Determination of 25 quaternary ammonium compounds in sludge by liquid chromatography-mass spectrometry.

With the pandemic of COVID-19, the application of quaternary ammonium compounds (QACs), which can be used in SARS-CoV-2 disinfection products, has increased substantially. QACs cumulated in sewer system are ultimately deposited and enriched in sludge. QACs in the environment can adversely affect human health and the environment. In this study, a liquid chromatography-mass spectrometry method was established for the simultaneous determination of 25 QACs in sludge samples. Ultrasonic extraction and filtration of the samples was performed using a 50 mM hydrochloric acid-methanol solution. The samples were separated by liquid chromatography and detected in multiple reaction monitoring mode. The matrix effects of the sludge on the 25 QACs ranged from - 25.5% to 7.2%. All substances showed good linearity in the range of 0.5-100 ng/mL, with all determination coefficients (R2) greater than 0.999. The method detection limits (MDLs) were 9.0 ng/g for alkyltrimethylammonium chloride (ATMAC), 3.0 ng/g for benzylalkyldimethylammonium chloride (BAC), and 3.0 ng/g for dialkyldimethylammonium chloride (DADMAC). The spiked recovery rates were in the range of 74-107%, while the relative standard deviations were in the range of 0.8-20.6%. Considering its sensitivity, accuracy, and easy operation, the proposed method in this study was used to determine 22 sludge samples collected from a comprehensive wastewater treatment plant. The results showed that the concentrations of ΣATMACs, ΣBACs, and ΣDADMACs were 19.684, 3.199, and 8.344 µg/g, respectively. The main components included ATMAC-C16, ATMAC-C18, ATMAC-C20, ATMAC-C22, BAC-C12, and DADMAC-C18:C18, with concentrations exceeding 1.0 µg/g. The concentration relationships of different components in the congeners showed that some components were of similar origin.

Preventing infectious diseases outbreaks at exercise facilities

Exercise facilities play an important role in enhancing physical fitness and in supporting an active lifestyle among users. During the global coronavirus disease 2019 (COVID-19) pandemic, exercise facilities have been shut as part of the "physical distancing” policies in many countries. Exercise facilities have been considered "high-risk” places for transmission because of their enclosed environment, shared equipment and the close contact between users and staff. In Japan, in response to the COVID-19 clusters developed from the exercise facilities in the early phase of pandemic, the Fitness Industry Association of Japan released guidelines for gym managers, workers, and users in March. This commentary aims to introduce exercise facilities guidelines in Japan. This article provides reference for the rest of the world to reopen exercise facilities safely in the post pandemic period or to prevent future outbreaks of infectious disease.

Acknowledging geodiversity in safeguarding biodiversity and human health.

Our existence on Earth is founded on a vital nature, which supports human physical and mental health. However, nature is often depicted only through biodiversity, whereas geodiversity-the diversity of non-living nature-has so far been neglected. Geodiversity consists of assemblages, structures, and systems of geological, geomorphological, soil, and hydrological components that fundamentally underlie biodiversity. Biodiversity can support overall human health only with the foundation of geodiversity. Landscape characteristics, such as varying topography or bodies of water, promote aesthetic and sensory experiences and are also a product of geodiversity. In this Personal View, we introduce the concept of geodiversity as a driver for planetary health, describe its functions and services, and outline the intricate relationships between geodiversity, biodiversity, and human health. We also propose an agenda for acknowledging the importance of geodiversity in health-related research and decision making. Geodiversity is an emerging topic with untapped potential for ensuring ecosystem functionality and good living conditions for people in a time of changing environments.

45 and Up COVID Insights: a dynamic and collaborative approach to evidence-making during the COVID-19 pandemic.

