Work alienation influences nurses' readiness for professional development and willingness to learn: A cross-sectional correlation study.

Work alienation has a negative impact on nursing profession and may affect professional nursing development and willingness to learn during the era of coronavirus disease 2019 (COVID-19). The aim of this study was to explore the perceived levels of professional development, willingness to learn, and work alienation during this pandemic among nurses in Jordan. It also assessed the influence of work alienation and sociodemographic factors on readiness for professional development and willingness to learn. We used a cross-sectional correlation study design using the Arabic readiness for professional development and willingness to learn and work alienation scales among 328 nurses working in Jordan University Hospital, Amman-Jordan. Data were collected during the period of October and November 2021. Data were analyzed using descriptive statistics (Mean ± Standard deviation), Pearson correlation coefficient (r), and regression analysis. The perceived levels of work alienation (3.12 ± 1.01) and readiness for professional development and willingness to learn (3.51 ± 0.43) among nurses were found to be at high levels during this era. Work alienation was negatively associated with readiness for professional development and willingness to learn (r = -0.54, p <0.001). The higher educational level of a nurse was found to be associated with a higher work alienation (r = -0.16, p = 0.008). Results indicated that work alienation had a direct influence on readiness for professional development and willingness to learn among nurses (R2 = 0.287, p < 0.001). Work alienation among nurses seems to be increased during the pandemic and it has reduced their readiness for professional development and willingness to learn. Nurse managers at hospitals must assess the perceived level of work alienation among nurses annually and design appropriate counseling interventions programs to reduce their work alienation and increase their willingness to learn.

Establishment of infection prevention and control strategy in nursing managements during surgical operations in COVID-19 patients based on Delphi method.

AIM: The aim of this study was to establish an infection prevention and control strategy for nursing managements during surgical operations in coronavirus disease 2019 (COVID-19) patients. DESIGN: A Delphi method. METHODS: Between November 2021 and March 2022, we first formulated a preliminary infection prevention and control strategy based on the literature review and institutional experience. Then, we applied Delphi method and performed expert surveys to reach a final strategy for nursing managements during surgical operations in COVID-19 patients. RESULTS: The strategy included seven dimensions with 34 items. The positive coefficients of Delphi experts in both surveys were 100%, indicating a high coordination among experts. The degree of authority and expert coordination coefficient were 0.91 and 0.097-0.213. After the second expert survey, value assignments for importance of each dimension and item were 4.21-5.00 and 4.21-4.76 points, respectively. The coefficients of variation for dimension and item were 0.09-0.19 and 0.05-0.19, respectively. PATIENT OR PUBLIC CONTRIBUTION: Except the medical experts and research personnel, there was no other patient or public contribution involved in the study.

Causal association of the brain structure with the susceptibility, hospitalization, and severity of COVID-19: A large-scale genetic correlation study.

Brain structure is related to its ability to resist external pathogens. Furthermore, there are several abnormal anatomical brain events and central system symptoms associated with COVID-19. This study, which was conducted based on genetic variables, aimed to identify the causal association between brain structure and COVID-19 phenotypes. We performed a two-sample bidirectional Mendelian randomization analysis using genetic variables obtained from large genome-wide association studies as instruments to identify the potential causal effects of various brain imaging-derived phenotypes (BIDPs) traits on susceptibility, hospitalisation, and severity of COVID-19. We explored the genetic correlations of 1325 BIDPs with the susceptibility, hospitalisation, and severity of COVID-19 using Linkage Disequilibrium Score Regression. We observed a causal relationship between increased cortical thickness of the left inferior temporal area and an increased risk of increased COVID-19 infection (p = 4.29 × 10-4) and hospitalisation (p = 3.67 × 10-3). Moreover, the larger total surface area of the whole brain was negatively correlated with the risk of hospitalisation for COVID-19. Furthermore, there was a significant causal association between increased cerebrospinal fluid volume and decreased severity of COVID-19 (p = 3.74 × 10-3). In a conclusion, we provide new insights into the causal association between BIDPs and COVID-19 phenotypes, which may help elucidate the aetiology of COVID-19.

Politics, preparedness, or resources Examining state responsiveness to the COVID-19 pandemic.

U.S. states are often the primary decision makers during a public health crisis. The COVID-19 pandemic led to several different reopening processes across states based on their unique characteristics. We analyze whether states' reopening policy decisions were driven by their public health preparedness, resources, COVID-19 impact, or state politics and political culture. To do so, we summarized state characteristics and compared them across three categories of reopening scores in a bivariate analysis using the chi-square or Fisher exact test for the categorical variables and a one-way analysis of variance (ANOVA) for the continuous variables. A cumulative logit model was used to assess the primary research question. A significant factor in a state's reopening decision was the party of the governor, regardless of the party in control of the legislature, state political culture, public health preparedness, cumulative number of deaths per 100,000, and Opportunity Index score.

