A Comparison of Retrieved Respiratory Viral load emitted by infected SARS-CoV-2 patients

Viral RNA in fine (< 5 µm) aerosols from 13 patients infected by the SARS-CoV-2 virus were obtained using the Gesundheit-II (G-II) equipment which collects respiratory emissions. The collection was performed in isolation wards of the National Centre for Infectious Diseases of Singapore under an approved protocol. The patients breathed normally for 30 minutes, talk, and sing for 15 minutes each (with 30 minutes rest in between activity) into a specially designed aerosol collector in two size fractions. The coarse fraction (> 5 µm) and the fine aerosols (< 5 µm) are subsequently collected and subjected to PCR analysis for their viral load quantification. Viral RNA detected from 59% of the patients showed that patients earlier in illness were more likely to emit detectable RNA, and loads differed significantly between breathing, talking, and singing. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Clinical Features and Management of COVID-19

Much has been learnt about severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) since the beginning of theCoronavirus disease 2019 (COVID-19) pandemic, including its clinical manifestations, diagnosis, and management. Unlike its zoonotic predecessor SARS-CoV which was largely a symptomatic disease where fever was a hallmark, a significant proportion of SARS-CoV-2 infections can be asymptomatic (40%), while severe disease (requiring oxygen supplementation or ventilatory support) occurs in approximately 20%, and mortality in about 2% of infected patients. Extra-pulmonary COVID-19 manifestations are also more protean, compared to SARS. Supportive care is the mainstay of treatment for most patients, but for those who progress to severe COVID-19, antivirals such as remdesivir and immunomodulatory treatment (such as corticosteroids or theJAK-inhibitor, baricitinib) may improve outcomes. While further advances in the management of COVID-19 are anticipated (including novel therapies), prevention of infection through public health measures (including vaccination), will remain as vital facets in confronting this pandemic. © 2023 by World Scientific Publishing Co. Pte. Ltd.

Successful Drilling of the Deepest and Hottest HPHT Carbonate Well in Offshore Malaysia, its Lesson Learnt and Way Forward

HPHT wells are typically associated with high complexity, technically challenging, long duration, high risk and high NPT as many things could go wrong especially when any of the critical nitty- gritty details are overlooked. The complexity is amplified with high risk of losses in carbonate reservoir with high level of contaminants compounded by the requirement of high mud weight above 17 ppg during monsoon season in an offshore environment. The above sums up the challenges an operator had to manage in a groundbreaking HPHT carbonate appraisal well which had successfully pushed the historical envelope of such well category in Central Luconia area, off the coast of Sarawak where one of the new records of the deepest and hottest carbonate HPHT well had been created. This well took almost 4 months to drill with production testing carried out in a safe and efficient manner whereby more than 4000m of vertical interval was covered by 6 hole sections. With the seamless support from host authority, JV partners and all contractors, the well was successfully delivered within the planned duration and cost, despite the extreme challenges brought about by the COVID-19 pandemic. This paper will share the experience of the entire cycle from pre job engineering/planning, execution, key lesson learnt and optimization plan for future exploitations which includes an appraisal well and followed by more than a dozen of development wells. Copyright © 2023, International Petroleum Technology Conference.

Knowledge, Attitudes, Practices, and Online Distance Learning Experience of Malaysian University Students towards COVID-19: A Cross Sectional Study

