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Short-range exposure to expired aerosols or droplet nuclei has been considered as the predominant route for SARS-CoV-2. The observed effect of mask wearing, and social distancing suggests the importance of expired jet in the spread of COVID-19. The well-known steady-state dilution model is no longer valid for the interrupted expiratory jet. We reanalysed the existing interrupted jet data and proposed a simple dilution model of expired jet using the two-stage jet model. The interrupted jet consists of two stages, i.e., the jet-like and puff-like stage. Results show dilution factor grows linearly with the distance at the jet-like stage but increases with the cubic of the increasing distance in the puff-like stage. Dilution factor at any distance for the puff-like stage decreases as the activity intensifies, which is still much larger than that estimated via the steady jet model. The findings can be further applied into the short-range airborne exposure assessment. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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To find out the circumstances under which airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) would happen, we conducted mechanistic and systematic modelling of two Coronavirus disease 2019 (COVID-19) outbreaks, i.e., Hunan 2-bus outbreak and Luk Chuen House outbreak (the horizontal cluster). Computational fluid dynamics (CFD) simulations, multi-zone airflow modelling, multi-route mechanistic modelling, and dose-response estimation were carried out selectively according to the transmission characteristics in each outbreak. Our results revealed that poorly ventilated bus indoor environments bred the Hunan 2-bus outbreak in which airborne transmission predominates;prevailing easterly background wind and probable door opening behaviour led to the secondary infections across the corridor in Luk Chuen House outbreak. Measures to facilitate sufficient ventilation indoors and positive pressure in the housing building corridor may help minimise infection risk. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.
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Objective This study aimed to examine the epidemic characteristics of the COVID-19 imported cases entering mainland China from March 4, 2020 to October 31, 2021, so as to provide the reference for the prevention and control of imported epidemic at present. Methods Data were collected from the Daily Summary on the COVID-19 epidemic issued by the national/provincial health commission official website from March 4, 2020 to October 31, 2021, including " number of imported cases and existing imported cases and source country/territory and destination province for imported cases. Joinpoint regression was used to examine the time trends in the number of imported cases over time. Results From March 4, 2020 to November 3, 2021, the number of monthly newly imported cases and existing confirmed cases changed as a " W” shape. The imported cases came from 152 counties and territories in total, mainly from Myanmar, United States, Philippines and Russia (accounting for 27.6% of all imported cases). The number of imported cases mainly entered Shanghai, Guangdong, Yunnan, Sichuan, and Fujian, explaining 70.59% of total imported cases. Conclusions The great fluctuating change of imported cases in the mainland of China may be related to the change of global COVID-19 epidemic and domestic prevention and control policies. Considering the imbalanced distribution of source country/territory and destination province of imported cases, the government should take targeted measures in important source countries/terriories and destination provinces. Each province and municipality should modify its policy for preventing the imported epidemic dynamically according to the latest characteristic of source country/territory and virus mutation. © 2023, Publication Centre of Anhui Medical University. All rights reserved.
