Evaluation of biocidal properties of biodegradable nanofiber filters and their use in face masks.

Due to the recent coronavirus-2019 pandemic, several studies have emerged looking for new materials, especially with biocidal characteristics. Thus, the present research investigates the antibacterial properties of biodegradable cellulose acetate (CA) / cetylpyridinium bromide (CPB) electrospun nanofibers, their aerosol filtration, and the possible use as a filter media of surgical face masks. Then, samples of these nanofibers were produced over a nonwoven substrate, using different volumes of polymeric solution during the electrospinning process. The evaluation of the antibacterial properties of the nanofibers was performed for Escherichia coli and Staphylococcus aureus using quantitative methods. The aerosol filtration performance was evaluated in these samples for NaCl nanoparticles (from 7-300 nm) and with 8 mL min-1 of air flow rate. The results show that the single use of the surfactant has antibacterial properties from a concentration of 39 µg mL-1 of solution. The nanofibers presented a reduction of 100% for both bacteria. Air filtration tests showed 126.03 and 207.73 Pa cm-² of pressure drops and 63 and 77% of aerosol filtration efficiency (FE) for samples with 0.13 and 0.15 mL, respectively. Regarding the nanofiber produced with 0.35 mL, the value obtained was 115.13 ± 33.64 Pa cm-2 and 3.15% of particle penetration. These breathability values are higher than those required for the surgical face mask standard, indicating that improvements in the porosity and thickness are necessary to meet the Brazilian requirements. However, the nanofibers could be applied as filter media for indoor air conditioning systems due to their FE and biocidal properties.

Comparison of Teen Virtual and Hybrid Intensive Outpatient Programs in a Multidisciplinary Mental Health Agency

Objectives: There are limited studies examining the effectiveness of virtual intensive outpatient programs (IOPs). We examined outcome differences on self-reported scales between teens completing a fully virtual IOP at the start of the COVID-19 pandemic and those completing a hybrid program once restrictions were eased. Method(s): A baseline sample of 133 teen patients enrolled in a San Jose community clinic's virtual and hybrid IOP from April 2020 to May 2022 was obtained from our electronic health record. Propensity scores were generated to match patients based on similar characteristics (age, sex, and time in program), and differences in survey scores were analyzed between the 2 groups at week 4 (n = 52) and week 7 (n = 39). Parent scores were also compared (n = 31 and 20, respectively). Result(s): By teen report, there were no significant differences detected by delivery format at 4 or 7 weeks for mood (p =.19,.17), stress (p =.07,.12), sleep (p =.38,.47), appetite (p =.43,.99), safety (p =.21,.14), parent interaction (p =.44,.46), peer interaction (p =.96,.89), or school (p =.51,.80). There were no significant differences for parent report at the same time periods: mood (p =.83,.35), stress (p =.81,.62), sleep (p =.97,.86), appetite (p =.45,.77), safety (p =.90,.58), parent interaction (p =.44,.39), peer interaction (p =.94,.50), or school (p =.66,.97). Teens did report significant positive changes in mood (p =.01) and sleep (p =.5) in the hybrid program, school (p =.03) in the virtual program at 4 weeks, and in mood (p =.01) at 7 weeks in the hybrid program. Parents reported significant changes in mood in both the virtual (p =.04) and hybrid (p =.01) programs at 7 weeks. Conclusion(s): According to our data, no significant overall differences in improvement were seen between either mode of delivery. Given that both modes of delivery showed significant positive changes in mood at 4 and 7 weeks by both parent and teen self-reports, it seems that IOP treatment was helpful irrespective of the mode of delivery. Future studies comparing a hybrid model to an in-person program will help clarify the significance that the mode of delivery of treatment in an IOP setting has on self-reported improvement ratings. Additionally, it would be prudent to look at dropout rates in different settings. ADOL, TVM, DTT Copyright © 2022

