The impact of the COVID-19 pandemic on vegetable farmers in Bangladesh

The COVID-19 pandemic not only imposed severe health risks but also raised major challenges to the economy, due to widespread and severe measures to control the spread of the disease. Food value chains were disrupted by restrictions of the movement of people and commodities, which had significant impacts on the livelihoods of smallholder farmers. The purpose of this research is to determine the impact of the COVID-19 pandemic on Bangladeshi vegetable farmers. A total of 320 vegetable farmers were selected from the North-West region of Bangladesh. Both quantitative and qualitative data were collected through a digital survey method. Analysis revealed that around 3-5% of the marketed surplus of the farms was reduced during the pandemic due to the disturbances. The majority of the farm households reported that there was a significant reduction in their family income and, as a consequence, around 38% of farm households had cut down on their food consumption during the pandemic. The farmers were found to follow different strategies to cope with the difficulties and respond to government initiatives to mitigate such impacts. Despite all the restrictions and risks, extension services were still available to help the farmers. On the basis of the findings, this study suggests the importance of collaborative participation of the relevant bodies to decrease the effects of COVID-19 on farm households by employing all available mechanisms and focusing more on identifying effective coping strategies that can be supported in the event of future shocks, for more sustainable and resilient food systems.

Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study.

INTRODUCTION: Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting. METHODS: We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (κ ≤ 0.4), "moderate" or "good" (κ > 0.6). RESULTS: 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barré syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). Good inter-rater agreement was observed for five diagnoses: cranial neuropathy, headache, myelitis, CVST, and GBS and poor agreement for encephalopathy. In 13% of vignettes, clinicians incorrectly assigned lowest association ranks, regardless of setting and specialty. CONCLUSION: The case definitions can help with reporting of neurological complications of SARS-CoV-2, also in settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed, and clinicians underestimated the association with SARS-CoV-2. Future work should refine the case definitions and provide training if global reporting of neurological syndromes associated with SARS-CoV-2 is to be robust.

Implementation of meaningful stakeholder engagement in community-based research in ruralIndia during Covid-19 pandemic

Background: The Covid-19 pandemic has hit Western India hard, with Pune district reporting extremely high numbers of cases. During this time, the KEM Hospital Research Centre (KEMHRC), Pune undertook a study determining COVID-19 seropositivity within villages in the Pune district. Aim(s): To engage various stakeholders in establishing sentinel sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in the general population in rural Western India. Method(s): An extensive stakeholder engagement drive was undertaken to drive successful recruitment and implementation of our study. Between February 2021 and May 2021, we conducted 150 meetings with a range of community stakeholders including: village heads;nurses;community health workers and local government representatives, in open-aired community spaces. We advised community members on the purpose and significance of the study, clarified any concerns, and gathered and incorporated their inputs regarding study implementation. Result(s): The team built trust with local communities through these meetings with continued engagement during field work and data collection helping build rapport and create ownership of the study. KEMHRC successfully enrolled 14,500 individuals residing in 150 villages in Pune district. Conclusion(s): The feedback sharing process is important in ensuring that engagement with the community is not limited to a one-time activity but continuous. Training & supplying opportunities can also generate stakeholder engagement champions. Effective communication, active engagement are key elements for effective engagement in research.

Brief Perspective on the Design and Operational System of the H2S Lab at the Dhahran Technology Center, Baker Hughes in Saudi Arabia

40% of the world gas reserves are located in in the Middle East, of which most contain high amounts of corrosive gases H2S and CO2, this with other environmental factors exerts stress on metallic and nonmetallic materials. For Baker Hughes to address these challenges, one answer was to establish local competencies in the Kingdom of Saudi Arabia as a H2S lab and materials science focused team, ultimately targeting the reduction of total expense of corrosion, and to tap into the research capabilities and expertise available in the ecosystem. H2S gas is a major health and safety challenge to deal with, as it is a lethal, flammable, corrosive. The analysis to design the lab was supported by methods of Asset Integrity Risk Management looking on barriers, process, and industry standards. The human factor was considered to ensure competency, mindset & culture. Among others, OSHA standards were followed to develop the Chemical Hygiene Plan (CHP) and respiratory protection program and Emergency Response and Operations Plan (EROP). An unexpected challenge arose during the COVID-19 pandemic where measures were taken to limit infection while maintaining lab operation. The lab started operation with a narrow scope to focus on critical lab operational skill development, successive new competencies and workflows are added following a Management of Change (MOC) process. Current developments leverage the labs growing competence to address arising challenges on ultra-high H2S, CO2 for CCUS, and hydrogen for the energy transaction. Copyright © 2022, International Petroleum Technology Conference.

