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It is well recognized that dermatology education across the UK is variable, sparse and oftentimes entirely absent from undergraduate medical curricula. However, annually 24% of the population in England and Wales present to general practitioners with a dermatological complaint. This quality-improvement project (QIP) aimed to improve medical students' understanding of common dermatological presentations as defined by one university's curriculum. Teaching sessions were conducted with penultimate and final-year medical students on their clinical placements. A questionnaire was used to establish student confidence levels at baseline, and following each session relating to various learning outcomes. Session 1 covered describing lesions with interactive cases, while session 2 included Objective Structured Clinical Examination (OSCE)-style scenarios for mock examination. Quantitative data were analysed using Microsoft Excel and qualitative data analysed using framework theory. A total of 67 datasets were analysed for key curriculum aspects as per university dermatological curriculum. Mean quantitative self-reported confidence levels preteaching (mean across all domains 6.04), post-cycle 1 (mean 7.62) and postcycle 2 (mean 8.01). A statistically significant improvement was identified in confidence for the domains 'confident describing cutaneous signs' (P = 0.026;Mann-Whitney U-test), 'management of chronic dermatological conditions' (P = 0.028), 'management of acute severe dermatological conditions' (P = 0.003), 'management of common benign, premalignant and malignant skin conditions' (P = 0.014), 'management of immunobullous skin conditions' (P = 0.004) from baseline to cycle 1, and 'dermatological history taking skills' (P = 0.232), 'examining skin' (P = 0.008) and 'dermatological prescribing' (P = 0.004) from baseline to after cycle 2. Thematic analysis of open-question feedback revealed that students found this teaching session useful, particularly with the examination-style of the sessions. Key areas to improve on included inclusion of ethnic skin types in the teaching. The statistically significant increase in student confidence levels suggests that the teaching programme was successful, thus our QIP outcomes were achieved. Furthermore, one can assume running similar programmes across other medical schools would be beneficial, particularly as dermatology education is underrepresented and variable across medical schools' curricula. Use of visual aids and a problem-centred approach is an effective tool that can be easily integrated into dermatology teaching. We aim to pursue further work to complete additional sessions, particularly focusing on the inclusion of ethnic skin types, which was identified as a key improvement point from students and reflects existing literature. Given the restrictions imposed by the COVID-19 pandemic, e-learning is vastly developing and we could also consider, in a repeat cycle, the use of video technology to help provide educational equality.
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The recent outbreak of Coronavirus disease 2019 (COVID-19) has posed serious threats and challenges to global supply chain management (GSCM). To survive the crisis, it is critical to rethink the proper setting of global supply chains and reform many related operational strategies. We hence attempt to reform the GSCM from both supply and demand sides considering different pandemic stages (i.e., pre, during, and post-pandemic stages). In this research paper, we combine a careful literature review with real-world case studies to examine the impacts and specific challenges brought by the pandemic to global supply chains. We first classify the related literature from the demand and supply sides. Based on the insights obtained, we search publicly available information and report real practices of GSCM under COVID-19 in nine top global enterprises. To achieve responsiveness, resilience, and restoration (3Rs), we then propose the "GREAT-3Rs” framework, which shows the critical issues and measures for reforming GSCM under the three pandemic stages. In particular, the "GREAT” part of the framework includes five critical domains, namely, "government proactive policies and measures,” "redesigning global supply chains,” "economic and financing strategies under risk,” "adjustment of operations,” and "technology adoption,” to help global enterprises to survive the pandemic;"3Rs” are the outputs that can be achieved after using the "GREAT” strategies under the three pandemic stages. Finally, we establish a future research agenda from five aspects. © 2022 Production and Operations Management Society.
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Background: Cancer patients are at high risk of severe COVID infection and recommended at least three doses of SARS-CoV2 mRNA vaccines. Various anti-neoplastic treatments may affect long-term vaccine immunogenicity. Methods: Patients with solid or haematological cancer were recruited from two Singapore hospitals between July 2021 and March 2022. GenScript cPASS surrogate virus neutralisation assays measured antibody responses, which were correlated with clinical outcomes obtained from medical records and national mandatory-reporting databases. Results: In total, 273 patients were recruited (40 with haematological malignancies and the rest solid tumours). Two-hundred and four patients (74.7%) were receiving active cancer therapy: 98 (35.9%) receiving systemic chemotherapy and the rest targeted or immunotherapy. All patients were seronegative at baseline. After receiving one, two and three doses of SARS-CoV-2-mRNA vaccination, seroconversion rate was 35.2%, 79.4% and 92.4% respectively. After three doses, patients on active treatment for haematological malignancies had lower antibodies (57.3%±46.2) as compared to patients on immunotherapy (94.1%±9.56, p<0.05) and chemotherapy (92.8%±18.1, p<0.05). SARS-CoV-2 infection was reported in 77 (28.2%) patients of which 18 were severe. Conclusion: This study demonstrates high immunogenicity of three doses of vaccines and protection against severe infection in cancer patients.