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Objective: To investigate the emergency surgical strategies for patients with acute abdomen during the Corona Virus Disease 2019 (COVID-19) outbreak. Method(s): The retrospective and descriptive study was conducted. The clinical data of 20 patients with acute abdomen who were admitted to the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 18, 2020 and February 10, 2020 were collected. There were 13 males and 7 females, aged from 25 to 82 years, with an average age of 57 years. All the patients with emergency surgeries received pulmonary computed tomography (CT) examination before surgery, and completed nucleic acid detection in throat swab if necessary. Patients excluded from COVID-19 underwent regular anesthesia, suspected and confirmed cases were selected a proper anesthesia based on their medical condition and surgical procedure. Patients excluded from COVID-19 underwent emergency surgeries following the regular procedure, suspected and confirmed cases underwent emergency surgeries following the three-grade protection. Observation indicators: (1) surgical situations;(2) postoperative situations. Measurement data with normal distribution were represented as average (range). Count data were described as absolute numbers. Result(s): (1) Surgical situations: of the 20 patients with acute abdomen, 16 patients were excluded from COVID-19, and 4 were not excluded. All the 20 patients underwent emergency abdominal surgeries successfully, of whom 2 received surgeries under epidural anesthesia (including 1 with open appendectomy, 1 with open repair of duodenal bulbar perforation), 18 received surgeries under general anesthesia (including 9 with laparoscopic repair of duodenal bulbar perforation, 3 with open partial enterectomy, 3 with laparoscopic appendectomy, 1 with laparoscopic left hemicolectomy, 1 with laparoscopic right hemicolectomy, 1 with cholecystostomy). The operation time of patients was 32-194 minutes, with an average time of 85 minutes. The volume of intraoperative blood loss was 50-400 mL, with an average volume of 68 mL. (2) Postoperative situations: 16 patients excluded from COVID-19 preopratively were treated in the private general ward postoperatively. One of the 16 patients had fever at the postoperative 5th day and was highly suspected of COVID-19 after an emergency follow-up of pulmonary CT showing multiple ground-glass changes in the lungs. The patient was promptly transferred to the isolation ward for treatment, and results of nucleic acid detection in throat swab showed double positive. Medical history described by the patient showed that the patient and family members were residents of Wuhan who were not isolated at home during the epidemic. There was no way to confirm whether they had a history of exposure to patients with COVID-19. Medical staffs involved in this case did not show COVID-19 related symptoms during 14 days of medical observation. The other 15 patients recovered well postoperatively. The 4 patients who were not excluded from COVID-19 preoperatively based on medical history and results of pulmonary CT examination were directly transferred to the isolation ward for treatment postoperatively. They were excluded from COVID-19 for two consecutive negative results of nucleic acid detection in the throat swab and recovered well. Two of the 20 patients with acute abdomen had postoperative complications. One had surgical incision infection and recovered after secondary closure following opening incision, sterilizing and dressing, the other one had intestinal leakage and was improved after conservative treatment by abdominal drainage. There was no death in the 20 patients with acute abdomen. Conclusion(s): Patients with acute abdomen need to be screened through emergency forward. Patients excluded from COVID-19 undergo emergency surgeries following the regular procedure, and patients not excluded from COVID-19 undergo emergency surgeries following the three-grade protection. The temperature, blood routine test and other l boratory examinations are performed to monitor patients after operation, and the pulmonary CT and throat nucleic acid tests should be conducted if necessary. Patients excluded from COVID-19 preopratively are treated in the private general ward postoperatively, and they should be promptly transferred to the isolation ward for treatment after being confirmed. Patients who are not excluded from COVID-19 preoperatively based on medical history should be directly transferred to the isolation ward for treatment postoperatively.Copyright © 2020 by the Chinese Medical Association.
