Pervasive human and organizational factors (HOFs) within the public sectors play a vital role in the prevention and control of epidemic (PCE). Insufficient analysis of HOFs has helped continue the use of flawed precautions. In this study, we attempted to establish a quantitative model to (a) clarify HOFs within the public sectors with regard to PCE, (b) predict the probability of relevant risk factors and an epidemic, and (c) diagnose the critical factors. First, we systematically identified 47 HOFs based on the Human Factors Analysis and Classification System (HFACS). We then converted the HFACS framework into a Bayesian Network (BN) after determining the causalities among these factors. Finally, we applied the hybrid HFACS-BN model to analyze the COVID-19 outbreak in China by virtue of its efficacy in probability prediction and diagnosis of key risk factors, and thus to test the feasibility of the model itself. This study contributes to a holistic analysis of HOFs within the public sectors with regard to PCE by providing a risk assessment model for epidemics or pandemics, and developing risk analysis methods for the public health field.

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been shown to cause multisystemic damage. We undertook a systematic literature review and comprehensive analysis of a total of 55 articles on arterial and venous thromboembolism in COVID-19 and articles on previous pandemics with respect to thromboembolism and compared the similarities and differences between them. The presence of thrombosis in multiple organ systems points to thromboembolism being an integral component in the pathogenesis of this disease. Thromboembolism is likely to be the main player in the morbidity and mortality of COVID -19 in which the pulmonary system is most severely affected. We also hypothesize that D-dimer values could be used as an early marker for prognostication of disease as it has been seen to be raised even in the pre-symptomatic stage. This further strengthens the notion that thromboembolism prevention is necessary. We also examined literature on the neurovascular and cardiovascular systems, as the manifestation of thromboembolic phenomenon in these two systems varied, suggesting different pathophysiology of damage. Further research into the role of thromboembolism in COVID-19 is important to advance the understanding of the virus, its effects and to tailor treatment accordingly to prevent further casualties from this pandemic.

The Covid\19 pandemic created the most urgent platform for change that the veterinary profession has ever seen. Every business in every sector throughout the world was forced to simultaneously redesign itself from the ground up against a singular overriding imperative C social distancing. As human safety became the priority, established systems, processes and operating models were torn apart and hastily replaced. This article illustrates how using efficiency models can help practices recover and redefine their working models following the pandemic.

A convalescent, non-severe, patient with COVID-19 was enrolled as a hyper-immune plasma voluntary donor by the Immuno-Hematology and Transfusion Unit of the Regina Elena National Cancer Institute in Rome, under the TSUNAMI national study criteria. During a nearly 6-month period (MayCOctober 2020), the patient was closely monitored and underwent four hyperimmune plasma collections. Serum SARS-CoV-2 (anti-S + anti-N) IgG and IgM, anti-S1 IgA, and neutralizing titers (NTs) were measured. Anti-SARS-CoV-2 antibody levels steadily decreased. No correlation was found between anti-S/anti-N IgG and IgM levels and viral NT, measured by either a microneutralization test or the surrogate RBD/ACE2-binding inhibition test. Conversely, NTs directly correlated with anti-S1 IgA levels. Hyperimmune donor plasma, administered to five SARS-CoV-2 patients with persistent, severe COVID-19 symptoms, induced short-term clinical and pathological improvement. Reported data suggest that high NTs can persist longer than expected, thus widening hyperimmune plasma source, availability, and potential use. In vitro RBD/ACE2-binding inhibition test is confirmed as a convenient surrogate index for neutralizing activity and patients follow-up, suitable for clinical settings where biosafety level 3 facilities are not available. IgA levels may correlate with serum neutralizing activity and represent a further independent index for patient evaluation.

