Scurvy in a Pediatric Patient Unable to Bear Weight: A Case Report.

Pediatric scurvy is uncommon in the twenty-first century but cases have been reported in children with neurodevelopmental issues and restricted diets. We are reporting a two-year and nine-month-old boy who had a coronavirus disease (COVID) infection and then presented with a refusal to walk. By careful history-taking, he was found to have a restricted diet, speech delay, and gum bleeding suggestive of scurvy, which was confirmed by extremely low levels of ascorbic acid. In this case, the diagnosis of scurvy was established before establishing the diagnosis of neurodevelopmental delay. Treatment with ascorbic acid resulted in a remarkable improvement in his symptoms. This case highlights the importance of collecting a thorough history, connecting exam findings to the history, and including scurvy in differential diagnoses for the presentation of inability to bear weight.

Effects of COVID-19 on Urban Mobility and Public Space Use in Kumasi, Ghana

The actual and perceived effects of the COVID-19 pandemic on mobility and use of public and social spaces in African cities are discussed. Due to their informal growth and less use of technology, residents in African cities usually depend on direct social and economic contacts in everyday business transactions. In Ghana restrictions were imposed on mobility and the use of public spaces in rapidly growing metropolitan areas of Accra and Kumasi. Using Kumasi this study investigated the following questions: What changes were made in mobility and travel patterns by urban residents due to COVID-19? To what extent did public transport vehicle operators suffer revenue losses due to changes in mobility patterns? Which physical and social changes took place in the use of public spaces during the pandemic? How is the city functioning as a place of intense movement and social interactions? In providing answers, we draw on secondary, primary and emerging data on the spread of COVID-19 and its effects on mobility and the use of public spaces. Findings from the study resonate with similar studies conducted around the world indicating a high preference for lower occupancy vehicles (taxis) being considered as a safer option and also an initial reduction in the use of public spaces. Also, there were reductions in vehicle operators' revenue, with those operating minibuses (trotro) being the most affected. In addition to improving the informal public transport services which appear to be a critical mode of transport for commuters in the city, the findings suggest the development of other transport modes, including non-motorized modes, which could contribute to making the city more resilient to future pandemics. The socio-cultural, economic and mobility implications of these findings for urban policy are highlighted and discussed. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

The Effect of a Moderately Restricted Carbohydrate Diet on Cardiometabolic Risk Factors in Overweight and Obese Women With Metabolic Syndrome: A Randomized Controlled Trial.

PURPOSE: Metabolic syndrome (MetS) is a major public health concern that increases the risk of cardiovascular disease and mortality. In previous studies of MetS management, low-carbohydrate diets have been strongly emphasized, despite the fact that many apparently healthy individuals have difficulties adhering to these diets on a long-term basis. The purpose of the present study was to elucidate the effects of a moderately restricted carbohydrate diet (MRCD) on cardiometabolic risk factors in women with MetS. METHODS: This parallel 3-month, single-blind randomized controlled trial was conducted in Tehran, Iran, among 70 women with overweight or obesity aged 20 to 50 years with MetS. Patients were randomly allocated to receive either MRCD (42%-45% carbohydrates and 35%-40% fats) (n = 35) or a normal weight loss diet (NWLD) (52%-55% carbohydrates and 25%-30% fats) (n = 35). Both diets contained the same quantity of protein, which accounted for 15% to 17% of total energy. Anthropometric measurements, blood pressure, lipid profile, and glycemic indices were all assessed before and after the intervention. FINDINGS: Compared with the NWLD group, following an MRCD significantly decreased weight (-4.82 vs -2.40 kg; P = 0.01), body mass index (-1.88 vs -0.94 kg/m2; P = 0.01), waist circumference (-5.34 vs -2.75 cm; P = 0.01), hip circumference (-2.58 vs -1.11 cm; P = 0.01), serum triglyceride (-26.8 vs -7.19 mg/dL; P = 0.01), and increased serum HDL-C levels (1.89 vs. 0.24 mg/dL; P = 0.01). There was no significant difference between the 2 diets in waist-to-hip ratio, serum total cholesterol, serum LDL-C, systolic and diastolic blood pressure, fasting blood glucose, insulin levels, or the homeostasis model assessment for insulin resistance. IMPLICATIONS: Moderate carbohydrate replacement with dietary fats significantly improved weight, body mass index, waist circumference, hip circumference, serum triglyceride, and HDL-C levels among women with MetS. Iranian Registry of Clinical Trials identifier: IRCT20210307050621N1.

