Reduced Presentation of Biliary Atresia During the COVID-19 Lockdown: A Population Based Observational Study.

OBJECTIVE: The aim of this study was to assess whether there has been a change in presentations of biliary atresia (BA) in England and Wales during the first and second coronavirus disease 2019 (COVID-19) lockdowns (January-June 2020 and 2021). DESIGN: This population study assessed all confirmed cases of BA, from January 2020 to December 2021 across the 3 UK pediatric liver centers originating from England and Wales. Data was then compared to the incidence of confirmed BA cases from January to December 2017, 2018, and 2019. RESULTS: During January-June 2020 and 2021, there were only 8 and 12 presenting cases of BA in England and Wales, compared to 16, 13, and 18 for the same time periods in 2017, 2018, and 2019, respectively. This difference was significant in a two-sided t test for 2020 ( P = 0.035) but not for 2021 ( P = 0.385). There was no difference in the mean days to Kasai procedure in January-June 2020 and 2021 compared to 2017-2019; however average time to Kasai after the lockdown periods was significantly higher. CONCLUSIONS: There was a significant reduction in the presenting cases of BA during the first COVID-19 lockdown, with an increased time for BA referrals after the pandemic lockdowns were lifted in England and Wales.

Energy policies shaping the solar photovoltaics business models in Malaysia with some insights on Covid-19 pandemic effect

Technology, economics, and government policies, disrupt business models. Since the initiation of feed-in tariffs and renewable energy policies, the Malaysian solar photovoltaic industry has experienced acceleration growth. Changes in policies and a limited feed-in tariff quota system affected the solar photovoltaic industry in Malaysia. However, new policies and frameworks towards self-consumption and large-scale solar with net energy metering and financing options have changed the business models. To better understand Malaysia's present solar PV business models and financing options, interviews and surveys were conducted with business representatives and customers. In addition, Malaysian solar PV business models were compared with Germany, the USA, Japan, and Thailand. The drivers, barriers, and challenges faced by solar service companies and customers in Malaysia are presented. Interestingly, the Malaysian solar energy business was immune to the Covid-19 pandemic, and an overwhelming increase in the installation capacity took place owing to existing attractive policies. The study provides valuable insights on the guidelines of existing business models and new energy policies that might assist renewable energy policymakers, local solar photovoltaics companies, and foreign investors.

Reduced presentation of biliary atresia during the COVID-19 lockdown – a population based observational study

BackgroundBiliary Atresia (BA) is the commonest surgical cause of cholestasis in infancy, affecting 1 in 1700 live births in England and Wales. Previous reports have demonstrated an average of 50 BA cases every year across the three UK centres, however observations from clinicians across these three centers have suggested a reduction in the number of presenting cases during the COVID-19 lockdown.ObjectivesThe aim of this study was to assess whether there has been a change in presentations of Biliary Atresia (BA) in England and Wales during the first COVID-19 lockdown (January – July 2020).MethodsThis population study assessed all confirmed cases of BA, from January 2020 to July 2020, across the 3 UK paediatric liver centers originating from England and Wales. Data was then compared to the incidence of confirmed BA cases from January - July 2017, 2018 and 2019, as documented within the Biliary Atresia National Registry.ResultsFrom January – July 2020, there were only 8 presenting cases of BA in England and Wales, compared to 24, 17 and 20 for the same time periods in 2017, 2018 and 2019 respectively. This difference was significant in a two-sided t-test (p = 0.0150). While the mean days to Kasai procedure was longer in 2020 compared to 2016–2019 (64.6 vs. 56.6), this difference was not observed to be significant (p=0.551).ConclusionsThere was a significant reduction in the presenting cases of BA during the first COVID-19 lockdown. This could either be due to a reduction in referrals or from a reduction in incidence of the condition, potentially due to an infectious cause being less prevalent during the national lockdown. If the former is correct there is potential for a significant number of BA babies with cholestatic jaundice remaining within the community. General practitioners and community paediatricians should be alert for these patients.

Case Report: Dilated Cardiomyopathy in a Newborn, a Potential Association With SARS-COV-2.

Objective: The objective of this study was to describe the clinical course of a newborn who developed dilated cardiomyopathy (DCM) after COVID-19 infection. Methods: We retrospectively assessed the clinical notes of a pediatric patient with decompensated heart failure and who was previously positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: A 23-day-old newborn presented with diarrhea, hypoactivity, tachypnea, and lethargy. The infant progressed to develop respiratory failure and required orotracheal intubation due to apnea. A nasopharyngeal swab tested positive for SARS-COV-2. An echocardiogram (ECHO) demonstrated severe left ventricular dysfunction. The patient was discharged after 18 days with furosemide and angiotensin-converting enzyme inhibitors. During the follow-up period, the infant had two episodes of decompensated heart failure, with evidence of DCM. Investigations for known causes of secondary DCM were negative. The infant was promptly referred for heart transplantation. Conclusion: Although rare, we have observed a case of DCM in a newborn following COVID-19 disease. DCM may be a complication following COVID-19 disease in newborns.

Pyrolysis and Combustion Kinetics of Disposable Surgical Face Mask Produced During Covid-19 Pandemic (preprint)

The authors have requested that this preprint be removed from Research Square.

Reducing orthopaedic theatre exposure during the COVID-19 lockdown: does a shift towards virtual reality-based training offer a solution?

PerspectiveOrthopaedic training in the United Kingdom has changed little from the Halstedian apprenticeship model of graduated responsibility, with the mantra "see one, do one, teach one". Whilst still relevant in surgical teaching, the current and ongoing disruption to surgical training secondary to the coronavirus disease 2019 (COVID-19) outbreak highlights the need for alternative methods of experiential surgical learning, which allow for the development of the knowledge, skills, and attitudes of orthopaedic surgeons, to be sought.