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Background: Aging and binge alcohol abuse are both known as independent risk factors for both atrial and ventricular arrhythmias. With the COVID-19 pandemic, increased social isolation has significantly increased alcohol consumption worldwide. Older adults are a high-risk drinking group and alcohol significantly enhances the risk of arrhythmia onset. Yet, how alcohol (a secondary stressor) drives spontaneous atrial and ventricular arrhythmia onset in the aged heart (a primary stressor) remains unclear. Objective(s): We recently reported the stress-response kinase c-jun N-terminal kinase 2 (JNK2) underlies alcohol-enhanced atrial arrhythmia vulnerability (pacing-induced) in healthy young hearts. Here, we reveal a critical role of JNK2 in alcohol-driven arrhythmia onset in the aged heart in vivo. Method(s): Ambulatory ECGs were recorded using wireless telemeters in binge alcohol-exposed aged (24 months) and young mice (2 months). Spontaneous premature atrial and ventricular contractions (PACs, PVCs), atrial and ventricular tachycardia (AT, VT) were quantified as previously described. The role of JNK2 in triggered arrhythmic activities was assessed using a well-evaluated JNK2-specific inhibitor and our unique cardiac-specific MKK7D and MKK7D-JNK2dn mouse models with tamoxifen inducible overexpression of constitutively active MKK7 (a JNK upstream activator) or co-expression of MKK7D and inactive dominant negative JNK2 (JNK2dn). Result(s): We found that binge alcohol exposure in aged mice (n=14) led to spontaneous PACs/PVCs (75% of the mice), and AT/VT episodes (50%) along with a 21% mortality rate. However, alcohol-exposed young (n=5) and non-alcohol-exposed aged mice (n=11) were absent of any spontaneous arrhythmic activities or premature death. Intriguingly, JNK2-specific inhibition in vivo abolished those alcohol-associated triggered activities and mortality in aged mice. The causative role of JNK2 in triggered arrhythmias and premature death was further supported by the high frequency of spontaneous PACs/PVCs and nonsustained AT/VT episodes along with a 50% mortality rate in MKK7D mice (n=10), which was strikingly alleviated in MKK7D-JNK2dn mice (n=5) with cardiac-specific JNK2 competitive inhibition. Conclusion(s): Our findings are the first to reveal that stress kinase JNK2 underlies binge alcohol-evoked atrial and ventricular arrhythmia initiation in aged mice. Modulating JNK2 could be a novel therapeutic strategy to treat and/or prevent binge drinking-evoked cardiac arrhythmias.Copyright © 2023
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OBJECTIVE: To determine the prevalence of CMV reactivation in a population admitted for severe COVID-19 to a general hospital. METHODS: Point prevalence study in all hospitalized patients with severe COVID-19 (admitted either to general wards or ICU). Determination of the presence of CMV DNA in circulating blood. COVID-19 was confirmed in patients with compatible clinical manifestations, usually with pneumonia and a positive nasopharyngeal PCR test. RESULTS: We included 140 hospitalized patients with COVID-19 who consented to participate. A total of 16 patients (11.42%), had circulating CMV-DNA in peripheral blood at the time of the study. Patients with positive CMV viral load were mainly ICU patients (11/37 -29,7%) and only 5/103 cases (4,85%) were hospitalized into general wards. The accumulated doses of corticosteroids (prednisone equivalents) in the study day were (median and IQR) 987.50 mg (396.87-2,454.68) and 187.50 mg (75.00-818.12) respectively in CMV positive and negative patients (p < 0.001). A significant proportion of CMV positive patients were discovered because of the study and were clinically unsuspected by their physicians. The coinfected COVID-CMV positive population had a higher risk of accumulated secondary nosocomially-acquired infections and a worse prognosis. CONCLUSIONS: CMV reactivation should be systematically searched in patients in COVID-19 cases admitted to the ICU.
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Micro and small enterprises are an important source of employment in underdeveloped economies, functioning as mitigating agents of the economic effects of major crises. However, one of the most marked constraints that prevents them from growing and developing is limited access to finance. This article analyzes the sources of short-term financing used by micro and small family businesses in the garment sector of Barranquilla – Colombia. The study is descriptive, field, non-experimental, and the source of information is a questionnaire of 27 items, applied to owners and / or managers of 93 family establishments affiliated to the Chamber of Commerce of Barranquilla. The results show that these productive units manage very precarious short-term financing schemes, since to maintain daily operations they resort to their own funds, as well as family and friends. As a next option, they show preferences for funds from informal lenders, which are very onerous and represent a financial burden that prevents them from growing. To a lesser extent, they make use of business credit and bank credit. It is concluded that in general terms the sector remains in subsistence conditions and without possibilities to expand productive capacity through investments in capital goods, given that it does not have the necessary funds and guarantees required to finance its expansion. Finally, under the scenario of the COVID-19 pandemic, a situation of reduction in the size of the sector is configured. © 2022, Universidad del Zulia. All rights reserved.