A Restricted SIR Model with Vaccination Effect for the Epidemic Outbreaks Concerning COVID-19

This paper presents a restricted SIR mathematical model to analyze the evolution of a contagious infectious disease outbreak (COVID-19) using available data. The new model focuses on two main concepts: first, it can present multiple waves of the disease, and second, it analyzes how far an infection can be eradicated with the help of vaccination. The stability analysis of the equilibrium points for the suggested model is initially investigated by identifying the matching equilibrium points and examining their stability. The basic reproduction number is calculated, and the positivity of the solutions is established. Numerical simulations are performed to determine if it is multipeak and evaluate vaccination's effects. In addition, the proposed model is compared to the literature already published and the effectiveness of vaccination has been recorded.

Jet lag type

Prior to the Covid-19 pandemic, an estimated 11 million jet passengers were traveling daily. While many were traveling within the same time zone, a significant portion were subjecting themselves to circadian desynchrony by rapidly crossing across multiple time zones. This phenomenon, commonly known as jet lag, is mechanistically similar to other forms of circadian misalignment such as shift work. Therefore, understanding the pathophysiology and treatment of jet lag has direct implications for high stakes industries such as aviation, military, medicine, and athletics as well other circadian rhythm disorders. © 2023 Elsevier Inc. All rights reserved

The macroeconomic effects of uncertainty and risk aversion shocks

This paper identifies two types of volatility shocks, namely quantity and price of risk shocks, which can intuitively be interpreted as uncertainty and risk aversion shocks, respectively. Identification is achieved in a shock-restricted SVAR framework using a combination of narrative and external variable restrictions. We find that uncertainty shocks have large negative effects on output, while risk aversion shocks are particularly damaging to asset prices and are deflationary. We also quantify to which extent the endogenous response of risk aversion can exacerbate the effects of uncertainty shocks, thereby providing an estimate of the quantitative relevance of the risk-premium channel of uncertainty shocks. A historical contribution exercise suggests that the GFC is best characterised by a combination of uncertainty and risk aversion shocks, while uncertainty shocks were more important than risk aversion shocks during the COVID pandemic. © 2023 The Author

Simultaneous hypothesis testing for multiple competing risks in comparative clinical trials.

Competing risks data are commonly encountered in randomized clinical trials or observational studies. Ignoring competing risks in survival analysis leads to biased risk estimates and improper conclusions. Often, one of the competing events is of primary interest and the rest competing events are handled as nuisances. These approaches can be inadequate when multiple competing events have important clinical interpretations and thus of equal interest. For example, in COVID-19 in-patient treatment trials, the outcomes of COVID-19 related hospitalization are either death or discharge from hospital, which have completely different clinical implications and are of equal interest, especially during the pandemic. In this paper we develop nonparametric estimation and simultaneous inferential methods for multiple cumulative incidence functions (CIFs) and corresponding restricted mean times. Based on Monte Carlo simulations and a data analysis of COVID-19 in-patient treatment clinical trial, we demonstrate that the proposed method provides global insights of the treatment effects across multiple endpoints.

Regression of treatment-resistant gyrate atrophy-associated intraretinal cystic spaces using long-term diet restriction: A case report.

PURPOSE: Gyrate atrophy of the choroid and retina (GA) is a rare genetic ophthalmologic condition which primarily manifests in childhood. It is characterized by hyperornithinemia and progressive chorioretinal atrophy. Patients may develop macular intraretinal cystic spaces (ICS) for which various treatment modalities have been reported. We report a patient who failed to demonstrate visual or anatomic improvement following multiple treatments for GA-associated ICS but showed improvement following prolonged dietary modification and vitamin supplementation. CASE DESCRIPTION: A 6-year-old male patient presented with previously undiagnosed GA associated with ICS. He received 6 consecutive monthly intravitreal bevacizumab injections as well as topical nepafenac and dorzolamide for treatment of ICS without significant change detected by optical coherence tomography (OCT) following treatment. He was also maintained on an arginine restricted diet with vitamin B6 supplementation. Over the course of the ensuing year, the patient was lost to follow-up due to the coronavirus disease 2019 pandemic. When he returned, his vision was stable, and OCT showed regression of the ICS. His mother reported that he had continued only on dietary restriction and vitamin B6 supplementation with no other medications or interventions. Plasma ornithine level measurement confirmed dietary compliance. Further follow-up showed continued stabilization of the condition. CONCLUSION: In addition to retarding progressive chorioretinal atrophy, prolonged dietary modifications may result in improvement of treatment-resistant GA-associated ICS. Parents' education on the value of dietary modifications for patients with GA is highly recommended.

