Barriers to Barrett's Esophagus Screening Within Veterans Affair Patient Population

Introduction: Barrett's esophagus (BE) is a metaplastic change in the distal esophagus in which squamous epithelium is replaced by columnar epithelium with goblet cells. Chronic gastroesophageal reflux disease (GERD) is strongly linked to the development of BE, which is a known precursor lesion to esophageal adenocarcinoma (EAC). There is no universal guideline for BE screening, however AJG suggest a single screening endoscopy in patients with chronic GERD symptoms and 3 or more addition risk factors, such as male sex, age > 50 years, white race, tobacco smoking, obesity and family history of BE or EAC. Within the Veteran's Affair (VA) hospital in Northport, New York, many veterans possess multiple risk factors for BE. Residents in VA primary care clinic are diligent in colorectal cancer screening, yet there is concern for limited offerings for BE screening. Our project aims to study the barriers to BE screening within a high-risk veteran population. Method(s): This is a survey-based study. A total of 36 internal medicine residents working in VA primary care clinic were asked to fill out a survey regarding their perspective towards BE screening. The results of the survey are compiled in Table. Result(s): 36 residents within the clinic completed the survey. As shown in Table, 35 out of 36 residents expressed that the primary care clinic does not screen for BE adequately. 30 residents expressed uncertainty regarding referral criteria for BE screening, 24 residents revealed having never referred patients for BE screening. When asked about barriers regarding BE screening, consensus polling showed that there is a lack of resident education surrounding indications for screening. Other common barriers include lack of transportation for veterans to appointments, the COVID 19 pandemic, and lack of health literacy within the veteran population. Conclusion(s): Although there is no established guideline for BE screening, per AJG there is recommendation for a one-time screening endoscopy in susceptible population. VA patients pose a high-risk population that appears to have low screening rates. Patients appear to be placed on long term PPIs without re-assessment and endoscopic screening despite possessing multiple risk factors for BE. Our survey shows that within our resident cohort there is concern for lack of awareness regarding screening criteria for BE. With the initiation of this project, we hope to increase awareness of BE screening within the resident group and improve health outcomes within veteran population. (Table Presented).

Modeling the influence of vaccination coverage on the dynamics of COVID-19 pandemic with the effect of environmental contamination

The emergence of COVID-19 pandemic has been a major social as well as economic challenges around the globe. Infections from the infected surfaces have also been identified as drivers of COVID-19 transmission, but most of the epidemic models do not include the effect of environmental contamination to account for the indirect transmission of the disease. The present study is devoted to the investigation of the effect of environmental contamination on the spread of the coronavirus pandemic by means of a mathematical model. We also consider the impact of vaccination coverage as an effective control measure against COVID-19. The proposed model is analyzed to discuss the feasibility as well as stability of the disease-free and endemic equilibria;an epidemic threshold in the form of basic reproduction number is obtained. Further, we incorporate the effect of seasonal periodic changes by letting the rate of direct transmission of disease as time dependent, and find sufficient conditions for the global attractivity of the positive periodic solution. We employ sophisticated techniques of sensitivity analysis to identify model parameters which significantly alter the epidemic threshold and the disease prevalence. We find that by enhancing the vaccination of the susceptible population and hospitalization of the symptomatic/asymptomatic individuals, the basic reproduction number can be lowered to a value less than unity. The findings show that the prevalence of disease can be potentially suppressed by increasing the vaccination of susceptible population, hospitalization of infected people and depletion of environmental contamination. Moreover, we observe that seasonal pattern in the disease transmission causes persistence of the pandemic in the population for a longer period. © 2023 John Wiley & Sons, Ltd.

