Nutrition therapy during critical illness has been a focus of recent research, with a rapid increase in publications accompanied by two updated international clinical guidelines. However, the translation of evidence into practice is challenging due to the continually evolving, often conflicting trial findings and guideline recommendations. This narrative review aims to provide a comprehensive synthesis and interpretation of the adult critical care nutrition literature, with a particular focus on continuing practice gaps and areas with new data, to assist clinicians in making practical, yet evidence-based decisions regarding nutrition management during the different stages of critical illness.

Evidence shows that chronic diseases are associated with COVID-19 severity and death. This study aims to estimate the fraction of hospitalizations and deaths from COVID-19 attributable to chronic diseases associated to poor nutrition and smoking among adults who tested positive to COVID-19 in Mexico. We analyzed 1,006,541 adults aged 20 who tested positive for COVID-19 from March 23 to December 5, 2020. Six chronic diseases were considered: obesity, chronic obstructive pulmonary disease (COPD), hypertension, diabetes, cardiovascular disease, and chronic kidney disease (CKD). We calibrated the database using a bias quantification method to consider undiagnosed disease cases. To estimate the total impact of multiple diseases, we defined a multimorbidity variable according to the number of diseases. Risks of hospitalization and death were estimated with Poisson regression models and used to calculate population attributable fractions (PAFs). Chronic diseases accounted for to 25.4% [95% CI: 24.8%C26.1%], 28.3% (95% CI: 27.8%C28.7%) and 15.3% (95% CI: 14.9%C15.7%) of the hospitalizations among adults below 40, 40C59, and 60 years and older, respectively. For COVID-19-related deaths, 50.1% (95% CI: 48.6%C51.5%), 40.5% (95% CI: 39.7%C41.3%), and 18.7% (95% CI, 18.0%C19.5%) were attributable to chronic diseases in adults under 40, 40C59, and 60 years and older, respectively. Chronic diseases linked to poor nutrition and smoking could have contributed to a large burden of hospitalization and deaths from COVID-19 in Mexico, particularly among younger adults. Medical and structural interventions to curb chronic disease incidence and facilitate disease control are urgently needed.

The article summarizes the arguments and counterarguments about the peculiarities of formation of competitive advantages on the services market in Ukraine on the example of consulting. Assessment of the development of consulting services market in Ukraine was conducted for ten years (2010;2011;2012;2013;2013;2014;2015;2016;2017;2018;2019, 2020). Methodology. The use of methods of analysis, synthesis and graphical representation allowed for a theoretical study of the formation of competitive advantages. The use of methods of economic, heuristic and strategic analysis became the basis for estimating the market of consulting services in Ukraine and working out practical recommendations for its development. Results. The author's understanding of the concept of "competitive advantages of the company", the factors of their formation and described the relationship of competitive strategies with the process of their formation. Analysis of the market of consulting services in Ukraine revealed its immaturity, exacerbated by the economic crisis, as well as the institutional vulnerability of consulting. The reasons of unstable demand for consulting services are described. According to the results of the expert assessment the Top 15 Ukrainian consulting companies (2020) out of 102 were determined. The leadership matrix of these companies is built depending on their role in the target market, taking into account the typology of competitive strategies of F. Kotler. The analysis showed the transformation of consulting in Ukraine under the influence of the COVID-19 pandemic and the broad interest in digital and HR consulting. Practical recommendations for the development of the market of consulting services in Ukraine are presented. Practical implications. It is proposed to include the following factors in the formation of the competitive advantages of the consulting company: the quality of services, competence of consultants and productivity of the company. The main competitive advantage is the competence of consultants, the level of which affects the quality of services, the results of the company and its customers. To strengthen the competitive advantage it is recommended to use the standard of consulting services in the activities of Ukrainian companies. Value/originality. The results of the study can be useful for any consulting company wishing to improve its competitiveness and expand the market for its services.

