GENOMIC SURVEILLANCE OF SARS-CoV-2 REVEALS SEVERITY OF DELTA VARIANT IN CAMEROON

Background: At the global level, the dynamics of the COVID-19 pandemic have been driven by several epidemiological waves, determined by the emergence of new SARS-CoV-2 variants from the original viral lineage from Wuhan, China. While the SARS-CoV-2 dynamic has been described globally, there is a lack of data from Sub-Saharan African. Method(s): A laboratory-based survey was conducted in Cameroon, from March 1, 2020 to March 30, 2022, through an assessment of the evolutionary patterns of SARS-CoV-2 lineages across the four COVID-19 waves in the country. Data on full-length sequencing from all four sequencing laboratories were consecutively entered into the GISAID platform. These data were downloaded, and the molecular phylogeny of the SARS-CoV-2 sequences was performed using Nexstrain. The Mann-Whitney U test was used to calculate the correlation between the duration of each outbreak and the number of confirmed cases and between hospitalised cases and CFR, with a p value < 0.05 considered statistically significant. Result(s): A total of 3,881 samples were successfully processed, of which 38.9% (n=1,509) using PCR mutation assay, 41.5% (n=1,612) using targeted sequencing, and 19.6% (n=760) using whole-genome sequencing. The mean age of the study population was 36 years (min-max: 2-86), and 45% were within the age range 26-45. Regarding gender distribution, 50.9% were male, and 49.1% were female. Phylogenetic analysis of the 760 whole-genome sequences generated from March 2020 to March 2022 revealed that the greater proportion of SARS-CoV-2 circulating in Cameroon belonged to the viral sub-lineages of the original strain from Wuhan (74%), 15% Delta variant, 6% Omicron variant, 3% Alpha variant and 2% Beta variant.The pandemic was driven by SARS-CoV-2 lineages of origin in Wave 1 (16 weeks, 2.3% CFR), the Alpha and Beta variants in Wave 2 (21 weeks, 1.6% CFR), Delta variants in Wave 3 (11 weeks, 2.0% CFR), and Omicron variants in Wave 4 (8 weeks, 0.73% CFR), with a declining trend over time (p=0.01208). Conclusion(s): In a nutshell, the SARS-CoV-2 epidemic in Cameroon appears to have been driven by the SARS-CoV-2 lineage of origin in Wave 1, the cointroduction of the Alpha and Beta variants in Wave 2, the Delta variant in Wave 3, and the Omicron variant in Wave 4, with an overall declining trend in the wave duration, confirmed cases and hospitalisations over time.The SARS-CoV-2 lineage of origin and the Delta variant appeared to be the drivers of COVID-19 severity in Cameroon.

KSMDB: A classification method in imbalanced COVID dataset based on KmeansSMOTE and DeBERT

2022 is already the third year of the COVID-19 outbreak, and public opinion information about the outbreak has always been at the forefront of hot searches. The imbalance problem prevalent in many reviews of COVID-19 causes classification models to favor most categories in training and prediction process, resulting in low accuracy of small sample classification data generated by imbalanced data sets. Therefore, it is suggested here that the text classification model is based on the combination of the KMeansSMOTE method combined with DeBERT. First of all, during data processing, the KmeansSMOTE algorithm is utilized to oversample the imbalance of the COVID dataset, which increases the classification accuracy of the model. Besides, we put a stacked denoising bidirectional transformer encoder (DeBERT) to use, a more and richer hidden feature vector is extracted by adding an embedded layer after the input tag, and the noise data is reconstructed to solve the noise problem in the process of raw data existence and oversampling. Furthermore, on the basis of model training, overfitting can be alleviated by adopting an early stopping strategy. A world of experiments using the COVID dataset demonstrates the effectiveness of the proposed method for solving simple imbalance and noise problems. With an overall accuracy of 87%, which improves the classification effect of minority samples and provides a new feasible method for the war of epidemic prevention. © 2022 IEEE.

Health Information Technology Adoption at U.S. Home Health Care Agencies: Results from a Multi-Methods Study

Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR;(2) Benefits of EHR;(3) Benefits of other HIT;(4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR;an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.