Urgency and Imminence The Politics of the Very Near Future

From pre-emptive military strikes, humanitarian campaigns and precarious financial bubbles, to the climate change emergency and public health measures undertaken in response to COVID-19, we live in an era increasingly marked by discourses of imminence that bring a future close while also leaving it hard to imagine or inhabit. Claims of urgency – ‘act now before it is too late!' – conduct the affective charge of these sometimes abject and often partially unimaginable futures. Yet urgency is rarely self-evident, but a claim in which the distribution of rights and resources, and particular forms of knowledge and expertise, are at stake. Which social actors are most invested in urgency and why? What possibilities does formatting a situation as ‘urgent' foreclose and what questions does it make impossible to ask? What happens to claims of urgency when they become protracted and routinised? Alterna-tively, under what conditions might claims of urgency presage new openings?. © The Author(s).

LivR Well, a 28-day, community-based liver optimization program for patients with acute-on-chronic liver failure: A feasibility study

Background and Aim: Acute-on-chronic liver failure (ACLF) is a global health care challenge, with a 28-day mortality rate of 33.9% and 30-day readmission rate of 37%.1,2 Management of ACLF is often complicated by multiorgan involvement, need for intensive care support, sarcopenia/frailty, and lack of universally accepted diagnostic criteria.3,4 Health care resource utilization is high. Our aims were to assess the safety, efficacy, acceptability, and cost of LivR Well, a new model of intensive, multidisciplinary ambulatory care for patients with ACLF. Method(s): We conducted a prospective, single-arm, mixed-methods study at Monash Health, a large Victorian tertiary network. Adult patients were enrolled from the inpatient ward, emergency department, or outpatient clinic in the first 28 days after a formal diagnosis of ACLF. ACLF was defined using Asian Pacific Association for the Study of the Liver criteria (an acute hepatic insult manifesting as jaundice and coagulopathy, complicated by ascites and/or encephalopathy within 4 weeks).5 Study criteria and the LivR Well intervention are shown in Figure 1. Patients were admitted to hospital in the home and received nursing visits up to 3 times a week and a weekly clinic medical review. Patients accessed physiotherapy, pharmacy, dietetics, social work, addiction medicine, and neuropsychiatry if appropriate. Blood test results were monitored weekly, and patients were followed up for 12 weeks. Health-related quality of life (HRQoL) was measured using EQ-5D and the Chronic Liver Disease Questionnaire (CLDQ) at baseline and Week 6. A qualitative substudy was undertaken to assess acceptability, with interviews performed between Weeks 6 and 12. The primary outcome was safety. Secondary outcomes were readmission, liver disease severity, HRQoL, symptom burden (CLDQ), acceptability, and health care resource utilization. Result(s): Fifty-nine patients (median age, 51 years [IQR, 45-59];66% male) were enrolled between March 2021 and April 2022. Forty-four patients completed the 28-day program, with two deaths (at Days 16 and 27), one drop-out due to COVID-19 requiring isolation, eight patients discharged due to failure to attend, and four patients who remain active in the program. There were no reported adverse events. Alcohol misuse was the most frequent liver disease etiology (73%). There was a significant reduction in median Model for End-Stage Liver Disease-Sodium (MELDNa) score from 16 at baseline (IQR, 12-21) to 15 at Day 28 (IQR, 11-18;P < 0.001). Sarcopenia prevalence decreased from baseline to Day 28 but did not reach statistical significance (27% vs 19%, P = 0.48). HRQoL significantly improved from a median baseline CLDQ score of 4.34 (IQR, 3.37-5.08) to 4.75 (IQR, 3.97-5.81;P = 0.02), with specific improvement in the domains of activity (P = 0.04), fatigue (P = 0.02), and worry (P = 0.001). The qualitative study highlighted universal themes of high acceptability, improved health literacy/insight, and increased autonomy. The median self-reported health perception using a visual analog scale significantly improved from 64% (IQR, 42-77%) to 72% (IQR, 50-80%;P = 0.05). The 28-day mortality rate was 3%, and the 30-day readmission rate was 14%. The median LivRWell program cost was A$4947. The total 6-month median direct health care cost for each LivR Well patient improved from a median of A$30 913 before LivR Well (IQR, $11 201-$61 464) to $784 after LivR Well (IQR, $0-$18 117;P < 0.001). The total direct health care cost for this cohort was reduced by 71%, from $1.16 million before to $335 000 after LivR Well, largely driven by a 40% reduction in 30-day readmission. Conclusion(s): LivR Well is a world-first multidisciplinary ambulatory care program for patients with ACLF. Our feasibility study supported the safety, potential efficacy, and cost-effectiveness of such an intervention, with lower than expected 30-admission, 28-day mortality, and total health care cost for this complex cohort. There was a small, but significant improvement in MELD-Na score, HRQoL, and self-rep rted health perception. We are further evaluating the clinical and economic impact of LivR Well as part of a randomized controlled trial comparing it with standard ambulatory care.

