Lessons learned from patient outcomes when lowering hemoglobin transfusion thresholds during COVID-19 blood shortages.

OBJECTIVES: This study examines whether patient outcomes were affected when the hemoglobin (Hb) transfusion threshold was lowered by 1 g/dL during COVID-19-related blood shortages. METHODS: Outcomes of lowered Hb thresholds (from <7 to <6 g/dL) were defined by 14-month intervals in 2 patient groups (prepandemic [January 2019-February 2020] and pandemic [April 2020-May 2021]). We evaluated patient admissions, pretransfusion (if transfused) or nadir admission (if not transfused) Hb levels between 5.0 and 8.0 g/dL, and total red blood cell (RBC) transfusions during admission (if transfused). Baseline variables and outcomes were selected from electronic health records. Primary COVID-19-related admissions were excluded. Regression analysis was conducted to determine outcomes. RESULTS: Those in the prepandemic group (1976) and pandemic group (1547) were transfused. Fewer RBCs (2186, vs 3337) were used in the prepandemic group than in the pandemic group, respectively. Those in the prepandemic group had significantly higher rates of hypertension and diabetes as well as more smokers. Significant differences were observed when comparing the number of procedures and incidence of sepsis between the patient groups. Similar patterns were observed for the not transfused and transfused subgroups. CONCLUSIONS: Patient outcomes were not affected after implementing lower Hb pretransfusion thresholds. Although confounding factors were mitigated, some may have been associated with procedures or sepsis. Proactive patient blood management strategies during COVID-19-related blood shortages may include adopting lower Hb thresholds.

Pain tolerance feedback and deliberate self-harm in men and women

There is a growing literature supporting the idea that those who engage in non-suicidal deliberate self-harm (DSH) have altered pain perception compared to individuals who do not. For example, individuals who report a history of non-suicidal DSH behavior have a decreased sensitivity to transient pain during laboratory-based pain induction (e.g., Glenn et al., 2014). Research suggests that brief manipulations targeting individual beliefs can affect performance on subsequent tasks, including measures of pain sensitivity. To date, however, no study has examined the effects of experimentally manipulated pain perception on DSH behavior. The Self-Aggression Paradigm (SAP: Berman & Walley, 2003;McCloskey & Berman, 2003) allows for the prospective observation of the effects of experimental manipulations on a laboratory analogue of DSH. Therefore, the aim of the current study was to determine if experimentally manipulated false feedback about pain tolerance affects DSH behavior during the SAP, thus potentially providing evidence for a causal linkage between pain perception and DSH. Eighty participants were randomly assigned to one of three feedback groups: High pain tolerance, low pain tolerance, and a control condition with neutral feedback provided after completing the SAP. Participants were provided false feedback regarding their pain tolerance after a pressure algometer task. It was predicted that participants in the high pain tolerance feedback group would have the highest DSH on the SAP, with DSH defined as the level of shock self-administered during a series of reaction-time trials. No significant group differences, however, emerged based on group assignment. Men engaged in more DSH than women during the study independent of feedback group assignment. A secondary aim of the current study was to provide further validation for the SAP using multiple pain induction modalities. Implications of the current findings and future research directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Omicron Subvariants: Clinical, Laboratory, and Cell Culture Characterization.

BACKGROUND: The variant of concern, Omicron, has become the sole circulating SARS-CoV-2 variant for the past several months. Omicron subvariants BA.1, BA.2, BA.3, BA.4, and BA.5 evolved over the time, with BA.1 causing the largest wave of infections globally in December 2021- January 2022. In this study, we compare the clinical outcomes in patients infected with different Omicron subvariants and compare the relative viral loads, and recovery of infectious virus from upper respiratory specimens. METHODS: SARS-CoV-2 positive remnant clinical specimens, diagnosed at the Johns Hopkins Microbiology Laboratory between December 2021 and July 2022, were used for whole genome sequencing. The clinical outcomes of infections with Omicron subvariants were compared to infections with BA.1. Cycle threshold values (Ct) and the recovery of infectious virus on VeroTMPRSS2 cell line from clinical specimens were compared. RESULTS: The BA.1 was associated with the largest increase in SARS-CoV-2 positivity rate and COVID-19 related hospitalizations at the Johns Hopkins system. After a peak in January, cases fell in the spring, but the emergence of BA.2.12.1 followed by BA.5 in May 2022 led to an increase in case positivity and admissions. BA.1 infections had a lower mean Ct when compared to other Omicron subvariants. BA.5 samples had a greater likelihood of having infectious virus at Ct values less than 20. CONCLUSIONS: Omicron subvariants continue to be associated with a relatively high rate of PCR positivity and hospital admissions. The BA.5 infections are more while BA.2 infections are less likely to have infectious virus, suggesting potential differences in infectibility during the Omicron waves.