Since COVID-19 suddenly broke out in 2020, the model of teaching in universities has changed completely. In order to improve the unsatisfied experience of online education under the epidemic situation and to meet the teaching needs of college teachers in the emergency situation, and on the basis of the online teaching practice of the Advertising Creativity course in Hunan University, the roles of online education college teachers can be divided into four major categories: learning experience designer, learning process guider, new knowledge production cooperator and learning ecosystem constructor. ? 2021, Springer Nature Switzerland AG.

[...]they dont do away with one fundamental need of business executives: to obtain sufficiently reliable estimates of the likely revenues and profits from making a strategic move, such as, the response to an unexpected aggressive new entrant into the companys core market (agility), the creation of a totally new value proposition and profit formula (business model), or coping with an escalating price war (execution). Bring together a number of business managers and build on their collective knowledge, experience, ambition and judgment to establish a revenue target that is stretched yet realistic enough to convince or even excite the companys stakeholders. [...]a supplier of e-bikes may set an ambitious revenue target claiming booming demand and touting its advanced technology or innovative business model to capture an impressive share of an expected emerging market. [...]the provider of payroll outsourcing services found that no single potential customer in the sample was willing to consider the new entrant because it lacked experience in the neighboring country, as measured by the lack of local reference clients.

INTRODUCTION This study aimed to measure the pressure generated during positive-pressure irrigation at the periapex of an in vitro tooth model using a novel method of measurement, investigating the effect of flow rate and needle design. Apical pressure was correlated with the extent of dye clearance from the end of a needle tip in a plastic root canal model with similar dimensions. METHODS The mesiobuccal canal of a mandibular molar was instrumented to #35/06 and placed into a chamber coupled to a pressure transducer. Irrigation was performed using a digital peristaltic pump using flow rates from 1-15 mL/min with irrigation needles of different sizes and designs. A plastic root canal model instrumented to the same size filled with dye was used to measure the extent of dye clearance beyond the needle tip using the same irrigation conditions. RESULTS Positive-pressure irrigation revealed a flow rate-dependent increase in apical pressure (P < .05). The apical pressure at high irrigation flow rates was several times higher than at low flow rates. Needle designs with safety features yielded statistically significant lower apical pressures than needles without safety features (P < .05). There was no further increase in dye clearance from the end of the needle tip in a plastic root canal model at flow rates higher than 4 mL/min. CONCLUSIONS If apical clearance of dye beyond the needle tip is a measure of irrigation effectiveness, then maximum effectiveness with safe apical pressures can be gained at specific flow rates using specific needle tip designs. The use of an irrigation flow rate of 4 mL/min was able to achieve maximum effectiveness in this study.

Murine hepatitis virus (MHV), a coronavirus, initiates infection by binding to its cellular receptor (MHVR) via spike (S) proteins projecting from the virion membrane. The structures of these S proteins vary considerably among MHV strains, and this variation is generally considered to be important in determining the strain-specific pathologies of MHV infection, perhaps by affecting the interaction between MHV and the MHVR. To address the relationships between S variation and receptor binding, assays capable of measuring interactions between MHV and MHVR were developed. The assays made use of a novel soluble form of the MHVR, sMHVR-Ig, which comprised the virus-binding immunoglobulin-like domain of MHVR fused to the Fc portion of human immunoglobulin G1. sMHVR-Ig was stably expressed as a disulfide-linked dimer in human 293 EBNA cells and was immobilized to Sepharose-protein G via the Fc domain. The resulting Sepharose beads were used to adsorb radiolabelled MHV particles. At 4 degrees C, the beads specifically adsorbed two prototype MHV strains, MHV JHM (strain 4) and a tissue culture-adapted mutant of MHV JHM, the JHMX strain. A shift to 37 degrees C resulted in elution of JHM but not JHMX. This in vitro observation of JHM (but not JHMX) elution from its receptor at 37 degrees C was paralleled by a corresponding 37 degrees C elution of receptor-associated JHM (but not JHMX) from tissue culture cells. The basis for this difference in maintenance of receptor association was correlated with a large deletion mutation present within the JHMX S protein, as sMHVR-Ig exhibited relatively thermostable binding to vaccinia virus-expressed S proteins containing the deletion. These results indicate that naturally occurring mutations in the coronavirus S protein affect the stability of the initial interaction with the host cell and thus contribute to the likelihood of successful infection by incoming virions. These changes in virus entry features may result in coronaviruses with novel pathogenic properties.

