Challenging the logic of lifesaving in the intensive care unit.

Intensive care units are considered life-saving medical services and a vital component of healthcare systems. These specialized hospital wards contain the life support machines and technical expertise to sustain seriously ill and injured bodies. However, as the COVID-19 pandemic has demonstrated, intensive care is an expensive, finite resource which is not necessarily available to all citizens, and which may be unjustly rationed. As a result, the intensive care unit may contribute more towards biopolitical narratives of investment in lifesaving than measurable improvements in population health. Drawing from ethnographic fieldwork and a decade of involvement in clinical research, this paper examines everyday activities of lifesaving in the intensive care unit and interrogates epistemological assumptions upon which they are organized. A closer look at how healthcare professionals, medical devices, patients, and families accept, refuse, and modify imposed boundaries of bodily finitude reveals how activities of lifesaving often lead to uncertainty and may even impose harm when they deny possibilities for desired death. Refiguring death as a personal ethical threshold, rather than inherently tragic ending, challenges the power of the logic of lifesaving and instead insists on greater attention towards improving conditions for living.

Using the Implementation Research Logic Model to design and implement community-based management of possible serious bacterial infection during COVID-19 pandemic in Ethiopia.

BACKGROUND: Community-based treatment of possible serious bacterial infection (PSBI) in young infants, when referral to a hospital is not possible, can result in high treatment coverage and low case fatality. However, in Ethiopia, the coverage of PSBI treatment remains low, worsened by COVID-19. To understand the challenges of delivery of PSBI treatment and design and test adaptative strategies to mitigate the impact of COVID-19 on neonatal mortality, we did implementation research (IR) employing Implementation Research Logic Model (IRLM). In this paper, we describe IRLM application experiences in designing, implementing, and evaluating strategies to improve community-based treatment of PSBI during the COVID-19 pandemic in Ethiopia. METHODS: This IR was conducted between November 2020-April 2022 at Dembecha and Lume woredas of Amhara and Oromia regions, respectively. We employed narrative reviews, formative assessment and facilitated stakeholder engagement to develop the PSBI treatment IRLM to identify barriers, understand the conceptual linkages among determinants, choose implementation strategies, elicit mechanisms, and link to implementation outcomes. In addition, we used the IRLM to structure the capture of emerging implementation challenges and resulting strategy adaptations throughout implementation. RESULTS: This IR identified COVID-19 and multiple pre-existing contextual factors. We designed and implemented implementation strategies to address these challenges. These adaptive strategies were implemented with sufficient strength to maintain the delivery of PSBI services and improve mothers' care-seeking behavior for their sick young infants. The IRLM offers us a clear process and path to prioritize implementation challenges, choose strategies informed by mechanisms of action, and where the adaptive implementation of community-based management of PSBI would lead to high-implementation fidelity and change in mother behavior to seek care for their sick young infants. The IRLM was also an effective tool for stakeholder engagement, easily explained and used to structure discussion and decision-making during co-design meetings. CONCLUSIONS: The use of the IRLM helps us to specify the conceptual links between the implementation challenges, strategies, mechanisms of action, and outcomes to explore the complex community-based management of PSBI during complex contexts to improve high-fidelity implementation and integration of PSBI treatment in the primary healthcare delivery systems through active engagement of stakeholders.

Colorimetric detection of viral RNA fragments based on an integrated logic-operated three-dimensional DNA walker.

Timely and accurate detection of virus is crucial for preventing spread of disease and early treatment of the infected cases. Herein we design an integrated logic-operated three-dimensional DNA walker for colorimetric detection of viral RNA fragments, by taking SARS-CoV-2 as an example. The DNA walker is composed of small amounts of dually-blocked walking strands and large amounts of dual-stem-loop track strands on gold nanoparticles. The walking strand contains a swing arm domain and a DNAzyme domain blocked at both sides of catalytic core, while the track strand contains a substrate domain located at the peripheral larger loop. Only the presence of both ORF1ab and N RNA fragments can fully de-block the walking strand, which then continuously hybridizes with track strands and cleaves them by DNAzyme-catalyzed hydrolysis. As the cleavage of track strands from long-stranded, double stem-loop structure to short-stranded, linear sequence, the DNA walker shows much lowered stability due to decreased negative charge density and diminished steric repulsion, which then gets aggregated at high salt concentration, accompanied by a visible color change. The colorimetric DNA walker detects RNA fragments down to 1 nM, responds dual viral genes in a "AND" logic way, and shows high specificity to target sequence. It can further detect large nucleic acids containing ORF1ab and N sequences, and reach 200 copies/mL detection limit by coupling a simple upstream amplification of sample. The method may provide a convenient way for reliable detection of viral RNA.

A Rebuilding-Free Nucleic Acid Detection Strategy Enables Ultrasensitive Genotyping, N-in-1 Logic Screening and Accurate Multiplex Assay of Dangerous Pathogens.