Some new norms need to be adapted due to COVID-19 pandemic period where people need to wear masks, wash their hands frequently, maintain social distancing, and avoid going out unless necessary. Therefore, educational institutions were closed to minimize the spread of COVID-19. As a result of this, online education was adapted to substitute face-to-face learning. Therefore, this study aimed to assess the Malaysian university students' adaptation to the new norms, knowledge and practices toward COVID-19, besides, their attitudes toward online learning. This study was conducted from January to February 2021 and included a sample of 500 Malaysian university students. For data collection, all students were asked to fill in a questionnaire that was developed based on previous literature, using Google Forms. 498 students completed the questionnaire (response rate 99.6%). Malaysian Ministry of Health was the main source (83.73%) that students refer to when looking for information on COVID-19. Only 40% of the participants had good overall knowledge about COVID-19;such knowledge was influenced by the students' field of study. The current practice towards COVID-19 was good only by 26.1% of participating students;such practice was influenced by the ethnic groups. Additionally, 60% of participated students agreed that COVID-19 can be successfully controlled. About one-third of participants had positive attitudes toward online learning. The major challenges facing students during online learning include distraction of the learning environment (80%), unstable internet connectivity (75%), lack of motivation (70%), limited technical skills (41%), and limited broadband data (34%). In conclusion, the knowledge and practice toward COVID-19 was good in less than half of Malaysian university students. Attitudes to the controlling of COVID- 19 were positive, while the attitudes toward online learning were neutral among most of the Malaysian university students. Challenges toward online learning are diverse and include both technical and student-related problems.Copyright © 2022 University of Baghdad - College of Pharmacy. All rights reserved.

Successful Drilling of the Deepest and Hottest HPHT Carbonate Well in Central Luconia, Off the Coast of Sarawak, Offshore Malaysia

HPHT wells are typically associated with high complexity, technically challenging, long duration, high risk and high NPT as many things could go wrong especially when any of the critical nitty- gritty details are overlooked. The complexity is amplified with high risk of losses in carbonate reservoir with high level of contaminants compounded by the requirement of high mud weight above 17 ppg during monsoon season in an offshore environment. The above sums up the challenges an operator had to manage in a groundbreaking HPHT carbonate appraisal well which had successfully pushed the historical envelope of such well category in Central Luconia area, off the coast of Sarawak where one of the new records of the deepest and hottest carbonate HPHT well had been created. This well took almost 4 months to drill with production testing carried out in a safe and efficient manner whereby more than 4000m of vertical interval was covered by 6 hole sections. With the seamless support from host authority, JV partners and all contractors, the well was successfully delivered within the planned duration and cost, despite the extreme challenges brought about by the COVID-19 pandemic. This paper will share the experience of the entire cycle from pre job engineering/planning, execution and key lesson learnt for future exploitations. Copyright © 2022, Offshore Technology Conference.

Challenges of Singapore's First Acute Geriatric Isolation Facility During the COVID-19 Pandemic

Aim: The COVID-19 pandemic has seen hospitals isolating suspect cases. Geriatric populations are at a risk of severe COVID-19 disease and often present with concomitant geriatric syndromes requiring holistic interdisciplinary care. However, isolation of older people poses challenges to care delivery. This study shares the experience of Singapore's first acute geriatric isolation facility geriatric PARI (Pneumonia-Acute Respiratory Infection) ward and describes the geriatric-related outcomes and pitfalls in care delivery. Method(s): This is a retrospective cross-sectional study performed in 7 negative pressure isolation rooms in an acute care public hospital in Singapore. 100 patients admitted consecutively to the geriatric PARI ward were included. Patient demographics, presenting symptoms and geriatric-related adverse outcomes associated with hospitalisation were collected and analysed. Result(s): Patients' mean age was 86.4 years (standard deviation [SD]: 6.8) with significant comorbidities being hypertension (81%), hyperlipidaemia (74%) and renal disease (70%). 51% of patients had dementia and 24% had behaviour and psychological symptoms of dementia (BPSD). 27% of patients presented atypically with delirium and 15% presented with a fall. Delirium was associated with restraint use (OR: 3.88;p-value 0.01). Falls rate was 1.64 per 1000 occupied bed. 1 patient screened positive for COVID-19. Conclusion(s): The geriatric PARI ward is essential for curbing nosocomial transmission of COVID-19. This is important in the older people with comorbidities who are more likely to develop morbidity and mortality. Our study reveals challenges in delivering person-centred care to the older patients in isolation rooms, especially in the management of delirium and falls prevention. Innovative strategies should be developed to minimise isolation-related adverse outcome.Copyright © The Author(s) 2022.

