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Artificial Intelligence (AI) has played a substantial role in the response to the challenges posed by the current pandemic. The growing interest in using AI to handle Covid-19 issues has accelerated the pace of AI research and resulted in an exponential increase in articles and review studies within a very short period of time. Hence, it is becoming challenging to explore the large corpus of academic publications dedicated to the global health crisis. Even with the presence of systematic review studies, given their number and diversity, identifying trends and research avenues beyond the pandemic should be an arduous task. We conclude therefore that after the one-year mark of the declaration of Covid-19 as a pandemic, the accumulated scientific contribution lacks two fundamental aspects: Knowledge synthesis and Future projections. In contribution to fill this void, this paper is a (i) synthesis study and (ii) foresight exercise. The synthesis study aims to provide the scholars a consolidation of findings and a knowledge synthesis through a systematic review of the reviews (umbrella review) studying AI applications against Covid-19. Following the PRISMA guidelines, we systematically searched PubMed, Scopus, and other preprint sources from 1st December 2019 to 1st June 2021 for eligible reviews. The literature search and screening process resulted in 45 included reviews. Our findings reveal patterns, relationships, and trends in the AI research community response to the pandemic. We found that in the space of few months, the research objectives of the literature have developed rapidly from identifying potential AI applications to evaluating current uses of intelligent systems. Only few reviews have adopted the meta-analysis as a study design. Moreover, a clear dominance of the medical theme and the DNN methods has been observed in the reported AI applications. Based on its constructive systematic umbrella review, this work conducts a foresight exercise that tries to envision the post-Covid-19 research landscape of the AI field. We see seven key themes of research that may be an outcome of the present crisis and which advocate a more sustainable and responsible form of intelligent systems. We set accordingly a post-pandemic research agenda articulated around these seven drivers. The results of this study can be useful for the AI research community to obtain a holistic view of the current literature and to help prioritize research needs as we are heading toward the new normal.

Background: Antiretroviral therapy (ART) for HIV has significantly reduced morbidity and mortality, but the drugs can be expensive. This study aims to estimate the lifetime cost of HIV management from the Australian healthcare perspective. Methods: A Markov cohort model, consisting of 21 health states based on CD4 count and line of ART, simulated disease progression over the lifetime of persons living with HIV. We reported costs using 2019 Australian dollars (A$) at a discount rate of 3·5% per annum. One-way sensitivity analysis was used to assess the impact of model inputs, and probabilistic sensitivity analyses were conducted to calculate the 95% confidence intervals for the lifetime cost estimate. Findings: The average discounted lifetime cost of HIV management was A$282,093 [95% CI: $194,206 – 421,345]. The largest proportion of lifetime cost was due to ART (92%). The lifetime cost was most sensitive to third- and second-line ART costs, followed by the probability of failing third-line therapy for those with CD4 count

Background: Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. Methods: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette. Findings: 2·4% (95% C.I. 2·2-2·7) of the subjects (2·5% men and 2·4% women; 0·4% never, 4·4% current- and 6·5% ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7·2% in England. Of the 272 electronic cigarette users, 52·6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58·8% used liquids with nicotine. In all, 65·1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34·9%) as well as bars and restaurants (41·5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend

BackgroundThe prevalence, association with disease status, and public health impact of infection with mixtures of M. tuberculosis strains is unclear, in part due to limitations of existing methods for detecting mixed infections.MethodsWe developed an algorithm to identify mixtures of M. tuberculosis strains using next generation sequencing data, assessing performance using simulated sequences. We identified mixed M. tuberculosis strains when there was at least one mixed nucleotide position, and where both the mixture’s components were present in similar isolates from other individuals. We determined risk factors for mixed infection among isolations of M. tuberculosis in England using logistic regression. We used survival analyses to assess the association between mixed infection and putative transmission.Findings6,560 isolations of TB were successfully sequenced in England 2016-2018. Of 3,691 (56%) specimens for which similar sequences had been isolated from at least two other individuals, 341 (9.2%) were mixed. Infection with lineages other than Lineage 4 were associated with mixed infection. Among the 1,823 individuals with pulmonary infection with Lineage 4 M. tuberculosis, mixed infection was associated with significantly increased risk of subsequent isolation of closely related organisms from a different individual (HR 1.43, 95% CI 1.05,1.94), indicative of transmission.InterpretationMixtures of transmissible strains occur in at least 5% of tuberculosis infections in England; when present in pulmonary disease, such mixtures are associated with an increased risk of tuberculosis transmission.FundingPublic Health England; NIHR Health Protection Research Unit Oxford; European Union.Research in ContextEvidence Before This StudyWe searched Pubmed using the search terms ‘tuberculosis’ and ‘mixed’ or ‘mixture’ for English Language articles published up to 1 April 2019. Studies, most performed without the benefit of genomic sequencing, report mixed TB infection from a range of medium and high prevalence areas and show it to be associated with delayed treatment response. Modelling suggests detection and treatment of mixed TB infection is an important goal for TB eradication campaigns. Although routine DNA sequencing of M. tuberculosis isolates is becoming widespread, efficient methods for detecting mixed infection from such data are underdeveloped, and the true prevalence of mixed infection and its association with transmission is unclear.Added Value of This StudyThis study investigated a large series of TB isolations obtained as part of a routine Mycobacterial sequencing program by two reference laboratories, in a low incidence area, England. We developed an efficient generalisable approach to identify transmitted mixed M. tuberculosis infection; our approach is capable of sensitive and specific detection of a single mixed nucleotide position. We identified mixed infection of similar strains (‘microvariation’) in about 9.2% of the M. tuberculosis samples which we were able to assess, and found evidence of increased transmission from individuals with mixed infection.Implications of All the Available EvidenceTB microvariation is a risk factor for TB transmission, even in the low incidence area studied. Although an efficient and highly specific technique identifying microvariation exists, it relies on comparison with similar sequences isolated from other patients. Sharing of sequence data from the many TB sequencing programs being deployed globally will increase the sensitivity of microvariation detection, and may assist targeted public health interventions.

In this paper, we analyse the problem of determining a negotiation offer scoring system using an alternative approach to the classic direct rating (DR). We examine the effectiveness of the prenegotiation preference elicitation on the basis of holistic judgments, supported by a software decision support tool. This approach is based on rank-ordering of examples of complete offers, which is then disaggregated using the Utilites Additives (UTA) method. In a series of studies, we analyse the accuracy of the scoring systems obtained from these approaches, as well as the negotiators’ subjective evaluation of their use and usefulness. The technical capability of the various setups of the UTA-based disaggregation models to produce accurate scoring systems is verified by simulation in Study 1. The empirical applicability of the most promising UTA-based models is studied in two experiments, in which the negotiators used examples of both predefined and self-declared sets of offers (Study 2), or applied an enhanced UTA algorithm (Study 3). The enhanced algorithm used a predefined set of offers, implemented certain elements of DR, and allowed for iterative improvements of the scoring system. The results show that the UTA-based approach works in a technical sense, but empirically its performance is worse than DR unless the set of example offers is predefined. The enhanced algorithm produced a better scoring system, but users' subjective evaluations were mixed.

The United Nations General Assembly proclaimed the Universal Declaration of Human Rights in 1948. It included the right to medical care. Now, 70 years later, psychologists are recognized as health care providers and have developed several evidence-based health interventions. Digital interventions have the potential to scale access to evidence-based interventions to a degree unimaginable even a few decades ago. This article addresses five key concepts: (a) knowledge is meant to be shared, (b) evidence-based interventions are essential, (c) treatment is not enough to reduce prevalence of mental disorders; prevention is key, (d) nonconsumable interventions have the greatest potential for scalability, and (e) technology now allows us to blanket the world with psychological interventions. By harnessing technology, we can now think globally, act locally, and share globally. Psychology can thus help reduce human suffering beyond our local settings, and contribute to making health care a universal human right.

