ABSTRACT IMPACT: These findings identify a new way in which the COVID-19 pandemic exacerbates racial/ethnic health disparities, and will thus direct future research to explore potentially avoidable hospitalizations, as well as direct health policy to improve the value of this specific aspect of care without further widening the disparity. OBJECTIVES/GOALS: Racial and ethnic disparities in potentially avoidable hospitalizations predate COVID-19. In order to identify and address healthcare disparities exacerbated by the pandemic, we examined whether and to what extent the pandemic affected numbers of potentially avoidable hospitalizations by race and ethnicity. METHODS/STUDY POPULATION: This single-center pre-post study of 904 patients at UCLA included all patients admitted to an internal medicine service for an ambulatory care sensitive condition (ACSC) between March-August of 2020 (post) and March-August of 2019 (pre). We measured the change in number of potentially avoidable hospitalizations (defined per the Agency for Healthcare Research and Quality guidelines) stratified by race and ethnicity. We calculated 95% CIs for the number of potentially avoidable hospitalizations using a cluster bootstrap procedure, clustering at the level of patients. We inverted the bootstrap CIs to calculate p-values for overall changes within racial/ethnic groups as well as differential changes between groups. Patients with missing or unspecified racial/ethnic data were excluded (n=1,003; 7.8%). RESULTS/ANTICIPATED RESULTS: Between March 1 and August 31, 2020, 347 out of 4,838 hospitalizations (7.2%) were potentially avoidable, compared to 557 out of 6,248 (8.9%) during the same 6-months of 2019. Reductions in potentially avoidable hospitalizations among Non-Hispanic White (-50.3%; 95% CI, -60.9 - -41.2; p<0.001) and Latinx (-32.3%; 95% CI, -59.8 - -12.2%, p<0.001) patients were statistically significant, whereas reductions among African American (-8.0%; 95% CI, -39.9 - +16.2) and Asian (-16.1%; 95% CI, -75.7 - +20.4) patients were not statistically different from 0%. The relative differences in magnitudes of reduction were only statistically significant between African American and non-Hispanic White patients (-50.3% v. -8.0%; 95% CI as above; p=0.015). DISCUSSION/SIGNIFICANCE OF FINDINGS: Racial disparities in potentially avoidable hospitalizations increased during the COVID-19 pandemic at this large urban health system. Healthcare leaders, researchers, and policy makers should focus on efforts to prevent a post-pandemic resurgence of low-value hospitalizations in ways that do not further widen disparities.

This study aimed to explore the lived experiences of six international and mature online learners studying on an undergraduate psychology course to identify barriers and facilitators to studying online. A secondary aim was to deductively explore the applicability of the Capability, Opportunity, Motivation, and Behaviour model to participants' narratives related to self-regulated online learning. Online interviews with six demographically diverse participants were conducted and analysed using Interpretative Phenomenological Analysis. The overarching theme was 'the balancing act of online learners', which consisted of three major themes (and respective subthemes): (1) 'identity as an online learner' ('in today's world, we're all very busy'), (2) 'access to resources' ('importance of location' and 'comparing online to on-campus teaching and learning'), and (3) 'changing nature of social interactions' ('tutors as a crutch' and 'peer-to-peer interactions'). A number of facilitators and barriers related to these themes were identified, which are applicable to the COM-B model. The COM-B model offers a novel approach in designing and delivering learning materials and activities that may instil or help maintain self-regulated learning in online psychology students.

