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OBJECTIVES: Brain dural arteriovenous fistulas(bDAVFs) are anomalous connections between dural arteries and cerebral veins or sinuses. Cerebral venous thrombosis(CVT) often precedes or coincides with bDAVFs and is considered a risk factor for these vascular malformations. Recently, vaccine-induced thrombotic thrombocytopenia causing CVTs has been associated with COVID-19 vaccines. Concurrently with the start of massive vaccination in our region, we have observed a fivefold increase in the average incidence of bDAVFs. Our objective is to raise awareness of the potential involvement of COVID-19 vaccines in the pathogenesis of bDAVF. METHODS: A retrospective review of demographic, clinical, radiological, COVID-19 infection and vaccination data of patients diagnosed with bDAVFs between 2011 and 2021 was conducted. Patients were divided into two cohorts according to their belonging to pre- or post-COVID-19 vaccination times. Cohorts were compared for bDAVFs incidences and demographic and clinical features. RESULTS: Twenty-one bDAVFs were diagnosed between 2011 and 2021, 7 of which in 2021. The mean age was 57.7 years, and 62 % were males. All cases except one were treated; of them, 85 % exclusively managed with surgery. All treated cases were successfully occluded. The incidence in 2021 was significantly higher than that in the prevaccination period (1.72 vs 0.35/100,000/year;p = 0.036; 95 %Confidence Interval=0.09-2.66). Cohorts were not different in age, sex, hemorrhagic presentation, dural sinus thrombosis or presence of prothrombotic or cardiovascular risk factors. CONCLUSION: The significant increase in the incidence of bDAVF following general vaccination policies against COVID-19 observed in our region suggests a potential correlation between these two facts. Our findings need confirmation from larger cohorts and further pathogenic research.
Subject(s)
COVID-19 , Central Nervous System Vascular Malformations , Brain/pathology , COVID-19/epidemiology , COVID-19 Vaccines , Central Nervous System Vascular Malformations/surgery , Cerebral Angiography , Female , Humans , Male , Middle AgedABSTRACT
COVID-19 is reflecting the importance of self-protection plans in nursing homes, especially when it concerns persons of older age. Self-protection plans intend to prevent and control the risks of residential buildings. The goal of this research is to develop a design process for self-protection plans of public buildings, and specifically a nursing home. In this regard, it is key for the viability of the nursing home operations to be capable of adapting to any potential future event. Starting from some initial hypotheses that establish the need for adaptability, a self-protection plan model is developed for public buildings based on a new approach consisting of four elements and three steps. It was applied to an elderly residence which is currently under construction. The methodology followed has consisted of a process by stages, to design and implement a novel self-protection plan for public buildings. Subsequently, it has been applied to the specific case study, using the most common tools and applications available for later analysis of the result obtained with the starting hypotheses. The results show how the research allows an increase in the adaptability of self-protection plans for any publicly owned building, although there is an extensive and precise subsequent work of adaptation to specific cases considering the different legal frameworks which makes the work challenging. Finally, the research on adaptability and its application for elderly residences enabled the derivation of recommendations regarding self-protection plans in general and specifically in homes for the elderly.
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Featured ApplicationA novel methodology for project management applicable for self-protection plans for public buildings based on the best practices of technologies, systems, and methods.Self-protection plans are the fundamental tool established to prevent and control the risks that threaten people and assets. In turn, they are essential to provide an adequate response to possible emergency situations that may occur in public or private buildings, facilities, or events. In this context, current and future challenges advocate increasing the usefulness, versatility, and adaptability of self-protection plans. For this purpose, this paper aims to develop a conceptual model for the project management of self-protection plans with a lifecycle approach. The research provides results concerning guidelines, aspects, and potential regulations, technologies, tools, methodologies, and maintenance frameworks to be followed for any building in different project phases. The methodology followed has consisted of a process in stages, with literature review and a conceptual development to obtain an adaptable model to any public building. The adaptability of the framework relies on the definition of potential methods, information systems, and technologies that can support any phase during the Self-Protection Plan life cycle. Moreover, it was applied in a specific environment, such as in public buildings under the Spanish regulation using the most common tools and applications available. Results proved that although it is possible to make a base model applicable to any publicly owned building, there is an extensive and precise subsequent work of adaptation to specific cases in which the applicable legal framework makes this task challenging. Finally, the results obtained have allowed us to reflect on future research needs.
