Racial diversity and Black vascular surgeons in vascular surgery workforce.

OBJECTIVES: The precise number of actively practicing vascular surgeons who self-identify as Black American and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data have been collected and maintained at the societal or national board level. Vascular surgery societal reports suggest that less than 2% of vascular surgeons identify as Black American. Black Americans comprise 13.4% of the U.S. population yet for disorders such as peripheral artery disease and end-stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age-adjusted basis. A significant body of research shows that clinical outcomes such as medication adherence, shared decision-making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black American vascular surgeons. METHODS: A cross-sectional survey was conducted via a questionnaire sent to all participants of the Society of Black Vascular Surgeons that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics, and professional society engagement. RESULTS: Fifty-nine percent of the Society of Black Vascular Surgeons members completed the survey. Males comprised 81% of the responding vascular surgeons. The majority (62%) of respondents were involved in academic practice. Less than 25% of the total medical staff were Black American in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings was as follows: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%), and American Indian and Alaskan Natives (0.4%). Forty-three percent of respondents had a current active membership in the Society for Vascular Surgery, and 24% had a regional society membership. Fifty-eight percent of respondents reported that they experienced a workplace event that they felt was racially or ethically driven in the 12 months before the survey. CONCLUSIONS: This survey describes an under-represented in medicine vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty and to develop benchmark goals of race composition that mirrors our society at large. The patients of this group of Black American vascular surgeons were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.

The footprints of Russia–Ukraine war on the intraday (in)efficiency of energy markets: a multifractal analysis

Purpose>This paper examines the impact of Russian invasion of Ukraine on the intraday efficiency of four major energy markets, namely, diesel oil, Brent oil, light oil and natural gas.Design/methodology/approach>This study applies the multifractal detrended fluctuation analysis (MFDFA) to high-frequency returns (30-min intervals) for the period from October 21, 2021, to May 20, 2022. The data sample of 5,141 observations is divided into two sub-samples, before and after the invasion of 24th February 2022. Additionally, the magnitude of long memory index is employed to investigate the presence of herding behavior around the invasion period.Findings>Results confirm the presence of multifractality in energy markets and reveal significant changes of multifractal strength due to the invasion, indicating a decline of intraday efficiency for oil markets. Surprisingly, the natural gas market, being the least efficient before the invasion, turns out to be more efficient after the invasion. The findings also suggest that investors in these energy markets are likely to show herding, more prominently after the invasion.Practical implications>The multifractal patterns, in particular the long memory property of energy markets, can help investors develop profitable investment strategies. Furthermore, the improved efficiency observed in the natural gas market, after the invasion, highlights its unique traits and underlying complexity.Originality/value>This study is the first attempt to assess the impact of the Russia–Ukraine war on the efficiency of global commodity markets. This is quite important because the adverse effects of the war on financial markets may potentially cause destabilizing outcomes and negative effects on social welfare on a global scale.

A case series of dermatomyositis following SARS-CoV-2 vaccination.

Background/Objective: The most significant adverse events following SARS-CoV-2 vaccination are myocarditis and pericarditis. Myositis and dermatomyositis have been reported following SARS-CoV-2 infection, but vaccine-induced dermatomyositis (DM) has not been reported. Our case series aimed to characterize new onset dermatomyositis or disease-related flares following SARS-CoV-2 vaccination. Materials and methods: A total of 53 patients from our institution with a new or pre-existing diagnosis of DM were recruited and consented. Phone interviews were conducted to obtain vaccination status and symptoms following vaccination. Electronic medical records were reviewed to extract age, sex, autoantibody profiles, comorbidities, immunomodulatory therapies, creatine kinase (CK) values, and SARS-CoV-2 vaccination dates from the provincial vaccination registry. For patients who reported disease flares, records were reviewed for the onset and nature of symptoms, extent of organ involvement and changes in immunomodulation. Results: On average, patients received 2.62 vaccine doses (range 1-3 doses). A total of 3 of 51 patients (5.88%) experienced dermatomyositis symptoms following vaccination. Two patients were newly diagnosed with dermatomyositis, one requiring hospitalization. Reported symptom onset following vaccination ranged from 1 to 30 days. Of note, all of these patients had normal CK values, even though there was muscle biopsy-confirmed myositis in one patient. Eight patients in the cohort (15.1%) had asymptomatic CK elevation (<1.5 X ULN). Conclusion: New onset dermatomyositis or flare up of pre-existing dermatomyositis may be a rare complication in SARS-CoV-2 vaccination although no studies can support a true correlation. Several pathophysiologic mechanisms are proposed.

Caecal Ameboma, colorectal malignancy mimicker in young male with ANCA-associated vasculitis.

Ameboma refers to the rare development of an inflammatory, ulcerated, exophytic mass in the gastrointestinal tract that can resemble carcinoma. Typically it presents as a right lower quadrant abdominal mass, Patients may also present with diarrhea or constipation and associated systemic symptoms, including weight loss and fever. In this article we present a young man with a background of ANCA associated vasculitis, who presented with fresh lower gastrointestinal bleeding during hospital admission for severe covid-19 pneumonia which turned out to be caecal aemboma. This case is highlighted for its rarity, the diagnostic challenge, and for the major role of colonoscopy as a diagnostic tool for this pathology.

