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Just prior to the COVID-19 pandemic, it was argued that studies of EMI university lectures had mostly addressed face-to-face settings and that more research needed to be done on EMI in online settings. At the start of the pandemic, universities all over the world scrambled to deliver teaching using digital technologies, offering a range of synchronous and asynchronous solutions. This article focuses on input in online EMI teaching during the pandemic and aims to identify and describe its salient features. The research uses mixed methods to investigate this topic, triangulating data from questionnaires sent out to lecturers, recordings of video lectures, and interviews with lecturers. The interviews use stimulated recall, or retrospective interview, in which respondents verbalise their thoughts about a task after carrying it out. The lectures were of the synchronous videoconferencing lecture variety, in which instruction occurs in real time. The study has implications for online EMI teaching well beyond the pandemic, given that blended learning models are increasingly adopted in higher education and EMI lecturers are concerned with how to make their lecturing more effective. The shift online has disrupted the kinds of face-to-face input ensembles that are possible, but led to the establishment of others. © 2023 selection and editorial matter, Francesca Costa and Cristina Mariotti;individual chapters, the contributors.
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Aim: To evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care unit of Coimbra Hospital and University Centre (CHUC), Portugal, and to assess factors associated with NIPPV failure. Method(s): Patients admitted to the Intermediate Care Unit of CHUC, from December 1st 2020 to February 28th 2021, treated with NIPPV due to confirmed COVID-19 were included. The primary outcome was NIPPV failure (orotracheal intubation (OTI) or death during hospital stay). Factors associated with NIPPV failure were included in an univariate binary logistic regression analysis and those with a significance level of p<0.001 were selected to enter a multivariate regression model. Result(s): 163 patients were included, 64.4% were males (n=105) and the median age was 66 years (IQR 56-75). Overall, 97 patients (59.5%) were successfully treated with NIPPV, while failure was observed in 66 (40.5%), of which 26 (39.4%) were intubated and 40 (60.6%) died during hospital stay. Highest CRP during hospital stay (OR 1.164;95%CI 1.036-1.308) and morphine use (OR 24.771;95%CI 1.809-339.241) were identified as independent predictors in the multivariate logistic model. Adherence to prone positioning (OR 0.109;95%CI 0.017-0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977;95%CI 0.960-0.994) were associated with a favourable outcome. Conclusion(s): Highest CRP and morphine use were independent predictors of OTI or death. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome.
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Introduction: The novel Coronavirus (SARS-CoV-2), responsible for severe acute respiratory syndrome, has emerged as a threat to humans since December 2019, and the search for a better understanding of the pathophysiology of coronavirus disease 2019 (COVID-19) and its definitive treatment is still in progress. Objective(s): To evaluate the plasma pro- and anti-inflammatory cytokines in COVID-19 patients and their associations with the disease severity and outcome. Method(s): Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 unvaccinated patients at the Hospital de Clinicas (HC), UNICAMP, Campinas, SP, were enrolled. Clinical and laboratory data were extracted from the medical records, and the plasma cytokines levels were quantified using LUMINEX and ELISA. Result(s): There were 154 COVID-19 patients (99 survivors and 55 non-survivors) with male:female of 1.4:1, and a median age of 60 years. The non-survivors were older than survivors (65 vs. 55 years, p < 0.0001);and coronary artery disease and autoimmunity, disease severity, and oxygen therapy, intensive care, and intubation were associated with mortality. Non-survivors had higher leukocyte and neutrophil counts, and RDW and lower lymphocyte count at diagnosis. Non-survivors had higher levels of pro-inflammatory (TNF-alpha, IL-6, IFN-gamma, CCL3, IL-17/IL-17A, IL-8, G-CSF, CCL2/MCP-1) and anti-inflammatory (IL-1ra and IL-27) cytokines, but lower TGF-beta levels than the survivors. TNF-alpha levels were positively correlated with all studied cytokines except TGF-beta, while TGF-beta levels were negatively correlated with TNF-alpha, IL-6, CCL3, G-CSF, and IL-27. IL-27 levels were significantly correlated with all the cytokines except IL-37 and IL-17E. More than half (55.2%) of our patients had severe COVID-19, 18.8% had moderate, 16.2% had critical, 5.2% had mild, and 4.5% were asymptomatic. Majority of the patients (68.2%) required ICU care and had higher TNF-alpha, IL-6, IL-8, IL-17, CCL3, CCL2, IL-1ra, and IL-27 than others. 