Indoor localization has the capability to change the way of providing location-based services in a closed environment and has more potential than that of GPS if the present shortcomings can be overcome. Thus, developing a ubiquitous Indoor Localization System (ILS) is the need of the day. WiFi-based indoor localization using smartphones is a promising approach to achieve ubiquity since smartphones are widely available today and most of the buildings are WiFi enabled. However, the significant variation of WiFi signal strengths with ambient conditions as well as device configuration badly affects the localization accuracy. Hence, a ubiquitous ILS, which would be widely available and would not require any specialized hardware support is still out of reach. Thus, this paper surveys state-of-the-art WiFi-based indoor localization techniques with a critical analysis of their applicability as a ubiquitous system. Consequently, the main objective of this paper is to highlight the key research challenges of implementing a WiFi-based ILS when system ubiquity is the prime concern with a discussion on future direction. Some of the experiments have been implemented on a real-life dataset in order to indicate the implementation challenges of such a system.

Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059

BACKGROUND: Following the outbreak of the COVID-19 pandemic, a change in the incidence and transmission of respiratory pathogens was observed. Here, we retrospectively analyzed the impact of COVID-19 on the epidemiologic characteristics of Mycoplasma pneumoniae infection among children in Chengdu, one of the largest cities of western China. METHOD: M. pneumoniae infection was diagnosed in 33,345 pediatric patients with respiratory symptoms at the Chengdu Women's & Children's Central Hospital between January 2017 and December 2020, based on a serum antibody titer of &#8805;1:160 measured by the passive agglutination assay. Differences in infection rates were examined by sex, age, and temporal distribution. RESULTS: Two epidemic outbreaks occurred between October-December 2017 and April-December 2019, and two infection peaks were detected in the second and fourth quarters of 2017, 2018, and 2019. Due to the public health response to COVID-19, the number of positive M. pneumoniae cases significantly decreased in the second quarter of 2020. The number of M. pneumoniae infection among children aged 3-6 years was higher than that in other age groups. CONCLUSIONS: Preschool children are more susceptible to M. pneumoniae infection and close contact appears to be the predominant factor favoring pathogen transmission. The public health response to COVID-19 can effectively control the transmission of M. pneumoniae.

BACKGROUND: In this study, we evaluated 3-month clinical outcomes of kidney transplant recipients (KTR) recovering from COVID-19 and compared them with a control group. METHOD: The primary endpoint was death in the third month. Secondary endpoints were ongoing respiratory symptoms, need for home oxygen therapy, rehospitalization for any reason, lower respiratory tract infection, urinary tract infection, biopsy-proven acute rejection, venous/arterial thromboembolic event, cytomegalovirus (CMV) infection/disease and BK viruria/viremia at 3 months. RESULTS: A total of 944 KTR from 29 different centers were included in this study (523 patients in the COVID-19 group; 421 patients in the control group). The mean age was 46 12 years (IQR, 37C55), and 532 (56.4%) of them were male. Total number of death was 8 [7 (1.3%) in COVID-19 group, 1 (0.2%) in control group; p = 0.082]. The proportion of patients with ongoing respiratory symptoms [43 (8.2%) vs. 4 (1.0%); p < 0.001)] was statistically significantly higher in the COVID-19 group compared to the control group. There was no significant difference between the two groups in terms of other secondary endpoints. CONCLUSION: The prevalence of ongoing respiratory symptoms increased in the first three months post-COVID in KTRs who have recovered from COVID-19, but mortality was not significantly different.

