Diabetes is a driver of non-alcoholic fatty liver disease (NAFLD) and fibrosis. We determine current practices in examining liver fibrosis in people with diabetes and record prevalence levels in primary and secondary care. We extracted HbA(1c) results 48 mmol/mol to identify people with diabetes, then examined the proportion who had AST, ALT, and platelets results, facilitating calculation of non-invasive fibrosis tests (NIT), or an enhanced liver fibrosis score. Fibrosis markers were requested in only 1.49% (390/26,090), of which 29.7% (n = 106) had evidence of significant fibrosis via NIT. All patients at risk of fibrosis had undergone transient elastography (TE), biopsy or imaging. TE and biopsy data showed that 80.6% of people with raised fibrosis markers had confirmed significant fibrosis. We also show that fibrosis levels as detected by NIT are marginally lower in patients treated with newer glucose lowering agents (sodium-glucose transporter protein 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists). In conclusion by utilising a large consecutively recruited dataset we demonstrate that liver fibrosis is infrequently screened for in patients with diabetes despite high prevalence rates of advanced fibrosis. This highlights the need for cost-effectiveness analyses to support the incorporation of widespread screening into national guidelines and the requirement for healthcare practitioners to incorporate NAFLD screening into routine diabetes care.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SAR-CoV-2) is the strain of coronavirus that causes coronavirus disease (COVID-19), the respiratory illness that resulted in COVID-19 pandemic in early December 2019. Due to lack of knowledge of the epidemiological cycle and absence of any type of vaccine or medications, the Government issued various non-pharmacological measures to end the COVID-19 pandemic. Several researchers applied the Susceptible-Infected-Recovered-Deceased (SIRD) compartmental epidemiology process model to identifying the effect of different governments intervention methods enforced to mollify the spread of COVID-19 epidemic. In this paper, we aim to provide a modified SIRD model for COVID-19 spread prediction. We have analyzed the data of the Northern and Southern states of India from January 30, 2020, to October 24, 2020 using the proposed SIRD model and existing SIRD model. We have made the predictions with reasonable assumptions based on real data, considering that the precise course of an epidemic is highly dependent on how and when quarantine, isolation, and precautionary measures were imposed. The proposed method gives better approximation values of new cases, R0 (Reproductive Number), daily deaths, daily infectious, transmission rate, and recovered individuals.Through the analysis of the reported results, the proposed SIRD model can be an effective method for investigating the effect of government interventions on COVID-19 associated transmission and mortality rate at the time of epidemic.

The objectives of this study were to determine coronavirus disease 2019 (COVID-19) vaccination hesitancy and influencing factors in China, while broadening the applicability of the Vaccine Hesitancy Scale (VHS). A cross-sectional survey was conducted in China from 4th to 26th February 2021. Convenience sampling method was adopted to recruit participants. A total of 2,361 residents filled out the questionnaire. Confirmatory factor analysis was used on the validation set to confirm the latent structure that resulted from the exploratory factor analysis, which was conducted on the construction set. Multiple linear regression model analyses were used to identify significant associations between the identified the revised version of VHS subscales and hypothesized explanatory variables. Two subscales were identified within the VHS through data analysis, including "lack of confidence in the need for vaccines" and "aversion to the risk of side effects." The results indicated that the hesitancy of the participants in our sample was both driven the two mainly aspects. In addition, more than 40% of the participants expressed hesitation in half of the items in VHS. This study characterized COVID-19 vaccine hesitancy in China, and identified disparities in vaccine hesitancy by socio-demographic groups and knowledge about the vaccine. Knowledge of the vaccine was statistically linked to respondents' answers to the clustered 'lack of confidence' and 'risks perception' items. Our results characterize Chinese citizens' COVID-19 vaccine concerns and will inform targeted health communications.

