Emotional well-being and performance of middle leaders: the role of organisational trust in early childhood education

PurposeThe current study investigated the impact of organisational trust on emotional well-being and performance of middle leaders during the coronavirus disease 2019 (COVID-19) pandemic.Design/methodology/approachA convenience sample of 265 middle leaders in kindergartens in China responded involving trust in schools (e.g. trust in principal and trust in colleagues), emotional well-being and job performance. Both confirmatory factor analysis and structural equation modelling (SEM) were used in the investigation.FindingsThree hypotheses on the relationships between the three constructs were verified. Trust in schools significantly influenced emotional well-being and job performance of middle leaders which correlated with each other. The interactive effects of trust in principal and trust in colleagues were discussed for improving the well-being and job performance of middle leaders. Relationships between the two kinds of trust and pride were also identified in the research.Research limitations/implicationsFurther studies may put efforts towards improving these three outcomes synchronously.Practical implicationsBased on the evidence of the current study, future research may focus on how middle leaders act as a bridging role between different stakeholders such as principal and teachers, principal and parents, teachers and children, meanwhile how to boost the leaders' own well-being and performance in the early childhood education (ECE).Originality/valueThis study established the empirical linkages between school trusts, emotional well-being and job performance.

The economic resilience of a city: the effect of relatedness on the survival of amenity shops during the COVID-19 pandemic

Amenity clusters consisting of coffee shops, restaurants and other small businesses improve urban life and are a source of employment for city dwellers. Although most small business clusters were hit hard by restrictions imposed during the COVID-19 pandemic, some were able to adapt. What determines the economic resilience of amenity clusters? Using store-location data for Seoul from 2016 to 2021, we identify spatial clusters of amenities, and from that build an amenity space to examine the effect of relatedness on the resilience of each cluster. We find that businesses are more likely to survive when located in clusters of related amenities. © 2022 The Author(s). Published by Oxford University Press on behalf of the Cambridge Political Economy Society. All rights reserved.

Retrospective Evaluation of COVID-19 Therapeutics

The pandemic outbreak of COVID-19 created panic all over the world. As therapeutics that can effectively wipe out the virus and terminate transmission are not available, supportive therapeutics are the main clinical treatments for COVID-19. Repurposing available therapeutics from other viral infections is the primary surrogate in ameliorating and treating COVID-19. The therapeutics should be tailored individually by analyzing the severity of COVID-19, age, gender, comorbidities, and so on. We aim to investigate the effects of COVID-19 therapeutics and to search for laboratory parameters indicative of severity of illness. Multi-center collaboration and large cohort of patients will be required to evaluate therapeutics combinations in the future. This study is a single-center retrospective observational study of COVID-19 clinical data in China. Information on patients' treatment modalities, previous medical records, individual disease history, and clinical outcomes were considered to evaluate treatment efficacy. After screening, 2,844 patients are selected for the study. The result shows that treatment with TCM (Hazard Ratio (HR) 0.191 [95% Confidence Interval (CI), 0.14–0.25];p < 0.0001), antiviral therapy (HR 0.331 [95% CI 0.19–0.58];p = 0.000128), or Arbidol (HR 0.454 [95% CI 0.34–0.60];p < 0.0001) is associated with good prognostic of patients. Multivariate Cox regression analysis showed TCM treatment decreased the mortality hazard ratio by 69.4% (p < 0.0001). © 2022, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

Capturing Secchi disk depth by using Sentinel-2 MSI imagery in Jiaozhou Bay, China from 2017 to 2021

Water clarity is a key parameter for assessing changes of aquatic environment. Coastal waters are complex and variable, remote sensing of water clarity for it is often limited by low spatial resolution. The Sentinel-2 Multi-Spectral Instrument (MSI) imagery with a resolution of up to 10 m are employed to solve the problem from 2017 to 2021. Distribution and characteristics of Secchi disk depth (SDD) in Jiaozhou Bay (JZB) are analyzed. Subtle changes in localized small areas are discovered, and main factors affecting the changes are explored. Among natural factors, precipitation and wind play dominant roles in variation in SDD. Human activities have a significant influence on transparency, among which fishery farming has the greatest impact. This is clearly evidenced by the significant improvement of SDD in JZB due to the sharp decrease in human activities caused by coronavirus disease 2019 (COVID-19).Copyright © 2022 The Authors

