A Comparative Analysis of Government Responses to COVID-19 in the United States, China, and South Korea: Lessons from the Early Stage of the Pandemic*

COVID-19 has spread quickly worldwide, presenting unprecedented challenges to countries all over the globe. To understand how different countries have responded to COVID-19 during the early stage of the outbreak, we develop a comprehensive research framework drawing on the literature on wicked problems. Specifically, we comparatively investigate the government responses of the United States, China, and South Korea and examine why and how these countries have adopted and implemented various strategies—authoritative, collaborative, and competitive—depending on their policy environment. Although scholars have argued that collaborative strategies are the preferred approach to dealing with wicked problems, it is found that the most applicable, implementable, and effective strategies vary according to the country's cultural, economic, and political contexts. In addition, the urgency and timing of the crisis may affect the choice of appropriate strategies. Our findings can provide lessons for public administration and policy to cope with other wicked problems. © 2023 by INSTITUTE OF KOREAN STUDIES.

SARS-CoV-2 Illness Severity and Early Hospitalization Outcomes in a Multicenter Prospective Cohort Study Among Veterans

Background. Over 600,000 SARS-CoV-2 infections and 20,000 deaths have occurred among users of the Veterans Health Administration, the US's largest integrated health care system. We explored early outcomes of SARS-COV-2 infection in Veterans. Methods. An ongoing, prospective longitudinal cohort study of Veterans ages >= 18 enrolled 1,826 participants (29.0% inpatient;49.1% vaccinated;68.3% SARS-CoV-2-positive;85.0% male, mean age = 57.1 years) seeking inpatient or outpatient care after SARS-CoV-2 testing at 15 Department of Veterans Affairs medical centers in July 2020 to February 13, 2022. Using multivariable regression, we estimated relationships of baseline demographic characteristics, COVID-19 vaccination, and clinical history to illness severity and cumulative length of hospital stay within 60 days of study entry. Illness severity was defined by a Veterans Affairs adaptation of the WHO COVID-19 severity scale and included 4 levels (mild, moderate, severe, or death). We derived the Charlson co-morbidity index (CCI) and other baseline characteristics from electronic health data and study questionnaires, and reported qualitative SARS-CoV-2 IgG responses using inpatients' study-collected blood specimens. Results. High CCI scores (>= 5) occurred in 47 (42.7%) vaccinated SARS-CoV-2-positive inpatients and 47 (21.2%) unvaccinated. Severe illness occurred in 17 (15.5%) vaccinated inpatients, 37 (16.7%) unvaccinated inpatients, 4 (0.9%) vaccinated outpatients, and 3 (0.7%) unvaccinated outpatients. Eleven (10%) of 110 vaccinated SARS-CoV-2-positive inpatients died, as did 15 (6.8%) of the 222 unvaccinated. In SARS-CoV-2-positive inpatients, a one-step higher CCI was associated with more severe illness (aOR 1.10, 95%CI 1.01-1.20) and more hospitalization days (aIRR 1.06, 95% CI 1.03-1.10), adjusting for vaccination status. Respectively, 93% of vaccinated and 63% of unvaccinated SARS-CoV-2 positive inpatients with baseline antibody results had an anti-spike IgG response. Conclusion. In an ongoing longitudinal cohort study of COVID-19 in US Veterans, comorbidity burden was higher among vaccinated than unvaccinated inpatients and was associated with more severe illness and hospitalization days, independent of vaccination status.

A Case of Encephalitis and Adrenal Insufficiency in a Patient With Panhypopituitarism After COVID-19 Vaccination

