Pulmonary thromboembolic disease associated with COVID-19 infection: a comparison between geriatric and non-geriatric populations.

INTRODUCTION: The magnitude of Coronavirus Disease 2019 (COVID-19) infection among the elderly population is expected to rise. Our study compares the clinical and computed tomographical (CT) features of pulmonary thromboembolic (PTE) disease associated with COVID-19 infection in geriatric and non-geriatric cases, and explores the 60-day mortality rate in these two groups. MATERIALS AND METHODS: We conducted this retrospective cross-sectional study in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. Patients admitted in April 2021 and May 2021 with concomitant COVID-19 infection and PTE disease were included. Demographic, clinical and laboratory data were retrieved, whilst CTPA images were analysed by a senior radiologist. RESULTS: A total of 150 patients were recruited, comprising 45 geriatric patients and 105 non-geriatric patients. The prevalence rate of hypertension, diabetes mellitus and dyslipidaemia were higher among the geriatric cohort. Evidently, the percentage of patients with fever and diarrhoea were significantly higher among the non-geriatric cohort. The geriatric cohort also recorded a significantly lower absolute lymphocyte count at presentation and albumin level during admission. Despite earlier presentation, the geriatric cohort suffered from more severe diseases. Analysis of the CT features demonstrated that the most proximal pulmonary thrombosis specifically limited to the segmental and subsegmental pulmonary arteries in both cohorts. The elderly suffered from a significantly higher inhospital mortality rate and their cumulative probability of survival was significantly lower. CONCLUSION: Typical COVID-19 symptoms may be absent among the elderly, prompting a lower threshold of suspicion during the COVID-19 pandemic. Additionally, the elderly demonstrated a higher probability of adverse outcomes despite earlier presentation and treatment.

Artificial Intelligence: Poverty Alleviation, Healthcare, Education, and Reduced Inequalities in a Post-COVID World

On October 25, 2015, the General Assembly of the United Nations (UN) set forth an agenda which included 17 Sustainable Development Goals (SDGs) and 169 targets to transform the world by 2030. The agenda set forth a plan of action that recognized a myriad of challenges which, if surmounted, could empower people, benefit the planet, and create an impetus for worldwide prosperity. Due to the coronavirus pandemic and its economic and social fallout, the world today is not on track to attain the SDGs by the year 2030. However, the disruptive impact of the pandemic on many areas of life among other things was in a sense a "game changer” with respect to our (human) approaches to artificial intelligence (AI) and to AI itself. The global pandemic caused a major shift with regard to AI. It revealed that in this day and time AI is a necessity for the flourishing of humanity worldwide. It is no longer a luxury. Developed and developing countries alike were caught unaware by the COVID disruption. All experienced gaps in healthcare and education delivery and increased poverty in one form or another. In this situation, AI turned out to be not merely useful, it quickly proved itself to be indispensable. In a world that is still struggling to recover from the pandemic, AI has and will continue to play a major role in transforming the work of poverty alleviation, hence affecting the advancement of the poverty-related SDGs. The chapter will present examples of AI implementation in areas of the world where poverty is significant: China, India, and two countries in Africa. It will look at rural poverty specifically, although urban poverty is growing at expediential rates, and examine how AI has affected the work of alleviating poverty through improving healthcare delivery and strengthening access to education. The analysis will delve into the advancement of specific SDGs with the use of AI, such as SDG #1 no poverty, SDG #3 good health and well-being, SDG #4 quality education, and SDG #10 reduced inequalities. Finally, this chapter will draw policy implications for the work of fighting extreme poverty in a post-COVID and increasingly AI-enabled world. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Crowding and Liquidity Shocks

The authors develop a model whose aim is to study the relationship between crowding and liquidity shocks. One of the main results of that model is that crowding is associated with a larger exposure to broader liquidity shocks on arbitrageurs. The authors confirm this link empirically by studying equity long–short strategies. They use short interest data both to identify liquidity shocks impacting sophisticated equity investors and to infer crowdedness for some of the well-known long–short equity factors. When liquidity shocks (such as the 2007 quant crisis or the more recent 2020 COVID-19–induced quant deleverage) occur, crowded strategies indeed tend to underperform. Copyright 2022 With Intelligence LLC.