Revisiting the COVID-19 vulnerability index in South Africa

This study uses the Census 2011 and Community Survey 2016 data, adopts the Alkire-Foster multidimensional poverty index (MPI) approach and addresses numerous shortcomings of the original Statistics South Africa method by including numerous indicators from four dimensions (socio-economic, demographic, housing and hygiene, health) to derive a revised COVID-19 vulnerability index. The empirical findings indicate the index was relatively higher for African female individuals living in rural areas of the Eastern Cape, KwaZulu-Natal and Limpopo provinces, coming from households headed by elderly aged 55 years or above. Alfred Nzo, Amathole, Harry Gwala, OR Tambo and Umzinyathi are the five district councils that are most vulnerable to COVID-19 (the first four were declared COVID-19 hotspot areas by the South African government in December 2020). The results of the index decomposition found that indicators from the housing and hygiene dimension contributed most to the COVID-19 vulnerability. © 2021 Government Technical Advisory Centre (GTAC).

Identifying Critical Dispute Causes in the Construction Industry: A Cross-Regional Comparative Study between China and the UK

Construction disputes have long been identified as epidemics in the construction industry worldwide, which has become a more serious problem due to the impact of the COVID-19 pandemic. Previous studies on the dispute causes have primarily focused on country- or region-specific contexts and hence the results cannot be generalized in solving this chronic problem in a broader construction project worldwide. This study aims to explore and evaluate the critical dispute causes in construction projects through a comparative study between China and the United Kingdom. A total of 33 common dispute causes were identified through a comprehensive literature review and further consolidated by pilot surveys in the two countries. An online questionnaire survey was administered among construction professionals in China and the United Kingdom, with 170 valid responses returned for data analysis. Principal component factor analysis, mean score ranking approach, quartile analysis, and Mann-Whitney U testing were employed to identify the most critical dispute causes. Similarities and differences were mapped between the two countries. It was found that the five most critical categories of dispute causes in the two territories are: delay-related problems, lack of communication, contractual problems, site conditions, and design problems. The importance of variation in quantities, breach of contract, misinterpretation of contractual terms and conditions, and poor contract management was perceived significantly differently by the respondents in China and the United Kingdom, whereas design defects and failure to make compensation for additional work were the most critical common dispute causes in both countries. The research provides important findings for both academics and practitioners to holistically understand the similarities and differences of dispute causes in China and the United Kingdom and aids in preventing disputes more effectively in the global construction industry. © 2022 American Society of Civil Engineers.

AM-RESNET50 Method for CT Image Diagnosis of COVID-19

At the beginning of 2020, coronavirus disease (covid-19) spread all over the world, making the world face a survival and health crisis. Automatic detection of pulmonary infection through computed tomography (CT) images provides great potential for strengthening the traditional health care strategy to deal with covid-19. At present, the use of artificial intelligence technology for image classification and lesion segmentation of COVID-19CT image has become a widely concerned content in medical image analysis. Segmenting the infected area from CT image faces several challenges, including high variation of infection characteristics, low-intensity comparison between infection and normal tissue and so on. Based on the in-depth analysis of covid-19 CT image features, this paper adds a mixed attention mechanism module to the RESNETneural network model, including channel attention mechanism and spatial attention mechanism. The combination of channel attention mechanism and spatial attention mechanism makes the backbone network have the ability to pay attention to more important local features from global features, making the model more sensitive to covid CT images. In terms of implementation efficiency, the convolution layer of the model is improved with smaller convolution kernel, and the loss function is modified to adjust the data training model, so as to realize the more accurate and efficient automatic recognition of covid-19 CT image. © 2022 ACM.

