Hyperosmia after COVID-19: hedonic perception or hypersensitivity?

OBJECTIVE: COVID-19 has been associated with a wide range of quantitative and qualitative disorders of smell, including hyposmia/anosmia, parosmia, and phantosmia; however, no reports to date have reported hyperosmia as a sequela of SARS-CoV-2 infection. PATIENTS AND METHODS: We present two cases of subjective hyperosmia in a South Tyrolean Alps family, occurring within days after recovery from SARS-CoV-2 infection with transient anosmia. RESULTS: The subjects, a mother and son, exhibited subjective hyperosmia despite normal objective olfactory testing. During independent assessments, the severity of hyperosmia and specific odors affected were highly correlated, consistent with shared genetic and environmental factors. In contrast, two other family members with COVID-19 had no perceptual distortion and normal recovery of smell. CONCLUSIONS: Subjective hyperosmia after COVID-19 infection exhibited striking similarity in two affected family members, suggesting interaction of environment, genetics, and perception.

Practice of tracheostomy in patients with acute respiratory failure related to COVID-19 - Insights from the PRoVENT-COVID study.

OBJECTIVE: Invasively ventilated patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) potentially benefit from tracheostomy. The aim of this study was to determine the practice of tracheostomy during the first wave of the pandemic in 2020 in the Netherlands, to ascertain whether timing of tracheostomy had an association with outcome, and to identify factors that had an association with timing. METHODS: Secondary analysis of the 'PRactice of VENTilation in COVID-19' (PRoVENT-COVID) study, a multicenter observational study, conducted from March 1, 2020 through June 1, 2020 in 22 Dutch intensive care units (ICU) in the Netherlands. The primary endpoint was the proportion of patients receiving tracheostomy; secondary endpoints were timing of tracheostomy, duration of ventilation, length of stay in ICU and hospital, mortality, and factors associated with timing. RESULTS: Of 1023 patients, 189 patients (18.5%) received a tracheostomy at median 21 [17 to 28] days from start of ventilation. Timing was similar before and after online publication of an amendment to the Dutch national guidelines on tracheostomy focusing on COVID-19 patients (21 [17-28] vs. 21 [17-26] days). Tracheostomy performed ≤ 21 days was independently associated with shorter duration of ventilation (median 26 [21 to 32] vs. 40 [34 to 47] days) and higher mortality in ICU (22.1% vs. 10.2%), hospital (26.1% vs. 11.9%) and at day 90 (27.6% vs. 14.6%). There were no patient demographics or ventilation characteristics that had an association with timing of tracheostomy. CONCLUSIONS: Tracheostomy was performed late in COVID-19 patients during the first wave of the pandemic in the Netherlands and timing of tracheostomy possibly had an association with outcome. However, prospective studies are needed to further explore these associations. It remains unknown which factors influenced timing of tracheostomy in COVID-19 patients.

Unemployment, Bankruptcies, and Deaths From Multiple Causes in the COVID-19 Recession Compared With the 2000‒2018 Great Recession Impact.

Objectives. To determine whether unemployment and bankruptcy rates are related to increased excess deaths during the COVID-19 recession and to examine whether the current recession-based mortality rate not only is dependent on COVID-19 but also continues the pattern of recessions, especially the Great Recession, in relation to chronic disease mortality rates and mental health disturbances (e.g., including suicide) from 2000 to 2018. Methods. This study used pooled cross-sectional time series analysis to determine the impact of unemployment and bankruptcy rates on excess deaths from February to November 2020 for US states. The study used a second pooled cross-sectional time series analysis to determine whether the COVID-19‒ era recessional mortality continues the impact of prepandemic recessions (2000-2018) on multiple causes of mortality. Results. Ten percent unemployment was associated with approximately 48[thin space]149 excess deaths, while, jointly with bankruptcies, their combined effect produced 35 700 and 144 483 excess deaths, for unemployment and bankruptcies, respectively. These health-damaging COVID-19‒recessional findings suggest a reiteration of the significantly increased major cause‒specific mortality during 2000 to 2018, mitigated by the size of the health care workforce. Conclusions. Minimization of deaths attributable to the COVID-19 recession requires ample funding for the unemployed and underemployed, especially Black and Hispanic communities, along with significant investments in the health workforce. (Am J Public Health. 2021;111(11):1950-1959. https://doi.org/10.2105/AJPH.2021.306490).

