Assessment of Construction Risk Management Maturity Using Hybrid Fuzzy Analytical Hierarchy Process and Fuzzy Synthetic Approach: Iraq as Case Study

Knowing and developing the construction organizations' maturity level in risk management is critical to ensure they achieve their strategic objectives. This paper aims to design a new construction organizations' risk-management maturity model (C.ORM3) using new hybrid techniques and a distinct validation strategy based on global and local experience, to assess risk management maturity level in developing countries. A multi-steps methodology was adopted in this research. The study adopted an excessive systematic literature reviews of 22 previous articles on RM maturity and four standards and guidelines for eliciting model components. These components include five attributes with 26 capabilities;24 capabilities identified from literature review and 2 from experts. These capabilities are evaluated against five levels: immature, ad-hoc, standard, managed, and optimized. The authors adopted a new strategy for validating the model by three groups of global and local experts and verifying the proposed model in a realistic-world case study. This study is the first to use a hybrid method based on the Fuzzy Analytic Hierarchy Process (FAHP) and Fuzzy Synthetic Evaluation (FSE) techniques in evaluating RM maturity (RMM). Iraqi construction organizations validate the practicality of the model. The results showed that the overall RMM level of the Iraqi construction sector is 1.52, between immature and ad-hoc. The model has been converted into a computer template for ease of use by organizations. This study concluded that the suggested C.ORM3 helpful for construction organisations to evaluate their current state of RM and plan for future development © 2023, Mathematical Modelling of Engineering Problems.All Rights Reserved.

Epidemiology of musculoskeletal injuries and injury mechanism in Iranian elite veteran athletes

BACKGROUND: In recent years, the study of the epidemiology of injuries of athletes during their sports career has been accelerated by researchers and responsible national and international institutions. Repetitive and continuous patterns and types of injuries with mechanisms of micro trauma and overuse and macro trauma and impact are some of the most important reasons that can leave an unpleasant legacy from sports during retirement for veteran athletes. METHODS: A researcher-made questionnaire was used to record the musculoskeletal injuries of retired elite athletes. Overall, 276 athletes in three sports — volleyball (N.=86), soccer (N.=107) and basketball (N.=80) — contributed in this study. In this questionnaire, three important and severe injuries during sports of veterans were selected based on priority by the athlete himself. Injury registration was done according to the injury location, damaged structure and mechanism of injury. RESULTS: Kruskal-Wallis Test to check the amount of injury per 1000 hours of training among the studied groups showed not significant difference between groups (P≥0.202). The most common injury location in all three groups was the foot and leg, this rate in volleyball athletes was 40.4%, in soccer athletes was 45.8%, and in basketball athletes was 35%. The results showed a significant difference in the most common injury location between the three studied groups (P≤0.008). Ligament injuries were the most common type of injury in athletes. The results showed a significant difference between the 3 studied groups (P≤0.008). Results showed a significant difference in the mechanism of injury between the three studied groups (P=0.008). CONCLUSIONS: Presenting the profile of musculoskeletal injuries of veteran athletes with the aim of explaining preventive strategies to reduce and eliminate injuries needs more studies. Especially since the present study was conducted during the corona pandemic period. The necessity of systematic screening and completing the rehabilitation process of athletes at the right time will reduce the risk of permanent and chronic injuries and will increase his physical, mental and social health during retirement. COPYRIGHT © 2023 EDIZIONI MINERVA MEDICA.

Acute Kidney Injury after Covid 19 Infection in Chronic Kidney Disease Patients of Bangladesh: Retrospective Study

