Characterising information gains and losses when collecting multiple epidemic model outputs.

BACKGROUND: Collaborative comparisons and combinations of epidemic models are used as policy-relevant evidence during epidemic outbreaks. In the process of collecting multiple model projections, such collaborations may gain or lose relevant information. Typically, modellers contribute a probabilistic summary at each time-step. We compared this to directly collecting simulated trajectories. We aimed to explore information on key epidemic quantities; ensemble uncertainty; and performance against data, investigating potential to continuously gain information from a single cross-sectional collection of model results. METHODS: We compared projections from the European COVID-19 Scenario Modelling Hub. Five teams modelled incidence in Belgium, the Netherlands, and Spain. We compared July 2022 projections by incidence, peaks, and cumulative totals. We created a probabilistic ensemble drawn from all trajectories, and compared to ensembles from a median across each model's quantiles, or a linear opinion pool. We measured the predictive accuracy of individual trajectories against observations, using this in a weighted ensemble. We repeated this sequentially against increasing weeks of observed data. We evaluated these ensembles to reflect performance with varying observed data. RESULTS: By collecting modelled trajectories, we showed policy-relevant epidemic characteristics. Trajectories contained a right-skewed distribution well represented by an ensemble of trajectories or a linear opinion pool, but not models' quantile intervals. Ensembles weighted by performance typically retained the range of plausible incidence over time, and in some cases narrowed this by excluding some epidemic shapes. CONCLUSIONS: We observed several information gains from collecting modelled trajectories rather than quantile distributions, including potential for continuously updated information from a single model collection. The value of information gains and losses may vary with each collaborative effort's aims, depending on the needs of projection users. Understanding the differing information potential of methods to collect model projections can support the accuracy, sustainability, and communication of collaborative infectious disease modelling efforts.

The impact of quality-adjusted life years on evaluating COVID-19 mitigation strategies: lessons from age-specific vaccination roll-out and variants of concern in Belgium (2020-2022).

BACKGROUND: When formulating and evaluating COVID-19 vaccination strategies, an emphasis has been placed on preventing severe disease that overburdens healthcare systems and leads to mortality. However, more conventional outcomes such as quality-adjusted life years (QALYs) and inequality indicators are warranted as additional information for policymakers. METHODS: We adopted a mathematical transmission model to describe the infectious disease dynamics of SARS-COV-2, including disease mortality and morbidity, and to evaluate (non)pharmaceutical interventions. Therefore, we considered temporal immunity levels, together with the distinct transmissibility of variants of concern (VOCs) and their corresponding vaccine effectiveness. We included both general and age-specific characteristics related to SARS-CoV-2 vaccination. Our scenario study is informed by data from Belgium, focusing on the period from August 2021 until February 2022, when vaccination for children aged 5-11 years was initially not yet licensed and first booster doses were administered to adults. More specifically, we investigated the potential impact of an earlier vaccination programme for children and increased or reduced historical adult booster dose uptake. RESULTS: Through simulations, we demonstrate that increasing vaccine uptake in children aged 5-11 years in August-September 2021 could have led to reduced disease incidence and ICU occupancy, which was an essential indicator for implementing non-pharmaceutical interventions and maintaining healthcare system functionality. However, an enhanced booster dose regimen for adults from November 2021 onward could have resulted in more substantial cumulative QALY gains, particularly through the prevention of elevated levels of infection and disease incidence associated with the emergence of Omicron VOC. In both scenarios, the need for non-pharmaceutical interventions could have decreased, potentially boosting economic activity and mental well-being. CONCLUSIONS: When calculating the impact of measures to mitigate disease spread in terms of life years lost due to COVID-19 mortality, we highlight the impact of COVID-19 on the health-related quality of life of survivors. Our study underscores that disease-related morbidity could constitute a significant part of the overall health burden. Our quantitative findings depend on the specific setup of the interventions under review, which is open to debate or should be contextualised within future situations.

Who acquires infection from whom? A sensitivity analysis of transmission dynamics during the early phase of the COVID-19 pandemic in Belgium.

