ABSTRACT
This study proposes a direction for the utilization of multi-agent simulation (MAS) to consider an optimal prevention strategy for the spread of the coronavirus disease of 2019 (COVID-19) through a pandemic modeling example in Japan. MAS can flexibly express macroscopic phenomena formed through the interaction of micro-agents modeled to act autonomously. The use of MAS can provide a variety of recommendations for bringing a pandemic under control, even in the case of the COVID-19 pandemic, which has become more intense as of 2021. However, models that do not consider individual heterogeneity, such as analytical Susceptible–Exposed–Infectious–Recovered (SEIR) models, are often used as predictive models for infectious diseases and the main reference for decision-making. In this study, we show that by constructing a MAS that simulates a metropolitan city in Japan in a simple manner while considering the heterogeneity of age and other background information, we can capture the effects of various measures such as vaccinations on the spread of infections in a more realistic setting. Moreover, it is possible to offer various recommendations for optimal strategies to suppress a pandemic by combining reinforcement learning with MAS. This study explicates the potential of MAS in the development of strategies to prevent the spread of infection.
ABSTRACT
Background: Artificial intelligence–assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years;n=27, 56.3% male patients) and 46.9 years (SD 12.3 years;n=28, 54.9% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method;0.062 vs 0.114;difference between groups −0.053, 95% CI −0.184 to 0.079;P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8;difference between groups −0.5, 95% CI −1.1 to 0.0;P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006;difference between groups 0.061, 95% CI 0.008 to 0.114;P=.03), and fear of movement at week 12 (−2.3 vs 0.5;difference between groups −2.8, 95% CI −5.5 to −0.1;P=.04). Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037;https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046866
ABSTRACT
Background During the ongoing coronavirus disease (COVID-19) pandemic, N95 filtering facepiece respirators (N95 respirators) are in short supply in many countries. Considering this, the Centers for Disease Control and Prevention suggested reusing N95 respirators and recommended the use of ultraviolet germicidal irradiation (UVGI) for sterilizing the respirators. However, only a few reports have described UVGI protocols for sterilizing the N95 respirators for reuse. Therefore, in this study, we aimed to develop and evaluate a novel method for the reuse of N95 respirators after sterilization by UVGI. Methods Before conducting the study, the function of N95 respirators after multiple UVGI with a total dose of up to 10 J (1 J/cm2 or more per dose) was assessed by measuring the particle collection efficiency and ventilation resistance. The participants used N95 respirators during work if they passed the fit test. After use, the respirators were sterilized using UVGI (1 J/cm2) and stored in a breathable paper bag for a week. The procedure was repeated up to three times after confirming the successful results of the fit tests. Results The particle collection efficiency without UVGI was 96.7%, while those after one, five, and 10 cycles of UGVI were 96.8%, 97.2%, and 97.2%, respectively. Ventilation resistance without UVGI was 42 Pa, and 43 Pa, 42 Pa, and 41 Pa after one, five, and 10 cycles of UVGI, respectively, which satisfied the Japanese national certification standard DS2. All 43 participants passed the fit test before the first reuse, and 39 participants (90.7%) completed the entire study protocol. The results of this study showed that N95 respirators could be used safely after repeated UVGI treatment. Conclusions This study developed a novel method for reusing the N95 respirators. A few cycles of UV radiation N95 masks retain their functionalities and can be reused with proper UVGI.
ABSTRACT
The aim of this study is to report a 7-year-old girl with psychogenic visual disturbance that improved upon staying at home after the declaration of a state of emergency in relation to Coronavirus disease. Her uncorrected visual acuity (UCVA) in the right eye was 0.4 and in the left eye was 0.3. Slit-lamp examination and fundoscopy showed no abnormalities. She had a tight schedule on six days a week due to various lessons. To prevent the spread of infection, her school was closed, and she was not able to attend any lessons. She enjoyed spending time at home. Six months after her initial visit during school closure, her UCVA had improved to 1.2. The situation of staying at home may have had a positive psychological effect after removing factors contributing to her stress.
ABSTRACT
The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19) and the ensuing worldwide pandemic. The spread of the virus has had global effects such as activity restriction, economic stagnation, and collapse of healthcare infrastructure. Severe SARS-CoV-2 infection induces a cytokine storm, leading to acute respiratory distress syndrome (ARDS) and multiple organ failure, which are very serious health conditions and must be mitigated or resolved as soon as possible. Mesenchymal stem cells (MSCs) and their exosomes can affect immune cells by inducing anti-inflammatory macrophages, regulatory T and B cells, and regulatory dendritic cells, and can inactivate T cells. Hence, they are potential candidate agents for treatment of severe cases of COVID-19. In this review, we report the background of severe cases of COVID-19, basic aspects and mechanisms of action of MSCs and their exosomes, and discuss basic and clinical studies based on MSCs and exosomes for influenza-induced ARDS. Finally, we report the potential of MSC and exosome therapy in severe cases of COVID-19 in recently initiated or planned clinical trials of MSCs (33 trials) and exosomes (1 trial) registered in 13 countries on ClinicalTrials.gov.