The Ukrainian Conflict: Impact on the Aviation Finance and Leasing Industry

The conflict between Russia and Ukraine has resulted in additional burdens on the aviation industry, compounding the impact of the COVID pandemic. Airline manufacturers and operators are suffering extra costs due to the steep rise in commodities prices, especially those linked to energy costs, and the decline in the supply of crucial manufacturing materials like titanium, as a result of supply chain issues and sanctions. The sanctions, led by the United States and the European Union, impacted Russia multilaterally. They included prohibiting the transfer of maintenance materials and technologies;forbidding aircraft leases to Russian operators;airspace closure;and suspension of airworthiness certificates. Russia responded to the sanctions by suspending bilateral agreements and unilaterally re-registering leased aircraft in Russia. Russia’s responses have impeded aircraft lessors seeking to repossess their assets and forced an inevitable write-down of asset values, leading lessors and financiers to file insurance claims. This has dampened the global aviation finance and ABS markets. © 2022 The Journal of Structured Finance. All rights reserved.

PHASE II TRIAL of ENPATORAN in PATIENTS HOSPITALIZED with COVID-19 PNEUMONIA

Background: Enpatoran is a selective and potent dual toll-like receptor (TLR) 7/8 inhibitor in development for the treatment of cutaneous and systemic lupus erythematosus (CLE/SLE). Enpatoran inhibits TLR7/8 activation in vitro and suppresses disease activity in lupus mouse models.1 Enpatoran was well tolerated and had linear pharmacokinetic (PK) parameters in healthy volunteers.2 As TLR7/8 mediate immune responses to single-stranded RNA viruses, including SARS-CoV-2, it was postulated that enpatoran may prevent hyperinfammation and cytokine storm in COVID-19. Objectives: In response to the COVID-19 pandemic, we conducted an exploratory Phase II trial to assess safety and determine whether enpatoran prevents clinical deterioration in patients (pts) hospitalized with COVID-19 pneumonia. PK and pharmacodynamics (PD) of enpatoran were also evaluated. Methods: ANEMONE was a randomized, double-blind, placebo (PBO)-con-trolled study conducted in Brazil, the Philippines, and the USA (NCT04448756). Pts aged 18-75 years, hospitalized with COVID-19 pneumonia (WHO 9-point scale score =4) but not mechanically ventilated, with SpO2 <94% and PaO2/FiO2 ≥150 (FiO2 maximum 0.4) were eligible. Those with a history of uncontrolled illness, active/unstable cardiovascular disease and SARS-CoV-2 vaccination were excluded. Pts received PBO or enpatoran (50 or 100 mg twice daily [BID]) for 14 days, with monitoring to Day 28 and safety follow-up to Day 60. Primary outcomes were safety and time to recovery (WHO 9-point scale ≤3). Clinical deterioration (time to clinical status >4, WHO 9-point scale) was a secondary outcome. Exploratory endpoints were enpatoran and biomarker concentrations (cytokines, C-reactive protein [CRP], D-dimer and interferon gene signature [IFN-GS] scores) assessed over time. Results: 149 pts received either PBO (n=49), or enpatoran 50 mg (n=54) or 100 mg (n=46) BID;88% completed treatment and 86% received concomitant steroids. Median age was 50 years (77% <60 years old), 66% were male, and 50% had ≥1 comorbidity (40% hypertension, 24% diabetes). Overall, 59% pts reported a treatment-emergent adverse event (TEAE) with three non-treatment-related deaths;11% reported a treatment-related TEAE. The proportion of pts in the enpatoran group reporting serious TEAEs was low (50 mg BID 9%;100 mg BID 2%) vs PBO (18%). Gastrointestinal disorders were most common (PBO 8%;50 mg BID 28%;100 mg BID 9%). The primary outcome of time to recovery with enpatoran vs PBO was not met;medians were 3.4-3.9 days. A positive signal in time to clinical deterioration from Day 1 through Day 28 was observed;hazard ratios [95% CI] for enpatoran vs PBO were 0.39 [0.13, 1.15] (50 mg BID) and 0.30 [0.08, 1.08] (100 mg BID). Mean enpatoran exposure was dose-proportional, and PK properties were within expectations. The median (quartile [Q]1-Q3) interleukin 6 (IL-6), CRP and D-dimer baseline concentration across the groups were 5.7 (4.0-13.5) pg/mL, 30.04 (11.40-98.02) and 0.62 (0.39-1.01) mg/L, respectively. Baseline IFN-GS scores were similar across groups. Conclusion: The ANEMONE trial was the frst to evaluate the safety and efficacy of a TLR7/8 inhibitor in an infectious disease for preventing cytokine storm. Enpa-toran up to 100 mg BID for 14 days was well tolerated by patients acutely ill with COVID-19 pneumonia. Time to recovery was not improved with enpatoran, perhaps due to the younger age of patients who had fewer comorbidities compared to those in similar COVID-19 trials. However, there was less likelihood for clinical deterioration with enpatoran than placebo. This trial provides important safety, tolerability, PK and PD data supporting continued development of enpatoran in SLE and CLE (NCT04647708, NCT05162586).