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OBJECTIVE: This study aimed to compare the survival experience of adult inpatients with laboratory-confirmed COVID-19 during the first three waves (wild type, Delta, and Omicron) of the pandemic in Mexico. STUDY DESIGN: A retrospective and nationwide study was conducted. METHODS: Data from 229,311 participants were analyzed using the Kaplan-Meier method, and estimates per each pandemic wave were obtained. A multivariate Cox proportional hazard regression model was fitted, and hazard ratios (HRs) and 95% confidence intervals (CIs) were computed. RESULTS: The overall mortality rate was 49.1 per 1000 person-days. Heterogeneous survival rates were observed during the analyzed emergences (log-rank test, P < 0.001), and the lowest survival functions were computed during the Omicron variant dominance. In multiple analyses and after adjusting by host characteristics and COVID-19 vaccination status, cases occurring during the Delta (vs wild type: HR = 1.03, 95% CI 1.01-1.05) and Omicron emergence were at increased risk for a fatal in-hospital outcome (HR = 1.17, 95% CI 1.13-1.22). CONCLUSIONS: Our results suggest variant-related differences in the survival rates of hospitalized patients with laboratory-positive COVID-19. When compared with the wild-type virus, lower rates were observed during the Delta and Omicron emergence.
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BACKGROUND: The COVID-19 pandemic magnified the digital health divide among marginalized populations when health systems scaled back inperson visits as a public health precaution. We conducted this qualitative study during the pandemic to solicit patient and provider perceptions of use of digital health programs (patient portals, telemedicine, remote hypertension/diabetes monitoring) and to inform strategies to surmount barriers to accessing remote care. METHODS: We conducted semi-structured interviews with 40 patients and 29 primary care providers (PCPs) from northern and southeastern Louisiana who were recruited within an integrated delivery health system and an FQHC between May and July 2021. We used constant comparative method of grounded theory to identify themes. Commonalities/differences in perspectives between patients and PCPs were analyzed. RESULTS:Most patients recruited to the study self-identified as Black (68%), female (73%), mean age 51, lived in an urban area (77%), and had Medicaid (58%). Most PCPs were White (79%), male (52%), mean age 39, and reported Medicaid as the predominant insurer (59%). Most patients reported using smartphones for accessing the internet for health and non-health activities. Some participants used apps to track their health but noted internet/data/storage limits. PCPs noted increased uptake of misinformation on the internet prompting them to proactively recommend websites and apps. Most patients had used a patient portal and reported convenience of messaging their PCP, getting refills, scheduling appointments, and reviewing test results. PCPs noted a concurrent increase in their in-basket workload with a particular concern for frequent messaging like cellphone texting. Most patients had telemedicine video visits using their smartphones - some of which converted to audio when technology problems arose. Patients and PCPs noted telemedicine is appropriate for routine follow-up but preferred in-person visits. PCPs noted additional workflow disruption when moving from in-person to video visits in the same clinic session. Few patients were enrolled in a digital health program for remote monitoring;however, patients and PCPs agreed these programs provide valuable adjuncts to chronic care. PCPs reported patient limitations in accessing such programs due to the need for smartphones/internet/WiFi and select insurance coverage which can lead to further disparities in access to care. CONCLUSIONS: Health policies that support broadband/internet/ smartphone service as a standard utility and insurance coverage for digital health programming are paramount for surmounting major patient barriers. Clinical practice procedures which optimize technical support for patients and providers are also needed. RESULTS: Of the 236 women in the study, there was a mean age of 66.5 years ± 7.1;67 self-identified as Black, 93 as White, 49 as Hispanic and 16 as Other. Median CA anxiety score was 3 while DM anxiety score was 2.5 (p<0.001). For the anxiety groups, 67 (28%) were in the high CA/high DM group, 52 (22%) in the high CA/low DM group, 15 (6%) in the low CA/high DM group, and 94 (39%) in the low CA/low DM group. Participants in the high CA/low DMand low CA/low DMgroups were more likely to adhere to a healthy diet (73% and 71% compared with 51% for high CA/high DM and 53% for low CA/high DM, p= 0.02). They also had an increased likelihood of consuming at least 5 servings of fruits and veggies daily (69% and 57% vs. 45% for high CA/high DM and 40% for low CA/high DM, p= 0.03) and adhering to oral DM medications (62% and 75% vs. 52% for high CA/high DM and 20% for low CA/high DM, p= 0.05). CONCLUSIONS: Older breast cancer survivors with DM have different levels of anxiety about CA versus DM and those with high DM anxiety are less likely to adhere to DMSMBs. Our findings suggest that increased anxiety might hinder one's ability to achieve disease control, making anxiety management vital to supporting patient adherence and health.
