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Objectives: The COVID-19 pandemic has led to significant morbidity and mortality in lung transplant recipients (LTR). Respiratory viral infections may be associated with de-novo HLA donor-specific antibody (DSA) production and impact lung transplant outcome. Since one of the immunomodulation strategies post-SARS-CoV-2 infection in LTR include decreasing or holding anti-metabolites, concerns have been raised for higher incidence of de-novo DSA production in LTR. Method(s): We performed a retrospective chart review of 80 consecutive LTR diagnosed with COVID-19 to investigate this concern. COVID-19 disease severity was divided into 3 groups: mild, moderate, and severe. Mild disease was defined as patients with COVID-19 diagnosis who were stable enough to be treated as out-patients. Moderate disease was defined as patients who required admission to the hospital and were on less than 10 liters of oxygen at rest. Severe disease was identified as patients who required hospitalization and were on more than 10 liters of oxygen with or without mechanical ventilation or extra corporal membrane oxygenation (ECMO). Groups were compared using the Kruskal-Wallis test. Result(s): A total of 23, 47, and 10 LTR were diagnosed with mild, moderate, and severe COVID-19 respectively. De-novo HLA DSAwere detected in 0/23 (0%), 3/47 (6.3%), and 4/10 (40%) LTR with mild, moderate, and severe COVID-19 respectively (p = 0.0007) within 6 months post-COVID-19 diagnosis. Conclusion(s): Severe COVID-19 may be associated with increased risk of de novo HLA DSA production resulting in allograft dysfunction.Copyright © 2023 Elsevier Inc.
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Objectives: To present an unusual complication related to prolonged ECMO support in a patient with COVID19 induced acute respiratory syndrome (ARDS). Method(s): Clinical chart review of the care process after obtaining the informed consent from the patient. Result(s): A 48-year-old female with COVID-19 infection during second wave of pandemic in August 2021 progressed to severe ARDS. She was put on VV-ECMO support after failing conventional therapy for refractory hypoxemia. Her cannulation configuration included a 25 F venous drainage cannula in the right femoral vein and a 21 F venous return cannula in the right Internal Jugular (IJ) vein. Cannulations were performed using the ;Seldinger technique;under USG guidance, and no difficulties or complications were reported. Her hospital course was notable for delirium, and intermittent bleeding from the cannula sites. After 80 days of support, she showed adequate respiratory improvement which allowed ECMO decannulation. She continued to show improvement, and was eventually discharged after 102 days of total hospital stay. During her 6 weeks follow-up clinic visit a palpable thrill was noted at the jugular ECMO cannula site. A CT angiogram of the neck demonstrated a large venous varix connecting the right IJ and the left common carotid artery with filling from the left common carotid artery. ECMO cannulation site complications such as aneurysm, clots, infections and stenosis are well known. What was unusual in this case is the nature of the aneurysm given that there were no arterial procedures performed on the left side of the neck. She was managed by an ;Amplatzer plug;to the carotid artery at the level of the connection to the varix without any complications. Conclusion(s): Longer duration of ECMO support needs careful follow-up for timely recognition and management of vascular complications. (Figure Presented).
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Objectives: More than 200 patients have benefited from lung transplantation who failed to recover from COVID-19-induced acute respiratory distress (ARDS) with conventional ventilatory support and/ or extracorporeal membrane oxygenation support (ECMO) in USA. We aim to share our experience and lessons learned at our institute through this case series. Method(s): After IRB approval, we performed a retrospective chart review and identified 37 patients who received ECMO for COVID-19 induced ARDS between May 2020 through January 2022. Out of these, 12 received a formal consultation from the transplant team. We studied patient characteristics, interventions during ECMO support, and evaluation outcomes. Result(s): Most of our patients had single organ failure i.e., lung, except for two who required dialysis after ECMO initiation. Six out of the 12 patients received bilateral lung transplant. One patient received the transplant before ECMO initiation. However, the patient required two runs of ECMO after the transplant due to postop complications from suspected COVID19 reinfection and deceased on postoperative day 101. All the patients after transplant had an expedited recovery except one who required prolonged hospitalization before starting physical therapy. The median length of hospital stay for the transplant group was 148 (89- 194) days and for the non-transplant group was 114 (58-178) days. The 30-day survival rate was 100% for the transplant group. At a median follow-up of 207 (0- 456) days after discharge, 5(83.3%) patients in the transplant group and 3(50%) patients in the nontransplant group were alive. In the non-transplant group, 4 patients received ECMO support for more than 75 days and at last follow-up 2 were alive and functioning well without needing new lungs. This asks for an objective prospective study to define the timeline of irreversibility of the lung injury. Conclusion(s): Lung transplantation is a viable salvage option in patients with COVI-19 induced irreversible lung injury. However, the irreversibility of the lung injury and the timing of lung transplant remains to be determined case-by-case. (Figure Presented).