The ongoing outbreak of coronavirus diseases (COVID-19) has been declared as Pandemic by the World Health Organization and now become a global health emergency Low and Middle income-countries lack standard pharmacy services in terms of staff, education, training, pharmaceutical care, research, and practice The literature aimed to provide emerging pharmacy services and recommend it to be implemented in low and middle-income countries Currently, pharmacies were easily accessible sites by the community, a trained staff under the guidance of pharmacist can be helpful for the management of visiting customers In the surge of disease, pharmacists proved themselves as a frontline defense for the community by significant contribution in identifying, reporting, and managing COVID-19 patients through pharmaceutical care services at the community level, hospital/clinical level, and through Tele-pharmaceutical services

Attitudes towards open peer review, open data and use of preprints influence scientists engagement with those practices. Yet there is a lack of validated questionnaires that measure these attitudes. The goal of our study was to construct and validate such a questionnaire and use it to assess attitudes of Croatian scientists. We first developed a 21-item questionnaire called Attitudes towards Open data sharing, preprinting, and peer-review (ATOPP), which had a reliable four-factor structure, and measured attitudes towards open data, preprint servers, open peer-review and open peer-review in small scientific communities. We then used the ATOPP to explore attitudes of Croatian scientists (n = 541) towards these topics, and to assess the association of their attitudes with their open science practices and demographic information. Overall, Croatian scientists attitudes towards these topics were generally neutral, with a median (Md) score of 3.3 out of max 5 on the scale score. We also found no gender (P = 0.995) or field differences (P = 0.523) in their attitudes. However, attitudes of scientist who previously engaged in open peer-review or preprinting were higher than of scientists that did not (Md 3.5 vs. 3.3, P<0.001, and Md 3.6 vs 3.3, P<0.001, respectively). Further research is needed to determine optimal ways of increasing scientists attitudes and their open science practices.

This article aims to contribute to the literature on the quest for resilient cities by focusing on the climate change resilience building discourse in peri-urban areas, and specifically by exploring the role of social capital-an under-researched topic. The article examines bonding social capital and bridging social capital, with a focus on how they can potentially contribute to, or inhibit, the socio-ecological system resilience building processes in the context of climate change reality in peri-urban areas. Theoretically, the author draws on the existing social capital and resilience related literatures; empirically, the article presents findings from a study conducted in the peri-urban areas of Pugu and Kazimzumbwi forest reserves on the outskirts of Dar es Salaam city in Tanzania. The study deployed a household survey and key informant interviews. It found that both bonding and bridging social capital were strong in the research area, suggesting the feasibility of building resilience to climate change effects. Examples are given of a number of resilience building interventions that were established through synergies between social capital actors and local communities, although some doubt is cast over the sustainability of these initiatives. Overall, both theoretical and empirical evidence suggests the importance of including a focus on social capital in exploring the building of climate change resilience pathways in peri-urban areas, and especially in the context of the global south.

A key parameter in epidemiological modeling which characterizes the spread of an infectious disease is the generation time, or more generally the distribution of infectiousness as a function of time since infection. There is increasing evidence supporting a prolonged viral shedding window for COVID-19, but the transmissibility in this phase is unclear. Based on this, we develop a generalized Susceptible-Exposed-Infected-Resistant (SEIR) model including an additional compartment of chronically infected individuals who can stay infectious for a longer duration than the reported generation time, but with infectivity reduced to varying degrees. Using the incidence and fatality data from different countries, we first show that such an assumption also yields a plausible model in explaining the data observed prior to the easing of the lockdown measures (relaxation). We then test the predictive power of this model for different durations and levels of prolonged infectiousness using the incidence data after the introduction of relaxation in Switzerland, and compare it with a model without the chronically infected population to represent the models conventionally used. We show that in case of a gradual easing on the lockdown measures, the predictions of the model including the chronically infected population vary considerably from those obtained under a model in which prolonged infectiousness is not taken into account. Although the existence of a chronically infected population still remains largely hypothetical, we believe that our results provide tentative evidence to consider a chronically infected population as an alternative modeling approach to better interpret the transmission dynamics of COVID-19.

