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1.
COVID-19 in Alzheimer's Disease and Dementia ; : 33-47, 2023.
Article in English | Scopus | ID: covidwho-20243024

ABSTRACT

Since the World Health Organization declared SARS-CoV-2 (COVID-19) a pandemic in March 2020, serious efforts have been made to understand the epidemiology, molecular mechanisms, pathology, and clinical evolution of this disease. Oxidative stress (OX-S) has been implicated in the etiologies of many diseases, including SARS-CoV-2. Recent studies suggest that superoxide radicals and the products of lipid peroxidation, such as the electrophilic aldehyde, 4-hydroxynonenal (4-HNE), are important mediators of the pathological effects of oxidative stress during microbial and viral infections. Numerous studies have confirmed that viral infections induce inflammatory responses that generate excessive amounts of reactive oxygen species and 4-HNE protein adducts in plasma and in various tissues, including alveolar epithelium and endothelium. In this book chapter, we will highlight and discuss the apparent and plausible relationships between SARS-CoV-2 virulence and oxidative stress/lipid peroxidation, which affect cellular and DNA repair mechanisms and immune response. © 2023 Elsevier Inc. All rights reserved.

2.
Proceedings of the 17th INDIACom|2023 10th International Conference on Computing for Sustainable Global Development, INDIACom 2023 ; : 962-966, 2023.
Article in English | Scopus | ID: covidwho-20237493

ABSTRACT

Multimedia is a diversified and powerful means to strengthen and aid the education methodology, by making learning interactive and interesting, this paper further justifies the same. The Internet acts as a gateway between multimedia producers and consumers. It is free from discipline boundaries. Several tools allow nontechnical educators to deal with diverse multimedia to create the learning material. These tools should stand fit some parameters, briefly discussed. Its employment is rapidly magnifying, enabling self-learning, which was boosted in the Covid era. This paper emphasizes on to prevent traditional teaching from being used as a supplement but should be primary. Various hiccups in its efficient use in education still prevail but are heading toward resolution. © 2023 Bharati Vidyapeeth, New Delhi.

3.
Indian Journal of Community Health ; 35(1):103-108, 2023.
Article in English | Web of Science | ID: covidwho-2326241

ABSTRACT

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people's perceptions of preventive and curative measures changed.Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients.Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients' healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview.Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 +/- 14.7 years. Self-medication was significantly associated with study subjects' mortality (p=0.03).Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

4.
Indian Journal of Allergy, Asthma & Immunology ; 36(1):23-27, 2023.
Article in English | CAB Abstracts | ID: covidwho-2319777

ABSTRACT

AIM: The study aimed to assess the effectiveness of the ChAdOx1 nCoV-19 vaccine in preventing laboratory-confirmed COVID-19. METHODS: It was a test-negative, case-control study conducted at Sharda Hospital, Greater Noida, India, between March 2021 and May 2021. An equal number of cases and controls were included in the study after taking proper informed consent. The individuals with positive reverse transcriptase-polymerase chain reaction test reports were taken as cases, whereas those with negative reports were included as controls. Data were analyzed and the groups were compared using multivariable logistic regression to calculate the odds ratio (OR), with adjustment for gender and presence or absence of comorbidities. The effectiveness of vaccine was calculated by the formula (1-adjusted OR) x100%. RESULTS: On analyzing the data from 560 case-control pairs, the vaccine effectiveness was calculated as 57.46% (95% confidence interval [CI]: 53.85-61.02) and 60.09% (95% CI: 56.32-63.77) for single dose and two doses, respectively. The effectiveness of complete and single-dose vaccination against the moderate-to-severe disease was calculated as 63.79% (95% CI: 58.58-68.77) and 56.19% (95% CI: 51.30-61.0), respectively. CONCLUSION: The ChAdOx1 nCoV-19 vaccine was found to be effective against COVID-19, with protection after two doses being a little more than that after a single dose. It also proved effective in protecting against the severe form of the disease.

