The most common method for SARS-CoV-2 testing is throat or nasal swabbing by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. In South Korea, drive-through swab test is used for screening system and community treatment centers (CTCs), which admit and treat confirmed COVID-19 patients with mild symptoms, are being used. This retrospective study was conducted on patients admitted to a CTC on March 6, 2020. A total of 313 patients were admitted. The nasal and throat swabs were collected from the upper respiratory tract, and a sputum test was performed to obtain lower respiratory samples. The positive rate of the first set of test, sputum test was higher than that of the swab test (p = 0.011). In the second set of test, 1 week after the first ones, the rate of positive swab tests was relatively high (p = 0.026). In the first set of test, 66 of 152 (43.4%) patients showed 24-h consecutive negative swab test results, when the sputum test results were considered together, that number fell to 29 patients (19.1%) (p < 0.001). Also, in the second set of test, 63 of 164 (38.4%) patients met the discharge criteria only when the swab test was considered; that number fell to 30 (18.3%) when the sputum test results were also considered (p < 0.001). Using the swab test alone is insufficient for screening test and discharge decision. Patients who may have positive result in the sputum test can be missed.

Background: The COVID-19 crisis has introduced a variety of stressors, while simultaneously decreasing the availability of strategies to cope with stress In this context, it could be useful to understand issues that people find most concerning and ways in which they cope with stress In this study, we explored these questions with a sample of graduate and professional students Method: Using open-ended assessments, we asked participants (n = 305) to identify their biggest challenge or concern ("top problem"), their most effective way of handling stress ("effective strategy"), and their most common way of handling stress ("common strategy") We applied thematic analysis and evaluated whether participants' strategies corresponded with evidence-based practices (EBPs) Results: Participants frequently reported top problems relating to productivity (27% of sample), physical health (26%), and emotional health (14%) Distraction was the most frequently classified common strategy (43%), whereas behavioral activation was the most frequently identified effective strategy (50%) Participants who reported a common strategy classified as an EBP reported lower depressive and anxiety symptoms In contrast, there was no evidence of an association between symptom levels and whether or not participants' effective strategy was an EBP Participants who reported the same strategy as both their common and effective strategy (29%) reported lower depressive symptoms than those whose common and effective strategies were different Conclusion: Our findings highlight stressors that students are experiencing and ways they are coping during the COVID-19 crisis We discuss how these findings can inform mental health promotion efforts and future research on coping with stressors

AIM: Experimental studies provided numerous evidence that caloric/dietary restriction may improve health and increase the lifespan of laboratory animals, and that the interplay among molecules that sense cellular stress signals and those regulating cell survival can play a crucial role in cell response to nutritional stressors. However, it is unclear whether the interplay among corresponding genes also plays a role in human health and lifespan. METHODS: Literature about roles of cellular stressors have been reviewed, such as amino acid deprivation, and the integrated stress response (ISR) pathway in health and aging. Single nucleotide polymorphisms (SNPs) in two candidate genes (GCN2/EIF2AK4 and CHOP/DDIT3) that are closely involved in the cellular stress response to amino acid starvation, have been selected using information from experimental studies. Associations of these SNPs and their interactions with human survival in the Health and Retirement Study data have been estimated. The impact of collective associations of multiple interacting SNP pairs on survival has been evaluated, using a recently developed composite index: the SNP-specific Interaction Polygenic Risk Score (SIPRS). RESULTS: Significant interactions have been found between SNPs from GCN2/EIF2AK4 and CHOP/DDI3T genes that were associated with survival 85+ compared to survival between ages 75 and 85 in the total sample (males and females combined) and in females only. This may reflect sex differences in genetic regulation of the human lifespan. Highly statistically significant associations of SIPRS [constructed for the rs16970024 (GCN2/EIF2AK4) and rs697221 (CHOP/DDIT3)] with survival in both sexes also been found in this study. CONCLUSION: Identifying associations of the genetic interactions with human survival is an important step in translating the knowledge from experimental to human aging research. Significant associations of multiple SNPxSNP interactions in ISR genes with survival to the oldest old age that have been found in this study, can help uncover mechanisms of multifactorial regulation of human lifespan and its heterogeneity.

