ASSIGNING PRIORITIES FOR RAW MATERIAL OF A LARGE PET FOOD PRODUCER IN THE CONTEXT OF SUPPLY DISRUPTION

The COVID-19 pandemic has affected everyday life in societies around the world. One of the most severe consequences has been the social isolation imposed by this extremely contagious disease. In this context, many people began looking for a pet for the first time. In Brazil, for instance, the pet sector increased its financial returns in 2020. In addition, companies that produce pet foods have experienced problems with the supply of materials. Supply chain disruption is a problem faced by many different organizations during this time of crisis. This study, therefore, investigated the supply of raw materials stored in the silos and tanks of a large company. This company have operations in 80 countries across the world and produces different products, including pet food. Thirteen raw materials used to produce pet food were con-sidered. In addition, eight criteria of the company's supply process were identified and explored. Moreover, the Flexible and Interactive Tradeoff (FITradeoff) method, which is a Multiple Criteria Decision Mak-ing/Aiding (MCDM/A) method, was applied to rank the raw materials based on supply difficulty. In terms of supply criticality, the order of materials was established from less critical to most critical. These results can be used by companies to better plan the receipt of these materials to reduce the risk of supply chain-related disruptions and propose better ways to distribute activities between planners to help them in their daily management. © 2023 Brazilian Operations Research Society.

Human Anti-Ace2 Monoclonal Antibodies as Pan-Sarbecovirus Prophylactic Agents

Background: Human monoclonal antibodies from convalescent individuals that target the SARS-CoV-2 spike protein have been deployed as therapeutics against SARS-CoV-2. However, nearly all of these antibodies have been rendered obsolete by SARS-CoV-2 variants that evolved to resist similar, naturally occurring antibodies. Moreover, Most SARS-CoV-2 specific antibodies are inactive against divergent sarbecoviruses Methods: By immunizing mice that carry human immunoglobulin variable gene segments we generated a suite of fully human monoclonal antibodies that bind the human ACE2 receptor (hACE2) rather than the viral spike protein and were engineered to lack effector functions such as ADCC. Result(s): These ACE2 binding antibodies block infection by all hACE2 binding sarbecoviruses, including emergent SARS-CoV-2 variants, with a potency that of the most potent spike binding therapeutic antibodies. Structural and biochemical analyses revealed that the antibodies target an hACE2 epitope that engages SARS-CoV-2 spike. Importantly, the antibodies do not inhibit hACE2 enzymatic activity, nor do they induce ACE depletion from cell surfaces. The antibodies exhibit favorable pharmacology in human ACE2 knock in mice and provide near complete protection of hACE2 knock-in mice against SARS-CoV-2 infection. Conclusion(s): ACE2 binding antibodies should be useful prophylactic and treatment agents against any current and future SARS-CoV-2 variants, as well as hACE2-binding sarbecoviruses that might emerge as future pandemic threats.

Role of 1-minute sit-to-stand in the diagnosis of Long COVID

Introduction: Current literature on 1-minute sit-to-stand (1-STS) role in COVID-19 focuses on its ability to predict need for hospitalization or home discharge, but not Long COVID diagnosis where gaps in knowledge are recognized in NICE Long COVID guidelines. Aim(s): Assess 1-STS role in Long COVID definition. Method(s): Prospective ongoing cohort of post COVID-19 patients referred to body plethysmography at a university tertiary hospital. Result(s): Thirty-two patients were analyzed (53.1% male, mean 54 years-old), of whom 15 (46.9%) fulfilled Long COVID criteria. Of these, the most common symptoms were insomnia and/or excessive fatigue (n=8, 53.3%) and dyspnea (n=4, 26.7%). Long COVID patients had higher body mass index (29.7+/-6.0 vs 26.2+/-3.3Kg/m2;p=0.043). Patients with and without Long COVID were similar regarding age (p=0.827), hospitalization due to COVID-19 (p=0.811) or smoking history (p=0.234). Parameters of the 1-STS most associated with Long COVID were lower heart rate (HR) at 30' (89.1+/-14.0 in Long COVID vs 105.9+/-14.3bpm for no Long COVID criteria;p=0.002) and at 60' (99.3+/-24.0 vs 120.8+/-13.9bpm;p=0.004), as well as lower SpO at 60' (94.5+/-4.4 vs 97.1+/-1.6%;p=0.046). The parameter with the highest predictive power for Long COVID was HR at 60'(AUC=0.808;p=0.003), and when <80bpm revealed 90% sensitivity and 99% specificity in this study population. Decline of SpO during 1-STS was tendentially greater in those with Long COVID, yet without significance (-2.7+/-4.4 vs -0.8+/-1.4%;p=0.093). Conclusion(s): Lower final SpO and HR on 1-STS, as well as 30' HR, were associated with the occurrence of Long COVID. Final HR<80 bpm in a post COVID-19 setting might be the best 1-STS predictor of Long COVID.

