Evaluation of ventilation in Australian school classrooms using long-term indoor CO2 concentration measurements

School classrooms are often reported as having insufficient ventilation with elevated indoor CO2 concentrations. This paper reports on pre-pandemic field measurements of CO2 concentration levels conducted for an academic year in 10 classrooms from four primary and a secondary school in Victoria, Australia. Measured CO2 concentrations across the 10 classrooms which were operated with a mix of intermittent natural ventilation and air-conditioning for cooling or heating, on average ranged between 657 ppm and 2235 ppm during school hours with median over 1000 ppm in 70% of classrooms. All 10 classrooms in the study exceeded the Australian recommended limit of 850 ppm. Using average peak CO2 concentrations from year-long measurements, estimated ventilation rate (VR) of 4.08 Ls-1 per person show under-performing classrooms where 60% had VRs 35–40% lower than the 10-12 Ls−1 per person Australian recommendation. Estimated VR range of 1.24–2.07 Ls-1 per person using peak maximum CO2 levels were 19–30% lower than ASHRAE recommendation of 6.7 Ls-1 per person. These VRs translate to a range of air change rates on average between 0.52 and 0.88 h−1 ± 0.26–0.59, well below the 6.0 h−1 recommendation for good indoor ventilation by the World Health Organisation in the context of COVID-19 pandemic. Characterisation of ventilation and indoor air quality in current Australian classroom stock is critical for the improvement of classroom design, induction on room operating practices, understanding of the school community on the relevance of building ventilation on school performance and health, and development of appropriate ventilation and indoor air quality guidelines for schools. © 2023 The Authors

Let's Regroup: Engaging Cancer-Bereaved Youth in Group Programming Following COVID-19

Background/Purpose: Inova Life with Cancer (LWC) is a communityoriented program providing outpatient education and support to families affected by cancer. During the pandemic, psychosocial providers trialed several service models, such as virtual monthly groups and in-person 5-week series, yet experienced low attendance and/or retention rates. To address these challenges, the LWC Grief Circle Program was developed as a one-time peer-based workshop to (1) re-engage youth bereaved by cancer (2) more effectively allocate facilitators' time and resources;and (3) flexibly tailor programming to identified community needs. Method(s): Grief Circles rotated age groups and were held quarterly to allow time to screen families and plan workshops. A rolling interest list identified potential participants and determined the next targeted age range. Eligible participants included children and adolescents who had lost a family member to cancer within the last four years. Referral sources included hospital-based providers, schools, community partners, and individual inquiries. Result(s): Four Grief Circle workshops have occurred since February 2022: two for ages 7-11 (in-person), one for tweens (virtual), and one for teens (in-person). Programming was evaluated by each workshop's referral numbers, attendance rates, and parent feedback. While referrals for each group were consistent, attendance fluctuated due to several barriers (e.g., child illnesses, caregiver forgetfulness). Facilitators adapted accordingly, rescheduling when necessary and updating processes. Benefits were reported, such as participants staying connected after workshop completion. Additional workshops are planned for early 2023 and will be incorporated into results. Conclusions and Implications: After the height of the pandemic, an age-based, one-time workshop model for bereavement support of children and adolescents allowed for improved allocation of facilitator's time and resources. While creative solutions to attendance barriers are still needed, the LWC Grief Circle program provides a potential framework for revitalizing community engagement in cancer-related bereavement support and demonstrates how providers can respond flexibly to changing community needs.

