The emergence and spread of 2019 coronavirus disease (COVID-19) are causing a growing global public health crisis. Despite advances in treatment, vaccination remains the best way to contain the pandemic [1]. Vaccines are currently available by means of conditional marketing approval, full approval and emergency use authorization pathways [2]. Evidence suggest that immunocompromised individuals including solid organ transplants recipients and patients under immunosuppressive treatment may have increased mortality from SARS-CoV-2 infection despite double dose messenger RNA (mRNA) vaccine regimens [3]. This is partially attributed to blunted immune responses to vaccination since only 38C54% of kidney and liver transplant recipients developed detectable SARS-CoV-2 antibodies following the second dose of mRNA vaccines [3, 4].

We report on a 33-year old Polish truck driver who was admitted as a COVID-19 suspicion case to our hospital after a short stay in northern Italy and was eventually diagnosed with fulminant Capnocytophaga canimorsus sepsis. In retrospect, the patient always had his dog with him in the truck cab and was regularly licked in the face. Following adequate therapy, the patient recovered completely after 8 weeks and was discharged from the hospital in good general condition.

There are few data on endovascular treatment of anterior nutcracker syndrome and pelvic varices in patients with anterior and posterior renal veins. Our objective is to report a case, identify occurrences and compare diagnosis and treatments. A 42-year-old woman presented with flank and pelvic pain and hematuria. She had anterior nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein. A successful complete endovascular approach was done with stent implantation in the anterior renal vein and left gonadal vein embolisation. After 12-month follow-up, the patient remained asymptomatic with good results on CT. Only two case reports of patients with nutcracker syndrome with anterior and posterior renal veins were identified. In both, a self-expanding stent was implanted in the anterior renal vein. In conclusion, endovascular treatment represents a safe and successful option in patients with nutcracker syndrome and pelvic varices with an anterior and a posterior renal vein.

OBJECTIVE: Compliance with the 5M health protocols of washing hands, wearing masks, keeping a distance of at least one meter, avoiding crowds, and reducing mobility is the best effort to prevent COVID-19. Adolescents are non-compliant in implementing health protocols during the pandemic. Therefore, this study aimed to investigate the level of compliance with the 5M health protocols. It also examines the relationship between self-efficacy, motivation, and compliance with health protocols. MATERIALS AND METHODS: Data analysis was conducted on a cross-sectional survey of 978 adolescents in Surabaya, Indonesia. Multiple logistic regression was performed to analyze the relationship between the three. Furthermore, adolescent self-efficacy was measured using the General Self Efficacy Scale (GSES), while motivation scale and sociodemographic questionnaire were measured to assess the motivation and characteristics of the respondents. RESULTS: Adolescent self-efficacy in compliance with health protocols is around (92.0%) with an average GSES score of 25.52 + 4.64. The analysis showed that adolescents with high self-efficacy and motivation had a high level of adherence (OR 2.804, 95% CI 2.008, 3.915) and high motivation (OR 2.926, 95% CI 2.087, 4.102), compared to those with low self-efficacy and motivation. CONCLUSIONS: The results suggested that initial identification of self-efficacy and motivation should be addressed to ensure compliance with health protocols to prevent the pandemic.

The global COVID-19 mass vaccination program has created a polemic amongst pro- and anti-vaccination groups on social media. However, the working mechanism on how the shared information might influence an individual decision to be vaccinated is still limited. This study embarks on adopting the elaboration likelihood model (ELM) framework. We examined the function of central route factors (information completeness and information accuracy) as well as peripheral route factors (experience sharing and social pressure) in influencing attitudes towards vaccination and the intention to obtain the vaccine. We use a factorial design to create eight different scenarios in the form of Twitter posts to test the interaction and emulate the situation on social media. In total, 528 respondents were involved in this study. Findings from this study indicated that both the central route and peripheral route significantly influence individually perceived informativeness and perceived persuasiveness. Consequently, these two factors significantly influence attitude towards vaccination and intention to obtain the vaccine. According to the findings, it is suggested that, apart from evidence-based communication, the government or any interested parties can utilize both experience sharing and social pressure elements to increase engagement related to COVID-19 vaccines on social media, such as Twitter.