Applying Principles and Methods of Risk Analysis: A Case Example of Northern Spotted Owl Research in a Dynamic Pandemic Landscape

This report presents considerations of potential hazards and mitigation measures associated with conducting field research in the context of a pathogenic epidemic or pandemic situation. We use an example of a specific risk assessment developed for advising decisions on initiating or continuing field activities (in this case, mark-resight and passive acoustic monitoring) associated with ongoing research of northern spotted owls (Strix occidentalis caurina) in the Pacific Northwest region of the United States under conditions imposed by the COVID-19 (severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) global pandemic. We review the structure of a risk assessment procedure that follows USDA Forest Service policy in general and has specifically been applied to owl research during the current pandemic. The risk assessment framework we used included listing job objectives, job tasks, and potential hazards associated with each task. For each task, we evaluated the severity of the hazard (negligible, moderate, critical, or catastrophic) and the probability of a mishap if the hazard was present (rare, unlikely, possible, likely, or almost certain) and assigned a risk assessment code that identified risks as low, moderate, high, or extremely high. We then described mitigation and abatement measures that we posited would reduce the risk severity or probability, and then scored the residual (decreased) severity, probability, and risk level. We briefly review other potential considerations for a job hazard risk assessment under conditions of pathogenic outbreaks, including considerations for additional costs and administrative duties, working in proximity and unexpected encounters in field situations, and changes in behavior of wildlife. © 2020, USDA Forest Service. All rights reserved.

THE COVID-19 PANDEMIC IN THE UNITED KINGDOM: A tale of convergence and divergence

This chapter examines the response of the United Kingdom (UK) to the Covid-19 pandemic during the first wave of infections from January to October 2020. In Western Europe, the UK was one of the worst affected countries during the first wave of the pandemic, registering more than 46, 000 deaths by the end of October 2020. Taking into account the UK’s devolved constitutional framework, this chapter highlights the territorial dynamics in play during the first wave of the pandemic. It traces the evolution of the UK response, from a coordinated effort between all four governments in England, Scotland, Wales, and Northern Ireland to curtail the spread of the virus at the beginning of the pandemic, to a disjointed approach in relation to lifting restrictions in early summer 2020. The findings demonstrate how the pandemic raised the profile of devolution more than any other event since the establishment of the devolved legislatures in the late 1990s. They point also to a limp federal spirit, particularly in the context of collaboration at both national and local levels, and consider the ramifications of the pandemic and perception of government responses for the future terrain of territorial politics in the UK. © 2022 selection and editorial matter, Nico Steytler.

BioAutoML: automated feature engineering and metalearning to predict noncoding RNAs in bacteria.

