BACKGROUND: The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. METHODS: The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) delay group: CRC care affected by the pandemic; 2) no delay group: unaltered CRC practice. RESULTS: A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the delay (745, 70.9%) and no delay (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the delay group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the no delay group, while the geographical distribution was not. CONCLUSIONS: Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospitals preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care.

OBJECTIVE To understand how policies developed by Local Government Authorities (LGAs) to address electronic gambling machine (EGM) harm are developed and implemented. METHODS Semi-structured interviews were conducted with 16 participants from 15 LGAs in metropolitan Melbourne who worked in a role associated or aligned with gambling. An inductive thematic analysis was used to interpret the data. RESULTS Three key themes emerged. First, participants described a shift from addiction frameworks to public health policy responses to EGMs, which was driven by increasing EGM losses and the harms caused by EGMs to communities. Second, there was the role of stakeholder groups in the policy-making process, including the challenges associated with engaging the community. Finally, there were barriers and facilitators to policy development and implementation. Barriers included a lack of financial resources and legislative boundaries imposed by the State Government. Facilitators included whole-of-LGA approaches, supportive councillors and collaborative efforts. Conclusions and implications for public health: LGAs have made shifts towards public health responses to EGM harm. Initiatives to further support policy development and implementation could include imposing a levy on EGM losses to directly support public health prevention activities and implementing robust state-based regulatory frameworks that support LGA responses to EGM harm.

Antenatal steroid (ANS) therapy is standard care for women at imminent risk of preterm labor. Despite extensive and long-standing use, 40-50% of babies exposed antenatally to steroids do not derive benefit; remaining undelivered 7d or more after ANS treatment is associated with a lack of treatment benefit, and increased risk of harms. We used a pregnant sheep model to evaluate the impact of continuous vs. pulsed ANS treatments on fetal lung maturation at an extended, eight-day treatment to delivery interval. Continuous low-dose ANS treatments for more than 72 hours in duration improved fetal lung maturation at eight days after treatment initiation. If fetal ANS exposure was interrupted, the beneficial ANS effect was lost. Truncated treatments, including that simulating the current clinical treatment regimen, did not improve lung function. Variable fetal lung maturation was correlated to the amount of saturated phosphatidylcholine present in the lung fluid. These data demonstrate that: i) the durability of ANS therapy may be enhanced by employing an extended, low-dose treatment regimen with reducing total dose; and ii) interrupting the continuity of fetal exposure by allowing it to fall below a minimal threshold was associated with comparably poor functional maturation of the preterm ovine lung.

Structural transformation can spur economic growth and development if it increases overall productivity growth. A labor market environment that enables workers and enterprises to transition smoothly across sectors and into more productive economic pursuits can enhance the effect of structural transformation on economic growth. This study examines Ghanas recent record of structural transformation and labor market performance. Based on the findings, the study proposes ways to further transform the countrys economy, in a way that stimulates stronger, sustained growth and produces gainful, productive, and inclusive private employment. The COVID-19 pandemic and associated global economic crisis have posed a substantial setback to Ghanas economic progress and plans, but these challenges also underscore the need for structural transformation that can both strengthen economic performance and improve labor conditions and outcomes.

Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a whole of practice approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.

OBJECTIVE: The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN: This is a retrospective review. SETTING: The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS: The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS: A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES: Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS: A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS: The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.

Amidst the increasing clinical demands and social distancing constraints of COVID-19, Twitter-based, resident-driven education offers adaptability for the current predicament faced by residency programs and sparks curiosity that will outlast this pandemic.