LONG-TERM SUPER HIGH-FLUX HEMODIALYSIS (OR EXPANDED HEMODIALYSIS;HDx) DOES NOT ALTER NUTRITION STATUS WITH THE SIGNIFICANTLY REDUCED MIDDLE-MOLECULE AND PROTEIN-BOUND UREMIC TOXINS IN HEMODIALYSIS PATIENTS

Introduction: Super high-flux hemodialysis (SHF-HD) provides comparable effectiveness in terms of middle-molecule and protein-bound uremic toxin removal to online hemodiafiltration in prevalent end-stage kidney disease (ESKD). However, dialysate albumin loss is raised awareness of the long-term using SHF-HD. The study aims to monitor the long-term use of SHF-HD in nutritional status change and the sustained effect of uremic toxin removal. Method(s): The present study was prospectively conducted on the 15 prevalent ESKD patients from a run-in period of standard high-flux hemodialysis (HF-HD) with ELISIO-H21 dialyzer for 4 weeks to thereafter 15 months follow-up with SHF-HD. The patients provided high-efficiency (high blood flow and dialysate flow rate) SHF-HD using PES17D alpha dialyzers for the first three months. After the amendment protocol, SHF-HD was run with the same type of dialyzer;ELISIO-17Hx (Nipro Corporation, Osaka, Japan) due to the COVID-19 pandemic. Nutritional parameters, BCM;body composition monitor (FMC, Bad Homburg, Germany), and uremic toxins were measured at baseline and every three months during SHF-HD. Result(s): Fourteen of 15 patients could complete the study. One patient was early terminated due to undergoing kidney transplantation. After 15 months of SHF-HD treatment compared to HF-HD at baseline, there was not a statistically significant change in clinical and laboratory parameters on nutritional status. The mean serum albumin levels were 4.09 (1.36) versus 4.01 (0.3) g/dL, respectively (p=0.52), and the mean difference (SE) of normalized protein catabolic rate (nPCR) was -0.04 (0.08), 95% confidence interval [CI] -0.19, 0.11. On the other hand, lean tissue mass (LTM) was significantly decreased, and fat mass was significantly increased (mean difference (SE) of -3.66 (1.07) gram, 95% CI -5.76, -1.55, and 1.79 (0.80), 95% CI 0.21, 3.36). SHF-HD sustainably and significantly removed medium to large middle-molecule uremic toxins including pre-dialysis beta-2 microglobulin, kappa-free light chain, and lambda-free light chain. In addition, protein-bound uremic toxin;indoxyl sulfate was significantly reduced during long-term follow-up using SHF-HD. SHF-HD with PES17D alpha dialyzer resulted in more dialysate albumin leaks than a newer type of SHF-HD with ELISIO-Hx17. Conclusion(s): Long-term use of SHF-HD in ESKD patients was associated with nutritional safety and effectiveness in middle-molecule and protein-bound uremic toxin removal. Although serum albumin and BMI were not changed. LTM was significantly reduced with lower levels of nPCR than in other studies but trended to increase over time. The LTM absolute levels are not below the 10 percentiles of the healthy reference range. Increasing protein intake to reach the current recommendation and physical activity was advised with long-term use of SHF-HD to avoid further reduce LTM. [Formula presented] [Formula presented] [Formula presented] No conflict of interestCopyright © 2023

Extending the Library of 4-Hydroxycoumarin Derivatives with Potential Pharmacological Activity by a Catalyst-Free and Purification-Free Method