Introduction: COVID 19 pandemic has caused unprecedented devastation worldwide. Spectrum of Covid 19 illness is wide and variable. Risk of mortality is increased in chronic kidney disease patients, during coronavirus disease. CKD is an independent risk factor for poor outcome. AKI is also common in COVID-19 patients who are hospitalized. This study was undertaken to see the outcome of Covid-19 infection in CKD patients. Method(s): This retrospective observational study was carried out in the Kidney Foundation Hospital and Research Institute, Bangladesh from January 2021 to July 2022. One hundred CKD patients who were on regular follow up in the outpatient department and developed COVID-19 as confirmed by reverse transcription polymerase chain reaction (RT-PCR) test underwent chart review after they consented to be part of the study. Their clinical parameters, treatment regiments and laboratory investigations were noted in a data collection sheet. Data was analyzed by Statistical Analysis Software. Result(s): The mean age of the patients was 55.2 years. Of them 43% were female. Diabetes mellitus was the most common comorbidity, seen in 65% of the patients. 24% were CKD stage 4 or 5 prior to the onset of COVID-19, rest were of earlier stage. Hospitalization was required in 65.3% patients;41.1% required oxygen, steroid given in 19.8% patients,8.4% required ICU transfer. 7 patients died, all of respiratory failure. Treatment with antiviral, biologics like Tocilizumab and plasma exchange was not commonly done. AKI developed in 28% of the patients during the course of the illness. Males were more prone to develop AKI (p = 0.23). People with longer duration of symptoms had higher incidence of AKI (p < 0.0001). AKI incidence did not vary according to baseline eGFR (p = 0.16). Among those who developed AKI, 17.9% required temporary dialysis and 7.1% went on to develop end stage kidney disease. Interim outcomes such as hospitalization, oxygen requirement, ICU transfer and death did not vary according to development of AKI. Conclusion(s): People with chronic kidney disease and other comorbid conditions are at higher risk for more serious COVID-19 illness. In our study it has been shown that a significant proportion of CKD patients developed AKI after COVID 19 infection of which a number of patients develop end stage kidney disease and required renal replacement therapy. No conflict of interestCopyright © 2023

An Assessment of the Knowledge, Perception, and Willingness to Use Telepharmacy Services Among the General Public in the Kingdom of Saudi Arabia.

Background and objective At the height of the coronavirus disease 2019 (COVID-19) pandemic, numerous strategies were introduced by the authorities to contain the spread of the virus, which significantly affected people's lives and impeded their mobility. As the general public was unable to leave their dwellings, many digitalized pharmacist-led services were initiated to meet the public's needs for pharmaceutical care. The aim of this study was to ascertain the knowledge, perception, and willingness to utilize telepharmacy services and the determinants associated with these services among the general public in the Kingdom of Saudi Arabia (KSA). Methodology A cross-sectional survey involving participants recruited from the Saudi general public was conducted by using a validated questionnaire. We collected information regarding participants' demographics, as well as knowledge, perception, and willingness toward telepharmacy. The results were analyzed via descriptive statistics. The Mann-Whitney U Test was applied to assess the associations between knowledge, perception, willingness, and demographic variables regarding the utilization of telepharmacy services. Results A total of 273 Saudi citizens participated in the study; 71% (n=193) of them were aware of telepharmacy services. Many respondents showed a positive perception towards telepharmacy services and 83% (n=227) of the total participants showed their willingness to use telepharmacy services in the future. A significant association was identified between education, gender, and the knowledge of the participants regarding telepharmacy services. The demographic characteristics such as age, gender, and education, were not associated with the participants' perception regarding telepharmacy services. However, gender was significantly associated with the willingness to use telepharmacy services in the future. Conclusions Many participants had a fair knowledge and positive perception of telepharmacy services. More than two-thirds of the participants showed their willingness to utilize telepharmacy services in the future. However, further measures should be implemented involving strategies to increase the knowledge about telepharmacy by targeting the less educated among the Saudi population and those with limited access to technology.

Automatic Monitoring and Control System for Different Water Levels in Interconnected Multiple Twin Tanks with Dry Run Protection Using Microprocessor Orange Pi

The proposed system effectively controlled and monitored the water level of the dual tank system with efficient dry-run protection to prevent the motor from burning out and avoid wastage of electricity in case of no water. An Orange Pi was used to test its working and ability to control and monitor a real-Time system as no prior research is done on a dual water tank control system using Orangepi SBC. Due to COVID-19, millions of people's financial condition has worsened, which is why an initiative is taken to use the cheap board for making prototypes and moving towards PLCs after the desired outcomes. This research aims to provide a system at cheaper rates to handle large water tanks. This system is very efficient and valuable in dams, tanks, purifiers, and water containers. The proposed system also has dry run protection to avoid wastage of electricity in case of no water. The research is an advancement in automation in real-Time virtual monitoring and different water level control systems. This research makes life more comfortable because real-Time monitoring with a water control system reduces water wastage, leading to the complete modern solution of the problems. © 2022 IEEE.

