5.5, interquartile range 3.0-12.0). Age &#8805;65 years, presence of comorbidities, cognitive deficit and SPPB % predicted <50% were significant predictors of high frailty. CONCLUSIONS: Most COVID-19 survivors exhibit substantial frailty and require continuing care after discharge from acute care. RELEVANCE TO CLINICAL PRACTICE: The BRASS index is a valuable tool for nurses to identify those patients most at risk of frailty, who require a programme of rehabilitation and community reintegration.

Cenexi, acteur fran?ais du fa?onnage pharmaceutique, spcialis dans la formulation de produits striles, et Humanigen, biopharma amricaine, annoncent un partenariat visant faire de Cenexi le fournisseur exclusif de lanticorps monoclonal lenzilumab en Europe.

Due to coronavirus pandemic (COVID-19) prevailing in more than 210 countries, out of them only few have promulgated lockdown and on March 24, 2020 India also implemented lockdown for 21 days to prevent the community spread of virus among people. Since then, lockdown heavily restricts travel movements of flights, rail, intercity bus services besides industrial activity halt throughout the country. The significant improvement in the air quality of Delhi region was observed due to strict implementation of lockdown. During the lockdown period, improvement in ambient air quality helped us in circumventing the coronavirus community spread. The preliminary results showing the decrease in horizontal advection of pollutants has given an opportunity to understand the background concentrations of air pollutants over Delhi. To analyse this peculiar situation, we have assessed the pollutants datasets collected by twelve different online ambient air quality monitoring stations (AQMS) of Central Pollution Control Board (CPCB), New Delhi, India and observed a colossal improvement in the ambient air quality. The analysis of data confirms the sharp decline in concentrations (nearly 200%) of PM(2.5) and PM(10). The concentration of nitrous oxides (NO(x)), recorded its maximum (342 ppb) on 12 January 2020 in CRRICMathura Road, Delhi with the lowest value as 24 ppb on 30 March 2020 (reduced to nearly 14 times of the peak value). In the triad of this infectious disease, the role of environment is not linked better however, the ground reality cannot be ignored due to environment around us receives, maintains, protects and transports the aetiological agents to host prevailing in polluted environment which makes our lungs more susceptible to viral attacks. Therefore, a cleaner environment would prove to be an effective measure to halt and reduce the transmission of viral infections.

Negara-negara di dunia sedang menghadapi pandemi COVID-19 termasuk Indonesia. Indonesia dengan jumlah kasus COVID-19 sebanyak 1.455.788 dan 5.034 di Kabupaten Tegal. Pengobatan pasti untuk COVID-19 belum ditemukan. Vaksinasi merupakan salah satu cara yang digunakan pemerintah untuk mencegah COVID-19. Vaksinasi bertujuan untuk mencegah penularan dan menurunkan angka kesakitan dan kematian. Kegiatan pengabdian masyarakat dilaksanalan tanggal 4 Juni 2021 di Desa Kalisapu Kab. Tegal. Sasaran dalam kegiatan ini adalah 30 masyarakat yang berusia ditas 18 tahun. Metode yang digunakan yaitu pemberian pendidikan kesehatan dengan booklet sebagai sarana. Hasil dari pengabdian adalah masyarakat sudah mengetahui tentang pentingnya vaksinasi dan bersedia melakukan vaksinasi di pelayanan kesehatan sesuai dengan jadwal yang ditentukan.

The pandemic has brought teachers, young children and their parents lots of uncertainties and challenges in adapting to new teaching and learning environment. Compared with other professionals, teachers might face more challenges in transiting from using a traditional face-to-face teaching method to an online or blended teaching and learning model. This study aimed to explore Chinese primary school English language and literacy teachers' teaching preparation, in particular, their knowledge with regard to incorporating online technologies in learning and teaching. Participants in this project were English language and literacy teachers in central China. The study used a survey with a Likert scale to examine primary school English language and literacy teachers' perceptions of using digital technology in teaching preparation, students' competence development, assessment and professional development (PD) for online teaching. The results confirmed differing perspectives between young teachers and their elder colleagues on the value of using digital technology for online teaching and their PD programmes. A call for PD programmes is also proposed and discussed.

