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We used open source data from the EpiWATCH observatory to monitor for early disease signals in Russia and surrounding countries following an explosion at a BSL 4 laboratory, Vector, in Siberia in September 2019. Upon news of the explosion at Vector on September 16th 2019, the EpiWATCH team added the Russian language and key words Russia, Siberia, Novosibirsk, and Koltsovo to the Standard Operating Procedures, in addition to the usual epidemic-specific keywords used in EpiWATCH. We also searched for outbreak reports in countries bordering Siberia, including Mongolia, Kazakhstan and China. Given local spread of an epidemic could manifest in these countries, we included searching in Chinese, Mongolian and Kazakh. We added "Ukraine” as a key word, given current conflict between Russia and Ukraine. Data collection began in September 2019, one week after the explosion, with this considered the baseline. We demonstrate a method for rapid epidemic intelligence following an incident of concern, the explosion at Vector. There were some unexplained outbreaks in Russia in the three months following the explosion. No unexplained outbreaks were detected in countries bordering Russia, nor in Ukraine in the three months following the explosion. We detected an accidental release of brucella from a laboratory in China in early December 2019 and two reports of severe pneumonia prior to official reports, which could have been early COVID-19 cases. Best practice in preparedness should include surveillance for disease events in the months following an event of concern at local, national and global levels. In the absence of official surveillance data, open source intelligence may be the only available means of detecting outbreaks and enabling early response and mitigation for the rest of the world. EpiWATCH was able to identify reports of Russian outbreaks in the weeks and months following the Vector explosion, which allowed monitoring of outbreaks of concern without a known cause. © 2020 The Author(s).
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Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. It is a multi-factorial disease with a variety of identified causes including age, male gender, obesity, craniofacial and upper airway abnormalities. We would like to describe a patient who had severe OSA following application of Halo traction, which significantly improved following the removal of the device. Report of Cases: 14-year-old male with medical history of spina bifida, chiari malformation s/p decompression, shunted hydrocephalus and severe scoliosis, was admitted to the hospital for anterior spinal discectomy L2-S1 and Halo application with traction for scoliosis. He previously had nocturnal polysomnogram (NPSG) in 2017 that demonstrated very mild mixed apnea with an apnea hypopnea index (AHI) of 5.5. Because central apneas were very brief and clustered in REM, family elected to repeat a study rather than treat. In 2019, he had a follow up study with complaints of snoring and thirst, and this demonstrated an AHI of 21 with 29 brief central apneas and 72 hypopneas, 1 obstructive apnea. He had a T&A and turbinate ablation and due to the global pandemic did not undergo repeat sleep study. During admission for his anterior spinal discectomy and Halo, he demonstrated persistent night time hypoxia. A split night sleep study showed evidence of severe OSA with pretreatment AHI of 94.4, oxygen nadir 86%. Continuous positive airway pressure (CPAP) was initiated at 5 cm of water and titrated to 11 cm of water. On CPAP of +11 severe obstructive events continued with an AHI of 40.6, oxygen nadir 92%. A bilevel positive airway pressure (BIPAP) titration study the subsequent night started at pressures of 12/6 and titrated to 21/9 with respiratory rate of 12 yet demonstrated AHI of 51, oxygen nadir 89%. Study transitioned to average volume assisted pressure support (AVAPS) with IPAP max of 26, IPAP minimum of 12 EPAP of 9, tidal volume of 175ml, rate of 12 with inadequate control of his obstructive events with an AHI of 24.8, minimum oxygen saturations of 91. While hospitalized, he remained on AVAPS with normal capillary blood gases. Halo traction was removed 2 weeks following his surgery with plan was to send him home on AVAPS and repeat NPSG in 6 weeks. However, as a result of COVID pandemic/Philips recall, CPAP was the only device available for home use, so CPAP therapy at +8 cm was trialed overnight, demonstrating oxygen nadir of 92% and a normal capillary blood gas in the morning. Patient was then discharged home on CPAP of +8 cm of water. He returned back to sleep center for a BIPAP titration study to re-establish BIPAP/AVAPS settings, as his inpatient sleep study had shown severe OSA. During the sleep study, he was started on BIPAP 12/6 and he remained on it throughout the night with 0 central and 0 obstructive events. As he did well, he was advised to continue CPAP +8 with plans to repeat the sleep study off CPAP. In clinic follow up, he reported mild skin breakdown and occasionally waking unrefreshed. Conclusion: As our patient did significantly better following the removal of Halo traction device, it is likely that Halo traction device caused fixed over flexion of the cervical spine that resulted in decrease in his airway diameter, which further worsened during his sleep, and caused severe OSA.
