Previous research has indicated that racial-ethnic minority communities lack a wide variety of health-related organizations. We examine how this relates to the early COVID-19 vaccine rollout. In a series of spatial error and linear growth models, we analyze how racial-ethnic residential segregation is associated with the distribution of vaccine sites and vaccine doses across ZIP codes in the five largest urban counties in Texas. We find that Black and Latino clustered ZIP codes are less likely to have vaccine distribution sites and that this disparity is partially explained by the lack of hospitals and physicians' offices in these areas. Moreover, Black clustering is also negatively related to the number of allocated vaccine doses, and again, this is largely explained by the unequal distribution of health care resources. These results suggest that extant disparities in service provision are key to understanding racial-ethnic inequality in an acute crisis like the COVID-19 pandemic.

Abstract Acute respiratory tract infections are the most common illnesses in all individuals, regardless of age or gender. Epidemiologic surveys and community-based studies conducted since the beginning of the 20th century have determined the rates of illness and the pathogens involved in such infections. These studies have shown that rhinoviruses cause the great majority of these respiratory illnesses, and their findings have examined the means of transmission of respiratory illness. More recently, advances in diagnostic techniques have enabled more complete identification of the viruses involved in respiratory infections, which has aided in the ability to direct specific therapeutic agents at the causative pathogens.

In order to ease lockdown restrictions and prevent a second wave of infections, countries must be able to find, test, trace, isolate and support new COVID-19 cases The simplicity of the 'test, trace, isolate' mantra dramatically understates the multitude of time-dependent processes that must occur seamlessly for the strategy to work effectively We reconceptualise the way out of lockdown as a Snakes and Ladders boardgame To succeed, countries must ensure that people with COVID-19 progress through the board as quickly as possible by putting in place measures that enhance their public health capacity (i e landing on ladders) and prevent setbacks caused by having insufficient capacity (i e avoiding snakes)

BACKGROUND: The COVID-19 pandemic has resulted in significant changes and restrictions to neonatal care. The aim of this study was to explore the impact of these changes on Neonatal Nurses globally. METHODS: We conducted a thematic analysis on written reflections by neonatal nurses worldwide, exploring their experiences of COVID-19. Twenty-two reflections were analysed from eleven countries. RESULTS: Thematic analysis revealed 4 main themes relating to the nurses role: 1) protector 2) challenges to human quality of care 3) vulnerability and 4) resilience. The measures taken as protector were described as compromising the human qualities of care fundamental to their role. This tension, together with other new challenges, heightened feelings of vulnerability. Concurrently, nurses identified role resilience, including resourcefulness and peer support, which allowed them to navigate the global pandemic. CONCLUSION: By identifying global challenges and strategies to overcome these, neonatal nurses may be better equipped as the pandemic continues. The reflections underscore the importance of family integrated care and the tension created when it is compromised.

BACKGROUND/AIMS: The coronavirus disease 2019 (CO-VID-19) pandemic is the major current health emergency worldwide, adding a significant burden also to the community of nephrologists for the management of their patients. Here, we analyzed the impact of COVID-19 infection in renal patients to assess the time to viral clearance, together with the production and persistence of IgG and IgM antibody response, in consideration of the altered immune capacity of this fragile population. METHODS: Viral clearance and antibody kinetics were investigated in 49 renal patients recovered from COVID-19 infection: 7 of them with chronic decompensated renal failure, 31 under dialysis treatment, and 11 kidney transplant recipients. RESULTS: The time span between the diagnosis of infection and recovery based on laboratory testing (2 negative nasopharyngeal swabs in consecutive days) was 31.7 13.3 days. Three new positive cases were detected from 8 to 13 days following recovery. At the first serological determination after swab negativization, all the patients developed IgG and IgM antibodies. The semiquantitative analysis showed a progressive increase in IgG and a slow reduction in IgM. DISCUSSION/CONCLUSION: In subjects with decompensated chronic kidney disease, under dialysis and in transplant recipients, viral clearance is lengthened compared to the general population. However, in spite of their common status of immunodepression, all of them were able to produce specific antibodies. These data might provide useful insights for monitoring and planning health-care activities in the weak category of patients with compromised renal function recovered from COVID-19.

