Characteristics of cardiotocography in pregnant women with mild COVID-19 in the third trimester.

Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Pandemic deceleration as the opening of potentials for social transformation. Some paths of critical theory

The global health crisis related to the spread of the Covid-19 pandemic has restored unexpected relevance to certain theoretical schemes that are part of the conceptual heritage of the Frankfurt critical theory. In particular, a new actuality seemed to regain the nexus between crisis, critique and emancipation, thematized in this tradition of critical thinking. Building on this premise, the article discusses a series of interventions on the pandemic crisis by exponents of contemporary critical theory, particularly those of Axel Honneth, Nancy Fraser, and Hartmut Rosa. In particular, the interventions of the latter provide a starting point for reasoning about the conceptual resources offered by Rosa's critical acceleration theory for thinking critically and politically about the pandemic event. The article highlights the political deficits of Rosa's resonance theory.

Characteristics of cardiotocography in pregnant women with mild COVID-19 in the third trimester.

Objective. To study the characteristics of cardiotocography (CTG) and pregnancy outcomes in patients who had a mild coronavirus infection in the third trimester. Patients and methods. The parameters and variations of CTG and pregnancy outcomes were analyzed in 32 low-risk pregnant women who experienced mild COVID-19 in the third trimester (the study group) and in 30 pregnant women (matched pairs) who had no coronavirus infection (the comparison group). Results. A total of 375 CTGs were analyzed: 221 in the study group and 154 in the comparison group. Normal CTG recordings were found in 87% of pregnant women in the study group, which was significantly less frequent than in those without COVID-19 (97%) (p = 0.02), and suspicious CTG in 10 and 1.3%, respectively, which was 3.38-fold more frequent than in the comparison group (p = 0.04). Pathological CTG recordings were observed only in two women in the study group. The features of CTG in women who had a mild form of COVID-19 in the third trimester were a significant decrease in the number of accelerations, short-term variation (STV) in the range of 3 to 5 ms, long-term variation (LTV) <50 ms, a tendency toward tachycardia and low heart rate variability (<5 ms), and prolonged decelerations. The frequency of fetal asphyxia and neonatal morbidity was higher in the study group. Conclusion. COVID-19 even in its mild form may have a negative effect on the fetus, increasing the frequency of fetal hypoxia and neonatal asphyxia.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Post‐pandemic cities: An urban lexicon of accelerations/decelerations

COVID‐19 has stimulated renewed societal and academic debate about the future of cities and urban life. Future visons have veered from the ‘death of the city' to visual renderings and limited experiments with novel 15 minute neighbourhoods. Within this context, we as a diverse group of urban scholars sought to examine the emergent ‘post'‐COVID city through the production of an urban lexicon that investigates its socio‐material contours. The urban lexicon makes three contributions. First, to explore how the pandemic has accelerated certain processes and agendas, while at the same time, other processes, priorities and sites have been decelerated and put on hold. Second, to utilise this framing to examine the impacts of the pandemic on how cities are governed, how urban geographies are managed and lived, and how care emerged as a vital urban resource. Third, to tease out what might be temporary intensifications and what may become configurational in urban governance, platforming, density, technosolutionism, dwelling, crowds, respatialisation, reconcentration, care, improvisation and atmosphere. The urban lexicon proposes a vocabulary for describing and understanding some of the key contours of the emergent post‐pandemic city. [ABSTRACT FROM AUTHOR] Copyright of Transactions of the Institute of British Geographers is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Slow Time, School Time, and Strange Times: Opposing and Entangled Discourses on Temporality in Teenagers' Everyday Lives During a Pandemic

In Spring 2020, the Finnish government declared a state of emergency over the Coronavirus outbreak, which lead to schools moving to remote teaching, cancelling all kind of event in society, recommending social distancing and the government encouraging children and adults to take walks. This article sets out to identify and discuss contradicting, complementing, entangling discourses on temporality in a public diary written by teenagers during a pandemic. The data consists of a corona diary published in a local newspaper, through which 34 pupils aged 13 to 16 provide their version of how a day unfolded during six weeks of the beginning of the state of emergency. The identified discourses include: regulation through temporality, change through temporality, normality and normativity through temporality, living present, acceleration and deceleration.

