Potential usage of anterior nasal sampling in clinical practice with three rapid antigen tests for SARS-CoV-2

Introduction: Anterior nasal sampling (AN) might be more convenient for patients than NP sampling to diagnose coronavirus disease. This study investigated the feasibility of rapid antigen tests for AN sampling, and the factors affecting the test accuracy. Methods: This single-center prospective study evaluated one qualitative (ESP) and two quantitative (LUMI and LUMI-P) rapid antigen tests using AN and NP swabs. Symptomatic patients aged 20 years or older, who were considered eligible for reverse-transcription quantitative polymerase chain reaction using NP samples within 9 days of onset were recruited. Sensitivity, specificity, and positive and negative concordance rates between AN and NP samples were assessed for the rapid antigen tests. We investigated the characteristics that affected the concordance between AN and NP sampling results. Results: A total of 128 cases were recruited, including 28 positive samples and 96 negative samples. The sensitivity and specificity of AN samples using ESP were 0.81 and 1.00, while those of NP samples were 0.94 and 1.00. The sensitivity of AN and NP samples was 0.91 and 0.97, respectively, and specificity was 1.00, for both LUMI and LUMI-P. The positive concordance rates of AN to NP sampling were 0.87, 0.94, and 0.85 for ESP, LUMI, and LUMI-P, respectively. No factor had a significant effect on the concordance between the sampling methods. Conclusions: ESP, LUMI, and LUMI-P showed practical diagnostic accuracy for AN sampling compared to NP sampling. There was no significant factor affecting the concordance between AN and NP sampling for these rapid antigen tests. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Diagnostic performance of computed tomography imaging for COVID-19 in a region with low disease prevalence

Coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in December 2019 as an out-break of pneumonia of unknown origin. Previous studies have suggested the utility of chest computed tomography (CT) in the diagnosis of COVID-19 because of its high sensitivity (93%-97%), relatively simple procedure, and rapid test results. This study, performed in Japan early in the epidemic when COV1D-19 prevalence was low, evaluated the diagnostic accuracy of chest CT in a population present-ing with lung diseases having CT findings similar to those of COVID-19. We retrospectively included all consecutive patients (18 years old) presenting to the outpatient department of Keio University Hospital between March 1 and May 31, 2020, with fever and respiratory symptoms. We evaluated the perfor-mance of diagnostic CT for COVID-19 by using polymerase chain reaction (PCR) results as the refer-ence standard. We determined the numbers of false-positive (FP) results and assessed the clinical utility using decision curve analysis. Of the 175 patients, 22 were PCR-positive. CT had a sensitivity of 68% and a specificity of 57%. Patients with FP results on CT diagnosis were mainly diagnosed with diseases mimicking COVID-19, e.g., interstitial lung disease. Decision curve analysis indicated that the clinical utility of CT imaging was limited. The diagnostic performance of CT for COVID-19 was inadequate in an area with low COV ID-19 prevalence and a high prevalence of other lung diseases with chest CT findings similar to those of COVID-19. Considering this insufficient diagnostic performance, CT findings should be evaluated in the context of additional medical information to diagnose COVID-19.

Reykjanes Mantle Convection and Climate: Crustal Objectives

The five primary sites proposed for International Ocean Discovery Program (IODP) Expedition 395, which was postponed because of the COVID-19 pandemic, were cored during IODP Expedition 395C. The Expedition 395C operations, shipboard measurements, and sampling were adjusted to account for the absence of a sailing science party. The Expedition 395/395C objectives are (1) to investigate temporal variations in ocean crust generation at the Reykjanes Ridge and test hypotheses for the influence of Iceland mantle plume fluctuations on these processes, (2) to analyze sedimentation rates at the Björn and Gardar contourite drifts, as proxies for Cenozoic variations of North Atlantic deepwater circulation, and for uplift and subsidence of the Greenland-Scotland Ridge gateway related to plume activity, and (3) to analyze the alteration of oceanic crust and its interaction with seawater and sediments. During Expedition 395C, basalt cores were collected at four sites: U1554, U1555, U1562, and U1563. Sediment cores were also collected from these sites as well as from Site U1564, and casing was installed to 602 m at Site U1554. The amount of recovered cores, their preliminary descriptions, and the analyses of shipboard samples show that the results of Expedition 395C will fulfill a significant part of the Expedition 395 objectives. Basalts were collected from two V-shaped ridge and trough pairs, which will allow the investigation of the variability in mantle source and temperature causing this ridge/trough pattern. Basalt cores span an expected age range of 2.8–13.9 Ma, which will allow us to investigate the hydrothermal weathering processes. Sediments from the Björn drift were cored to basement, along with the uppermost 600 m of sediments from the Gardar drift. The data provided by Expedition 395C are a major advancement in achieving the work of Expedition 395. © 2022 Authors. All rights reserved.

