Vaccine hesitancy among patients with idiopathic inflammatory myopathies and rheumatic diseases patients in 2021-2022: Covad survey

Background: Patients with comorbidities and active rheumatic disease have increased morbidity and hospitalization following SARS-CoV- 2 infection. While vaccination has decreased this, many unknown factors still influence COVID-19 vaccine hesitancy. The data on predictors of vaccine hesitancy is regional and scarce. We aimed to analyze the factors influencing vaccine hesitancy in 2022 and compare them with those in 2021 through multicentre international e-surveys (The COVID-19 Vaccination in Autoimmune Diseases Studies -COVAD study 1 and 2). Method(s): COVAD 1 and 2 are multi-centre international e-survey with 152 collaborators in 106 countries including patients with idiopathic inflammatory myopathies (IIM), autoimmune rheumatic diseases (AIRDs), other autoimmune diseases (AIDs), and healthy controls (HCs) conducted in March-December 2021 and February-June 2022 (ongoing), respectively. Descriptive and multivariable regression adjusting for age, gender, ethnicity, and stratified by country of residence was performed. Result(s): Among the 18 882 (2021) and 7666 complete responses (2022), and 3109 (16.5%) and 387 (5.1%) did not receive any COVID-19 vaccine, respectively. The prevalence of vaccine hesitancy has decreased [OR 0.26 (0.24-0.3), P < 0.001]. Among the 387 vaccine non-recipients in 2022, numbers were as follows: IIM 69 (17%), AIRDs 179 (46%), other AIDs 80 (20.6%), and HC 59 (15%). The reasons for vaccine hesitancy in 2022 included: doctor advising against it 47 (12%), do not believe in the science behind the vaccine 79 (21%), long-term safety concerns 152 (39%), awaiting more safety data 105 (27%), and not recommended due to recent infection 30 (7%). Compared to AIRDs and HCs, IIM patients were more disbelievers of the science behind the vaccine [OR 1.8 (1.08-3.2), P = 0.023 AIRDs, OR 4 (1.9-8.1), P < 0.001 HC], had more long-term safety concerns [OR 1.9 (1.2-2.9), P = 0.001 AIRDs, OR 5.4 (3-9.6), P < 0.001 HC] and had more doctors recommending against the vaccine [OR 12.9 (2.8-59), P < 0.001 HC]. Vaccine non-recipients had higher pain visual analog score (VAS) (P < 0.001), lower fatigue VAS (P = 0.003), lower PROMIS10a physical health (P < 0.001), and mental health scores (P = 0.015). The factors predicting vaccine hesitancy in regression were lower PROMIS10a global physical health score [OR 0.9 (0.8-0.97), P = 0.014] and Caucasian ethnicity [OR 4.2 (1.7-10.3), P = 0.001]. Compared to 2021, doctor's advising against vaccination [OR 2.5 (1.8-3.6), P < 0.001] and long-term safety concerns [OR 3.6 (2.9-4.6), P < 0.001] were more frequent causes of vaccine hesitancy overall whereas vaccine non-availability [OR 0.05 (0.02-0.11), P < 0.001] and have scheduled the vaccination but not received [OR 0.1 (0.06-0.3), P < 0.001] were less frequent causes in 2022. Conclusion(s): Overall, the prevalence of COVID-19 vaccine hesitancy has decreased. Long-term safety concerns and the need for more safety data are now the major reasons for vaccine hesitancy. Caucasian ethnicity and lower physical health scores are predictors of vaccine hesitancy. The increase in physicians recommending against vaccination calls for more physician awareness to mitigate vaccine hesitancy.