Purpose : There is scant research examining urban refugee youth mental health outcomes, including potential impacts of the COVID-19 pandemic. We examine prevalence and ecosocial risk factors of depression in the periods before and after the COVID-19 pandemic declaration among urban refugee youth in Kampala, Uganda. Methods : Data from a cohort of refugee youth (n=367) aged 16-24 years were collected in periods before (February 2020) and after (December 2020) the WHO COVID-19 pandemic declaration. We developed crude and adjusted generalized estimating equation logistic regression models to examine demographic and ecosocial factors (food insecurity, social support, intimate partner violence) associated with depression, and include time-ecosocial interactions to examine if associations differed before and after the pandemic declaration. Results : The prevalence of depression was high, but there was no significant difference before (27.5%) and after (28.9%) the pandemic declaration (p=0.583). In adjusted models, food insecurity (aOR: 2.54; 95% CI: 1.21-5.33) and experiencing violence (aOR: 2.53; 95% CI: 1.07-5.96) were associated with increased depression, and social support was associated with decreased depression (aOR: 0.85; 95% CI: 0.81-0.89). Conclusions : These findings highlight the urgent need for interventions to address chronic depression, food insecurity, and ongoing effects of violence exposure among urban refugee youth in Kampala.

Background: World Health Organization (WHO) developed the Safe Childbirth Checklist as an intervention to improve care and outcomes in maternal and newborn health. In the primary BetterBirth traditional trial analysis, the intervention did not significantly improve . However, a novel subgroup-based analysis could identify subpopulations that benefited from the intervention. Methods: In this work, we employ data-driven analysis methods to identify differentiated subgroups with unexpected characteristics compared to the average population. Specifically, we aim to identify: 1) vulnerable subgroups and 2) subpopulation in the intervention arm with significantly reduced outcome. The method utilizes the existing subset scanning literature that searches over a combination of features to identify the differentiated groups. Findings: We found that low birthweight (

Background: Early and accurate diagnosis of acute infection has important consequences for antibiotic stewardship, resource allocation, and clinical outcomes. However, limited sensitivity and specificity of current diagnostics lead to the erroneous prescription of antibiotics. Host-response-based diagnostics have the potential to address these challenges, but accuracy varies widely across heterogeneous global patient populations. Methods: We performed a multi-cohort analysis of 4,200 unique samples across 69 retrospective blood transcriptome datasets from 20 countries. These samples were collected from patients with acute bacterial or viral infections representing a broad spectrum of biological (age, sex, race, ethnicity, pathogen, host genetics), clinical (severity, day of presentation), and technical (Affymetrix, Agilent, Illumina) heterogeneity. We also enrolled patients with infectious diseases in two cohorts from Laos and Nepal. Findings: Current host-response-based gene signatures distinguished intracellular bacterial infection from viral infections with substantially lower accuracy. Using 69 datasets, divided into training and validation datasets, we identified an 8-gene signature that distinguished intracellular or extracellular bacterial infections from viral infections with an area under the receiver operating characteristic curve (AUROC) >0.91 (85.9% specificity, 90.2% sensitivity). In two prospective cohorts from Nepal and Laos, profiled using Fluidigm RT-PCR, the 8-gene classifier distinguished bacterial infections from viral infections with an AUROC of 0.94 (87.9% specificity, 91% sensitivity). Interpretation: The 8-gene signature met the target product profile (90% sensitivity, 80% specificity) proposed by the WHO and others for distinguishing bacterial and viral infections. The 8-gene signature should be considered for further validation and implementation. Funding Information: PK is funded in part by the Bill and Melinda Gates Foundation (OPP1113682); the National Institute of Allergy and Infectious Diseases (NIAID) grants 1U19AI109662, U19AI057229, and 5R01AI125197; Department of Defense contracts W81XWH-18-1-0253 and W81XWH1910235; and the Ralph & Marian Falk Medical Research Trust. DAR is supported by NIH/NIAID U19 AI109761 and the Thomas C. and Joan M. Merigan Endowment at Stanford University. LOMWRU is funded by the Wellcome Trust of Great Britain. AMR is funded by the National Science Foundation Graduate Research Fellowship and the Stanford Graduate Fellowship. This research was funded in whole, or in part, by the Wellcome Trust [Grant number 220211]. Declaration of Interests: AMR, SJP, TES, DAR, and PK are named as inventors on a patent application describing the 8-gene set, which has been licensed to Inflammatix. TES and SAT are employees of Inflammatix, and TES and PK are shareholders in Inflammatix. Inflammatix had no role in the design, funding, or reporting of this work. SD is currently employed by FIND. The other authors declare no conflicts of interest. Ethics Approval Statement: Ethical clearance was granted by the former Faculty of Medical Sciences Ethical Review Committee (now University of Health Sciences Ethics Committee), National University of Laos, the Oxford University Tropical Ethics Committee, and the Stanford University Institutional Review Board.