BACKGROUND This study aimed to describe the presentation and outcomes of horses with signs of colic (abdominal pain) seen 'out-of-hours' in equine practice. METHODS This was a retrospective study of horses seen 'out-of-hours' with colic by two equine veterinary practices between 2011 and 2013. Case outcomes were categorised as 'critical' or 'not critical'. A critical outcome was defined as requiring medical or surgical hospital treatment, or resulting in euthanasia or death. A non-critical outcome was defined as resolving with simple medical treatment. A hierarchical generalised linear model was used to identify 'red flag' parameters (aspects of signalment, history and presenting clinical signs) associated with critical outcomes. RESULTS Data were retrieved from 941 cases that presented with colic; 23.9 per cent (n=225/941) were critical. Variables significantly associated with the likelihood of a critical outcome in the final multivariable model were increased heart rate (P<0.001), age of the horse (P=0.013) and abnormal mucous membrane colour (P<0.001). Overall 18 per cent (n=168/941) of cases were euthanased. CONCLUSIONS This study highlights the mortality associated with colic. The 'red flag' parameters identified should be considered an essential component of the primary assessment of horses with colic.

The utility of endovascular thrombectomy for acute occlusion of the distal intracranial artery (A2/A3/M2/M3/P2/P3) is unclear, and aspiration and stent thrombectomy are associated with risk of bleeding. We analyzed patients with acute occlusion of the distal intracranial artery to assess the safety and efficacy of microcatheter-based tirofiban infusion.We retrospectively reviewed data of the endovascular thrombectomy registry of our center between January 2018 and June 2019. Patients with distal intracranial artery occlusion who underwent endovascular thrombectomy with microcatheter-based infusion of tirofiban were recruited.Of 13 patients included, 1 presented with anterior cerebral artery occlusion, 2 with posterior cerebral artery occlusion, 2 with posterior inferior cerebellar artery occlusion, and 7 with middle cerebral artery M2 occlusion. The mean National Institute of Health Stroke scale score was 10.1 (3-19). Three patients (23.1%) underwent bridging treatment of intravenous thrombolysis with recombinant plasminogen activator and endovascular thrombectomy. The arithmetic mean onset-to-recanalization time was 696.3 minutes (140-1440) and average operating time was 47.1 minutes (30-80). After treatment, 10 patients (76.9%) underwent revascularization. No operative complications were observed in any case. All patients underwent angiography and were reviewed 7 to 14 days after surgery. Imaging revealed significant improvements in recanalization compared with the immediate postoperative period, with no reoccurrence of occlusion. The mean modified Rankin scale score at the 3-month follow-up was 0.54 (0-2).Microcatheter-based infusion of bolus-dose tirofiban can result in safe and effective recanalization of acute occlusion of the distal artery in the case of a relatively light thrombotic load.

Introduction: The Covid -19 Pandemic had caused a worldwide crisis leading to many negative consequences on healthy habits, biomechanical system, and mental health to students and workers. The National University is the main University in Colombia;it has around 30.000 students and 10.000 workers. Due to the Pandemic, many workers had to work from home, which generated consequences that had to be interrupted. Material and Methods: Through the application of many virtual surveys, we could choose the main topics to be included in this strategy. Finally we selected the next ones and worked on them from our office: - biomechanical, due to the new physical ergonomics conditions. - psychosocial, related to many factors as epidemic Pandemic behavior, new family issues at home, addictions, etc. - nutrition facts, because of inadequate eating habits. - cardiovascular, due to the aspects listed above, and sedentary lifestyle. - occupational health facts, remembering the importance of preventing work-related injuries. Results and Conclusions: Many employees and students at our university had been highly motivated to go back on having healthy habits, which, in some cases have had a positive impact on their families;who have been sharing the same home space with the workers during the Pandemic. According to the intervention developed by our Occupational Health Office, in alliance with the Universitys Faculty of Medicine, we are improving our workers lifestyle, which will have positive impacts on them and their families. It represents such an important aspect that will ameliorate our community public health results.