Law's temporality and the construction of death-worlds: Custodial neglect of older prisoners in India

The vexed relation between law and age/ageing is most apparent in the context of older prisoners. Late life may be accompanied by disabilities and dependencies. So, access to appropriate forms of care including medical care becomes even more crucial in custodial institutions like prisons where older prisoners live isolated from society. Since the spread of COVID-19, there have been attempts to decongest Indian prisons. However, older political prisoners charged (not convicted) for anti-state, terrorist activities continue to suffer in prison due to denial of bail. I argue that elderliness and the condition of health ought to be factors on which bail should be given irrespective of the nature of the charges. By using the framework of ‘law as temporality', I elucidate how the politics around the denial of bail by courts in India and the treatment of older political prisoners by prison authorities lead to the production of a ‘carceral time'. This article discusses how carceral time structures the embodied experiences of ageing in ways that defy the human rights of prisoners. Time not only disciplines but also determines the expendability of ageing bodies, particularly when time is an insidious form of waiting, as in the case of older political prisoners in the Bhima Koregaon case in India. This article highlights the need for the criminal justice system in India to consider elderliness as a ground for compassionate treatment towards older prisoners, and to uphold their rights to healthcare and to live with dignity. © 2022, The Author(s), under exclusive licence to O.P. Jindal Global University (JGU).

Compromised well-being: implications on female geriatric abuse during the COVID-19 crisis in India

Purpose This study aims to reflect on how the COVID-19 pandemic has intensified the social and economic vulnerability of Indian elderly women, thereby making them prone to varied forms of abuse and denying them of the basic rights of secured existence. Design/methodology/approach This study was conducted by analyzing primary data from government sources that dealt with the aging Indian population and the common predicaments that elderly women experienced during the pandemic. A qualitative interview was conducted in three old-age homes in India where the experiences of 26 elderly female residents were documented for understanding their experiences during the pandemic. The secondary data collected from different newspaper articles and online resources also enabled in perusing the difficulties that they faced both at home and the caregiving space at the critical juncture of COVID-19. Findings Nearly 73% of the elderly population in the country has faced an incidence in different forms of abuse and exploitation during the subsequent waves of the pandemic. Disrespect and neglect were the most common type of mistreatment and around 23.1% reported physical assault. The elderly women were victimized further on socioeconomic grounds and their rights of living a secured and dignified life were significantly neglected. Research limitations/implications The basic premise of this paper operates on the ground that the family as an institution has shunned taking care of the responsibilities vis-a-vis the elderly and therefore formal institutions have been introduced to aid in the conventional caretaking responsibilities in the Indian societal structure. This situation became all the more grave during the pandemic and therefore needed much intervention. This paper follows the theoretical lens of gender theory and case study method to analyze the data. Social implications The HelpAge India report findings entail that elderly women/widows are doubly marginalized in the Indian society, and the COVID-19 pandemic has escalated the caregiver stress on manifold levels, thus exacerbating the problem. As most of the female senior citizens are economically dependent on their children and relatives, financial exploitation became one of the important premise that deprived them of a healthy living both at home and elderly caregiving institution. Despite the prevalence of certain elderly assistance schemes in the country, the older women's needs and well-being got heavily impacted and their voice gets hardly recognized in the wider spectrum of sociopolitical events. To extend the requisite help and assistance to this socially vulnerable section, the government on September, 2021, launched a pan-India, toll-free helpline number "Elder Line" to provide relevant information on elderly legal and medical aid and guidance on procuring pension. Originality/value According to the secondary findings, a significant percentage of elderly women have been susceptible to physical and emotional abuse and factors such as widowhood, economic dependency, physical infirmity, cognitive impairment along with other stressors have aggravated their exposure to ill-treatment during the pandemic span. Thus, to recognize and mitigate the existing problems affecting the elderly subjects, the government should devise the necessary protocols and adopt essential measures to ensure the welfare of the marginalized section and protect their basic rights of a holistic existence.

The Development of Job Aids to Support the Use of Field Instruments, Methods, and Techniques by Environment and Climate Change Canada’s Environmental Emergency Personnel