A Systematic Literature Review on Human Ear Biometrics: Approaches, Algorithms, and Trend in the Last Decade

Biometric technology is fast gaining pace as a veritable developmental tool. So far, biometric procedures have been predominantly used to ensure identity and ear recognition techniques continue to provide very robust research prospects. This paper proposes to identify and review present techniques for ear biometrics using certain parameters: machine learning methods, and procedures and provide directions for future research. Ten databases were accessed, including ACM, Wiley, IEEE, Springer, Emerald, Elsevier, Sage, MIT, Taylor & Francis, and Science Direct, and 1121 publications were retrieved. In order to obtain relevant materials, some articles were excused using certain criteria such as abstract eligibility, duplicity, and uncertainty (indeterminate method). As a result, 73 papers were selected for in-depth assessment and significance. A quantitative analysis was carried out on the identified works using search strategies: source, technique, datasets, status, and architecture. A Quantitative Analysis (QA) of feature extraction methods was carried out on the selected studies with a geometric approach indicating the highest value at 36%, followed by the local method at 27%. Several architectures, such as Convolutional Neural Network, restricted Boltzmann machine, auto-encoder, deep belief network, and other unspecified architectures, showed 38%, 28%, 21%, 5%, and 4%, respectively. Essentially, this survey also provides the various status of existing methods used in classifying related studies. A taxonomy of the current methodologies of ear recognition system was presented along with a publicly available occlussion and pose sensitive black ear image dataset of 970 images. The study concludes with the need for researchers to consider improvements in the speed and security of available feature extraction algorithms.

An Early Detection Of NIPAH Infectious Disease Based On Integrated Medical Features For Human Using Ensemble RBM Techniques

Background: The importance of early diagnosis of a hazardous illness cannot be overstated. The transmission rate is extremely high, especially in the current pandemic condition. The ability to predict epidemics will aid public health in reducing mortality and morbidity. Machine Learning (ML) approaches are used in the construction of an effective disease prognosis model. Furthermore, only if the model learns good associated features from the data is it possible to generate a speedy outcome. As a result, selecting features is also necessary before beginning the forecasting process. Objective(s): However, because of the virus's dynamic structure, it's difficult to predict Nipah disease and/or zoonotic infection. Furthermore, there is no clinical treatment for Nipah. The major goal of this research is to develop a prognostic model for early diagnosis of Nipah disease using a combination of several clinical factors such as symptoms, disease incubation information, and routine blood test results confirmed by a lab technician.Proposed System: The healthcare application and data are more complex to handle than other ML applications since various clinical features are assessed throughout disease manifestation. As a result, selecting the most relevant variables is critical when designing a prognosis model for any viral disease. To deal with clinical features from a vast number of features, we proposed a Restricted Boltzmann Machine (RBM) method in this research. Additionally, we employed a hybrid ensemble learning method to predict if the patient was infected with NiV after choosing features using the RBM. Data Collection: The proposed system is being implemented using the NiV infection dataset that erupted in Kozhikode, Kerala in 2018 and 2019. Result(s): The developed stacking-based ensemble Meta classifier was successfully implemented using the python programming language, and its performance was evaluated using a variety of metrics includingaccuracy, precision, recall, f1-score, log loss, AUROC and MCC. Our proposed Stacking Ensemble Meta Classifier (SEMC) model achieved an accuracy rate of 88.3% with a log loss of 0.36. Model precision, recall, f1-score, AUROC, and MCC value were 92.5%, 89.2%, 90.9%, 92.1%, and 0.74 respectively. In addition, we calculated the gravitational pull of each feature using the SHAP approach and discovered that altered sensorium, fever, headache, and cough were the most critical clinical indicators that distinguished NiVD infection from our dataset. Therefore, this classification may assist the pathologist in diagnosing NiVD with symptoms before performing the RT-PCR medical test. Conclusion(s): Using our proposed SEMC technique, we developed a prognostic model for the diagnosis of Nipah in humans. The proposed technique's discriminatory efficiency exhibited good NiVD diagnosis efficacy. We anticipate that this model will aid medics in determining a prognosis more quickly during future epidemics. However, to achieve maximum accuracy, the model requires more unique samples.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Protein level in feed for gestating sows can be reduced

Research showed that reducing the protein level in the compound feed for gestating sows can have a positive effect on piglet growth. Sows fed with a lower protein content had more energy to produce milk, resulting in heavier piglets at weaning. Reducing protein intake did not negatively affect birth weight or the number of live-born piglets. The results suggest that the sows' daily need for crude protein may be even lower than the level investigated in the study. The findings are particularly relevant in light of the global shortage of organic soyabean meal and other protein sources due to the COVID-19 crisis.