Detecting Primary Hyperparathyroidism with Image Discordant Findings

Introduction: Primary hyperparathyroidism is a common cause of hypercalcemia, with 80-85% of cases being due to a single gland adenoma. The sensitivity of imaging modalities varies, with ultrasound at 76%, sestamibi scintigraphy at 63%, and 4-dimensional computed tomography (CT) scan at 89%. Clinical Case: A 48-year-old woman with a remote history of iron deficiency anemia presented with 2 weeks of dry cough. She reported associated body aches and fatigue, but review of systems was otherwise negative. Family history was notable for a maternal grandmother with an unknown thyroid disease. On presentation, her blood pressure was 115/74 mm Hg, temperature was 37.1 Celsius, pulse was 64 beats per minute, with a respiratory rate of 16 breaths per minute, and oxygen saturation of 100 percent on room air. On exam, there was no thyromegaly, and there were decreased breath sounds. Initial labs were notable for calcium of 11.4 mg/dL (reference range: 8.4-10.2 mg/dL). Her rapid Covid antigen test was negative. A chest x-ray showed bilateral opacifications, suggestive of community acquired pneumonia. She was started on isotonic intravenous (IV) fluids, as well as ceftriaxone and azithromycin. The calcium remained persistently elevated and peaked at 12.6 mg/dL. Creatinine levels remained between 0.7-1. 0 mg/dL (reference range: 0.5-1. 0 mg/dL). Phosphorus level was 3.6 mg/dL (reference range: 2.5-4.5 mg/dL). Parathyroid hormone level was 174.6 pg/mL (reference range: 37.87-83.87 pg/mL). 24-hour urinary calcium was 660 mg (reference range: 0-320 mg). Ultrasound of the neck showed multiple mildly suspicious thyroid nodules, but no notable findings for the parathyroid gland. Subsequent nuclear medicine sestamibi scan revealed no discrete parathyroid adenomas. The 4-dimensional CT scan did not mention parathyroid pathology on the report. However upon review by a head and neck surgeon, a suspicious lesion was identified adjacent to the right thyroid lobe. Intervention was indicated given her age (<50), serum calcium > 1 mg/dL above the upper limit of normal, and 24-hour urinary calcium > 400 mg. The patient underwent a right neck exploration, and a right superior parathyroidectomy was performed. Conclusion: The patient met the criteria for primary hyperparathyroidism based on her normal kidney function, elevated serum calcium, and elevated parathyroid hormone. While imaging is frequently ordered, it is important to note that it does not have a role in confirming or ruling out the diagnosis of primary hyperparathyroidism. It should instead be used to localize abnormal parathyroid glands for operative planning. This case highlights the importance of surgical consultation in primary hyperparathyroidism, especially in the setting of negative or conflicting imaging results.Presentation: No date and time listed

RARE CASE OF SALMONELLA MYOCARDITIS MIMICKING ACUTE INFERIOR ST-ELEVATION MYOCARDIAL INFARCTION (STEMI)

SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute bacterial myocarditis due to Salmonella bacteremia is a rare cause of ST-segment elevation that can manifest as acute decompensated heart failure, life threatening arrhythmias, and sudden cardiac death. CASE PRESENTATION: A 62-year-old male with a past medical history of HTN, HLD, DM2, and TIA presented with nausea, vomiting, nonbloody diarrhea, and right upper quadrant pain for five days. He quickly decompensated in the ED, becoming increasingly hypotensive, tachycardic, and lethargic concerning for sepsis. Broad spectrum antibiotics and IV fluids were initiated. Chest X-ray revealed multifocal pneumonia. Labs revealed a metabolic acidosis consistent with acute hypoxic respiratory failure warranting emergent intubation. CTA chest showed multifocal pneumonia and Covid-19 antigen testing was negative. Troponin I was elevated at.211 ng/mL (n <.08) and ECG showed new onset atrial fibrillation, for which cardiology was consulted. On admission to the ICU, repeat labs showed acute renal failure and he was anuric warranting hemodialysis initiation. Despite medical optimization, his Troponin I trended up to 1.458 ng/mL, and repeat ECG showed 2:1 atrial flutter with new ST-elevations in leads II, III, and aVF, consistent with an acute inferior STEMI. Labs did not show hyperkalemia nor hypercalcemia. Transthoracic echocardiography revealed normal systolic and diastolic function, with a left ventricle ejection fraction of 65-70%. A heparin infusion was started and he was taken for a cardiac catheterization which showed no evidence of occlusive CAD. His blood cultures revealed Salmonella enteritidis for which he was switched to ciprofloxacin. Abdominal ultrasound appeared benign, but CT abdomen with contrast showed findings of cholecystitis, which was confirmed on HIDA scan. Gastroenterology and Surgery were consulted who recommended a cholecystostomy tube placement, with a delayed laparoscopic cholecystectomy (LC) when stable. Repeat ECG following the LC showed complete resolution of the previous STEMI. He was discharged to a rehabilitation facility where he made a full recovery. DISCUSSION: Acute bacterial myocarditis can mimic acute coronary syndromes and warrants a high index of suspicion in the setting of Salmonella bacteremia. Our patient presented with signs of acute cholecystitis and an ECG concerning for acute STEMI. Bacterial etiologies of myocarditis are less reported in the literature compared to viral infections, and are seen more often in patients with severe sepsis such as our patients. Common findings associated with Salmonella myocarditis include ST-segment elevation on ECG and elevated troponin levels. Serial ECG findings can distinguish myocarditis from acute myocardial infarction. Early diagnosis is essential to improve outcomes and reduce mortality. CONCLUSIONS: Acute bacterial myocarditis can mimic acute coronary syndromes. Reference #1: Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT. Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. World J Cardiol. 2015;7(12):931-937. doi:10.4330/wjc.v7.i12.931 Reference #2: Sundbom P, Suutari AM, Abdulhadi K, Broda W, Csegedi M. Salmonella enteritidis causing myocarditis in a previously healthy 22-year-old male. Oxf Med Case Reports. 2018;2018(12):omy106. Published 2018 Nov 26. doi:10.1093/omcr/omy106 Reference #3: Majid A, Bin Waqar SH, Rehan A, Kumar S. From Gut to Heart: Havoc in a Young Patient with Typhoid-associated Cardiomyopathy. Cureus. 2019;11(7):e5049. Published 2019 Jul 1. doi:10.7759/cureus.5049 DISCLOSURES: No relevant relationships by Mohamed Faher Almahmoud No relevant relationships by JONATHAN BROWN No relevant relationships by Hytham Rashid No relevant relationships by Syed Raza

CoughNet-V2: A Scalable Multimodal DNN Framework for Point-of-Care Edge Devices to Detect Symptomatic COVID-19 Cough

With the emergence of COVID-19 pandemic, new attention has been given to different acoustic bio-markers of the respiratory disorders. Deep Neural Network (DNN) has become very popular with the audio classification task due to its impressive performance for speech detection, audio event classification etc. This paper presents CoughNet-V2 - a scalable multimodal DNN framework to detect symptomatic COVID-19 cough. The framework was designed to be implemented on point-of-care edge devices to help the doctors at pre-screening stage for COVID-19 detection. A crowd-sourced multimodal data resource which contains subjects' cough audio along with other relevant medical information was used to design the CoughNet-V2 framework. CoughNet-V2 shows multimodal integration of cough audio along with medical records improves the classification performance than that of any unimodal frameworks. Proposed CoughNet-V2 achieved an area-under-curve (AUC) of 88.9% for the binary classification task of symptomatic COVID-19 cough detection. Finally, measurement of the deployment attributes of the CoughNet-V2 model onto processing components of an NVIDIA TX2 development board is presented as a proposition to bring the healthcare system to consumers' fingertips. Clinical relevance - CoughNet-V2 will help medical practitioners to asses whether the patients need intensive medical help without physically interacting with them. © 2022 IEEE.