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The experience of going through a pandemic like Covid-19 forced many sectors of the economy to evolve, including education, specifically higher education. Teaching methods in Engineering, Architecture, and Construction (IAC) adopted tools, which had been developed primarily for industry, to adapt them to teach. These tools have been added to the already existing Information and Communication Technologies (ICT), and in this study, they are used as didactic teaching techniques. These tools are Building Information Modeling (BIM), Virtual Reality (VR), and the video game (VG) Call of Duty: Warzone (CoD: Wz). Some investigations have studied the scope that the use of BIM, VR, and video games can have in teaching separately. However, no research so far has been found that unites the three tools in a single methodology. This study aims to show the methodology and its results when implementing the Hydraulic 3D Lab (Hydr3D-Lab) tool for teaching in IAC. As will be explained later, in the procedure of implementing the methodology, the use of BIM, VR, and CoD: Wz software was promoted during teaching hours to improve skills and help students understand concepts that are difficult to comprehend and teach theoretically. The implementation of this technological tool was developed in the context of IAC's national higher education programs at a university in Mexico. This study demonstrates the effectiveness of using the collaborative tool Hydr-3D-Lab as a teaching method for IAC. Additionally, this study proves that the learning experience can be enhanced using other technology tools such as Unreal Engine and Revit. © 2022 IEEE.
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The past decade has seen the development of student-focused programmes in the aerospace industry, including the European Space Agency’s suite of gravity-related student experiment programmes. These opportunities enable student teams to propose and conduct research experiments on altered gravity platforms including a drop tower, a hypergravity centrifuge, an aircraft performing parabolic flights, and on-board the International Space Station (ISS). In a sector with significant barriers to entry, these programmes offer students a practical end-to-end research experience and an introduction to working in the space industry. This paper will explore the benefits and challenges unique to each of ESA’s ‘Spin Your Thesis!’, ‘Fly Your Thesis!’, and ‘Drop Your Thesis!’ educational programmes from the perspective of the 2021 student cohort. The programmes will be compared and contrasted, highlighting the changes in approach and methodologies depending on the platform. This interdisciplinary cohort is split into eight international teams, each consisting of students from a wide range of cultural and/or educational backgrounds. The role of this diversity in successful collaboration is examined, discussing whether teams from diverse disciplines can collect higher quality data on a wider range of topics. Diversity is also evident in the selection of experiments being performed on the three altered gravity platforms. Research topics range from attitude control, acoustic levitation, and debris removal technology demonstrations, to biological process simulations, and smart granular gases. An overview of the individual projects and their anticipated outcomes will demonstrate how this research relates to ongoing research in the space sector. Finally, the impact of the COVID-19 pandemic on the undertaking of these programmes is assessed, with this cohort taking part in these programmes in a virtual format, often without direct contact with other teammates. The results of this paper will not only benefit future students hoping to take part in these altered gravity programmes but will also emphasise the benefits of these opportunities, both for the participating students and the space industry. Copyright © 2021 by the International Astronautical Federation (IAF). All rights reserved.
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Case Report Sinus venosus ASDs are usually associated with one or more anomalous right sided pulmonary veins. Diagnosis by transthoracic echocardiogram (TTE) and confirmation with transesophageal echocardiogram (TEE) and right heart catherization can lead to a multidisciplinary approach for appropriate surgical correction. Case A 21-year-old male with no PMH presented to clinic for a routine physical to return to collegiate athletics post COVID-19 infection. His only complaint during this time was residual dyspnea (NYHA Class 1). An ECG was obtained and showed an incomplete right bundle branch block and TTE revealed an ASD with moderate RV dilation. Repeat TTE at our institution showed an interatrial shunt on injection of agitated saline via the right arm within three beats after injection. Subsequent right heart catheterization with shunt series revealed a step in oxygen saturation from 75% in the superior vena cava (SVC) to 88% in the right atrium. Additional imaging obtained with TEE confirmed a sinus venosus ASD. Cardiovascular surgery was engaged and further imaging with computed tomography angiography (CTA) of the chest confirmed a large superior sinus venosus ASD measuring 16 mm in diameter as well as partial anomalous right pulmonary venous drainage into the SVC. The heart team decided on a minimally invasive robotic approach and performed an autologous pericardial patch repair of the ASD with redirection of the right and superior pulmonary veins into the left atrium. Intra-op TEE showed no residual shunt across the interatrial septum. The patient had an uncomplicated post-operative course and was discharged home on day 4. Decision-Making Sinus venosus ASDs and associated anomalous pulmonary veins are often missed on TTE. In our patient, TEE and CTA assisted in the detection of anomalous pulmonary venous connection. A multidisciplinary heart team approach helped determine and tailor the best option for surgical correction in our patient's case. Conclusion Sinus venosus defects account for up to 10% of ASDs and can lead to pulmonary hypertension if left uncorrected. TTE remains the first imaging modality in assessing for ASDs, but TEE, RHC, and CTA can assist in comprehensive diagnosis and planning for procedural correction. Surgical closure in patients less than 25 years old without pulmonary hypertension is associated with low postoperative mortality, and a multidisciplinary approach can help ensure the most optimal method of surgical correction. (Figure Presented).