BACKGROUND: There are indications that during the lockdown and the measures of social distancing due to the coronavirus disease 2019 (COVID-19) pandemic, physical and sexual child abuse and neglect may have increased Additionally, decreased social control may have led to a lower detection rate of child protection cases OBJECTIVE: This study aimed to better understand the impact of the lockdown in Germany on the frequency and severity of child abuse and neglect To do so the quantity and quality of cases of suspected child abuse and neglect in German pediatric departments and outpatient departments for medical child protection were examined METHODS: In May 2020 a total of 343 institutions of medical child protection were invited to fill in a questionnaire with items describing their institution and items depicting cases of child protection in March and April 2019 and 2020 regarding age, form and severity of abuse as well as items to describe particular remarks and ideas for child protection during the pandemic RESULTS: Out of the 343 pediatric departments and outpatient departments of medical child protection invited, the participation rate was 46% In this study 81 institutions reported the total cases of suspected child abuse or neglect for both March and April 2019 and 2020 The number of cases dropped from 454 to 387 (-15%) in outpatient child abuse clinics and from 307 to 246 (-20%) in pediatric inpatient departments Regarding the age of affected children and the form of abuse no significant differences were found CONCLUSION: The study found a decrease in reported cases of suspected child abuse and neglect during the lockdown in March and April 2020 compared to 2019 While the results do not show an increase of total child abuse and neglect, as suspected by many professionals, the decrease in reported cases may be explained by a steep increase in unreported cases due to reduced social control Publisher: Abstract available from the publisher ger

BACKGROUND: Currently, there is an urgent need for efficient tools to assess the diagnosis of COVID-19 patients. In this paper, we present feasible solutions for detecting and labeling infected tissues on CT lung images of such patients. Two structurally-different deep learning techniques, SegNet and U-NET, are investigated for semantically segmenting infected tissue regions in CT lung images. METHODS: We propose to use two known deep learning networks, SegNet and U-NET, for image tissue classification. SegNet is characterized as a scene segmentation network and U-NET as a medical segmentation tool. Both networks were exploited as binary segmentors to discriminate between infected and healthy lung tissue, also as multi-class segmentors to learn the infection type on the lung. Each network is trained using seventy-two data images, validated on ten images, and tested against the left eighteen images. Several statistical scores are calculated for the results and tabulated accordingly. RESULTS: The results show the superior ability of SegNet in classifying infected/non-infected tissues compared to the other methods (with 0.95 mean accuracy), while the U-NET shows better results as a multi-class segmentor (with 0.91 mean accuracy). CONCLUSION: Semantically segmenting CT scan images of COVID-19 patients is a crucial goal because it would not only assist in disease diagnosis, also help in quantifying the severity of the illness, and hence, prioritize the population treatment accordingly. We propose computer-based techniques that prove to be reliable as detectors for infected tissue in lung CT scans. The availability of such a method in todays pandemic would help automate, prioritize, fasten, and broaden the treatment of COVID-19 patients globally.

The emergence of the Covid-19 (coronavirus) pandemic in late 2019 and early 2020 presented new and urgent challenges to mental health services and legislators around the world. This special issue of the International Journal of Law and Psychiatry explores mental health law, mental capacity law, and medical and legal ethics in the context of Covid-19. Papers are drawn from India, Australia, the United Kingdom, Ireland, Germany, Portugal and the United States. Together, these articles demonstrate the complexity of psychiatric and legal issues prompted by Covid-19 in terms of providing mental health care, protecting rights, exercising decision-making capacity and a range of other topics. While further work is needed in many of these areas, these papers provide a strong frame-work for addressing key issues and meeting the challenges that Covid-19 and, possibly, other outbreaks are likely to present in the future.

We are concerned that yet another erroneous report of the electron microscopical observation of coronavirus in tissue has been published. The paper by Colmenero et al. presents a study of skin biopsies from paediatric patients presenting with chilblains during the COVID-19 pandemic.1 Seven cases were examined by histopathological and immunohistochemical techniques, and one of these was additionally studied by transmission electron microscopy.