Randomized clinical trial "olfactory dysfunction after COVID-19: olfactory rehabilitation therapy vs. intervention treatment with Palmitoylethanolamide and Luteolin": preliminary results.

OBJECTIVE: Approximately 30% of patients with confirmed COVID-19 report persistent smell or taste disorders as long-term sequalae of infection. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with inflammatory changes to the olfactory bulb, and treatments with anti-inflammatory properties are hypothesized to attenuate viral injury and promote recovery of olfaction after infection. Our study investigated the efficacy of a supplement with Palmitoylethanolamide (PEA) and Luteolin to support recovery of olfaction in COVID-19 patients. PATIENTS AND METHODS: We conducted a randomized-controlled pilot study in outpatients with history of confirmed COVID-19 with post-infection olfactory impairment that persisted ≥ 90 days after SARS-CoV-2 negative testing. Patients were randomized to two times a day olfactory rehabilitation alone or weekly olfactory rehabilitation plus daily oral supplement with PEA and Luteolin. Subjects with preexisting olfactory disorders were excluded. Sniffin' Sticks assessments were performed at baseline and 30 days after treatment.  Data on gender, age, and time since infection were collected. Kruskal-Wallis (KW) test was used to compare variances of Sniff scores between groups over time, and Spearman's correlation coefficients were calculated to assess for correlations between Sniff Score and gender or duration of infection. RESULTS: Among 12 patients enrolled (n=7, supplement; n=5, controls), patients receiving supplement had greater improvement in olfactory threshold, discrimination, and identification score versus controls (p=0.01). Time since infection was negatively correlated with Sniff Score, and there was no correlation between gender. CONCLUSIONS: Treatment combining olfactory rehabilitation with oral supplementation with PEA and Luteolin was associated with improved recovery of olfactory function, most marked in those patients with longstanding olfactory dysfunction. Further studies are necessary to replicate these findings and to determine whether early intervention including olfactory rehabilitation and PEA+Luteolin oral supplement might prevent SARS-CoV-2 associated olfactory impairment.

Angular velocimetry for fluid flows: an optical sensor using structured light and machine learning.

Most velocimetry approaches for fluid flows measure linear components of the velocity vector; yet, the angular velocity components, particularly at small scales in turbulent flows, also need to be resolved to study energy transfer and other important flow characteristics. Here, we detail an optical sensor approach to determine a component of the angular velocity vector. This approach uses beams of structured light and a machine learning-based analysis. We discuss the methodology to train the machine learning model and test it in experimentally validated simulations. This approach represents an interesting new direction for fluid flow velocimetry which may be extended to sense other flow parameters by selecting different light structures.

Acceleration of Anxiety, Depression, and Suicide: Secondary Effects of Economic Disruption Related to COVID-19.

