Interstitial changes after severe SARS-CoV-2 Infection

Introduction and aim: COVID19 pandemic caused by SARS-CoV-2 is associated with high morbidity and mortality rate worldwide,producing inflammation that can lead to persistent parenchymal lesions. The aim was to analyse the medium-long term evolution of patients with severe COVID19. Method(s): Follow-up of a cohort of 97 COVID19 patients admitted to intensive care unit from March 2020 to June 2021,requiring invasive/non-invasive mechanical ventilation (IMV/NIMV) and/or high-flow nasal cannula (HFNC). They were clinically evaluated in the Interstitial Diseases consult at 4-6 weeks after discharge with spirometry (SP),CO diffusion capacity (DLCO) and thoracic ultrasound (TU);those suggestive of mild interstitial changes (IC) were evaluated at 3 months and moderate-severe ones at 6 months with HRCT,SP and DLCO. Result(s): Mean age was 61+/-15 years (61% male) and hospital stay was 26+/-17 days.93% used HFNC,57% NIMV and 31% IMV. At 4-6 week after discharge assessment showed 45% dyspnea and 33% crackles. SP was normal in 63%,with mild DLCO disorders in 36% and 77% pathological TU. The most frequent abnormality on HRCT was ground glass. After clinical-functional and ultrasound-radiological evaluation at 4-6 weeks after COVID19,37% of cases were discharged,another 2% at 3 months,22% at 6 months and 7% at 12 months. The remaining 32% are still being followed up for persistent IC(6 receiving home oxygen therapy,6 treated with steroids and 4 with antifibrotic). Conclusion(s): Most patients with severe COVID19 infection have after discharge IC with mild clinical-functional impact at 4-6 weeks,although one third have persistent changes after 12 months. Medium to long-term follow-up of postCOVID19 patients is necessary to identify those with permanent abnormalities.

The Covid-19 Pandemic, the Financial crisis and the Dynamic (Overshooting) of the Exchange Rate

The aim of this paper is to analyze the dynamics of the exchange rate (E) in the face of expansionary policies undertaken to cope with external shocks over the period 2000: 01-2020: 03. Our results, based on an ARDL model and impulse-response functions, confirm evidence of overshooting of E in South Korea, Mexico, the United Kingdom and the United States, while in Germany, Brazil and Japan no such evidence was found;perhaps this is due to the semi-fixed nature of the euro, the reprimarization of the Brazilian trade structure and Japan's stagnation cum deflation. Our original contribution and main conclusion is that expansionary policies undertaken to tame the effects of both the 2007/08 financial crisis and the Covid-19 pandemic act upon the dynamics of E, in turn implying significant effects on: foreign debt, institutional sectors' balance sheets, balance of payments and economic growth. Hence governments should adopt countervailing measures, it is highly recommended. Lack of sufficient data to estimate the impact of E overshooting, triggered by the Covid-19, on the latter variables is the main shortcoming of the paper. © 2021 The Author(s).

Mepolizumab effectiveness in severe asthma supported by federated analysis of European SHARP data

Background: Innovative information techniques are increasingly used to perform federated analyses in real-world studies. Whether these techniques are suitable for harmonizing patient data from non-standardized registries and evaluating treatment outcomes needs further evidence. Aim(s): To standardize patient-level registry data from SHARP (Severe Heterogeneous Asthma Registry Patientcentred) and evaluate the effectiveness of mepolizumab on frequent (>=2/yr) exacerbations in patients with severe asthma. Method(s): We standardized data from 5,871 adults with severe asthma in 10 European countries using the OMOP Common Data Model (www.ohdsi.org). Patients who had taken mepolizumab >=1 yr (2016-2021) and had exacerbation data available were included. Changes in odds of >=2 exacerbations/yr were evaluated. Result(s): Of 2,109 patients who initiated mepolizumab 563 met inclusion criteria. Analysis showed a reduction of having >=2 (vs 0-1) annual exacerbations after 1 yr mepolizumab therapy: OR (95%CI) 0.18 (0.13-0.25)[N=369] pre and 0.08 (0.05-0.13)[N=194] during the COVID-19 pandemic (Fig). Conclusion(s): By harmonizing non-standardized, patient-level registry data and applying federated analysis we demonstrated that mepolizumab reduced asthma exacerbations, consistent with current knowledge. This paves the way for future pan-European real-world severe asthma studies using patient-level data in a privacy-proof way. (Figure Presented).