In July 2020, four months into the disruption of normal life caused by the Covid-19 pandemic, we assessed the institutional climate within the School of Medicine. Voluntary surveys were completed by 135 graduate students in 11 PhD-granting programs and by 83 members of the graduate training faculty. Several themes emerged. PhD students work hard, but the number of hours spent on research-related activities has declined during the pandemic. The students are worried about the pandemics impact on their research productivity, consequent delays in their graduation, and diminished future job prospects. Many late stage PhD students feel they do not have adequate time or resources to plan for their future careers. Symptoms of anxiety and/or depression are prevalent in 51% of the students, based on answers to standardized questions. Most students report they have strong mentoring relationships with their faculty advisors and like their programs, but they identify to a lesser extent with the medical school as a whole. Faculty think highly of their graduate students and are also worried about the pandemics impact upon productivity and the welfare of students. Students are interested in access to an Ombuds office, which is currently being organized by the medical school. Moving forward, the school needs to address issues of bias, faculty diversity, support for mentor training, professional development, and the imposter syndrome. We must also work to create a climate in which many more graduate students feel that they are valued members of the academic medicine community.

The concurrence of COVID-19 with Guillain-Barre syndrome (GBS) can increase the likelihood of neuromuscular respiratory failure, autonomic dysfunction, and other life-threatening symptoms. Currently, very little is known about the underlying mechanisms, clinical course, and prognostic implications of comorbid COVID-19 in patients with GBS. We reviewed COVID-19-associated GBS case reports published since the outbreak of the pandemic, with a database search up to August 2020, including a manual search of the reference lists for additional relevant cases. Fifty-one (51) case reports of COVID-19 patients (aged 23C84 years) diagnosed with GBS in 11 different countries were included in this review. The results revealed atypical manifestations of GBS, including para-infectious profiles and onset of GBS without antecedent COVID-19 symptoms. Although all tested patients had signs of neuroinflammation, none had SARS-CoV-2 in the cerebrospinal fluid (CSF), and only four (4) patients had antiganglioside antibodies. The majority had a 1- to 10-day time interval between the onset of COVID-19 and GBS symptoms, and many had a poor outcome, with 20 out of the 51 (39.2%) requiring mechanical ventilation, and two deaths within 12 to 24 h. The atypical manifestations of COVID-19-associated GBS, especially the para-infectious profile and short time interval between the onset of the COVID-19 and GBS symptoms, increase the likelihood of symptom overlap, which can complicate the treatment and result in worsened disease progression and/or higher mortality rates. Inclusion of a neurological assessment during diagnosis of COVID-19 might facilitate timely identification and effective management of the GBS symptoms and improve treatment outcome.

PURPOSE: The Mother and Child COVID-19 study is a cohort recruiting pregnant women and their children in Cantabria, North of Spain, during COVID-19 pandemic in order to ascertain consequences of SARS-CoV-2 infection on pregnant women and their descendants. This article reports the cohort profile and preliminary results as recruitment is still open. PARTICIPANTS: Three subcohorts can be identified at recruitment. Subcohort 1 includes women giving birth between 23 March and 25 May 2020; they have been retrospectively recruited and could have been exposed to COVID-19 only in their third trimester of pregnancy. Subcohort 2 includes women giving birth from 26 May 2020 on; they are being prospectively recruited and could have been exposed to COVID-19 in both their second and third trimesters of pregnancy. Subcohort 3 includes women in their 12 week of pregnancy prospectively recruited from 26 May 2020 on; they could have been exposed to COVID-19 anytime in their pregnancy. All women are being tested for SARS-CoV-2 infection using both RT-PCR for RNA detection and ELISA for anti-SARS-CoV-2 antibodies. All neonates are being tested for antibodies using immunochemoluminiscency tests; if the mother is tested positive for SARS-CoV-2 RNA, a nasopharyngeal swab is also obtained from the child for RT-PCR analysis. FINDINGS TO DATE: As of 22 October, 1167 women have been recruited (266, 354 and 547 for subcohorts 1, 2 and 3, respectively). Fourteen women tested positive to SARS-CoV-2 RNA by the day of delivery. All 14 children born from these women tested negative for SARS-CoV-2 RNA. FUTURE PLANS: Children from women included in subcohort 3 are expected to be recruited by the end of 2020. Children will be followed-up for 1 year in order to ascertain the effect that COVID-19 on their development.

