title: Outcomes of an Online Virtual Boot Camp to Prepare Fourth-Year Medical Students for a Successful Transition to Internship

text: Introduction Changes in medical education and health care delivery have limited the ability of fourth-year medical students to perform the role of an intern prior to graduating from medical school. To address this issue, many schools have instituted residency preparation courses (sometimes referred to as boot camps) particularly for students entering surgical fields. Courses for students entering nonprocedural fields are less common and most assess increases in self-reported confidence without providing objective evidence of a gain in knowledge or skills improvement. Materials and Methods We used a Plan, Do, Study, Act (PDSA) model to develop and pilot cycle 1 of a nonprocedural internship preparation elective in 2019. Feedback was used to refine the course and map sessions to core competencies outlined by the Accreditation Council of Graduate Medical Education (ACGME) for PDSA cycle 2. The curriculum was adapted for remote synchronous delivery due to the coronavirus pandemic in spring 2020 using a combination of didactic lectures containing embedded polls and case-based role play responses using a chat box. Students completed anonymous surveys assessing self-perceived levels of confidence, as well as an objective comprehensive assessment after course completion. Results A total of 89 students participated in the course. Pre-session confidence was lowest for transfusion medicine, handling pages from nursing while on call, and knowledge of the role of a chief resident. A statistically significant increase in median scores for self-reported knowledge or confidence was seen in all sessions. The percentage of students reporting that they were either confident or extremely confident also increased significantly after each session (p<0.001 for all). All sessions analyzed were rated as useful or extremely useful by more than half of the students, and 94% of the students scored 70% or higher on the comprehensive course assessment. Conclusions An online virtual synchronous boot camp increased students’ confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. We were able to adapt our curriculum to a remote model and will likely keep several sessions in an online format in the future.


title: Zwischen Asthma und COPD differenzieren — mehr Mut zur probatorischen Therapie!: Seminar / Atemwegserkrankungen

text: Bei Patienten mit obstruktiver Atemwegserkrankung muss zwischen einem Asthma bronchiale und einer COPD differenziert werden. Die Unterscheidung ist wegweisend für die Therapie — in der Praxis aber oft nicht einfach. Sind die Zusammenhänge nicht ganz klar, kann im individuellen Fall eine probatorische Therapie weiterhelfen.


title: Well-Being and the Good Death

text: The philosophical literature on well-being and the good life contains very little explicit discussion of what makes for a better or worse death. The purpose of this essay is to highlight some commonly held views about the good death and investigate whether these views are recognized by the leading theories of well-being. While the most widely discussed theories do have implications about what constitutes a good death, they seem unable to fully accommodate these popular good death views. I offer two partial explanations for why these views have been neglected in discussions of well-being and make two corresponding recommendations for future work in the philosophy of well-being.


Das Stethoskop bleibt wichtig — auch in COVID-19-Zeiten: Kein Auslaufmodell


Wie Dampfen den Gefäßen schadet: Shisha und E-Zigarette


title: Allgemeinärztliche Sonografie — Teil 2: Schilddrüse, Thorax, Gefäße, Lymphknoten: Bildgebende Diagnostik

text: Nicht nur das Abdomen, sondern auch Schilddrüse, Thorax, Gefäße und Lymph- knoten können in der Hausarztpraxis sonografiert werden. Durch eine strukturierte und fundierte Diagnostik werden Doppeluntersuchungen vermieden sowie Befunde an einer Stelle erfasst und dokumentiert. In einigen Fällen sollte der Patient jedoch an einen Teilgebietsarzt überwiesen werden.


title: Complex Networks: a Mini-review

text: Network analysis is a powerful tool that provides us a fruitful framework to describe phenomena related to social, technological, and many other real-world complex systems. In this paper, we present a brief review about complex networks including fundamental quantities, examples of network models, and the essential role of network topology in the investigation of dynamical processes as epidemics, rumor spreading, and synchronization. A quite of advances have been provided in this field, and many other authors also review the main contributions in this area over the years. However, we show an overview from a different perspective. Our aim is to provide basic information to a broad audience and more detailed references for those who would like to learn deeper the topic.


title: COVID-19: the impetus for change—sustaining healthcare team communication in times of social distancing

text: The COVID-19 pandemic has challenged existing healthcare systems and has made prevention of healthcare personnel exposure a high priority. Essential healthcare services, including multi-disciplinary team (MDT) meetings that make medical decisions, are expected to continue uninterrupted in this time of social distancing. There are a multitude of virtual platforms available to enable remote MDT meetings, and the pandemic has accelerated their arrival into daily healthcare practice. While we deal with a pandemic crisis, we have comprehensively reviewed and reported on the popular platforms and services available for this purpose. While each platform has its own unique features and drawbacks, it is essential to liaise with information technology departments and data governance teams to understand the optimal platforms for use within each healthcare setting. Level of evidence: Not ratable


title: Praxis-Digitalisierung: So zieht die Karawane weiter: Telematik-Infrastruktur

text: Alle Praxen in Deutschland sollen sich an die Telematik-Infrastruktur (TI) anschließen. Konnektoren und Lesegeräte sind inzwischen weit verbreitet. Doch ausruhen sollte sich niemand, denn der Marsch in die Zukunft geht weiter, von Oase zu Oase. Ein Ausblick.


The Neuropsychological Impact of E-learning on Children


Single-Cell Analyses in the Multi-omics Era


title: Antiviral immunity and nucleic acid sensing in haematopoietic stem cell gene engineering

text: The low gene manipulation efficiency of human hematopoietic stem and progenitor cells (HSPC) remains a major hurdle for sustainable and broad clinical application of innovative therapies for a wide range of disorders. Given that all current and emerging gene transfer and editing technologies are bound to expose HSPC to exogenous nucleic acids and most often also to viral vectors, we reason that host antiviral factors and nucleic acid sensors play a pivotal role in the efficacy of HSPC genetic manipulation. Here, we review recent progress in our understanding of vector–host interactions and innate immunity in HSPC upon gene engineering and discuss how dissecting this crosstalk can guide the development of more stealth and efficient gene therapy approaches in the future.


Reflecting on the challenges of sustaining emergency care research during the Covid-19 pandemic


Directions & Connections


Emotional state should not be used to differentiate IBD from IBS – Authors' reply


Tackling cervical cancer in Europe amidst the COVID-19 pandemic


HIV, tuberculosis, and malaria: how can the impact of COVID-19 be minimised?


Emotional state should not be used to differentiate IBD from IBS


Going Virtual: Redesigning the Interview Experience


title: False-Negative Nasopharyngeal Swab RT-PCR Assays in Typical COVID-19: Role of Ultra-low-dose Chest CT and Bronchoscopy in Diagnosis

text: On 11 March 2020, the WHO declared COVID-19 a pandemic and global health emergency. We describe the clinical features and role of ultra-low-dose chest computed tomography (CT) and bronchoscopy in the diagnosis of coronavirus disease (COVID-19). In our patient, who was highly suggestive clinically and radiologically for COVID-19, we had two false-negative results for nasopharyngeal and oral swab reverse-transcriptase polymerase chain reaction (RT-PCR) assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eventually, we confirmed the diagnosis using bronchoscopy and bronchoalveolar lavage (BAL). LEARNING POINTS: Clinical and laboratory findings in COVID-19 are unspecific. Chest CT has a diagnostic sensitivity comparable to nasopharyngeal swab RT-PCR assay but lacks specificity. RT-PCR assays on biological specimens, particularly nasopharyngeal swabs, are considered the diagnostic gold standard. Bronchoscopy and bronchoalveolar lavage can help confirm the diagnosis and should be performed in patients in whom diagnostic-driven treatment for COVID-19, such as tocilizumab or remdesivir, is being considered.


title: Prevalence and correlates of physical activity in a sample of UK adults observing social distancing during the COVID-19 pandemic

text: OBJECTIVE: To investigate the levels and correlates of physical activity during COVID-19 social distancing in a sample of the UK public. METHODS: This paper presents analyses of data from a cross-sectional study. Levels of physical activity during COVID-19 social distancing were self-reported. Participants also reported on sociodemographic and clinical data. The association between several factors and physical activity was studied using regression models. RESULTS: Nine hundred and eleven adults were included (64.0% were women and 50.4% of the participants were aged 35–64 years). 75.0% of the participants met the physical activity guidelines during social distancing. Meeting these guidelines during social distancing was significantly associated with sex (reference: male; female: OR=1.60, 95% CI 1.10 to 2.33), age (reference: 18–34 years; ≥65 years: OR=4.11, 95% CI 2.01 to 8.92), annual household income (reference: <£15 000; £15 000–<£25 000: OR=2.03, 95% CI 1.11 to 3.76; £25 000–<£40 000: OR=3.16, 95% CI 1.68 to 6.04; £40 000–<£60 000: OR=2.27, 95% CI 1.19 to 4.34; ≥£60 000: OR=2.11, 95% CI 1.09 to 4.09), level of physical activity per day when not observing social distancing (OR=1.00 (per 1 min increase), 95% CI 1.00 to 1.01), and any physical symptom experienced during social distancing (reference: no; yes: OR=0.31, 95% CI 0.21 to 0.46). CONCLUSION: During COVID-19, social distancing interventions should focus on increasing physical activity levels among younger adults, men and those with low annual household income. It should be noted in the present sample that women and younger adults are over-represented.


