HFO versus usual care in pulmonary rehabilitation of post-COPD-exacerbation patients

Introduction/Aim: Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients cannot participate in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR of COPD patients post-exacerbation. Method(s): We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for acute COPD exacerbation were enrolled and randomized to either HFO application or usual standard care during an early 6-week outpatient, twice-weekly pulmonary rehabilitation program. Result(s): 22 patients were randomized between May 2019 and December 2019 and 18 patients completed the study. 2 patients in the HFO arm and 1 patient in the usual care arm withdrew for reasons unrelated to the study. The 22 nd patient (HFO arm) ceased participation due to research restrictions at the COVID pandemic onset. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in the 6-min walk distance (6MWD) between the two arms being 30 m (95% CI: -23 to 84 m). All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending >=75% of exercise sessions). HFO was well tolerated with no adverse events associated with its implementation. Conclusion(s): This RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early pulmonary rehabilitation on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO's benefits and has the potential to change PR practice.

Changes in Working Women's Self-Reported Subjective Wellbeing and Quality of Interpersonal Relationships During COVID-19: A Quantitative Comparison of Essential and Non-essential Workers in Singapore

The COVID-19 pandemic has affected working women's well-being in different ways due to contrasting national responses. This article focuses on the specific context of Singapore, which implemented differentiated rules for workers: essential workers continued to report to workplaces, while non-essential workers were required to work from home. This policy had far-reaching implications for working women, who are more likely than husbands to juggle paid work and household duties. The article uses longitudinal data collected in 2018 and during the pandemic in 2020, specifically during Singapore's lockdown period, to measure changes in 287 working women's self-reported levels of stress, fatigue, and quality of interpersonal relationships by essential worker status. While all workers were affected by the pandemic, female essential workers were more likely than their non-essential peers to report declines in stress levels from 2018 to 2020, and less likely to report changes in spousal relationships, both positive and negative. Findings suggest that the differences were driven by exposure to quarantine conditions faced by non-essential workers. Our results highlight the importance of policies supporting frontline workers and more gender-equitable labour market policies to support married women juggling the twin demands of employment and household responsibilities.

Corporate social responsibility and international students mobility in higher education

Purpose: Building upon the attribution and brand resonance theories, this paper aims to investigate the effects of perceived corporate social responsibility (CSR) in higher education institutions on brand reputation, trust, equity and loyalty. Design/methodology/approach: The data for this study were collected from international students of one public and one private university in Malaysia. Partial least squares-structural equation modelling was applied to analyse the data. Findings: The findings revealed very strong effects of perceived CSR on brand reputation and trust. Moreover, the results determined the positive effects of brand reputation and trust on brand equity and loyalty. Additionally, findings support the positive indirect effects of perceived CSR on brand equity and loyalty through brand reputation and trust. Originality/value: This study provides unique theoretical and practical contributions which can inform countries how to attract international students, particularly in post COVID-19 era. © 2023, Emerald Publishing Limited.

FROM RESEARCH TO PRACTICE: bridging the “ knowledge-action” gap

This chapter discusses the inadequate application of the available scientific knowledge to the improvement of human health in urban areas, leading to what we define as a “knowledge-action” gap. The current state of efforts to implement the “Nature as Health” concept is reviewed, and recommendations are made to adopt an evidence-based design process as a framework for addressing the knowledge-action gap and the science-action gap. While Chapter 39 provided case studies from near the Pacific Rim, this chapter details the cases in Taiwan that bridged the knowledge-action gap in the relationship between nature and public health. Chapter 40 discussed several research tools, methods, and interdisciplinary concepts that might lend light to future studies. This chapter will discuss more detailed information of the HealthCloud app and its application, which provides psychological questionnaires and monitors heart rate and environmental information and could be a useful tool for data collection on the changing behaviors and patterns of humans experiencing nature, especially during the COVID-19 pandemic. A “Landscape and Health Information Note” application could be used to connect health data and environmental information as a feedback system for users. The chapter concludes with the following questions: what is the future relationship between human and environment interaction? Given the rapid advancement of technology and the COVID-19 pandemic, how can we apply this technology and the strategies of landscape design to fill the knowledge-action gap? Finally, how can we respond to sustainable development goals (SDGs)? © 2022 selection and editorial matter, Yizhao Yang and Anne Taufen;individual chapters, the contributors.

