Using theory of mind to understand the impact of Covid-19 fear on healthcare workers' withdrawal intentions

PurposeHealthcare workers' (HCWs') job-related high exposure to Covid-19 virus arouses fear of Covid-19 among them. Based on the Theory of Mind (ToM), the study predicts that fears will lead to negative psychological (psychological distress) and behavioral (withdrawal intentions) outcomes. ToM is also used to identify social intelligence as a means to counter fear of Covid-19 on heightened psychological distress and increased withdrawal intentions.Design/methodology/approachTo investigate the study design, a sample of 262 HCWs, including doctors, nurses and technicians, were surveyed using standardized questionnaires.FindingsAs predicted, Covid-19 fear led to increased withdrawal intentions with heightened psychological distress partially mediating the relationship. The alleviating role of social intelligence on the effects of Covid-19 was supported as high social intelligence reduced HCWs' turnover intentions, with decreased psychological distress partially mediating the relationship.Originality/valueGiven the universality of the Theory of Mind (ToM), the findings of this study are likely to be generalizable to all pandemics. The study results support the increased application of ToM in organizational settings and have both theoretical and practical implications for health administrators. Based on study results, health administrators are exhorted to develop ToM-based mental models to understand and deal with the fear of contagious diseases. Health administrators can also increase HCWs' social intelligence to deal with the negative perceptual and behavioral outcomes arising from the emotions aroused by the nature of their work.

Inflammatory Pathways Associated with Covid-19 Severity Differ Based on Obesity Status

Background: Severe COVID-19 and obesity are characterized by higher inflammation. We aimed to examine early inflammatory patterns in people with (Ob) and without (NOb) obesity and COVID-19 and how they relate to COVID-19 disease severity Methods: Ob (BMI >30 Kg/m2) and NOb with COVID-19 matched for age, sex and WHO disease severity provided blood early after diagnosis. Immunoassays measured 57 plasma biomarkers reflecting innate immune and endothelial activation, systemic inflammation, coagulation, metabolism and microbial translocation (Fig 1). Between-group differences were assessed by Mann- Whitney. Associations between subsequent maximal COVID-19 severity (mild vs moderate/severe/critical) and biomarkers were explored by logistic regression adjusted for age, sex, hypertension (HTN) and diabetes (DM). Data are median pg/mL [IQR] or n [%] unless stated Results: Of 100 subjects (50 Ob and 50 Nob) presenting between April 2020 and March 2021, characteristics (Ob vs Nob) included: age 65 [23-91] vs 65 [21-95];female sex 27 (48%) vs 28 (56%);BMI 33.7 [30.0-71.8] vs 23.3 [15.3-25.9];disease severity mild 22 [48%] vs 23 [46%], moderate 15 [30%] vs 13 [26%], severe 6 [12%] vs 7 [14%];HTN 30 (60%) vs 17 (34%);DM 19 [38%] vs 6 [12%];days from symptom onset 7 [2-17] vs 8 [1-15];vaccinated 3 (6%) vs 0 (0%). Compared to NOb, Ob had higher IFN-alpha (1.8 [0.6;11] vs 0.9 [0.1;4.7]), CRP (10 mAU/mL [9.6;10.2] vs 9.7 [7.2;10]), IL-1RA (197 [122;399] vs 138 [88;253]), IL-4 (288 AU/mL [161;424] vs 205 [82;333]), vWF (252 [166;383] vs 163 [96;318]), Zonulin (114 ng/mL [77;131] vs 57 [18;106]), Resistin (956 [569;1153] vs 727 [712;1525]), Leptin (3482 [1513;5738] vs 848 [249;2114]), and lower Adiponectin (1.12 mg/L [0.09;1.5] vs 1.5 [1.18;1.93]), all p< 0.05. In both groups higher, proinflammatory IL-18 and lower levels of antiinflammatory CCL22 and IL-5 were associated with higher odds of disease severity, and lower E-selectin with higher disease severity only in Ob. However, in NOb higher type 3 interferons (IL-28A), macrophage activation (sCD163, CCL3) and vascular inflammation markers (ICAM-1, VCAM-1), along with higher S100B, GM-CSF and leptin were also associated with disease severity, a pattern not observed in Ob (Fig 1) Conclusion(s): Although Ob had higher overall levels of inflammation than NOb, few biomarkers predicted subsequent COVID-19 severity in Ob. These differential inflammatory patterns suggest dysregulated immune responses in Ob with COVID-19. (Figure Presented).