Environment and Climate Change Canada’s (ECCC’s) Emergencies Science and Technology Section (ESTS) is tasked with providing scientific and technical advice to its federal partners during environmental emergencies including oil spill incidents. In addition, ESTS maintains a wide array of field instrumentation and equipment, which is available to support different areas of a spill response such as detection and monitoring, health and safety, and sampling. During a response, ESTS needs to quickly, and effectively, convey to ECCC Environmental Emergencies Officers what tools and equipment could be available for the response, and how they can help meet ECCCs objectives for the response. This can often be a challenge, especially when ESTS personnel cannot deploy on-site alongside the instrumentation and equipment, as the information must be provided in an easily understandable format, yet thorough enough to ensure proper usage of the particular tool or piece of equipment. To address these challenges, ESTS has begun the development of a suite of job aids or “Tactical Sheets”. Each Tactical Sheet contains necessary, condensed, information on a field method or equipment maintained by ESTS for use at an environmental emergency. The goal of these Tactical Sheets is to highlight what the specific objectives for ECCC are, and how a given piece of equipment or method can help meet that objective at a response. These Tactical Sheets come with a number of features including a standardized format, a visually appealing design layout, a required equipment list, a simplified procedure, and a summary of the typical use for the particular tool or piece of equipment. ESTS has begun trialing these Tactical Sheets at certain incidents throughout the Covid-19 pandemic to increase ESTS’ capability of providing remote support when on-site presence is not an option. These Tactical Sheets are meant to bolster ESTS’ portfolio of support options available to our partners during environmental emergency responses. This paper will present information on the program to update field methods used during an environmental emergency by ECCC. © 2022 44th AMOP Technical Seminar on Environmental Contamination and Response. All rights reserved.

COVID-19 lesion segmentation using convolutional LSTM for self-attention

We propose a fast and robust multi-class deep learning framework for segmenting COVID-19 lesions: Ground-Glass opacities and High opacities (including consolidations and pleural effusion), from non-contrast CT scans using convolutional Long Short-Term Memory network for self-attention. Our method allows rapid quantification of pneumonia burden from CT with performance equivalent to expert readers. The mean dice score across 5 folds was 0.8776 with a standard deviation of 0.0095. A low standard deviation between results from each fold indicate the models were trained equally good regardless of the training fold. The cumulative per-patient mean dice score (0.8775±0.075) for N=167 patients, after concatenation, is consistent with the results from each of the 5 folds. We obtained excellent Pearson correlation (expert vs. automatic) of 0.9396 (p<0.0001) and 0.9843 (p<0.0001) between ground-glass opacity and high opacity volumes, respectively. Our model outperforms Unet2d (p<0.05) and Unet3d (p<0.05) in segmenting high opacities, has comparable performance with Unet2d in segmenting ground-glass opacities, and significantly outperforms Unet3d (p<0.0001) in segmenting ground-glass opacities. Our model performs faster on CPU and GPU when compared to Unet2d and Unet3d. For same number of input slices, our model consumed 0.83x and 0.26x the memory consumed by Unet2d and Unet3d. © 2022 SPIE

The first and the second waves of Covid-19;difference in clinical dynamics as regards the symptoms- an appraisal

Background: Covid-19 affected our population in multiple waves. We have looked for the differences in frequency and the weight/impact of symptoms between the first and the second waves. Method: The post-covid-19 subjects attending our out-patient department for post-covid-19 problems after the 1st and he 2nd waves were enquired retrospectively about the demography with the frequency and severity of different symptoms cough, breathlessness, throat pain, nasal discharge, fever, body-ache, weakness, diarrhoea, constipation, pedal/finger swelling, headache, expectoration. anosmia, and loss of taste) that they suffered from. The weight/impact of a symptom was derived by multiplying the duration of symptoms (in days) with the severity (in Likert scale;0 to 5;0=none and 5=maximum possible symptoms). The data was analysed statistically using unpaired 't-test' and 'chi-square test' to compare between the two covid-19 waves. Result: 185 and 222 subjects' data were included for the 1st and the 2nd waves of covid-19 respectively. The gender ratio was similar but the mean age was significantly lower in the victims of the second wave (56.17±13.64, 51.32±15.59;p=0.0017). As regards the symptom-frequency, fever (p=0.0154), constipation (p=0.0243), headache (p=0.0014), anosmia (p=<0.0001) and loss of taste (p=0.0009) were significantly worse in the 2nd wave. The symptom severity of cough (p=0.0184), throat pain (p=0.039), mild weakness (p=0.0063), anosmia (p=0.0004) and loss of taste (p=0.0026) were also higher in the 2nd wave of Covid-19. Conclusion: It appears that each wave of the pandemic was distinct as regards the symptomatology. Such peculiarity in the clinical dynamics of Covid-19 needs to be noticed and followed in future.