Neutrophils are vital for antimicrobial defense; however, their role during viral infection is less clear. Furthermore, the molecular regulation of neutrophil fate and function at the viral infected sites is largely elusive. Here we report that BCL6 deficiency in myeloid cells exhibited drastically enhanced host resistance to severe influenza A virus (IAV) infection. In contrast to the notion that BCL6 functions to suppress innate inflammation, we find that myeloid BCL6 deficiency diminished lung inflammation without affecting viral loads. Using a series of Cre-transgenic, reporter, and knockout mouse lines, we demonstrate that BCL6 deficiency in neutrophils, but not in monocytes or lung macrophages, attenuated host inflammation and morbidity following IAV infection. Mechanistically, BCL6 bound to the neutrophil gene loci involved in cellular apoptosis in cells specifically at the site of infection. As such, BCL6 disruption resulted in increased expression of apoptotic genes in neutrophils in the respiratory tract, but not in the circulation or bone marrow. Consequently, BCL6 deficiency promoted tissue neutrophil apoptosis. Partial neutrophil depletion led to diminished pulmonary inflammation and decreased host morbidity. Our results reveal a previously unappreciated role of BCL6 in modulating neutrophil apoptosis at the site of infection for the regulation of host disease development following viral infection. Furthermore, our studies indicate that tissue-specific regulation of neutrophil survival modulates host inflammation and tissue immunopathology during acute respiratory viral infection.

We present here an evidence-based review of the utility, timing, and indications for laboratory test use in the domains of inflammation, cardiology, hematology, nephrology and co-infection for clinicians managing the care of hospitalized COVID-19 patients. Levels of IL-6, CRP, absolute lymphocyte count, neutrophils and neutrophil-to-lymphocyte ratio obtained upon admission may help predict the severity of COVID-19. Elevated LDH, ferritin, AST, and d-dimer are associated with severe illness and mortality. Elevated cardiac troponin at hospital admission can alert clinicians to patients at risk for cardiac complications. Elevated proBNP may help distinguish a cardiac complication from noncardiac etiologies. Evaluation for co-infection is typically unnecessary in nonsevere cases but is essential in severe COVID-19, intensive care unit patients, and immunocompromised patients.

INTRODUCTION/OBJECTIVE: Key challenges against early diagnosis of COVID-19 are its symptoms sharing nature and prolong SARS-CoV-2 PCR turnaround time. Hither machine learning (ML) tools experienced by routinely generated clinical data; potentially grant early prediction. METHODS/CASE REPORT: Routine and earlier diagnostic data along demographic information were extracted for total of 21,672 subsequent presentations. Along conventional statistics, multilayer perceptron (MLP) and radial basis function (RBF) were applied to predict COVID-19 from pre-pandemic control. Three feature sets were prepared, and performance evaluated through stratified 10-fold cross validation. With differing predominance of COVID-19, multiple test sets were created and predictive efficiency was evaluated to simulate real-fashion performance against fluctuating course of pandemic. Models validation was also inducted in prospective manner on independent dataset, equating framework forecasting to conclusions from PCR. RESULTS (IF A CASE STUDY ENTER NA): RBF model attained superior cross entropy error 20.761(7.883) and 20.782(3.991) for Q-Flags and Routine Items respectively while MLP outperformed for cell population data (CPD) parameters with value of 6.968(1.259) for training(testing). Our CPD driven MLP framework in challenge of lower (<5%) COVID-19 predominance affords greater negative predictive values (NPV >99%). Higher accuracy (%correct 92.5) was offered during prospective validation using independent dataset. Sensitivity analysis advances illusive accuracy (%correct 94.1) and NPV (96.9%). LY-WZ, Blasts/Abn Lympho?, HGB Interf?, and RBC Agglutination? are among novel enlightening study attributes. CONCLUSION: CPD driven ML tools offer efficient screening of COVID-19 patients at presentation to hospital to backing early expulsion and directing patients flow-from amid the initial presentation to hospital.