[Analysis of the dynamics of mortality from respiratory diseases in the Russian Federation for 2019-2020].

AIM: To study the dynamics and contribution of mortality from Diseases of the respiratory system (DRS) in 2019 and 2020 to mortality from all causes with and without deaths from COVID-19 in 82 regions of the Russian Federation. MATERIALS AND METHODS: The data provided by Rosstat for 2019 and 2020 on the average annual population and the number of deaths due to causes of DRS (class J00J99) were used the standardised death rate (SDR) were calculated, the regional average value, standard deviation and coefficient of variation. RESULTS: The average increase in the SDR from DRS in 2020 was 22.1913.22 per 100 thousand population (66.4489.6% higher than in 2019). The average regional SDR from DRS + COVID-19 in 2020 was higher than the SDR from DRS in 2019 by 87.6530.1 per 100 thousand population. The average regional share of SDR in the structure of mortality excluding COVID-19 increased from 3.661.44 to 5.062.49%; taking into account COVID-19, it increased to 10.963.13%. In 16 regions, the SDR from DRS + COVID-19 exceeded the increase in mortality from all causes. No correlation was found between SDR (2020) from all causes and SDR from COVID-19 (r=0.09; p=0.39); an inverse correlation was found between SDR from DRS and SDR from COVID-19 in 2020 (r=-0.42; p0.0001). CONCLUSION: Against the background of high interregional variability of SDR from DRS in most regions, an increase in the mortality rate from DRS and the contribution of DRS to total mortality in 2020 was registered.

Specialist physicians battle against the COVID-19 pandemic: the relationship between specialist physicians working conditions and levels of burnout during the COVID-19 pandemic.

OBJECTIVE: This study was planned to determine the burnout levels of physicians during the COVID-19 pandemic, and to contribute to taking the necessary measures by determining the associated factors. MATERIALS AND METHODS: This research was designed via Google Online Form as an online survey with questions of Sociodemographic Data Form, Maslach Burnout Inventory and Beck Anxiety Inventory and was conducted with 40 specialist physicians actively working at the Sakarya University Training and Research Hospital. The same questionnaire was re-applied online after two months, and 24 out of 40 physicians were accessed. The SPSS 25 (IBM, Armonk, NY, USA) program was used for the analysis of the data. RESULTS: According to the Maslach Burnout Inventory applied in the pre-test, it was found that the feeling of personal accomplishment was high, emotional burnout was normal, and depersonalization was low. Anxiety and burnout were found to be positively correlated, and there were no statistically significant differences in the average values of the pre-and post-test Maslach Burnout Inventory and Beck Anxiety Inventory scores. CONCLUSIONS: Detecting possible burnout in physicians working in a pandemic, identifying associated factors and taking required measures can be beneficial both for physicians and society from a biopsychosocial perspective.

Influence of state reopening policies in COVID-19 mortality.

By the end of May 2020, all states in the US have eased their COVID-19 mitigation measures. Different states adopted markedly different policies and timing for reopening. An important question remains in how the relaxation of mitigation measures is related to the number of casualties. To address this question, we compare the actual data to a hypothetical case in which the mitigation measures are left intact using a projection of the data from before mitigation measures were eased. We find that different states have shown significant differences between the actual number of deaths and the projected figures within the present model. We relate these differences to the states different policies and reopening schedules. Our study provides a gauge for the effectiveness of the approaches by different state governments and can serve as a guide for implementing best policies in the future. According to the Pearson correlation coefficients we obtained, the face mask mandate has the strongest correlation with the death count than any other policies we considered.

Molecular Networking for Drug Toxicities Studies: The Case of Hydroxychloroquine in COVID-19 Patients.