5.
Bio Futures: Foreseeing and Exploring the Bioeconomy ; : 301-318, 2021.
Article in English | Scopus | ID: covidwho-2266035

ABSTRACT

The unregulated use of chemical pesticides and fertilizers has led to unanticipated harmful consequences to human health as well as environment. The pandemic Covid-19 crisis is not permanent, but it has magnified the impact on livestock farming already present in the agricultural system. Farmers are facing the shortage of agricultural inputs due to the global trade disturbance. An effective alternative method of conventional pesticides is the application of biopesticides. These substances are sustainable solution for farming, pest control, and disease management. The post-Covid-19 pandemic impact on agriculture, regulatory hurdles, and the limitations of large-scale biopesticides production are discussed here. © Springer Nature Switzerland AG 2021. All rights reserved.

6.
Journal of Pure and Applied Microbiology ; 16(3):1465-1478, 2022.
Article in English | CAB Abstracts | ID: covidwho-2276878

ABSTRACT

Since its sudden outbreak in December 2019 in Wuhan, A pandemic of SARS-CoV-2 has been announced. Vitamin C is a water-soluble vitamin with anti-oxidant and immunity-boosting properties. Vitamin C acts as a nutritional supplement profoundly impacting the immune response to the second or third wave of the coronavirus disease (COVID-19). Vitamin C efficacy as an adjuvant treatment for inflammation and symptoms associated with COVID-19 infection should be investigated further. This report sheds light on the available information on the current clinical trials and pharmacotherapy related to COVID-19. Information available on Pubmed, EMBASE, Scopus, Web of Science databases and EU clinical trials regarding the use of therapeutic agents in patients with COVID-19 was used to perform analysis. Data was taken from 18 clinical trials available in the U.S. National Library of Medicine. All trials that are active, completed, or in the process of recruiting are included in data. Because of majority of clinical trials are still ongoing, specific results and high-quality clinical evidence are lacking. Before being standardised for use, the protocol must undergo large randomised clinical studies using a variety of existing medications and potential therapies. The pivotal role played by vitamins C in maintaining our immune system, is quite apparent. This review is an attempt to summarize the available information regarding the use of vitamin C as an adjuvant therapy in Covid -19 patients.

7.
Indian Journal of Animal Sciences ; 92(11):1360-1363, 2022.
Article in English | EMBASE | ID: covidwho-2114660

ABSTRACT

This study was conducted among the Maldhari community to understand the sustainability of migratory pastoralism during Covid-19. Bhuj and Lakpat Talukas of Kachchh district, Gujarat were selected to study the effect of profile variables on the annual income and net income of the families. The study revealed that family size and taluka were the significant factors influencing total income whereas taluka was the only significant factor influencing net income. Due to reduced sale of milk resulting from Covid-19, most of the milk was converted into khoa and the income generated from its sale was the major source of income for the migratory families. Cow dung fetched a minimal price which served as major source of their livelihood with no input cost. The value addition with better marketing facilities can significantly enhance the income of the pastoralists in the Kachchh district. Copyright © 2022 Indian Council of Agricultural Research. All rights reserved.