ABSTRACT: Graduate level nursing programs are having increasing difficulty obtaining clinical sites for their students. Nurse practitioner (NP) students need a minimum of 500 direct care hours in addition to indirect hours. Simulation experiences may not be used as direct patient care hours for NP students, but telehealth experiences may be used if the focus is on obtaining similar competencies to what would be acquired with face-to-face patient experiences. One college of nursing adapted several opportunities for NP students to acquire indirect clinical experiences and specific NP competencies during the coronavirus (COVID-19) pandemic. Several different clinically focused teaching methodologies were planned and implemented. These varied by NP specialty track and included complex case analyses, virtual (Zoom) rounds, well-child cases, and objective structured clinical examinations. These adapted clinical experiences are effective methods of helping students acquire clinical competencies and skills; however, they bring their own challenges. Post-COVID may be a time of new beginnings, moving nursing education forward on finding new and better ways to ensure that students acquire clinical competencies. What the new normal will be for nursing education is yet to be determined, but nursing education will likely never return to where we were before the pandemic.

Many low-income countries (LICs), including Nepal, endeavour to deliver climate mitigation by reducing greenhouse gas (GHG) emissions and achieving more sustainable resource consumption. However, their prospects of delivering on such goals alongside the rapid structural changes in the economy prevalent in the LICs are not clear. This research aims to better understand the underlying complexity in the linkage between the framing of climate mitigation actions into government policies and the prospects for their delivery. We use critical discourse analysis, post-structural discourse analysis, and thematic analysis of textual data corpus generated from government policies (n = 12) and semi-structured interviews (n = 12) with policy actors, such as government policymakers and private sector and non-government organisations representatives. We also develop energy and material consumption and GHG emissions models to predict their values up to 2050 via the R tools and machine learning algorithms that validate the accuracy of models. Our findings suggest that the social context of policymaking creates a knowledge structure on climate mitigation which is reflected in government policies. The policy actors and their institutions exchange their ideas and interests in a deliberative and collaborative environment to prioritise policies for the energy, forest, and transport sectors to deliver climate mitigation actions in Nepal. However, the energy sector, together with the agriculture sector, has insufficient climate mitigation actions. Reflecting on the high proportion of biomass in the energy mix and the rapid rise in fossil fuel and energy consumption per capitaboth of which are driven by the remittance inflowsthis research suggests measures to reduce these in an absolute sense.

Background: BNT162b2 and mRNA-1273 are the two recently approved mRNA-based vaccines against COVID-19 which has shown excellent safety and efficacy. Preliminary data about specific and neutralizing antibodies is available covering the first 100 days after vaccination. Methods: We reviewed all the publications regarding the immunologic consequences of BNT162b2 and mRNA-1273 vaccination. A summary of specific antibodies concentration and neutralizing antibodies titers elicited by each vaccine is provided. Results: BNT162b2 and mRNA-1273 displayed a reassuring safety and efficacy profile, with the latter above 94%. They can elicit specific antibodies titers and neutralizing antibodies concentrations that are far superior from those observed among COVID-19 human convalescent serum, across a wide span of age, for at least 100 days after vaccination. Moreover, the vaccine-induced T cellular response is oriented toward a T(H)1 response and no evidence of vaccine-enhanced disease have been reported. Discussion: BNT162b2 and mRNA-1273 can elicit specific antibodies titers and neutralizing antibodies concentrations above those observed among COVID-19 human convalescent serum in the first 100 days after vaccination. Data about vaccine efficacy in those with previous COVID-19 or immunocompromised is still limited.

