A Structural Equation Model to Analyze the Effects of COVID-19 Pandemic Risks on Project Success: Contractors' Perspectives

The purpose of this paper is to capture the direct and indirect effects of COVID-19 emerging risks on construction projects' success in developing countries from the contractors' perspective. To achieve this, we collected data from Iraqi construction industry and conducted the following multistage research methodology: (1) preliminary investigation with four construction contractors to identify the success indicators of construction projects;(2) focus group session with 11 experts to identify the COVID-19 emerging risks for the construction industry;(3) semistructured interviews with seven construction experts to develop several hypotheses on the effect of COVID-19 emerging risks on project success;(4) survey data collection from 99 construction contractors;and (5) development of a structural equation model (SEM) to analyze the effects of COVID-19 emerging risks on project success. The results of the SEM analysis show that financial market (FM)-related risks, supply chain operations (SCO)-related risks, health and safety of construction workforce (HSCW)-related risks, organizational implications (OI)-related risks, and contractual implications (CI)-related risks have a significant impact on construction projects success. CI-related risks have the strongest total effects on project success, followed by OI-related risks, FM-related risks, HSCW-related risks, and SCO-related risks, respectively. The results also emphasis the significant mediation role of CI between COVID-19 emerging risks and project success. This study contributes to the body of knowledge and contracting companies by helping researchers and construction contractors to better understand how the key risk factors emerging from extreme conditions like the COVID-19 pandemic affect construction projects' success and may serve as a guideline for developing effective response strategies. © 2023 American Society of Civil Engineers.

Correlation between vitamin D and anosmia in post acute Covid syndrome clinic

Introduction: Anosmia has emerged as a clinical feature of Covid-19. It is estimated over half of patients with Covid19 report anosmia. It is primarily transient, but can persist over a month in around 20% of cases. There is a hypothetical interaction between hypovitaminosis D and diminished smell. A deficiency may lead to neurologic decline in cranial nerves, including the olfactory nerve. Few studies investigating this are available. Loss of smell is a common occurrence through adulthood, with many physiologic and anatomic contributing factors. Limited data is available addressing anosmia post Covid-19. Aim(s): To assess the correlation between vitamin D (VD) and anosmia, in patients referred to post acute COVID syndrome (PACS) clinic, and to assess the variation of data across age groups. Method(s): A "Sniffin' Sticks" test was undertaken for all patients referred to the PACS clinic. This was correlated with a recent serum VD level. Result(s): 143 patients presented to the PACS clinic over a 10 month period. 84% were under 65 years. 60% of these patients who developed anosmia were found to have VD insufficiency. A similar proportion of patients with hyposmia, and patients with normal smell were found to be VD insufficient (36% vs 34.7%). Within the older cohort, none of the patients with anosmia were deficient in VD, and 7.7% of patients with smell dysfunction had insufficiency. Conclusion(s): There is an association between anosmia and VD deficiency in patients under 65 years of age seen at PACS clinic. This did not reflect in the cohort with hyposmia. In the older age group, the majority of patients had normal VD levels, which may indicate other contributing factors towards the decrease in smell.

Retrospective Analysis of Wastewater-Based Epidemiology of SARS-CoV-2 in Residences on a Large College Campus: Relationships between Wastewater Outcomes and COVID-19 Cases across Two Semesters with Different COVID-19 Mitigation Policies

Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response. © 2022 American Chemical Society.

COVID-19 emerging risk assessment for the construction industry of developing countries: evidence from Iraq

In developing countries, the construction industry has been one of the hardest hit by the COVID-19 pandemic. The impact of the pandemic has created a whole new set of risks, causing workforce-related issues, supply chain disruptions, and legal and contractual implications. This research aims to identify and quantitatively analyse COVID-19 emerging risks in the construction industry of Iraq. A mixed method approach was used for data collection and analysis, including a focus group session to identify COVID-19 emerging risks, a survey to rate the identified risks, and the development of a fuzzy-based risk assessment model to analyse the level of riskiness of the identified risks. Results indicate that the most critical COVID-19 risks are (1) contract suspension, (2) contractor bankruptcy, (3) materials price escalation, (4) construction contract claims, (5) inappropriate risk allocation, (6) non-compliance with social distancing guidelines, (7) skills shortage, and (8) poor site and virtual communication. This paper contributes to the body of knowledge by providing academics and industry practitioners with a more comprehensive understanding of the risks arising from the COVID-19 pandemic. Moreover, this paper presents a novel model for analysing risks related to extreme conditions, such as the COVID-19 pandemic and future pandemics. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Retrospective Analysis of Wastewater-Based Epidemiology of SARS- CoV-2 in Residences on a Large College Campus: Relationships between Wastewater Outcomes and COVID-19 Cases across Two Semesters with Different COVID-19 Mitigation Policies

