A Realist Perspective on Agile Policy for Future Skills in a Digital Age—An Example from the Kingdom of Bahrain

Within the context of the Kingdom of Bahrain, this case study applies a realist lens to analyse a new policy approach to education reform. Called the ‘Tertiary Action Plan' (TAP), the design and consultation of this policy process provides an example of a different more Agile policy approach. Critics of traditional linier policy processes highlight that they do not consider the cultural, social and economic complexities of the policy context. This has become particularly important within the future skills agenda driven by the fourth industrial revolution and post-COVID recovery. Interviews with policy experts directly involved at a senior level in the TAP process highlight key themes that describe the ‘different' approach. These themes include whole system change and different rhetoric used to describe education ‘transformation' rather than reform;focusing on educational and labour market outcomes over delivering KPIs;and high-level integrated collaboration and responsibility. The conclusion and recommendations state that there is some evidence of Agile policy making, but this could be made more explicit by ensuring realist evaluation and monitoring principles are added to the implementation of the various TAP initiatives. © 2023, Gulf Research Centre Cambridge.

Transforming Clinical Research to Meet Health Challenges.

This Viewpoint discusses specific areas of improvement in the National Institutes of Health's funding of and research criteria for clinical trials to be inclusive, transparent, and broad reaching.

Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings.

Introduction: We explored priorities and perspectives on health policy and payer strategies for improving HPV vaccination rates in safety-net settings in the United States. Methods: We conducted qualitative interviews with policy and payer representatives in the greater Los Angeles region and state of New Jersey between December 2020 and January 2022. Practice Change Model domains guided data collection, thematic analysis, and interpretation. Results: Five themes emerged from interviews with 11 policy and 8 payer participants, including: (1) payer representatives not prioritizing HPV vaccination specifically in incentive-driven clinic metrics; (2) policy representatives noting region-specific HPV vaccine policy options; (3) inconsistent motivation across policy/payer groups to improve HPV vaccination; (4) targeting of HPV vaccination in quality improvement initiatives suggested across policy/payer groups; and (5) COVID-19 pandemic viewed as both barrier and opportunity for HPV vaccination improvement across policy/payer groups. Discussion: Our findings indicate opportunities for incorporating policy and payer perspectives into HPV vaccine improvement processes. We identified a need to translate effective policy and payer strategies, such as pay-for-performance programs, to improve HPV vaccination within safety-net settings. COVID-19 vaccination strategies and community efforts create potential policy windows for expanding HPV vaccine awareness and access.

Need of Technological Interventions for Indoor Air Quality and Risk Assessment Upon Short-Term Exposure: A Futuristic Approach

The variation in ambient air pollution hampers indoor air quality (IAQ), and even the short-term variation is very hazardous for the exposed population. Technological interventions including sensors, smartphones and other gadgets are implemented to build smart environments. However, these interventions are still not fully explored in developing countries like India. The COVID-19 pandemic has made it very important to keep a tab on the air we breathe in as those already suffering from respiratory troubles are prone to fall victim to the deadly disease. In such a scenario, even a rise in pollution for a short duration is dangerous to the exposed pollution. Such short-term exposure facilitated by the meteorological creates a disaster for environmental health. The short-term rise in the concentration of pollutants makes things worse for the exposed people, even indoors. It is therefore critical to come up with a concrete solution to predict the IAQ instantly and warn the exposed population which can be only achieved by technological interventions and futuristic Internet of Things-based computational predictions. This chapter is intended to elaborate the health hazards linked to short-term rise in pollutants, which often goes unnoticed but has a critical impact and how with the help of IoT-based applications, the short-term variation can be predicted through different strategies. Similarly, the assessment of the health impact associated with short-term exposure to air pollution is also significant, and different exposure assessment models and computational strategies are discussed in the course of the study. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

All Feet On Deck-The Role of Podiatry During the COVID-19 Pandemic: Preventing hospitalizations in an overburdened healthcare system, reducing amputation and death in people with diabetes.