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Objective: To investigate the emergency surgical strategies for patients with acute abdomen during the Corona Virus Disease 2019 (COVID-19) outbreak. Method(s): The retrospective and descriptive study was conducted. The clinical data of 20 patients with acute abdomen who were admitted to the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 18, 2020 and February 10, 2020 were collected. There were 13 males and 7 females, aged from 25 to 82 years, with an average age of 57 years. All the patients with emergency surgeries received pulmonary computed tomography (CT) examination before surgery, and completed nucleic acid detection in throat swab if necessary. Patients excluded from COVID-19 underwent regular anesthesia, suspected and confirmed cases were selected a proper anesthesia based on their medical condition and surgical procedure. Patients excluded from COVID-19 underwent emergency surgeries following the regular procedure, suspected and confirmed cases underwent emergency surgeries following the three-grade protection. Observation indicators: (1) surgical situations;(2) postoperative situations. Measurement data with normal distribution were represented as average (range). Count data were described as absolute numbers. Result(s): (1) Surgical situations: of the 20 patients with acute abdomen, 16 patients were excluded from COVID-19, and 4 were not excluded. All the 20 patients underwent emergency abdominal surgeries successfully, of whom 2 received surgeries under epidural anesthesia (including 1 with open appendectomy, 1 with open repair of duodenal bulbar perforation), 18 received surgeries under general anesthesia (including 9 with laparoscopic repair of duodenal bulbar perforation, 3 with open partial enterectomy, 3 with laparoscopic appendectomy, 1 with laparoscopic left hemicolectomy, 1 with laparoscopic right hemicolectomy, 1 with cholecystostomy). The operation time of patients was 32-194 minutes, with an average time of 85 minutes. The volume of intraoperative blood loss was 50-400 mL, with an average volume of 68 mL. (2) Postoperative situations: 16 patients excluded from COVID-19 preopratively were treated in the private general ward postoperatively. One of the 16 patients had fever at the postoperative 5th day and was highly suspected of COVID-19 after an emergency follow-up of pulmonary CT showing multiple ground-glass changes in the lungs. The patient was promptly transferred to the isolation ward for treatment, and results of nucleic acid detection in throat swab showed double positive. Medical history described by the patient showed that the patient and family members were residents of Wuhan who were not isolated at home during the epidemic. There was no way to confirm whether they had a history of exposure to patients with COVID-19. Medical staffs involved in this case did not show COVID-19 related symptoms during 14 days of medical observation. The other 15 patients recovered well postoperatively. The 4 patients who were not excluded from COVID-19 preoperatively based on medical history and results of pulmonary CT examination were directly transferred to the isolation ward for treatment postoperatively. They were excluded from COVID-19 for two consecutive negative results of nucleic acid detection in the throat swab and recovered well. Two of the 20 patients with acute abdomen had postoperative complications. One had surgical incision infection and recovered after secondary closure following opening incision, sterilizing and dressing, the other one had intestinal leakage and was improved after conservative treatment by abdominal drainage. There was no death in the 20 patients with acute abdomen. Conclusion(s): Patients with acute abdomen need to be screened through emergency forward. Patients excluded from COVID-19 undergo emergency surgeries following the regular procedure, and patients not excluded from COVID-19 undergo emergency surgeries following the three-grade protection. The temperature, blood routine test and other l boratory examinations are performed to monitor patients after operation, and the pulmonary CT and throat nucleic acid tests should be conducted if necessary. Patients excluded from COVID-19 preopratively are treated in the private general ward postoperatively, and they should be promptly transferred to the isolation ward for treatment after being confirmed. Patients who are not excluded from COVID-19 preoperatively based on medical history should be directly transferred to the isolation ward for treatment postoperatively.Copyright © 2020 by the Chinese Medical Association.
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Social distance monitoring is of great significance for public health in the era of COVID-19 pandemic. However, existing monitoring methods cannot effectively detect social distance in terms of efficiency, accuracy, and robustness. In this paper, we proposed a social distance monitoring method based on an improved YOLOv4 algorithm. Specifically, our method constructs and pre-processes a dataset. Afterwards, our method screens the valid samples and improves the K-means clustering algorithm based on the IoU distance. Then, our method detects the target pedestrians using a trained improved YOLOv4 algorithm and gets the pedestrian target detection frame location information. Finally, our method defines the observation depth parameters, generates the 3D feature space, and clusters the offending aggregation groups based on the L2 parametric distance to finally realize the pedestrian social distance monitoring of 2D video. Experiments show that the proposed social distance monitoring method based on improved YOLOv4 can accurately detect pedestrian target locations in video images, where the pre-processing operation and improved K-means algorithm can improve the pedestrian target detection accuracy. Our method can cluster the offending groups without going through calibration mapping transformation to realize the pedestrian social distance monitoring of 2D videos. © 2023 World Scientific Publishing Company.