Aversive memories are long-lasting and prone to have adverse effects on our emotional wellbeing and mental health. Yet, how to remedy the maladaptive effects of aversive memories remains elusive. Using memory reactivation and emotional updating manipulations, we investigated how positive and neutral emotion updates aversive memories for reconsolidation in humans. We found that positive updating after reactivation was equivalent to neutral updating in altering true memories of the aversive story, but introduced more false memory. Moreover, an additional 12 hours of sleep reconsolidation did not further enlarge true memory differences, but attenuated the effect of reactivation and updating on false memory. Interestingly, the neutral rather than the positive updating reduced the emotional arousal of the aversive memory 24 hours later. Our findings provide novel insights into real-world therapeutic applications regarding how updating with positive and neutral emotion may reshape aversive memories, especially when taking wake- and sleep-filled reconsolidation into account.

INTRODUCTION: SARS-CoV-2 (COVID-19) has caused death and economic injury around the globe. The urgent need for COVID-19 research created new ethical, regulatory, and practical challenges. The next public health emergency could be worse than COVID-19. We must learn about these challenges from the experiences of researchers and Research Ethics Committee professionals responsible for these COVID-19 studies to prepare for the next emergency. MATERIALS AND METHODS: We conducted an online survey to identify the ethical, oversight, and regulatory challenges of conducting COVID-19 research during the early pandemic, and proposed solutions for overcoming these barriers. Using criterion-based, convenience sampling, we invited researchers who proposed or conducted COVID-19 research to complete an anonymous, online survey about their experiences. We administered a separate but related survey to Institutional Review Board (IRB) professionals who reviewed COVID-19 research studies. The surveys included open-ended and demographic items. We performed inductive content analysis on responses to open-ended survey questions. RESULTS: IRB professionals (n = 143) and researchers (n = 211) described 19 types of barriers to COVID-19 research, related to 5 overarching categories: policy and regulatory, biases and misperceptions, institutional and inter-institutional conflicts, risks of harm, and pressure of the pandemic. Researchers and IRB professionals described 8 categories of adaptations and solutions to these challenges: enacting technological solutions; developing protocol-based solutions; disposition and team management; establishing and communicating appropriate standards; national guidance and leadership; maintaining high standards; prioritizing studies before IRB review; and identifying and incorporating experts. DISCUSSION AND CONCLUSIONS: This inventory of challenges represents ongoing barriers to studying the current pandemic, and they represent a risk to research during future public health emergencies. Delays in studies of a pandemic during a pandemic threatens the health and safety of the public. We urge the development of a national working group to address these issues before the next public health emergency arises.

Although recognized as effective measures to curb the spread of the COVID19 outbreak, social distancing and home confinement have generated a mental health burden with older adults who are considered to be more vulnerable to psychosocial strains To date, the application of digital technologies in response to COVID-19 pandemic has been narrowed to public-health needs related to containment and mitigation However, information and communications technology (ICT)-based initiatives directed toward prediction and prevention of psychosocial support are still limited Given the power of digital health solutions to allow easy and accurate characterization and intervention for health and disease, as well as to flatten the COVID19 incidence curves in many countries, our ECLB-COVID19 consortium is highlighting the importance of providing innovative ICT-based solutions (ICT-COVID-Companion) to improve elderly physical and mental health, thereby preventing/dampening psychosocial strain during pandemics Based on innovative approaches (e g , emotional/social computing, open social platform, interactive coaching, gamification, fitness-tracker, internet of things) and smart digital solutions (smartwatch/smartphone), smart companions must provide safe personalised physical, mental and psychosocial health surveillance Additionally, by delivering personalised multi-dimension crisis-oriented health recommendations, such innovative crisis-oriented solutions would help (i) facilitate a user's adherence to active and healthy confinement lifestyle (AHCL), (ii) achieve a rapid psychosocial recovery in case of depression issues and (iii) enhance preparedness for eventual future pandemics