The article addresses framework conditions and imperatives created by COVID-19 for tourism sector with the aim to prioritise the concept of destination resilience Resilience-oriented market framework is described within the fields that affect strategic positioning and product policy of destinations The article introduces a conceptual integrative model of destination resilience elaborated in the context of the post-COVID19 framework conditions The proposed directions of resilient orientation of tourism enterprises and destinations are justified with empirical evidence received from the survey on tour operators in Germany The research suggests considerations for future product development of resilient tourism products based on local resources and competences The component of personal resilience, mental wellbeing and spirituality is advocated for expansion of the destination value-chain The research concludes that the concept of destination resilience ensures increase of tourist attractiveness of destinations and competitiveness of their product portfolio as well as innovative business models for tourism enterprises

Reflecting on experiences in the United Arab Emirates, one professor?s thoughts on surveillance and human dignity is explored Different forms of surveillance are touched upon, including the use of ankle bracelets to track those who are infected with COVID-19 Human rights are touched upon offering observations and closing with the fact that the number of deaths, in the UAE, have been exceptionally low

Background: The novel Coronavirus disease (COVID-19) outbreak, caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), is seeing a rapid increase in infected people worldwide and linked with various risk factors. Objective: To find out the risk factors zone associated with Coronavirus disease among children under five age using malnourished status, pre-existing morbidity conditions, household environmental factors, and also with case fatality and active case rate of COVID-19 disease in India.Data sources & Methods: Data was utilized from the 4th round of the National Family Health Survey (NFHS), 2015-16, and CFR and ACR of COVID-19 related data from the Ministry of Health and Family Welfare (MoHFW) on 18th May 2020. Mean, standard deviation, and Z-score statistical methods have been employed to identify the risk factors zone and hot spot analysis (Getis-Ord Gi) has been used. Results: The states and UTs which have a high composite vulnerability score of the COVID-19 among under-5 children are Meghalaya (CVS=1), Uttar Pradesh (CVS=0.93), Jharkhand (CVS=0.86), Bihar, (CVS=0.74), Madhya Pradesh (CVS=0.74), and Odisha (CVS=0.55). The states and UTs which have low composite vulnerability score of the COVID-19 among under-5 children are Sikkim (CVS= -0.90), Daman & Diu (CVS= -0.76) Lakshadweep (CVS= -0.74), Kerala (CVS= -0.72), Chandigarh (CVS= -0.71). The COVID-19 vulnerable/ risk factors zone (hot spot: 99% Confidence interval [CI]) were observed in Madhya Pradesh, Uttar Pradesh, Jharkhand, Bihar, and Meghalaya states of India, which are spatially high clustered. The low rates of (cold spot: 95% CI) less vulnerable zones were observed in Kerala, Mizoram which is spatially low clustered. Conclusions: Well-built public health measures, including rapidly searching in high focus areas and testing of COVID-19, should be performed in vulnerable areas of COVID-19.

Public health surveillance is the systematic and ongoing collection, analysis and interpretation of data to produce information useful for decision-making. With the development of data science, surveillance methods are evolving through access to big data. More data does not automatically mean more information. For example, the massive amounts of data on Covid-19 was not easily transformed in useful information for decision-making. Further, data scientists have often difficulties to make their analyses useful for decision-making. For the implementation of evidence-based and data-driven public health practice, the culture of public health surveillance and population health monitoring needs to be strengthened.

Before vaccines for COVID-19 became available, a set of infection prevention behaviors constituted the primary means to mitigate the virus spread. Our study aimed to identify important predictors of this set of behaviors. Whereas social and health psychological theories suggest a limited set of predictors, machine learning analyses can identify correlates from a larger pool of candidate predictors. We used random forests to rank 115 candidate correlates of infection prevention behavior in 56,072 participants across 28 countries, administered in March-May 2020. The machine-learning model predicted 52% of the variance in infection prevention behavior in a separate test sampleexceeding the performance of psychological models of health behavior. Results indicated the two most important predictors related to individual-level injunctive norms. Illustrating how data-driven methods can complement theory, some of the most important predictors were not derived from theories of health behaviorand some theoretically-derived predictors were relatively unimportant.