9.
Chest ; 162(4):A488, 2022.
Article in English | EMBASE | ID: covidwho-2060607

ABSTRACT

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Community Acquired Respiratory Viruses (CARVs) are associated with poor outcome in Solid Organ Transplant (SOT) recipients. We reviewed some of these outcomes such as respiratory support, length of stay (LOS), ICU admission, steroid use & 30-day all-cause mortality. METHODS: Multihospital, single center, retrospective review of electronic health records from 01/01/2014-12/31/2019. RESULTS: 23 SOT recipients (M=20, F=3) who tested positive for CARVs were identified. SOT distribution was heart=2, kidney=4, liver=3, lung=11, heart-lung=1, lung-kidney=1 & heart-kidney=1. Mean age at admission was 60 years, average LOS was 8 days with 2 pts needing >2 weeks. 6 pts required intensive care unit;8 pts required supplemental oxygen support. 16 pts had infiltrates on chest imaging. 15 pts had a 90-day readmission with respiratory complaints. 8 pts had bronchoscopy & 20 had positive nasal swab. 3 pts had a negative nasal swab but positive Bronchoalveolar lavage (BAL) for CARV while 2 pts had negative BAL but positive nasal swab. CARV distribution was Rhinovirus 48%, Parainfluenza 29%, Metapneumovirus 12%, Respiratory syncytial virus 0.03%, Adenovirus 0.03% & Non-novel Coronavirus 0.06%. 5 pts had bacterial coinfection (Pseudomonas aeruginosa, Corynebacterium striatum & Stenotrophomonas maltophilia). All pts were immunosuppressed, intravenous immunoglobulins (IVIG) were used in 3 pts, antivirals in 7 pts (ribavirin in 6 & oseltamivir in 1) & steroids in 10 pts. 12 pts had transplant organ biopsy with 5 showing acute cellular rejection. 11 pts had underlying Coronary artery disease and 17 pts had hematologic disorders (Post-transplant lymphoproliferative disorder, leukemia, Myelodysplastic syndrome, & multiple myeloma). 35% pts died within 1 year (2 during same admit). Cause of death was refractory septic shock (1), respiratory failure (3), cardiac arrest (3) & chronic lung allograft dysfunction (CLAD) (1). CONCLUSIONS: In this cohort, we assessed the SOT recipients positive for CARVs who required admission & evaluated the impact on their clinical course. This analysis noted a significant rate of acute & chronic rejections, bronchiolitis obliterans and CLAD in these patients. Newer tests like multiplex NAT & (semi) quantitative NAT (QNAT) can diagnose CARVs in addition to Human Influenza Virus. Patients can present with wheezing, croup, bronchiolitis, pneumonitis & pneumonia. Impact of CARVs seems to vary by the type of organ transplant, level of neutropenia/lymphopenia, upper versus lower respiratory infection and intrinsic pathogenicity of virus. Various preventive & therapeutic measures were employed in an attempt to improve outcomes in these patients. CLINICAL IMPLICATIONS: Transplant receipients are at a high risk of infections especially CARVs which may increase morbidity and mortality. This analysis emphasizes the value of timely diagnosis and treatment in this specific patient population who are immunocompromised. DISCLOSURES: No relevant relationships by Supriya Singh

10.
Artificial Intelligence Applications in Agriculture and Food Quality Improvement ; : 1-16, 2022.
Article in English | Scopus | ID: covidwho-2055571

ABSTRACT

A world hunger crisis has risen since 2019 when COVID-I9 hit the world. This pandemic has shifted this generation back in time, and now it is very important to be involved in new techniques that are effective in terms of better yield with less toxins. With the rate at which the population is growing, it is expected that by the year 2050, the world population would cross 9 billion. This exponential rise would require the food production to rise by 70 to 80%. This is a matter of concern for agriculture and food industries. As the world is in the fourth industrial revolution, it is the need of the hour to embed artificial intelligence and machine learning algorithms with agriculture. This research aims to accumulate different methodologies that are present and come up with a critical analysis. These methodologies have the capability to increase the yield, predict the diseases, and even increase the safety and help enhance traceability. © 2022, IGI Global.

11.
Journal of Cardiovascular Disease Research ; 13(3):709-719, 2022.
Article in English | GIM | ID: covidwho-2045618

ABSTRACT

Background: World health organization declared covid-19 pandemic worldwide. Efforts are being made to increase the awareness about covid-19 in the general public and as well as in patients through various health education programs. Material and Methods: The study included 1000 individuals and was conducted by The Department of Pulmonary Medicine, Government Medical College, Patiala during the 6-month period from January 2021 to June 2021. Patient intentions, apprehensions, and reasons for not getting vaccinated were be assessed by questionnaire. All walk-in patients above 18yr of age were included. To assess the knowledge, attitude, and practice of the participants, 18 questions (including for knowledge, attitude, for practice) were included. The questions were directly asked from patients in their vernacular language along with demographic details and responses noted. Need of study: To spread the Knowledge about vaccination and the need for getting vaccinated so that hesitancy for covid-19 vaccination can be decreased and the severity of infection can be controlled. Awareness about vaccination is vitally important for developing effective control measures in a public health crisis.