Initial five and ten-minute regional cerebral oxygen saturation as a predictor of the futility of resuscitation for out-of-hospital cardiac arrest

This study aimed to investigate the usefulness of cerebral regional oxygen saturation (rSO2) during the initial 5 and 10 minutes of cardiopulmonary resuscitation (CPR) compared with an initial rSO2 and mean rSO2 during entire CPR to predict the futility of resuscitation for patients without of-hospital-cardiac arrest (OHCA). This was a prospective study involving 52 adult patients presenting in OHCA and whose cerebral rSO2 values were measured until either CPR was terminated or sustained return of spontaneous circulation (ROSC) was achieved. Receiver operating characteristics analyses were used to evaluate which time and type of measurement is better to predict non-ROSC. The area under the curve (AUC) of each rSO2 value according to measurement time (overall, initial 5 minutes and 10 minutes) were the highest value of 0.743, 0.724, and 0.739, mean values of 0.724, 0.677 and 0.701 and rSO2 (Changes in values of regional cerebral oxygen) value of 0.722, 0.734 and 0.724, respectively, while all of the initial values had a poor AUC (<0.7) and also were not statistically significant. The optimal cut-off value of each rSO2 values during overall, initial 5 minutes and 10 minutes were the highest value of 26% (sensitivity, 53.9% specificity, 92.3%), 24% (sensitivity, 56.4% specificity, 92.3%), and 30% (sensitivity, 61.5% specificity, 84.6%), mean value of 15.2%, 15.3% and 16%, respectively. None of the patients with a persistent rSO2 <=18% during the overall period achieved ROSC. Initial 5 minutes and 10 minutes cerebral rSO2 values an out-of-hospital-cardiac arrest (OHCA) are a better predictor in deciding the futility of CPR, compared to initial and overall measurements.Copyright © 2023 The Author(s). Published by MRE Press.

UNDERSTANDING OLDER HEALTH CARE WORKERS' BURNOUT DURING COVID-19

The prolonged battle against the COVID-19 pandemic has left many health care workers physically, mentally, and emotionally exhausted, exacerbating burnout that was already endemic in the healthcare sector. Burnout places not only an individual's well-being but patient care at risk. In this study, we examine protective and risk factors contributing to burnout specifically among older health care workers during COVID-19. We address these questions using data collected from an online survey conducted on health care workers employed at hospitals in Pittsburgh, Pennsylvania in February 2022. Health care workers ages 50 and older (n=165) –a subset of surveyed health care workers– were included in the analytic sample. Participants were asked a series of questions about burnout, mental health, workplace stressors, intent to leave the job, and demographics. Participants were predominantly female (88%) and white (91%) with a mean age of 57.2 years. Almost 70% were registered nurses and the remaining were service, clerical, and technical workers;the mean years of work experience was 21.5 years. Most participants (77%) experienced moderate levels of burnout. Preliminary regression analysis suggests that perceived inadequate staffing (β=2.12, p<.001) and workplace discrimination (β=1.23, p=.001) were positively associated with burnout while job autonomy (β=-1.77, p<.05) and schedule flexibility (β=-.2.09, p=.001) were negatively associated with burnout. Burnout was in turn positively associated with depression, anxiety, and intent to leave the job. These findings demonstrate the need for workplace support to address older health care workers' burnout, better accommodate their needs, and keep them safe and healthy in their jobs.

Building Immunity: Crisis And Contagion In The City State

From the financial contagion of the 2007 Global Financial Crisis (GFC) to viral contagion in the recent COVID-19 pandemic, Singapore has been severely impacted by ripples and shockwaves that have emanated from global financial and healthcare crises. At the same time, it has proven to be highly resilient amidst such instability. This book provides an in-depth account of Singapore's policy responses to the COVID-19 pandemic and GFC. It focuses on the policy capacity-building efforts that have taken place in the aftermath of earlier crises such as the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak and the 1997 Asian Financial Crisis. Linked across time and space, these four crises - SARS, COVID-19, the AFC and GFC - reflect a consistent pattern in Singapore's approach to crisis management. This is a pattern that involves policy learning and capacity-building after each crisis, and the application of these lessons and capacities to subsequent crises. In focusing on the role of policy capacity in Singapore's crisis response measures, this book will provide policymakers and practitioners with a useful framework that can be used to plan for future crises and pandemics. © 2022 by World Scientific Publishing Co. Pte. Ltd. All rights reserved.