Study on pathogen spectrum of 1,046 hospitalized children with respiratory tract infections during COVID-19

Objectives: This study aimed to describe the pathogen spectrum of bacteria and viruses of RTIs in hospitalized children during the Coronavirus disease 2019 (COVID-19) epidemic in Shenzhen. Method(s): From October 2020 to October 2021, the results of pathogenic tests causing RTIs were retrospectively analyzed in hospitalized children in Shenzhen Luohu Hospital Group. Result(s): 829 sputum samples for bacterial isolation and 1,037 nasopharyngeal swabs for virus detection in total. The positive detection rate (PDR) of bacteria was 42.1%. Staphylococcus aureus (18.8%) was the predominant bacteria detected in positive cases, with Moraxella catarrhalis (10.9%), Streptococcus pneumoniae (9.5%) following. The PDR of the virus was 65.6%. The viruses ranking first to third were Human Rhinovirus (HRV), Respiratory syncytial virus (RSV), and Human Parainfluenza (HPIV), with rates of 28.0, 18.1, and 13.5%, respectively. Children under 3 years were the most susceptible population to RTIs. The pathogens of S. aureus, M. catarrhalis, S. pneumoniae, HRV, and HPIV were more prevalent in autumn. Meanwhile, RSV had a high rate of infection in summer and autumn. S. aureus and HRV had higher co-infection rates. Conclusion(s): Our findings demonstrate the pathogen spectrum of 1,046 hospitalized children with RTIs in Shenzhen, China, during the COVID-19 outbreak.Copyright © 2022 the author(s), published by De Gruyter, Berlin/Boston.

Etiology, clinical features, infection control and therapy of SARS-CoV-2 Omicron variant.

The Omicron variant of SARS-CoV-2 is a new variant of concern after Alpha, Beta, Gamma and Delta variants. The amino acid mutations in the viral antigens, especially in the receptor binding region (RBD) of spike protein, were significantly more than those of other variants, which lead to the significant increase of infectivity, transmissibility and immune escape of Omicron variant. In addition, those spike mutations impaired the protective effect of vaccination. When compared to the infection of other variants, the latency of Omicron variant infection was significantly shortened, and the pathogenicity decreased markedly, which is in consistence with the fact that the vast majority of infected individuals showed no symptoms or only mild disease. Exacerbations in patients infected by Omicron variant were often associated with the progress of underlying disease. Early detection and medical isolation of infected persons, careful personal protection measures to cut off transmission routes, and active vaccination to protect susceptible people are key measures to prevent the spread of Omicron variant epidemic. A small number of patients infected with Omicron variant may develop so-called long COVID-19, post-COVID-19 syndrome, or post-COVID-19 condition, which means that long-term follow-up is needed in those patients. Effective anti-Omicron variant therapy can shorten the course of infection, promote the recovery from infection, and also contribute to the control of infection. Therefore, the development of antiviral drugs with ideal cost-benefit ratio and convenient administration is one of the research hotspot in the future.Copyright © 2022 Authors. All rights reserved.

Global stability and analysing the sensitivity of parameters of a multiple-susceptible population model of SARS-CoV-2 emphasising vaccination drive

The study explores the dynamics of a COVID-19 epidemic in multiple susceptible populations, including the various stages of vaccination administration. In the model, there are eight human compartments: completely susceptible;susceptible with dose-1 vaccination;susceptible with dose-2 vaccination;susceptible with booster dose vaccination;exposed;infected with and without symptoms, and recovered compartments. The biological feasibility of the model is analysed. The threshold value, R0, is derived using the next-generation matrix. The stability analysis of the equilibrium points was performed locally and globally using the threshold parameter of the model. The conditions determining disease persistence is obtained. The model is subjected to sensitivity analysis, and the most sensitive parameters are identified. Also, MATLAB is used to verify the mathematical outcomes of the system's dynamic behaviour and suggests that necessary steps should be taken to keep the spread of the omicron variant infectious disease under control. The findings of this study could aid health officials in their efforts to combat the spread of COVID-19. © 2022 International Association for Mathematics and Computers in Simulation (IMACS)