BACKGROUND: Scant data are currently available about a potential link between comorbid chronic lung diseases (CLD) and the risk and severity of the coronavirus disease 2019 (COVID-19) infection. METHODS: To describe the clinical characteristics of and outcomes for patients with COVID-19 infection, including patients with comorbid respiratory diseases, who have been primarily hospitalized in the pulmonology department of Strasbourg University Hospital, France. In this retrospective, single-center study, we included all confirmed cases of COVID-19 from March 3 to April 15, 2020. We then compared the symptoms, biological and radiological findings, and outcomes for patients with and without CLD. RESULTS: Of the 124 patients that were enrolled, the median age was 62 years, and 75 patients (60%) were male. Overall, 40% of patients (n=50) had preexisting CLD, including chronic obstructive pulmonary disease (COPD) (n=15, 12%) and asthma (n=19, 15%). Twenty-eight patients were transferred to the intensive care unit (ICU), and six patients died in our unit. CLD were not predictive of ICU hospitalization, but a significantly higher total mortality was observed (17.6% vs. 5.5%, P<0.05) in these patients. CONCLUSIONS: Our results suggest the lack of an over-representation of CLD in COVID-19, representing 40% of patients in this cohort and even within a pulmonology department. CLD were not a risk factor for ICU management. However, a tendency to higher global mortality was observed in COVID-19 patients with CLD. Further studies are warranted to determine the risk of COVID-19 for patients with comorbid CLD.

BACKGROUND: In Belgium, schools closed during the first lockdown in March 2020, with a partial reopening in May. They fully reopened in September. During the summer, infections started to increase in the general population, speeding up in September. Some measures were taken to limit social contacts but those were insufficient to mitigate the exponential rise of infections in October. Children were still receiving all lessons at school at that time and it was questioned whether this position was tenable. We systematically compared the benefits and harms of closing primary and secondary schools and developed a recommendation. METHODS: A multidisciplinary panel, including school pupils and teachers, educational experts, clinicians and researchers, produced this recommendation in compliance with the standards for trustworthy rapid guidelines. The recommendation is based on data collected through national surveillance or studies from Belgium, and supported by a rapid literature review. RESULTS: Closing schools during the first lockdown probably resulted in a large learning delay and possibly led to more cases of child abuse. We are uncertain about the effect on the infection rate, hospitalisations, transmission rates, mental health of children, teachers and parents. The panel concluded that the balance of benefits and harms of closing schools clearly shifts against closing schools. Detrimental effects are even worse for vulnerable children. This recommendation is affected by the local virus circulation. CONCLUSION: The guideline panel issues a strong recommendation against closing schools when the virus circulation is low to moderate, and a weak recommendation against closing schools when the virus circulation is high. It does not apply when the school system cannot function due to lack of teachers, too many children who are at home or a shortage of support services. As the results of international studies are consistent with Belgian study results, this recommendation may also be relevant internationally.

Background: This case report describes a large sporadic benign phaeochromocytoma with classic symptoms and an unexpected SARS-CoV-2 virus contagious during the first pandemic wave. Clinical Case: A 61-years-old healthy man was admitted in the hospital emergency with hypertension, facial flushing, headache, nausea, vomiting and tremors. The patient presented hypertensive encephalopathy requiring orotracheal intubation. During the procedure, after rocuronium administration, the arterial pressure levels suddenly incresead more. An abdomen CT performed for vomiting investigation showed a mass in the left upper quadrant measuring 12.3 x 8.1 x 11.4 cm, central cystic area and sparse coarse calcifications, solid component density of 30 UH in the non-contrast phase and absolut washout of 48%, suggesting phaeochromocytoma (FEO) etiology. The patient renal function impaired and hemodialysis was required as replacement therapy. Even with small amount of urine available for exams, 24h urine tests were compatible with FEO diagnosis: (normetanephrines above 4260 mcg/L, n&amp;lt;732 mcg/L, 250 mL of urine). Considering the severity of symptoms, a chest CT scan was provided, not demonstrating any metastatic disease. Parenteral antihypertensive medication to manage blood pressure was required and this withdraw was reached after the introduction of prazosin 2 mg twice a day. After adequate preoperative preparation, the surgical removal was performed. Systolic BP intraoperative fluctuations occurred, with variations between 70 and 210mmHg. Splenectomy was necessary due the intimate contact with the adrenal mass. No obvious metastases were observed. The anatomopathological showed a 390 grams adrenal mass confirming FEO (PASS score 5). Genetic panel for phaeochromocytoma and paraganglioma with complete sequencing found no pathogenic variants in any of the 22 genes analyzed, suggesting sporadic etiology. The patient got infected with COVID-19 after a family visitor confirmed by molecular test. He developed mild respiratory symptoms, delaying his hospital discharge. He was released seven weeks after surgery with complete kidney recover function using low doses of prazosin. Plasma metanephrines and normetanephrines were normal. Conclusion: Phaeochromocytoma is a rare disease with no specific clinical signs and symptoms. It implies in potentially lethal cardiovascular complications, especially during the COVID-19 pandemic. On the other hand it is a curable illness through the surgical tumor removal. Attention should be paid to high blood pressure levels even after the tumor is removed which can be justified by the remaining vascular hypertrophy as long as the suspicion of malignant FEO is excluded.