Age-related heterogeneity in a host population, whether due to how individuals mix and contact each other, the nature of host-pathogen interactions defining epidemiological parameters, or demographics, is crucial in studying infectious disease dynamics. Compartmental models represent a popular approach to address the problem, dividing the population of interest into a discrete and finite number of states depending on, for example, individuals' age and stage of infection. We study the corresponding linearised system whose operator, in the context of a discrete-time model, equates to a square matrix known as the next generation matrix. Performing formal perturbation analysis of the entries of the aforementioned matrix, we derive indices to quantify the age-specific variation of its dominant eigenvalue (i.e., the reproduction number) and explore the relevant epidemiological information we can derive from the eigenstructure of the matrix. The resulting method enables the assessment of the impact of age-related population heterogeneity on virus transmission. In particular, starting from an age-structured SEIR model, we demonstrate the use of this approach for COVID-19 dynamics in Belgium. We analyse the early stages of the SARS-CoV-2 spread, with particular attention to the pre-pandemic framework and the lockdown lifting phase initiated as of May 2020. Our results, influenced by our assumption on age-specific susceptibility and infectiousness, support the hypothesis that transmission was only influenced to a small extent by children in the age group [0,18) and adults over 60 years of age during the early phases of the pandemic and up to the end of July 2020.

Integrins regulate hERG1 dynamics by girdin-dependent Gαi3: signaling and modeling in cancer cells.

The hERG1 potassium channel is aberrantly over expressed in tumors and regulates the cancer cell response to integrin-dependent adhesion. We unravel a novel signaling pathway by which integrin engagement by the ECM protein fibronectin promotes hERG1 translocation to the plasma membrane and its association with ß1 integrins, by activating girdin-dependent Gαi3 proteins and protein kinase B (Akt). By sequestering hERG1, ß1 integrins make it avoid Rab5-mediated endocytosis, where unbound channels are degraded. The cycle of hERG1 expression determines the resting potential (Vrest) oscillations and drives the cortical f-actin dynamics and thus cell motility. To interpret the slow biphasic kinetics of hERG1/ß1 integrin interplay, we developed a mathematical model based on a generic balanced inactivation-like module. Integrin-mediated cell adhesion triggers two contrary responses: a rapid stimulation of hERG1/ß1 complex formation, followed by a slow inhibition which restores the initial condition. The protracted hERG1/ß1 integrin cycle determines the slow time course and cyclic behavior of cell migration in cancer cells.

The direct disease burden of COVID-19 in Belgium in 2020 and 2021.

BACKGROUND: Burden of disease estimates have become important population health metrics over the past decade to measure losses in health. In Belgium, the disease burden caused by COVID-19 has not yet been estimated, although COVID-19 has emerged as one of the most important diseases. Therefore, the current study aims to estimate the direct COVID-19 burden in Belgium, observed despite policy interventions, during 2020 and 2021, and compare it to the burden from other causes. METHODS: Disability-adjusted life years (DALYs) are the sum of Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) due to disease. DALYs allow comparing the burden of disease between countries, diseases, and over time. We used the European Burden of Disease Network consensus disease model for COVID-19 to estimate DALYs related to COVID-19. Estimates of person-years for (a) acute non-fatal disease states were calculated from a compartmental model, using Belgian seroprevalence, social contact, hospital, and intensive care admission data, (b) deaths were sourced from the national COVID-19 mortality surveillance, and (c) chronic post-acute disease states were derived from a Belgian cohort study. RESULTS: In 2020, the total number of COVID-19 related DALYs was estimated at 253,577 [252,541 - 254,739], which is higher than in 2021, when it was 139,281 [136,704 - 142,306]. The observed COVID-19 burden was largely borne by the elderly, and over 90% of the burden was attributable to premature mortality (i.e., YLLs). In younger people, morbidity (i.e., YLD) contributed relatively more to the DALYs, especially in 2021, when vaccination was rolled out. Morbidity was mainly attributable to long-lasting post-acute symptoms. CONCLUSION: COVID-19 had a substantial impact on population health in Belgium, especially in 2020, when COVID-19 would have been the main cause of disease burden if all other causes had maintained their 2019 level.

How contact patterns during the COVID-19 pandemic are related to pre-pandemic contact patterns and mobility trends.

