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We examine nonprofit organizations' involvement in the Paycheck Protection Program (PPP). The PPP provided participants with forgivable loans to pay employee salaries, increasing participants' financial flexibility during the pandemic. We examine the associations between nonprofits' prepandemic financial obligations (e.g., long-term debt and donorrestricted net assets) and PPP participation and participants' loan characteristics. First, we find nonprofit organizations participated at a lower rate than other small business industries and that nonprofits with greater financial obligations were more likely to participate in the program. Second, we find financial obligations were positively associated with the loan amount received as a percentage of total payroll costs. Last, although approximately 11% of nonprofits failed to obtain loan forgiveness, we find nonprofits with restricted net assets were more likely to have their loans forgiven. Our results suggest nonprofits with greater debt and donor obligations used the PPP to increase their financial flexibility.
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Voriconazole is a fluoride-containing anti-fungal. Prolonged exposure can result in fluoride deposition within the bone extracellular matrix, resulting in periostitis and arthritis. We report a patient who developed widespread bony pain and polyarthralgia while on voriconazole therapy for COVID-19-associated pulmonary aspergillosis. No associated autoimmune rheumatic disease or alternative cause was noted. Blood investigations showed elevated total serum alkaline phosphatase, bone-specific ALP and fluoride levels, with normal serum voriconazole levels. A whole body nuclear bone scan showed multifocal periostitis. A diagnosis of voriconazole-induced periostitis and arthritis was made. Complete resolution of clinical symptoms with normalisation of the serum ALP occurred within four weeks of voriconazole cessation. While voriconazole-induced periostitis/arthritis is a recognised phenomenon in solid organ and haematopoietic stem cell transplant patients on long-term voriconazole, this case highlights the importance of having a high index of suspicion in other settings including CAPA. Clinical presentation can be mistaken for bony metastatic disease or other inflammatory arthritis.
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Intro: Ritonavir-boosted nirmatrelvir has shown efficacy in reducing the rate of hospitalisation and 28-day mortality among unvaccinated populations with COVID-19. The role of Ritonavir-boosted nirmatrelvir among high risk hospitalised COVID-19 patients remained uncertain. Our study aimed to assess the efficacy of Ritonavir-boosted nirmatrelvir in reducing disease progression among high-risk hospitalised COVID-19 patients. Method(s): This is a retrospective case-control study (ratio 1:1) among hospitalised COVID-19 patients with mild-moderate severity, within 5 days of illness, and had at least one risk factor for severe disease. Treatment group (case) received Nirmatrelvir and Ritonavir twice daily for 5 days. Historical controls before the introduction of Ritonavir-boosted nirmatrelvir were obtained in the same hospital. Both groups received standard of care. The primary outcome was rate of clinical progression from non-hypoxia to hypoxia. Finding(s): 200 patients from January to July 2022 were included in the analysis, where 108 (54%) were male, mean age of 63.7 (SD 17.1), 95% completed primary COVID-19 vaccination and 91 (45.5%) had evidence of pneumonia (moderate severity). Most common comorbids were hypertension(65%), diabetes mellitus(40%) and overweight(36%). Clinical progression to hypoxia was significantly lower in the treatment group (4%) compared to the control group (18%) (OR=0.190, 95% CI: 0.0618 - 0.583). Comparing case to control, the rates of ICU admission were 1% vs 3%, mechanical ventilation 0% vs 2% and inpatient mortality 2% vs 2%. 97% patients completed Ritonavir-boosted nirmatrelvir in the treatment group. Conclusion(s): Among high-risk hospitalised COVID-19 patients who received ritonavir-boosted nirmatrevir, they were 81% less likely to experience desaturation. Ritonavir-boosted Nirmatrelvir remains beneficial among highly vaccinated populations during the Omicron wave in COVID-19 pandemic.Copyright © 2023