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Objective This study aimed to examine the epidemic characteristics of the COVID-19 imported cases entering mainland China from March 4, 2020 to October 31, 2021, so as to provide the reference for the prevention and control of imported epidemic at present. Methods Data were collected from the Daily Summary on the COVID-19 epidemic issued by the national/provincial health commission official website from March 4, 2020 to October 31, 2021, including " number of imported cases and existing imported cases and source country/territory and destination province for imported cases. Joinpoint regression was used to examine the time trends in the number of imported cases over time. Results From March 4, 2020 to November 3, 2021, the number of monthly newly imported cases and existing confirmed cases changed as a " W" shape. The imported cases came from 152 counties and territories in total, mainly from Myanmar, United States, Philippines and Russia (accounting for 27.6% of all imported cases). The number of imported cases mainly entered Shanghai, Guangdong, Yunnan, Sichuan, and Fujian, explaining 70.59% of total imported cases. Conclusions The great fluctuating change of imported cases in the mainland of China may be related to the change of global COVID-19 epidemic and domestic prevention and control policies. Considering the imbalanced distribution of source country/territory and destination province of imported cases, the government should take targeted measures in important source countries/terriories and destination provinces. Each province and municipality should modify its policy for preventing the imported epidemic dynamically according to the latest characteristic of source country/territory and virus mutation.Copyright © 2023, Publication Centre of Anhui Medical University. All rights reserved.
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In testing hypotheses pertaining to Lorenz dominance (LD), researchers have examined second- and third-order stochastic dominance using empirical Lorenz processes and integrated stochastic processes with the aid of bootstrap analysis. Among these topics, analysis of third-order stochastic dominance (TSD) based on the notion of risk aversion has been examined using crossing (generalized) Lorenz curves. These facts motivated the present study to characterize distribution pairs displaying the TSD without second-order (generalized Lorenz) dominance. It further motivated the development of likelihood ratio (LR) goodness-of-fit tests for examining the respective hypotheses of the LD, crossing (generalized) Lorenz curves, and TSD through approximate Chi-squared distributions. The proposed LR tests were assessed using simulated distributions, and applied to examine the COVID-19 regional death counts of bivariate samples collected by the World Health Organization between March 2020 and February 2021.
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Introduction: While the negative consequences of insomnia are welldocumented, a strengths-based understanding of how sleep can promote health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience;however, this relationship has not yet been experimentally tested. This talk will examine resilience as an ingredient and outcome of insomnia treatment Methods: Participants were randomized to either digital Cognitive Behavioral Therapy for insomnia (dCBT-I;n = 358) or sleep education control (n = 300), and assessed at pre-treatment, post-treatment, and one-year follow-up. Change in self-reported resilience was tested across the time points, and also examined as a mechanism driving insomnia and depression as outcomes. A follow-up study during the COVID-19 pandemic further examined the protective effect of dCBT-I. Result(s): DCBT-I resulted in greater improvements in resilience compared to the sleep education control. The improved resilience was a significant mediator of reduced insomnia and depression severity following treatment. Furthermore, improved resilience following dCBT-I also reduced insomnia and depression at one-year follow-up by lowering latent risk. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression one year later by 76% and 65% respectively. Finally, those who previously received dCBT-I demonstrated greater resilience via protection from insomnia, depression, and COVID-19 specific stress. Conclusion(s): Improved resilience is a contributing mechanism to treatment gains following dCBT-I and may further protect against longer-term insomnia and depression by reducing risk.
