A novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which caused a large respiratory outbreak in Wuhan, China in December 2019, is currently spreading across many countries globally. Here, we show that a TMPRSS2-expressing VeroE6 cell line is highly susceptible to SARS-CoV-2 infection, making it useful for isolating and propagating SARS-CoV-2. Our results reveal that, in common with SARS- and Middle East respiratory syndrome-CoV, SARS-CoV-2 infection is enhanced by TMPRSS2.

OBJECTIVE: To determine the maximum permissible number of missed items on the 10-item Catherine Bergego Scale administered following the Kessler Foundation Neglect Assessment Process (KF-NAP?). Secondary objectives were to determine the frequency, characteristics, and most commonly cited reasons reported for missed items. DESIGN: Retrospective diagnostic accuracy study. SETTING: 16 inpatient rehabilitation facilities in the United States. PARTICIPANTS: A consecutive clinical sample of 4,256 patients with stroke or other neurological deficits who were assessed for spatial neglect with the KF-NAP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Catherine Bergego Scale via KF-NAP. RESULTS: The majority (69.7%) of patients had at least one missed item on their KF-NAP. Among those with missed items, it was most common to have two missed items (51.4%) and few had more than three missed items (11.3%). The most commonly missed items were Collisions (37.2%), Cleaning After Meals (36.1%), Meals (34.0%), and Navigation (19.7%). The most commonly reported reasons for missed items included time constraints, cognitive or communication deficits, and behavior or refusal of the therapy session. These reasons were reported for nearly all item types. Item-specific reasons were also commonly reported, such as a lack of a needed resource for task completion or low functional status of the patient. Prorated scoring of measures with up to three missed items maintained an acceptable level of concordance with complete measures (Lin's Concordance Correlation Coefficienta?=a?0.96, 95% CIa?=a?0.9478-0.9626) for the combination of three missed items with lowest concordance. CONCLUSIONS: Clinicians should make every effort to capture all items on the KF-NAP. However, missed items occur in the majority of cases due to patient factors and barriers inherent to the inpatient hospital setting. When missed items are necessary, clinicians can confidently interpret a prorated score when seven or more items are scored.

Beginning in December of 2019, a novel coronavirus, SARS-CoV-2, emerged in China and is now a global pandemic with extensive morbidity and mortality. With the emergence of this threat, an unprecedented effort to develop vaccines against this virus began. As vaccines are now being introduced globally, we face the prospect of millions of people being vaccinated with multiple types of vaccines many of which use new vaccine platforms. Since medical events happen without vaccines, it will be important to know at what rate events occur in the background so that when adverse events are identified one has a frame of reference with which to compare the rates of these events so as to make an initial assessment as to whether there is a potential safety concern or not. Background rates vary over time, by geography, by sex, socioeconomic status and by age group. Here we describe two key steps for post-introduction safety evaluation of COVID-19 vaccines: Defining a dynamic list of Adverse Events of Special Interest (AESI) and establishing background rates for these AESI. We use multiple examples to illustrate use of rates and caveats for their use. In addition we discuss tools available from the Brighton Collaboration that facilitate case evaluation and understanding of AESI.

We analyzed GWAS results released by COVID-19 Host Genetics Initiative, UK biobank and GWAS Catalog to explore the genetic overlap between COVID-19 and a broad spectrum of traits and diseases. We validate previously reported medical conditions and risk factors based on epidemiological studies, including but not limited to hypertension, type 2 diabetes and obesity. We also report novel traits associated with COVID-19, which have not been previously reported from epidemiological data, such as opioid use and educational attainment. Taken together, this study extends our understanding of the genetic basis of COVID-19, and provides target traits for further epidemiological studies.

During the COVID-19 pandemic, personnel shortages for vaccinations and differences between new methods and conventional methods were encountered. Therefore, this study investigates the characteristics of a force-feedback device as the key component of a medical training system that reproduces the actions of a clinical injection. ? 2022 IEEE.