Malnutrition is one of the most common complications of cancer and its treatments with a prevalence of up to 80% among cancer patients. Thus, standardized and target-oriented attitudes of oncologists toward nutritional management are particularly important. This study aims to report the questionnaire-based evaluation of different views toward medical nutrition among medical and radiation oncologists with the purpose to underline the problems and requirements of cancer nutrition. A national web-based survey composed of 26 multiple choice questions about participant demographics, level of knowledge about cancer nutrition, and approaches to malnutrition were completed by 247 oncologists. The survey was answered by a total of 247 (34%) radiation and medical oncologists. The majority of the oncologists (77%) were working at the University Hospitals and Education & Research Hospitals. Most of them were specialists with 5-10 years of experience. Nutritional status was routinely assessed in oncology units of 84% of (206) oncologists. However, only 50% reported nutritional evaluation follow-ups without waiting for a patient's declaration and 5 (2%) oncologists reported the absence of nutritional evaluation in their unit. Additionally, more than 79% of participants reported that their knowledge was not enough about enteral and parenteral nutrition while 8% were skeptical about the benefits of medical nutrition. Although the role of nutrition as an essential part of cancer care is widely recognized, the availability of limited high-quality evidence, problems of accessibility, lack of routine nutritional evaluation, and varying indicators for malnutrition are some of the problems preventing standardized nutritional management. Therefore, there are a variety of approaches and barriers to the implementation of guidelines. Further studies are needed to identify areas of improvement, as well as strategies to implement nutritional therapy in cancer care.

Background: From December 2019, the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, and spread rapidly around the world. The pandemic also becomes a great challenge to radiation oncology departments since interruptions of radiation therapy increase the risks of cancer recurrence or the whole therapy failure. The present study aims to elucidate the influences of COVID-19 on the radiotherapy (RT) staff in China. Methods: The working staff members from different radiation oncology departments in China were retrospectively enrolled between December 1st, 2020 and March 9th, 2020 as many as possible. All the enrolled ones were invited to fill out a specific questionnaire to collect essential data. The basic information, anxiety levels, and workload of the staff were analyzed. Results: 1. A total of 1,755 questionnaires were sent back; 2. From December 1st , 2019 to March 9th, 2020, 7 out of 1,755 radiation oncology staff members contracted COVID-19 (P 0.05);3. The anxiety level of the RT staff about the COVID-19 outbreak (average score: 6.57) was higher than that of Wuhan medical staff (5.18) and higher than the national level (4.79); 71.43% of infected RT staff members expressed the need for psychological interventions; 4. During the epidemic, the departments of the 428 RT staff members shut down (24.39%). The 76.71% of the RT staff members felt workload relief during COVID-19 as compared to before. Conclusion: Among the 1,755 RT staff, the gender, age, and comorbidities were not related to COVID-19 infection. The geographic position and whether the person worked in a designated COVID-19 hospital were relevant factors with COVID-19 infection. The staff contracting COVID-19 experienced greater psychological pressure than that of the uninfected ones and therefore needed more psychological interventions. Funding Statement: This research was supported by grant No.2014CFB394, 2019CFB721 from the Natural Science Foundation of Hubei Province (CN) and No.WJ2017M027, No.WJ2019M200 from Health and Family Planning Commission of Hubei Province (CN). Declaration of Interests: None. Ethics Approval Statement: This study was approved by the Ethics Committee of Renmin Hospital of Wuhan University.

