Thermal Tourism: Study of the Profile and Motivations of the Practitioner in Portugal

Health and wellness tourism had a growing interest in the Portuguese population until 2019. However, with the ap-pearance of Covid-19, several establishments had to close over these two years, this segment being one of the most affected areas. Many water users looked forward to the opening of the spa resorts to continue their treatments. Giv- en the importance of this theme, this work has as its main goal the definition of a consumer profile and to identify the determinants of satisfaction of the thermal tourists, as well as to gauge the degree of knowledge of thermal tourism and specifically of spas in the Portuguese context. In methodological terms, a questionnaire survey was conducted among the tourists to achieve the research objectives. The results show a younger, healthier and diversified thermal tourism practitioner. It also reveals similarities with other profile and motivations studies. However, it is possible to notice a few differences. Practitioners are seeking a combination of a leisure and health dimension and valorise fac- tors such as location and access of the establishments, quality of the services provided and rest and tranquillity. An issue regarding their length of stay has been identified. As they are locals and live in the same country as the thermal spa, most respondents do not stay overnight at the destination. In the future, it would be interesting to research product development and market strategies for diversified thermal practitioners.

The impact of COVID-19 on Tuberculosis diagnosis

Introduction: The impact of COVID-19 on the transmission of M. tuberculosis has not yet been accurately ascertained. In addition to the exposure of contacts in household settings, it will be worth considering the impact of respiratory contacts in the community and health care settings, due to the widespread use of masks. Aims and Objectives: We aimed to know if there is an increase in a local hospital TB diagnosis in the postpandemic period and which causes are associated with that increase. Method(s): We collected data from April 2018 to December 2021 and divided it into two 20 months groups - prepandemic (Apr18'-Jan20') and post-pandemic (Mar20'-Dec21'). We analyzed sociodemographic variables, time to diagnosis and type of tuberculosis. Results and Discussion We notified a total of 41 cases after the pandemic started, a 78% increase from the pre-pandemic period (N=23). This increase happened mainly in patients who worked in the primary sector of the economy (agriculture), showing a 4.6x increase in the number of cases (p<0.05) and is probably related to household transmission in low socioeconomic backgrounds. The mean age was 51 years, and most of the patients (78.5%) were male. Time until diagnosis was 102 days (compared to 82 days before). Increased time until diagnosis was independent of any of the variables studied (p>0.05) and happened across all groups. People with>6 months of symptoms were more frequent after Mar20' (8 vs 2). Conclusion(s): The number of cases and the time to diagnosis increased after the onset of the pandemic. The increase was cross-sectional for all groups of patients. The increase in cases occurred mainly in farmworkers, with 40% of post-pandemic cases (and statistical significance) compared to the pre-pandemic period.

Optimizing computational costs of Spark for SARS-CoV-2 sequences comparisons on a commercial cloud

Cloud computing is currently one of the prime choices in the computing infrastructure landscape. In addition to advantages such as the pay-per-use bill model and resource elasticity, there are technical benefits regarding heterogeneity and large-scale configuration. Alongside the classical need for performance, for example, time, space, and energy, there is an interest in the financial cost that might come from budget constraints. Based on scalability considerations and the pricing model of traditional public clouds, a reasonable optimization strategy output could be the most suitable configuration of virtual machines to run a specific workload. From the perspective of runtime and monetary cost optimizations, we provide the adaptation of a Hadoop applications execution cost model extracted from the literature aiming at Spark applications modeled with the MapReduce paradigm. We evaluate our optimizer model executing an improved version of the Diff Sequences Spark application to perform SARS-CoV-2 coronavirus pairwise sequence comparisons using the AWS EC2's virtual machine instances. The experimental results with our model outperformed 80% of the random resource selection scenarios. By only employing spot worker nodes exposed to revocation scenarios rather than on-demand workers, we obtained an average monetary cost reduction of 35.66% with a slight runtime increase of 3.36%. © 2023 John Wiley & Sons, Ltd.