Unlike previous outbreaks like SARS and MERS, caused by corona family viruses, COVID-19 became a much worse worldwide pandemic. SARS CoV-2, another coronavirus, causes it. Finding effective therapeutics against this global health crisis became a significant challenge for researchers. However, Allopathic medicine is effective to some extent with severe side effects, which cause concern. In this process, some researchers focused on natural compounds like plant-synthesized secondary metabolites (PSMs) for the treatment of COVID-19. Because these natural compounds like PSMs had a history of tackling a wide range of viral pathogens successfully without significant side effects. Many medicinal plants from different families have antiviral activities. This review intends to systematically evaluate the natural metabolites that could be used against this new disease looking at their natural sources, mechanism of action, and previous pharmacological usages. So, it can be a good initiation for the greater goal of finding effective natural therapeutics for the treatment of Covid-19 without any severe side effects.

OBJECTIVES: The aim was to evaluate the safety and effectiveness of thalidomide, an immunomodulatory agent, in combination with glucocorticoid, for the treatment of COVID-19 patients with life-threatening symptoms. METHODS: A nonrandomized comparative case series study was performed. Six patients received thalidomide 100 mg per day (with therapy lasting for 7 days) plus low-dose short-term dexamethasone, and 6 control patients matched with patients in the thalidomide group, received low-dose short-term treatment with dexamethasone alone. The main outcomes were: the duration of SARS-CoV-2 negative conversion from admission; length of hospital stay; and changes in inflammatory cytokine concentrations and lymphocyte subsets. RESULTS: The median thalidomide treatment time was 12.0 days. The median duration of SARS-CoV-2 negative conversion from admission and hospital stay length were briefer in the thalidomide group compared to the control group (respectively, 11.0 vs 23.0 days, P = 0.043; 18.5 vs 30.0 days, P = 0.043). The mean reduction rates at 7C10 days after treatment for serum interleukin-6 and interferon- concentrations were greater in the thalidomide group compared to the control group. Alterations in lymphocyte numbers in the subsets between the 2 groups were similar. CONCLUSIONS: Thalidomide plus short-term glucocorticoid therapy is an effective and safe regimen for the treatment of severely ill COVID-19 patients. The mechanism of action is most likely inhibition of inflammatory cytokine production.

Smartphones have been an alternative resource in emergency remote learning. In this paper, we introduce the Opi application, an educational game aimed at students from the 1st to the 5th grade of elementary school. The application was developed with the objective of contributing to the engagement and motivation of children in the context of remote classes during the Covid-19 pandemic, in addition to promoting the participation of parents in the process. The main functionalities and characteristics of Opi are described from a mobile game-based learning framework. We report the usability evaluation carried out with children and parents, listing the problems found and the suggestions and feedback. It ends with some lessons learned on the design and evaluation for children in the context of the pandemic and of mobile game-based learning. ? 2021 ACM.

OBJECTIVE: Sense of purpose has been associated with greater health and well-being, even in daily contexts. However, it is unclear whether effects would hold in daily life during COVID-19, when people may have difficulty seeing a path towards their life goals. DESIGN: The current study investigated whether purposefulness predicted daily positive affect, negative affect, and physical symptoms. Participants (n = 831) reported on these variables during the first weeks of the COVID-19 response in North America. MAIN OUTCOME MEASURES: Participants completed daily surveys asking them for daily positive events, stressors, positive affect, negative affect, physical symptoms, and purposefulness. RESULTS: Purposefulness at between- and within-person levels predicted less negative affect and physical symptoms, but more positive affect at the daily level. Between-person purposefulness interacted with positive events when predicting negative and positive affect, suggesting that purposeful people may be less reactive to positive events. However, between-person purposefulness also interacted with daily stressors, insofar that stressors predicted greater declines in positive affect for purposeful people. CONCLUSION: Being a purposeful person holds positive implications for daily health and well-being, even during the pandemic context. However, purposefulness may hold some consequences unique to the COVID-19 context, which merit attention in future research.

