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Intro: It is hypothesized that metagenomics could contribute to the effective sentinel surveillance of emerging infections to identify plausible cause of respiratory symptoms in the population. Method(s): This study forms part of a longitudinal household cohort study involving the collection of respiratory symptoms and vaccination history in Hong Kong. As a pilot, selected households were provided with swab collection kit for collecting nasopharyngeal and throat samples when there was an influenza-like illness (ILI) during a 4-month presumptive period of the year's winter influenza season. Sequence-Independent Single Primer Amplification (SISPA) and nanopore metagenomic sequencing were performed. After basecalling, demultiplexing, and quality filtering, taxonomic classification was done. Unclassified and host reads were removed and only taxon with over 0.1% abundance were included in the analysis. Finding(s): Between December 2021 and April 2022, of 101 collection kits delivered, 36 (36%) participants returned the samples. Two (6%) had previous COVID-19 diagnosis and almost all (97%) received at least one dose of COVID-19 vaccination. Metagenomics sequencing was performed on 13 samples collected from participants when ILI was present. Of the 1,592,219 reads obtained, 5308 taxa were identified and 136 had over 0.1% abundance, including 128 bacteria, 6 fungi, and 1 virus, which was a bacteriophage. The five most abundant genera of bacteria included Neisseria (19%), Streptococcus (10%), Haemophilus (9%), Veillonella (3%), and Rothia (3%). Haemophilus parainfluenzae was the most abundant species with 97,542 (6%) reads, followed by Neisseria meningitides (5%). Other bacteria identified included Rothia mucilaginosa, Acinetobacter baumannii, Lautropia mirabilis, Veillonella atypica, Streptococcus salivarius, and Streptococcus pneumonia. Inter-participant abundance profile was significantly different (p<0.001). Conclusion(s): The absence of viral infections identified echoed the extremely low proportion (3/21986, or 0.01%) of respiratory specimens testing positive for influenza virus by the government laboratory during the same period. The metagenomic profile could be useful for identifying the likely ILI-causing pathogen.Copyright © 2023
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While the HIV/AIDS epidemic has informed the responses to the COVID-19 pandemic, there is a lack of understanding of the empirical links between stigmas associated with COVID-19 and HIV/AIDS. Surveying 247 adults in the United States online, this study aims to examine the relationships between COVID-19 and HIV/AIDS stigmas in order to understand how they are similar and different from each other, taking into consideration the context relevant to the COVID-19 pandemic. Four scales of stigmas conveying different attitudes (i.e., rejection, despise, accusation, and caution) were used to examine the relationships between the stigmas of these two infectious diseases. Findings based on the mean comparisons from paired t tests showed the mean difference in scores between respondents who supported the exclusion of COVID-19-infected individuals versus HIV-infected individuals was statistically significant. In addition, the mean difference in scores between respondents who were wary of their need to protect their rights around COVID-19-infected persons versus HIV-infected persons was statistically significant. Controlling for the respondents' sociodemographics and factors that were relevant to the COVID-19 pandemic, multiple regression analyses showed that all four types of COVID-19 stigmas were positively associated with their corresponding types of HIV/AIDS stigmas. The preliminary findings between COVID-19 and HIV/AIDS stigmas suggested that HIV/AIDS stigma mitigation strategies may present a fruitful approach to inform stigma mitigation of COVID-19. © The Author(s) 2023.