59.7% of the patients required endotracheal intubation and had higher TNF-alpha, IL-6, IL-8, CCL3, CCL2, and IL-1ra than those who did not have intubation. TNF-alpha, IL-6, and IL-8 had the highest Area Under the Receiver Operating Characteristics (AUROC) curve, sensitivity, and specificity for predicting mortality in these COVID-19 patients. Discussion and conclusion: The altered levels of pro- and anti-inflammatory cytokines support the role of SARS-CoV-2 in inducing cytokine storm, and higher concentrations seen in the deceased patients meant a more severe storm. Also, the increased leukocytes and neutrophils in our patients could have led to the release of reactive oxygen species, and end-organ damage, thus leading to poor outcomes. This study showed that the levels of these cytokines could be used as markers of mortality in COVID-19. It is possible to suggest that TNF, IL-6, and IL-8 levels at diagnosis could be efficient predictors of fatal outcomes in COVID-19 patients. If properly measured at diagnosis, these markers could be useful for triaging and predicting the outcome of COVID-19, thus guiding the treatment of the COVID-19. Funding(s): CNPq (#190374/2017-9), CAPES, FAPESP and FAEPEX (#338619). Copyright © 2022
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Due to the COVID-19 pandemic, social confinement was declared in Portugal on 19th March 2020. Schools and sports clubs were closed, access to all sports and leisure facilities was limited, and young people have experienced restrictions regarding the practice of physical activities and sports. The purpose of this study was to identify the physical activity (PA) levels and sports participation of adolescents before and during confinement, with whom they practice during restrictions and to identify the activities adopted by their physical education (PE) teachers and sports coaches to keep them physically active. An online survey was conducted between March 27th and April 14th 2020. A total of 3,012 Portuguese adolescents (57% females) aged between 10 and 19 years old (14.3 +/- 2.4 years old) took part in this study. Wilcoxon test and paired-sample t-test and chi-square test of independence were used in the data analysis. The results show that the number of students engaged in PA increased during the lockdown (72.7% to 88.2%). For those who practiced PA before lockdown, the frequency of PA decreased from 4.7 sessions/week to 4.4 sessions/week (during confinement). For those who did not practice PA before confinement, they started by doing 4.1 sessions/week. The vast majority of PE teachers (77.3%) proposed some pedagogical activities such as video conference classes (53.6%). Regarding the coaches, 53.4% pro-posed some activity, mainly time circuit training, walking and cycling (around 18% each), or specific training exercises and video conference classes (about 12% each). The number of students who increased their regular PA practice can be justified by the immediate intervention of PE teachers, who implemented several online activities, or because students were able to choose different options to stay active.
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Background: Podoplanin (PDPN) and CLEC-2 have been involved in the pathogenesis of thrombosis in inflammatory and neoplastic diseases. In addition, prior studies suggested that PDPN can be protective animal models of sepsis, as well as in models of acute lung injury. Aim(s): To measure circulating levels of PDPN and CLEC-2 in COVID-19 and explore their relationship with clinical and laboratory markers of disease severity. Method(s): Thirty consecutive patients with COVID-19 admitted due to hypoxemia and 30 age and sex-matched controls were enrolled. PDPN and CLEC-2 levels were measured by commercial ELISA kits on admission, and at day+4 (PDPN). Biomarkers of hemostasis were measured using commercial kits and clinical data were obtained from medical records. Result(s): CLEC-2 levels were similar between patients and controls, while lower PDPN levels were observed in patients when compared to healthy volunteers and these results were confirmed using two different ELISA kits. In addition, patients requiring intensive care presented lower PDPN levels compared to ward patients. PDPN levels were inversely correlated with biomarkers of coagulation and fibrinolysis activation. Conclusion(s): Circulating levels of PDPN were reduced in patients with COVID-19, and negatively correlated with markers of coagulation and fibrinolysis activation, as well as with and ICU need. Co-expression of ACE2 and PDPN in alveolar epithelial cells could underlie these findings. Additional studies are warranted to confirm these observations in independent populations and to explore their potential mechanistic implications. (Figure Presented).