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Silver diamine fluoride (SDF) has been used for many years for the treatment of caries, and minimally invasive dentistry concepts have made it popular again. The fact that its application does not require the administration of anesthesia makes its use in children more desirable. The aim of this study was to determine the cytotoxicity of two new commercial SDF products: Riva Star (SDI Dental Limited) and e-SDF (Kids-e-Dental) on mesenchymal stromal cells from human exfoliated deciduous teeth (SHEDs). SHEDs were exposed to SDF products at different concentrations (0.1%, 0.01% and 0.005%). Then different assays were performed to evaluate their cytocompatibility on SHEDs: IC50, MTT, cell migration (wound healing), cell cytoskeleton staining, cell apoptosis, generation of intracellular reactive oxygen species (ROS), and ion chromatography. Statistical analyses were performed using one-way ANOVA and Tukey's post hoc test (p < 0.05). Riva Star Step 2 showed the same cell metabolic activity when compared to the control condition at any time and concentration. Meanwhile, e-SDF displayed high cytotoxicity at any time and any concentration (*** p < 0.001), whereas Riva Star Step 1 displayed high cytotoxicity at any time at 0.1% and 0.01% (*** p < 0.001). Only e-SDF showed a statistically significant decreased cell migration rate (*** p < 0.001) at all times and in all concentrations. At 0.1%, e-SDF and Riva Star Step 1 only showed 4.37% and 4.47% of viable cells, respectively. These results suggest that Riva Star has better in vitro cytocompatibility on SHEDs than does e-SDF. Riva Star Step 1 was found to be as cytotoxic as e-SDF, but it had better biological properties when mixed with Riva Star Step 2. Our findings suggest that Riva Star is more suitable when used in deciduous teeth due to its lower cytotoxicity compared to e-SDF.
Subject(s)
COVID-19 , Rural Population , Humans , Mexico/epidemiology , Outpatients , Pandemics , SARS-CoV-2ABSTRACT
Featured ApplicationProcurement planning adapted to suppliers’ behavior and the related risks for procurement based on the appropriate selection of procurement order quantities.In the current global system;supply chains are at risk due to increasing procurement shortages, supply disruptions, and the reliability of on-time deliveries with the original order quantities. As a result, an anticipated management model is of vital importance to provide companies with the productive flexibility necessary to adapt quickly to supply changes, in order to ensure the quality and delivery time through efficient management of stocks and supply costs. In this context, this research aims to develop a system to complement classical procurement planning based on inventory management methods and MRP (material requirements planning) systems by considering suppliers’ behavior regarding procurement risks. For this purpose, a system is developed that seeks to simulate the impacts of procurement shortages of different natures. Moreover, the research investigates the development of a system that performs procurement planning of a component manufacturer to determine the supply orders necessary to meet the master production schedule. The system is analyzed based on a set of indicators in the event that the supplier of a material needed for production does not supply on time or has short-term problems. Several scenarios are simulated, and the results are quantified by changing the procurement order quantities, which may or may not follow the economic order quantity (EOQ) model, and the potential procurement disruptions or shortages. The results show how the simulation and anticipation of potential suppliers’ procurement behavior concerning potential shortages and their probability are key for successful procurement within a joint strategy with classical procurement methods.
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Featured ApplicationManagement model for air mobility and Service-oriented On-Demand Air Mobility. Modeling method for aircraft units between different vertiports within a given region considering mobility needs, capacity constraints, maintenance and charging needs. Exemplary application in a simulation model for a regional area of fifteen vertiports and their interconnection by means of electric aircraft units.Vertical mobility, as a commercial service, has been considered for scheduled volume and long-distance mobility services. To overcome its limits and increase its potential coverage, flexibility, and adaptability, centralized mobility hubs, similar to airports, will need to be constructed. Within this context, a customized and on-demand air mobility concept providing high flexibility in location combinations and time schedules could provide a solution for regional mobility needs. The aim of this research was to provide a generic framework for various mobility schemes as well as to design a holistic air mobility management concept for electric vertical mobility. A system dynamics simulation case study applied the conceptual model for an on-demand air mobility network of electric aircraft in a regional area with capacity constraints including vertiports, aircraft, charging, and parking stations. Therefore, bottlenecks and delays were quantified using a digital twin tool for customized scenarios. Simulation results showed that optimized maintenance management and the redistribution of aircraft units improved service indicators such as the number of customers served, and customer wait times as well as a reduction in the amount of time an aircraft spent on the ground. As a result, a digital twin air mobility network model with simulation capabilities may be a key factor for future implementation.