Early Inflammatory Profiles Predict Maximal Disease Severity in Covid-19

Background: Better understanding of host inflammatory changes that precede development of severe COVID-19 could improve delivery of available antiviral and immunomodulatory therapies, and provide insights for the development of new therapies. Method(s): In plasma from individuals with COVID-19, sampled <=10 days from symptom onset from the All-Ireland Infectious Diseases Cohort study, we measured 61 biomarkers, including markers of innate immune and T cell activation, coagulation, tissue repair, lung injury, and immune regulation. We used principal component analysis (PCA) and k-means clustering to derive biomarker clusters, and univariate and multivariate ordinal logistic regression to explore association between cluster membership and maximal disease severity, adjusting for risk factors for severe COVID-19, including age, sex, ethnicity, BMI, hypertension and diabetes. Result(s): From March 2020-April 2021, we included 312 individuals, (median (IQR) age 62 (48-77) years, 7 (4-9) days from symptom onset, 54% male) in the analysis. PCA and clustering derived 4 clusters. Compared to cluster 1, clusters 2-4 were significantly older and of higher BMI but there were no significant differences in sex or ethnicity. Cluster 1 had low levels of inflammation, cluster 2 had higher levels of markers of tissue repair and endothelial activation (EGF, VEGF, PDGF, TGFalpha, serpin E1 and p-selectin). Cluster 3 and 4 were both characterised by higher overall inflammation, but compared to cluster 4, cluster 3 had downregulation of growth factors, markers of endothelial activation, and immune regulation (IL10, PDL1), but higher alveolar epithelial injury markers (RAGE, ST2). In univariate analysis, compared to cluster 1, cluster 3 had the highest odds of severe disease (OR (95% CI) 9.02 (4.62-18.31), followed by cluster 4: 5.59 (2.75-11.72) then cluster 2: 4.5 (2.38-8.81), all p < 0.05). Cluster 3 remained most strongly associated with severe disease in fully adjusted analyses;cluster 3: OR(95% CI) 5.99 (2.69-13.35), cluster 2: 3.14 (1.54-6.42), cluster 4: 3.13 (1.36-7.19), all p< 0.05). Conclusion(s): Distinct early inflammatory profiles predicted maximal disease severity independent of known risk factors for severe COVID-19. A cluster characterised by downregulation of growth factor and endothelial markers and early evidence of alveolar injury was associated with highest risk of developing severe COVID19. Whether this reflects a dysregulated inflammatory response that could improve targeted treatment requires further study. Heatmap of biomarker derived clusters and forest plot of association between clusters and disease severity. A: Heatmap demonstrating differences in biomarkers between clusters B: Forest plot demonstrating odds ratio of specific clusters for progressing to moderate or severe disease (reference Cluster 1), calculated using ordinal logistic regression. Odds ratio (95% CI) presented as unadjusted and fully adjusted (for age, sex, ethnicity, BMI, hypertension, diabetes, immunosuppression, smoking and baseline anticoagulant use). Maximal disease severity graded per the WHO severity scale.

Knowledge Practice Gap Among Nurses Towards COVID-19 Patients' Dead Body Care in a Tertiary Care Hospital

COVID-19 due to SARS-CoV-2 is a global pandemic that presents a serious challenge from many angles for healthcare professionals. The virus causes a potentially fatal disease that is easily transmitted among patients and caregivers, hence specific dead body care is required for such patients. Our study was conducted to identify knowledge, attitude, and practice regarding COVID-19 dead body care among hospital nursing personnel. A cross sectional survey-based study was performed involving 282 nurses who worked in COVID-19 units during data collection from July 2020 to September 2020. The online structured questionnaire was based on world health organization guidelines, institutional infection control protocols, and course material regarding emerging respiratory diseases including COVID-19. We found that work experience in the COVID-19 unit had a significant impact on knowledge and practice regarding COVID-19 dead body care. Similarly, we observed that training improved the knowledge and practice of nursing personnel regarding dead body care. Good knowledge, attitude, and practice were observed in experienced and trained nurses (p-value <0.005). No significant changes were observed with age, gender, and education qualification. Overall knowledge, attitude, and practice regarding COVID-19 dead body care were moderate to good. Adequate training among nurses should prevent the transmission of disease due to occupational exposure.Copyright © 2023, Science Publications. All rights reserved.

Is daily home spirometry feasible in remote monitoring of interstitial lung disease?