To assist physicians identify COVID-19 and its manifestations through the automatic COVID-19 recognition and classification in chest CT images with deep transfer learning. In this retrospective study, the used chest CT image dataset covered 422 subjects, including 72 confirmed COVID-19 subjects (260 studies, 30,171 images), 252 other pneumonia subjects (252 studies, 26,534 images) that contained 158 viral pneumonia subjects and 94 pulmonary tuberculosis subjects, and 98 normal subjects (98 studies, 29,838 images). In the experiment, subjects were split into training (70%), validation (15%) and testing (15%) sets. We utilized the convolutional blocks of ResNets pretrained on the public social image collections and modified the top fully connected layer to suit our task (the COVID-19 recognition). In addition, we tested the proposed method on a finegrained classification task; that is, the images of COVID-19 were further split into 3 main manifestations (ground-glass opacity with 12,924 images, consolidation with 7418 images and fibrotic streaks with 7338 images). Similarly, the data partitioning strategy of 70%-15%-15% was adopted. The best performance obtained by the pretrained ResNet50 model is 94.87% sensitivity, 88.46% specificity, 91.21% accuracy for COVID-19 versus all other groups, and an overall accuracy of 89.01% for the three-category classification in the testing set. Consistent performance was observed from the COVID-19 manifestation classification task on images basis, where the best overall accuracy of 94.08% and AUC of 0.993 were obtained by the pretrained ResNet18 (P < 0.05). All the proposed models have achieved much satisfying performance and were thus very promising in both the practical application and statistics. Transfer learning is worth for exploring to be applied in recognition and classification of COVID-19 on CT images with limited training data. It not only achieved higher sensitivity (COVID-19 vs the rest) but also took far less time than radiologists, which is expected to give the auxiliary diagnosis and reduce the workload for the radiologists.

We characterized coronavirus disease 2019 (COVID-19) breakthrough cases admitted to a single center in Florida. With the emergence of delta variant, an increased number of hospitalizations was seen due to breakthrough infections. These patients were older and more likely to have comorbidities. Preventive measures should be maintained even after vaccination.

In this study, we analyzed full-length SARS-CoV-2 genomes from multiple countries to determine early trends in the evolutionary dynamics of the novel COVID-19 pandemic Results indicated SARS-CoV-2 evolved early into at least three phylogenetic groups, characterized by positive selection at specific residues of the accessory proteins ORF3a and ORF8 Also, we are reporting potential relevant sites under positive selection at specific sites of non-structural proteins nsp6 and helicase Our analysis of co-evolution showed evidence of epistatic interactions among sites in the genome that may be important in the generation of variants adapted to humans These observations might impact not only public health but also suggest that more studies are needed to understand the genetic mechanisms that may affect the development of therapeutic and preventive tools, like antivirals and vaccines Collectively, our results highlight the identification of ongoing selection even in a scenario of conserved sequences collected over the first 3 months of this pandemic

How to cite this article: Tyagi N. Prevalence of Bloodstream Infections and their Etiology in COVID-19 Patients: A Tale of Two Cities. Indian J Crit Care Med 2021;25(4):355C357.

A survey-based pilot study was performed to examine the feasibility of videoconferencing to facilitate multidisciplinary rounds following the initiation of strict isolation and social distancing policies in a pediatric intensive care unit (PICU). The use of a mobile workstation was implemented as the central hub for rounding at the bedside by the attending physicians, while other members of the multidisciplinary and multispecialty team joined rounds from other locations with maintaining appropriate social distance. Fifty-eight staff members who participated in videoconferencing rounds completed the postimplementation survey. Eighty-eight per cent of staff agreed that the use of videoconferencing to facilitate rounds was an effective strategy to maintain social distancing between team members during the pandemic. Sixty-four percent of staff agreed that the use of videoconferencing improved participation of the PICU team and consultants by increasing access to rounds. Over 50% of staff agreed that the use of videoconferencing improved the efficiency of rounds and team productivity. Only 4% of staff responded that videoconferencing increased the duration of rounds and 37% responded that it decreased resident and team education. Fifty-five percent of staff agreed that videoconferencing was used to promote parental participation during this pandemic month. Videoconferencing was found to be a feasible solution to safely conduct multidisciplinary rounds while maintaining social distancing, and participants found it effective without interfering with normal workflow. Incorporating videoconferencing into traditional rounding practices may be advantageous following the pandemic to improve team and family access to rounds and workflow efficiency and rounding structure.

