BACKGROUND: The role of high-frequency oscillatory ventilation (HFOV) has long been debated. Numerous studies documented its benefits, whereas several more recent studies did not prove superiority of HFOV over protective conventional mechanical ventilation (CV). One of the accepted explanations is that CV and HFOV act differently, including gas exchange. METHODS: To investigate a different level of coupling or decoupling between oxygenation and carbon dioxide elimination during CV and HFOV, we conducted a prospective crossover animal study in 11 healthy pigs. In each animal, we found a normocapnic tidal volume (V(T)) after the lung recruitment maneuver. Then, V(T) was repeatedly changed over a wide range while keeping constant the levels of PEEP during CV and mean airway pressure during HFOV. Arterial partial pressures of oxygen (P(a)O(2)) and carbon dioxide (P(a)CO(2)) were recorded. The same procedure was repeated for CV and HFOV in random order. RESULTS: Changes in P(a)CO(2) intentionally induced by adjustment of V(T) affected oxygenation more significantly during HFOV than during CV. Increasing V(T) above its normocapnic value during HFOV caused a significant improvement in oxygenation, whereas improvement in oxygenation during CV hyperventilation was limited. Any decrease in V(T) during HFOV caused a rapid worsening of oxygenation compared to CV. CONCLUSION: A change in P(a)CO(2) induced by the manipulation of tidal volume inevitably brings with it a change in oxygenation, while this effect on oxygenation is significantly greater in HFOV compared to CV.

Objective: The emergence of the novel coronavirus disease 2019 (COVID-19) has resulted in precautionary measures by governments worldwide to contain the spread of the virus. However, the degree of compliance toward personal precautionary measures has varied, despite the urgent need to contain the pandemic. This study aimed to assess the level of compliance toward personal protective precautions during and after the lockdown among residents of Riyadh, Saudi Arabia. Methods: We conducted a cross-sectional study with 1,108 residents using an online survey to collect sociodemographic data, compliance with personal protective measures, and other factors during and after the lockdown. Statistical Package for Social Sciences (SPSS) version 26 (IBM SPSS Statistics, Armonk, NY) was used for data analysis. Results: During the lockdown, 35.5% of respondents were very compliant, whereas 30.1% were less compliant. Additionally, compliance levels in those who depended on official sites as their primary source of information were significantly higher than those who depended on their family, friends, and social media. Approximately 39.76% of those who were very compliant intended on getting vaccinated against COVID-19, while 28% of those with high compliance did not intend on getting vaccinated. Further, compliance levels were high in participants who were not in direct contact with COVID-19 cases as well. Conclusion: This study highlights the importance of maintaining the level of compliance toward personal precautionary measures against COVID-19 even after lockdown release to prevent further waves. This study showed that compliance toward personal protective measures was high for those who did not have direct contact with COVID-19 positive people after lockdown, those planning for inoculation, and those insuring applications of precautionary measures by their children. Additionally, higher compliance was noted in participants who sought information from official sites.

BACKGROUND Laparoscopic management of adhesive small bowel obstruction (SBO) has become an established technique within the domain of acute care surgery. As minimally invasive management of SBO becomes more widely accepted, there is increased need for reporting of outcomes. OBJECTIVE To compare outcomes of laparoscopic versus open surgery for adhesive SBO. METHODS Patients undergoing surgery for adhesive SBO at our institution between 2005 and 2013 were eligible for inclusion. The primary outcome was overall complication rate, while secondary outcomes included operative time, gastrointestinal (GI) function, and postoperative length of stay (LOS). Univariable analysis compared laparoscopic (including conversions) and open groups with regard to patient baseline and perioperative characteristics as well as outcomes of interest. Multivariable analysis was performed comparing the endpoint of overall complications between groups. Sensitivity analysis excluding patients who underwent bowel resection was performed to assess effect on outcomes. Factors associated with laparoscopic success, as well as impact of conversion to open on postoperative outcomes, are reported. RESULTS A cohort of 269 patients with adhesive SBO was identified: 186 patients (69.1%) underwent open surgery, 83 (30.9%) were managed laparoscopically. Within the laparoscopy group, 32 (38.6%) underwent conversion to open. Operative time was similar between groups (P = 0.506), while laparoscopy was associated with quicker recovery of GI function indicated by removal of nasogastric tube (P = 0.031) and passage of flatus (P = 0.005). Postoperative LOS was shorter (5 vs. 7 days, P = 0.031) with laparoscopy. The overall complication rate was significantly lower in the laparoscopic group (27.7 vs. 43.6%, P = 0.014), with an adjusted odds ratio (OR) for overall complications of 0.37 (P = 0.002). Following exclusion of bowel resections, secondary outcomes continued to favor laparoscopy, while reduction in overall complications trended toward significance, OR 0.47 (P = 0.050). CONCLUSION Laparoscopic surgical management of adhesive SBO was associated quicker GI recovery, shorter LOS, and reduced overall complications compared to open surgery.