A Case of Eosinophilic Colitis after BNT162b2 mRNA COVID-19 Vaccination

Background: BNT162b2 is a widely used mRNA COVID-19 vaccine for which 8.2% of participants above the age of 56 years have reported diarrhea as an adverse event. This case report highlights the possibility of eosinophilic colitis in post-vaccination diarrhea. Case report: A 72-year-old male patient presented with generalized colicky abdominal pain and acute diarrhea after receiving the first dose of the BNT162b2 vaccine. Laboratory examination revealed peripheral blood eosinophilia with cecal and ascending colon mucosal eosinophilia with 100-130 cells/HPF and eosinophilic cryptitis. The patient's symptoms and eosinophilia resolved spontaneously and did not recur after the second dose of vaccination. More research is needed to confirm eosinophilic colitis as a possible vaccine adverse reaction. Copyright © 2022 Selva Yuwaraj Vadioaloo et al., published by Sciendo.

Using Deep Learning to Identify Linguistic Features that Facilitate or Inhibit the Propagation of Anti- and Pro-Vaccine Content on Social Media

Anti-vaccine content is rapidly propagated via social media, fostering vaccine hesitancy, while pro-vaccine content has not replicated the opponent's successes. Despite this dis-parity in the dissemination of anti- and pro-vaccine posts, linguistic features that facilitate or inhibit the propagation of vaccine-related content remain less known. Moreover, most prior machine-learning algorithms classified social-media posts into binary categories (e.g., misinformation or not) and have rarely tackled a higher-order classification task based on divergent perspectives about vaccines (e.g., anti-vaccine, pro-vaccine, and neutral). Our objectives are (1) to identify sets of linguistic features that facilitate and inhibit the propagation of vaccine-related content and (2) to compare whether anti-vaccine, pro-vaccine, and neutral tweets contain either set more frequently than the others. To achieve these goals, we collected a large set of social media posts (over 120 million tweets) between Nov. 15 and Dec. 15, 2021, coinciding with the Omicron variant surge. A two-stage framework was developed using a fine-tuned BERT classifier, demonstrating over 99 and 80 percent accuracy for binary and ternary classification. Finally, the Linguistic Inquiry Word Count text analysis tool was used to count linguistic features in each classified tweet. Our regression results show that anti-vaccine tweets are propagated (i.e., retweeted), while pro-vaccine tweets garner passive endorsements (i.e., favorited). Our results also yielded the two sets of linguistic features as facilitators and inhibitors of the propagation of vaccine-related tweets. Finally, our regression results show that anti-vaccine tweets tend to use the facilitators, while pro-vaccine counterparts employ the inhibitors. These findings and algorithms from this study will aid public health officials' efforts to counteract vaccine misinformation, thereby facilitating the delivery of preventive measures during pandemics and epidemics. © 2022 IEEE.

Development of Ultrapure and Potent Tannic Acids as a Pan-coronal Antiviral Therapeutic

The rampageous transmission of SARS-CoV-2 has been devastatingly impacting human life and public health since late 2019. The waves of pandemic events caused by distinct coronaviruses at present and over the past decades have prompted the need to develop broad-spectrum antiviral drugs against them. In this study, our Pentarlandir ultrapure and potent tannic acids (UPPTA) showed activities against two coronaviral strains, SARSCoV-2 and HCoV-OC43, the earliest-known coronaviruses. The mode of inhibition of Pentarlandir UPPTA is likely to act on 3-chymotrypsin-like protease (3CLpro) to prevent viral replication, as supported by results of biochemical analysis, a 3CLpro assay, and a "gain-of-function" 3CLpro overexpressed cell-based method. Even in the 3CLpro overexpressed environment, Pentarlandir UPPTA remained its antiviral characteristic. Utilizing cell-based virucidal and cytotoxicity assays, the 50% effective concentrations (EC50) and 50% cytotoxicity concentration (CC50) of Pentarlandir UPPTA were determined to be similar to 0.5 and 52.5 mu M against SARS-CoV-2, while they were 1.3 and 205.9 mu M against HCoV-OC43, respectively. In the pharmacokinetic studies, Pentarlandir UPPTA was distributable at a high level to the lung tissue with no accumulation in the body, although the distribution was affected by the food effect. With further investigation in toxicology, Pentarlandir UPPTA demonstrated an overall safe toxicology profile. Taking these findings together, Pentarlandir UPPTA is considered to be a safe and efficacious pancoronal antiviral drug candidate that has been advanced to clinical development.