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In early 2020, COVID-19 crossed international borders and became a pandemic severely affecting public health worldwide. Health services were stretched thin. The confinement also triggered other social, economic, and cultural problems. Unemployment increased, family dynamics changed, and educational institutions faced the challenge of continuing academic operations. Governments implemented mechanisms to address the situation, but their efforts have been insufficient. Private companies, foundations, civic organizations, universities, and citizens in general, began to respond with creative problem-solving projects. Moreover, universities implemented social innovation projects to deal with pandemic challenges. In this study, we reviewed the websites of 20 universities selected from a pool of internationally ranked institutions to analyze such projects. Of these, seven universities were in North America, Europe and Asia;seven in Latin America, and six in Mexico. The analysis was qualitative and inductive. There was information related to COVID 19 in all the websites reviewed, such as sanitation measures, recommendations, news, and the university's guidelines. They also featured information about the social innovation projects organized by these universities. The identified projects were categorized into four areas: a) scientific research, including projects related to vaccine development and treatments;b) education, enclosing digital systems for academic continuity and educational programs for society;c) technology, used in team development projects and strategies, and d) innovation, with holistic proposals for emotional, physical, and psychological care and well-being. Several projects leveraged technological tools to resolve the various complexities of health confinements, resulting in digital social innovations. It was observed that the pandemic accelerated the social-digital innovations, thereby blurring the limits between the technological and the social. Such a tendency presents an opportunity for universities to generate more projects and escalate those already in existence. Therefore, reviewing the status of these projects may ensure their continuity or adaptation to the new normal of pandemic and post-pandemic times. © 2021, Academic Conferences and Publishing International Limited. All rights reserved.
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Objective. Identify the scientific production published in journals indexed in the Scopus database on SARS-CoV-2, to quantify the scientific information available for the decision-making process of the relevant authorities. Design/Methodology/Approach. It is a documentary research, which uses bibliometric analysis of articles published in scientific journals indexed in the Scopus database, using EndNote and VOSviewer, among other processing tools. Results/Discussion. 1,779 publications were found that met the inclusion criteria-more than 75% are open access and 61% are articles- The English language predominates (more than 90%). Eleven articles collect 65, 8% of the citations, and three journals account for 65, 2% of the citations. The US stands out with 18% of the authors, the rest of the countries have less than 10%, even though Italy and China stick out. Collaborations between countries are dynamic with six different groups of alliances of researchers throughout the world. Regarding the specific topic discussed, five base topics were found: risk factors, description of the disease, effects in different countries, curative drugs, and detection tests. Conclusions. Scientists have done their job to stop this global threat, creating and disseminating relevant knowledge;the decision-making powers have the say: it is in their hands to use or not the knowledge generated. Originality/Value. It has become clear that the assessment of scientific knowledge, especially in extreme circumstances and / or emergencies, could mean a great saving in resources, time and lives.
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Introduction: after 42 days of lockdown imposed due to the global COVID-19 pandemic, children under 14 years were allowed to leave their homes. The aim of the study was to analyse the impact of the period following the lifting of confinement measures on traumatic injury trends in children. Material and methods: we carried out a retrospective and observational study in children aged less than 16 years that presented with traumatic injuries to the emergency department of a tertiary care hospital between April 26 and the start of the scaling down in the Community of Madrid on May 24. We compared the frequency of traumatic injuries and fractures, the mechanism and site of injury and other variables to those recorded in the same period the year before. Results: there was a significant increase in the proportion of fractures compared to 2019 (41.9 vs. 11.3%;p <0.001). The percentage of accidents related to wheeled vehicles was significantly higher in 2020 (43.9 vs. 6.2%;p <0.001), with these accidents most frequently involving bicycles (35.4%) and scooters (32.2%). Conclusions: in the period following the lockdown, there was a remarkable increase in accidents related to wheeled vehicles in the paediatric population, although this outcome was probably influenced by specific organizational measures implemented in Madrid in the period under study. © 2021, Spanish Association of Primary Care Pediatrics. All rights reserved.