12.
Journal of General Internal Medicine ; 37:S506, 2022.
Article in English | EMBASE | ID: covidwho-1995821

ABSTRACT

CASE: A 31-year-old woman G4P2204 was admitted with respiratory failure. Her hemoglobin was 9.7 g/dl, D-dimer 1349 ng/mL feu, procalcitonin 0.44 ng/ mL, CRP 91.4 mg/L, normal white count and nasal RT-PCR positive for COVID-19. Chest x-ray showed bilateral patchy airspace opacities. She underwent emergent C-section, was intubated and placed on mechanical ventilation, received Remdesivir, dexamethasone, vancomycin and piperacillintazobactam. On day 11, she developed bilateral pneumothorces and had chest tubes placed. She had new elevation in white blood count (16,000/ul) and inflammatory markers. She was put on extracorporeal membrane oxygenation (ECMO). Computed Tomography ( CT) chest on day 15 showed large multiloculated cavity. She underwent bronchoscopy with bronchoalveolar lavage cultures positive for Mucorales. She had CT abdomen-pelvis, CT head and nasal endoscopy without evidence of invasive disease. She was started on amphotericin B and posaconazole. She had tracheostomy on day 21 and underwent successful ECMO weaning and decannulation on day 35. Chest tubes were removed. Amphotericin B was discontinued. She was discharged on nasal cannula and oral posaconazole and continued to improve. IMPACT/DISCUSSION: There are 6 other cases reported in literature with isolated pulmonary mucormycosis associated with SARS-CoV-2. All of these patients had clinical improvement before deteriorating again with SARS Cov-2 treatment. The timeline of new imaging findings like cavities, changing opacities, pleural effusions or bronchopleural fistula was usually 2 to 3 weeks from diagnosis of SARS-CoV-2 pneumonia. On analysis 5/7 of these patients were not diabetic, 6/7 received steroids, 3/7 received Tocilizumab and 4/7 received Remdesivir. 2 patients received surgical intervention with medical management although it did not change the outcome. Unfortunately despite aggressive medical and surgical treatment, there were poor outcomes. 4/7 patients died, 1/7 was permanently ventilator dependent and 2/7 survived. The diagnosis of isolated pulmonary mucormycosis is challenging. This might be secondary to hesitance of invasive diagnostic tests like bronchoscopy, lack of rapid diagnostic tests and fewer autopsies. Amphotericin B, posaconazole and isavuconazole remain the main treatment options along with surgical debridement of necrotic tissue. The pathology of mucormycosis in COVID-19 has been attributed to impaired T-cell function, impaired phagocytosis and more availability of fungal heme oxygenase which facilitates iron uptake for its metabolism. Glucocorticoids, IL-6 inhibitors and monoclonal antibodies further increase the risk of secondary infections. CONCLUSION: Mucormycosis is a lifethreatening disease with high morbidity and mortality. Based on our case and literature review, it is important to have high index of suspicion for pulmonary mucormycosis in patients who are recently treated with immunosuppressants for SARS-CoV-2 pneumonia and suddenly deteriorate after treatment.

13.
Annals of Indian Psychiatry ; 6(1):44-48, 2022.
Article in English | Web of Science | ID: covidwho-1855974

ABSTRACT

Introduction: In the face of the coronavirus disease 2019 (COVID-19) pandemic, the leadership of the institute felt a need for mental health interventions among patients admitted in COVID-19 isolation, university students, and health-care workers engaged in COVID-19 care. This article aims to share our experience in providing these services. Methodology: COVID-19 inpatients were telephonically counseled. Counseling protocol was based on national guidelines. Students of the university were assessed for emotional problems using a symptom checklist and Kessler 10-item Distress Scale. Subsequently, the faculty assigned as mentors were trained in providing telephonic psychological first aid (PFA) to the students. Psychosocial help was offered to health-care workers through daily guided relaxation sessions. Results: Forty-two of 69 COVID-19 inpatients were telephonically contacted. New-onset mental health problems were found in 40%. Half of the COVID-19 confirmed patients and half of the females had a higher prevalence of mental health problems. On the symptom checklist, 330 students were responded. Worry about the future, contagion, and boredom were reported by the majority of students. On the Kessler 10-item Distress Scale, 272 students were responded. Thirty-seven percent had likely mental disorders (22 males and 79 females). Twenty-two students contacted psychiatrists through mentors and were provided teleconsultation. Eighty health-care workers attended guided relaxation sessions. Twenty-nine responded on the feedback form. Most respondents felt guided relaxation was useful in reducing stress, with strongly agree (n = 12) and agree (n = 14) responses. Conclusions: Emotional problems were significantly prevalent among students and COVID-19 patients. Training faculty in PFA can help address students in distress. Guided relaxation may help frontline workers manage stress.& nbsp;