PURPOSE: The trajectory of mechanically ventilated patients with coronavirus disease 2019 (COVID-19) is essential for clinical decisions, yet the focus so far has been on admission characteristics without consideration of the dynamic course of the disease in the context of applied therapeutic interventions. METHODS: We included adult patients undergoing invasive mechanical ventilation (IMV) within 48 h of intensive care unit (ICU) admission with complete clinical data until ICU death or discharge. We examined the importance of factors associated with disease progression over the first week, implementation and responsiveness to interventions used in acute respiratory distress syndrome (ARDS), and ICU outcome. We used machine learning (ML) and Explainable Artificial Intelligence (XAI) methods to characterise the evolution of clinical parameters and our ICU data visualisation tool is available as a web-based widget (https://www.CovidUK.ICU). RESULTS: Data for 633 adults with COVID-19 who underwent IMV between 01 March 2020 and 31 August 2020 were analysed. Overall mortality was 43.3% and highest with non-resolution of hypoxaemia [60.4% vs17.6%; P < 0.001; median PaO(2)/FiO(2) on the day of death was 12.3(8.9C18.4) kPa] and non-response to proning (69.5% vs.31.1%; P < 0.001). Two ML models using weeklong data demonstrated an increased predictive accuracy for mortality compared to admission data (74.5% and 76.3% vs 60%, respectively). XAI models highlighted the increasing importance, over the first week, of PaO(2)/FiO(2) in predicting mortality. Prone positioning improved oxygenation only in 45% of patients. A higher peak pressure (OR 1.42[1.06C1.91]; P < 0.05), raised respiratory component (OR 1.71[ 1.17C2.5]; P < 0.01) and cardiovascular component (OR 1.36 [1.04C1.75]; P < 0.05) of the sequential organ failure assessment (SOFA) score and raised lactate (OR 1.33 [0.99C1.79]; P = 0.057) immediately prior to application of prone positioning were associated with lack of oxygenation response. Prone positioning was not applied to 76% of patients with moderate hypoxemia and 45% of those with severe hypoxemia and patients who died without receiving proning interventions had more missed opportunities for prone intervention [7 (3C15.5) versus 2 (0C6); P < 0.001]. Despite the severity of gas exchange deficit, most patients received lung-protective ventilation with tidal volumes less than 8 mL/kg and plateau pressures less than 30cmH(2)O. This was despite systematic errors in measurement of height and derived ideal body weight. CONCLUSIONS: Refractory hypoxaemia remains a major association with mortality, yet evidence based ARDS interventions, in particular prone positioning, were not implemented and had delayed application with an associated reduced responsiveness. Real-time service evaluation techniques offer opportunities to assess the delivery of care and improve protocolised implementation of evidence-based ARDS interventions, which might be associated with improvements in survival. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-021-06389-z.

BACKGROUND: Lung histopathology demonstrates vasculopathy in a subset of deceased COVID19 patients, which resembles histopathology observed in antibody-mediated lung transplant rejection. Autoantibodies against angiotensin II type 1 receptor (AT1R) and Endothelin receptor Type A (ETAR) have been demonstrated in antibody-mediated rejection and may also be associated with severe COVID19 infection. Objective To assess AT1R and ETAR auto-antibodies in COVID19 patients and controls, and explore their association with disease course. METHODS: 65 hospitalized patients with COVID19 infection were included. Clinical and laboratory findings were retrospectively assessed. Patients with unfavorable disease course, admitted at the intensive care unit and/or deceased during hospital admission (n=33) were compared to admitted COVID19 patients with favorable disease course (n=32). The presence of antinuclear antibodies (ANA) and auto-antibodies against AT1R or ETAR in peripheral blood were compared between COVID19 with unfavorable and favorable disease course and age matched controls (n=20). RESULTS: The presence of ANA was not significantly different between COVID19 patients with unfavorable (n=7/33; 21%) and favorable disease course (n=6/32; 19%) (p= 0.804) and controls (n=3/20; 15%). Auto-antibodies against AT1R were significantly increased in unfavorable disease course (median 14.59 U/mL, IQR 11.28 C 19.89) compared to favorable disease course (median 10.67 U/mL, IQR 8.55 C 13.0, p< 0.01). ETAR antibody titers were also significantly increased in unfavorable disease course (median 7.21, IQR 5.0 C 10.45) as compared to favorable disease course (median 4.0, IQR 3.0 C 6.0, p <0.05). CONCLUSION: Auto-antibodies against AT1R and ETAR are significantly increased in COVID19 patients with an unfavorable disease course.

ATU-3 Frigure 1ConclusionsOur data provide reassurance for the continued evidence-based use of corticosteroids, immunomodulators and biologic therapies in IBD during the ongoing COVID-19 pandemic, and is consistent with an as yet unexplained association between mesalazine use and severe COVID-19 outcomes.

Aim: Chagas disease is a serious public health problem, endemic in 21 countries in Latin America. A future vaccine can contribute to decreasing the number of cases and its complications. Methods: A cross-sectional study was conducted with residents of the northern region of Brazil, on the willingness to pay for a hypothetical vaccine against Chagas disease (effective protection of 80%). Results: We interviewed 619 individuals and seven were excluded from the analysis and the value of willingness to pay was US$23.77 (100.00 BRL). Conclusion: The Northern region of Brazil is one of the largest markets for this vaccine, due to its epidemiological relevance, so economic studies with this vaccine will be important to assist in the assessment of technologies.