The COVID-19 pandemic is driving significant change in the healthcare system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, ER visits, hospitalizations, length-of-stay, and costs. But podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the COVID-19 risk. The goal of podiatrists during the pandemic is to reduce the burden on the healthcare system by keeping diabetic foot and wound patients safe, functional, and at home.

COVID-19 and Its Impact on Diverse Aspects of Women's Lives

The objective of this article is to study the impact of COVID-19 on the lives of women by exploring different aspects like their daily work patterns, hygiene practices, psychological effects and nutritional status during the pandemic. 510 women participated in the online survey. The majority of the respondents belonged to the age group of 20-29 years and were either graduates or above. 37.3% of the working respondents reported increased professional responsibilities during the pandemic. Cooking and cleaning occupied most of the time during the lockdown. Anxiety, lack of concentration and frequent arguments with the family members were reported by the respondents. Many of the respondents took up physical activities to maintain their fitness. They also believed that usage of masks would prevent them from catching the infection. 75.2% of women included vitamin-rich sources in their diet. This level of consciousness might be linked to the educational profile of the respondents.

Psychological and Mental Health Issues During the SARS-CoV-2 Global Pandemic: A Critical Analysis

Introduction: With the outbreak of the SARS-CoV-2 in Wuhan, China in December, 2019, presently over 200 countries have been facing gruesome health effects of the deadly virus, with cases and casualties on the rise. So far, no concrete medicinal drug or vaccine has been developed to check the lethal viral infection, henceforth authorities have emphasized on practicing social distancing and imposed strict lockdowns forcing people to confine in their homes. Material(s) and Method(s): This review was aimed to analyze the effects on mental health and well being during the pandemic. The studies cited in the review were sourced from journals, books and digital media reports. The research papers indexed in databases such as PUBMED, SCOPUS, INDEX COPERNICUS, CHEMICAL AND BIOLOGICAL S, MEDLINE, EMBASE, EBS-CO, DOAJ and THOMSON REUTERS were reviewed and have been included in the review. Result(s): The coronavirus mayhem has not only posed a threat to human health, but also jolted different aspects of society, including mental and psychological health. Loss of freedom, boredom, fear and angst are some of the mild psychological effects, whereas a rise in domestic violence and suicidal tendencies is the more serious consequence reported from different parts of the world during the lockdown period. Conclusion(s): This article is a comprehensive analysis of the effects on mental and psychological well being during this critical time. Strategic measures to be adopted by individuals and administration to cope up with the situation are also suggested as it should be an immediate priority to address the overall distress caused by the pandemic in public.Copyright © 2021 Bentham Science Publishers.

Triglyceride Lowering with Pemafibrate to Reduce Cardiovascular Risk.