OBJECTIVES: In response to the coronavirus 2019 (COVID-19) pandemic, a research project was developed with a cohort of 45 and Up Study participants to generate timely, relevant evidence to guide policy, practice and planning. This paper describes the research model, the cohort establishment and characteristics, and some findings. METHODS: A subgroup of 45 and Up Study participants was invited to enrol in 45 and Up COVID Insights -a series of five online surveys conducted during 2020-22. The model involved a close collaborative partnership with the New South Wales Ministry of Health and a panel of scientific advisers, an agile data collection methodology and rapid dissemination of findings. Frequent, iterative engagement with stakeholders provided a framework for identifying survey themes and questions and ensured wide dissemination of findings. Themes included healthcare use, attitudes toward and uptake of COVID-19 prevention measures, and the impact of the pandemic on mental health, loneliness, and lifestyle behaviours. RESULTS: 45 and Up COVID Insights achieved strong stakeholder engagement through extensive consultation and rapid reporting of results. The project recruited a diverse cohort of 32 115 participants: median age 68 years (range: 56-100+); 8% from outer regional/remote areas; 12% from the most socioeconomically disadvantaged communities; and 9% from culturally and linguistically diverse backgrounds. The first four surveys found that the impact of the pandemic varied across populations and stages of the pandemic. Between February-April (survey 2) 2021, 10% reported missed healthcare in the past month because of the pandemic, rising to 26% by September-November 2021 (survey 4). Quality of life remained high (>90% good-excellent across the surveys). As the pandemic progressed, the proportion reporting worsened mental health as a result increased from 29% (July-December 2020, survey 1) to 46% (survey 4). In survey 2 (February-April 2021), 89% intended to get the COVID-19 vaccine, with 8% unsure. By late 2021, vaccination uptake was high, with 98% of respondents having received at least one vaccination. CONCLUSION: There is great value in harnessing a large longitudinal, well-described, and diverse cohort study to generate evidence in a changing context with evolving information needs. The collaborative model enhanced the value and relevance of the data to inform decisions.

Preventing infectious diseases outbreaks at exercise facilities. (Special Issue: Managing sport and leisure in the era of Covid-19.)

Exercise facilities play an important role in enhancing physical fitness and in supporting an active lifestyle among users. During the global coronavirus disease 2019 (COVID-19) pandemic, exercise facilities have been shut as part of the "physical distancing" policies in many countries. Exercise facilities have been considered "high-risk" places for transmission because of their enclosed environment, shared equipment and the close contact between users and staff. In Japan, in response to the COVID-19 clusters developed from the exercise facilities in the early phase of pandemic, the Fitness Industry Association of Japan released guidelines for gym managers, workers, and users in March. This commentary aims to introduce exercise facilities guidelines in Japan. This article provides reference for the rest of the world to reopen exercise facilities safely in the post pandemic period or to prevent future outbreaks of infectious disease.

Selecting Pseudo Supervision for Unsupervised Domain Adaptive SAR Target Classification (preprint)

In recent years, deep learning has brought significant progress for the problem of Synthetic Aperture Radar (SAR) target classification. However, SAR image characteristics are highly sensitive to the change of imaging conditions. The inconsistency of imaging parameters (especially the depression angle) leads to the distribution shift between the training and test data and severely deteriorates the classification performance. To address this problem, in this paper we propose an unsupervised domain adaptation method based on selective pseudo-labelling for SAR target classification. Our method directly trains a deep model using the data from the target domain by generating pseudo labels in the target domain. The key idea is to iteratively select valuable samples from the target domain and optimize the classifier. In each iteration, the breaking ties (BT) criterion is adopted to select the best samples with the highest scores of relative confidence. Besides, to avoid error accumulation in the iterative process, class confusion regularization is used to improve the accuracy of pseudo-labelling. Our method is compared with state-of-the-art methods, including supervised classification and unsupervised domain adaptation methods, over the moving and stationary target acquisition and recognition (MSTAR) dataset. The experimental results demonstrate that the proposed method can achieve better classification performance, especially when the difference of depression angles of the source and target domain images is large. Besides, our method also shows its superiority under limited-sample conditions.

Perspective: Are Online Food Delivery Services Emerging as Another Obstacle to Achieving the 2030 United Nations Sustainable Development Goals?

