The present study uses the analysis of the EUs regional performance structure based on clusters to test the versatility of the regional administrative capacity in relation to three disruptive global phenomena: the economic crisis, the coronavirus epidemic and the phenomenon of refugee migration to Europe. We defined a regional performance model based on maintaining sustainability indicators in the 240 EU regions. The objectives of the study are aimed primarily at a structured assessment of regional administrative capacity in the initial version, based on statistical indicators, and in the current version, after the outbreak of the pandemic, based on quantifying the impact of the disturbing factors. Secondly, the objectives of the study are to evaluate the reaction of the administrative units according to their ability to respond to the economic problems in the region, in the sense of improving the performance of the regional economies. The methods used in this paper will be empirical (the study of the specialized literature), analytical and will contain econometric modelling and statistical processing of the data. The results of the study will allow the identification of the necessary traits to train a leader in regional performance, traits that will be useful to European decision makers in adjusting the EU regional policy. Moreover, the need to redefine the EU in terms of performance will be substantiated once again. The study is current and is based on the latest Eurostat information, pertinent tables and diagrams.

Radiology departments were forced to make significant changes in their routine during the coronavirus disease 2019 pandemic, to prevent further transmission of the coronavirus and optimize medical care as well. In this article, we describe our Radiology Department's policies in a private hospital for coronavirus disease 2019 preparedness focusing on quality and safety for the patient submitted to imaging tests, the healthcare team involved in the exams, the requesting physician, and for other patients and hospital environment.

Neocortical layer 1 is a major site of convergence for a variety of brain wide afferents carrying experience-dependent top-down information, which are integrated and processed in the apical tuft dendrites of pyramidal cells. Two types of local inhibitory interneurons, Martinotti cells and layer 1 interneurons, dominantly shape dendritic integration, and work from recent years has significantly advanced our understanding of the role of these interneurons in circuit plasticity and learning. Both cell types instruct plasticity in local pyramidal cells, and are themselves subject to robust plastic changes. Despite these similarities, the emerging hypothesis is that they fulfill different, and potentially opposite roles, as they receive different inputs, employ distinct inhibitory dynamics and are implicated in different behavioral contexts.

AIM: Our hospital took part in a multi-centre prospective cohort study the CASCADE study investigating the management and early outcomes of children with appendicitis in the UK and Ireland during the first wave of the COVID-19 pandemic (1). The aim of this study was to compare our local outcomes to those at a national level. METHOD: This was a prospective cohort study with data collected from 01/04/2020 to 31/05/2020. Primary outcome was treatment strategy for appendicitis. Secondary outcomes were duration of symptoms, ultrasound findings, rate of simple vs perforated appendicitis and complications. RESULTS: Overall, only a minority (2/24 [8%]) were initially treated non-operatively, with both proceeding to appendicectomy due to pain. Remaining children (24/26 [92%]) were primarily treated with appendicectomy. All were performed laparoscopically with no conversions to open. Ultrasound was performed for most children (23/26 [88%]) which accurately identified appendicitis (22/23 [95%]) and negative appendicectomy rate of zero. Rates of complex appendicitis were not higher than expected (10/26 [38%]) but had a longer duration of symptoms (median 66.0h [IQR21.5] vs 30.0h [27.2], p = 0.008) and more complications (4 vs 1). Post-operative length of stay was significantly shorter for simple appendicitis than complicated (median 1.0d [IQR0.0] vs 4.0 [IQR2.8], p = 0.001). CONCLUSIONS: Practice in our centre contrasts with the CASCADE study's National findings where 39% were treated non-operatively, only 48% of appendicectomies were performed laparoscopically, only 53% of children had diagnostic imaging and negative appendicectomy rate was 4.5%. Rates of complications for simple and complex appendicitis were similar, but post-operative length of stay shorter in our centre.

