Clinical outcomes in patients with solid tumors living in rural and urban areas followed via telemedicine: experience in a highly complex latin american hospital.

BACKGROUND: Difficulties in cancer services access increase the burden of disease and mortality in rural areas, and telehealth can be a useful tool to address these inequalities. OBJECTIVE: We aimed to describe the outcomes of patients in rural and urban areas with solid tumors managed by oncologists through telemedicine. METHODS: We conducted a retrospective cohort study of patients with solid tumors from March to December 2020. A total of 1270 subjects with solid tumors were included, 704 living in urban areas and 566 in rural areas. RESULTS: The most frequent tumors were breast (51.8%) and prostate (12.4%). The trend of telemedicine care was similar for both populations; in-person care was more frequent in the urban population. There were no differences in referral to the emergency room, need for hospitalization, and mortality for both groups. CONCLUSION: Telemedicine is a care modality that reduces barriers in the care of patients with solid tumors, evidencing similar outcomes regardless of living in rural or urban areas.

Circulating MR-proADM levels, as an indicator of endothelial dysfunction, for early risk stratification of mid-term mortality in COVID-19 patients.

OBJECTIVES: Thromboinflammation, resulting from a complex interaction between thrombocytopathy, coagulopathy, and endotheliopathy, contributes to increased mortality in COVID-19 patients. MR-proADM, as a surrogate of adrenomedullin system disruption, leading to endothelial damage, has been reported as a promising biomarker for short-term prognosis. We evaluated the role of MR-proADM in the mid-term mortality in COVID-19 patients. METHODS: A prospective, observational study enrolling COVID-19 patients from August to October 2020. A blood sample for laboratory test analysis was drawn on arrival in the emergency department. The primary endpoint was 90-day mortality. The area under the curve (AUC) and Cox regression analyses were used to assess discriminatory ability and association with the endpoint. RESULTS: A total of 359 patients were enrolled, and the 90-day mortality rate was 8.9%. ROC AUC for MR-proADM predicting 90-day mortality was 0.832. An optimal cutoff of 0.80 nmol/L showed a sensitivity of 96.9% and a specificity of 58.4%, with a negative predictive value of 99.5%. Circulating MR-proADM levels (inverse transformed), after adjusting by a propensity score including eleven potential confounders, were an independent predictor of 90-day mortality (HR: 0.162 [95% CI: 0.043-0.480]) CONCLUSIONS: Our data confirm that MR-proADM has a role in the mid-term prognosis of COVID-19 patients and might assist physicians with risk stratification.

Acceso, usos y problemas en la educación virtual: una aproximación a las experiencias de estudiantes y docentes durante la cuarentena obligatoria en Argentina

This article aims to reconstruct a state of a situation based on the experiences and representations of teachers and students, during the period of compulsory quarantine, in the context of the global pandemic by Covid-19. From this, an attempt is made to contribute to deepening the debate about the transformations and emerging problems that are taking place within the framework of the so-called virtual education, paying special attention to the current scenario that is opening up alongside the implementation of confinement policies or preventive isolation. It is expected that reading like this, in terms of access, uses, and problems will allow us to closely follow the inequalities that affect the countries of our region.Alternate :El presente artículo se propone reconstruir un estado de situación a partir de las experiencias y representaciones de docentes y estudiantes, durante el período de cuarentena obligatoria, en el contexto de la pandemia mundial por Covid-19. A partir de ello se intenta contribuir a profundizar el debate acerca de las transformaciones y problemáticas emergentes que están teniendo lugar en el marco de la llamada educación virtual, prestando especial atención al actual escenario que se abre a la par de la implementación de políticas de confinamiento o aislamiento preventivo. Se espera que una lectura como esta, en clave de acceso, usos y problemas permita seguir de cerca las desigualdades que afectan a los países de nuestra región.

Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study.