A LEGAL HISTORY OF THE FIGHT AGAINST THE COVID-19 PANDEMIC

The arrival of the Covid-19 pandemic has tested the law we have in Spain to deal with extreme public health crises. In this context, the author explains, firstly, the mechanisms that exist for this purpose both at the level of our constitutional emergency law and in the field of health legislation. Secondly, it analyses how the state of alarm has been applied and the problems of constitutionality that have arisen with its use. Thirdly, it examines the way in which the minimum public health legislation we have in our country has been used to deal with epidemics and pandemics, which is really reduced to a general clause that enables the health authorities to adopt any health measures that may be necessary to deal with communicable diseases, in order to explain, finally, the legal problems arising from the effective application of that general clause. © 2023, Iustel. All rights reserved.

The Effects of a Physical Therapy Program and the Covid-19 Pandemic on Student's Health Outcomes

PURPOSE/HYPOTHESIS: In 2020, COVID-19 became a global pandemic affecting multiple aspects of everyday life.1-4 Since COVID-19 was a highly transmissible disease, in-person classes weremoved online,5,6 gyms were closed,1-3 and social interactions were limited.4 While some data exist on the impact COVID-19 has had on students,5,6 there is a need for further research to examine the compounding effects of the graduate level workload and the COVID-19 pandemic on physical therapy students. The purpose of this study is to understand how COVID-19 affects the cardiovascular (CV) and mental health of Doctor of Physical Therapy (DPT) students as they progress through the program. We hypothesize that students would have better health outcomes in their second year, when the COVID-19 restrictions lessen, compared to their first year, when COVID restrictions were at their peak. NUMBER OF SUBJECTS: 16 students from the University of Texas at El Paso's DPT Class of 2023 were recruited via in-class presentation and email. MATERIALS AND METHODS: Data collection occurred over the time period of a year and a half with a total of 3 visits (Oct 2020, June 2021, and April 2022). Primary outcome measures included cardiovascular fitness level via VO2max, arterial stiffness via Pulse Wave Velocity (PWV), and endothelial function via Venous Occlusion Plethysmography (VOP). Secondary outcome measures included Perceived Stress Survey (PSS), International Physical Activity Questionnaire (IPAQ), and Dietary Screening Questionnaire (DSQ). A repeated-measures analysis of variance (RM-ANOVA) and Cohen's d for standardized effect size were utilized. Significance was set prior at an alpha level of 0.05. RESULT(S): VO2max increased from visit 1 to visit 2 (P5.02, d50.63) and then decreased fromvisit 2 to visit 3 (P< 01, d = 0.85), with no change between visits 1 and 3 (P>.05). Endothelial function increased from visit 1 to visit 3 (P< 01, d=0.89) and from visit 2 to visit 3 (P = .02, d = 0.65), with no differences between visits 1 and 2. Overall, there were no significant differences observed for PWV, PSS, METs, sitting time, sweetened beverages, and added sugar (P>05) between visits. CONCLUSION(S): The DPT Class of 2023 started their graduate education in the beginning of the COVID pandemic, with an already limited physical freedom. COVID restrictions were lessen in early 2021~4 months before visit 2. It appears that those 4 months were enough time to improve VO2max but not endothelial function. Interestingly, VO2max decreased back to baseline after the second year, with an increase in endothelial function. These changes could be attributed to an increase in time spent at school during the second year and increased travel time due to classes moving from virtual to in person, which could impact cardiopulmonary fitness but not endothelial function. CLINICAL RELEVANCE: Results from this study can help DPT programs throughout the nation understand the importance of developing strategies to support their students during times of crisis to reduce the risk of CV and mental health diseases in the future.

Incidence, morbidity and mortality, and management of acute coronary syndrome during the time of COVID-19 lockdown

Introduction and objectives: During the lockdown due to the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a decrease in the number of admissions due to acute coronary syndrome (ACS) was observed. The objective of our study was to evaluate the impact lockdown had on the incidence, morbidity and mortality, and management of ACS. Methods: A retrospective and multicenter study was conducted including patients admitted due to ACS from February 14 through June 24, 2020. Patients with acute myocardial infarction and coronary arteries without significant lesions were excluded. The following groups were established based on the period of admission: a) 1 month before lockdown;b) during lockdown;and c) 1 month after lockdown. The differences in mortality seen among the 3 groups were evaluated, as well as the temporal differences reported between symptom onset and the first medical contact (FMC). Results: a total of 634 patients were included (group a, 205;group b, 303, and group c, 126). A 41% decrease in the number of admissions due to ACS was observed during the first month of lockdown compared to the previous month, as well as diagnostic delay during this same period (group a, 66 minutes (45-180), group b, 120 minutes (60-240), and group c, 120 minutes (60-240), P =.007). However, a higher mortality rate during confinement was not reported (RR, 1.26;95%CI, 0.53-2.97;P =.60). Conclusions: During lockdown, a remarkable decrease in the number of admissions due to ACS was observed, and although there was an increase in the time elapsed from symptom onset to the FCM in this period in patients with STEMI, the mortality rate was similar in the 3 groups studied.

