Evaluating a Covid-19 Vaccine Centre in the UK Using a DES Model

Efficient management of a Covid-19 vaccine centre (VC) is necessary for proper-functioning of a mass vaccination programme. This study reports on an evaluation of the operational performance of a VC. There are two key considerations: the VC capacity (patients per hour) and the patient flow-time (total time patients spent in the centre). In this paper, Witness Horizon a simulation model tool that can be used to enhance the effectiveness of vaccination facilities is introduced. The model is developed using discrete event simulation. The model utilises animation whilst dynamically displaying key performance indicators. The uniqueness of this approach is the ability to simulate and analyse VC scenarios stochastically by varying hourly arrivals, walk-ins to drive-in ratios, staffing levels, registration, immunization, and observation capacities. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Using DES to Improve the Efficiency of a Covid-19 Vaccination Centre

Many research and development teams around the world have developed and continue to improve Covid-19 vaccines. As vaccines are produced, preparedness and planning for mass vaccination and immunization has become an important aspect of the pandemic management. Mass vaccination has been used by public health agencies in the past and is a viable option for Covid-19 immunization. To be able to rapidly and safely immunize a large number of people against Covid-19, mass vaccination centres are accessible in the UK. Careful planning of these centres is a difficult and important job. Two key considerations are the capacity of each centre (measured as the number of patients served per hour) and the time (in minutes) spent by patients in the centre. This paper discusses a simulation study done to support this planning effort. In this paper, we explore the operations of a vaccination centre and use a simulation tool to enhance patient flow. The discrete event simulation (DES) tool outputs visually and numerically show the average and maximum patient flow times and the number of people that can be served (throughput values) under different number of patient arrivals (hourly). With some experimentation, the results show that marginally reducing the hourly arrival rate, patient congestion reduces enabling good patient service levels to be achieved. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

AUTCD-Net: An Automated Framework for Efficient Covid-19 Diagnosis on Computed Tomography Scans

The coronavirus pandemic has caused one of the biggest global crises. With an inevitable need for fast screening of the disease, deep learning-based segmentation of Covid-19 infected lung regions in computed tomography (CT) scans gained significant attention. The automated screening procedure generated results significantly faster than the manual screening techniques and directly helped provide a wider outreach to patients. Therefore, to aid in computer-aided diagnoses, this paper presents AUTCD-Net (AUTomated framework for efficient Covid-19 Diagnosis-Network), based on hierarchical resolution steps, to efficiently segment Covid-19 infected lung regions in CT scans. The approach results in a 0.71 dice score and rivals all previous state-of-the-art approaches. The overall evaluation combined with our in-depth model analysis, and critical inferences can be further extended for developing a computer-aided diagnostic (CAD) tool to assist the CT image reading process for detecting Covid-19 infected regions in the near future. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Concern over career is the primary reason for poor mental health among students

COVID-19 is the cause of a lot of concern around the world. Apart from the obvious physical distress it has contributed significantly to elevation of mental health issues. Students who mostly have not been vaccinated are doing online classes with severe restriction on their social lives. Survey was done with students from school, college and university to determine their mental health status. Their mental health was evaluated with the DASS-21 questionnaire that was distributed and collected online. The students were found to have become vulnerable to stress, anxiety and depression. Their mental health status was found to be poor with university students being most affected. Upon Correlation studies with relevant questions on online education and consequent change in their mode of studies and interaction with family and friends, it was found that university students' concern over their career led to their poor mental health. Copyright © 2022, Institute of Medico-legal Publication. All rights reserved.

A new approach to predict COVID-19 using artificial neural networks

In COVID-19, most of the patients have been diagnosed with pneumonia in their early stages. Most of the symptoms that have been in the display or have evolved in the last couple of months like fever, cough, and shortness of breath have been predominant. Moreover, based on the studies and reports of the infected patients, symptoms like heart disease, hypertension, chest pain, diarrhea, and nasal congestion have shown a significant impact in the sustenance of COVID-19. Taking all these symptoms into consideration along with the person’s age, a prediction process has been developed in this chapter to check whether the person is infected with COVID-19 or not. Based on the significance of these attributes, we have applied artificial neural network to classify the patient’s condition into three classes, which include no infection, mild infection, and serious infection. We have achieved an accuracy of 84.7% in predicting the cases. © 2022 Elsevier Inc. All rights reserved.