Collection and quality characteristics of Coronavirus Disease 2019 convalescent plasma

Objective To explore the application and safety of apheresis technology in collection of Coronavirus Disease 2019 (COVID-19) convalescent plasma (CP), and to analyze the quality characteristics of the plasma. Methods The general data of COVID-19 convalescent plasma (CP) donors, including gender, age, date of discharge or release from medical isolation, were collected based on informed consent. After physical examination, the CP was collected by apheresis technology with plasma separator, inactivated with methylene blue, and determined for severe acute respiratory symptom Coronavirus 2 (SARS-CoV-2) nucleic acid and specific antibody (RBD-IgG) against SARS-CoV-2. Results The collection process went well, and no serious adverse events related to plasma collection were reported during or after the collection. The average age of COVID-19 CP donors was 38 years (n = 933). The distributions of blood groups A, B, AB and 0 in RhD (+) COVID-19 CP were 33. 4%, 29. 2%, 10% and 27. 2% respectively. The plasma donation date was 18 d from the discharge date in average. All the test results of SARS-CoV-2 nucleic acid in CP were negative, while the proportion of plasma samples at SARS-CoV-2 antibody titer of more than 1: 160 was 92. 60%. Conclusion Apheresis technology was safe and reliable. The COVID-19 CP contained high titer antibody. Large-scale collection and preparation of inactivated plasma against SARS-CoV-2 played an important role in the treatment of COVID-19.

ENPATORAN SAFETY and EFFICACY in COVID-19 PNEUMONIA: ANEMONE TRIAL

Background: Enpatoran, a selective and potent toll-like receptor 7 and 8 (TLR7/8) inhibitor, is in development for treating autoimmune diseases. Enpatoran may prevent hyperinflammation and cytokine storm in COVID-19 by targeting pro-inflammatory pathways induced by SARS-CoV-2. Methods: The ANEMONE study, a phase II, randomized, double-blind, placebo-controlled trial conducted in the US, the Philippines, and Brazil, assessed the safety and efficacy of enpatoran in COVID-19 pneumonia (NCT04448756). Eligible hospitalized patients were aged 18-75 years, with a WHO 9-point scale score of 4, confirmed COVID-19 pneumonia, SpO2 <94%, PaO2/FiO2 ≥150 (FiO2 max 0.4) and not on mechanical ventilation. Key exclusion criteria were active/unstable cardiovascular disease, history of uncontrolled illness and SARS-CoV-2 vaccination. Randomized patients (N=149) received placebo (PBO;n=49), enpatoran 50 mg twice daily (BID;n=54) or 100 mg BID (n=46) for 14 days, with monitoring up to Day 28 and safety follow-up to Day 60. Primary outcomes were safety and time to recovery (WHO 9-point scale ≤3). Clinical deterioration (time to clinical status >4, WHO 9-point scale) was a secondary outcome. Results: 88% of patients completed treatment (66% male, median age 50 years);50% had ≥1 comorbidity (including 40% hypertension, 24% diabetes). Treatment-emergent adverse events (TEAEs) were reported by 59% of patients;11% reported treatment-related TEAEs (Table). Serious TEAEs were higher with PBO (18%) than enpatoran (6%). Three non-treatment-related deaths occurred. Gastrointestinal disorders were most common (PBO 8%;50 mg BID 28%;100 mg BID 9%). Infections and infestations were reported by 18% (PBO), 17% (50 mg BID) and 4% (100 mg BID);COVID-19 worsening (PBO 8%;50 mg BID 9%) and bacterial sepsis (PBO 4%) were most common. Headache and dizziness were only reported with enpatoran (<3% across groups). Psychiatric disorders were higher with PBO (14%) than enpatoran (50 mg BID 7%;100 mg BID 4%). There was no dose effect on TEAEs. Median [95% CI] time to recovery from Day 1 through Day 28 was 3.4 [2.7, 4.9] (PBO), 3.7 [2.6, 4.0] (50 mg BID) and 3.9 [2.0, 4.8] (100 mg BID) days. A positive signal in time to clinical deterioration from Day 1 through Day 28 was observed;hazard ratios [95% CI] for enpatoran versus PBO were 0.39 [0.13, 1.15] (50 mg BID) and 0.30 [0.08, 1.08] (100 mg BID). Conclusion: Enpatoran was considered safe and well tolerated in hospitalized patients with acute COVID-19 pneumonia.