Decreased Speech Comprehension and Increased Vocal Efforts Among Healthcare Providers Using N95 Mask.

AIM: N95 masks are recommended for the healthcare providers (HCPs) taking care of patients with coronavirus disease 2019. However, the use of these masks hampers communication. We aimed to evaluate the effect of N95 masks on speech comprehension among listeners and vocal efforts (VEs) of the HCPs. MATERIALS AND METHODS: This prospective study involved 50 HCPs. We used a single observer with normal hearing to assess the difficulty in comprehension, while VE was estimated in HCPs. The speech reception threshold (SRT), speech discrimination score (SDS), and VEs were evaluated initially without using N95 mask and then repeated with HCPs wearing N95 mask. RESULTS: The use of masks resulted in a statistically significant increase in mean SRT [4.25 (1.65) dB] and VE [2.6 (0.69)], with simultaneous decrease in mean SDS [19.2 (8.77)] (all p-values < 0.0001). Moreover, demographic parameters including age, sex, and profession were not associated with change in SRT, SDS, and VE (all p-values > 0.05). CONCLUSION: Though use of N95 masks protects the HCPs against the viral infection, it results in decreased speech comprehension and increased VEs. Moreover, these issues are universal among the HCPs and are applicable to the general public as well.

Big ideas in the geography curriculum: nature, awareness and need

Big ideas, sometimes referred to as key, core, fundamental or threshold concepts, are widely applicable concepts at the heart of disciplines that are or have been central and influential for their fields. Attention here is particularly directed to meta-concepts common to sister disciplines in the sciences. "Learning thresholds”, "powerful knowledge” and their meanings are singled out for discussion having become widely relevant to geography. Other empowering big ideas for geography are identified;collectively these can be close to the global concerns that new learners may have, giving them motivation for their learning. Developing global challenges, from coronavirus infections to climate change, are geographically varied in their reach and impacts. Student engagement can be enhanced as concepts are addressed and they embark on the methodological and factual knowledge and skills that give new value to HE learning. Fresh concepts can also be realized from students' individual projects or enquiries. In these ways big ideas can provide motivational stimuli for progressing enterprising research through such learning.

Impact of Using Soft Exposure Thresholds in Automatic Contact Tracing

Current automatic exposure notification apps primarily operate based on hard distance/time threshold guidelines (e.g., 2 m/15 min in the United States) to determine exposures due to close contacts. However, the possibility of virus transmission through inhalation for distances over the specified distance threshold might necessitate consideration of soft distance/time thresholds to accommodate all transmission scenarios. In this paper, using a simplifying approximation on the instantaneous rate of the viral exposure versus distance, we extend the definition of "contact"by proposing a soft distance/time threshold which includes the possibility of getting exposed at any distance (within certain limits) around an infected person. We then analyze the performance of automatic exposure notification with Bluetooth-based proximity detection by comparing the exposure results when soft or hard thresholds are used. This study is done through an agent-based simulation platform that allows for a comprehensive analysis using several system parameters. By tuning the parameters of the proposed soft thresholds, a more accurate determination of possible exposures at any distance would be possible. This would enhance the effectiveness of an automatic contact tracing system. Our results indicate the noticeable impact of using the soft distance/time threshold on the exposure detection accuracy. © 2022 IEEE.

Association of SARS-CoV-2 viral load distributions with individual demographics and suspected variant type: results from the Liverpool community testing pilot, England, 6 November 2020 to 8 September 2021.