Breast cancer surgery in COVID19 outbreak: the role of therapeutic mammoplasty

Goals: There is no doubt, that Severe Acute Respiratory Syndrome Coronavirus-2 and it’s associated disease (COVID19) has been quite challenging not only for all Health Systems worldwide, but also for all medical professionals, particularly those dealing with cancer patients. There has been a rearrangement of healthcare resources, so that the health systems to be able to deal with the high volume of covid19 patients and the required facilities for their treatment. As a result, routine treatment pathways have been modified. Surgical management of breast cancer patients could not be exempted from treatment pathway modification in the covid19 outbreak era. Main goal is to reduce hospital stay and minimizing the risk for complications and consequently hospital visits, facilitating at the same time oncologic efficiency. Aim of this study is apart from comparing breast surgery cases in two consecutive years, to evaluate the efficacy of therapeutic mammoplasty in breast cancer patients in Covid Outbreak era. Methods: We compared all the breast cases done by a Consultant Oncoplastic Breast Surgeon during covid19 outbreak from March until June in 2020 to the cases done during the same period of time in 2019. Parametres like tumor characteristics, hospital stay, complications, oncologic efficacy, and cosmetic outcome were evaluated. Results: Asseen in theTable1, all breast cases duringCovid19outbreak were cancer cases, without any reconstruction or surgery for benign breast diseases. The number of cases in total was slightly smaller during the outbreak, compared to ones in 2019. As anticipated, there was no reconstruction or benign cases surgery during Covid19 in compliance with Association of Breast Surgery recommendations and regional/national guidelines during Covid19 outbreak. In terms of Wide Local Excisions all of our cases underwent therapeutic mammoplasties, mainly with Modified Round Block technique. (Table Presented) Conclusion(s): In view of Covid19 outbreak, surgical approach to breast cancer patients should ensure oncologic efficiency and minimize exposure to hospital environment. As our data demonstrate, therapeutic mammoplasty is a safe and oncologically efficient approach for breast cancer patients, with minimum complication rates and high satisfaction rates in terms of cosmesis. Therefore, even in challenging pandemic times we are, it can be safely performed by trained Oncoplastic Surgeons. Conflict of Interest: No significant relationships.

COVID-19 Vaccine Distribution Policy Design with Reinforcement Learning

COVID-19 has become a global crisis and the vaccine has been seen as an effective approach to stop the epidemic spread. However, the resources for distributing and allocating different types of vaccines are limited and we need a better vaccine distribution policy design to prevent the spread of COVID-19 more efficiently. In this study, a pipeline of combing a random forest model and a DQN model is proposed. The random forest model is built to predict the daily new confirmed cases with the vaccine data as the inputs. And the DQN model is built to design the daily allocation ratio of three types of vaccines, with the aim to minimize the new confirmed cases. The experimental results based on the real-world datasets collected in San Diego validate the effectiveness of the proposed pipeline. © 2021 ACM.

A retrospective cross-sectional study on the risk factors and survival outcome of End Stage Kidney Disease patients receiving regular maintenance haemodialysis with COVID-19 infection in Hospital Enche' Besar Hajjah Khalsom, Kluang

