Lung Aspergillus niger infection after SARS-CoV2

A 64-year-old never-smoker man, with professional exposure, presented to Marius Nasta Pneumophtisiology Institute for fatigability to effort, in the context of severe SARS-COV2 infection one month previously. His medical history includes pulmonary tuberculosis (55 years ago) and newly diagnosed type II diabetes (261 mg/dL glycemia). The thoracic tomography computer in the immediate post-COVID period (Fig. 1A) revealed the presence of glass ground lesions and a 3 cm nodule with cystic degeneration in the upper left lobe. A gross examination of the specimen identified a condensation area of 2.5 cm diameter, brown-grey colored, with necrosis and central ulceration. Microscopic examination showed the presence of bronchiectasis with squamous metaplasia of the epithelium, which appears ulcerated;numerous calcium oxalate crystals with adjacent foreign body granulomatous reaction;endobronchial are present fibrinous and inflammatory debris, brown-black pigment, and septate, dichotomous branching hyphae, suggestive of Aspergillus spp. A periodic acid-Schiff stain was performed, identifying the fungal hyphae. The histopathological diagnosis was bronchiectasis supra-infected and colonized with fungal filaments (Aspergillus niger).

Generating students' loyalty towards the sustainable university during the later COVID-19 pandemic

PurposeThe COVID-19 pandemic has brought tremendous changes in society. Universities were among the few organisations with some previous knowledge of online education, being able to rapidly adapt by transferring already known best practices to the new context. As teaching moved to online, students encountered less sustainable implementation by their universities. This allowed the development of previously planned sustainable strategies so that when face-to-face teaching resumed, universities could be even more sustainable. This paper aims to explore loyalty to the sustainable university during the later COVID-19 pandemic based on the university's efforts to manage a green campus. Design/methodology/approachTo investigate loyalty towards the sustainable university during the later COVID-19 pandemic, a conceptual model is proposed. This research is grounded in an empirical investigation using a quantitative online survey implemented with online interviews, the relations between all latent constructs being analysed with SmartPLS. FindingsThe results show that university sustainability reflects student loyalty, outlining the image developed under the influence of green campus management. The results show that universities must intensify their efforts to support the sustainable agenda and create a sustainable academic brand, inducing student loyalty. The findings may attract the attention of other universities wishing to gain knowledge about the factors that students consider important in generating their loyalty. Research limitations/implicationsAs this research was carried out in the later COVID-19 pandemic context from 2021, the students already had experience of online teaching, so their assessment of the sustainability strategies implemented could be quite different from their perceptions in the first months of the pandemic. This research provides a comprehensive insight into the overall strategy that a sustainable university might apply in a crisis context. Social implicationsResearch has shown that green campus management has a positive impact on the sustainability of a university's image, on how students perceive the university at which they study and on the university's efforts to ensure efficient campus management. These factors contribute to the development of a strong and sustainable image of the university within the community. Originality/valueThe originality of this paper lies in the research questions designed to conceptualise and operationalise the generation of students' loyalty towards their university by encouraging and implementing sustainable strategies on campus. This paper highlights a structural model that combines strategic practices to determine students' loyalty towards a sustainable university during the COVID-19 pandemic.

Inclusive Study Group Formation at Scale

Underrepresented students face many significant challenges in their education. In particular, they often have a harder time than their peers from majority groups in building long-term high-quality study groups. This challenge is exacerbated in remote-learning scenarios, where students are unable to meet face-to-face and must rely on pre-existing networks for social support. We present a scalable system that removes structural obstacles faced by underrepresented students and supports all students in building inclusive and flexible study groups. One of our main goals is to make the traditionally informal and unstructured process of finding study groups for homework more equitable by providing a uniform but lightweight structure. We aim to provide students from underrepresented groups an experience that is similar in quality to that of students from majority groups. Our process is unique in that it allows students the opportunity to request group reassignments during the semester if they wish. Unlike other collaboration tools our system is not mandatory and does not use peer-evaluation. We trialed our approach in a 1000+ student introductory Engineering and Computer Science course that was conducted entirely online during the COVID-19 pandemic. We find that students from underrepresented backgrounds were more likely to ask for group-matching support compared to students from majority groups. At the same time, underrepresented students that we matched into study groups had group experiences that were comparable to students we matched from majority groups. B-range students in high-comfort and high-quality groups had improved learning outcomes. © 2023 Owner/Author.