COVID-19 challenges and employees' stress: mediating role of family-life disturbance and work-life imbalance

Purpose: The paper focuses on examining the relationship between challenges caused by COVID-19 pandemic and employees' stress through the mediating role of family-life disturbance and work-life imbalance. Design/methodology/approach: A total of 1,556 respondents from 45 countries across all continents were included in this survey. Statistical techniques such as exploratory factor analysis (EFA), confirmatory factor analysis (CFA), correlations, multiple regression and bootstrapping were used to analyse the data. Findings: The results depicted that COVID-19 challenges induced stress among employees. In combination with this, family-life disturbance and work-life imbalance mediated the relationship between COVID-19 challenges and employees' stress individually as well as serially. The paper further suggests some recommendations to mitigate the impact of COVID-19 challenges on employees' stress. Research limitations/implications: The major limitation of the study was in the data collection process. As the data were collected during the time period of pandemic, so, limited respondents were approached. Also, the international and cross-sectional design of the study can limit the applicability of the results. Practical implications: The study suggests organizations and HR managers to help in balancing family and work-life of employees, so that their mind can be kept stress free. Originality/value: The study has added knowledge to the existing literature of stress created due to the COVID-19 pandemic by explaining the serial mediation of family-life disturbance and work-life imbalance between the relationship of COVID-19 challenges and employees' stress. © 2022, Emerald Publishing Limited.

Impact of COVID 19 infection on patients with obstructive sleep apnea: A longitudinal study

Background: OSA patients like other high risk category patients suffered and experienced post covid syndromes significantly. Aim: To study the severity and impact of COVID 19 infection in patients already diagnosed with Obstructive Sleep Apnea (OSA). Methodology: This is a longitudinal observational study of 19 patients diagnosed with OSA in January to April 2021, these patients suffered COVID 19 infection over next three months and 12 patients were studied within 4 months of discharge from COVID ward as 5 patients died and 2 patients lost to follow up.12 subjects had mean age of 52.92 (SD: 6.88) and majority were male 8 (66.7%) and mean BMI was 27.72 (SD: 3.60). Subjects were assessed through COVID 19 infection medical record, repeat Epworth Sleepiness Score and present complaints and Polysomnography. Results: Most of the OSA patients (66.7%) suffered from Severe COVID 19 infection and of them majority were male (62.5%). Severity of COVID correlated significantly with BMI and AHI (r=0.774;p 0.003 and r=0.907;p<0.001) and associated with more use of high flow oxygen device and noninvasive ventilation with mean hospital stay of 27.33 (SD:10.7). Mean AHI, ESS scores increased in post covid period (mean AHI-22.58;SD: 11.12 to 24.58;SD: 12.01 and mean ESS- 15.08;SD: 3.67 to 18.67;SD: 3.52) significantly (r=0.907;p<0.001 and r= 0.893;p<0.001 respectively) and maximum desaturation dropped significantly from mean 83.33 (SD: 4.83) to 79.50 (SD: 4.81) (r=0.727;p=0.007). Conclusion: This study reveals that OSA patients suffered from severe COVID 19 infection. Sleepiness and severity of OSA both has increased in post COVID period. This result may be an explanation for persistent post COVID symptoms in OSA patients.

Impact of COVID-19 Mitigation Measures on PrEP Care at a Safety Net Health System in Atlanta