Impact analysis of COVID-19 on the imminent tightness of hospital beds using the mathematical model of infectious disease: a case study in Shiga Prefecture

Objectives: In Shiga Prefecture, the third wave of a novel coronavirus infection (COVID-IQ) caused an imminent tightness of hospital beds. In this study, we constructed a mathematical model of infectious disease to conduct a sensitivity analysis and evaluated the effectiveness of policy interventions and medical systems management to avoid the shortage of hospital beds.

Reduction of mask-associated dry eye by using surgical tape to secure the top edge of the mask

Purpose : During the COVID-19 pandemic, mask-associated dry eye (MADE) has increased worldwide possibly because the breath leaks from the top of the masks changes the ocular surface conditions. We tested the hypothesis that surgical taping of the top edge of the mask to the skin reduces the risk of ocular surface damage. Methods : We enrolled 60 volunteers (30 females, 30 males;mean age, 27.1±5.2 years) who wear face masks over 5 hours a day. We measured the fluorescein tear break-up time (FBUT), ocular surface temperature, and conjunctival blood flow before wearing masks, after wearing masks taped on the top edge, and after wearing masks without tape. We used the Ocular Surface Disease Index (OSDI) to record participants' symptoms of MADE and measured their corneal tactile and pain sensitivity using a Cochet-Bonnet esthesiometer. Results : The FBUT with masks without tape (4.4±2.4 seconds) was significantly shorter than that without masks (6.4±3.1 seconds) and with taped masks (5.8±3.2 seconds) (P<0.01 and P=0.05, respectively, Tukey HSD test). There was no significant difference in the FBUT between use of no masks and taped masks (P>0.05). The differences in the corneal and conjunctival temperatures after wearing masks without tape (0.19±0.28 and 0.13±0.28°C, respectively) were significantly higher than after wearing taped masks (0.05±0.27 and 0.06±0.24°C, respectively, P<0.01, paired t-test). The conjunctival blood flow with masks without tape was significantly higher than that of taped masks (P<0.01). Of the 60 subjects, 13 (21.7%) subjects reported MADE symptoms. In the MADE group, the OSDI (P=0.001, analysis of covariance) was significantly higher and the FBUT of masks without tape (P=0.006) was significantly shorter than in the non-MADE group. Pain sensitivity in the MADE group was significantly higher than in the non-MADE group (P<0.01), indicating that subjects in the MADE group were significantly hypersensitive to corneal pain. Conclusions : Wearing masks decreased FBUT and increased ocular surface temperature and blood flow. Taping the top edge of the mask prevented those changes. Fitting masks tightly to the nose or applying tape over the mask may reduce the MADE risk, which can be associated with ocular surface hypersensitivity.