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Intro The RECOVERY trial showed evidence that dexamethasone given at moderate doses for a short period of time reduced mortality in comparison to standard of care in hospitalised COVID-19 patients. However, there is no evidence to demonstrate whether higher doses of steroid may improve or worsen the outcomes. This study compares the effectiveness of low-dose- methylprednisolone to pulse-methylprednisolone among the critically-ill COVID- 19 patients. Methods This is a retrospective observational study among critically-ill COVID- 19 patients whom were admitted to intensive care unit Hospital Pulau Pinang from August 2020 until February 2021. We collected the data of patients that received either methylprednisolone dose more than 2mg/kg/day or methylprednisolone dose equal or less than 2mg/kg/day. Both groups received standard of care. The primary outcome is all-cause mortality within 30 days from symptoms onset. The secondary outcomes are duration of mechanical ventilation, length of ICU stays and rate of complications such as acute kidney injury, sepsis, bleeding tendency and diabetic ketoacidosis. Findings A total of 100 patients were included in the analysis, whom 64% were male, mean age of 56.6 (SD 13.4) and 53% have at least one comorbidity. The survival analysis revealed that 30 days survival rate were 91.2% in the low-dose- methylprednisolone group and 81.8% in the pulse-methylprednisolone group (p = 0.226) and showed no significant differences after adjustment for covariates such as the doses of methylprednisolone, gender, requirement of mechanical ventilation and absence or presence of comorbidity. However, age more than 60 years old does increase the risk of mortality (p value 0.018). Comparing the low- dose-methylprednisolone to pulse-methylprednisolone, the duration of mechanical ventilation were 15.7 days vs 13.8 days (p 0.572), length of ICU stay were 14.9 days vs 15 days (p 0.875) and rate of complications were not significantly differences. Conclusion The use of pulse-methylprednisolone in critically-ill COVID-19 patients does not improve the survival rate.
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Prior studies on night market tourism have mainly investigated by governments and scholars on the current situation products and development strategies with descriptive research. There are no empirical studies that have explored the perceptions of tourists in the development of night market tourism. More importantly, because of the COVID-19 pandemic, issues of night market products and services, and tourists' opinions about night markets have become a challenge. This study aims to examine the relationships between attitude, subjective norm (SN), perceived behavioural control (PBC), perceived without travel risk, and visit intention towards night markets aftermath of the COVID-19 pandemic. A quantitative approach was used using an online survey method involving 387 respondents followed by subsequent empirical testing of the proposed hypotheses, which was performed using SPSS and AMOS. The results indicate that attitude, SN, PBC, and perceived without travel risk positively influence intention. Furthermore, SN also displayed a significant positive influence on attitude, PBC, and perceived without travel risk. Finally, the theoretical and practical implications, as well as limitations were discussed. © by the author.
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Purpose: Most educational institutions worldwide have shifted to online teaching and learning approaches to mitigate risks imposed by the COVID-19 pandemic. This causes several issues, particularly in delivering the construction management (CM) courses which require site visits, interpreting technical drawings and developing 3D building models. This paper aims to identify the key strategies for online learning and teaching adopted during the COVID-19 pandemic and to investigate the implications for construction management education. Design/methodology/approach: The research approach is twofold. First, the study presents a systematic literature review (SLR) through a synthesis of the existing literature to identify the key strategies and lessons learned about online education during the COVID-19 pandemic in tertiary programs. It also discusses their implications in the context of the construction management (CM) sector in particular. Secondly, the authors shared their hands-on experience as construction management course facilitators – using the autoethnography approach – during the COVID-19 crisis. Findings: In addition to identifying the key strategies such as online course delivery and assessments, the paper critically discusses the barriers to online learning and teaching, including (1) the technological and infrastructure barriers;(2) required online teaching skills and competencies;(3) issues surrounding mental health and wellbeing;(4) lack of consistency in the online delivery of various courses in a given program (5) difficulties around students' engagement and (6) the course characteristics and requirements. Originality/value: The study offers some implications and recommendations not only for educational institutions and staff but also for vendors of online course delivery software. To prepare educational institutions for future online course delivery, the paper proposes several strategies. These include developing a set of guidelines for online course delivery, incorporating online teaching training modules into the recruitment process for academic staff, applying agile and resilience teaching and learning methods, wellbeing and mental health support and continuously improving course features to adapt to the online environment. © 2023, Emerald Publishing Limited.