Telehealth has long held promise as a way to increase access to subspecialty care for children and families, including in developmental and behavioral pediatrics (DBP). The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid uptake of telehealth to continue care delivery that was facilitated by "temporary" policy changes related to the pandemic. As a result, the field of DBP has recognized telehealth as a potential model of care for performing home-based diagnostic assessments, providing medication management follow-up, and delivering therapeutic interventions for children with neurodevelopmental disorders. Telehealth has been helpful in mitigating barriers families often face when attending in-person visits (lack of transportation and child care, missed work hours, etc) but has also highlighted additional determinants of health that need to be addressed to provide equitable access to care (broadband connectivity, device access, digital literacy, access to interpretation and sign language services, etc). Anticipating the lifting of pandemic-related emergency declaration and expiration of temporary policies around telehealth, the ability to continue to deliver DBP care by telehealth is uncertain. The purpose of this policy statement is to advocate for legislation and policies that support ongoing, equitable, home-based telehealth care for patients seen by DBP providers while ensuring equitable access to DBP in general. In addition, there is a need to recognize the benefits and challenges of telehealth versus in-person care and to identify clinical scenarios that favor 1 model of care versus the other.

Background Methods Results Conclusions Population studies have shown that rates of depressive and anxious symptoms have increased as a result of COVID‐19. We analyzed trends in the dispensing rates of antidepressants and benzodiazepines in Canada to determine whether the pandemic has caused changes in rates of pharmacological treatment for depression and anxiety.We conducted a population‐based, cross‐sectional time‐series analysis of antidepressants and benzodiazepines dispensed monthly by Canadian community pharmacies between January 2017 and December 2020. We used March 2020 as the intervention month to determine if there were any significant changes in the national rate of antidepressant and benzodiazepine tablets dispensed as the result of the COVID‐19 pandemic.There was a temporary reduction in the dispensing rate of antidepressants in April 2020 (from 489 tablets per 100 in March 2020 to 356 tablets per 100 in April 2020;p ≤ .0001);however, the rate returned to its previous level by August 2020. There were no detectable deviations in benzodiazepine dispensing after the declaration of the state of emergency in Ontario.Despite the increased reporting of depressive and anxious symptoms during the COVID‐19 pandemic, there have been no changes in the dispensing trends of medications used to treat these disorders. As the pandemic continues to evolve, future research is needed to monitor the prevalence of depression and anxiety, and associated medication use, in the Canadian population. [ FROM AUTHOR] Copyright of Depression & Anxiety (1091-4269) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

BACKGROUND Despite well-defined American Academy of Neurology guidelines for death by whole brain criteria (brain death), there is marked variability in national practice, which some have attributed to lack of formal education. Further, communication with surrogates and families about brain death is integral to brain death declaration. As such, we developed a targeted brain death curriculum combining didactics and simulation-based education to improve examination and subsequent communication skills with families. METHODS Multidisciplinary critical care fellows participated in (1) didactic and case-based curriculum, (2) brain death simulated examination (SimMan3G mannequin), and (3) a standardized family scenario with delivery of a brain death diagnosis to a surrogate "family member". Fellows completed a precurriculum and postcurriculum multiple choice knowledge test and survey (Likert 1 to 10 scale) evaluating measures regarding diagnosis and communication of brain death. t Test and 2-tailed Wilcoxon signed rank test were used for statistical analysis (P

The declaration of COVID-19 as a global pandemic by the World Health Organisation in March 2020 brought many changes to the early childhood sector internationally. The South African response is best understood in the context of an under-developed sector with pre-existing vulnerabilities. In this article, we present a contextual understanding of the lived experiences of early childhood development (ECD) teachers and managers during the lockdown and the opening phases of a risk-adjusted approach. Our use of a phenomenological lens together with systems theory provides a reality check through a focus on lived experiences. Data were produced through an online survey with 28 ECD teachers and managers. We conducted semi-structured interviews with a subset of 8 of these participants. Findings show that disruptions of COVID-19 led to entrenching inequities in service provision and early learning opportunities. These intersecting dimensions have implications for building effective ECD systems.