Model-informed Dose Selection of Dual Toll-like Receptor 7/8 Inhibitor Enpatoran (M5049) for the Treatment of COVID-19 Pneumonia

Background. Enpatoran, formerly known as M5049, is a potential first-in-class small molecule antagonist of toll-like receptors (TLR) 7 and 8, which may prevent viral-associated hyperinflammatory response and progression to 'cytokine storm' in coronavirus disease 2019 (COVID-19) patients. The objective of this study was to leverage existing population pharmacokinetic/pharmacodynamic (popPK/PD) models for enpatoran to inform dose selection for an accelerated Phase II study in COVID-19 patients with pneumonia. Methods. The popPK/PD models were based on plasma PK and PD biomarker (ex vivo-stimulated interleukin [IL]6 and interferon α [IFNα] secretion) data from the enpatoran first-in-human Phase I study in healthy participants (Port A, et al. Lupus Sci Med 2020;7(Suppl. 1): P135). A two-compartment model describing PK used a sigmoidal Emax model with proportional decrease from baseline characterizing the PD response across the investigated single and multiple daily dose range of 1-200 mg (N=72). Concentrations that inhibited 50% and 90% (IC50/IC90) of cytokine secretion were estimated and stochastic simulations were performed to assess target coverage under different dosing regimens. Results. Simulations suggested that, to achieve maximal inhibition of IL-6 over time, enpatoran PK concentrations would be maintained above the IC90 throughout the dosing interval with doses of 100 mg and 50 mg twice daily in 90% and 30% of participants, respectively. In comparison, IFNα inhibition was predicted to be lower, with IC90 coverage in 60% and 8% of participants with twice daily doses of 100 mg and 50 mg enpatoran, respectively. Conclusion. Utilization of existing popPK/PD models allowed for the accelerated development of enpatoran in COVID-19 to address an unprecedented global pandemic. Rational model-informed dose selection was supported by data from a Phase I study in which there were no safety concerns.

Sharp schedule compression in urgent emergency construction projects via activity crashing, substitution and overlapping: a case study of Huoshengshan and Leishenshan Hospital projects in Wuhan

Purpose To meet the rapidly increasing demand for medical treatment during the outbreak of COVID-19, Huoshengshan and Leishenshan Hospital are rapidly built (9-12 days) in Wuhan. These two urgent emergency projects are unprecedented. In general, substantial literature suggests that the possibility of shortening a schedule by more than a quarter of its original duration is implausible. By contrast, the two projects had successfully compressed the schedules from months and years to about ten days. This study aims to investigate how this was done and provide references for future projects. Design/methodology/approach The study uses qualitative case study techniques to analyze the project practices in two urgent emergency projects. Data were gathered through semi-structured interviews and archival research. During interviews, interviewees were asked to describe the project practices adopted to overcome the challenges and freely share their experiences and knowledge. Findings The results illustrate that a high degree of schedule compression is achievable through tactful crashing, substitution and overlapping applications. The successful practices heavily rely on the high capacity of participants and necessary organization, management and technology innovations, such as three-level matrix organizational structure, reverse design method, site partition, mock-up room first strategies and prefabricated construction technology. For instance, the reverse design method is one of the most significant innovations to project simplification and accelerate and worthy of promotion for future emergency projects. Practical implications The empirical findings are significant as they evoke new thinking and direction for addressing the main challenges of sharp schedule compression and provide valuable references for future emergency projects, including selecting high-capacity contractors and replacing the conventional design methods with reverse design. Originality/value Substantial studies indicate that the maximum degree of schedule compression is highly unlikely to exceed 25%, but this study suggests that sharp compression is possible. Although with flaws in its beauty (i.e. compressing schedule at the expense of construction cost and quality), it is also a breakthrough. It provides the building block for future research in this fertile and unexplored area.