BACKGROUND: The use of cloud computing (involving storage and processing of data on the internet) in health care has increasingly been highlighted as having great potential in facilitating data-driven innovations. Although some provider organizations are reaping the benefits of using cloud providers to store and process their data, others are lagging behind. OBJECTIVE: We aim to explore the existing challenges and barriers to the use of cloud computing in health care settings and investigate how perceived risks can be addressed. METHODS: We conducted a qualitative case study of cloud computing in health care settings, interviewing a range of individuals with perspectives on supply, implementation, adoption, and integration of cloud technology. Data were collected through a series of in-depth semistructured interviews exploring current applications, implementation approaches, challenges encountered, and visions for the future. The interviews were transcribed and thematically analyzed using NVivo 12 (QSR International). We coded the data based on a sociotechnical coding framework developed in related work. RESULTS: We interviewed 23 individuals between September 2020 and November 2020, including professionals working across major cloud providers, health care provider organizations, innovators, small and medium-sized software vendors, and academic institutions. The participants were united by a common vision of a cloud-enabled ecosystem of applications and by drivers surrounding data-driven innovation. The identified barriers to progress included the cost of data migration and skill gaps to implement cloud technologies within provider organizations, the cultural shift required to move to externally hosted services, a lack of user pull as many benefits were not visible to those providing frontline care, and a lack of interoperability standards and central regulations. CONCLUSIONS: Implementations need to be viewed as a digitally enabled transformation of services, driven by skill development, organizational change management, and user engagement, to facilitate the implementation and exploitation of cloud-based infrastructures and to maximize returns on investment.

In vitro Characterization of Anti-SARS-CoV-2 Intravenous Immunoglobulins (IVIg) Produced From Plasma of Donors Immunized With the BNT162b2 Vaccine and Its Comparison With a Similar Formulation Produced From Plasma of COVID-19 Convalescent Donors.

Despite vaccines are the main strategy to control the ongoing global COVID-19 pandemic, their effectiveness could not be enough for individuals with immunosuppression. In these cases, as well as in patients with moderate/severe COVID-19, passive immunization with anti-SARS-CoV-2 immunoglobulins could be a therapeutic alternative. We used caprylic acid precipitation to prepare a pilot-scale batch of anti-SARS-CoV-2 intravenous immunoglobulins (IVIg) from plasma of donors immunized with the BNT162b2 (Pfizer-BioNTech) anti-COVID-19 vaccine (VP-IVIg) and compared their in vitro efficacy and safety with those of a similar formulation produced from plasma of COVID-19 convalescent donors (CP-IVIg). Both formulations showed immunological, physicochemical, biochemical, and microbiological characteristics that meet the specifications of IVIg formulations. Moreover, the concentration of anti-RBD and ACE2-RBD neutralizing antibodies was higher in VP-IVIg than in CP-IVIg. In concordance, plaque reduction neutralization tests showed inhibitory concentrations of 0.03-0.09 g/L in VP-IVIg and of 0.06-0.13 in CP-IVIg. Thus, VP-IVIg has in vitro efficacy and safety profiles that justify their evaluation as therapeutic alternative for clinical cases of COVID-19. Precipitation with caprylic acid could be a simple, feasible, and affordable alternative to produce formulations of anti-SARS-CoV-2 IVIg to be used therapeutically or prophylactically to confront the COVID-19 pandemic in middle and low-income countries.

SARS-CoV-2 Infection in an Adolescent With X-linked Agammaglobulinemia.

We present a case of a 17-year-old boy with X-linked agammaglobulinemia who had mild disease when initially infected with SARS-CoV-2 but after recovering from acute infection developed fevers and a raised erythrocyte sedimentation rate that persisted for several weeks without any ongoing respiratory symptoms. Multiple nasopharyngeal swabs were found to be negative for SARS-CoV-2 during the febrile period, but typical changes of COVID-19 on high resolution CT chest scan led to the detection of SARS-CoV-2 on RT-PCR in a sample from a bronchoalveolar lavage. His fevers completely resolved after a 5-day course of remdesivir.

High Efficacy of Therapeutic Equine Hyperimmune Antibodies Against SARS-CoV-2 Variants of Concern.

SARS-CoV-2 variants of concern show reduced neutralization by vaccine-induced and therapeutic monoclonal antibodies; therefore, treatment alternatives are needed. We tested therapeutic equine polyclonal antibodies (pAbs) that are being assessed in clinical trials in Costa Rica against five globally circulating variants of concern: alpha, beta, epsilon, gamma and delta, using plaque reduction neutralization assays. We show that equine pAbs efficiently neutralize the variants of concern, with inhibitory concentrations in the range of 0.146-1.078 µg/mL, which correspond to extremely low concentrations when compared to pAbs doses used in clinical trials. Equine pAbs are an effective, broad coverage, low-cost and a scalable COVID-19 treatment.

Parents' Acceptance of Educational Technology: Lessons From Around the World.