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Introduction The WHO Prison Health Framework was developed to assess prison health system performance and support Member States (MS) in improving their prison health systems. Moreover, it shall enhance MS capacity to evaluate: the impact of changes in governance models, progress in service provision and improvements of the health status of people in prison (PiP). Methods The framework informed the 2021 data collection round of the Health In Prisons European Database Survey. Invitations were sent to all 53 MS of the WHO European Region. Those MS nominating a focal point and providing valid answers were included in the analysis. Results Answers were obtained from 36 MS, representing a total of 613,497 PiP. Access to immunization was very good across all MS, with the highest for COVID-19 (90% of MS provide it in all prisons). Vaccination against HBV was only available in all prisons of 25 MS. Access in all prisons to HIV post and PrEP were reported, respectively, by 78% and 58% of MS. Screening for diseases at entrance was common for HIV, HCV and HBV. In all prisons of 35 MS soap was provided for free, while needles & syringes and lubricants were only provided free of charge, respectively, in 3 and 4 MS. 5 MS did not have therapeutic spaces to tackle drug problems in any prison, in 73% of those having, accessibility was restricted to some prisons. HIV prevalence ranged from 0-16% and treatment was accessible to 55-100% of those diagnosed. Prevalence of HCV ranged from 0-34%, with access to treatment ranging from 0-91%. The most common format of health records in European prisons was paper based (44%). Conclusions Prison-based data collection systems resulted in limited capacity for extraction so that some countries were unable to provide any data on disease prevalence or treatments offered. Given the scarcity of data on this topic obtained from real-world and not from ad-hoc studies, this snapshot provides an important contribution to public health.
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The text seeks to discuss the impacts of the Covid-19 pandemic on the educational sector considering the rise and deepening of learning-market. The spread of contagion directly affected educational systems across the globe. Remote education emerges as a solution by governments to reduce the consequences of the suspension of classes. The use of these resources in a centralized way expresses the interests of the learning market, since the financialization of education is deepened by the purchase of packages from EdTechs companies by the public sector. It appears that business sectors linked to some spheres of education, especially distance education through the sale of technological resources and with the work of EdThecs seek to carry out learning-market in an opportunistic way and without considering the future of state public education and students from popular layers.
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The paper explores the impact of Covid-19 on scientists' collaboration behaviour in the 14 countries with the largest research output. The approach is bibliometric, taking the unit of analysis of collaborations as the individual researchers and the co-authorships in their preprints. The time plot of the data confirms a clear discontinuity in the number of preprint depositions after the Covid-19 outbreak. Less evident is the discontinuity in average number of co-authors per preprint, and also in propensity to collaborate. Investigating further, a multivariate econometric analysis shows that for propensity to national collaboration (both intra- and extramural) there has been a positive “effect” from the pandemic, but negative one on international collaboration. The same analysis conducted by country, however, reveals that these effects are significant only in some countries and often with discordant signs. © 2022, Akadémiai Kiadó, Budapest, Hungary.