Relationships between sensory reactivity, restricted and repetitive behaviors, and autonomic nervous system activity in autistic and non-autistic individuals

The current dissertation includes seven chapters. Chapter 1 includes my professional background and describes the experiences that led me to study restricted and repetitive behaviors. It also briefly describes my personal journey as an international graduate student. Chapter 2 is devoted to the rich literature that this dissertation is based on. The literature review covers both the foundational and most recent findings in the fields of sensory reactivity, restricted and repetitive behaviors, and autonomic activity, as well as the known relationships between these areas in autistic and non-autistic individuals. In Chapter 3, I describe in detail the methodology used in the current dissertation, including a description of the participants and the study design and analysis choices. Chapters 4 through 6 describe three experimental studies examining different aspects of the relationships between sensory reactivity, restricted and repetitive behaviors, and autonomic activity. Chapter 4 presents findings from a study conducted with both children and adults examining the pupil light reflex as it relates to levels of autistic traits in both age groups. Chapter 5 presents findings from a remote questionnaire study using caregiver-report measures that examines the relationships among sensory reactivity, restricted and repetitive behaviors, and adaptive behaviors in non-autistic children. Chapter 6 extends the questionnaire study of Chapter 5, presenting findings from an in-person study with a subset of children (limited due to restrictions related to COVID-19) that aimed to examine the role of autonomic activity in the relationship between sensory reactivity and restricted and repetitive behaviors in order to begin uncovering the potential mechanisms underlying this relationship. Finally, Chapter 7 is devoted to an overarching conclusion, potential implications, and a description of future plans for my own line of research, which include examining new questions in autistic populations and then extending these questions into the general, broader, population. The motivation behind the research presented in this dissertation is to better understand behaviors that are associated with and prevalent in autism and are also highly stigmatized. Research showing that autistic traits vary widely in the general population can speak to and contribute to the increasing awareness and acceptance of the autistic experience, which is just different, not less. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Meal-timing patterns and chronic disease prevalence in two representative Austrian studies.

PURPOSE: This study aimed at describing meal-timing patterns using cluster analysis and explore their association with sleep and chronic diseases, before and during COVID-19 mitigation measures in Austria. METHODS: Information was collected in two surveys in 2017 (N = 1004) and 2020 (N = 1010) in representative samples of the Austrian population. Timing of main meals, nighttime fasting interval, last-meal-to-bed time, breakfast skipping and eating midpoint were calculated using self-reported information. Cluster analysis was applied to identify meal-timing clusters. Multivariable-adjusted logistic regression models were used to study the association of meal-timing clusters with prevalence of chronic insomnia, depression, diabetes, hypertension, obesity and self-rated bad health status. RESULTS: In both surveys, median breakfast, lunch and dinner times on weekdays were 7:30, 12:30 and 18:30. One out of four participants skipped breakfast and the median number of eating occasions was 3 in both samples. We observed correlation between the different meal-timing variables. Cluster analysis resulted in the definition of two clusters in each sample (A17 and B17 in 2017, and A20 and B20 in 2020). Clusters A comprised most respondents, with fasting duration of 12-13 h and median eating midpoint between 13:00 and 13:30. Clusters B comprised participants reporting longer fasting intervals and later mealtimes, and a high proportion of breakfast skippers. Chronic insomnia, depression, obesity and self-rated bad health-status were more prevalent in clusters B. CONCLUSIONS: Austrians reported long fasting intervals and low eating frequency. Meal-timing habits were similar before and during the COVID-19-pandemic. Besides individual characteristics of meal-timing, behavioural patterns need to be evaluated in chrono-nutrition epidemiological studies.