Development of a System for Identifying Community-dwelling Outpatients with Mental Disorders Needing Emergency Management Amid a Public Health Emergency by General Practitioners

Background: In the context of public health emergencies, for example, the COVID-19 pandemic, community hospitals may face challenges to provide diagnosis and treatment services and to reduce the disease burden for patients with mental problems. However, general practitioners(GPs)' capabilities in diagnosing and treating mental disorders are unsatisfactory. Objective: To develop a system for identifying community-dwelling outpatients with mental disorders needing emergency management amid a public health emergency by GPs, to promote GPs' capabilities in diagnosing and treating mental disorders, and the health of such patients. Methods: From May to June 2020, based on a literature review and an investigation of work requirements for GPs, we formed a framework for identifying community-dwelling outpatients with mental disorders needing emergency management amid a public health emergency by GPs with indicators initially determined. Then we screened and revised the indicators according to the results of a two-round Delphi survey with 15 experts(in the field of general practice or mental health medicine), and finally determined the indicators(with a mean value of weighted importance>3.5, coefficient of variation <25%, and rate of getting full marks >20%) for the formal system identifying community-dwelling outpatients with mental disorders needing emergency management amid a public health emergency by GPs. Results: Information of the experts surveyed: 13 of them had a graduate degree, and 10 had a senior professional title. Positive coefficients of the experts: All the experts(100%) actively responded to the two rounds of survey. Authority coefficients of the experts: the authority coefficient of the six domains were >0.70. The degree of agreement between the experts: the Kendall's W in the second round of survey was 0.278(χ2=100.197, P<0.001), which was higher than 0.245(χ2=73.597, P<0.001)in the first round of survey. The final indicators: 24 indicators in six domains involving mental symptoms, diagnosis of mental illness, severity of mental illness, personality, physical status, family and social background. Conclusion: Our system may help GPs to high-efficiently identify community-dwelling outpatients with severe mental disorders needing emergency treatment or referrals. However, the accuracy of the system needs to be verified further. Copyright © 2021 by the Chinese General Practice.

Efficiency and safety of plasma exchange in the treatment of severe covid-19

Objective. To study an efficacy and safety of therapeutic plasma exchange in the treatment of COVID-19. Material and methods. Efficacy and safety of plasma exchange in severe COVID-19 were retrospectively analyzed. Plasma exchange was performed within 24 hours after admission to ICU. Circulating plasma volume (70-150%) was replaced with donor fresh frozen plasma, CovRec plasma ≤300 ml and balanced crystalloid solutions ≤800 ml. Mean volume of exchange was 3000 ml (min 2000 ml, max 4000 ml). We analyzed mortality and need for mechanical ventilation in patients after plasma exchange in addition to standard therapy (main group) and in the control group (standard therapy alone). Results. Mortality in the main group was 16.67% (n=5), in the control group — 57.41% (n=31) (p=0.001). Conclusion. Plasma exchange is an effective and safe method significantly reducing mortality in patients with severe COVID-19. These data are confirmed by laboratory data. A multiple-center study of efficacy and safety of plasma exchange in the treatment of severe COVID-19 is needed. © S.S. OCHKIN, A.S. SAMOYLOV, YU.D. UDALOV, N.M. KRUGLYAKOV, G.I. BAGZHANOV.

The method of inhalation therapy with micro-doses of mixtures noble gases with oxygen (preprint)

In this research, we presented the method of inhalation therapy with noble gas micro-doses and results of clinical studies in hospital of Russian Academy of Sciences (RAS). We have designed a device that allows dosed injection of noble gas with a volume of about 2-4 ml with peroxide vapors into the nasal cavity. After testing on the authors of the project and obtaining a positive impact of xenon and krypton, a study was conducted on a group of conditionally healthy volunteers in the amount of 20 people. We have noted a positive effect from 18 people. And also, in this article we briefly described the methods and devices that are used for inhalation therapy with mixtures of noble gases with oxygen. Keywords: noble gases, oxygen, inhalation therapy, device, respiratory apparatus, aerosols, COVID-19 pneumonia.