BACKGROUND: Human Immunodeficiency Virus (HIV) infection continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In Liberia, where the health system is being rebuilt following protracted civil wars and an Ebola virus disease outbreak, the Resilient and Responsive Health System (RRHS) is assisting with quality HIV services delivery through support from PEPFAR and HRSA but gaps remain across the cascade of care from diagnosis to viral load suppression. OBJECTIVE: To highlight gaps in HIV service delivery in Liberia, identify opportunities and offer recommendations for improving the quality of service delivery. METHODS: A narrative review of relevant literature was conducted following a search of all local and online databases known to the authors. FINDINGS: Antiretroviral therapy (ART) has transformed the HIV response in Liberia by averting deaths, improving quality of life, and preventing new HIV infections but critical gaps remain. These include weak HIV prevention and testing strategies; suboptimal ART initiation and retention in care; low viral load testing volumes, commodity supply chain disruptions and a HIV workforce built on non-physician healthcare workers. In the context of the prevailing socioeconomic, heath system and programmatic challenges, these will impact achievement of the UNAIDS targets of 95-95-95 by 2030 and ending the epidemic. CONCLUSION: Combination prevention approaches are necessary to reach the most at risk populations, while a robust health workforce operating through facilities and communities will be needed to reach people with undiagnosed HIV earlier to provide efficient and effective services to ensure that people know their HIV status, receive and sustain ART to achieve viral suppression to maintain a long and healthy life within the framework of overall health system strengthening, achieving universal health coverage and the sustainable development goal.

The recent coronavirus disease 2019 (COVID-19) global pandemic has resulted in unprecedented job losses in the United States, disrupting health insurance coverage for millions of people. Several models have predicted large increases in Medicaid enrollment among those who have lost jobs, yet the number of Americans who have gained coverage since the pandemic began is unknown. We compiled Medicaid enrollment reports covering the period from March 1 through June 1, 2020, for twenty-six states. We found that in these twenty-six states, Medicaid covered more than 1.7 million additional Americans in roughly a three-month period. Relative changes in Medicaid enrollment differed significantly across states, although enrollment growth was not systemically related to job losses. Our results point to the important effects of state policy differences in the response to COVID-19.

Porphyry ore deposits, Earth's most important resources of copper, molybdenum, and rhenium, are strongly associated with felsic magmas showing signs of high-pressure differentiation and are usually found in places with thickened crust (>45 kilometers). This pattern is well-known, but unexplained, and remains an outstanding problem in our understanding of porphyry ore deposit formation. We approach this problem by investigating the oxidation state of magmatic sulfur, which controls the behavior of ore-forming metals during magma differentiation and magmatic-hydrothermal transition. We use sulfur in apatite to reconstruct the sulfur oxidation state in the Gangdese batholith, southern Tibet. We find that magma sulfate content increased abruptly after India-Eurasia collision. Apatite sulfur content and the calculated magma S6+/ΣS ratio correlate with whole-rock dysprosium/ytterbium ratio, suggesting that residual garnet, favored in thickened crust, exerts a first-order control on sulfur oxidation in magmatic orogens. Our findings link sulfur oxidation to internal petrogenic processes and imply an intrinsic relationship of magma oxidation with synmagmatic crustal thickening.