BACKGROUND: Non-pharmaceutical interventions (NPIs) were adopted in Belgium in order to decrease social interactions between people and as such decrease viral transmission of SARS-CoV-2. With the aim to better evaluate the impact of NPIs on the evolution of the pandemic, an estimation of social contact patterns during the pandemic is needed when social contact patterns are not available yet in real time. METHODS: In this paper we use a model-based approach allowing for time varying effects to evaluate whether mobility and pre-pandemic social contact patterns can be used to predict the social contact patterns observed during the COVID-19 pandemic between November 11, 2020 and July 4, 2022. RESULTS: We found that location-specific pre-pandemic social contact patterns are good indicators for estimating social contact patterns during the pandemic. However, the relationship between both changes with time. Considering a proxy for mobility, namely the change in the number of visitors to transit stations, in interaction with pre-pandemic contacts does not explain the time-varying nature of this relationship well. CONCLUSION: In a situation where data from social contact surveys conducted during the pandemic are not yet available, the use of a linear combination of pre-pandemic social contact patterns could prove valuable. However, translating the NPIs at a given time into appropriate coefficients remains the main challenge of such an approach. In this respect, the assumption that the time variation of the coefficients can somehow be related to aggregated mobility data seems unacceptable during our study period for estimating the number of contacts at a given time.

Combination Therapy with a Bispecific Antibody Targeting the hERG1/ß1 Integrin Complex and Gemcitabine in Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) represents an unmet medical need. Difficult/late diagnosis as well as the poor efficacy and high toxicity of chemotherapeutic drugs result in dismal prognosis. With the aim of improving the treatment outcome of PDAC, we tested the effect of combining Gemcitabine with a novel single chain bispecific antibody (scDb) targeting the cancer-specific hERG1/ß1 integrin complex. First, using the scDb (scDb-hERG1-ß1) in immunohistochemistry (IHC), Western blot (WB) analysis and immunofluorescence (IF), we confirmed the presence of the hERG1/ß1 integrin complex in primary PDAC samples and PDAC cell lines. Combining Gemcitabine with scDb-hERG1-ß1 improved its cytotoxicity on all PDAC cells tested in vitro. We also tested the combination treatment in vivo, using an orthotopic xenograft mouse model involving ultrasound-guided injection of PDAC cells. We first demonstrated good penetration of the scDb-hERG1-ß1 conjugated with indocyanine green (ICG) into tumour masses by photoacoustic (PA) imaging. Next, we tested the effects of the combination at either therapeutic or sub-optimal doses of Gemcitabine (25 or 5 mg/kg, respectively). The combination of scDb-hERG1-ß1 and sub-optimal doses of Gemcitabine reduced the tumour masses to the same extent as the therapeutic doses of Gemcitabine administrated alone; yielded increased survival; and was accompanied by minimised side effects (toxicity). These data pave the way for a novel therapeutic approach to PDAC, based on the combination of low doses of a chemotherapeutic drug (to minimize adverse side effects and the onset of resistance) and the novel scDb-hERG1-ß1 targeting the hERG1/ß1 integrin complex as neoantigen.

Prognostic Factors of the Latarjet Procedure.

Objective To investigate the factors that influence the functional results of patients submitted to the Latarjet procedure. Methods Evaluation of 26 patients submitted to surgical treatment following the Latarjet technique due to traumatic recurrent anterior dislocation of the glenohumeral joint, with glenoidal bone loss greater than 20% and/or off-track injury. The minimum follow-up time was of 12 months. The Visual Analogue Scale (VAS), The Western Ontario Shoulder Instability Index (WOSI), and the Subjective Shoulder Value (SSV) scales, as well as objective data from the participants, were evaluated. Results Most patients (84.62%) did not present recurrence of the dislocation, and 92.31% were satisfied. Regarding the functional analysis, the physical component score (PCS) and the mental component score (MCS) found were within the mean quality of life of the population. The physical symptoms, according to the WOSI, presented the best percentage (8.5%), while the worst result was observed regarding lifestyle (20%). On the VAS, pain was classified as moderate (3/10) by 15.38% of the patients (4/26). In relation to sports, patients who practice sports showed improvement in SSV parameters, which had an inverse relationship with the number of relapses. It was also observed that the shorter the time between the first dislocation and the surgery, the greater the patient's satisfaction. Conclusion Early indication of surgical treatment of anterior glenohumeral instability may provide better subjective functional results to the patient.