Expert consensus on the prevention and treatment of substance use and addictive behaviour-related disorders during the COVID-19 pandemic


title: Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data

text: OBJECTIVES: To compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D. DESIGN: Population-based cohort study. SETTING: Primary and secondary care, England, UK. PARTICIPANTS: 108 588 people with T2D and 528 667 comparators registered in 391 English general practices. Each patient with T2D aged ≥16 years between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D. RESULTS: Overall, 77% of patients with T2D had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women and those most socially deprived. Conditional logistic regression models fitted to estimate (OR, 95% CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR 2.13, 95% CI 1.85 to 2.46); heart failure (OR 2.12, 1.84 to 2.43); depression (OR 1.75, 1.62 to 1.89), but non-significant for cancer (OR 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions as highly prevalent comorbidities in people with T2D. CONCLUSIONS: T2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and under-reported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.


This summer, not all flu-like symptoms will be COVID-19s…


Cet été, les syndromes pseudo-grippaux ne seront pas tous des COVID-19


Quels symptômes inhabituels doivent faire rechercher une COVID-19 ?


Suivi des soignants impliqués dans la prise en charge de la COVID-19


Dépistage des porteurs du SARS-CoV-2 : et les tests salivaires ?


Artemisia et COVID-19


Comment maintenir une activité chirurgicale vitale en cas de crise sanitaire grave ? L’exemple de la transplantation chez l’adulte


Comment gérer, après confinement, les malades porteurs d’une affection chronique à risque ?


Déconfinons avec prudence pour ne pas avoir à reconfiner dans l’urgence


Les abattoirs : une cible majeure pour la prévention de la COVID-19


COVID-19 : interprétation des données de morbidité et mortalité


Vacciner contre la COVID-19 : la quête du Graal ?


La précarité : un risque majoré de COVID-19


Successful spontaneous breathing trial, early reintubation and mechanisms of weaning failure


title: Thrombocytopenia: is it a prognostic factor for development of post-hemorrhagic hydrocephalus in neonates?

text: PURPOSE: Post-hemorrhagic hydrocephalus (PHH) is a rare but serious complication among premature babies in the neonatal intensive care unit. The causes of PHH are still not entirely understood, and its prevention and treatment are controversial. We tried to analyze the risk factors for such complication in our cohort. METHODS: We reviewed our neonatology data bank and included all preterms below 28 weeks who were born in the period between 1999 and 2014 and suffered from an intraventricular hemorrhage (IVH). We reviewed gestational age, gender, birth weight, type of birth, IVH degree, comorbidities, therapy, complications, time to event, protein content of cerebrospinal fluid, and clinical follow-up. RESULTS: We identified 180 patients, divided into two subgroups, “B1” with 37 cases (IVH + PHH) and “B2” with 143 cases (IVH − PHH). In group B1, the presence of IVH grades I, II, III, or IV was in 11%, 19%, and 70% respectively. Nineteen patients were treated with a ventricular access device (VAD) or external ventricular drain (EVD). A total of 20 shunts were implanted, with 11 revisions (55%). One patient suffered from thrombocytopenia. In subgroup B2, 51% showed IVH grade I, whereas severe IVH grades were only present in 22%. 25.9% suffered from thrombocytopenia. Thrombocytopenia was significantly higher in patients who did not develop PHH (p value: 0.002). CONCLUSION: According to our results, thrombocytopenia could play a decisive role in avoiding development of PHH as a sequel of IVH. We recommend a randomized controlled trial to assess the possible efficacy of antiplatelet drugs in avoiding PHH in this vulnerable group.


title: Inactivation effect and mechanisms of combined ultraviolet and metal-doped nano-TiO(2) on treating Escherichia coli and Enterococci in ballast water

text: The discharge of ship ballast water (containing large amounts of alien organisms) has caused severe ecological hazards to marine environments. In this study, three metal elements (Ag, Fe, and Gd) were doped to nano-TiO(2) material respectively (content: 0.4%, 0.7%, and 1.0%) to improve inactivation effect of Escherichia coli and Enterococci in ballast water. Experimental results indicate that compared with the sole ultraviolet (UV) and the UV and original nano-TiO(2), the UV and metal-doped nano-TiO(2) increased the bacterial inactivation rate to different extents. For each metal element, high external metal content (1.0%) corresponded to high inactivation effort. The doping of Ag resulted in optimal inactivation effort, and the addition of Fe and Gd caused unobvious effort. At the end of the inactivation process (20 s), the UV and 1% Ag-doped nano-TiO(2) reached the highest logarithmic sterilization rates (0.915 for Escherichia coli and 0.805 for Enterococcus). The doping of Ag, Fe, and Gd did not change the anatase phase TiO(2) crystal form, and 1% Ag-doped nano-TiO(2) had the smallest particle diameter and the evenest distribution of nanoparticles. Compared with the sole UV, the UV and Ag-doped nano-TiO(2) treatment resulted in higher malondialdehyde contents (0.0646 μmol/L for Escherichia coli and 0.0529 μmol/L for Enterococci) and lower superoxide dismutase activities (0.672 U/mL for Escherichia coli and 0.792 U/mL for Enterococci), which were in accordance with high inactivation rates in these cases.


title: Power and Message Framing: the Case of Comparative Advertising

text: Two studies tested the hypothesis that power affects an individual’s likelihood to be influenced by positively vs. negatively framed comparative messages. Experiment 1 showed that individuals with a higher personal sense of power are more persuaded by positively framed messages than negatively framed messages. Experiment 2 showed that this effect is partly attributable to higher power individuals being more suspicious of the negatively framed communicator’s motivation. Message frame did not have a significant influence on individuals with lower levels of power. These results have important implications for tailoring comparative messages aimed at persuasion toward targets with different levels of power.


title: The Future of Infectious Diseases Education

text: The infectious diseases (ID) specialty continues to be in crisis due to a lack of interest by residents in the recruitment pool. It is possible that enhancing and innovating how microbiology is taught in medical school could increase the interest in ID. We need to improve teaching of preclinical medical microbiology and immunology by incorporating advancements in education and learning technologies to reignite the interest in the field. The shortage of ID specialists has important implications in our fight against ID threats such as the current COVID-19 global pandemic. In order to address this problem, we need to perform extensive research to identify the issues that medical learners and trainees are facing as they progress through their medical education towards the ID specialty.


title: Telepresence Mobile Robots Design and Control for Social Interaction

text: Human–robot interaction has extended its application horizon to simplify how human beings interact with each other through a remotely controlled telepresence robot. The fast growth of communication technologies such as 4G and 5G has elevated the potential to establish stable audio–video-data transmission. However, human–robot physical interactions are still challenging regarding maneuverability, controllability, stability, drive layout, and autonomy. Hence, this paper presents a systematic design and control approach based on the customer’s needs and expectations of telepresence mobile robots for social interactions. A system model and controller design are developed using the Lagrangian method and linear quadratic regulator, respectively, for different scenarios such as flat surface, inclined surface, and yaw (steering). The robot system is capable of traveling uphill (30[Formula: see text] ) and has a variable height (600–1200 mm). The robot is advantageous in developing countries to fill the skill gaps as well as for sharing knowledge and expertise using a virtual and mobile physical presence. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12369-020-00676-3) contains supplementary material, which is available to authorized users.


title: The Hopeless University: Intellectual Work at the End of the End of History

text: The University is being explicitly restructured for the production, circulation and accumulation of value, materialised in the form of rents and surpluses on operating activities. The pace of restructuring is affected by the interplay between financial crisis and Covid-19, through which the public value of the University is continually questioned. In this conjuncture of crises that affect the body of the institution and the bodies of its labourers, the desires of Capital trump human needs. The structural adjustment of sectoral and institutional structures as forms, cultures as pathologies, and activities as methodologies enacts scarring. However, the visibility of scars has led to a reawakening of politics inside and beyond the University. The idea that History had ended because there is no alternative to capitalism or its political horizon, is in question. Instead, the political content of the University has reasserted itself at the end of The End of History. In this article, the idea that the University at The End of History has become a hopeless space, unable both to fulfil the desires of those who labour within it for a good life and to contribute solutions to socio-economic and socio-environmental ruptures, is developed dialectically. This enables us to consider the potential for reimagining intellectual work as a movement of sensuous human activity in the world, rather than being commodified for value.


title: Functional and cognitive outcomes after COVID-19 delirium

text: PURPOSE: To ascertain delirium prevalence and outcomes in COVID-19. METHODS: We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. RESULTS: In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium − 50 out of 166 points (95% CI − 83 to − 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. CONCLUSIONS: Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s41999-020-00353-8) contains supplementary material, which is available to authorized users.