The Innovative Medicines Initiative (IMI) is making great strides in promoting patient and public involvement (PPI) in health research across Europe, supporting patient organisations to be involved in the projects that it funds. Despite this, the literature around PPI in health services and research originating from European countries appears less than from the United Kingdom (UK), where PPI is well established. Therefore, we conducted a systematic review to explore the attitudes and approaches to PPI across Europe. Eight scientific databases were systematically searched and data extracted. Data quality was assessed using a checklist based on the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) (Staniszewska et al., Research, Involvement and Engagement, 3, 13, 2017) and the critical appraisal guidelines developed by Wright et al. (Health Expectations, 13, 359, 2010). We included all studies reporting PPI activity in both public and private health services and research institutions in the World Health Organization European region, excluding the UK, published in the English language from 1996 to 2018. Forty studies in total were included in the analysis. The studies imply a growing interest and support for the idea of PPI in health services and, to a lesser extent, in health research. There seems to be a convergence of conceptualisations of PPI across Europe, with internationally significant areas of innovative work taking place in countries such as the Netherlands and the Scandinavian countries. However, the implementation of PPI is highly uneven, and PPI is not yet firmly embedded or adequately formalised in European healthcare systems and research, possibly due to a lack of infrastructure, guidance and support. In order to try to get a better understanding of what is happening on the ground, we are carrying out a survey with potential follow-up interviews as the next part of this research project. This work is currently on hold due to the COVID-19 pandemic.

Missing or incomplete phenotypic information can severely deteriorate the statistical power in epidemiological studies. High-throughput quantification of small-molecules in bio-samples, i.e. metabolomics, is steadily gaining popularity, as it is highly informative for various phenotypical characteristics. Here we aim to leverage metabolomics to impute missing data in clinical variables routinely assessed in large epidemiological and clinical studies. To this end, we have employed ~25,000 1H-NMR metabolomics samples from 28 Dutch cohorts collected within the BBMRI-NL consortium, to create 19 metabolomics-based predictors for clinical variables, including diabetes status (AUC5-Fold CV = 0.94) and lipid medication usage (AUC5-Fold CV = 0.90). Subsequent application in independent cohorts confirmed that our metabolomics-based predictors can indeed be used to impute a wide array of missing clinical variables from a single metabolomics data resource. In addition, application highlighted the potential use of our predictors to explore the effects of totally unobserved confounders in omics association studies. Finally, we show that our predictors can be used to explore risk factor profiles contributing to mortality in older participants. To conclude, we provide 1H-NMR metabolomics-based models to impute clinical variables routinely assessed in epidemiological studies and illustrate their merit in scenarios when phenotypic variables are partially incomplete or totally unobserved.

During the COVID-19 pandemic, healthcare workers stand in the frontline of the fight against the disease. This study aimed to assess the challenges with personal protection during the pandemic in Tehran, Iran. Seven-hundred healthcare workers were surveyed between April and May 2020, and the study was performed in surgical care wards. Questionnaires, which were sent to 1000 workers via online platforms, social networks, and emails to different associations, were used to assess the use of personal protective equipment (PPE) and the reasons for not using it. A total of 700 replied. Face masks and face shields had the highest and lowest use, respectively. Equipment shortage, time constraint, low supervision, and lack of information were the reasons for personnel not using PPE. To reduce the burden of COVID-19 and accelerate the process of patient care, it is important to protect and maintain the well-being of staff. Organised national and international arrangements to protect them are critical.