Constant mutations of SARS-CoV-2 from 2019 to the present commences potential dilemma to the efficacy of developed COVID-19 antiviral drugs. In this current report, series of 3-phenyl(alkylamino)methyl-4-hydroxycoumarin was identified as compounds of drug-likeliness that, through molecular docking simulations, also demonstrated favourable binding to different sites of the SARS-CoV-2 RBD/hACE2 complex. This was achieved by varying the chain of the alkyl length and the substituent of the phenyl moiety. The subjected 3-phenyl(alkylamino)methyl-4-hydroxycoumarin compounds were successfully synthesized by a catalyst-free multicomponent condensation reaction of 4-hydroxycoumarin, p-substituted benzaldehyde, and linear alkyl amines in dichloromethane (DCM) at 22 °C. The crude products were achieved in a moderate (40–50 %) to a very good (80–90 %) yield with excellent purity without the need for chemical purification verified by nuclear magnetic resonance (NMR) spectroscopy. The simple method to produce 3-phenyl(alkylamino)methyl-4-hydroxycoumarin and the preliminary docking results present an opportunity for advancement in drug discovery. © 2023 The Authors. ChemistrySelect published by Wiley-VCH GmbH.

Rehabilitation of intubated COVID-19 patients in a Singapore regional hospital with early intensive care unit and sustained post-intensive care unit rehabilitation

Background: A proportion of patients with COVID-19 become critically ill, but few studies describe the functional outcomes and rehabilitation process of these patients. Objective(s): To describe the complications encountered and functional outcomes of critically ill COVID-19 patients requiring intubation and subsequent intensive care unit (ICU) management and rehabilitation. Method(s): Retrospective case note review was conducted on all patients requiring intubation and ICU admission and subsequently discharged from our hospital from February 15, 2020 to May 1, 2020. Demographics, preexisting medical conditions, complications encountered in ICU, ICU and General Ward Length of Stay, number of therapy sessions delivered, nutritional data, and functional outcomes on discharge were collected from electronic medical records and entered in a deidentified database. Result(s): Most patients developed significant breathlessness affecting post-ICU rehabilitation, a few patients developed ICU associated delirium while no patient developed ICU-associated weakness. All patients survived and could walk 20 m within 12 days post-extubation. Conclusion(s): Early ICU and sustained post-ICU rehabilitation of critically ill, intubated COVID-19 patients is feasible. Further studies could look into the outcomes of this group of patients, in particular the effect of nutrition and pulmonary training on functional outcomes. We strongly recommend an interdisciplinary rehabilitation team approach in managing critically ill COVID-19 patients. Copyright © The Author(s) 2022.

Increasing teleconsultation utilisation for pre-operative anaesthesia evaluation in the COVID-19 pandemic era: a qualityimprovement project

The COVID-19 pandemic has accelerated the growth of telemedicine. Advantages include patient convenience, reduced waiting time, minimising hospital commute and the risk of virus transmission and healthcare cost-savings [1]. Compared with other specialties, anaesthesiology is less engaged with telemedicine- based clinical work and challenges in implementation exist [2]. To align with the Ministry of Health, Singapore COVID-19-safe management measures, pre-anaesthetic assessment via video consultation (VC) workflow was implemented in Sengkang General Hospital, Singapore, in December 2020;however, the referral rate amongst our surgical colleagues remained low. Therefore the aim was to increase the number of VCs by 50% within 12 months (from June 2021) and evaluate patients' experiences. Methods Eligibility criteria included low-risk surgeries (duration < 4 h) with minimal expected blood loss, patients aged 21-65 years, ASA status 1 or 2, body mass index < 35 and the patient's ability to use the Zoom video-conferencing application. Post-consultation, patients were invited to complete an electronic patient satisfaction survey. The main reasons for the low VC referral rate were identified based on ground engagement and feedback. Two plan-do-study-act (PDSA) cycles were conducted to address these issues. PDSA cycle 1 (June 2021): to increase awareness amongst surgeons, surgical champions were engaged to promote VC within their departments;however, the VC referral rate remained low. Therefore, a second PDSA cycle was undertaken. PDSA cycle 2 (October 2021): to increase patient and staff awareness by placing posters publicising VC and enlisting the help of Patient Service Associates (PSAs) to screen for patient eligibility. This led to a significant increase in VC referrals. The current workflow will be evaluated for sustainability. Results Pre-intervention, the average number of monthly VCs was 3, and remained unchanged during PDSA cycle 1. This was increased to 14 during PDSA cycle 2. Discussion VC referrals have increased after the modified workflow, achieving high patient satisfaction and no surgical cancellations. Future work includes developing an automated VC workflow for low-risk surgeries. (Figure Presented).