Establishing Genomic SARS-CoV-2 Surveillance at the National Level: Germany, 2021

Background. The COVID-19 pandemic has demonstrated the importance of pathogen genomic surveillance. At RKI, the German National Institute of Public Health, we established the Integrated Molecular Surveillance for SARS-CoV-2 (IMS-SC2) network to perform SARS-CoV-2 genomic surveillance. Methods. SARS-CoV-2 positive samples from laboratories distributed across Germany regularly undergo whole-genome sequencing at RKI. This surveillance instrument enables (i) almost-real-time monitoring of SARS-CoV-2 genomic diversity and evolution, (ii) in vitro assessment of vaccine coverage against emerging variants and (iii) genome-based estimates of SARS-CoV-2-incidences. Results. We report the results of our analyses of 3623 SARS-CoV-2 genomes collected between 12/1/2020 and 12/31/2021. All variants of concern were identified, at ratios equivalent to those in the 100-fold larger German GISAID sequence dataset from the same time period. Lineage distributions fluctuated over time, covering the rise of the Alpha and Delta, as well as the emergence of Omicron. Phylogenetic analysis confirmed variant assignments. Multiple mutations of concern emerged during the observation period. To model vaccine effectiveness in vitro, we employed authentic-virus neutralization assays, confirming that both the Beta and Zeta variants are capable of immune evasion. The IMS-SC2 sequence dataset facilitated an estimate of the SARS-CoV-2 incidence based on genetic evolution rates. Together with modelled vaccine efficacies, Delta-specific incidence estimation indicated that the German vaccination campaign contributed substantially to a deceleration of the nascent German Delta wave. Conclusion. This example illustrates that pathogen genomics enables a proactive approach to controlling a pandemic as the virus evolves. Molecular and genomic SARS-CoV-2 surveillance will be crucial during the post-pandemic future, informing public health policies including vaccination strategies. Of note, the IMS-SC2 infrastructure can be adapted to many other pathogens, serving as a blueprint for future efforts to increase genomic pathogen surveillance.

Latin America and the Caribbean SARS-CoV-2 Surveillance: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has placed unprecedented stress on economies, food systems, and health care resources in Latin America and the Caribbean (LAC). Existing surveillance provides a proxy of the COVID-19 caseload and mortalities; however, these measures make it difficult to identify the dynamics of the pandemic and places where outbreaks are likely to occur. Moreover, existing surveillance techniques have failed to measure the dynamics of the pandemic. OBJECTIVE: This study aimed to provide additional surveillance metrics for COVID-19 transmission to track changes in the speed, acceleration, jerk, and persistence in the transmission of the pandemic more accurately than existing metrics. METHODS: Through a longitudinal trend analysis, we extracted COVID-19 data over 45 days from public health registries. We used an empirical difference equation to monitor the daily number of cases in the LAC as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. COVID-19 transmission rates were tracked for the LAC between September 30 and October 6, 2020, and between October 7 and 13, 2020. RESULTS: The LAC saw a reduction in the speed, acceleration, and jerk for the week of October 13, 2020, compared to the week of October 6, 2020, accompanied by reductions in new cases and the 7-day moving average. For the week of October 6, 2020, Belize reported the highest acceleration and jerk, at 1.7 and 1.8, respectively, which is particularly concerning, given its high mortality rate. The Bahamas also had a high acceleration at 1.5. In total, 11 countries had a positive acceleration during the week of October 6, 2020, whereas only 6 countries had a positive acceleration for the week of October 13, 2020. The TAC displayed an overall positive trend, with a speed of 10.40, acceleration of 0.27, and jerk of -0.31, all of which decreased in the subsequent week to 9.04, -0.81, and -0.03, respectively. CONCLUSIONS: Metrics such as new cases, cumulative cases, deaths, and 7-day moving averages provide a static view of the pandemic but fail to identify where and the speed at which SARS-CoV-2 infects new individuals, the rate of acceleration or deceleration of the pandemic, and weekly comparison of the rate of acceleration of the pandemic indicate impending explosive growth or control of the pandemic. Enhanced surveillance will inform policymakers and leaders in the LAC about COVID-19 outbreaks.

Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses.

BACKGROUND: The COVID-19 pandemic has severely impacted Europe, resulting in a high caseload and deaths that varied by country. The second wave of the COVID-19 pandemic has breached the borders of Europe. Public health surveillance is necessary to inform policy and guide leaders. OBJECTIVE: This study aimed to provide advanced surveillance metrics for COVID-19 transmission that account for weekly shifts in the pandemic, speed, acceleration, jerk, and persistence, to better understand countries at risk for explosive growth and those that are managing the pandemic effectively. METHODS: We performed a longitudinal trend analysis and extracted 62 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in Europe as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: New COVID-19 cases slightly decreased from 158,741 (week 1, January 4-10, 2021) to 152,064 (week 2, January 11-17, 2021), and cumulative cases increased from 22,507,271 (week 1) to 23,890,761 (week 2), with a weekly increase of 1,383,490 between January 10 and January 17. France, Germany, Italy, Spain, and the United Kingdom had the largest 7-day moving averages for new cases during week 1. During week 2, the 7-day moving average for France and Spain increased. From week 1 to week 2, the speed decreased (37.72 to 33.02 per 100,000), acceleration decreased (0.39 to -0.16 per 100,000), and jerk increased (-1.30 to 1.37 per 100,000). CONCLUSIONS: The United Kingdom, Spain, and Portugal, in particular, are at risk for a rapid expansion in COVID-19 transmission. An examination of the European region suggests that there was a decrease in the COVID-19 caseload between January 4 and January 17, 2021. Unfortunately, the rates of jerk, which were negative for Europe at the beginning of the month, reversed course and became positive, despite decreases in speed and acceleration. Finally, the 7-day persistence rate was higher during week 2 than during week 1. These measures indicate that the second wave of the pandemic may be subsiding, but some countries remain at risk for new outbreaks and increased transmission in the absence of rapid policy responses.

BNT162b2 mRNA SARS-CoV- 2 vaccination does not cause upregulation of endothelial activation markers or hypercoagulability: A prospective, single-arm, longitudinal study

Background: Reports of thrombosis post COVID-19 mRNA vaccination have sparked concerns about safety. Aim(s): We prospectively evaluated blood samples of 18 participants who had received 2 doses of the BNT162b2 mRNA vaccine to determine if vaccination results in endothelial activation or hypercoagulability. Method(s): 18 participants who received the BNT162b2 vaccine were enrolled. Participants completed a questionnaire on their cardiovascular and thrombotic risk factors. Blood samples were collected at three time points: Pre-vaccination (day of vaccination), a median of 17 (IQR 16-18) days after the first dose and a median of 9 (IQR 7.5-14.5) days after the second dose of BNT162b2 vaccine. Endothelial markers included ICAM-1, VCAM-1 and P-selectin. Coagulation tests included PT and aPTT with clot waveform analysis, von Willebrand factor levels, Factor VIII and D-dimer levels. Statistical tests of association between endothelial and coagulation parameters were performed with repeated measures ANOVA and Mauchly's test of sphericity. Result(s): The median age of the participants was 35 years (IQR 31 -44), and 14 (78%) were female. 15 did not have any cardiovascular risk factors. There was a statistically significant increase in median ICAM levels post first (66.1ng/ml) and second dose of vaccination (69.5ng/ml)(p = 0.04), although this remained within the normal limit of ICAM levels. A statistically significant decrease in median PT (p = 0.005) and aPTT (p = 0.03) was observed post vaccination, with a corresponding statistically significant increase in aPTT clot waveform analysis (CWA) for maximum acceleration (max2)(p = 0.03) and maximum deceleration (max2)(p = 0.04) post first and second dose of vaccination. However, all evaluated endothelial and coagulation parameters remain within the reference ranges (Table 1). Conclusion(s): Our findings provide reassuring preliminary data that BNT162b2 vaccination does not result in endothelial activation or hypercoagulability. Mild variations in endothelial markers and coagulation parameters, though statistically significant, remain within the reference ranges and may be related to an inflammatory immune response to vaccination. (Table Presented).