BACKGROUND: High triglyceride levels are associated with increased cardiovascular risk, but whether reductions in these levels would lower the incidence of cardiovascular events is uncertain. Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, reduces triglyceride levels and improves other lipid levels. METHODS: In a multinational, double-blind, randomized, controlled trial, we assigned patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia (triglyceride level, 200 to 499 mg per deciliter), and high-density lipoprotein (HDL) cholesterol levels of 40 mg per deciliter or lower to receive pemafibrate (0.2-mg tablets twice daily) or matching placebo. Eligible patients were receiving guideline-directed lipid-lowering therapy or could not receive statin therapy without adverse effects and had low-density lipoprotein (LDL) cholesterol levels of 100 mg per deciliter or lower. The primary efficacy end point was a composite of nonfatal myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes. RESULTS: Among 10,497 patients (66.9% with previous cardiovascular disease), the median baseline fasting triglyceride level was 271 mg per deciliter, HDL cholesterol level 33 mg per deciliter, and LDL cholesterol level 78 mg per deciliter. The median follow-up was 3.4 years. As compared with placebo, the effects of pemafibrate on lipid levels at 4 months were -26.2% for triglycerides, -25.8% for very-low-density lipoprotein (VLDL) cholesterol, -25.6% for remnant cholesterol (cholesterol transported in triglyceride-rich lipoproteins after lipolysis and lipoprotein remodeling), -27.6% for apolipoprotein C-III, and 4.8% for apolipoprotein B. A primary end-point event occurred in 572 patients in the pemafibrate group and in 560 of those in the placebo group (hazard ratio, 1.03; 95% confidence interval, 0.91 to 1.15), with no apparent effect modification in any prespecified subgroup. The overall incidence of serious adverse events did not differ significantly between the groups, but pemafibrate was associated with a higher incidence of adverse renal events and venous thromboembolism and a lower incidence of nonalcoholic fatty liver disease. CONCLUSIONS: Among patients with type 2 diabetes, mild-to-moderate hypertriglyceridemia, and low HDL and LDL cholesterol levels, the incidence of cardiovascular events was not lower among those who received pemafibrate than among those who received placebo, although pemafibrate lowered triglyceride, VLDL cholesterol, remnant cholesterol, and apolipoprotein C-III levels. (Funded by the Kowa Research Institute; PROMINENT ClinicalTrials.gov number, NCT03071692.).

Understanding Student Perceptions Around Mandatory Use of Smartphone Apps for COVID-19

In this short paper, we present our findings from a survey (n=178) conducted on a college campus to understand student perceptions of the deployment of CoVerified app to regulate COVID-19 spread on campus by limiting access to on-campus locations and events to only those with a "cleared"status. We expect our recommendations could help with future deployments of smartphone apps for managing spread of COVID-19, should there be new variants. Additionally, we also highlight our innovative pedagogy of bringing research into the classroom by incorporating the study data into a class project. © 2022 Owner/Author.

Association of Chest CT Score During Acute COVID-19 Illness with Subsequent Lung Function Loss Among Lung Transplant Patients

Purpose: Limited data exists on CT chest abnormalities during acute Coronavirus disease 2019 (COVID-19) infection and associated post-illness loss of lung function among lung transplant (LT) patients. Method(s): The institutional database was interrogated for any LT patient diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021;n=54). 44 patients with acute COVID-19 were alive at 3-month follow up (COVID-survivors: 81.5%). Of the survivors, 34 had a CT chest during the first two weeks of acute illness. A validated CT score was used to quantify the parenchymal abnormalities due to COVID-19. Each lung was divided into 10 separate regions which were scored 0-2 based on the severity and extent of parenchymal opacification (maximum score per lung=20). To avoid confounding from underlying lung disease, only the allograph was assessed in single LT. The average score of both lungs was calculated in bilateral LT. The primary outcome measure was sustained decline of FEV1 or FVC >10% from pre-infection spirometry. Result(s): Abnormal CT score and lung opacities on CT chest were nearly ubiquitous during acute COVID-19 illness (>0;36/37, 97.3%, median score with IDR: 7.25, 4.625-10.125). The lower lobes (LL) were more affected by COVID-19 than the upper and middle lobes (UML) (median CT score in LL: 4, 2.75-6 vs 3.5, 1.25-5 in UML). A >10% decline in FEV1 or FVC was common after COVID-19 pneumonia (38.2%). The overall CT score correlated with amount of lung function loss (r=0.36, p=0.03) although the association was modest and limited to regions reflecting the UML. On ROC curve, CT score was modestly predictive of lung function decline (Fig 1). CT score from UML had the highest area under the curve (78.2%, 61.1-95.4%;p=0.006) with a score of 4.5 being the best cut-off (sensitivity 71%, specificity 85% for post-COVID lung function loss >10%). An UML CT score >4.5 was strongly associated with respiratory failure during acute illness (69% vs 24%;OR: 7.2, 1.5-33.8;p=0.01) and lung function decline >10% (77% vs 19%;OR: 14.2, 2.6-76.7;p=0.001). Conclusion(s): The CT score during acute COVID-19 infection provides prognostic information regarding loss of lung function among LT patients who survive COVID-19. Parenchymal abnormalities in the UML best predict subsequent lung function loss.