Improving Outpatient Rehabilitation Compliance of Post-Stroke Patients: A Quality Improvement Project

Objective: To improve compliance of post-stroke patients attending outpatient rehabilitation from 65% to 80% after discharged from an acute inpatient rehabilitation unit within a 1-year period. Design(s): Quality improvement project Setting: Acute inpatient rehabilitation unit Participants: Rehabilitation team members and poststroke patients Interventions: Root causes were identified by fish bone analysis. The most important root causes were subsequently determined by Pareto vote. Using a tree diagram and prioritization matrix, 2 specific interventions were developed. Firstly, on a specific day of the week, assigned rehabilitation nurses would check if outpatient referral to local rehabilitation center was completed and submitted by the team. This intervention was presented at the department meeting to promote awareness among staff about the importance of timely referral. Secondly, when a patient with stroke was identified to be suitable for outpatient rehabilitation, he/she would be briefed by the team about the importance for outpatient rehabilitation and given an education pamphlet. Main Outcome Measure(s): Compliance, measured by percentage of patients with an arranged appointment for outpatient rehabilitation services within a week of discharge Time, measured as time taken for outpatient referral creation to submission of referral. Result(s): Compliance improved from 65% at baseline to 75%. Time taken for creation of referral to submission was reduced from 7.8 days to 1.4 days. Conclusion(s): We did not achieve our goal of 80% compliance rate likely due to small sample size and COVID-19 pandemic with concerns of safety for elderly to attend outpatient rehabilitation. The improvement was 10% which could have been partially accounted by the suspension of outpatient rehabilitation services during the circuit breaker period which was a nationwide partial lockdown, instituted by the government, to contain the spread of COVID-19 in Singapore. Nonetheless, the improvement is still of significance, as studies had showed functional improvements gained while in inpatient rehabilitation were reinforced and maintained in outpatient rehabilitation.

Staying connected in a disconnected COVID world with urology podcasts. A review of the growing trend

Introduction: The outbreak of the Wuhan Covid-19 virus has had a significant impact across all industries. How we practice, medicine has seen substantial change. Consequently, medical education has diminished as it has not been deemed essential given the current climate. Here in Australia and other parts of the globe, experienced education restrictions across all the Health Science Universities and university hospitals. Given the substantial research output in Urology and the necessity of local, national, and global conferences, education within the specialty has suffered. Therefore, there has been significant demand for medical education to be delivered through alternative mediums. In contrast to the Spanish flu of 1918- 1920, we have the luxury of modern technology and a plethora of platforms to deliver education in the field of Urology. One such platform is podcasts. Aim: We aim to investigate whether the Urology industry has invested in podcasts since the outbreak of COVID-19 to combat this educational dilemma. Methods: On October 12th, 2021, we searched the term Urology on Spotify. We excluded all non-English podcasts that were not Urology-focused, podcasts that didn't make Urology the focus, and channels that didn't show continued and consistent output, i.e., < 5 episodes. We included all podcasts that focused on Urology education, non-English podcats that were clearly Urology focused (i.e., Anotomia Urologica), and included podcats on sexual health that had a Urology focus (i.e. 'The Full release'). Results: We obtained 97 podcasts on the Spotify search engine using the above criteria. After excluding podcats based on our above methodology, we had 63 results. Of the 63 results, 33 were in English. Out of the 33 in English, one was on andrology, four on urological products, one on sexual health, two on Urology anecdotes, two on prostate health, 14 on general Urology education for trainees, two on urology pediatrics, 3 were patientfocused, three were for guideline updates and one on the news in Urology. Of the 63 podcasts, 53 were created post the outbreak of the COVID-19 outbreak. Conclusion: In conclusion, 84% of educational Urology podcasts today have been created post the outbreak of the COVID-10 outbreak, confirming our hypothesis.