The impact of the covid-19 pandemic on engineering foundation student course experience

This study explored the impact of the COVID-19 pandemic on the academic quality of a foundation in engineering programme. A course experience questionnaire (CEQ) was administered before and during the pandemic to evaluate the six dimensions of academic quality assessment, workload, teaching, academic environment, standards, and skills development. A total of 234 students participated in the study, and the findings revealed that course satisfaction decreased during the pandemic. Many students were not satisfied with the teaching quality and skills development of the emergency online learning. On the contrary, students rated online assessment (during COVID-19) positively for being more appropriate in testing higher order thinking skills. The study suggested that online classes lack formal and informal social interactions to enhance various facets of skills development. Given the limitations of emergency online learning, the future of education might include moving towards blended learning. © 2022 IGI Global. All rights reserved.

Clinical characteristics and computed tomographical features of pulmonary thromboembolic disease associated with COVID-19 infection: A tertiary hospital analysis.

INTRODUCTION: The co-existence of coronavirus disease 2019 (COVID-19) and pulmonary thromboembolic (PTE) disease poses a great clinical challenge. To date, few researches have addressed this important clinical issue among the South-East Asian populations. The objectives of this study were as follow: (1) to describe the clinical characteristics and computed tomographical (CT) features of patients with PTE disease associated with COVID-19 infection and (2) to compare these parameters with those COVID-19 patients without PTE disease. MATERIALS AND METHODS: This cross-sectional study with retrospective record review was conducted in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. We included all hospitalised patients with confirmed COVID-19 infection who had undergone CT pulmonary angiogram (CTPA) examinations for suspected PTE disease between April 2021 and May 2021. Clinical data and laboratory data were extracted by trained data collectors, whilst CT images retrieved were analysed by a senior radiologist. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20. RESULTS: We studied 184 COVID-19 patients who were suspected to have PTE disease. CTPA examinations revealed a total of 150 patients (81.5%) suffered from concomitant PTE disease. Among the PTE cohort, the commonest comorbidities were diabetes mellitus (n=78, 52.0%), hypertension (n=66, 44.0%) and dyslipidaemia (n=25, 16.7%). They were generally more ill than the non-PTE cohort as they reported a significantly higher COVID-19 disease category during CTPA examination with p=0.042. Expectedly, their length of both intensive care unit stays (median number of days 8 vs. 3; p=0.021) and hospital stays (median number of days 14.5 vs. 12; p=0.006) were significantly longer. Intriguingly, almost all the subjects had received either therapeutic anticoagulation or thromboprophylactic therapy prior to CTPA examination (n=173, 94.0%). Besides, laboratory data analysis identified a significantly higher peak C-reactive protein (median 124.1 vs. 82.1; p=0.027) and ferritin levels (median 1469 vs. 1229; p=0.024) among them. Evaluation of CT features showed that COVID-19 pneumonia pattern (p<0.001) and pulmonary angiopathy (p<0.001) were significantly more profound among the PTE cohort. To note, the most proximal pulmonary thrombosis was located in the segmental (n=3, 2.0%) and subsegmental pulmonary arteries (n=147, 98.0%). Also, the thrombosis predominantly occurred in bilateral lungs with multilobar involvement (n=95, 63.3%). CONCLUSION: Overall, PTE disease remains prevalent among COVID-19 patients despite timely administration of thromboprophylactic therapy. The presence of hyperinflammatory activities, unique thrombotic locations as well as concurrent pulmonary parenchyma and vasculature aberrations in our PTE cohort implicate immunothrombosis as the principal mechanism of this novel phenomenon. We strongly recommend future researchers to elucidate this important clinical disease among our post- COVID vaccination populations.

How Partial Anonymity May Reduce Students' Anxiety During Remote Active Learning─A Case Study Using Clubhouse

Active learning, a common practice in higher education, has been shown to promote higher order thinking and skills. Class discussions have been chosen to be the medium to incorporate active learning in schools‘ curriculum. However, the rate of class participation could be low for certain courses. Literature has shown that the fear of negative evaluation from peers is the most common reason as to why students choose not to partake in class discussions. Anonymity via clickers or applications such as Kahoot! has shown to be useful in reducing students' anxiety and increasing class participations. However, this is not a viable method to employ if vocal discussion is required for the course. Here, partial anonymity (voice only), Speak Your Mind, was applied into an environmental chemistry course with 20 students in the National University of Singapore (NUS) to study its correlation with students‘ anxiety and class participation. Participants survey results suggested that a reason for not participating in class discussions was the fear of being judged by their peers. Remote learning was conducted due to COVID-19 and partial anonymity was obtained by a proxy application: Clubhouse. This application allowed students to partake in a podium discussion while maintaining psychological safety via partial anonymity. Participants survey responses indicated that partial anonymity reduced their anxiety (Cohen's d = 0.58) and slightly increased their self-reported class participation rate (Cohen's d = 0.21);it was noted that partial anonymity did not have much effect on their fears of being judged if they provided the wrong answer (Cohen's d = 0.11). © 2023 American Chemical Society and Division of Chemical Education, Inc.