COVID-19 and macular edema: a necessarily blindness?


title: Food system disruption: initial livelihood and dietary effects of COVID-19 on vegetable producers in India

text: Disruption to food systems and impacts on livelihoods and diets have been brought into sharp focus by the COVID-19 pandemic. We aimed to investigate effects of this multi-layered shock on production, sales, prices, incomes and diets for vegetable farmers in India as both producers and consumers of nutrient-dense foods. We undertook a rapid telephone survey with 448 farmers in 4 states, in one of the first studies to document the early impacts of the pandemic and policy responses on farming households. We find that a majority of farmers report negative impacts on production, sales, prices and incomes. Over 80% of farms reported some decline in sales, and over 20% of farms reported devastating declines (sold almost nothing). Price reductions were reported by over 80% of farmers, and reductions by more than half for 50% of farmers. Similarly, farm income reportedly dropped for 90% of farms, and by more than half for 60%. Of surveyed households, 62% reported disruptions to their diets. A majority of farm households reported reduced ability to access the most nutrient-dense foods. Around 80% of households reported ability to protect their staple food consumption, and the largest falls in consumption were in fruit and animal source foods other than dairy, in around half of households. Reported vegetable consumption fell in almost 30% of households, but vegetables were also the only food group where consumption increased for some, in around 15% of households. Our data suggest higher vulnerability of female farmers in terms of both livelihoods and diet, and differential effects on smaller and larger farms, meaning different farms may require different types of support in order to continue to function. Farms reported diverse coping strategies to maintain sales, though often with negative implications for reported incomes. The ability to consume one’s own produce may be somewhat protective of diets when other routes to food access fail. The impacts of COVID-19 and subsequent policy responses on both livelihoods and diets in horticultural households risk rolling back the impressive economic and nutrition gains India has seen over the past decade. Food systems, and particularly those making available the most nutrient-dense foods, must be considered in ongoing and future government responses.


title: Epidemiology and short-term outcomes of acute kidney injury among patients in the intensive care unit in Laos: a nationwide multicenter, prospective, and observational study

text: BACKGROUND: Acute kidney injury (AKI) has become a global health issue. Little is known about the disease burden in Laos. We aimed to evaluate the burden and outcomes of AKI as well as assess the availability of AKI treatment in Laos. METHODS: We performed a multicentric prospective observational study in adult patients who had been admitted to 5 intensive care units (ICU) in Laos. The data was serially collected on the first 28 days of ICU admission. Patients were diagnosed by the KDIGO 2012 criteria for AKI. We used AKI occurrence as the primary outcome and explored risk factors on the development and outcomes of AKI. RESULTS: We enrolled 1480 patients from 5 ICU centers across Laos from January to December 2016. After excluding patients with end-stage renal disease and those with incomplete data, AKI occurred in 508 of the 1460 enrolled patients (34.8%). Overall, the rates of maximum AKI staging were 4% for stage 1, 10.3% for stage 2, and 20.5% for stage 3. Risk factors for AKI were older age, obesity, cardiovascular diseases, respiratory diseases, renal diseases, oncologic diseases, and chronic kidney diseases. Only 1.8% of all participants received RRT. The mortality rate was 28.4% in non-AKI patients compared to 44.5% in AKI patients, which increased according to the stage of AKI (stage 1, 4.9%; stage 2, 28.3%; stage 3 66.8%; P < 0.001). There were 13.6% who were discharged against medical advice. CONCLUSIONS: AKI is a huge burden in Laos with under-recognition and poor outcomes.


„Corona-Angst“ wegwischen?


title: Accuracy of CT in a cohort of symptomatic patients with suspected COVID-19 pneumonia during the outbreak peak in Italy

text: OBJECTIVE: To assess sensitivity/specificity of CT vs RT-PCR for the diagnosis of COVID-19 pneumonia in a prospective Italian cohort of symptomatic patients during the outbreak peak. METHODS: In this cross-sectional study, we included all consecutive patients who presented to the ER between March 13 and 23 for suspected COVID-19 and underwent CT and RT-PCR within 3 days. Using a structured report, radiologists prospectively classified CTs in highly suggestive, suggestive, and non-suggestive of COVID-19 pneumonia. Ground-glass, consolidation, and visual extension of parenchymal changes were collected. Three different RT-PCR-based reference standard definitions were used. Oxygen saturation level, CRP, LDH, and blood cell counts were collected and compared between CT/RT-PCR classes. RESULTS: The study included 696 patients (41.4% women; age 59 ± 15.8 years): 423/454 (93%) patients with highly suggestive CT, 97/127 (76%) with suggestive CT, and 31/115 (27%) with non-suggestive CT had positive RT-PCR. CT sensitivity ranged from 73 to 77% and from 90 to 94% for high and low positivity threshold, respectively. Specificity ranged from 79 to 84% for high positivity threshold and was about 58% for low positivity threshold. PPV remained ≥ 90% in all cases. Ground-glass was more frequent in patients with positive RT-PCR in all CT classes. Blood tests were significantly associated with RT-PCR and CT classes. Leukocytes, lymphocytes, neutrophils, and platelets decreased, CRP and LDH increased from non-suggestive to suggestive CT classes. CONCLUSIONS: During the outbreak peak (in a high-prevalence setting), CT presented high PPV and may be considered a good reference to recognize COVID-19 patients while waiting for RT-PCR confirmation. KEY POINTS: • During the epidemic peak, CT showed high positive predictive value and sensitivity for COVID-19 pneumonia when compared with RT-PCR. • Blood tests were significantly associated with RT-PCR and CT classes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00330-020-07050-x) contains supplementary material, which is available to authorized users.


Ultrasonographic diagnosis of pancreatic diseases: this is all you need


Message from the Editor-in-Chief


title: In silico analysis of a chimeric fusion protein as a new vaccine candidate against Clostridium perfringens type A and Clostridium septicum alpha toxins

text: In silico analysis is the most important approach to understand protein structure and functions, and the most important problem for designing and producing a fusion construct is producing large amounts of functional protein. Clostridium perfringens type A and Clostridium septicum produce alpha (plc) and alpha toxins respectively. C. perfringens can cause gas gangrene and gastrointestinal diseases. C. septicum can cause traumatic and non-traumatic gas gangrene. The aim of current research was in silico analysis of a chimeric fusion protein against C. perfringens type A and C. septicum alpha toxins. Firstly, the chimeric fusion gene was designed according to nucleotide sequences of C. perfringens type A alpha (KY584046.1) and C. septicum alpha (JN793989.2) toxin genes and then its fusion protein is constructed by amino acid sequences of C. perfringens type A and C. septicum alpha toxins. Secondly, online software was used to determine prediction of secondary and tertiary structures and physicochemical characteristics of the fusion protein. Finally, the validation of the fusion protein was confirmed by Rampage and proSA program. The designed fusion protein has 777 amino acids in length. TASSER server and physicochemical parameters are showed: C-score = − 2.68 and molecular weight = 87.9 KD respectively. Rampage and proSA software revealed the fusion protein is valid. Deposited accession number for the sequence of the fusion gene in the GenBank is MK908396. The designed fusion protein is valid and functional. Thus, the fusion gene could be used for clone and expression in a proper prokaryotic cell and also as a recombinant vaccine candidate.


Correction to: ChemoPROphyLaxIs with hydroxychloroquine For covId-19 infeCtious disease (PROLIFIC) to prevent covid-19 infection in frontline healthcare workers: A structured summary of a study protocol for a randomised controlled trial


Prone positioning under VV-ECMO in SARS-CoV-2-induced acute respiratory distress syndrome


Nurse-performed ultrasound: a new weapon against COVID-19


Atorvastatin associated with decreased hazard for death in COVID-19 patients admitted to an ICU: a retrospective cohort study


title: Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation

text: STUDY DESIGN: Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin-Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission. OBJECTIVES: Determine the implications of MRSA-related infection isolation on spinal cord injury patients’ anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls. SETTING: National Spinal Injuries Centre, England, UK. METHODS: Secondary analyses were conducted on pre-existing data based on patients’ first admission for primary rehabilitation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge. RESULTS: Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups. CONCLUSIONS: Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation.


title: Unleashing the mysterious link between COVID-19 and a famous childhood vasculitis: Kawasaki disease

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged as a small outbreak in Wuhan rapidly progressing into the deadliest pandemic since the Spanish flu of 1918. The disease was deemed trivial in children, until the reporting, few days ago, of an emerging pediatric multi-inflammatory syndrome mimicking Kawasaki disease (KD). MAIN BODY: This report reveals that coronaviridae were implicated in induction of several post-infectious vasculitides, namely, KD, AHEI, and HSP. This occurs in genetically susceptible individuals to vascular inflammation. Shared genetic susceptibilities between KD and CoV include genes encoding for CD 40, HLAB-15:03, and ACE. This leads to augmented inflammation with hypersecretion of cytokines especially IL-6. CONCLUSION: The revealed relationships between KD and CoV can help to predict the risk of KD in COVID-19 patients through screening levels of upregulated cytokines. It might also signify that classic treatment of KD with IVIG might need to be replaced with anti-cytokine therapy in COVID-19 patients.


title: Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

text: The objective of this study was to assess the predictive value of a lung ultrasound (LUS) score in the development of moderate–severe bronchopulmonary dysplasia (sBPD). This was a prospective observational diagnostic accuracy study in a third-level neonatal intensive care unit. Preterm infants with a gestational age below 32 weeks were included. A LUS score (range 0–24 points) was calculated by assessing aeration semiquantitatively (0–3 points) in eight lung zones on the 7th day of life (DOL) and repeated on the 28th DOL. ROC curves and logistic regression were used for analysis. Forty-two preterm infants were included. The LUS on the 7th DOL had an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI: 0.87–1) for the prediction of sBPD (optimal cutoff of ≥8 points: sensitivity 93%, specificity 91%). The LUS score was independently associated with sBPD [OR 2.1 (95% CI: 1.1–3.9), p = 0.022, for each additional point in the score]. Conclusions: Lung aeration as assessed by LUS on the 7th DOL may predict the development of sBPD.