The current statistical modeling of coronavirus (COVID-19) spread has mainly focused on spreading patterns and forecasting of COVID-19 development; these patterns have been found to vary among locations. As the survival time of coronaviruses on surfaces depends on temperature, some researchers have explored the association of daily confirmed cases with environmental factors. Furthermore, some researchers have studied the link between daily fatality rates with regional factors such as health resources, but found no significant factors. As the spreading patterns of COVID-19 development vary a lot among locations, fitting regression models of daily confirmed cases or fatality rates directly with regional factors might not reveal important relationships. In this study, we investigate the link between regional spreading patterns of COVID-19 development in Italy and regional factors in two steps. First, we characterize regional spreading patterns of COVID-19 daily confirmed cases by a special patterned Poisson regression model for longitudinal count; the varying growth and declining patterns as well as turning points among regions in Italy have been well captured by regional regression parameters. We then associate these regional regression parameters with regional factors. The effects of regional factors on spreading patterns of COVID-19 daily confirmed cases have been effectively evaluated.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), was first identified in December 2019 in Wuhan, China, and has since spread worldwide. On March 11, 2020, the World Health Organization declared COVID-19 a pandemic (1). That same day, the first confirmed COVID-19-associated fatality occurred in New York City (NYC). To identify confirmed COVID-19-associated deaths, defined as those occurring in persons with laboratory-confirmed SARS-CoV-2 infection, on March 13, 2020, the New York City Department of Health and Mental Hygiene (DOHMH) initiated a daily match between all deaths reported to the DOHMH electronic vital registry system (eVital) (2) and laboratory-confirmed cases of COVID-19. Deaths for which COVID-19, SARS-CoV-2, or an equivalent term is listed on the death certificate as an immediate, underlying, or contributing cause of death, but that do not have laboratory-confirmation of COVID-19 are classified as probable COVID-19-associated deaths. As of May 2, a total of 13,831 laboratory-confirmed COVID-19-associated deaths, and 5,048 probable COVID-19-associated deaths were recorded in NYC (3). Counting only confirmed or probable COVID-19-associated deaths, however, likely underestimates the number of deaths attributable to the pandemic. The counting of confirmed and probable COVID-19-associated deaths might not include deaths among persons with SARS-CoV-2 infection who did not access diagnostic testing, tested falsely negative, or became infected after testing negative, died outside of a health care setting, or for whom COVID-19 was not suspected by a health care provider as a cause of death. The counting of confirmed and probable COVID-19-associated deaths also does not include deaths that are not directly associated with SARS-CoV-2 infection. The objective of this report is to provide an estimate of all-cause excess deaths that have occurred in NYC in the setting of widespread community transmission of SARS-CoV-2. Excess deaths refer to the number of deaths above expected seasonal baseline levels, regardless of the reported cause of death. Estimation of all-cause excess deaths is used as a nonspecific measure of the severity or impact of pandemics (4) and public health emergencies (5). Reporting of excess deaths might provide a more accurate measure of the impact of the pandemic.

INTRODUCTION General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. STUDY OBJECTIVE The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. METHODS A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. RESULTS These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs' ability to facilitate GP integration; and (2) DMs' difficulty engaging with GPs as a single group. Other considerations included GPs' limited DHM knowledge, limited preparedness, and their heightened vulnerability.Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. CONCLUSION Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