Use of Half RBC Units in Oncology Patients during Severe RBC Shortage to Extend Hospital Supply

Background/Case Studies: Blood supply during the COVID-19 pandemic was at record lows due to blood drive cancellations, fear of contracting COVID-19, and COVID-19 donor deferrals. Splitting platelet units is a well-known method of extending platelet supply. Due to the blood type O RBC shortage during the pandemic, we split one RBC unit into two half-units to extend the RBC supply. RBC splitting has been utilized in pediatric and fluid overloaded patients, however there is no research demonstrating the effectiveness of RBC splitting to extend RBC supply. Study Design/Methods: We examined transfusion data on half and whole RBC units transfused from May 21, 2021 to November 1, 2021. The criteria for half-unit transfusion were dependent on the blood supply. In general, if there was less than one day supply of RBC units on hand, half-units were issued for stable, non-bleeding patients with hemoglobin above 7.0 g/dL in outpatients and 6.5 g/dL in inpatients. During the study period if a patient received any half RBC units, the time between the first half-unit transfused to the next RBC transfusion within the next 90 days was noted. If a patient received only whole units during this time, we observed the time from the first RBC transfusion to the next RBC transfusion in the subsequent 90 days. Pre-transfusion hemoglobin was obtained the day of the transfusion and posttransfusion hemoglobin was obtained either the day of or day after the RBC transfusion. Results/Findings: Over 6 months, 276 patients received only whole units and 229 patients received at least one halfunit. The median number of days to next transfusion in patients who received a transfusion within 90 days after a half-unit was 3 (mean 6.7 +/- 11.4) and whole unit was 5 (mean 11.8 +/- 16.7) (p <0.001). There were 38 (16.6%) patients who did not receive a transfusion within 90 days of first transfusion after a half-unit and 62 (22.5%) patients after a whole unit. The median pre-transfusion hemoglobin in those transfused half-units was 6.9 (mean 6.9 +/- 0.5) g/dL and whole units 7.0 (mean 7.2 +/- 1.3) g/dL (p <0.001). The median hemoglobin prior to the second transfusion was 6.8 (mean 6.8 +/- 0.6) g/dL in those previously transfused halfunits and 7.0 (mean 7.2 +/- 1.1) g/dL after a previous whole unit (p <0.0001). Of those transfused half-units, 46.7% received a second unit within 3 days, 56.8% within 5 days and 65.9% within 7 days. After a whole unit, 30.4% received a second unit within 3 days, 37.3% within 5 days and 44.9% within 7 days. Conclusion(s): Our study demonstrates the use of half RBC units can extend RBC inventory in the short term. Patients transfused half-units received a second transfusion earlier than those who received a whole unit, median 3 days versus 5 days after whole unit (p <0.001).

METAGENOMIC INTERROGATION OF RESPIRATORY AND GUT MICROBIAL COMMUNITIES, HOST IMMUNE RESPONSE, AND RISK OF SEVERE COVID-19