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The electrical industry has greatly evolved over the past several decades. Originally, there was no such thing as a "safety culture". Now, hundreds of the industry's leading minds show up annually for a full week to learn, listen, and exchange ideas for stopping electrical incidents and injuries in the workplace. Under normal operations, most companies have adopted the " Safety First" mantra. In 2020, the world was faced with something it had never seen before;a modern-day pandemic. This completely changed the way that we here in the United States were able to conduct business. When circumstances change so rapidly even on a day to day basis and people's businesses and the ability to support their families are put on the line, is safety still first? In this paper, we will discuss the struggles of operating a business and keeping employees as safe as possible during the 2020 SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) (COVID-19) Pandemic. We linked with other professionals and centers of excellence from around the world in the electrical sector to advance our mission of a Safety-First culture. The innovations required involved human performance best practices to overcome these substantial barriers to everyday work tasks. The US Department of Homeland Security deemed the Energy Sector as critically essential. They stated, "The U.S. energy infrastructure fuels the economy of the 21st century. Without a stable energy supply, health and welfare are threatened, and the U.S. economy cannot function [1]." The electrical industry could not shut down in this crisis. Our industry needed to adapt, in real-time, to the environments they were in. Engineers, technicians, and electricians dealt daily with this new hazard that they could not see, interestingly not unlike electricity. The ongoing respect for electricity that our employees have always had, along with the ability to adapt quickly in innovative ways made it possible to still provide this essential work to keep the country moving.
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The electrical industry has greatly evolved over the past several decades. Originally, there was no such thing as a 'safety culture'. Now, hundreds of the industry's leading minds show up annually for a full week to learn, listen, and exchange ideas for stopping electrical incidents and injuries in the workplace. Under normal operations, most companies have adopted the 'Safety First' mantra. In 2020, the world was faced with something it had never seen before;a modern-day pandemic. This completely changed the way that we here in the United States were able to conduct business. When circumstances change so rapidly even on a day to day basis and people's businesses and the ability to support their families are put on the line, is safety still first? In this paper, we will discuss the struggles of operating a business and keeping employees as safe as possible during the 2020 SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) (COVID-19) Pandemic. We linked with other professionals and centers of excellence from around the world in the electrical sector to advance our mission of a Safety-First culture. The innovations required involved human performance best practices to overcome these substantial barriers to everyday work tasks. The US Department of Homeland Security deemed the Energy Sector as critically essential. They stated, 'The U.S. energy infrastructure fuels the economy of the 21st century. Without a stable energy supply, health and welfare are threatened, and the U.S. economy cannot function [1].' The electrical industry could not shut down in this crisis. Our industry needed to adapt, in real-time, to the environments they were in. Engineers, technicians, and electricians dealt daily with this new hazard that they could not see, interestingly not unlike electricity. The ongoing respect for electricity that our employees have always had, along with the ability to adapt quickly in innovative ways made it possible to still provide this essential work to keep the country moving. © 2021 IEEE.
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Introduction: recent studies have reported the occurrence of thrombotic phenomena or coagulopathy in patients with COVID-19. There are divergent positions regarding the prevention, diagnosis, and treatment of these phenomena, and current clinical practice is based solely on deductions by extension from retrospective studies, case series, observational studies, and international guidelines developed prior to the pandemic. Objective: to generate a group of recommendations on the prevention, diagnosis and management of thrombotic complications associated with COVID-19. Methods: a rapid guidance was carried out applying the GRADE Evidence to Decision (EtD) frameworks and an iterative participation system, with statistical and qualitative analysis. Results: 31 clinical recommendations were generated focused on: a) Coagulation tests in symptomatic adults with suspected infection or confirmed SARS CoV-2 infection;b) Thromboprophylaxis in adults diagnosed with COVID-19 (Risk scales, thromboprophylaxis for outpatient, in-hospital management, and duration of thromboprophylaxis after discharge from hospitalization), c) Diagnosis and treatment of thrombotic complications, and d) Management of people with previous indication of anticoagulant agents. Conclusions: recommendations of this consensus guide clinical decision-making regarding the prevention, diagnosis, and treatment of thrombotic phenomena in patients with COVID-19, and represent an agreement that will help decrease the dispersion in clinical practices according to the challenge imposed by the pandemic.