ABSTRACT
Objectives: Treatment of severe respiratory distress syndrome (ARDS) due to COVID-19 by veno-venous extracorporeal membrane oxygenation (VV-ECMO) had a mortality of up to 70% in Germany. Many patients with COVID-19 need VV-ECMO support longer than 28 days (long-term VV-ECMO). Evidence on mortality, complications during intensive care, functional status after discharge and mortality-predictors for patients supported with long-term VV-ECMO is lacking. Method(s): Retrospective study of 137 consecutive patients treated with VV-ECMO for ARDS due to COVID-19 at University Hospital Regensburg from March 2020 to March 2022. Result(s): 38% (n=52;87% male) of patients needed longterm VV-ECMO support. In these, SOFA score (median [IQR]) at ECMO initiation was 9 [8-11], age 58.2 [50.6- 62.5] years, PaO2/FiO2-ratio 67 [52-88] mmHg, pCO262 [52-74] mmHg, Murray-Score 3.3 [3.0-3.6] and PEEP 15 [13 - 16] cmH2O. Duration of long-term support was 45 [35-65] days. 26 (50%) patients were discharged from the ICU. Only one patient died after hospital discharge. At VVECMO initiation, baseline characteristics did not differ between deceased and survivors. Complications were frequent (acute kidney injury: 31/52, renal replacement therapy: 14/52, pulmonary embolism: 21/52, intracranial hemorrhage 8/52, major bleeding 34/52 and secondary sclerosing cholangitis: 5/52) and more frequent in the deceased. Karnofsky index (normal 100) after rehabilitation was 70 [57.5-82.5]. Twelve of the 18 patients discharged from rehabilitation had a satisfactory quality of life according to their own subjective assessment. Four patients required nursing support. Mortality-predictors within the first 30 days on VV-ECMO only observed in those who deceased later, were: Bilirubin >5mg/dl for > 7 days, pulmonary compliance <10ml/mbar for >14 days, and repeated serum concentrations of interleukin 8 >150ng/L. Conclusion(s): Long-term extracorporeal lung support in patients with COVID-19 resulted in 50 % survival and subsequently lead to a satisfactory quality of life and functionality in the majority of patients. It should preferably be performed in experienced centers because of a high incidence of complications. Several findings during the early course were associated with late mortality but need validation in large prospective studies.
ABSTRACT
In this paper, we provide an overview of the upcoming ImageCLEF campaign. ImageCLEF is part of the CLEF Conference and Labs of the Evaluation Forum since 2003. ImageCLEF, the Multimedia Retrieval task in CLEF, is an ongoing evaluation initiative that promotes the evaluation of technologies for annotation, indexing, and retrieval of multimodal data with the aim of providing information access to large collections of data in various usage scenarios and domains. In its 21st edition, ImageCLEF 2023 will have four main tasks: (i) a Medical task addressing automatic image captioning, synthetic medical images created with GANs, Visual Question Answering for colonoscopy images, and medical dialogue summarization;(ii) an Aware task addressing the prediction of real-life consequences of online photo sharing;(iii) a Fusion task addressing late fusion techniques based on the expertise of a pool of classifiers;and (iv) a Recommending task addressing cultural heritage content-recommendation. In 2022, ImageCLEF received the participation of over 25 groups submitting more than 258 runs. These numbers show the impact of the campaign. With the COVID-19 pandemic now over, we expect that the interest in participating, especially at the physical CLEF sessions, will increase significantly in 2023. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
Introduction: The SARS-COV-2 pandemic has resulted in over than 5 millions confirmed deaths. Although vaccination is a major strategy to control this pandemic, to date, only 54% of the world population has received at least one dose of a COVID-19 vaccine. Booster inoculations are increasingly recommended. Thus, the vaccination effort may need to continue for several years before the epidemic can be considered as contained. Although antibody response is just one facet of the adaptive immune system’s response to vaccination, it is considered to be a clinically significant biomarker of protection. The role of insufficient sleep duration in individual differences in antibody responses to vaccination against influenza or hepatitis has been examined in a number of studies, with somewhat mixed results. In order to summarize and clarify these findings, we have used a meta-analytical approach to determine whether the current body of evidence suggests that optimizing sleep duration may be an easily modifiable behavior that could increase the efficacy of anti-viral vaccination. Materials and Methods: The PubMed database was searched with the combination “sleep*” and “vaccin*” keywords. Studies were selected if they met the following criteria: (1) were performed on healthy human adults;(2) assessed vaccine efficacy by antibody titers or