HLA-A∗11:01:01:01, HLAC∗ 12:02:02:01∼HLA-B∗52:01:02:02, age and sex are associated with severity of Japanese COVID-19 with respiratory failure

Coronavirus disease 2019 (COVID-19) was announced as an outbreak by the World Health Organization (WHO) in January 2020 and as a pandemic in March 2020. The majority of infected individuals have experienced no or only mild symptoms, ranging from fully asymptomatic cases to mild pneumonic disease. However, a minority of infected individuals develop severe respiratory symptoms. The objective of this study was to identify susceptible HLA alleles and clinical markers that can be used in risk prediction models for the early identification of severe COVID-19 among hospitalized COVID-19 patients. A total of 137 patients with mild COVID-19 (mCOVID-19) and 53 patients with severe COVID-19 (sCOVID-19) were recruited from the Center Hospital of the National Center for Global Health and Medicine (NCGM), Tokyo, Japan for the period of February-August 2020. High-resolution sequencing-based typing for eight HLA genes was performed using next-generation sequencing. In the HLA association studies, HLA-A∗11:01:01:01 [Pc = 0.013, OR = 2.26 (1.27-3.91)] and HLA-C∗12:02:02:01∼HLAB∗ 52:01:01:02 [Pc = 0.020, OR = 2.25 (1.24-3.92)] were found to be significantly associated with the severity of COVID-19. After multivariate analysis controlling for other confounding factors and comorbidities, HLAA∗ 11:01:01:01 [P = 3.34E-03, OR = 3.41 (1.50-7.73)], age at diagnosis [P = 1.29E-02, OR= 1.04 (1.01-1.07)] and sex at birth [P = 8.88E-03, OR= 2.92 (1.31-6.54)] remained significant. The area under the curve of the risk prediction model utilizing HLA-A∗11:01:01:01, age at diagnosis, and sex at birth was 0.772, with sensitivity of 0.715 and specificity of 0.717. To the best of our knowledge, this is the first article which describes associations of HLA alleles with COVID-19 at the 4-field (highest) resolution level. Early identification of potential COVID-19 could help clinicians prioritize medical utility and significantly decrease mortality from COVID-19.

ROLE OF COMMUNITY-LED PLANNING FOR EFFECTIVE WIDE-AREA REGIONAL EVACUATION

Abnormal weather caused by global warming has brought about unprecedented torrential rain, causing heavy rain disasters in various parts of Japan. Since recent river flooding caused inundation damage over a wide area, area-wide evacuation, that is, evacuation to a safe place beyond municipalities' boundaries is necessary to save lives. This paper first introduces the community disaster management planning system that was established in Japan in the wake of the Great East Japan Earthquake in 2011. Next, the necessity of wide-area evacuation that has become apparent due to the recent flooding of large-scale rivers and a few problems that have arisen in the government-led wide-area evacuation plan are introduced, because residents' concrete evacuation behaviour was not sufficiently reflected. The author discusses efforts of a community in the Kofu basin, Yamanashi Prefecture which has been working to formulate a community disaster management plan for wide-area evacuation and city and prefectural efforts that support this district. The author also describes the risk communication that was undertaken to clarify the role of central ministries, local governments and community residents in the formulation of wide-area evacuation plans. Finally in wide-area evacuation drills, planned and conducted by the community in 2020 during the COVID-19 pandemic, the community disaster management plan is further reviewed. In this article, the author addresses how such a community-led wide-area evacuation plan is indispensable for administrations' effective wide-area evacuation planning. © 2021 WIT Press.

Positive Ratio of Polymerase Chain Reaction (PCR) and Validity of Pre-Screening Criteria at an Outpatient Screening Center during the Early Phase of the COVID-19 Epidemic in Japan

Despite the increase in COVID-19 cases globally, the number of cases in Japan has been relatively low, and an explosive surge in the prevalence has not occurred. In March 2020, the Ministry of Health, Labour and Welfare (MHLW) in Japan recommended the original criteria for polymerase chain reaction (PCR) testing, although there was a lack of evidence for appropriate targets for COVID-19 testing. This study aimed to evaluate the COVID-19 positive ratio and pre-screening criteria in Tokyo immediately after the insurance-covered SARS-CoV-2 PCR testing became available in Japan. We subjected 277 individuals with mild symptoms in metropolitan Tokyo (positive: 9.0%) from March 9 to 29, 2020, to SARS-CoV-2 PCR testing. The results revealed that 25 (9.0%) of them were PCR-positive. The sensitivity and specificity of the MHLW criteria were 100% and 10.7%, respectively. When the criteria excluded nonspecific symptoms, fatigue, and dyspnea, the sensitivity slightly decreased to 92%, and the specificity increased to 22.2%. The specificity was highest when the fever criterion was >= 37.5 degrees C for >= 4 days, and exposure/travel history, including age and underlying comorbidities, was considered. Our findings suggest that the MHLW criteria, including the symptoms and exposure/travel history, may be useful for COVID-19 pre-screening.