Wastewater-based epidemiology (WBE) has been utilized for outbreak monitoring and response efforts in university settings during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies examined the impact of university policies on the effectiveness of WBE to identify cases and mitigate transmission. The objective of this study was to retrospectively assess relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater outcomes and COVID-19 cases in residential buildings of a large university campus across two academic semesters (August 2020-May 2021) under different COVID-19 mitigation policies. Clinical case surveillance data of student residents were obtained from the university COVID-19 response program. We collected and processed building-level wastewater for detection and quantification of SARS-CoV-2 RNA by RT-qPCR. The odds of obtaining a positive wastewater sample increased with COVID-19 clinical cases in the fall semester (OR = 1.50, P value = 0.02), with higher odds in the spring semester (OR = 2.63, P value < 0.0001). We observed linear associations between SARS-CoV-2 wastewater concentrations and COVID-19 clinical cases (parameter estimate = 1.2, P value = 0.006). Our study demonstrated the effectiveness of WBE in the university setting, though it may be limited under different COVID-19 mitigation policies. As a complementary surveillance tool, WBE should be accompanied by robust administrative and clinical testing efforts for the COVID-19 pandemic response.

THE EFFECTS OF THE COVID-19 PANDEMIC ON PRESENTATIONS AND DIAGNOSIS OF UPPER GI AND HEPATOPANCREATICOBILIARY MALIGNANCIES

Introduction: In March 2020, Coronavirus Disease 2019 (COVID-19) was declared a pandemic. Elective healthcare services were reorganised worldwide. This study addresses the impact of measures taken in the early stages of the pandemic on diagnosing Upper Gastrointestinal (UGI) and Hepatopancreaticobiliary (HPB) malignancies in a university teaching hospital. Aims: To ascertain whether fewer cases of UGI/HPB cancers were detected, the differences in inpatient and outpatient diagnosis and whether there was an increased detection of later stage disease during the pandemic than in the preceding year. Methods: This was a retrospective cohort study conducted in Tallaght University Hospital in Ireland. All new diagnoses of UGI/HPB cancers, excluding hepatocellular carcinomas, are managed at a weekly Multidisciplinary Team (MDT) meeting. Data was retrieved from the MDT database and medical records and analysed using IBM SPSS Statistics V20. Results: 111 cases were detected. There was no significant difference in the proportion of cases detected in the overall post-COVID period (n=53, 47.7%) compared to the Pre-COVID period (n=58, 52.3%) (p=0.7884). When COVID-19 cases were at their highest levels in Ireland, we observed a significant drop in new UGI/HPB cases detected compared to the pre-COVID period. This was mitigated in the third quarter of 2020, when transmission was depressed and a sharp increase in detection of UGI/HPB cases was observed. The variance of distribution of cases per quarter in the two periods was statistically significant with a P-value of 0.0001. There was a non-significant trend towards fewer diagnoses of early cancer (stage ≤2) in the Post- COVID period (21% v 26%) (p=0.6416). The proportion of patients diagnosed as an inpatient did not differ between the two periods, p=.739. Discussion: As fears about aerosolization abated, endoscopy services quickly increased the number of scopes performed after the initial reduction at the start of the pandemic. There are several limitations to this study, however it does lead us to conclude that our fears regarding cancer diagnosis in the postpandemic period did not materialise. It also offers solace that when transmission of COVID- 19 is depressed, as it was in Ireland in Q3 2020 before the peak of the second wave in Q4 2020, that outpatient services can quickly escalate their level of activity and detect cancers that were missed with no significant change in stage. A further observation is that when lockdown measures in Ireland were reintroduced in winter 2020/2021 but outpatient services were kept open, a similar reduction in detections was observed compared to when they were closed. Therefore, the question may be posed if the primary driver of reduced detection of UGI/HPB cancers is primary care services being overwhelmed with pandemic work rather than a reduction in outpatient services . (Table Presented) (Figure Presented)