Background: Since COVID-19 vaccination was introduced, various adverse effects have been linked to the vaccines. In patients with hypopituitarism, adrenal insufficiency due to the side reactions including fever of COVID-19 vaccination is concerned. Clinical Case: A 33-year woman was on medical therapy including hydrocortisone (HC) for panhypopituitarism arising from surgical treatment of a pituitary adenoma in 2006. She received a COVID-19 vaccination on day X-3. On day X-2, she developed fever in the morning and became unconscious in the evening. She was brought to our hospital by her family at night on day X. She had fever of 40.5°C, low blood pressure, and Glasgow Coma Scale (GCS) of 11. Her neck was supple and she had no quadriplegia. A COVID-19 PCR test was negative. Blood tests showed elevated white blood cell count (8900/μL;reference range: 3300–8600/µL) and C-reactive protein (138.3 mg/l;reference range: 0-1.44 mg/l). Blood glucose (81 mg/dL), ACTH (<3. 00 pg/mL;reference range: 7.2–63.3 pg/mL), and cortisol (1.9 μg/dL;reference range: 2.9–19.4 µg/dL) were low. Serum electrolytes were normal. A computed tomography scan showed no abnormality. Adrenal insufficiency was suspected, and she received HC intravenously. Her blood glucose and blood pressure increased, but her disorientation persisted. Lumbar puncture with cerebrospinal fluid (CSF) examination revealed slightly elevated cell counts (8 μ/L;reference range ≤4 μ/L) with average protein and glucose levels. Magnetic resonance imaging (MRI) of the brain revealed abnormal hyperintensity in the splenium of the corpus callosum on diffusion-weighted images and decreased apparent diffusion coefficient in the lesion, suggesting clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). During her hospital stay, she received a 7-day course of meropenem and acyclovir for suspected meningoencephalitis. Her consciousness disturbance improved to GCS of 15 on day X+1 and her fever decreased on day X+2. HSV and VZV PCR tests were negative on CSF examination, and antibiotics and antivirals were discontinued on day X+7. On day X+8, brain MRI showed complete resolution of the corpus callosum lesion. She discharged on day X+18 without any neurological sequelae. Conclusions: For most vaccines, the incidence rates of encephalitis are low at 0.1–0.2 per 100,000 vaccinated individuals (1). The present patient developed fever and adrenal insufficiency after COVID-19 vaccination, and her prolonged disturbance of consciousness after HC administration led to the diagnosis of MERS. MERS should be considered in patients with adrenocortical insufficiency who show delayed recovery from unconsciousness with HC administration after COVID-19 vaccination. Reference: (1) Huynh W, Cordato DJ, Kehdi E, Masters LT, Dedousis C. Post-vaccination encephalomyelitis: literature review and illustrative case. J Clin Neurosci. 2008 Dec;15(12): 1315-22.Presentation: No date and time listed

Relationship of Students' Engagement with Learning Management System and their Performance- An Undergraduate Programming Course Perspective

The Covid-19 pandemic forced the closures of universities across the United States, resulting in multiple modes of instruction. These transitions required both students and instructors to adequately use educational technology tools and applications. Most instructors used a learning management system (e.g., Canvas, Blackboard) and an online conference tool (e.g., Zoom, Teams) to ensure students' access to course material, class participation, and engagement. In the new normal time, although the in-person classes started in many universities, the hybrid of Hyflex mode (i.e., students in both in-person and on zoom sessions) is more prevalent. Students and instructors find educational technology tools as an easier way to disseminate the course information (e.g., videos), material (e.g., course videos, study guides, and notes), and assessments (e.g., quizzes). Considering the reliance on technology tools, it is crucial to understand the relationships between students' application engagement and performance. This paper examined the relationship between students' engagement with an educational Learning Management System (LMS) and their performance. In addition, we also evaluated the way students' engagement with the LMS changed over time during a semester (15 weeks). For this purpose, we collected the data from two sections, 84 students of the introductory engineering programming (MATLAB) course. For students' engagement with the LMS (Canvas in this case), we collected the timestamps each week, indicating the number of hours spent by each student on the LMS. As the timestamps were cumulative, we collected the data at the end of each week at the same time and calculated the weekly time spent by each student on the LMS. We used students' performance scores in two exams for students' performance. We used Pearson correlation and multiple regression analysis for this semester-long study to understand the relationship between students' engagement with the LMS and students' performance. We also conducted the repeated measures ANOVA to understand the trends of students' engagement with the LMS. The study results bring an interesting perspective indicating a significant relationship between students' app engagement in three weeks and programming parts of exam1 and four weeks on the programming part of exam2. Although instructor-based variations were significant in PartII of both exams, app engagement significantly predicted exam2 and PartII of exam1. The paper discusses these results with course content, limitations, and future directions. © American Society for Engineering Education, 2022.