Applying Clustering and Association Rules on attracting tourists to the South Central Area post Covid-19 pandemic in Vietnam

Covid-19 has caused a plummet in the number of tourists visiting to the South Central of Vietnam and driven changes in their traveling behaviors. This has formed challenging barriers over the operations of entities in the tourism industry. The purpose of this paper is supporting the tourism organizations to attract domestic and foreign visitors to the South Central of Vietnam post the pandemic. The research uses the secondary data collected by Vitours company - a leading travel agency in South Central - to demonstrate tourists' demands when visiting destinations in the area between September 2020 and April 2021. Data mining, clustering and association rules techniques are also applied to classify traveler's segmentations and analyze the connections among these groups. The findings of this research indicates 4 clusters of tourists and 6 association rules, which contributes to the stimulus of the tourism industry in South Central after Covid-19. © 2022 ACM.

POST-MRNA VACCINE FLARES in AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES: INTERIM RESULTS from the CORONAVIRUS NATIONAL VACCINE REGISTRY for IMMUNE DISEASES SINGAPORE (CONVIN-SING)

Background: Published data suggest no increased rate of fare of autoimmune infammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination;however, the studies are limited by small sample size, short follow up or at risk of selection bias (voluntary physician reports or patient surveys). Objectives: To study fares of AIIRD within three months of the frst dose of an anti-SARS-COV2 mRNA vaccine. Methods: A retrospective cohort study of consecutive AIIRD patients ≥ 12 years old, across six public hospitals in Singapore who received at least one dose of an mRNA (Pfzer/BioNTech or Moderna) vaccine. Data were censored at the frst post-vaccine clinic visit when the patient had fared or if ≥ three months had elapsed since the frst dose of the vaccine, whichever came frst. Predictors of fare were determined by Cox proportional hazards analysis and time to fare was examined using a Nelson Aalen cumulative hazard estimate (Figure 1). Results: 2339 patients (74% Chinese, 72% female) of median (IQR) age 64 (53, 71) years were included in the interim analysis (Table 1). 2112 (90%) had the Pfzer/BioNTech vaccine and 195 (8%) had Moderna, with a median (IQR) interval of 21 (21, 23) days between the two doses. The most common AIIRD diagnoses were Rheumatoid arthritis (1063, 45%), Psoriatic arthritis (296, 12.6%) and Systemic lupus erythematosus (SLE) (288, 12.3%). 186 (8%) were treated with biologics/targeted disease modifying agents. 2125 (91%) patients were in low disease activity or remission. Treatment was interrupted for vaccination in only 18 (0.8%) patients. Seven (0.3%) patients had previous COVID-19 infection. 452 (19%) fares were recorded during 9798.8 patient-months [4.6/100 patient-months, median (IQR) follow up duration 4.2 (3.3, 5.3) months], of which 272 (11.6%) patients fared within the 3-month period of interest and 180 (7.7%) fared outside of the 3-month period (Table 1). Median (IQR) time-to-fare was 40.5 (18, 56.6) days. 60 (22.1%) were mild and self-limiting, 170 (62.5%) were mild-moderate and 42 (15.4%) were severe. 190 (69.8%) of those who fared required escalation of treatment and 15 (5.5%) required hospital admission. 239 (10.2%) had improved disease activity after the vaccine. On multivariate Cox regression analysis, patients in the oldest age tertile [median (IQR) 74 (71, 79) years] were less likely to fare [HR 0.80 (95% CI 0.63, 1.00), p = 0.05] Patients with infammatory arthritis (compared with connective tissue disease, vasculitis and others) and patients with baseline active disease were more likely to fare [HR 1.72 (95% CI 1.35, 2.20), p < 0.001 and 1.82 (95% CI 1.39, 2.39), p < 0.001 respectively] Conclusion: There was a moderately high rate of AIIRD fares after mRNA vaccination;however, there was no clustering of fares in the immediate post-vaccine period to suggest causality. Older patients were less likely to fare, while those with infammatory arthritis and active disease at baseline were more likely to fare.

Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in uncomplicated COVID-19 survivors

5COVID-19 is a multi-systemic infectious disease. Nearly 20-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, not much is known about the long-term cardiac effects of the disease. Also, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. In this study, we aimed to investigate the long-term cardiac effects in patients with prior mild-moderate COVID-19 infection, using both conventional and speckle tracking echocardiographic imaging modalities. A total number of 58 patients who have been diagnosed with COVID-19 within the previous six months and 20 age-, sex- and risk factormatched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and twodimensional speckle tracking echocardiographic measurements were done. Also, serum cardiac biomarkers were obtained on the day of echocardiographic examination. Compared with healthy controls, COVID-19 survivors had similar left and right ventricular systolic function at six months. Also, left and right atrial peak systolic strain values did not differ between the groups. Long-term cardiac sequelae of COVID-19 infection are still widely unknown, resulting in concern among survivors. This study is valuable in putting forth the unaffected systolic and diastolic myocardial function on long-term in uncomplicated COVID-19 cases and may decrease the survivors' anxiety and the number of unnecessary applications to cardiology clinics.

Knowledge, Skills, and Attitudes of Faculty Members and Residents-in-Training of the Department of Rehabilitation Medicine of the Philippine General Hospital towards Virtual Learning: A Cross-sectional Study

Background and Objectives. Virtual learning has been utilized in residency programs to continue training amid the COVID-19 pandemic. This study aimed to determine the knowledge, skills, and attitudes of faculty members and residents of the Department of Rehabilitation Medicine of the Philippine General Hospital towards virtual learning. Method. This is a descriptive cross-sectional study. Respectively, residents and faculty members answered the Online Learning Readiness Scale (OLRS) and Faculty Readiness to Teach Online (FRTO) through Google Forms. Results. Twenty (20) residents and 19 faculty members participated in the study. The majority of the residents preferred asynchronous learning (50%), while faculty members preferred the hybrid mode (74%). Residents’ readiness for online learning was generally high, though problems with easy distractibility (60%) and time management (40%) were revealed. Female residents had higher online communication self-efficacy compared to males (p = 0.0367). Faculty members’ perceived attitude was significantly higher than ability in course design (p = 0.00102), time management (p = 0.00159), and technical competence (p < 0.0001). Males had higher perceived ability in course design (p = 0.0320). Older age groups had lower perceived abilities in course design (p = 0.0301) and technical competence (p = 0.0371). Conclusion. This study revealed the levels of readiness of residents and faculty for virtual learning. Findings indicate the need to address both issues by developing programs to enhance faculty’s online teaching abilities and observing best practices to minimize problems such as distractibility. Large-scale studies with longer time frames are also recommended. © 2022 University of the Philippines Manila. All rights reserved.

Decrease in Invasive Pneumococcal Disease in 7 United States Children's Hospitals during the COVID-19 Pandemic

Background. During the 2020 SARS-CoV-2 pandemic, physical distancing and mask use guidelines were implemented resulting in a decline in the number of infections caused by influenza, respiratory syncytial virus and otitis media. A surveillance analysis from England and Taiwan showed a decline in invasive pneumococcal disease (IPD) (Clin Infect Dis. 2021;72: e65-75 and J Infect. 2021;82:296-297). We hypothesized that COVID mitigation efforts resulted in a decrease in incidence of pediatric IPD within the U.S. during 2020 compared to previous years. Methods. We reviewed all cases of IPD among 7 children's hospitals from the U.S. Pediatric Multicenter Pneumococcal Surveillance Group from 2017-2020. IPD was defined by the isolation of Streptococcus pneumoniae from normally sterile sites (eg. blood, cerebrospinal, pleural, synovial or peritoneal fluid). Pneumococcal pneumonia was defined as an abnormal chest radiograph in the presence of a positive blood, pleural fluid or lung culture. Mastoiditis was identified by positive middle ear, subperiosteal abscess or mastoid bone culture. Serotypes were determined by the capsular swelling method. Hospital admission numbers were obtained for incidence calculations. Statistical analyses were performed using STATA11. A p< 0.05 was considered significant. Results. A total of 410 IPD cases were identified. The cumulative incidence of IPD (0-22 years of age) decreased from 99.2/100,000 admissions in 2017-2019 to 53.8/100,000 admissions in 2020 (risk ratio 0.54, CI: 0.40-0.72, p< 0.00001). Pneumococcal bacteremia and pneumonia decreased significantly in 2020 (p< 0.05), and although not statistically significant, there were fewer cases of meningitis and mastoiditis when compared to previous years (p=0.08) (Figure 1). Sex, race, age or presence of comorbidities were not significantly different between groups. Most common serotypes in 2020 were 35B, 3 and 15B/C (Figure 2). Conclusion. The observed decline in IPD cases during the first year of the SARSCoV-2 pandemic is likely associated with mask use and physical distancing limiting transmission of S. pneumoniae via droplets and viral infections frequently preceding IPD. These precautions might be useful in the future to decrease IPD, especially in high-risk patients.