The non-structural protein 1 (Nsp1), also referred to as the host shutoff factor, is the first viral protein that is synthesized in SARS-CoV-2 infected human cells to suppress host innate immune functions1,2. By combining cryo-electron microscopy and biochemical experiments, we show that SARS-CoV-2 Nsp1 binds to the human 40S subunit in ribosomal complexes including the 43S pre-initiation complex. The protein inserts its C-terminal domain at the entrance to the mRNA channel where it interferes with mRNA binding. We observe potent translation inhibition in the presence of Nsp1 in lysates from human cells. Based on the high-resolution structure of the 40S-Nsp1 complex, we identify residues of Nsp1 crucial for mediating translation inhibition. We further show that the full-length 5 untranslated region of the genomic viral mRNA stimulates translation in vitro, suggesting that SARS-CoV-2 combines inhibition of translation by Nsp1 with efficient translation of the viral mRNA to achieve expression of viral genes3.

Background The sensitivity of commercially available RT-PCR assays varies over 10,000 fold, ranging from 10 to 20,000 viral copies/ml. The reporting of high Ct value results has been under scrutiny, as the clinical significance of these values is not yet completely understood. The early detection of infected individuals (high Ct results) in the pre-symptomatic phase of the disease using highly sensitive RT-PCR methods has been argued as a strategy to prevent transmission, while on the contrary, the reporting of high Ct has been criticized as false-positive results causing unnecessary testing and having several negative implications. The purpose of this study was to verify the presence of SARS-CoV-2 genomes in samples with a wide range of RT-PCR Ct values including samples with high Ct (37 to 42) using next-generation sequencing (NGS). Methods The study evaluated a total of 547 previously positive samples tested with the PerkinElmer New Coronavirus Nucleic Acid Detection RT-PCR kit. The samples included in this study ranged from Ct values of 17-42, with 44 samples having a Ct > 37. Of the 547 samples, 149 were sequenced using PerkinElmer NEXTFLEX Variant-Seq SARS-CoV2 assay on NovaSeq 6000, and 398 samples were sequenced using Illumina SARS-CoV-2 respiratory viral panel kits using the NextSeq 500/550 system. Results Between the two clinical laboratories, a total of ~1.95 million samples were tested using the FDA-EUA PerkinElmer New Coronavirus RT-PCR assay. Of the 1.95 million samples, ~1.72 million were negative, ~250,000 positive, and ~16,500 in the range of 37-42. Of the 547 samples sequenced, the percentage of sequencing reads that aligned to the SARS-CoV-2 Wuhan-hu-1 reference genome (NC_045512.2) ranged from 25.5% to 99.69%. All samples sequenced showed high sequence specificity to the SARS-CoV-2 virus. Low Ct samples showed complete uniform coverage across the entire 29kb SAR-CoV-2 genome. The average coverage in samples with high Ct (>37) was found to be 55.5% (range 16.1-99.2%). However, as sample Ct increased, a gradual decrease in coverage uniformity was observed for few samples. Conclusion This study demonstrates for the first time that the viral RNA is present in the high Ct value range of 37- 42 and the sequence is unique to SARS-CoV-2 confirmed using two separate sequencing assays. This confirms that the detected Ct values are reflective of the presence of the SARS-CoV-2 virus and they are not an artifact or contamination. In light of the recent work highlighting the majority of transmission being pre-symptomatic/ asymptomatic, and high Ct results being observed at both the early and late phases of infection warrants further investigation into the clinical utility of high Ct results to curtail the spread of the virus.

The COVID-19 Psychological Wellbeing Study was designed and implemented as a rapid survey of the psychosocial impacts of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known as COVID-19 in residents across the United Kingdom. This study utilised a longitudinal design to collect online survey based data. The aim of this paper was to describe (1) the rationale behind the study and the corresponding selection of constructs to be assessed; (2) the study design and methodology; (3) the resultant sociodemographic characteristics of the full sample; (4) how the baseline survey data compares to the UK adult population (using data from the Census) on a variety of sociodemographic variables; (5) the ongoing efforts for weekly and monthly longitudinal assessments of the baseline cohort; and (6) outline future research directions. We believe the study is in a unique position to make a significant contribution to the growing body of literature to help understand the psychological impact of this pandemic and inform future clinical and research directions that the UK will implement in response to COVID-19.