Background: The homebound older adult population is increasing owing to a rapidly ageing population and improved healthcare. This objective of this study was to systematically examine the literature to identify the multidimensional factors affecting homebound status. Methods: We reviewed electronic databases including PubMed and MEDLINE, without date restrictions, using search terms related to older, homebound adults. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment. This study is under registration with PROSPERO, ID 175812. Findings: Fifteen studies met the review criteria. Most focused on personal factors affecting homebound older adults, ten studies identified influencing factors at the structural level beyond each individual level. The individual construct consisted of demographic, biological, psychological, functional and health-related factors. The structural construct was divided into architectural environmental, community, and social factors. Homebound definitions encompassed people who left the house 3∙5%-39∙8% of the time. Interpretation: Homebound status results from the interaction between individual and structural constructs. Depending on the definition, the reported prevalence varies widely, so health care professionals should note this carefully. Although few studies have explored the impacts of homebound status among older adults, the literature on increased mortality rates among this population suggests it is an important issue. Funding Statement: This study was funded by the Basic Science Research Program through the National Research Foundation of Korea (NRF) from the Ministry of Education (2018R1D1A1A02085559). Declaration of Interests: The authors declare no competing interests.

Cybercrime is a crime involving computers and networks that began to develop after the Cold War. International politics also have developed through computer networks or cyberspace, especially in communication and diplomacy. Many actors who have different interests make the cybersphere unstable. Several state and non-state actors themselves have collaborated and conventions in the cyber realm. In 2018, France made a high-level declaration called the Paris Call for Trust and Security in Cyberspace to maintain stability in cyberspace. Through the Paris Call, France tries to establish an international norm in the cyber domain known as Cybernorms. This norm has been supported by several state and non-state actors. This study seeks to see the importance of the Paris Call that has been made by the French government which aims to remind the general norms of cyber that are not popular or see the formation of international norms in the cybersphere. This study uses a qualitative method with the process-tracing data analysis method used to explain change and cause-and-effect. This research argues that cyber norms are very important for state or non-state actors in maintaining the stability of the cyber world.

The prevalence of inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis, in Canada, is over 0.75% in 2021. Many individuals with IBD are immunocompromised. Consequently, the World Health Organization’s declaration of a global pandemic uniquely impacted those with IBD. Crohn’s and Colitis Canada (CCC) formed the COVID-19 and IBD Taskforce to provide evidence-based guidance during the pandemic to individuals with IBD and their families. The Taskforce met regularly through the course of the pandemic, synthesizing available information on the impact of COVID-19 on IBD. At first, the information was extrapolated from expert consensus guidelines, but eventually, recommendations were adapted for an international registry of worldwide cases of COVID-19 in people with IBD. The task force launched a knowledge translation initiative consisting of a webinar series and online resources to communicate information directly to the IBD community. Taskforce recommendations were posted to CCC’s website and included guidance such as risk stratification, management of immunosuppressant medications, physical distancing, and mental health. A weekly webinar series communicated critical information directly to the IBD community. During the pandemic, traffic to CCC’s website increased with 484,755 unique views of the COVID-19 webpages and 126,187 views of the 23 webinars, including their video clips. CCC’s COVID-19 and IBD Taskforce provided critical guidance to the IBD community as the pandemic emerged, the nation underwent a lockdown, the economy reopened, and the second wave ensued. By integrating public health guidance through the unique prism of a vulnerable population, CCC’s knowledge translation platform informed and protected the IBD community.

Introduction. Circulatory-respiratory death declaration is a common duty of physicians, but little is known about the amount of education and physician practice patterns in completing this examination. Methods. We conducted an online survey of physicians evaluating the rate of formal training and specific examination techniques used in the pronouncement of circulatory-respiratory death. Data, including level of practice, training received in formal death declaration, and examination components were collected. Results. Respondents were attending physicians (52.4%), residents (30.2%), fellows (10.7%), and interns (6.7%). The majority of respondents indicated they had received no formal training in death pronouncement, however, most reported self-perceived competence. When comparing examination components used by our cohort, 95 different examination combinations were used for death pronouncement. Conclusions. Formal training in death pronouncement is uncommon and clinical practice varies. Implementation of formal training and standardization of the examination are necessary to improve physician competence and reliability in death declarations.