This chapter reviews the basic principles of medical management of rat colonies and diagnostic approaches to detect infectious diseases of rats. Due to the fact that a comprehensive colony health monitoring program is so vital in protecting the validity and reproducibility of experimental research data, it must be devoted an appropriate priority in terms of budget, personnel, and other resources. The policies and practices should be defined in written plans, and agreement with the principles set forth should be secured by the scientific and administrative leadership of the institution, as well as by the veterinary and animal care group. Programs should be designed to monitor individual animal health through the use of direct methods such as close observation and physical examination. A program created to monitor the overall health status of a colony population often utilizes more indirect methods. Routine testing of selected representative animals (even in the absence of any signs of illness or disease) can provide valuable information regarding the viral, parasitic, and bacterial agents that such animals are either currently harboring or have been exposed to in the past. Risk analysis should be done by any institution planning on holding rodents, a process that should involve a discussion of the relative costs and benefits of the various options available for routine health monitoring as well as quarantine isolation and testing.

Surgery remains the curative treatment modality for colorectal cancer in all stages, including stage IV with resectable liver metastasis. There is emerging evidence that the stress response caused by surgery as well as other perioperative therapies such as anesthesia and analgesia may promote growth of pre-existing micro-metastasis or potentially initiate tumor dissemination. Therapeutically targeting the perioperative period may therefore reduce the effect that surgical treatments have in promoting metastases, for example by combining -adrenergic receptor antagonists and cyclooxygenase-2 (COX-2) inhibitors in the perioperative setting. In this paper, we highlight some of the mechanisms that may underlie surgery-related metastatic development in colorectal cancer. These include direct tumor spillage at the time of surgery, suppression of the anti-tumor immune response, direct stimulatory effects on tumor cells, and activation of the coagulation system. We summarize in more detail results that support a role for catecholamines as major drivers of the pro-metastatic effect induced by the surgical stress response, predominantly through activation of -adrenergic signaling. Additionally, we argue that an improved understanding of surgical stress-induced dissemination, and more specifically whether it impacts on the level and nature of heterogeneity within residual tumor cells, would contribute to the successful clinical targeting of this process. Finally, we provide a proof-of-concept demonstration that ex-vivo analyses of colorectal cancer patient-derived samples using RGB-labeling technology can provide important insights into the heterogeneous sensitivity of tumor cells to stress signals. This suggests that intra-tumor heterogeneity is likely to influence the efficacy of perioperative -adrenergic receptor and COX-2 inhibition, and that ex-vivo characterization of heterogeneous stress response in tumor samples can synergize with other models to optimize perioperative treatments and further improve outcome in colorectal and other solid cancers.