Using drugs to treat COVID-19 symptoms may induce adverse effects and modify patient outcomes. These adverse events may be further aggravated in obese patients, who often present different illnesses such as metabolic-associated fatty liver disease. In Rennes University Hospital, several drug such as hydroxychloroquine (HCQ) have been used in the clinical trial HARMONICOV to treat COVID-19 patients, including obese patients. The aim of this study is to determine whether HCQ metabolism and hepatotoxicity are worsened in obese patients using an in vivo/in vitro approach. Liquid chromatography high resolution mass spectrometry in combination with untargeted screening and molecular networking were employed to study drug metabolism in vivo (patient's plasma) and in vitro (HepaRG cells and RPTEC cells). In addition, HepaRG cells model were used to reproduce pathophysiological features of obese patient metabolism, i.e., in the condition of hepatic steatosis. The metabolic signature of HCQ was modified in HepaRG cells cultured under a steatosis condition and a new metabolite was detected (carboxychloroquine). The RPTEC model was found to produce only one metabolite. A higher cytotoxicity of HCQ was observed in HepaRG cells exposed to exogenous fatty acids, while neutral lipid accumulation (steatosis) was further enhanced in these cells. These in vitro data were compared with the biological parameters of 17 COVID-19 patients treated with HCQ included in the HARMONICOV cohort. Overall, our data suggest that steatosis may be a risk factor for altered drug metabolism and possibly toxicity of HCQ.

Soluble ST2 concentrations associate with in-hospital mortality and need for mechanical ventilation in unselected patients with COVID-19.

OBJECTIVE: Soluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes. METHODS: We enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death. RESULTS: Concentrations of sST2 at baseline was median 48 (IQR 37-67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36-59) ng/mL; ICU 67 (39-104) ng/mL and non-survivors 107 (72-116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9 . CONCLUSIONS: sST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19. TRIAL REGISTRATION NUMBER: NCT04314232.

Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units.

BACKGROUND: Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. METHODS: This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. RESULTS: The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70-1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57-1.06). CONCLUSIONS: There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT04321265.

Assessment of proarrhythmogenic risk for chloroquine and hydroxychloroquine using the CiPA concept.

Chloroquine and hydroxychloroquine have been proposed recently as therapy for SARS-CoV-2-infected patients, but during 3 months of extensive use concerns were raised related to their clinical effectiveness and arrhythmogenic risk. Therefore, we estimated for these compounds several proarrhythmogenic risk predictors according to the Comprehensive in vitro Proarrhythmia Assay (CiPA) paradigm. Experiments were performed with either CytoPatch™2 automated or manual patch-clamp setups on HEK293T cells stably or transiently transfected with hERG1, hNav1.5, hKir2.1, hKv7.1+hMinK, and on Pluricyte® cardiomyocytes (Ncardia), using physiological solutions. Dose-response plots of hERG1 inhibition fitted with Hill functions yielded IC50 values in the low micromolar range for both compounds. We found hyperpolarizing shifts of tens of mV, larger for chloroquine, in the voltage-dependent activation but not inactivation, as well as a voltage-dependent block of hERG current, larger at positive potentials. We also found inhibitory effects on peak and late INa and on IK1, with IC50 of tens of µM and larger for chloroquine. The two compounds, tested on Pluricyte® cardiomyocytes using the ß-escin-perforated method, inhibited IKr, ICaL, INa peak, but had no effect on If. In current-clamp they caused action potential prolongation. Our data and those from literature for Ito were used to compute proarrhythmogenic risk predictors Bnet (Mistry HB, 2018) and Qnet (Dutta S et al., 2017), with hERG1 blocking/unblocking rates estimated from time constants of fractional block. Although the two antimalarials are successfully used in autoimmune diseases, and chloroquine may be effective in atrial fibrillation, assays place these drugs in the intermediate proarrhythmogenic risk group.

Mobility indicators and COVID-19 growth ratio in Iraq: a correlation study.

BACKGROUND: There is no prior study of the effect of mobility-limiting measures on the occurrence of COVID-19 in Iraq. OBJECTIVES: To determine the relationship between publicly available mobility index data and the growth ratio (GR) of COVID-19. METHOD: We used Google COVID-19 Community Mobility Reports to extract Iraq's mobility data and the official Ministry of Health COVID-19 statements. We used the data to calculate the Pearson's correlation coefficient and fit a linear regression model to determine the relationship between percentage change from the baseline in the mobility indices and the GR of COVID-19 in Iraq. RESULTS: There was a moderate positive correlation between each of the mobility indices except the residential index and COVID-19 GR in Iraq. The general linear model indicated that as each of the mobility indices increases by one unit, the GR of COVID19 increases by 0.002-0.003 except for the residential index. As the residential mobility index increases by one unit, the GR decreases by 0.009. All the findings were statistically significant (P-value < 0.0001). CONCLUSION: Mobility-limiting measures may be able to reduce the growth rate of COVID-19 moderately. Accordingly, mobility-limiting measures should be combined with other public control measures particularly mass mask use.

Natural processes dominate the pollution levels during COVID-19 lockdown over India.