Introduction: Access to in-clinic spirometry for patients with interstitial lung disease (ILD) has been restricted by the COVID19 pandemic. Remote monitoring of patient-recorded at-home spirometry & pulse oximetry offers an alternative approach to traditional hospital-based monitoring. Objective(s): To assess the feasibility of a remote monitoring programme (with spirometry & pulse oximetry) delivered within ILD clinical care settings for a 3-month period through assessment of adherence to study measurements. Method(s): In this prospective, single-arm, observational study (NCT04850521), patients were asked to record 1 spirometry and pulse oximetry measurement per day for 91 days, using a digital health application (patientMpowerTM) & Bluetooth-linked devices. Patient-recorded data could be viewed in real time by their clinical teams via a secure, password-restricted web-based portal. Health-related quality of life and patient experience were also assessed. Result(s): 51 ILD patients enrolled and provided >=1 spirometry reading. Baseline demographics: 35M/16F;29 idiopathic pulmonary fibrosis (IPF)/22 non-IPF ILD;age: 67+/-12Y;in-clinic FVC: 84+/-20% predicted;TLCO 54+/-19% predicted (mean+/-SD);median modified ILD GAP score: 3. Patients recorded spirometry on median 92% of days & pulse oximetry on median 93% of days. To date, 30 patients have completed follow-up. 26/30 patients recorded spirometry and pulse oximetry >=3 days/week & >=70% of days. Conclusion(s): In this study, daily recording of home spirometry & pulse oximetry over 3 months appeared feasible. Further research is needed to understand how remote monitoring is best used within ILD clinical services. .

A Review Study to Investigate the Tracking of Biomedical Waste during Covid-19 Pandemic in India

The aim of this review article is planning to collect, transport, processing and dispose of hazardous and non-hazardous biomedical waste, with a special concern on the biomedical waste tracking system in India. This review article sheds insight on some of the tracking systems of COVID-19 waste over the barcode, IoT, and GPS-based trash monitoring, related to COVID-19 waste management. Better waste management may reduce the amount of time that garbage is exposed to the environment and the risk of transportation. COVID-19 waste treatment facility might assist to reduce the risk of coronavirus transmission, as well as the hazardous component risk respectively. © 2021 Taylor & Francis Group, LLC.

Lower B-Cell Responses Rather Than Circulating Antibody Titres Are Associated With SARS-CoV-2 Infection Post Third Dose COVID-19 Vaccination

Background. Which components of the immune response to SARS-CoV-2 vaccination best protect against subsequent infection remains unclear. We explored SARS-CoV-2 specific antibody and B-cell responses post 3rd dose vaccine and their relationship to subsequent SARS-CoV-2 infection. Methods. In a multicentre prospective cohort, adult subjects provided samples before and 14 days (d14) post 3rd dose vaccine with Pfizer-BioNTech 162b2. At 18-22 weeks post vaccine, subjects self-reported SARS-CoV-2 infection (confirmed by PCR or antigen test). We used electrochemiluminescence assays to quantify antibodies to SARS-CoV-2 spike subunit 1 (S1), subunit 2 (S2) and receptor-binding domain (RBD) in plasma (reported inWHOIU/mL). In a subset of subjects, we assessed SARS-CoV-2 specific differentiated B-cell (plasma cell) and memory B-cell responses from peripheral blood mononuclear cells. Unstimulated plasma cells, and memory B cells stimulated with R848 and IL2, were seeded on plates coated with RBD or full Spike antigen and antigen-specific responses measured by ELISpot (Mabtech ELISpot, Sweden). We compared between group differences by Wilcoxon signed rank or Mann-Whitney tests. Data are median [IQR] unless specified. Results. Of 133 subjects (age 43 [32-50], 81.2% female (table 1), 77 subjects in the B-cell subgroup (table 2)), 47 (35.3%) reported SARS-CoV-2 infection post 3rd vaccine. Antibody titres, plasma cell and memory B-cell responses all increased significantly at d14 post 3rd vaccine (Table 1 & 2, all P< 0.001). Although d14 antibody titres did not differ in those with and without subsequent infection (table 1), those reporting subsequent infection had significantly lower d14 RBD-specific plasma cells and a lower proportion of RBD-specific memory B-cells (Figure 1a-b, both P< 0.05). Similar results were observed with full-spike-specific memory B-cell responses (Figure 1d). The differences persisted when the non-infected group was restricted only to those reporting a confirmed close contact (n=26). Conclusion. Infection following 3rd dose vaccine is associated with lower d14 circulating and memory B cell responses, but not antibody titres, suggesting B-cell responses better predict protection against subsequent SARS-CoV-2 infection.