BACKGROUND: Considering the gravity of coronavirus disease 2019 (COVID-19) and its potential to unfold within the dental workplace or institutions, a shift from traditional dental practice to a newer method is needed. Teledentistry is widely being practiced in this pandemic era for the diagnosis and to give instructions to the patients. Hence, an attempt has been made to explore the knowledge, attitude, and awareness of practicing orthodontists regarding the usage of teledentistry during COVID lockdown, in Kerala. MATERIALS AND METHODS: A cross-sectional, descriptive study was done on about 150 orthodontic professionals. A pretested, self-organized, close-ended survey was managed through online stages that comprised of 15 questions. The information gathered was assembled in a systematic way and investigated regarding recurrence and Chi-square test was utilized for the examination of frequencies. RESULTS: It was observed that 93.3% orthodontic practitioners had knowledge regarding teledentistry and a positive attitude toward teledentistry was shown by younger age group practitioners and those who were working in institutions (P < 0.05). 77.3% believed that teledentistry can save dentist's time and 71.3% responded that the new technology can be helpful in reducing the cost of treatment for patients. CONCLUSION: The knowledge, awareness, and attitudes were discovered to be acceptable among the orthodontic practitioners. Younger practitioners had more positive attitude toward teledentistry, and there was an overall positive attitude for using teledentistry as a temporary alternate for direct patient contact in COVID-19 pandemic time.

Abstract Background and aim The coronavirus 2019 (COVID-19) pandemic has led to a rapid shift in care delivery models for patients with inflammatory bowel disease (IBD), however little is known about patient perceptions during this period We aimed to prospectively evaluate the attitudes, concerns, and health behaviour of IBD patients during COVID-19 Methods An online survey was sent to patients from a tertiary IBD Service The survey included demographic information and questions about the impact of COVID-19, levels of concern caused by COVID-19, perceived risk of IBD medications, medication cessation, and care delivery preferences Results Of 97 respondents (39%), 95 (98%) reported concern about the impact of COVID-19 on their health and 43% felt their risk of contracting COVID-19 was above average 62% reported concern about medication induced COVID-19 risk and 11% stopped medications because of COVID-19 Patients considered all medications to increase risk of COVID-19 susceptibility and severity 45% preferred telehealth whilst 16% preferred face-to-face clinic reviews Preference for IBD monitoring tools in decreasing order was blood testing, stool collection, gastrointestinal ultrasound, magnetic resonance enterography then colonoscopy Conclusions Patients with IBD are demonstrated to experience concern related to their diagnosis and medications The insights provided by the survey are informative for a possible ?second-wave? of COVID-19 and routine care, including acceptance of telemedicine, preference for non-invasive investigations, and a need for dissemination of information and education

BACKGROUND: COVID-19 has caused an ongoing worldwide pandemic. Much remains unknown about detailed symptomatic features of COVID-19 onset and rehabilitation. METHODS: In this retrospective cohort study, 932 hospitalized patients with COVID-19 in Wuhan were enrolled, including 52 severe cases and 880 non-severe cases. The symptomatic features were analyzed and compared between the severe and non-severe groups. All patients were followed up 3 months after discharge. RESULTS: Of the 932 patients, fever (60%), cough (50.8%), and fatigue (36.4%) were the most common symptoms, followed by anorexia (21.8%) and dyspnea (19.2%). The median duration of fever was 7 days, which was characterized by persistent low fever. The median duration of cough was 17 days, characterized by dry cough without sputum. Most dyspnea occurred on the fourth day after illness onset, with a median duration of 16 days. The incidences of taste loss and olfactory disturbance were only 6.2% and 3.1%, respectively. After adjusting age and gender, multivariate regression analysis showed that fever lasting for more than 5 days (OR 1.90, 95%CI 1.00-3.62, P = 0.0498), anorexia at onset (2.61, 1.26-5.40, P = 0.0096), and modified Medical Research Council level above grade 2 when dyspnea occurred (14.19, 7.01-28.71, P < 0.0001) were symptomatic risk factors for severe COVID-19. Through follow-up, cough (6.2%), dyspnea (7.2%), fatigue (1.8%), olfactory and taste disorders (1.5%) were the significant remaining symptoms. CONCLUSIONS: COVID-19 caused clusters of symptoms with multiple systems involved. Certain symptomatic characteristics have predictive value for severe COVID-19. Short-term follow-up showed that most patients had a good prognosis.