Sensitive, rapid and low-cost nucleic acid detection is critical for controlling infectious pathogens. Here, we develop a ready-to-use and multimodal detection based on a rebuilding-free, ultrasensitive and selective strategy named dual hairpin ligation-induced isothermal amplification pro (DHLApro). Taking influenza A, influenza B, MERS-CoV, SARS-CoV-2 as model targets, we demonstrate DHLApro provides ≈zM level ultra-sensitivity, being equaling to 0.45 copy/µL in original sample. By simply changing the recognition module, a set of DHLApro components can be applied to a new target without performance loss. Moreover, DHLApro innovatively allows flexible logic/multiplex assay using one set of primer, for example, the "N pathogens-in-1" OR gate screening and accurate multi-channel multiplex assay. Compared with traditional methods, the cost of this logic/multiplex assay has been largely reduced and the cross-interference between the multiple primer sets is also avoided.

Organizational logics in time of crises: How physicians narrate the healthcare response to the Covid-19 pandemic in Swedish hospitals.

BACKGROUND: The COVID-19 pandemic has challenged healthcare organizations and puts focus on risk management in many ways. Both medical staff and leaders at various levels have been forced to find solutions to problems they had not previously encountered. This study aimed to explore how physicians in Sweden narrated the changes in organizational logic in response to the Covid-19 pandemic using neo-institutional theory and discursive psychology. In specific, we aimed to explore how physicians articulated their understanding of if and, in that case, how the organizational logic has changed during this crisis response. METHODS: The empirical material stems from interviews with 29 physicians in Sweden in the summer and autumn of 2020. They were asked to reflect on the organizational response to the pandemic focusing on leadership, support, working conditions, and patient care. RESULTS: The analysis revealed that the organizational logic in Swedish healthcare changed and that the physicians came in troubled positions as leaders. With management, workload, and risk repertoires, the physicians expressed that the organizational logic, to a large extent, was changed based on local contextual circumstances in the 21 self-governing regions. The organizational logic was being altered based upon how the two powerbases (physicians and managers) were interacting over time. CONCLUSIONS: Given that healthcare probably will deal with future unforeseen crises, it seems essential that healthcare leaders discuss what can be a sustainable organizational logic. There should be more explicit regulatory elements about who is responsible for what in similar situations. The normative elements have probably been stretched during the ongoing crisis, given that physicians have gained practical experience and that there is now also, at least some evidence-based knowledge about this particular pandemic. But the question is what knowledge they need in their education when it comes to dealing with new unknown risks.

Pressure and Volume Control in a new Emergency Mechanical Ventilator based on PLC and Industrial Pneumatic Parts in Peru.

This work details a methodology of design and test of a new prototype emergency mechanical ventilator called Fenix for the COVID-19 crisis in Peru. This equipment was manufactured with industrial equipment for the embedded and pneumatic systems, such as a Programmable Logic Controller (PLC), proportional flow valves, sensors, uninterruptible power supply (UPS), industrial panel HMI 15" and other electrical and pneumatic parts from Festo and Schneider Electric. This selection was in accordance with safety requirements based on ISO 80601-2-12: 2020-02. This study included two ventilatory modes, pressure- controlled in continuous mandatory ventilation (PC-CMV) and volume-controlled in continuous mandatory ventilation (VC-CMV), these control algorithms were evaluated analytically and experimentally in a FLUKE VT-650 Gas Flow Analyzer and an Acculung Fluke connected with a computer for comparing 9 ventilatory parameters in 4 different states as µ, simulation of the variation of the pressure control in a patient, and Ï´, simulation of alveolar recruitment in an intensive care patient, both states to PC-CMV, and also ß, simulation of the variation of the flow control in a patient, and α, simulation of alveolar recruitment in an intensive care patient, both last states to VC-CMV. Additionally, we study the pressure, volume, and flow graphs in the Fenix user interface for comparison with data recovered from Fluke Medical VT650 Gas Flow Analyzer. The results demonstrate an error in the flow measurement for the 4 states due to the peaks that are not detected by the low-pass filter of the sensor, however, a similar trend is seen in the control ventilatory graphs of the calibrator. Finally, the ventilator prototype provides ventilatory support, with a maximum tidal volume error of 12.93 % and inspiratory pressure of -20.15 % with respect to the set value; and it allows to monitor the main ventilation parameters with a calculation error between -6 to 25 %.Clinical Relevance - Established the design of emergency mechanical ventilator using PLC and industrial components.

Toward a systematic conflict resolution framework for ontologies.