Can neglegence toward COVID-19 symptoms initiate third wave of COVID-19 in India

Background: The second wave of Covid-19 had a huge number of asymptomatic, false negative (indeterminant) and symptomatic untested cases (query Covid). Objective: The aim is to understand the dynamics among these groups to know their impact on the spread of the diseases. Methods: In a prospective online survey we collected data using snowball sampling method via social media, from in and around Kolkata with the help of Google forms. The data included Covid related symptoms, evaluation, and behavior related to treatment during first and second wave of the disease. The discrepancies and duplicities were first excluded, and 989 respondents' data were statistically analyzed using SPSSver26. Results: The percentage of RT-PCR confirmed symptomatic and asymptomatic Covid cases were 21.84% (n=216) and 2.12% (n=21) respectively. Symptomatic but unconfirmed cases (query Covid) were 17.18% (n=170) and symptomatic false-negative cases (indeterminant) were 93 (9.40%). Rest 489 (49.44%) did not have any symptoms or never tested positive. The analysis revealed the reasons for doing RT-PCR test include a) less symptoms severity (47.06%), b)considering test unnecessary (22.94%),c) home collection unavailability(14.71%) and d)longer waiting time for results(8.82%). According to regression analysis, compared to confirmed Covid symptomatic group, only 47% [OR: 0.13(0.57-0.30) p<0.0001] of query covid patients consulted doctor for test or treatment and 21% [OR:9.55 (1.97-46.16), p<0.001] of indeterminant cases took medicine based on advice of friends/ relatives. Conclusion: There is a high percentage of untested (query Covid) and probable false negative cases (indeterminant) likely going unreported. The reasons for poor testing and seeking medical attention inadequately needs to be addressed and further investigated.

UNDERSTANDING THE EFFICACY OF TELECONSULTATION IN ASSUAGING ABUSE AGAINST INDIAN WOMEN DURING COVID-19 OUTBREAK

Covid-19 pandemic has impacted societal well-being in different and interacting contexts and its long duree consequences on human health, both biological and psychological serves to be a key element in the public discourse. The “pandemic-lockdown” in the Indian context made the health and social faultlines existing in the country hypervisible making one question the ‘normal’ we were existing with, in the pre-Covid times. As the virus took its toll on the fragile health system, nearly crushing it, individual’s rights to a safe and dignified life got threatened in the private spaces. The psycho-social effects of the pandemic arising from the exploitation in the public/private domains can be recognized as infringements with severe and sustained negative repercussions on the vulnerable sections of society. While analysing the intersecting vulnerabilities on varied fronts, another intense predicament related to women and elderly abuse in the (un)safe homely space awaits address and redressal. The nature of stressors underlying such abuse reflects on a complex interplay among several factors at an individual, community, and collective levels. The use of digital platforms, social media sites, and teleconsultation in moments of unprecedented crisis suggests towards creating an alternative paradigm for addressing the psychosocial dimension of the pandemic that lies intertwined with the “underlying injustices and social conditions”. In the backdrop of the Covid context, this paper would analyse how teleconsultation and telepsychiatry became an apparent channel to ensure health based services and extend support and safety to those victims and survivors of family abuse who remain marginalized in the society on sexist and ageist constructs © 2021,Journal of Content, Community and Communication.All Rights Reserved

In silico Studies Predict Efficient Binding of Remdesivir and Favipiravir with 3-chymotrypsin like protease of SARS-CoV-2 for COVID-19 Interventional Therapy