COVID-19 and Pneumonia Detection using Hybrid VGG-16 model using Chest X-rays

The time frame of 2020 to present day 2022 primarily highlights the COVID-19 pandemic. The humanity is being largely affected by SARS-CoV-2(The Severe Acute Respiratory Syndrome CoronaVirus 2) because of its highly infectious characteristic which can be even fatal in severe cases. The World Health Organization (WHO), have reported over 544.3 million verified cases of COVID-19 globally till date, including over 6.3 million deaths. The reason why SARS-CoV-2 is considered to be a dangerous illness is due to this relatively high mortality and contagious rates, in addition to asymptomatic individuals also being carriers of the virus. The only way to identify susceptible populations and to attempt to control the spread would be via RT-PCR COVID testing of all individuals, which is time consuming and expensive. The challenges of this testing mechanism and the prolonging end of the pandemic are the primary motivation to bring up an effective system over a large test cases with a reduced time constraints. This paper proposes a combination of the pretrained convolutional neural network, VGG-16(Visual Geometry Group-16) and GRU(Gated Recurrent Unit) to differentiate the Pneumonia and COVID-19 attack from chest X-rays(CXRs). The proposed model employs VGG-16 to extract features from the CXR inputs, and the GRU classifies it. We experimented this model over 6939 CXR images with 3 classes (COVID-19, Pneumonia, and Normal) and the training produced encouraging macro average precision, recall, and f1-score of 0.9525, 0.9524, and 0.9524 respectively. These results indicate hybrid deep learning systems can greatly aid in the early detection of COVID-19 using CXRs and thereby reduce the widespread of the pandemic. We believe that early diagnosis can be easily and effectively done using this model. © 2022 IEEE.

A Study on Functional Satisfaction with Smart Health Care Air Purification Product in the Post-epidemic Era

In the context of the COVID-19, respiratory diseases have become the focus of social attention, and the elderly, as a susceptible population, is more significantly affected by the epidemic. In order to fully protect the respiratory system of the elderly and enhance their satisfaction with the function of smart products, this study proposes a design method for smart health care product based on the cognitive behavior of elderly users. Firstly, the user demand gap is explored and determined by using the A-Kano model;secondly, a functional model is created based on the FAST functional theory. After converting the user demand into function, and then the TRIZ theory is applied to choose to use 40 invention principles and 39 general engineering parameters to analyze the problem and get conflict domain solutions, so as to filter out the most ideal solution and innovate its function;Finally, by the design and practice of the smart health care air purification product, its purification range, monitoring data and wearing method will be effectively optimized, and the feasibility of the design solution will be verified by the user interaction satisfaction questionnaire. The study provides new ideas for the design of smart health care products and the solutions of contradictory problems, which would also be a theoretical guidance for relevant designer and researchers. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Nonlinear Modeling of COVID-19 and the Significance of Testing: The Case of Kazakhstan

It has been more than two years since the world faced a global pandemic of COVID-19, which affected the global economy negatively and took many human lives. This paper considers the extended susceptible-exposed-infectious-recovered (SEIR) model and finds out whether it is effective for the government of Kazakhstan to conduct massive free PCR testing of the exposed population. To this end, we constructed a new mathematical model and the government cost function that incorporates the hospital cost for the COVID-19 treatment and the cost of PCR testing. To address the above-mentioned objectives, we constructed nonlinear differential equations for our epidemic model and numerically solved them. Furthermore, the government's cost was modeled as a function that depends on the rate of PCR tests. The findings of the numerical analysis show that the government's cost is minimized if the exposed individuals were tested for the disease as often as possible. Moreover, testing both susceptible and exposed individuals is not beneficial in terms of the economic cost. © 2022 IEEE.

Factors Impacting Rural Access to Head and Neck Cancer Care During COVID-19

Introduction: Access to specialty care is challenging in rural health environments, and this has been compounded by the COVID-19 pandemic. Routes to establishing care for head and neck cancer patients are especially important. We sought to quantify our referral patterns and processes to identify opportunities for optimization. Method(s): Retrospective review was performed of patients with initial head and neck tumor board presentation between January 1, 2020, through December 31, 2021. Assessed time points were date of referral, biopsy, pathological diagnosis, imaging order, imaging obtained, and initial presentation at head and neck tumor board. Result(s): A total of 429 patients were included. Squamous cell carcinoma (n=350, 81.6%) made up the majority, and most common primary sites were oropharynx (27.4%), oral cavity (20.3%), larynx (16.9%), and cutaneous (16.5%). At time of referral, 37.6% of patients had biopsy proven diagnosis. Average time to tumor board was 22 days, and significantly greater in those undiagnosed at referral (29 vs 14 days). Distance to provider did not correlate with time to tumor board. The period since the onset of the COVID crisis did not appear to affect access to care once in our system. However, there was evidence that patients presented with advanced locoregional disease during COVID-19. Conclusion(s): This study creates an approach to map access to care, evaluating critical time points and opportunities to expedite multiple steps that initiate therapy for head and neck cancer. There are both external (rural geography and the COVID-19 pandemic) and internal aspects that may pose barriers to access. Identification of these barriers allows for improved timely access to care in this susceptible population.

