Scaling law of COVID-19 cases and city size and its evolution over time

Urban scaling law quantifies the disproportional growth of urban indicators with urban population size, which is one of the simple rules behind the complex urban system. Infectious diseases are closely related to social interactions that intensify in large cities, resulting in a faster speed of transmission in large cities. However, how this scaling relationship varies in an evolving pandemic is rarely investigated and remains unclear. Here, taking the COVID- 19 epidemic in the United States as an example, we collected daily added cases and deaths from January 2020 to June 2022 in more than three thousand counties to explore the scaling law of COVID- 19 cases and city size and its evolution over time. Results show that COVID- 19 cases super- linearly scaled with population size, which means cases increased faster than population size from a small city to a large city, resulting in a higher morbidity rate of COVID- 19 in large cities. Temporally, the scaling exponent that reflects the scaling relationship stabilized at around 1.25 after a fast increase from less than one. The scaling exponent gradually decreased until it was close to one. In comparison, deaths caused by the epidemic did not show a super-linear scaling relationship with population size, which revealed that the fatality rate of COVID-19 in large cities was not higher than that in small or medium-sized cities. The scaling exponent of COVID- 19 deaths shared a similar trend with that of COVID- 19 cases but with a lag in time. We further estimated scaling exponents in each wave of the epidemic, respectively, which experienced the common evolution process of first rising, then stabilizing, and then decreasing. We also analyzed the evolution of scaling exponents over time from regional and provincial perspectives. The northeast, where New York State is located, had the highest scaling exponent, and the scaling exponent of COVID- 19 deaths was higher than that of COVID-19 cases, which indicates that large cities in this region were more prominently affected by the epidemic. This study reveals the size effect of infectious diseases based on the urban scaling law, and the evolution process of scaling exponents over time also promotes the understanding of the urban scaling law. The mechanism behind temporal variations of scaling exponents is worthy of further exploration. © 2023 Science Press. All rights reserved.

Water quality analysis in a municipal outdoor swimming pool complex before and during the COVID-19 pandemic

Like all public utility, swimming pools had been treated with special procedures during the COVID19 pandemic. In addition to the basic rules (social distance + hand disinfection + masks), applicable to all citizens, the managers of swimming pools were obliged to reduce the number of swimmers and to increase the effects of water treatment. Monitoring, control and rapid response to unfavourable changes in the quality of swimming pool water are the basis for minimizing the risk of disease transmission or exposure of bathers to pathogens. The main purpose of this work is to analyse and compare the quality of swimming pool water in a municipal outdoor swimming pool complex, before (2018-2019) and during the COVID-19 pandemic (2020-2021). Water samples taken from a paddling pool for children (CP), a recreational pool (RP), and a sports pool (SP) were analysed. The results of the research, based on real case studies, were compared with the documents on water quality in swimming pools in force at the time. An analysis was carried out to determine the relationships between swimming pool water quality before and during the COVID-19 pandemic. The tested parameters determining the quality of water were physico-chemical parameters (temperature, pH, redox, and bacteriological parameters (colony forming units CFU of Pseudomonas aeruginosa, Escherichia coli, Legionella sp.). Based on the results of the analysis of the parameters mentioned-above, the validation of the procedures applied during the COVID-19 hazard and their impact on the quality of swimming pool water were evaluated. The results of the pool water quality tests were discussed with particular emphasis on disinfection by-products (THM and combined chlorine). Detailed analysis showed better water quality in the first year of the pandemic (2020) compared to 2018-2019 (before COVID-19) and 2021 (the second year of COVID-19 pandemic). The following parameters were found to be significantly different: THM (before 0.069 mg/L and during 0.034 mg/L), free chlorine (before 0.86 mg/L and during 0.66 mg/L), and redox potential (before 667 and during 713 mV).