Background: Medium secure forensic psychiatric units (MSUs) in the UK aim to be recovery-oriented to enable discharge to community-based services. Risk assessments are key to discharge planning, but clinical practice tends to focus on risk factors for violence rather than protective factors associated with a decrease in risk. The aims of this study were to investigate the reliability and validity of the Structured Assessment of Protective Factors (SAPROF) as a useful measure to support an assets-based approach when planning discharge from MSUs. Method: A prospective cohort follow-up design was chosen for this study using a confidential inquiry design to ensure a total sample of all discharges. All forensic patients discharged from 32 NHS MSUs over a 12-month period were assessed at discharge and followed-up at six and 12 months post discharge. The occurrence and frequency of post-discharge violence were compared with discharge SAPROF scores. Findings: The inter-rater reliability between SAPROF raters was very high, the SAPROF significantly predicted community violence and scores were strongly correlated with violence frequency. The higher the SAPROF score the higher the protection against violence and risk significantly diminished. Interpretation: Assessing protective factors is essential to identify assets and prevent violence with a focus on what makes somebody safe. This study supports the use of the SAPROF to inform discharge planning. Cultivating protective factors is likely to be motivating for patients and the SAPROF can provide an objective, reliable measure of internal, motivational and external assets that reduce risk and support defensible decision making at discharge. Funding: The study was funded by The National Institute for Health Research Programme Grants for Applied Research programme. Declaration of Interest: None to declare. Ethical Approval: The North West England Multi Site Research Ethics Committee approved the study.

Supplemental Digital Content is available in the text., Background and Purpose: Emergency department visits and hospitalizations for stroke declined significantly following declaration of coronavirus disease 2019 (COVID-19) as a national emergency on March 13, 2020, in the United States. This study examined trends in hospitalizations for stroke among Medicare fee-for-service beneficiaries aged ≥65 years and compared characteristics of stroke patients during COVID-19 pandemic to comparable weeks in the preceding year (2019). Methods: For trend analysis, we examined stroke hospitalizations from week 1 in 2019 through week 44 in 2020. For comparison of patient characteristics, we estimated percent reduction in weekly stroke hospitalizations from 2019 to 2020 during weeks 10 through 23 and during weeks 24 through 44 by age, sex, race/ethnicity, and state. Results: Compared to weekly numbers of hospitalizations for stroke reported during 2019, stroke hospitalizations in 2020 decreased sharply during weeks 10 through 15 (March 1–April 11), began increasing during weeks 16 through 23, and remained at a level lower than the same weeks in 2019 from weeks 24 through 44 (June 7–October 31). During weeks 10 through 23, stroke hospitalizations decreased by 22.3% (95% CI, 21.4%–23.1%) in 2020 compared with same period in 2019; during weeks 24 through 44, they decreased by 12.1% (95% CI, 11.2%–12.9%). The magnitude of reduction increased with age but similar between men and women and among different race/ethnicity groups. Reductions in stroke hospitalizations between weeks 10 through 23 varied by state ranging from 0.0% (95% CI, −16.0%–1.7%) in New Hampshire to 36.2% (95% CI, 24.8%–46.7%) in Montana. Conclusions: One-in-5 fewer stroke hospitalizations among Medicare fee-for-service beneficiaries occurred during initial weeks of the COVID-19 pandemic (March 1–June 6) and weekly stroke hospitalizations remained at a lower than expected level from June 7 to October 31 in 2020 compared with 2019. Changes in stroke hospitalizations varied substantially by state.