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Background/objective: The severity and outcome of COVID-19 are determined by the level of overstimulation of the immune response, age, and comorbidities in the patients infected by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Lymphopenia is the most consistent finding that characterizes the hemogram in COVID-19 patients. We evaluated the hemogram and compared the lymphocyte count (LC),neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) at diagnosis in COVID-19 patients hospitalized at the Clinical Hospital of the State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil. Methods: In this retrospective study, we reviewed the medical notes of 320 adult hospitalized patients with PCR-confirmed COVID-19 at the Clinical Hospital of UNICAMP, Campinas, from March 2020 to March 2021. The hemogram (performed using automated counter-XN 9000™, Sysmex, Japan) at COVID-19 diagnosis was analyzed, and NLR and PLR were calculated. The primary outcomes were discharge (n = 257 patients who recovered from the disease and were discharged from the hospital), and death (n = 63 those who died during treatment). Statistical analyses were performed using SPSS (version 22). Unpaired data of deceased and discharged COVID-19 patients were compared using Mann-Whitney tests. All results were significant if p < 0.05 or except otherwise stated. Results: Compared to the 257 discharged patients, the 63 deceased patients were older 56.0 vs 64.7 ys respectively, p = 0.000), the males are more in each group and the duration of hospitalization was not different (18.6 vs 19.7 days respectively, p = 0.12). The leukocyte (8.89 ± 4.50 vs 10.37 ± 7.03, p = 0.289) and platelet counts (227.00 ± 91.15 vs 197.79 ± 97.47, p = 0.119) were not significantly different in the two groups, the hematocrit was higher in the discharged than in the deceased patients (38.84 ± 6.86 vs 35.89 ± 8.57, p = 0.021). The LC was lower in the deceased (0.81 ± 0.59 × 103 vs 1.09 ± 0.80x103/μL, p = 0.002), and negatively correlated with the age of the patients(r = -0.145, p=0.009 at a significant level of 0.01). The deceased group had a higher NLR (17.52 ± 19.20 vs 10.06 ± 12.31, p < 0.001) and PLR (366.32 ± 275.03 vs 319.23 ± 331.54, p = 0.047) higher than the discharged group, and both parameters were strongly correlated (r = 0.734, p < 0.001 significant level of 0.01). One hundred and thirty-eight (53.7%) of the discharged patients and 45 (71.4%) of the deceased had LC of < 1.0 × 103/μL. The LC is associated with the disease outcome (χ2 = 6.498, df = 1, p = 0.011), and the odds for a deceased to have a lymphopenia is 1.9 times that for the discharged patients [OR = 1.87 (95% CI = 1.135-3.085). Discussion: Though lymphopenia is consistent in COVID-19, the cause is unclear. Acute recruitment of lymphocytes to the site of infection (mainly the lung) may explain this, thus the lymphopenia may worsen and the LRs will be elevated with the increasing severity of COVID-19. The negative correlation of LC with age and higher odds of lymphopenia in the deceased patients suggest that LC and the LRs at diagnosis could be easily accessible and useful predictors of severity and mortality in these patients. Conclusion: Our study supports that lymphopenia is negatively associated with mortality in COVID-19 patients and that the deceased patients have elevated NLR and PLR at diagnosis. These parameters are easily derived from the hemogram and could be utilized as affordable and accessible predictors of outcomes in patients with COVID-19.