protection status;(3) performed subjective (survey items, questionnaire, sleep diary, interview) and/or objective (actigraphy, polysomnography) measures of sleep duration;(4) were laboratory-conducted studies of manipulation of sleep duration over 1 or more nights;(5) were cohort studies;(6) were peer reviewed original research papers. Since the number of available studies was small, we have engaged in a collaborative effort with the authors of all publications to obtain the information needed to optimize the estimation of the pooled effect size (ES) and the 95% confidence intervals: log transformed data when non parametric testing was used;calculation of separate ES for men and women;analyses corrected for age and overweight/obesity status whenever appropriate;sleep data no more than one week apart from inoculation. Number of participants, mean, beta or odd ratio and their respective dispersion were collected. The ES was interpreted as small when ≤0.20, moderate when >0.50 - ≤ 0.80 or large when >0.80. Results: No relationship was observed between self-reported short sleep and vaccine efficacy (n=504;overall ES=0.16 [-0.12, 0.44]). In contrast, when studies that used objective measures of sleep were examined, a robust adverse impact of short sleep on vaccine efficacy was detected (n=282;overall ES=0.96 [0.15, 1.78]). The pooled ES for experimental studies (n=111) was 0.84 [0.20, 1.49] and 1.08 [0.10, 2.06] for prospective studies (n=171). The meta-analysis did not find significant differences in ES between women and men. Conclusions: When assessed objectively, short sleep duration was associated with a clinically relevant decrease in efficacy of anti-viral vaccination. These findings suggest that achieving adequate amount of sleep during the time window surrounding the time of inoculation may increase the efficacy of vaccines against diverse strains of viruses, possibly including strains of SARS-CoV-2. Acknowledgements: Collectively, the authors acknowledge the support of their respective institutions in these challenging times.
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This article describes the impact of coronavirus disease 2019 (COVID-19) preventive measures on the undocumented migrant domestic workers in the Netherlands. Undocumented migrants (UDMs) are likely to experience inequalities due to the COVID-19 pandemic. They rely on the informal market for work and housing and are usually not entitled to a healthcare insurance. However, they are not represented in the COVID-19 registrations or surveys. In order to advise the policymakers and healthcare professionals on how to tailor the preventive activities in handling a pandemic, including vaccination strategy, to the needs of this group, an insight into their experiences is needed. In our qualitative study, two focus group discussions were held with 14 UDMs, recruited through a snowball technique. The UDMs perceived the COVID-19 as a threat. Their precarious position affected their perceived vulnerability, which motivated them to seek information on and comply with preventive measures and testing. However, structural barriers decreased their self-efficacy and opportunity to comply. The COVID-19 measures impacted the lives of UDMs on essential domains, resulting in job, food, and housing insecurity, and increased barriers in access to healthcare. An intersectoral approach addressing health communication, access to healthcare, and social support, as well as legal rights for safe employment, is needed to alleviate the impact of the measures on UDMs. Copyright © 2022 van den Muijsenbergh, Torensma, Skowronek, de Lange and Stronks.
ABSTRACT
As the COVID-19 crisis developed, the International Labor Organization estimated that 4.7 percent of the global labor pool, comprising 164 million people, were migrant workers who were living and working outside their home country. While some were laid off and sent home for the lockdown, others continued working. These others were migrants performing crucial jobs in the front line of the crisis. They help to produce our food, pack our orders, and build or clean our houses, among other tasks. Many COVID-19 infections appear to be labor-related, with many of the crucial sectors exhibiting an extra-high risk of virus transmission. Migrant workers on the frontline can be low-waged, hold a temporary job, lack knowledge of their legal position and the local language, and have a limited social network and high dependency on others - such as recruiters or temporary employment agencies - for work and housing. This essay addresses these migrant vulnerabilities in the labor market and identifies measures that might simultaneously curb the vulnerabilities and account for industrial needs for labor in essential sectors. We argue that the vulnerability of migrant laborers is structural;the COVID-19 crisis has put a magnifying glass on a preexisting vulnerability and clarified the need for solutions. Copyright © Tesseltje de Lange, Sandra Mantu and Paul Minderhoud 2020.