Prioritizing the vulnerable over the susceptible for COVID-19 vaccination.

The COVID-19 pandemic led to a health crisis with widespread social and economic adverse effects. To address the fallout, vaccine development has been pursued in record time. Several vaccines have already been deployed in countries worldwide, but as the supply is limited, these have been provided selectively. Various allocation schemes, premised on ensuring an equitable distribution, have prioritized the elderly, given their apparent susceptibility. For the Philippines and possibly other countries with extremely limited supplies, the elderly need not always be given primary preference. The level of available supplies can be so low that the immediate focus of allocation should be on mitigating both infection and transmission. The proposed alternative vaccine allocation framework gives priority to groups rendered more vulnerable, such as those who are unable to avoid prolonged exposure to possibly infected people because of medical necessity or occupational conditions. Vulnerable groups include healthcare and other essential workers as well as patients requiring continued healthcare services. The proposed allocation scheme is meant to be complementary to concurrent public health measures, which have to be maintained though made less restrictive as the pandemic is brought under control.

Energy balance of torrefied microalgal biomass with production upscale approached by life cycle assessment.

Torrefaction is a thermochemical process used to convert the biomass into solid fuel. In this study, torrefaction increased the raw microalgal biomass' energy content from 20.22 MJ⋅kg-1 to 27.93 MJ⋅kg-1. To determine if more energy is produced than energy consumption from torrefaction, this study identified the energy balance of torrefied microalgal biomass production based on a life cycle approach. The energy analysis showed that, among all processes, torrefaction had the least amount of energy demand. The experimental setup, defined as scenario A, revealed that the principal source of energy demand, about 85%, was consumed on the microalgal growth using a photobioreactor system. A sensitivity analysis was also performed to determine the varying energy demand for torrefied microalgal biomass production. The different types of cultivation methods and various production scales were considered in scenarios B to D. Scenario D, which represented the commercial production-scale, the energy demand drastically decreased by 59.46% as compared to the experimental setup (scenario A). The open-pond cultivation system resulted in the least energy requirement, regardless of the production scale (scenarios B and C) among all the given scenarios. Unlike scenarios A and D, scenarios B and C identified the drying process to consume a high amount of energy. All the scenarios have shown an energy demand deficit. Therefore, efforts to decrease the energy demand on the upstream processes are needed to make the torrefied microalgal biomass a viable alternative energy source.

Hydrops fetalis and neonatal abdominal compartment syndrome continuum from immature gastric teratoma: a case report.

BACKGROUND: Hydrops fetalis as well as abdominal compartment syndrome (ACS) are conditions that are associated with high mortality rates. A rare case of immature gastric teratoma causing fetal hydrops and subsequent ACS is presented. The related pathophysiologic mechanisms are discussed, and the importance of timely recognition and appropriate interventions are highlighted. CASE PRESENTATION: The male patient was born preterm, weighing 3.9 kg., by Cesarean section. Prior prenatal ultrasounds were normal, but a scan done just before delivery had findings indicating polyhydramnios, fetal ascites, and meconium peritonitis. Upon delivery, the patient had respiratory distress, anasarca and a massively distended abdomen. Resuscitation measures, including ventilatory support, were instituted. Imaging studies showed ascites as well as a large, complex intra-abdominal lesion with calcifications. In the succeeding hours, anuria persisted, anasarca worsened, the abdomen became more distended, and inotrope requirements increased. The occurrence of ACS, from what was presumed to be a retroperitoneal teratoma, was therefore considered. Laparotomy was done on the 28th hour of life, with en bloc excision of a massive tumor and attached section of the greater curvature of the stomach. Passage of urine occurred intra-operatively, and the patient was soon after weaned off inotropes and ventilator support. The histopathologic result was immature gastric teratoma. No chemotherapy was given, and the patient's serum AFP is at normal levels 15 months following surgery. CONCLUSION: The presence of a massive intra-abdominal lesion can result in the pathophysiologic continuum of hydrops fetalis and neonatal ACS. The early recognition of such an association can enable appropriate expectant management of similarly affected neonates, including emergent decompression laparotomy.

Recognizing odontogenic sinusitis: A national survey of otolaryngology chief residents.