Research on the Development Strategy of China Railway Highspeed Express in Guangxi Based on SWOT

The rapid development of e-commerce industry has put forward higher requirements on the speed, safety, reliability and low price of logistics services, and China Railway Highspeed Express (CRHE) has ushered in a broad market prospect because it meets these requirements very well. Firstly, according to the SWOT analysis of CRHE in Guangxi, propose that its strengths are transportation network, speed, safety and stability and cost effectiveness, weaknesses are informatization and operation process, opportunities are national and local policies, threats are competition in the industry and COVID-19. After that, make an attempt of making four strategic combinations, and make a strategic decision of strengths-opportunities combination through comparison. Finally propose many measures to ensure the implementation of the strategy: seizing the external opportunities by following up the polities and giving full play to the strengths by increasing investment in capital and technology, adjusting the management mode, determining annual production target reasonably and cooperating with other express enterprises. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A Comparison of WebRTC and Conventional Videoconferencing for Synchronized Remote Medical Image Presentation.

DICOM viewers must fulfill roles beyond primary diagnostic interpretation, including serving as presentation tools in teaching and multidisciplinary conferences, thereby enabling multiple individuals to review images collaboratively in real time. When in-person gathering is not possible, a variety of solutions have been deployed to maintain the ability for spatially separated users to view medical images simultaneously. These approaches differ in their backend architectures, utilization of application-specific optimizations, and ultimately in their end user satisfaction. In this work, we systematically compare the performance of conventional screensharing using a videoconferencing application with that of a custom, synchronized DICOM viewer linked using Web Real Time Communications (WebRTC) technology. We find superior performance for the WebRTC method with regard to image quality and latency across a range of simulated adverse network conditions, and we show how increasing the number of conference participants differentially affects the bandwidth requirements of the two viewing solutions. In addition, we compare these two approaches in a real-world teaching scenario and gather the feedback of trainee and faculty radiologists, who we found to favor the WebRTC method for its decreased latency, improved image quality, ease of setup, and overall experience. Ultimately, our results demonstrate the value of application-specific solutions for the remote synchronized viewing of medical imaging, which, given the recent increase in reliance on remote collaboration, may constitute a significant consideration for future enterprise viewer procurement decisions.

A Fuzzy Theory Based Topological Distance Measurement for Undirected Multigraphs

The topological distance is to measure the structural difference between two graphs in a metric space. Graphs are ubiquitous, and topological measurements over graphs arise in diverse areas, including, e.g. COVID-19 structural analysis, DNA/RNA alignment, discovering the Isomers, checking the code plagiarism. Unfortunately, popular distance scores used in these applications, that scale over large graphs, are not metrics, and the computation usually becomes NP-hard. While, fuzzy measurement is an uncertain representation to apply for a polynomial-time solution for undirected multigraph isomorphism. But the graph isomorphism problem is to determine two finite graphs that are isomorphic, which is not known with a polynomial-time solution. This paper solves the undirected multigraph isomorphism problem with an algorithmic approach as NP=P and proposes a polynomial-time solution to check if two undirected multigraphs are isomorphic or not. Based on the solution, we define a new fuzzy measurement based on graph isomorphism for topological distance/structural similarity between two graphs. Thus, this paper proposed a fuzzy measure of the topological distance between two undirected multigraphs. If two graphs are isomorphic, the topological distance is 0;if not, we will calculate the Euclidean distance among eight extracted features and provide the fuzzy distance. The fuzzy measurement executes more efficiently and accurately than the current methods.

Transmission Process Prediction of Novel Coronavirus Based on System Dynamics

The transmission characteristics of novel coronavirus is considered and a new SE4IR2 model based on the principle of system dynamics is proposed. The US epidemic data from June to November is used to set the isolation rate and other parameters, and the SE4IR2 model is used to fit, analyze and predict the development of the epidemic trend in the next stage. The empirical part uses the data from June to November in the United States to achieve the parameters of the SE4IR2 model, obtains the parameter values in December and January through the time series prediction model, and compares the predicted number of deaths and the people cured with those of the WTO published in December and January. The error in December is 0.75% and -0.86%, and the error in January is 2.78% and 3.57%.Based on the results of the empirical analysis, considering the constraints between the various parameters, the corresponding recommendations for epidemic prevention and control are given. The results show that the SE4IR2 model has better simulation accuracy and is more suitable for simulating the spread of COVID-19. © 2021, The Editorial Board of Journal of System Simulation. All right reserved.