Analyzing the Impact of the COVID-19 Pandemic Risks on Construction Projects in Developing Countries: Case of Iraq

The construction industry has been exposed to many risks emerging from the COVID-19 pandemic. This can be seen from project schedule delays, cost overrun, legal claims to supply chain distribution, and workforce restrictions. To this end, the purpose of this study is to identify and analyze the risks emerging from the COVID-19 pandemic for the construction industry in developing countries by considering the case of the Iraqi construction industry. To achieve this, a mixed-methods approach was adopted as follows: (1) focus group session with eight construction experts to identify the risks emerging from the COVID-19 pandemic;(2) development of Analytic Hierarchy Process (AHP) method based on probability and impact risk matrix by considering two additional dimensions, namely Estimated Recovery Time Level (ERTL), and Expected Cost Level (ECL);and (3) survey data collection from 41 Iraqi construction experts to quantify the identified risks. Ultimately, a total of 29 risks were identified and categorized into four construction themes, namely contractual/legal implications, construction financial market, supply chain operations, and health and safety of the construction workforce. The findings show that the most significant COVID-19 pandemic risks are claims arising under a construction contract, virus spreading due to poor hygiene and lack of sanitizing stations, and contractor bankruptcy. This research offers a better understanding of the critical risks emerging from COVID-19, which can be used as a reference for researchers and industry stakeholders in planning to address the impact of the COVID-19 pandemic risks during the life cycle of a construction project.

Conducting a nationwide brain tumor epidemiology study in an lmic: A multi-institutional experience

Very little research has been conducted on brain tumor epidemiology in Pakistan and a few studies that do exist provide regional data only. Conducting population based epidemiological studies in low-and-middle income countries (LMICs) like Pakistan can be particularly challenging due to limited resources, poor clinical and research infrastructure, unreliable or incomplete hospital records and a lack of standardization across the health care system. Population-wide studies and registries play an important role in cancer epidemiology and can help identify the current magnitude of cancer burden and its likely future evolution, allowing for better planning of prevention, diagnosis, management, and rehabilitation. This paper describes our experience in designing and conducting Pakistan Brain Tumor Epidemiology Study (PBTES), a first-ever nationwide study carried out to assess the distribution of brain tumors in Pakistan. In addition to the aforementioned obstacles, we were also faced with the global health crisis caused by the COVID-19 pandemic and had to promptly adjust our study accordingly. Other investigators conducting epidemiological studies in LMICs with similarly challenging and constricting settings could benefit from our experiences.

Hospital within the Hospital - Renaissance of Elective Surgery Amidst the Pandemic

Aim: COVID had an unprecedented effect on the NHS elective surgical care. To overcome the deficit created due to the pandemic, the concept of a 'COVID protected zone' gave birth to the 'hospital within the hospital'. This included 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen and a separated entrance. Of the fundamentals of the model were enhanced infection control and PPE guidance for staff. The aim of our study was to evaluate the recovery of elective activity brought about by this elective centre. Methods: Theatre activity data was collected weekly (7/20 to 1/21) through the business informatics system. This was used to compare the activity achieved during the recovery phase from COVID after the first and subsequent wave. Results: Pre COVID-19, 11 theatres were operating. These managed an average of 263 cases were per week. In the first week of operation of elective centre, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. During the 2nd wave the capacity was reduced to 42% as opposed to 0% during the first wave. This was only possible due to our model elective centre. Conclusion: This model elective centre has enabled elective care to return to above normal levels, with increased efficiencies. This has not only shortened patient waiting times and cleared the back-log but also delivered training to surgical trainees without compromising safety.

Potential Drug Candidates in Clinical Trials for the Treatment of Covid-19: An Updated Overview