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Given that natural gas is a vital input for the U.S. utility sector, this study empirically investigates the return connectedness between the natural gas and utility stocks in the U.S. market. Using the quantile connectedness approach, we show that the nexus between natural gas and utility stocks is more pronounced at the tails compared to the central of the conditional distribution. The return connectedness indices are time-varying with a net receiver role of natural gas and driven by various macro-variables. Finally, our portfolio implication analyses with alternative tail risk measures suggest that it can be more beneficial for risk-adverse investors to allocate substantial weights into the electricity utility stocks in normal market conditions. However, during the COVID-19- induced recession, it is critical to shift more fund to the natural gas futures to reduce tail risks. © 2023 Elsevier B.V.
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Ex vivo lung perfusion (EVLP) could impact waitlist morbidity and mortality by increasing the number of transplantable allografts. Remote EVLP with a centralized lung evaluation system (CLES) at a dedicated facility has been shown to be feasible. There are no reports comparing the outcomes of remote vs local EVLP. Our institution has access to both modes of EVLP. Hereby, we describe the outcomes for remote EVLP (r-EVLP) and local EVLP (l-EVLP) at Mayo Clinic Florida. We did a retrospective analysis of the demographics, clinical characteristics, and outcomes of recipients of lungs that underwent EVLP as part of a r-EVLP clinical trial (NCT02234128) or at Lung Bioengineering Jacksonville (l-EVLP) with data obtained from the patient's electronic medical record. The r-EVLP cohort (n=10) tended to be younger than the l-RVLP cohort (n=12) (57.3 vs 61.6 years), and had a lower percentage of female recipients (20% vs 41.67% respectively). 80% of recipients were white in both cohorts. Most recipients were in the diagnosis group D (restrictive lung disease) in both cohorts. Three recipients in the l-EVLP group received a lung transplant due to complications from COVID-19. There were 5 single lung transplants (SLTx) in the r-EVLP (50%) and one in l-EVLP (8.33%). Lungs from donors after circulatory death (DCD) accounted for 40% of the allografts in the r-EVLP cohort and for 16.67% in the l-EVLP group. The median cold ischemia time (CIT) 1 was 5h:27min for the r-EVLP and 4h:35min for l-EVLP. The median CIT-2 time was 4h:16min for the r-EVLP and 3h:12min for the l-EVLP. EVLP time was similar for both groups. The median total preservation time was 13h:44min for the r-EVLP and 11h:38min for the l-EVLP cohorts. One (10%) in the r-EVLP and five (42%) in the l-EVLP groups were on ECMO at 72 hours post-transplant. Most of the remaining patients in both groups had a PGD-1 at 72 hours. All patients were alive at 30 days, and there was one death on each group at 1-year. At our center, survival at 1-year appeared similar in recipients of lungs assessed on r-EVLP or l-EVLP. Postoperative ECMO was used more frequently in the l-EVLP group. Median CIT-1 and CIT-2 were longer in the r-EVLP compared to the l-EVLP group by 52 and 64 minutes, respectively. Limitations of this study include single center retrospective experience, small sample size and lack of long-term outcomes. Future research comparing r-EVLP vs l-EVLP is warranted. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. 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.)
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This paper investigates the relationship between oil and airline stock returns under different time frequencies. First, we propose an Autoregressive moving average model with mixed frequency exogenous variable to analyse the different impacts of oil on airline stock returns on daily, weekly, and monthly basis. We consistently find a negative oil-airline stock return nexus on a daily basis, but a positive relationship on a weekly basis. While the former supports the economic-based channel, the latter is in line with the market inertia channel. Our findings help explain mixed results reported in the literature. Further, our time frequency connectedness analysis shows that the economic-based channel dominates the market inertia channel since the connectedness is more pronounced in the short-run compared to the medium- and long-run. Our block connectedness results highlight that business models of airline firms can play a significant role in affecting the connectedness, in which the low-cost airlines are more sensitive to the oil price changes. It is worth noting that there are distinguished drivers of the oil-airline stock return nexus in different time frequencies. The drivers also vary between the Global Financial Crisis and the COVID-19 pandemic. Our results are consistent under a battery of robustness checks and deliver important implications to investors, portfolio managers, and executives of airline firms. © 2022 Elsevier B.V.