Trastuzumab deruxtecan (T-DXd) + durvalumab (D) as first-line (1L) treatment for unresectable locally advanced/metastatic hormone receptor-negative (HR-), HER2-low breast cancer: updated results from BEGONIA, a phase 1b/2 study

Background: Patients with HR- advanced/metastatic breast cancer (a/mBC) with a low level of HER2 (immunohistochemistry [IHC] score 1+ or IHC 2+ and negative in situ hybridization [ISH]) have poor prognosis. Combining 1L chemotherapy with immune checkpoint inhibitors can modestly improve outcomes vs chemotherapy alone, but treatment benefit is largely seen in patients with PD-L1+ disease. BEGONIA (NCT03742102) is an ongoing 2-part, open-label platform study, evaluating safety and efficacy of D, an anti-PD-L1 antibody, combined with other novel therapies in 1L triple-negative a/mBC, including HR-, HER2-low disease. T-DXd is a trastuzumab-topoisomerase I inhibitor antibody-drug conjugate that improves survival in patients with previously treated HR-, HER2-low mBC (NCT03734029;Modi NEJM 2022). Here, we report updated results of the T-DXd + D combination from BEGONIA. Method(s): Patients with unresectable HR-, HER2-low (per local testing, IHC 2+/ISH-, IHC 1+/ISH-, or IHC 1+/ISH untested) a/mBC were enrolled in the T-DXd + D arm. Patients eligible for 1L treatment, regardless of PD-L1 status, received intravenous T-DXd 5.4 mg/kg + D 1120 mg every 3 weeks until progression or unacceptable toxicity. PD-L1, assessed using the VENTANA PD-L1 (SP263) Assay, was defined as high if >= 5% of the tumor area was populated by PDL1-expressing tumor or immune cells. Primary endpoints were safety and tolerability. Secondary endpoints included investigator-assessed objective response rate (ORR;RECIST v1.1);progressionfree survival [PFS];and response duration. Patients included in the efficacy analysis had >= 2 ontreatment disease assessments, progressed, died, or withdrew from the study. Result(s): As of April 8, 2022, 56 patients received T-DXd + D (34 ongoing) and 46 were included in the efficacy analysis. Median (range) follow-up was 10.1 (0-22) months. Median age was 53.5 years, 71% had received prior treatment for early stage BC, and 64% had visceral metastases at baseline. Confirmed ORR was 26/46 (57% 95% CI, 41-71) and unconfirmed ORR was 33/54 (61% 95% CI, 47-74);1/46 patients (2%) had complete and 25/46 (54%) had partial responses. Confirmed response occurred irrespective of PD-L1 expression (PD-L1 high ORR, 5/7 [71%];PD-L1 low, 13/21 [62%];PD-L1 missing, 8/18 [44%]). Median duration of response was not reached;however, 64% of patients remained in response at 12 month follow-up and 73% had an ongoing response at data cutoff. Median PFS was 12.6 months (95% CI, 8-not reached). Adverse events (AEs) were consistent with the agents' known safety, with treatment-related AEs occurring in 49 patients (88%), any Grade 3/4 AEs in 18 patients (32%), and any serious AEs in 10 patients (18%). The most common all-Grade AEs were nausea (41 [73%]), fatigue (26 [46%]), and vomiting (17 [30%]). Adjudicated treatment-related interstitial lung disease/pneumonitis occurred for 5 patients (9%), which were mostly Grade 1 or 2 and 1 case of Grade 5 associated with COVID pneumonia. Seven patients (13%) and 21 patients (38%) had T-DXd dose reduction and dose delay, respectively;22 (39%) had D dose delay. Seven patients (13%) discontinued treatment due to AEs. Conclusion(s): For patients with HR-, HER2-low a/mBC, T-DXd in combination with D in the 1L setting shows manageable safety and promising efficacy including durable responses and an encouraging PFS. Although subgroups were small, responses were observed irrespective of PD-L1 expression. Analysis of additional translational data is ongoing. Funding(s): AstraZeneca/Daiichi Sankyo.

"I Believe in Science and in All Vaccines:" Older Adult and the Intention for a Vaccine against COVID-19

Introduction: To investigate the intention of older Brazilian adults to receive the COVID-19 vaccine, to find out their perception of the older adults' fragility to the virus, and to know their opinion on the progress of the national immunization plan against COVID-19. Methods: An exploratory qualitative study was carried out through semi-structured telephone calls with 32 participants (aged 60-89), between February and March 2021. Data were analyzed thematically, emerging three major themes. Results: Most participants expressed concern about the vulnerability of their immune system to the coronavirus, and dissatisfaction with the organization of the national immunization plan. Strong criticism was leveled at the leadership of the President of the Republic due to his resistance to vaccination and encouraging the use of hydroxychloroquine. Conclusion: The vast majority of respondents reported an intention to receive the vaccine. The short time for the production of vaccines generated distrust with its effectiveness. All expressed dissatisfaction with the organization of the national immunization plan, and agreed that after the pandemic, their lives and the world will no longer be as before.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements Type of funding sources: None. Background Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.