Prosecutorial Discretion During a Pandemic: Implications for the Criminal Justice System and the Rule of Law

The COVID-19 pandemic has altered the course of history in many significant ways. This virus is highly contagious, and it has proven to be a major concern in densely populated communities such as prisons. In addition to sheer density, prisons tend to hold clusters of people belonging to vulnerable populations which are at an elevated risk of becoming seriously ill or dying as a result of contracting the virus. Many localities across the nation have responded to the threat COVID poses to prison operations by preemptively announcing non-prosecution policies and blanket release policies. Under the former, a locality announces particular crimes or levels of offenses which will not be prosecuted for a certain period of time or for the foreseeable future, thereby allowing those who violate these particular laws to go unpunished. Under the latter, a locality allows groups of prisoners to be released en masse--whether by crime, by age, or by another metric or formula--rather than based upon the exigencies of their individual situations. This Note argues that the criminal justice system's blanket release and non-prosecution policies are not the proper response to the COVID pandemic.

Air Pollution Trend and Variation during a Mega Festival of Firecrackers (Diwali) in Context to COVID-19 Pandemic

The present study was conducted in Lucknow city to assess the impact of firecracker burning during Diwali, from 2 November 2021-6 November 2021 including the pre and post-Diwali days. The concentrations of PM10, PM2.5, SO2, NO2, CO, O3, benzene and toluene, were monitored from the Central Pollution Control Board site on an hourly basis. The Air Quality Index was also recorded for PM10, PM2.5, SO2 and NO2. A questionnaire survey was done with 51 doctors to know the reported complaints post-Diwali. On Diwali night the PM2.5 value reached 262 μg m-3 around 22:00 hours and the maximum value (900 μg m-3) was obtained on 5 November, reported from the Central School monitoring station. From Gomti Nagar highest PM2.5 value obtained on Diwali day was 538 μg m-3 at 23:00 hours reaching 519 μg m-3 post-Diwali. Areas belonging to the old part of the city witnessed higher variations as PM2.5 crossed 900 μg m-3, in Lalbagh and Talkatora areas. The multivariate analysis showed that on Diwali night there was an increase of 204, 386, 344 and 341 in the PM2.5 concentration reported from Gomtinagar, Central School, Talkatora and Lalbagh stations, showing that firecracker burning resulted in a significant increase in air pollution. The Toluene/Benzene ratio was mostly more than 1 indicating that toluene and benzene may be emitted from other sources as well including the mobile sources. Around 50-75% rise was seen in the number of patients post-Diwali. 57.1% of the reported cases had respiratory issues, followed by allergic reactions. The data obtained from Lalbagh, Talkatora and Central School showed that although the values remained high, a decreasing trend was seen in the AQI compared to previous years which is a good sign and may be attributed to public awareness and the ongoing pandemic making people conscious © 2022 by Asian Association for Atmospheric Environment

A Critical Analysis of Covid-19 with Special Emphasis on Air Quality and its Consequences during Lockdown

SARS-CoV-2 (Covid-19) has taken over the world. The deadly virus causes serious respiratory infections in humans. A number of research are ongoing to contain the spread of the virus. The aim of this review is to assess the impact of air pollution and environmental factors which may influence the transmission of the disease. The utilization of indigenous natural sources as remedial measures has also been explored. The studies cited in the review have been sourced from journals, books and digital media reports. The research papers indexed in databases such as PUBMED, SCOPUS and MEDLINE, etc., have been included. Evidence has suggested that the spike in air pollution may exacerbate the number of infections and the improved air quality during the lockdown period may influence the faster recovery rate. Environmental factors, like temperature, humidity and air pollution have been explored as contributing factors for the facilitated spread of the infection, or atleast in making people more vulnerable to it which makes it an issue of considerable attention in developing countries, like India, due to the high air pollution levels in megacities. © 2022 - Kalpana Corporation.