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Background/Introduction: Hyperinflammatory responses to SARS-CoV-2 can cause myocarditis and cardiac dysfunction including congestive heart failure [1]. SARS-CoV-2 RNA induces type I interferon (IFN-I), activating IFN regulatory factors (IRFs) and downstream IFN stimulated genes (ISGs) to initiate inflammatory processes. SARS-CoV-2 variants may develop immune escape, undercutting benefits of vaccinations. These challenges highlight the need of variant-independent therapies to improve COVID-19 outcomes. Apabetalone is an epigenetic BD2-selective BET inhibitor in phase 3 trials for cardiovascular disease [2]. Apabetalone has the potential to treat COVID-19. It counters inflammatory signals caused by cytokine storm (CS), preventing cardiac dysfunction associated with severe COVID-19 symptoms in cardiac organoids [3]. It also downregulates angiotensin-converting enzyme 2 (ACE2) expression, the main host cell receptor for SARS-CoV-2 spike protein thus impeding propagation of wild-type SARS-CoV-2 [3,4]. Purpose: 1) Evaluate apabetalone's effect on inflammatory processes induced by viral-RNA mimetic in human lung cells;2) Assess apabetalone's ability to prevent binding of the highly contagious delta variant spike protein to human lung cells. Methods: Inflammatory gene expression was examined by real-time PCR in apabetalone treated human bronchial epithelial cells (Calu-3) stimulated with poly I:C, a well-accepted viral RNA mimetic that elicits inflammatory signals similar to SARS-CoV-2 RNA [5]. Binding of SARS-CoV-2 delta or wild-type spike protein to apabetalone treated Calu-3 cells was determined by flow cytometry. Results: In Calu-3 cells, apabetalone dose-dependently downregulated poly I:C induced transcription of key COVID-19 associated cytokines (IL6, CXCL10, CCL2) to a similar extent as baricitinib (up to 86%, p<0.0001), an anti-inflammatory agent in emergency use for COVID-19 treatment. Moreover, apabetalone but not baricitinib diminished IL1B mRNA levels (up to 66%, p<0.0001). Apabetalone and baricitinib opposed poly I:C induced expression of IFNB1 (an IFN-I), IRF1 and IRF9 (upstream regulators) as well as IFIT1 and IFIT2 (downstream ISGs that regulate CXCL10 expression;up to 90%, p<0.0001). Clinically relevant doses of apabetalone did not alter expression of anti-viral IFITM2, an ISG that blocks SARS-CoV-2, particularly omicron, endosomal entry [6]. Therefore, apabetalone counters the expression of inflammatory factors with roles in CS and IFN-I signaling in response to poly I:C. Additionally, apabetalone reduced delta and wild-type spike protein binding to unstimulated Calu-3 cells (up to 72%, p<0.0001). Conclusions: Apabetalone's dual anti-viral and anti-inflammatory mechanism positions it as a variant-independent COVID-19 therapeutic. Together with an established safety profile from >2000 treatment-years with apabetalone, the data provide rationale for an ongoing clinical trial (NCT04894266) which includes analysis of cardiac damage. Funding Acknowledgement: Type of funding sources: Private company. Main funding source(s): Resverlogix Corp
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The increasing trend of young tourists today is a global phenomenon due to the influence of social media and new technologies, as in the case of traveler's destination choice and making a purchase decision. Short form video is another new trend such as TikTok, Instagram and Facebook platform which are growing fastest worldwide. Due to the fact that youth tourists are more likely to make purchases based on social media referrals, therefore creating tourism product awareness and its visual impact on social media acts important to capture their attention, especially during this covid-19 pandemic period. This study aims to figure out the perception of youth tourists and visual features on social media that affecting their purchase intention before visiting in a destination. This paper provides significant information for tourism products that can be brought up globally via social media platforms.
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Online learning has been extensively researched, and online educators have a wealth of resources to build upon. However, when the COVID-19 pandemic hit, we were forced to abruptly convert course delivery from face-to-face to online. To make matters worse, this occurred in the middle of the semester, and the majority of us were not prepared - the majority of us had never taught online, nor have we received the required training to do so. This abrupt change also made it challenging for students which, in turn, posed additional challenges for educators, especially in relation to navigating student expectations. Unlike students who sign up for an online course, these students were also caught unaware by the switch, and online learning was new to most of them. We reflect upon this experience, paying special attention to the challenges associated with the discipline of Computer Science as well as those faced by teaching assistants. The COVID-19 pandemic will come to an end, but this change to education will stay with us. Hence, we share the lessons we learned.