Recent technological advances have led to an exponential expansion of biological sequence data and extraction of meaningful information through Machine Learning (ML) algorithms. This knowledge has improved the understanding of mechanisms related to several fatal diseases, e.g. Cancer and coronavirus disease 2019, helping to develop innovative solutions, such as CRISPR-based gene editing, coronavirus vaccine and precision medicine. These advances benefit our society and economy, directly impacting people's lives in various areas, such as health care, drug discovery, forensic analysis and food processing. Nevertheless, ML-based approaches to biological data require representative, quantitative and informative features. Many ML algorithms can handle only numerical data, and therefore sequences need to be translated into a numerical feature vector. This process, known as feature extraction, is a fundamental step for developing high-quality ML-based models in bioinformatics, by allowing the feature engineering stage, with design and selection of suitable features. Feature engineering, ML algorithm selection and hyperparameter tuning are often manual and time-consuming processes, requiring extensive domain knowledge. To deal with this problem, we present a new package: BioAutoML. BioAutoML automatically runs an end-to-end ML pipeline, extracting numerical and informative features from biological sequence databases, using the MathFeature package, and automating the feature selection, ML algorithm(s) recommendation and tuning of the selected algorithm(s) hyperparameters, using Automated ML (AutoML). BioAutoML has two components, divided into four modules: (1) automated feature engineering (feature extraction and selection modules) and (2) Metalearning (algorithm recommendation and hyper-parameter tuning modules). We experimentally evaluate BioAutoML in two different scenarios: (i) prediction of the three main classes of noncoding RNAs (ncRNAs) and (ii) prediction of the eight categories of ncRNAs in bacteria, including housekeeping and regulatory types. To assess BioAutoML predictive performance, it is experimentally compared with two other AutoML tools (RECIPE and TPOT). According to the experimental results, BioAutoML can accelerate new studies, reducing the cost of feature engineering processing and either keeping or improving predictive performance. BioAutoML is freely available at https://github.com/Bonidia/BioAutoML.

Debt management capacity: A tale of three Asias

Over the last 2 decades, many Asian countries have sought to build their capacity to manage public debt and develop their domestic debt markets. This has contributed to greater resilience to shocks and some have been well placed to weather the coronavirus disease (COVID-19) crisis. But given the diversity of countries in developing Asia - ranging from governments that rely on official external sources of finance to countries that borrow entirely in domestic markets - the picture is mixed, and strengthening of institutions and markets is required in most. Also, public debt managers can take advantage of new opportunities for borrowing and to manage fiscal risks more effectively. We discuss four in this chapter: (i) environmental, social, and governance investing;(ii) sovereign asset-liability management;(iii) management of explicit contingent liabilities;and (iv) transferring risks arising from commodity prices and natural disasters to markets. © Asian Development Bank 2022.

Early evaluation of a re-designed MB CHB paediatric course using practice assessments

Background A redesigned MB ChB Medicine course at the University of Bristol had its first intake of students in 2017 and its first paediatric placement in 2020. An identical paediatric Practice Objective Structured Clinical Exam (pOSCE) was included in the 2020-2021 redesigned paediatric course as was previously in the 2019-2020 course. This provided us with an opportunity to assess any difference in outcome of the new Case Based Learning course. Objectives We evaluated whether the new redesigned, shorter (6-week versus 9-week) Case Based Learning paediatric course altered student performance in this identical pOSCE. Methods We evaluated the pOSCE marks of year 4 MB ChB students at the end of their paediatric courses, following initial successful pilot of the formative assessment. The two pOSCE stations (A and B) were identical in 2019-2020 and 2020- 2021 and each student's performance was examined using the same University structured mark scheme. The teaching fellow examiners were different in 2020-2021 and were blinded to the 2019-2020 student marks. We compared student marks of 2020-2021 to 2019-2020. Results One pOSCE took place in 2019-2020, due to Covid interruption, assessing 33 students. To date, 61 students have sat the pOSCE in the 2020-2021 cohort. After incomplete mark sheets were excluded, our evaluation compared 27 pOSCE mark sheets from 2019-2020 with 49 from 2020- 2021. The mean scores are outlined in the table 1 below. Conclusions Our evaluation provided evidence that students' paediatric clinical performance was similar from both courses. Whilst this is reassuring, perhaps one aim of a redesigned course would be increased clinical performance. Maintained performance despite the shortened course may have been due to the introduction of regular bedside teaching on the 2020 course. Limitations of our study included OSCE limitations and small sample size. Keeping practice assessments unchanged when introducing new courses can facilitate early course evaluation. Shorter courses may not reduce clinical performance when well designed.