EFFECT OF NEOADJUVANT CHEMOTHERAPY IN IMPROVING OVERALL SURVIVAL OF T2-4AN0M0 BLADDER CANCER PATIENTS: A SYSTEMIC REVIEW AND META-ANALYSIS ACCORDING TO EAU COVID-19 RECOMMENDATION

INTRODUCTION AND OBJECTIVE: In situation with the COVID-19 outbreak, the EAU guidelines Rapid Reaction Group provided recommendations to guide muscle invasive bladder cancer (MIBC) priorities, and they recommended that neoadjuvant chemotherapy should be considered omitted in T2/3 focal N0M0 MIBC patients. This meta-analysis aims to evaluate the efficacy of neoadjuvant chemotherapy compared to radical cystectomy alone in improving overall survival of T2-4aN0M0 MIBC patients. METHODS: Following the PRISMA guideline, PubMed, EMBASE, and Cochrane Library were searched up to September 2021. The articles were searched with keywords muscle-invasive bladder cancer, neoadjuvant chemotherapy, cystectomy, and overall survival. Participants, patients with T2-4aN0M0 MIBC;Interventions, T2- 4aN0M0 MIBC patients who underwent neoadjuvant chemotherapy;Outcomes, comparison of overall survival included for analysis. The overall survival was analyzed as hazard ratio (HR) and 95% confidence interval (CI) and presented in a forest plot. We also conducted a sub-analysis of only T2N0M0 MIBC patients. Quality assessments were performed independently by two reviewers using the Scottish Intercollegiate Guidelines Network. RESULTS: A total of 8 studies were included in the metaanalysis. 8 studies were intermediate risk for detection bias and there were no major problems. In T2-4aN0M0 MIBC patients, the overall survival was significantly better in the neoadjuvant chemotherapy + radical cystectomy group than in the radical cystectomy alone group (HR, 0.79;95% CI, 0.69-0.92;p=0.002) (Fig. 1A). A subgroup analysis was performed on only T2N0M0 MIBC patients and 5 studies were included. There was no difference in overall survival between the neoadjuvant chemotherapy + radical cystectomy group and the radical cystectomy alone group (HR, 0.83;95% CI, 0.69-1.02;p=0.06) (Fig. 1B). CONCLUSIONS: As recommended by the EAU guidelines Rapid Reaction Group, it is thought that patients with T2N0M0 MIBC should strongly consider omitting neoadjuvant chemotherapy until the end of the COVID-19 pandemic. Whether to omit neoadjuvant in T2- 4aN0M0 MIBC should be discussed further, and studies targeting only T2-3N0M0 MIBC are expected to proceed further.

Clinical characteristics and treatments of multi-system inflammatory syndrome in children: a systematic review.

OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) can occur in association with coronavirus disease 2019 (COVID-19). It is not easy to differentiate MIS-C from severe COVID-19 or Kawasaki disease based on symptoms. The aim of this study was to describe the clinical and laboratory characteristics of MIS-C. PATIENTS AND METHODS: We searched PubMed/Medline for case series and reports of MIS-C published until June 20, 2020. From a total of nine articles involving 45 cases, various clinical and laboratory data were extracted. Each target case was evaluated by using different diagnostic criteria. RESULTS: The average age at onset of MIS-C was 8.6 years. In 80% of cases, the age of patients ranged from 5 to 15 years. Fever (100%) and shock (82%) were the most common presenting symptoms. Sixty percent of cases met the diagnostic criteria for typical or atypical Kawasaki disease. Biomarkers indicative of inflammation, coagulopathy, or cardiac injury were characteristically elevated as follows: ferritin (mean: 1,061 ng/mL), CRP (217 mg/L), ESR (69 mm/hr), IL-6 (214.8 pg/mL), TNFα (63.4 pg/mL), D-dimer (3,220 ng/mL), PT (15.5 s), troponin I (1,006 ng/L), and BNP (12,150 pg/mL). Intravenous immunoglobulin was administered in all target cases, and inotropic agents were commonly used as well. No case of death was observed. CONCLUSIONS: This study demonstrated that MIS-C is a serious condition that presents with fever, rash, as well as cardiovascular and gastrointestinal symptoms. Although it is challenging to differentiate MIS-C from Kawasaki disease or severe COVID-19, initiation of appropriate treatments through early diagnosis is warranted.