Prognostic Factors of the Latarjet Procedure / Fatores prognósticos da cirurgia de Latarjet

Abstract Objective To investigate the factors that influence the functional results of patients submitted to the Latarjet procedure. Methods Evaluation of 26 patients submitted to surgical treatment following the Latarjet technique due to traumatic recurrent anterior dislocation of the glenohumeral joint, with glenoidal bone loss greater than 20% and/or off-track injury. The minimum follow-up time was of 12 months. The Visual Analogue Scale (VAS), The Western Ontario Shoulder Instability Index (WOSI), and the Subjective Shoulder Value (SSV) scales, as well as objective data from the participants, were evaluated. Results Most patients (84.62%) did not present recurrence of the dislocation, and 92.31% were satisfied. Regarding the functional analysis, the physical component score (PCS) and the mental component score (MCS) found were within the mean quality of life of the population. The physical symptoms, according to the WOSI, presented the best percentage (8.5%), while the worst result was observed regarding lifestyle (20%). On the VAS, pain was classified as moderate (3/10) by 15.38% of the patients (4/26). In relation to sports, patients who practice sports showed improvement in SSV parameters, which had an inverse relationship with the number of relapses. It was also observed that the shorter the time between the first dislocation and the surgery, the greater the patient's satisfaction. Conclusion Early indication of surgical treatment of anterior glenohumeral instability may provide better subjective functional results to the patient.

Resumo Objetivo Investigar os fatores que influenciam os resultados funcionais dos pacientes submetidos ao procedimento de Latarjet. Métodos Avaliação de 26 pacientes submetidos ao tratamento cirúrgico, seguindo a técnica de Latarjet, devido a luxação anterior recidivante traumática da articulação glenoumeral, com perda óssea glenoidal maior do que 20% e/ou lesão off-track. O tempo mínimo de seguimento foi de doze meses. Foram avaliadas as seguintes escalas: Escala Visual Analógica (EVA), The Western Ontario Shoulder Instability Index (WOSI), e Subjective Shoulder Value (SSV), além dos dados objetivos dos participantes. Resultados A maioria dos pacientes (84,62%) não apresentou recidiva de luxação, e 92,31% ficaram satisfeitos. Em relação à análise funcional, a pontuação do componente físico (PCF) e a pontuação do compenente mental (PCM) encontradas estavam dentro da média de qualidade de vida da população. Os sintomas físicos, pela escala WOSI, apresentaram a melhor porcentagem (8,5%), ao passo que o pior resultado foi observado com relação ao estilo de vida (20%). Na EVA, a dor foi classificada como moderada (3/10) por 15,38% dos pacientes (4/26). Em relação aos esportes, os pacientes que praticavam alguma atividade esportiva apresentaram melhora nos parâmetros da escala SSV, que tiveram relação inversa com o número de recidivas. Observou-se ainda que, quanto menor foi o tempo entre a primeira luxação e a realização da cirurgia, maior foi a satisfação do paciente. Conclusão A indicação precoce do tratamento cirúrgico da instabilidade anterior glenoumeral pode proporcionar melhores resultados funcionais subjetivos ao paciente.

Impacto de COVID-19 en la formación de los alumnos de la Carrera de Posgrado de Cirugía General en un Hospital COVID / Impact of COVID-19 pandemic on trainees' education in the Postgraduate Program in General Surgery in a COVID-19-dedicated hospital

RESUMEN Antecedentes: El Hospital Eva Perón de la ciudad de Granadero Baigorria se destinó a la atención casi exclusiva de pacientes afectados por COVID-19, lo que implicó modificar las actividades que allí se desarrollan. Allí se realizan actividades correspondientes al Posgrado de Cirugía General de la Facultad de Ciencias Médicas de la Universidad Nacional de Rosario. El objetivo es describir los cambios y el funcionamiento del posgrado de Cirugía General en el HEEP durante la pandemia por COVID-19, y el impacto que esta tuvo sobre la formación de los alumnos. Material y métodos: se realizó un trabajo descriptivo, comparativo. Período 20 de marzo de 2020 al 30 de septiembre de 2020 y el mismo período del año 2019. Variables analizadas: número de cirugías, horas en el hospital, número de guardias, actividad en consultorio y pacientes evaluados, seminarios teóricos, cursado de la carrera de posgrado. Resultados: las cirugías totales se redujeron un 74,88%. Las cirugías programadas se redujeron un 85,59%. Las cirugías de guardia se redujeron un 63,19%. Las guardias de R1, R2 y R3 se vieron disminuidas, al contrario de R4. Las horas en el hospital se redujeron en todos los alumnos. Los pacientes ingresados disminuyeron el 74,06%. La atención en todos los consultorios se vio reducida. Las actividades académicas se incrementaron, de forma no presencial. Conclusión: la pandemia por COVID-19 afectó significativamente la formación de los alumnos del posgrado de Cirugía General del HEEP. Se recurrió a métodos no tradicionales de enseñanza para realizar actualizaciones y discutir trabajos científicos.