One of the long-term lessons from the school closures due to the global pandemic COVID 19, is that technology and parental engagement are the best levers to access education so as to bridge the achievement gap between socially disadvantaged children and their peers. However, using technology is not as simple as bringing equipment into the school and home and initiating its usage; these are just the first steps into a more complex and ambitious achievement of using technology as a catalyst for a shift toward new learning models in remote and hybrid settings. A theoretical framework based on the theory of acceptance and use of technology and social cognitive learning theory was used to analyse data from a survey completed by 4,600 parents from 19 countries during the national lockdowns in 2020. Regression models and thematic analysis of open-ended responses were employed to identify factors that contribute to parental acceptance and use of technology in support of their children's learning. Our results show that parents are more engaged in children's learning when well-structured technological tools are provided or suggested by schools, and when parents are socially influenced by the opinions of other parents, teachers, children, the general public, relatives, etc. Conversely, they are less engaged when they perceive the technological tools to be challenging and beyond their knowledge or skills. The study's findings have practical implications for governments and school leaders, who need to be aware of the factors likely to determine the use of technology at home and take action to meet parents' needs when using technology to support learning.

COVID-19 Crisis: Exploring Community of Inquiry in Online Learning for Sub-Degree Students.

The COVID-19 pandemic has brought a tremendous impact on the pedagogy and learning experience of students in sub-degree education sector of Hong Kong. Online learning has become the "sole" solution to deal with student learning challenges during this chaotic period. In this study, we explore online learning for sub-degree students by using a community of inquiry (CoI). As such, confirmatory factor analysis (CFA) was conducted on survey data gathered from 287 sub-degree students from the business and engineering disciplines. Results indicated that the network speed for online education determines the perceived cognitive presence, social presence, and teaching presence of students, whereas gender and academic disciplines of students are not moderating factors that create a significant difference in perceived cognitive presence, social presence, and teaching presence of students. Our study findings for creating and sustaining a purposeful online learning community are highlighted.

Understanding Public Perceptions of COVID-19 Contact Tracing Apps: Artificial Intelligence-Enabled Social Media Analysis.

BACKGROUND: The emergence of SARS-CoV-2 in late 2019 and its subsequent spread worldwide continues to be a global health crisis. Many governments consider contact tracing of citizens through apps installed on mobile phones as a key mechanism to contain the spread of SARS-CoV-2. OBJECTIVE: In this study, we sought to explore the suitability of artificial intelligence (AI)-enabled social media analyses using Facebook and Twitter to understand public perceptions of COVID-19 contact tracing apps in the United Kingdom. METHODS: We extracted and analyzed over 10,000 relevant social media posts across an 8-month period, from March 1 to October 31, 2020. We used an initial filter with COVID-19-related keywords, which were predefined as part of an open Twitter-based COVID-19 dataset. We then applied a second filter using contract tracing app-related keywords and a geographical filter. We developed and utilized a hybrid, rule-based ensemble model, combining state-of-the-art lexicon rule-based and deep learning-based approaches. RESULTS: Overall, we observed 76% positive and 12% negative sentiments, with the majority of negative sentiments reported in the North of England. These sentiments varied over time, likely influenced by ongoing public debates around implementing app-based contact tracing by using a centralized model where data would be shared with the health service, compared with decentralized contact-tracing technology. CONCLUSIONS: Variations in sentiments corroborate with ongoing debates surrounding the information governance of health-related information. AI-enabled social media analysis of public attitudes in health care can help facilitate the implementation of effective public health campaigns.

Development and characterization of two equine formulations towards SARS-CoV-2 proteins for the potential treatment of COVID-19.

In the current global emergency due to SARS-CoV-2 outbreak, passive immunotherapy emerges as a promising treatment for COVID-19. Among animal-derived products, equine formulations are still the cornerstone therapy for treating envenomations due to animal bites and stings. Therefore, drawing upon decades of experience in manufacturing snake antivenom, we developed and preclinically evaluated two anti-SARS-CoV-2 polyclonal equine formulations as potential alternative therapy for COVID-19. We immunized two groups of horses with either S1 (anti-S1) or a mixture of S1, N, and SEM mosaic (anti-Mix) viral recombinant proteins. Horses reached a maximum anti-viral antibody level at 7 weeks following priming, and showed no major adverse acute or chronic clinical alterations. Two whole-IgG formulations were prepared via hyperimmune plasma precipitation with caprylic acid and then formulated for parenteral use. Both preparations had similar physicochemical and microbiological quality and showed ELISA immunoreactivity towards S1 protein and the receptor binding domain (RBD). The anti-Mix formulation also presented immunoreactivity against N protein. Due to high anti-S1 and anti-RBD antibody content, final products exhibited high in vitro neutralizing capacity of SARS-CoV-2 infection, 80 times higher than a pool of human convalescent plasma. Pre-clinical quality profiles were similar among both products, but clinical efficacy and safety must be tested in clinical trials. The technological strategy we describe here can be adapted by other producers, particularly in low- and middle-income countries.

