State Estimation and Synchronization

This chapter is dedicated to the estimation problem as an alternative to the system synchronization problem. A class of estimators and their application to real-world problems is given, such as the case of the COVID-19 pandemic described by an epidemiological model. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Association of Hemoperfusion Disease Progression among Patients with Severe-to-Critical Covid-19

Introduction: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) which can lead to respiratory failure, acute respiratory distress syndrome (ARDS), pneumonia, and sepsis1. The symptoms of severe COVID-19 usually occur after a few days when viral replication is decreasing and excessive inflammation in the lung alveoli are present. Subsequently, excessive inflammation led to abnormalities in gas exchange, abnormalities in ventilation, and abnormalities in blood perfusion in the lungs2. Severe disease also has the characteristics present in Cytokine Release Syndrome (CRS) such as high fever, and elevated levels of ferritin and C-reactive protein2. Hemoperfusion has been offered to patients with severe COVID-19 who continue to have disease progression and increased inflammatory markers despite maximizing medical therapy. Our main objective is to determine the association of hemoperfusion with the development of disease progression among patients with at least severe COVID-19 in Asian Hospital and Medical Center from March 2020 to March 2021. Method(s): This is a retrospective cohort of patients aged-19 and older with a diagnosis of at least severe COVID-19 who were grouped according to whether they received hemoperfusion or not. These patients were monitored throughout their hospital course for the development of disease progression (i.e., mortality or need for mechanical ventilation). Multivariate analysis was used to determine the association of hemoperfusion with disease progression. Result(s): A total of 267 patients were included in the study, 128 (47.9%) underwent hemoperfusion, and 139 (52.1%) did not. Those who underwent hemoperfusion were older, had more co-morbidities (hypertension, diabetes, and chronic kidney disease), and had more severe disease. Disease progression occurred in 127 patients (47.5%), which was higher in those who underwent hemoperfusion (94 patients). On multivariate analysis, hemoperfusion was significantly associated with the need for intubation (RR 11.94, CI 5.3-26.8;p<0.0001), in-hospital mortality (RR 4.56, CI 2.2-9.4, p<0.0001), and the composite of disease progression (RR 7.44, CI 3.9-14.2, p<0.0001). Thrombocytopenia and hypocalcemia were also significantly more common among those who received hemoperfusion (p<0.0001). [Formula presented] [Formula presented] Conclusion(s): Our cohort showed that hemoperfusion was associated with the development of disease progression and more adverse events. However, those who received hemoperfusion had more co-morbidities and had more severe disease at the onset, which may explain our findings. Based on this study, hemoperfusion could not be recommended in the routine management of patients with at least severe COVID-19;however, a randomized controlled trial is highly recommended to verify our findings. No conflict of interestCopyright © 2023

Antithrombin Iii (At3) in Covid-19: A Pilot Study Defining At3 Levels and Safety of Exogenous At3