Contemporary organizations function in a complex business and operational environment composed of closely interdependent systems. They are also complex by their internal structure, management and deployed modern technologies. This complexity is not always well understood, and cannot be efficiently controlled. As the complexity and interdependencies increase, man-made systems become more unstable creating conditions for cascading, system-level failures causing serious threats to both themselves and society in general. Such breakdowns may consist of a) serious physical damages and destruction of their physical assets (caused by natural disasters, extreme weather phenomena and climate change, malicious human actions, etc.), and/or b) large functional disruptions with no physical damages of assets (caused by major organizations internal disturbances, market crashes, pandemics, disruptions of supply chains, etc.). Those sources of risks are basically external to organizations. They are unable to control them, but are deeply affected by those risks. The latest case of the COVID-19 pandemic demonstrates the above. It is affecting both all sectors of life and businesses worldwide. It convincingly shows that we need to think, plan and act globally in order to deal with such situations that will also take place in the future. Thus, organizations have to find ways of coping with this reality to remain economically viable. We are of opinion that the concepts of structured Asset Management (AM) and resilience put together may provide an efficient framework in this regard. Two case studies in a major North American electrical utility demonstrate the applicability of this approach: i) during an exceptional ice storm with significant damages of its physical assets, and ii) coping with challenges of COVID-19 with no destruction of its physical assets.

The argument of this theoretical paper is that the existence and availability of suitable digital curriculum resources, accelerated by the recent pandemic, have required a revision of the pedagogical landscape in terms of ways in which students can be empowered to (co-)design their own curriculum trajectories. For this purpose, I argue, students need to be supported in considering many connections, to arrive at coherent trajectories. Based on complexity thinking and curriculum design with digital resources, I propose the concept of connectivity as a crucial principle for creating coherent curriculum trajectories. If students are to become the co-designers of their own curriculum, they need a frame that raises their awareness about the many connections to be made and that supports their capability for actually realizing them. Drawing strongly on my own work and related work by others, I analyse and illustrate the connections made by students, teachers and curriculum designers in their design of mathematics tasks, lessons and learning trajectories with digital resources. Results show that connections can be made at several levels, namely, at a social level, at a material level, at programme level, and at a didactical level. Leaning on systems thinking, connections can be systematically considered, which is likely to help students to enhance the coherence of their designs. I contend that a student-designed connected curriculum trajectory is likely to become the focus of future research activities in innovative learning environments: this endeavor would connect aspects of curriculum, mathematical content, learning strategies of students, and the use of new technologies.

Background: Coronavirus disease (COVID-19) is a global pandemic with more than 60 million cases worldwide and over 1.5 million deaths by March 2021. Its outbreak has caused a huge burden on healthcare systems all over the world. Several studies in the medical literature have suggested that patients with underlying cardiovascular disease (CVD) are at higher risk for developing severe symptoms, poor prognosis, and high mortality rates. The aim of this study was to assess the prevalence of CVD risk factors among COVID-19 patients based on the Framingham risk score (FRS), and to evaluate the association of CVD risk factors with clinical outcomes. Patients and Methods: In this retrospective cross-sectional study, we identified 264 confirmed cases with COVID-19 at King Saud University Medical City in Riyadh, Saudi Arabia. Patients aged 18-80 years were included, and their electronic records were reviewed. They were classified into low, intermediate, and high risk of CVD according to FRS classification. Results: Two-hundred-six patients (67% male) were included in this study. The mean age was 55.3 15.1 years. Most patients had comorbidities: the most common were hypertension (48.1%), diabetes (45.1%), and ischemic heart disease (11.2%). More than half required intensive care admission, and 58 (28.2%) patients died. Pneumonia was the most frequently observed complication (85%), followed by mechanical ventilation (28.3%) and acute kidney injury (27.7%). Age, male gender, hypertension, and diabetes mellitus showed significant differences between FRS categories, and were associated with intermediate and high-risk groups of FRS (p < 0.05). Pneumonia and length of stay were associated with the Intermediate risk group of FRS. Conclusion: Cardiovascular disease risk factors are prevalent in Saudi patients infected with COVID-19. FRS could be a useful tool to identify CVD risk factors among COVID-19 patients and predict a complicated course.