ABSTRACT IMPACT: This real-world study of what students value in crisis leadership fills an important gap in the literature and may inform future leadership development programs in undergraduate medical education. OBJECTIVES/GOALS: Leadership training is of growing importance and prevalence in medical education. The COVID-19 pandemic provides a unique insight into the qualities students value in leaders. Our qualitative study examined these leadership themes and provides a grounding for future development of leadership programs. METHODS/STUDY POPULATION: A conventional qualitative approach was used in order to allow open expression of ideas related to leadership in a pandemic. The authors developed a 5 free-text question survey instrument aimed to uncover student perceptions of leadership both during the current pandemic and in crises in general. A participant pilot was performed in order to ensure readability and ease of understanding. We used thematic analysis to examine the content of the survey responses, and inductive coding of the responses allowed identification of emerging themes. Medical students at the University of Michigan were surveyed. RESULTS/ANTICIPATED RESULTS: In total, 162 students completed the survey. The demographic characteristics of participants are shown in Table 1. Median age was 25 years old (range, 22-39). There was good representation from the 4 classes in the medical school with 20-30% from each medical school class and 5% of dual degree students. Thematic analysis demonstrated that students value personal characteristics of excellence in their leaders with an orientation towards helping other people. Students believe that leaders must know how to interpret and use information and then that these leaders must be able to communicate expertly to guide organizations. The final theme that emerged is that effective leaders must commit to decisive action. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study took place at a time of unprecedented crises and response examples were grounded in this real-world practice of leadership. These results and themes that emerged fill a critical gap and may facilitate future curriculum development for medical students and trainees.

INTRODUCTION: The SARS-CoV-2 is a human pathogenic coronavirus that causes a respiratory tract infection, which may lead to systemic hyper-inflammation that is associated with a hypercoagulable state. Anticoagulation as an adjunct may decrease thrombi formation. OBJECTIVES: This study aims to evaluate the efficacy and safety of enoxaparin for the prevention of thrombotic events in hospitalized SARS-CoV-2 patients with elevated D-dimer. METHODS: A single-center retrospective cohort study was conducted to evaluate three enoxaparin dosing regimens: full treatment (1 mg/kg SC Q12H or 1.5 mg/kg SC Q24H), intermediate (.5 mg/kg SC Q12H or 1 mg/kg SC Q24H), and prophylaxis (40 mg SC Q24H). The primary endpoint evaluated the percentage of patients who developed a venous thromboembolism (VTE). The secondary endpoints evaluated the development of a major bleed, mechanical ventilation need, and death. RESULTS: Forty-five patients were included with 27, 8, and 10 participants in the full treatment, intermediate, and prophylaxis arms, respectively. Six patients developed a VTE: 3, 1, and 2 in the listed above groups, respectively (P = .83). Twenty patients died: 11, 3, and 6, respectively (P = .64). Four patients developed a major bleed: 1, 1, and 2, respectively (P = .17). Six patients required intubation: 1, 2, and 3 in the arms, respectively (P = .043). CONCLUSION: The study did not find a difference in respect to the development of a VTE between the three investigated doses of anticoagulation. However, our findings suggest that treatment dose of enoxaparin might be associated with lower risk for mechanical ventilation in hospitalized COVID-19-positive patients with elevated D-dimer.

The United Nations identified decent work and economic growth as a sustainable development goal for 2030. Decent work is a term that sums up aspirations for people in their working lives. One of the factors that influences the achievement of decent work is aging. This article examines how aspects of aging and organizational factors affect work ability across the lifespan and throughout ones work career. Additionally, the critical issue of worker physical mobility was also addressed as a practical limitation to functional aging. Through our investigation, we identified gaps in the literature where research and interventions should be promoted. These include early disability studies; population dashboards of workers health metrics; intervention and cost effectiveness in health promotion and prevention of early functional aging at work; policies for tailoring demands to individual needs and abilities; and inequities of social protection for aging workers.