Changes in HIV testing services after COVID-19 in 11 sub-saharan african countries

Background: The COVID-19 pandemic has interrupted the implementation of many HIV prevention programs supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), especially in sub-Saharan Africa. We evaluated the effects of COVID-19 pandemic (e.g., lockdowns, lack of personal protective equipment, community fears) on efforts to reach the UNAIDS 90-90-90 targets by HIV case finding using index testing (IT) and provider-initiated testing and counseling (PITC) as well as HIV treatment initiation. Methods: We conducted a descriptive analysis using programmatic data from persons aged 15 years and older reported to PEPFAR from 11 purposefully selected countries in sub-Saharan Africa. We calculated the percentage change in reported HIV case finding indicators during the COVID period, defined as January-June 2020, as compared to the pre-COVID period, during the same time frame in the preceding year, January-June 2019. Results: Of the 11 countries, persons tested for HIV through PITC declined in seven (64%) and persons testing positive declined in 10 (91%), comparing the COVID to pre-COVID periods (see Table 1). Across all countries, total HIV testing and total number of persons testing positive by PITC decreased by 20% and 23% when comparing the COVID to the pre-COVID period, respectively. In parallel, five of the 11 countries (Cameroon, DRC, Mozambique, Nigeria, South Africa) saw an increase in both IT and HIV case finding through IT, in COVID as compared to the pre-COVID period. Across all countries, total IT increased by 13% and HIV case finding through IT increased by 17% when comparing the COVID to the pre-COVID period. The number of HIV-positive people linked to treatment decreased in seven (64%) countries during the COVID period compared to pre- COVID. Across all countries, an increase of 3% in those HIV-positive people linked to treatment. Conclusion: While testing through PITC decreased during the COVID period, testing and case finding through IT increased. The increase in IT may reflect the actions of healthcare facilities and providers to ensure that HIV-exposed individuals identified by an index case were still tested. Focusing on IT may help programs effectively identify HIV-positive people, even during a pandemic or other disturbance.

COVID-19 preparedness in hospice and palliative care

Background: Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown. Methods: An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7-28, 2020. Summary statistics were computed. Results: We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit. More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/ local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19;of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19. Conclusion: Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate.

A fuzzy theory based topological distance measurement for undirected multigraphs

The topological distance is to measure the structural difference between two graphs in a metric space. Graphs are ubiquitous, and topological measurements over graphs arise in diverse areas, including, e.g. COVID-19 structural analysis, DNA/RNA alignment, discovering the Isomers, checking the code plagiarism. Unfortunately, popular distance scores used in these applications, that scale over large graphs, are not metrics, and the computation usually becomes NP-hard. While, fuzzy measurement is an uncertain representation to apply for a polynomial-time solution for undirected multigraph isomorphism. But the graph isomorphism problem is to determine two finite graphs that are isomorphic, which is not known with a polynomial-time solution. This paper solves the undirected multigraph isomorphism problem with an algorithmic approach as NP=P and proposes a polynomial-time solution to check if two undirected multigraphs are isomorphic or not. Based on the solution, we define a new fuzzy measurement based on graph isomorphism for topological distance/structural similarity between two graphs. Thus, this paper proposed a fuzzy measure of the topological distance between two undirected multigraphs. If two graphs are isomorphic, the topological distance is 0;if not, we will calculate the Euclidean distance among eight extracted features and provide the fuzzy distance. The fuzzy measurement executes more efficiently and accurately than the current methods. © 2020 IEEE.

[Analysis of clinical characteristics of 49 cases of COVID-19].