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Purpose: A debate emerged among members of public administration academia soon after COVID-19 appeared on the roles and measures that governments ought to deploy to prevent infection. One prevalent discourse is the strength of “strong government” in the fight against the virus—the administrative capacity to launch prompt, appropriate and effective actions that entail collaboration with citizens. A notable development in governance is that new public management (NPM) principles, such as the value of money and the pluralisation of service delivery, are gradually put aside when governments urgently need to curb the spread of infection. The roles of bureaucracy and centralised action are re-emphasised in the policymaking and implementation of anti-epidemic measures. Such a trend allows us to examine if the COVID-19 public health crisis has fundamentally reversed the trend of government retreat in public service within neoliberal regimes since the 1980s. Design/methodology/approach: For this research, the authors selected two “strong governments” in Asia—Hong Kong and Taiwan—by showing how administrators outline their anti-pandemic strategies, examining the role of government in coordinating responses and how bureaucracy interacts with the other two key domains of the governance mechanism: civil society and the market. These two offshore Chinese capitalist economies and pluralistic societies are perceived to have “strong government capacity” in the fight against COVID-19, presumably as a key attribute to their success confining the spread of infection during the early stages of the first outbreak. Both societies reported low infection rates and low mortality rates until September 2020. The authors browsed databases developed by scholars (Cheng et al., 2020;Hale et al., 2020) and referred to two “rubrics” to assess and compare government actions in both places in response to COVID-19. The authors itemised, categorised and counted the policy actions in both places according to the rubrics, noticed that the policy footprint appeared in over two-thirds of indicators of proactive government interventions and identified double-digit counts in nearly half of the categories. Findings: The authors found that both governments attempted to establish strong stewardship and quick measures to contain the infection. The pattern of “strong government” is, however, not the same as that superficially exhibited. Taiwan took limited steps to regulate business activities but proactively intervened and coordinated the supply of hygienic utilities. Hong Kong launched aggressive attempts to reduce human mobility but remained non-active despite the “face mask run” in society. The “strong government” aspect also received divergent reactions from society. There was extensive cross-sectoral collaboration under the centralised “National Team” advocacy in Taiwan, and there has been no record of local infection for over 10 months. The Hong Kong government was repeatedly doubted for its undesirable stewardship in anti-epidemic measures, the effectiveness of policy interventions and the impartiality of law enforcement. Spontaneous actions during the health crisis from civil societies and private markets were noted, but they seemed uncoordinated with official attempts. Originality/value: The initial findings enable us to rethink correlations between state capacity and legitimacy in the fight against the virus and its development post-COVID-19. Apparently, Taiwan and Hong Kong demonstrated a “re-expansion” of their public sector during the public health crisis, but not in the same format. This can be understood based on their varying regime values and administrative systems. The pandemic has been a catalyst, pushing both regimes back to their original track of public administration establishments. The concept of “path dependence” might explain the initial development and project the longer-term transformation of the public sector in both places. © 2022, Emerald Publishing Limited.
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Background/Introduction: SARS-CoV-2 causes life threatening COVID- 19 complications including acute coronary syndrome, venous thromboembolism, hyperinflammation and damage in multiple tissues. The SARSCoV- 2 spike protein binds cell surface receptors including angiotensinconverting enzyme 2 (ACE2) for entry into host cells to initiate infection. Host cell dipeptidyl peptidase-4 (DPP4 / CD26) is implicated as a cofactor in uptake. Recent evidence indicates expression of factors involved in SARS-CoV-2 uptake into host cells is regulated by BET proteins, epigenetic readers modulating gene expression. Apabetalone, the most clinically advanced BET inhibitor (BETi), is in phase 3 trials for cardiovascular disease (CVD) (a, b). In cultured human cardiomyocytes, apabetalone suppressed infection with SARS-CoV-2 and prevented dysfunction of cardiac organoids induced by the cytokine-storm that arises in patients with severe symptoms (c). However, anti-viral properties of apabetalone in other cell types are not known. Purpose: To examine effects of apabetalone on SARS-CoV-2 infection in cell culture via downregulated expression of cell surface receptors involved in viral entry. Cell