Rheumatic disease management in the Campania region of Italy during the COVID-19 pandemic


title: Containing the Anxieties of Children, Parents and Families from a Distance During the Coronavirus Pandemic

text: The coronavirus pandemic and the move to teletherapy has created uncertainty among both clinicians and patients. As therapists who work with children, we have heard from parents who are desperate for support and advice about how to respond to their children’s behavioral changes, as well as those who feel too overwhelmed to continue their children’s sessions at the moment and want to take a break from treatment. We have had to rethink the frame in concrete ways, reimagine how to play, and renegotiate parameters around confidentiality. At a time when fear and uncertainty make mentalizing difficult, the hallmarks of a mentalizing approach—curiosity and flexibility—are most critical. This paper will describe how the Mentalization-Based Treatment for Children (MBT-C) model offers a framework for an integrative approach that can inform treatment via teletherapy, so that clinicians can continue supporting young people and their families through this period. We will begin by describing how the mentalizing stance, particularly an awareness of our own mentalizing capacities in the moment, has become more important than ever. Ways in which clinicians maintain their mentalizing in the face of the mentalizing breakdowns will be also discussed. Finally, we illustrate with clinical vignettes how the developmental levels of mentalizing—attention control, emotion regulation, and explicit mentalizing—can inform the structure, techniques and interventions in teletherapy with children and parents.


From economic crisis to the COVID-19 pandemic crisis: evidence from a mental health helpline in Greece


title: The Role of the Patient-Centered Medical Home in Treating Depression

text: PURPOSE OF REVIEW: This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. RECENT FINDINGS: Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. SUMMARY: The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.


title: Fight Against COVID-19: ARCI’s Technologies for Disinfection

text: COVID-19 (SARS-CoV-2) is causing a huge concern to the global population due to its highly contagious properties. The SARS-CoV-2 is a new variant in the coronavirus family. The world is focussing on several methods to battle against this novel corona virus, including control of its spread. In this context, ARCI has quickly made efforts to develop disinfection systems including a UVC-based disinfection trolley, honeycomb air heater and a fogging chamber using UVC germicidal lamps, dry heat sterilization and HOCl-based chemical disinfectant to provide rapid and effective inactivation of microorganisms causing the pandemic. These systems have been successfully deployed at different hospitals for their validation.


Hydroxychloroquine and Potential Drug Interactions in Older Adults


Commentary: Are Thoracic Surgery Program Websites A Charming Vitrine to Attract?


Pneumomédiastin spontané : une complication rare du COVID-19 ?


El cierre de Acta Pediátrica Española. La publicación pediátrica en España en peligro de extinción


Évacuation sanitaire et déploiement d’un hôpital militaire durant la crise COVID : le biomédical également sollicité


Commentary: Managing Thoracic Aortic Emergencies During A Pandemic


Commentary: Eliminating cervical anastomotic leak after esophagectomy: To supercharge or not to supercharge that’s the question.


title: Human Population and the Environment

text: One of the burning issues of the present world is the explosion of human population due to which shortage of resources in terms of food, space, employment and other basic needs has cropped up. The chapter discusses a comprehensive population policy, which is based not on the traditional foundation of family planning, but on the pillars of women’s access to education, health care, economic and political decisions. To solve the acute unemployment problem, a non-conventional alternative livelihood has also been presented as annexure to the chapter.


title: Herpes Zoster Co-Infection in an Immunocompetent Patient With COVID-19

text: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a broad spectrum of manifestations. A variety of dermatological manifestations were described. We present a case of an immunocompetent middle-aged man who presented with novel coronavirus disease 2019 (COVID-19) and later developed herpes zoster (HZ). The case highlights the possibility of COVID-19-related HZ. The highest infection control measures must be abided when managing patients with cutaneous complaints until COVID-19 is ruled out.


title: COVID-19 Trends and Forecast in the Eastern Mediterranean Region With a Particular Focus on Pakistan

text: First reported in China, the coronavirus responsible for coronavirus disease 2019 (COVID-19) has spread to 213 countries and territories around the world as of April 26, 2020. This study was designed to explore COVID-19 trends in the Eastern Mediterranean Region (EMR), with a particular focus on Pakistan. Daily reports and updates from the Ministry of National Health Services Regulations and Coordination COVID-19 Pakistan and the European Centre for Disease Prevention and Control were collected and study-specific data were extracted and analyzed. Our analysis revealed that, as of April 26, 2020, a total of 22 countries and territories in the EMR have reported COVID-19 cases. Iran had the highest number of cases (89,329) followed by Saudi Arabia (16,299), Pakistan (12,723), and the United Arab Emirates (9,813). Egypt (7.1%), Iran (6.3%), and Iraq (4.9%) had high case fatality rates; Lebanon (3.4%) and Pakistan (2.1%) had moderate case fatality rates; Saudi Arabia and the United Arab Emirates had low case fatality rates of 0.8% and 0.7%, respectively. Iran (76.3%) and Iraq (69.4 %) had the highest recovery rate followed by Pakistan (22.5%), the United Arab Emirates (19.2%), and Saudi Arabia (13.6%). If the current trend continues, based on the susceptible, infected, recovered (SIR) epidemiological model, we predict that EMR countries might experience a surge in the number of COVID-19 cases, resulting in as many as 2.12 million cases in Iran, 0.58 million in Saudi Arabia, and 0.51 million in Pakistan by June 20, 2020. Pakistan is the most populated country in the EMR and was the third most-affected country in terms of the number of cases with moderate case fatality and recovery rates. We predict that Pakistan’s weak healthcare system would not be able to sustain care if there is an explosive increase in the number of cases due to insufficient and inconsistent disease prevention and control policies. The best strategy for mitigating the COVID-19 pandemic is to strictly follow recommendations based on epidemiological principles.


title: Coronavirus Disease 2019 (COVID-19)-Associated Thromboembolic Disease: A Report of Three Patients With Pulmonary Embolism

text: Coagulopathy and thromboembolic disease, including pulmonary embolism (PE), are reported complications of coronavirus disease 2019 (COVID-19). The mechanism is not fully understood. We present three patients with COVID-19 and concurrent PE.


title: Effect of T-Piece Resuscitator versus Self Inflating Bag on Arterial CO(2) Levels in Preterm Neonates

text: OBJECTIVE: To compare the effect of self-inflating bag (SIB) vs. T-piece resuscitator (TPR) on PaCO(2) levels, when used for brief manual ventilation during administration of first dose of surfactant. METHODS: Preterm neonates were randomized to receive positive pressure ventilation with either self-inflating bag or T-piece resuscitator during administration of first dose of surfactant. Arterial blood gases were obtained at baseline and 1 h after the intervention. Primary outcome was the mean change in PaCO(2) levels 1 h after the intervention. RESULTS: Eighty neonates were enrolled (40 in each group). The drop in PaCO(2) at 1 h was significantly greater in the self inflating bag group as compared to the T-piece resuscitator group [8.96 ± 9.06 mmHg vs. 1.37 ± 9.06 mmHg, Mean difference = 7.58 mmHg, (95% CI: 3.78 to 11.4); P < 0.01]. The PaCO(2) change was also statistically significant in the subgroup of infants that required only non-invasive ventilation. The need for second dose of surfactant was higher in the self-inflating bag group [77% vs. 55%, RR - 1.41 (95% CI: 1.02 to 1.94); P = 0.03]. CONCLUSIONS: T-piece resuscitator results in smaller reduction in PaCO(2) levels compared to the self inflating bag, when used for brief manual ventilation during surfactant administration.


title: Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response

text: BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems’ decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.


title: Through thick and thin: Russia, China and the future of Eurasian International Society

text: Recent years have seen Moscow and Beijing driven closer together as their respective relations with Washington have deteriorated. While a normative convergence between Russia and China appears to be underway, there remains a legacy of historical mistrust in addition to potential irritants that could plague their bilateral relationship. Nonetheless, if Western sanctions against Russia and pressure on China continue unabated, they may have little option but to continue their rapprochement. Against this backdrop, this article will explore whether the two countries currently display a ‘thin’ or ‘thick’ bilateral relationship, making use of an English School theoretical framework. It will do so by exploring established English School concepts such as pluralism and solidarism and discussing notable literature within the School on contestation in order to derive conclusions regarding the potential future shape of international order in Eurasia.


title: Searching for the HERO in Youth: Does Psychological Capital (PsyCap) Predict Mental Health Symptoms and Subjective Wellbeing in Australian School-Aged Children and Adolescents?