A morphological analysis of COVID-19 novel words used in Malaysia

The novel Coronavirus (COVID-19) outbreak has changed thinking, feeling, and behaving among Malaysians. The pandemic has spawned new words to describe normal behaviours and changed the meaning of standard terms accustomed to using without thinking. Novel words like movement control order (MCO) and SElangkah have been extended in Malaysia in conjunction with COVID-19. This study has assembled a list of terms that are applied to comprehend the pandemic in the Malaysian context. COVID-19 has prompted a blast of new words and expressions in English and Malay languages in Malaysia (e.g. MySejahtera). The descriptive qualitative study uses secondary data collected during the first MCO (March - September 2020) and covers most of the data in the COVID-affected 2020. The study focuses on the morphological analysis of COVID-19 novel words and the meaning of the words. New words used during the outbreak are mostly coined by compounding. It is shown that multiple processes are involved in coining new words. Novel vocabulary for the COVID-19 and other old words can have very different meanings during a time of drastic change. This new vocabulary helped people understand that progressions have unexpectedly become an aspect of our lives today. However, some terms are new, and their formation is compliant with the term formation guidelines, though not favourable among terminologists and Malaysian. © 2022 selection and editorial matter, Komalata Manokaran, Shyi Nian Ong, and Rodney C. Jubilado.

Measuring Real-World Impact of Subsidy Decision on Sleep Tests Utilisation for the Diagnosis of Obstructive Sleep Apnoea

Objectives: Lab-based polysomnography (PSG), for diagnosing obstructive sleep apnoea (OSA), is a subsidised inpatient service in Singapore’s public healthcare institutions (PHIs). The alternative, home sleep test (HST), is cheaper and can be prescribed in the outpatient setting. Following health technology assessment performed by Agency for Care Effectiveness, HST was listed as a subsidised service in PHIs in May 2019. This study aims to assess the impact of the subsidy decision on sleep tests utilisation. Methods: We conducted an interrupted time series (ITS) analysis using sleep tests utilisation data submitted by PHIs from January 2018 to June 2021. Segmented regression models were used to assess the degree of level change (LC) and trend change (TC) of HST and PSG. Data points during Singapore’s most stringent COVID-19 restrictions were modelled as “wild” points to account for drastic reduction of elective procedures. Autocorrelation was tested and corrected by including an autoregressive or moving average term in the models. Results: Subsidy implementation increased the use of HST, from 12% of all sleep tests pre-subsidy to 26% post-subsidy. Despite multiple periods of interruptions, associated with COVID-19 restrictions, ITS showed subsidy implementation led to significant level change in HST utilisation [LC 36.1 (95% CI: 15.1 - 57.2);TC -0.5 (95% CI: -2.3 - 1.4)]. There was also a trend towards reduction in PSG, though this did not reach statistical significance [LC -44.3 (95% CI: -126.6 - 38.2);TC -2.0 (95% CI: -11.6 - 7.7)]. As HST is much cheaper than PSG, total charge avoided by the healthcare system in 10 years is projected to be in the range of SGD9 million to SGD14 million. Conclusion: Extension of subsidy to HST appeared to have improved accessibility of sleep tests for OSA diagnosis and resulted in cost saving to Singapore’s healthcare system.