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Infections are common after solid organ transplantation (SOT) and are an important cause of significant morbidity and mortality. Many of these infections can be prevented or their severity reduced by vaccination in pre and posttransplantation period. It is better to complete the vaccination before transplantation as protection and seroconversion is better, and live vaccines are mostly contraindicated after SOT. Live vaccines should be given at least 4 weeks before transplantation but killed vaccines can be given up to 2 weeks before the planned transplantation. Vaccination for some diseases which are endemic in South Asia should be given, along with usual vaccinations. Serological monitoring is required for some vaccines to check their efficacy. Similarly, some vaccines are recommended for SOT recipients traveling to various endemic regions. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.
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Purpose: SARS CoV-2 vaccination elicits both robust humoral and T-cell immune responses in healthy individuals. However, a comprehensive assessment of immune responses to SARS-CoV-2 vaccination in renal allograft recipients is variable and dependent primarily on Spike IgG levels. Here, we analyzed the humoral and T-cell responses in vaccinated transplant recipients. Method(s): 61Tx patients maintained either on Tacrolimus (TAC, 32) or Belatacept (BELA, 29) who were greater than one month post 2nd dose of the Pfizer BNT162b2, and 41 healthy individuals were enrolled. Fresh whole blood was incubated with SARS CoV-2 Spike peptides pool and the activated CD4+ (IL-2/TNF-alpha)+ and CD8+ (TNF-alpha/IFN-gamma)+ T cells were enumerated by flow cytometry and defined as CoV-2-specific T cells. Plasma was analyzed for Spike Receptor Binding Domain (RBD)-specific IgG by ELISA. The Spike RBD-specific IgG levels and Spikespecific CD4+/CD8+ T-cell immune responses were analyzed in TAC- and Bela- Tx patients along with healthy controls. Result(s): Our data demonstrated poor Spike IgG and T cell immune responses in Tx patients1M post-2nd dose of vaccine (21% v. 93% in positive Spike IgG and 37% v. 88% in positive T cell responses, Tx v. controls, respectively). However, 34% of Spike IgG (-) patients demonstrated positive CD4+ and/or CD8+ T-cell immune responses. No significant difference in T cell immunity was found between TAC and BELA treated patients. Conclusion(s): Immunocompromised Tx patients demonstrated significant defects in humoral and T cell immune response after vaccination. Patients maintained on TAC v. BELA demonstrated similar depressions in immune responses post-vaccination. 34% of vaccinated Tx patients, demonstrated Spike-specific T cell immunity despite being Spike IgG negative. This is suggestive of a divergent immune response with dominant cellular immunity. These observations are important since activation of T-cell immunity early after exposure to SARS-CoV2, while not preventing infection will likely modify severity of disease. (Table Presented).
