BACKGROUND: Emerging evidence suggests ethnic minorities are disproportionately affected by COVID-19. Detailed clinical analyses of multi-cultural hospitalized patient cohorts remain largely undescribed. METHODS: We performed regression, survival and cumulative competing risk analyses to evaluate factors associated with mortality in patients admitted for COVID-19 in three large London hospitals between February 25 and April 5, censored as of May 1, 2020. RESULTS: Of 614 patients (median age 69 years, (IQR 25) and 62% male), 381 (62%) had been discharged alive, 178 (29%) died and 55 (9%) remained hospitalized at censoring. Severe hypoxemia (aOR 4.25, 95%CI 2.36-7.64), leukocytosis (aOR 2.35, 95%CI 1.35-4.11), thrombocytopenia (aOR 1.01, 95%CI 1.00-1.01, increase per 10x9 decrease), severe renal impairment (aOR 5.14, 95%CI 2.65-9.97), and low albumin (aOR 1.06, 95%CI 1.02-1.09, increase per g decrease) were associated with death. Forty percent (244) were from black, Asian and other minority ethnic (BAME) groups, 38% (235) white and for 22% (135) ethnicity was unknown. BAME patients were younger and had fewer comorbidities. Whilst the unadjusted odds of death did not differ by ethnicity, when adjusting for age, sex and comorbidities, black patients were at higher odds of death compared to whites (aOR 1.69, 95%CI 1.00-2.86). This association was stronger when further adjusting for admission severity (aOR 1.85 95% CI 1.06-3.24). CONCLUSIONS: BAME patients were over-represented in our cohort and, when accounting for demographic and clinical profile of admission, black patients were at increased odds of death. Further research is needed into biologic drivers of differences in COVID-19 outcomes by ethnicity.

Objectives: The COVID-19 pandemic caused by the novel coronavirus strain SARS-CoV-2 had a catastrophic consequence in global physical and psychological health, as well as economic recession. Development of vaccines can be the most prominent approach to prevent the virus to cause COVID-19 and hence will play a vital role in controlling the spread of the virus and reducing mortality. This study was conducted to review the current pipeline of vaccines in clinical trials for the COVID-19. Methods: We conducted a review of clinical trials of vaccines for COVID-19 using trial data obtained from the and World Health Organisation (WHO) registries and performed an analysis. We also assessed active vaccine development projects that had completed one clinical phase but were yet to start the next. Results: A total of 125 vaccines in 365 trials assessing the efficacy and safety for COVID-19: 36 vaccines in phase III, 49 in phase II, and 35 in phase I. As of June, 2021, there were 18 vaccines approved for COVID-19. Of these, seven approved by WHO, three by US FDA, and four by EMA. Among the approved vaccines, eight were inactivated, five were non-replicating viral vector, three were RNA, and two were protein subunit. Among the top five vaccines approved in most number of countries, Oxford/AstraZeneca AZD1222 approved in 115 countries, followed by Pfizer/BioNTech BNT162b2 in 89 countries, Gamaleya Sputnik V in 68 countries, Moderna mRNA-1273 in 53 countries), Janssen (Johnson & Johnson) Ad26.COV2.S in 52 countries, and Sinopharm (Beijing) BBIBP-CorV in 53 countries. Conclusions: Emerging COVID-19 will continue to pose significant challenges to the global community. This pipeline analysis shows that we have a strong pipeline of new vaccines in late stage development. Till date, 18 received approval and several additional promising vaccines are being evaluated in later stage clinical trials.