Abstract Background: Coronavirus Disease 2019 (COVID-19) is an infection caused by a novel coronavirus that affects respiratory tract. People's awareness and knowledge of, and behavior and attitude toward COVID-19 are scarcely investigated , making medical literature related to this point poor. we aim to measure the knowledge of, and the reaction to COVID-19 among University of Aleppo students in Syria, and the determinants of their awareness and behavior regarding this disease. Materials and Methods: This was an online, questionnaire-based cross-sectional study, that was conducted from 21st March to 30 March 2020. We included undergraduate students of the University of Aleppo (Syria). The questionnaire consisted of three sections: Demographics ,knowledge and behaviours . Every participant's knowledge was scored from 0-13 depending on the number of correct answers in the knowledge section. The correctness was judged depending on WHO recommendations at the time of questionnaire administration. P-value of 0.05 was considered significant. Results: Among this well-educated and predominantly medical and health-related students, 682 (45.4%) students had a good knowledge level, which is somehow disappointing. The current study shows that 1st year students and non-medical specialties students and smokers had significantly lower knowledge levels than others. On contrary, residing with less people -which may indicate a higher socioeconomic status-, was associated with a higher knowledge level. We also found that commitment to preventive measures was in general satisfying and correlated significantly with knowledge level and gender in most cases. Conclusion: Junior students, non-medical specialties, smokers and those who live with high number of people are vulnerable to less knowledge level and awareness campaigns should concentrate on them. Increasing awareness is useful to increase commitment to preventive measures, and groups that have less adherence to preventive measures, as described in detail, should be taken into consideration while designing public health responses. Finally, we should be aware of the negative impact of quarantine on public health to take it into consideration for current campaigns and future policies.

A 5-year-old castrated male domestic longhair cat was presented with neurological signs consistent with a central vestibular lesion and left Horners syndrome. Computed tomography images revealed hyperattenuating, moderately contrast-enhancing material within the left tympanic bulla, most consistent with left otitis media/interna. Marked neutrophilic pleocytosis was identified on cerebrospinal fluid analysis. Streptococcus equi subspecies zooepidemicus (SEZ) was isolated from the cerebrospinal fluid. Intracranial extension of otitis media/interna is relatively infrequent in small animals. There are no reports of otitis media/interna caused by SEZ in dogs or cats. This is the first report of otitis media/interna and presumptive secondary meningoencephalitis caused by SEZ in a cat.

Unfortunately, malaria still remains a major problem in tropical areas, and it takes thousands of lives each year and causes millions of infected cases. Besides, on December 2019, a new virus known as coronavirus appeared, that its rapid prevalence caused the World Health Organization (WHO) to consider it a pandemic. As a potential drug for controlling or treating these two undesired diseases at the cellular level, chloroquine and its derivatives are being investigated, although they possess side effects, which must be reduced for effective and safe treatments. With respect to the importance of this medicine, the current research aimed to calculate the solubility of chloroquine in supercritical carbon dioxide, and evaluated effect of pressure and temperature on the solubility. The pressure varied between 120 and 400 bar, and temperatures between 308 and 338 K were set for the measurements. The experimental results revealed that the solubility of chloroquine lies between 1.64 10(?5) to 8.92 10(?4) (mole fraction) with different functionality to temperature and pressure. Although the solubility was indicated to be strong function of pressure and temperature, the effect of temperature was more profound and complicated. A crossover pressure point was found in the solubility measurements, which indicated similar behaviour to an inflection point. For the pressures higher than the crossover point, the temperature indicated direct effect on the solubility of chloroquine. On the other hand, for pressures less than the crossover point, temperature enhancement led to a reduction in the solubility of chloroquine. Moreover, the obtained solubility results were correlated via semi-empirical density-based thermodynamic correlations. Five correlations were studied including: Kumar & Johnston, Mendez-Santiago-Teja, Chrastil, Bartle et al., and Garlapati & Madras. The best performance was obtained for Mendez-Santiago-Teja's correlation in terms of average absolute relative deviation percent (12.0%), while the other examined models showed almost the same performance for prediction of chloroquine solubility.

