Protocol for systematic review and meta-analysis: magnitude, reasons, associated factors, and implications of the out-of-pocket expenditure during pregnancy.

OBJECTIVES: Health-related out-of-pocket expenditure (OOPE) impedes utilization for maternal health care. We aim to systematically review the magnitude, reasons, associated factors, and implications of OOPE during pregnancy. STUDY DESIGN: The study design is a protocol for systematic review and meta-analysis. METHODS: A comprehensive literature search will be conducted with the electronic databases of PubMed, Web of Science, Scopus, Cochrane, Trip, Social care online, IDEAS, EconPapers, ERIC, and EconStor. A manual search will be carried out for the reference lists of eligible studies and reviews. The search strategy will include combining two key blocks of terms, namely: 'pregnancy' and 'OOPE,' using database-specific subject headings and text words. Two independent reviewers will screen and assess data quality and extract data for synthesis. Any disagreements during any stage will be determined by consensus with the involvement of a third reviewer. The 'Mixed methods appraisal tool' will be adapted for the quality appraisal of the eligible studies. A narrative synthesis will be provided for the reasons, associated factors, and implications of OOPE, and a meta-analysis will be conducted for the magnitude of OOPE. Furthermore, a subgroup analysis will be done with countries with different income levels and health care policies. TRIAL REGISTRATION: PROSPERO 2020 CRD42020168566.

'Why are you not dead yet?' - dimensions and the main driving forces of stigma and discrimination among COVID-19 patients in Sri Lanka.

OBJECTIVES: To explore the experiences, and main driving forces of stigma and discrimination among COVID-19 patients, following hospital discharge, in Sri Lanka. STUDY DESIGN: A qualitative study was used in order to gain insight and explore the depth and complexity of COVID-19 patients' experiences. METHODS: Semi-structured interviews were conducted via telephone in a purposively selected sample of 139 COVID-19 patients. Participants were interviewed during the first 3 weeks following discharge from four main state hospitals that were treating COVID-19 patients during the early phase of the pandemic. Questions on stigma and discrimination were open-ended, enabling patients to provide responses about their different experiences and settings; results were analysed using thematic analysis. RESULTS: The majority of participants were men (n = 80; 57.6%), with a mean age of 43 years (SD = 11.2). In total, up to one-third of the study participants experienced stigma related to COVID-19 and were discriminated against by the community, co-workers and healthcare workers in Sri Lanka. Social discrimination included barriers in accessing basic needs, insulting, blaming, defaming, spreading rumours and receiving no support during emergencies. Workplace discrimination included loss of jobs, not allowing re-entry and loss of earnings due to self-employment. Discrimination by healthcare workers included breaching of confidentiality, lack of respect, not providing health services and communication barriers. Discrimination has led to social isolation, not seeking help and severe psychosocial issues impacting their family relationships. Irresponsible media reporting and sensationalism of news coverage leading to breaching of privacy and confidentiality, defaming, false allegations and reporting household details without consent were perceived as the main factors underlying the views and opinions of the general public. CONCLUSIONS: Stigma and discrimination experienced by COVID-19 patients in society, workplaces and healthcare facilities have serious negative consequences at the individual and family level. Regulations on responsible media reporting, including an effective risk communication strategy to counteract its effects, are strongly recommended.

A cosmic virosphere.

The concept of a cosmic virosphere that serves as the repository of information for all life on Earth and throughout the Universe is discussed. Recent studies in geology, astronomy and biology point to an intimate connection between the evolution of life and a cosmic virosphere/biosphere.

An internet of microbes straddling the cosmos.

Exchanges of information analogous to a global internet have been known to take place between biological systems on the Earth ranging from bacteria and viruses to plants and animals. We argue that this process can be extended to include a cosmic biosphere within which evolution would seem to be intimately interlinked across astronomical, perhaps cosmological distance scales. Comets and interstellar dust, argued to have a bacterial/viral component, could be involved in establishing these links.

Is the 2019 novel coronavirus related to a spike of cosmic rays?

WHO's pronouncement of the 2019 novel coronavirus outbreak as a pandemic disease came months after we published a warning that the present deepest minimum of the sunspot cycle would be likely to facilitate the onset of a viral pandemic. During a deep sunspot minimum (deepest in 100 years) such as we are now witnessing, two space related phenomena could have an effect on the disposition of viral disease and potential pandemics. With the weakening of the magnetic field in the Earth's vicinity, there would be a high flux of mutagenic cosmic rays. These processes would be likely to herald the onset of new pandemics. Neutron counts from Moscow Neutron Monitor show that the flux of cosmic rays reaching Earth in 2019 was indeed at a maximum over a timespan of half a century since 1962. It is of interest to note that immediately prior to the first recorded cases of the novel Corona virus in China a peak of cosmic rays was measured as is indicated by the Huon neutron monitor data. Recent research revealed that estimates of the timing of the most recent common ancestor of COVID-19 made with current sequence data point to emergence of the virus in late November 2019 to early December 2019, compatible with the earliest retrospectively confirmed cases and the cosmic ray spike in late November 2019. In our view, this strong cosmic ray spike was in some way connected with the onset of the outbreak.