Transcriptional profiles and common genes link lung cancer with the development and severity of COVID-19.

Lung cancer patients with COVID-19 present an increased risk of developing severe disease and, consequently, have poor outcomes. Determining SARS-CoV-2-host interactome in lung cancer cells and tissues, infected or uninfected with SARS-CoV-2, may reveal molecular mechanisms associated with COVID-19 development and severity in lung cancer patients. Here, we integrated transcriptome data of lung tumors from patients with small- or non-small cell lung cancer (SCLC and NSCLC) and normal lung and lung cancer cells infected with SARS-CoV-2. We aimed to characterize molecular mechanisms potentially associated with COVID-19 development and severity in lung cancer patients and to predict the SARS-CoV-2-host cell interactome. We found that the gene expression profiles of lung cell lines infected with SARS-CoV-2 resemble more primary lung tumors than non-malignant lung tissues. In addition, the transcriptomic-based interactome analysis of SCLC and NSCLC revealed increased expression of cancer genes BRCA1 and CENPF, whose proteins are known or predicted to interact with the SARS-CoV-2 spike glycoprotein and helicase, respectively. We also found that TRIB3, a gene coding a putative host-SARS-CoV-2 interacting protein associated with COVID-19 infection, is co-expressed with the up-regulated genes MTHFD2, ADM2, and GPT2 in all tested conditions. Our analysis identified biological processes such as amino acid metabolism and angiogenesis and 22 host mediators of SARS-CoV-2 infection and replication that may contribute to the development and severity of COVID-19 in lung cancers.

Mental health and social protection of children during times of crisis: The case of the COVID-19 pandemic

Background: Children and adolescents have been silent victims during global crisis periods. In recent decades, a worldwide discussion has been developed to include health, education, social protection, housing, food, healthy coexistence, and participation, among others, as rights on a global agenda and consolidate children's and adolescents' rights. The world is still experiencing the COVID-19 outbreak, which has been considered one of the greatest crises of humanity, with repercussions throughout the complex of social life. Children and adolescents seem to be most affected by the synergistic effects of this pandemic, with evidence of increased mental health problems, abuse, violence, and other forms of violation of their rights. Objective: This article discusses care strategies based on articulated and coordinated actions between social protection systems that include mental health services. Method: A narrative review of the literature on the Scopus platform was carried out during the beginning of the COVID-19 pandemic in 2020. At that time, many organizations pointed out the impact of the pandemic on children's mental health and the challenges for social protection systems. Therefore, we sought to capture this moment through a narrative literature review to identify the experiences of other health crises and what could be done at that moment. From this review, we drew analytical categories to develop a recommendation guide that can be used to improve social protection systems for children and adolescents. Results: The analyses suggested that the protection systems must develop different social policies and care plans for children and adolescents during the humanitarian crisis that must include mental health actions and guarantee their rights. Conclusion: Based on our reflections, we developed a guide of recommendations that governments could adopt to improve their response to children during the post-pandemic future or in other times of crisis.