MR-proADM as marker of endotheliitis predicts COVID-19 severity.

BACKGROUND: Early identification of patients at high risk of progression to severe COVID-19 constituted an unsolved challenge. Although growing evidence demonstrates a direct association between endotheliitis and severe COVID-19, the role of endothelial damage biomarkers has been scarcely studied. We investigated the relationship between circulating mid-regional proadrenomedullin (MR-proADM) levels, a biomarker of endothelial dysfunction, and prognosis of SARS-CoV-2-infected patients. METHODS: Prospective observational study enrolling adult patients with confirmed COVID-19. On admission to emergency department, a blood sample was drawn for laboratory test analysis. Primary and secondary endpoints were 28-day all-cause mortality and severe COVID-19 progression. Area under the curve (AUC) and multivariate regression analysis were employed to assess the association of the biomarker with the established endpoints. RESULTS: A total of 99 patients were enrolled. During hospitalization, 25 (25.3%) cases progressed to severe disease and the 28-day mortality rate was of 14.1%. MR-proADM showed the highest AUC to predict 28-day mortality (0.905; [CI] 95%: 0.829-0.955; P < .001) and progression to severe disease (0.829; [CI] 95%: 0.740-0.897; P < .001), respectively. MR-proADM plasma levels above optimal cut-off (1.01 nmol/L) showed the strongest independent association with 28-day mortality risk (hazard ratio [HR]: 10.470, 95% CI: 2.066-53.049; P < .005) and with progression to severe disease (HR: 6.803, 95% CI: 1.458-31.750; P = .015). CONCLUSION: Mid-regional proadrenomedullin was the biomarker with highest performance for prognosis of death and progression to severe disease in COVID-19 patients and represents a promising predictor for both outcomes, which might constitute a potential tool in the assessment of prognosis in early stages of this disease.

Survey data on the impact of COVID-19 on parental engagement across 23 countries.

This data article describes the dataset of the International COVID-19 Impact on Parental Engagement Study (ICIPES). ICIPES is a collaborative effort of more than 20 institutions to investigate the ways in which, parents and caregivers built capacity engaged with children's learning during the period of social distancing arising from global COVID-19 pandemic. A series of data were collected using an online survey conducted in 23 countries and had a total sample of 4,658 parents/caregivers. The description of the data contained in this article is divided into two main parts. The first part is a descriptive analysis of all the items included in the survey and was performed using tables and figures. The second part refers to the construction of scales. Three scales were constructed and included in the dataset: 'parental acceptance and confidence in the use of technology', 'parental engagement in children's learning' and 'socioeconomic status'. The scales were created using Confirmatory Factor Analysis (CFA) and Multi-Group Confirmatory Analysis (MG-CFA) and were adopted to evaluate their cross-cultural comparability (i.e., measurement invariance) across countries and within sub-groups. This dataset will be relevant for researchers in different fields, particularly for those interested in international comparative education.

Spatiotemporal transmission dynamics of the COVID-19 pandemic and its impact on critical healthcare capacity.

The role of geospatial disparities in the dynamics of the COVID-19 pandemic is poorly understood. We developed a spatially-explicit mathematical model to simulate transmission dynamics of COVID-19 disease infection in relation with the uneven distribution of the healthcare capacity in Ohio, U.S. The results showed substantial spatial variation in the spread of the disease, with localized areas showing marked differences in disease attack rates. Higher COVID-19 attack rates experienced in some highly connected and urbanized areas (274 cases per 100,000 people) could substantially impact the critical health care response of these areas regardless of their potentially high healthcare capacity compared to more rural and less connected counterparts (85 cases per 100,000). Accounting for the spatially uneven disease diffusion linked to the geographical distribution of the critical care resources is essential in designing effective prevention and control programmes aimed at reducing the impact of COVID-19 pandemic.