Occupational standing is associated with musculoskeletal and venous disorders. The aim was to investigate whether lower leg oedema and muscle fatigue development differ between standing and walking and whether age, gender and standing work habituation are factors to consider. 60 participants (15 young females, 15 young males, 15 older males, and 15 young males habituated to standing work) were included and required to stand/walk for 4.5 hours in three periods with two seated breaks. Waterplethysmography/bioelectrical impedance, muscle twitch force and surface electromyography were used to assess lower leg swelling (LLS) and muscle fatigue as well as gastrocnemius muscle activity, respectively. While standing led to LLS and muscle fatigue, walking did not. Low-level medial gastrocnemius activity was not continuous during standing. No significant influence of age, gender and standing habituation was observed. Walking can be an effective prevention measure to counteract the detrimental effects of quasi-static standing.Practitioner Summary: Prolonged standing leads to lower leg oedema and muscle fatigue while walking does not. The primary cause of fatigue may be in other muscles than the medial gastrocnemius. Walking may be an effective prevention measure for health risks of occupational standing when included intermittently.

Background: Prior to the Covid-19 pandemic, telemedicine was only used to deliver health care to patients living in remote areas of Australia. However, the spread of the Covid-19 virus pushed the widespread uptake of telemedicine across Australia, including in metropolitan regions. This qualitative study will explore the medical oncology (MO) patient and clinician experience of telemedicine in a metropolitan setting as a result of Covid-19. Method: Participants were selected and invited to participate by theoretical sampling from MO clinicians and patients attending MO clinics at Prince of Wales Hospital. Data was collected by in-depth semi-structured interviews. Thematic analysis was performed to analyse the interview data. Transcripts were coded using the grounded theory approach to identify overarching themes. Results: : Twelve participants were recruited to the study. Most participants viewed the adoption of telemedicine positively because it was considered as convenient, efficient and could be used in order to reduce the spread of Covid-19. Nonetheless, participants complained about the poor implementation of telemedicine, technical difficulties and lack of proper training. Finally, providers expressed mixed views over the lack of personal interaction and the lack of physical examination from telemedicine. However, both clinicians and patients viewed telemedicine as acceptable to be used in the context of routine follow-ups. Conclusion: Although some operational improvements are necessary, the role of telemedicine in the follow up of MO patients seems likely to continue beyond Covid-19.

Background and study aims When capsule endoscopy (CE) detects a small bowel (SB) target lesion that may be manageable with enteroscopy, the selection of the insertion route is critical. Time- and progression-based CE indices have been proposed for localization of SB lesions. This systematic review analysed the role of CE transit indicators in choosing the insertion route for double-balloon enteroscopy (DBE). Methods A comprehensive literature search identified papers assessing the role of CE on the choice of the route selection for DBE. Data on CE, criteria for route selection, and DBE success parameters were retrieved and analyzed according to the PRISMA statement. Risk of bias was assessed through the STROBE assessment. The primary outcome evaluated was DBE success rate in reaching a SB lesion, measured as the ratio of positive initial DBE to the number of total DBE. Results Seven studies including 262 CEs requiring subsequent DBE were selected. Six studies used time-based indices and one used the PillCam Progress indicator. SB lesions were identified and insertion route was selected according to a specific cut-off, using fixed landmarks for defining SB transit except for one study in which the mouth-cecum transit was considered. DBE success rate was high in all studies, ranging from 78.3 % to 100 %. Six of seven studies were high quality. Conclusions The precise localization of SB lesions remains an open issue, and larger studies are required to determine the most accurate index for selecting the DBE insertion route. In the future, 3 D localization technologies and tracking systems will be essential to accomplish this tricky task.