INTRODUCTION: COVID pathogenesis involves a dysregulated inflammatory state and coagulopathy. Affected patients are at risk for thrombosis and bleeding as well as cytokine storming. Antithrombin 3 (AT3) has antiinflammatory and anti-coagulant properties but its role in COVID is unknown. The incidence of AT3 deficiency (< 80% activity) in COVID is unknown. We hypothesize that AT3 supplementation is safe in patients with COVID and AT3 deficiency. METHOD(S): Prospective randomized control trial of COVID, IRB approved at 2 centers from July 2021 to March 2022. Those with plasma AT3< 100% were randomized to either standard of care (SOC) or SOC+AT3 q48hr weight-based for a goal of 120% for up to 5 doses. An additional group with AT3>100% received SOC. Data are compared using ANOVA and Fisher's exact test. Enrollment was concluded early due to reduced COVID cases and reduced length of stay. RESULT(S): In 531 subjects assessed for eligibility, 324 did not meet inclusion criteria, 151 did not consent, 4 withdrew consent, and 52 subjects completed the study. Enrollment AT3 (M+/-SD) was 96+/-12%. AT3 levels were < 100% in 40 (77%) and < 80% in 11(21%). SOC+AT3, SOC only, and AT3>100% had a Disseminated Intravascular Coagulation (DIC) score change (M+/-SD) of 0.4+/-1.5, -0.13+/-1.85 and 0+/-1.2, respectively, (p=0.63). Hospital length of stay was 13.9+/-14.9, 9.1+/-8.4, and 13+/-0.5 days respectively, (p=0.39). Mortality occurred in 2 (10%), 3 (15%), and 3 (25%), respectively, (p=0.56). There was 1 bleeding event in a subject with AT3>100% and no bleeding events were observed with exogenous AT3. There were no observed drug-related adverse events. Of the 18 subjects assigned to receive AT3, 15 received a median of 2 doses (IQR 2) for a total of 38 doses with a median dose of 1825.5 IU (IQR 794). CONCLUSION(S): COVID is associated with a relative AT3 deficiency and was observed in 21% of this cohort with reports of .02% to .2% in the general population. Exogenous AT3 supplementation was safe with no bleeding complications or drug-related adverse events. There was no significant change in outcomes, likely due to under-dosing and sample size. Further studies should evaluate higher doses of exogenous AT3 and focus on higher risk groups.

Tourism Development Policy and the Use of Scenario Analysis: A synthesis model

COVID-19's pandemic made us learn to live with a renewed sense of limits and a new level of uncertainty. One of the governance responses that emerged from this panorama was the shift to scenario analysis, which generates narratives about multiple future possibilities. This paper attempts to answer the question of why and how to use scenario analysis when defining tourism development policy. In this study, a semi-systematic investigation is conducted to broaden the scope of discussion and explore new paths associated with the topic of tourism development policy. It is believed that the use of scenarios in tourism development policy can prove to be a valuable experimental technique for developing innovative ideas. With that end, this paper proposes a scenario development process model for policy and decision makers. As in any exploratory study, there are limitations, including the difficulty to generalising certain assumptions.

Sustainable Tourism in Natural Territories that Have Suffered from Catastrophes: The Perception of Public and Private Stakeholders of the Alva Great Route

This study analyses the current meaning of the sustainable tourism model, especially for natural and rural areas, with the aim of understanding the new development scenarios in a post-COVID-19 era. The interpretation of the value of water and landscape for tourism and leisure is our main motivation for studying the different types of resources associated with the Alva River in the central region of Portugal. This region has been recently affected by two catastrophes that affect the tourist attraction, first the large forest fires in 2017 and then the pandemic calamity of COVID-19 that still affects tourism worldwide. The objective of this study is to interpret the tourism potential and the appropriate development model for this region, which leads us to evaluate the model of sustainability and competitiveness of this area with low population density. Considering the impact of these disruptive events, both regional and global, it is important to understand what are the associated threats and ultimately the opportunities. The methodology adopted for this exploratory study is essentially quantitative, and, in addition to the literature and secondary data review, questionnaires were sent to the main public and private stakeholders of the municipality of Oliveira do Hospital to obtain responses to the objectives of the study and to understand their opinions and expectations regarding the recent creation of the Alva Great Route (AGR). The main results indicate that new and innovative actions are needed to better articulate the development of tourism in the region, the majority of whose tourist situation is considered adequate or negative. In fact, there is a great lack of knowledge in the region itself about the existence and purpose of the AGR. However, those who know about this route consider it very important and agree on the strategy to be followed, which is an integrated management structure at the level of all the municipalities along the Alva River. The sustainability of this area, whose main attributes are the landscape/nature and the river, and which is therefore very vulnerable to disasters, requires a model of shared management between public and private entities. Their involvement in a network performance is important both for the planning and development of the tourist offer and for the promotion and communication with the tourist demand. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Flipping the model: A novel approach to expand access and increase capture of ovarian cancer patients for genetic testing