Improved method for COVID-19 Classification of Complex-Architecture CNN from Chest CT volumes using Orthogonal Ensemble Networks

This paper introduces the improved method for the COVID-19 classification based on computed tomography (CT) volumes using a combination of a complex-architecture convolutional neural network (CNN) and orthogonal ensemble networks (OEN). The novel coronavirus disease reported in 2019 (COVID-19) is still spreading worldwide. Early and accurate diagnosis of COVID-19 is required in such a situation, and the CT scan is an essential examination. Various computer-aided diagnosis (CAD) methods have been developed to assist and accelerate doctors' diagnoses. Although one of the effective methods is ensemble learning, existing methods combine some major models which do not specialize in COVID-19. In this study, we attempted to improve the performance of a CNN for the COVID-19 classification based on chest CT volumes. The CNN model specializes in feature extraction from anisotropic chest CT volumes. We adopt the OEN, an ensemble learning method considering inter-model diversity, to boost its feature extraction ability. For the experiment, We used chest CT volumes of 1283 cases acquired in multiple medical institutions in Japan. The classification result on 257 test cases indicated that the combination could improve the classification performance. © 2023 SPIE.

POSSIBLE ROLE OF PEPTIDE EPITOPES OF COVID-19 BNT-162B2 MRNA VACCINE IN FOMENTING AUTOIMMUNITY: AN IN SILICO ANALYSIS

BackgroundFollowing the launch of the global COVID-19 vaccination campaign, there have been increased reports of autoimmune diseases developing de novo following vaccination. These cases include rheumatoid arthritis, autoimmune hepatitis, immune thrombotic thrombocytopenia, and connective tissue diseases. Nevertheless, COVID-19 vaccines are considered safe for patients with autoimmune diseases and are strongly recommended.ObjectivesThe aim of this in silico analysis is to investigate the presence of protein epitopes encoded by the BNT-162b2 mRNA vaccine, one of the most commonly administered COVID-19 vaccines, that could elicit an aberrant adaptive immune response in predisposed individuals.MethodsThe FASTA sequence of the protein encoded by the BNT-162b2 vaccine was retrieved from http://genome.ucsc.edu and used as a key input to the Immune Epitope Database and Analysis Resource (www.iedb.org). Linear peptides with 90% BLAST homology were selected, and T-cell, B-cell, and MHC ligand assays without MHC restriction were searched and evaluated. HLA-disease associations were screened on the HLA-SPREAD platform (https://hla-spread.igib.res.in) by selecting only positive markers.ResultsA total of 183 epitopes were found, corresponding to 178 SARS-CoV-2 and 5 SARS-CoV spike epitopes, respectively. Results were obtained from 22 T-cell assays, 398 B-cell assays, and 2 MHC ligand assays. Complementary receptors included 1080 T-cell receptors and 0 B-cell receptors.Specifically, the IEDB_epitope:1329790 (NATNVVIKVCEFQFCNDPFLGVYY) was shown to bind to HLA-DRB1*15:02 and HLA-DRB1*15:03 alleles, whereas the IEDB_epitope:1392457 (TKCTLKSFTVEKGIYQTSNFRVQPT) was reported to bind to HLA-DRB1*07:01, HLA-DRB1*03:01, HLA-DRB3*01:01, and HLA-DRB4*01:01 alleles. The HLA alleles detected were found to be positively associated with various immunological disorders (Table 1).Table 1.MHC-restricted epitopes of the BNT-162b2 vaccine and potentially associated immunological conditionsEpitopeAssayMHC moleculeAssociated disease (population)NATNVVIKVCEFQFCNDPFLGVYY + OX(C10)cellular MHC/mass spectrometry ligand presentationHLA-DRB1*15:02Takayasu arteritis (Japanese) Arthritis (Taiwanese) Scleroderma (Japanese) Colitis (Japanese)HLA-DRB1*15:03Systemic lupus erythematosus (Mexican American)TKCTLKSFTVEKGIYQTSNFRVQPT + SCM(K2)as aboveHLA-DRB1*07:01Allergy, hypersensitivity (Caucasian)HLA-DRB1*03:01Type 1 diabetes (African) Sarcoidosis, good prognosis (Finnish)HLA-DRB3*01:01Graves' disease (Caucasian) Thymoma (Caucasian) Sarcoidosis (Scandinavian) Autoimmune hepatitis (Caucasian)HLA-DRB4*01:01Vitiligo (Saudi Arabian)ConclusionSimilar to the SARS-CoV-2 spike protein, the protein product of the BNT-162b2 mRNA vaccine contains immunogenic epitopes that may trigger autoimmune phenomena in predisposed individuals. Genotyping for HLA alleles may help identify at-risk individuals. However, further research is needed to elucidate the underlying mechanisms and potential clinical implications.References[1]Vita R, Mahajan S, Overton JA et al. The Immune Epitope Database (IEDB): 2018 update. Nucleic Acids Res. 2019 Jan 8;47(D1):D339-D343. doi: 10.1093/nar/gky1006.[2]Dholakia D, Kalra A, Misir BR et al. HLA-SPREAD: a natural language processing based resource for curating HLA association from PubMed s. BMC Genomics 23, 10 (2022). https://doi.org/10.1186/s12864-021-08239-0[3]Parker R, Partridge T, Wormald C et al. Mapping the SARS-CoV-2 spike glycoprotein-derived peptidome presented by HLA class II on dendritic cells. Cell Rep. 2021 May 25;35(8):109179. doi: 10.1016/j.celrep.2021.109179.[4]Knierman MD, Lannan MB, Spindler LJ et al. The Human Leukocyte Antigen Class II Immunopeptidome of the SARS-CoV-2 Spike Glycoprotein. Cell Rep. 2020 Dec 1;33(9):108454. doi: 10.1016/j.celrep.2020.108454.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Path Planning of Follow-up Transport Robot Based on Machine Vision