Features of an Aseasonal 2021 Rsv Epidemic in the Uk and Ireland: Analysis of the First 10,000 Patients

Aims Respiratory syncytial virus (RSV) causes annual winter epidemics that usually peak in December in the UK and Ireland. Infants are disproportionately affected, with infection leading to lower respiratory tract disease, most commonly bronchiolitis, that often result in emergency department visits and hospitalisations. Non-pharmaceutical interventions (NPIs) introduced globally to limit the spread of SARS-CoV-2 led to disruption of the typical RSV seasonality. Studies examining the aseasonal resurgence of RSV have been limited by sample size, and lack of information on secondary care episodes and clinical features. The BronchStart study is a prospective multicentre cohort study with the objective to monitor RSV disease in children under two years of age attending emergency departments (EDs) across the UK and Ireland and examine the impact on timing, age and severity of clinical presentations as NPI restrictions are reduced throughout the UK and Ireland in 2021. Methods Paediatric emergency departments (PED) within PERUKI (Paediatric Emergency Research in the UK and Ireland) submit data on all children under 2 years of age who visit a PED with symptoms of an acute lower respiratory tract infection (diagnosed as bronchiolitis, lower respiratory tract infection, or first episode of acute wheeze), to a secure online Research Electronic Data Capture (REDCap) database. Followup information is submitted 7 days later. Here we present initial data for 10,347 infants and children from 44 study sites for the period 1st June to 5th December 2021. Results At the time of submission the aseasonal 2021 RSV epidemic in the UK has now come to an end, with infections having peaked in August (figure 1A). Comparing the age distribution of hospitalised infants <12 months to previous years at two large paediatric centres currently participating in the BronchStart Study (Leicester Children's Hospital and Bristol Royal Hospital for Children), we observed a similar age distribution (figure 1B). This suggests reduced community exposure to RSV during the 15 months preceding the start of the season did not result in a clinically significant lack of protective maternal antibody transfer to those <3 months of age, or that the NPIs introduced were not strong enough to prevent low level transmission. Disease severe enough to require intensive care was 2.5% in our cohort (for those aged 6 weeks to one year), comparable to 4.2% reported in previous studies. We also observed a substantial number of PED visits and admissions for RSV positive 12-23 month old children in BronchStart: 362 out of 1,468 (24.7%) admissions were in this age group. Conclusion We found that the 2021 summer lower respiratory tract infection peak in the UK and Ireland, although temporally disrupted and with an attenuated disease burden, predominantly affected younger age groups as in previous years The overall lower burden of disease in 2021 suggests incomplete infection by RSV of its usual susceptible population, probably due to the effect of ongoing non-pharmaceutical interventions over the study time period, and raises the strong possibility of a further wave of infection in the coming months.

First national household seroprevalence survey of SARS-CoV 2 antibodies in Tunisia, April 2021