BACKGROUND Web-based mindfulness programs may be beneficial in improving the well-being outcomes of those living with chronic illnesses. Adherence to programs is a key indicator in improving outcomes; however, with the digitization of programs, it is necessary to enhance engagement and encourage people to return to digital health platforms. More information is needed on how engagement strategies have been used in web-based mindfulness programs to encourage adherence. OBJECTIVE The aim of this study is to develop a list of engagement strategies for web-based mindfulness programs and evaluate the impact of engagement strategies on adherence. METHODS A narrative systematic review was conducted across the MEDLINE Complete, CINAHL Complete, APA PsycINFO, and Embase databases and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Articles were screened using the population, intervention, comparator, and outcome framework. Adults aged >18 years with chronic health conditions were included in the study. Mindfulness interventions, including those in combination with mindfulness-based cognitive therapy, delivered on the web through the internet or smartphone technology were included. Interventions lasted at least 2 weeks. Studies with a randomized controlled trial design or a pilot randomized controlled trial design were included. Engagement strategies, including web-based program features and facilitator-led strategies, adherence, and retention, were included. RESULTS A total of 1265 articles were screened, of which 19 were relevant and were included in the review. On average, 70.98% (2258/3181) of the study participants were women with a mean age of 46 (SD 13) years. Most commonly, mindfulness programs were delivered to people living with mental health conditions (8/19, 42%). Of the 19 studies, 8 (42%) used only program features to encourage adherence, 5 (26%) used facilitator-led strategies, and 6 (32%) used a combination of the two. Encouraging program adherence was the most common engagement strategy used, which was used in 77% (10/13) of the facilitator-led studies and 57% (8/14) of the program feature studies. Nearly two-thirds (63%) of the studies provided a definition of adherence, which varied between 50% and 100% completion across studies. The overall mean participant compliance to the mindfulness programs was 56% (SD 15%). Most studies (10/19, 53%) had a long-term follow-up, with the most common follow-up period being 12 weeks after intervention (3/10, 30%). After the intervention, the mean retention was 78% (SD 15%). CONCLUSIONS Engagement strategies in web-based mindfulness programs comprise reminders to use the program. Other features may be suitable for encouraging adherence to interventions, and a facilitator-led component may result in higher retention. There is variance in the way adherence is measured, and intervention lengths and follow-up periods are inconsistent. More thorough reporting and a standardized framework for measuring adherence are needed to more accurately assess adherence and engagement strategies.

Although the respiratory tract is the main target of SARS-CoV-2, other tissues and organs are permissive to the infection. In this report, we investigated this wide-spectrum tropism by studying the SARS-CoV-2 genetic intra-host variability in multiple tissues. The virological and histological investigation of multiple specimens from a post-mortem COVID-19 patient was performed. SARS-CoV-2 genome was detected in several tissues, including the lower respiratory system, cardio-vascular biopsies, stomach, pancreas, adrenal gland, mediastinal ganglion and testicles. Subgenomic RNA transcripts were also detected, in favor of an active viral replication, especially in testicles. Ultra-deep sequencing allowed us to highlight several SARS-CoV-2 mutations according to tissue distribution. More specifically, mutations of the spike protein, i.e., V341A (18.3%), E654 (44%) and H655R (30.8%), were detected in the inferior vena cava. SARS-CoV-2 variability can contribute to heterogeneous distributions of viral quasispecies, which may affect the COVID-19 pathogeny.

The recent Zika and Ebola virus outbreaks highlight the need for low-cost diagnostics that can be rapidly deployed and used outside of established clinical infrastructure. This demand for robust point-of-care (POC) diagnostics is further driven by the increasing burden of drug-resistant diseases, concern for food and water safety, and bioterrorism. As has been discussed in previous chapters, paper-based tests provide a simple and compelling solution to such needs.

Food waste is a global problem, causing significant environmental harm and resulting in substantial economic losses globally. Bread is the commonly wasted food item in the developed world and presents a severe problem for the majority of European nations. It is the second most wasted food item in the UK after potatoes, with an equivalent of 20 million slices of bread thrown away daily. Bread is a starchy material and a rich and clean source of easily extractable fermentable sugars - this is in direct contrast to lignocellulosic feedstocks where harsh physical, chemical and/or enzymatic pretreatment processes are required for release of fermentable sugars. Furthermore, these necessary lignocellulosic pretreatment methods often produce sugars contaminated with fermentation inhibitors. Therefore, bread waste presents a clear opportunity as a potential carbon source for novel commercial processes and, to this end, several alternative routes have been developed to utilize bread waste. Possibilities for direct recycling of bread waste within the food industry are limited due to the relatively short material lifetime, stringent process and hygiene requirements. Anaerobic digestion (AD) and incineration are commonly employed methods for the valorisation of bread waste, generating limited amounts of green energy but with little other environmental or economic benefits. Most food wastes and by-products in the UK including bakery waste are treated through AD processes that fail to harness the full potential of the these wastes. This short communication reviews the challenges of handling bread waste, with a focus on a specific UK scenario. The review will consider how bread waste is generated across the supply chain, current practices to deal with the waste and logistics challenges in waste collection. The presence of clean and high-quality fermentable sugars, proteins and other nutrients in bread make it an ideal substrate for generating chemicals, fuels, bioplastics, pharmaceuticals and other renewable products through microbial fermentations. We suggest potential applications for recycling bread waste into its chemical building blocks through a fermentative route where a circular biorefining approach could maximize resource recovery and environmental savings and eliminate waste to as close to zero as possible.