INTRODUCTION: COVID-19 pandemic has affected healthcare services around the globe as hospitals were turned into designated hospitals to accommodate high risk groups of patients with COVID-19 infection including end stage kidney disease (ESKD) patients. In Malaysia, there was insufficient data on COVID-19 infection among ESKD patients. This study aims to determine factors and survival outcomes associated with COVID-19 infection among ESKD patients in a designated COVID-19 hospital in Malaysia. METHODS AND MATERIALS: A retrospective cross-sectional study involving 80 haemodialysis (HD) patients recruited from March 2020 till March 2021. Patients' information and results was retrieved and evaluated. Risk factors affecting the COVID-19 mortality were analysed using a one-way analysis of variance (ANOVA) and binary logistic regression. RESULTS: The mean age of the patients was 54 years who were predominantly Malays (87.5%) and living in rural areas. Majority of them had comorbidities such as diabetes mellitus (71%) and hypertension (90%). The most common presentations were fever (46%) and cough (54%) with chest radiographs showing bilateral lower zone ground glass opacities (45%). A quarter of the study population were admitted to the intensive care unit, necessitating mechanical ventilation. This study found that 51% of the patients were given steroids and 45% required oxygen supplementation. The COVID-19 infection mortality among the study population was 12.5%. Simple logistic regression analysis showed that albumin, Odd Ratio, OR=0.85 (95% Confidence Interval, 95%CI: 0.73, 0.98)) and absolute lymphocyte count OR=0.08 (95%CI: 0.11, 0.56) have inverse association with COVID-19 mortality. C-reactive protein OR=1.02 (95%CI: 1.01, 1.04), lactate dehydrogenase OR=1.01 (95%CI: 1.00, 1.01), mechanical ventilation OR=17.21 (95%CI: 3.03, 97.67) and high dose steroids OR=15.71 (95%CI: 1.80, 137.42) were directly associated with COVID-19 mortality. CONCLUSION: The high mortality rate among ESKD patients receiving HD was alarming. This warrants additional infection control measures to prevent the spread of COVID- 19 infection among this vulnerable group of patients. Expediting vaccination efforts in this group of patients should be advocated to reduce the incidence of complications from COVID-19 infection.

O.3 High-flow humidified nasal oxygen versus facemask oxygen for preoxygenation of pregnant women: A prospective randomised controlled crossover study

Introduction: Airway management guidelines recommend the preoxygenation of obstetric patients to an end-tidal oxygen (etO2) concentration of 90% or more prior to general anaesthesia. A previous study showed that despite a plausible role for high-flow humidified nasal oxygen (HFNO) in this context, only 60% of participants achieved this target after t hree minutes of HFNO.1 This was vastly lower than reported rates with face mask (FM) oxygen. We conducted a randomised controlled crossover trial to determine if HFNO is non-inferior to FM oxygen for increasing etO2 concentration after simulated preoxygenation of women in late pregnancy (gestational age [Formula presented]6 weeks). Methods: After ethics approval, trial registration and consent, 70 women underwent simulated preoxygenation protocols with HFNO and FM oxygen sequentially. They were randomised to receive HFNO first then FM oxygen or vice versa. Baseline variables were measured before each protocol including etO2 concentration to ensure adequate oxygen washout between protocols. Protocols were three minutes long and conducted with the women in a ramped position and left lateral tilt. HFNO was delivered at highest tolerable flow rate with a maximum of 70 L/min and FM oxygen was delivered at 10 L/min. The primary outcome was first etO2 concentration after each protocol with a chosen non-inferiority margin of 5%. Recruitment occurred prior to COVID-19 pandemic restrictions. Results: 70 women were randomised. 62 women completed the study protocols without complications. Eight women were excluded due to technical faults or incomplete protocols. Participant characteristics were age (mean ± SD, 34.7 ± 4.6 years) and body mass index (BMI) (median (IQR), 28.5 (26.6–32.4 kg/m2). First etO2 concentration after HFNO protocol was non-inferior to first etO2 concentration after FM oxygen protocol (mean difference, 1.45;95% CI, 0.19–2.72;two-tailed [Formula presented]value, 0.025). 71% of participants achieved first etO2 concentration of [Formula presented]0% after the HFNO protocol versus 43.5% after the FM protocol. There was no evidence of correlation between first etO2 concentration after either modality and BMI or gestation. First etO2 concentration after HFNO was weakly correlated to percentage of time of mouth closure (Pearson’s coefficient, 0.287). First etO2 concentration after FM oxygen was moderately correlated to respiratory rate in the final protocol minute and minute ventilation (Pearson’s coefficient, 0.426 and 0.339 respectively). Discussion: HFNO was non-inferior to FM oxygen for increasing etO2 concentration after simulated preoxygenation of women in late pregnancy. These results suggest that HFNO may be a suitable alternative to FM oxygen for preoxygenation of pregnant women prior to general anaesthesia. Disclosure: Fisher & Paykel Healthcare provided equipment for this trial.