OBJECTIVE: Evaluate the real-world accuracy of Myxovirus resistance protein A (MxA) detected by the rapid, point-of-care FebriDx test during the second-wave pandemic in Italy in patients with acute respiratory infection (ARI) and a clinical suspicion of COVID-19. DESIGN AND METHODS: Prospective, observational, diagnostic accuracy study whereby hospitalized patients with ARI were consecutively enrolled in a single tertiary care center in Italy from August 1, 2020 to January 31, 2021. RESULTS: COVID-19 was diagnosed in 136/200 (68.0%) patients and Non-COVID-19 was diagnosed in64/200 (32.0%) patients. COVID-19 patients were younger and had a lower Charlson comorbidity index compared to non-COVID-19 patients (p < 0.001). Concordance between FebriDx, MxA and rt-PCR for SARS-CoV-2 (gold standard) was good (k 0.93, 95%CI 0.87-0.99). Overall sensitivity and specificity were 97.8% [95%CI 93.7-99.5] and 95.3% [95%CI 86.9%-99.0%], respectively. FebriDx demonstrated a negative predictive value of 95.3% (95%CI 86.9-99.0) for an observed disease prevalence of 68%. CONCLUSIONS: FebriDx MxA showed high diagnostic accuracy to identify COVID-19 and could be considered as a real-time triage tool to streamline the management of suspected COVID-19 patients. FebriDx also detected bacterial etiology in non-COVID-19 patients suggesting good performance to distinguish bacterial from viral respiratory infection.

The pandemic caused by the new SARS-CoV2 coronavirus has led to an effort to find treatments that are effective against this disease that the World Health Organization calls COVID-19. In severe cases of COVID-19, there is an increase in cytokines, among which IL-6 seems to play an important role. A search has been performed for studies using IL-6 blocking drugs (tocilizumab, siltuximab, and sarilumab) in PubMed, Web of Science, and Scopus. Also, a search of ongoing trials registered at clinicaltrials.gov was performed. We found very little published clinical experience with these drugs, consisting mainly of case reports or case series with few patients. The results of clinical trials are necessary to clarify the role of these drugs in patients with COVID-19.

Movement primitives have the property to accommodate changes in the robot state while maintaining attraction to the original policy. As such, we investigate the use of primitives as a blending mechanism by considering that state deviations from the original policy are caused by user inputs. As the primitive recovers from the user input, it implicitly blends human and robot policies without requiring their weightings -- referred to as arbitration. In this paper, we adopt Dynamical Movement Primitives (DMPs), which allow us to avoid the need for multiple demonstrations, and are fast enough to enable numerous instantiations, one for each hypothesis of the human intent. User studies are presented on assisted teleoperation tasks of reaching multiple goals and dynamic obstacle avoidance. Comparable performance to conventional teleoperation was achieved while significantly decreasing human intervention, often by more than 60%.

This study aimed to compare rates of participation in physical activity according to the type of disability, sex, point of disability diagnosis (congenital vs. acquired), and ability to walk independently. The study involved individuals who were registered as disabled based on the 2020 Sports Survey for the Disabled project of the Korea Ministry of Health and Welfare. Participants (mean age: 49.94 12.35 years) included those with physical disabilities (n = 889), visual impairments (n = 523), hearing/speech impairments (n = 412), intellectual disabilities (n = 561), and disabilities associated with brain lesions (n = 364). Rates of severe (100%) and congenital disability (65.95%) were highest in the intellectual disability group. Acquired disability was most frequent in the physical disability group (94.71%). The highest frequency of independent walking ability was observed in the hearing/speech impairment group (99.27%). The rate of participation in physical activity was significantly higher in the acquired (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.12C1.87, p = 0.005) and independent walking (OR = 1.43, 95% CI = 1.11C1.84, p = 0.005) hearing/speech impairment groups than in the corresponding physical disability groups after adjusting for age, sex, and severity. Our findings highlight the need to promote physical activity for people with physical and intellectual disabilities based on the factors examined in this study.

BACKGROUND Equine whole blood collection and storage methods have been evaluated to assess red blood cell viability; however, platelet (PLT) viability has not been comprehensively assessed. OBJECTIVES The purpose of the study was to compare viability of PLTs collected in whole blood into 2 different anticoagulants. METHODS Whole blood from 6 healthy adult Thoroughbred horses was collected into citrate-phosphate-dextrose-adenine (CPDA) or acid-citrate-dextrose (ACD). Platelet count, pH, and concentrations of glucose, lactate, carbon dioxide, oxygen, bicarbonate, sodium, potassium, and chloride were measured within 10 minutes of collection and then again one hour later at which time PLT aggregometry was performed to assess PLT function. RESULTS Aggregometry mean amplitudes were significantly higher in CPDA compared to ACD. Blood glucose, pH, bicarbonate, sodium, and lactate concentrations were significantly higher in CPDA compared to ACD. Lactate concentration was higher following one hour in either anticoagulant. Potassium, oxygen, and carbon dioxide concentrations were significantly higher in ACD compared to CPDA at collection. CONCLUSIONS Platelet aggregometry results suggest that CPDA is superior to ACD for maintaining PLT viability following whole blood collection. This may be associated with the higher, more neutral pH as well as an increase in glucose available for metabolism. Although lactate was increased in the CPDA samples it was not high enough to decrease pH and therefore may not have been high enough to cause morphologic lesions and loss of PLT viability.