As the COVID-19 pandemic continues, there is an imminent need for rapid diagnostic tools and effective antivirals targeting SARS-CoV-2. We have developed a novel bioluminescence-based biosensor to probe a key host-virus interaction during viral entry: the binding of SARS-CoV-2 viral spike (S) protein to its receptor, angiotensin-converting enzyme 2 (ACE2). Derived from Nanoluciferase binary technology (NanoBiT), the biosensor is composed of Nanoluciferase split into two complementary subunits, Large BiT and Small BiT, fused to the Spike S1 domain of the SARS-CoV-2 S protein and ACE2 ectodomain, respectively. The ACE2-S1 interaction results in reassembly of functional Nanoluciferase, which catalyzes a bioluminescent reaction that can be assayed in a highly sensitive and specific manner. We demonstrate the biosensor's large dynamic range, enhanced thermostability and pH tolerance. In addition, we show the biosensor's versatility towards the high-throughput screening of drugs which disrupt the ACE2-S1 interaction, as well as its ability to act as a surrogate virus neutralization assay. Results obtained with our biosensor correlate well with those obtained with a Spike-pseudotyped lentivirus assay. This rapid in vitro tool does not require infectious virus and should enable the timely development of antiviral modalities targeting SARS-CoV-2 entry.

The persistence of severe acute respiratory syndrome coronavirus 2 (SARS\CoV\2) antibodies is a matter of importance regarding the coronavirus disease 19 (COVID\19) pandemic. To observe antibody dynamics, 105 blood donors, positive for SARS\CoV\2 antibodies by a lateral flow test within a seroprevalence study, were included in this study. Thirty\nine (37%) of 105 the donors were confirmed positive by a total Ig Wantai enzyme\linked immunosorbent assay (ELISA). Three (8%) in this group of 39 reported severe and 26/39 (67%) mild to moderate COVID\19 symptoms. By further ELISA\testing, 33/39 (85%) donors were initially positive for IgG antibodies, 31/39 (79%) for IgA, and 32/39 (82%) for IgM, while 27/39 (69%) were positive for all three isotypes. Persistence of IgG, IgA, and IgM was observed in 73%, 79%, and 32% of donors, respectively, after 6C9 months of observation. For IgM antibodies, the decline in the proportion of positive donors was statistically significant (p = 0.002) during 12 months observation, for IgG only the decline at 3 months was statistically significant (p = 0.042). Four donors exhibited notable increases in antibody levels. In conclusion, persistent SARS\CoV\2 IgA antibodies and IgG antibodies at 6C9 months are present in approximately three of four individuals with previous mild to moderate COVID\19.

The coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2. The virus can be spread by close person-to-person contact primarily by respiratory droplets. Given the close proximity of the sonographer or sonologist with the patient during ultrasound examinations, special precautions should be taken to limit the exposure of radiology personnel to patients with coronavirus disease 2019 while still providing optimal patient care. Methods covered in this article include modified workflow, close scrutiny and prioritization of imaging orders, and design of targeted ultrasound protocols. These guidelines summarize the personal experience and insight of multiple colleagues who lead ultrasound sections or are experts in the field.

BACKGROUND: The impact of COVID-19 on adolescents with cerebral palsy (CP) and their families is under investigated, particularly in the Southeastern United States. OBJECTIVE/HYPOTHESIS: Examine the impact of COVID-19 on lifestyle activities, general and mental health, and basic needs among a cohort of adolescents with CP in the Southeast U.S. A second purpose was to identify key factors that impacted their lifestyles. METHODS: Cross-sectional survey of adolescents with CP (ages 10-19 years) who completed a child-modified version of the Coronavirus Disability Survey (COV-DIS). Health and behavior items were associated with the perceived lifestyle impact of COVID-19. RESULTS: A total of 101 respondents completed the survey (mean age 14 2 years). Respondents reported minimal-to-no change in general health since the COVID-19 outbreak. Basic needs were met for most families. Nearly all participants (94.1%) reported a mental health concern that resulted from COVID-19: 32.7% felt down or depressed; 47.5% felt little pleasure in doing things; and 64.4% felt isolated. Moreover, 74.3% reported decreased socialization; 51.5% reported reduced exercise participation; 43.6% reported difficulties in obtaining medical care. Most participants (90.1%) were negatively affected by COVID-19 and key associated factors were: reduced interactions with friends and family (p=0.001), exercise participation (p=0.016), interest in doing things (p=0.005), worsened depression (p=0.015), increased isolation from others and (p=0.02) at home (p=0.006), technological communication (p=0.00), and virus exposure (p=0.008). CONCLUSIONS: Study findings highlight problem areas that warrant urgent intervention among adolescents with CP located within the Southeast U.S.