COMPUTERIZED TOMOGRAPHY OF CHEST AND ABSOLUTE LYMPHOCYTE COUNT AS PREDICTOR OF POSITIVE SARS-COV-2 POLYMERASE CHAIN REACTION

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-COV2) is the virus responsible for the coronavirus disease 2019 (COVID-19) which has caused a pandemic generating over half a million deaths in the United States. Lymphopenia is common at presentation in COVID-19 and has been associated with disease severity. Furthermore, patients with severe infection are more likely to have multifocal, bilateral, peripheral ground glass opacities on chest computerized tomography (CT). COVID-19 is diagnosed with a polymerase chain reaction (PCR) test using a nasopharyngeal swab (NPS) for SARS-COV2. The turnaround time for this test has improved;however, as the pandemic continues there have been shortages of reagents leading to continued challenges in timely testing. The aim of our study is to evaluate whether CT chest findings combined with absolute lymphocyte count (ALC) can predict positive COVID-19 PCR swab result. METHODS: We included 3544 patients who presented to the emergency department at a large, urban academic center between March and September 2020. All patients had a NPS for the presence of SARS-CoV-2 using the Luminex NxTAG CoV Extended Panel, a low-resolution chest CT scan without contrast, and a complete blood count with differential to determine ALC. CT scans were classified into three standardized categories by a board-certified chest radiologist based on features of multifocal pneumonia. Category 1 is consistent with multifocal pneumonia, category 2 is indeterminate for multifocal penumonia, and category 3 is inconsistent with multifocal pneumonia. In our analysis we combined categories 2 and 3 into one group. Using the Youden index (J) method, a joint test was performed on CT scan and lymphocyte count. Logistic regression was used determine the parameters of our model. RESULTS: We found that patients with category 1 CT scans and ALC < 1.6 K/mm

Muscle mass index at the level Th12 vertebra as a prognostic factor for fatal outcome in the patients with pneumonia caused by SARS-CoV2

Purpose: To develop a methodology for determining the muscle mass index (MMI) at the level of Th12 based on the computed tomography of the chest;to estimate the impact of MMI on the outcome of the COVID19 patients as a prognostic factor. Material and methods: The medical data and computed tomography of the chest of 247 patients with confirmed pneumonia caused by SARS-Cov2 were used. A technique has been developed for determining MMI based on the cross-sectional area of paraspinal muscles at the level of the Th12 vertebra and the length of the thoracic spine. A correlation analysis of MMI calculated based on the length of the thoracic spine MMI(L) and height MMI(H) was performed. A statistical analysis of the differences of the MMI(L) in the groups of male and female patients with fatal outcome and recovered, as well as younger and older than 65 years were performed. Results: A strong correlation was found between the MMI calculated on the basis of the length of the thoracic spine and height (r = 0.861, p <0.001). The age threshold, which was associated with an increase in the likelihood of death, in men was 60 years (Se 77.3 %, Sp 60.5 %, PPV 51.5 %, NPV 83.1 %, Youden's index 0.378, area under ROC- curve 0.728), in women 65 years old (Se 72.2 %, Sp 68.6 %, PPV 49.1 %, NPV 85.5 %, Youden's index 0.408, the area under the ROC curve 0.734). The odds ratio of death when the age thresholds are exceeded was 5.2 for men (95 % CI: 2.3 - 12.0), for women - 5.7 (95 % CI: 2.4 - 13.4). MMI(L) 3.37cm2/m2 is a threshold value, below which the probability of death in male patients under 60 years increased 26.3 times (95 % CI: 4.8 - 143.0). In female patients, there was no statistically significant threshold value of MMI(L), which would be associated with a higher risk of death. Conclusion: MMI, calculated at the level Th12 on the basis of the length of the thoracic spine, can be reliably used as a tool to estimate sarcopenia associated muscle atrophy, if there is no anthropometric data. The MMI(D) less than 3.37 cm2/m2 is a strong predictor of death in men under 60 years of age. Further work is needed to study the effect of sarcopenia on the severity and outcome of COVID19 in female patients, taking into account comorbid conditions. © 2021 State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. All rights reserved.