Analysis of COVID-19 Mortality in Japan by Using Support Vector Machine

To look for factors of the COVID-19 spreading in the whole world currently, an empirical study has been tried by using a multi-regression analysis for mortality rates of 47 prefectures as an objective variable, and various indices as the explanatory variables. A support vector machine method was applied to deal with a nonlinear relationship between objective and explanatory variables, and a sensitivity analysis was applied to search the factors of the COVID-19 mortality. Welfare, urbanization, poverty rate, service industry, and sex ratio were obtained as dangerous factors which increase mortality, while single-person households, meals, and sleep were obtained as defensing factors which decrease mortality. Novel and useful knowledge for prevention measure of the COVID-19 was obtained: three factors of urbanization, service industry, and single-person household relating to the Three Cs contribute largest to the mortality, and two factors of welfare and poverty rate, reflecting the reality' of the poor people also contribute.

Relationship between tacrolimus blood levels and covid-19 pandemic in kidney transplant recipients

Purpose: The novel coronavirus 2019 infection (COVID-19) caused a pandemic, prompting Tokyo, Japan, to restrict on the free movement of people in March 2020. Kidney transplant recipients are at high risk for critical COVID-19 due to chronic immunosuppression and coexisting conditions. For the follow-up of kidney transplant recipients during this pandemic, the number of hospital visits or use remote counseling should be reduced to minimize the risk of infection. However, the management of kidney transplant recipients during the COVID-19 pandemic is uncertain. Methods: This single-center retrospective observational study included 980 patients who, more than a year previously, had undergone kidney transplantation and were taking extended-release tacrolimus once a day, with a target trough level of 4 to 6 ng/ml. We evaluated the effects of coronavirus pandemic on clinical outcomes such as tacrolimus blood level, renal function, and rejection in kidney transplant recipients, comparing pandemic data with non-pandemic data obtained between September 2019 and August 2020 in our hospital. Results: Comparing pandemic data with non-pandemic data, the mean interval between hospital visits was 5.5±2.6 vs. 7.3±4.5 weeks (P=2.68×10-14). Serum Cr levels and rejection rates after kidney transplant showed no significant differences between both groups. There were no significantly differences in the coefficient of variation (CV) in tacrolimus blood levels, the rate of changes in oral medication, and the rate of deviation from the target trough level during the pandemic. Conclusions: In kidney transplant recipients, blood levels of tacrolimus were maintained at target trough levels during the COVID-19 pandemic.

VFep: 3D Graphic Face Representation Based on Voice-based Emotion Recognition

Human communication on the Internet is increasing as a substitute to direct human interaction in a physical space. This trend is expanding particularly with the COVID-19 pandemic. Furthermore, presenting the face expressed in 3D graphics to the communication partner is preferred owing to the discomfort felt in showing the actual face of the communicating person. However, showing emotional expressions with a 3D graphic face is difficult. To overcome this problem, we design and implement Voice to Face Expression (VFep) that analyzes the speaker's voice signal, recognizes the emotion of the speaker, and reflects it in the 3D model of the face in real time. In this paper, the design and implementation of VFep and the preliminary evaluation results are described.