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The COVID-19 vaccine rollout expects to mitigate the severe negative impacts of the pandemic on global financial markets. Our study provides supporting evidence for this expectation. We find robust evidence that vaccinations significantly reduce the cross-country stock volatility connectedness among G7 nations, suggesting that the diversification benefits of an international equity portfolio may be enhanced during the pandemic when vaccinations accelerate. We present two explanations for this result. First, the vaccine deployment improves stock market return and decreases individual stock market volatility. Second, the vaccine rollout helps a country's stock market be more resilient to exogenous shocks. We further demonstrate that a global portfolio using a tactical allocation rule based on the intensity of vaccinations can outperform a buy-and-hold portfolio in terms of risk-adjusted returns.
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Soap is an indispensable product in households, schools, offices, and hospitals in the prevention of diseases such as Covid-19 and respiratory diseases. Vietnam is a country with plentiful coconuts, and the mass production of soap products from coconut oil is feasible and highly competitive. Therefore, science, technology, engineering, and mathematics (STEM) teaching on the topic of making soap from coconut oil is practically meaningful. As a result, not only are students educated on the importance of soap but also develop their STEM knowledge. They also become engaged in their learning and try hard to perfect their products in the fastest and best way possible. Among the teaching methods of making soap from coconut oil, the 5E (engagement, exploration, explanation, elaboration, and evaluation) cycle model is the most appropriate. This teaching model helps students thoroughly explore the knowledge and to work harmoniously in groups. The study aimed to investigate how 9th Grade students at Vo Van Tan Secondary School, Ho Chi Minh City made soap from coconut oil. These students were members of 9A2 and 9A7. After learning how to make soap from coconut oil, students can make similar products, such as dishwashing detergent, from fruit or vegetable peels. This model thus helps students to be creative in STEM disciplines through problem analysis and exploration. We found that the students were very interested in making natural products such as soap and, in addition to STEM and 5E learning, they addressed an important real-world challenge with their own safe and simple handmade soap for hand-washing, disinfecting, and pandemic prevention. © 2023 International Conference on Multidisciplinary Research. All rights reserved.
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Background. Studies have consistently shown a high proportion of antimicrobial usage in hospitalized COVID-19 patients despite low prevalence of bacterial coinfection. Improving antibiotic utilization is one of the main goals of antimicrobial stewardship program (ASP). This study aimed to determine the impact of prospective audit and feedback intervention (PAF) performed by ASP pharmacists on antibiotic utilization in hospitalized COVID-19 patients. Methods. A retrospective chart review was conducted at a 90-bed Veteran Affairs hospital. This study included patients who were admitted to the hospital due to laboratory confirmed COVID-19 infection from November 1, 2020 to January 31, 2021. The primary outcome of this study was to evaluate the impact of ASP PAF on avoiding the unnecessary use of antibiotics in hospitalized patients with acute COVID-19. The secondary outcomes included the prevalence of bacterial co-infection in hospitalized COVID-19 patients and the clinical outcomes. Results. A total of 199 patients were included in this study. Sixty-one patients (30.7%) had antibiotics started empirically upon hospital admission. Fifty (82%) out of 61 patients had antibiotics discontinued due to the lack of indication for antibiotics during their hospital admission, with 47 (94%) was done by ASP team versus 3 of them (6%) was done by Internal Medicine. Fifty-eight of these patients were followed by ASP team, with 28 patients (48.3%) met SIRS criteria upon admission and 25 (43.1%) with elevated procalcitonin level. The overall readmission rate was 5.8%, with readmission rate of the intervention group to be 6.4% and the non-intervention group to be 5.6% (p = 0.29). The overall mortality rate was 13.1% in hospitalized COVID-19 patients, with 19% reported in the intervention group and 10.1% in the non-intervention group (p = 0.09). Overall, only 5 patients (2.5%) had laboratoryconfirmed bacterial co-infection upon admission. Sixteen patients (8%) were found to have microbiologically confirmed nosocomial infection. Conclusion. Thefindings suggested that ASP PAF safely and effectively avoided the unnecessary use of antibiotics in hospitalized patients with acute COVID-19 infection. In addition, low prevalence of microbiologically confirmed bacterial co-infection was observed.