Epidemiology of peritoneal dialysis outcomes.

Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

Towards Post-pandemic Occupancy Patterns: Investigating Building Occupancy in New York City

Urban-scale energy simulation relies on the understanding of occupants' presence in buildings and consequently in cities. Therefore, occupancy profiles (i.e., the relative number of occupants in a specific hour of the day) are usually used in the energy simulation on the city level. However, available occupancy standard profiles are incapable of considering the dynamic nature of occupancy schedules and any changes that occurred due to contextual changes (such as the dramatic increase in remote working last year). Therefore, the need for a scalable method to generate dynamic occupancy profiles for buildings is crucial. Moreover, the targeted method should allow for tracking the changes that occur in occupancy profiles due to external disruption such as pandemics. In this context, this study aims at using the emerging mobile positioning data to generate context-specific data-driven occupancy profiles for commercial and institutional buildings in New York City. The generated profiles were then compared versus ASHRAE standard profiles for each building category. Then, the occupancy profiles were clustered for each building category, using K-means clustering algorithm. Finally, the effect of COVID-19 pandemic on the peak points and shape of occupancy profiles was investigated. The results showed a significant difference between the data-driven and ASHRAE standard profiles. Additionally, a considerable variation in the shape and peak hours of the generated occupancy profile clusters was detected for some building categories. These results can be used to improve the accuracy of the urban-scale simulation models. Furthermore, they can provide a more precise evaluation of the occupant's schedules and consequently the urban scale energy consumption before field implementation of the operational strategies.

COVID-19 screening before gastrointestinal procedures

Background: In March 2020, the World Health Organization declared coronavirus 2019 (COVID-19) a global pandemic. We aimed to assess the ability of COVID-19 screening to detect preprocedural infection at the gastrointestinal units. One hundred and three patients indicated for gastrointestinal tract interventional procedures were included. All patients surveyed for COVID-19-related symptoms and COVID-19 rapid IgM/IgG antibodies. Symptomatic and COVID-19 antibody-positive patients further tested for COVID-19 reverse transcriptase by polymerase chain reaction (RT-PCR). All patients contacted, 14 days after the procedure and asked about the possible development of COVID-19. All health care workers (HCWs) (n=18) were screened weekly for COVID-19-related symptoms. Results: The mean age was 46.11 ± 17.16 years of them 58.25% were males. 2.9% patients had COVID-19-related symptoms and 97.1% were asymptomatic. All symptomatic patients tested positive for COVID-19 IgM antibody and RT-PCR. Among asymptomatic patients 23% had positive COVID-19 antibodies, of them 56.5%patients had positive RT-PCR. One HCW developed COVID-19 during the study. None of the included patients developed new onset of COVID-19 infection, two weeks after the procedure. Conclusion: COVID-19 antibody test may be a reasonable preprocedural screening method for low-income countries and COVID-19 RT-PCR screening for symptomatic patients and those with positive COVID-19 antibody test. [ FROM AUTHOR] Copyright of Egyptian Liver Journal is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The Covid-19 Pandemic and the Fate of Globalization Between Fragmentation and Confrontation

This paper aims to review the repercussions of the Covid-19 pandamic on the expected dynamics and fate of globalization and the pattern of the global economic system. The research tried to distinguish between three possibilities for the fate of the global system and globalization. On the one hand, it reviews the research into the possibility of returning the situation to its first course before the crisis, even if some sporadic changes have occurred. On the other hand, the research shows the possibility of pushing the lessons learned by officials and the amendments recommended by experts towards a process of reviewing the features of globalization that we have witnessed since the 1990s. Then research reviews the third scenario, where the differences and conflicts that have escalated between the great powers may begin to exacerbate, leading to an increase in polarization, hostility and confrontation, and an end to globalization.

Decline in mild stroke presentations and intravenous thrombolysis during the COVID-19 pandemic: The Society of Vascular and Interventional Neurology Multicenter Collaboration.