The purpose of this study was to examine the effect of a practitioner education program (consisting of education on exercise guidelines and exercise prescription) on practitioner (i) confidence in prescribing exercise and (ii) rate of prescribing exercise. A pre-post study design was utilized. A two-session practitioner education and a toolbox of resources was developed and implemented in January 2020, targeting 12 eligible practitioners at a large primary care and functional medicine office in New York City. A three-question confidence survey was given pre and post. Fifty randomly selected charts were reviewed at baseline (pre), and 25 charts were reviewed monthly for 3 months (February C April 2020) post. There were significant increases and a large effect size in both confidence in prescribing exercise (30% to 89% [p = .020, Phi = 0.596]) and individualizing an exercise prescription between pre- and post-education sessions (20% to 78% [p = .023, Phi = 0.578]). There was also a sustained and significant increase (24% to 63% [p < .001, Phi = 0.379]) in exercise prescription over the three-month period following the education sessions. No statistically significant data was obtained regarding increasing the rate of physical activity among patients. The evidence from this study demonstrates the effectiveness of increasing practitioner confidence and uptake of exercise prescription through education sessions that provide them with the knowledge and tools to properly assess patients activity level and offer individualized exercise recommendations.

In the race to publish papers and secure funding, science can sometimes seem like a competition. But, in reality, modern science relies on open sharing and collaboration. One unexpected aspect of open science is the role it has played in uplifting the careers of myself and my lab members.

We propose modeling COVID-19 infection dynamics using a class of two-type branching processes. These models require only observations on daily statistics to estimate the average number of secondary infections caused by a host and to predict the mean number of the non-observed infected individuals. The development of the epidemic process depends on the reproduction rate as well as on additional facets as immigration, adaptive immunity, and vaccination. Usually, in the existing deterministic and stochastic models, the officially reported and publicly available data are not sufficient for estimating model parameters. An important advantage of the proposed model, in addition to its simplicity, is the possibility of direct computation of its parameters estimates from the daily available data. We illustrate the proposed model and the corresponding data analysis with data from Bulgaria, however they are not limited to Bulgaria and can be applied to other countries subject to data availability. ? 2021 Walter de Gruyter GmbH, Berlin/Boston 2021.

This study aimed to compare physical activity (PA) levels before and during a pandemic lockdown among adolescent Polish youths in relation to meeting the World Health Organizations (WHO) recommendations of moderate-to-vigorous physical activity (MVPA) and identify potential environmental factors that may affect these levels An online survey tool that included validated measures of adolescents MVPA and socio-environmental, potential confounders was administered to youths (e g , lack of classmates, motivation, possibility of choosing any physical exercise time, possibility of choosing your own exercises, home environment) The analytic sample comprised 127 adolescents aged 15 4 0 5 years on average (52% girls and 48% boys) The results highlight that among adolescents who did not meet the WHO MVPA recommendations before the lockdown, 13 4% had an increased frequency of PA (from 2 9 to 5 4 day/week) (p = 0 01) during the lockdown In the group who did meet these recommendations before the lockdown, 50% significantly decreased their level of MVPA below the WHOs recommendations (p = 0 01) Self-rated health for PA showed a significantly strong correlation with MVPA in the group of students who met the WHO recommendations before the pandemic (r = 0 76;p &lt; 0 05) but failed to maintain that recommendation during the COVID-19 restriction The results suggest a negative impact of the pandemic on PA undertaken by youths Based on these results we see the need for increased action by both Physical Education (PE) teachers and parents to motivate and support youngsters in taking up systematic PA consciously ? 2021 by the authors Licensee MDPI, Basel, Switzerland