With the upgrading and innovation of the logistics industry, the requirements for the level of transportation smart technologies continue to increase. The outbreak of the COVID-19 has further promoted the development of unmanned transportation machines. Aimed at the requirements of intelligent following and automatic obstacle avoidance of mobile robots in dynamic and complex environments, this paper uses machine vision to realize the visual perception function, and studies the real-time path planning of robots in complicated environment. And this paper proposes the Dijkstra-ant colony optimization (ACO) fusion algorithm, the environment model is established by the link viewable method, the Dijkstra algorithm plans the initial path. The introduction of immune operators improves the ant colony algorithm to optimize the initial path. Finally, the simulation experiment proves that the fusion algorithm has good reliability in a dynamic environment. © 2022 IEEE.

The transition of humanity from a predominantly cohesive energy system to one of predominantly negative energy. And then what?

To answer the question, and then what? It is first necessary to ask ourselves how we appeared on Earth and how we got to where we are;then to answer what happens today;and, finally, to try to establish how our disturbed human system might unfold in the future. Development and preparation of this document use a complex systems perspective. The link between human system components is considered as a social energy that can unite or repel. The greater the cohesion energy, the greater the adaptive capacity of the system;its continuity implies transformation. Entropic energy leads to collapse. The human system's historical deployment has generated changes in the predominance of cohesion and repulsion energies that have manifested themselves in the pattern of bonds., Entropic energy has been enhanced with the appearance of the COVID-19 pandemic. The same goes for the growth of mental disorders and the use of fossil energy. To mitigate its negative impact, it is necessary to change the components' role and their behavior logic. © 2022, Pontificia Universidad Catolica del Peru. All rights reserved.

The Economic Impact of COVID-19 Crisis Based on Complex Network Evolution Model

The Covid-19 crisis impacts the economy with non-equilibrium and non-linear shocks. This paper builds a trading network model based on the theory of trading economics. Using the network model, the evolutionary procedure of the economic depression triggered by the shocks are researched. The study shows that under the impact of shocks, small and medium-sized trading agents with weak profitability will first experience cash flow crisis. Then the crisis contagion is formed in upstream and downstream through the trading network. The credit reduction caused by the business deterioration will make the interest rate in the economy increase and promote each other with the bankruptcy of trading entities. Eventually, it leads to the feedback loop in liquidity crisis and debt crisis, which accelerates the bankruptcy of enterprises and possibly causing a debt crisis in the banking sector. It is found that after the shock, the economic recovery may take three patterns: stable recovery, slow recession and secondary crisis. Finally, the paper proposes relevant policy recommendations to reduce the impact of the crisis. © 2023 Editorial Borad of Complex Systems and Complexity Science. All rights reserved.