Online food delivery usage has soared during the 2019 novel coronavirus (COVID-19) pandemic which has seen increased demand for home-delivery during government mandated stay-at-home periods. Resulting implications from COVID-19 may threaten decades of development gains. It is becoming increasingly more important for the global community to progress toward sustainable development and improve the wellbeing of people, economies, societies, and the planet. In this perspective article, we discuss how the rising use of these platform-to-consumer delivery operations may impede advances toward the United Nations 2030 Sustainable Development Goals (SDGs). Specifically, online food delivery services may disrupt SDGs that address good health and wellbeing, responsible consumption and production, climate action and decent work and economic growth. To mitigate potential negative impacts of these meal delivery apps, we have proposed a research and policy agenda that is aligned with entry points within a systems approach identified by the World Health Organization. Food industry reforms, synergised public health messaging and continuous monitoring of the growing impact of online food delivery should be considered for further investigation by researchers, food industry, governments, and policy makers.

Three-Dimensional SAR Imaging with Sparse Linear Array using Tensor Completion in Embedded Space (preprint)

Due to the huge data storage and transmission pressure, sparse data collection strategy has provided opportunities and challenges for 3-D SAR imaging. However, sparse data brought by the sparse linear array will produce high-level side-lobes, as well as the aliasing and the false-alarm targets. Simultaneously, the vectorizing or matrixing of 3-D data makes high computational complexity and huge memory usage, which is not practicable in real applications. To deal with these problems, tensor completion (TC), as a convex optimization problem, is used to solve the 3-D sparse imaging problem efficiently. Unfortunately, the traditional TC methods are invalid to the incomplete tensor data with missing slices brought by sparse linear arrays. In this paper, a novel 3-D imaging algorithm using TC in embedded space is proposed to produce 3-D images with efficient side-lobes suppression. With the help of sparsity and low-rank property hidden in the 3-D radar signal, the incomplete tensor data is taken as the input and converted into a higher order incomplete Hankel tensor by multiway delay embedding transform (MDT). Then, the Tucker decomposition with incremental rank has been applied for completion. Subsequently, any traditional 3-D imaging methods can be employed to obtain excellent imaging performance for the completed tensor. The proposed method achieves high resolution and low-level sidelobes compared with the traditional TC-based methods. It is verified by several numerical simulations and multiple comparative studies on real data. Results clearly demonstrate that the proposed method can generate 3-D images with small reconstruction error even when the sparse sampling rate or signal to noise ratio is low, which confirms the validity and advantage of the proposed method.

The prevalence of loneliness across 113 countries: systematic review and meta-analysis.

OBJECTIVES: To identify data availability, gaps, and patterns for population level prevalence of loneliness globally, to summarise prevalence estimates within World Health Organization regions when feasible through meta-analysis, and to examine temporal trends of loneliness in countries where data exist. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Embase, Medline, PsycINFO, and Scopus for peer reviewed literature, and Google Scholar and Open Grey for grey literature, supplemented by backward reference searching (to 1 September 2021) ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies based on nationally representative samples (n≥292), validated instruments, and prevalence data for 2000-19. Two researchers independently extracted data and assessed the risk of bias using the Joanna Briggs Institute checklist. Random effects meta-analysis was conducted in the subset of studies with relatively homogeneous research methods by measurement instrument, age group, and WHO region. RESULTS: Prevalence data were available for 113 countries or territories, according to official WHO nomenclature for regions, from 57 studies. Data were available for adolescents (12-17 years) in 77 countries or territories, young adults (18-29 years) in 30 countries, middle aged adults (30-59 years) in 32 countries, and older adults (≥60 years) in 40 countries. Data for all age groups except adolescents were lacking outside of Europe. Overall, 212 estimates for 106 countries from 24 studies were included in meta-analyses. The pooled prevalence of loneliness for adolescents ranged from 9.2% (95% confidence interval 6.8% to 12.4%) in South-East Asia to 14.4% (12.2% to 17.1%) in the Eastern Mediterranean region. For adults, meta-analysis was conducted for the European region only, and a consistent geographical pattern was shown for all adult age groups. The lowest prevalence of loneliness was consistently observed in northern European countries (2.9%, 1.8% to 4.5% for young adults; 2.7%, 2.4% to 3.0% for middle aged adults; and 5.2%, 4.2% to 6.5% for older adults) and the highest in eastern European countries (7.5%, 5.9% to 9.4% for young adults; 9.6%, 7.7% to 12.0% for middle aged adults; and 21.3%, 18.7% to 24.2% for older adults). CONCLUSION: Problematic levels of loneliness are experienced by a substantial proportion of the population in many countries. The substantial difference in data coverage between high income countries (particularly Europe) and low and middle income countries raised an important equity issue. Evidence on the temporal trends of loneliness is insufficient. The findings of this meta-analysis are limited by data scarcity and methodological heterogeneity. Loneliness should be incorporated into general health surveillance with broader geographical and age coverage, using standardised and validated measurement tools. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019131448.