Background Genetic testing for ovarian cancer patients is essential to consideration of PARP inhibitor therapy. To improve access, we piloted a Genetic Testing Station (GTS) which allowed patients to have a drop-in, same-day genetic testing visit facilitated by Genetic Counselor Assistants (GCAs) under the supervision of Genetic Counselors (GCs). Methods The GTS was implemented in December 2018 and operated through February 2020. Gynecologic Oncologist offered ovarian cancer patients a same-day GTS visit with a GCA, where the patient received education via videos designed by GCs. The patient also provided consent, a brief family history, and a sample for a standardized 133-gene panel. Results were provided by a telehealth or clinic visit with a GC. We compared uptake of genetic testing post-GTS, and also time from referral to delivery of testing results. Patients were retrospectively identified by querying the medical record for ovarian cancer patients seen 12 months prior to and 18 months after GTS implementation. Results A total of 482 patients pre-GTS were compared to 625 patients post-GTS. Genetic testing increased from 68.5% to 75.66665% (p = 0.012) after implementation of the GTS, with the majority of the increase in patients with epithelial histologies (80% vs 89% in pre-GTS vs post-GTS, p = 0.005). Time from referral to genetic testing to obtaining results was evaluated in the post-GTS cohort, comparing patients who had traditional counseling to those who utilized the GTS. The time to obtaining results was shorter in the GTS group at 21 days (95% CI [10, 34]) compared to 56 days (95% CI [41,76]) in the traditional genetic counseling group. Discussion The GTS reduces barriers to care and facilitates discussion of precision treatment and prevention strategies with patients and their families in a timely fashion while optimizing Genetic Counselor clinic time. Post-COVID, access improvement remains integral to improving uptake of genetic testing.

Addressing Barriers to Immunization Against Acute Respiratory Infectious: A Qualitative Synthesis

RATIONALE: The COVID-19 pandemic highlighted the need for population adherence to recommended prevention and control measures for acute respiratory infections. This study aims to summarize and evaluate the evidence on barriers for populational adherence to vaccine to prevent acute respiratory infections. METHODS: A qualitative evidence synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols statement and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. An electronic search was performed in three databases (MEDLINE [Ovid], Embase [Ovid], and PsycINFO) from their inception to the present. We included studies published in Portuguese, English and Spanish that used both qualitative data collection and analysis methods. We also included studies that used mixed methods, when used qualitative methods of analysis. Risk of bias of the included studies was assessed using the Critical Skills Appraisal Programme (CASP). The certainty of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research (GRADECERQual) approach. The best-fit framework approach was followed as the strategy for data analysis and synthesis. Data were synthesized using adapted dimensions from the 'The Health Belief Model' (HBM) and the 'Behaviour Change Wheel' (BCW). RESULTS: Thirteen studies were included. The studies were related to influenza, H1N1, invasive pneumococcal disease, pertussis, and other acute respiratory infections. Most studies were assessed as having appropriate methological rigour. Regarding the confidence in the evidence of the thirteen findings, identified from the thirteen included studies, four were we graded four as high confidence certainty of evidence, four as moderate, three as low and two as very low certainty of evidence. The findings were presented within the six identified themes of the being two of the HBM model (perceived susceptibility and perceived barriers) and four of the COM-B model (social opportunity, automatic motivation, psychological capability and reflective motivation). CONCLUSIONS: Several factors can be considered barriers to implementing adequate populational adherence to immunization against respiratory infectious diseases: misperceptions on vaccination costs, lack of knowledge about the disease and its severity, lack of personal and environmental susceptibility, general misperceptions about vaccines (including their production, testing, and distribution protocols) and vaccine availability. In addition, other cultural and personal backgrounds can also be considered a leading cause: fear, lack of public awareness, inconvenience to take vaccination, unfortunate experiences in the past, and other misperceptions about efficacy, risks, side effects, among others.