BACKGROUND: Lateral flow device (LFD) viral antigen immunoassays have been developed around the world as diagnostic tests for SARS-CoV-2 infection. They have been proposed to deliver an infrastructure-light, cost-economical solution giving results within half an hour. METHODS: LFDs were initially reviewed by a Department of Health and Social Care team, part of the UK government, from which 64 were selected for further evaluation from 1st August to 15th December 2020. Standardised laboratory evaluations, and for those that met the published criteria, field testing in the Falcon-C19 research study and UK pilots were performed (UK COVID-19 testing centres, hospital, schools, armed forces). FINDINGS: 4/64 LFDs so far have desirable performance characteristics (orient Gene, Deepblue, Abbott and Innova SARS-CoV-2 Antigen Rapid Qualitative Test). All these LFDs have a viral antigen detection of >90% at 100,000 RNA copies/ml. 8951 Innova LFD tests were performed with a kit failure rate of 5.6% (502/8951, 95% CI: 5.1C6.1), false positive rate of 0.32% (22/6954, 95% CI: 0.20C0.48). Viral antigen detection/sensitivity across the sampling cohort when performed by laboratory scientists was 78.8% (156/198, 95% CI 72.4C84.3). INTERPRETATION: Our results suggest LFDs have promising performance characteristics for mass population testing and can be used to identify infectious positive individuals. The Innova LFD shows good viral antigen detection/sensitivity with excellent specificity, although kit failure rates and the impact of training are potential issues. These results support the expanded evaluation of LFDs, and assessment of greater access to testing on COVID-19 transmission. FUNDING: Department of Health and Social Care. University of Oxford. Public Health England Porton Down, Manchester University NHS Foundation Trust, National Institute of Health Research.

The rapid spread of the SARS-CoV-2 virus has highlighted many social interaction problems that favor the spread of disease, particularly airborne spread, which can be addressed by adjusting existing systems. Of particular interest are places where large numbers of people interact, as they become a focus for the spread of these diseases. This paper proposes and evaluates an autonomous identification scheme for certain surfaces considered high risk due to their continuous handling. These high-contact surfaces can be identified by an autonomous system to apply specific cleaning tasks to them. We evaluate three convolutional models from a proprietary dataset with a total of 2000 images ranging from wall switches to water dispensers. The objective is to identify the ideal architecture for the system. The ResNet (Residual Neural Network), DenseNet (Dense Convolutional Network), and NASNet (Neural Architecture Search Network) models were selected due to their high performance reported in the literature. The models are evaluated with specialized metrics in non-binary classification problems, and the best scheme is selected for prototype development. ? 2021 Institute of Physics Publishing. All rights reserved.

The traffic control bundle consists of procedures designed to help prevent epidemic nosocomial infection. We retrospectively studied the serial infection control measures to determine factors most effective in preventing nosocomial infections of healthcare workers (HCWs) during the 2003 Taiwanese severe acute respiratory syndrome (SARS) epidemic. Fever screening stations, triage of fever patients, separating SARS patients from other patients, separation of entrances and passageways between patients and HCWs, and increasing hand-washing facilities all demonstrated a protective effect for HCWs (univariate analysis; P < 0.05). By multiple logistic regression: (i) checkpoint alcohol dispensers for glove-on hand rubbing between zones of risk, and (ii) fever screening at the fever screen station outside the emergency department, were the significant methods effectively minimising nosocomial SARS infection of HCWs (P < 0.05). The traffic control bundle should be implemented in future epidemics as a tool to achieve strict infection control measures.

BACKGROUND Previous meta-analyses on the clinical outcome after laparo-endoscopic single-site surgery (LESS) versus conventional laparoscopic surgery (CLS) have not revealed any major differences in postoperative pain between the two procedures. This meta-analysis aims to evaluate the difference in postoperative pain between the two procedures, focusing on whether LESS was conducted with a non-expanding port (LESSnonex) or a port expanding (LESSex) within the incision. METHOD EMBASE, Medline, PubMed, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) on LESS versus CLS for general abdominal procedures. Weighted mean difference (WMD) and Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS A total of 29 RCTs with 2999 procedures were included. Pain (VAS 0-10) 6 h after surgery was significantly lower in the group where LESS was conducted with LESSnonex compared to CLS, WMD=-0.72 (- 1.10 to - 0.33). Pain 18-24 h was significantly higher in the group where LESS was conducted with LESSex compared to CLS, WMD = 0.38 (0.01-0.75). Wound-related complications were significantly more frequent in LESSex procedures compared to CLS, OR = 1.94 (1.03-3.63). CONCLUSION The present meta-analysis indirectly indicates that the type of access device that is used for an abdominal LESS procedure may contribute to the development of early postoperative pain as the use of a non-expanding model was associated with a more advantageous outcome. Direct randomized comparison of LESSnonex and LESSex is warranted to confirm if the use of expanding access devices generates more pain and wound complications.

Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18 months. Coronavirus disease 19 (COVID-19) causes mild-to-moderate symptoms in most individuals. However, rapid deterioration to severe disease with or without acute respiratory distress syndrome (ARDS) can occur within 1C2 weeks from the onset of symptoms in a proportion of patients. Early identification by risk stratifying such patients who are at risk of severe complications of COVID-19 is of great clinical importance. Computed tomography (CT) is widely available and offers the potential for fast triage, robust, rapid, and minimally invasive diagnosis: Ground glass opacities (GGO), crazy-paving pattern (GGO with superimposed septal thickening), and consolidation are the most common chest CT findings in COVID pneumonia. There is growing interest in the prognostic value of baseline chest CT since an early risk stratification of patients with COVID-19 would allow for better resource allocation and could help improve outcomes. Recent studies have demonstrated the utility of baseline chest CT to predict intensive care unit (ICU) admission in patients with COVID-19. Furthermore, developments and progress integrating artificial intelligence (AI) with computer-aided design (CAD) software for diagnostic imaging allow for objective, unbiased, and rapid assessment of CT images.

Mineralocorticoid receptor antagonists have been successfully used for many years to treat patients with primary hyperaldosteronism, refractory arterial hypertension and chronic heart failure. The increased interest in this drug in recent years is due to new information about its antifibrotic and antiproliferative effects, both cardiac and extracardiac. The article also discusses the possibility of using spironolactone in patients with the new coronavirus infection SARS-CoV-2 (COVID-19).

Cardiac accessory pathways (APs) in WolffCParkinsonCWhite (WPW) syndrome are conventionally diagnosed with decision tree algorithms; however, there are problems with clinical usage. We assessed the efficacy of the artificial intelligence model using electrocardiography (ECG) and chest X-rays to identify the location of APs. We retrospectively used ECG and chest X-rays to analyse 206 patients with WPW syndrome. Each AP location was defined by an electrophysiological study and divided into four classifications. We developed a deep learning model to classify AP locations and compared the accuracy with that of conventional algorithms. Moreover, 1519 chest X-ray samples from other datasets were used for prior learning, and the combined chest X-ray image and ECG data were put into the previous model to evaluate whether the accuracy improved. The convolutional neural network (CNN) model using ECG data was significantly more accurate than the conventional tree algorithm. In the multimodal model, which implemented input from the combined ECG and chest X-ray data, the accuracy was significantly improved. Deep learning with a combination of ECG and chest X-ray data could effectively identify the AP location, which may be a novel deep learning model for a multimodal model.

Aims: This study aimed to identify patients receiving total hip arthroplasty (THA) for trauma during the peak of the COVID-19 pandemic in the UK and quantify the risks of contracting SARS-CoV-2 virus, the proportion of patients requiring treatment in an intensive care unit (ICU), and rate of complications including mortality. Methods: All patients receiving a primary THA for trauma in four regional hospitals were identified for analysis during the period 1 March to 1 June 2020, which covered the current peak of the COVID-19 pandemic in the UK. Results: Overall, one of 48 patients (2%) contracted COVID-19 during their admission. Although they required a protracted stay in hospital, they did not require ICU treatment. Two patients did require ICU support for medical problems but not relating to COVID-19. Complications were no greater than expected given the short follow-up. There were no mortalities. Conclusion: There is a paucity of evidence to guide restarting elective joint arthroplasties following the COVID-19 pandemic. Although THAs for trauma are by no means a perfect surrogate, the results of this study show a low incidence of contracting COVID-19 virus during admission and no significant sequalae during this period.Cite this article: Bone Joint Open 2020;1-7:438-442.

BACKGROUND/OBJECTIVE: To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to stay at home. Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine. SUBJECTS/METHODS: This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6(?). Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019CFebruary 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24CMay 18, 2020; T1) were compared. RESULTS: Sixty-two children and adolescents (11.1 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001). CONCLUSIONS: Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.

South Asia, a sub\region with nearly a third of the world's population living in extreme poverty and hunger, has been affected by the COVID\19 pandemic in an unprecedented way. The pandemic has undermined the progress achieved by the subregion towards attaining sustainable development goals. This study argues that fostering environmental sustainability in the South Asian region is crucial to Building Back Better while taking cognisance of future climate\related risks. With the low level of preparedness, the collapse of global supply chains, and restrictive regional integration, the individual country in the region lacks the fiscal and technical capacity to implement sustainable development goals effectively. Therefore, based on the analytical approach to regional integration, this paper explores the potential role of regional integration in ensuring environmental sustainability in South Asia. Additionally, this study illustrates how the COVID\19 pandemic has affected several environmental aspects at the regional level, such as clean energy, disaster risk reduction, and waste management, and shows how regional cooperation can address these challenges post pandemic. While previous studies mainly focus on regional integration in the European Union, this study targets the crucial importance of regional cooperation in South Asia in achieving environmental sustainability.