Living With Early-Onset Dementia in China: Through a Person-Centered Care Lens

We conducted semi-structured interviews with 35 dyads of persons with early-onset dementia (EOD) and their primary informal care partners to explore their dyadic experiences of living EOD in Shanghai, China. Many of them are in their 50s and still need to make familial, financial, and social commitments. They experienced significant disruptions of their "normal" family life and family dynamics, social stigma, and felt marginalized when there was very limited age-appropriate support for them. During COVID-19 pandemic, many persons with EDO and their care partners had decreased social networking opportunities, physical exercises and experienced an increased level of social isolation. The pandemic further complicated their family dynamics, relationships, and communications. Care partners used their strengths to adaptively deal with multiple challenges, cope with the stress, social isolation, and normalize their family life by facilitating collaborative work with persons with EOD.

Exercise frequency during the COVID-19 pandemic: A longitudinal probability survey of the US population.

Regular physical activity is important for general health and reduces the risk for COVID-19 infections and for severe outcomes among infected people. However, measures to mitigate COVID-19 likely decrease population physical activity. This study aimed to examine 1) changes in exercise frequency in a representative sample of US adults during the pandemic (04/01/2020-07/21/2021), and 2) how sociodemographic characteristics, pre-COVID health-related behaviors and outcomes, and state-level stringency of COVID-19 containment measures predict exercise frequency. Self-reported exercise frequency and its individual-level predictors were determined based on 151,155 observations from 6,540 adult participants (aged ≥ 18 years) in all US states from the Understanding America Study. State-level stringency of COVID-19 control measures was examined from the Oxford COVID-19 Government Response Tracker. Exercise frequency varied significantly over 28 survey waves across 475 days of follow-up (F 1,473 = 185.5, p < 0.001, η2 = 0.28, 95% CI = 0.23-1.00), where exercise frequency decreased between April 2020 and January 2021, and then increased from January 2021 to July 2021. Those who were younger, living alone, non-White, had no college degree, lower household income, low pre-pandemic physical activity levels, obesity, diabetes, kidney disease and hypertension had lower exercise frequency. State-level stringency of COVID-19 control measures was inversely associated with exercise frequency (B = 0.002, SE = 0.001, p < 0.01) between April and December 2020 when the overall stringency level was relatively high; but the association was non-significant (B = 0.001, SE = 0.001, p > 0.05) between January and July 2021, during which the stringency index sharply declined to a low level. This longitudinal probability survey of the US population revealed significant fluctuations in exercise during COVID-19. Low exercise levels are concerning and deserve public health attention. Health inequalities from physical inactivity are likely to exacerbate because of COVID-19. Physical activity promotion in safe environments is urgently warranted, especially in at-risk population subgroups.

Impact of the COVID-19 pandemic on people with epilepsy: Findings from the Brazilian arm of the COV-E study.