Recent advances in the effect of ultrasound on the binding of protein−polyphenol complexes in foodstuff

Foodstuff is a complex system that consists of a variety of nutrients. Protein is the basis of human life and health, which is made up of amino acids combined in different proportional orders. Polyphenols are a class of small molecule active substances with strong pro-life health effects. It has been found that protein and polyphenols can be combined by covalent and non-covalent interactions to form complex delivery carriers. The interaction between the two can effectively improve the physiological activities of proteins and enhance the bio-accessibility of polyphenols. With the maturation of ultrasound technology, several studies have shown that ultrasound can promote the production of protein−polyphenol complexes. To promote the study of protein–polyphenol interactions in foodstuff by ultrasound technology, the preparation methods of protein−polyphenol complexes, the effects of ultrasound on complex generation, and analytical methods were systematically summarized based on an extensive literature review, and further research directions were proposed. It provides the reference for the ultrasound study of protein−polyphenol complexes.

Managing severe warm autoimmune haemolytic anaemia after the SARS-Cov- 2 vaccine with emergency splenectomy and eculizumab

Autoimmune haemolytic anaemia (AIHA) is rare but described after the SARS-CoV- 2 Pfizer-BioNTech vaccine. We present a case of severe refractory warm AIHA after this vaccine, managed with emergency splenectomy and complement inhibition with eculizumab. A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and AIHA (aged 6 years) presented to his district general hospital with jaundice, dark urine, fatigue and chest discomfort 48 h after the first dose of SARS-CoV- 2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed haemoglobin (Hb) of 70 g/L and bilirubin of 98 mumol/L, which was treated as AIHA. The patient initially responded to prednisolone (1 mg/kg, 60 mg) but subsequently deteriorated and failed to respond to second-line rituximab (375 mg/m2) and two units of packed red blood cells (PRBC). By day 29 the patient had developed life-threatening anaemia culminating in a Hb of 35 g/L (after transfusion), lactate dehydrogenase (LD) of 1293 units/L and bilirubin of 228 mumol/L. This necessitated an immediate transfer to our tertiary centre for specialist support. Further investigations revealed a haptoglobin <0.1 g/L and direct antiglobulin test (DAT) strongly positive for IgG (4+) and negative for C3d. The peripheral blood film showed severe anaemia, nucleated red cells, anisocytosis and spherocytes with no autoagglutination, schistocytes or platelet clumps. Thrombocytopaenia (platelets 49 +/- 109/L) was present. Differentials were ruled out, such as paroxysmal nocturnal haemoglobinuria and heparin-induced thrombocytopaenia. HIV and hepatitis serology were negative, as were adenovirus, cytomegalovirus and Epstein-Barr virus PCR assays. A CT showed splenomegaly of 15.5 cm. Urinalysis found urobilinogen and bilirubin at high concentrations and negative urinary haemosiderin. Together, the investigations were consistent with warm AIHA. On day 29, four units of PRBC were transfused alongside 100 mg methylprednisolone and 1 g/kg IVIG. On day 30 the patient deteriorated despite the escalated treatment: Hb had only increased to 54 g/L, bilirubin was 200 mumol/L and LD was rising. Considering this life-threatening fulminant haemolysis, an emergency splenectomy was performed. This slowed haemolysis but did not completely ameliorate it: by day 33 the patient had received 15 units of PRBC. Thus, eculizumab, a terminal complement pathway inhibitor, was trialled to arrest intravascular haemolysis, alongside rituximab, repeat IVIG 1 g/kg, prednisolone 40 mg and tacrolimus 2 mg. This showed a favourable response, requiring less frequent transfusions and settling haemolysis. This case highlights the rare complication of warm AIHA with the SARS-CoV- 2 Pfizer-BioNTech vaccine, the use of emergency splenectomy for disease control, and the potential of eculizumab for refractory cases.