A REVIEW OF FAST DATA IN TALLAGHT UNIVERSITY HOSPITAL, AND THE IMPACT OF COVID ON TREATMENT

Introduction Stroke is a leading cause of morbidity. Current guidelines advise maximum of 4.5 hours post symptom onset for thrombolysis, and 24 hours for thrombectomy. (1) Delay between symptom onset and treatment is associated with an inferior outcome. Thrombolysis is available in 27 Irish centers. Average rate of thrombolysis is 11%. (3) Fewer than half of stroke patients arrived in hospital within three hours of symptom onset in 2019. (4) Median door-to-needle time is 48 minutes. Method FAST calls in Tallaght University Hospital, from 2/7/19–1/7/21, were included in this analysis (n = 594). Results 160 FAST calls took place pre-Covid (20/month), and 434 post-Covid (27.12/month). Time of symptom onset was recorded in 390 cases. Time patients last seen well was known in 185 cases, unknown time of onset in 19. After review by the stroke clinician, FAST imaging was obtained in 78% of cases (n = 464). Of these, 34 cases of FAST imaging were performed for inpatients. Average time from registration to CT was 35:24 minutes pre covid, and 45:52 minutes post. 9.7% of patients were thrombolysed. The median door-to-needle time was 41 minutes pre-Covid(n = 21, 2.625/month), and 54 minutes after (n = 37, 2.3/month). Thrombectomy was performed in 46 cases. 222 patients were diagnosed with an ischaemic stroke, 50 had TIA and 48 had haemorrhagic strokes. Other diagnoses included migraine (6.7%, n = 40), seizures (6.7%, n = 40) and Bells Palsy (3.7%, n = 22). 55% (n = 330) of cases were registered to ED with FAST call between the hours of 9 am-5 pm. 27% (n = 161) of cases occurred during the night shift. Conclusion The median door-to-needle times were below national median pre-Covid, and longer post-pandemic, with an increase in the rate of presentation in the same time-frame. This report highlights the effect of the pandemic on time-critical patient interventions in stroke and the need to stratify services to respond to structural challenges.

Surviving intimate partner violence and disaster

Purpose Few studies investigating disaster have examined the risks associated with surviving both disaster and intimate partner violence (IPV). IPV is psychological or physical abuse in a personal relationship. Using an intersectional approach, the purpose of this study is to investigate contributions to and differences in perceived stress and personal resilience during the COVID-19 pandemic among a sample of predominantly female-identified IPV survivors (n = 41) to examine risks associated with this vulnerable population during disaster. Design/methodology/approach Using a structured interview guide, IPV survivors were interviewed regarding their perceived stress (i.e. perceived stress scale), personal resilience, (i.e. Connor Davidson Resilience Scale), type of violence experienced (i.e. physical violence), COVID-19-related stressors (i.e. loss of income due to the pandemic) and relevant socio-demographic characteristics (i.e. race). Findings These interviews indicate that participants exhibited low levels of resilience and a moderate amount of stress exposure highlighting risk factors associated with experiencing personal violence during disaster. Originality/value At the height of their need for support and assistance, the disaster generated additional rent and nutritional stress compounding the pressures violence survivors face. These findings suggest those who are socially vulnerable due to violence need structural support services to cope with disaster and violence-related stresses.