BackgroundThe PCR quantification cycle (Cq) is a proxy measure of the viral load of a SARS-CoV-2-infected individual.AimTo investigate if Cq values vary according to different population characteristics, in particular demographic ones, and within the COVID-19 pandemic context, notably the SARS-CoV-2 type/variant individuals get infected with.MethodsWe considered all positive PCR results from Cheshire and Merseyside, England, between 6 November 2020 and 8 September 2021. Cq distributions were inspected with Kernel density estimates. Multivariable quantile regression models assessed associations between people's features and Cq.ResultsWe report Cq values for 188,821 SARS-CoV-2 positive individuals. Median Cqs increased with decreasing age for suspected wild-type virus and Alpha variant infections, but less so, if not, for Delta. For example, compared to 30-39-year-olds (median age group), 5-11-year-olds exhibited 1.8 (95% CI: 1.5 to 2.1), 2.2 (95% CI: 1.8 to 2.6) and 0.8 (95% CI: 0.6 to 0.9) higher median Cqs for suspected wild-type, Alpha and Delta positives, respectively, in multivariable analysis. 12-18-year-olds also had higher Cqs for wild-type and Alpha positives, however, not for Delta. Overall, in univariable analysis, suspected Delta positives reported 2.8 lower median Cqs than wild-type positives (95% CI: 2.7 to 2.8; p < 0.001). Suspected Alpha positives had 1.5 (95% CI: 1.4 to 1.5; p < 0.001) lower median Cqs than wild type.ConclusionsWild-type- or Alpha-infected school-aged children (5-11-year-olds) might transmit less than adults (> 18 years old), but have greater mixing exposures. Smaller differences in viral loads with age occurred in suspected Delta infections. Suspected-Alpha- or Delta-infections involved higher viral loads than wild type, suggesting increased transmission risk. COVID-19 control strategies should consider age and dominant variant.

A novel technique for the detection of Covid-19 patients with the applications of three-way decisions using variance-based criterion.

Everyone is making constant efforts to establish an effective diagnostic approach, therapy and control of the spread of the pandemic. Due to a flexible formulation, the parameters prior to the normal distributions and explicitly formulate assumptions on the transition probabilities between these categories over time. The spread of the COVID-19 pandemic represents a serious threat for scientists and academics, health professionals and even governments today. The Hospital wards are classified into Intensive Care Unit (ICU), Regular Wards (RW) with Recovered (R) and Deceased (D).. The formulation may be truncated to include particular hypotheses with an epidemiological interpretation. The principles of Three-Way Decision Theory could be used to anticipate and diagnose COVID-19 patients were classified into one of three zones based on their symptoms: Positive, Negative, or Boundary, and treatment are recommended if necessary. The thresholds that distinguish the three zones are determined using a variance-based criterion. Examine the impact of nonpharmaceutical interventions and the findings from data gathered during the second wave of the pandemic in Trivandrum, India.The Three-Way Decision Theory model has a good fit and gives good predictive performance, especially for RW and ICU patients, according to suitable discrepancy metrics that were created to assess and compare models. 95 percent accuracy increased and calculated values for 10 days to demonstrate the temporal aspects of the expected daily reproduction number R.

Is COVID-19 to Blame for Sensorineural Hearing Deterioration? A Pre/Post COVID-19 Hearing Evaluation Study.

OBJECTIVES: Here, we aimed to (a) determine whether a clinically significant sensorineural hearing loss (SNHL) change could be detected in post-coronavirus disease (COVID-19) hearing levels on comparing them with pre-infection hearing levels after controlling for the effect of age and (b) to identify risk factors, such as hypertension, diabetes, and smoking, which increase the likelihood of hearing loss in COVID-19 patients. METHODS: We retrospectively analyzed hearing thresholds in unvaccinated patient's pre- and post-COVID-19 infection. Thresholds were controlled for age and the duration between the pre- and post-COVID-19 hearing evaluations. Correlations between additional COVID-19-related symptoms, hypertension, diabetes, and smoking and hearing threshold changes were analyzed. RESULTS: A significant (but not clinical) threshold elevation was found post-COVID-19 infection. However, on controlling for age and the duration between the pre- and post-COVID-19 hearing evaluations, no significant threshold elevation was found. No significant correlation was found between hearing threshold changes and additional COVID-19-related symptoms, hypertension, diabetes, or smoking. CONCLUSION: COVID-19 did not lead to a significant hearing threshold elevation in our cohort, even among patients with additional COVID-19 symptoms, hypertension, or diabetes mellitus or among those who smoked. LEVEL OF EVIDENCE: 3: nonrandomized controlled cohort, follow-up study Laryngoscope, 2022.