Virtual and Hybrid Classes as The Challenge Assumed During The SARS-CoV-2 Pandemic: An Interdisciplinary Qualitative Approach

The SARS-CoV-2 pandemic forced educational institutions worldwide to deploy virtual and hybrid classes as a unique option to continue with the teaching-learning process. However, these modalities imply important efforts on the part of teachers, students, and administrative staff to ensure the teaching-learning process quality. Considering the above, this research work carries out a qualitative interdisciplinary analysis using the focus group technique intending to determine the perceptions, challenges, trends, and trade-offs of the virtual and hybrid modalities during and after the SARS-CoV-2 pandemic. Our analysis involves various disciplines (e.g., pedagogical and andragogical, social-economic, ergonomic, educational technology, and product & service innovation perspectives). As a result, some particular findings of each perspective are shown. The results of this research work can help the body of technical knowledge related to the curricula design at different educational levels to increase the efficiency of hybrid and virtual classes. Finally, this research work has some limitations, therefore the findings presented are suggestive rather than definitive. © 2022 IEEE.

The impact of COVID-19 lockdown on the health and care of children and adolescents with a childhood-onset disability

Introduction: During the initial period of COVID-19 lockdown, restriction measures modified the day-to-day life of the population. This study sought to know the impact of this period on the physical and mental health of children and young people with disabilities originating in childhood, and their families, and to describe the changes that occurred in access to education and health services. Material and methods: An observational and cross-sectional analytical study was carried out. The data were obtained by means of an electronic survey through an online platform carried out by the European Academy of Childhood Disability. The survey included questions on four thematic blocks: sociodemographic and health characteristics, impact of lock down on health and well-being, and access to education and health services. Results: One hundred and forty-five responses were obtained. 45.5% of the children and young people were totally dependent. There was an impact on their physical (54.5%), mental health (47.6%) and both (32%), higher levels of stress (68.3%), and sleep problems (41.4%), as well as a high burden in 84.8% of parents, especially in families of children with a higher level of dependency (P =.00). 55% of children and young people did not receive any treatment during this period, not even remotely. Conclusions: COVID lock down period greatly affected physical and mental health, as well as the services for children and young people with disabilities and their families. © 2022 The Author(s)

The Administrative Procedure in Exceptional Situations

In exceptional situations, certain modulations of the rules that ordinarily govern the administrative procedure may be essential in order to respond quickly to a specific danger. During the coronavirus pandemic, the participation of judicial bodies in the procedure for the adoption of general health provisions to deal with the public health crisis has transformed the administrative procedure into a debatable mixed regulatory procedure of an administrative and judicial nature. This work analyzes, on the one hand, the content of the different measures adopted by the health authorities in procedural matters;and, on the other hand, the effective limits and legal controls that must be instituted to avoid, as far as possible, the temptation to abuse the Law of the exception.

THE ADMINISTRATIVE PROCEDURE IN EXCEPTIONAL SITUATIONS

In exceptional situations, certain modulations of the rules that ordinarily govern the administrative procedure may be essential in order to respond quickly to a specific danger. During the coronavirus pandemic, the participation of judicial bodies in the procedure for the adoption of general health provisions to deal with the public health crisis has transformed the administrative procedure into a debatable mixed regulatory procedure of an administrative and judicial nature. This work analyzes, on the one hand, the content of the different measures adopted by the health authorities in procedural matters;and, on the other hand, the effective limits and legal controls that must be instituted to avoid, as far as possible, the temptation to abuse the Law of the exception. © 2022, Iustel. All rights reserved.

Remote detection of COVID-19 using 5G and AI

This work presents a novel solution for the detection of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV-2) that produces the disease COVID-19 from gel electrophoresis images for the application of the analysis of samples from sewage systems for the control of the pandemic, using the fifth generation mobile network (5G) and artificial intelligence (AI) for the reduction of noise in the samples and the detection of characteristic bands of the virus. It is composed of five steps, allowing to reduce the fatigue of the experts and the cost to perform the SARS-CoV-2 detection process compared to an RT-qPCR. In terms of energy savings in transmission, a gain was achieved that stops the value of a BER of 10-4, it is 0.5 dB when going from N from 64 to 128, similar for the difference from 32 to 64 and a gain of 1dB when going from N from 16 to 32, respectively. © 2022 IEEE.

Factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia

Objective: To determine the factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia. Design: Nested, single-center case-control study, conducted between March and August 2020. Patients: Patients over 18 years of age, a hospital stay greater than 72 h, with invasive mechanical ventilation support admitted to the intensive care unit. Interventions: None. Measurements: Clinical variables were grouped for both cases and controls. Means and standard deviation were calculated in quantitative variables and proportions in categorical variables. Fisher's exact test was used to evaluate the differences between proportions, and the Mann-Whitney U test was used for differences in means. Variables with statistically significant differences were run in an explanatory model based on binary logistic regression. Results: The frequency of bacterial pneumonia was 10.07%, finding a high consumption of empirical antibiotic therapy. A statistical association was found between the time of dexamethasone use (OR 1.520;95% CI 1.131-2.042) with the development of bacterial pneumonia. The rest of the variables were not statistically significant after adjusting the model with logistic regression. Conclusion: Low rates of bacterial pneumonia were found, with Klebsiella pneumoniae prevailing as the most frequent bacterium. Overuse of dexamethasone in intensive care unit COVID-19 patients could increase the risk of bacterial pneumonia. For this reason, it must be evaluated in greater depth to explain causality and effect. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Knowledge management model applied to business financing after the economic crisis generated by the pandemic

In the face of the economic crisis in many productive sectors, generated by the COVID-19 virus pandemic, and being this understood as a “black swan-like” event, the need of to identify ways to reactivate the means of production was detected, in order to achieve the economic normality as soon as possible. To do this, it was decided to analyze models already implemented in organizations, which have shown great efficiency and which, due to their characteristics, can function as an aid to economic reactivation;or failing that, adapt a model to the economic reality of the current situation. For this, it was decided to make an analysis of models already presented in previous academic works, which have shown great efficiency and that due to their characteristics can function as an aid to economic recovery;or failing that, adapt one of the existing ones to the current economic reality. This research sought to reach the stage of formulating the Knowledge Management model that is most adapted to economic reality, and to evaluate its ease of implementation in companies, so that they can reactivate themselves financially and begin to give movement to the economy. from the knowledge generated in them. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

A Strategic Curriculum Design for an Introductory Engineering Course to Encourage Self-Empowerment of Minority Students

The objective of this paper is to report on the preliminary implementation of educational activities and learning modules to improve the curriculum design of an introductory engineering course. The new curriculum, which was strategically designed to empower underrepresented minoritized (URM) students in STEM, incorporates complementary educational activities and academic interventions including 1) the use of EduGuide online coaching platform to equip students to pursue their personal growth goals, and 2) the implementation of professional development workshops to reinforce and influence the academic career decision-making and preparedness of first-year undergraduate students. The proposed curriculum design was applied to two class sections of an introductory engineering course with a total of 53 first-year students during the fall semester of 2020. Virtual teaching and learning environments were required across this institution to comply with the social distancing and lockdown requirements enacted by the federal government in response to the Covid-19 pandemic.. As part of the coaching platform, students in these two classes had access to an online mentoring community of 32 members from academia and industry. The professional development workshops were also provided in a virtual format yet synchronous format to support engagement with the facilitators and among peers. Students were asked to complete an online pre-semester survey, develop feedback essays, and respond to self-reflecting open-ended questions to gather substantial data to assess the impact of the implemented interventions and educational activities. From this study, the new curriculum design showed great potential in encouraging self-empowerment of minority students, which can consequently result in greater rates of persistence, motivation, and academic success. The university provided the required support to create an introductory university course under the Engineering Leadership and Education department to offer the new curriculum design to first-year undergraduate students interested in engineering programs. © American Society for Engineering Education, 2022.