Home-based educational interventions for children with asthma, a Cochrane review

Introduction/Aim: Strategies implemented to minimize infection risk from COVID-19, such as social distancing and community lockdowns, means that policy makers, health professionals and asthma patients are considering alternative approaches of service delivery. Home-based asthma education is one approach that may appeal to these groups, and those experiencing socioeconomic disadvantage, where barriers to care such as travel costs can prevent effective management. The efficacy of home-based asthma education to influence health outcomes was last evaluated in a Cochrane systematic review in 2011. Therefore, the aim of this study was to update the evidence to inform policy, clinical care and patient outcomes. Methods: A Cochrane systematic search was undertaken by two-independent researchers using records retrieved from four databases and grey literature (September 2021). Included studies were RCTs of asthma education delivered in the home to children, their caregivers or both. Data extraction, evidence synthesis and reporting of results were conducted in accordance with recommended Cochrane methodology (i.e., Higgins 2021 Cochrane Handbook). Results: Twenty-five studies were included involving 4923 participants predominantly from low socioeconomic and ethnic minority communities. Fourteen studies reported on exacerbations requiring ED visits, with no overall intervention effect. Three studies reported on exacerbations requiring a course of oral corticosteroids (OCS), in which there was a significant reduction in the total number of courses of OCS in the intervention arm compared to the control in one study. Quality of life was reported in eight studies with two able to be meta-analysed (Figure 1), Three reported statistically significant improvements in the intervention arm. Three studies assessed asthma symptom-free days with two producing statistically significant improvements. One showed no evidence of effect. Two studies were metaanalysed identifying no evidence of effect (Figure 2). Conclusion: Substantial diversity across studies/ interventions resulted in an inconsistent evidence base, and the inability to provide meaningful recommendations on home-based education for asthma. (Figure Presented).

The One Minute Preceptor: A Vital Tool During COVID-19.

The One Minute Preceptor (OMP) model of teaching has an important role to play during the COVID-19 pandemic. It's quick and easy to learn and can be applied to any clinical setting. By responding directly to a student's needs, and building on the knowledge they already hold, the OMP is able to offer relevant and opportunistic teaching that the learner can immediately apply. Finally, the OMP can be taught in under two hours meaning medical staff not used to regularly teaching can develop the confidence to offer high quality educational interventions.

The Potential of Calcium Phosphate Nanoparticles as Adjuvants and Vaccine Delivery Vehicles

Vaccination is one of the most efficacious and cost-effective ways to protect people from infectious diseases and potentially cancer. The shift in vaccine design from disrupted whole pathogens to subunit antigens has brought attention on to vaccine delivery materials. For the last two decades, nanotechnology-based vaccines have attracted considerable attention as delivery vehicles and adjuvants to enhance immunogenicity, exemplified with the current COVID vaccines. The nanoparticle vaccines display unique features in protecting antigens from degradation, controlled antigen release and longer persisting immune response. Due to their size, shape and surface charge, they can be outstanding adjuvants to achieve various immunological effects. With the safety and biodegradable benefit of calcium phosphate nanoparticles (CaP NPs), they are an efficient carrier for vaccine design and adjuvants. Several research groups have studied CaP NPs in the field of vaccination with great advances. Although there are several reports on the overview of CaP NPs, they are limited to the application in biomedicine, drug delivery, bone regeneration and the methodologies of CaP NPs synthesis. Hence, we summarised the basic properties of CaP NPs and the recent vaccine development of CaP NPs in this review. Copyright © 2021 Sun, Li, Lenzo, Holden, McCullough, O’Connor and O’Brien-Simpson.

Necrotic Liver Abscess secondary to Duodenal Perforation caused by ingestion of a Fish Bone - A Case Report

Introduction: Ingestion of foreign bodies are not uncommon, however enterohepatic migration of fish bones causing liver abscesses remains a rare phenomenon. Case Report: We present the case of a 58-year-old female admitted with 11 days history of fever, rigors, shortness of breath and malaise associated with vomiting and diarrhoea. Her COVID-19 rapid antigen test was negative. She was tender in the left lower quadrant of her abdomen and inflammatory markers were markedly high so initial differential diagnosis included colitis and diverticulitis. Contrast Computed Tomography of the abdomen and pelvis showed an 8.1cm irregular hepatic lesion initially thought to be a multiloculated abscess, malignancy or complex cyst. She was started on broad-spectrum antibiotics, escalated to Intensive Care Unit (ICU) and discussed at the hepato-biliary multi-disciplinary team (MDT) where magnetic resonance images demonstrated a perforated duodenum from a 2.5cm fish bone penetrating from the duodenal wall into the liver parenchyma causing a necrotic abscess. She underwent percutaneous drainage of the hepatic abscess. Endoscopic retrieval was then attempted;however, the fish bone was not visualised. Definitive management followed with laparoscopic removal of the fish bone and primary duodenal repair. Discussion: Identification of the cause of the abscess during MDT discussion enabled prompt source control which was key in managing intra- abdominal sepsis - radiological drainage in the first instance prevented secondary peritonitis from a potentially ruptured abscess and enabled the patient to be de-escalated from ICU. Previous literature suggests endoscopic retrieval however, laparoscopic surgery remains safer for managing complications following removal of sharp foreign bodies.