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Introdução: A educação vem passando por profundas transformações ao longo dos anos. Mudanças na forma de ensinar e de aprender, pois a velocidade com que as informações chegam é intensificada na era digital. Além disso, a pandemia por Sars-CoV-2 propiciou, quase que de maneira obrigatória, através do distanciamento social, o uso de recursos digitais para o ensino remoto nos mais variados níveis. O uso de tecnologias digitais e de estratégias inovadoras nesse contexto é importante. Falando exclusivamente do ensino superior e dos cursos da área da saúde que utilizam estratégias inovadoras, o ensino remoto traz algumas dificuldades. A primeira delas é: como cursos da área da saúde podem ter algum aprendizado no ensino remoto se as diretrizes curriculares exigem vivências práticas? A resposta é simples: não tem como ter práticas em saúde de forma remota. No entanto, todo o arcabouço teórico pode ser ministrado de forma remota e com o uso de estratégias inovadoras. Ante o exposto, o professor deixa de ser o detentor exclusivo do saber para ser um facilitador no processo de ensino-aprendizagem. O professor adquire novas habilidades e competências para seu crescimento profissional e pessoal e contribui nos processos de ensino-aprendizagem dos alunos. O espaço colaborativo propicia essa troca de experiências e o aprendizado é constante. Objetivos: Relatar a experiência da discussão de casos clínicos e construção de scripts do projeto de extensão Minuto Hematologia da UFSC-Araranguá em ambiente virtual, demonstrando a sua contribuição para a formação acadêmica e profissional. Metodologia: Para a realização desta proposta em ambiente remoto, foram disponibilizados casos clínicos extraídos do livro “101 Hemogramas: Desafios Clínicos para o Médico ”. Os casos foram selecionados de forma a contemplar as mais variadas patologias. Em cada encontro síncrono de 1 hora de duração, foram discutidos de 1 a 2 casos clínicos. A sequência de atividades foi a seguinte: leitura do caso clínico;explicação dos termos semiológicos;interpretação do hemograma identificando as alterações;determinação de hipóteses diagnósticas e discussão e fechamento do caso clínico. Após a discussão dos casos clínicos, os scripts foram elaborados na forma de um modelo esquemático conforme as hipóteses diagnósticas. Resultados e discussão: Foram realizados três encontros e foram discutidos cinco casos clínicos. Os seguintes casos clínicos foram discutidos: Três vacinas para três sinais;Idosa Dengosa;Um Jovem Carente;α ou β? A Vegana Engana. Cinco scripts foram elaborados baseados na discussão dos cinco casos clínicos. Os scripts são modelos mentais da doença que ajudam no desenvolvimento do raciocínio clínico. Na percepção dos alunos, a discussão de casos clínicos de forma remota foi bastante positiva. A estratégia auxiliou no aprendizado de interpretar os hemogramas e no desenvolvimento do raciocínio clínico. O raciocínio clínico é um processo cognitivo, através do qual, o médico é capaz de estabelecer o diagnóstico correto e uma conduta adequada frente a um problema clínico. A metodologia proposta atendeu às expectativas de aprendizagem. Conclusão: A discussão de casos clínicos é uma estratégia eficaz para construção do conhecimento em todas as áreas da saúde. É necessário que o estudante tenha contato com problemas clínicos de forma repetida, além do conhecimento biomédico, com o intuito de estimular a construção dos esquemas mentais das patologias.
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Objetivos: Os mecanismos fisiopatológicos que determinam a gravidade da Covid-19 estão associados a ativação da hemostasia e da imunidade inata, em um processo coletivamente referido como imunotrombose, e que envolve ativação plaquetária, geração de NETs (do inglês, Nucleo extracelular traps), expressão de fator tecidual, ativação do complemento e ativação endotelial. Um elemento importante da ativação endotelial é a quebra da barreira endotelial (BE), que ocorre para facilitar o acesso de leucócitos aos tecidos, onde contribuem para erradicação dos patógenos. No entanto, a avaliação da integridade da BE é desafiadora, exigindo o uso de modelos celulares. O objetivo desse estudo foi avaliar o efeito do soro de pacientes com Covid-19 sobre a integridade da BE em monocamadas de células endoteliais, e sua correlação com características clínicas da doença. Materiais e métodos: A população do estudo consistiu em 30 pacientes com Covid-19 que apresentavam comprometimento pulmonar confirmado por tomografia de tórax, e necessidade de internação hospitalar por hipoxemia e 30 controles saudáveis pareados por sexo e idade. Os pacientes recrutados fizeram parte