Performance and validation of an adaptable multiplex assay for detection of serologic response to SARS-CoV-2 infection or vaccination

Background. A wide array of assays to detect the serologic response to SARS-CoV-2 have been developed since the emergence of the pandemic. The majority of these are either qualitative or semi-quantitative, detect antibodies against one antigenic target, and are not adaptable to new antigens. Methods. We developed a new, multiplex immunoassay to detect antibodies against the receptor binding domain, S1 and S2 spike subunits and nucleocapsid (N) antigens of SARS-CoV-2 (the CEPHR SARS-CoV-2 Serology Assay). This assay uses electrochemiluminescence technology which allows for a broad dynamic range, and a linker format which allows for the addition of new antigenic targets. We tested this assay on a series of biobanked samples and validated its performance against the Abbott SARS-CoV-2 IgG and Abbott SARS-CoV-2 IgG II assays, and the MesoScale Diagnostics V-PLEX SARS-CoV-2 Panel 2 Kit. Results. Participant demographics are shown in Table 1. The mean (standard deviation (SD)) intra-assay (within plate) coefficient of variation (CV) of 80 plasma samples run on the same plate was 3.9% (2.9) for N, 3.8% (6.2) for RBD, 3.8% (5.9) for S1 and 3.9% (5.3) for S2. The mean (SD) inter-assay CV derived from 5 samples run across 3 days by two different operators was 11% (6.5) for N, 13% (5.7) for RBD, 14% (8.9) for S1 and 13% (5.1) for S2. In the convalescent group (n=193), overall sensitivity for each assay was;RBD 82% (95% CI 76-87), S1 86% (81-91%), S2 88% (83 - 92%) and N 72% (64 - 78%). Sensitivity improved when analysis included only individuals who were sampled more than 14 days from onset of symptoms (n=166), RBD 87% (81 - 95%), S1 91% (85 - 95%), S2 91% (85 - 95%) but not for the N-target (73% (66-80%)). In vaccinated individuals (n = 58), 100% (94-100%) had both detectable RBD and S1 antibodies. Overall specificity was 96% (87-99%) for RBD, 90% (78-97%) for S1, 94% (84-99%) for S2 and 90% (78-97%) for N. There was excellent correlation between the Abbott IgG II and both CEPHR anti-RBD IgG (rho 0.91) and CEPHR anti-S1 IgG (rho 0.9, both p < 0.001, Figure 1.) and the V-PLEX full spike and both CEPHR RBD IgG (rho 0.83) and S1 IgG (rho 0.82, both p < 0.001, Figure 4). Conclusion. The CEPHR SARS-CoV-2 Serology Assay is a robust, customisable, multiplex serologic assay for the detection of several different IgG specific to SARS-CoV-2.

Design of framework for cognitive styles in formulating individualistic approach

These times of pandemic influence remote working and understanding of the new normal. This new normal helps in reaching out the importance of an individualistic approach with the psychological contribution in procuring sustainable thinking. The benefaction of the individual and community helps in understanding these difficult times by accessing some psychological variables such as individual potential, stimulant drivers, identity traits and emotional health. These variables show their involvement in forming an individualistic approach. An individualistic approach will help in developing sustainable thinking which contributes to using the limited resources to the fullest in Covid-19 times. It can be concluded that individuals with high individual potential and stimulant drivers will promote an individualistic approach which promotes sustainable thinking. Emotional health and identity traits help in a flourishing individualistic approach which promotes sustainable thinking. The futuristic approach of the study throws light on the execution of cognitive styles in the individualistic approach which can be altered by individual potential, stimulant drivers, identity traits and emotional health accentuating the approach to stimulating sustainable thinking.

Comparative Study of Biomedical Physiological based ECG Signal heart monitoring for Human body

Cardiovascular disease the major challenges in the current 21st century in terms of health care and related to diagnostic developments. In this pandemic COVID-19 scenario, the cardiovascular disease or non-cardiovascular disease has been increased like cardiac arrest or silent heart attack. According to WHO has guidelines, it is set to reduce 25% overall mortality rate due to cardiovascular disease upto 2025 on the priority basis kept as prevention and control. Some techniques developed for heart rate estimation from multimodal physiological signals namely ECG, AB, and PPG, EEG, EMG and EOG etc. are the part of cardiovascular and non-cardiovascular signals have been reviewed. ©2021 Copyright for this paper by its authors.