SARS-CoV-2 infection causes cardiomyocyte swelling, cardiac pericyte loss, increased permeability, and diastolic dysfunction in a hamster model

Background/Introduction: Recovered COVID-19 patients often display cardiac dysfunction, even after a relatively mild infection. Purpose: We present an in-depth physiological and histological timeline of the cardiac consequences of SARS-CoV-2 infection using a hamster model. Methods: We used several methods, including transthoracic echocardiography, RNA sequencing on in vitro cultures, and in-situ hybridization techniques, complemented with histological analysis. Results: We analysed cardiac function by echocardiography over a period of 35 dpi. Already by 14 dpi and continuing at 35 dpi, infected hamsters presented with an increased E/E', decreased MV deceleration time, and an increased isovolumetric contraction time as compared to control, indicating the presence of diastolic dysfunction. Histologically, cardiomyocytes were enlarged already by 4 dpi and remained enlarged over 5 weeks. We observed the presence of fibrin-rich microthrombi at 4 dpi, which were resolved by 14 dpi. SARS-CoV-2 RNA was present in cardiac pericytes, accompanied by reduced pericyte coverage of capillaries at 4 dpi and 14 dpi, which mostly recovered by 35 dpi. At 14 dpi, the reduced pericyte coverage coincided with increased vascular permeability, suggesting that SARS-CoV-2 infection of pericytes affects microvascular integrity. SARS-CoV-2 infection of pericytes in vitro induced the expression of genes involved in viral defence, and affected genes involved in pericyte contractility and extracellular matrix proteins. Loss of cardiac pericytes was observed in cardiac biopsies from patients recovered from SARSCoV- 2 infection. Conclusion(s): Overall, our results demonstrate that SARS-CoV-2 infection causes a phenotype similar to ischemia-reperfusion, without overt ischemia. We propose that partial occlusion by microthrombi and microvascular dilation caused by pericyte loss induces regional variations in blood flow, and results in a stiffer ;swollen' heart that shows diastolic dysfunction.

Slow Time, School Time, and Strange Times: Opposing and Entangled Discourses on Temporality in Teenagers’ Everyday Lives During a Pandemic

In Spring 2020, the Finnish government declared a state of emergency over the Coronavirus outbreak, which lead to schools moving to remote teaching, cancelling all kind of event in society, recommending social distancing and the government encouraging children and adults to take walks. This article sets out to identify and discuss contradicting, complementing, entangling discourses on temporality in a public diary written by teenagers during a pandemic. The data consists of a corona diary published in a local newspaper, through which 34 pupils aged 13 to 16 provide their version of how a day unfolded during six weeks of the beginning of the state of emergency. The identified discourses include: regulation through temporality, change through temporality, normality and normativity through temporality, living present, acceleration and deceleration.