Entrepreneurial resilience and market turbulence in SMEs: Perspectives from the COVID-19 pandemic context

Entrepreneurial resilience is a recent topic and is widespread in scientific research, especially when associated with periods of instability and crises. This chapter aims to analyze the relationship between the variables open-mindedness (OM), entrepreneurial resilience (ER), market turbulence (MT), and overall performance (OP) in SMEs located in the legal amazon. Data collection coincided with the pandemic of COVID-19, with 384 SME managers participating. The sample was analyzed using structural equation modeling (SEM). The results suggest mediation of the variable ER on the relationship between OM and OP, and moderation of the variable MT on OM and ER. The research's originality is attested by the model's empirical relationships, research context, and adverse scenario provided by the COVID-I9 expansion. The practical implications indicate that managers should pay more attention to the variables investigated through the creation of new skills and competencies necessary for entrepreneurial activity in periods of economic crisis and market turbulence. © 2021 by IGI Global. All rights reserved.

Academic Performance of Micro-Entrepreneurs in Business Training Programs: Evidence from the Application of an i4.0 Educational System During the COVID-19 Pandemic

There is limited information on the academic performance obtained by teaching through an i4.0 educational system. Therefore, this article aims to close the gap by presenting the existing literature and the quantitative results obtained from the evaluations and surveys made to micro-entrepreneurs with little knowledge ofdigital technologies, and in many cases with different levels of education, who have been trained during theCOVID-19 pandemic, between August and December 2020. The business training program used an i4.0 educational system based on IoT, the cloud, social networks and web services. Theresultsshowedthat the participants achieved a satisfactory academic performance and met the objectives of the training programin business-related topics. Likewise, the results established that the academic performance of the student in a business training program through an i4.0 system is not directly related to the student's previous educational level. © Faculty of Mechanical Engineering, Belgrade. All rights reserved

A new quantile regression for the COVID-19 mortality rates in the United States

An outbreak of coronavirus disease 2019 (COVID-19) has quickly spread worldwide from December 2019, thus characterizing a pandemic. Until August 2020, the United States of America (U.S.) accounted for almost one-fourth of the total deaths by coronavirus. In this paper, a new regression is constructed to identify the variables that affected the first-wave COVID-19 mortality rates in the U.S. states. The mortality rates in these states are computed by considering the total of deaths recorded on 30, 90, and 180 days from the 10th recorded case. The proposed regression is compared to the Kumaraswamy and unit-Weibull regressions, which are useful in modeling proportional data. It provides the best goodness-of-fit measures for the mortality rates and explains 76.57% of its variability. The population density, Gini coefficient, hospital beds, and smoking rate explain the median of the COVID-19 mortality rates in these states. We believe that this article's results reveal important points to face pandemic threats by the State Health Departments in the U.S.