SAFETY OF COVID-19 VACCINATION IN INFLAMMATORY BOWEL DISEASE PATIENTS ON BIOLOGIC THERAPY

Introduction: The International Organization for the Study of Inflammatory Bowel Disease (IBD) has recommended vaccination of all patients with IBD as soon as they are able to receive the vaccine, regardless of immune-modifying therapies or disease activity. Nevertheless, some articles have shown a large percentage of individuals who are unwilling to receive the COVID-19 vaccine with fear of potential adverse events. Moreover, IBD patients were excluded from safety and efficacy phase III vaccine trials, as well as those treated with immunosuppressive therapies. Thus, we performed a monocentric real-life survey to assess the adverse events of COVID-19 vaccination among patients with IBD under biologic therapy. Methods: All adult individuals with IBD undergoing biological treatment and followed at Centro Hospitalar Universitário de São João were included. Each patient answered a telephone questionnaire conducted by a gastroenterologist. Results: A total of 301 patients agreed to participate in the study, the majority females (53.2%), with a median age of 42 years old (IQR 32-54). IBD diagnosis included Crohn's disease (76.7%) and ulcerative colitis (23.3%). The proportions of patients receiving tumor necrosis factor inhibitors, ustekinumab and vedolizumab were 75.4%, 13.0% and 11.6%, respectively. This cohort included 239 vaccinated patients (59.0% Pfizer-BioNTech, 20.5% Moderna, 14.2% Janssen and 6.3% AstraZeneca), 173 (57.5%) of whom had complete vaccination. Of the remaining individuals, only 12 did not intend to be vaccinated. The main reasons were: fear of potential adverse events (50.0%), lack of confidence in the vaccine development process (25.0%) and little information about vaccination in IBD patients (16.6%). Among vaccinated patients, the overall adverse events frequency was 56.8% after dose 1 (D1) and 74.1% after dose 2 (D2). The most common symptoms were localized injection-site reactions and fatigue. The vast majority of adverse events were mild and lasted only a few days. Only 4 (1.7%) patients had IBD exacerbation after the vaccine. No serious adverse events were reported and any patient was hospitalized. The percentage of adverse events was higher among patients younger than 50 years (77.6% vs 62.5% after D1, p=0.011;83.0% vs 58.8% after D2, p=0.002). No significant differences were seen based on sex, vaccine type, biologic drug or disease type. Compared to the general population, a lower percentage of IBD patients suffered from local or systemic reactions during the first week after vaccination (Figure 1). Conclusion: We found a high acceptance rate and a good safety profile of SARS-CoV-2 vaccination in IBD patients treated with biologics drugs. Indeed, adverse events were common but overall mild and transitory. These data support the prioritization and rapid vaccination of these individuals. (Figure Presented) Figure 1 – Adverse reactions occurring within seven days after vaccination in IBD patients compared with the general population.

Cardiorespiratory fitness assessment on active patientswhokept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Background: Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose: Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods: A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results: A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion: In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF. (Figure Presented).

EDUCATION IN TIMES OF PANDEMIC: a reflection on poverty, oppression and humanization

This paper discusses how social, cultural and economic conditions interfere in the perpetuation of the place of oppression of families and, consequently. of their children, aiming to discuss education in times of pandemic, considering the context of poverty, the mechanisms of oppression and its effects on the humanization process in the light of Freirean and Vygotskian assumptions. It is an excerpt from a research that originally addresses learning difficulties. Later, this same study also allowed us to analyze the observed social aspects, which are at the origin of the issues of humanization/dehumanization of children. This research is a case study carried out during the Covid-19 pandemic, in the second half of the year 2020. It was analyzed the case of a boy who, according to the teacher's indication, had literacy difficulties. The survey data were built through interviews and individualized care for him, his mother and teacher. The analysis was supported by the contributions of Freire and Vigotski. Data analysis highlighted the impact of deprivation of material and cultural goods on student education and. thus, the crystallization of the oppressed condition and its impact on the student's humanization process.

Social Inequity and Health: From the Environment to the Access to Healthcare in Composite Indicators, the Portuguese Case

The relationship between social inequity and health and healthcare is a priority and recurrent issue in health policy. It has been aggravated by the SARS-CoV-2 pandemic outbreak worldwide, which, in turn, is likely to impact citizens’ quality of life. Such an effect implies the revision of the agenda for 2030. This chapter analyses the inequity and the social-economic impact of health in theoretical terms. It uses the Portuguese case for measuring the quality of life, which is of utmost importance for many policy purposes. One can understand the quality of life in municipalities as the outcome of both local and global policies in a panacea of fields, including access to health and education, purchasing power, quality of the environment, and security, to name a few. However, little is known about the quality of life in Portuguese municipalities, neither the contributions of environment, energy, and health, among other aspects, to this field. This study aims to use robust benchmarking methods with statistics on the various criteria underlying quality of life to construct composite indicators associated with the latter. We expect to establish a link between aspects like environment and access to healthcare and education. Besides, this model should be replicated in other countries in the future, allowing the comparison of quality of life before and after the SARS-CoV-2 pandemic outbreak. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Differences of venous thromboembolism (Vte) events in COVID-19 and non-COVID-19 hospitalized patients