OBJECTIVE: This study aims to explore factors associated with the work intention of hospital workers in the early stages of the coronavirus disease (COVID-19) outbreak in South Korea. METHODS: An online self-reported survey was conducted in a tertiary hospital. Respondents were asked to report their perceived threat and perceived risk of infection, evaluation of hospital response, demographics, and job-related factors. Descriptive statistics and multivariate regression analyses were performed. RESULTS: A total of 441 employees participated in this study. Of respondents, 60% were willing to accept their work during an infectious disease outbreak and 12.5% were unwilling to accept the work. In addition, 8% of respondents reported that they had considered quitting their job, 54.4% reported that their job was dangerous, and 50.1% of respondents perceived the severity of COVID-19 as high. Perceived threat and effectiveness of hospital response were associated with hospital employees intention to work. CONCLUSIONS: Hospital workers are at the front line of the COVID-19 outbreak. This study highlighted hospital workers perceived effectiveness of organizational response to the outbreak, and perceived threats were found to be important factors for whether they continued to work or not in the fight against the outbreak.

Although COVID-19 has caused severe suffering globally, the efficacy of nonpharmaceutical interventions has been greater than typical models have predicted. Meanwhile, evidence is mounting that the pandemic is characterized by superspreading. Capturing this phenomenon theoretically requires modeling at the scale of individuals. Using a mathematical model, we show that superspreading drastically enhances mitigations which reduce the overall personal contact number and that social clustering increases this effect.

Due to the prevalence of the COVID-19 pandemic, the demand for disposable facemasks has become a global issue. Unfortunately, the use of these products has negative effects on the environment, and therefore, the use of biodegradable materials is a powerful strategy to overcome this challenge. Aligned with this concept, in this work, biodegradable facemasks were developed using poly(-caprolactone) (PCL) polymer and cotton natural fibers. The filter layer was produced using an electrospinning technique, since electrospun membranes present remarkable characteristics for air filtration. The electrospun membranes were functionalized with different nanoparticles (NPs), including silver (Ag), titanium dioxide (TiO2) and magnesium oxide (MgO), in order to include new properties, namely antibacterial effect. The developed membranes were characterized by FESEM, EDS, ATR-FTIR, GSDR and TGA, which confirmed the successful impregnation of NPs onto PCL membranes. The antibacterial effect and filtration efficiency were assessed, with the PCL/MgO NPs membrane presenting better results, showing inhibition zone diameters of 25.3 and 13.5 mm against Gram-positive and Gram-negative bacteria, respectively, and filtration efficiency of 99.4%. Three facemask prototypes were developed, and their filtration efficiency, air permeability and thermal comfort were evaluated. Overall, this study demonstrates the potential of PCL/NPs electrospun membranes to act as an active and biodegradable filter layer in facemasks.

Interferons have prominent roles in various pathophysiological conditions, mostly related to inflammation. Interferon-gamma (IFN) was, initially discovered as a potent antiviral agent, over 50 years ago, and has recently garnered renewed interest as a promising factor involved in both innate and adaptive immunity. When new disease epidemics appear such as SARS-CoV (severe acute respiratory syndrome coronavirus), MERS-CoV (Middle East respiratory syndrome coronavirus), IAV (Influenza A virus), and in particular the current SARS-CoV-2 pandemic, it is especially timely to review the complexity of immune system responses to viral infections. Here we consider the controversial roles of effectors like IFN, discussing its actions in immunomodulation and immunotolerance. We explore the possibility that modulation of IFN could be used to influence the course of such infections. Importantly, not only could endogenous expression of IFN influence the outcome, there are existing IFN therapeutics that can readily be applied in the clinic. However, our understanding of the molecular mechanisms controlled by IFN suggests that the exact timing for application of IFN-based therapeutics could be crucial: it should be earlier to significantly reduce the viral load and thus decrease the overall severity of the disease.