text: Psychological capital (PsyCap) comprising the positive psychological resources of hope, efficacy, resilience, and optimism (HERO) has strong empirical associations with increased wellbeing and reduced mental health symptoms in adult samples. Emerging studies of PsyCap among school-age students have also shown preliminary, positive associations between PsyCap and student wellbeing. The present study is the first to examine PsyCap-HERO constructs and associations with both mental health symptoms and subjective wellbeing in school-aged children and adolescents (aged 9–14 years). A convenience sample of Australian school students (N = 456, Mage = 11.54, SD = 1.20, 47% female) completed an online survey during class time. Measures of hope, efficacy, resilience, optimism, flourishing, anxiety, and depression previously well-validated in school samples were used. Significant associations between each HERO construct and flourishing, anxiety and depression symptoms in the expected direction were found, and importantly, the combination of HERO constructs was shown to be a stronger predictor of increased levels of student flourishing, and decreased levels of anxiety and depression symptoms, than individual HERO constructs. Findings indicate that student PsyCap may be a promising area of further investigation for schools, policymakers, clinicians and researchers looking to identify positive psychological resources in youth that may buffer poor mental health and promote wellbeing.


title: Is it financially beneficial for hospitals to prevent nosocomial infections?

text: BACKGROUND: Financial incentives represent a potential mechanism to encourage infection prevention by hospitals. In order to characterize the place of financial incentives, we investigated resource utilization and cost associated with hospital-acquired infections (HAI) and assessed the relative financial burden for hospital and insurer according to reimbursement policies. METHODS: We conducted a prospective matched case-control study over 18 months in a tertiary university medical center. Patients with central-line associated blood-stream infections (CLABSI), Clostridium difficile infection (CDI) or surgical site infections (SSI) were each matched to three control patients. Resource utilization, costs and reimbursement (per diem for CLABSI and CDI, diagnosis related group (DRG) reimbursement for SSI) were compared between patients and controls, from both the hospital and insurer perspective. RESULTS: HAIs were associated with increased resource consumption (more blood tests, imaging, antibiotic days, hospital days etc.). Direct costs were higher for cases vs. controls (CLABSI: $6400 vs. $2376 (p < 0.001), CDI: $1357 vs $733 (p = 0.047) and SSI: $6761 vs. $5860 (p < 0.001)). However as admissions were longer following CLABSI and CDI, costs per-day were non-significantly different (USD/day, cases vs. controls: CLABSI, 601 vs. 719, (p = 0.63); CDI, 101 vs. 93 (p = 0.5)). For CLABSI and CDI, reimbursement was per-diem and thus the financial burden ($14,608 and $5430 respectively) rested on the insurer, not the hospital. For SSI, as reimbursement was per procedure, costs rested primarily on the hospital rather than the insurer. CONCLUSION: Nosocomial infections are associated with both increased resource utilization and increased length of stay. Reimbursement strategy (per diem vs DRG) is the principal parameter affecting financial incentives to prevent hospital acquired infections and depends on the payer perspective. In the Israeli health care system, financial incentives are unlikely to represent a significant consideration in the prevention of CLABSI and CDI.


title: Automated detection and quantification of COVID-19 pneumonia: CT imaging analysis by a deep learning-based software

text: BACKGROUND: The novel coronavirus disease 2019 (COVID-19) is an emerging worldwide threat to public health. While chest computed tomography (CT) plays an indispensable role in its diagnosis, the quantification and localization of lesions cannot be accurately assessed manually. We employed deep learning-based software to aid in detection, localization and quantification of COVID-19 pneumonia. METHODS: A total of 2460 RT-PCR tested SARS-CoV-2-positive patients (1250 men and 1210 women; mean age, 57.7 ± 14.0 years (age range, 11–93 years) were retrospectively identified from Huoshenshan Hospital in Wuhan from February 11 to March 16, 2020. Basic clinical characteristics were reviewed. The uAI Intelligent Assistant Analysis System was used to assess the CT scans. RESULTS: CT scans of 2215 patients (90%) showed multiple lesions of which 36 (1%) and 50 patients (2%) had left and right lung infections, respectively (> 50% of each affected lung’s volume), while 27 (1%) had total lung infection (> 50% of the total volume of both lungs). Overall, 298 (12%), 778 (32%) and 1300 (53%) patients exhibited pure ground glass opacities (GGOs), GGOs with sub-solid lesions and GGOs with both sub-solid and solid lesions, respectively. Moreover, 2305 (94%) and 71 (3%) patients presented primarily with GGOs and sub-solid lesions, respectively. Elderly patients (≥ 60 years) were more likely to exhibit sub-solid lesions. The generalized linear mixed model showed that the dorsal segment of the right lower lobe was the favoured site of COVID-19 pneumonia. CONCLUSION: Chest CT combined with analysis by the uAI Intelligent Assistant Analysis System can accurately evaluate pneumonia in COVID-19 patients.


title: Comparison between volume-controlled ventilation and pressure-controlled volume-guaranteed ventilation in postoperative lung atelectasis using lung ultrasound following upper abdominal laparotomies: a prospective randomized study

text: BACKGROUND: Atelectasis is a common side effect of general anesthesia. Prevention of lung atelectasis, carbon dioxide retention, and chest infection would improve the quality of medical care and decrease hospital stay and costs. The aim of this study was to compare the effects of volume-controlled ventilation (VCV) and pressure-controlled volume-guaranteed ventilation (PCVG) on postoperative lung atelectasis using lung ultrasound (LUS) following upper abdominal laparotomies. RESULTS: Sixty patients (male and female) scheduled for upper abdominal laparotomies. They were randomly allocated into two equal groups: Group A (n = 30): received intraoperative volume-controlled ventilation (VCV) mode and group (n = 30): received intraoperative pressure-controlled ventilation volume-guaranteed (PCV-VG) mode. Arterial blood samples were obtained immediately after extubation, and 30, 120, 240, and 360 min postextubation. Lung ultrasound was done intraoperatively at 30 min from induction, immediate, and 120 and after 360 min postoperatively. There was difference between two groups favoring PCV-VG group but that difference failed to be statically significant regarding arterial partial pressure of oxygen (PaO(2)) and arterial carbon dioxide tension (PaCo(2)) between the two groups in preoperative, immediate postoperative, and 120, 240, and 360 min postoperative. Arterial oxygen saturation (SaO(2)) was significantly lower among patients in the VCV group immediate postextubation compared with patients in group PCV-VG (p value = 0.009*). Although signs of atelectasis were low in group B, 36.7% of the patients showed normal lung ultrasound, 63.3% showed various abnormalities, 46.7% showed the presence of lung pulse (vertical rhythmic movement synchronous with cardiac pulsation through motionless lung), and 46.7% showed B lines (vertical lines indicate abnormal lung aeration), while 30% of the patients showed the absence of A-lines (indicates the absence of lung sliding and abnormal lung aeration). Also, some patients demonstrated more than one sign. However, there was no a significant difference between the two groups both showed atelectasis immediate, 2 h and 6 h postoperatively. CONCLUSION: PCV-VG offered no significant advantage over VCV regarding the occurrence of the postoperative atelectasis. However, we prefer to use PCV-VG as postoperative hypoxia and atelectasis was much less in that mode. Further, large-scale studies are required to confirm these findings and to establish a definite conclusion.


title: Central venous pressure measurement is associated with improved outcomes in septic patients: an analysis of the MIMIC-III database

text: PURPOSE: Measurement of central venous pressure (CVP) can be a useful clinical tool. However, the formal utility of CVP measurement in preventing mortality in septic patients has never been proven. METHODS: The Medical Information Mart for Intensive Care III (MIMIC-III) database was searched to identify septic patients with and without CVP measurements. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between CVP measurement and 28-day mortality, and propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) were employed to validate our findings. RESULTS: A total of 10,275 patients were included in our study, of which 4516 patients (44%) underwent CVP measurement within 24 h of intensive care unit (ICU) admission. The risk of 28-day mortality was reduced in the CVP group (OR 0.60 (95% CI 0.51–0.70; p < 0.001)). Patients in the CVP group received more fluid on day 1 and had a shorter duration of mechanical ventilation and vasopressor use, and the reduction in serum lactate was greater than that in the no CVP group. The mediating effect of serum lactate reduction was significant for the whole cohort (p = 0.04 for the average causal mediation effect (ACME)) and patients in the CVP group with an initial CVP level below 8 mmHg (p = 0.04 for the ACME). CONCLUSION: CVP measurement was associated with decreased risk-adjusted 28-day mortality among patients with sepsis and was proportionally mediated through serum lactate reduction.


title: Japanese Animals in Calamity

text: This chapter provides a brief background of the empirical research in this volume by describing the position of companion animals in contemporary Japan and the context of the 3.11 earthquake and tsunami. Today, about 34.3% (Cabinet Office Government of Japan 2010) of Japanese households keep some kind of pet. It is evident from the multiple social surveys that a strong attachment to pets has emerged since the mid-1990s. On 11 March 2011, the Tohoku region in Japan was struck by a large earthquake and the tsunami that followed. This was the largest earthquake on record in Japan. The Fukushima No. 1 nuclear power plant was seriously damaged and released radiation which continues to be an ongoing issue for those living in that part of Japan. The serious damage to humans and other animals caused by the tsunami and the radioactive contamination is outlined. The author provides an overview of the study and shows research questions. Then, she reviews the relevant literature, noting that most of the studies are set in a Western context and pointing to the contributions that might be made by considering how one highly developed Asian society has responded to the plight of pet owners following a major disaster. The chapter ends by showing the structure of the book.