Comparison of maintenance of intravesical BCG therapy between 1 year and more than 1 year therapies for recurrence rate in high-risk NMIBC: Systematic review and network meta-analysis according to EAU COVID-19 recommendation

Introduction & Objectives: During coronavirus disease 2019 (COVID-19) pandemic, EAU recommended intravesical bacillus Calmette-Guérin (BCG) therapy courses that have been ongoing for longer than 1 year can be safely terminated for high-risk non-muscle-invasive bladder cancer(NMIBC) patients. Thus, we conducted a systematic review and network meta-analysis according to EAU COVID-19 recommendation.Materials & Methods: Systematic review was performed following the PRISMA guideline. PubMed/Medline, EMBASE, and Cochrane Library weresearched up to Sep, 2021. We conducted a network meta-analysis to outcomes including only induction therapy group (No_M), 1-year (M1) andmore than 1 year (MM1) maintenance therapies groups for recurrence rate in patients with NMIBC. Participants, patients with NMIBC;Interventions,NMIBC patients who underwent intravesical BCG therapy;Outcomes, comparison of recurrence rate included for analysis. Quality assessmentswere performed independently by two reviewers using the Scottish Intercollegiate Guidelines Network.Results: Nineteen studies with a total of 3,957 patients were included for network meta-analysis. 19 studies were intermediate risk for detectionbias and there were no major problems. There was just two published studies between M1 and MM1. Five studies between No_M and M1 and 12articles between No_M and MM1 were identified. In node-split forest plot using Bayesian Markov Chain Monte Carlo (MCMC) modeling, there couldbe no difference between M1 and MM1 in recurrence rate (OR 0.95 (0.73-1.2)). However, recurrence rate in No_M group was higher than M1 (OR1.9 (1.5-2.5)) and MM1 (OR 2.0 (1.7-2.4)) groups (Fig. 1A). P-score test using frequentist method to rank treatments in network demonstrate MM1(P-score 0.8701) was superior to M1 (P-score 0.6299) and No_M groups (P-score 0). In the rank-probability test using MCMC modeling, MM1 had the highest rank, followed by M1 and No_M groups (Fig. 1B). (Figure Presented)(Figure Presented)Conclusions: In network meta-analysis, there could be no difference between 1-year and more than 1-year maintenance intravesical BCGtherapies in recurrence rate. In the rank test, more than 1-year therapy could be most effective. During COVID-19 pandemic, 1-year maintenancetherapy can be performed, however, after the COVID-19 pandemic, more than 1-year therapy will be decided

Inflammation of sars-cov2-infected human pluripotent stem cell-derived cardiomyocytes and the effects and side effects of remdesivir

Introduction: The global pandemic of the coronavirus 2019 disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to respiratory failures, COVID-19 patients exhibited cardiac complications. Studies observed the direct infection and replication of SARS-CoV2 in human pluripotent stem cell-derived cardiomyocytes (hPSC-CMs) accompanied by cytopathic effects. However, the underlying mechanisms of SARS-CoV-2-mediated CM death remain poorly understood. In addition, the therapeutic potential of remdesivir (RDV) on CMs has yet to be answered. Methods and Results: We confirmed that SARS-CoV-2 is infectious to and effectively replicates in hPSC-CMs and is cytopathic to hPSC-CMs. We also found that RDV effectively inhibited viral replication at a concentration of 50 nM. RNA-seq analyses demonstrated that expression of immune responsive genes was elevated in SARS-CoV-2 infected hPSC-CMs. Immunostaining and an ELISA assay further revealed formation of inflammasomes and secretion of inflammasome-mediated cytokines, such as IL-1β, IL-18, and IL-6 in SARS-CoV-2 infected hPSC-CMs. RNA-seq analyses showed gene profile changes in SARS-CoV-2 infected hPSC-CMs corroborating with activation of inflammatory signals and cell death pathways. While gene profiles of 0.1 μM RDV-treated SARS-CoV-2-infected hPSC-CMs showed reversal of such changes, a high dose (10 μM) RDV-treated CoV-2-infected hPSC-CMs showed changes in 44% of genes expressed compared to non-RDVtreated CoV2-infected hPSC-CMs. Among those, expression of protein stability related genes, such as genes associated with autophagy and protein ubiquitination increased while expression of antiviral responsive genes decreased. In addition, a high dose of RDV inhibited expression of mitochondrial genes, particularly MitoComplex I and V compositions, which are related to energy production. Conclusions: This study demonstrates that SARS-CoV2 induced inflammasome in hPSC-CMs, which can underlie cardiac damage in addition to direct cytopathic effects. In addition, RDV can reduce inflammasome when introduced early after SARS-CoV2 infection while a high-dose can aggravate cytopathic effects by potential toxicity to mitochondria.