Subclinical inflammation has been associated with psychosis; however, it remains unknown whether this phenomenon appears also in the premorbid phase. Therefore, we performed a systematic review and meta-analysis of studies comparing peripheral blood levels of C-reactive protein (CRP) and cytokines between individuals at risk of psychosis and controls. Moreover, we tested the hypothesis that the levels of these markers may be different in high-risk converters versus non-converters. Two independent reviewers searched electronic databases until Dec 16th, 2020. After reviewing publication records, 16 studies (548 high-risk individuals and 559 controls) were included. Random-effects meta-analyses with Hedges' g as the effect size estimate were performed. Individuals at clinical risk of psychosis had significantly higher levels of interleukin-6 (IL-6) compared to controls (g = 0.33, 95%CI: 0.06-0.60, p = 0.018). Heterogeneity was not significant in this subgroup analysis. Changes in the levels of IL-6 in subjects at familial risk of psychosis were not significant (g = 0.04, 95%CI: -0.24 to 0.31, p = 0.798). The use of antidepressants was associated with significantly higher levels of IL-6 in high-risk individuals (Beta = 1.56, 95%CI: 0.60-2.53, p = 0.001). No significant differences in the levels of immune-inflammatory markers were found between high-risk converters and non-converters. Our findings suggest that individuals at clinical risk of psychosis show subclinical inflammation in terms of elevated IL-6 levels. This phenomenon might be related to the use of antidepressants. The present meta-analysis does not support the usefulness of single immune-inflammatory markers in predicting transition to psychosis.

This chapter seeks to survey many of the common pathological entities identified in the lungs at autopsy and the potential role of pulmonary disease in formulating an opinion regarding the cause of death. Appreciation of pulmonary pathology in the medicolegal context is important as it frequently contributes to the immediate or underlying mechanisms of death. The primacy of the lungs in breathing and their coordinated function with the cardiovascular system means that -pulmonary failure can rapidly compromise tissue oxygenation and body chemistry, leading to an alteration in blood pH, hypoxic damage to downstream tissues and ultimately multiorgan failure and death. Moreover, given that the lungs have direct contact with the environment through inhalation and receive approximately 50% of the cardiac output with each beat of the heart, they may be adversely affected by hazardous agents from the outside world or other pathologic processes not primarily located in the lungs. The range of topics discussed herein is limited by design to deaths due to disease and largely foregoes discussion of more forensically relevant issues relating to toxicology or trauma. Furthermore, the content and format of this chapter is not intended to be encyclopedic, but rather attempts to highlight selected issues regarding pulmonary disease of potential relevance to surgical or forensic pathologists who perform medicolegal postmortem examinations.

The new coronavirus pneumonia (NCP), also named as COVID-19 by WHO on Feb 11 2020, is now causing a severe public health emergency in China since. The number of diagnosed cases is more than 40,000 until the submission of this manuscript. Coronavirus has caused several epidemic situations world widely, but the present contagious disease caused by 2019 new coronavirus is unprecedentedly fulminating. The published cohorts of 2019 new coronavirus (n-Cov) are single-center studies, or retrospective studies. We here share the therapeutic experiences of NCP treatment with literature review. Combination of Ribavirin and interferon- is recommended by the 5(th) edition National Health Commission's Regimen (Revised Edition) because of the effect on Middle East respiratory syndrome (MERS), and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial (RCT), given the situation of no specific antivirus drug on NCP is unavailable. Systemic glucocorticosteroid is recommended as a short term use (1~2 mgkg(-1)d(-1), 3~5 d) by the 5(th) edition National Health Commission's Regimen (Revised Edition) yet RCTs are expected to confirm the effectiveness. Inappropriate application of antibiotics should be avoided, especially the combination of broad-spectrum antibiotics, for the NCP is not often complicated with bacterial infection.

The effect of the COVID-19 related stressors on the mental health of both infected patients and the general public has been well established. However, knowledge is limited on how psychosocial support buffers the association. This study aimed to examine this buffering role in the context of China. We utilized cross-sectional data collected online in mid-March 2020, involving 585 respondents. Mental health status was determined through depression symptoms and loneliness. COVID-19 related stressors include three aspects: perceived severity, perceived threat to life and health, and perceived risk of COVID-19 infection. Psychosocial support included family and social supports. Analyses include ordinary linear regression. The finding showed that psychosocial support buffered the negative effect of loneliness in the context of perceived severity of COVID-19, but appeared to intensify the negative effect of depression symptoms in the context of perceived threat to life and health. However, there was no significant buffering effect on depression or loneliness in the context of the perceived risk of infection. The buffering effect of psychosocial support on COVID-19 related stressors is of mixed patterns. This study contributes to the emerging body of literature trying to understand how the COVID-19 impacts the mental health of individuals.