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PURPOSE: We describe the design of a longitudinal cohort study to determine SARS-CoV-2 incidence and prevalence among a population-based sample of adults living in six San Francisco Bay Area counties. METHODS: Using an address-based sample, we stratified households by county and by census-tract risk. Risk strata were determined by using regression models to predict infections by geographic area using census-level sociodemographic and health characteristics. We disproportionately sampled high and medium risk strata, which had smaller population sizes, to improve precision of estimates, and calculated a desired sample size of 3400. Participants were primarily recruited by mail and were followed monthly with PCR testing of nasopharyngeal swabs, testing of venous blood samples for antibodies to SARS-CoV-2 spike and nucleocapsid antigens, and testing of the presence of neutralizing antibodies, with completion of questionnaires about socio-demographics and behavior. Estimates of incidence and prevalence will be weighted by county, risk strata and sociodemographic characteristics of non-responders, and will take into account laboratory test performance. RESULTS: We enrolled 3842 adults from August to December 2020, and completed follow-up March 31, 2021. We reached target sample sizes within most strata. CONCLUSIONS: Our stratified random sampling design will allow us to recruit a robust general population cohort of adults to determine the incidence of SARS-CoV-2 infection. Identifying risk strata was unique to the design and will help ensure precise estimates, and high-performance testing for presence of virus and antibodies will enable accurate ascertainment of infections.
Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Antibodies, Viral , COVID-19/epidemiology , Cohort Studies , Humans , Incidence , Longitudinal Studies , Prevalence , San Francisco/epidemiologyABSTRACT
Early diagnosis of SARS-CoV-2 infection is very important to establish timely treatment. In the present report, through the examination carried out in otorhinolaryngology, we found a pearlescent vesicular enanthema in the upper palate in 954/958 patients with the classic strain and it was not found in patients with the English strain. This finding had not been reported. The patients were successfully treated on time, only two patients died, which was associated with decompensated diabetes mellitus. The present report suggests that the vesicular enanthem found is pathognomonic for Covid-19 classic strains.
El diagnóstico temprano de la infección por SARS-CoV-2 es muy importante para establecer un tratamiento oportuno. En el presente reporte, en la exploración realizada en otorrinolaringología encontramos un enantema vesicular aperlado en el paladar superior en 954 de 958 pacientes con la cepa clásica, y no se encontró en pacientes con la cepa inglesa. Este hallazgo no se había reportado. Los pacientes fueron tratados a tiempo exitosamente y solo dos pacientes murieron, lo cual se asoció a diabetes mellitus descompensada. Este reporte sugiere que el enantema vesicular encontrado es patognomónico de COVID-19 por cepas clásicas.
Subject(s)
COVID-19 , Diabetes Mellitus , Humans , SARS-CoV-2ABSTRACT
Healthcare service centers must be sited in strategic locations that meet the immediate needs of patients. The current situation due to the COVID-19 pandemic makes this problem particularly relevant. Assume that each center corresponds to an assigned place for vaccination and that each center uses one or more vaccine brands/laboratories. Then, each patient could choose a center instead of another, because she/he may prefer the vaccine from a more reliable laboratory. This defines an order of preference that might depend on each patient who may not want to be vaccinated in a center where there are only her/his non-preferred vaccine brands. In countries where the vaccination process is considered successful, the order assigned by each patient to the vaccination centers is defined by incentives that local governments give to their population. These same incentives for foreign citizens are seen as a strategic decision to generate income from tourism. The simple plant/center location problem (SPLP) is a combinatorial approach that has been extensively studied. However, a less-known natural extension of it with order (SPLPO) has not been explored in the same depth. In this case, the size of the instances that can be solved is limited. The SPLPO considers an order of preference that patients have over a set of facilities to meet their demands. This order adds a new set of constraints in its formulation that increases the complexity of the problem to obtain an optimal solution. In this paper, we propose a new two-stage stochastic formulation for the SPLPO (2S-SPLPO) that mimics the mentioned pandemic situation, where the order of preference is treated as a random vector. We carry out computational experiments on simulated 2S-SPLPO instances to evaluate the performance of the new proposal. We apply an algorithm based on Lagrangian relaxation that has been shown to be efficient for large instances of the SPLPO. A potential application of this new algorithm to COVID-19 vaccination is discussed and explored based on sensor-related data. Two further algorithms are proposed to store the patient's records in a data warehouse and generate 2S-SPLPO instances using sensors.