14.
Journal of Forensic Medicine and Toxicology ; 38(1):98-101, 2021.
Article in English | Scopus | ID: covidwho-1811180

ABSTRACT

COVID-19 leads to a serious impact on health of people worldwide which not only as a direct consequence of the infection but also due to the measures taken to reduce its transmission. The present study was conducted at Government Medical College Patiala .The aim of our study was to identify and compare the characteristics of cases referred for autopsy during the lockdown period for the COVID-19 First wave 2020, Second wave 2021 and the same period in year 2019.There was fall of 34.3 % and 24.7% in no. of postmortem cases in year 2020 and 2021 respectively when compared to 2019. During all periods 21-40 age group is most vulnerable. There is substantial fall in road traffic accident causalities during lockdown period. Rise in no. of suicides is seen in lockdown period while there is not much change seen in no. of assault cases. India needs to implement evidence-based road safety interventions, promote strong policies and traffic law enforcement, have better road and vehicle design, and improve care for road injuries. The patterns for suicide are alarming. There is urgency for implementing a comprehensive response service for mental health during the pandemic. © 2021, Medico Legal Society. All rights reserved.

15.
Med J Armed Forces India ; 2022 Apr 19.
Article in English | MEDLINE | ID: covidwho-1796301

ABSTRACT

Background: Despite having an effective COVID-19 vaccine, the COVID-19 pandemic is far from over and the delta variant continues to cause havoc across several continents. The present study was conducted to analyze and describe the occurrence of COVID-19 cases among completely vaccinated individuals. Methods: In an educational institute in Western Maharashtra, we analyzed a cluster of RTPCR positive COVID-19 cases among fully vaccinated students which occurred in 12 days. The cases were linked to a series of curricular and co-curricular events in the institute. A detailed epidemiological investigation and genome sequencing of cases were conducted. IgG antibodies against S1 protein of novel SARS-CoV-2 were estimated for cases and age, sex, and vaccination status matched controls. Results: All 37 identified cases were mild COVID. 188 high risk (HR) contacts of the cases were identified. The overall secondary attack was 9.5%. Out of 31 cases and 50 controls, 09 (29%) cases and 08 (16%) controls were found to have IgG antibodies against S1 protein of novel SARS-CoV-2 titer of more than 60 U/ml. Whole-genome sequencing of 15 samples of the cluster showed the presence of the Delta variant of SARS-CoV-2. No correlation was observed between Ct value and IgG S1 antibody titers. Conclusion: The study provides significant evidence that only vaccination alone does not completely protect against SARS-CoV-2 B.1.617.2 (Delta) variant infection. An all-encompassing multicomponent strategy involving implementation of NPIs, robust contact tracing, early identification and isolation of cases, and high vaccination coverage is the way forward for the prevention of COVID-19.

16.
Journal of Clinical & Translational Research ; 8(2):125-137, 2022.
Article in English | MEDLINE | ID: covidwho-1777224