systems used mimic initial sites of infection in the lung as well as cell types contributing to complications in late stages of infection. Methods: Gene expression was measured by real-time PCR, protein levels by immunoblot or flow cytometry, and binding of recombinant SARSCoV- 2 spike protein by flow cytometry. Infection with SARS-CoV-2 was determined in a BSL3 facility. Infectivity was quantified by determining levels of viral spike protein amongst total cells via imaging on an Operetta CLS. Results: In Calu-3, a human bronchial epithelial cell line, apabetalone dose-dependently downregulated ACE2 gene expression (up to 98%), reduced ACE2 protein levels (up to 84%) and diminished binding of SARSCoV- 2 spike protein (up to 77%, p<0.001 for all parameters). Further, apabetalone abolished infection of Calu-3 cells with live SARS-CoV-2, which was comparable to other antiviral agents. Apabetalone-driven ACE2 downregulation was also observed in extrapulmonary cell types including HepG2, Huh-7 or primary hepatocytes (up to 90%, p<0.001 for all cell types), and Vero E6, a monkey kidney epithelial cell line (up to 38%, p<0.05). DPP4/CD26, a potential cofactor for SARS-CoV-2 uptake, was also downregulated by apabetalone in Calu-3 cells (mRNA ∼65% and protein ∼40%, p<0.001), which may be synergistic with ACE2 reductions to impede SARS-CoV-2 infection. Conclusions: Apabetalone, an investigational drug for CVD, reduced cell surface receptors (ACE2 and DPP4) involved in SARS-CoV-2 uptake into host cells and dramatically attenuated SARS-CoV-2 infection/propagation in vitro. Our results suggest apabetalone can mitigate SARS-CoV-2 replication in multiple organs, which together with an established safety profile supports clinical evaluation of apabetalone to treat.
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Introduction: COVID19 has stressed and stretched healthcare resources to the limit, thus the rational deployment of any resource should be necessary and of patient benefit. This retrospective audit aims to ascertain if a policy of two valid group and save tests prior to transurethral prostate surgery is necessary and if this resource can be redistributed safely during the ongoing pandemic. Methods: A retrospective review of electronic patient records for patients that underwent transurethral prostate surgery from June 2017 to June 2018. During a single admission for surgery it was identified how many pre-operative group and save tests, and if a post-operative blood transfusion patients underwent. Results: 146 patients underwent transurethral prostate surgery between June 2017 to June 2018. 97 patients had two valid group and save tests prior to surgery. 49 patients did not have 2 valid group and save tests. 21 patients had expired tests, 20 had only one valid sample, and 8 had no group and save test at all. No patient underwent a blood transfusion during their admission for transurethral prostate surgery. Conclusion: This single centre study illustrates pre-operative group and save tests before transurethral prostate surgery are unnecessary as no patient required an associated blood transfusion during admission;and can safely be omitted. The clinical time and resource could be redirected elsewhere for greater patient benefit. £2855.00 of efficiency savings could be made foregoing unneeded group and save tests. A policy omitting pre-operative group and save before transurethral prostate surgery will be implemented under COVID19 pandemic conditions and re-audited in 6 months.
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Purpose: Open hernia repair is a common elective and emergency surgical procedure;the majority of which are performed without complication. A primary audit indicated pre-operative group and save could be disregarded without compromising safety. A selective group and save policy was introduced, and safety of this approach examined with a 2nd cycle audit. Methods: Retrospective review of electronic patient records between October 2019 to September 2020. Cross referencing of operative and blood transfusion records performed compared to the primary audit cycle of April 2018 to March 2019. Results: A total of 225 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed during the 2nd cycle compared to 410 in the 1st cycle. Patients were ASA 1-5 including emergencies. The post-operative blood transfusion rate was reduced from 1.46% to 0% following implementation of the selective policy. The number of pre-operative group and saves obtained reduced to 117;saving £6,840.19. Conclusions: This single centre full cycle audit indicates pre-operative group and save tests are unnecessary in open hernia repair. A selective group and save policy introduced for certain patient characteristics such as emergency repair, ASA ≥3 or incisional hernia abdominal wall reconstruction reduced the post-operative blood transfusion rate to 0%. Discontinuing mandatory pre-operative group and save is a safe approach synchronously reducing clinical and financial burden. COVID-19 has stretched already limited resources, resulting in reduced surgical services and diminished case numbers during the 2nd cycle. Therefore, rational resource utilisation with a selective group and save policy maintains patient safety during the pandemic.