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Introduction: Because of the limited donor pool, transplants are being done across the blood group and even HLA incompatibility barriers. But this comes at the cost of increased immunosuppression and the side effects. Effect of this intensified immunosuppression on the incidence of post transplant infections and the type of infection has not been studied extensively. Methods: We retrospectively analysed the incidence of infection in ABO incompatible transplants (ABOi) and compared it with propensity matched cohort of ABO compatible transplants(ABOc) over the same timeframe i.e. 2011 to April 2019. using hospital eHIS record system. Patients were matched with 1:2 ratio (ABOi: ABOc) for age (<60yr, >60yrs),sex, number of previous transplants, pretransplant infections, history of prior immunosuppression, diabetic status, NODAT, and induction agent used. Desensitization protocol for ABO incompatible transplant includes rituximab with double filtration plasmapheresis, plasmapharesis or immunoadsorption to target anti blood group titre of 8. Patient with high immunological risk (e.g.second transplant, HLA incompatible) receive ATG induction while others receive basiliximab induction. Valganciclovir prophylaxis was given only in patients with ATG induction. Results: [Formula presented] [Formula presented] During the study period 89 patients underwent ABOi transplants which were compared with 178 ABOc transplants. (Table1)Mean follow up duration was 50.45months (SD 26.8) in ABOi group and 49.47months (SD28.7) in ABOc group. 17% patients lost to follow up with their last follow up being more than 2 years before. Incidence of overall infections was similar in both the groups (59% (43/89) Vs 44.3% (79/178);p=0.6). (Table2) Incidence of urinary tract infections(UTI)was significantly more in ABOi group vs ABOc group.(23.5% (21/89) vs 11.79% (21/178);p=0.019). Cytomegalovirus infections (CMV) were significantly more in ABOi group 12.3% (11/89) as compared to ABOc group 5% (9/187) (p=0.04). All the patients with CMV infection were CMV IgG positive pretransplant except 2, one from ABOc group who was CMV IgG negative and another from ABOi group who’s pretransplant CMV serology was unavailable. There was no significant difference in incidence of fungal infection, pneumocystis infection, diarrheal infections (other than CMV),pneumonia (other than CMV, PCP, fungal), Herpes, BKV infection. Incidence of post-transplant tuberculosis (3.3% (3/89) Vs 2.8% (5/178);p=1.0) and SARS COV2 infections (12.3% (11/89) vs 9% (16/178);p=0.39 was similar in both the groups. Patient survival was similar in both the groups i.e.95.5% but death censored graft loss was significantly more in ABOi group 0.9% (8/89) as compared ABOc group 0.3% (5/178) p=0.03. Reason of graft loss in all the patients was immunological and not infection. Infection was cause for death in three ABOi patients and four ABOc patients. Conclusions: Overall incidence of infections in ABOi transplants was similar to Abo compatible transplant. Incidence of UTIs and CMV infections were significantly higher in ABOi group. No conflict of interest
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Purpose The unexpected outbreak of COVID-19 has expedited the trend toward online education. To facilitate undisruptive learning, EdTech companies are continuously working on providing solutions to restore teaching and learning practices. This has caused a significant behavioral shift of the investors in the EdTech market. This study aims to analyze the effects of Web Market Traffic on the increased number of investors funding an EdTech Company in the market. Design/methodology/approach By drawing on the multi-method web analytics approach, this study analyses the nexus between Web Market Traffic and Investor's Behavior in the US and India, proving the hypothesized relationship in the proposed Model using a data sample of 300 EdTech Players. Findings There is a significant difference between the investor's behavior in India and the US. This study shows that the investors in the US are more inclined towards investing in EdTech companies in comparison to India. The Results demonstrate that monthly visits of consumers and the number of acquisitions by players positively affect the investor's behavior, while bounce rates take a toll on the number of investors. Practical implications This Study suggests that EdTech investors in the US and India should harness Web Traffic to capture the EdTech market. Further, this study offers practical implications that EdTech players can use to attract potential investors and increase brand visibility by improving web market traffic parameters. Originality/value This paper's original contribution is to empirically shed light on the effects of web market traffic on the investor's behavior. The study emphasizes the quintessentiality of managing the bounce rates and monthly visits for an EdTech market to attract more investors and capital inflow that enhance brand visibility. The study found that the investors behave distinctly in the developed and emerging markets in the US and India.
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This paper investigates how the optimization of policymaker interventions against an epidemic disease is affected by contextual factors related to (i) a cost-centered approach to countering the epidemic, (ii) eventual correlative popular discontent, and (iii) growing social fatigue engendered by nontherapeutic interventions. Three nontherapeutic policies-mobility restrictions (MR), securing social interactions (SSI), and a combination of both (MR + SSI)-are compared in terms of effectiveness and efficiency in preventing infections and saving lives. The costs associated with these policies are economic as well as operational. The objective is to select the lowest cost policy that is the least sensitive to the cited contextual factors. In many ways, our model applies to the Covid-19 pandemic in its prevaccine phase. Our study shows the significant influence of popular discontent on epidemic control policies. We show that in contrast to the standard delayed peak strategy, which seeks to delay and flatten the epidemic peak, there is an alternative strategy, counter to conventional wisdom, which consists of accelerating the onset of the epidemic peak. Although the delayed peak strategy is contingent on popular neutrality, the advanced peak strategy results from popular discontent as a corollary of a cost-centered approach. We also find that social fatigue does not affect the social cost much but, in contrast to the controlled scenarios without social fatigue, it amplifies the peak of infections. In this context, the inclusive policy that incorporates MR + SSI mitigates the negative impact of social fatigue, although it comes at the cost of tighter restrictions than either of the exclusive policies. We conclude that, as opposed to popular discontent, social fatigue should be disregarded for the sake of greater effectiveness and efficiency in infection and death prevention. Our results can be used by policymakers to allocate resources appropriately in MR, SSI, or both and to build treatment capability.