We comprehensively study the variability of Miras in the Large Magellanic Cloud (LMC) by simultaneous analysing light curves in 14 bands in the range of 0.5$-$24 microns. We model over 20-years-long, high cadence $I$-band light curves collected by The Optical Gravitational Lensing Experiment (OGLE) and fit them to light curves collected in the remaining optical/near-infrared/mid-infrared bands to derive both the variability amplitude ratio and phase-lag as a function of wavelength. We show that the variability amplitude ratio declines with the increasing wavelength for both oxygen-rich (O-rich) and carbon-rich (C-rich) Miras, while the variability phase-lag increases slightly with the increasing wavelength. In a significant number of Miras, mostly the C-rich ones, the spectral energy distributions (SEDs) require a presence of a cool component (dust) in order to match the mid-IR data. Based on SED fits for a golden sample of 140 Miras, we calculated synthetic period-luminosity relations (PLRs) in 42 bands for the existing and future sky surveys that include OGLE, The VISTA Near-Infrared $YJK_\mathrm{s}$ Survey of the Magellanic Clouds System (VMC), Legacy Survey of Space and Time (LSST), Gaia, Spitzer, The Wide-field Infrared Survey Explorer (WISE), The James Webb Space Telescope (JWST), The Nancy Grace Roman Space Telescope (formerly WFIRST), and The Hubble Space Telescope (HST). We show that the synthetic PLR slope decreases with increasing wavelength for both the O-rich and C-rich Miras in the range of 0.1$-$40 microns. Finally, we show the location and motions of Miras on the color-magnitude (CMD) and color-color (CCD) diagrams.

BACKGROUND: Risk assessment of patients with acute COVID-19 in a telemedicine context is not well described. In settings of large numbers of patients, a risk assessment tool may guide resource allocation not only for patient care but also for maximum health care and public health benefit. OBJECTIVE: The goal of this study was to determine whether a COVID-19 telemedicine risk assessment tool accurately predicts hospitalizations. METHODS: We conducted a retrospective study of a COVID-19 telemedicine home monitoring program serving health care workers and the community in Atlanta, Georgia, with enrollment from March 24 to May 26, 2020; the final call range was from March 27 to June 19, 2020. All patients were assessed by medical providers using an institutional COVID-19 risk assessment tool designating patients as Tier 1 (low risk for hospitalization), Tier 2 (intermediate risk for hospitalization), or Tier 3 (high risk for hospitalization). Patients were followed with regular telephone calls to an endpoint of improvement or hospitalization. Using survival analysis by Cox regression with days to hospitalization as the metric, we analyzed the performance of the risk tiers and explored individual patient factors associated with risk of hospitalization. RESULTS: Providers using the risk assessment rubric assigned 496 outpatients to tiers: Tier 1, 237 out of 496 (47.8%); Tier 2, 185 out of 496 (37.3%); and Tier 3, 74 out of 496 (14.9%). Subsequent hospitalizations numbered 3 out of 237 (1.3%) for Tier 1, 15 out of 185 (8.1%) for Tier 2, and 17 out of 74 (23%) for Tier 3. From a Cox regression model with age of 60 years or older, gender, and reported obesity as covariates, the adjusted hazard ratios for hospitalization using Tier 1 as reference were 3.74 (95% CI 1.06-13.27; P=.04) for Tier 2 and 10.87 (95% CI 3.09-38.27; P<.001) for Tier 3. CONCLUSIONS: A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified populations with low, intermediate, and high risk of hospitalization.