The National Program for Linking Academic Institutes with Industrial Sectors (Faculty for Factory) is distinguished as the first of its kind in Jordan and the region, and one of the best programs in the world Its idea is characterized as a non-traditional one, applicable to the mechanism of linking academic institutions to the productive community represented by the industrial sector Development of an applied model of cooperation between industrial companies (SMEs) and academic institutions During the life cycle of the program in 2020, Covid-19 virus appeared in the world, where the program worked to develop its goals and the nature of its work to confront the virus in all possible academic ways, starting from directing students and academics to work under one goal in proposing and adopting various ideas that contribute to supporting the Jordanian government in facing the virus FFF also participated in various governmental tasks such as providing the crisis cell responsible for planning in the Crisis Management Center with the academics who are required to complete the planning process according to the best scientific practices, in addition to participating in the various committees formed by the Prime Minister and concerned with the promotion of manufacturing operations ? 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG

In clinical trials with time-to-event outcome as the primary endpoint, the end of study date is often based on the number of observed events, which drives the statistical power and the sample size calculation. It is of great value for study sponsors to have a good understanding of the recruitment process and the event milestones to manage the logistical tasks, which require a considerable amount of resources. The objective of the proposed statistical approach is to predict, as accurately as possible, the timing of an analysis planned once a target number of events is collected. The method takes into account the enrollment, the time to event, and the time to censor processes, using Weibull models in a Bayesian framework. We also consider a possible delay in the event reporting by the investigators, and covariates may also be included. Several metrics can be obtained, such as the probability of study completion at specific timepoints or the credible interval of the date of study completion. The approach was applied to oncology trials, with progression-free survival as primary outcome. A retrospective analysis shows the accuracy of the approach on these examples, as well as the benefit of updating the predictive probability of study completion as data are accumulating or new information becomes available. We also evaluated the performances of the proposed method in a comprehensive simulation study.

Background: The prevalence of SARS-CoV-2 infections in Ontario is disproportionately concentrated in areas with lower-income and racialized groups. We examined whether school-level and area-level socio-economic factors were associated with elementary school student infections in Ontario. Methods: We performed multi-level modeling analyses using data from the Ministry of Education on school-based infections in Ontario in the 2020-21 school year and on school-level demographics, the Ontario Marginalization Index, and census data to estimate the variability of the cumulative incidence of SARS-CoV-2 infections amongst elementary school students attributable to individual schools (school level, Level 1) and forward sortation areas (FSAs) of schools (area level, Level 2). We explored whether socio-economic factors within individual schools and/or factors common to schools within FSAs predicted the incidence of elementary school student infections. Results: At the school level, the proportion of students from low-income households within a school was positively related with the cumulative incidence of SARS-CoV-2 elementary school student infections ({beta}=.083,p<0.001). At the area level, the dimensions of FSA marginalization were significantly related with cumulative incidence. Ethnic concentration ({beta}=.454,p<0.001), residential instability ({beta}=.356,p<0.001), and material deprivation ({beta}=.212,p<0.001) were positively related. Area-related variables were more likely to explain variance in cumulative incidence than school-related variables (58% versus 1%, respectively). Interpretation: Socio-economic characteristics of the geographic location of schools were more important in determining the cumulative incidence of SARS-CoV-2 elementary school student infections than individual school characteristics. Given inequitable effects of protracted education disruption, schools in marginalized areas should be prioritized for infection prevention measures and education continuity and recovery plans.

Maritime activities are an important part of the European economy as many goods are transported by ship. Ports are important players in the maritime sector because they provide the infrastructure for many maritime activities. Therefore, the potential impact of the port on the local carbon footprint should not be underestimated.