PURPOSE: Odontogenic sinusitis is underrepresented in sinusitis literature as well as in the otolaryngology teaching curriculum sponsored by the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngologists and residents in training may therefore have a decreased awareness of the condition. The objective of this study was to survey otolaryngology chief residents toward the ends of their training to determine how often they considered odontogenic sinusitis as a cause of unilateral sinus disease. MATERIALS AND METHODS: An online REDCap survey was conducted from December 2018 to January 2019. Online surveys were emailed to 119 Otolaryngology residency program directors in the United States of America, which were then forwarded to their chief residents. Surveys included 3 demographic and 4 clinical questions. Clinical questions included 3 computed tomography-based questions requiring either differential diagnoses or most likely diagnosis, and 1 question on residents' perceived prevalence of odontogenic sinusitis as a cause of unilateral sinus opacification. Answer choices were tabulated and compared based on geographic region and post-residency career plans. RESULTS: Of 293 chief residents emailed, 94 completed the survey (32.1%). While answer choices on imaging-based questions varied, odontogenic sinusitis was generally underrecognized. Approximately 70% of residents felt odontogenic sinusitis represented 0%-40% of unilateral sinus opacification. There were no statistically significant differences in answers based on geographic distribution or post-residency career plans. CONCLUSIONS: Otolaryngology chief residents recognized odontogenic sinusitis with variable accuracy on imaging, and generally underestimated its prevalence as a cause of unilateral sinus opacification. Efforts should be made to teach otolaryngology residents about odontogenic sinusitis.

Postoperative pain with or without nasal splints after septoplasty and inferior turbinate reduction.

PURPOSE: To determine the effect of intranasal Doyle splints on postoperative pain following septoplasty and inferior turbinate reduction (ITR). Changes in Nasal Obstruction Symptom Evaluation (NOSE) scores were also evaluated. MATERIALS AND METHODS: A prospective cohort study conducted from January 2017 to January 2019. Patients were recruited if they experienced nasal obstruction due to septal deviation and inferior turbinate hypertrophy, and failed a one-month trial of intranasal corticosteroids. All patients underwent septoplasty with ITR, and either had Doyle splints or no splints placed. Patients were prescribed hydrocodone-acetaminophen 5-325 mg and asked to keep a daily log of pain medication use and visual analog scale (VAS) scores. Pain logs and NOSE scores were compared between patients who had splints versus patients who had no splints placed after septoplasty and ITR over the first postoperative week. NOSE scores were also collected at every postoperative visit (1 week, 1 month, and 6 months). RESULTS: Fifty-seven patients were enrolled (37 splints, 20 no-splints). The median postoperative pain VAS score was 3.0 (interquartile range [IQR] 2.0-5.0) for the splint group and 4.0 (IQR 2.0-5.0) for the no-splint group (P = 0.906). The median postoperative pain medication requirement in morphine equivalents at the first postoperative visit was 5.4 mg/day (IQR 2.0-13.3) for the splint group and 8.4 mg/day (IQR 1.8-15.3) for the no-splint group (P = 0.833). CONCLUSIONS: There were no statistically significant differences in postoperative pain VAS scores or pain medication use between the two groups. All patients experienced significant reductions in NOSE scores postoperatively.

Immediate Latissimus Dorsi and Prosthetic Reconstruction in the Setting of Postmastectomy Radiation: An Analysis of 376 Breast Reconstructions.

BACKGROUND: In immediate breast reconstruction, the plastic surgeon must strive to create an aesthetically pleasing result while minimizing complications. The latissimus dorsi (LD) myocutaneous flap has long been used a workhorse flap in breast reconstruction. Often times, it is used a salvage flap after other methods of breast reconstruction have failed. In this study, we review the use of this flap in conjunction with prosthetic devices, regardless of the need for adjuvant radiation, to determine the safety and efficacy of this approach as a primary method of reconstruction. METHODS: A single surgeon practice with a standardized reconstructive algorithm was reviewed. This compromises a 2-stage approach involving the use of LD myocutaneous flaps and tissue expanders for immediate reconstruction after mastectomy, followed by exchange for implants at a secondary surgery. A retrospective chart review was performed on 201 patients (376 breast reconstructions) who met inclusion criteria. Patient demographics and outcomes were compared based on radiation status. The primary outcome, reconstructive success, was defined as no need for further autologous reconstruction beyond the 2-stage approach utilized. RESULTS: Statistical analysis was performed on both patient demographics, complications, and reconstructive outcomes. Demographics were equivalent between the 2 groups. When analyzing complications and outcomes, there was no difference between nonradiated patients and radiated patients except when looking at reconstructive loss, which was 3.6% in the nonradiated group and 16.6% in the radiated group (P = 0.03). However, one third of the patients in the radiated group who had reconstructive losses were due to reasons not related to radiation therapy. Taking this into account, overall reconstructive success showed no statistical significance between the 2 groups. CONCLUSIONS: The findings from this study show that immediate reconstruction with LD myocutaneous flaps in conjunction with prosthetic devices is a reliable and safe option, even in the setting of adjuvant radiation therapy, as the autologous tissue mitigates many sequelae of radiation therapy. Not only does this type of reconstruction provide an aesthetically pleasing result in 2 stages, but also has a favorable complication profile and success rate.