Identifying Antibiotic Use Targets for the Management of Antibiotic Resistance Using an Extended-Spectrum ß-Lactamase-Producing Escherichia coli Case: A Threshold Logistic Modeling Approach.

The aim of this study was to develop a logistic modeling concept to improve understanding of the relationship between antibiotic use thresholds and the incidence of resistant pathogens. A combined approach of nonlinear modeling and logistic regression, named threshold logistic, was used to identify thresholds and risk scores in hospital-level antibiotic use associated with hospital-level incidence rates of extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli). Threshold logistic models identified thresholds for fluoroquinolones (61.1 DDD/1000 occupied bed days (OBD)) and third-generation cephalosporins (9.2 DDD/1000 OBD) to control hospital ESBL-producing E. coli incidence. The 60th percentile of ESBL-producing E. coli was determined as the cutoff for defining high incidence rates. Threshold logistic analysis showed that for every one-unit increase in fluoroquinolones and third-generation cephalosporins above 61.1 and 9.2 DDD/1000 OBD levels, the average odds of the ESBL-producing E. coli incidence rate being ≥60th percentile of historical levels increased by 4.5% and 12%, respectively. Threshold logistic models estimated the risk scores of exceeding the 60th percentile of a historical ESBL-producing E. coli incidence rate. Threshold logistic models can help hospitals in defining critical levels of antibiotic use and resistant pathogen incidence and provide targets for antibiotic consumption and a near real-time performance monitoring feedback system.

Symptomatic but not Asymptomatic COVID-19 Impairs Conditioned Pain Modulation in Young Adults.

Pain is a common symptom reported in COVID-19 patients. Impaired endogenous pain-modulatory mechanisms such as conditioned pain modulation (CPM), and exercise-induced hypoalgesia (EIH) have been found in chronic pain conditions but is often overlooked in acute conditions that evoke painful symptoms, such as COVID-19. The purpose was to compare pressure-pain sensitivity, CPM, and EIH function among individuals who previously had COVID-19, both symptomatically and asymptomatically, and a healthy control group. Pressure pain thresholds of 59 participants were assessed in the forearm and leg using a pressure algometer before and after 1) submersion of their dominant foot in cold water (2°C) for 1min; and 2) isometric knee extension performed to task-failure at 25% of their maximal contraction. The CPM response was attenuated in individuals who were infected with symptomatic COVID-19 (N = 26) compared to asymptomatic COVID-19 (N = 13) in arm (-1.0% ± 20.3 vs 33.3% ± 26.2; P < .001) and leg (12.8% ± 22.0 vs 33.8% ± 28.2; P = .014) and compared to controls (N = 20) in arm only (-1.0% ± 26.2 vs 23.4% ± 28.2; P = .004). The EIH response was not different between groups. CPM was impaired in individuals who had symptomatic COVID-19, which may have long-term implications on pain modulation. PERSPECTIVE: This study reveals that CPM was impaired in individuals who had symptomatic COVID-19 during the first wave of COVID-19, pre vaccine. These findings present a preliminary motive to study the long-term implications of COVID-19 and its effects on pain modulation.

The Climate Emergency: A Statement from Genocide Scholars on the Necessity for a Paradigm Shift