ABSTRACT Background: Hospital Eva Perón in the city of Granadero Baigorria was almost exclusively dedicated to the care of COVID-19 patients; thereby, it was necessary to modify its activities, as those of the postgraduate program in General Surgery of Facultad de Ciencias Médicas, Universidad Nacional de Rosario, which take place in this hospital. The aim of this study is to describe the changes made and the performance of the postgraduate program in general surgery at HEEP during the COVID-19 pandemic, and its impact on trainees' education. Material and methods: We conducted a descriptive study comparing the period between March 20, 2020, and September 30, 2020, with the same period in 2019. The variables analyzed included number of surgeries, hours spent in hospital, number of in-house call shifts, activities in the outpatient clinic and evaluation of patients, theoretical seminars, attendance to classes of the postgraduate programs and research work. Results: The total number of surgeries decreased by 74.88%, scheduled surgeries by 85.59% and emergency surgeries by 63.19%. The numbers of in-house call shifts of PGY-1, PGY-2 and PGY-3 residents decreased but not those of PGY-4 residents. The hours spent in hospital decreased in all the trainees. The number of patients hospitalized decreased by 74.06% and there was a reduction in all the activities of the outpatient clinics. The academic activities, performed non-face-to-face, increased. Conclusion: The COVID-19 pandemic significantly affected trainees' education in the postgraduate program in General Surgery at HEEP. Non-traditional teaching methods were used for updating and discussing scientific papers.

Different forms of superspreading lead to different outcomes: Heterogeneity in infectiousness and contact behavior relevant for the case of SARS-CoV-2.

Superspreading events play an important role in the spread of several pathogens, such as SARS-CoV-2. While the basic reproduction number of the original Wuhan SARS-CoV-2 is estimated to be about 3 for Belgium, there is substantial inter-individual variation in the number of secondary cases each infected individual causes-with most infectious individuals generating no or only a few secondary cases, while about 20% of infectious individuals is responsible for 80% of new infections. Multiple factors contribute to the occurrence of superspreading events: heterogeneity in infectiousness, individual variations in susceptibility, differences in contact behavior, and the environment in which transmission takes place. While superspreading has been included in several infectious disease transmission models, research into the effects of different forms of superspreading on the spread of pathogens remains limited. To disentangle the effects of infectiousness-related heterogeneity on the one hand and contact-related heterogeneity on the other, we implemented both forms of superspreading in an individual-based model describing the transmission and spread of SARS-CoV-2 in a synthetic Belgian population. We considered its impact on viral spread as well as on epidemic resurgence after a period of social distancing. We found that the effects of superspreading driven by heterogeneity in infectiousness are different from the effects of superspreading driven by heterogeneity in contact behavior. On the one hand, a higher level of infectiousness-related heterogeneity results in a lower risk of an outbreak persisting following the introduction of one infected individual into the population. Outbreaks that did persist led to fewer total cases and were slower, with a lower peak which occurred at a later point in time, and a lower herd immunity threshold. Finally, the risk of resurgence of an outbreak following a period of lockdown decreased. On the other hand, when contact-related heterogeneity was high, this also led to fewer cases in total during persistent outbreaks, but caused outbreaks to be more explosive in regard to other aspects (such as higher peaks which occurred earlier, and a higher herd immunity threshold). Finally, the risk of resurgence of an outbreak following a period of lockdown increased. We found that these effects were conserved when testing combinations of infectiousness-related and contact-related heterogeneity.

Increasing Environmental Complexity by Providing Different Types of Litter and Perches during Early Rearing Boosts Coping Abilities in Domestic Fowl Chicks.