The SARS-CoV-2 (COVID-19) pandemic has contributed to increasing levels of anxiety, depression and other symptoms of stress around the globe. Reasons for this increase are understandable in the context of individual level factors such as self-isolation, lockdown, grief, survivor guilt, and other factors but also broader social and economic factors such as unemployment, insecure employment and resulting poverty, especially as the impacts of 2008 recession are still being felt in many countries further accompanied by social isolation. For those who are actively employed a fear of job and income loss and those who have actually become ill and recovered or those who have lost family and friends to illness, it is not surprising that they are stressed and feeling the psychological impact. Furthermore, multiple uncertainties contribute to this sense of anxiety. These fears and losses are major immediate stresses and undoubtedly can have long-term implications on mental health. Economic uncertainty combined with a sense of feeling trapped and resulting lack of control can contribute to helplessness and hopelessness where people may see suicide as a way out. Taking a macro view, we present a statistical model of the impact of unemployment, and national income declines, on suicide, separately for males and females over the life cycle in developed countries. This impact may reflect a potent combination of social changes and economic factors resulting in anomie. The governments and policymakers have a moral and ethical obligation to ensure the physical health and well-being of their populations. While setting in place preventive measures to avoid infections and then subsequent mortality, the focus on economic and social recovery is crucial. A global pandemic requires a global response with a clear inter-linked strategy for health as well as economic solutions. The models we have constructed represent predictions of suicide rates among the 38 highly industrialized OECD countries over a period of 18 years (2000-2017). Unemployment has a major effect on increasing suicide, especially in middle-aged groups. However, the impact of economic decline through losses of national income (GDP per capita) are substantially greater than those of unemployment and influence suicide throughout the life course, especially at the oldest ages.

Utilization of endovascular and open surgical repair in the United States: A 10-year analysis of the National Trauma Databank (NTDB).

BACKGROUND: Endovascular therapy provides a less invasive alternative to open surgery for critically ill patients who have sustained arterial injuries. The purpose of this study was to evaluate recent trends in the management of arterial injuries in the United States with specific reference to the use of endovascular strategies and to examine the outcomes of endovascular vs open therapy for the treatment of civilian arterial traumatic injuries. METHODS: We performed a 10-year (2004-2014) analysis of ACS-NTDB and identified all adult trauma patients who had arterial injuries. Data regarding demographics, injury parameters, endovascular or open vascular repair and outcomes were extracted. Cochran-Armitage trend analysis and multivariate logistic regression analysis were performed. RESULTS: A total of 111,061 patients with arterial injuries were identified and included in our analysis. Mean age was 39 ± 19y, 82% were male and 79% were white. The most common artery injured was iliac artery followed by brachial artery and thoracic aorta. Overall 6.7% (7434) patients underwent endovascular repair while 38.8% (42,495) had open vascular repair. The rate of endovascular repair increased from 3.1% to 8.9% while the incidence of open vascular repair decreased from 47% to 32% over the study period. Patients in endovascular group had lower ISS compared to patients in open vascular repair group (17 + 10 vs 24 + 10, p < 0.001). Patients who underwent endovascular repair had shorter hospital length of stay (days: 10 + 17 vs 11 + 15, p < 0.001), lower mortality (8% vs 14%, p = 0.01). On multivariate regression analysis after controlling for confounding variables, endovascular repair was independently associated with improved survival (OR: 2.45[1.84-4.26], p = 0.01). CONCLUSIONS: The use of endovascular modalities to repair arterial injuries in the setting of acute trauma is increasing in a dramatic fashion. Endovascular repair of trauma arterial injuries is associated with shorter length of stay and improved survival compared to open vascular procedures.

Correction: Sediment biomarkers elucidate the Holocene ontogeny of a shallow lake.

[This corrects the article DOI: 10.1371/journal.pone.0191073.].

Sediment biomarkers elucidate the Holocene ontogeny of a shallow lake.