de um estudo clínico (REBEC: U1111-1250-1843), e as amostras utilizadas nesta avaliação foram obtidas no momento da internação, antes de qualquer intervenção. Monocamadas de células endoteliais de duas fontes (HUVECs: células de cordão umbilical;HULECs: células endoteliais pulmonares) foram estimuladas com soro de pacientes e indivíduos saudáveis (diluição 15% em meio de cultura) e a integridade da BE foi avaliada por um sensor de impedância celular (ECIS;Eletric Cell-substrate Impedance Sensing System) continuamente por 36 horas. Biomarcadores de gravidade e relacionados à ativação da hemostasia foram avaliados por kits comerciais. Dados clínicos foram obtidos a partir dos prontuários digitais. Resultados: O soro de pacientes com Covid-19 induziu quebra de BE significativamente mais acentuada que o de indivíduos saudáveis em HUVECs nos tempos 15 min (p < 0,01);30 min (p ≤ 0,001);1h (p ≤ 0,0001);2h (p ≤ 0,0001);3h (p ≤ 0,0001);4h (p ≤ 0,01) e 5h (p ≤ 0,05). Estes resultados foram confirmados no modelo de células endoteliais pulmonares (HULECs). A magnitude da quebra apresentou correlação significativa com desfechos clínicos relevantes como tempo de internação total (RS até 0.57) e tempo de UTI (RS = 0,47). Em relação a biomarcadores de interesse na Covid-19, a quebra da BE apresentou correlação significativa com neutrofilia, relação neutrófilo/linfócito, fator de Von Willebrand, fatores IX e XI, fibrinogênio, D-dímero e uPAR (Receptor de Uroquinase). Discussão: Através de um método considerado padrão-ouro para avaliação in vitro da integridade da BE nós demonstramos que componentes presentes no soro de pacientes com Covid-19 são capazes de promover a quebra da BE, e que a magnitude deste processo está relacionada à gravidade desta doença. A correlação com outros marcadores inflamatórios corrobora a conexão entre os mecanismos envolvidos na imunotrombose em pacientes com Covid-19. Conclusão: nossos resultados apontam a quebra da BE como um alvo terapêutico atrativo nestes pacientes.
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The COVID-19 pandemic has led many serving environments to seek solutions to control people's access and avoid crowding in order to contain its spread, and to ensure the health and safety of users. Given the various current solutions, this paper presents a monitoring system that shows, in real-time, via web, the status of people in closed environments. It uses internet of things (IoT) techniques for data interconnections and electronic components - NodeMCU board and proximity sensors - to monitor the entrance and exit of people in an enclosed environment, providing the statistics through an IoT platform (application) that can be installed in a mobile device (smartphone). This study highlights a low-budget system, shows the implementation of IoT platforms in the development of prototypes and the tests carried out in the academic service office.
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Food waste negatively impacts the three dimensions of sustainability. Environmentally and financially, it represents a waste of natural resources and increases the cost respectively. Socially, it represents an ethical issue as about 800 million people are suffering from hunger worldwide. Therefore, the purpose of this paper is to explore if and how resilience contributes to food waste reduction in fruits and vegetables distribution in the Brazilian market. Multiple case studies were conducted in the supplier-retailer dyad of four retail chains. Results have shown that resilience plays the role of both enabler and barrier to food waste reduction. On the positive side, collaboration, communication, flexibility, innovation, knowledge management, leadership, security technologies and supply chain design contributed to food waste reduction;especially during the COVID-19 pandemic. On the negative side, financial health and redundancy increased the level of food waste. Additionally, it was observed that flexibility can reduce or increase food waste. Our findings have implications for academics and practitioners as the developed framework summarizes the role of resilience to food waste reduction. As a social impact, the implementation of food waste reduction initiatives by non-governmental organizations and retailer associations can result in increased communication, knowledge diffusion, and training about how to build resilience and improve food waste reduction practices among different agents. To the best of our knowledge, this is the first empirical study that explores the relationship among elements of resilience and food waste. Thus, it advances the current literature by operationalizing resilience to reduce food waste. © 2022 Elsevier Ltd