Slowing Down Society? Theoretical Reflections on Social Deceleration in Pandemic Times (and Beyond)

The COVID-19 pandemic has caused a major change in everyday life and also reinvigorated the theoretical and political discussion on the temporal rhythms of social existence. Taking the situation of the coronavirus crisis as a starting point, the present paper attempts to provide the outlines of a theoretical account of social deceleration, a topic that has been hitherto barely explored in the field of social studies of time. In view of the complexity of the phenomenon, a distinction is made between two ways of theoretically approaching it, namely, a descriptive and a normative perspective. The paper proceeds in three steps: First, upon adopting a descriptive perspective, it advances a definition of social deceleration and proposes a typology of its different manifestations. The second step analyzes the coronavirus crisis as a process of partial deceleration of social life. The final step gives an overview of the current normative, i.e., ethical-political, disputes over social speed. © 2022 Copyright 2022 by Koninklijke Brill NV, Leiden, The Netherlands.

Development of the TOA-Related Models for PM2.5 Prediction Pre- and Post-COVID-19 Outbreak over Yangtze River Delta Region of China

The lockdown and the strict regulation measures implemented by Chinese government due to the outbreak of the COVID-19 pandemic not only decelerated the spread of the virus but also brought a positive effect on the nationwide atmospheric quality. In this study, we extended our previous research on remotely sensed estimation of PM2.5 concentrations in Yangtze River Delta region (i.e., YRD) of China from 2019 to the strict regulation period of 2020 (i.e., 24 Jan, 2020-31 Aug, 2020). Unlike the method using aerosol optical depth (AOD) developed in previous studies, we validated the possibility of moderate resolution imaging spectroradiometer (MODIS) top-of-atmosphere (TOA) reflectance (i.e., MODIS TOA) at 21 bands in estimating the PM2.5 concentrations in YRD region. Two random forests (i.e., TOA-sig RF and TOA-all RF) incorporated with different MODIS TOA datasets were developed, and the results showed that the TOA-sig RF model performed better with R2 of 0.81 (RMSE=8.07 μg/m3) than TOA-all RF model with R2 of 0.79 (RMSE=9.13 μg/m3). The monthly averaged PM2.5 exhibited the highest value of 50.81 μg/m3 in YRD region in January 2020 and sharply decreased from February to August 2020. The annual mean PM2.5 concentrations derived by TOA-sig RF model were 47.74, 32.14, and 21.04 μg/m3 in winter, spring, and summer in YRD during the strict regulation period of 2020, respectively, showing much lower values than those in 2019. Our research demonstrated that the PM2.5 concentrations could be effectively estimated by using MODIS TOA reflectance at 21 bands and the random forest.

Variations of High-Intensity GPS Derived Measures between Playing Status during a Full Soccer Season in a Professional Male Team

Background: This study's aim was twofold: (i) to compare starters and non-starters on a professional soccer team in terms of variations in training intensity indexes across a season, calculated through total distance, sprint distance, accelerations (Acc), and decelerations (Dec) and (ii) to analyse the relationship between the intensity indexes for each playing status. Methods: Nineteen players (age, 29.4 ± 4.4 years;height, 1.8 ± 0.1 m;body mass, 74.8 ± 2.3 kg) were divided into starters and non-starters and followed for 43 weeks using global positioning systems. Results: Training intensity measures (acute:chronic workload ratio [ACWR], coupled and uncoupled) were higher during the latter stage of the season. Total distance peaked during the mid-season, whereas the highest value for exponentially weighted moving average (EWMA) was recorded later in the season. Interestingly, the EMWA of total distance showed little variation during the season for players of both playing statuses. The EWMA of total distance showed a significant higher value for starters than non-starters (p = 0.036;g = 1.27 [0.31, 2.32]). The interruption in games between week 34 and week 35 due to COVID-19 moved some measures into the injury risk zone - namely, the ACWR coupled of sprint distance and Dec;the ACWR uncoupled of total distance, sprint distance, Acc, Dec;and the EWMA of sprint distance, Acc and Dec. Conclusions: The highest training intensity measures were reported late in the season and were similar between starters and non-starters. Across the season, only one difference between starters and non-starters occurred, revealing that training intensity was properly managed throughout the season regardless of the status of the players.