title: Avoiding or Co-Opting ATP Inhibition: Overview of Type III, IV, V, and VI Kinase Inhibitors

text: As described in the previous chapter, most kinase inhibitors that have been developed for use in the clinic act by blocking ATP binding; however, there is growing interest in identifying compounds that target kinase activities and functions without interfering with the conserved features of the ATP-binding site. This chapter will highlight alternative approaches that exploit unique kinase structural features that are being targeted to identify more selective and potent inhibitors. The figure below, adapted from (Sammons et al., Molecular Carcinogenesis 58:1551–1570, 2019), provides a graphical description of the various approaches to manipulate kinase activity. In addition to the type I and II inhibitors, type III kinase inhibitors have been identified to target sites adjacent to the ATP-binding site in the catalytic domain. New information on kinase structure and substrate-binding sites has enabled the identification of type IV kinase inhibitor compounds that target regions outside the catalytic domain. The combination of targeting unique allosteric sites outside the catalytic domain with ATP-targeted compounds has yielded a number of novel bivalent type V kinase inhibitors. Finally, emerging interest in the development of irreversible compounds that form selective covalent interactions with key amino acids involved in kinase functions comprise the class of type VI kinase inhibitors.


title: A comprehensive investigation of the mRNA and protein level of ACE2, the putative receptor of SARS-CoV-2, in human tissues and blood cells

text: The outbreak of pneumonia caused by SARS-CoV-2 posed a great threat to global human health, which urgently requires us to understand comprehensively the mechanism of SARS-CoV-2 infection. Angiotensin-converting enzyme 2 (ACE2) was identified as a functional receptor for SARS-CoV-2, distribution of which may indicate the risk of different human organs vulnerable to SARS-CoV-2 infection. Previous studies investigating the distribution of ACE2 mRNA in human tissues only involved a limited size of the samples and a lack of determination for ACE2 protein. Given the heterogeneity among humans, the datasets covering more tissues with a larger size of samples should be analyzed. Indeed, ACE2 is a membrane and secreted protein, while the expression of ACE2 in blood and common blood cells remains unknown. Herein, the proteomic data in HIPED and the antibody-based immunochemistry result in HPA were collected to analyze the distribution of ACE2 protein in human tissues. The bulk RNA-seq profiles from three separate public datasets including HPA tissue Atlas, GTEx, and FANTOM5 CAGE were also obtained to determine the expression of ACE2 in human tissues. Moreover, the abundance of ACE2 in human blood and blood cells was determined by analyzing the data in the PeptideAtlas and the HPA Blood Atlas. We found that the mRNA expression cannot reflect the abundance of ACE2 factor due to the strong differences between mRNA and protein quantities of ACE2 within and across tissues. Our results suggested that ACE2 protein is mainly expressed in the small intestine, kidney, gallbladder, and testis, while the abundance of which in brain-associated tissues and blood common cells is low. HIPED revealed enrichment of ACE2 protein in the placenta and ovary despite a low mRNA level. Further, human secretome shows that the average concentration of ACE2 protein in the plasma of males is higher than those in females. Our research will be beneficial for understanding the transmission routes and sex-based differences in susceptibility of SARS-CoV-2 infection.


title: Ageusia and anosmia, a common sign of COVID-19? A case series from four countries

text: Over the course of the pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), multiple new clinical manifestations, as the consequence of the tropism of the virus, have been recognized. That includes now the neurological manifestations and conditions, such as headache, encephalitis, as well as olfactory and taste disorders. We present a series of ten cases of RT-PCR-confirmed SARS-CoV-2-infected patients diagnosed with viral-associated olfactory and taste loss from four different countries.


title: Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China

text: BACKGROUND: In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. OBJECTIVE: Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. METHODS: This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. RESULTS: All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. CONCLUSIONS: COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.


title: Protecting Frontline Health Care Workers from COVID-19 with Hydroxychloroquine Pre-exposure Prophylaxis: A structured summary of a study protocol for a randomised placebo-controlled multisite trial in Toronto, Canada

text: OBJECTIVES: Primary Objective: To determine if pre-exposure prophylaxis (PrEP) with 400mg hydroxychloroquine (HCQ), taken orally once daily reduces microbiologically confirmed COVID-19 among front line health care workers at high risk for SARS-CoV-2 exposure. Secondary Objectives: To compare the following between study arms: adverse events; symptomatic COVID-19; duration of symptomatic COVID-19; days hospitalized attributed to COVID-19; respiratory failure attributable to COVID-19 requiring i) non-invasive ventilation or ii) intubation/mechanical ventilation; mortality attributed to COVID-19, number of days unable to work attributed to COVID-19, seroconversion (COVID-19 negative to COVID-19 positive over the study period); ability of participant plasma to neutralize SARS-CoV-2 virus in vitro; To describe short-term psychological distress associated with risk of COVID-19 exposure at 1, 60, 120 days of the study. To explore laboratory markers within participants with confirmed COVID-19: including circulating markers of host immune and endothelial activation in participant plasma and their correlation with disease severity and outcome TRIAL DESIGN: The HEROS study is a two-arm, parallel-group, individually randomized (1:1 allocation ratio), placebo controlled, participant and investigator-blinded, multi-site superiority trial of oral HCQ 400 mg taken once daily for 90 days as PrEP to prevent COVID-19 in health care workers at high risk of SARS-CoV-2 exposure. At 90 days, there is an open label extension wherein all participants are offered a one-month course of HCQ 400mg once daily for PrEP of COVID-19. PARTICIPANTS: Frontline HCWs aged 18 years of age or older, at high risk of SARS-CoV-2 exposure (including staff of emergency departments, intensive care units, intubation teams, COVID-wards, and staff deployed to Long Term Care facilities) of five academic hospitals in downtown Toronto, Canada. Exclusion criteria include: currently pregnant, planning to become pregnant during the study period, and/or breast feeding; known hypersensitivity/allergy to hydroxychloroquine or to 4-aminoquinoline compounds; current use of hydroxychloroquine; known prolonged QT syndrome and/or baseline resting ECG with QTc>450 ms and/or concomitant medications which simultaneously may prolong the QTc that cannot be temporarily suspended/replaced; known pre-existing retinopathy, G6PD deficiency, porphyria, liver disease including cirrhosis, encephalopathy, hepatitis or alcoholism, diabetes on oral hypoglycemics or insulin, or renal insufficiency/failure; disclosure of self-administered use of hydroxychloroquine or chloroquine within 12 weeks prior to study; confirmed symptomatic COVID-19 at time of enrollment. INTERVENTION AND COMPARATOR: Intervention: hydroxychloroquine, 400mg (2 tablets) orally per day. Comparator: placebo, two tablets visually identical to the intervention, orally per day MAIN OUTCOMES: The primary outcome is microbiologically confirmed COVID-19 (i.e. SARS-CoV-2 infection). This is a composite endpoint which includes positive results from any validated SARS-CoV-2 diagnostic assay including detection of viral RNA, and/or seroconversion. Participants will be assessed at baseline, and then undergo monthly follow-up at day 30, 60, and 90, 120. At each visit, participants will provide an oropharyngeal sample, blood sample, and will undergo electrocardiogram monitoring of the QTc interval. Secondary outcome measures include: adverse events; symptom duration of COVID-19; days of hospitalization attributed to COVID-19; respiratory failure requiring ventilator support attributed to COVID-19; mortality attributed to COVID-19; total days off work attributed to COVID-19; seropositivity (reactive serology by day 120); and short term psychological impact of exposure to SARS-CoV-2 at day 1, 60, 120 days using the K10, a validated measure of non-specific psychological distress. RANDOMISATION: Within each site, participants will be individually randomized to either the intervention arm with HCQ or the placebo arm using a fixed 1:1 allocation ratio using an interactive web-based response system to ensure concealment of allocation. Randomization schedules will be computer-generated and blocked using variable block sizes. BLINDING (MASKING): All participants, research coordinators, technicians, clinicians and investigators will be blinded to the participant allocation group. Numbers to be randomised (sample size) N=988, randomised into two groups of 494 patients. TRIAL STATUS: This summary describes protocol version No. 1.6, May 15, 2020. Recruitment is ongoing - started April 20, 2020 and anticipated end date is July 30, 2021 TRIAL REGISTRATION: ISRCTN.com Identifier: ISRCTN14326006, registered April 14, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


title: Origin and evolution of emerging Liao ning Virus (genus Seadornavirus, family Reoviridae)