Introduction/ Background: Population-based serosurveys measuring anti- SARSCoV- 2 antibodies are indicated for monitoring and estimating the real extent of the epidemic. This study aims to estimate the seroprevalence of SARS-CoV-2 antibodies among the Tunisian population. Methods: A national household cross sectional study was conducted in Tunisia on April 2021 among adults aged ≥18 years regardless gender, geographical distribution, and vaccination status using a random stratified two stage sampling. A sample size of 10000 subjects was calculated using Openepi Software. Trained interviewers collected data using a standardized electronic questionnaire (CSPAmong software) on sociodemographic characteristics, symptom history, and exposure factors. Blood samples were collected to identify IgG Antibodies, using ELISA test. Data analysis was performed using SPSS 26 and R. Estimations were adjusted to sample design and non-response rate. Results: A total of 9833 individuals from 5039 households were enrolled in the study. The weighted national seroprevalence was 29.5% (95%CI [28.2-30.8%]). It varied between governorates, ranging from 19.9% (95%CI [15.3%-25.5%]) in Kasserine to 41.9 % (95%CI [39.2%-49%]) in Kebili. The highest seroprevalence was among female 30.7%(95%CI [29.1%-32.3%]) Vs 28.2%(95%CI [26.3- 30.1%]) among male and age group 55-64 years 33.8% (95%CI [31.2%- 36.5%]). The lowest seroprevalence was among group age 18-24 25.9% (95%CI [22.4%-29.8%]. Impact: Our study provides estimates on national SARS-CoV- 2 seroprevalence showing significant variations between affected area. Highest seroprevalence where recorded in regions were circulation of SARSCoV- 2 occurred intensively and earlier during the first wave. Conclusion: This is the first national household seroprevalence survey of SARS-CoV-2 antibodies in Tunisia. Findings from this study are useful for adjusting vaccineprioritization decisions and guiding preventive measures especially for susceptible population with lower seropositivity rates.

A Systematic Review of COVID-19 Transmission Dynamics and Clinical Response on Cruise Ships Globally between January and October 2020

Background. Cruise ships provide an ideal setting for efficient transmission of SARS-CoV- 2 given a socially dense exposure environment. No systematic review of transmission of COVID-19 on cruise ships to date has been completed. Methods. MEDLINE was searched in accordance with PRIMSA guidelines for COVID-19 cases associated with cruise ships. A list of cruise ships with COVID-19 was crossed referenced with the Centers for Disease Controls' list of cruise ships that had at least one COVID-19 case associated with them within 14 days of disembarkation. News articles were also searched for epidemiologic information. 43 full text articles from MEDLINE and 177 from news sources were included in the final analysis. Narratives of the outbreak in ships with over 100 cases are presented. Results. A total of 80 ships and 104 unique voyages on cruise ships were identified with at least one COVID-19 case before 30 October 2020. Nineteen ships had more than one voyage with a case of COVID-19. The median number of cases per ship was three (intraquartile range (IQR) 1-17.8), with two notable outliers the Diamond Princess and Ruby Princess which had 712 and 907 cases respectively. The median attack rate for COVID-19 was 0.2% (IQR 0.03% -1.5%), though this distribution was skewed to the right with a mean attack rate of 3.7%. 25.9% of voyages had at least one associated death. Outbreaks involving only crew were later than outbreaks with guests and crew. Conclusion. COVID-19 can spread easily on cruise ships in a susceptible population when there is an absence of mitigation measures due to the confined space and high-density of contact networks. This can not only create super spreader events but also facilitate international spread.

Comparative Study on Epidemic Prevention and Control in Taiwan and Guangdong Provinces

Novel Coronavirus Pneumonia (COVID-19) has ravaged the world since 2019, seriously affecting human production and life. Although my country has controlled the epidemic on the whole, there are still local outbreaks. To this end, a classic infectious disease SEIR model was established to study the spread of the new coronavirus pneumonia epidemic. The population was divided into four categories: susceptible population, exposed population, infected population and removed population. After the parameters of the SEIR model were determined, Python was applied to conduct drills on the SEIR model, and simulation analysis was conducted on the epidemic transmission in Taiwan and Guangdong provinces with and without control measures. The results show that there are significant differences in the number of exposed, infected, and removed numbers between the two provinces. It shows that early and timely strict prevention and control measures can effectively control the spread of the new coronavirus pneumonia epidemic. © 2021 ACM.

[Challenges to prevent and control the outbreak of COVID-19].

An outbreak of severe pneumonia of unknown cause was reported in December 2019 in Wuhan, Hubei province, China. The infectious virus was soon identified and named as 2019 novel coronavirus (2019-nCoV). The name of the COVID-19 was given by WHO on 11 February 2020. It has so far caused about 118 000 cases in 114 countries including China ending March 10, and was characterized as a pandemic by WHO on March 11. We still face great challenges in control of the epidemic: uncertain initial source of infection, infected populations widely scattered, complex routs of transmission, populations generally susceptible, high contagiousness of the virus, and finally vaccines unlikely available in the near future.