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Background: The current COVID-19 pandemic and social isolation measures are deeply affecting individual mental well-being on a national and global level. However, no research has been done specifically on the impact of the pandemic on the mental health (MH) of medical students and the teaching faculty. Objectives: To investigate whether (1) these two groups would report greater psychological distress, a lower sense of belonging, greater loneliness and lower mental wellbeing overall, and (2) resilience would serve as protective factors against the development of psychological distress during COVID-19. Methods: We present the results of an online survey conducted between 20 May 2020 and 4 June 2020 in an Indian university during the first-wave outbreak of COVID-19. The Brief Resilience Scale, Distress Tolerance Scale, Loneliness-UCLA Version 3 Scale and The Mindful Attention Awareness Scale were administered as a part of this survey. Findings: We present the data collected from 246 respondents, on items of the Loneliness Scale, Brief Resilience Scale, the Mindful Attention Awareness Scale and Distress Tolerance Scale. The scores were items of Loneliness, 47.83 ± 11.9;Brief Resilience Scale, the average score was 18.99 ± 2.58;the Distress Tolerance Scale, 44.76 (13, 63);Mindful Attention Awareness Scale, 58.35 (13, 63). About 23.4% of participants scored within the low band of resilience, and there was a significant correlation between loneliness, mindful attention and distress tolerance (p > 0.01).
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Purpose- Online banking has redefined the concept of financial services. Given the limitations brought on by the Covid- 19 pandemic, people are depending on these mediums even more. Even though the adaptability is significantly seen in the kids and the younger generation but a considerable size of population containing the people of age group 60 and more are still ignorant about the whole scenario. The paper aims to explore the various factors responsible for their resistance in shifting to online mode of transactions. The objective of this paper is to study a customer's perception in choosing online banking over physical banking The study analyses the main factors which lead to this gap. The main contribution of the research study is to understand and suggest a probable solution which can be incorporated by the financial bodies to make the concept more acceptable by the senior citizens. Design/Methodology/Approach-This quantitative study was conducted using a survey. The sample size for the study waswhich included people above the age of 60 years. The study was conducted during2020. Data collected was cleaned and prepared for further analysis. Established scales were used to measure the acceptance and adaptability of digital banking by senior citizens in India Confirmatory factor analysis followed by regression analysis/SEM was used to analyse the data. Findings- Our findings conclude that trust and technological aspects are the key variables to be taken care off and the factors influencing these variables are predominantly user oriented which are to be dealt with by the Banks. Originality/Value-Little research is reported on technology acceptance andonline banking by the senior citizens. The paper identifies the key enablers and establishes relationships between the variables under study. Managerial implications: The study providesimportant insights for Banks for improving their access to this segment. Greater understanding of the requirements of the senior citizens would help banks develops products and their communication accordingly
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The present year saw the emergence of a pandemic Corona Virus Disease of 2019 (COVID 19). The unpreparedness for the pandemic and lack of drugs/vaccine against this virus has led to a high mortality rate across the world. In the process, a number of drugs have been tried against the corona virus including antivirals like remdesivir, lopinavir-ritonavir, and favipiravir, monoclonal antibodies like tocilizumab and sarilumab and antimalarial drugs like chloroquine and hydroxychloroquine. At the present time, none of these drugs have reported efficacy against the virus. Here we present a review of all these drugs, their proposed mechanism of action against the corona virus and their status in clinical trials.