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Introduction: The COVID-19 pandemic has caused massive school closures worldwide and many schools were forced to adopt online teaching mode. Purpose: This survey study aims to examine the effectiveness of online teaching in physical education (PE) and support needed from the teachers’ perspective. Methods: Responses from 294 frontline PE teachers were collected via an online survey between 4 and 29 January 2021. Results: Four major findings were highlighted in our study. First, most teachers reported that online PE lessons were not effective to improve motor skill acquisition and physical activity level, the major reasons for which were “lack of practical training”, “students’ lack of learning motivation/interest”, and “limited interpersonal interactions”. Second, most teachers encountered difficulties in online teaching, with major difficulties comprising “limited interpersonal interactions’ and “difficult to retain students’ learning motivation/interest”. Third, most teachers felt that online teaching was stressful due to the increased workload in preparation and safety concerns of the home-exercise programme. Fourth, many teachers suggested that schools or governments should provide online teaching kits, such as suggested online lesson plans or home activity recommendations, for their reference. Conclusions: In summary, the effectiveness of online teaching in PE during COVID-19 school closures was generally perceived to be low and difficult by the frontline PE teachers. Schools and governments should provide sufficient support, such as online teaching kits and concrete teaching guidelines, for PE teachers to develop creative and interactive online lessons, which will in turn benefit students in motor skill acquisition and physical activity level. © JPES.
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Background/AimsAlemtuzumab is an efficacious therapy for relapsing remitting multiplesclerosis (RRMS) preventing neural damage and reducing relapse rateby up to 74%. Administered in 2 treatment cycles 12 months apart andauthorised for use in > 40 countries, it is a humanized monoclonalantibody selectively directed against the CD52 antigen of T- and BLymphocytes. Significant autoimmune effects of Alemtuzumab arereported 6-60 months post-treatment including secondary autoimmunity (40%), thyroid disease (18-26%), idiopathic thrombocytopenicpurpura (1-3%) and anti-glomerular basement membrane disease(1%). There are 2 case reports of haemophagocyticlymphohistiocytosis(HLH) in people with MS triggered byAlemtuzumab. HLH is a clinical syndrome of dysregulated, pathological overactivation of innate immunity leading to cytokinestorm, multi-organ failure and a very high mortality rate. Clinicalfeatures are difficult to distinguish from, and may coexist with, othersyndromes such as sepsis. Recognition requires a high index ofclinical suspicion and management through multidisciplinary teams(MDT) using immune suppression. Early recognition and treatmentimprove outcome.MethodsWe report a case of HLH in a 30-year-old female 1 year after her firstcycle of alemtuzumab (second cycle delayed due to COVID-19pandemic) for treatment of RRMS. She was well until presentation 2days post gadolinium-contrasted routine MRI head scan with headache, fever, bacterial pneumonia/empyema and acute kidney injury.Febrile episodes persisted despite antibiotics.ResultsInvestigations revealed hepatosplenomegaly, pancytopenia(Haemoglobin: 80g/L, WBC: 0.9x109/L, neutrophils: 0.67x109/L, lymphocytes: 0.14 X109/L, platelets: 82x109/L), hypertriglyceridaemia(5.5mmol/L) and hyperferritinaemia (94023ng/ml). She fulfilled theHistiocyte Society HLH-2004 diagnostic criteria for HLH (H-score:238). Initial treatment was IV methylprednisolone (1g) and intravenousimmunoglobulin (IVIG) 2g/kg. Ferritin levels initially decreased(66933ng/ml) but re-escalated (93912ng/ml) with clinical deterioration, necessitating additional treatment with subcutaneous Anakinra 4mg/kg(recombinant interleukin-1 receptor antagonist) alongside oralprednisolone 1mg/kg. There was rapid, sustained improvement withresolution of fever but ferritin levels remained highly elevated(45000ng/ml) and cytopaenia was slow to resolve. Marker T cellsubsets showed significant T cell depression presumably postalemtuzumab. MDT discussion locally and nationally through theHLH Across Speciality Collaboration (HASC) led to discharge withcareful outpatient monitoring. Further IVIG 2g/kg was administeredwhich led to complete resolution of HLH and treatment wean.