Genocide scholarship is underpinned by an implicit revulsion at the suffering, violence and degradation perpetrated by human beings against other human beings. Those of us who work in the field may deploy different methodologies, standpoints and frames of reference by which we seek to understand both the causes and consequences of mass violence as inflicted on whole groups of people across historical time. Implicitly, where not explicitly, we are impelled in what we do by a desire to live in a world where genocide and all such crimes against humanity have been consigned to the past. This statement, as predicated on aspirations for a kinder, gentler commonwealth, is rendered inoperable, however, so long as we seek to ignore or avoid the biospheric crisis facing humankind. A generation on from when anthropogenic climate change became general knowledge, nearly all of human society – usually excepting those most directly involved either as earth science practitioners, or as environmental victims – have been too slow in recognizing or acknowledging the far-reaching and destructive scale of the biogeochemical disruption as it will impact on our lives and wellbeing. The present coronavirus pandemic in these terms is simply a signal warning from nature reminding us that ever increasing human disturbance to an already threadbare ecological balance must in turn have severe consequences for ourselves. Yet the overall effect of human-induced planetary destablization in coming decades will make of one singular zoonotic event a passing footnote. The bigger picture is one in which the thresholds allowing for our sustainable, cross-generational flourishing are in the process of being breached at an alarming and exponentially escalating rate. At the core of this ongoing ecological collapse is the rapid heating of the planet as a result of the vast quantities of fossil fuels some of us – primarily in the Global North – are burning and thus emitting as greenhouse gases into the atmosphere. The consequential breakdown of sustainable food production and the permanent salination or inundation of the land much of us inhabit, alongside the direct effects of soaring, unbearable temperatures, will lead to the displacement and death of hundreds of millions, if not billions of human beings. Yet this apocalypse in the making is not some unforeseen blip or caesura. On the contrary, its causes can be traced to the same forces which created the conditions for modernity, not least through colonial conquest and predation and with them the arrival of a hegemonic world system. The interrelationship thus between ecocidal and genocidal warfare, waged against peoples and planet is built into this anthropocenic turn.

Temporal Dynamics of Nasopharyngeal and Tracheal Severe Acute Respiratory Syndrome Coronavirus 2 Cycle Thresholds in Coronavirus Disease 2019 Patients With Tracheostomy.

In this study of 45 patients with COVID-19 undergoing tracheostomy, nasopharyngeal and tracheal cycle threshold (Ct) values were analyzed. Ct values rose to 37.9 by the time of tracheostomy and remained >35 postoperatively, demonstrating that persistent test positivity may not be associated with persistent transmissible virus in this population.

Analysis of IBNR Liabilities with Interevent Times Depending on Claim Counts.

We extend a recently proposed stochastic loss reserving model for liabilities from incurred but not reported (IBNR) micro-level claims. We propose viewing the number of claims from an event as a measure of catastrophic severity. This view covers catastrophes with arbitrarily many classes of magnitude. Our Markovian model allows the time between disasters to depend on the previous event's level of severity. Simultaneously, we let the discount rate vary in the same manner. First, we find the moments of IBNR liabilities in our model. Then, we permit a later time horizon for IBNR claims when considered jointly with incurred and reported claims.

Edge Detection of COVID-19 CT Image Based on GF_SSR, Improved Multiscale Morphology, and Adaptive Threshold

Edge detection is an effective method for image segmentation and feature extraction. Therefore, extracting weak edges with the inhomogeneous gray of Corona Virus Disease 2019 (COVID-19) CT images is extremely important. Multiscale morphology has been widely used in the edge detection of medical images due to its excellent boundary detection accuracy. In this paper, we propose a weak edge detection method based on Gaussian filtering and single-scale Retinex (GF_SSR), and improved multiscale morphology and adaptive threshold binarization (IMSM_ATB). As all the CT images have noise, we propose to remove image noise by Gaussian filtering. The edge of CT images is enhanced using the SSR algorithm. In addition, based on the extracted edge of CT images using improved Multiscale morphology, a particle swarm optimization (PSO) algorithm is introduced to binarize the image by automatically getting the optimal threshold. To evaluate our method, we use images from three datasets, namely COVID-19, Kaggle-COVID-19, and COVID-Chestxray, respectively. The average values of results are worthy of reference, with the Shannon information entropy of 1.8539, the Precision of 0.9992, the Recall of 0.8224, the F-Score of 1.9158, running time of 11.3000. Finally, three types of lesion images in the COVID-19 dataset are selected to evaluate the visual effects of the proposed algorithm. Compared with the other four algorithms, the proposed algorithm effectively detects the weak edge of the lesion and provides help for image segmentation and feature extraction. © 2022 Tech Science Press. All rights reserved.

The displacement of the SARS-CoV-2 variant Delta with Omicron: An investigation of hospital admissions and upper respiratory viral loads.