Tropospheric ozone production and chemical regime analysis during the COVID-19 lockdown over Europe

The COVID-19 (coronavirus disease 2019) European lockdowns have led to a significant reduction in the emissions of primary pollutants such as NO (nitric oxide) and NO2 (nitrogen dioxide). As most photochemical processes are related to nitrogen oxide (NOx≡ NO + NO2) chemistry, this event has presented an exceptional opportunity to investigate its effects on air quality and secondary pollutants, such as tropospheric ozone (O3). In this study, we present the effects of the COVID-19 lockdown on atmospheric trace gas concentrations, net ozone production rates (NOPRs) and the dominant chemical regime throughout the troposphere based on three different research aircraft campaigns across Europe. These are the UTOPIHAN (Upper Tropospheric Ozone: Processes Involving HOx and NOx) campaigns in 2003 and 2004, the HOOVN1 -https://media.proquest.com/media/hms/PFT/1/Q2apM?_a=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&_s=4R%2BrSLBAOWkAv60BD6umfsLkEuQ%3D

Validation of a new intuitive software for automatic heart function analysis. An intraobserver variability study

Background/Introduction: In recent years there has been a growing interest in artificial intelligence (AI) applications in the echocardiography field. This is in order to simplify, reduce time and amplify the use of advanced analyses in the echo lab. Purpose: to compare results of the fully automated analysis and manual tracing analysis using a new intuitive software. Methods: 28 consecutive previously healthy patients less than 18 years old who were screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection were enrolled. All they were in sinus rhythm. Standard transthoracic echocardiography (TTE) was performed for each patient using Canon Aplio i900, software 2D Wall Motion Tracking. Optimized apical 4-, 3- and 2- chamber views, mitral valve inflow pattern and LVOT Doppler interrogation were collected. Off-line data analysis of each examination was performed by both fully automated analysis (AI) and pediatric cardiologists with experience in echocardiography i.e. by manual tracing, evaluation and adjustment of the track by the operator (Echocardiographers). Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients datasets were performed twice by both operators and AI. Results: Patients' demographic data were: age 9,8+/-4,7 years;males 22 (78%);height 134,3+/- 34,9 cm;weight 41,8+/-28,7 kg;BSA 1,2+/-0,4 mq, HR 85+/-15/min. The time taken for off-line analysis by AI and echocardiographers was 4-5 and 13-20 minutes, respectively. Reproducibility of echocardiographers' analysis was found to be excellent for left ventricle assessment (IC from 0,88 to 0,98);moderate for LVOT mean gradient (IC 0,73), RV end diastolic area (IC 0,69) and right atrial strain (IC 0,59);poor for deceleration time (IC 0,5), left ventricle strain (IC 0,49), RV FAC and strain (IC from 0,27 to 0,45). Conversely, reproducibility of the AI analysis was found to be excellent for any parameter (ICC from 0,87 to 0,99) (Table 1). About the mitralic valve inflow pattern assessment, despite the excellent reproducibility of AI analysis, the margin of error was found to be high. Particularly, a systematic error was observed with a tendency of the AI to overestimate deceleration time (DT-AI 176,6 ± 63,8 vs DTEcocardiographers 150,4 ± 24,3). Conclusion(s): Fully automated analysis is technically simple, less time consuming and highly reproducible. AI analysis of the mitralic inflow pattern should be optimized, having found a systematic error in the calculation of deceleration time. Reproducibility is the strong point of AI. This reduces the variability of manual measurements between different sonographers and at different times.