BACKGROUND: Coronavirus disease 2019 (COVID-19) has significantly impacted endonasal surgery, and recent experimentation has demonstrated that sinonasal drilling and cautery have significant propensity for airborne particulate generation immediately adjacent to the surgical field. In the present investigation, we assessed nasopharyngeal suctioning as a mitigation strategy to decrease particulate spread during simulated endonasal surgical activity. METHODS: Airborne particulate generation in the 1-m to 10-m range was quantified with an optical particle sizer in real-time during cadaveric-simulated anterior and posterior endonasal drilling and cautery conditions. To test suction mitigation, experiments were performed both with and without a rigid suction placed in the contralateral nostril, terminating in the nasopharynx. RESULTS: Both anterior (medial maxillary wall and nasal septum) and posterior (sphenoid rostrum) drilling produced significant particulate generation in the 1-m to 10-m range throughout the duration of drilling (p < 0.001) without the use of suction, whereas nasopharyngeal suction use eliminated the detection of generated airborne particulate. A similar effect was seen with nasal cautery, with significant particle generation (p < 0.001) that was reduced to undetectable levels with the use of nasopharyngeal suction. CONCLUSION: The use of nasopharyngeal suctioning via the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery. In the era of COVID-19, this technique offers an immediately available measure that may increase surgical safety.

The federal governments economic response to the COVID-19 epidemic has principally been one in which the Federal Reserve has set up extraordinary lending facilities in partnership with the Treasury Department. These facilities were modeled on multi-trillion-dollar lending facilities set up by the Federal Reserve in 2008 in response to the prior economic crisis. These Federal Reserve lending facilities are extraordinary in size but also extraordinary because they involve lending to firms that are not banks. Federal Reserve lending over the first hundred years of its history was almost exclusively limited to banks. Congress put in place statutory limits on this extraordinary lending authority in the Dodd-Frank Act of 2010 to limit the Federal Reserves discretion and minimize the risk that generous lending by the Federal Reserve would encourage excessive risk taking. Those limits prohibit the Fed from supporting insolvent firms, from propping up individual firms like it did with AIG in 2008, includes a number of other prescriptive measures to ensure the Federal Reserve takes reasonable risk management practices even in extraordinary times. This paper argues that those limits have not proven enforceable nor constraining on the Feds discretion, and this paper instead argues that a private right of action to enforce them would better fulfill Congress objective in the Dodd-Frank Act to limit Federal Reserve discretion in lending to non-banks.

In the last decades, optimizing implant properties in terms of materials and biointerface characteristics represents one of the main quests in biomedical research. Modifying and engineering polyvinylidene fluoride (PVDF) as scaffolds becomes more and more attractive to multiples areas of bio-applications (e.g., bone or cochlear implants). Nevertheless, the acceptance of an implant is affected by its inflammatory potency caused by surface-induced modification. Therefore, in this work, three types of nano-micro squared wells like PVDF structures (i.e., reversed pyramidal shape with depths from 0.8 to 2.5 microns) were obtained by replication, and the influence of their characteristics on the inflammatory response of human macrophages was investigated in vitro. FTIR and X-ray photoelectron spectroscopy analysis confirmed the maintaining chemical structures of the replicated surfaces, while the topographical surface characteristics were evaluated by AFM and SEM analysis. Contact angle and surface energy analysis indicated a modification from superhydrophobicity of casted materials to moderate hydrophobicity based on the structures depth change. The effects induced by PVDF casted and micron-sized reversed pyramidal replicas on macrophages behavior were evaluated in normal and inflammatory conditions (lipopolysaccharide treatment) using colorimetric, microscopy, and ELISA methods. Our results demonstrate that the depth of the microstructured surface affects the activity of macrophages and that the modification of topography could influence both the hydrophobicity of the surface and the inflammatory response.