Environmental Policy for the Restriction on the Use of Plastic Products in Taiwan: Regulatory Measures, Implementation Status and COVID-19's Impacts on Plastic Products Recycling

In response to international trends regarding the reduction in plastic waste (or plastic pollution), this work used the official statistics that were recently released, focusing on regulatory actions restricting the use of plastic products and/or the increase in recycling in Taiwan. In addition, the impacts of the COVID-19 pandemic on plastic waste generation and plastic products' recycling were also addressed in the present study. The results showed that the plastic compositions in the garbage slightly increased in recent years, suggesting that the effect of restrictions on the use of plastic products in Taiwan was not significant, even though the regulatory measures have been implemented since 2002. However, chlorine contents in the garbage were significantly increased in 2020. The increase could be attributed to the fact that kitchen waste (containing salt), household waste containing disinfectant (e.g., chlorine dioxide, sodium hypochlorite) or PVC-made products were generated more during the COVID-19 pandemic. Furthermore, the data also indicated that the monthly quantities of recycled plastic containers and other plastic products had no significant change since January 2020, especially in the outbreak period from May 2021 to July 2021.

Transcortical sensory aphasia heralding SARS-Cov-2-induced autoimmune encephalitis with gyral restricted diffusion hyperintensities: a novel case report.

Background: Coronavirus disease 2019 (CoVID-19), primarily thought of as a respiratory system disease is actually a multi-system disease with immunological implications. CNS involvement in COVID has been explained in recent literature mainly for stroke, encephalopathy, encephalitis, acute disseminated encephalomyelitis and myelopathy. There are few studies characterizing clinical spectrum of COVID autoimmune encephalitis. We present a unique case of post-COVID autoimmune encephalitis in a diabetic male presenting with language dysfunction and novel radiologic findings. Case presentation: Patient admitted to inpatient department of a tertiary care hospital of India was evaluated by bedside clinical examination, routine blood tests, CSF study with intrathecal SARS-Cov-2 antibody detection, commercially available tests for autoimmune encephalitis, neuroviral panel with HSV PCR, EEG, 3-Tesla MRI and PET scan. Patient was found to have personality change and transcortical sensory aphasia in the outset of COVID encephalitis. MRI findings like temporal involvement and insular ribboning are also being reported. The patient was treated with IV immunoglobulin and is on an improving course. Conclusions: This case reports dysphasia due to COVID-mediated injury to the language networks, with novel radiologic findings. Role of parainfectious versus immune etiology is also discussed. Further studies are needed to elucidate the mechanism and clinical spectrum of post-COVID autoimmune encephalitis.

"These Rules Are So Cruel": Bedside Picu Healthcare Providers' Impactful Experiences Associated with Covid-19- Related Restricted Family Presence: A Qualitative Analysis of Free Text

BACKGROUND AND AIM: Family centered care is a core value adopted by most healthcare providers (HCPs) working in North American PICUs. Restricted family presence (RFP) policies adopted during the COVID-19 pandemic threatened this value, with the potential for significant impact. This study explores how implementing and enforcing RFP policies impacted bedside HCPs in PICUs. METHOD(S): We conducted a national, online, selfadministered cross-sectional survey of bedside HCPs from all 19 Canadian PICUs about their experience with RFP. The Impact of Event Scale (IES), an existing validated scale, was included as a survey instrument. Prior to completing the scale, respondents were asked to describe the impactful experience(s) that they planned to reference. The resulting free-text responses were inductively coded for emergent themes, which were discussed for consensus. RESULT(S): 146/388 survey respondents completed the IES (94% English speaking;62% RN, 18% MD, 15% RT;87% self-identified women). Six themes related to impactful situations or events emerged from the event descriptions: 1. Concern about the impact on the patient and family (n=57);2. Non-family centered end-of-life situations (n=43, including 5 who reported family members unable to be present for a death);3. Separating families and denying access (n=36);4. The general, overall experience (n=25), a subtheme of which was "RFP was a positive or neutral experience" (n=13);5. Policies and enforcement felt unjust and unfair (n=23);and 6. Family member non-compliance and aggressive reactions (n=15). CONCLUSION(S): Bedside HCPs experienced multiple impactful, potentially trauma-inducing situations related to RFP.