Failure of pre-exposure prophylaxis with daily tenofovir/emtricitabine and the scenario of delayed HIV seroconversion

Failure of pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine may occur despite perfect adherence, although this is uncommon. Failure results in breakthrough HIV infection. Delayed seroconversion associated with antiretroviral use may complicate the picture, causing uncertainties in interpreting adherence patterns for establishing the true cause of PrEP failure.

Impact of COVID-19 Confinement on Alcohol Purchases in Great Britain: Controlled Interrupted Time-Series Analysis During the First Half of 2020 Compared With 2015-2018

AIMS: To investigate if COVID-19 confinement led to excess alcohol purchases by British households. METHODS: We undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 26 March 2020, using purchase data from Kantar Worldpanel's of 23,833 British households during January to early July 2020, compared with 53,428 British households for the same time period during 2015-2018. RESULTS: Excess purchases due to confinement during 2020 were 178 g of alcohol per 100 households per day (adjusted for numbers of adults in each household) above an expected base of 438 g based on averaged 2015-2018 data, representing a 40.6% increase. However, when adjusting for expected normal purchases from on-licenced premises (i.e. bars, restaurants, etc.), there was evidence for no excess purchases of grams of alcohol (a 0.7% increase). With these adjustments, beer purchases dropped by 40%, wine purchases increased by 15% and spirits purchases by 22%. Excess purchases increased the richer the household and the lower the age of the main shopper. Confinement was associated with a shift in purchases from lower to higher strength beers. CONCLUSION: During the COVID-19 confinement, the evidence suggests that households did not buy more alcohol for the expected time of the year, when adjusting for what they normally would have purchased from on-licenced premises.

Using telehealth to support expectant and breastfeeding momsduring the COVID-19 pandemic

Program Goals: Since the COVID-19 pandemic began in March 2020, an increased number of healthy, full-termnewborns are being discharged 24 hours after delivery. No study has demonstrated the presence of SARS-CoV-2 in breast milk, so breastfeeding promotion and education are still of the utmost importance. Withshelter-at-home recommendations in place, mothers face challenges with finding lactation guidance.Telehealth allows this gap to be filled by providing breastfeeding support virtually when in-person contact islimited. Telehealth breastfeeding support initiatives were piloted for expectant and new mothers (andfamilies). The objective is to provide breastfeeding education by establishing interactive, support groupsfacilitated by lactation professionals using telehealth services. Evaluation: Two models were established basedon experiences with the prior in-person sessions, as well as those of local and national colleagues. Model A:Small group teaching Several 1-hour IBCLC-led sessions (one in Spanish) were offered weekly online on aHIPAA-compliant videoconferencing platform through a consistent link. A toll-free number was provided if no internet access was available. English and Spanish flyers with link, instructions for joining, and email to answertechnology questions were distributed to 150+ partners electronically. Each session was structured aroundopportunity for individualized questions on video chat or chatbox, with additional resources provided onslides. A separate team member managed technology, slides, attendance and the chatbox, which freed theIBCLC to serve solely as subject matter expert. Challenges addressed are listed in Table. This model'sattendance was initially limited but increased each week with additional promotional efforts. Ultimately 29expectant and breastfeeding mothers joined across 10 sessions, including several repeaters. Mothers foundthe sessions helpful and informative, and offered to spread the word. Model B: Traditional didactic teaching A1-hour webinar, led by IBCLCs (including Spanish), was offered weekly with unique themes on a differentHIPAA-compliant videoconferencing platform. The weekly theme was sent to a listerv with a registration linkfor attendance tracking and for distribution of the attendee link to address security concerns. A formal slidepresentation (45 minutes) was given, followed by Q+A (15 minutes) via chatbox. Presentation slides and videorecording were sent to registrants with an access code for security. This model had consistently highattendance -- 110 mothers across 4 sessions, including several repeaters. Each session had a different theme,which allowed for women to select a session specific to their needs. Discussion: Establishing virtual lactationsupport groups is realistic and important. Our 5-week pilot initiative successfully created telelactation sessionsfacilitated by IBCLCs and CLCs. Notable challenges faced in transitioning to a virtual support environment were able to be quickly met, resulting in increased attendance and engagement. Using telehealth servicesallowed vital accessibility to essential breastfeeding support for mothers during this public health crisis.