Objective: To analyze the epidemiological and clinical characteristics, and imaging features of patients with COVID-19 in Henan Province People's Hospital. Methods: The epidemiology, clinical symptoms, laboratory and radiologic data of 49 patients with COVID-19 infection admitted to the department of infectious disease in our hospital from January 23, 2020 to February 22, 2020 were retrospectively analyzed. All analyses were performed with SPSS software, version 22.0. Results: A total of 49 patients with COVID-19 were enrolled, of which 28 were ordinary, 16 were severe, and 5 were critical in disease severity. The average ages of the 3 groups were (46±19) , (60±16) and (68±20) years, with statistical differences (P=0.015). Common symptoms at the onset were fever (41 patients), dry cough (35 patients), and fatigue (21 patients). Epidemiological investigations found that 31 (63%) patients had direct or indirect contact with confirmed cases, and 14 cases were family clustered. Laboratory test results showed that the lymphocyte counts progressively decreased [0.85 (0.5-1.6) ×10(9)/L,0.51 (0.4-0.9) ×10(9)/L and 0.43 (0.47-0.61) ×10(9)/L, respectively], while LDH [162 (145.1-203.5) U/L,265 (195.3-288.4) U/L and 387 (312.3-415.5) U/L, respectively] and D-dimer [0.15 (0.09-0.40) mg/L,0.4 (0.2-0.6) mg/L and 0.9 (0.5-1.4) mg/L, respectively] were significantly increased (P<0.05), in all the 3 groups. The levels of IL-6 [(43.2±15.4) µg/L, (78.5±31.2) µg/L and (132.4±47.9) µg/L, respectively] and IL-10 [(3.5±3.2) µg/L, (7.6±6.4) µg/L and (9.4±7.2) µg/L respectively] increased significantly with disease severity. Pulmonary imaging of ordinary patients mainly showed unilateral or bilateral multiple infiltrates, while severe and critically ill patients showed diffuse exudation and consolidation of both lungs, and a few patients showed signs of "white lungs". Conclusions: Patients with COVID-19 has a definite history of contact with diagnosed patients, and has family aggregation. The clinical symptoms were mainly fever and dry cough. Laboratory results showed that lymphocyte count, LDH, D-dimer, interleukin-6 and interleukin-10 levels had a significant correlation with the severity of the disease, which could be used as markers for disease progression and prognosis. Pulmonary imaging showed unilateral or bilateral ground glass infiltration. In severe and critically ill patients, diffuse infiltration and consolidation or even "white lung" were present.

Virtual Read-Out: Radiology Education for the 21st Century During the COVID-19 Pandemic.

Technologic advances have resulted in the expansion of web-based conferencing and education. While historically video-conferencing has been used for didactic educational sessions, we present its novel use in virtual radiology read-outs in the face of the COVID-19 pandemic. Knowledge of key aspects of set-up, implementation, and possible pitfalls of video-conferencing technology in the application of virtual read-outs can help to improve the educational experience of radiology trainees and promote potential future distance learning and collaboration.

[Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia].

Objective: To analyze the clinical characteristics of 2019 novel coronavirus (2019-nCoV) pneumonia and to investigate the correlation between serum inflammatory cytokines and severity of the disease. Methods: 29 patients with 2019-ncov admitted to the isolation ward of Tongji hospital affiliated to Tongji medical college of Huazhong University of Science and Technology in January 2020 were selected as the study subjects. Clinical data were collected and the general information, clinical symptoms, blood test and CT imaging characteristics were analyzed. According to the relevant diagnostic criteria, the patients were divided into three groups: mild (15 cases), severe (9 cases) and critical (5 cases). The expression levels of inflammatory cytokines and other markers in the serum of each group were detected, and the changes of these indicators of the three groups were compared and analyzed, as well as their relationship with the clinical classification of the disease. Results: (1) The main symptoms of 2019-nCoV pneumonia was fever (28/29) with or without respiratory and other systemic symptoms. Two patients died with underlying disease and co-bacterial infection, respectively. (2) The blood test of the patients showed normal or decreased white blood cell count (23/29), decreased lymphocyte count (20/29), increased hypersensitive C reactive protein (hs-CRP) (27/29), and normal procalcitonin. In most patients,serum lactate dehydrogenase (LDH) was significantly increased (20/29), while albumin was decreased(15/29). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), serum creatinine (Scr) and other items showed no significant changes. (3) CT findings of typical cases were single or multiple patchy ground glass shadows accompanied by septal thickening. When the disease progresses, the lesion increases and the scope expands, and the ground glass shadow coexists with the solid shadow or the stripe shadow. (4) There were statistically significant differences in the expression levels of interleukin-2 receptor (IL-2R) and IL-6 in the serum of the three groups (P<0.05), among which the critical group was higher than the severe group and the severe group was higher than the mildgroup. However, there were no statistically significant differences in serum levels of tumor necrosis factor-alpha (TNF-α), IL-1, IL-8, IL-10, hs-CRP, lymphocyte count and LDH among the three groups (P>0.05). Conclusion: The clinical characteristics of 2019-nCoV pneumonia are similar to those of common viral pneumonia. High resolution CT is of great value in the differential diagnosis of this disease. The increased expression of IL-2R and IL-6 in serum is expected to predict the severity of the 2019-nCoV pneumonia and the prognosis of patients.