Early experience of a complex environment can improve biologically relevant traits related to coping abilities. However, the mechanisms underlying these positive effects have not been well explored. We hypothesized that giving chicks possibilities to express choices within relevant resources could be an important part of the mechanism, as well as a novel way to increase environmental complexity. In a balanced design, laying hen hatchlings of the white hybrid Bovans Robust were reared in a "single-choice" environment (single litter and perch type) or a "multi-choice" environment (four different litter and perch types). Immunological and behavioral indicators of chicks' coping abilities were explored in this experimental study at three weeks of age. Chicks from "multi-choice" environments had shorter durations of tonic immobility, lower heterophil/lymphocyte ratios, higher natural antibody concentrations, and were more successful in gaining novel food rewards in a repeated opportunity test. These results imply that chicks having access to variation within resource types were less fearful, experienced less chronic stress, would be more able to cope with pathogenic challenges, and potentially had an improved learning ability. To conclude, the more complex environment, achieved by increasing chicks' possibilities to choose, seemed to make chicks better prepared for potential challenges, boosting their adaptive capacities and their ability to make the most of opportunities.

Inferring age-specific differences in susceptibility to and infectiousness upon SARS-CoV-2 infection based on Belgian social contact data.

Several important aspects related to SARS-CoV-2 transmission are not well known due to a lack of appropriate data. However, mathematical and computational tools can be used to extract part of this information from the available data, like some hidden age-related characteristics. In this paper, we present a method to investigate age-specific differences in transmission parameters related to susceptibility to and infectiousness upon contracting SARS-CoV-2 infection. More specifically, we use panel-based social contact data from diary-based surveys conducted in Belgium combined with the next generation principle to infer the relative incidence and we compare this to real-life incidence data. Comparing these two allows for the estimation of age-specific transmission parameters. Our analysis implies the susceptibility in children to be around half of the susceptibility in adults, and even lower for very young children (preschooler). However, the probability of adults and the elderly to contract the infection is decreasing throughout the vaccination campaign, thereby modifying the picture over time.

Leveraging of SARS-CoV-2 PCR Cycle Thresholds Values to Forecast COVID-19 Trends.

Introduction: We assessed the usefulness of SARS-CoV-2 RT-PCR cycle thresholds (Ct) values trends produced by the LHUB-ULB (a consolidated microbiology laboratory located in Brussels, Belgium) for monitoring the epidemic's dynamics at local and national levels and for improving forecasting models. Methods: SARS-CoV-2 RT-PCR Ct values produced from April 1, 2020, to May 15, 2021, were compared with national COVID-19 confirmed cases notifications according to their geographical and time distribution. These Ct values were evaluated against both a phase diagram predicting the number of COVID-19 patients requiring intensive care and an age-structured model estimating COVID-19 prevalence in Belgium. Results: Over 155,811 RT-PCR performed, 12,799 were positive and 7,910 Ct values were available for analysis. The 14-day median Ct values were negatively correlated with the 14-day mean daily positive tests with a lag of 17 days. In addition, the 14-day mean daily positive tests in LHUB-ULB were strongly correlated with the 14-day mean confirmed cases in the Brussels-Capital and in Belgium with coinciding start, peak, and end of the different waves of the epidemic. Ct values decreased concurrently with the forecasted phase-shifts of the diagram. Similarly, the evolution of 14-day median Ct values was negatively correlated with daily estimated prevalence for all age-classes. Conclusion: We provide preliminary evidence that trends of Ct values can help to both follow and predict the epidemic's trajectory at local and national levels, underlining that consolidated microbiology laboratories can act as epidemic sensors as they gather data that are representative of the geographical area they serve.

El cuidado invisible en pacientes críticos desde la perspectiva del equipo de enfermeria / nvisible care in critical patients from the perspective of the nursing team