Assessing the Impact of SARS-CoV-2 on Water Consumption in São Paulo State, Brazil

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2020 led to a significant change in human behaviors, mainly because of the quarantine to avoid the spread of the virus. Measures affected both economic activities and citizens' behaviors as they developed more intense hygiene habits to avoid contamination and switched to home offices. These exceptional behaviors also affected the way that water is consumed and need to be fully understood to manage supply systems. Therefore, this study aims to investigate changes in residential and commercial water consumption in 31 municipalities in the state of São Paulo, Brazil, during SARS-CoV-2. To do this, the expected consumption for the first half of 2020 was forecasted using the Holt-Winters multiplicative method and compared with the data observed for the same period. In addition, we compared monthly records of new contaminations and the social distancing index to establish a correlation with changes in water consumption. The results show an average difference between forecasted and observed consumption equal to +6.23% and -18.59% for residential and commercial activities, respectively. For the first one, the consumption per capita increased at the rate of 8.44 L.person-1.day-1. The observed changes in consumption seem to be a consequence of hygiene habits, social distancing and the closing of nonessential services in commerce. © 2022 American Society of Civil Engineers.

USING MACHINE LEARNING TECHNIQUES TO SUPPORT THE EMERGENCY DEPARTMENT

This research lays down foundations for a stronger presence of machine learning in the emergency department. Using machine learning to make predictions on a patient???s situation can increase patient???s health and decrease the waiting time. This paper explores to what extent it is possible to accurately predict ER outcome. These predictions will be based on routinely available ER data from a Dutch hospital. The data set used is representative for any Dutch Hospital. Prediction performance is compared between ML predictors. Using random forest and stacked ensemble gathered the best results. This research found that for more than half of the adult patients, the algorithm can very accurately predict hospitalization, with similar results for children and during the COVID-19. Moreover, it is investigated which characteristics and events contribute to the direction of the patient. Finally, several plans are introduced to substantially improve the ER process, for example by quickly reviewing patients selected by the algorithms. These might lead to an ER process that is significantly quicker, with more accurate diagnosis.

Particle Size, Mass Concentration, and Microbiota in Dental Aerosols.

Many dental procedures are considered aerosol-generating procedures that may put the dental operator and patients at risk for cross-infection due to contamination from nasal secretions and saliva. This aerosol, depending on the size of the particles, may stay suspended in the air for hours. The primary objective of the study was to characterize the size and concentrations of particles emitted from 7 different dental procedures, as well as estimate the contribution of the nasal and salivary fluids of the patient to the microbiota in the emitted bioaerosol. This cross-sectional study was conducted in an open-concept dental clinic with multiple operators at the same time. Particle size characterization and mass and particle concentrations were done by using 2 direct reading instruments: Dust-Trak DRX (Model 8534) and optical particle sizer (Model 3330). Active bioaerosol sampling was done before and during procedures. Bayesian modeling (SourceTracker2) of long-reads of the 16S ribosomal DNA was used to estimate the contribution of the patients' nasal and salivary fluids to the bioaerosol. Aerosols in most dental procedures were sub-PM1 dominant. Orthodontic debonding and denture adjustment consistently demonstrated more particles in the PM1, PM2.5, PM4, and PM10 ranges. The microbiota in bioaerosol samples were significantly different from saliva and nasal samples in both membership and abundance (P < 0.05) but not different from preoperative ambient air samples. A median of 80.15% of operator exposure was attributable to sources other than the patients' salivary or nasal fluids. Median operator's exposure from patients' fluids ranged from 1.45% to 2.75%. Corridor microbiota showed more patients' nasal bioaerosols than oral bioaerosols. High-volume saliva ejector and saliva ejector were effective in reducing bioaerosol escape. Patient nasal and salivary fluids are minor contributors to the operator's bioaerosol exposure, which has important implications for COVID-19. Control of bioaerosolization of nasal fluids warrants further investigation.