DID WE NEED THOSE ANTIBIOTICS? OUTCOMES OF PATIENTS WITH COVID-19 TREATED FOR BACTERIAL SUPERINFECTION OF THE LUNGS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The COVID-19 pandemic has affected over half a billion people worldwide. Series report that up to 75% of hospitalized patients with COVID-19 receive broad-spectrum antibiotics;however, the incidence of bacterial coinfection is consistently reported to be low. The diagnosis of bacterial superinfection of the lungs (BSL) is clinical, which presents the possibility of overdiagnosis and overutilization of antibiotics. The aim of this study was to describe the outcomes of patients who were treated for a bacterial superinfection of the lungs (BSL) compared to those who were not. METHODS: We conducted a retrospective chart review of all consecutive patients with a diagnosis of COVID-19 hospitalized at our center. We defined BSL as a documented episode of pneumonia treated with antibiotics. We collected information on demographics, comorbidities, and microbiological markers. We compared patients with and without a diagnosis of BSL in terms of intensive care unit (ICU) stay, intubation, length on mechanical ventilation, length of hospital stay (LOS) and 7-day and 30-day mortality. RESULTS: Five hundred eighty-two patients had a diagnosis of COVID-19, of which 105 had BSL. Patients with BSL were older compared to those without BSL (mean age 74 vs 70 years) and more likely to be male (57% vs 47%), but they were similar in proportion of White patients (64 vs 63.6) and Charlson comorbidity index (5 vs 4). Patients with BSL had a higher likelihood of admission to the ICU (63% vs 19%) and higher intubation rates (31% vs 9%). BSL patients had longer mechanical ventilation (9 vs 3 days) and greater length of stay (13 vs 7). Only 17 BSL patients had sputum cultures, of which 10 were positive. None of the BSL patients had a positive Legionella urinary antigen or Streptococcus pneumoniae urinary antigen, and only 6/57 (10.5%) had a positive MRSA nasal screen. Seven-day and 30-day mortality were not statistically different between BSL and non-BSL patients (p=0.18, p=0.65 respectively). Interestingly, Cox proportional hazard analysis adjusted for age, sex, race, CCI and ICU stay yielded a significantly reduced mortality at 7 and 30-day among BSL patients (HR=0.2 CI [.1-0.7], p=.0106, HR=0.5 [CI.3-0.8], p=0.0101, respectively). CONCLUSIONS: Patients with BSL received more intense supportive care, and had a longer ICU stay, yet did not have a greater mortality. When adjusting for age, sex, race, CCI and ICU, there was a significant reduction in mortality. It is tempting to interpret these finding as an effect of antibiotics;however, we did not record COVID-19-specific treatments such as steroids, tocilizumab and remdesivir. It is likely that the BSL patients received more steroids, which have been associated with reduced mortality. In our population, microbiological testing was performed in a minority of patients, and it was therefore not a reliable marker of true infection. It is possible that many patients in the BSL group did not truly have a bacterial infection. CLINICAL IMPLICATIONS: Patients with a diagnosis of BSL were sicker, but we observed no difference in unadjusted mortality. Studies on the outcomes of the BSL among COVID-19 patients should account for the effect of concurrent COVID-19 specific therapy. DISCLOSURES: No relevant relationships by Abdelrhman Abo-zed, source=Web Response No relevant relationships by Abasin Amanzai, source=Web Response No relevant relationships by Ricardo Arbulu Guerra, source=Web Response No relevant relationships by NIRZARI PANDYA, source=Web Response No relevant relationships by Morgan Stalder, source=Web Response No relevant relationships by Rosalie Traficante, source=Web Response No relevant relationships by Mohamed Yassin, source=Web Response

The covid-19 pandemic as a world catastrophe: Human rights crisis and application of the principle of solidarity

Objective: The objective of this article is to analyze the pandemic of the coronavirus as a global catastrophe, as well as the fact that its effects are more serious on people in vulnerable situations, indicating the existence of a real human rights crisis. As a global problem, its confrontation requires the adoption of joint and coordinated measures by the States, applying the principle of solidarity. Methodology: The hypothetical-deductive method is used in this research, since it is based on the assumption that more vulnerable groups are more susceptible to the violation of rights caused by the pandemic. Results: This research has shown that Brazil is experiencing a human rights crisis due to the impact of the COVID-19 catastrophe, especially in the impact on some groups of people in vulnerable situations. In addition, it is observed that in the face of the deficiency of effective public policies, numerous individual actions with support from private initiative have been undertaken on behalf of these groups in situations of vulnerability and in application of the principle of solidarity. Contributions: The present work outlines in the application of the principles of global solidarity and non-indifference as a true compass to guide the practices of States in the face of the most adverse situations that manifest themselves in the field of international relations, whether they come from economic crises, environmental catastrophes, social upheaval, organized crime, drug trafficking, breakdown with the rule of law, armed conflicts, hunger, misery and diseases, as in the case of COVID-19. © 2021, Centro Universitário Curitiba - UNICURITIBA. All rights reserved.