Pulmonary fibrosis (PF), a pathological outcome of chronic and acute interstitial lung diseases associated to compromised wound healing, is a key component of the "post-acute COVID-19 syndrome" that may severely complicate patients' clinical course. Although inconclusive, available data suggest that more than a third of hospitalized COVID-19 patients develop lung fibrotic abnormalities after their discharge from hospital. The pathogenesis of PF in patients recovering from a severe acute case of COVID-19 is complex, and several hypotheses have been formulated to explain its development. An analysis of the data that is presently available suggests that biomarkers of susceptibility could help to identify subjects with increased probability of developing PF and may represent a means to personalize the management of COVID-19's long-term effects. Our review highlights the importance of both patient-related and disease-related contributing risk factors for PF in COVID-19 survivors and makes it definitely clear the possible use of acute phase and follow-up biomarkers for identifying the patients at greatest risk of developing this disease.

The raison d'tre for this article is simple: traditional ways of researching, theorizing, and practicing purchasing and supply management (PSM) are no longer sufficient to meet the moment. Scholars need to advance a business-not-as-usual footing approach to their work, if they are to make a meaningful contribution to addressing the current and future emergencies, as highlighted by recent extreme weather and the COVID-19 pandemic. Yet, what can this, or should this, mean for a field rooted in traditional business thinking? This article builds on the Journal of Purchasing and Supply Management's (JPSM) 25th Anniversary Special Issue editorial (2019);members of the JPSM's editorial team advance their unique perspectives on what business-not-as-usual means for PSM. Specifically, we advocate both thinking much more widely, in scope and ambition, than we currently do, and simultaneously building our ability to comprehend supply chains in a more nuanced and granular way. We explore whether the bias toward positivist work has omitted potentially interesting findings, and viewpoints. This leads to a call to re-think how we approach our work: should the key criteria always be to focus on theory development or testing? Should academics think bigger? Turning to specific research themes, illustrations of how our current thinking can be challenged or broadened by addressing the circular economy, and role of purchasing and innovation. Specifically, the focus on the PSM function as an intrapreneur within the larger organization, and the role of innovation and technology in PSM work. Taken together, we hope the ideas and arguments presented here will inform and inspire ambitious and novel approaches to PSM research with significant and enduring impact on the transformation of business.

BACKGROUND: The quality of root canal treatments performed by undergraduate students is often unsatisfactory questioning the current methods of teaching. Based on treatment errors made by students participating the endodontic courses at RWTH Aachen University (Germany), new radiopaque artificial root canal treatment models (DRSK RCT; incisor, premolar, molar) were designed and developed. The aim of the study was to evaluate these models by groups of students and demonstrators. METHODS: A total number of 60 students and seven demonstrators from a single institution (RWTH Aachen) participated in this study. They performed endodontic treatments on either initial versions of the DRSK RCT or modified versions. The initial versions were evaluated by students (n = 25) and demonstrators (n = 7). The obtained questionnaire was conducted as 7-point Likert-Scale covering the topics material properties, feeling while performing exercises and perception of its closeness to reality via 19 items (students) and 21 items (demonstrators). According to the evaluations several alterations were applied to the DRSK RCT, the whole study was repeated and evaluated by different students (n = 35) and the same demonstrators (n = 7). Additionally, the demonstrators blindly evaluated the quality of root canal treatments performed by the students (n = 35) on the modified DRSK RCT. Comparisons between the initial versions and the modified versions were calculated using Chi-squared tests. RESULTS: Students as well as demonstrators positively evaluated both variants of the DRSK RCT with especially high ratings in the overall evaluation. Students rating of the pulp anatomy significantly increased from 5.4 1.1 (mean SD) to 5.9 0.9 (mean SD; p < 0.05) for the modified model. Likewise, students felt that the ability to flare root canals improved after alterations have been applied. Ratings significantly increased from 4.8 1.6 (mean SD) to 5.6 1.0 (mean SD; p < 0.05). CONCLUSION: The results indicate that the DRSK RCT is a promising candidate to be used as an alternative to extracted teeth or as an additional tool for improving dental education. However, some limitations of our analysis have to be considered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-021-02848-9.