OBJECTIVES: To find out how medical students think well-being should be measured. DESIGN: A mixed-methods study comprising a cross-sectional online survey (November 2020CMarch 2021) and semi-structured online interviews. Views on the frequency of availability for measurement, the format, type and purpose of measurement, and with whom well-being should be discussed were measured. When an outcome was scored 7C9 on a 9-point Likert scale of agreement by 75% of participants it was considered critical. Inductive thematic analysis was undertaken on the interview transcripts. SETTING: All medicine programmes at University of Southampton. PARTICIPANTS: Medical students from all years took part in the survey (n=118) and interviews (n=16). RESULTS: Most participants (94%) felt able to give 5 min to measure their well-being at least once per month. Research, governance and individual feedback were all considered critically important. Only subjective assessments undertaken by the individual in real-time were rated critically important (78.1%) measurement tools. Students selected that they would discuss their well-being with other medical students (n=87) nearly as often as they selected a member of the faculty (n=104). Five interview themes further explained these findings: (1) well-being is mental well-being; (2) exercise and support from friends and family are most important; (3) isolation and the design of the medicine programme are detrimental to well-being; (4) there are advantages to surveys, and conversations; (5) personal academic tutors and medical students in later years are the best to discuss well-being with. CONCLUSIONS: Medical students thought that measurement of their well-being was critically important for governance showing their support for quality assurance of well-being and peer support. They wanted to be able to choose surveys, or conversations, to measure their well-being, as well as the person they discussed well-being with. Four recommendations are discussed in light of these findings.

BACKGROUND: Reliable high-throughput serological assays for SARS-CoV-2 antibodies are urgently needed for the effective containment of the COVID-19 pandemic, as it is of crucial importance to understand the strength and duration of immunity after infection, and to make informed decisions concerning the activation or discontinuation of physical distancing restrictions. METHODS: In 184 serum samples from 130 COVID-19 patients and 54 SARS-CoV-2 negative subjects, the analytical and clinical performances of four commercially available chemiluminescent assays (Abbott SARS-Cov-2 IgG, Roche Elecsys anti-SARS-CoV-2, Ortho SARS-CoV-2 total and IgG) and one enzyme-linked immunosorbent assay (Diesse ENZY-WELL SARS-CoV-2 IgG) were evaluated and compared with the neutralization activity achieved using the plaque reduction neutralization test (PRNT). FINDINGS: Precision results ranged from 0.9% to 11.8% for all assays. Elecsys anti-SARS-CoV-2 demonstrated linearity of results at concentrations within the cut-off value. Overall, sensitivity ranged from 78.5 to 87.7%, and specificity, from 97.6 to 100%. On limiting the analysis to samples collected 12 days after onset of symptoms, the sensitivity of all assays increased, the highest value (95.2%) being obtained with VITRO Anti-SARS-CoV-2 Total and Architect SARS-CoV-2 IgG. The strongest PRNT50 correlation with antibody levels was obtained with ENZY-Well SARS-CoV-2 IgG (R2adj = 0.569). INTERPRETATION: The results confirmed that all immunoassays had an excellent specificity, whereas sensitivity varied across immunoassays, depending strongly on the time interval between symptoms onset and sample collection. Further studies should be conducted to achieve a stronger correlation between antibody measurement and PRNT50 in order to obtain useful information for providing a better management of COVID-19 patients, effective passive antibody therapy, and developing a vaccine against the SARS-CoV-2 virus. FUNDING: None.

This review paper discusses the properties of nanomaterials, namely graphene, molybdenum disulfide, carbon nanotubes, and quantum dots for unique sensing applications Based on the specific analyte to be detected and the functionalization techniques that are employed, some noteworthy sensors that have been developed are discussed Further, biocompatible sensors fabricated from these materials capable of detecting specific chemical compounds are also highlighted for COVID-19 detection purposes, which can aid in efficient and reliable sensing as well as timely diagnosis IEEE

PURPOSE This study aimed to adapt a guideline for endotracheal suctioning of adults with artificial airways in the perianesthesia setting in China. DESIGN This study was guided by the ADAPTE framework. METHODS The development process consisted of setup, adaptation, and finalization phases. A heterogeneous consultant panel that included a patient representative was established to contribute guidance and suggestions regarding guideline development. Relevant evidence documents were searched, critically appraised, selected, and synthesized to develop the draft guideline. After revisions, the adapted guideline was evaluated by 20 external reviewers. FINDINGS A 155-page adapted guideline was developed with 26 key recommendations (including 3 procedure phases and 17 points of care). CONCLUSIONS The adapted guideline provided the best evidence for endotracheal suctioning of adults with artificial airways and supported practitioner decisions about appropriate endotracheal suctioning practices for this population. The study also lays the groundwork for future projects on quality improvement and knowledge translation.