Introgression, gene flow from one population into another, can be asymmetric. Yang et al. suggest that reduction of gene flow in one direction, rather than elevated gene flow in the opposite direction, explains the pattern of asymmetric introgression between two lizard lineages. The authors propose that a dominant male phenotype in one lineage blocks a submissive male phenotype from another lineage in mating with females of the opposite lineage. This case underscores just how capricious introgression can be.

Breath research during the SARS-CoV-2 pandemic offers an opportunity for discovery of a rapid point-of-care screening test, but also introduces a hazard to researchers collecting, transporting and analyzing breath samples not only for COVID -19 research, but all human breath-related research during the ongoing pandemic. Safe workflows to protect study participants and staff collecting and analysing the samples must be determined. We developed a SARS-CoV-2 breath test protocol for collection and processing of breath samples in ambulatory care COVID-19 testing sites and prospectively evaluated the protocol. 528 breath samples from 393 participants at COVID-19 testing sites were safely collected, transported, stored, and analysed with zero transmission to staff. Our method development for the safe collection of samples included the examination of 2 different filters for added safety. We discovered the use of filters leads to increased sample contamination and/or reduction of endogenous features in breath samples. Personal protective equipment (PPE) is essential for all breath collection while SARS-CoV-2 remains wide-spread through the general population. We have demonstrated that use of completely disposable breath collection devices and PPE, are sufficient for safe collection. Filters in the workflow add complexity to an already complex breath matrix and may compromise bio-safety.

PURPOSE The purpose of this study is to develop and assess the accuracy of a new intraocular lens (IOL) power calculation method based on machine learning techniques. METHODS The following data were retrieved for 260 eyes of 260 patients undergoing cataract surgery: preoperative simulated keratometry, mean keratometry of posterior surface, axial length, anterior chamber depth, lens thickness, and white-to-white diameter; model and power of implanted IOL; and subjective refraction at 3 months post surgery. These data were used to train different machine learning models (k-Nearest Neighbor, Artificial Neural Networks, Support Vector Machine, Random Forest, etc). Implanted lens characteristics and biometric data were used as input to predict IOL power and refractive outcomes. For external validation, a dataset of 52 eyes was used. The accuracy of the trained models was compared with that of the power formulas Holladay 2, Haigis, Barrett Universal II, and Hill-RBF v2.0. RESULTS The SD of the prediction error in order of lowest to highest was the new method (designated Karmona) (0.30), Haigis (0.36), Holladay 2 (0.38), Barrett Universal II (0.38), and Hill-RBF v2.0 (0.40). Using the Karmona method, 90.38% and 100% of eyes were within 0.50 and 1.00 D respectively. CONCLUSIONS The method proposed emerged as the most accurate to predict IOL power.

Background: While dialysis patients are at greater risk of serious SARS-CoV-2 complications, stringent infection prevention measures can help mitigate the risk of infection and transmission within dialysis facilities. We describe an outbreak of 14 cases diagnosed in a 13-day period between May and June of 2021 in a hospital-based ESRD facility, and our coordinated use of epidemiology, viral genome sequencing, and infection control practices to quickly end the cycle of transmission. Methods: Symptomatic patients and staff members were diagnosed via RT-PCR tests. Facility-wide screening was conducted using rapid SARS-CoV-2 antigen tests. SARS-CoV-2 genome sequences were obtained from residual diagnostic PCR specimens. Results: Of the 106 patients who received dialysis in the facility, 10 were diagnosed with SARS-CoV-2 infection, as was one patient support person. Of three positive staff members, two were unvaccinated and had provided care for six and four of the affected patients, respectively. Sequencing demonstrated that all the cases in the cluster shared an identical B.1.1.7./Alpha substrain. Attack rates were greatest among unvaccinated patients and staff. Vaccine effectiveness was 88% among patients. Conclusions: Prompt recognition of an infection cluster and rapid intervention efforts successfully ended the outbreak. Alongside consistent adherence to core infection prevention measures, vaccination was highly effective in reducing disease incidence and morbidity in this vulnerable population.