Diffusion of COVID-19 in the Northern Metropolis in Northeast Brazil: territorial dynamics and risks associated with social vulnerability

Throughout history, humankind has lived through many crises arising from pandemics, and it is currently in the midst of one. Coronavirus disease, caused by the severe acute respiratory syndrome coronavirus 2, is causing serious problems related to public health and socioeconomic status across the globe. Having started in Asia, the disease has already reached Europe, Africa, and more recently the Americas;hence, it is necessary to understand the context in which it spreads in regions that carry high risks associated with social vulnerability, as in the case of Latin America. Brazil is the South American country most affected by the pandemic-its first case was confirmed at the end of February 2020, and in less than two months, its total number of cases has already crossed 25,000. Among its worst-hit states, Ceara in Northeast Brazil worries health agencies as there have already been more than 2,000 cases in the 30 days of the outbreak in the state. Even more worrying is its capital Fortaleza, which has become the epicenter of the spread of the disease in Ceara, accounting for 86.5% cases and 67% deaths in the state-95% of the neighborhoods in Fortaleza have confirmed cases of the disease. An aspect that particularly causes concern is the disease's diffusion, from neighborhoods with the highest family income to those with the lowest, directly affecting the socially vulnerable populations in territories with a majority of precarious settlements;in Fortaleza, favelas are the main type of precarious settlements (73.6%). The analyses presented as part of this research can assist in identifying priority areas for state intervention through family assistance resources.

The role of simulation as an educational strategy in the COVID-19 pandemic

Simulation-based learning has been widely used to improve response to crisis situations. It has played an important role in preparing care teams for patients with infections such as Ebola, influenza, severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS). The recent pandemic caused by the coronavirus (SARS CoV-2) declared by the World Health Organization (WHO) in March of this year 2020, requires special attention in these moments, where the disease has exceeded the response of the health systems in several countries, so it is necessary training of response teams to reduce risks. The objectives proposed in this review through deliberate practice, the clinical scenario and simulation in situ, in the patient with suspected or infected by COVID-19, try to systematize the placement and removal of personal protective equipment (PPE), the management of the airway and the approach of the patient in cardiac arrest, in order to improve technical skills and strengthen non-technical skills. Furthermore, during the development of these strategies, unexpected situations can be identified and addressed, some compromise in patient and/or staff safety can be detected, which allows these deficiencies to be rectified and response capacity to be optimized. Likewise, it allows to reflect and analyze the emotions of the staff to prevent adverse situations regarding the performance of health workers. With this, it seeks to strengthen the safety and quality of patient care during the course of this pandemic. © 2020, Colegio Mexicano de Anestesiologia A.C.. All rights reserved.

Perioperative management of the patient with COVID-19

Currently, the SARS-CoV-2 pandemic has put health systems to the test throughout their world. The impact of surgical stress and anesthesia on predisposition to a new COVID-19 infection or exacerbation of the infection in a COVID-19 infected patient to be operated on is unknown. Although COVID-19 mortality is between 1-5%, most deaths have occurred in elderly patients with underlying cardiopulmonary conditions, most of them hypertensive, diabetic and obese, therefore, it should be specially attention in its handling. Carefull perioperative preparation and planning is key in successfully achieving adequate clinical care and maintaining the safety of the health team in a difficult and high risk moment. An additional role for the anesthesiologist, considering that he has the most experience in the management of the airway, is to support the emergency services for endotracheal intubation of patients who require ventilatory support, being a procedure with very specific protection recommendations. Therefore, there is a commitment as specialists, to know the subject thoroughly and protect ourselves along with the health team involved in saving lives during this contingency.

SOME NOTES ABOUT THE TOURISM ADMINISTRATIVE LAW: COVID-19

The aim of this paper is to achieve a study of the complex regulatory framework applicable to the spanish tourism sector, based on the rapid and violent emergence of the coronavirus (COVID-19). It analyzes the current normative group of the hotel, restaurant, tourist transport and realize some brief considerations on the tourist leases of business premises, company and accommodation management, in an attempt to configure the basic legal structures of the tourism sector in Spain. It offer a current vision of tourism legislation in our country, analyzing the European Union law and the internal one, after the state of alarm declaration, and realize a brief references to the hospitality companies, restaurant, tourist transport as well as the rental accommodation contract and of tourist company.