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Background: Several studies have demonstrated immunogenicity after COVID-19 vaccination in patients with autoimmune rheumatic diseases (AIRD) [1], but the differences between mRNA-based and vector vaccines and the cellular responses to COVID-19 vaccines according to distinct immunogenicity in AIRD patients are still unclear. Objectives: To investigate the differences in efficacy and safety between the vector vaccine ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca) and mRNA-based vaccine mRNA-1273 (Moderna) in patients with AIRD, and to explore the cell-cell interactions between high and low anti-SARS-CoV-2 IgG levels in patients with rheumatic arthritis (RA) by single-cell RNA sequencing (scRNA-seq). Methods: From September 16 to November 15, 2021, we consecutively enrolled 243 participants aged ≥20 years with AIRD who received COVID-19 vaccination, of whom 113 were immunized with AZD1222 and 130 with mRNA-1273. The level of serum IgG antibodies to the SARS-CoV-2 receptor-binding domain on the spike protein S1 subunit was quantifed by electrochemiluminescence immuno-assay at 4-6 weeks after vaccination. Moreover, peripheral blood mononuclear cells were isolated from two RA patient with high anti-SARS-CoV-2 IgG level and four RA patients with low level for scRNA-seq and cell-cell communication signal was analyzed by CellChat. Results: The anti-SARS-CoV-2 IgG seropositivity rate was 78.8% (89/113) for AZD1222 and 83.1% (108/130) for mRNA-1273. The level of anti-SARS-CoV-2 IgG was higher in patients who received mRNA-1273 than in those who received AZD1222 (β: 30.15, 95% CI: 11.67-48.63, p=0.002) (Table 1). Prednisolone-equivalent dose >5 mg/day and methotrexate (MTX) use in AIRD patients, and non-anti-tumor necrosis factor (TNF)-α biologics and Janus kinase (JAK) inhibitor use in RA patients were associated with inferior immunogenicity. ScRNA-seq revealed CD16-monocytes were predominant in RA patients with high anti-SARS-CoV2-IgG antibody level, and enriched pathways related to antigen presentation via major histocompatibility complex class II (MHC class II) were found (Figure 1). HLA-DRA and CD4 interaction was vigorous among all identifed MHC-II pathway and was enhanced in high anti-SARS-CoV2-IgG antibody group. Conclusion: mRNA-1273 and AZD1222 vaccines exhibited differential immunogenicity in patients with AIRD. Enriched pathways related to antigen presentation via MHC class II in CD16-monocytes might be associated with higher anti-SARS-CoV2-IgG level in RA patients and further study is warranted.
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Background: COVID-19 is caused by infection with a new form of coronavirus (SARS-CoV-2). The WHO raised the COVID-19 alert to the highest level. The virus is a highly contagious via human-to-human transmission. The median duration of viral shedding is 20.0 days. We report a long duration of viral shedding that was 32.0 days from illness onset in a patient with moderate COVID-19 admitted to Qianjiang Central Hospital. Case report: A 37-year-old patient sought medical advice while suffering from fever, dry cough, fatigue, dizziness, runny nose and diarrhoea. Five days before the visit, he had a history of travel from affected geographic areas. The patient had a positive RT-PCR test, and chest CT images showed multiple nodules and mixed ground-glass opacification with consolidation in bilaterally in the lungs. Laboratory findings showed that the lymphocyte and CD4+ counts were below the normal range. The patient was given antiviral treatment, including arbidol, lopinavir, IFN-α, and traditional Chinese medicine, and other necessary supportive care. All clinical symptoms and CT imaging manifestation ab-normalities resolved during the course of therapy. Conclusion: Although the positive RT-PCR tests were verified in consecutive upper respiratory specimens, the patient’s clinical symptoms, CT imaging findings, CD4+ lymphocyte counts, and IgG antibody levels had obviously improved. Positive tests may be detecting pieces of inactive viruses, which would not be transmissible in individual cases.
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Introduction: The 2019 coronavirus disease (COVID-19) pandemic is a protracted stressor with far-reaching effects on daily life. Although most individuals exhibit resilience in the wake of adversity, it is not clear which characteristics reliably predict resilience versus longstanding distress. It is vital to delineate predictors of pandemic-related distress to highlight modifiable risk factors that can be targeted to enhance psychological resilience. Sleep reactivity may be an important predictor of pandemic reactions because it reflects a vulnerability to experience pronounced sleep disturbances in response to stress, which serve as barriers to healthy adjustment to adversity. Therefore, this study tested sleep reactivity as a prospective predictor of pandemic-related distress. Methods: Participants were recruited from a previous randomized controlled trial (RCT) comparing self-guided digital CBT-I against a sleep education control in treating insomnia and preventing depression. Participants in the RCT were enrolled between 2016-2017 and were eligible for this follow-up study conducted between April and May 2020 (N = 208;dCBT-I: n = 102;control: n = 106). Pre-treatment sleep reactivity was measured in 2016-2017 (T1) using the Ford Insomnia Response to Stress Test (FIRST). COVID-19 distress was measured in April 2020 (T2) using the Impact of Events Scale (IES) and Quick Inventory of Depressive Symptomatology (QIDS). All analyses controlled for treatment condition and COVID-19 impact. Results: T1 FIRST predicted T2 IES (b = 0.29, + 0.14 SE, p < .05) and QIDS (b = 0.16, + 0.04 SE, p < .001), such that higher sleep reactivity pre-pandemic predicted more severe stress responses and depressive symptoms during the pandemic 3-4 years later. Exploratory analyses revealed T1 FIRST was a predictor of the IES subscales arousal and intrusions (bs = 0.02, + 0.01 SEs, ps < .05), but not avoidance. Conclusion: These findings build on evidence that sleep reactivity prospectively predicts reactions to trauma and demonstrate its predictive utility generalizes to pandemic responses. Sleep reactivity is a modifiable risk factor that may be targeted using cognitivebehavioral or mindfulness-based approaches, and thus may offer a new pathway to resilience.