text: BACKGROUND: Liao ning virus (LNV) is a member of the genus Seadornavirus, family Reoviridae and has been isolated from kinds of vectors in Asia and Australia. However, there are no systematic studies describe the molecular genetic evolution and migration of LNVs. With the development of bioinformatics, viral genetic data combining the information of virus isolation time and locations could be integrated to infer the virus evolution and spread in nature. METHODS: Here, a phylogenetic and phylogeographic analysis using Bayesian Markov chain Monte Carlo simulations was conducted on the LNVs isolated from a variety of vectors during 1990–2014 to identify the evolution and migration patterns of LNVs. RESULTS: The results demonstrated that the LNV could be divided into 3 genotypes, of which genotype 1 mainly composed of LNVs isolated from Australia during 1990 to 2014 and the original LNV strain (LNV-NE97–31) isolated from Liaoning province in northern China in 1997, genotype 2 comprised of the isolates all from Xinjiang province in western China and genotype 3 consisted the isolates from Qinghai and Shanxi province of central China. LNVs emerged about 272 years ago and gradually evolved into three lineages in the order genotype 1, genotype 2 and genotype 3. Following phylogeographic analysis, it shows genotype 1 LNVs transmitted from Australia (113°E-153°E,10°S-42°S) to Liaoning province (118°E-125°E,38°N-43°N) in Northeast Asian continent then further spread across the central part of China to western China (75°E-95°E,35°N-50°N). CONCLUSION: LNVs were initially isolated from Liaoning province of China in the Northeast Asia, however, the present study revealed that LNVs were first appeared in Australia in the South Pacific region and transmitted to mainland China then rapidly spread across China and evolved three different genotypes. The above results suggested that LNV had the characteristics of long-distance transmission and there were great genetic diversity existed in the LNV population. Notably, current information of 80 strains of LNVs are limited. It is of great importance to strengthen the surveillance of LNVs to explore its real origin in nature and monitoring of the LNVs’ population variation and maintain vigilance to avoid LNV breaking through the species barrier and further clarify its relationship to human and animal infection.


title: The role of surgeons during the COVID-19 pandemic: impact on training and lessons learned from a surgical resident’s perspective

text: BACKGROUND: Surgeons are trained as “internists that also operate,” bringing an important skillset to patient management during the current COVID-19 pandemic. A review was performed to illustrate the response of surgical staff during the pandemic with regard to patient care and residency training. METHODS: The evaluation and assessment of the changes enacted at Stony Brook Medicine’s Department of Surgery is illustrated through the unique perspective of surgical residents. No IRB approval or written consent was obtained nor it was necessary for the purposes of this paper. RESULTS: Hospital policy was enacted to hinder transmission of COVID-19 and included limited gatherings of people, restricted travel, quarantined symptomatic staff, and careful surveillance for disease incidence. Surgical residency transformed as residents were diverted from traditional surgical services to staff new COVID-19 ICUs. Education transitioned to an online-based platform for lectures and reviews. New skills sets were acquired such as PICC line placement and complex ventilator management. CONCLUSIONS: The viral surge impacted surgical training while also providing unique lessons regarding preparedness and strategic planning for future pandemic and disaster management.


COVID-19-Pandemie: Management kinderchirurgischer Patienten: Stellungnahme der Deutschen Gesellschaft für Kinderchirurgie (DGKCH), der Deutschen Gesellschaft für Kinder- und Jugendmedizin (DGKJ) und der Deutschen Gesellschaft für pädiatrische Infektiologie (DGPI)


title: A mobile DNA laboratory for forensic science adapted to coronavirus SARS-CoV-2 diagnosis

text: The Forensic Science Institute of the French “Gendarmerie Nationale” (IRCGN™) developed in 2015 an ISO 17025 certified mobile DNA laboratory for genetic analyses. This Mobil’DNA laboratory is a fully autonomous and adaptable mobile laboratory to perform genetic analyses in the context of crime scenes, terrorism attacks or disasters. To support the hospital task force in Paris during the peak of the COVID-19 epidemic, we adapted this mobile genetic laboratory to perform high-throughput molecular screening for coronavirus SARS-CoV-2 by real-time PCR. We describe the adaptation of this Mobil’DNA lab to assist in Coronavirus SARS-CoV-2 diagnosis.


title: Patterns of activity rhythms of invasive coypus Myocastor coypus inferred through camera-trapping

text: Studies on activity rhythms are pivotal for the management of invasive alien species, as they provide basic insights into species basic ecology and may increase the success of control programs. The coypu Myocastor coypus, introduced from South America for fur farms, has become one of the most invasive rodents in Europe. Introduced coypus may affect crop productions, as well as natural vegetation and the breeding success of wading birds. In this study, we examined activity data collected through intensive camera-trapping in three Italian areas, including two natural areas in Northern and Central Italy, and a suburban area in Central Italy. Coypus were mostly diurnal in areas characterised by low predator pressure and, at night, they are mostly active in bright moonlight. Conversely, where predators, human pressure or numerical control programmes are present, coypus remarkably shift their behaviour towards crepuscular and night hours. In these last areas, nocturnal activity increased as moonlight decreased, possibly to reduce predation risk or encounters with humans. Where winter temperature are low, diurnal habits may have developed as a physiological adaptation and a strategy to preserve energy, potentially achieving a cost/effective thermal balance. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s42991-020-00052-8) contains supplementary material, which is available to authorized users.


title: Breath Regulation and yogic Exercise An online Therapy for calm and Happiness (BREATH) for frontline hospital and long-term care home staff managing the COVID-19 pandemic: A structured summary of a study protocol for a feasibility study for a randomised controlled trial

text: OBJECTIVES: Objective 1: To determine if it is feasible to conduct an RCT of online Sudarshan Kriya Yoga (SKY) for frontline hospital and long-term care home staff under the constraints imposed by the COVID-19 pandemic and need for remote trial monitoring. Objective 2: To assess whether online versions of SKY and/or Health Enhancement Program (HEP) result in improvement in self-rated measures of insomnia, anxiety, depression, and resilience. TRIAL DESIGN: This is an open-label feasibility randomized controlled trial (RCT), comparing an online breath based yogic intervention SKY versus an online control mind-body intervention HEP in frontline hospital and long-term care home staff managing the COVID-19 pandemic. PARTICIPANTS: Participants will include frontline hospital and long-term care home staff that are involved in the management of COVID-19 patients in London, Ontario, Canada. Participants will be willing and able to attend via online video conferencing software to participate in the study interventions. Participants must have an adequate understanding of English and be able to sit without physical discomfort for 60 minutes. INTERVENTION AND COMPARATOR: Sudarshan Kriya Yoga (SKY): The online version of SKY will be delivered by at least one certified Canadian SKY teacher, with at least one back up teacher at all times, under the supervision of Ms. Ronnie Newman, Director of Research and Health Promotion, Art of Living Foundation, USA. The online version of SKY for healthcare workers has a total duration of 3 hours. Phase I will consist of 5 self-paced online modules of 4-10 minutes each to learn the breath control techniques. Participants will be sent an online survey in REDCap requesting that they self-confirm completion of the Phase I modules. In Phase II, 2 interactive online sessions of 1 hour each will be held on consecutive days with a certified SKY teacher, during which participants will learn the fast, medium and slow breaths. For ease of scheduling, multiple time windows will be offered for Phase II. There will be at least one back up teacher at all times. Both Phase I and II will be completed in the first week. Health Enhancement Program (HEP): The active control arm, HEP, will consist of time-matched online self-paced modules for Phase I. Phase II will consist of mindfulness-based meditation sessions delivered by mental health staff. HEP will be an active treatment program that incorporates mind-body interventions. HEP will consist of time-matched online self-paced modules with psychoeducation on healthy active living as well as interactive modules comprising of guided de-stressing exercises including music therapy, mindfulness and progressive muscle relaxation. Weekly follow up sessions will be offered to all recruited participants for 30 minutes each for the subsequent 4 weeks in both study arms. MAIN OUTCOMES: The following feasibility outcomes will be measured at the end of the study: (1) rate of participant recruitment, (2) rate of retention, (3) completeness of data entry, (4) cost of interventions, and (5) unexpected costs. Such measures will be collected on a daily basis through-out the study and tabulated 5 weeks later at the end of the study. RANDOMISATION: Participants will be randomized after they have electronically signed the consent form and the research staff have confirmed eligibility. We will use REDCap to perform randomization in a 1:1 ratio as well as allocation concealment. REDCap is widely used by health researchers worldwide to significantly reduce data entry and study management errors to improve data fidelity. BLINDING (MASKING): All study participants will be blinded to the study hypotheses so as to prevent any expectation bias. Group allocation will be masked during analysis. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): This study will randomize a total of 60 participants in a 1:1 ratio to either SKY or HEP interventions. TRIAL STATUS: Protocol version number 2.0 (June 5, 2020). Recruitment is currently ongoing (starting June 25, 2020). We anticipate to complete recruitment by June 30, 2021 and complete the study by September 30, 2021. TRIAL REGISTRATION: ClinicalTrials.gov protocol ID NCT04368676 (posted April 30, 2020). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


title: SARS-CoV-2 induces transcriptional signatures in human lung epithelial cells that promote lung fibrosis

text: BACKGROUND: Severe acute respiratory syndrome (SARS)-CoV-2-induced coronavirus disease-2019 (COVID-19) is a pandemic disease that affects > 2.8 million people worldwide, with numbers increasing dramatically daily. However, there is no specific treatment for COVID-19 and much remains unknown about this disease. Angiotensin-converting enzyme (ACE)2 is a cellular receptor of SARS-CoV-2. It is cleaved by type II transmembrane serine protease (TMPRSS)2 and disintegrin and metallopeptidase domain (ADAM)17 to assist viral entry into host cells. Clinically, SARS-CoV-2 infection may result in acute lung injury and lung fibrosis, but the underlying mechanisms of COVID-19 induced lung fibrosis are not fully understood. METHODS: The networks of ACE2 and its interacting molecules were identified using bioinformatic methods. Their gene and protein expressions were measured in human epithelial cells after 24 h SARS-CoV-2 infection, or in existing datasets of lung fibrosis patients. RESULTS: We confirmed the binding of SARS-CoV-2 and ACE2 by bioinformatic analysis. TMPRSS2, ADAM17, tissue inhibitor of metalloproteinase (TIMP)3, angiotensinogen (AGT), transformation growth factor beta (TGFB1), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF) A and fibronectin (FN) were interacted with ACE2, and the mRNA and protein of these molecules were expressed in lung epithelial cells. SARS-CoV-2 infection increased ACE2, TGFB1, CTGF and FN1 mRNA that were drivers of lung fibrosis. These changes were also found in lung tissues from lung fibrosis patients. CONCLUSIONS: Therefore, SARS-CoV-2 binds with ACE2 and activates fibrosis-related genes and processes to induce lung fibrosis.