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Purpose This paper aims to examine the economic rationale for the COVID-19 wage subsidy and grants related to assets and the accounting for these wealth transfers under NZ IAS 20 Accounting for Government Grants and Disclosure of Government Assistance. The principal contribution is presenting an economics-accounting nexus for government assistance to firms during a pandemic and for the nation's economic development. Design/methodology/approach This is a descriptive study that draws on the economic theory of regulation to understand the rationale for wealth transfers, then examining the accounting for the wealth transfers by analyzing the financial statements of NZX 50 companies that received the wage subsidy and SkyCity and Chorus that received substantial grants to develop and operate the New Zealand International Convention Centre and building a large part of New Zealand's Ultra-Fast Broadband fiber optic network, respectively. Findings First, the 10 NZX 50 companies that received the government's wage subsidy were justified to receive it from the legal, ethical and moral perspectives. However, some non-NZX 50 companies, while legally entitled to the wage subsidy, took advantage of the wealth transfer when they were profitable and paid dividends. This latter group of companies was not seen as behaving ethically and morally. Second, the government granted millions of dollars to SkyCity and Chorus for building critical infrastructures that are economically beneficial for the nation and that are unlikely to attract private investment, and these companies accounted for the grants related to assets in accordance with NZ IAS 20. Research limitations/implications The financial statement impacts of the wage subsidy are based on a subset of NZX 50 companies with available information at the time of writing. However, they do not compromise the external validity of the findings because the wage subsidy applies to all businesses. Similarly, the manner in which SkyCity and Chorus accounted for the grants related to assets would apply equally to any entity that is a recipient of such a grant. Originality/value This paper presents an economic understanding for the existence of government grants and how the accounting mirrors the economic rationale for the "grants related to income" and "grants related to assets." This paper demonstrates the importance of the economics-accounting nexus.
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Background: The Houston Veterans Affairs (VA) Medical Center is one of six VA liver transplant centers and has typically brought patients to Houston for evaluation and follow-up During the coronavirus 2019 (COVID-19) pandemic, VA Video Connect (VVC) - a VA-specific HIPAAcompliant video telehealth portal - was pilot-tested to provide remote and socially-distanced care for transplant patients We assessed VVC implementation by measuring patient and provider satisfaction Methods: Pilot implementation of VVC between March 13 & May 27, 2020 was based on model for improvement and Plan-Do-Study-Act (PDSA) frameworks Patients opted into VVC visits Providers were surveyed on overall satisfaction, technical difficulties, and missed crucial physical exam findings. Patients were surveyed on overall satisfaction, quality of interface, and self-report of time- and money-savings All satisfaction scores were assessed using a 5-point Likert scale (1= least satisfied, 5=most satisfied or 1=very easy, 5=very difficult). Demographic information was obtained via chart review Summary statistics were performed Results: There were 63 VVC liver transplant encounters with 2 providers. Technical difficulties occurred in 33 (53 2%) encounters, with 46 (74 2%) completed using VVC alone (8 1% switched to telephone;6 4% to other video modality) Average (standard deviation) provider satisfaction was 4 0 (1 2) No providers reported management would have changed if in-person physical exam were available Of 20 (32 3%) patients who responded to the telephone survey (95% male;average age 59 years), average patient satisfaction was 4 8 (0 7), quality of interface was 4 1 (1 3), and ease of technical set up was 1 6 (1 4] All patients would do a VVC visit again Overall, respondents lived a median of 219 miles away from the study site and reported a median time saving of 1 75 hours and median money saving of $50 Conclusion: Our pilot implementation demonstrated VVC encounters are feasible and acceptable to liver transplant patients and their providers We found substantial time and money savings for our patients Although this pilot occurred during restrictions of the COVID-19 pandemic, our findings hold promise to continue video visits beyond the pandemic and thus improve access to care for liver transplant patients who live far from transplant centers Notably, technical issues were common Further resources should be directed towards studying and improving video telehealth, especially among older populations.