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This study investigated the effects of integrating the “CloudClassRoom” (CCR) and the DEmo-CO-design/teach-feedback-DEbriefing (DECODE) model to improve pre-service teachers’ online technological pedagogical and content knowledge (TPACK). The DECODE model includes four stages: Teacher’s DEmonstrations, Students CO-train in using CloudClassRoom, Students CO-design a CloudClassRoom-integrated course, Students CO-teach, and finally DE-brief what they have learned through the stages mentioned above. This model integrates teacher-student experiences, teaching-learning processes, and technology-embedded systems to promote collaborative and active learning, information and resources sharing, and creative communication. A self-evaluating questionnaire with open-ended questions evaluated participants’ technological pedagogical and content knowledge outcomes. CloudClassRoom significantly increases technology-related knowledge considering the current social distancing measures provoked by COVID-19. The findings show that DECODE with CloudClassRoom provides an integrated process for improving pre-service teachers’ technological pedagogical and content knowledge, assisting pre-service teachers in designing educational technology-integrated courses. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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Introduction: The current Joint Commission recommendation for door to skin puncture is less than 60 minutes for transfer cases. It is imperative that no time is lost in moving these patients safely through the Emergency Department (ED) to the Interventional Radiology (IR) Suite. The goal of this study was to assess if a rapid, 11-step nursing driven checklist could decrease time spent in the ED and subsequently improve our thrombectomy times in transfer patients. Methods: We developed the following 11 steps: (1) ED staff is notified of incoming ED Pause transfer. (2) ED receives report from sending facility RN. (3) Register the patient upon arrival.(4) Activate EMS Stroke alert. (5) Verify patient's identity using two patient identifiers, apply wristband. (6) Vital signs (to ensure no decompensation en route), connect patient to the transport monitor. (7) Chart weight in the system. (8) Confirm two working IVs. (9) Confirm negative Covid test or send a rapid if a negative Covid test cannot be confirmed. (10) Ensure the patient is undressed and ready to go to IR. (11) Confirm the 'admit to inpatient' order is placed. ED staff were educated and checklists were posted in the ambulance bay and nurses' station. Data were reviewed pre- (April 2019 to March 2020) and post- (April 2020 to March2021) implementation to assess the percentage of patients captured by the tool and its impaction thrombectomy times. Data were analyzed using a t-test. Results: There were 25 patients transferred in the post vs 16 in the pre-implementation group. The median door to skin puncture (DTS) (post: 37 mins {IQR 31-43} vs. pre: 50 mins {IQR 47- 71}p=0.045), door to device deployed (post: 52 mins {IQR 45-65} vs. pre: 70 mins {IQR 65- 94}p=0.037), and door to recanalization (post: 71 mins {IQR 54-102} vs. pre: 99 mins {IQR 70- 118}p=0.043) times decreased in the post implementation group. Conclusion: A nursing driven ED checklist is a successful tool in decreasing thrombectomy times in transfer patients.