Kinetics of immune responses to SARS-CoV-2 proteins in individuals with varying severity of infection and following a single dose of the AZD1222.

To characterize the IgG and IgA responses to different SARS-CoV-2 proteins, we investigated the antibody responses to SARS-CoV-2 following natural infection and following a single dose of AZD1222 (Covishield), in Sri Lankan individuals. The IgG and IgA responses were assessed to S1, S2, RBD, and N proteins in patients at 4 weeks and 12 weeks since the onset of illness or following vaccination. Antibodies to the receptor-binding domain of SARS-CoV-2 wild type (WT), α, ß, and λ and ACE2 (Angiotensin Converting Enzyme 2) receptor blocking antibodies were also assessed in these cohorts. For those with mild illness and in vaccines, the IgG responses to S1, S2, RBD, and N protein increased from 4 weeks to 12 weeks, while it remained unchanged in those with moderate/severe illness. In the vaccines, IgG antibodies to the S2 subunit had the highest significant rise (P < 0.0001). Vaccines had several-fold lower IgA antibodies to all the SARS-CoV-2 proteins tested than those with natural infection. At 12 weeks, the haemagglutination test (HAT) titres were significantly lower to the α in vaccines and significantly lower in those with mild illness and in vaccines to ß and for λ. No such difference was seen in those with moderate/severe illness. Vaccines had significantly less IgA to SARS-CoV-2, but comparable IgG responses those with natural infection. However, following a single dose vaccines had reduced antibody levels to the VOCs, which further declined with time, suggesting the need to reduce the gap between the two doses, in countries experiencing outbreaks due to VOCs.

Kinetics of immune responses to SARS-CoV-2 proteins in individuals with varying severity of infection and following a single dose of the AZD1222

To characterize the IgG and IgA responses to different SARS-CoV-2 proteins, we investigated the antibody responses to SARS-CoV-2 following natural infection and following a single dose of AZD1222(Covishield), in Sri Lankan individuals. The IgG and IgA responses were assessed to S1, S2, RBD and N proteins in patients at 4 weeks and 12 weeks since onset of illness or following vaccination. Antibodies to the receptor binding domain of SARS-CoV-2 wild type (WT), alpha, beta and delta and ACE2 (Angiotensin Converting Enzyme 2) receptor blocking antibodies were also assessed in these cohorts. Those with mild illness and in vaccinees, the IgG responses to S1, S2, RBD and N protein increased from 4 weeks to 12 weeks, while it remained unchanged in those with moderate/severe illness. In the vaccinees, IgG antibodies to the S2 subunit had the highest significant rise(p<0.0001). Vaccinees had several fold lower IgA antibodies to all the SARS-CoV-2 proteins tested than those with natural infection. At 12 weeks, the Haemagglutination test (HAT) titres were significantly lower to the alpha in vaccinees and significantly lower in those with mild illness and in vaccinees to beta and for delta. No such difference was seen in those with moderate/severe illness. Vaccinees had significantly less IgA to SARS-CoV-2, but comparable IgG responses those with natural infection. However, following a single dose vaccinees had reduced antibody levels to the VOCs, which further declined with time, suggesting the need to reduce the gap between the two doses, in countries experiencing outbreaks due to VOCs.

Role of the Built Environment in the Recovery From COVID-19: Evidence From a GIS-Based Natural Experiment on the City Blocks in Wuhan, China

The built environment closely relates to the development of COVID-19 and post-disaster recovery. Nevertheless, few studies examine its impacts on the recovery stage and corresponding urban development strategies. This study examines the built environment's role in Wuhan's recovery at the city block level through a natural experiment. We first aggregated eight built environmental characteristics (BECs) of 192 city blocks from the perspectives of density, infrastructure supply, and socioeconomic environment;then, the BECs were associated with the recovery rates at the same city blocks, based on the public "COVID-19-free" reports of about 7,100 communities over the recovery stages. The results showed that three BECs, i.e., "number of nearby designated hospitals," "green ratio," and "housing price" had significant associations with Wuhan's recovery when the strict control measures were implemented. At the first time of reporting, more significant associations were also found with "average building age," "neighborhood facility development level," and "facility management level." In contrast, no associations were found for "controlled residential land-use intensity" and "plot ratio" throughout the stages. The findings from Wuhan's recovery pinpointing evidence with implications in future smart and resilient urban development are as follows: the accessibility of hospitals should be comprehensive in general;and the average housing price of a city block can reflect its post-disaster recoverability compared to that of the other blocks.