BACKGROUND: The increase in SARS-CoV-2 infections in December 2021 was driven primarily by the Omicron variant, which largely displaced the Delta over a three-week span. Outcomes from infection with Omicron remain uncertain. We evaluated whether clinical outcomes and viral loads differed between Delta and Omicron infections during the period when both variants were co-circulating. METHODS: In this retrospective observational cohort study, remnant clinical specimens, positive for SARS-CoV-2 after standard of care testing at the Johns Hopkins Microbiology Laboratory, between the last week of November and the end of December 2021, were used for whole viral genome sequencing. Cycle threshold values (Ct) for viral RNA, the presence of infectious virus, and levels of respiratory IgG were measured, and clinical outcomes were obtained. Differences in each measure were compared between variants stratified by vaccination status. FINDINGS: The Omicron variant displaced Delta during the study period and constituted 95% of the circulating lineages by the end of December 2021. Patients with Omicron infections (N = 1,119) were more likely to be vaccinated compared to patients with Delta (N = 908), but were less likely to be admitted (0.33 CI 0.21-0.52), require ICU level care (0.38 CI 0.17-0.87), or succumb to infection (0.26 CI 0.06-1.02) regardless of vaccination status. There was no statistically significant difference in Ct values based on the lineage regardless of the vaccination status. Recovery of infectious virus in cell culture was reduced in boosted patients compared to fully vaccinated without a booster and unvaccinated when infected with the Delta lineage. However, in patients with Omicron infections, recovery of infectious virus was not affected by vaccination. INTERPRETATION: Compared to Delta, Omicron was more likely to cause breakthrough infections of vaccinated individuals, yet admissions were less frequent. Admitted patients might develop severe disease comparable to Delta. Efforts for reducing Omicron transmission are required as, though the admission risk might be lower, the increased numbers of infections cause large numbers of hospitalizations. FUNDING: NIH/NIAID Center of Excellence in Influenza Research and Surveillance contract HHS N2772201400007C, Johns Hopkins University, Maryland department of health, Centers for Disease Control and Prevention contract 75D30121C11061, and The Modeling Infectious Diseases in Healthcare Network (MInD) under awards U01CK000589.

A MARTINGALE FORMULATION FOR STOCHASTIC COMPARTMENTAL SUSCEPTIBLE-INFECTED-RECOVERED (SIR) MODELS TO ANALYZE FINITE SIZE EFFECTS IN COVID-19 CASE STUDIES

Deterministic compartmental models for infectious diseases give the mean behaviour of stochastic agent-based models. These models work well for counterfactual studies in which a fully mixed large-scale population is relevant. However, with finite size populations, chance variations may lead to significant departures from the mean. In real-life applications, finite size effects arise from the variance of individual realizations of an epidemic course about its fluid limit. In this article, we consider the classical stochastic Susceptible-Infected-Recovered (SIR) model, and derive a martingale formulation consisting of a deterministic and a stochastic component. The deterministic part coincides with the classical deterministic SIR model and we provide an upper bound for the stochastic part. Through analysis of the stochastic component depending on varying population size, we provide a theoretical explanation of finite size effects. Our theory is supported by quantitative and direct numerical simulations of theoretical infinitesimal variance. Case studies of coronavirus disease 2019 (COVID-19) transmission in smaller populations illustrate that the theory provides an envelope of possible outcomes that includes the field data.

