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Objectives This article observes the mean daily dose of fentanyl required for adequate sedation in critically ill, mechanically ventilated children randomized to receive dexmedetomidine or placebo.Methods We conducted Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE), a multicenter, double-blind, randomized, placebo-controlled, dose-escalating trial. We enrolled children aged 35 weeks postmenstrual to 17 years (inclusive) admitted across 13 pediatric multidisciplinary and cardiac intensive care units. Adequate sedation was based on a State Behavioral Score and Richmond Agitation-Sedation Scale of -1 or lower. Only the first two dexmedetomidine dosing cohorts opened for enrollment, due to early trial closure during the coronavirus 2019 pandemic. Thirty children were randomized over 13 months and included in the analyses.Results Demographic and baseline characteristics were not different between dexmedetomidine and placebo cohorts. Similarly, mean daily fentanyl use was not different, using an unadjusted mixed regression model that considered treatment, time, and a treatment-by-time interaction. Adverse events and safety events of special interest were not different between cohorts.Conclusion The DOSE trial revealed that dexmedetomidine added to fentanyl does not impact safety and may not spare fentanyl use in critically ill children, although the trial did not meet its recruitment goals, due to early closure during the coronavirus 2019 pandemic. More rigorous inpatient pediatric trials like DOSE that study critically ill, mechanically ventilated children are needed. Despite the many obstacles faced, the DOSE trial presents challenges from which the greater research community can learn and use to optimize future therapeutic trials in children.
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This article explores the heterogeneous and uneven EU response to the COVID-19 pandemic across policy fields and examines how integration theories can contribute to explaining the presence (or absence) of new integration steps and their varying nature. To analyse European activities in three policy fields, namely fiscal policy, centralised European vaccine procurement, and border politics, we develop a ‘Domain of Application' approach (DOA). Instead of testing integration theories against each other, DOA allows bridging different theoretical traditions by making use of their complementary explanatory power to derive better explanations of complex empirical issues. We find that Liberal Intergovernmentalism and Neofunctionalism offer complementary explanations for several empirical puzzles, which together provide a more compelling picture of the effects of the pandemic on European integration. In addition, DOA advances our understanding of the scopes of both theories. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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BACKGROUND AND PURPOSE: Reduced olfactory function is the symptom with the highest prevalence in coronavirus disease 2019 (COVID-19) with nearly 70% of infected individuals experiencing partial or total loss of their sense of smell at some point during the disease. The exact cause is not known, but beyond peripheral damage, studies have demonstrated insults to both the olfactory bulb and central olfactory brain areas. However, these studies often lack both baseline pre-COVID-19 assessments and control groups, and the effects could, therefore, simply reflect pre-existing risk factors. MATERIALS AND METHODS: Shortly before the COVID-19 outbreak, we completed an olfactory-focused study, which included structural MR brain images and a full clinical olfactory test. Opportunistically, we invited participants back 1 year later, including 9 participants who had experienced mild-to-moderate COVID-19 (C19+) and 12 who had not (C19-), creating a natural pre-post experiment with a control group. RESULTS: Despite C19+ participants reporting subjective olfactory dysfunction, few showed signs of objectively altered function. Critically, all except 1 individual in the C19+ group had reduced olfactory bulb volume (average reduction, 14.3%), but this did not amount to a significant statistical difference compared with the control group (2.3%) using inference statistics. We found no morphologic differences in olfactory brain areas but stronger functional connectivity between olfactory brain areas in the C19+ group at the postmeasure. CONCLUSIONS: Our data suggest that COVID-19 might cause long-term reduction in olfactory bulb volume and altered functional connectivity but with no discernible morphologic differences in cerebral olfactory regions.
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Background: COVID-2019 caused by SARS-CoV-2 has become a pandemic that has claimed more than 6.2 million lives so far. Vaccination is the most effective tool in the fight against infectious diseases. However, low vaccination coverage is hampering our efforts to contain the COVID- 19 pandemic. Vaccine side effects are one of the reasons for reluctance to vaccinate. In this study, we systematically investigated self-reported vaccine side effects (SE) after the first, second, and booster vaccinations. Method(s): The data was collected during the TuSeRe:exact Study (Tubinger Monitoring Studie zur exakten Analyze der Immunantwort nach Vakzinierung). The coworkers from University Hospital Tubingen, Center for Clinical Transfusion Medicine and Natural and Medical Sciences Institute were invited to participate in the study. Study participants were asked to fill an online questionnaire and report SE after first, second and booster vaccinations. Result(s): A total of 889 participants (mean age: 43 +/- 12.7 years;female: n= 664 (77%), male: n= 205 (23%)) were included in the analysis. Pain on injection site was the most common local SE after first, second and booster vaccination (68%, 70%, 57%, respectively). Fatigue was the most common systemic SE after first, second and booster vaccination (61%, 64%, 46%, respectively). Local and systemic SE were highest after vector based vaccine ChAdOx1 nCoV-19 in the 1. vaccination. However, local and systemic SE were more common after mRNA vaccines (BNT162b2, mRNA-1273) in the 2. vaccination. Compared to BNT162b2 vaccine, more SE have been observed after mRNA-1273 vaccine in the booster vaccination. Conclusion(s): Local and systemic SE are common after SARS-CoV-2 vaccines. The frequency of self-reported local and systemic SE are significantly different between mRNA and vector vaccines. SE are more common after mRNA-1273 vaccine than BNT162b2 vaccine.