The spread of the SARSCov2 virus presents an unprecedented event that rapidly introduced widespread life threat, economic de-stabilization, and social isolation. The human nervous system is tuned to detect safety and danger, integrating body and brain responses via the autonomic nervous system. Polyvagal Theory provides a perspective to understand the impact of the pandemic on mental and physical health. This perspective highlights the important role of the state of the autonomic nervous system in exacerbating or dampening threat reactions to the pandemic. In addition, the theory alerts us to the impact of clinical history (e.g., trauma) on autonomic regulation as an important compounding risk factor lowering the threshold to behaviorally and physiologically destabilize in response to the pandemic. The theory provides a strategy to dampen the adverse reactions to threat (e.g., acute stress disorders) through portals of social engagement that evolved to downregulate defenses to promote calmness and connectedness.

Facing the urgent demand of medical devices for COVID\19 treatment, many automakers have recently begun manufacturing ventilators, even though they are inefficient in production and uninformed of demand variability. To help them, some incumbent ventilator manufacturers have chosen to share knowledge, such as production techniques and demand information. Clearly, the incumbent ventilator manufacturers are fulfilling social responsibility, but is their knowledge sharing rewarding, especially when the automakers are entrant rivals? If possible, are winCwin situations in the sense of social responsibility and firms profitability identifiable? In this work, we develop a game\theoretic model in which an incumbent and an entrant ventilator manufacturer engage in two\dimensional competition in production investment and sales volume. We examine the incumbent manufacturer's profitability with and without knowledge sharing by formulating the tradeoffs among supply expansion, intensified competition, and the entrant's production efficiency improvement and demand variance reduction. We identify both win\win and lose\lose situations for the two competing manufacturers. Specifically, we find that free knowledge could be harmful for the entrant manufacturer, but the incumbent manufacturer benefits from knowledge sharing when market competition is intense, or when market competition is mild but the production investment efficiency varies.

BACKGROUND: Therapy of severely affected coronavirus patient, requiring intubation and sedation is still challenging. Recently, difficulties in sedating these patients have been discussed. This study aims to describe sedation practices in patients with 2019 coronavirus disease (COVID-19)-induced acute respiratory distress syndrome (ARDS). METHODS: We performed a retrospective monocentric analysis of sedation regimens in critically ill intubated patients with respiratory failure who required sedation in our mixed 32-bed university intensive care unit. All mechanically ventilated adults with COVID-19-induced ARDS requiring continuously infused sedative therapy admitted between April 4, 2020, and June 30, 2020 were included. We recorded demographic data, sedative dosages, prone positioning, sedation levels and duration. Descriptive data analysis was performed; for additional analysis, a logistic regression with mixed effect was used. RESULTS: In total, 56 patients (mean age 67 (14) years) were included. The mean observed sedation period was 224 (139) hours. To achieve the prescribed sedation level, we observed the need for two or three sedatives in 48.7% and 12.8% of the cases, respectively. In cases with a triple sedation regimen, the combination of clonidine, esketamine and midazolam was observed in most cases (75.7%). Analgesia was achieved using sufentanil in 98.6% of the cases. The analysis showed that the majority of COVID-19 patients required an unusually high sedation dose compared to those available in the literature. CONCLUSION: The global pandemic continues to affect patients severely requiring ventilation and sedation, but optimal sedation strategies are still lacking. The findings of our observation suggest unusual high dosages of sedatives in mechanically ventilated patients with COVID-19. Prescribed sedation levels appear to be achievable only with several combinations of sedatives in most critically ill patients suffering from COVID-19-induced ARDS and a potential association to the often required sophisticated critical care including prone positioning and ECMO treatment seems conceivable.