On the Requirements and Architecture of All-in-One Platform for Virtual Conferences

With the contact-free situation due to the COVID-19 pandemic, many organizations tend to host virtual events instead of conventional offline events. Since many things should be handled through the online operations, the traditional system for offline events should be re-designed to support the whole process of virtual events. In this paper, we propose an architecture of an all-in-one platform for virtual conferences. The platform provides full services required by a virtual conference which is easy enough for both IT and non-IT experts. The platform provides tailored functions and menus according to the specific size, nature, and field of an academic event. Experimental results show that the parallel upload function of the proposed architecture achieves significantly higher upload speed for sharing a presentation video after the recording ends, compared to the usual video upload function.

Peritoneal dialysis for COVID-19-related acute kidney injury: A case report

INTRODUCTION: Acute kidney injury (AKI) is strongly associated with poor prognosis of Coronavirus disease 2019 (COVID-19) patients. The great pandemic made it challenging to allocate renal replacement therapy (RRT) such as hemodialysis or continuous hemodiafiltration to anuria patients in terms of infection control and medical resources. Herein, using an actual case, we argue that peritoneal dialysis (PD) could become a more practical and safer RRT, particularly during this pandemic crisis. METHODS: Our case was a 62-year-old male with a PCR test positive for severe acute respiratory syndrome coronavirus (SARS-CoV-2). He had a medical history of lung cancer and some commodities of hypertension, hyperuricemia, and hyperlipidemia. The next day after the admission, his oxygenation and hemodynamics rapidly deteriorated. We started mechanical ventilation, and administered vasopressors, favipiravir, and ciclesonide. Additionally, serum creatinine also became gradually elevated (creatinine: day1 0.77 mg/dL → day5 7 mg/dL). We diagnosed with COVID-19-associated AKI, because urine tests and sonography did not indicate any other cause. It progressed to anuria and made it difficult to control the serum potassium and the hemodynamics due to acidemia. On day 6, using a portable X-ray machine, we inserted the peritoneal dialysis (PD) catheter to the recto-vesical pouch at the bedside and infused the peritoneal dialysate. Although the anuria persisted for a while, the increased amount of peritoneal dialysate easily normalized the acidemia and serum potassium level. After the normalization, the vasopressors could be tapered off, and the inflammation status was also improved. On day 14, the patient was discharged from our ICU with the PD catheter. SARS-CoV-2 was detectable in sputum, but not in the peritoneum and PD waste. The whole procedure of PD catheter insertion and dialysate exchange did not influence the respiratory status and hemodynamics at any time. RESULTS: Taken together, PD could be a useful option for the AKI management, particularly in the COVID-19 pandemics.

Persistent Last-mile Congestion: Not so Uncommon

Last-mile is the centerpiece of broadband connectivity, as poor last-mile performance generally translates to poor quality of experience. In this work we investigate last-mile latency using traceroute data from RIPE Atlas probes located in 646 ASes and focus on recurrent performance degradation. We find that in normal times probes in only 10% ASes experience persistent last-mile congestion but we recorded 55% more congested ASes during the COVID-19 outbreak. Persistent last-mile congestion is not uncommon, it is usually seen in large eyeball networks and may span years. With the help of CDN access log data, we dissect results for major ISPs in Japan, the most severely affected country in our study, and ascertain bottlenecks in the shared legacy infrastructure. © 2020 ACM.