Loss of an Immunodominant HLA-Α *01:01 Restricted Epitope for CD8+ Cytotoxic T Lymphocytes (CTLs) in the Delta Variant of COVID-19: An Example of Immunologic Escape and Implications for Immunologic Treatment

SARS-COV-2 (COVID-19) has resulted in over 4 million deaths worldwide. While vaccination has decreased mortality, there remains a need for curative therapies for active infections. Uncertainties regarding the duration of post-vaccination immunity and the rapidity of mutational evolution by this virus suggest that it is unwise to rely on preventative measures alone. Humoral and cellular immunity provide selective pressure for the emergence of variant strains which have eliminated target epitopes. Elimination of immunodominant epitopes provides the strongest advantage to newly emerging strains and, consequently, immunodominant epitopes would be expected to be preferentially eliminated compared to subdominant epitopes in emerging variants. Immunologic treatments for SARS-COV-2 need to be continuously reassessed as new sequence information becomes available. TVGN-489 is a clinical grade product consisting of highly enriched, highly potent CD8+ CTLs recognizing peptides derived from COVID-19 gene/ORF products in an HLA restricted manner. CTLs are generated from apheresis products from individuals who have recovered from COVID-19 infections. Lymphocytes are serially primed and selected using APCs from these donors pulsed with small numbers of peptides encoded by the COVID-19 genome predicted or demonstrated to bind to specific HLA class I alleles. The resulting products are typically >95% CD3+/CD8+, >60% positive by tetramer staining and demonstrate strong cytolytic activity with >60% lysis of peptide pulsed targets typically at an effector to target ratio of 3:1 (See Figure). Given the immunologic pressure to lose dominant target epitopes, we assessed whether the peptides derived from genomic sequences from early SARS-COV-2 strains (and successfully used to generate CTLs from donors infected with these early strains) were still present in the more recently evolved Delta variant. Seven peptides were used to generate CTL products restricted by HLA-A*02:01, the most common allele worldwide. These peptides are derived from the spike (S) and nucleocapsid (N) proteins as well as ORF3a and ORF1ab. The contributions of these peptides to the overall cytotoxicity and tetramer staining range from 2% to 18% without clear immunodominance by one of these peptides. Though identified in early viral strains, these sequences persist in 97.5%-100% of the more than 120 Delta variant sequences present in the NIH database. For HLA-A*01:01, eight peptides derived from the matrix (M) protein as well as ORF1ab and ORF3a were utilized to generate CTLs. Seven of the eight peptides showed binding similar to what was seen with the HLA-A*02:01 peptides (1% to 18%). However, in contrast to HLA-A*02:01, an immunodominant peptide (TTDPSFLGRY, ORF1ab 1637-1646) was noted which was responsible for over half of the observed tetramer binding. This region of ORF1ab was mutated in the Delta variant resulting in loss of this immunodominant epitope from nearly 93% of the Delta genomic sequences in the NIH database. The remaining subdominant peptides were all preserved in 100% of the sequences. Given the growing number of Delta cases, it will be essential to remove this peptide from the HLA-A*01:01 peptide pool used to stimulate SARS-COV-2-specific CD8+ CTLs to avoid encouraging the expansion of cells which would recognize early strains of the virus, but not Delta variants. The remaining CTLs, generated in the absence of TTDPSFLGRY, should be capable of eradicating Delta as well as the earlier prototypic strains of COVID-19. The loss of immunodominant epitopes is not surprising in a virus such as SARS-COV-2, with a high frequency of mutation. This provides an example of immunologic escape similar to what has been described for the Delta variant in the case of HLA-A24. These data are consistent with the hypothesis that immunodominant epitopes will be preferentially eliminated as the virus continues to evolve. They further illustrate the need to monitor viral sequences and to tune the production of CTLs in order to ensure that they can continue to recognize and e fectively treat newly emerging variants of COVID-19. [Formula presented] Disclosures: No relevant conflicts of interest to declare. OffLabel Disclosure: The drug is Cytotoxic T lymphocytes that are specific to COVID-19. Preclinical data.