Background : Although the novel coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous thromboembolism (VTE), different VTE incidences are reported according to the population profile. Aims : To compare risk factors, prophylaxis regimens, laboratory data, incidence and mortality rates of VTE associated with COVID-19 and non-COVID-19 patients, hospitalized in an institution with best practices in thromboprophylaxis. Methods : We retrospectively analyzed all confirmed cases of VTE (pulmonary embolism [PE] and/or deep vein thrombosis [DVT]) reported in electronic medical records diagnosed at admission, during hospitalization or readmitted to the hospital within 90 days after discharge, between January/2020 and February/2021. Characteristics of VTE events associated with COVID-19 and VTE associated with other diseases (non-COVID patients), were compared. Results : Over the study period, 177 patients presented VTE events (63.8% male, mean age 63.8 ± 18.9 years, 38.4% confirmed COVID-19;85% critically ill patients). Clinical characteristics were summarized in Table 1. In contrast to non-COVID group, COVID-19 patients were predominantly male (78% vs. 55%;P = 0.002) and older (66 vs. 61 years old ;P = 0.034), had less clinical risk factors for VTE, and developed VTE more frequently during hospital stay, despite using higher doses of enoxaparin (Tables 1 and 2). Mortality rate was higher in the COVID group (38.2% vs. 5.5%;P < 0.0001). Additionally, COVID group presented higher D-Dimer levels (17481 ± 26278 UI/ ml vs. 7291 ± 11708 UI/ml;P = 0.004), but similar C-reactive protein levels (12.5 ± 11.8 vs.13.8 ± 79.2;P = 0.892). Regarding critically ill patients, COVID-19 was associated with an increased risk of VTE compared to non-COVID group (5.6% [34/602] vs. 0.5% [20/3690], unadjusted OR = 10.98 [95% CI 6.3-19.2;P < 0.00001]) (Table 2). Conclusions : Despite of having less clinical risk factors for VTE and using greater doses of enoxaparin, COVID-19 patients had higher incidence of In-hospital VTE and higher mortality rate. These findings suggest that a hypercoagulability state could be induced by the coronavirus itself. .

Use of D-dimer as a predictor of venous thromboembolism events (VTE) in COVID-19 patients

Background : D-Dimer (DD) values are often elevated in coronavirus disease 2019 (COVID-19), but its role as a diagnostic test of VTE is controversial. Aims : To analyze the performance of DD in the VTE events diagnosis in a cohort of COVID-19 patients. Methods : We retrospectively analyzed, from March/2020 to February/2021, all cases of proven COVID-19 submitted to a compression ultrasound (CUS) or CT pulmonary angiogram (CTPA) to investigate deep venous thrombosis [DVT] and/or pulmonary embolism [PE]. DD levels were recorded at hospital admission and at the day (±24 h) of each imaging studies. DD levels were categorized into 3 groups according to terciles, in order to determine VTE risk. ROC curve analysis was used to determine optimal DD cut-off to predict VTE. Results : From 717 COVID-19 admissions, we identified 169 patients (median age 65 years [20-103], 66% male) submitted to a 208 imaging studies (74 CTPA, 134 CUS). In the overall cohort, 54 (32%) patients had VTE diagnosis according to 62 positive exams (39 CUS and 23 CTPA). Confirmed VTE patients had higher median levels of DD at admission (2364 vs. 831 ng/mL;P = 0.004) and at the day of exam (7013 vs. 1378 ng/mL;P < 0.0001). The AUROC for DD and VTE at admission and at the day of imaging study was 0.72 (95%CI,0.63-0.81) and 0.80 (95%CI,0.73-0.87), respectively. The best DD cut-off point to predict VTE was 2000 ng/mL (86% sensitivity, 63% specificity). Greater values of DD were associated with an increased rate of VTE diagnosis: group I≤1200 ng/mL: 7.6%;group II-1201-5000 ng/mL: 35.8% and group III>5000 ng/mL: 60.3% ( P < 0.001). The OR of group II and III vs. group I was 6.8 (95%CI 2.4-19.3;P < 0.0001) and 18.5 (95%CI6.6-52.0;P < 0.0001), respectively. Conclusions : In a cohort of hospitalized COVID-19 patients, DD test was a good discriminator of VTE events. Serial measurements of DD could help physicians to initiate anticoagulation therapy in COVID-19 patients suspected of VTE diagnosis.