Pharmacological Properties and Safe Use of 12 Medicinal Plant Species and Their Bioactive Compounds Affecting the Immune System

This paper presents raw plant materials and their characteristic compounds which may affect the immune system. Plant-derived agents in specific doses affect the body's non-specific, antigen-independent defense system. They have immunostimulatory effects on the entire immune regulatory system. They can enhance the immune response through various factors such as macrophages, leukocytes, and granulocytes, as well as through mediators released by the cellular immune system. This paper was inspired by the threats caused by the COVID-19 pandemic. The proper functioning of the immune system is important in limiting the effects of viral infection and restoring the normal functioning of the body. This paper also emphasizes the importance of the skillful use of plant immunostimulants by potential patients, but also by those who prescribe drugs. It is important not only to choose the right plant drug but above all to choose the correct dose and duration of treatment.

Pandemic techno-politics in the global South

Brazil has been standing out as one of the worst places on Earth to be during a global health crisis, especially for those whose struggle for basic humanitarian rights is already routine. How do the political environment and historical inequalities in countries like Brazil affect the ways in which public policy and technologies are framed as responses for the pandemic crisis? In this paper we aim to present the sequence of actions and omissions in the fight against sars-cov2 in Brazil, concentrating on measures based on the use of digital technologies and the sociotechnical arrangements unfolding in materialities that give shape to such measures. We will also discuss possible repercussions of the widespread adoption of surveillance technologies as a quick fix to the effects of the pandemic. Our focus is to explain how the materiality of the virus and its political as well as territorial effects are combined with digital technologies as responses (or lack of them) in the fields of healthcare, education, communication and labour in the context of the global South. [ FROM AUTHOR] Copyright of Information Polity: The International Journal of Government & Democracy in the Information Age is the property of IOS Press 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 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 . (Copyright applies to all s.)

Cognition-oriented Facilitation and Guidelines for Collaborative Problem-solving Online and Face-to-face: An in-depth examination of format and facilitation influence on problem-solving performance

During the Covid-19 pandemic, more guidelines were created to teach people how to facilitate meetings online, but few were designed from a cognition-oriented perspective. Additionally, solving complex problems is essential in many occupations. However, the influence of online and face-to-face discussion formats on the performance in complex problem-solving tasks is unclear, even though remote working has become common over the past several few years. Hence, this study aims to answer two research questions: (a) Does problem-solving performance differ between online and face-to-face meetings? and (b) Does facilitation improve problem-solving performance when different formats are used? We conducted experiments with 40 groups using a 2 × 2 factorial design, which were controlled for both facilitation and format. Each group comprised two randomly selected participants, and each problem-solving discussion lasted between 1.5-2 h. The obtained evidence showed that format can influence the performance of balancing intercorrelated factors in a complex scenario, but it does not affect the performance of achieving a predefined goal. Instead, it we found that facilitation is helpful for achieving a predefined goal. Based on the results obtained, we propose future design directions for problem-solving centric computer-supported cooperative work systems from a cognition-oriented perspective. © 2023 Owner/Author.

Cost-Effectiveness Analysis of Liposomal Amphotericin B Versus Isavuconazole for Treating Mucormycosis in the Consolidation Phase from the Perspective of the Brazilian Unified Health System

Objectives: Mucormycosis is a rare invasive fungal infection with high lethality, affecting mainly patients with hematological neoplasia, decompensated diabetes, and covid-19 infection. The aim was to perform a cost-effectiveness analysis of liposomal Amphotericin B (standard treatment) versus isavuconazole for treating mucormycosis in the consolidation phase from the perspective of the Brazilian Unified Health System. Method(s): A decision tree model was built. The analysis considered the costs of the treatment over a six-month time horizon. This included hospitalization during the entire course of treatment and the expenditures related to dialysis, complication occurring in 5% (3%-6%) of cases treated with the Amphotericin B. Appointments with specialists were included in the isavuconazole arm, and amphotericin B was used if the patient failed to respond to isavuconazole. The utility of the patient with mucormycosis, cured and with renal failure was estimated. Uncertainties were assessed through probabilistic and deterministic sensitivity analyses. Result(s): The average cost of amphotericin B and isavuconazole arm was R$1.054.874,39 and R$522.344,05, respectively. The utility was 0.479 with amphotericin B and 0.480 with isavuconazole. The ICER was R$ -684,494,237 (dominant). In deterministic sensitivity analysis, the probability of dialysis was the variable with the greatest impact. In probabilistic analysis, the ICER is distributed in the right and left lower quadrant, the acceptability curve for all the scenarios analyzed is favorable for isavuconazole. The budget impact suggests a potential savings of between R$ 350 million and R$ 415 million over five years. Conclusion(s): The treatment of mucormycosis during the consolidation phase with isavuconazole represents a lower cost, besides the convenience of oral treatment and reduced incidence of severe adverse events, with mortality similar to the Amphotericin B arm. In Brazil, the formulation of posaconazole approved is inadequate for treating mucormycosis during the consolidation phase, therefore isavuconazole is the single oral drug available.Copyright © 2023