We carried out geochemical analyses on a sediment core from Lake Harris, Florida (USA) to identify sources of organic matter to the sediment throughout the Holocene, and relate changes in those sources to shifts in past climate and environmental conditions. We hypothesized that the sources of organic matter changed in response to regional hydrologic shifts following de-glaciation, and to human population expansion in the state during the 20th century. Hydroclimate shifts in Florida were related to: 1) a steady rise in relative sea level and the fresh water table that began in the early Holocene, 2) wetland formation and expansion ca. 5,000 cal yrs BP, and 3) the onset of the modern El Niño (ENSO) cycle ~3,000 cal yrs BP. Stratigraphic changes in sediment variables from Lake Harris reflect each of these hydroclimate periods. Early in the Holocene, Lake Harris was a marsh-like system in a relatively dry, open-prairie environment. Organic sediments deposited at that time were derived largely from terrestrial sources, as inferred from high TOC/TN ratios, a dominance of longer-chain of n-alkanes (n-C29-31), relatively negative organic carbon isotope values (δ13CTOC), and low biogenic silica concentrations. In the middle Holocene, a positive shift in δ13CTOC coincided with the onset of wetter conditions in Florida. Submerged macrophyte biomarkers (n-C21-23) dominated, and during that period bulk organic carbon isotope values were most similar to δ13C values of mid-chain-length n-alkanes. In the late Holocene, δ13CTOC values declined, CaCO3 levels decreased to trace amounts, organic carbon concentrations increased and diatom biogenic silica concentrations increased from 10 to 120 mg g-1. Around 2,900 cal yrs BP, the effects of ENSO intensified and many Florida lakes deepened to their current limnetic state. Concentrations of algal and cyanobacterial biomarkers in the Lake Harris core increased by orders of magnitude after about AD 1940, in response to human-induced eutrophication, an inference supported by values of δ15N that fluctuate around zero.

Research priorities for specialized nursing practice in the United Arab Emirates.

BACKGROUND: Globally, nurses are undertaking expanded and more specialized roles in healthcare planning and service delivery in response to changing patterns and levels of health service demand. This means the nursing profession is increasingly considered as leaders in health service policy, research and practice. The United Arab Emirates has strengthened nursing governance and practice by establishing a Nursing and Midwifery Council and increasing the activity of nursing specialization, service leadership and research. This study aimed to identify clinically relevant research priorities to facilitate nursing contributions to evidence-based care and strengthening health services in the country. METHODS: A two-stage Delphi study design was used. RESULTS: The first round involved 783 participants. The second round involved 1116 participants, as more clinical settings were accessed. In total, 58 research priorities across a variety of nursing specialties (paediatrics, emergency care, intensive care, labour and maternity care, operating theatre and long-term care) were identified as highly important. CONCLUSION: These identified priorities will guide a more informed programme of research in each nursing specialty, with the aim of strengthening the evidence base to improving outcomes for patients and their families in the United Arab Emirates. IMPLICATIONS FOR NURSING PRACTICE, RESEARCH AND POLICY: The findings provide guidance on key areas for nurses to focus research contributions to enhance evidence-based care and strengthen health systems. The identified priorities may also guide researchers in academic institutions to conduct research informed by current, clinically relevant issues. The findings may help inform funders and policymakers to support allocation of funding to research that has potential to contribute to enhancing nursing care in specialist areas.

Risk of psychological ill health and methods of organisational downsizing: a cross-sectional survey in four European countries.

BACKGROUND: The manner in which organizational downsizing is implemented can make a substantial difference as to whether the exposed workers will suffer from psychological ill health. Surprisingly, little research has directly investigated this issue. We examined the likelihood of psychological ill health associated with strategic and reactive downsizing. METHODS: A cross-sectional survey included 1456 respondents from France, Sweden, Hungary and the United Kingdom: 681 employees in stable workplaces (reference group) and 775 workers from downsized companies. Reactive downsizing was exemplified by the exposures to compulsory redundancies of medium to large scale resulting in job loss or surviving a layoff while staying employed in downsized organizations. The workforce exposed to strategic downsizing was represented by surplus employees who were internally redeployed and supported through their career change process within a policy context of "no compulsory redundancy". Symptoms of anxiety, depression and emotional exhaustion were assessed in telephone interviews with brief subscales from Hospital Anxiety Scale (HADS-A), Hopkins Symptom Checklist (SCL-CD6) and Maslach Burnout Inventory (MBI-GS). Data were analyzed using logistic regression. RESULTS: We observed no increased risk of psychological ill health in the case of strategic downsizing. The number of significant associations with psychological ill health was the largest for the large-scale reactive downsizing: surviving a layoff was consistently associated with all three outcome measures; returning to work after the job loss experience was related to anxiety and depression, while persons still unemployed at interview had elevated odds of anxiety. After reactive medium-scale downsizing, unemployment at interview was the only exposure associated with anxiety and depression. CONCLUSIONS: The manner in which organizational downsizing is implemented can be important for the psychological wellbeing of workers. If downsizing is unavoidable, it should be achieved strategically. Greater attention is needed to employment and health policies supporting the workers after reactive downsizing.