This manuscript aims to provide an overview of the etiology and diagnosis of olfactory and gustatory disorders. Not only are they common with about 5% of the population affected, but olfactory and gustatory disorders have recently gained attention in light of the rising SARS-CoV?2 pandemic: sudden loss of smell and/or taste is regarded as one of the cardinal symptoms. Furthermore, in the early diagnostics of neurodegenerative diseases, olfactory disorders are of great importance. Patients with olfactory dysfunction often show signs of depression. The impact of olfactory/gustatory disorders is thus considerable, but therapeutic options are unfortunately still limited. Following a description of the etiology, the diagnostic and therapeutic options are discussed on the basis of current literature. Potential future treatments are also addressed, e.g. autologous mucosal grafts or olfactory implants.

BACKGROUND: The traditional knowledge on wild edible plants has been shown in many studies a worrying decline throughout the last few decades. Therefore, the first aim of this study was to document the population knowledge on wild edible plants among the Messiwa people. The second objective was to assess the traditional knowledge of our informants according to their socio-economic status. METHODS: The survey was conducted among 149 informants through a semi-structured questionnaire. The relative importance of the plants was obtained by calculating the relative frequency of citation (RFC) for each species. To compare means, we used Student's t test for two-group comparisons and Snedecor's F-test for multi-group comparisons. The multi-range Duncan test was used for multiple mean comparisons. The correspondence factor analysis (CFA) was also used. RESULTS: A set of 64 species belonging to 56 genera from 34 families has been collected and identified. The species used for nutritional and medicinal purposes represent 56%, while 44% were used exclusively as nutritional plants. The most used parts are, respectively, the aerial parts (58%), the fruits (17%), the underground parts (13%), the seeds (8%), and finally the flowers (5%). On the other hand, the higher level of knowledge on wild edible plants was found among women, the elderly, illiterate, married people, and those engaged in agricultural occupations. CONCLUSION: This work could be a basis to be reproduced on other regions in Morocco and to be widened through pharmacological and nutritional studies in order to promote and valorize these wild edible plants.

OBJECTIVES: The goal of this study is twofold: (1) identifying design strategies that enhance efficiency and support teamwork in emergency departments (EDs) and (2) identifying design features that contribute to the spread of COVID-19, based on staff perception. BACKGROUND: Due to increasing ED visits annually, an efficient work environment has become one of the main concerns in designing EDs. According to the literature, an efficient work environment and teamwork improve healthcare outcomes and positively impact staff satisfaction. During the COVID-19 pandemic, EDs faced various changes such as workflow and space usage. Few studies explored staff perceptions about the influence of design features on efficiency, teamwork, and the COVID-19 spread. METHOD: An online survey with 14 open- and closed-ended questions was distributed among ED staff members to collect data about unit design features that impact efficiency, teamwork, and the COVID-19 spread. RESULTS: The central nursing station was one of the preferred configurations that increased efficiency and teamwork in EDs. Decentralizing disposal rooms in small-size EDs and decentralizing the medication room in large-size EDs with more than 65 exam rooms can decrease staff walking steps. Flexibility to expand treatment spaces on demand, one-way track circulation path, and changing the air pressure in COVID-19 treatment areas were some of the staff suggestions for future EDs. CONCLUSION: The findings of this study contribute to the body of knowledge that EDs' physical environments can impact efficiency and teamwork among staff and, consequently, healthcare outcomes. Compartmentalization of the ED layout can reduce the spread of COVID-19.

CONTEXT Medical students are faced with the challenge of synthesizing large volumes of information quickly. With the increasing accessibility of technology, a "flipped classroom" allows students to learn foundational material independently. Class time is instead devoted to in-depth skill building with instructors, promoting an active learning environment. This method of content delivery is also relevant given the current COVID-19 pandemic. OBJECTIVES To comprehensively evaluate the benefit of adopting a flipped classroom approach in teaching physical exam skills (PES) to first-year osteopathic medical students. METHODS A cohort study was conducted comparing first-year osteopathic students in the class of 2022 (n=201), who had taken the PES course traditionally, with the class of 2023 (n=203), who experienced the flipped classroom approach. Objective metrics such as cumulative grades, objective structural clinical examination performance (OSCE), and practical exam performance were compared using nonparametric Mann-Whitney U rank sum tests. Subjective measures such as student course evaluations were used to analyze course perceptions using independent sample t-tests assuming unequal variances. A faculty survey was administered to faculty who taught both cohorts to assess instructor attitudes toward the flipped classroom approach. Due to the COVID-19 pandemic, Spring 2020 quarter data was not included, given the transition of all classes to an online learning environment. RESULTS The flipped classroom approach significantly improved objective student performance for the Fall (p=0.009) and Winter (p<0.001) student cumulative grades and the History-Taking OSCE (p=0.010). Performance on Fall and Winter practical exam scores had no significant association with the flipped classroom. General student perceptions of the course remained unchanged between both cohorts. Faculty survey results from 10 faculty members showed that six (60%) faculty members preferred the traditional classroom, while four (40%) preferred the flipped classroom. CONCLUSIONS The flipped classroom approach showed some statistically significant improvement in student PES. Further studies are needed to evaluate the benefits of a flipped classroom approach using skills-based assessments styles to measure student performance, with a focus on standardization of in-classroom groupwork.