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There are around 300 night markets in Taiwan, and they have been drawing an increasing number of tourists in recent years. As a result, public awareness over air quality in the night markets has grown tremendously. In response to this, a specific night market in Kaohsiung City was chosen for this study in order to characterize the existing air quality in and around the night markets. In this present study, we employed an Industrial Source Complex Short-Term (ISCST3) air quality model for the simulation of PM2.5 diffusions. The model as a technique can simulate the pollutants emissions, diffusions, transportation, and pollution sources in specific areas and subsequently evaluate the influence between the source and the receiver. Therefore, we compared pollutants emissions data from several air quality monitoring stations with our sampling data of three different sampling sites in Kaohsiung City. The findings of this study showed that the average concentration of PM2.5 was in the range of 29-61 mu g m(-3) during opening hours of the night market, whereas the average concentration of PM2.5 range was between 22-38 mu g m(-3) before the night market opening hours. The concentration of metallic elements (ME) (Mg, Na, Cr, Mn, Fe, Cu, Al, Ba, Cd, Pb and Ca) was determined with the support of Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES). During the night market opening hours, the result disclosed that the ME concentrations in PM2.5 was in an increasing order as follows: Na > Fe > Al > Ca. With respect to the concentration of carbonaceous species, our results showed that the highest total carbon (TC) concentration was found to be 6.52 mu g m(-3) during the downwind sampling interval. The highest elemental carbon (EC) and organic carbon (OC) concentration were found to be 6.53 mu g m(-3) and 2.70 mu g m(-3) of the PM2.5 concentration, respectively. This study's findings have significant consequences for Taiwan policymakers and urban planners, particularly those responsible for coordinating environmental protection and economic development in cities. Therefore, policy actions to abate urban air pollution can be attained on diverse governing echelons, resulting in synergistic effects such as a reduction in climate change impacts.
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Introduction Microcatheter exchange increases the risks of intracranial angioplasty and stenting using the Wingspan/Gateway system and may have contributed to the high procedural risks in the SAMMPRIS trial. We present a case series of direct stent deployment through the balloon catheter, simplifying the technique of intracranial angioplasty and stenting using self-expanding stents. Materials and Methods We retrospectively reviewed all patients who underwent stenting for intracranial stenosis with deployment of the Neuroform Atlas stent through the Gateway balloon in our hospital system since this technique was first utilized in October 2020. Procedural success, complication rate, short term clinical and imaging follow-up were assessed. Results Ten Neuroform Atlas stents were deployed through either the Gateway or Emerge balloon catheter in eight patients. The median age was 59 (range 30-75) and 50% were female. All patients had symptomatic severe intracranial stenosis with mean stenosis of 83% (range 70% to 90%). Six patients had recurrent strokes and had failed medical therapy, while two patients presented with acute stroke symptoms and were treated emergently. Mean post-stenting stenosis was 32% (range 0% to 50%). Two procedures were performed under conscious sedation and the rest under general anesthesia. Four stents were placed in the supraclinoid internal carotid artery (ICA), one in the middle cerebral artery M1, two in M2, two in the basilar artery and one in the intracranial vertebral artery. All five patients who underwent short-term follow-up angiograms (mean interval 1.2 months) had further improvement of residual stenosis. There were no ischemic or hemorrhagic periprocedural complications. None of the patients had recurrent TIAs or strokes. One patient died of a COVID-19 infection. One patient had transient neurological deterioration at four months due to profound hypoglycemia. Conclusion Deploying self-expanding stents through an angioplasty balloon catheter is feasible, safe, and can greatly simplify the procedure. The Neuroform Atlas stent is strong enough to prevent immediate recoil of intracranial stenosis after angioplasty.