Who is responsible for social responsibility in a pandemic? Insights from a qualitative study in Singapore during the first wave of the COVID-19 pandemic

Introduction: The role of social responsibility has been used to underpin the implementation of rapidly changing non-pharmaceutical interventions (NPIs) to slow COVID-19 community transmission. Methods: To explore public awareness of COVID-19 and social responsibility in a pandemic, we conducted eight mobile app-based online focus group discussions (FGDs) with participants in Singapore between 28 March and 13 April 2020. Results: Findings from our online FGDs indicate that social responsibility, especially during the early stages of COVID-19, was influenced by external factors such as appropriate legislation and allowances in existing societal culture, as well as action-based factors including mask wearing and safe distancing. Both were further mitigated by individual factors that mediated an individual’s capacity and capability to comply with rapidly changing legislation during a pandemic. Conclusion: While similar NPIs have been imposed globally, considerable between-country differences remain in health outcomes and adherence rates, displaying the complex nature of social responsibility. Evol-ving the role of social responsibility should be accompanied by expanding social norms and less reliance on punitive approaches. Copyright © 2021 Jane Lim et al. Edizioni FS Publishers.

COVID-19 outcomes in renal transplant patients-a single-center case series

Purpose of Study Initially detected in Wuhan, China, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which is responsible for coronavirus disease 2019 (COVID-19) rapidly became a global pandemic. Immunocompromised patients, including kidney transplant recipients, are at increased risk of morbidity and mortality but granular data from transplant centers such as ours serving a majority- minority and rural population are still scant. We aim to describe the impact of COVID-19 in our unique cohort of transplant patients. Methods Used During the pandemic, all transplant patients followed up at our center with reported COVID-19 were included in a registry. A case series of 136 patients drawn from this registry were included in this preliminary analysis spanning the period of March 2020 to March 2021. Statistical analysis was performed with R. Summary of Results The characteristics of our patients were: 54% male, 53% Black, 40% White, Median age 53 years, Median BMI 31, 47% were diabetic, 96% had hypertension, 16% had coronary artery disease. Median time after transplantation was 6.2 years (range 4 days to 37 years), 61% had thymoglobulin induction and almost uniformly were on tacrolimus, mycophenolate and prednisone. Baseline median creatinine 1.3 mg/dl and urine protein to creatinine ratio 0.18 g/g. The most commonly reported symptoms were fever (51%) dyspnea (48%), fatigue (46%) and myalgia (31%). 49% were hospitalized of whom half required ICU care. 82% of ICU patients were on ventilator support. 45% of patients had AKI, 7% required dialysis. 35% of patients required oxygen. There were 6 graft losses (4%) and 26 deaths (19%). Immunosuppression was reduced in most patients with antimetabolite reduction in 54%, and calcineurin inhibitor reduction in 44%. Treatments included dexamethasone (31%), and remdesivir (21%, convalescent plasma (6%), and monoclonal antibodies (4%). Creatinine and proteinuria post-COVID remained stable (1.4 mg/dl and 0.17 g/g respectively). 118 patients were followed up in clinic post-COVID and of these 15% reported continued severe COVID symptoms. On univariate analysis, age, race, gender, ABO blood type, diabetes status, cardiovascular disease, induction, time from transplant, baseline creatinine, proteinuria, baseline immunosuppression regimen, ACEi or ARB use, and reported symptoms (except for dyspnea) were not associated with risk of death. On multivariate analysis, ICU admission and need for dialysis were strongly predictive of death. Conclusions Despite serving a large rural population with a high burden of comorbidities, patient outcomes following COVID infection from our study are similar to other singlecenter and multi-center reports. As expected, the mortality rate in our cohort is much higher than the general population with high rates of hospitalization and need for ICU care. Aside from a significant minority, most patients recovered well and had stable renal allograft function. Our study is limited by its retrospective nature and risk of reporting bias.