PROGNOSTIC FACTORS FOR SEVERITY AND MORTALITY IN COVID-19: ARE LIVER TESTS IMPORTANT?

Introduction: The identification of prognostic factors related to worse outcomes in the coronavirus disease (COVID-19) is essential in the care of this challenging disease. Objectives: To identify prognostic factors that may help in decision-making related to patients’ care with COVID-19. Methods: This retrospective observational study included confirmed COVID-19 patients hospitalized in a private Brazilian hospital between March and September/2020. The following variables were analyzed: age, gender, comorbidities, admission laboratory data (leukocyte, lymphocyte and platelet count, D-dimer [DD], C-reactive protein [CRP], aspartate aminotransferase [AST], alanine aminotransferase [ALT], and total bilirubin [Bb]) and during follow-up (DD, CRP, AST, ALT, Bb). The severity of disease was evaluated according to the extension of pulmonary infiltration by CT scan at admission, classified as mild (<25%), moderate (25%-50%) or severe (>50%), and by mechanical ventilation need. Results: 414 patients (63% males, aged 61) were included. The main comorbidities were arterial hypertension (54%) and diabetes mellitus (34%). Typical pulmonary involvement was present at admission in 318 patients: 51% mild, 39% moderate, 10% severe. 65% of patients were admitted to ICU and 25% needed mechanical ventilation. The mortality rate was 20.4%. Admission DD values (p=0.012), Bb (p=0.039), need for mechanical ventilation (p<0.001) and the extension of lung infiltration (p<0.001) were associated with mortality. During follow-up, the peak of DD (AUROC=0.875), CRP (AUROC=0.875), AST (AUROC=0.820) and Bb (AUROC=0.804) were significantly associated to mortality and the peak levels of DD (p=0.019), AST (p=0.039), ALT (p=0.021) and Bb (p=0.011) were associated to severe pulmonary infiltration. Follow-up levels of AST >60U/L (N<59) with specificity=76% and sensitivity=78%, ALT>70U/L (N<51) with specificity=77% and sensitivity=58% and Bb>0.5mg/dL with specificity=77% and sensitivity=73%, were able to predict mortality. Conclusion: In association with well-known prognostic factors of mortality, serial measurements of aminotransferases and Bb can identify patients of greater severity and higher mortality risk.

Comparing SARS-CoV-2 sequences using a commercial cloud with a spot instance based dynamic scheduler

There has been an increasing interest in running High Performance Computing (HPC) applications in the cloud, mainly due to rapid resource provisioning and significant reduction of operational costs. Biological sequence comparison is an important HPC application that compares sequences in search of similarities. MASA-OpenMP is a highly optimized sequence comparison tool that obtains optimal results. Yet, it can take a long time, depending on the number of sequences compared and their lengths. The Covid-19 pandemic study is of particular interest nowadays, and the comparison of SARS-CoV-2 sequences is crucial to understanding this disease. In this paper, we compare SARS-CoV-2 sequences with MASA-OpenMP in the Amazon Elastic Compute Cloud (Amazon EC2), using both spot and on-demand instances. To efficiently execute a MASA-OpenMP application composed of more than 22, 000 tasks on EC2 respecting a given deadline, we propose an execution modeling for MASA-OpenMP on top of the Burst-HADS framework. Burst-HADS is a spot instance-based dynamic scheduler for Bag-of-Tasks applications in the cloud, which minimizes both execution time and financial costs regarding a given deadline even in the presence of spot interruptions. Performance results reveal that, by using spots, our Burst-HADS strategy considerably reduces the monetary cost for executing 22, 600 SARS-CoV-2 sequence comparisons with MASA-OpenMP when contrasted to the on-demand only approach. We also show that our strategy can meet the deadlines, even in scenarios with several spot interruptions. © 2021 IEEE.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Entrepreneurship and coronavirus: impacts, strategies, and opportunities in the global crisis

The present study aimed to identify the impacts and strategies of entrepreneurs from different market segments during the COVID-19 crisis scenario. Semi-structured interviews were carried out with 17 entrepreneurs from different segments, transcribed, and submitted to content analysis. The results highlighted the effects of a personal and professional order, emphasizing the financial field and strategies for disseminating products and services while focusing on quality and flexible payment terms. Regarding opportunities, professional growth, reinvention, new ways of working, professional development, and e-commerce were of note. It was possible to conclude that some segments present higher demand, evidencing the trend of change in the consumption pattern of society due to the current scenario. Finally, further studies are suggested in terms of research participants, geographic extension, and market segmentation.