Microbial transfers from Venus to Earth.

The possibility that the clouds of Venus are habitats for microorganisms has been discussed for several decades. Over the past two decades evidence to support this point of view has grown with new data from space probes and space exploration. In this article we argue that microorganisms are likely to be widely present in the clouds of Venus, and may under certain conditions have a ready route to Earth. Such transfers could occur by the action of the solar wind that leads to expulsion of parts of the atmosphere laden with microorganisms. The expelled material forms a comet-like tail in the antisolar direction and during inferior conjunctions of Venus could lead to injections of bacteria and other microorganisms onto the Earth. In situations of very low sunspot activity as now prevails, with a consequent weakening of the magnetopause this flux of microbes will be considerably enhanced. The inferior conjunction of 4 June 2020 together with the prevailing deep minimum in the sunspot cycle provides a combination of circumstances that is particularly favorable to such a process.

The efficient Lamarckian spread of life in the cosmos.

In this Chapter we discuss the various mechanisms that are available for the possible transfer of cosmic microbial living systems from one cosmic habitat to another. With the 100 or so habitable planets that are now known to exist in our galaxy alone transfers of cometary dust carrying life including fragments of icy planetoids/asteroids would be expected to occur on a routine basis. It is thus easy to view the galaxy as a single connected "biosphere" of which our planet Earth is a minor component. The Hoyle-Wickramasinghe Panspermia paradigm provides a cogent biological rationale for the actual widespread existence of Lamarckian modes of inheritance in terrestrial systems (which we review here). Thus the Panspermia paradigm provides the raison d'etre for Lamarckian Inheritance. Under a terrestrially confined neoDarwinian viewpoint such an association may have been thought spurious in the past. Our aim here is to outline the main evidence for rapid terrestrial-based Lamarckian-based evolutionary hypermutation processes dependent on reverse transcription-coupled mechanisms among others. Such rapid adaptation mechanisms would be consistent with the effective cosmic spread of living systems. For example, a viable, or cryo-preserved, living system traveling through space in a protective matrix will of necessity need to adapt rapidly and proliferate on landing in a new cosmic niche. Lamarckian mechanisms thus come to the fore and supersede the slow (blind and random) genetic processes expected under neoDarwinian Earth centred theories.

Experiments to prove continuing microbial ingress from Space to Earth.

A wide range of evidence for pointing to our cosmic origins is close to the point of being overwhelming. Yet the long-entrenched paradigm of Earth-centered biology appears to prevail in scientific culture. A matter of crucial importance is to carry out a decisive experiment that is long overdue-establishing empirically beyond any doubt that extraterrestrial microbiota reaches the surface of the Earth at the present day. Such an experiment may of course happen naturally by the appearance of pandemics of new disease as discussed in an earlier chapter.

The sociology of science and generality of the DNA/RNA/protein paradigm throughout the cosmos.

The theory of cometary panspermia argues that life cannot have originated on Earth in the time available. It must have an ultimate, but still undiscovered cosmological source. The origin of life remains an open question. Life on Earth was introduced by impacting comets, and its further evolution was driven by the subsequent acquisition of cosmically derived genes. Explicit predictions of this theory stating how the acquisition of new genes drives evolution, are compared with recent developments in relation to horizontal gene transfer, and the role of retroviruses in evolution. Precisely stated predictions of the theory of cometary panspermia are shown to have been verified.

Cometary panspermia and origin of life?

A range of astronomical observations are shown to be in accord with the theory of cometary panspermia. This theory posits that comets harbor a viable biological component in the form of bacteria and viruses that led to origin and evolution of life on Earth. The data includes (1) infrared, visual and ultraviolet spectra of interstellar dust, (2) infrared spectra of the dust released from comet Halley in 1986, (3) infrared spectra of comet Hale-Bopp in 1997, (4) near and mid-infrared spectra of comet Tempel I in 2005, (5) the discovery of an amino acid and degradation products attributable to biology in the material recovered from the Stardust Mission in 2009, (6) jets from comet Lovejoy showing both a sugar and Ethyl alcohol and finally, (7) a diverse set of data that has emerged from the Rosetta mission. The conjunction of all the available data points to cometary biology and interstellar panspermia as being inevitable.

Origin of new emergent Coronavirus and Candida fungal diseases-Terrestrial or cosmic?

The origins and global spread of two recent, yet quite different, pandemic diseases is discussed and reviewed in depth: Candida auris, a eukaryotic fungal disease, and COVID-19 (SARS-CoV-2), a positive strand RNA viral respiratory disease. Both these diseases display highly distinctive patterns of sudden emergence and global spread, which are not easy to understand by conventional epidemiological analysis based on simple infection-driven human- to-human spread of an infectious disease (assumed to jump suddenly and thus genetically, from an animal reservoir). Both these enigmatic diseases make sense however under a Panspermia in-fall model and the evidence consistent with such a model is critically reviewed.

The world should establish an early warning system for new viral infectious diseases by space-weather monitoring.