Pediatric Anastomosing Hemangioma: Case Report and Review of Renal Vascular Tumors in Children.

The case involves a 10-year-old child who underwent a left radical nephrectomy for what was believed to be a Wilms' tumor. Histopath examination indicated a benign vascular lesion, subsequently determined to be an anastomosing hemangioma of the kidney. A comparison with the previously cited pediatric patients with renal vascular tumors is provided, and the inconsistent diagnostic terminologies for these conditions are highlighted. The therapeutic implications of these predominantly benign renal tumors, in the context of the much more frequently encountered malignant neoplasms in children, are additionally discussed.

Grit: A predictor of medical student performance.

Background: Several predictors of medical school performance have been identified, yet more research is needed to select applicants who will perform well. Grit is a personality trait that is described as persevering through difficult tasks. Although it is hypothesized that this type of trait would be high in a medical student population, this has not been studied. The purpose of this study was to examine grit among medical students and to explore whether grit-predicted performance in medical school. Methods: There were 131 graduating medical students who completed a questionnaire in May 2014 on grit as well as demographic questions and involvement in other activities in medical school. Data on test scores, years in medical school, and class ranking were obtained from the medical school. Results: The average grit score among 130 medical students was high (mean = 4.01, standard deviation = 0.42). Those who completed the program in 4 years had higher grit scores than those who completed in 5 years (P = 0.01). Grit was related to medical school performance including clinical knowledge scores (P = 0.02). There was also a difference between the highest and lowest class rank (P = 0.03). Discussion: Medical students have high levels of trait-like perseverance and it appears that those with higher levels of grit are more likely to perform better in medical school.

Predictors of repeated "no-showing" to clinic appointments.

OBJECTIVE: To determine the variables that contribute to repeated patient non-compliance with showing up to clinic appointments. STUDY DESIGN: Retrospective chart review. SETTING: Single tertiary care academic institution. SUBJECTS AND METHODS: Patients who did not show up to 3 or more clinic appointments in the otolaryngology department in the Henry Ford Health System in metro Detroit, Michigan between July 1, 2011 to June 30, 2012 area were compared to control patients randomly chosen from those who had appointments on the same day with the same provider as the no-show patients. RESULTS: 105 patients were identified who no-showed to 3 or more clinic appointments. Younger age, black race, and lower income were all found to be significant factors for patients missing appointments in a multiple variate model. On logistic regression, Medicaid insurance, closer distance from home to appointment, less bus transfers, and less time by bus travel were also found to correlate with no-showing. CONCLUSION: Age, race, and income are significantly related to patient non-compliance with clinic appointments. Paradoxically, proximity to the clinical appointment location is also significantly related - we hypothesize this may be the result of significant income inequality in the metro Detroit population distribution. Follow up studies include analyzing factors that precluded patient access and interventions to improve compliance and decrease cost.

Dental ethics and emotional intelligence.

Dental ethics is often taught, viewed, and conducted as an intell enterprise, uninformed by other noncognitive factors. Emotional intelligence (EQ) is defined distinguished from the cognitive intelligence measured by Intelligence Quotient (IQ). This essay recommends more inclusion of emotional, noncognitive input to the ethical decision process in dental education and dental practice.

Let's talk about flux: the rising potential of autophagy rate measurements in disease.