Between 16 May and 15 August 2020, seven highly pathogenic avian influenza (HPAI) A(H5N8) virus outbreaks were reported in Europe in poultry, with one outbreak reported in Bulgaria(n=1) andsix in Hungary (n=6) and one low pathogenic avian influenza (LPAI) A(H5N3) virus outbreak was reported in poultry in Italy. All six outbreaks detected in Hungary were secondary outbreaks and seem to be the tail end of the HPAI A(H5N8) epidemic that wasobserved in poultry over the winter and spring in central Europe from December 2019 (n=334).Genetic analysis of the HPAI A(H5N8) viruses isolated during this reporting period from Bulgaria and Hungary did not identify any major changes compared tothe viruses collected in the respective countries during the first months of 2020. This suggests a persistence of the virus in the two countries rather than new introductions via infectedwild birds. HPAI A(H5N8) virus has been detected in poultry and wild birds in western Russia within the reporting period, and as of the middle of September also in Kazakhstan. The presence of HPAI virus in western Russiaand in north Kazakhstan,spatially associated with autumnmigration routes of wild waterbirds, is of concern due to the possible spread of the virus via wild birds migrating to the EU.It is highly recommended thatMember States take appropriate measures to promptly detect suspected cases of HPAI, including increasing biosecurity measures. According to past experiences (2005-2006 and 2016-2017 epidemic waves), the northern and eastern European areas might be at higher risk of virus introduction in the coming autumn-winter seasonand should be the key regions where prompt response measures to early detect the virusshould be set up. One human case due to A(H9N2) avian influenza virus infection was reported during the reporting period.

A new artificial liver support system (ALSS) consisting of plasma exchange (PE) in combination with hemodiafiltration (HDF) using high-performance membranes of polymethyl metacrylate (PMMA) and cellulose triacetate (CTA) was developed to efficiently remove middle molecules from plasma and treat fulminant hepatic failure (FHF) complicated, by the onset of hepatic coma. Twenty-seven patients with FHF due to viral hepatitis, two with type A (HA), nine with type B (HB), and 16 with type non-A, non-B (NANB) underwent therapy with this new ALSS over the last five years. Three patients, with an exacerbation of chronic HB and 15/16 with type NANB hepatitis were treated with interferon (IFN) also. Of these, 25 patients (92.6%), regained consciousness and 15 (55.6%) [1/2 (50%) with type A, 6/9 (66.7%) with type B and 8/16 (50%) with type NANB hepatitis] survived Including four patients who survived with intensive, care and plasma exchange alone, 19/31 (61.3%) patients survived. Because of its biocompatibility, both survivors and nonsurvivors could be sustained with the ALSS without complications for long periods (19.3 days for the survivors and 32.4 days for nonsurvivors). With this ALSS the ability to sustain life for such prolonged periods allows hepatic regeneration to occur and result in patient survival. It is anticipated that this new ALSS will not only be of value in cases of fulminant hepatic failure but that it may also play a role in sustaining life for those, awaiting liver transplantation.