With the emergence of several new epidemics of viral infections - SARS, MERS, EBOLA, ZIKA, Influenza A (H1N1) pandemic,Covid-2019 - over the past 3 decades we suggest that a world-wide programme of stratospheric surveillance and space weather monitoring should be urgently put in place without further delay.

Trainee experience of 'out of hours' surgical working in the UK: A cross-sectional analysis.

BACKGROUND: Changes to working practices and increasing service demand have contributed to low morale amongst UK surgical trainees, with pressures particularly acute 'out of hours' (OOH). Surgeons may be expected to be 'on call' for multiple hospitals, or to provide remote consultations, yet healthcare systems may undermine their professional safety and patient care. This cross-sectional study sought to define the perceptions of UK-based Royal College of Surgeons of Edinburgh (RCSEd) affiliated trainees of OOH surgical care and training. METHODS: The RCSEd Trainees' Committee conducted a design-thinking exercise to produce an online questionnaire. Non-consultant grade RCSEd Members and Fellows were invited to participate. Quantitative data was analysed using descriptive statistics, and qualitative data was coded to identify emergent themes. RESULTS: One hundred and fifty-five surgeons participated. Of those surgeons working in multiple hospitals OOH (n = 16), many did not receive access cards (12[75%]) or site-specific induction (13[81%]), and 8(50%) were not confident in using local electronic investigation and records systems. Only 14/114 (12%) of the surgeons providing remote opinion had access to a consultation record system, and most perceived dissatisfaction with the system. Emergent themes from qualitative data revealed that trainee surgeons desire specific training in OOH working, concerns that OOH work experience is diminishing, and that hospital infrastructure such as IT and communications, rest facilities and catering were inadequate in facilitating safe care. CONCLUSIONS: The participants perceived that the systems supporting delivery of safe surgical care OOH were inadequate. Hospital leaders should ensure that systems minimise risk to staff and patients.

Lamarck and Panspermia - On the Efficient Spread of Living Systems Throughout the Cosmos.

We review the main lines of evidence (molecular, cellular and whole organism) published since the 1970s demonstrating Lamarckian Inheritance in animals, plants and microorganisms viz. the transgenerational inheritance of environmentally-induced acquired characteristics. The studies in animals demonstrate the genetic permeability of the soma-germline Weismann Barrier. The widespread nature of environmentally-directed inheritance phenomena reviewed here contradicts a key pillar of neo-Darwinism which affirms the rigidity of the Weismann Barrier. These developments suggest that neo-Darwinian evolutionary theory is in need of significant revision. We argue that Lamarckian inheritance strategies involving environmentally-induced rapid directional genetic adaptations make biological sense in the context of cosmic Panspermia allowing the efficient spread of living systems and genetic innovation throughout the Universe. The Hoyle-Wickramasinghe Panspermia paradigm also developed since the 1970s, unlike strictly geocentric neo-Darwinism provides a cogent biological rationale for the actual widespread existence of Lamarckian modes of inheritance - it provides its raison d'être. Under a terrestrially confined neo-Darwinian viewpoint such an association may have been thought spurious in the past. Our aim is to outline the conceptual links between rapid Lamarckian-based evolutionary hypermutation processes dependent on reverse transcription-coupled mechanisms among others and the effective cosmic spread of living systems. For example, a viable, or cryo-preserved, living system travelling through space in a protective matrix will need of necessity to rapidly adapt and proliferate on landing in a new cosmic niche. Lamarckian mechanisms thus come to the fore and supersede the slow (blind and random) genetic processes expected under a traditional neo-Darwinian evolutionary paradigm.

Cause of Cambrian Explosion - Terrestrial or Cosmic?

We review the salient evidence consistent with or predicted by the Hoyle-Wickramasinghe (H-W) thesis of Cometary (Cosmic) Biology. Much of this physical and biological evidence is multifactorial. One particular focus are the recent studies which date the emergence of the complex retroviruses of vertebrate lines at or just before the Cambrian Explosion of ∼500 Ma. Such viruses are known to be plausibly associated with major evolutionary genomic processes. We believe this coincidence is not fortuitous but is consistent with a key prediction of H-W theory whereby major extinction-diversification evolutionary boundaries coincide with virus-bearing cometary-bolide bombardment events. A second focus is the remarkable evolution of intelligent complexity (Cephalopods) culminating in the emergence of the Octopus. A third focus concerns the micro-organism fossil evidence contained within meteorites as well as the detection in the upper atmosphere of apparent incoming life-bearing particles from space. In our view the totality of the multifactorial data and critical analyses assembled by Fred Hoyle, Chandra Wickramasinghe and their many colleagues since the 1960s leads to a very plausible conclusion - life may have been seeded here on Earth by life-bearing comets as soon as conditions on Earth allowed it to flourish (about or just before 4.1 Billion years ago); and living organisms such as space-resistant and space-hardy bacteria, viruses, more complex eukaryotic cells, fertilised ova and seeds have been continuously delivered ever since to Earth so being one important driver of further terrestrial evolution which has resulted in considerable genetic diversity and which has led to the emergence of mankind.