Background. The Grady Health System pre-exposure prophylaxis (PrEP) program modified its care practices to accommodate COVID-19 mitigation measures. Changes enacted included: transition to telemedicine visits, medication mail delivery, and flexible timing of quarterly laboratory testing. These were implemented in March 2020 and remain in place presently. This study aimed to evaluate patients' long-term acceptability of these modifications and to assess their impact on PrEP care. Methods. This was a cross-sectional study in a convenience sample of PrEP patients, ages 18 and older, at an urban clinic in Atlanta. They were invited to complete a survey between December 2020 and April 2021. The survey assessed the impact of mitigation measures on overall PrEP care, follow up visits, medication access, and ability to complete laboratory testing. It also evaluated the usability, quality, satisfaction, and concerns with telemedicine. Data were examined using median and interquartile ranges, and proportions. Results. Of 145 patients contacted, 61 completed the survey (median age 33 years, 72% Black, 75% cisgender men, 15% transgender women). Most participants did not report interruptions in their PrEP care (72%) or follow up visits (74%). Most found it easy to access medications (82%), as participants' report of medication mail delivery usage increased from 57% (pre-pandemic) to 73% (in-pandemic period). Interruptions in completing quarterly labs were more frequently reported, as only 62% found this to be easy. Overall, 89% reported using telemedicine;telephone call was the most used method (78%). Telemedicine users' ratings for quality, usability, and satisfaction of telemedicine was high (median score: 6/7) and nearly all users (97%) reported no concerns about its continued use for PrEP care. A few participants (5%) raised concerns about loss of telephone services due to financial issues, impacting their ability to complete telemedicine visits. Conclusion. PrEP care at an urban clinic was well- maintained despite COVID-19 mitigation measures. Telemedicine was found to be acceptable and usable by surveyed participants. Future research on widescale implementation of telemedicine for PrEP care is needed.

Automatic Face Mask Detection Using a Hide and Seek Algorithm

The coronavirus has affected millions around the world and has inevitably brought about a necessity to wear face masks in official and public places to take the first step in keeping one’s self safe. To monitor personnel and public areas and prevent the spread of the disease we present a scalable and deployable face mask detection system in a real time setting using a novel hide and seek algorithm. Our model, based on openCV library and dlib environment utilizes the facial landmarks where in the algorithm detects face masks through the presence and absence of facial markers. We call this process as seeking and hiding. We overcome present issues of high computational cost of deep learning models and low inference speeds of general detection paradigms. We also validate our algorithm on several aspects which affect the accuracy of other models such as image and face orientation, type of face masks and more. As our model requires no data for model training, we eliminate the highly sensitive issue of acquiring facial data and bias. Our model achieves 98.79 % precision and 94.81 % recall. © 2021, Springer Nature Switzerland AG.

Ultrasound characteristics, serum biochemistry and outcome of ectopic pregnancies presenting during COVID-19 pandemic.

OBJECTIVE: To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early-pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non-coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. RESULTS: There were 22 683 consultations over the 2-year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first-line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. CONCLUSIONS: No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID-19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first-line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID-19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Impacts of COVID-19: A Comprehensive Study Using Linear Regression Analysis in a Predictive Approach

Human history is observing a very strange time fighting an invisible enemy;the novel COVID-19 is the greatest challenge to humankind since the Second World War. The current outbreak of COVID-19 coronavirus infection among humans in Wuhan (China) and its spreading around the globe is heavily impacting global health and mental health. Novel coronavirus (n-CoV) is a generic name given to severe acute respiratory syndrome coronavirus 2(SARs-CoV-2). It has rapidly spread around the world posing enormous mental, social, economic, and environmental challenges to the entire human population. This paper evolved from an overview of the coronavirus and its effect on public health and economics. The main focus of this paper is to survey the various species and types of COVs. The overall statistics of the count around the world and an inclusive survey of its impact on society is being discussed in this paper. In this paper, the linear regression analysis of different vaccines commissioned around the world in COVID-19 and manifold updated information across India has been analyzed in a statistical approach. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Aesthetically Acceptable, Breath Friendly Triboelectric Face Masks: Design, Fabrication, and Its Efficacy

Since the beginning of the COVID-19 pandemic, several attempts have been made worldwide to control the spread of the virus. It is widely accepted that wearing face masks in public and workplaces suppresses the transmission of the virus. Highly effective face masks, e.g. N95, have a high filtration efficiency but with a large pressure drop, which does not allow one to wear the mask comfortably for long hours. A larger population wearing a moderate efficiency mask can also cut the transmission at large. Herein, mask panels from readily available fabrics are developed, that can generate triboelectricity, which enhances the filtration efficiency by around 18% without compromising the pressure drop-allowing one to wear the mask for an extended period. The unique cup-shaped design of the mask provides a snug fit with no speech distortion or fogging on the glasses.