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Introduction and Objective: Idiopathic inflammatory myopathies(IIMs) is a group of autoimmune disease characterized by muscular and extra-muscular manifestation. IIMs with anti-MDA5 antibody positivity carries poor prognosis due to rapid progressive interstitial lung disease (RP-ILD). We report clinical course of patients cared in our centre. Method(s): Patients medical record were reviewed for data collection. Result(s): Four patients with MDA5 antibody positive IIMs following up in our clinic (Table 1). None has reported Covid infection. Two has respiratory disease responded to induction therapy. One still undergoing titration of immunosuppressant. One female patient presented unwell with pleural effusion and acute pneumonitis. Patient later developed rapid progression of interstitial lung inflammation with refractory supraventricular tachycardia. IVIG was initiated, however she succumbed to adult respiratory distress syndrome (ARDS) due to pneumonia. Plasma exchange was not carried out due to source limitation at that time of period. Conclusion(s): Prevalence of anti MDA-5 positive is 30%-50% in Asians patients with IIMs particularly the east. However, it is likely under-reported in Malaysia due to lack of understanding of the pattern of disease in our multiracial population as well as lack of myositis serology tests availability especially in government hospitals. Research and registry should be instituted to allow better study of this disease in our population, to better the treatment and reduce morbidity and mortality due to rapid progressing interstitial lung disease. (Table Presented).
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COVID-19 , Kidney Failure, Chronic , Kidney Transplantation , Humans , Renal Dialysis , Hong KongABSTRACT
The importance of social networks has increased in recent decades, yet the use of social learning in higher education is nascent. Little is known how to foster high levels of social learning discourse among students in higher education classrooms. To address this gap, the present study analyses the use of a mobile application (Soqqle) for sharing student-generated content and peer to-peer communication. Students from Hong Kong, Malaysia, and Indonesia uploaded videos linked to assessments and received feedback from their instructors and peers through social engagement features (e.g., comments, likes). The majority of students reported that the social learning experience promoted idea generation, increased creativity, and improved attention. These results indicate that integrating online platforms and mobile applications can promote social learning. The findings have important implications for educational practice because many educational institutions have adopted online learning due to the COVID-19 pandemic. © 2022 Hong Kong Bao Long Accounting And Secretarial Limited. All rights reserved.
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The purpose of this study is to incorporate a collaborative flipped classroom technique using student-generated videos to increase classroom participation. Traditional flipped classroom methods depend on educators to spend resources to produce video content. However, there is uncertainty whether a scalable and sustainable method with student-generated content can be used. Student-generated videos may provide opportunities for increasing collaboration and online engagement. The lack of knowledge and evidence has motivated this pilot study for which students record short reflective videos prior or after class using a private social media application, Soqqle. This was performed across three classes of differing modules in Hong Kong and Thailand. Evaluation and analysis of the classes differ, between participation and learning improvements, although having a similar teaching method of using student-generated videos. Results were mixed. In some cases, the predictors of correlational analysis were contradicting. In one group, results show a 64.2% increase in participation compared to the COVID-19 period. In another group, a regression analysis was able to predict learning performance with 41.2% accuracy (p= <. 001), using the number of videos watched and average duration as predictors. A teaching and learning framework for using the collaborative flipped classroom model is proposed and can be adapted by future researchers. Suggestions to further enhance the model are discussed. © 2022 IEEE.