BACKGROUND: The ontology authoring step in ontology development involves having to make choices about what subject domain knowledge to include. This may concern sorting out ontological differences and making choices between conflicting axioms due to limitations in the logic or the subject domain semantics. Examples are dealing with different foundational ontologies in ontology alignment and OWL 2 DL's transitive object property versus a qualified cardinality constraint. Such conflicts have to be resolved somehow. However, only isolated and fragmented guidance for doing so is available, which therefore results in ad hoc decision-making that may not be the best choice or forgotten about later. RESULTS: This work aims to address this by taking steps towards a framework to deal with the various types of modeling conflicts through meaning negotiation and conflict resolution in a systematic way. It proposes an initial library of common conflicts, a conflict set, typical steps toward resolution, and the software availability and requirements needed for it. The approach was evaluated with an actual case of domain knowledge usage in the context of epizootic disease outbreak, being avian influenza, and running examples with COVID-19 ontologies. CONCLUSIONS: The evaluation demonstrated the potential and feasibility of a conflict resolution framework for ontologies.

SARS-CoV-2: An Empirical Investigation of Rose's Population-based Logic.

BACKGROUND: Geoffrey Rose's paper "Sick Individuals, Sick Populations" highlights the counterintuitive finding that the largest share of morbidity arises from populations engaging in low- to moderate-risk behavior. Scholars refer to this finding as the prevention paradox. We examine whether this logic applies to SARS-CoV-2 infected persons considered low to moderate risk. METHODS: We conducted a population-representative survey and sero-surveillance study for SARS-CoV-2 among adults in Orange County, California. Participants answered questions about health behaviors and provided a finger-pin-prick sample from 10 July to 16 August 2020. RESULTS: Of the 2979 adults, those reporting low- and moderate-risk behavior accounted for between 78% and 92% of SARS-CoV-2 infections. Asymptomatic individuals, as well as persons with low and moderate scores for self-reported likelihood of having had SARS-CoV-2, accounted for the majority of infections. CONCLUSIONS: Our findings support Rose's logic, which encourages public health measures among persons who self-identify as unlikely to have SARS-CoV-2. See video abstract at, http://links.lww.com/EDE/B860.

"If a rabbi did say 'you have to vaccinate,' we wouldn't": Unveiling the secular logics of religious exemption and opposition to vaccination.

Maintaining 'faith' in vaccination has emerged as a public health challenge amidst outbreaks of preventable disease among religious minorities and rising claims to 'exemption' from vaccine mandates. Outbreaks of measles and coronavirus have been particularly acute among Orthodox Jewish neighbourhoods in North America, Europe and Israel, yet no comparative studies have been conducted to discern the shared and situated influences on vaccine decision-making. This paper synthesises qualitative research into vaccine decision-making among Orthodox Jews in the United Kingdom and Israel during the 2014-15 and 2018-19 measles epidemics, and 2020-21 coronavirus pandemic. The methods integrate 66 semi-structured informal interviews conducted with parents, formal and informal healthcare practitioners, and religious leaders, as well as analysis of tailored non-vaccination advocacy events and literature. The paper argues that the discourse of 'religious' exemption and opposition to vaccination obscures the diverse practices and philosophies that inform vaccine decisions, and how religious law and leaders form a contingent influence. Rather than viewing religion as the primary framework through which vaccine decisions are made, Orthodox Jewish parents were more concerned with safety, trust and choice in similar ways to 'secular' logics of non-vaccination. Yet, religious frameworks were mobilised, and at times politicised, to suit medico-legal discourse of 'exemption' from coercive or mandatory vaccine policies. By conceptualising tensions around protection as 'political immunities,' the paper offers a model to inform social science understandings of how health, law and religion intersect in contemporary vaccine opposition.

The probability of conditionals: A review.

A major hypothesis about conditionals is the Equation in which the probability of a conditional equals the corresponding conditional probability: p(if A then C) = p(C|A). Probabilistic theories often treat it as axiomatic, whereas it follows from the meanings of conditionals in the theory of mental models. In this theory, intuitive models (system 1) do not represent what is false, and so produce errors in estimates of p(if A then C), yielding instead p(A & C). Deliberative models (system 2) are normative, and yield the proportion of cases of A in which C holds, i.e., the Equation. Intuitive estimates of the probability of a conditional about unique events: If covid-19 disappears in the USA, then Biden will run for a second term, together with those of each of its clauses, are liable to yield joint probability distributions that sum to over 100%. The error, which is inconsistent with the probability calculus, is massive when participants estimate the joint probabilities of conditionals with each of the different possibilities to which they refer. This result and others under review corroborate the model theory.

Dual recognition element-controlled logic DNA circuit for COVID-19 detection based on exonuclease III and DNAzyme.

Two fragments of the COVID-19 genome (specific and homologous) were used as two inputs to construct an AND logic gate for COVID-19 detection based on exonuclease III and DNAzyme. The detection sensitivity of the assay can reach fM levels. Satisfactory recovery values were obtained in real sample analysis.