title: A tertiary center experience of multiple myeloma patients with COVID-19: lessons learned and the path forward

text: BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2 virus, has resulted in over 100,000 deaths in the USA. Our institution has treated over 2000 COVID-19 patients during the pandemic in New York City. The pandemic directly impacted cancer patients and the organization of cancer care. Mount Sinai Hospital has a large and diverse multiple myeloma (MM) population. Herein, we report the characteristics of COVID-19 infection and serological response in MM patients in a large tertiary care institution in New York. METHODS: We performed a retrospective study on a cohort of 58 patients with a plasma-cell disorder (54 MM, 4 smoldering MM) who developed COVID-19 between March 1, 2020, and April 30, 2020. We report epidemiological, clinical, and laboratory characteristics including the persistence of viral detection by polymerase chain reaction (PCR) and anti-SARS-CoV-2 antibody testing, treatments initiated, and outcomes. RESULTS: Of the 58 patients diagnosed with COVID-19, 36 were hospitalized and 22 were managed at home. The median age was 67 years; 52% of patients were male and 63% were non-White. Hypertension (64%), hyperlipidemia (62%), obesity (37%), diabetes mellitus (28%), chronic kidney disease (24%), and lung disease (21%) were the most common comorbidities. In the total cohort, 14 patients (24%) died. Older age (> 70 years), male sex, cardiovascular risk, and patients not in complete remission (CR) or stringent CR were significantly (p < 0.05) associated with hospitalization. Among hospitalized patients, laboratory findings demonstrated elevation of traditional inflammatory markers (CRP, ferritin, D-dimer) and a significant (p < 0.05) association between elevated inflammatory markers, severe hypogammaglobulinemia, non-White race, and mortality. Ninety-six percent (22/23) of patients developed antibodies to SARS-CoV-2 at a median of 32 days after initial diagnosis. The median time to PCR negativity was 43 (range 19–68) days from initial positive PCR. CONCLUSIONS: Drug exposure and MM disease status at the time of contracting COVID-19 had no bearing on mortality. Mounting a severe inflammatory response to SARS-CoV-2 and severe hypogammaglobulinemia was associated with higher mortality. The majority of patients mounted an antibody response to SARS-CoV-2. These findings pave a path to the identification of vulnerable MM patients who need early intervention to improve outcomes in future outbreaks of COVID-19.


Applying the precautionary principle to personal protective equipment (PPE) guidance during the COVID-19 pandemic: did we learn the lessons of SARS?


title: The paediatric global musculoskeletal task force - ‘towards better MSK health for all’

text: There is increasing concern about the emerging global non-communicable diseases (NCDs) burden. The focus has mainly been on NCDs in adults but it is important that MSK morbidity in both children and adults is included in strategic planning. There have been considerable advances in the understanding and treatment options for children and young people (CYP) and clinical outcomes are improving for those who can access such high quality care. However vast inequity exists and there are many CYP who live in areas of the world with high burden of health care challenges, compounded by paucity of specialist care and limited access to treatments. The Paediatric Global Musculoskeletal Task Force aims to raise awareness about unmet needs for CYP with MSK conditions, promotion of MSK health through lifestyle and the avoidance of injury. We aim to leverage change through ‘working together better’.


title: Variability in the systems of care supporting critical neonatal intensive care unit transitions

text: OBJECTIVE: Assess practices supporting care transitions for infants and families in the neonatal intensive care unit (NICU) using a model of four key drivers: communication, teamwork, family integration, and standardization. STUDY DESIGN: Single-day audit among NICUs in the Vermont Oxford Network Critical Transitions collaborative addressing policies and practices supporting the four key drivers during admission, discharge, shift-to-shift handoffs, within hospital transfers, and select changes in clinical status. RESULTS: Among 95 NICUs, the median hospital rate of audited policies in place addressing the four key drivers were 47% (inter-quartile range (IQR) 35–65%) for communication, 67% (IQR 33–83%) for teamwork, 50% (IQR 33–61%) for family integration, and 70% (IQR 56–85%) for standardization. Of the 2462 infants included, 1066 (43%) experienced ≥1 specified transition during the week prior to the audit. CONCLUSIONS: We identified opportunities for improving NICU transitions in areas of communication, teamwork, family integration, and standardization.


title: Combined throat/nasal swab sampling for SARS-CoV-2 is equivalent to nasopharyngeal sampling

text: PURPOSE: PCR on a nasopharyngeal sample is the reference method for the detection of SARS-nCoV-2. However, combined throat/nasal sampling as a testing method has several advantages. We compared the combined throat/nasal sampling with nasopharyngeal sampling for detection of SARS-CoV-2 in healthcare workers suspected of COVID-19. METHODS: In 107 healthcare workers with symptoms of COVID-19, combined throat/nasal sampling and nasopharyngeal sampling was performed. Detection of SARS-CoV-2 was performed by RT-PCR targeting. RESULTS: A total of 80 healthcare workers (74.8%) tested negative with both sampling methods, and 25 healthcare workers (23.4%) tested positive with both sampling methods. There were two discrepant results with positive PCR in combined throat/nasal swabs and negative PCR in nasopharyngeal swabs (1.9%). The κ index for concordance between the 2 sampling methods was high (0.95). The median cycle threshold (Ct) value of PCR on nasopharyngeal samples was significantly lower than the Ct value of PCR on combined throat/nasal samples (19 (IQR 17–20) versus 21 (IQR 18–29) cycles, p value 0.01). CONCLUSION: Combined throat/nasal swabs yield a similar sensitivity to detect SARS-CoV-2 as nasopharyngeal swabs and are a good alternative sampling method, despite a lower Ct value for the nasopharyngeal samples.


title: The Canadian Health Clock and health calculators

text: SETTING: This paper documents a participatory process of Health Portfolio staff in the design of a clock, and announces the 2020 Canadian Health Clock, with links to numerous online health calculators. The clock is part of the Health Portfolio’s celebration activities in 2019 of “100 Years of Health”, as the Department of Health was established in Canada in 1919. INTERVENTION: The intervention was the development of a clock on the Government of Canada website with linkage to calculators as a health promotion tool. The clock was built on the concept of the 2004 Chronic Disease Clock, which shows the number of deaths so far today, and so far this year. The clock was developed using a consultative approach, following a review of the original clock. OUTCOMES: The 2020 clock incorporates new data visualization concepts. New features, facilitated by improved technology, include: expansion to all causes of death; blinking red dots to enhance visual impact; and three clock versions (analogue, featuring a moving circle; digital, table format; and graphical, bar chart format). The clock also provides links to a number of health calculators, to allow people to seek personalized information to improve their health. IMPLICATIONS: The online health clock and health calculators are good examples of innovation in health risk communication tools for effective knowledge translation and dissemination. They inform people about health statistics (clock) and their health (calculators). The clock engages people in the context of the Canadian population, whereas the calculators provide personalized information about improving an individual’s future health.


Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation


Therapieempfehlungen in Pandemiezeiten: Richtig (be‑)handeln unter Handlungsdruck


title: Graph based feature extraction and hybrid classification approach for facial expression recognition

text: In the current trends, face recognition has a remarkable attraction towards favorable and inquiry of an image. Several algorithms are utilized for recognizing the facial expressions, but they lack in the issues like inaccurate recognition of facial expression. To overcome these issues, a Graph-based Feature Extraction and Hybrid Classification Approach (GFE-HCA) is proposed for recognizing the facial expressions. The main motive of this work is to recognize human emotions in an effective manner. Initially, the face image is identified using the Viola–Jones algorithm. Subsequently, the facial parts such as right eye, left eye, nose and mouth are extracted from the detected facial image. The edge-based invariant transform feature is utilized to extract the features from the extracted facial parts. From this edge-based invariant features, the dimensions are optimized using Weighted Visibility Graph which produces the graph-based features. Also, the shape appearance-based features from the facial parts are extracted. From these extracted features, facial expressions are recognized and classified using a Self-Organizing Map based Neural Network Classifier. The performance of this GFE-HCA approach is evaluated and compared with the existing techniques, and the superiority of the proposed approach is proved with its increased recognition rate.