Introducción: es cierto que existen cuidados que son visiblemente notorios y de hecho quedan asentados en los registros de enfermería e historia clínica. Sin embargo, existen otros cuidados, comúnmente llamados cuidados invisibles. Estos últimos son acciones y cuidados que la mayoría de las veces son intangibles pero que contribuyen al bienestar y mejoría de las personas, tanto o más que las acciones técnicas y/o delegadas, dirigidas al plano físico/clínico del paciente. Objetivos: Comprender e interpretar los cuidados invisibles de enfermería y su importancia en la evolución del paciente crítico en el servicio de Terapia Intensiva, de un hospital del departamento de San Martín, Mendoza, durante el mes de Junio de 2019. Material y Método: estudio cualitativo fenomenológico. La población estuvo dada por enfermeros del servicio de terapia intensiva de adultos. Muestreo por saturación. Se emplearon entrevistas abiertas en profundidad. Se registraron de manera manual escrita los datos y luego se realizó un análisis detallado de la información. Se entregó previamente a cada entrevistado un consentimiento informado explicativo. Conclusiones: El enfermero crítico ejerce un rol fundamental durante la estancia de sus pacientes, ya que su papel involucra muchas más cosas que solo los procedimientos técnicos. Esta relación vincular requiere no solo de conocimiento científico sino también de valores y cuidados éticos. El enfermero es por consideración, un buen acompañante terapéutico, ya que es capaz de ser educador, poseer actitud empática, ejercer escucha activa, contener frente a situaciones estresantes, brindar afecto y ser fiel frente a las necesidades de los pacientes[AU]

Introduction: it is true that there are care that are clearly visible and in fact are recorded in the nursing records and clinical history. However, there are other care, commonly called invisible care. The latter are actions and care that most of the time are intangible but that contribute to the welfare and improvement of people, as much or more than the technical and / or delegated actions, directed to the physical / clinical plane of the patient. Objectives: To understand and interpret the invisible nursing care and its importance in the evolution of the critical patient in the Intensive Therapy service of the Alfredo Italo Perrupato Hospital, in the department of San Martín, Mendoza during the month of June 2019. Material and Method: qualitative phenomenological study. The population was given by nurses of the adult intensive care service. Saturation sampling. Open interviews were used n depth. The data was recorded manually and then a detailed analysis of the information was made. An explanatory informed consent was previously given to each respondent. Conclusions: The critical nurse plays a fundamental role during the stay of his patients, since his role involves many more things than just the technical procedures. This relationship requires not only scientific knowledge but also values and ethical care. The nurse is, by consideration, a good therapeutic companion, since he is able to be an educator, have an empathic attitude, exercise active listening, contain stressful situations, provide affection and be faithful to the needs of patients[AU]

Introdução: é verdade que existem cuidados que são claramente visíveis e de fato estão registrados nos registros de enfermagem e na história clínica. No entanto, existem outros cuidados, comumente chamados de cuidados invisíveis. Estas últimas são ações e cuidados que na maioria das vezes são intangíveis, mas que contribuem para o bem-estar e a melhoria das pessoas, tanto ou mais do que as ações técnicas e / ou delegadas, direcionadas ao plano físico / clínico do paciente. Objetivos: Compreender e interpretar o cuidado invisível de enfermagem e sua importância na evolução do paciente crítico no serviço de Terapia Intensiva do Hospital Alfredo Italo Perrupato, no departamento de San Martín, Mendoza, durante o mês de junho de 2019. Material e Metodo: estudo fenomenológico qualitativo. A população foi atendida por enfermeiras do serviço de terapia intensiva adulto. Amostragem de saturação. Entrevistas abertas foram usadas em profundidade. Os dados foram registrados manualmente e, em seguida, foi feita uma análise detalhada das informações. Um consentimento informado explicativo foi dado previamente a cada respondente. Conclusões: O enfermeiro crítico desempenha um papel fundamental durante a internação de seus pacientes, visto que sua atuação envolve muito mais coisas do que apenas os procedimentos técnicos. Essa relação requer não apenas conhecimento científico, mas também valores e cuidados éticos. O enfermeiro é, por consideração, um bom companheiro terapêutico, pois pode ser educador, ter atitude empática, exercer a escuta ativa, conter situações estressantes, proporcionar carinho e ser fiel às necessidades dos pacientes[AU]

COVID-19 Belgium: Extended SEIR-QD model with nursing homes and long-term scenarios-based forecasts.