Tackling the burden of the hepatitis C virus in the UK: characterizing and assessing the clinical and economic consequences.

OBJECTIVES: The hepatitis C virus (HCV) remains a significant public health issue. This study aimed to quantify the clinical and economic burden of chronic hepatitis C in the UK, stratified by disease severity, age and awareness of infection, with concurrent assessment of the impact of implementing a treatment prioritization approach. STUDY DESIGN AND METHODS: A previously published back projection, natural history and cost-effectiveness HCV model was adapted to a UK setting to estimate the disease burden of chronic hepatitis C and end-stage liver disease (ESLD) between 1980 and 2035. A published meta-regression analysis informed disease progression, and UK-specific data informed other model inputs. RESULTS: At 2015, prevalence of chronic hepatitis C is estimated to be 241,487 with 22.20%, 33.72%, 17.22%, 16.67% and 10.19% of patients in METAVIR stages F0, F1, F2, F3 and F4, respectively, but is estimated to fall to 193,999 by 2035. ESLD incidence is predicted to peak in 2031. Assuming all patients are diagnosed and treatment is prioritized in F3 and F4 using highly efficacious direct-acting antiviral (DAA) regimens, a 69.85% reduction in ESLD incidence is predicted between 2015 and 2035, and the cumulative discounted medical expenditure associated with the lifetime management of incident ESLD events is estimated to be £1,202,827,444. CONCLUSIONS: The prevalence of chronic hepatitis C is expected to fall in coming decades; however, the ongoing financial burden is expected to be high due to an increase in ESLD incidence. This study highlights the significant costs of managing ESLD that are likely to be incurred without the employment of effective treatment approaches.

Robust scalable high throughput production of monodisperse drops.

Monodisperse drops with diameters between 20 µm and 200 µm can be used to produce particles or capsules for many applications such as for cosmetics, food, and biotechnology. Drops composed of low viscosity fluids can be conveniently made using microfluidic devices. However, the throughput of microfluidic devices is limited and scale-up, achieved by increasing the number of devices run in parallel, can compromise the narrow drop-size distribution. In this paper, we present a microfluidic device, the millipede device, which forms drops through a static instability such that the fluid volume that is pinched off is the same every time a drop forms. As a result, the drops are highly monodisperse because their size is solely determined by the device geometry. This makes the operation of the device very robust. Therefore, the device can be scaled to a large number of nozzles operating simultaneously on the same chip; we demonstrate the operation of more than 500 nozzles on a single chip that produces up to 150 mL h-1 of highly monodisperse drops.

A whole blood model of thrombocytopenia that controls platelet count and hematocrit.

In patients with thrombocytopenia, it can be difficult to predict a patient's bleeding risk based on platelet count alone. Platelet reactivity may provide additional information; however, current clinical assays cannot reliably assess platelet function in the setting of thrombocytopenia. New methods to study platelet reactivity in thrombocytopenic samples are needed. In this study, we sought to develop a laboratory model of thrombocytopenia using blood from healthy subjects that preserves the whole blood environment and reproducibly produces samples with a specific platelet count and hematocrit. We compared the activation state of unstimulated and agonist-stimulated platelets in thrombocytopenic samples derived from this method with normocytic controls. Whole blood was diluted with autologous red blood cell concentrate and platelet-poor plasma, which were obtained via centrifugation, in specific ratios to attain a final sample with a predetermined platelet count and hematocrit. P-selectin exposure and GPIIbIIIa activation in unstimulated platelets and platelets stimulated with collagen-related peptide (CRP) or adenosine diphosphate (ADP) in thrombocytopenic samples and the normocytic control from which they were derived were quantified by flow cytometry. Our methodology reliably produced thrombocytopenic samples with a platelet count ≤50,000/µL and an accurately and precisely controlled hematocrit. P-selectin exposure and GPIIbIIIa activation on unstimulated platelets or on ADP- or CRP-stimulated platelets did not differ in thrombocytopenic samples compared to normocytic controls. We describe a new method for creating thrombocytopenic blood that can be used to better understand the contributions of platelet number and function to hemostasis.