Many recent studies reported coronavirus point of care tests (POCTs) based on isothermal amplification. However, the performances of these tests have not been systematically evaluated. We searched databases for studies that provide data to calculate sensitivity, specificity and diagnostic odds ratio (DOR). We included 43 studies on 5204 specimens. Most studies had high risk of patient selection and index test bias but low risk in other domains. Most studies (n = 21) used reverse-transcribed loop-mediated isothermal amplification (RT-LAMP) to diagnose Coronavirus disease 2019 (COVID-19). Summary estimated ln(DOR) for RT-LAMP of RNA purified COVID-19 samples is 6.50 (95%CI 5.25-7.76), similar to the previously reported value for RT-LAMP of other RNA virus. RT-LAMP from crude samples has significantly lower ln(DOR) at 4.46 (95%CI 3.53-5.38). SAMBA-II has the highest ln(DOR) at 8.00 (95%CI 6.14-9.87). Abbott ID Now performance is similar to RT-LAMP of crude sample. The performances of CRISPR diagnosis and RT-LAMP are not significantly different. Types of coronaviruses and publication status have no significant effect on diagnosis performance. Existing nucleic acid POCTs, particularly RT-LAMP, CRISPR diagnosis and SAMBA-II, have good diagnostic performance. Future work should focus on improving a study design to minimize the risk of biases.

COVID-19 cases in Indonesia on 22 November 2020 were 493,308 cases. Social determinants of health and behavior influence mortality and morbidity in a community. Physical-distancing is an effort to maintain a distance between one person and another to avoid transmission of the COVID-19 disease. The purpose of this study was to research about social health determinants with physical-distancing behavior during the COVID-19 Pandemic for Students. Method: This research applied analytic observational with design of cross sectional, case study on students of Universitas Negeri Semarang. The sampling technique was used a probability sampling technique with a cluster sampling type with a total sample size of 235. The instrument used was a questionnaire. The results of this study are based on statistical tests known that gender (P=0.044, PR=1.155), knowledge level of COVID-19 (P=0.000, PR=2.508), family support (P=0.003, PR=1.710), support from community leaders (P=0.013, PR=1.311), government support (P=0.002, PR=1.854), and respondents' perceptions (P=0.000, PR=4.465) are related to physical distancing behavior. The social determinant most related to physical distancing behavior is the level of knowledge (P=0.000). Conclusion: The conclusion of this study is the level of knowledge is the most influential factor in physical distancing behavior in College Students of Universitas Negeri Semarang. Keywords: COVID-19, Social Health Determinant, Physical Distancing Behavior

This paper investigates the profile of COVID-19 cases in Hong Kong, highlighting the unique age structure of confirmed cases compared to other territories. While the majority of cases in most territories around the world have fitted an older age profile, our analysis shows that positive cases in Hong Kong have been concentrated among younger age groups, with the largest incidence of cases reported in the 15C24 age group. This is despite the populations rapidly aging structure and extremely high levels of population density. Using detailed case data from Hong Kongs Centre for Health Department and Immigration Department, we analyze the sex and age distribution of the confirmed cases along with their recent travel histories and immigration flows for the period January to April 2020. Our analysis highlights Hong Kongs high proportion of imported cases and large overseas student population in developing COVID-19 hotspot areas such as the United Kingdom. Combined with community action and targeted and aggressive early policy measures taken to contain the virus, these factors may have contributed to the uniquely younger age structure of COVID-19 cases in the city. Consequently, this young profile of confirmed cases may have prevented fatalities in the territory. Recent research has highlighted the importance of a demographic approach to understanding COVID-19 transmission and fatality rates. The experience in Hong Kong shows that while an older population age structure may be important for understanding COVID-19 fatality, it is not a given. From a social science perspective at least, there is no easy answer to why one area should experience COVID-19 differently from another.