Point of care ultrasound training during the coronavirus disease 2019 pandemic

BACKGROUND: Coronavirus disease 2019 has caused a major worldwide disruption to nearly all aspects of the medical education process, which includes the teaching of point-of-care ultrasound (POCUS). However, the impacts of the pandemic on POCUS training during this time have not been well studied. AIM: This was a retrospective observational study of the 1st year of emergency medicine (EM) residents at the Department of EM who had received POCUS training at a tertiary university hospital in Thailand. METHODS: The study was conducted throughout the 2019–2020 Academic year. The primary aim of this study was to evaluate the new POCUS training methodology, which, due to health and safety protocols, was carried out through virtual learning. RESULTS: A total of 18 1st-year EM residents were evaluated. The average pre-training scores in the 2019–2020 academic years were 5.25 and 5, respectively. The average post-training scores in the 2019 and 2020 academic years were 8.5 and 8.67, respectively. In terms of the ultrasound (US) skills test, the total average scores in the 2019–2020 academic year were 17 out of 20 (85%) and 14.875 out of 20 (74.38%), respectively (p < 0.001). CONCLUSIONS: Virtual learning is effective for teaching theoretical US knowledge. However, it was not suitable for teaching practical skills, including US skills.

Emergency medical services amid new wave of coronavirus disease 2019 outbreak in khon kaen, thailand

BACKGROUND: Coronavirus disease 2019 (COVID-19) outbreaks occurring in many countries around the world have had a significant impact on emergency medical services (EMSs) in terms of the number of operations and procedures performed, including those on ambulances. However, the number of EMS amid the rising number of COVID-19 cases in Khon Kaen, Thailand, has not been well studied. AIM: The aim of this study was to identify and analyze the relationship between the use of EMS and the outbreak of COVID-19. METHODS: A cross-sectional study was done in Srinagarind Hospital, Khon Kaen, Thailand, with a single EMS centered. Data were collected between March 27, 2021, and April 9, 2021, and designated as day-7 to day 7 of pandemic services as well as normal services which collected data between March 27, 2019, and April 9, 2019 (day-7 to day 7 of normal services). RESULTS: Three hundred and eight EMS operations were examined. A total of 77.9% (n = 95) of pandemic services were for males and the mean age of the patients was 32.1 ± 5.4 years. During the normal services in 2019, the average number of EMS operations was 13.3 ± 2.4 times/day over the 2 weeks of the study. In 2021, before the outbreak (day-7 to day 1), the average number of EMS operations was 13.2 ± 1.8 times/day. After day 1, there was a drop in the number of EMS operations which was associated with an increase in COVID-19 infections (p < 0.001). CONCLUSIONS: The number of EMS users during the COVID-19 outbreak decreased considerably compared to the pre-epidemic levels and normal service intervals, including the severity of the users, was more severe than normal.

Development of emergency medical services amid 5 years’ experience at a medical school in Thailand

BACKGROUND: The development of emergency medical services (EMSs) in Thailand is divided into two phases following the enactment of the Emergency Medical Act in 2007 aimed at making the work model more systematic. However, the amount of EMS operations has not been well studied. AIM: The aim of this study was to describe the pattern of EMS operations throughout a 5-year period. METHODS: A retrospective, single-centered study at a medical school hospital in Thailand. Data were gathered from the EMS database at Srinagarind Hospital throughout the years 2016–2020. RESULTS: A total of 10,384 EMS operations were examined over a 5-year period (2016–2020). The mean age of patients in 2016 was 40.2 ± 3.5 years, and 55.3% (n = 1178) were male. Operations were most commonly performed during the afternoon shift (4.00 p.m.–0.00 a.m.) 41.0%, 38.6%, 39.5%, 39.2%, and 50.8%, respectively. The amount of EMS members had a tendency to increase in number throughout the 5 years of study (p = 0.022). The average times from 1669 center call receipt to arrival on scene (response time) for 2016 and 2020 were 8.52 ± 2.20 min and 5.52 ± 3.02 min, respectively (p < 0.001). CONCLUSION: The development of EMS at Srinagarind Hospital took place with an increase in the age of patients, number of operations in the afternoon shift, and EMS members, yet with a decrease in response times.