Background: Human-associated microbial communities have been linked to host immune response to respiratory viral infections. Prior investigations have observed shifts in the composition of the gut or respiratory microbiome in severe COVID-19. However, there has been no comprehensive metagenomic evaluation of the interaction between lower respiratory and gut microbiomes and host immune factors in COVID-19. Methods: From April 2020 to May 2021, we prospectively enrolled 153 hospitalized patients with mild (n=12), moderate (n=65), and severe (n=76) COVID-19 infection categorized using established clinical criteria. We longitudinally collected stool (n=270) for metagenomic profiling, and in a subset, we generated comprehensive host-microbiome-molecular profiles by collecting sputum metagenomes (n=87 participants with 212 samples) and blood cytokine levels (n=109 with 181 samples) weekly until hospital discharge. We performed omnibus testing of overall gut and respiratory community structure, species-level differential abundance testing using mixed effects modeling accounting for repeated sampling, hierarchical clustering of paired gut and respiratory metagenomic profiles, and multi-omic machine learning classification of disease severity. Results: Patients with severe COVID-19 tended to be older, were more frequently male, had higher rates of overweight/obesity, and a greater mean Charlson Comorbidity Index. Patients with severe COVID-19 infection had significantly decreased stool and respiratory microbiome a-diversity irrespective of antibiotic administration. COVID severity accounted for a small proportion of variance in stool (R2=2.4%, p=0.002) and sputum (R2=4.4%, p= 0.03) profiles. Hierarchical clustering of paired gut and respiratory samples from patients with severe COVID revealed the joint expansion of oral-typical taxa typically present during systemic inflammation (i.e., increases in Streptococcus and Peptostreptococus spp. in both gut and sputum). A pro-inflammatory milieu defined by a composite elevation of circulating plasma cytokines (e.g., IL-6, TNF-a, and IL-29 among others) were linked to broad microbial excursions in community structure for both stool and sputum as measured by Bray-Curtis distances. A random forest classifier incorporating either stool or sputum taxonomic features and accounting for age, sex, body mass index, and recent antibiotic use achieved excellent classification of biospecimens from patients with severe vs. non-severe COVID patients (AUROC > 0.80). Conclusions: Alterations of the gut and respiratory microbiome were associated with differences in host immune response and COVID-19 disease severity. Further studies are needed to identify the potential role of human-associated microbial communities as a biomarker for poor patient outcomes in COVID-19 who may warrant escalated levels of care.(Figure Presented) Fig. 1. (A) Using unsupervised feature selection (species abundance > 0.001) inclusive of taxa differentially abundant by non-parametric Wilcoxon rank-sum testing (nominal p-value < 0.05), (B) we performed random forest classification using a twice-repeated 5-fold crossvalidation scheme to predict COVID-19 disease severity from shotgun metagenomic stool profiles (C) yielding an AUROC of 0.91.

Predictors and Outcomes for COVID-19 Re-Admissions in the Anticipate Cohort.

Aims To describe readmissions of hospitalised patients with COVID-19, define predictors of readmission and explore the long term outcomes using the SF-12 score compared to patients who were not readmitted and those not hospitalised. Methods A single centre retrospective in North Inner-City Dublin. Recruitment was done through a COVID follow up clinic. Predictors of readmission and SF-12 scores at two timepoints post follow up at median 3 months and 12 months. Results Seventy (45%) participants were admitted, with a median age of 49.5 years (IQR 41.3-56.9), 36(51%) of whom were female. Unscheduled readmissions at ≤30 days in COVID-19 patients were 9(12.9%) and length of stay was four days (IQR 2-5). Readmissions were due to ongoing symptoms(n=9(64.3%)) or new complications(n=5(35.7%)). Mechanical ventilation and having symptoms of nausea and vomiting on index admission were predictive of readmission. (p=0.002). SF-12 scores at one year of readmitted patients were not different to patients who were never admitted at median one year follow up, p=.089. Conclusions Most readmissions were of short duration. Early follow up of patients post MV or who had nausea and vomiting on index admission should be prioritised. Wellbeing of readmitted patients was not different to those never hospitalised, at one year.

Medical Image Labeling via Active Learning is 90% Effective

Medical imaging AI models require large image datasets that have been labeled, or annotated, by medical professionals who are a scarce and expensive resource. Manual image labeling is also a repetitive and thus error-prone activity. We discuss active learning as a methodology to partially automate this process. This paper presents five methods by which standard active learning can be improved: (1) unsupervised structure learning prior to the active learning loop, (2) using a pre-label model to initialize the image prior to human labeling, (3) using an enhanced model inside the learning loop, (4) augmenting the trained model in the loop with an unsupervised model, and (5) improving the acquisition function that chooses the next batch of images to be labeled. We demonstrate in three practical cases, for Covid-19, breast cancer, and colonoscopies, that this method is highly effective in reducing the human workload in labeling. Finally, we discuss some of the obstacles in designing AI systems based on medical images. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Computational Fluid Dynamics Modeling Of The Efficacy Of HVAC Adjustments On Mitigating Airborne Transmission of SARS-COV-2