A socio-economic study for establishing an environment-friendly metro in Kuwait

Purpose> This paper aimed to study the optimal way to implement and subsequently manage the new metropolitan lines in the Kuwait city as well as to justify them from a social and economic-financial viability standpoint and the most important aspects of transport infrastructure projects viability. The implementation of new modes of transport in an urban environment requires the study of several factors that allow their incorporation on the transport system in the most efficient method. These factors include reviewing the organization of the transport system. The concept of transport system organization, financing models and common trends was defined. Finally, the Public Transport Authority was created to define global objectives and establish specific policies to achieve them was suggested.Design/methodology/approach> After the analysis of the “status quo” of transport systems organization, the financing and management schemes, both infrastructure projects and the provision of rail service were analysed. The characteristics of the PPP scheme (Public–Private Participation) contract, advantages and disadvantages, its structure, and the definition and share of risk (matrix of risk, rights and obligations of the parties) as a key element of the PPP contracts were defined. From this point onwards, the legal framework in force in Kuwait was analysed, particularly the administrative and commercial regulations applying to this project and the authors verified that the economic-financial viability analysis suggested before can be established under this framework.Findings> For the viability of these alternatives, the authors developed a simulation economic-financial model that reflects Financial Statements for the “Society Vehicle Project” and are considered some minimum thresholds of profitability, both from the viewpoint of the partners sponsoring the project as from the standpoint of lenders, which make attractive participation of private initiative. Finally, there was a short socio-economic analysis to justify the project implementation from a social standpoint. It analyses and quantifies the reduction of operating expenses of other modes of transport, travelling times, accident rates, environmental pollution etc. All these factors affect the quality of life of the population of Kuwait and are the main reason to carry out this project. Several recommendations were raised that aimed at preparing the projects, bidding and selection of private partner and the articulation and implementation of projects.Originality/value> This research contributes to the existing body of knowledge through setting the framework for metro projects in arid regions with the hottest temperature on Earth such as Kuwait where such projects are missing completely. This work will be very helpful to governments and municipalities in taking investment decisions. It sets the strategy for utilizing the best of decision-making theory, identifying the reliability advantages and finding the larger economic effects. This work identified, through the analysis of alternative management options generally used in underground and rail projects in different parts of the world, the most convenient alternative in developing countries. It also clearly showed, through the analysis carried out on governmental contributions, how to obtain economic viability for such types of projects. Finally, it helped drawing a roadmap for preparing the projects, bidding and selection of private partner and the articulation and implementation of projects in Kuwait and Gulf Cooperation Countries (GCC).

Health Information on COVID-19 Vaccination: Readability of Online Sources and Newspapers in Singapore, Hong Kong, and the Philippines

To address the COVID-19 pandemic, as with other infectious diseases, a key intervention is vaccination. Health communications are thus of vital importance for informing the public on the benefits and risks of vaccines. This in turn makes the readability of media content fundamental. Previous studies of COVID-19-related information have found the readability of online information considerably more difficult than recommended. However, studies on the readability of information related to COVID-19 vaccination in Asian contexts have yet to be carried out. Furthermore, especially in the case of the current pandemic, health information is communicated by a variety of information channels, including the internet and mass media. This paper investigates the readability of textual information on COVID-19 vaccination found online and in newspaper articles in parts of Asia where English is one of the main languages, namely Singapore, Hong Kong, and the Philippines. Readability was assessed using a set of readability tests (Flesch–Kincaid Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog Index, Coleman–Liau Index, and Simple Measure of Gobbledygook Grade level). It was found that a low proportion of URLs scored within recommended readability thresholds, and did so consistently across locations and types of sources. Furthermore, a relatively low proportion of web searches returned information from local sources;most URLs linked to sources outside of Singapore, Hong Kong, or the Philippines. Further, local online and newspaper sources scored similarly poorly on readability on average compared to non-local sources. Understanding of fast-evolving health communications concerning COVID-19 vaccination encompasses information about vaccine development and deployment from other locations, as well as locally. Nevertheless, these findings indicated a fairly low proportion of local sources among the top search results, and relatively low (i.e., difficult-to-read) readability scores for top search results and for local newspapers. An important issue for health communications strategies addressing COVID-19 vaccination will therefore be to consider different types of media sources in order to achieve the right mix of local and non-local sources while also ensuring appropriate readability.

Supporting Hospital Logistics during the First Months of the COVID-19 Crisis: A Simheuristic for the Stochastic Team Orienteering Problem

The unexpected crisis posed by the COVID-19 pandemic in 2020 caused that items such as face shields and ear savers were highly demanded. In the Barcelona area, hundreds of volunteers employed their home 3D-printers to produce these elements. After the lockdown, they had to be collected by a reduced group of volunteer drivers, who transported them to several consolidation centers. These activities required a daily agile design of efficient routes, especially considering that routes should not exceed a maximum time threshold to minimize drivers' exposure. These constraints limit the number of houses that could be visited. Moreover, travel and service times are considered as random variables. This logistics challenge is modeled as a stochastic team orienteering problem. Our main performance indicator is the collected reward, which should be maximized. This problem is solved by employing a biased-randomized simheuristic algorithm, which is capable of generating high-quality solutions in short computing times. © 2021 IEEE.