Improving Smart Healthcare Safety and Security Using Kinect

Modern healthcare operating rooms are cumbersome, especially in the current pandemic of Coronavirus (COVID-19) to manage the safety and security of the patients and the staff. Conditions in a modern operating room are like, a patient’s medical diagnosis or x-ray or the MRI images are the vital resources to be considered. In general, the doctors are impelled to scrub out their hands every time they scroll through or examine the images in mid-operation. To avoid departing the operating table, several doctors put their faith in assistants or nurses and ask to examine the system that can be clumsy and disappointing and can rise the gathering in the room itself. To overcome this problem and emphasizing the use of the touchless smart healthcare system in medical diagnosis we have developed an application for the same. We propose and demonstrate a gesture and speech-based system to help staff to deal with such critical conditions. The proposed system is composed of two main parts: the healthcare operating software and sensor Microsoft Kinect. Test results conclude the efficiency of the viewing system in terms of time complexity, and the value and the safety of the recording system have increased. © 2021, Springer Nature Switzerland AG.

Wastewater-based epidemiology for novel Coronavirus detection in wastewater

The entire world is reeling under the worst pandemic of last 100 years. Over 128 million people have been infected with it and 2.8 million deaths have already taken place, till 30th March 2021. The identification of materials positive cases is the first step towards its containment and treatment. However, testing of individuals is an extensive, expensive and time-consuming exercise. In addition, societal taboos are also associated with infected individuals resulting in very few people volunteering for testing, esp. in the developing and under-developed world. An alternative approach that circumvents individual testing is the wastewater-based epidemiology. A state-of-the-art review of this method is provided in context of its utility for COVID-19 detection. This technique relies on collecting and testing samples from sewers and/or wastewater treatment plants for the presence of pathogens and then using that data to determine and predict the spread of the infection, thereby allowing the provision of appropriate containment and treatment steps. The study covers key aspects of wastewater-based epidemiology application for COVID-19 detection including its need, detailed process of detection and assessment, data analysis, economics and challenges to its application. Findings from a number of case studies are presented to elucidate the utility of this technique. It is clearly seen that WBE-based approach is a much better strategy as compared to individual testing and can be adopted to prevent further spread of Covid-19. The work is expected to further emphasize the application of this method for COVID (and other pandemic) detection and implementing containment strategies. This is clearly a much more economical and non-intrusive approach as compared to the individual testing.

Home spirometry as a clinical endpoint in fibrotic ILD: Lessons from the injustis interim analysis

Home handheld spirometry enables repeated measurements of forced vital capacity (FVC), offering opportunities for longitudinal evaluation in interstitial lung disease (ILD). Whilst recent studies have not blinded participants to their home spirometry performance, they support feasibility in participants with idiopathic pulmonary fibrosis (IPF). However little data exists for the utility of home spirometry in non-IPF ILD. We assess correlation, agreement and non-inferiority of blinded daily home spirometry over three months relative to hospital spirometry, informing the feasibility of remote monitoring as a primary endpoint in clinical settings. We utilised interim data from the ongoing INJUSTIS study (NCT03670576). Participants with fibrotic ILD were offered a handheld spirometer linked via bluetooth to a smartphone application and asked to perform daily, blinded FVC for three months. Hospital spirometry was concurrently obtained at baseline and three months. Home FVC values were based on week averages at study timepoints. Correlation, Bland-Altman plots and equivalence tests were used to compare baseline, 3 month and delta. Sensitivity analysis was performed where test dates matched. 82 participants with ILD were included. Mean age was 69.8±8 years, 72.3% were male and mean FVC was 2.96 ±0.88L. Median adherence to daily spirometry was 79.5%, four participants had an adherence <10%. At the time of (Table presented) censorship, 35 participants had 3 month data for both home and hospital spirometry, 45 participants had date-matched values. High correlation was observed between home and hospital spirometry at baseline (r=0.86) and three-months (r=0.81), changes in 3 month DFVC were not correlated (r=-0.09). At least 90% of home spirometry values were within agreement limits of hospital values at baseline (mean difference -0.31L/min,95%CI -0.39;-0.22), three-months (-0.13L/min,95%CI -0.31;0.05) and 3 month DFVC (-0.03L/min,95%CI 0.13;0.20). Home values more frequently underestimated hospital values but non-inferiority was confirmed within 400 ml. Home spirometry in fibrotic ILD is feasible and non-inferior to hospital spirometry. This is particularly relevant in the context of the current covid-19 pandemic, where an urgent need has arisen to consider remote monitoring of lung function. Adherence to daily spirometry was high in blinded participants, but variability in home values was observed when using week-averages, supporting importance of longitudinal modelling for clinical endpoint precision.