The lockdown measures that were taken to combat the COVID-19 pandemic minimized anthropogenic activities and created natural laboratory conditions for studying air quality. Both observations and WRF-Chem simulations show a 20-50% reduction (compared to pre-lockdown and same period of previous year) in the concentrations of most aerosols and trace gases over Northwest India, the Indo Gangetic Plain (IGP), and the Northeast Indian regions. It is shown that this was mainly due to a 70-80% increase in the height of the boundary layer and the low emissions during lockdown. However, a 60-70% increase in the pollutants levels was observed over Central and South India including the Arabian sea and Bay of Bengal during this period, which is attributed to natural processes. Elevated (dust) aerosol layers are transported from the Middle East and Africa via long-range transport, and a decrease in the wind speed (20-40%) caused these aerosols to stagnate, enhancing the aerosol levels over Central and Southern India. A 40-60% increase in relative humidity further amplified aerosol concentrations. The results of this study suggest that besides emissions, natural processes including background meteorology and dynamics, play a crucial role in the pollution concentrations over the Indian sub-continent.

The relationship between Google search interest for pulmonary symptoms and COVID-19 cases using dynamic conditional correlation analysis.

This study aims to evaluate the monitoring and predictive value of web-based symptoms (fever, cough, dyspnea) searches for COVID-19 spread. Daily search interests from Turkey, Italy, Spain, France, and the United Kingdom were obtained from Google Trends (GT) between January 1, 2020, and August 31, 2020. In addition to conventional correlational models, we studied the time-varying correlation between GT search and new case reports; we used dynamic conditional correlation (DCC) and sliding windows correlation models. We found time-varying correlations between pulmonary symptoms on GT and new cases to be significant. The DCC model proved more powerful than the sliding windows correlation model. This model also provided better at time-varying correlations (r ≥ 0.90) during the first wave of the pandemic. We used a root means square error (RMSE) approach to attain symptom-specific shift days and showed that pulmonary symptom searches on GT should be shifted separately. Web-based search interest for pulmonary symptoms of COVID-19 is a reliable predictor of later reported cases for the first wave of the COVID-19 pandemic. Illness-specific symptom search interest on GT can be used to alert the healthcare system to prepare and allocate resources needed ahead of time.

Could urinary kidney injury molecule-1 be a good marker in subclinical acute kidney injury in mild to moderate COVID-19 infection?

PURPOSE: To evaluate urinary kidney injury molecule-1 (uKIM-1), which is a proximal tubule injury biomarker in subclinical acute kidney injury (AKI) that may occur in COVID-19 infection. METHODS: The study included proteinuric (n = 30) and non-proteinuric (n = 30) patients diagnosed with mild/moderate COVID-19 infection between March and September 2020 and healthy individuals as a control group (n = 20). The uKIM-1, serum creatinine, cystatin C, spot urine protein, creatinine, and albumin levels of the patients were evaluated again after an average of 21 days. RESULTS: The median (interquartile range) uKIM-1 level at the time of presentation was 246 (141-347) pg/mL in the proteinuric group, 83 (29-217) pg/mL in the non-proteinuric group, and 55 (21-123) pg/mL in the control group and significantly high in the proteinuric group than the others (p < 0.001). Creatinine and cystatin C were significantly higher in the proteinuric group than in the group without proteinuria, but none of the patients met the KDIGO-AKI criteria. uKIM-1 had a positive correlation with PCR, non-albumin proteinuria, creatinine, cystatin C, CRP, fibrinogen, LDH, and ferritin, and a negative correlation with eGFR and albumin (p < 0.05). In the multivariate regression analysis, non-albumin proteinuria (p = 0.048) and BUN (p = 0.034) were identified as independent factors predicting a high uKIM-1 level. After 21 ± 4 days, proteinuria regressed to normal levels in 20 (67%) patients in the proteinuric group. In addition, the uKIM-1 level, albuminuria, non-albumin proteinuria, and CRP significantly decreased. CONCLUSIONS: Our findings support that the kidney is one of the target organs of the COVID-19 and it may cause proximal tubule injury even in patients that do not present with AKI or critical/severe COVID-19 infection.

Vaccine-induced thrombotic thrombocytopenia: the elusive link between thrombosis and adenovirus-based SARS-CoV-2 vaccines.