UNVEILING CONTEXTS AND REITERATING PRINCIPLES IN SCHOOL MANAGEMENT IN TOCANTINS IN TIMES OF PANDEMIC

The article addresses the theme of school management in the state of Tocantins, aiming to raise reflection on challenges and lessons learned that stood out in school management in Tocantins during the new Coronavirus pandemic period from 2020 to mid-2021. it bases on a critical perspective using bibliographical and document review. In the pandemic scenario, the school needed to reinvent its, so the management area should guarantee the fundamental means for quality learning. The new challenges made the problems that already existed in education even more difficult. The context of the pandemic revealed challenging scenarios and re-presented lessons/principles that are part of the normative framework, permeated by the dispute of corporate projects. In this field full of provocations, it is possible to understand that the principle of democratic management is one of the mediating elements of an emancipatory education for a democratic society.

Palliative care for patients with cardiovascular disease and COVID-19 in a major referral hospital

Introduction: COVID-19 disease has a wide spectrum of severity, ranging from asymptomatic to severe acute respiratory syndrome. Although the estimated mortality is around 3% in the general population, individuals with comorbidities such as cardiovascular disease (CVD) may develop worse virus-related outcomes and have higher mortality rates. Furthermore, triage systems in pandemics may have low sensitivity to the need for palliative care, leaving many patients without appropriate end-of-life support. Purpose: The aim of this study was to evaluate the palliative care offered to patients with CVD and COVID-19 in a major referral hospital in Brazil. Methods: Descriptive and retrospective study of adult patients with CVD and COVID-19 admitted to a major referral hospital in Brazil. Medical records of patients with CVD and COVID-19 were reviewed. Patients were screened for the need for palliative care through the Supportive and Palliative Care Indicators Tool (SPICT). Pearson's chi-squared tests were performed and p < 0.05 was considered statistically significant. Results: The sample was composed of 526 (53.6%) males and 456 (46.4%) females. Median [IQR] age was 65 [55-73] years old. Regarding department of admission, 194 (19.8%) patients were admitted to the wards, 359 (36.5%) to the emergency room (ER), and 429 (43.7%) to the intensive care unit (ICU). Regarding SPICT criteria, 285 (29%) were at risk of deteriorating and dying. Palliative care was offered to 82 (8.4%) patients. From the patients who met SPICT criteria (n = 285), only 64 (22.5%) had access to palliative care during hospitalization. Patients who received palliative care were more likely to be ≥60 years old, to meet SPICT criteria, and to die (p < 0,001) (Table). Sex and department of admission were not associated with the likelihood of receiving palliative care (Table). Regarding outcomes, 356 patients died (36.3%), 573 were discharged (58.3%), and 53 (5.4%) were transferred to another unit. From the patients who died (n = 356), only 65 (18.3%) had access to palliative care. Conclusions: In our study, there was a high mortality rate in patients with CVD and COVID-19, although a considerable proportion of them did not have access to palliative care before dying. It is important to give further attention to the end-of-life support offered to patients with CVD and COVID-19. (Figure Presented).

Molecular Docking Study of Antibiotics, Anti-Inflammatory Drugs and [Eu(TTA)3·AMX] Complex as COVID-19 Biomarker through Interaction of Its Main Protease (Mpro)

Coronavirus Acute Respiratory Syndrome (SARS-CoV-2) is a very recent viral infection and has generated one of the world's biggest problems of all time. There is no scientific evidence and clinical trials to indicate that possible therapies have shown results in suspected or confirmed patients other than the use of immunizations. Given the above, some substances are being studied to be applied to contain their spread and further damage. This work aims to perform an in silico study of amoxicillin, widely known as an antibiotic and used to prevent bacterial infections and a possible biomarker made from a complex with Europium (Eu). It was shown to have the ability to interact with the COVID-19 protein in Mproprotease as ligands. The study was conducted using the AutoDock Vina with Lamarckian genetic model algorithm (GA) combined with the estimation of grid-based energy in rigid and flexible conformation. Compared to affinity energy, amoxicillin presented â-7.7kcal/mol, which was better than its co-crystallized ligand in the study. The Europium complex, where its synthesis was also demonstrated in this work, presented energy of -6.3kcal/mol with hydrogen bonds and possible color change when UV light was applied. For the choice of the best poses in the simulation, the neural network parameter, NNScore2, was used. It can be affirmed that this study is still introductory but promising both in the treatment and identification of the virus. © 2021 Journal of Computational Biophysics and Chemistry. All Rights Reserved.