Drivers for inappropriate fever management in children: a systematic review.

Background Fever is one of the most common childhood symptoms and accounts for numerous consultations with healthcare practitioners. It causes much anxiety amongst parents as many struggle with managing a feverish child and find it difficult to assess fever severity. Over- and under-dosing of antipyretics has been reported. Aim of the review The aim of this review was to synthesise qualitative and quantitative evidence on the knowledge, attitudes and beliefs of parents regarding fever and febrile illness in children. Method A systematic search was conducted in ten bibliographic databases from database inception to June 2014. Citation lists of studies and consultation with experts were used as secondary sources to identify further relevant studies. Titles and abstracts were screened for inclusion according to pre-defined inclusion and exclusion criteria. Quantitative studies using a questionnaire were analysed using narrative synthesis. Qualitative studies with a semi-structured interview or focus group methodology were analysed thematically. Results Of the 1565 studies which were screened for inclusion in the review, the final review comprised of 14 studies (three qualitative and 11 quantitative). Three categories emerged from the narrative synthesis of quantitative studies: (i) parental practices; (ii) knowledge; (iii) expectations and information seeking. A further three analytical themes emerged from the qualitative studies: (i) control; (ii) impact on family; (iii) experiences. Conclusion Our review identifies the multifaceted nature of the factors which impact on how parents manage fever and febrile illness in children. A coherent approach to the management of fever and febrile illness needs to be implemented so a consistent message is communicated to parents. Healthcare professionals including pharmacists regularly advise parents on fever management. Information given to parents needs to be timely, consistent and accurate so that inappropriate fever management is reduced or eliminated. This review is a necessary foundation for further research in this area.

Play distraction versus pharmacological treatment to reduce anxiety levels in children undergoing day surgery: a randomized controlled non-inferiority trial.

BACKGROUND: Perioperative experience can be one of the most distressful experiences in a child's life if not managed properly by healthcare professionals. Its consequences can extend well beyond surgery and recovery into the child's future life. Healthcare professionals have a responsibility to decrease the anxiety associated with this experience, improve the child's and the parent's experience and prevent negative consequences. This has traditionally been performed through pharmacological treatment which might have negative side effects. More developmentally appropriate distraction methods are currently being trialled globally to augment the evidence that supports their use as a similarly efficient alternative. OBJECTIVES: The aim of this study was to explore the efficiency of storytelling, pictures and colouring activities as an anxiolytic intervention in comparison to the traditional pharmacological premedication technique in a non-inferiority study. STUDY DESIGN: A randomized non-inferiority controlled trial was carried out in 168 children scheduled for day surgery. Children's perioperative anxiety was assessed by a trained anaesthetist using the modified Yale Preoperative Assessment Scale and by parents using the State-Trait Anxiety Inventory for Children. Children's vital signs were also collected preoperatively during the induction period and during the recovery period. RESULTS: The primary endpoint, which is non-inferiority in terms of anxiety as per Yale Preoperative Assessment Scale survey between play distraction and preoperative medication, was met [average score 10.95 vs. 10.94, respectively, 95% confidence interval (-0.35; 0.37); P = 0.941]. Moreover, anxiety scores of both the intervention and the control group were quite comparable as per STAIC survey [20.90 vs. 20.73, respectively, 95% confidence interval (-0.52; 0.88); P = 0.708] and in terms of vital signs. CONCLUSION: The results indicate that the distraction technique employed can be considered as an efficient alternative to traditional pharmacological premedication for children undergoing day surgery.