BACKGROUND: Patients with chronic kidney disease stage 5 and those on immunosuppression are particularly vulnerable and are shielded as per public health strategy. We present our experience of coronavirus disease 2019 (COVID-19) transplant patients in one of the most affected parts of the UK with direct comparison to waitlisted patients. METHODS: A single-center prospective study of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive waitlisted and transplant patients was undertaken to compare these groups and assess clinical outcomes. RESULTS: A total of 60 consecutive symptomatic SARS-CoV-2 positive patients were identified with 32 active waitlisted patients and 28 functioning renal transplants. Demographics were similar. The incidence of symptomatic COVID-19 in the waitlisted group was 9.9% compared to 1.9% in renal transplant patients (P < 0.001). Immunosuppression did not influence initial symptomology. Fifteen percent of patients in the waitlisted and 32% in the transplant groups died (P = 0.726). Mortality as proportion of total waitlisted (321 patients) and transplant population (1434 patients) of our centre was 1.5% and 0.6% (P < 0.001), respectively. C-reactive protein (CRP) at 48 h and peak CRP were associated with mortality in both groups while quick sequential organ failure assessment score at 48 h (P = 0.036) was associated with mortality for transplant patients. CONCLUSIONS: Incidence of COVID-19 is higher in the waitlisted population but transplant patients have more severe disease, reflected by higher mortality. CRP at 48 h can be used as a predictive tool. In the absence of effective treatments, the current strategy of shielding is arguably the most important factor in protecting patients while resuming transplantation.

In response to the spread of the COVID-19 pandemic, governments implement containment policies to restrict people's activities. It raises the question of whether these policies are necessary and strict enough. Using two datasets, a national survey in the United States and a government response tracker, I show that lockdown substitutes for self-protection measures when there is no labour uncertainty. However, when the labour uncertainty is prevalent, lockdown and self-protection are complements.

Background: South Korea faced the Middle East Respiratory Syndrome (MERS) outbreak for the first time in 2015, which resulted in 186 infected patients and 39 deaths. This study investigated the level of post-traumatic stress disorder (PTSD) and turnover intention, the relationship between PTSD and turnover intention, and the buffering effect of supervisor support among nurses post-MERS outbreak. Methods: In total, 300 nurses from three of 15 isolation hospitals in South Korea were invited to participate. We collected data pertaining to PTSD, turnover intention, supervisor support, work-related factors, and socio-demographic factors through a structured survey distributed to the nurses at the hospitals after the outbreak. For the statistical analyses, descriptive statistics and multiple regression were employed. Findings: Of the 147 participants, 33.3% were involved in the direct care of the infected patients, whereas 66.7% were involved in the direct care of the suspected patients. More than half (57.1%) of the nurses experienced PTSD, with 25.1% experienced full PTSD and 32.0% with moderate or some level of PTSD. The mean score of turnover intention was 16.3, with the score range of 4 to 20. The multiple regression analysis revealed that PTSD was positively associated with turnover intention, and supervisor support had a strong buffering effect. Conclusion/Application to Practice: These findings confirmed that after a fatal infectious disease outbreak like MERS, nurses experience high level of PTSD and show high intention to leave. Organizational strategies to help nurses to cope with stress and to prevent turnover intention, especially using supervisor support, would be beneficial.