RNA helicases perform essential housekeeping and regulatory functions in all domains of life by binding and unwinding RNA molecules. The bacterial RhlE-like DEAD-box RNA helicases are among the least well studied of these enzymes. They are widespread especially among Proteobacteria, whose genomes often encode multiple homologs. The significance of the expansion and diversification of RhlE-like proteins for bacterial fitness has not yet been established. Here, we study the two RhlE homologs present in the opportunistic pathogen Pseudomonas aeruginosa. We show that, in the course of evolution, RhlE1 and RhlE2 have diverged in their biological functions, molecular partners and RNA-dependent enzymatic activities. Whereas RhlE1 is mainly needed for growth in the cold, RhlE2 also acts as global post-transcriptional regulator, affecting the level of hundreds of cellular transcripts indispensable for both environmental adaptation and virulence. The global impact of RhlE2 is mediated by its unique C-terminal extension, which supports the RNA unwinding activity of the N-terminal domain as well as an RNA-dependent interaction with the RNase E endonuclease and the cellular RNA degradation machinery. Overall, our work reveals how the functional and molecular divergence between two homologous RNA helicases can contribute to bacterial fitness and pathogenesis.

BACKGROUND: Non-pharmaceutical interventions (NPIs) against Coronavirus Disease 2019 (COVID-19) are vital to reducing the transmission risks. However, the relative efficiency of social distancing against COVID-19 remains controversial, since social distancing and isolation/quarantine were implemented almost at the same time in China. METHODS: In this study, surveillance data of COVID-19 and seasonal influenza in the year 2018-2020 were used to quantify the relative efficiency of NPIs against COVID-19 in China, since isolation/quarantine was not used for the influenza epidemics. Given that the relative age-dependent susceptibility to influenza and COVID-19 may vary, an age-structured Susceptible-Infected-Recovered model was built to explore the efficiency of social distancing against COVID-19 under different population susceptibility scenarios. RESULTS: The mean effective reproductive number, R(t), of COVID-19 before NPIs was 2.12 (95% confidential interval (CI): 2.02-2.21). By March 11, 2020, the overall reduction in R(t) of COVID-19 was 66.1% (95% CI: 60.1%-71.2%). In the epidemiological year 2019/20, influenza transmissibility reduced by 34.6% (95% CI: 31.3%-38.2%) compared with that in the epidemiological year 2018/19. Under the observed contact patterns changes in China, social distancing had similar efficiency against COVID-19 in three different scenarios. By assuming same efficiency of social distancing against seasonal influenza and COVID-19 transmission, isolation/quarantine and social distancing could lead to a 48.1% (95% CI: 35.4%-58.1%) and 34.6% (95% CI: 31.3%-38.2%) reduction of the transmissibility of COVID-19. CONCLUSIONS: Though isolation/quarantine is more effective than social distancing, given that typical basic reproductive number of COVID-19 is 2-3, isolation/quarantine alone could not contain the COVID-19 pandemic effectively in China.

Covid-19, an ongoing global pandemic, is one of the major reasons for the current disruption in the field of health and education. Although the Covid-19 led to a plethora of problems for students and negatively impacted the health and education of students, on the brighter side, it also exposed every country's weakness and vulnerability to this situation and forced them to deal with the pandemic in innovative ways all the while ensuring the safety of their people. Schools were required to shift to an online platform, students and teachers were involuntary asked to adapt and adopt the same rapidly. At the same time, students observed fewer physical activities and both their mental and physical health were adversely affected. The present study focuses on ascertaining the impact of this Covid-19 Pandemic on the health and education of students, as well as propose solutions to tackle any challenges in the future. ? 2021 IEEE.

OBJECTIVES: Origin of outbreaks could be natural, accidental, deliberate, and caused by a new or re-emerging bioagent. The aim of this study was the retrospective analysis of whether the COVID-19 outbreak was natural, accidental, deliberate one, or caused by a new or re-emerging bioagent. METHODS: Analysis was performed according to the RadosavljevicCBelojevic method for outbreak scoring and differentiation. Data for the application of this method were obtained by literature review in the Medline database for the period from 2000 to 2020. RESULTS: The analysis of the unusual COVID-19 outbreak shows that the present official assumption of its natural origin is questionable and pointed out to a probability that the pathogen could have also been accidentally introduced in the human population. CONCLUSION: There are no conclusive pieces of evidence about the reservoir of the pathogen or the source of infection. These parameters are essential for the final clarification of the outbreak origin. This study suggests that the COVID-19 outbreak is a consequence of an accidental release of a new COVID-19 virus, probably during the technical accident and/or negligent violation of hygienic norms in the laboratory facility. Further epidemiological, microbiological, and forensic analyses are needed to clarify the COVID-19 outbreak.