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COVID apps are being quickly rolled out worldwide by governments and private institutions to mitigate the pandemic. This research aimed to understand the behavioral and attitudinal barriers to the widespread adoption of the Safer in Illinois app among community stakeholders at a Big Ten public university in the Midwest. Using a Human Centered Design (HCD) approach, 25 campus members were interviewed to explore (1) issues around privacy and security of data, (2) institutional trust, and (3) community norms. Interviews were conducted during Summer 2020 and were analyzed to develop recommendations for the app development team and key university administrators. Such recommendations included (1) effective and trauma-informed communication by the university about Fall 2020 reopening and the data management and privacy features of the app, (2) incorporating mental health features and an anti-racist training on the app, and (3) address technological inequities and racial health disparities around COVID-19 as an institutional policy. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Since its outbreak, the COVID-19 pandemic's interlinkages with illegal wildlife trade have caught a lot of attention and been touted as a primary cause. Dwelling on the carrier species of coronavirus that have been implicated and the channels of zoonotic spillover, the policies implemented to curb bushmeat consumption with incomplete ramifications to curb illegal wildlife markets are critiqued. The urgent need to address the problem is highlighted, requiring significant enforcement efforts at the local and national level along with transnational cooperation to make them successful. There is a need for alternative coordinated solutions for the COVID-19 vaccine which ironically finds its origin in a wildlife product.
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The COVID-19 pandemic has been a global health crisis since December 2019, when the first infection was reported in Wuhan, China. The critical and lethal advancement of this disease is associated with the failure of multiple organs including, but not limited to, the brain, lungs, heart, liver, kidneys, etc., which makes it very challenging to understand. Current high-throughput technologies generate multi-omics datasets to enable a comprehensive and in-depth analysis of different organs at the cellular and molecular level. To understand the multi-organ impact of COVID-19 and the mechanistic aspects of disease prognosis and its interactions with other comorbidities, computational approaches need to be implemented by integrating data from multiple organs, correlating results across data types, and applying machine learning (ML) tools on the high-throughput data. This chapter is expected to provide valuable insights to help explain the multi-organ association of COVID-19 using state-of-the-art computational resources and modeling of high-volume data. We have emphasized the importance of big data analytics and systematic integration of data from different domains including omics, clinical, demographic, and others in understanding the organ- and system-level biological processes and comorbidity networks associated with COVID-19. These findings and proposed strategies could help perform comorbidity-focused studies to understand and tackle COVID-19. © Springer Nature Switzerland AG 2021.
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Effective strategies to control COVID-19 pandemic need high attention to mitigate negatively impacted communal health and global economy, with the brim-full horizon yet to unfold. In the absence of effective antiviral and limited medical resources, many measures are recommended by WHO to control the infection rate and avoid exhausting the limited medical resources. Wearing mask is among the non-pharmaceutical intervention measures that can be used as barrier to primary route of SARS-CoV2 droplets expelled by presymptomatic or asymptomatic individuals. Regardless of discourse on medical resources and diversities in masks, all countries are mandating coverings over nose and mouth in public areas. Towards contribution of public health, the aim of the paper is to devise a real-time technique that can efficiently detect non mask faces in public and thus enforce to wear mask. The proposed technique is ensemble of one stage and two stage detectors to achieve low inference time and high accuracy. We took ResNet50 as a baseline model and applied the concept of transfer learning to fuse high level semantic information in multiple feature maps. In addition, we also propose a bounding box transformation to improve localization performance during mask detection. The experiments are conducted with three popular baseline models namely ResNet50, AlexNet and MobileNet. We explored the possibility of these models to plug-in with the proposed model, so that highly accurate results can be achieved in less inference time. It is observed that the proposed technique can achieve high accuracy (98.2%) when implemented with ResNet50. Besides, the proposed model can generate 11.07% and 6.44% higher precision and recall respectively in mask detection when compared to RetinaFaceMask detector. © This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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INTRODUCTION: Since its first reported from Wuhan in December 2019, the clinical symptoms of COVID-19 and its complications