Situation of COVID-19 in Brazil in August 2020: An Analysis via Growth Models as Implemented in the ModInterv System for Monitoring the Pandemic

In this work we introduce a novel methodology to classify the dynamical stages of an epidemic, based on the different acceleration regimes of the corresponding growth curve. Our classification scheme is implemented by fitting the empirical data with a general class of mathematical growth models, from which we compute not only the growth acceleration but also its jerk and jounce (i.e., the first and second derivatives of the acceleration, respectively), thus allowing for a finer distinction of the epidemic stages. Using this methodology, we analyze the cumulative curves of deaths attributed to COVID-19 in the 26 Brazilian States and the Federal District, up until August 21, 2020. The online application ModIntervCOVID-19, which automatically implements the classification scheme and which can be accessed via an internet browser or a mobile app, was used to investigate the epidemic stages in each of the Brazilian federal units. The analysis revealed that almost all states in the Northern and Northeastern regions were already in the saturation phase, meaning that the epidemic was relatively under control, whereas in all Southern states and in most states in the Midwest the epidemic was still accelerating or showed only a slight deceleration. The Southeastern region presented a great diversity of epidemic stages, with each state being found at a different stage, ranging from acceleration to saturation. It is argued that understanding this heterogeneous geographical distribution of the epidemic is relevant for public health authorities, as it may help in devising more effective strategies against the COVID-19 pandemic in a continental country like Brazil.

Utility of APTT Based CLOT Waveform Parametersin Various Clinical Conditions-A Study at Tertiary Care Center

Introduction: Coagulation tests performed in laboratory are prothrombin time, activated partial thromboplastin time (APTT),thrombin time help in understanding of pathways involved in coagulation, yet they lack information on the complexity of haemostasis.Global coagulation assays like Thromboelastogram, Thrombin Generation Test and Clot waveform analysis (CWA) are point of caretests which provide rapid approach to a clinical condition. Clot waveis an optical waveform which measures changes in transmittance orabsorbance of light beam through sample. Various applications ofCWA have been extensively studied in last few years.Aims &Objectives: To analyze clot wave form characteristics likemorphology, first and second derivative values in cases with abnormalAPTT.Materials &Methods: APTT and curves generated by ACL TOP300 analyzer of total 125 patients and 20 controls were included.Parameters studied were first derivative (maximum velocity of clotformation), second derivatives (maximum acceleration and deceleration), morphology of curve: sigmoid, biphasic, prolonged precoagulation phase, second derivative morphology like early and lateshoulder, biphasic peak, delayed deceleration were noted. MannWhitney U test was performed and p value was determined.Result: The APTT waveforms were analyzed in 125 patients (M: F-2.2:1, mean age: 46.9 ± 20 years). A spectrum of clinical conditionsshowed covid (20%), liver disease (23%), polytrauma (10.4%), cardiac (8.8%), sepsis/DIC (7.2%), thromboembolism (7.2%), renal(6.4%), bacterial infections (4%), dengue (4%), snake bite (1.6%),factor deficiency (1.6%). There was significant difference in acceleration and deceleration peaks in cases of liver and heart disease,sepsis, dengue, polytrauma and sepsis/DIC cases. Deceleration peakwas additionally prolonged in patients of covid (p<0.05). Firstderivative peak was prolonged in only sepsis and liver diseases(p< 0.05). The pre coagulation phase was prolonged in 75 cases(60%) cases and predominantly covid patients along with secondderivative showing delayed deceleration, early and late shoulder.Conclusions: CWA is readily available on automated coagulationanalyzers being inexpensive with fast turn round time. It providesboth quantitative information on coagulation like velocity, acceleration of clot formation and qualitative details of wave pattern. Therewas significant association of second derivative with the disease inour study. Our study highlights importance to probe into quantitativeand qualitative CWA parameters acquired by performing a simpleAPTT test.

Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has had profound and differential impacts on metropolitan areas across the United States and around the world. Within the United States, metropolitan areas that were hit earliest with the pandemic and reacted with scientifically based health policy were able to contain the virus by late spring. For other areas that kept businesses open, the first wave in the United States hit in mid-summer. As the weather turns colder, universities resume classes, and people tire of lockdowns, a second wave is ascending in both metropolitan and rural areas. It becomes more obvious that additional SARS-CoV-2 surveillance is needed at the local level to track recent shifts in the pandemic, rates of increase, and persistence. OBJECTIVE: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk and persistence, and weekly shifts, to better understand and manage risk in metropolitan areas. Existing surveillance measures coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until, and after, an effective vaccine is developed. Here, we provide values for novel indicators to measure COVID-19 transmission at the metropolitan area level. METHODS: Using a longitudinal trend analysis study design, we extracted 260 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in the 25 largest US metropolitan areas as a function of the prior number of cases and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Minneapolis and Chicago have the greatest average number of daily new positive results per standardized 100,000 population (which we refer to as speed). Extreme behavior in Minneapolis showed an increase in speed from 17 to 30 (67%) in 1 week. The jerk and acceleration calculated for these areas also showed extreme behavior. The dynamic panel data model shows that Minneapolis, Chicago, and Detroit have the largest persistence effects, meaning that new cases pertaining to a specific week are statistically attributable to new cases from the prior week. CONCLUSIONS: Three of the metropolitan areas with historically early and harsh winters have the highest persistence effects out of the top 25 most populous metropolitan areas in the United States at the beginning of their cold weather season. With these persistence effects, and with indoor activities becoming more popular as the weather gets colder, stringent COVID-19 regulations will be more important than ever to flatten the second wave of the pandemic. As colder weather grips more of the nation, southern metropolitan areas may also see large spikes in the number of cases.

Outcomes of the modified pathway for urgent upper GI cancer referrals during the COVID-19 pandemic

Introduction There has been significant change in endoscopy referral pathways as departments reorganise their services during COVID-19. As per BSG guidance, a modified referral pathway was instituted locally for patients with urgent suspicion of upper gastrointestinal cancer (USOC-UGI). We aimed to assess the impact of this modified pathway on outcomes of USOC-UGI referrals during the deceleration and early recovery phases of endoscopy provision during COVID-19 at our institution. Methods We performed a retrospective observational singlecentre study, comparing outcomes of the COVID-impacted USOC-UGI pathway from March to June 2020 to the corresponding pre-COVID period in 2019 when all patients had straight to test endoscopy. During the COVID-impacted period all patients referred were first assessed in a virtual clinic (VC) by a consultant gastroenterologist. Risk stratification and the Edinburgh dysphagia score (EDS) questionnaire were used to triage patients;alternative investigations such as barium study and CT requested when indicated. The primary outcome was cancer detection rate. We also assessed vetting outcomes, symptom concordance, and delayed cancer diagnosis at 6- month follow-up. Results 253 patients were included in the study. 118 patients were referred through the modified COVID-impacted pathway and 135 in 2019, indicating a drop in referrals by 12.5% (p=0.13). The median age was similar (66.5yrs in COVID impacted vs 67yrs pre-COVID). The most common reason for referral during both periods was dysphagia (58.5% vs 62.9%;P=0.221). Symptom concordance between those recorded in the referral and those reported at the time of VC was 86.4%. Following VC, 27/118 (22.9%) patients were deemed not to require UGI investigations of which 9 (7.6%) stated that their symptoms had resolved. Nearly half (55.3%) of the patients reviewed in VC were referred for an alternative investigation to endoscopy, of which barium swallow and meal was most common 36/57 (63%). Overall, the rate of upper GI cancer diagnosed between both periods was not statistically different (8.5% vs 5.2%;P=0.3). All patients diagnosed with oesophageal cancer reported to have symptoms of dysphagia and had a calculated EDS of ≥5. There has been no delayed cancer diagnosis at 6-month follow-up. Conclusions The rate of UGI cancer was similar between the two time periods. Initial virtual consultation reduced the demand for endoscopy or alternative investigations by nearly a quarter. Dysphagia remains an especially worrisome symptom and the incorporation of EDS questionnaire in this pathway appears appropriate. The use of alternative investigations in a select group of patients during restricted endoscopy services seems safe although long-term follow-up data is still required.