Objective: To assess the efficacy and outcome of a pilot model in triaging urgent suspected head and neck cancer referrals during the Covid-19 pandemic. Design Prospective observational cohort study Setting Regional Head and Neck Cancer hub, United Kingdom. Participants 84 patients who were referred via the 2 week wait pathway and streamed directly for imaging investigations after initial telephone consultation. Main outcome measures The malignancy detection rate using the telephone-and-test model Results 495 2-week wait referrals were received during the study period. 104 patients were discharged following their initial telephone consultation. 84 (17%) patients were streamed directly for imaging investigations following their telephone consultation. Malignancy was identified in 11.9% of patients which included squamous cell carcinoma, differentiated thyroid carcinoma and lymphoproliferative disease. 51% of patients had other benign pathologies such as benign salivary gland tumour, benign thyroid disease and physiological lymphadenopathy. Following their radiological investigation, 48.8% of patients were discharged without any need for further consultations. Conclusions The telephone-and-test approach is an effective and efficient model for triaging head and neck two-week wait referrals, which could be applicable outside the pandemic times.

INTRODUCTION: Fatigue is one of the most common symptoms in patients with cancer and is responsible for a reduced quality of life. There is a strong evidence base for mindCbody interventions (MBIs) to manage cancer-related fatigue (CRF). However, the efficacy of Tai Chi and other MBIs in the treatment of CRF remains controversial. METHODS AND ANALYSIS: We will perform a systematic review and network meta-analyses (NMAs) that aim to assess the effects of Tai Chi and other MBIs in patients with CRF. The following databases will be searched from their inception to 1 August 2021: PubMed, EMBASE, Scopus, OVID, Web of Science, Cochrane Central Register of Controlled Trials, the China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese Biomedical Database and Wan Fang Digital Journals. We will include randomised controlled trials that compare MBIs with no treatment, placebo and usual care in the treatment of CRF. The primary outcome will be changes in the fatigue state as evaluated by validated scales. We will perform a Bayesian NMA to analyse all the evidence for each outcome. The surface under the cumulative ranking curve and the mean ranks will be used to rank the various treatments. We will assess the quality of evidence contributing to network estimates of outcomes using the Grading of Recommendations Assessment, Development and Evaluation system framework. ETHICS AND DISSEMINATION: This NMAs will be disseminated through publication in a peer-reviewed journal. Since no individual patient data will be involved in the review, ethics approval and concerns about privacy are not needed. PROSPERO REGISTRATION NUMBER: CRD42021244999.

Abstract Databases are critical to all scientific endeavours. They manage our email, funding, and scientific literature, and provide access to the ever-growing mountains of scientific data. In molecular virology, all researchers are familiar with performing BLAST searches of the DNA and protein sequence databases; however, in some respects these are simple databases tailored to this specific task. This collection of virus databases illustrates a greater diversity of purpose, but reveals they often function to support only one or a few virus families grouped by a common theme. The common characteristic is usually genome size as small RNA viruses are typically sequenced in vastly greater numbers and are much less complex than the large DNA viruses; they have variability at the level of SNPs rather than gene presence/absence. Here, we present the basics of database organization and aim to compare and contrast these features and the manner by which the databases are used by the scientific community.