The coronavirus (SARS-CoV-2) emerged in December 2019 in Wuhan, China and by the end of April 2020, it spread to more than 200 countries worldwide. Particularly the USA, Brazil, Spain, Italy, France, Germany, UK, Turkey, Iran, and Russia were the most affected countries till December 2020. Currently, most of the researchers are in a continuous struggle to develop a vaccine or new drugs to combat Covid-19. There are more than 30 drug candidates including Western medicines, natural products, and traditional Chinese medicines, that have shown to exhibit some efficacy against this highly infectious virus. This review encompasses the potential efficacy of some key drugs recently tested against Covid-19. With the rapid spread of Covid-19 reaching a new level every day, there is an immediate need to find safe and effective measures to diagnose, treat, mitigate, and combat the disease. Looking at the alarming dimensions that the disease is acquiring, treatment strategies among the different drug systems are being investigated. Currently, clinical management includes infection prevention, control measures, and supportive care, including supplemental oxygen and mechanical ventilation when indicated. The pharmaceutical interventions evaluated for the treatment of Covid-19 include human immunoglobulin, interferons, chloroquine, hydroxychloroquine, arbidol, remdesivir, oseltamivir, favipiravir, carrimycin, methylprednisolone, bevacizumab, thalidomide, vitamin C, pyrodfenidone, darthviravir, bromexistone, ryrexavir, lopinavir, xiyanping, and traditional Chinese medicine. But still, the researchers are struggling to discover the most effective drug for the treatment of the current pandemic of Covid-19.

ACUTE REVERSAL OF SYSTOLIC HEART FAILURE IN A CASE OF COXSACKIEVIRUS MYOCARDITIS

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Viral Myocarditis is generally a self-limiting condition. Patients usually recover from viral myocarditis within a few weeks to months. Some patients can develop hemodynamic instability and may require critical care management. We present a unique case of acute systolic heart failure secondary to Coxsackievirus myocarditis which recovered within a few days. CASE PRESENTATION: A 19-year-old male came to ER for vomiting and abdominal pain for five days. Initial vitals were Temperature of 98 F, BP of 80/47 mm Hg HR of 124/min, and oxygen saturation of 93% on room air. EKG showed sinus tachycardia without ischemic changes. Initial labs were creatinine-2.6 mg/dl, troponin-2.15 ng/ml. CT of abdomen was unremarkable. CT of chest showed bilateral pulmonary edema and pleural effusion. Lung perfusion scan showed no perfusion defect. He did not respond to intravenous(IV) fluid. Initially it required IV vasopressor support- norepinephrine, phenylephrine, and dobutamine. Echocardiogram showed ejection fraction(EF) of 20-24% with severe global hypokinesis. COVID-19 PCR was negative. The pleural fluid study revealed transudative in nature. On day 3, he was weaned off from vasopressors. Acute kidney injury also resolved. Cytomegalovirus, HIV, autoimmune panel, and respiratory virus panel were negative. Coxsackievirus antibody came back positive. It was consistent with viral myocarditis. Patient showed clinical improvement, and we decided to repeat echocardiogram before discharge. On day 6, repeat echocardiogram showed significant improvement of EF to 54%. The patient was discharged on low dose carvedilol and lisinopril. Clinic follow up showed the patient's significant clinical recovery within a few weeks. DISCUSSION: In case of severe cardiomyopathy secondary to viral myocarditis, patient generally recovers within a few weeks to months. However, in our case, the patient developed acute systolic heart failure from Coxsackievirus myocarditis recovered within a few days after aggressive hemodynamic support. Repeat echocardiogram on the same admission also showed significant improvement in ejection fraction from 24% to 54%. It is a rapid recovery as per our knowledge and published data. CONCLUSIONS: Our case highlights that viral myocarditis has the potency to recover quickly, even from severe systolic dysfunction. This case also emphasizes the importance of repeating an echocardiogram on the same admission rather than waiting for a couple of months to ensure cardiac function recovery, particularly with very low ejection fraction on presentation. REFERENCE #1: Tschöpe, C., Cooper, L., Torre-Amione, G., & Van Linthout, S. (2019). Management of Myocarditis-Related Cardiomyopathy in Adults. Circulation Research, 124(11), 1568-1583. https://doi.org/10.1161/circresaha.118.313578 REFERENCE #2: 3. Schultz J, Hilliard A, Cooper L, Rihal C. Diagnosis and Treatment of Viral Myocarditis. Mayo Clin Proc. 2009;84(11):1001-1009. doi:10.4065/84.11.1001 DISCLOSURES: No relevant relationships by Gnananandh Jayaraman, source=Web Response No relevant relationships by Ramesh Babu Kesavan, source=Web Response No relevant relationships by Tusharkumar Pansuriya, source=Web Response No relevant relationships by Hytham Rashid, source=Web Response No relevant relationships by Sivatej Sarva, source=Web Response No relevant relationships by Aswin Srinivasan, source=Web Response No relevant relationships by BRANDEN WILSON, source=Web Response