Diversity of respiratory viruses present in nasal swabs under influenza suspicion in respiratory disease cases of weaned pigs.

Respiratory diseases in weaned pigs are a common problem, with a complex etiology involving both viruses and bacteria. In the present study, we investigated the presence of eleven viruses in nasal swabs, collected from nurseries (55 cases) under the suspicion of swine influenza A virus (swIAV) and submitted by swine veterinarians for diagnosis. The other ten viruses included in the study were influenza B (IBV) and D (IDV), Porcine reproductive and respiratory syndrome virus (PRRSV), Porcine respiratory coronavirus (PRCV), Porcine cytomegalovirus (PCMV), Porcine circovirus 2 (PCV2), 3 (PCV3) and 4 (PCV), Porcine parainfluenza 1 (PPIV1) and Swine orthopneumovirus (SOV). Twenty-six swIAV-positive cases and twenty-nine cases of swIAV-negative respiratory disease were primarily established. While IBV, IDV, PCV4 and PPIV1 were not found in any of the cases, PRCV, SOV, and PCMV were more likely to be found in swIAV-positive nurseries with respiratory disease (p < 0.05). Overall, PCV3, PRRSV, and PCMV were the most frequently detected agents at herd level. Taken individually, virus prevalence was: swIAV, 48.6%; PRCV, 48.0%; PRRSV, 31.6%; SOV, 33.8%; PCMV, 48.3%, PCV2, 36.0%; and PCV3, 33.0%. Moreover, low Ct values (<30) were common for all agents, except PCV2 and PCV3. When the correlation between pathogens was individually examined, the presence of PRRSV was negatively correlated with swIAV and PRCV, while was positively associated to PCMV (p < 0.05). Also, PRCV and SOV were positively correlated between them and negatively with PCMV. Besides, the analysis of suckling pig samples, collected in subclinically infected farrowing units under an influenza monitoring program, showed that circulation of PRCV, PCMV, SOV, and PCV3 started during the early weeks of life. Interestingly, in those subclinically infected units, none of the pathogens was found to be correlated to any other. Overall, our data may contribute to a better understanding of the complex etiology and epidemiology of respiratory diseases in weaners. This is the first report of SOV in Spain and shows, for the first time, the dynamics of this pathogen in swine farms.

Assessing the Effect of the U.S. Vaccination Program on the Coronavirus Positivity Rate With a Multivariate Framework.

The factors influencing the incidence of COVID-19, including the impact of the vaccination programs, have been studied in the literature. Most studies focus on one or two factors, without considering their interactions, which is not enough to assess a vaccination program in a statistically robust manner. We examine the impact of the U.S. vaccination program on the SARS-CoV-2 positivity rate while simultaneously considering a large number of factors involved in the spread of the virus and the feedbacks among them. We consider the effects of the following sets of factors: socioeconomic factors, public policy factors, environmental factors, and non-observable factors. A time series Error Correction Model (ECM) was used to estimate the impact of the vaccination program at the national level on the positivity rate. Additionally, state-level ECMs with panel data were combined with machine learning techniques to assess the impact of the program and identify relevant factors to build the best-fitting models. We find that the vaccination program reduced the virus positivity rate. However, the program was partially undermined by a feedback loop in which increased vaccination led to increased mobility. Although some external factors reduced the positivity rate, the emergence of new variants increased the positivity rate. The positivity rate was associated with several forces acting simultaneously in opposite directions such as the number of vaccine doses administered and mobility. The existence of complex interactions, between the factors studied, implies that there is a need to combine different public policies to strengthen the impact of the vaccination program.