Palliative care for 317 cancer patients with COVID-19 in a major public hospital in South America

Background: Cancer patients are at higher risk of developing severe COVID-19 and worse virus-related outcomes. In addition, low- and middle-income countries may be even more impacted by COVID-19, and not offer appropriate end-of-life support to many patients. The aim of this study was to evaluate the palliative care offered to cancer patients with COVID-19 in a major referral hospital in South America. Methods: Descriptive and retrospective study in Hospital das Clínicas, Faculty of Medicine of the University of São Paulo, Brazil. This hospital is considered one of the major referral and public hospitals in South America. Medical records of adult cancer patients admitted for COVID-19 were reviewed. Patients were screened for the need for palliative care through Supportive and Palliative Care Indicators Tool (SPICT). Data was analyzed using Stata 14. Results: The sample was composed of 317 Latino patients, of which 155 (48.9%) were male and 162 (51.1%) were female. Median [IQR] age was 68 [56-81] years old. In addition, 119 (37.5%) were admitted to the wards, 110 (34.7%) to the emergency room, and 88 (27.8%) to the intensive care unit. Patients admitted to the wards were more likely to receive palliative care (46.7% vs. 32.9%;p=0.016). A total of 107 (33.7%) patients had access to palliative care. Regarding SPICT criteria, 260 (82.0%) were at risk of deteriorating and dying. Of the patients who met SPICT criteria, 98 (37.7%) had access to palliative care during hospitalization. Regarding outcomes;155 patients (48.9%) died, 128 (40.4%) were discharged, and 34 (10.7%) were transferred to another unit. Of the patients who died, 72 (46.5%) did not have access to palliative care. Conclusions: In our study, there was a high mortality rate in Latino cancer patients with COVID-19, although a considerable percentage of them did not have access to palliative care before dying. It is important to give further attention to the end-of-life support offered to cancer patients with COVID-19, especially in underserved communities and among racial/ethnic minorities.

Development and validation of the ABC2-SPH risk score for in-hospital mortality in COVID-19 patients

Introduction: Fast and efficient assessment of prognosis of coronavirus disease 19 (COVID-19) is needed to optimize the allocation of health care and human resources, to empower early identification and intervention of patients at higher risk of poor outcome. A proper assessment tool may guide decision making, to develop an appropriate plan of care for each patient. Although different scores have been proposed, the majority of them are limited due to high risk of bias, and there is a lack of reliable prognostic prediction models. Purpose: To develop and validate an easy applicable rapid scoring system that employs routinely available clinical and laboratory data at hospital presentation, to predict in-hospital mortality in patients with COVID-19, able to discriminate high vs non-high risk patients. Additionally, we aimed to compare this score with other existing ones. Method: Cohort study, conducted in 36 Brazilian hospitals in 17 cities. Consecutive symptomatic patients (≥18 years old) with laboratory confirmed COVID-19 admitted to participating hospitals. Primary outcome was in-hospital mortality. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients that were admitted between March-July, 2020. The model was then validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Results: Median (25th-75th percentile) age of the model-derivation cohort was 60 (48-72) years, 53.8% were men, in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. From 20 potential predictors, seven significant variables were included in the in-hospital mortality risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859) and Spanish (0.899) validation cohorts. Our ABC2-SPH score showed good calibration in both Brazilian cohorts, but, in the Spanish cohort, mortality was somewhat underestimated in patients with very high (>25%) risk. The ABC2- SPH score is implemented in a freely available online risk calculator. Conclusions: We designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Background: Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose: To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARSCoV- 2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. (Figure Presented).