ABSTRACT

Background and Aim: The present study intends to investigate COVID-19 by targeting their main proteins with 17 selected drugs used for treating Oral Lichen Planus (OLP) which is a chronic muco-cutaneous disorder. Here, an attempt is made to gain better insight into the structure of various drugs targeting specific proteins which will be helpful in developing drugs useful for therapeutic and preventive measures. Method: In silico studies, molecular docking and molecular dynamic simulations were performed to repurpose the therapeutic drugs (n = 17) which were used to treat OLP against COVID-19. In addition, the maximum binding affinities of the key protein spike glycoprotein, main-protease (Mpro) of coronavirus, and Angiotensin-Converting Enzyme-2 (ACE-2) in the human body were evaluated with the selected drugs. Results: Epigallocatechin-3-gallate (EGCG) showed the highest docking values among the drugs selected for repurposing. Among the target proteins, EGCG has shown maximum binding affinity with ACE-2 receptor. Further, according to the molecular dynamic simulation studies, EGCG has shown the least conformational fluctuations with Mpro. Conclusion: EGCG can be a potential inhibitor drug which can bind with ACE-2 receptor thus inhibiting the interaction of mainly Mpro protein and spike glycoprotein of SARS-CoV-2. Relevance for Patients: EGCG, a natural compound shows antiviral potential having considerably high affinity and stability with SARS-CoV-2. It might be further employed as a lead drug against selective inhibitors of SARS-CoV-2 for the therapeutic management of COVID-19 patients after necessary clinical trials.

17.
Annals of International Medical and Dental Research ; 7(5):414-419, 2021.
Article in English | CAB Abstracts | ID: covidwho-1733405

ABSTRACT

Background: Viral diseases continue to emerge and represent a serious issue to public health. The present study compared Covishield versus Covaxin in COVID- 19 pandemic.

18.
Journal of the Practice of Cardiovascular Sciences ; 7(2):135-141, 2021.
Article in English | Web of Science | ID: covidwho-1701570

ABSTRACT

Objective: The objective is to assess the clinical course and outcomes of heart transplant (HTx) recipients affected by COVID-19 disease in a tertiary care health care institution. Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is a contagious illness with alarming morbidity and mortality. The HTx recipients are chronically immunosuppressed and thus COVID-19 infection in them may result in an unpredictable clinical course. Materials and Methods: HTx recipients in a tertiary care transplant center in North India were retrospectively reviewed from January 2020 to January 2021. Case records of 28 patients of HTx were reviewed, and four (14%) were found to have developed Covid-19 infection. Clinical parameters and outcomes of these four HTx recipients with confirmed SARS-CoV-2 infection are described. Results: Fourteen percent of our HTx patients (4 out of 28 patients under follow-up) developed COVID-19 in the first infection wave. The study population consisted of 3 males and 1 female patient with a median age of 28 years (range 15-39). The most common presenting symptoms were fever (100%), myalgia (100%) and cough (75%). There was no mortality observed in this study. None required intensive care admission or mechanical ventilatory support. Three were managed with hospital admission while one was subjected to home isolation. The mean hospital stay was 13.5 days (12-17 days). Immunosuppressants were modified by reducing tacrolimus and mycophenolate, however, corticosteroids were continued. Conclusion: The dose modification rather than discontinuation of immunomodulatory agents should be established as standard of care for transplant recipients. Steroids may provide added benefit and should be continued. The morbidity and mortality in such cases may be lower than anticipated;however, this needs to be substantiated with larger multicentric studies.

19.
20.
Operations Management Research ; 2021.
Article in English | Scopus | ID: covidwho-1446237

ABSTRACT

Previous pandemics in 1918, 1957, 1968, and the ongoing COVID-19 pandemic have provided sufficient evidence of health concerns caused by influenza pandemics. The existing health care system is overwhelmed by the surging demand of susceptible and infected individuals due to the COVID-19 outbreak. It is crucial to identify and isolate infected individuals to prevent pandemic spread. Thus, a mixed-integer linear programming model is proposed in this study for the location-allocation of health care facility networks (i.e., temporary testing laboratories). The objective of this study is to ensure that test samples from various geographical locations reach testing laboratories as soon as possible and at minimum cost to ensure timely testing. Hence, the proposed model has two objectives: (i) minimization of the total cost and (ii) minimization of the maximum travel time from a patient node to a testing facility. Furthermore, to prevent capacity underutilization, the capacity of temporary testing laboratories is tailored in the model. A case study in Maharashtra, India, is used to demonstrate the real-life applicability of the proposed model. The study results has interesting implications for decision- and policy-makers. © 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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