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Background: Dysgeusia is a distortion of taste sensation. Etiologies can include medications and Covid-19, among others. Dysgeusia may lead to appetite loss which is nonspecific and can have multiple causes, including major depressive disorder (MDD) (Coulter, 1988). Although post-marketing data revealed no association between nifedipine and dysgeusia (Ackerman, 1997), case reports of dysgeusia from nifedipine exist (Ackerman, 1997). We present a case of nifedipine-induced dysgeusia mistaken for depression. Case Report: A 42-year-old man with hypertension and diabetes was admitted to the hospital following right thalamocapsular and intraventricular hemorrhages. Hypertension was managed with metoprolol, lisinopril, nifedipine, and chlorthalidone. Levetiracetam was started for seizure prophylaxis. Medications included pantoprazole, simethicone, transdermal lidocaine, insulin, metformin, docusate, senna, and subcutaneous heparin. Psychiatric consultation was requested out of concern that appetite loss indicated depression. The day before psychiatric evaluation, mirtazapine 15 mg at bedtime for mood and appetite was started. Nifedipine 90 mg daily had been started 9 days prior to his first complaint of decreased appetite. The patient reported feeling disconnected from his family and “sad" for ∼10 years, complaining that family members “talk behind his back.” He was otherwise without paranoia. He denied insomnia, anhedonia, hopelessness, poor concentration, suicidal ideation, homicidal ideation, guilt, mania, or hallucinations. He reported poor appetite due to epigastric discomfort and bad taste to foods. Covid-19 testing was not yet widely available. No other signs or symptoms suggestive of Covid-19 were present. Although alert and fully oriented, concentration was impaired with sometimes tangential thought processes. Affect was full without depression. A diagnosis of adjustment disorder was made. The psychiatry team suspected nifedipine-induced dysgeusia and advised discontinuing nifedipine. Appetite improved two days later. Discussion: This case highlights the importance of considering alternative causes of nonspecific symptoms of depression, including decreased appetite, that may have non-psychiatric causes. Dysgeusia is widely recognized as a symptom of Covid-19. Other causes, including medications may be underrecognized and amenable to intervention. Conclusion: It would be helpful to consider medication side-effects as potential causes for taste distortion alongside psychiatric diagnoses, and COVID-19. References: 1. Coulter DM: Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of post marketing surveillance BMJ 1988;296: 1086–8. 2. Ackerman BH, Kasbekar N: Disturbances of taste and smell induced by drugs. Pharmacotherapy 1997;17(3):482-96.
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Artificial intelligence (AI) has entered tourism and become a new service in a tour guide. AI technology can help tourism by providing customized services and attracting visitors to fight with the crisis of the COVID-19 epidemic. This paper introduces how AI tour guide services contribute to tourism and its main issues. The future development of AI tour guides also was discussed at the end and the authors believe lifelong machine learning is the key to developing AI tour guides. © 2021 IEEE.
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Cancer patients display immunomodulation related to malignancy and anti-cancer therapies, but how these factors impact COVID-19 remains unknown. To investigate immune responses in cancer patients with COVID-19, we undertook a prospective case-control study, enrolling hospitalized solid tumor patients with acute COVID-19, as well as age-, gender-, and comorbidity-matched COVID-19 patients without cancer as controls. Using biospecimens collected during hospitalization, we performed virologic measurements as well as in-depth immunophenotyping of cellular, antibody and cytokine responses. We enrolled 17 cancer patients (cases) admitted to Yale-New Haven Hospital between March 15 and June 30, 2020 with COVID-19, as well as 17 matched non-cancer patients (controls) admitted with COVID-19. No significant differences were observed between cases and controls based on patient characteristics (age, gender, race, co-morbidities, smoking history, days from symptom onset to COVID-19 diagnosis) or outcomes (COVID-19 severity, length of hospital stay, rate of intubation or mortality). The most common primary tumor sites were lung (4/17) and gastrointestinal (4/17);all cases had received cancer-directed therapy within 6 months of COVID-19 diagnosis, with 13/17 receiving treatment less than 1 month prior to hospitalization. Three of 17 cases had received immune checkpoint inhibitor therapies. Despite having similar SARS-CoV-2 viral RNA loads at the time of COVID-19 diagnosis when compared with controls, cancer cases had increased viral RNA abundance during hospitalization, suggesting slower clearance. Antibody responses against SARS-CoV-2 were preserved in cancer cases, with cases displaying similar levels of IgM and IgG antibodies directed against SARS-CoV-2 epitopes compared to controls. Cytokine profiling revealed higher plasma levels of CCL3, IL1A and CXCL12 in cancer cases compared to controls. Using flow cytometric immunophenotyping, we found that innate immune and non-T cell adaptive immune parameters were similar between cases and controls hospitalized with COVID-19. However, among cancer cases on conventional therapies, T cell lymphopenia was more profound, and these cases demonstrated higher levels of CD8+ exhausted (CD8+CD45RA-PD1+TIM3+ ), CD8+GranzymeB+ and CD4+CD38+HLA-DR+ and CD8+CD38+HLA-DR+ activated T cells when compared with controls;interestingly, these differences were not observed in patients who had received immune checkpoint inhibition. Thus, we found reduced viral RNA clearance and specific alterations in T cell and cytokine responses in cancer patients hospitalized with COVID-19 compared with matched controls with COVID-19. This dysregulated T cell response in cancer patients, which may reflect immune modulation due to chronic antigen stimulation as well as cancer therapies, may lead to altered virologic and clinical outcomes in this population.
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Background The COVID-19 pandemic has brought significant challenges to clinicians caring for liver transplant (LT) recipients. Researchers have sought to better understand the risk and clinical outcomes of LT recipients infected with COVID-19 globally, however, there is a paucity of data from within Canada. Aims Our multi-center study aims to examine the characteristics and clinical outcomes of LT patients with COVID-19 in Canada. Methods We identified a retrospective cohort of adult LT recipients with RT-PCR confirmed COVID-19 from 7 Canadian tertiary care centers between March 2020 and June 2021. Demographic and clinical data were compiled by clinicians within those centers. We identified liver enzyme profile at the time of COVID-19 infection, immunosuppression type and post-infection adjustments, rate of hospitalization, ICU admission, mechanical ventilation, and death. Results A total of 49 patients with a history of LT and COVID-19 infection were identified. Twenty nine patients (59%) were male, the median time from LT was 66 months (1, 128) and the median age at COVID-19 infection was 59 years (52, 65). At COVID-19 diagnosis, the median ALT was 37 U/L (21, 41), AST U/L was 34 (20, 37), ALP U/L was 156 (88, 156), Total Bilirubin was 11 umol/L (7, 14), and INR was 1.1 (1.0, 1.1). The majority of patients (92%) were on tacrolimus monotherapy or a combination of tacrolimus and mycophenolate mofetil (MMF);median tacrolimus level at COVID-19 diagnosis was 5.3 ug/L (4.0, 8.1). Immunosuppression was modified in 8 (16%) patients post-infection;either the tacrolimus dose was reduced or MMF was held. One patient developed acute cellular rejection which recovered after re-initiation of the prior regimen. Eighteen patients (37%) required hospitalization, 6 (12%) were treated with dexamethasone, and 3 (6%) required ICU admission and mechanical ventilation. Four patients (8%) died due to complications of COVID-19. On univariate analysis, neither age, sex, co-morbidities nor duration post-transplant were associated with risk of hospitalization. Conclusions In our national retrospective study, approximately 40% of patients required hospitalization with a mortality rate of < 10%. Previous studies have shown proximity to LT as an independent factor for mortality with COVID-19;the median time from LT for our patients was 5 years, which may explain the lower mortality rate. Of note, the median tacrolimus levels were much lower in comparison to the target of 8–10 ug/L used in the first year post-transplant. As the landscape of COVID-19 changes with vaccination, evolving treatments, and increasing rates of variant transmission, additional studies are required to continue identifying trends in clinical outcomes. Funding Agencies None