BACKGROUND: The outbreak of the novel coronavirus disease 2019 (COVID-19) pandemic presented a great threat to the physical and mental health of the general population. Patients with chronic disease have always been vulnerable to stressful life conditions. Therefore, determining the perceived stress and coping strategies among chronic disease patients is crucial to minimize the mental health consequences related to the outbreak. OBJECTIVE: This study aimed to determine COVID-19-related stress and coping strategies among adults with chronic disease in southwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted among 613 randomly selected adults with chronic disease in southwest Ethiopia. A multiple linear regression analysis was used to determine the relationship between the COVID-19-related stress score and coping strategy types, and independent sample t-tests and ANOVA tests were conducted. Statistical significance was accepted at p-values <0.05. RESULTS: More than two-thirds of study participants (68.4%) were moderately stressed, 13.9% were severely stressed, and 17.8% had low levels of perceived stress. Active coping (=1.238, 95% CI: 0.0 to 2.477), denial (=3.678, 95% CI: 2.44 to 4.915), behavioral disengagement (=3.669, 95% CI: 2.193 to 5.146), self-blame (=1.722, 95% CI: 0.146 to 3.297), and religion (=3.443, 95% CI: 2.028 to 4.858) coping strategies positively predicted the COVID-19-related stress score. Only the acceptance coping strategy (=?2.710, 95% CI: ?3.926 to ?1.493) negatively predicted the COVID-19-related stress score. CONCLUSION: Significant numbers of participants suffered from moderate to severe perceived stress levels due to the COVID-19 outbreak. Both adaptive and maladaptive coping strategy types were significantly associated positively and negatively with perceived stress score among adults with chronic disease. There were significant differences in the mean scores of perceived stress and categories of variables such as family size, duration of disease, and age of the participants.

BACKGROUND: Since the spread of Severe Acute Respiratory Syndrom Corona Virus 2 (SARS-CoV?2) in Germany, intensive care beds have been kept free for patients suffering from Corona Virus Disease (COVID-19). Also, after the number of infections had declined, intensive care beds were kept free prophylactically; however, the percentage of beds reserved for COVID-19 differ in the individual federal states in Germany. The aim of this article is to define a necessary clearance quota of intensive beds for COVID-19 patients in Germany. An escalation and de-escalation scheme was created for rising and falling numbers of infected patients. METHODS: Data from the COVID-19 resource board of the state of Baden-Wrttemberg, the daily situation report of the Robert Koch Institute (RKI), the register of COVID-19 intensive care beds of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) as well as the daily report of COVID-19 Baden-Wrttemberg from April to November 2020 were used for the calculation. RESULTS: At the end of November 2020 approximately 13.5% of intensive care beds in Germany were used by COVID-19 patients. Of all persons tested positive for SARS-CoV?2, 1.5% were admitted to an intensive care unit. The hospitalization rate was 6% and the mean age of infected persons was 43 years. Based on these numbers hospitals are recommended to keep 10% of intensive care beds available for COVID-19 patients in the case of less than 35 new infections/100,000 in the catchment area, 20% should be kept free in case of an advanced warning level of 35 new infections/100,000 inhabitants and 30% for a critical limit of 50 new infections/100,000 inhabitants. Further internal hospital triggers, such as the occupancy of the intensive care beds with COVID-19 patients, should be considered. CONCLUSION: If the number of infections is low a general nationwide retention rate of more than 10% of intensive care beds for COVID-19 patients is not justified. Locally increasing numbers of infections require a local dynamic approach. If the number of infections increases, the free holding capacity should be increased according to a step by step concept in close coordination with the local health authorities and other internal hospital triggers. In order not to overwhelm hospital capacities in the event of local outbreaks, a corresponding relocation concept should be considered at an early stage.