PREVENTION OF EXACERBATION OF NON-CYSTIC FIBROSIS BRONCHIECTASIS WITH COMBINATION OF AZTREONAM LYSINE INHALATION AND AZITHROMYCIN

TOPIC: Obstructive Lung Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bronchiectasis is a chronic respiratory disease characterized by bronchial dilatation leading to daily productive cough and recurrent respiratory infections.[1] Causes of bronchiectasis is broadly divided into Cystic fibrosis (CF) and non-CF. Reducing the microbial load with antibiotics and clearing secretions form the cornerstone of prophylactic and therapeutic management of exacerbations. We present a case were initiation of cyclical prophylaxis with combined Aztreonam lysine inhalation (AZLI) and azithromycin resulted in a significant increase in exacerbation free interval of a patient with non-CF bronchiectasis. CASE PRESENTATION: This is a 63-year-old female non-smoker with history of non-CF bronchiectasis who presented to the emergency department with complaints of productive cough associated with greenish brown sputum, fever and shortness of breath for 2 weeks. Her past medical history was significant for recurrent exacerbations of bronchiectasis every 2-3 months including pneumonia with pseudomonas. She was then started on prophylactic 28 day cyclical 75mg AZLI inhalation TID and oral azithromycin daily. Since then she remained exacerbation free for 19 months before this presentation. On presentation, the patient was afebrile, spo2 96% on room air. On physical examination, she was in mild respiratory distress with rhonchi present in bilateral lung fields. WBC was elevated at 14.6, Sars-Cov-19 RAT was negative. Chest x-ray demonstrated diffuse bilateral pulmonary opacities. Patient was initiated on meropenem and de-escalated to ceftazidime after sensitivities were known. She improved clinically and was discharged home after 14 days of treatment. At discharge, patient was continued on the cyclical AZLI and daily azithromycin regiment. DISCUSSION: Several clinical trials have attempted to use inhaled antibiotic treatment for CF bronchiectasis to prevent exacerbations. The inhalation of anti-pseudomonal antibiotics including aztreonam is the preferred therapeutic option. In addition, macrolides also provide benefit to reduce frequency of exacerbations.[2]With increasing prevalence of non-CF bronchiectasis, small studies have begun to address this population. Two randomized control trials utilizing AZLI demonstrated reduction in sputum Pseudomonas density but did not show reduction in bronchiectasis exacerbations or hospitalizations.[3]Thus inconsistent results from studies assessing antibiotics used in non-CF bronchiectasis leave need for further study. CONCLUSIONS: This case illustrates an effective cyclical prophylactic regiment with both a low risk of toxicity and a low risk for emergence of organisms in non-CF bronchiectasis. Further attention with a randomized control study to assess the effects on need for systemic antibiotics, hospitalization, and overall morbidity is warranted. REFERENCE #1: Chalmers JD, Aliberti S, Blasi F. Management of bronchiectasis in adults. Eur Respir J. 2015;45: 1446-1462 REFERENCE #2: Kelly C, Chalmers JD, Crossingham I, et al. Macrolide antibiotics for bronchiectasis. Cochrane database Syst Review. 2018;3: CD012406 REFERENCE #3: Fjaellegaard K, Sin MD, Browatzki A, Ulrik CS. Antibiotic therapy for stable non- CF bronchiectasis in adults- A systematic review. Chron Respir Dis. 2017;14: 174-186 DISCLOSURES: No relevant relationships by Sindhoora Adyanthaya, source=Web Response No relevant relationships by Manjyot Bajwa, source=Web Response No relevant relationships by Sucheta Kundu, source=Web Response No relevant relationships by Aksiniya Stevasarova, source=Web Response No relevant relationships by Jan Westerman, source=Web Response