Following the spread of the COVID-19 pandemic and pending the establishment of vaccination campaigns, several non pharmaceutical interventions such as partial and full lockdown, quarantine and measures of physical distancing have been imposed in order to reduce the spread of the disease and to lift the pressure on healthcare system. Mathematical models are important tools for estimating the impact of these interventions, for monitoring the current evolution of the epidemic at a national level and for estimating the potential long-term consequences of relaxation of measures. In this paper, we model the evolution of the COVID-19 epidemic in Belgium with a deterministic age-structured extended compartmental model. Our model takes special consideration for nursing homes which are modelled as separate entities from the general population in order to capture the specific delay and dynamics within these entities. The model integrates social contact data and is fitted on hospitalisations data (admission and discharge), on the daily number of COVID-19 deaths (with a distinction between general population and nursing home related deaths) and results from serological studies, with a sensitivity analysis based on a Bayesian approach. We present the situation as in November 2020 with the estimation of some characteristics of the COVID-19 deduced from the model. We also present several mid-term and long-term projections based on scenarios of reinforcement or relaxation of social contacts for different general sectors, with a lot of uncertainties remaining.

Environmental complexity: A buffer against stress in the domestic chick.

Birds kept in commercial production systems can be exposed to multiple stressors from early life and this alters the development of different morphological, immunological and behavioural indicators. We explore the hypothesis that provision of a complex environment during early life, better prepares birds to cope with stressful events as well as buffers them against future unpredictable stressful episodes. In this study, 96 one day old pullets were randomly distributed in eight pens (12 birds/pen). Half of the chicks (N = 48) were assigned to a Complex Environment (CENV: with perches, a dark brooder etc.) the others to a Simple Environment (SENV: without enrichment features). Half of the birds from each of these treatments were assigned to a No Stress (NSTR, 33°C) or to an acute Cold Stress (CSTR, 18-20°C) treatment during six hours on their second day of life. At four weeks of age, chicks with these four different backgrounds were exposed to an Intermittent Stressful Challenges Protocol (ISCP). In an immunological test indicative of pro-inflammatory status Phytohemagglutinin-P (PHA-P), the response of CSTR birds was ameliorated by rearing chicks in a CENV as they had a similar response to NSTR chicks and a significantly better pro-inflammatory response than those CSTR birds reared in a SENV (five days after the CSTR treatment was applied). A similar better response when coping with new challenges (the ISCP) was observed in birds reared in a CENV compared to those from a SENV. Birds reared in the CENV had a lower heterophil/lymphocyte ratio after the ISCP than birds reared in SENV, independently of whether or not they had been exposed to CSTR early in life. No effects of stress on general behaviour were detected, however, the provision of a CENV increased resting behaviour, which may have favoured stress recover. Additionally, we found that exposure to cold stress at an early age might have rendered birds more vulnerable to future stressful events. CSTR birds had lower humoral immune responses (sheep red blood cells induced antibodies) after the ISCP and started using elevated structures in the CENV later compared to their NSTR conspecifics. Our study reflects the importance of the early provision of a CENV in commercial conditions to reduce negative stress-related effects. Within the context of the theory of adaptive plasticity, our results suggest that the early experience of the birds had long lasting effects on the modulation of their phenotypes.

Insights into thermal stress in Japanese quail (Coturnix coturnix): dynamics of immunoendocrine and biochemical responses during and after chronic exposure.

Avian require comfortable temperatures for optimal development and heat stress is a high concern in warm weather countries. We aimed to assess the dynamics of immunoendocrine and biochemical variables responses of birds exposed to a heat stressor applied during daylight hours, during the chronic stress and the recovery periods. We hypothesize that variables involved in the birds response will be differentially and gradually modified during those periods. Female quail (n = 210) were housed in six rearing boxes. At 29 days of age, the temperature in three boxes was increased from 24 to 34 °C during the light period throughout the nine days (Stress Treatment). The other three boxes remained at 24 °C and were used as controls. The subsequent 12 days were considered as recovery period. Different sets of 12 birds/treatment were blood-sampled at 29 (basal), 32, 35, 38 (stress), 41, 44, 47, and 50 (recovery) days of age, respectively. Immunoendocrine (corticosterone, lymphoproliferation, heterophil/lymphocyte ratio (H/L), and antibody response) and biochemical (glucose, total proteins, globulins, and albumin) variables were assessed. During stress, progressive corticosterone and H/L increments, and antibody titers and lymphoproliferation decreases were detected. No clear pattern of changes was found in biochemical variables. During recovery, while corticosterone and lymphoproliferation had recovered three days after the stressor ended, H/L and antibody responses required respectively nine and 12 days to recover to their basal levels, respectively. Findings suggest that immunity is already threatened when heat stress is sustained for three or more days. However, the system appears resilient, needing six to 12 days to recover to their basal responses.