The Experience of Picu Leaders with Restricted Family Presence during the Covid-19 Pandemic: A Qualitative Descriptive Interview Study

BACKGROUND AND AIM: Due to the COVID-19 pandemic, restricted family presence (RFP) policies were rapidly developed and implemented. PICU leadership was instrumental in dissemination, clarification, and policy enforcement. However, the experience of PICU leaders has not been explored. This study examines the lived experience of physician leads and operational/clinical managers with RFP policies and practices in the PICU. METHOD(S): Qualitative descriptive study. We invited physician leads and managers from all Canadian PICUs to participate in telephone or virtual, audio-recorded, semi-structured interviews, which were transcribed. We performed inductive content analysis: three researchers generated a codebook, two independent coders met regularly to compare codes and refine the codebook, and three researchers organized the data into themes. RESULT(S): We interviewed 9 managers and 15 physician leads from 13 Canadian PICUs. We identified 6 main themes. (1) Operationalizing the policies required enhancement and adaptation of usual leadership roles while (2) working in the middle of organizational hierarchy. (3) The RFP policies made explicit the need to balance stakeholder safety with compassion in caring for the sickest children. (4) Most PICU leaders perceived unintended effects of the RFP policies as having a negative impact on families, healthcare providers, and family centered care. (5) Implementing, communicating, and enforcing restrictions took personal tolls on many of the leaders. (6) Leaders recognized multiple opportunities for policy improvements. CONCLUSION(S): RFP policies had significant professional and personal impacts on PICU leaders, who identified both unintended consequences of and future opportunities for restricted presence policies.

"We Aren't Meant to Go through the Hardest Parts of Our Lives Alone": Caregiver Supports during Covid-19- Related Picu Presence Restrictions: A Mixed Methods Survey Analysis

BACKGROUND AND AIM: In response to the COVID-19 pandemic, multiple Canadian PICUs restricted presence to one caregiver. Though patients could receive support, sources of caregiver support were limited. We sought to examine caregiver support during PICU admission under restricted family presence policies. METHOD(S): We conducted a cross-sectional survey of caregiver experience with restriction policies in Canadian PICUs. Support, or lack thereof, emerged as a dominant theme. Hence, in this sub-study, open-ended questions were analyzed using inductive content analysis, focusing on the concept of support. Likert-scale questions related to being alone at a PICU bedside were summarized using descriptive statistics. RESULT(S): 250 respondents experienced restriction policies (Mean [SD] age 38.8[8.4] years;226[91%] primarily Englishspeaking;230[92%] post-secondary education;208[83%] in a maternal role). Of 187 responses referring to the most difficult aspects of RFP policies, 84 (45%) addressed lack of support. Respondents felt alone in facing the admission and its associated experiences (n=32). RFP resulted in unmet needs for: emotional/moral support (n=42);a specific person's presence (n=28);and respite (n=10). Lack of support impaired medical care, communication, and decisionmaking (n=23). Weighted for strength of agreement, the top situation in which respondents were alone and both wished for a support person (n=9, 81.8%) and felt it was traumatic being alone (n=6, 85.7%) was when their child died. Nonweighted, the highest agreement was when the child's condition worsened (n=99 [89.2%] "wanted support" and n=94 [87.8%] "it was traumatic"). CONCLUSION(S): Restricted family presence policies in PICUs limited caregivers' access to social support systems, resulting in unmet needs and traumatic experiences.

Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study.

BACKGROUND: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. OBJECTIVE: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. METHODS: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator's office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. RESULTS: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing-related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff's limited technical knowledge to perform certain technical tasks was challenging. CONCLUSIONS: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements.

Importance of Intermittent Fasting Regimens and Selection of Adequate Therapy on Inflammation and Oxidative Stress in SARS-CoV-2 Infection.

The unpredictable nature of new variants of coronavirus 2 (SARS-CoV-2)-highly transmissible and some with vaccine-resistance, have led to an increased need for feasible lifestyle modifications as complementary therapies. Systemic inflammation is the common hallmark of communicable diseases like severe coronavirus disease 2019 (COVID-19) and non-communicable chronic diseases (NCDs) such as obesity, cardiovascular diseases (CVD), diabetes mellitus, and cancers, all for which mitigation of severe outcomes is of paramount importance. Dietary quality is associated with NCDs, and intermittent fasting (IF) has been suggested as an effective approach for treatment and prevention of some NCDs, similar to that of caloric restriction. There is a paucity of high-quality data from randomized controlled trials regarding the impact of IF and the intake of specific nutrients on inflammation and post-infection outcomes in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current review of recent literature was performed to explore the immunomodulatory roles of IF regimens and supplements involving the intake of specific nutrients including vitamins (A, B, C, D, and E), zinc, and nutraceuticals (n-3 polyunsaturated fatty acids, quercetin, and probiotics) on inflammatory and oxidative stress markers, with consideration of how they may be related to SARS-CoV-2.