BACKGROUND: To evaluate overall ischemic stroke volumes and rates, specific subtypes, and clinical presentation during the COVID-19 pandemic in a multicenter observational study from eight states across US. METHODS: We compared all ischemic strokes admitted between January 2019 and May 2020, grouped as; March-May 2020 (COVID-19 period) and March-May 2019 (seasonal pre-COVID-19 period). Primary outcome was stroke severity at admission measured by NIHSS stratified as mild (0-7), moderate [8-14], and severe (>14). Secondary outcomes were volume of large vessel occlusions (LVOs), stroke etiology, IV-tPA rates, and discharge disposition. RESULTS: Of the 7969 patients diagnosed with acute ischemic stroke during the study period, 933 (12 %) presented in the COVID-19 period while 1319 (17 %) presented in the seasonal pre-COVID-19 period. Significant decline was observed in the mean weekly volumes of newly diagnosed ischemic strokes (98 ± 3 vs 50 ± 20,p = 0.003), LVOs (16.5 ± 3.8 vs 8.3 ± 5.9,p = 0.008), and IV-tPA (10.9 ± 3.4 vs 5.3 ± 2.9,p = 0.0047), whereas the mean weekly proportion of LVOs (18 % ±5 vs 16 % ±7,p = 0.24) and IV-tPA (10.4 % ±4.5 vs. 9.9 % ±2.4,p = 0.66) remained the same, when compared to the seasonal pre-COVID-19 period. Additionally, an increased proportion of patients presented with a severe disease (NIHSS > 14) during the COVID-19 period (29.7 % vs 24.5 %,p < 0.025). The odds of being discharged to home were 26 % greater in the COVID-19 period when compared to seasonal pre-COVID-19 period (OR:1.26, 95 % CI:1.07-1.49,p = 0.016). CONCLUSIONS: During COVID-19 period there was a decrease in volume of newly diagnosed ischemic stroke cases and IV-tPA administration. Patients admitted to the hospital had severe neurological clinical presentation and were more likely to discharge home.

Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry.

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is associated with a small but clinically significant risk of stroke, the cause of which is frequently cryptogenic. In a large multinational cohort of consecutive COVID-19 patients with stroke, we evaluated clinical predictors of cryptogenic stroke, short-term functional outcomes and in-hospital mortality among patients according to stroke etiology. METHODS: We explored clinical characteristics and short-term outcomes of consecutively evaluated patients 18 years of age or older with acute ischemic stroke (AIS) and laboratory-confirmed COVID-19 from 31 hospitals in 4 countries (3/1/20-6/16/20). RESULTS: Of the 14.483 laboratory-confirmed patients with COVID-19, 156 (1.1%) were diagnosed with AIS. Sixty-one (39.4%) were female, 84 (67.2%) white, and 88 (61.5%) were between 60 and 79 years of age. The most frequently reported etiology of AIS was cryptogenic (55/129, 42.6%), which was associated with significantly higher white blood cell count, c-reactive protein, and D-dimer levels than non-cryptogenic AIS patients (p

COVID-19 patient with coronary thrombosis supported with ECMO and Impella 5.0 ventricular assist device: a case report.

BACKGROUND: COVID-19 can present with cardiovascular complications. CASE SUMMARY: We present a case report of a 43-year-old previously fit patient who suffered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with thrombosis of the coronary arteries causing acute myocardial infarction. These were treated with coronary stenting during which the patient suffered cardiac arrest. He was supported with automated chest compressions followed by peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO). No immediate recovery of the myocardial function was observed and, after insufficient venting of the left ventricle was diagnosed, an Impella 5 pump was implanted. The cardiovascular function recovered sufficiently and ECMO was explanted and inotropic infusions discontinued. Due to SARS-CoV-2 pulmonary infection, hypoxia became resistant to conventional mechanical ventilation and the patient was nursed prone overnight. After initial recovery of respiratory function, the patient received a tracheostomy and was allowed to wake up. Following a short period of agitation his neurological function recovered completely. During the third week of recovery, progressive multisystem dysfunction, possibly related to COVID-19, developed into multiorgan failure, and the patient died. DISCUSSION: We believe that this is the first case report of coronary thrombosis related to COVID-19. Despite the negative outcome in this patient, we suggest that complex patients may in the future benefit from advanced cardiovascular support, and may even be nursed safely in the prone position with Impella devices.

Global impact of COVID-19 on education systems: the emergency remote teaching at Sultan Qaboos University: JET

In response to the lockdown of Sultan Qaboos University and closure of all schools in Oman, the college of education activated an E-learning ‘Emergency Remote Teaching’ Plan for the Spring semester, and the student teacher practicum programme. The primary purpose of the intended paper is to highlight the impact of COVID-19 pandemic on the Sultanate of Oman in general, and the education system in particular. The paper will also provide an analytic description of the college experience and lessons learnt from the impact of the pandemic on the changing teaching and learning landscape, and the diffusion and adoption of e-learning in teacher education.

Mortality in COVID-19 disease patients: Correlating the association of major histocompatibility complex (MHC) with severe acute respiratory syndrome 2 (SARS-CoV-2) variants.

Genetic factors such as the HLA type of patients may play a role in regard to disease severity and clinical outcome of patients with COVID-19. Taking the data deposited in the GISAID database, we made predictions using the IEDB analysis resource (TepiTool) to gauge how variants in the SARS-CoV-2 genome may change peptide binding to the most frequent MHC-class I and -II alleles in Africa, Asia and Europe. We caracterized how a single mutation in the wildtype sequence of of SARS-CoV-2 could influence the peptide binding of SARS-CoV-2 variants to MHC class II, but not to MHC class I alleles. Assuming the ORF8 (L84S) mutation is biologically significant, selective pressure from MHC class II alleles may select for viral varients and subsequently shape the quality and quantity of cellular immune responses aginast SARS-CoV-2. MHC 4-digit typing along with viral sequence analysis should be considered in studies examining clinical outcomes in patients with COVID-19.