Development of a mathematical model to predict the health impact and duration of SARS-CoV-2 outbreaks on board cargo vessels

The Coronavirus Disease (COVID-19) pandemic has brought significant impact onto the maritime activities worldwide, including disruption to global trade and supply chains. The ability to predict the evolution and duration of a COVID-19 outbreak on cargo vessels would inform a more nuanced response to the event and provide a more precise return-to-trade date. This paper presents the SEIQ(H)R (Susceptibility–Exposed–Infected–Quarantine–(Hospitalisation)–Removed/Recovered) model, which is the first deterministic mathematical model developed and fit-tested to describe the transmission dynamics of COVID-19 on board cargo vessels of up to 60 crew members. Due to specific living and working circumstances on board cargo vessels, instead of utilising the reproduction number, we consider the highest fraction of crew members who share the same nationality to quantify the transmissibility of the disease. The performance of the model is verified using case studies based on data collected during COVID-19 outbreaks on three cargo vessels in Western Australia during 2020. The simulations show that the model can forecast the time taken for the transmission dynamics on each vessel to reach their equilibriums, providing informed predictions on the evolution of the outbreak, including hospitalisation rates and duration. The model demonstrates that (a) all crew members are susceptible to infection;(b) their roles on board are a determining factor in the evolution of the outbreak;and (c) an unmitigated outbreak could affect the entire crew and continue on for many weeks. The ability to model the evolution of an outbreak, in both duration and severity, is essential to predict outcomes and to plan for the best response strategy. At the same time, it offers a higher degree of certainty regarding the return to trade, which is of significant importance to multiple stakeholders.

COVID-19 Independent Risk Factors for Unfavorable Disease Progression: A Cross-Sectional Study from Romania

Purpose: Since the initial documentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late December 2019, the coronavirus disease 2019 (COVID-19) pandemic has become a leading cause of morbidity and mortality worldwide. Under these circumstances, the present study aimed to analyze the characteristics of hospitalized cases, according to the progression and severity of the disease, to reveal the main independent risk factors for death by COVID-19 in the western Romanian population. Patients and Methods: This retrospective study included 936 patients admitted to Victor Babes Clinical Hospital of Infectious Diseases Timisoara, with COVID-19 between 1 February 2020 and 31 January 2021. The patients were divided into three subsamples based on disease severity: subsample I (n = 344), comprising patients with mild forms of the disease;subsample II (n = 475) comprising patients with moderate disease;and subsample III (n = 117) for patients with severe disease. Biochemical analysis and assessment of disease severity were performed on all patients. Results: The mean age was 48.76 years (two months to 94 years). The median values for age, number of hospitalization days, and disease duration days before hospital admission varied with high statistical significance between the three subsamples (p < 0.001). A statistically significant difference was also observed regarding body mass index (BMI), with higher values in subsample III (p < 0.001). The in-hospital fatality rate was zero in subsample I, 3.58% in subsample II, and 71.79% in subsample III (p < 0.001). Of the deceased patients, 69.31% were over the age of 65 years, 29.70% were aged 36–64 years, and 0.99% were aged 19–35 years. Cumulated comorbidities were recorded in 92.08% of the deceased patients. Conclusion: Older age, the number of disease duration days before hospital admission, BMI, and renal pathology are independent risk factors for mortality in COVID-19 and can help clinicians to identify patients with poor prognosis and who are at high risk for mortality at an early stage.

Perioperative SARS-CoV-2 infection is not associated with increased morbidity and mortality rates after pancreatico-duodenectomy. a single center experience

Introduction: SARS-CoV-2 infection represented a huge burden on the healthcare systems worldwide during the pandemic year 2020. Perioperative infection with SARS-CoV-2 was previously associated with increased mortality and morbidity rates for few surgical procedures, but data about pancreatic resections are scarce. The study aims to assess the impact of perioperative SARS-CoV-2 infection on early outcomes after pancreatico-duodenectomies. Methods: The data of 50 patients with pancreatico-duodenectomies performed during the pandemic year 2020 at our institution were retrospectively assessed from a prospective electronic database. The patients were divided into two groups: with and without perioperative SARS-CoV-2 infection. Demographic, clinical, bioumoral, pathological, intraoperative and early postoperative outcomes were compared between the groups, with the appropriate statistical tests. All patients were negative for SARS-CoV-2 infection at RT-PCR test 48 hours prior to surgery. Results: A number of 8 patients (16%) were diagnosed with SARS-CoV-2 infection at a median POD 11 (range, 6 – 32 POD). Perioperative SARS-CoV-2 infection was only associated with statistically significant increased overall length of hospital stays (33 vs. 15 days, p < 0.0001) but not with increased intensive care unit stay, overall or severe morbidity, clinically relevant pancreatic fistulae, delayed gastric emptying, hemorrhage, bile leak, pulmonary complications or in-hospital mortality rates (p values ≥ 0.062, ns). Conclusion: Perioperative SARS-CoV-2 infection was not associated with increased morbidity or mortality rates after pancreatico-duodenectomies. However, significant prolonged overall hospital stays were observed. The data should be interpreted with caution due to the limited number of patients.