Long-term intraperitoneal catheters: A novel ambulatory care intervention for the management of refractory cirrhotic ascites during COVID-19

Background and Aim: The coronavirus disease 2019 (COVID-19) pandemic has created challenges in how health care systems provide care for patients with refractory cirrhotic ascites. We aimed to investigate the safety and efficacy of a novel ambulatory care program developed with Hospital in the Home (HITH) to allow frequent low-volume ascitic drainage through a long-term, tunneled, intraperitoneal catheter (IPC;Rocket Medical) in patients with advanced cirrhosis. Methods: We conducted a prospective cohort study at a Victorian tertiary health care service from April to July 2020. Adult patients with refractory cirrhotic ascites requiring large-volume abdominal paracentesis twice in the past 8 weeks were recruited. We excluded patients otherwise eligible for transjugular intrahepatic portosystemic shunt (TIPS) insertion or liver transplantation and those with Child-Pugh C disease, prior spontaneous bacterial peritonitis, active infection, loculated ascites, or hepatic hydrothorax. All IPCs were inserted by an interventional radiologist and managed for 12 weeks by HITH in lieu of recurrent hospital admission for large-volume paracentesis. The drainage schedule was individualized, with 1-6 L drained by HITH nurses over 1-3 sessions per week, without human albumin infusions. All patients received antibiotic prophylaxis (norfloxacin 400 mg daily or trimethoprim-sulfamethoxazole 160-800 mg daily). The primary endpoint was safety (death related to IPC, rates of bleeding, peritonitis, and cellulitis), with secondary endpoints including symptom burden, IPC attrition rates, and quality of life (EuroQol 5 dimensions). Results: Five patients (median age, 60 years;IQR, 53-74;four male) underwent insertion of an IPC. All had Child-Pugh B disease, with a median Model for End-Stage Liver Disease score of 11 (IQR, 9-13). The etiology of liver disease was alcohol (n = 4) and hepatitis C (n = 1). All patients were ineligible for TIPS due to prior hepatic encephalopathy and ineligible for liver transplantation due to active alcohol use (n = 3), advanced age (n = 1), and underlying malignancy (n = 1). There were no deaths during the follow-up period and only one adverse event (cellulitis). IPC attrition rate over the 12-week program was 100%. The IPC was removed in one patient due to resolution of ascites at Week 11 and in a second patient due to non-compliance at Week 13. At 30 days after IPC insertion, the median self-reported health score on a vertical visual analog scale increased from a median of 50 (IQR, 50-70) to 78 (IQR, 50-85), attributable to a reduction in symptom burden. Conclusion: Long-term tunneled IPCs for the management of refractory cirrhotic ascites were safe. The IPC was associated with improved symptom control and patient perceptions of health, compared with baseline. The study is ongoing, and a larger sample size will allow further exploration of the safety and cost-effectiveness of this novel intervention in a vulnerable population during and after the COVID-19 pandemic.