The wealthy world's open-economy from fdi inflow is a real thing: Malaysia's experience

Fiscal policy is one of the popular instruments used by government to provide balance to growth in the national economy and market. In Malaysia's context, fiscal policy is implemented using such as the annual budgets, Malaysia Plans, and multiple stimulus packages aimed at boosting Malaysia's economy especially during the recent lock down which has threatened to cause an economic crisis due to the Covid-19 pandemic. Additionally, one of the Malaysian Government's biggest spending using fiscal policy is its development expenditure, and tax is one of the largest contributions used to support this development expenditure. In order to attract investors to Malaysia, critical features such as benefits, facilities, and social welfare have been designed by decision-makers in each formulated policy. Initiatives such as inter-governmental forums, trade agreements and discussions are platforms that can be used to share and respond to economic problems. However, the existence of competition and foreign policy have become major challenges to the country's efforts to attract investors. Therefore, the aim of this study is to investigate the relationship between Malaysia's federal government development expenditure with foreign direct investment (FDI) inflow, as well as the country's openness towards investment. The two dimensions of asymmetric FDI inflow were analysed to see how they react to government expenditure from 1970 until 2019 using the Linear and Nonlinear Autoregressive Distributed Lag method. Findings from the Nonlinear Autoregressive Distributed Lag Model (NARDL) model indicated that FDI has a positively significant effect on fiscal accumulation for development expenditure. In conclusion, increases in government expenditure increase FDI inflow into Malaysia in both the short- and long-run. Hence, government development expenditure behaviour represents accelerating economic growth in the Malaysian context, and it is proven to have a significant impact towards economic growth in the long-run. This study contributes to empirical literature on the relationship between federal government development expenditure and FDI inflow, particularly the effect of openness to investment into a developing country towards economic growth in the long- run. © 2021 by authors.

High-fidelity simulation training with PPE may optimise resuscitation outcomes in the COVID-19 era

High-fidelity simulation training in CPR (CPR-HFST) could identify weaknesses in pre-COVID-19 Code Blue (CB) practices. Importantly, PPE donning may delay CPR thus worsening patient outcomes. We sought to determine the effect of our CPR-HFST on clinical practice. A retrospective review of CB events in a 1000-bedded hospital, pre- and intra-pandemic was conducted from 01/05/2019 to 30/10/2020. Onset of the pandemic was taken as 04/02/2020. CPR-HFST commenced in January 2020. The primary objective was to determine pre- and intra-pandemic response times. Intubation times, patient outcomes (quantified by CB survival rates and the CPC score), and incidence of HCW infection were our secondary objectives. The CCI score was used to stratify patients with similar comorbidities. Two-tailed Chi-square and Mann-Whitney tests were used for statistical comparisons, alpha = 0.05. 158 CB events were reviewed. Median response time was longer intra-pandemic compared to prepandemic;4.0 mins (IQR: 3-5) vs. 3.0 mins (IQR:1-4), p=0.0007. Cardiac rhythms were asystole (25.5%), PEA (53.8%), VT (5.7%), and VF (11.3%). 67.1% of patients required CPR, of which, 88.7% were intubated. There were no significant differences in median intubation times: 12.0 (prepandemic) vs. 11.0 mins (intra-pandemic), p=0.89. Survival to hospital discharge were similar;14.1% (pre-pandemic) vs. 21.4% (intra-pandemic), p=0.33. We did not find any significant differences in survival rates and CPC scores (Table 1). There were no HCW infections. Survival to hospital discharge rates of patients requiring in-hospital CPR may be lower intrapandemic;Miles et al reported 3.2% vs 12.8% respectively, p<0.01. These were significantly different compared to our intra-pandemic cohort (3.2% vs. 21.4%, p<0.01) but not in our pre-pandemic cohort (12.8% vs. 14.1%, p=0.82). Reasons for the differences are likely multifactorial. Nonetheless, in our experience and data, we believe CPR-HFST prevents deterioration in the standards of care and may help in optimising CPR outcomes. (Table Presented) .