Reviews and notices are provided on 23 books, published over the years 2017C2020. These are concerned with diverse aspects of biodiversity and conservation, including historical works on different types of institutions, climate change and palaeobiology, global health and sustainability, ecology, restoration, community involvement, animal behaviour, utilization, and regional studies. This is the eighth of a series of cumulative book reviews and notices, based on works submitted by the publishers, which generally appear annually in the journal.

The article describes a study aimed at developing an interaction template for mobile card games for visually impaired gamers. First, accessibility features of existing mobile card games were analyzed. Then various types of actions in common card games were studied and classified to proper categories. Next a simplified layout was proposed in a simplified form of single card view. The interaction mode also was limited to six simple gestures. This approach was used in the sample game. Finally, the new approach was evaluated obtaining satisfactory results.

BACKGROUND: The Human Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory disorder that may result in acute respiratory distress syndrome. The aim of this review was to investigate the incidence and type of respiratory function abnormalities during the follow-up of patients who recovered from COVID-19. METHODS: A systematic search of MEDLINE was conducted, utilising various term combinations. Studies that assessed any respiratory function parameter during the re-evaluation of patients who recovered from COVID-19 and were published as full-text articles in English are included in this review. RESULTS: Amongst 183 articles initially retrieved, 8 fulfilled the criteria and were included in this review; they involved a total of 341 adult patients. Four were retrospective studies, one was a prospective cohort study, one was a randomised control trial and two were case reports/case series. The follow-up time ranged from 1 month since symptom onset to 3 months after discharge. The most frequent abnormality was reduced lung diffusion for carbon monoxide (DLCO), followed by a restrictive pattern. Other findings are the lack of resting hypoxemia, the reduced respiratory muscle strength and the decreased exercise capacity, although relative data are extremely limited. CONCLUSION: Patients who recovered from COVID-19 present with abnormal respiratory function at short-term follow-up, mainly with reduced lung diffusion and a restrictive pattern. However, results are currently very limited in order safe conclusions to be made, regarding the exact incidence of these abnormalities and whether they may be temporary or permanent.

Seven human coronaviruses (hCoVs) are known to infect humans. The most recent one, SARS-CoV-2, was isolated and identified in January 2020 from a patient presenting with severe respiratory illness in Wuhan, China. Even though viral coinfections have the potential to influence the resultant disease pattern in the host, very few studies have looked at the disease outcomes in patients infected with both HIV and hCoVs. Groups are now reporting that even though HIV-positive patients can be infected with hCoVs, the likelihood of developing severe CoV-related diseases in these patients is often similar to what is seen in the general population. This review aimed to summarize the current knowledge of coinfections reported for HIV and hCoVs. Moreover, based on the available data, this review aimed to theorize why HIV-positive patients do not frequently develop severe CoV-related diseases.

The SARS-CoV-2 pandemic is continuing to disrupt personal lives, global healthcare systems and economies. Hence, there is an urgent need for a vaccine that prevents viral infection, transmission and disease. Here, we present a two-component protein-based nanoparticle vaccine that displays multiple copies of the SARS-CoV-2 spike protein. Immunization studies show that this vaccine induces potent neutralizing antibody responses in mice, rabbits and cynomolgus macaques. The vaccine-induced immunity protected macaques against a high dose challenge, resulting in strongly reduced viral infection and replication in upper and lower airways. These nanoparticles are a promising vaccine candidate to curtail the SARS-CoV-2 pandemic.