The COVID-19 pandemic has had an unprecedented impact on people and healthcare services. The disruption to chronic illnesses, such as epilepsy, may relate to several factors ranging from direct infection to secondary effects from healthcare reorganization and social distancing measures. OBJECTIVES: As part of the COVID-19 and Epilepsy (COV-E) global study, we ascertained the effects of COVID-19 on people with epilepsy in Brazil, based on their perspectives and those of their caregivers. We also evaluated the impact of COVID-19 on the care delivered to people with epilepsy by healthcare workers. METHODS: We designed separate online surveys for people with epilepsy and their caregivers. A further survey for healthcare workers contained additional assessments of changes to working patterns, productivity, and concerns for those with epilepsy under their care. The Brazilian arm of COV-E initially collected data from May to November 2020 during the country's first wave. We also examined national data to identify the Brazilian states with the highest COVID-19 incidence and related mortality. Lastly, we applied this geographic grouping to our data to explore whether local disease burden played a direct role in difficulties faced by people with epilepsy. RESULTS: Two hundred and forty-one people returned the survey, 20% were individuals with epilepsy (n = 48); 22% were caregivers (n = 53), and 58% were healthcare workers (n = 140). Just under half (43%) of people with epilepsy reported health changes during the pandemic, including worsening seizure control, with specific issues related to stress and impaired mental health. Of respondents prescribed antiseizure medication, 11% reported difficulty taking medication on time due to problems acquiring prescriptions and delayed or canceled medical appointments. Only a small proportion of respondents reported discussing significant epilepsy-related risks in the previous 12 months. Analysis of national COVID-19 data showed a higher disease burden in the states of Sao Paulo and Rio de Janeiro compared to Brazil as a whole. There were, however, no geographic differences observed in survey responses despite variability in the incidence of COVID-19. CONCLUSION: Our findings suggest that Brazilians with epilepsy have been adversely affected by COVID-19 by factors beyond infection or mortality. Mental health issues and the importance of optimal communication are critical during these difficult times. Healthcare services need to find nuanced approaches and learn from shared international experiences to provide optimal care for people with epilepsy as the direct burden of COVID-19 improves in some countries. In contrast, others face resurgent waves of the pandemic.

Mutations in spike protein and allele variations in ACE2 impact targeted therapy strategies against SARS-CoV-2.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread rapidly worldwide with high rates of transmission and substantial mortality. To date, however, no effective treatments or enough vaccines for COVID-19 are available. The roles of angiotensin converting enzyme 2 (ACE2) and spike protein in the treatment of COVID-19 are major areas of research. In this study, we explored the potential of ACE2 and spike protein as targets for the development of antiviral agents against SARS-CoV-2. We analyzed clinical data, genetic data, and receptor binding capability. Clinical data revealed that COVID-19 patients with comorbidities related to an abnormal renin-angiotensin system exhibited more early symptoms and poorer prognoses. However, the relationship between ACE2 expression and COVID-19 progression is still not clear. Furthermore, if ACE2 is not a good targetable protein, it would not be applicable across a wide range of populations. The spike-S1 receptor-binding domain that interacts with ACE2 showed various amino acid mutations based on sequence analysis. We identified two spike-S1 point mutations (V354F and V470A) by receptor-ligand docking and binding enzyme-linked immunosorbent assays. These variants enhanced the binding of the spike protein to ACE2 receptors and were potentially associated with increased infectivity. Importantly, the number of patients infected with the V354F and V470A mutants has increased with the development of the SARS-CoV-2 pandemic. These results suggest that ACE2 and spike-S1 are likely not ideal targets for the design of peptide drugs to treat COVID-19 in different populations.

How COVID-19 lockdown and reopening affected daily steps: evidence based on 164,630 person-days of prospectively collected data from Shanghai, China.

BACKGROUND: COVID-19 lockdowns may lead to physical inactivity, a major risk factor for non-communicable diseases. This study aims to determine: 1) the trajectory in daily step counts before, during and after the lockdown in China, and 2) the characteristics associated with the trajectories. METHODS: From December 2019 to July 2020, smartphone-based step counts were continuously collected in 815 Chinese adults residing in Shanghai over 202 days across three phases: before, during, and after the lockdown. Participant characteristics were reported, and height, weight and body composition measured before the lockdown. A 'sharp' regression discontinuity design with cluster robust standard errors was used to test the effect of the lockdown and reopening on daily steps and a linear mixed model was used to examine the characteristics associated with trajectories during the observed period. RESULTS: Based on 164,630 person-days of data, we found a sharp decline in daily step counts upon the lockdown (24/01/2020) by an average of 3796 (SE = 88) steps, followed by a significant trend of increase by 34 steps/day (SE = 2.5; p < .001) until the end of the lockdown (22/03/2020). This increasing trend continued into the reopening phase at a slower rate of 5 steps per day (SE = 2.3; p = 0.029). Those who were older, married, university educated, insufficiently active, had an 'at risk' body composition, and those in the control group, were slower at recovering step counts during the lockdown, and those who were older, married, without university education and with an 'at risk' body composition recovered step counts at a slower pace after the reopening. CONCLUSIONS: Despite later increases in step counts, COVID-19 lockdown led to a sustained period of reduced physical activity, which may have adverse health implications. Governments and health professionals around the world should continue to encourage and facilitate physical activity during the pandemic.