Network segregation in aging females and evaluation of the impact of sex steroid hormones.

Males and females show differential patterns in connectivity in resting-state networks (RSNs) during normal aging, from early adulthood to late middle age. Age-related differences in network integration (effectiveness of specialized communication at the global network level) and segregation (functional specialization at the local level of specific brain regions) may also differ by sex. These differences may be due at least in part to endogenous hormonal fluctuation, such as that which occurs in females during midlife with the transition to menopause when levels of estrogens and progesterone drop markedly. A limited number of studies that have investigated sex differences in the action of steroid hormones in brain networks. Here we investigated how sex steroid hormones relate to age-network relationships in both males and females, with a focus on network segregation. Females displayed a significant quadratic relationship between age and network segregation for the cerebellar-basal ganglia and salience networks. In both cases, segregation was still increasing through adulthood, highest in midlife, and with a downturn thereafter. However, there were no significant relationships between sex steroid hormone levels and network segregation levels in females, and they did not exhibit significant associations between progesterone or 17ß-estradiol and network segregation. Patterns of connectivity between the cerebellum and basal ganglia have been associated with cognitive performance and self-reported balance confidence in older adults. Together, these findings suggest that network segregation patterns with age in females vary by network, and that sex steroid hormones are not associated with this measure of connectivity in this cross-sectional analysis. Though this is a null effect, it remains critical for understanding the extent to which hormones relate to brain network architecture.

Patient Experience With Anti-Vascular Endothelial Growth Factor (VEGF) Therapy in Neovascular Age-Related Macular Degeneration (nAMD) and Diabetic Macular Edema (DME): A Multinational Survey

Objectives: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is efficacious for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). However, the frequent treatment and monitoring required for optimal real-world outcomes can be burdensome to patients and can impact adherence to treatment. This study aimed to understand patient treatment experience with anti-VEGF standard of care. Method(s): A cross-sectional survey was employed comprising de novo questions, patient-reported outcome (PRO) measures and medical chart extraction. Adult patients with nAMD or DME treated with intravitreal anti-VEGF injections for >=12 months were recruited via 38 clinical sites (6 Canada, 6 France, 4 Italy, 7 Spain, 6 United Kingdom, 9 United States). Result(s): Surveys were completed by 391 patients with nAMD and 183 patients with DME. PRO scores indicated that patients across both conditions had relatively high vision-related functioning and were generally satisfied with their current treatment. Mean number of anti-VEGF injections over 12 months across countries ranged from 6.3-9.7 for nAMD and 4.3-8.0 for DME. Nineteen patients with nAMD (19/391;5%) and 27 patients with DME (27/183;15%) missed >=1 injection or examination visit in the past 12 months. Reported barriers were mainly related to treatment (eg, pain and discomfort during/after anti-VEGF injection), clinic (eg, not having someone to accompany them to appointments) and, to a lesser extent, the COVID-19 pandemic. After treatment, the majority recovered in <=1 day;however, 24% (139/574) needed >1 day to recover. Impairment in daily activities due to treatment was reported by 45% (258/574) of patients. Among working patients 62% (41/66) reported productivity impairment from absenteeism. Conclusion(s): Patients reported impairment of daily activities, burden and barriers related to intravitreal anti-VEGF therapy, despite high adherence and treatment satisfaction levels. More durable therapy options, requiring less frequent treatments may be able to reduce treatment-related burden and barriers. Copyright © 2022

Controlling High Blood Pressure: An Evidence-Based Blueprint for Change.

Recently published national data demonstrate inadequate and worsening control of high blood pressure (HBP) in the United States, outcomes that likely have been made even worse by the coronavirus disease 2019 (COVID-19) pandemic. This major public health crisis exposes shortcomings of the US health care delivery system and creates an urgent opportunity to reduce mortality, major cardiovascular events, and costs for 115 million Americans. Ending this crisis will require a more coherent and systemic change to traditional patterns of care. The authors present an evidence-based Blueprint for Change for comprehensive health delivery system redesign based on current national clinical practice guidelines and quality measures. This innovative model includes a systems-based approach to ensuring proper BP measurement, assessment of cardiovascular risk, effective patient-centered team-based care, addressing social determinants of health, and shared decision-making. The authors also propose building on current national quality improvement initiatives designed to better control HBP.