Actinobacillus pleuropneumoniae (APP) is the causative agent of porcine pleuropneumonia, resulting in high economic impact worldwide. There are currently 19 known serovars of APP, with different ones being predominant in specific geographic regions. Outbreaks of pleuropneumonia, characterized by sudden respiratory difficulties and high mortality, can occur when infected pigs are brought into na?ve herds, or by those carrying different serovars. Good biosecurity measures include regular diagnostic testing for surveillance purposes. Current gold standard diagnostic techniques lack sensitivity (bacterial culture), require expensive thermocycling machinery (PCR) and are time consuming (culture and PCR). Here we describe the development of an isothermal point-of-care diagnostic test - utilizing recombinase polymerase amplification (RPA) for the detection of APP, targeting the species-specific apxIVA gene. Our APP-RPA diagnostic test achieved a sensitivity of 10 copies/L using a strain of APP serovar 8, which is the most prevalent serovar in the UK. Additionally, our APP-RPA assay achieved a clinical sensitivity and specificity of 84.3 and 100%, respectively, across 61 extracted clinical samples obtained from farms located in England and Portugal. Using a small subset (n = 14) of the lung tissue samples, we achieved a clinical sensitivity and specificity of 76.9 and 100%, respectively) using lung imprints made on FTA cards tested directly in the APP-RPA reaction. Our results demonstrate that our APP-RPA assay enables a suitable rapid and sensitive screening tool for this important veterinary pathogen.

BACKGROUND: Depression is highly prevalent and considered as the most common psychiatric disorder in home-based elderly, while study on forecasting depression risk in the elderly is still limited. In an endeavor to improve accuracy of depression forecasting, machine learning (ML) approaches have been recommended, in addition to the application of more traditional regression approaches. METHODS: A prospective study was employed in home-based elderly Chinese, using baseline (2011) and follow-up (2013) data of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort study. We compared four algorithms, including the regression-based models (logistic regression, lasso, ridge) and ML method (random forest). Model performance was assessed using repeated nested 10-fold cross-validation. As the main measure of predictive performance, we used the area under the receiver operating characteristic curve (AUC). RESULTS: The mean AUCs of the four predictive models, logistic regression, lasso, ridge, and random forest, were 0.795, 0.794, 0.794, and 0.769, respectively. The main determinants were life satisfaction, self-reported memory, cognitive ability, ADL (activities of daily living) impairment, CESD-10 score. Life satisfaction increased the odds ratio of a future depression by 128.6% (logistic), 13.8% (lasso), and 13.2% (ridge), and cognitive ability was the most important predictor in random forest. CONCLUSIONS: The three regression-based models and one ML algorithm performed equally well in differentiating between a future depression case and a non-depression case in home-based elderly. When choosing a model, different considerations, however, such as easy operating, might in some instances lead to one model being prioritized over another.

Visual inspection of world maps shows that coronavirus disease 2019 (COVID-19) is less prevalent in countries closer to the equator, where heat and humidity tend to be higher. Scientists disagree how to interpret this observation because the relationship between COVID-19 and climatic conditions may be confounded by many factors. We regress confirmed COVID-19 cases per million inhabitants in a country against the countrys distance from the equator, controlling key confounding factors: air travel, distance to Wuhan, testing intensity, cell phone usage, vehicle concentration, urbanization, and income. A one-degree increase in absolute latitude is associated with a 2.6% increase in cases per million inhabitants (p value <0.001). The Northern hemisphere may see a decline in new COVID-19 cases during summer and a resurgence during winter.