Assessing and improving the safety of social settings is pivotal for the reopening of facilities and institutions during the pandemic. Recent discoveries now suggest that the predominant medium of SARS-CoV-2 transmission is exposure to infectious respiratory aerosols. Airborne viral spread is particularly effective in indoor environments-which have been strongly implicated in high transmission rates and super-spreading events. This study focuses on computational fluid dynamics models developed to study the specific ventilation features of an indoor space and their effects on indoor particle spread. A case study is conducted on a typical classroom at the Cooper Union. Masked occupants are modeled in the room as aerosol sources to compare the performance of different ventilation settings on the exhaust rates of airborne particles. Simulation results reveal that increasing ventilation rates accelerate particle evacuation. Visualization and segregated data comparisons indicate regions of particle accumulation induced by the design and geometry of the classroom in relation to its occupants. Visualization is also used to observe a uniform distribution of airborne particles after only 10 minutes of simulated time-confirming the need for safety measures beyond the six feet distancing guideline. © 2021 by ASME.

Clinical Outcomes in Critically-Ill Patients with COVID-19 Treated with Therapeutic Dose of Anticoagulants for Suspected Thromboembolism

Introduction Since March 2020, the New York City hospitals have experienced a tremendous surge of COVID-19 cases. Our hospital admitted 877 patients in a 2-week period, from March 15 to Apr 1, 2020. The exact mechanism of how COVID-19 causes vascular injury is unclear but some experts attribute it to widespread vascular inflammation[2,3]. The limited understanding of the hypercoagulable mechanism has limited our treatment techniques. To date, whether therapeutic anticoagulation is the right choice in regard to optimal management of patients with COVID-19 in suspected but not confirmed DVT (deep vein thrombosis) or PE (pulmonary embolism) is still a question[4]. Method We performed a retrospective observational cohort analysis of 145 adult ICU patients at an acute care teaching hospital located in Queens County, New York between March 15, 2020 to April 1, 2020. The study was approved by IRB. All patients >18 years of age with confirmed SARS-CoV-2 infection and determined to require admission to intensive care units between March 15, 2020 and April 1, 2020, inclusive of those dates, were included in the investigation, with the exclusion of pregnant patients. All data was collected from the electronic health record (Allscripts) and was compiled in REDCap software for data encryption. During that study period, therapeutic anticoagulants were used in hospitalized patients with COVID-19 with high clinical risk or suspicion for venous thromboembolism (VTE). As per hospital protocol, heparin continuous infusion with a target activated partial thromboplastin time of 50 to 70 seconds or enoxaparin 1mg/kilogram(kg) twice a day for creatinine clearance (CrCl) above 30 ml/min or once a day for CrCl below 30 ml/min were used to achieve therapeutic anticoagulation. The primary outcome of the study was 28-day in-hospital mortality for critically ill patients affected by COVID-19 with or without the use of therapeutic anticoagulation. Covariates included in analysis were hypertension, diabetes, hyperlipidemia, cardiac history, and use of antiplatelet and anticoagulant medications prior to admission. Statistical analysis was done using R version 4.0.2. Results Out of 145 ICU patients, 61 received therapeutic anticoagulation. Kaplan-Meier survival curves show the survival probability with respect to days after admission for the two groups (those who used anticoagulant therapeutic drugs and those who didn't) using 28-day in-hospital mortality.(Fig 1) Median age for patients was 61 years for patients who didn't receive therapeutic anticoagulants compared to 60 years for patients who received therapeutic doses. The mean D-dimer among patients who received therapeutic anticoagulation was 20462 ng/ml (D-dimer units) compared to 7872 ng/ml for those who did not. The median number of days of survival for those who did not take anticoagulant therapeutic drugs is 10 days, while the median for those who did take anticoagulant therapeutic drugs is 25 days. After adjusting for hypertension, diabetes, hyperlipidemia, cardiac history, home antiplatelet medication use and continuous response for peak d-dimer levels, the results also show that there is a causal effect of 22.2 % decreased risk of 28-day in-hospital mortality if one received the therapeutic anticoagulant in the hospital. Conclusion Our findings suggest that there is a significantly higher median survival time in critically ill patients who received therapeutic anticoagulants in the hospital compared to those who didn't. However, our study is limited by observational nature, possible unobserved confounding, lack of metrics to classify illness severity as well as lack of evidence based decision guideline in initiation of therapeutic anticoagulation. There is an urgent need for further evidence-based studies like clinical trials which are necessary to provide specific guidelines for use of therapeutic anticoagulants in patients with COVID-19 infection. References 1. Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis. 2020;50(1):54-67. 2. Tay, M.Z., Poh, C M., Rénia, L. et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 20, 363-374 (2020). 3. Lisa K. Moores, Tobias Tritschler, et al. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report, Chest, Volume 158, Issue 3, 2020, Pages 1143-1163, ISSN 0012-3692. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Cos-CBDC: Design and Implementation of CBDC on Cosmos Blockchain