PCR61 Burden and Impacts Associated with Caring for Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema Patients: A Multinational Caregiver Survey

Objectives: Optimal real-world outcomes in neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) require frequent and potentially burdensome visits for patients and their caregivers. This study aimed to understand the caregiver perspective on treatment burden, barriers and the impact of caregiving, with a particular focus on the demands of frequent anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection treatment. Methods: Caregivers of adult nAMD/DME patients treated with anti-VEGF injections were enrolled from 21 clinical sites in the USA, UK and Canada. Caregivers completed a cross-sectional survey comprising de novo questions and a self-reported outcome instrument. Results: Overall, 18 DME and 44 nAMD caregivers completed surveys. On average, caregivers provided care 4.3±3.0 days/week, 4.0±4.3 hours/day. Caregivers reported supporting patients on a diverse array of tasks including transportation to doctors' appointments, providing emotional support, and helping with shopping and household chores. Twelve (67%) DME and 30 (68%) nAMD caregivers reported at least one barrier that prevented patients from receiving treatment or attending visits. Barriers were mainly related to the COVID-19 pandemic restrictions, particularly preventing caregivers from accompanying patients to appointments, clinic/appointment factors (distance, difficulty in scheduling appointments, other medical appointments priority, appointment duration), and social/health related factors (caregiver’s availability, care recipient’s reduced mobility/physical limitations). Overall, 13/22 (59%) working caregivers reported an impact on work absenteeism due to helping with treatment appointments. Based on the Caregiver Reaction Assessment scores, caregivers experienced a moderate impact on schedule disruptions, and a milder impact on financial problems, lack of family support, health and self-esteem in relation to their caregiving situation. Conclusions: Caregivers devote significant time to caring for the recipient, with the greatest impact on caregiver schedule disruptions and absenteeism for those working. More durable treatments with longer intervals and fewer appointments may alleviate some of that burden.

How Much Are Borrowers Willing to Pay to Remove Uncertainty Surrounding Mortgage Defaults?

Using a large, non-student sample, we assess and differentiate between borrowers’ Risk Aversion and Ambiguity Aversion levels and their willingness to pay to resolve a mortgage default settlement negotiation. Ambiguity Aversion is found to be negatively associated with willingness to pay for borrowers with high financial literacy in both the gain and loss domains, whereas personality traits matter more for borrowers with low financial literacy. This finding is important to policymakers in that they should adopt differential resolution strategies for defaulting borrowers based on these intervening variables.

Risk of food and housing insecurity among college students during the COVID-19 pandemic.

The aim of this study was to assess college students' food and housing insecurity risk amidst the pandemic. Data were collected through an online survey in the summer of 2020 from 1956 graduate and undergraduate students attending a large, private, urban university in the Midwest, U.S. Food insecurity among students increased (25% before; 29% during COVID) with housing insecurity staying roughly the same (34% before; 36% during COVID). Results indicate certain student groups were at greater risk of basic needs insecurity during the pandemic compared to their counterparts. Results also suggest changes in food and housing insecurity trends. College students are burdened with basic needs insecurity, exacerbated during the pandemic. Institutions need to work toward solutions to address the needs of vulnerable populations disproportionately affected by basic needs insecurity. Recommendations on addressing the basic needs of college students are also provided.

Delirium and COVID-19: a narrative review of emerging evidence.

Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.

A mutagenic screen reveals NspS residues important for regulation of Vibrio cholerae biofilm formation.

Biofilm formation in the human intestinal pathogen Vibrio cholerae is in part regulated by norspermidine, spermidine and spermine. V. cholerae senses these polyamines through a signalling pathway consisting of the periplasmic protein, NspS, and the integral membrane c-di-GMP phosphodiesterase MbaA. NspS and MbaA belong to a proposed class of novel signalling systems composed of periplasmic ligand-binding proteins and membrane-bound c-di-GMP phosphodiesterases containing both GGDEF and EAL domains. In this signal transduction pathway, NspS is hypothesized to interact with MbaA in the periplasm to regulate its phosphodiesterase activity. Polyamine binding to NspS likely alters this interaction, leading to the activation or inhibition of biofilm formation depending on the polyamine. The purpose of this study was to determine the amino acids important for NspS function. We performed random mutagenesis of the nspS gene, identified mutant clones deficient in biofilm formation, determined their responsiveness to norspermidine and mapped the location of these residues onto NspS homology models. Single mutants clustered on two lobes of the NspS model, but the majority were found on a single lobe that appeared to be more mobile upon norspermidine binding. We also identified residues in the putative ligand-binding site that may be important for norspermidine binding and interactions with MbaA. Ultimately, our results provide new insights into this novel signalling pathway in V. cholerae and highlight differences between periplasmic binding proteins involved in transport versus signal transduction.