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The emergence of variants of Covid-19, the persistence of lockdowns in many countries, and the necessity to maintain sustainable education have resulted in a shift from the traditional classroom to virtual space. As such, there is a strong need to leverage technological advances while mitigating the challenges faced by primary teachers. Through the incorporation of eight elements, the authors sought to better understand factors that influence teacher readiness to deliver sex education in primary schools. Structural Equation Modeling was employed to assess the proposed conceptual model. The online survey was designed and distributed by Google Forms. Based on the results from 383 individuals, the findings revealed that facilitating conditions, educational policy, and parental involvement all had a relationship with teacher readiness. Digital content positively influenced performance expectancy and effort expectancy. Sexual knowledge had a statistically significant and positive influence on effort expectancy. Finally, openness had a statistically significant and positive influence on performance expectancy. The significant exceptions were that effort expectancy was not found to predict teacher readiness, and performance expectancy was not found to influence teacher readiness. The reasons for these non-significant correlations were briefly discussed and more studies on this topic are called to investigate these unexpected outcomes in more detail. The level of readiness, as well as theoretical and practical implications for scholars and practitioners, were discussed. ©Authors
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The early stages of the COVID-19 pandemic intensified the role of healthcare workers in hospitals. This study examines how healthcare workers reflected on their in-hospital experiences in the early stages of the pandemic in North America. Audio diary entries from The Nocturnist podcast recorded from March – June 2020 were analyzed using epistemic network analysis (ENA) and heat map models. Overall, there was a shift from responding to immediate needs in March 2020 (such as Anger with Policies and Fear with Resource Availability) to deeper reflections in May-June 2020, more focused on Psychosocial Support and Purpose and more complex emotions involving Sadness and Compassion. Uncertainty was a prominent emotion throughout the May – June 2020 period. These results help document the complexity of reflections early in the pandemic, while informing ways to better support health care workers in future crisis. © 2022, Springer Nature Switzerland AG.
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INTRODUCTION: The severity of clinical presentation of COVID-19 myocarditis ranges from incidental identification of depressed left ventricular ejection fraction, cardiogenic shock requiring percutaneous mechanical circulatory support, to fatal fulminant myocarditis. In previously reported cases, surviving patients experienced improvement in left ventricular ejection fraction with the use of glucocorticoids and antivirals (+/- intravenous immunoglobulin/ convalescent plasma). We report the first case of COVID-myocarditis in a surviving patient where a persistently depressed left ventricular ejection fraction (less than 35 percent) despite optimal therapy prompted implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death. CASE PRESENTATION: A previously healthy 67-year-old man, diagnosed with mild COVID-19 pneumonia five days prior, presented to the emergency department with suspected STEMI (hypoxia, substernal chest pain and known left bundle branch block). Left heart catheterization showed patent coronary arteries. Transthoracic echocardiogram showed severely depressed ejection fraction (15-20 percent). CT showed bilateral infiltrates: treatment was started with dexamethasone, remdesivir and convalescent plasma for acute hypoxic respiratory failure due to COVID-19 pneumonia. After a four-day hospitalization, guideline-directed medical therapy at maximum tolerated doses over three months did not improve left ventricular ejection fraction. CONCLUSION: This is the index case of COVID-19 myocarditis-mediated heart failure with reduced ejection fraction requiring ICD for primary prevention of sudden cardiac death.
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OBJECTIVE: A new pandemic coronavirus causing coronavirus disease-2019 (COVID-19), initially called 2019-nCoV and successively named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The COVID-19 refers to the disease while the SARS-CoV-2 refers to the virus and is characterized by a rapid contagious capacity able to spread worldwide in a very short time. The rise in the number of infected patients and deaths is of great concern especially because symptoms are vague and similar to other forms of flu infection and corona syndrome infections characterized by fever, fatigue, dry cough, and dyspnea. According to the latest guidelines published by the World Health Organization (WHO), the diagnosis of COVID-19 must be confirmed by quantitative reverse transcription polymerase chain reaction (rRT-PCR) or gene sequencing of specimen obtained from throat, sputum and blood samples. However, the limitations due to logistics, as well as low sensitivity and specificity diagnostic tools currently available have been reported as the main cause of high incidence of either false-negative or positive results. PATIENTS AND METHODS: The purpose of the present translational research protocol is to discuss and present the original findings from our research team on new diagnostic technique to detect four Coronaviridae family members (SARS-CoV-2, SARS-CoV, HCoV and MERS-CoV), highlighting the methodology, the procedure and the possible advantages. Moreover, the authors review the current epidemiology, precautions and safety measures for health personnel to manage patients with known or suspected COVID-19 infection. RESULTS: Implementation of an effective and rapid plan of diagnosing, screening and checking is a key factor to reduce and prevent further transmission. This procedure based on rRT-PCR could be of great help to decisively validate the results obtained from more conventional diagnostic procedures such as chest computed tomography (CT) imaging and chest ultrasound. CONCLUSIONS: This translational diagnostic tool will assist emergency and primary care clinicians, as well as out-of-hospital providers, in effectively managing people with suspected or confirmed SARS-CoV-2.