Inspiring Academic Engagement and Motivation of Minority College Students through Transformative Success Stories on Social Media (Work-in-Progress)

This Work-in-Progress paper presents an alternative approach to use social media not only to engage students but also to motivate them academically by showcasing success stories of graduating senior students. The U.S. Department of Education sponsored the Yes She Can program at The University of Texas at El Paso to contribute to the education of women students in science, technology, engineering, and math (STEM) disciplines. The use of social media became a key component of the Yes She Can program, especially during the COVID 19 pandemic. The Yes She Can program has published four types of social media posts, namely: 1) Quote of the week, 2) Announcements of events and opportunities, 3) Stories of famous people, and 4) Student success stories. While the content of the first three social media posts is self-explained, the 'student success stories' posts were generated from information provided by senior students through an online survey, specifically graduating women students. By showcasing 'student success stories' posts during the spring of 2021, our social media disseminated information of 14 internships, 20 scholarships, 23 conferences, 34 student organizations, 16 research programs, and 27 community service opportunities that are available at our university. From this study, the 'student success stories' posts were identified as a promising strategy to not only increase students' engagement but to inspire and motivate younger students to succeed academically in STEM education. © American Society for Engineering Education, 2022

Knowledge Management Model in Telework

Today telework has become increasingly important after the boost that ICTs have given to society, since thanks to its implementation, a job can be carried out from anywhere without the need to be in the physical space in question. It should be noted that this way of working has been strengthened after the shaking that the planet has suffered with the appearance of Covid19, but it must be borne in mind that not all organizations have the appropriate infrastructure and organizational management for the development of telework, affecting to people not only in a social way but also in their physical and/or emotional health. A literary review about telework and knowledge management was carried out in this: search in the databases of Mendeley, ScienceDirect and ProQuest, as well as the use of the Google Scholar search engine. Following this, the main topics were selected for the adaptation of the knowledge management model in telework. The proposed model focuses on knowledge management for teleworking, taking into account the importance of human, technological and organizational resources. There is evidence of the need to develop a knowledge management model applied to Telework in order to minimize the direct and indirect implications generated by this type of work, as well as the commitment to teleworker learning so organizations are more productive. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The uptake of vaccinations in adults with sickle cell disease receiving care at the Cambridge University Hospitals NHS Foundation Trust

Those affected by sickle cell disease have an increased susceptibility to infection by encapsulated bacteria and hepatitis B virus due to reduced splenic function and increased likelihood of receiving blood transfusions. Sickle cell disease patients are also more likely to suffer from complications, such as vaso-occlusive crises or acute chest syndrome, following infection with influenza or COVID-19. Standards for Clinical Care of Adults with Sickle Cell Disease in the UK (2018) outline that that those with sickle cell disease are recommended to be vaccinated against invasive pneumococcal disease, Haemophilus influenza type B, Neisseria meningitis types ACWY and type B, hepatitis B, and influenza . These patients are also recommended to have their hepatitis B immunity reviewed annually and to receive a hepatitis B vaccination booster if hepatitis B surface antibody (HBsAb) levels are less than 100 mIU/ml. According to the Standards , hospital staff is advised to remind and check with the patients' primary care teams whether these vaccinations have been administered. In this audit, we examined the records of 64 patients with sickle cell disease who receive regular care at the Cambridge University Hospitals NHS Foundation Trust. We collected data on the uptake of the pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPV23 or Pneumovax) within 5 years, two doses of Meningitis B vaccine, Meningitis ACWY vaccine (MenACWY), Haemophilus influenzae type b vaccine (Hib/MenC), influenza vaccine within 1 year, hepatitis B vaccine (HepB), whether HBsAb levels have been reviewed within 1 year, HepB booster if HBsAb levels were less than 100 mIU/ml, and two doses of COVID-19 vaccine. These records were obtained from electrical medical records provided by patients' general practitioners. Data collection took place from 23 September to 4 November 2021. The uptake of vaccinations was 67.4% for PCV13, 61.0% for PPV23 or Pneumovax within 5 years, 75.0% for Hib/MenC, 45.3% for MenACWY, 42.2% for the first dose of MenB and 29.3% for the second dose of MenB, 54.7% for influenza within 1 year, 75.0% for HepB, 71.9% for the first dose of the COVID-19 vaccine, and 68.3% for the second dose of the COVID-19 vaccine. 43.8% had their HbsAB reviewed and 20.0% received a HepB booster following HBsAb levels of less than 100mIU/ml. The uptake levels for the recommended vaccinations are lower than expected in our hospital trust. The COVID-19 pandemic has highlighted the effect of health inequalities and the uptake of the vaccination programme by patients of different ethnicities. During our patient support group, patients identified the Tuskegee syphilis experiment as one of the reasons why there is still distrust of the medical profession by those with Afro-Caribbean heritage. Beyond directed patient education, more communication is needed with the primary care teams to raise awareness of which vaccinations are required for sickle cell patients. Certain vaccinations, such as MenACWY and MenB were only introduced in 2015, meaning that some general practitioners may be still unaware of their necessity in adults with sickle cell disease..