Since late 2019, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has resulted in more than 143 million confirmed infections and more than 3 million deaths worldwide (as of publication time). In this article, we discuss current knowledge of immune responses that confer protection to more than 80% of the people who have been infected and possible mechanisms by which the virus escapes immune surveillance in people who develop severe disease and those who die from the disease. We also discuss the differences in the immune responses by which, in most children, the infection results in only mild disease, although causing severe disease in some adults. Understanding these differences in both the innate and adaptive immune responses among these people can lead to the development of biotherapeutic treatment modalities that could modulate immune responses to offer protection against SARS-CoV-2 and block the ability of the virus to cause severe disease or death in humans. [Pediatr Ann. 2021;50(5):e222-e226.].

In vitro-transcribed messenger RNA-based therapeutics represent a relatively novel and highly efficient class of drugs. Several recently published studies emphasize the potential efficacy of mRNA vaccines in treating different types of malignant and infectious diseases where conventional vaccine strategies and platforms fail to elicit protective immune responses. mRNA vaccines have lately raised high interest as potent vaccines against SARS-CoV2. Direct application of mRNA or its electroporation into dendritic cells was shown to induce polyclonal CD4+ and CD8+ mediated antigen-specific T cell responses as well as the production of protective antibodies with the ability to eliminate transformed or infected cells. More importantly, the vaccine composition may include two or more mRNAs coding for different proteins or long peptides. This enables the induction of polyclonal immune responses against a broad variety of epitopes within the encoded antigens that are presented on various MHC complexes, thus avoiding the restriction to a certain HLA molecule or possible immune escape due to antigen-loss. The development and design of mRNA therapies was recently boosted by several critical innovations including the development of technologies for the production and delivery of high quality and stable mRNA. Several technical obstacles such as stability, delivery and immunogenicity were addressed in the past and gradually solved in the recent years. This review will summarize the most recent technological developments and application of mRNA vaccines in clinical trials and discusses the results, challenges and future directions with a special focus on the induced innate and adaptive immune responses.

We report here on the nuclear magnetic resonance (NMR) 19 F screening of 14 RNA targets with different secondary and tertiary structure to systematically assess druggability of RNAs. Our RNA targets include representative bacterial riboswitches that naturally bind with nanomolar affinity and high specificity to cellular metabolites of low molecular weight. Based on counter\screens against five DNAs and five proteins, we can show that RNA can be specifically targeted. To demonstrate the quality of the initial fragment library that has been designed for easy follow\up chemistry, we further show how to increase binding affinity from an initial fragment hit by chemistry that links the identified fragment to the intercalator acridine. Thus, we achieve low micromolar binding affinity without losing binding specificity between two different terminator structures.

Informal caregivers face risks of social isolation. Given the high prevalence of informal caregivers in Europe, a considerable proportion of the population are also former caregivers. The Finnish Expert Caregiver intervention sought to train former caregivers to become volunteers aiming to support current caregivers through mainly peer support. The aims of this mixed method non-controlled exploratory intervention study were to assess the feasibility of the Finnish Expert Caregiver intervention by co-designing and implementing the intervention, and by assessing demand and practicality with special attention to the impact of COVID-19. The findings imply that the intervention was feasible as it resulted in a co-designed training course consisting of 30 h with 25 participants enrolling and 19 of them trying volunteering activities. The participants reported high scores on well-being at all timepoints of study, however, without statistically significant differences. The analysis of the focus group interviews revealed that the Expert Caregivers experienced the intervention as meaningful and offered them a sense of belonging with the other participants. Apart from using their caregiving past as an asset, the participants also took advantage of other personal skills and resources. Risks of adverse effects were related to the participants expectations on their own contribution, demanding peer support recipients, poorly functioning peer support groups, and insufficient distance to ones caregiving past. The participants stressed the need for continuing support from intervention facilitators. Future studies with larger samples should investigate whether the effects differ between subgroups of participants and explore the perspective of the peer support recipients.