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Citizen science (CS) projects, being popular across many fields of science, have recently also become a popular tool to collect biodiversity data. Although the benefits of such projects for science and policy making are well understood, relatively little is known about the benefits participants get from these projects as well as their personal backgrounds and motivations. Furthermore, very little is known about their expectations. We here examine these aspects, with the citizen science project "German Butterfly Monitoring" as an example. A questionnaire was sent to all participants of the project and the responses to the questionnaire indicated the following: center dot Most transect walkers do not have a professional background in this field, though they do have a high educational level, and are close to retirement, with a high number of females;center dot An important motivation to join the project is to preserve the natural environment and to contribute to scientific knowledge;center dot Participants benefit by enhancing their knowledge about butterflies and especially their ability to identify different species (taxonomic knowledge);center dot Participants do not have specific expectations regarding the project beyond proper management and coordination, but have an intrinsic sense of working for a greater good. The willingness to join a project is higher if the project contributes to the solution of a problem discussed in the media (here, insect decline). Based on our findings from the analysis of the questionnaire we can derive a set of recommendations for establishing a successful CS project. These include the importance of good communication, e.g., by explaining what the (scientific) purpose of the project is and what problems are to be solved with the help of the data collected in the project. The motivation to join a CS project is mostly intrinsic and CS is a good tool to engage people during difficult times such as the COVID-19 pandemic, giving participants the feeling of doing something useful.
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Chemistry laboratory experiments are invaluable tostudents'acquisition of necessary synthetic, analytical, andinstrumental skills during their undergraduate studies. However,the COVID-19 pandemic rendered face-to-face (f2f), in-personteaching laboratory experiences impossible from late 2019-2020and forced educators to rapidly develop new solutions to deliverchemistry laboratory education remotely. Unfortunately, achievinglearning and teaching objectives to the same caliber of in-personexperiments is very difficult through distance learning. Toovercome these hurdles, educators have generated many virtual and remote learning options for not only foundational chemistrycourses but also laboratory experiments. Although the pandemic challenged high-level chemistry education, it has also created anopportunity for both students and educators to be more cognizant of virtual learning opportunities and their potential benefits withinchemistry curriculum. Irrespective of COVID-19, virtual learning techniques, especially virtual lab experiments, can complement f2flaboratories and offer a cost-efficient, safe, and environmentally sustainable alternative to their in-person counterparts.Implementation of virtual and distance learning techniques???including kitchen chemistry and at-home laboratories, prerecordedvideos, live-stream video conferencing, digital lab environment, virtual and augmented reality, and others???can provide a wide-ranging venue to teach chemistry laboratories effectively and encourage diversity and inclusivity in thefield. Despite their relevanceto real-world applications and potential to expand upon fundamental chemical principles, polymer lab experiments areunderrepresented in the virtual platform. Polymer chemistry education can help prepare students for industrial and academicpositions. The impacts of polymers in our daily life can also promote students'interests in science and scientific research. Hence, thetranslation of polymer lab experiments into virtual settings improves the accessibility of polymer chemistry education. Herein, weassess polymer experiments in the emergence of virtual learning environments and provide suggestions for further incorporation ofeffective polymer teaching and learning techniques into virtual settings
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Introduction The COVID-19 pandemic drastically changed the life of children and adolescents since the start of 2020. The COPSY study Hamburg is one of the first population-based studies to examine the mental health and quality of life of children and adolescents in Hamburg during the pandemic. The COPSY study Hamburg is part of the nationwide COPSY study. Methods From June 12 to July 31 n = 1,037 children and adolescents aged 11 to 17 years and their parents were surveyed online on the impact of the pandemic on quality of life and mental health. Established instruments were used to assess life satisfaction (Cantril Ladder), quality of life (KIDSCREEN-10), mental health problems (Strengths and Difficulties Questionnaire), psychosomatic complaints (HBSC Symptom Checklist) as well as other relevant instruments to assess COVID-19-related stress. Data were compared with representative reference samples from the pre-pandemic BELLA and HBSC studies. Relative frequencies including confidence intervals were reported. Based on bivariate and multiple logistic regression analyses, children with particularly high levels of stress were identified. The risk group was presented, and potential resources were analysed. Results Two thirds of Hamburg's children and adolescents felt burdened by the pandemic. Their life satisfaction and quality of life have decreased compared to before the pandemic. The children and adolescents reported more frequent psychosomatic complaints such as irritability, problems falling asleep and headaches. Socially disadvantaged children were particularly burdened. Good family cohesion had a protective effect and was able to mitigate the burden caused by the pandemic. Conclusions To protect and maintain the mental health of children and adolescents during the COVID-19 pandemic as well as in future crisis situations, target group-specific and low-threshold prevention and health promotion strategies need to be discussed.
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BACKGROUND: Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM: To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS: In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS: A total of 6306 patients were included. During the pandemic peak, a 13.9+/-6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min;P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min;P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%;P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020;P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS: During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.