Optimising the quarantining and response sequence towards SARS-CoV-2 outbreaks on board cargo vessels (preprint)

The Coronavirus Disease (COVID-19) pandemic has brought significant impact onto the maritime activities worldwide, including disruption to global trade and supply chains. The ability to predict the evolution and duration of a COVID-19 outbreak on cargo vessels would inform a more nuanced response to the event and provide a more precise return-to-trade date. A SEIQ(H)R (Susceptibility-Exposed-Infected-Quarantine-(Hospitalisation)-Removed/Recovered) model is developed and fit-tested to simulate the transmission dynamics of COVID-19 on board cargo vessels of up to 60 crew. Due to specific living and working circumstances on board cargo vessels, instead of utilising the reproduction number, we consider the crew members from the same country to quantify the transmission of the disease. The performance of the model is verified using case studies based on data collected during COVID-19 outbreaks on three cargo vessels in Western Australia during 2020. The convergence between simulation results and the data verifies the performance of the model. The simulations show that the model can forecast the time taken for the transmission dynamics on each vessel to reach their equilibriums, providing informed predictions on the evolution of the outbreak, including hospitalisation rates and duration. The ability to model the evolution of an outbreak, both in duration and severity, is essential to predict outcomes and to plan for the best response strategy. At the same time, if offers a higher degree of certainty regarding the return to trade, which in turn is of significant importance to multiple stakeholders.

Azure Web Application for Testing the Factors Influencing Online Assessment Quality

During the COVID-19 pandemic, many countries have placed lockdowns that forced teachers to perform online education exclusively and therefore online testing became, from an additional evaluation tool, the main evaluation method of student performance. There are multiple factors that can influence a test result and some of them can be exacerbated in an online environment compared to an in person testing environment. This paper reviews and analyses the factors that influence test results and places accent on factors related to test design quality (validity and reliability): test length, question length, question complexity, question order, blocking the possibility to go back to previous questions, etc. and presents the implementation of an open-source Azure cloud-based web application for testing their influence. The code of this platform is free (https://github.com/manuelcore/onlinetestingfactors) with GPL license and will allow further developing and testing to be completed in the future. Problems related to solution implementation are discussed and cloud web app constraints. © 2021 IEEE.

SARS-CoV-2 infections among Australian passengers on the Diamond Princess cruise ship: A retrospective cohort study.

BACKGROUND: Prolonged periods of confined living on a cruise ship increase the risk for respiratory disease transmission. We describe the epidemiology and clinical characteristics of a SARS-CoV-2 outbreak in Australian passengers on the Diamond Princess cruise ship and provide recommendations to mitigate future cruise ship outbreaks. METHODS: We conducted a retrospective cohort study of Australian passengers who travelled on the Diamond Princess from 20 January until 4 February 2020 and were either hospitalised, remained in Japan or repatriated. The main outcome measures included an epidemic curve, demographics, symptoms, clinical and radiological signs, risk factors and length of time to clear infection. RESULTS: Among 223 Australian passengers, 56 were confirmed SARS-CoV-2 positive. Forty-nine cases had data available and of these over 70% had symptoms consistent with COVID-19. Of symptomatic cases, 17% showed signs and symptoms before the ship implemented quarantine and a further two-thirds had symptoms within one incubation period of quarantine commencing. Prior to ship-based quarantine, exposure to a close contact or cabin mate later confirmed SARS-CoV-2 positive was associated with a 3.78 fold (95% CI, 2.24-6.37) higher risk of COVID-19 acquisition compared to non-exposed passengers. Exposure to a positive cabin mate during the ship's quarantine carried a relative risk of 6.18 (95% CI, 1.96-19.46) of developing COVID-19. Persistently asymptomatic cases represented 29% of total cases. The median time to the first of two consecutive negative PCR-based SARS-CoV-2 assays was 13 days for asymptomatic cases and 19 days for symptomatic cases (p = 0.002). CONCLUSION: Ship based quarantine was effective at reducing transmission of SARS-CoV-2 amongst Australian passengers, but the risk of infection was higher if an individual shared a cabin or was a close contact of a confirmed case. Managing COVID-19 in cruise ship passengers is challenging and requires enhanced health measures and access to onshore quarantine and isolation facilities.