Macroautophagy/autophagy is increasingly implicated in a variety of diseases, making it an attractive therapeutic target. However, many aspects of autophagy are not fully understood and its impact on many diseases remains debatable and context-specific. The lack of systematic and dynamic measurements in these cases is a key reason for this ambiguity. In recent years, Loos et al. 2014 and Beesabathuni et al. 2022 developed methods to quantitatively measure autophagy holistically. In this commentary, we pose some of the unresolved biological questions regarding autophagy and consider how quantitative measurements may address them. While the applications are ever-expanding, we provide specific use cases in cancer, virus infection, and mechanistic screening. We address how the rate measurements themselves are central to developing cancer therapies and present ways in which these tools can be leveraged to dissect the complexities of virus-autophagy interactions. Screening methods can be combined with rate measurements to mechanistically decipher the labyrinth of autophagy regulation in cancer and virus infection. Taken together, these approaches have the potential to illuminate the underlying mechanisms of various diseases.Abbreviation MAP1LC3/LC3: microtubule-associated protein 1 light chain 3; R1: rate of autophagosome formation; R2: rate of autophagosome-lysosome fusion; R3: rate of autolysosome turnover.

Water, Sanitation, and Hygiene (WASH) Factors Influencing the Effectiveness of Mass Drug Administration to Eliminate Trachoma as a Public Health Problem in Malawi.

PURPOSE: Following a national population-based trachoma survey in Malawi one round of azithromycin mass drug administration (MDA) was carried out, with a post-MDA impact survey showing TF prevalence below 5% and considered eliminated as a public health problem. However, active trachoma was still present in over 200 children. We assessed whether water, sanitation, and hygiene (WASH) factors were associated with ongoing presence of TF in children aged 1-9 years following MDA. METHODS: A secondary analysis was performed on a sub-set of the post-MDA impact survey data for children aged 1-9 years. We used a logistic regression analysis, adjusted for clustering at the household and village level. RESULTS: Among 16,142 children aged 1-9 years, 209 (1.3%) had TF after MDA. Factors associated with a significantly lower odds of TF after MDA were living in a household with a handwashing facility (aOR: 0.37) and living in a household where water for washing is located further away from the home (30 min away aOR: 0.39, p = .034, or more than 1 h away aOR: 0.31, p = .018) compared with water in the yard. CONCLUSION: The inverse association between a domestic handwashing facility and TF is consistent with previous findings, but the association of increasing distance to collect water for washing with a reduced risk of TF was unexpected and may reflect the impact of drought and unmeasured behavioural factors related to water usage. A more comprehensive collection of sociodemographic and WASH factor information in population-based trachoma surveys will provide insight into achieving and maintaining low levels of trachoma.

Cathelicidin, kallikrein 5, and serine protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel.

BACKGROUND: Excess cathelicidin and kallikrein 5 (KLK5) have been hypothesized to play a role in the pathophysiology of rosacea. OBJECTIVE: We sought to evaluate the effects of azelaic acid (AzA) on these elements of the innate immune system. METHODS: Gene expression and protease activity were measured in laboratory models and patients with rosacea during a 16-week multicenter, prospective, open-label study of 15% AzA gel. RESULTS: AzA directly inhibited KLK5 in cultured keratinocytes and gene expression of KLK5, Toll-like receptor-2, and cathelicidin in mouse skin. Patients with rosacea showed reduction in cathelicidin and KLK5 messenger RNA after treatment with AzA gel. Subjects without rosacea had lower serine protease activity (SPA) than patients with rosacea. Distinct subsets of patients with rosacea who had high and low baseline SPA were identified, and patients with high baseline exhibited a statistically significant reduction of SPA with 15% AzA gel treatment. LIMITATIONS: Study size was insufficient to predict clinical efficacy based on the innate immune response to AzA. CONCLUSIONS: These results show that cathelicidin and KLK5 decrease in association with AZA exposure. Our observations suggest a new mechanism of action for AzA and that SPA may be a useful biomarker for disease activity.

Global transcriptional analysis of psoriatic skin and blood confirms known disease-associated pathways and highlights novel genomic "hot spots" for differentially expressed genes.