Lipid profile variations and their associations with kidney injury in patients with COVID-19

Background: COVID effects different people in different ways. Acute kidney injury and variations in lipid profile are frequent complications among patients hospitalized for Covid-19. Severely infected patients with Covid-19 have higher frequency of kidney injury and hypolipidemia, resulting in higher mortality rate. Objectives: The current study was designed to explore variations in lipid profile and estimated Glomerular Filtration Rate (eGFR) in Covid-19 patients, and to evaluate the association of eGFR with lipid parameters in Covid-19 patients (confirmed cases) and healthy controls. Methodology: This comparative cross sectional study was carried out at pathology lab of MACCA Diagnostic, Multan from Oct 2020 to Jan 2021. We enrolled 225 Covid-19 patients as test group and 225 healthy subjects (negative for Covid-19) as control group. Fasting blood samples of Covid-19 and control group were collected to test lipid profile and eGFR. Estimated GFR was calculated from the value of serum creatinine, age, gender and ethnicity of all participants by applying Modification of Diet in Renal Disease (MDRD) equation.

Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC

Background: Cancer patients experience significant distress throughout treatment and especially during transition back to normal life with greater burden on socially disadvantaged patients and those with medical comorbidities. Patient stressors can interfere with their ability to make reasoned and timely decisions about survivorship care and lead to poor quality of life and low physical and social functioning. This pilot effectiveness-implementation study examined the impact and feasibility of offering the Bright IDEAS system of Problem-Solving Skills Training (PSST) to adult cancer survivors to help them and their caregivers cope more successfully with decision making and distress. Methods: Patients with breast (21), prostate (9) or colorectal (20) cancer who completed their definitive cancer treatment within the last 6 months and had their cancer survivorship visit were recruited from two regional cancer centers and affiliated community oncology clinics. Patients with an NCCN distress level > 2 were randomly assigned to either care as usual (CAU) or 8 weekly PSST sessions provided by a trained therapist in person or remotely. Patients were invited but not required to include a supportive other (n = 17). Patient and caregiver assessments at baseline (T1), end of intervention/3 months (T2), and 3 months post intervention/6 months (T3) focused on problem-solving skills (SPSI-25), distress (HADS) and quality of life (FACT). We also collected healthcare utilization data. We compared outcome changes T1-T2 and T1-T3, by study arm, using t-tests. Multivariate regression analysis identified subgroups of patients with positive and negative responses to skills training. Results: Average age of the participants was 63 years (45 to 87) with racial and ethnic distributions representative of the local population (88% white). Two thirds were women (n = 32), one third of the patients were recruited and received therapy fully remotely due to COVID-19-related protocol changes. Patients who received PSST reported a reduction in dysfunctional problemsolving style and improvement in constructive style while problem-solving skills of CAU patients trended in the opposite direction. Patients in the PSST arm also reported significant reduction in anxiety and depression and improvement in cancer-specific quality of life (p < 0.05) that was sustained at 6 months. Patients in the PSST arm reported lower use of hospital and ED services compared to CAU patients (p = 0.07). Better improvement in outcomes was driven by lower problem-solving skills at baseline. Conclusions:Despite the logistical complexity of running a clinical trial during quarantine, patients and caregivers in the PSST arm demonstrated meaningful improvement in distress and quality of life. The evidence from this pilot study will help guide development of a future multi-site randomized clinical trial of the effect of PSST on cancer survivorship care and outcomes.

Re-envisioning Healthcare Urbanism and Architecture

Professor Hani Rashid of the University of Applied Arts Vienna directs Studio Hani_Rashid and the Deep_Futures Lab. Rashid has long been a cyber-evangelist, being one of the first architects to recognise the paradigm-shifting potential of computers in the early 1990s. His students are likewise utilising the most up-to-date computation processes and techniques to posit all manner of formal articulations housing new and audacious concepts for the future of architecture.