are still evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema and pneumomediastinum. We report the case series of 10 patients of COVID-19, with subcutaneous emphysema along with pneumomediastinum. METHODS: All patients were admitted to the critical care area from April to June 2020 at Aga Khan University Hospital, Karachi, Pakistan. Electronic records and medical files reviewed for the patient's baseline characteristics, days of ventilation before subcutaneous emphysema, treatment given for COVID-19, cytokine release syndrome (CRS) grade, and with in-hospital mortality. RESULTS: The mean (±SD) age of the patients was 59±8 years (range, 23-97). The majority of them were men (80%), and common symptoms were dyspnea (100%), fever (80%), and cough (80%). None of them had underlying lung disorder. Six patients had hypertension, and five had diabetes. All patients had acute respiratory distress syndrome (ARDS) on admission, with a median PaO2/FiO2 ratio of 122.5. Eight patients with CRS grade III were being managed in high dependency units at the time of development of subcutaneous emphysema, and two with CRS grade IV were treated in ICU. The median duration of assisted ventilation before the development of subcutaneous emphysema was 7 days (interquartile range, 5-10 days). The highest PEEP for invasively ventilated patients was 10, while the CPAP ranged from 12-16, in non-invasive ventilation patients. Eventually, all required intubation. Chest tubes thoracostomy was done in five patients. All received corticosteroids, 6 received tocilizumab, and 7 received convalescent plasma therapy. Seven patients died during their hospital stay. Obstructive shock with tension pneumothorax was the cause of death in 1 patient, while four died of septic shock. Two patients had their ventilator withdrawn due to multiorgan dysfunction syndrome. CONCLUSIONS: High risk COVID-19 patients requiring positive pressure ventilation can develop subcutaneous emphysema and pneumomediastinum. One has to be vigilant about lung-protective ventilator strategies for the management of hypoxia in COVID -19 patients.
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The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first recorded in Wuhan, China. The World Health Organization initially classified COVID-19 as a public health emergency and subsequently declared the disease a global pandemic. COVID-19 can take at least three distinct forms: severe acute distress syndrome with a potentially fatal outcome, mild respiratory illness (pneumonia with eventual recovery) and asymptomatic infection. All three disease forms have the potential to transmit the infection to healthy contacts. At present, real-time reverse transcription polymerase chain reaction (RT-PCR) is the only available laboratory tool to confirm the presence of viral RNA in patient specimens. These assays are designed to detect one or more (at least 2) SARS-CoV-2 RNA gene targets allowing the detection of the virus. Commercially available RT-PCR assays employ various gene targets of the viral genome in their assay systems. Additionally, there are differences in primer selection for the same gene region of SARS-CoV-2. At present, it is unclear whether the results from different RT-PCR assays are comparable in detecting the spectrum of COVID-19 manifestations. The purpose of the present article is twofold: first, to briefly focus on the findings of these reports;and second, to emphasize the various challenges and flaws that can potentially impact the diagnostic accuracy of RT-PCR testing for SARS-CoV-2. © 2021 Shneh Sethi and Trinad Chakraborty, published by De Gruyter, Berlin/Boston 2021.
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Since December 2019, the clinical symptoms of coronavirus disease 2019 (COVID-19) and its complications are evolving. As the number of COVID patients requiring positive pressure ventilation is increasing, so is the incidence of subcutaneous emphysema (SE). We report 10 patients of COVID-19, with SE and pneumomediastinum. The mean age of the patients was 59 ± 8 years (range, 23-75). Majority of them were men (80%), and common symptoms were dyspnoea (100%), fever (80%) and cough (80%). None of them had any underlying lung disorder. All patients had acute respiratory distress syndrome on admission, with a median PaO2/FiO2 ratio of 122.5. Eight out of ten patients had spontaneous pneumomediastinum on their initial chest x-ray in the emergency department. The median duration of assisted ventilation before the development of SE was 5.5 days (interquartile range, 5-10 days). The highest positive end-expiratory pressure (PEEP) was 10 cmH2O for patients recieving invasive mechanical ventilation, while 8 cmH2O was the average PEEP in patients who had developed subcutaneous emphysema on non-invasive ventilation. All patients received corticosteroids while six also received tocilizumab, and seven received convalescent plasma therapy, respectively. Seven patients died during their hospital stay. All patients either survivor or non-survivor had prolonged hospital stay with an average of 14 days (range 8-25 days). Our findings suggest that it is lung damage secondary to inflammatory response due to COVID-19 triggered by the use of positive pressure ventilation which resulted in this complication. We conclude that the development of spontaneous pneumomediastinum and SE whenever present, is associated with poor outcome in critically ill COVID-19 ARDS patients.