There are major gaps in our knowledge regarding the exact mechanisms and genetic basis of psoriasis. To investigate the pathogenesis of psoriasis, gene expression in 10 skin (5 lesional, 5 nonlesional) and 11 blood (6 psoriatic, 5 nonpsoriatic) samples were examined using Affymetrix HG-U95A microarrays. We detected 535 (425 upregulated, 110 downregulated) DEGs in lesional skin at 1% false discovery rate (FDR). Combining nine microarray studies comparing lesional and nonlesional psoriatic skin, 34.5% of dysregulated genes were overlapped in multiple studies. We further identified 20 skin and 2 blood associated transcriptional "hot spots" at specified genomic locations. At 5% FDR, 11.8% skin and 10.4% blood DEGs in our study mapped to one of the 12 PSORS loci. DEGs that overlap with PSORS loci may offer prioritized targets for downstream genetic fine mapping studies. Novel DEG "hot spots" may provide new targets for defining susceptibility loci in future studies.

Information-seeking trends of medical professionals and students from middle-income countries: a focus on the Philippines.

BACKGROUND: Increased emphasis has been given to the practice of evidence-based medicine (EBM) worldwide. Access to quality health information is essential to the practice of EBM in developing countries. OBJECTIVES: To understand the information needs and sources of information of physicians from low- and middle-income countries (LMICs). METHODS: Medical doctors and students participated in an 18-question online or paper study. RESULTS: Of the 156 respondents from six LMICs, 146 (94%) came from the Philippines. Eighty-eight per cent encountered at least one clinical question daily, while 58% were very likely to search for answers. A basic mobile phone was the most used device at home (94%) and at work (82%). More than half had Internet connectivity at home (62%) and just under half at work (46%). In decreasing order, short messaging services (SMS), email, instant messaging and multimedia messaging services (MMS) were the most commonly used messaging tools at home and at work. The primary source for medication questions was a formulary, but for diagnostic dilemmas, colleagues were consulted first. PubMed use was high for therapy and management questions. CONCLUSION: The use of health information from the Internet through mobile devices may be increasing. Access to health information was higher at home than at work. These results may be useful when planning resources for healthcare givers in resource-poor settings.

Multi-objective operation optimization of spent coffee ground torrefaction for carbon-neutral biochar production.

Many energy-intensive processes are employed to enhance biomass fuel properties to overcome the difficulties in utilizing biomass as fuel. Therefore, energy conservation during these processes is crucial for realizing a circular bioeconomy. This study develops a newly devised method to evaluate SCG biochars' higher heating value (HHV) and predict moisture content from power consumption. It is found that the increasing rates of HHV immediately follow decreases in power consumption, which could be used to determine the pretreatment time for energy conservation. The non-dominated sorting genetic algorithm II (NSGA-II) maximizes SCG biochar's HHV while minimizing energy consumption. The results show that producing SCG biochar with 23.98 MJ∙kg-1 HHV requires 20.042 MJ∙kg-1, using a torrefaction temperature of 244 °C and torrefaction time of 27 min and 43 sec. Every kilogram of biochar with an energy yield of 85.93 % is estimated to cost NT$ 12.21.

Application of regression and artificial neural network analysis of Red-Green-Blue image components in prediction of chlorophyll content in microalgae.

This study presented a novel methodology to predict microalgae chlorophyll content from colour models using linear regression and artificial neural network. The analysis was performed using SPSS software. Type of extractant solvents and image indexes were used as the input data for the artificial neural network calculation. The findings revealed that the regression model was highly significant, with high R2 of 0.58 and RSME of 3.16, making it a useful tool for predicting the chlorophyll concentration. Simultaneously, artificial neural network model with R2 of 0.66 and low RMSE of 2.36 proved to be more accurate than regression model. The model which fitted to the experimental data indicated that acetone was a suitable extraction solvent. In comparison to the cyan-magenta-yellow-black model in image analysis, the red-greenblue model offered a better correlation. In short, the estimation of chlorophyll concentration using prediction models are rapid, more efficient, and less expensive.

Design of biorefineries towards carbon neutrality: A critical review.

The increase in worldwide demand for energy is driven by the rapid increase in population and exponential economic development. This resulted in the fast depletion of fossil fuel supplies and unprecedented levels of greenhouse gas in the atmosphere. To valorize biomass into different bioproducts, one of the popular and carbon-neutral alternatives is biorefineries. This system is an appropriate technology in the circular economy model. Various research highlighted the role of biorefineries as a centerpiece in the carbon-neutral ecosystem of technologies of the circular economy model. To fully realize this, various improvements and challenges need to be addressed. This paper presents a critical and timely review of the challenges and future direction of biorefineries as an alternative carbon-neutral energy source.