PURPOSE Onyx has been successfully applied in the treatment of various neurovascular lesions. However, some experience is required to get accustomed to its unpredictable fluoroscopic visibility during injection. This in vitro study aimed to evaluate the characteristics of radiopacity change in a simulated embolization procedure. MATERIALS AND METHODS Using a bench-top Onyx injection experiment simulating a typical brain arteriovenous malformation embolization, nine cycles of casting modes (continuous injection) and plugging modes (injection with intermittent pauses) were performed. Radiodensity of Onyx droplets collected from the microcatheter tip and the distal head portion of the microcatheter were measured as time lapsed. Distribution of droplet radiodensity (radiodensity) and distribution of radiographic grade (grade) were analyzed and compared by repeated measurements. RESULTS Within-group analysis revealed no significant radiodensity change with time (P>0.05). The radiodensity was significantly higher in the casting mode than in the plugging mode (P<0.01). The lateral radiograph of the microcatheter showed higher radiopacity (P<0.01) and better evenness (P<0.01) in the casting mode than in the plugging mode. A significant difference in microcatheter attenuation (both radiographic grade mean and SD; P<0.01) was noted between the two modes. Radiodensity had a significant influence on the radiopacity and radiopacity evenness of the microcatheter. CONCLUSION The radiopacity of the Onyx can vary significantly over time because of early precipitation of tantalum powder. Radiopacity decreased significantly during plugging modes, characterized by pauses between injections.

BACKGROUND/AIMS: The COVID-19 pandemic has significantly impacted face-to-face research. This has propelled ideas and plans for more remote styles of research and provided new perspectives on conducting research. This paper aimed to identify challenges specific to conducting remote forms of experimental addiction research, although some of these challenges apply to all types of addiction research. ARGUMENT: The impact of the COVID-19 pandemic has led to important lessons for future addiction research. Although remote research has been conducted for decades, little experimental research has been performed remotely. To do so require a new perspective on what research questions we can ask and could also enable preferential capture of those who may be more reluctant to engage in research based in clinical settings. There may, however, be crucial factors that will compromise this process. We illustrate our argument with three real-world, ongoing case studies centred on gambling behaviour, opioid overdose, and cannabinoid psychopharmacology. We highlight the obstacles to overcome to enable more remote methods of study. CONCLUSIONS: The future of experimental research and, more generally, addiction research, will be shaped by the pandemic and may result in advantages, such as reaching different populations and conducting addiction research in more naturalistic settings.

OBJECTIVE This study examines the impact of the COVID-19 pandemic and the lock-down on patients with mental illness. METHODS Patients in inpatient or outpatient psychiatric treatment received a questionnaire, examining psychological distress and psychiatric care during the COVID-19 pandemic. RESULTS More than half of the patients indicated that the state of emergency had a negative impact on their mental illness. Severely ill patients were more affected. CONCLUSION Patients with mental illness are a particularly vulnerable group in the current crisis. Psychiatric and psychotherapeutic care needs to be adapted accordingly; the specific burden and distress needs to be examined actively in patients from all diagnostic groups.

[ ]our ever-changing understanding of transmission - will surface transmission and asymptomatic transmission be sufficient to necessitate barriers, systems and controls on a permanent basis? Or, are they a shorter-term concern with an interim response? DATA SET TWO - THE REAL ESTATE SUPPLY In examining real estate markets, we must consider existing fragility, adaptability to new demands, and potential relevance to new markets Among existing buildings, advantage may go to those that support resilience in the face of this and future crises-sufficient storage space, life-safety and isolation features, ability to reconfigure for surges in demand, isolation without loss of capacity, and ease of cleaning After the Great Depression, a generation was left with habits of thrift, savings and risk aversion that lasted their lifetimes and was not reset until the emergence of baby boomers [ ]the increase:

Objectives: SARS-CoV-2 may cause acute lung injury, and secondary infections are thus relevant complications in patients with COVID-19 pneumonia However, detailed information on community- and hospital-acquired infections among patients with COVID-19 pneumonia is scarce Methods: We identified 220 SARS-CoV-2-positive patients hospitalized at the University Hospital Basel, Switzerland (between 25 February and 31 May 2020) We excluded patients who declined the general consent (n = 12), patients without clinical evidence of pneumonia (n = 29), and patients hospitalized for &lt; 24 h (n = 17) We evaluated the frequency of community- and hospital-acquired infections using respiratory and blood culture materials with antigen, culture-based, and molecular diagnostics For ICU patients, all clinical and microbial findings were re-evaluated interdisciplinary (intensive care, infectious disease, and clinical microbiology), and agreement reached to classify patients with infections Results: In the final cohort of 162 hospitalized patients (median age 64 4 years (IQR, 50 4C74 2);61 1% male), 41 (25 3%) patients were admitted to the intensive care unit, 34/41 (82 9%) required mechanical ventilation, and 17 (10 5%) of all hospitalized patients died In total, 31 infections were diagnosed including five viral co-infections, 24 bacterial infections, and three fungal infections (ventilator-associated pneumonia, n = 5;tracheobronchitis, n = 13;pneumonia, n = 1;and bloodstream infection, n = 6) Median time to respiratory tract infection was 12 5 days (IQR, 8C18) and time to bloodstream infection 14 days (IQR, 6C30) Hospital-acquired bacterial and fungal infections were more frequent among ICU patients than other patients (36 6% vs 1 7%) Antibiotic or antifungal treatment was administered in 71 (43 8%) patients Conclusions: Community-acquired viral and bacterial infections were rare among COVID-19 pneumonia patients By contrast, hospital-acquired bacterial or fungal infections were frequently complicating the course among ICU patients ? 2021, The Author(s)

In recent years, increasing levels of resistance to the four FDA-approved anti-influenza virus drugs have been described and vaccine manufacturers have experienced demands that exceed their capacity. This situation underlines the urgent need for novel antivirals as well as innovations in vaccine production in preparation for the next influenza epidemic. Here we report the development of a cell-based high-throughput screen which we have used for the identification of compounds that modulate influenza virus growth either negatively or positively. We screened a library of compounds with known biological activity and identified distinct groups of inhibitors and enhancers that target sodium channels or protein kinase C (PKC). We confirmed these results in viral growth assays and find that treatment with a sodium channel opener or PKC inhibitor significantly reduces viral replication. In contrast, inhibition of sodium channels or activation of PKC leads to enhanced virus production in tissue culture. These diametrically opposing effects strongly support a role for PKC activity and the regulation of Na(+) currents in influenza virus replication and both may serve as targets for antiviral drugs. Furthermore, we raise the possibility that compounds that result in increased viral titers may be beneficial for boosting the production of tissue culture-grown influenza vaccines.

A comprehensive translational cancer research approach focused on personalized and precision medicine, and covering the entire cancer researchCcareCprevention continuum has the potential to achieve in 2030 a 10\year cancer\specific survival for 75% of patients diagnosed in European Union (EU) member states with a well\developed healthcare system. Concerted actions across this continuum that spans from basic and preclinical research through clinical and prevention research to outcomes research, along with the establishment of interconnected high\quality infrastructures for translational research, clinical and prevention trials and outcomes research, will ensure that science\driven and social innovations benefit patients and individuals at risk across the EU. European infrastructures involving comprehensive cancer centres (CCCs) and CCC\like entities will provide researchers with access to the required critical mass of patients, biological materials and technological resources and can bridge research with healthcare systems. Here, we prioritize research areas to ensure a balanced research portfolio and provide recommendations for achieving key targets. Meeting these targets will require harmonization of EU and national priorities and policies, improved research coordination at the national, regional and EU level and increasingly efficient and flexible funding mechanisms. Long\term support by the EU and commitment of Member States to specialized schemes are also needed for the establishment and sustainability of trans\border infrastructures and networks. In addition to effectively engaging policymakers, all relevant stakeholders within the entire continuum should consensually inform policy through evidence\based advice.