AZITHROMYCIN-INDUCED TORSADES DE POINTES

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Azithromycin (AZ) is extensively used, with millions of prescriptions written yearly. In 2013 US food and drug administration issued a warning against the pro-arrhythmogenic activity of this drug in the presence of pre-existing cardiac conditions, known QT prolongation or QT-prolonging drug use and electrolyte abnormalities.(1) A recent study collected data on over 12 million patients showing the risk of cardiac events with AZ was rare ~0.03%, and there was no increased risk when compared to amoxicillin.(1,2) Here we report a patient with no known cardiac comorbidities who developed torsades des pointes (TdP) after 2 days of initiating AZ. CASE PRESENTATION: A 77-year-old African American female with a history of acid reflux, type 2 diabetes mellitus, hypertension, hypothyroidism, presented to the emergency room with dyspnea and dry cough for one day. On arrival, patient had a temperature of 99.5F, pulse 115 beats/min, respirations at 32 breaths/min, blood pressure 120/66 and saturating in the 80s on room air, with an unremarkable physical exam. She had leukocytosis at 12.8k, d-dimer 2.15. Computed tomography with angiography ruled out pulmonary embolism but showed bibasilar opacities. She had normal sinus rhythm with a QTc of 393 on ECG at presentation. COVID test was negative;She was empirically treated for community-acquired pneumonia with IV ceftriaxone and IV AZ, with which patient had significant clinical improvement and oxygen requirement. However on day 2 of hospitalization, she developed an episode of generalized tonic-clonic seizure followed by a cardiac arrest secondary to TdP with successful resuscitation in 15 minutes. Magnesium was 1.9, potassium 3.8. In the absence of risk factors like, cardiac disease, arrhythmias, concomitant use of QT prolonging drugs, and significant electrolyte abnormality, this event was attributed to the use of azithromycin. Naranjo adverse drug reaction scale score was 6. While in the ICU, patient was managed with amiodarone, metoprolol, AZ was discontinued. She made marked recovery and was extubated within 3 days, transferred to the floor where no further arrhythmias were noted. She was subsequently discharged to rehab on a short course of amoxicillin-clavulanate, amiodarone, metoprolol, and close cardiology follow-up. DISCUSSION: AZ is a relatively safe drug compared to other macrolides, and reports of cardiac arrhythmias induced solely by this drug with no concomitant risk factors are extremely rare. The evidence from meta-analyses and systematic reviews on the association of AZ with cardiac events are conflicting (3), and further investigations are warranted to assess this association. CONCLUSIONS: This case serves to reiterate the association of potentially fatal arrhythmias induced by a commonly prescribed antibiotic. Although these events are rare, they should be on our radar in clinical practice. REFERENCE #1: Patel H, Calip GS, DiDomenico RJ, Schumock GT, Suda KJ, Lee TA. Comparison of Cardiac Events Associated With Azithromycin vs Amoxicillin. JAMA Network Open. 2020;3(9):e2016864-e2016864. REFERENCE #2: Patel H, DiDomenico RJ, Suda KJ, Schumock GT, Calip GS, Lee TA. Risk of cardiac events with azithromycin-A prediction model. PLoS One. 2020;15(10):e0240379. REFERENCE #3: Almalki ZS, Guo JJ. Cardiovascular events and safety outcomes associated with azithromycin therapy: a meta-analysis of randomized controlled trials. Am Health Drug Benefits. 2014;7(6):318-328. DISCLOSURES: No relevant relationships by Khushdeep Chahal, source=Web Response No relevant relationships by Sangeetha Isaac, source=Web Response No relevant relationships by Sucheta Kundu, source=Web Response No relevant relationships by Ishita Mehra, source=Web Response

The era of covid-19 in india: An economic overview

The magnitude of the COVID-19 outbreak is devastating and completely unprecedented. Impeding every social and economic activity that requires human contact was thence the instantaneous response by almost every nation. Looking at the course of actions taken to save life and livelihood by other nations, it is expected that India will follow the same path. Considering that, most of the fiscal and monetary measures introduced in India are medium-term or long term, it is a matter of time till any conclusion can be drawn. Apart from that, implementation has always been a challenge for Indian policymakers. This article evaluates the era of coronavirus pandemic in India from four directions;the precursory economic condition that helps to apprehend the incident and impact of the outbreak, the humanitarian and economic shock that the nation is going through, policy measures that have been introduced to combat the situation and last but not the least, way ahead of this crisis, that essentially determines the future of the nation. © 2021 Biodiversity Research Center, Academia Sinica. All rights reserved.