We present a novel mobile robot manipulator named BALTO, which can precisely and autonomously disinfect critical items of buildings, yet be easily deployed in different environments by non-expert operators. Conventional approaches based on greedy disinfection actions can be dangerous for surrounding humans, or provide non-controlled coverage of critical items such as door-handles, push-bars or switches. Other robotic solutions providing precision disinfection can require time-consuming geometric and semantic mapping of the environment, placement of non-natural landmarks, or the presence of an operator on-site for programming to adapt to the use case. Our approach is different: we integrate preliminary knowledge of the building within the robot control system itself, using Building Information Modelling (BIM) data readily available from modern construction processes. BIM models completely describe a building and its components with the corresponding geometric and semantic data. We use these data to provide the robot with the components to disinfect and their location, as well as the description of the environment in which it operates, without requiring any prior mapping procedure. Precise disinfection actions are enabled by an automatic calibration procedure based on a learned 3D model of the target. We finally present results of experiments performed in operational environment that verify the effectiveness of our proposed solution. ? 2021 IEEE.

The knowledge of epidemiology and clinical profile is essential to understand the severity of the disease and to come up with timely intervention and proper treatment to reduce the morbidity and mortality caused by it. Severe Acute Respiratory SyndromeCoronavirus2 (SARS-CoV-2) the cause of Novel Coronavirus caused an outbreak in December 2019 in China, Wuhan. COVID-19 was declared to be a global pandemic on 11 March 2020 and it was found to cause pneumonia. This is a retrospective study done by reviewing the medical records of patients admitted to the COVID ward of a tertiary health care hospital in Chennai, Tamil Nadu. This study is focused on the epidemiology, clinical features and outcome of the patients. Patients were admitted based on RT-PCR results, patients aged between 0-17 whose RT-PCR for COVID-19 was positive were included in this study. Furthermore the disease severity, co-morbidities and treatment have also been analysed in this study. Out of 68 children tested 50 of them were positive for COVID-19, whose extensive histories regarding various details were recorded. Among various age groups, the most affected age group was found to be between 5-10 years and between 1-5 years. There was found to be male predominance in our study. Most of the patients were from the urban area and were from lower socioeconomic status. The mode of transmission in the paediatric age group was straightforward, the disease was contracted from a family member or from travelling to an endemic area. Mild symptoms were predominantly noticed in these children. Fever and sore throat were the chief complaints of most patients. Children with co-morbidities such as asthma, obesity etc... was given special attention as these conditions might increase the risk of severity of the disease. All the children admitted were given symptomatic treatment and a repeat RT-PCR test was taken before being discharged. The conducted study demonstrates that disease severity was mild in children than in adults. Further studies are required to understand the clinical course and early and late complications in children.

The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed.

Boron neutron capture therapy (BNCT) has been around for decades and is continued to be practiced in many centers around the globe. Most of the active clinical trials utilize boronophenylalanine as the drug containing boron atoms; and the important aspect that has been added to the BNCT practice is the use of an F-18 radiolabeled analog for ascertaining targeting and monitoring follow-up studies. The recent widespread application of therapeutic radiopharmaceuticals, especially peptides (somatostatin analogs), prostate-specific antigen-binding ligands, or immunomolecules, offers the ambit for invention of new tumor-specific BNCT agents, especially for BNCT-susceptible tumors, that is, locoregional cancers such as head and neck cancer. Such BNCT agents, when radiolabeled, can enable simultaneous imaging and/or therapeutic applications (depending on the radionuclide used) through multimodal approaches. Development of boron-rich moieties such as sodium borocaptate and neutral carboranes combined with tumor-targeting moieties can lead to a new horizon in BNCT. The review covers various aspects of drug design, tumor targeting, and possible future radiopharmaceutical development for multimodal theranostic application in humans.

The Coronavirus Disease 2019 (COVID-19) pandemic has infected millions of individuals and posed unprecedented challenges to health care systems. Acute care hospitals have been forced to expand hospital and intensive care capacity and deal with shortages in personal protective equipment. This guide will review two areas where the anesthesiologists will be caring for COVID-19 patients: the operating room and on airway teams. General principles for COVID-19 preparation and hospital procedures will be reviewed to serve as a resource for anesthesia departments to manage COVID-19 or future pandemics.