Evaluating risk to people with epilepsy during the COVID-19 pandemic: Preliminary findings from the COV-E study.

The COVID-19 pandemic has caused global anguish unparalleled in recent times. As cases rise, increased pressure on health services, combined with severe disruption to people's everyday lives, can adversely affect individuals living with chronic illnesses, including people with epilepsy. Stressors related to disruption to healthcare, finances, mental well-being, relationships, schooling, physical activity, and increased isolation could increase seizures and impair epilepsy self-management. We aim to understand the impact that COVID-19 has had on the health and well-being of people with epilepsy focusing on exposure to increased risk of seizures, associated comorbidity, and mortality. We designed two online surveys with one addressing people with epilepsy directly and the second for caregivers to report on behalf of a person with epilepsy. The survey is ongoing and has yielded 463 UK-based responses by the end of September 2020. Forty percent of respondents reported health changes during the pandemic (n = 185). Respondents cited a change in seizures (19%, n = 88), mental health difficulties (34%, n = 161), and sleep disruption (26%, n = 121) as the main reasons. Thirteen percent found it difficult to take medication on time. A third had difficulty accessing medical services (n = 154), with 8% having had an appointment canceled (n = 39). Only a small proportion reported having had discussions about epilepsy-related risks, such as safety precautions (16%, n = 74); mental health (29%, n = 134); sleep (30%, n = 140); and Sudden Unexpected Death in Epilepsy (SUDEP; 15%, n = 69) in the previous 12 months. These findings suggest that people with epilepsy are currently experiencing health changes, coupled with inadequate access to services. Also, there seems to be a history of poor risk communication in the months preceding the pandemic. As the UK witnesses a second COVID-19 wave, those involved in healthcare delivery must ensure optimal care is provided for people with chronic conditions, such as epilepsy, to ensure that avoidable morbidity and mortality is prevented during the pandemic, and beyond.

Keeping people with epilepsy safe during the COVID-19 pandemic.

OBJECTIVES: To provide information on the effect of the coronavirus disease of 2019 (COVID-19) pandemic on people with epilepsy and provide consensus recommendations on how to provide the best possible care for people with epilepsy while avoiding visits to urgent care facilities and hospitalizations during the novel coronavirus pandemic. METHODS: The authors developed consensus statements in 2 sections. The first was "How should we/clinicians modify our clinical care pathway for people with epilepsy during the COVID-19 pandemic?" The second was "What general advice should we give to people with epilepsy during this crisis? The authors individually scored statements on a scale of -10 (strongly disagree) to +10 (strongly agree). Five of 11 recommendations for physicians and 3/5 recommendations for individuals/families were rated by all the authors as 7 or above (strongly agree) on the first round of rating. Subsequently, a teleconference was held where statements for which there was a lack of strong consensus were revised. RESULTS: After revision, all consensus recommendations received a score of 7 or above. The recommendations focus on administration of as much care as possible at home to keep people with epilepsy out of health care facilities, where they are likely to encounter COVID-19 (including strategies for rescue therapy), as well as minimization of risk of seizure exacerbation through adherence, and through ensuring a regular supply of medication. We also provide helpful links to additional helpful information for people with epilepsy and health providers. CONCLUSION: These recommendations may help health care professionals provide optimal care to people with epilepsy during the coronavirus pandemic.