Neospora caninum infection has been reported in a large number of intermediate hosts, such as ruminants, rabbits, mice, etc. but neosporosis has emerged as a serious disease in cattle and dogs worldwide. Abortions and other infertility issues have been reported in the infected cows, leading to great economic losses in farmers. The aim of our study was to assess N. caninum seroprevalence in dairy cattle from Northern Greece (region of Xanthi) by using the indirect fluorescent antibody technique. Blood samples were collected from 875 Holstein C Friesian dairy cows and tested for Neospora caninum antibodies. Among the cows that were studied, 184 (21.03%) were positive for N. caninum antibodies and concurrently their farms had a known previous history of infertility problems, such as abortions, increased number of artificial inseminations needed for conception, increased rate of returning to estrus and retention of fetal membranes.

A chronic immunosuppressed state as in solid organ transplant recipients is a reported risk factor for the novel 2019 coronavirus infection. Patients with a history of orthotopic heart transplant (OHT) at a tertiary care transplant center in Detroit, Michigan were retrospectively reviewed from March until May 2020. Clinical parameters and outcomes of 5 OHT recipients and one combined heart-lung recipient with confirmed SARS-CoV-2 were obtained. The cohort was predominately African American males with median age of 59 years (interquartile range, 48.25-73.25). All patients were classified as having mild-moderate disease; none required intubation or ICU admission with no deaths. The most common presenting symptoms were fever and shortness of breath 83% (n = 5), followed by cough and chills 67% (n = 4). All admitted patients (n = 5) received hydroxychloroquine and 3 received high-dose steroids. Antimetabolites were held for 2 patients (33.3%). The calcineurin inhibitor trough goal was decreased in only 1 patient; 3 other patients, without change in goal, required calcineurin inhibitor dosage reduction. Two patients requiring readmission presented 7 and 23 days after initial symptoms onset. In conclusion, our experience with OHT patients infected by the SARS-CoV-2 virus did not have an elevated risk of severe infection. Impact of modifying immunosuppression remains unclear.

BACKGROUND: Biobanks are imperative infrastructures, particularly during outbreaks, when there is an obligation to acquire and share knowledge as quick as possible to allow for implementation of science-based preventive, diagnostic, prognostic and therapeutic strategies. METHODS: We established a COVID-19 biobank with the aim of collecting high-quality and well-annotated human biospecimens, in the effort to understand the pathogenic mechanisms underlying COVID-19 and identify therapeutic targets (COVID-BioB, NCT04318366). Here we describe our experience and briefly review the characteristics of the biobanks for COVID-19 that have been so far established. RESULTS: A total of 46,677 samples have been collected from 913 participants (63.3% males, median [IQR] age 62.2 [51.2 - 74.0] years) since the beginning of the program. Most patients (66.9%) had been admitted to hospital for COVID-19, with a median length of stay of 15.0 (9.0 - 27.0) days. A minority of patients (13.3% of the total) had been admitted for other reasons and subsequently tested positive for SARS-CoV-2. The remainder were managed at home after being seen at the Emergency Department. CONCLUSIONS: Having a solid research infrastructure already in place, along with flexibility and adaptability to new requirements, allowed for the quick building of a COVID-19 biobank that will help expand and share the knowledge of SARS-CoV-2.

Suicidal behaviour is a global public health problem, and one population group with high prevalence rates is medical students, especially in the ideation component. Various models have tried to explain it, but there are few inferential studies in the Colombian population. The structural equation models used in controlled social sciences to explain this problem and their analytical power allow generalisations to be made with a certain degree of precision. These analyses require a large amount of data for robust estimation, which limits their usability when there are restrictions to access the data, as is the case today due to Covid-19, and a question that stands out in these models is the evaluation of the fit. Through a set of 1,200 simulated data, an appropriate model fit was found ([Formula: see text] , CFI = 0.97, GFI = 0.97, TLI = 0.97, RMSEA = 0.04[0.042-0.046], SRMR = 0.06) for the predictors of depression and perceived burdensomeness, which were analysed using the JASP program. The role of thwarted belongingness is discussed, as well as the appropriateness of the assessment instrument used to evaluate it an considerations regarding suicidal ideation monitoring, evaluation and intervention in medical students.

We read with interest, "D-dimer triage for COVID-19" by Chenghong et al. This observational cohort study from Wuhan, China concludes that a D-dimer done at admission could be an effective and easily available diagnostic surrogate marker for coronavirus disease-19 (COVID-19). We are concerned that several limitations in the study's methodology affect the authors' conclusions.