ABSTRACT
FASTER is an H2020 research project, within the European framework, in which Urban Search and Rescue (USAR) teams, in addition to other first responders, conduct an on-theground assessment of latest support technologies. These technologies are to be used in victim rescue response situations well as for coordination and safety procedures between disaster responders in diverse types of catastrophe scenarios. The tools have been developed by technical partners of the FASTER project committee and, with the aim of assessing the tools, two pilot exercises were conducted in collapsed buildings in Spain, simulating the impact of two earthquakes. The objective is to integrate and adapt the FASTER tools in initial interventions during the search for and rescue of victims. The focus is placed on information gathering in the disaster area, among other aspects. Simulation exercises were conducted in real locations involving collapsed buildings using drones, unmanned vehicles, canine wearables, a mobile command centre, a weather station and social network analysis, with real people acting the part of victims together with human dummy figures. Through these exercises, an assessment was carried out of the acceptability, ease of use, applicability, efficiency, and effectiveness of FASTER technology. The outbreak of the COVID-19 pandemic during the implementation of various pilot exercises was a setback that led us to introduce a USAR Camp deployment procedure involving preventive anti-COVID-19 measures, in accordance with the recommendations of official organisations such as INSARAG and the WHO. © 2023 by Nova Science Publishers, Inc. All rights reserved.
ABSTRACT
In The Laws of Fear, Cass R. Sunstein (2013) suggests that the temporal duration of policies that restrict citizens' freedoms will depend, fundamentally, on quantitative criteria. This research note tests that hypothesis. With this objective, the data from the Sociological Research Center are analyzed, from which it is extracted that when public opinion has a perception of real risk, a notable majority of the population will be in favour of tightening the restrictive measures. The results suggest that, in addition to the quantitative criteria, other factors will determine the position of citizens regarding the maintenance, or hardening, of limitations on their own freedoms.
ABSTRACT
Postmortem analysis in COVID-19 infected patients has shown diffuse alveolar damage with inflammatory infiltrate present. It has been suggested that COVID-19 can induce a cytokine release syndrome caused by a systemic inflammatory response. This pulmonary hyperinflammation would be associated with severe acute respiratory syndrome, which has been described as the main cause of COVID-19 mortality. Radiation therapy administered at low doses (LD-RT) has antiinflammatory properties such as lowering levels of proinflammatory cytokines, inhibiting endothelial-leukocyte interaction, and changing the polarization of macrophages. In addition, LD-RT was used for pneumonia in the first half of the 20th century with evidence suggesting potential efficacy. In this context, several institutions proposed trials to evaluate the safety and efficacy LDRT to treat COVID-19 pneumonia. We conducted a prospective phase I-II trial enrolling COVID-19 patients ≥ 50 years-old, with bilateral lung involvement at imaging study and oxygen requirement. Patients received 1 Gy to total lungs in a single fraction. Forty-one patients were included. Three patients died <72h after LD-RT and were excluded from the analysis. Primary outcome was radiological response assessed by severity and extension scores at days 0, +3 and +7. Lung extension score on CT improved significantly (p=0.02) on day +7, however severity score was stable or slightly decreased (p=0.1). Clinically, patients improved SatO2/ FiO2 index significantly on day +3 and +7 (p<0.01). Our results are in agreement with previous data published by Ameri et al. They analyzed 9 patients treated with 0.5 or 1 Gy and found a SatO2 improvement in 63.6% of the patients 24 hours after RT, no significant differences were found between both fractionations. Hess et al compared 10 patients treated with 1.5 Gy whole-lung LD-RT with 10 control patients blindly matched by age and comorbidity, and they concluded that patients treated with LD-RT showed a significant faster recovery to room air than controls (3 days vs 12 days respectively, p=0.05). Also, LD-RT cohort trended toward superior rates of improved radiographs (P=0.12), delirium (P <.01), rate of intubation (10% vs 40%) and median time to hospital discharge (12 days vs 20 days). At our cohort with a median follow up of 95 days, 25 (66%) patients were discharged with a similar time to that reported by Hess et al, and 13 (34%) died. Less promising results were found when LD-RT was explored in critically ill patients requiring mechanical ventilation. Papachristofilou et al, randomized 22 patients to either 1 Gy whole-lung RT or sham-RT. They hypothesized that LD-RT would increase ventilator-free days (VFDs) to 10 days. The study failed to improve VFDs compared to sham-RT. LD-RT neither improved PaO2/FiO2 or overall survival at 28 days at this severe ill cohort. Moreover, although the baseline characteristics were overall similar in both groups, there was a higher proportion of patients managed with endotracheal intubation and higher rate of comorbidities in the LD-RT group. At our cohort only 5 patients (13%) were at ICU, 3 died and 2 were discharged. Regarding toxicity, no grade 3 was found in the reported studies. However, in our cohort 9 patients (23.7%) experimented grade 3-4 lymphopenia, although 8 of them had lymphopenia before treatment. Preliminary results show that LD-RT is feasible and well-tolerated treatment, with potential clinical improvement. Prospective randomized trials are needed to define the real efficacy of LD-RT.