Safe ECMO reconfiguration from veno-venous to veno-veno-venous to support hypoxic patients with severe COVID 19, a single centre cohort

Objective: Veno-venous ECMO is a well-established support technique for patients with respiratory failure-induced hypoxia allowing for pulmonary recovery and implementation of lung-protective ventilatory settings. However, in severe respiratory failure cases, ECMO may be unable to provide full support, and patients remain hypoxic. In this case series, we describe the reconfiguration of VV ECMO to veno-veno-venous (VV-V) ECMO, a more complex hybrid cannulation strategy, where a third cannula is inserted to improve venous drainage to provide more ECMO blood flow and therefore increase systemic oxygenation in patients receiving ECMO for severe COVID-19. Methods: Data from patients who received circuit reconfiguration from VV ECMO to VV-V ECMO at the Royal Brompton Hospital during the COVID-19 pandemic between March 2020 - February 2021 was collected from the ICU's Clinical Information System (ICCA, Philips Healthcare) and analysed. Endpoints included PaO2, ECMO blood flow, arterial saturation and any complications relating to the reconfiguration. Results: 15 patients (9/15 male) with an average BMI of 39.0 ± 10.7 received circuit configuration bedside with no complications. An increase in ECMO blood flow (average 0.54 ± 0.76 LPM), PaO2 (average 4.96 ± 4.23 kPa) and arterial saturation (7 ± 6%) were demonstrated over the cohort of patients. 10/15 patients survived their ECMO run, 2 patients died on ECMO and 3 patients are still receiving ECMO at the time of writing. Conclusions: ECMO reconfiguration to a VV-V cannulation strategy is a safe procedure to increase ECMO blood flow and therefore, arterial oxygenation and saturation in hypoxic patients with severe COVID-19.

Confronting inequality in the “new normal”: Hyper-capitalism, proto-socialism, and post-pandemic recovery

Post-pandemic recovery must address the systemic inequality that has been revealed by the coronavirus crisis. The roots of this inequality predate the pandemic and even the global financial crisis. They lie rather in the uneasy relationship between labor and capital under conditions of declining economic growth, such as those who have prevailed in advanced economies for almost half a century. This paper explores the dynamics of that relationship using a simple stock-flow consistent (SFC) macroeconomic model of a closed economy. It examines in particular the role of two key factors—the savings rate and the substitutability (elasticity of substitution) between labor and capital—on the severity of systemic inequality under conditions of declining growth. The paper goes on to test the efficacy of three redistributive measures—a graduated income tax, a tax on capital and a universal basic income—under two distinct structural scenarios for an economy with a declining growth rate. We find that none of these measures is sufficient to control structural inequality when institutions aggressively favor capital over labor (hyper-capitalism). Taken in combination, however, under conditions more favorable to wage labor (proto-socialism), these same measures have the potential to eliminate inequality, almost entirely, even as the growth rate declines. © 2021 The Authors. Sustainable Development published by ERP Environment and John Wiley & Sons Ltd.

Increases in Risky Drinking During the COVID-19 Pandemic Assessed via Longitudinal Cohort Design: Associations With Racial Tensions, Financial Distress, Psychological Distress and Virus-Related Fears.

BACKGROUND: The COVID-19 pandemic has created disruptions to daily life resulting in wide-spread unemployment and psychological distress. Recent studies have reported high rates of alcohol use during this time; however, longitudinal data remain scarce and factors associated with increases in high-risk drinking observed over time are unknown. AIMS: The current study examined changes in high-risk drinking patterns across four 7-day observation periods, prior to and following a university wide campus closure. Additionally, factors associated with changes in alcohol use patterns were examined including financial distress, psychological distress, impact of racial tensions and virus-related fears. METHOD: Students (N = 1001) in the Midwestern USA completed repeated assessments between March and June 2020. Each survey included a timeline follow-back measure of alcohol use. Pandemic-related distress spanning several factors was assessed at the final follow-up. RESULTS: Risky drinking patterns increased significantly over time. Overall, psychological distress and impact of racial tensions were associated with higher rates of risky drinking, whereas COVID-19-related fears were associated with lower rates. However, only financial-related distress was associated with an increase in risky drinking patterns over time. CONCLUSIONS: Increased risky drinking patterns observed in the current study may signal problems that are likely to persist even after the direct impact of the COVID-19 pandemic on daily life ends. Individuals experiencing financial distress may represent a particularly high-risk group. Interventions targeting the cross-section of job loss, financial stress and problematic alcohol use will be important to identify.