Vaccine-induced immune thrombotic thrombocytopenia: what do we know hitherto?

Vaccine-induced immune thrombotic thrombocytopenia (VITT), also known as thrombosis with thrombocytopenia syndrome, is a catastrophic and life-threatening reaction to coronavirus disease 2019 (COVID-19) vaccines, which occurs disproportionately in response to vaccination with non-replicating adenovirus vector (AV) vaccines. The mechanism of VITT is not well defined and it has not been resolved why cases of VITT are predominated by vaccination with AV vaccines. However, virtually all VITT patients have positive platelet-activating anti-platelet factor 4 (PF4) antibody titers. Subsequently, platelets are activated and depleted in an Fcγ-receptor IIa (FcγRIIa or CD32a)-dependent manner, but it is not clear why or how the anti-PF4 response is mounted. This review describes the pathogenesis of VITT and provides insight into possible mechanisms that prompt the formation of a PF4/polyanion complex, which drives VITT pathology, as an amalgam of current experimental data or hypotheses.

Neuraxial anesthesia for abdominal surgery, beyond the pandemic: a feasibility pilot study of 70 patients in a suburban hospital.

The aim of this study is to establish the feasibility of awake laparotomy under neuraxial anesthesia (NA) in a suburban hospital. A retrospective analysis of the results of a consecutive series of 70 patients undergoing awake abdominal surgery under NA at the Department of Surgery of our Hospital from February 11th, 2020 to October 20th, 2021 was conducted. The series includes 43 cases of urgent surgical care (2020) and 27 cases of elective abdominal surgery on frail patients (2021). Seventeen procedures (24.3%) required sedation to better control patient discomfort. Only in 4/70 (5.7%) cases, conversion to general anesthesia (GA) was necessary. Conversion to GA was not related to American Society of Anesthesiology (ASA) score or operative time. Only one of the four cases requiring conversion to GA was admitted to the Intensive Care Unit (ICU) postoperatively. Fifteen patients (21.4%) required postoperative ICU support. A statistically non-significant association was observed between conversion to GA and postoperative ICU admission. The mortality rate was 8.5% (6 patients). Five out of six deaths occurred while in the ICU. All six were frail patients. None of these deaths was related to a complication of NA. Awake laparotomy under NA has confirmed its feasibility and safety in times of scarcity of resources and therapeutic restrictions, even in the most frail patients. We believe that this approach should be considered as an useful asset, especially for suburban hospitals.

Stellate Ganglion Block for Complex Regional Pain Syndrome Treatment After SARS-CoV-2 Vaccine: A Case Report.

Complex regional pain syndrome (CRPS) is a poorly understood neuropathic pain syndrome that may have different etiologies. Reports of this syndrome after vaccination are rare. We report a female patient with a medical history of acute stroke of the right carotid artery in the previous four months who developed hyperalgesia, allodynia, edema, and color changes in the upper left member compatible with CRPS one day after SARS-CoV-2 vaccination. A multimodal therapeutic approach was adopted, including a stellate ganglion block, with favorable results, including pain score reduction and increased mobility of the affected member.

An Agenda for Advancing Research and Prevention at the Nexus of Work Organization, Occupational Stress, and Mental Health and Well-Being.

Work characteristics and worker well-being are inextricably connected. In particular, the characteristics of work organization shape and perpetuate occupational stress, which contributes to worker mental health and well-being outcomes. Consequently, the importance of understanding and addressing connections between work organization, occupational stress, and mental health and well-being-the focus of this Special Issue-increasingly demand attention from those affected by these issues. Thus, focusing on these issues in the long-haul truck driver (LHTD) sector as an illustrative example, the purpose of this commentary is as follows: (1) to outline current research approaches and the extant knowledge base regarding the connections between work organization, occupational stress, and mental health; (2) to provide an overview of current intervention strategies and public policy solutions associated with the current knowledge base to protect and promote worker mental health and well-being; and (3) to propose a two-pronged agenda for advancing research and prevention for workers during the 21st century. It is anticipated that this commentary, and this Special Issue more broadly, will both echo numerous other calls for building knowledge and engaging in this area and motivate further research within complementary current and novel research frameworks.