ABSTRACT
By carrying out an Empirical Descriptive Research, it is expected to determine the degree of satisfaction of residential users with their habitat, considering the atypical scenario of social confinement, in its strictest instance, appropriate for the collection of information. The present work is based on a comparative study of two residential typologies: the single-family home and the apartment. Through a structured electronic survey, 3,973 data are obtained referring to the habitability conditions of a sample of 137 users of apartments and single-family homes. The processed responses reveal common indicators of dissatisfaction of the respondents regarding the amplitude, dimensions, location, and comfort of the habitat that are perceived in the quarantine period. These results graph a cross-sectional instant of the inhabitant's interaction with their living space, being useful for overcoming disagreements and emerging trends in the habitability of residential physical spaces and their post-pandemic urban insertion, which could currently and in the future. short term conflict with trends in the residential real estate market.
ABSTRACT
Purpose/Objective(s): To evaluate the safety and efficacy of Low-Dose Radiation (LD-RT) to treat COVID-19 pneumonia. Materials/Methods: We conducted a prospective phase I-II trial enrolling patients ≥ 50 years-old, COVID-19 positive, with lung involvement at imaging study and oxygen requirement. Patients received 100 cGy to total lungs in a single fraction. Dose planning goals were PTV95 > 80% with Dmax < 115%. Primary outcome was radiological response assessed as severity and extension scores at days 0, +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/ FiO2 index (SAFI) at +3 and +7 (normal SAFI > 315, mild respiratory failure < 300, and severe < 200). Descriptive analyses were summarized as means with standard deviation (SD) and medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. Results: Forty-one patients were included. Three patients died < 72h after LD-RT and were excluded from the analysis. Median age was 71 (IQR 60-84). Eighteen patients (47%) received previously any anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids (GC) during LD-RT. Extension score improved significantly (P = 0.02) on day +7;severity score was stable or slightly decreased (P = 0.1). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7 (P < 0.01). SAFI improvement was associated with overall survival (P = 0.01). Significant decrease was found in C-reactive protein on day +7 (P = 0.02) and in lymphocytes counts on day +3 and +7 (P = 0.02). Median time to receive RT from the date of admission was 19 days (ranging 2-87). Median number of days in hospital after RT was 11 (4-78) and overall was 37 days (range 11-155). With a median follow-up of 67 days after LD-RT, 24 (63%) patients were discharged, twelve (32%) died and two (5%) are still inpatients. Conclusion: Our preliminary results show that LD-RT was feasible and well-tolerated treatment, with potential clinical improvement. Randomized trials are needed to establish whether LD-RT improves severe pneumonia.