A gest?o de laboratrio tornou-se essencial em raz?o da preocupa??o com a sade e com o meio ambiente. Conhecer todos os processos e atividades desenvolvidas nessas unidades e adotar bons indicadores para avaliar o desempenho, facilitam o controle interno do laboratrio. O uso combinado dos indicadores com as ferramentas de gest?o como Gest?o da Qualidade Total, Redesenho de Processos, Normas ISO, Pensamento Lean e Gest?o do Erro, poder?o propiciar uma melhora significativa na eficincia. Esse trabalho de Engenharia Biomdica, com linha de pesquisa em Engenharia Clnica e Gest?o, tem como objetivo selecionar e avaliar indicadores que facilitem o controle interno de laboratrios e provoquem seu uso pelos tomadores de decis?o e todos da Engenharia Clnica. O controle interno permite detectar desvios e realizar corre??es no desempenho das rotinas, prestando assim um servi?o com confiabilidade nos resultados das pesquisas e laudo de testes e exames. A metodologia constou em selecionar um conjunto de indicadores a partir das rotinas utilizadas em laboratrio clnico, por dispor de maior experincia e publica??es na rea de gest?o. Este conjunto de indicadores foi aplicado em dois perfis de laboratrios: em um estrato, laboratrios que influenciam diretamente a sade e em outro estrato, laboratrios que, o resultado de suas pesquisas possa alterar o meio ambiente e, dessa forma, impactar indiretamente a sade humana. Sustentado em trabalhos da literatura especializada de autores conceituados, selecionou-se 30 indicadores contemplando uma Avalia??o Prvia e as categorias de Indicadores de Lideran?a, de Responsabilidade Pblica, de Planejamento Estratgico, de Operacionaliza??o Estratgica e dos Grupos de Usurios. Os indicadores buscaram explorar a rotina das atividades e o envolvimento dos participantes e usurios na gest?o de laboratrios universitrios de Odontologia, Nutri??o e Farmacologia (laboratrios com influncia direta sobre a sade) e laboratrios universitrios de Veterinria, Agronomia e Zootecnia (laboratrios com influncia indireta sobre a sade). Para cada Indicador foram delineadas trs op??es de respostas que permitisse analisar a existncia da prtica, da rotina, sua intensidade e a vis?o do participante quanto administra??o da unidade laboratorial. Os resultados foram analisados comparativa e proporcionalmente em trs abordagens. Na primeira anlise, cada op??o de resposta de cada indicador foi comparada entre todos os laboratrios. Na segunda anlise, cada op??o de resposta de cada indicador foi comparada entre os dois estratos. E na terceira anlise, foi comparado o percentual de cada op??o entre todas as respostas. Estabelecido o limite de tolerancia, pode-se identificar: os indicadores que atendem a expectativa, a qual estrato pertence e em que propor??o. Da mesma forma pode-se identificar os indicadores com maior comprometimento na gest?o e de quantos participantes espera-se o n?o atendimento do indicador. Com a metodologia proposta foi possvel visualizar a realidade da unidade laboratorial, verificar a flexibilidade em estabelecer o limite de aceita??o por prioridades e perceber que com o uso das ferramentas de gest?o possvel, com pequenas interven??es, esperar grandes resultados.

Background: The traditional surgical treatment for upper urinary tract urothelial carcinoma (UTUC) is time-consuming owing to changing the surgical position and larger surgical trauma because of open surgery in handling the distal ureter. Therefore, we created a new surgical technique of combination retroperitoneal with transperitoneal (CRT) laparoscopic nephroureterectomy (LNU) in a single position and here report our early outcomes. Methods: From January 2017 to December 2019, a total of 106 patients underwent LNU by a single surgeon at our department, of whom 50 patients underwent standard technique and 56 patients underwent CRT technique. Relevant clinical data were collected including each patient's characteristics, surgical outcomes, and follow-up results. A comparative analysis between standard LNU cases and CRT LNU cases was performed. Results: LNU was performed successfully on all 106 patients. There was no significant difference in patients' characteristics. Compared to the standard group, patients in the CRT group had shorter operative time (P=0.001), less estimated blood loss (EBL) (P<0.001), lower visual analogue scale (VAS) pain score (P=0.020) and less scarring (P=0.013). The median time of surgical drain stay decreased from 5 to 2 days (P=0.004) and median hospital stay after surgery decreased from 5 to 3 days (P=0.001). The complication rates did not show statistical differences between the two groups within the first 30 days postoperatively (P=0.263). For the long-term complications, the incidence of abdomen bulge or incisional hernia in the CRT group was less than that in the standard group (P<0.001). Conclusion: The CRT technique, which combines both the advantages of retroperitoneal and transperitoneal approaches, is a more minimally invasive, simplified and effective way to perform the LNU.