The amazing effort of vaccination against COVID-19, with more than 2 billion vaccine doses administered all around the world as of 16 June 2021, has changed the history of this pandemic, drastically reducing the number of severe cases or deaths in countries were mass vaccination campaign have been carried out. However, the people's rising enthusiasm has been blunted in late February 2021 by the report of several cases of unusual thrombotic events in combination with thrombocytopenia after vaccination with ChAdOx1 nCov-19 (Vaxzevria), and a few months later also after Ad26.COV2. S vaccines. Of note, both products used an Adenovirus-based (AdV) platform to deliver the mRNA molecule - coding for the spike protein of SARS-CoV-2. A clinical entity characterized by cerebral and/or splanchnic vein thrombosis, often associated with multiple thromboses, with thrombocytopenia and bleeding, and sometimes disseminated intravascular coagulation (DIC), was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). VITT was mainly observed in females under 55 years of age, between 4 and 16 days after receiving only Adenovirus-based vaccine and displayed a seriously high fatality rate. This prompted the Medicine Regulatory Agencies of various countries to enforce the pharmacovigilance programs, and to provide some advices to restrict the use of AdV-based vaccines to some age groups. This point-of view is aimed at providing a comprehensive review of epidemiological issues, pathogenetic hypothesis and treatment strategies of this rare but compelling syndrome, thus helping physicians to offer an up-to dated and evidence-based counseling to their often alarmed patients.

Is the Intestine a Portal of Entry for the Serious COVID-19 Complications of Endotoxemia and Thrombosis?

Severe acute respiratory syndrome coronavirus 2 infection has been associated with both endotoxemia and thrombosis of small and large vessels, but the relationship between these 2 phenomena has not been pursued. Oliva et al. in this issue of Clinical and Translational Gastroenterology demonstrate an association between the 2 findings and suggest that increased intestinal permeability is a possible mechanism to explain the endotoxemia. Although the evidence to support this hypothesis is only suggestive, the role of the small intestine in the illness produced by the virus needs to be further explored.

Low-Grade Endotoxemia and Thrombosis in COVID-19.

INTRODUCTION: Patients with community-acquired pneumonia display enhanced levels of lipopolysaccharides (LPS) compared with controls, suggesting that low-grade endotoxemia may be implicated in vascular disturbances. It is unknown whether this occurs in patients with coronavirus 2019 (COVID-19) and its impact on thrombotic complications. METHODS: We measured serum levels of zonulin, a marker of gut permeability, LPS, and D-dimer in 81 patients with COVID-19 and 81 healthy subjects; the occurrence of thrombotic events in COVID-19 during the intrahospital stay was registered. RESULTS: Serum LPS and zonulin were higher in patients with COVID-19 than in control subjects and, in COVID-19, significantly correlated (R = 0.513; P < 0.001). Among the 81 patients with COVID-19, 11 (14%) experienced thrombotic events in the arterial (n = 5) and venous circulation (n = 6) during a median follow-up of 18 days (interquartile range 11-27 days). A logistic regression analysis showed that LPS (P = 0.024) and D-dimer (P = 0.041) independently predicted thrombotic events. DISCUSSION: The study reports that low-grade endotoxemia is detectable in patients with COVID-19 and is associated with thrombotic events. The coexistence of low-grade endotoxemia with enhanced levels of zonulin may suggest enhanced gut permeability as an underlying mechanism.

Interrelationship between daily COVID-19 cases and average temperature as well as relative humidity in Germany.

COVID-19 pandemic continues to obstruct social lives and the world economy other than questioning the healthcare capacity of many countries. Weather components recently came to notice as the northern hemisphere was hit by escalated incidence in winter. This study investigated the association between COVID-19 cases and two components, average temperature and relative humidity, in the 16 states of Germany. Three main approaches were carried out in this study, namely temporal correlation, spatial auto-correlation, and clustering-integrated panel regression. It is claimed that the daily COVID-19 cases correlate negatively with the average temperature and positively with the average relative humidity. To extract the spatial auto-correlation, both global Moran's [Formula: see text] and global Geary's [Formula: see text] were used whereby no significant difference in the results was observed. It is evident that randomness overwhelms the spatial pattern in all the states for most of the observations, except in recent observations where either local clusters or dispersion occurred. This is further supported by Moran's scatter plot, where states' dynamics to and fro cold and hot spots are identified, rendering a traveling-related early warning system. A random-effects model was used in the sense of case-weather regression including incidence clustering. Our task is to perceive which ranges of the incidence that are well predicted by the existing weather components rather than seeing which ranges of the weather components predicting the incidence. The proposed clustering-integrated model associated with optimal barriers articulates the data well whereby weather components outperform lag incidence cases in the prediction. Practical implications based on marginal effects follow posterior to model diagnostics.