ABSTRACT
No disponible COVID-19 confinement situation imposed to the population by the public health reasons causes a considerable reordering of daily habits in families with children. Parent-child interactions might crease and, accordingly, the opportunities to strengthen adaptive behavioral dynamics between the child and their parents and other family members. If this is not the case, problematic behavior increases and, in the context of confinement conditions, the probability of COVID-19 might also infection. Functional Analysis of Behavior is a key reference to shape child'behavior and in the same functional root, Acceptance and Commitment Therapy (ACT) is proving to be useful to build psychological flexibility in many arenas beyond the clinical one where it accumulates remarkable evidence. One of this arenas points to building flexible behavioral patterns in children both in educational and family contexts. The present work aims to apply the ACT model for managing the child's behavior and for improving psychological flexibility during family interactions in the context of following the instructions to reduce virus infection
ABSTRACT
Introduction and objective: Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic. Methods: This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model. Results: In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with nonST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [P < .001] and 15.2% vs 1.8% [P = .001], respectively). GRACE score > 140 (OR, 23.45;95%CI, 2.52-62.51;P = .005) and COVID-19 (OR, 6.61;95%CI, 1.82-24.43;P = .02) were independent predictors of in-hospital death. Conclusions: During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Subject(s)
Anesthesiology/organization & administration , COVID-19/epidemiology , Health Care Surveys/statistics & numerical data , Pandemics , SARS-CoV-2 , Anesthesiologists/organization & administration , Anesthesiology/statistics & numerical data , Bed Conversion/statistics & numerical data , COVID-19/therapy , Cost-Benefit Analysis , Critical Care/statistics & numerical data , Hospital Bed Capacity/statistics & numerical data , Humans , Intensive Care Units , Personnel Staffing and Scheduling , Spain/epidemiologyABSTRACT
Introduction: during the COVID-19 pandemic, the use of personal protective equipment and devices by health care workers is essential to prevent transmission of the infection in the health care community. Methods: the Occupational-Professional Group of the Asociación Española de Pediatría de Atención Primaria (Spanish Association of Primary Care Paediatrics, AEPap) carried out a survey of the regional chapters of the AEPap to establish the availability of personal protective equipment to primary care paediatricians (PCPs), and the diagnostic tests used to detect infection in PCPs. Results: in the month of March, adequate protection was available to PCPs in 32% of the autonomous communities (ACs), a percentage that rose to 70% in April. Cases of COVID-19 in PCPs have been re-corded in every AC., although it is difficult to quantify the number of affected providers. Based on our data, adding the number of providers with positive tests, the providers that were quarantined and the providers admitted to hospital, the total amounts to 7.65% of PCPs. Rapid serologic tests, PCR tests or both have been used to test PCPs in the last days of April in 6 ACs, and in 6 others in the first days of May. The only AC where testing has not been performed is Aragon. We found an association between the availability of protective equipment and health care expenditure. Conclusions: the supply of protective equipment has been inadequate. Autonomous communities with the highest health care expenditures had adequate supplies of personal protective equipment earlier. There have been cases of infection in PCPs in every AC, with the highest frequencies reported in Madrid, Castilla y Leon and Valencia. Testing for detection of affected health professionals was performed at a late stage. © 2020, Spanish Association of Primary Care Pediatrics. All rights reserved.
ABSTRACT
Background: Several descriptive cohort studies of patients affected by COVID-19 have been published. Objective: To describe the characteristics of patients with SARS-CoV-2 infection who were admitted to Hospital Universitario la Plana, Castellon, Spain. Methods: Retrospective, observational cohort study that included 18-year-old or older patients who were consecutively admitted with SARS-CoV2 confirmed infection. Demographic characteristics, comorbidities, clinical symptoms, laboratory results and radiological tests are described. Results: The study included 255 patients, with a mean age of 70 years;54.9 % were males. Most common comorbidities were high blood pressure (58 %), dyslipidemia (42.4 %), diabetes (25.5 %) and obesity (24.3 %). Median number of days from the onset of clinical symptoms prior to hospital admission was seven. Most common manifestations prior to admission were fever (74.5 %), dry cough (61.2 %), malaise (51.8 %) and dyspnea (51.0 %);19 patients (7.4 %) were admitted to the intensive care unit, where mortality was 50 %;overall mortality was 16.9 %. Conclusions: Our cohort reflects similar characteristics to those of other European series. Mortality was lower than that in similar studies.