The post-pandemic city

The COVID-19 coronavirus pandemic that began in January 2020 has transformed people's lives and activities globally, especially in cities where the majority of the world's population currently live, work, shop, recreate, socialize and move about. News since early 2020 from around the world has reported that people and nations were unprepared or hesitant in responding to the COVID-19 outbreak, which has contributed to both the spread of infections and the longevity of the pandemic. The eventual impact around the world has affected how people behave and interact, both in public and in private, and how they might view cities, buildings and the open spaces around them. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Way-Making: Portability and Practice amid Protestantization in American Confucianism

While the study of Confucianism has been ongoing in the United States for quite some time, the idea of its viability in the American context is quite recent. Even more recent are experimental attempts to practice Confucianism in the U.S. This article chronicles several such attempts and considers what demographic data there are, and their frameworks of measurement, of Confucianism in the U.S. It focuses on a case study of debates and conversations about what it means for Confucianism to be 'portable';among a small but committed second generation of Boston Confucians. From quiet-sitting meditation, to textual studies and interpretation, to ritual veneration of Confucius and ancestors, this article is one of the first empirical studies of Confucianism as a lived tradition in the United States. It situates these practices, and descriptions, discussions, and debates about them by their enactors, in the context of the Protestantized religious landscape in the U.S. It also considers how Confucianism has registered in unexpected ways in the U.S. context amidst the COVID-19 pandemic. Confucianism in the U.S. emerges as a form of way-making, irreducible to the categories of philosophy or religion, that both reflects and transforms its inheritance of Confucianism from East Asia.

T cell response to intact SARS-CoV-2 includes coronavirus cross-reactive and variant-specific components.

SARS-CoV-2 provokes a robust T cell response. Peptide-based studies exclude antigen processing and presentation biology, which may influence T cell detection studies. To focus on responses to whole virus and complex antigens, we used intact SARS-CoV-2 and full-length proteins with DCs to activate CD8 and CD4 T cells from convalescent people. T cell receptor (TCR) sequencing showed partial repertoire preservation after expansion. Resultant CD8 T cells recognize SARS-CoV-2-infected respiratory tract cells, and CD4 T cells detect inactivated whole viral antigen. Specificity scans with proteome-covering protein/peptide arrays show that CD8 T cells are oligospecific per subject and that CD4 T cell breadth is higher. Some CD4 T cell lines enriched using SARS-CoV-2 cross-recognize whole seasonal coronavirus (sCoV) antigens, with protein, peptide, and HLA restriction validation. Conversely, recognition of some epitopes is eliminated for SARS-CoV-2 variants, including spike (S) epitopes in the Alpha, Beta, Gamma, and Delta variant lineages.

T cell response to intact SARS-CoV-2 includes coronavirus cross-reactive and variant-specific components (preprint)

SARS-CoV-2 provokes a brisk T cell response. Peptide-based studies exclude antigen processing and presentation biology and may influence T cell detection studies. To focus on responses to whole virus and complex antigens, we used intact SARS-CoV-2 and full-length proteins with DC to activate CD8 and CD4 T cells from convalescent persons. T cell receptor (TCR) sequencing showed partial repertoire preservation after expansion. Resultant CD8 T cells recognize SARS-CoV-2-infected respiratory cells, and CD4 T cells detect inactivated whole viral antigen. Specificity scans with proteome-covering protein/peptide arrays show that CD8 T cells are oligospecific per subject and that CD4 T cell breadth is higher. Some CD4 T cell lines enriched using SARS-CoV-2 cross-recognize whole seasonal coronavirus (sCoV) antigens, with protein, peptide, and HLA restriction validation. Conversely, recognition of some epitopes is eliminated for SARS-CoV-2 variants, including spike (S) epitopes in the alpha, beta, gamma, and delta variant lineages.