Fake news detection has become an emerging and critical topic of research in recent years. One of the major complications of fake news detection lies in the fact that news in social networks is multilingual, and therefore developing methods for each and every language in the world is impossible, especially for low resource languages like Persian. In an effort to solve this problem, researchers use machine translation to uniform the data and develop a method for the uniformed data. In this paper, we aim to explore the impacts of machine translation on fake news detection. For this purpose, we extracted and labeled a dataset of Persian Tweets from Twitter on the subject of COVID-19 and developed a method for detecting fake news on the extracted Tweets based on the SVM classifier, then we machine translated the data and applied our proposed method to it. Finally, the result for binary class (only fake and legitimate) fake news detection was 87%, and for multiclass (satire, misinformation, neutral and legitimate) fake news detection was 62%, and our findings demonstrate that machine translation has a 4 % negative impact on binary classification accuracy and a 23% negative impact on multiclass classification. ? 2021 IEEE.

The diffusion of the COVID-19 pandemic has induced fundamental changes in travel habits. Although many previous authors have analysed factors affecting observed variations in travel demand, only a few works have focused on predictions of future new normal conditions when people will be allowed to decide whether to travel or not, although risk mitigation measures will still be enforced on vehicles, and innovative mobility services will be implemented. In addition, few authors have considered future mandatory trips of students that constitute a great part of everyday travels and are fundamental for the development of society. In this paper, logistic regression models were calibrated by using data from a revealed and stated-preferences mobility survey administered to students and employees at the University of Padova (Italy), to predict variables impacting on their decisions to perform educational and working trips in the new normal phase. Results highlighted that these factors are different between students and employees;furthermore, available travel alternatives and specific risk mitigation measures on vehicles were found to be significant. Moreover, the promotion of the use of bikes, as well as bike sharing, car pooling and micro mobility among students can effectively foster sustainable mobility habits. On the other hand, countermeasures on studying/working places resulted in a slight effect on travel decisions.

The global health crisis due to the pandemic of the SARS\CoV\2 is associated with processes of urbanisation and globalisation. Globally well\connected areas with high population densities are hence expected to be disproportionately affected by COVID\19. This paper investigates the role of population density within the Netherlands, comparing hospitalisation and mortality related to COVID\19 across municipalities. The paper finds that infections, hospitalisation and mortality related to COVID\19 are not clearly correlated with the population density or urbanity of the municipality, also when controlling for age and public health factors. The paper concludes that while the public debate stresses the elevated risk of infections in cities, due to transgressive behaviour, the evidence in this paper suggests that the geography of the epidemic in the Netherlands is more complex. It speculates that the variation in urbanisation in most of the country might just be too small to expect significant differences.

Archaeological deposits build up inside standing buildings both under and between floors and these have the potential to provide considerable information about human behavior in the past. Under and between floor spaces provide a unique depositional environment that allow the survival of rare and fragile organic materials that typically do not survive in other archaeological contexts, including paper, cardboard, fabric and other fibres, seeds, leather, and human hair and skin cells. However, they require a clear understanding of depositional processes to allow their interpretation. Experimental archaeology was conducted to understand the process of artifact deposition and the interpretation of underfloor deposits in twelve standing buildings in Western Australia. Floors were built and a range of artifacts swept across them to determine how artifacts travelled across floorboards or fell through gaps between boards. Size, shape, and angularity of artifacts were key determinants of the likelihood of deposition. Sweeping activity makes it more likely that material will be deposited around the margins of rooms, and particularly, to either side of doorways. Underfloor deposits excavated from two specific Western Australian buildings, Ellensbrook Homestead, and the York Residency Museum, are interpreted based on the results of these experiments.