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IMPORTANCE: In December 2019, an infectious disease caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) emerged. There remains limited information regarding the epidemiology and clinical features of pediatric patients affected by COVID-19, particularly in the pulmonary sub-population. OBJECTIVE: Describe the clinical course of pediatric pulmonary patients with COVID-19 throughout the initial wave of infection at a single pediatric center. METHODS: Retrospective chart review was conducted on 1,350 patients, ≤ 35 years who tested positive for SARS-CoV-2 infection between March 1 and August 31, 2020. Patients followed by our pulmonary group, and evaluated at least once in the three years preceding study completion, were identified for additional chart review. Demographics, pulmonary diagnoses, co-morbidities, presenting symptoms, clinical course and management were collected for analysis. RESULTS: 70 pulmonary patients (mean age 8.3 years, range 8 months to 23 years;45% male;44% Black of African American;29% Hispanic or Latino) were identified from 1,350 patients who tested positive for COVID-19 via nasopharyngeal PCR testing through our hospital system. Most frequently reported symptoms were fever (49%), cough (49%), and nasal congestion (29%). Thirteen patients (19%, mean age 9.2 years, range 12 months to 18 years) required inpatient treatment for symptoms related to SARS-CoV-2 infection, one asymptomatic patient tested positive while admitted. Most common pulmonary diagnoses of those requiring admission were asthma (57%), prematurity (29%), sleepdisordered breathing (29%), and respiratory disorders with positive pressure requirement (29%). For those requiring inpatient care, extra-pulmonary co-morbidities included chronic neurological disorders (71%), gastrointestinal disease (43%), and allergic rhinitis (36%). Disease severity was defined as asymptomatic (17%), mild (67%), moderate (6%), severe (6%), or critical (3%). Mild disease was defined as cases managed outpatient or those admitted for observation and supportive care;moderate as those admitted for medical intervention or respiratory support via supplemental oxygen or high-flow nasal cannula;severe as those who received noninvasive ventilation or an increase in baseline respiratory support;critical were patients who received mechanical ventilation. Inpatient complications associated with SARS-CoV-2 included superinfection, thrombosis, refractory hypoxemia and tracheostomy placement. Seven experienced complications and required intensive care unit services;two required tracheostomy. No deaths were reported. CONCLUSIONS: Patients followed by our pediatric pulmonary group presented with similar symptoms compared to the general pediatric population. The majority of our patients were managed outpatient, however the rate of hospitalization was higher than those of the general pediatric population in existing studies. Of those admitted, few required invasive mechanical ventilation.
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Introduction: The COVID-19 pandemic presents obstacles to time sensitive emergencies, such as stroke care. In acute strokes, knowing the COVID-19 status may help to preserve personal protective equipment (PPE) in patients in whom a thrombectomy may be indicated and helps to decrease unnecessary exposure. This study aims to demonstrate that rapid evaluation of a patient's COVID-19 status is feasible without delaying treatment times. Methods: An intradisciplinary team was convened to create a workflow for rapid COVID-19 testing. The Abbott Rapid® COVID-19 swab kit and assay were stocked in the ED Pyxis, utilizing the narcotic count feature to ensure all swabs were accounted. Upon activation of Code Stroke, the ED RN donned PPE and swabbed the patient's naso-oral pharynx. The collected swab was labeled, placed in a bio-hazard bag, sanitized and handed to a second RN outside of the room. The specimen was taken to a pre-alerted lab technician who prepped the assay after hearing the code stroke. After specimen collection, the patient followed the normal code stroke pathway and was taken to the CT scanner. Metrics were analyzed for the pre COVID-19 (January through April) and during active COVID-19 (May through July) periods. Results: There were 136 code strokes from January thru July 2020. 81 were during pre-COVID vs. 55 during active-COVID. 47 of 55 (96%) were swabbed, 2 (4%) of whom were positive. There was no difference between pre-COVID and active-COVID door to CT initiated time (16 mins [IQR 13-24] vs. 22 mins [IQR 13-25] p=0.75), door to CT resulted time (21 mins [IQR 15-26]) vs. 23 mins [IQR 16-29] p=0.63). 18 patients received tPA pre-COVID and 5 during active-COVID with no difference in DTN (pre: 37.5 mins [IQR 30-43] vs. active: 28 mins {IQR 26-41] p=0.37). Door to CT initiated was faster for those who had their COVID swab performed pre-CT (14 mins [IQR 11.5-16.5] p=0.034) vs. post-CT (20 mins [IQR 17-28]). Likewise, door to CT resulted was also faster pre-CT: 24 mins [IQR 19-32] vs. post-CT: 17 mins [IQR 15-23] (p=0.04). Conclusion: The COVID-19 rapid swab code stroke process was feasible and did not delay treatment times.