With the advent of e-commerce and electronic payment systems, the use of paper currency is decreasing. Therefore, it is sufficiently predictable that most paper currencies will disappear and digital currencies will become the mainstream. This phenomenon is further accelerated by advances in blockchain technology and COVID-19. This is why the Central Bank Digital Currency (CBDC) has recently begun to attract attention. Currently, there are studies on CBDC with a blockchain-based distributed ledger. In this paper, we propose Cosmos blockchain based CBDC (Cos-CBDC) that enables communication between blockchains using Inter-Blockchain Communication (IBC) protocol to ensure interoperability. We not only analyze the requirements of Cos-CBDC but also design and implement it using Cosmos-SDK. Furthermore, we propose a Group Key Management system in Cos-CBDC. It can give different user privileges, and privacy-preserving is possible in the key generation process. © 2021 IEICE.

Design Considerations for Robot Partner System based on Modular Structure

Socially isolated and exposed to lonely situations affect states of health and lifespan. Under these circumstances, the social distance caused by COVID-19 is accelerating people's isolation. Therefore, we should consider how we prepare for the post COVID-19 era. One of the solutions is the introduction of robot partners as community centric system. In this paper, we show the current state about our development of socially embedded robot partner. First, we show several examples of development of robot partners. Next, we explain the modular structured systems used for robot partners. Finally, we show several examples of the effectiveness of robot partner system, and discuss the applicability of the proposed system.

Building IoT-based Zero-Contact Experimental Environment for Studying Picture Preference under Various Illumination Conditions

We propose a zero contact experiment environment like a living room at home using 'Internet of Things'-based light devices, display and smart-phone or tablet. For our experimental environment, we constructed a large room that has specific lighting systems on the ceiling. For providing a general look-and-feel of living room condition, we also prepared the room with neutral-colored wallpaper and placed the display in the room. Subjects and Experimenters can tap on buttons on the smart-phones or tablets for adjusting the illumination conditions and picture options of the display. Under various illumination conditions, subjects are asked to choose the best preferred picture mode set while watching ten kinds of test images. All these series of our experiments are conducted under no-contact experimental environment thanks to the wireless applications loaded onto the smart-phone, tablet and display. These applications: (i) collect the data;(ii) automatically build a dataset;(iii) analyze the data by using machine learning techniques. By employing our system, large datasets that contain participants' preferences for the given display under various illumination conditions are collected safely and easily without risking COVID-19 spread. As a result, after finishing our experiment, most participants, specifically color scientists, praised our zero-contact experimental solution which can be used for other perceptual experimental processes by providing an easy way to build and analyze databases. © 2021 IEEE.