Pandemic Futures and Nuclear Weapon Risks: The Nagasaki 75th Anniversary pandemic-nuclear nexus scenarios final report

This report is an outcome document of the Nagasaki 75th Anniversary Pandemic-Nuclear Nexus Scenarios Project, an international initiative aimed at exploring how the far-reaching effects of the COVID-19 pandemic (and future pandemics) could alter the landscape for nuclear risk and disarmament. The project was convened as a series of online workshops in October-November 2020, and co-sponsored by the Research Center for Nuclear Weapons Abolition, Nagasaki University (RECNA), the Asia-Pacific Leadership Network for Nuclear Non-proliferation and Disarmament (APLN), and the Nautilus Institute for Security and Sustainability, in cooperation with the Nagasaki University Planetary Health Project and the Panel on Peace and Security of Northeast Asia (PSNA). The goals of the workshop were to (1) develop an analytical understanding of the interrelated nature of the co-occurring existential threats of nuclear weapons and global pandemics;(2) explore potential levers and pathways to influence the future under various conditions;and (3) identify concrete strategies to reduce the risk of nuclear war and resume nuclear disarmament by state and non-state actors, particularly in the Northeast Asia region.

Comparison of emergency medical services duration amid routine service for covid-19 patients

BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 patients. AIM: The aim of this study was to compare the EMS time for COVID-19 patients and routine services. METHODS: This cross-sectional study was conducted in a tertiary university hospital in Khon Kaen, Thailand. Information gathering was carried out by employing the Srinagarind Hospital EMS database throughout January 1, 2020, and February 10, 2021. RESULTS: A total of 2420 EMS operations were examined, of which five tested positive for COVID-19 (0.21%). The mean age of the COVID-19 patients was 35.6 ± 7.2 years, with the activation interval for COVID-19 and routine services at 64.20 ± 10.14 and 1.42 ± 0.42 min, respectively (p < 0.001). The on-scene time for COVID-19 and routine services was 3.20 ± 0.44 and 5.20 ± 2.20 min, respectively. CONCLUSIONS: EMS operating time amid the activation interval for COVID-19 patients was significantly longer than in the normal group. However, on-scene time for COVID-19 patients was less time than in normal operations.

Conventional and Kampo medicine in the treatment of mild to moderate COVID-19: A multicenter, retrospective observational study protocol by the Integrative Management in Japan for Epidemic Disease (IMJEDI study-Observation)

Aim: We present the study protocol of a multicenter, retrospective observational study that aims to investigate the efficacy of the actual treatment (the efficacy of conventional and Kampo medicines) of patients with mild to moderate or suspected coronavirus disease (COVID-19). Methods: This study is designed as a multicenter, retrospective observational study. Outpatients and inpatients will be recruited from Japanese hospitals. The inclusion criteria are as follows: having or suspected to have COVID-19, mild to moderate COVID-19, symptomatic, ≥20 years of age, male or female, able to communicate in Japanese, and treated with conventional and Kampo medicine. The exclusion criteria are: unable to provide informed consent due to dementia, psychosis, or psychiatric symptoms, severe COVID-19, or determined unsuitable for this study. The sample size is set at 1000, as this number of people can be treated at the collaborating medical institutions during the study period. Results: The main outcome is the number of days without fever, with a body temperature of less than 37°C. The secondary outcome is set at common cold-like symptoms other than fever (fatigue, cough, shortness of breath, sputum, diarrhea) and severity of illness and hospitalization up to 14 days after the visit. Trial registration: The trial was registered in the University Hospital Medical Information Network (Reservation No. UMIN000041301) on August 4, 2020. Conclusion: Our study will explore the contribution of conventional and Kampo medicine in the treatment of patients with mild and moderate COVID-19.

Nightlife clusters of coronavirus disease in Tokyo between March and April 2020.

We analysed associations between exposure to nightlife businesses and severe acute respiratory syndrome coronavirus 2 PCR test results at a tertiary hospital in Tokyo between March and April 2020. A nightlife group was defined as those who had worked at or visited the businesses. We included 1517 individuals; 196 (12.9%) were categorised as the nightlife group. After propensity score matching, the proportion of positive PCR tests in the nightlife group was significantly higher than that in the non-nightlife group (nightlife, 63.8%; non-nightlife, 23.0%; P < 0.001). An inclusive approach to mitigate risks related to the businesses needs to be identified.