The Healthy Crew, Clean Vessel, and Set Departure Date Triad: Successful Control of Outbreaks of COVID-19 On Board Four Cargo Vessels.

BACKGROUND: A variety of infectious diseases can cause outbreaks on board vessels, with both health and economic effects. Internationally, Coronavirus Disease 2019 (COVID-19) outbreaks have occurred on numerous cruise and cargo vessels and the containment measures, travel restrictions, and border closures continue to make it increasingly difficult for ship operators world-wide to be granted pratique, effect crew changes, and conduct trade. An effective outbreak management strategy is essential to achieve the outcome triad - healthy crew, clean vessel, and set departure date - while maintaining the safety of the on-shore workers and broader community and minimizing disruption to trade. This report describes the principles of COVID-19 outbreak responses on four cargo vessels, including the successful use of one vessel as a quarantine facility. METHODS: Established principles of management and the experiences of COVID-19 outbreaks on cruise ships elsewhere informed a health-lead, multi-agency, strict 14-day quarantine (Q) regime based on: population density reduction on board; crew segregation; vessel cleaning and sanitation; infection risk zones, access, and control measures; health monitoring; case identification and management; food preparation and delivery; waste management control; communication; and welfare and security. FINDINGS: Sixty-five crew were diagnosed with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection (range 2-25; attack rate 10%-81%; 15 asymptomatic). No deaths were recorded, and only one crew was hospitalized for COVID-19-related symptoms but did not require intensive care support. Catering crew were among the cases on three vessels. All non-essential crew (n-EC) and most of the cases were disembarked. During the vessel's Q period, no further cases were diagnosed on board, and no crew became symptomatic after completion of Q. The outbreak response duration was 15-17 days from initial decision.No serious health issues were reported, no response staff became infected, and only two Q protocol breaches occurred among crew. INTERPRETATION: Despite increasing risk of outbreaks on cargo vessels, maritime trade and crew exchanges must continue. The potential consequences of COVID-19 outbreaks to human life and to trade necessitate a balanced response. The principles described can offer health, financial, operational, and safety advantages.

Delusions of Certainty: Commercial Vessel COVID-19 Risk Stratification.

Since the World Health Organization's (WHO's) pandemic declaration on March 11, 2020, coronavirus disease 2019 (COVID-19) outbreaks have occurred on numerous maritime vessels and the containment measures, travel restrictions, and border closures continue to make it increasingly difficult for ship operators world-wide to be granted pratique, conduct trade, and conduct crew changes.Knowledge of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) circulating on-board a ship prior to its arrival has significant implications for the protection of shore-based maritime workers (ie, pilots, stevedores, and surveyors), the broader community, and trade. A useful approach is a graded assessment of the public health risk. The Western Australia (WA) experience and associated observed pitfalls in implementing the prediction equation for the potential presence of SARS-CoV-2 on-board based on five COVID-19 outbreaks on commercial and cruise vessels during 2020 is described.Despite best efforts, the qualitative and quantitative predictors of SARS-CoV-2 circulating on-board commercial vessels are failing to deliver the required certainty, and to date, the only accepted method of ascertaining the presence of SARS-CoV-2 remains the real-time reverse transcription polymerase chain reaction (rRT-PCR) testing reported by an accredited laboratory.Based on legal or regulatory requirements, germane processes, underpinned by robust and auditable processes and procedures, must be put in place to inform the risk assessment of SARS-CoV-2 circulating on-board vessels.

Successful Control of an Onboard COVID-19 Outbreak Using the Cruise Ship as a Quarantine Facility, Western Australia, Australia.

Onboard quarantining has been only partially effective to control outbreaks of coronavirus disease on cruise ships. We describe the successful use of the ship as a quarantine facility during the response to the outbreak on the MS Artania, which docked in Western Australia, Australia. The health-led 14-day quarantine regime was based on established principles of outbreak management and experiences of coronavirus disease outbreaks on cruise ships elsewhere. The attack rate in the crew was 3.3% (28/832) before quarantine commencement and 4.8% (21/441) during quarantine on board. No crew members became symptomatic after completion of quarantine. Infection surveillance involved telephone correspondence, face-to-face visits, and testing for severe acute respiratory syndrome coronavirus 2. No serious health issues were reported, no response staff became infected, and only 1 quarantine breach occurred among crew. Onboard quarantine could offer financial and operational advantages in outbreak response and provide reassurance to the shore-based wider community regarding risk for infection.