Canadians produce a lot of food, but harvesting that food has increasingly meant relying on a growing force of temporary foreign workers (TFWs) In 2020, however, border restrictions imposed by Canadian governments to control the spread of the novel coronavirus, and perhaps the reluctance of TFWs to travel to Canada during the pandemic, have significantly impeded the use of TFWs in Canada's food-production system That has revealed the vulnerabilities of the Canadian food supply chain to globally disruptive events, such as the COVID-19 pandemic, and the risk to a system that has, historically, provided Canadians with a stable, affordable supply of food for their local grocery stores By the end of 2019, Canada had seen a record number of TFWs employed in the agriculture sector, as the number of Canadian citizens and permanent residents employed in the industry has remained relatively stagnant and even declined However, travel restrictions imposed by Canadian governments due to the COVID-19 pandemic have coincided with a significant reduction in TFWs working in Canada in 2020 In total, there has been a 14-per-cent drop in the arrival of TFWs working in Canadian agriculture this year Producers in the secondary agricultural sector, such as meat-processing and seafood-processing facilities, had been experiencing the fastest growth in the use of TFWs until now, and have seen the greatest relative reduction in TFW arrivals in comparison to 2019 Farms, which are primary producers, have experienced the largest reduction in TFW arrivals in absolute terms Although the economic effects of the pandemic-related lockdown have put many Canadians out of work, replacing TFWs with Canadian workers may not be practicable Producers may not be able to hire Canadians willing to work on farms, ranches or in food-processing plants in sufficient numbers to make up for the shortfall in TFWs When the government of New Brunswick completely banned the entry of TFWs due to the pandemic, it did not result in a significant increase in local hiring In addition, TFWs often come with experience gained from previous years working in Canada's food sector;training Canadians to replace them requires time and resources that can jeopardize the precious time that producers have to complete seasonal seeding, harvesting, and fishing activities Policy-makers will need to consider ways to ensure that TFWs, which have become critical to Canada's food supply chain, are able to come to Canada safely and work in safe environments, in the face of the pandemic health risk This year will already be a more difficult one for producers, and future years could face similar challenges Canadians have come to rely on the use of TFWs to ensure fully stocked grocery stores carrying affordable food products If producers are increasingly unable to source international labour to produce that food, Canada's reliable and affordable food supply may be at risk [ABSTRACT FROM AUTHOR] Copyright of School of Public Policy Publications is the property of University of Calgary, School of Public Policy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Covid-19 is caused by a novel form of coronavirus for which there are currently no vaccines or anti-viral drugs This virus, termed SARS-CoV-2 (CoV2), contains Papain-like protease (PLpro) involved in viral replication and immune response evasion Drugs targeting this protease therefore have great potential for inhibiting the virus, and have proven successful in older coronaviruses Here, we introduce two effective inhibitors of SARS-CoV-1 (CoV1) and MERS-CoV to assess their potential for inhibiting CoV2 PLpro We ran 1 s molecular dynamics (MD) simulations of CoV2, CoV1, and MERS-CoV ligand-free PLpro to characterize the dynamics of CoV2 PLpro, and made comparisons between the three to elucidate important similarities and differences relevant to drug design and ubiquitin-like protein binding for deubiquitinating and deISGylating activity of CoV2 Next, we simulated the inhibitors bound to CoV1 and CoV2 PLpro in various poses and at different known binding sites to analyze their binding modes We found that the naphthalene-based ligand shows strong potential as an inhibitor of CoV2 PLpro by binding at the putative naphthalene inhibitor binding site in both computational predictions and experimental assays Our modeling work suggested strategies to improve naphthalene-based compounds, and our results from molecular docking showed that the newly designed compounds exhibited improved binding affinity The other ligand, chemotherapy drug 6-mercaptopurine (6MP), showed little to no stable intermolecular interaction with PLpro and quickly dissociated or remained highly mobile We demonstrate multiple ways to improve the binding affinity of the naphthalene-based inhibitor scaffold by engaging new residues in the unused space of the binding site Analysis of CoV2 PLpro also brings insights into recognition of ubiquitin-like proteins that may alter innate immune response

We describe the bailout of banks by governments as a Markov Decision Process (MDP) where the actions are equity investments. The underlying dynamics is derived from the network of financial institutions linked by mutual exposures, and the negative rewards are associated to the banks' default. Each node represents a bank and is associated to a probability of default per unit time (PD) that depends on its capital and is increased by the default of neighbouring nodes. Governments can control the systemic risk of the network by providing additional capital to the banks, lowering their PD at the expense of an increased exposure in case of their failure. Considering the network of European global systemically important institutions, we find the optimal investment policy that solves the MDP, providing direct indications to governments and regulators on the best way of action to limit the effects of financial crises.