Favipiravir and remdesivir are investigational drugs for coronavirus disease 2019 that is caused by severe acute respiratory syndrome coronavirus 2. The active forms of these drugs are reported to target and inhibit viral RNA dependent RNA polymerase, which is derived from 3-chymotrypsin like protease, a viral replicase enzyme. The present in silico study explores the comparative efficacy of these drugs to inhibit 3-chymotrypsin like protease and RNA dependent RNA polymerase, to plan therapeutic options for patients based on their disease severity. Active favipiravir and remdesivir molecules bind to 3-chymotrypsin like protease with energies of 6.18 and -6.52 kcal/mol in contrast to -5.62 and -3.91 kcal/mol for RNA dependent RNA polymerase. Further, hydrophobic interactions and salt bridge formations cement drug bindings with 3-chymotrypsin like protease, but not with RNA dependent RNA polymerase. Molecular dynamic simulation experiments, performed under certain experimental constraints reveal that the root mean square flexibilities of active residues in drug complexes with 3-chymotrypsin like protease are lower than in free 3-chymotrypsin like protease making the former more stable than the latter because of their rigidity and stabilities. Both drugs may hence serve as good therapeutic options for early stages of coronavirus disease 2019. However, more severe symptoms may be treated better with favipiravir due to its better binding with RNA dependent RNA polymerase, as compared to remdesivir. The "one drug does not fit all" concept is true for coronavirus disease 2019 as it is being currently realized by clinicians all around the world. Hence precise knowledge about critical interactions of these drugs with the viral enzymes will help medicos make vital therapeutic decisions on interventional options for patients who report to hospitals without over symptoms or with varying degrees of disease severity.

Therapeutic Phytochemical Actives for Potential Control of SARS-CoV-2

Background: Drug development strategies for treating COVID-19 focus on actives that either physically block angiotensin-converting enzyme-2 (ACE-2) receptors (viral entry point), or those, which inactivate viral proteases like 3CLpro or RdRp, inside the infected host cells. Objectives: The objective of the present study is to virtually screen phytochemicals for both these purposes. Methods: Molecular docking, molecular dynamic simulation (MDS) and multiple sequence alignment were employed. Results: All the screened phytochemical actives showed negative binding energies with their respective targets, attesting good complex stabilities. Among each set of ten actives, for blocking ACE-2 receptors and for inactivation of 3CLpro and RdRp, Dichamanetin-ACE-2, Glabrene-3CLpro and Naringenin-RdRp complexes were most stable, with binding energies of -9.8, -9.11 and -7.7 Kcal/mol respectively. MDS studies of these representative actives and their complexes, also attested to complex stabilities. Multiple sequence alignment analysis of nine significant amino acid residues of the Homo sapiens ACE-2 receptor, with nine different species, showed conservation of several residues. Conclusion: A set of phytochemicals actives can block ACE-2 receptors and prevent the entry of SARS-CoV-2 into host endothelial cells. Two other sets of actives can inactivate viral 3CLpro and RdRp enzymes and prevent replication of SARS-CoV-2 inside host cells. They all can hence be further explored for the control of COVID-19.

A novel medical image encryption using cyclic coding in COVID-19 pandemic situation

During this Covid - 19 pandemic situation, encryption of medical images takes a major role in medical information systems as well as in telemedicine. However according to government rule, it is essential to hide the information of the patients. Recent development in computer network enhances a lot of facilities in communication area. Unfortunately, hackers are misusing this facility and always try to attack on the transmitted information in insecure network. For secure transmission of medical images, it is essential to encrypt the information before transmitting. In this communication, we are going to present a novel approach of medical image encryption using cyclic coding. We have proved that it is quite difficult to decrypt the original information from encoded data in one common mode of attacking- chosen ciphertext attack. Moreover, we have proved the effectiveness of the encryption using correlation coefficients. Our proposed scheme is suitable for efficient encoding of multiple medical images. © 2021 Institute of Physics Publishing. All rights reserved.

The Supply Chain Disruption Framework Post COVID-19: A System Dynamics Model

The COVID pandemic seems to have raised the question, 'whether existing supply chain (SC) disruption philosophies and strategies continue to remain valid?'. This article assesses the differences in the business scenarios pre-and post-COVID. The authors capture the mathematical and operational relationships amongst the relevant factors and propose a System Dynamics (SD) model to carry out the simulations. The approach considers the impact of the force majeure condition, that is, COVID period on individuals' income, prices and demand of goods, cost of input and supply of finished goods. The results show that earnings may increase demand but, disruption in supplies of raw materials and finished products nullify the effect. On the other hand, even if flow returns to normal, reduced income affects normal goods businesses.