ObjectivesThe aim of this study was to determine the risk factors associated with SARS-CoV-2 infection in a cohort of homeless people using survival analysis. Seroprevalence in the homeless community was also compared with that of the general population.DesignCohort study.SettingData were collected across two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face survey.ParticipantsAll homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible.Primary outcome measuresOccurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population.ResultsA total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% (4.7–7.3) during the first session to 18.9% (16.0–21.7) during the second one, compared with 3.0% (1.9–4.2) and 6.5% (4.5–8.7) in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 (1.18–3.15)), being an isolated parent (1.64 (1.07–2.52)) and having contact with more than 5–15 people per day (1.84 (1.27–2.67)). By contrast, smoking (0.46 (0.32–0.65)), having financial resources (0.70 (0.51–0.97)) and psychiatric or addictive comorbidities (0.52 (0.32–0.85)) were associated with a lower risk.ConclusionWe confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters. There is growing evidence that, in addition to usual preventive measures, public policies should pay attention to adapt the type of accommodation and overall approach of precariousness.Trial registration numberNCT04408131

BACKGROUND: Social distancing measures to prevent the spread of coronavirus disease 2019 may cause changes in psychosocial factors. This study aimed to clarify changes in psychosocial factors among older adults before and after Japan's declaration of a state of emergency over coronavirus disease 2019. METHODS: This was a longitudinal cohort questionnaire study. A baseline survey was conducted in March 2020, and a follow-up survey was conducted in August 2020. The subjects were 1103 community-dwelling older adults not certified as having long-term care needs who responded to both the baseline and follow-up surveys. Changes in psychosocial factors before and after the state of emergency declaration were analysed by gender using the McNemar-Bowker test. RESULTS: Data for 397 men (mean age ± standard deviation: 80.6 ± 4.7 years) and 486 women (80.3 ± 4.3 years) were analysed in this study. The frequency of meeting friends increased over the study period for men (P = 0.04). An increasing number of women lived alone (P = 0.01). However, many people's financial status improved (P < 0.01), and the number of friends met in the previous month increased (P < 0.01). CONCLUSIONS: None of the examined psychosocial factors worsened, except for the increase in the number of women living alone. However, many of the study subjects refrained from engaging in certain activities. If the coronavirus disease 2019 pandemic persists, changes in psychosocial factors may occur. Therefore, a long-term investigation of the secondary psychosocial effects of coronavirus disease 2019 is necessary.

Air pollution is one of the main environmental reasons for many diseases in Bulgaria. Plenty of studies indicate that the country is still far from achieving air quality levels that do not pose a risk to people and the environment. The current research is directed toward eight companies in Bulgaria, which are responsible for over 70% of greenhouse gas emissions from fixed installations. The study was conducted during the period of 2016 to 2019. The main hypothesis is that due to the public importance of these companies’ activities, the quantity and quality of non-financial information disclosed by them will be significant. Additionally, it is examined how the required obligation for some companies to publish together with their annual financial statements and non-financial declaration has reflected on the disclosures made by them. The research is conducted on the basis of annual financial statements published by the companies, non-financial declarations, annual activity reports and information contained on their websites.

In summer 2020, the Russian Federation initiated amendments to agreements on double taxation avoidance concluded with foreign States. The President of the Russian Federation outlined the goal of this procedure, namely: to ensure the collection of tax on dividends and other payments in the amount of at least 15%. It is extremely curious that the change in such tax agreements correlates with the legal institution of the re-domiciliation of foreign companies to the Russian jurisdiction (to special administrative regions on the Oktyabrsky and Russian Islands). New provisions of agreements on the avoidance of double taxation in conjunction with the re-domiciliation procedure, as well as the existing mechanism for voluntary declaration of accounts and assets, can potentially bring the fight against offshorization of the domestic economy to a new level.The aim of the study is to compare the financial and other operating conditions of an international company registered in the order of re-domiciliation in a Russian special administrative region and an organization registered in a “low-tax” (offshore) jurisdiction. To achieve this goal, analytical and comparative legal research methods were used, which made it possible to draw the following conclusions: in the changing circumstances, the Russian special administrative regions are approaching in terms of the conditions for carrying out commercial activities and the volume of financial preferences provided to traditional offshore jurisdictions. However, in order to activate the process of re-domiciliation of foreign companies to the Oktyabrsky and Russky Islands, it is necessary to eliminate the shortcomings of legal regulation by amending the existing regulatory legal acts.

This Declaration has emanated from the Latin American Conference on Person-Centered Medicine, held in Lima-Peru on December 13 and 14, 2019, organized by the Peruvian Association of Person Centered Medicine (APEMCP), the Latin American Network of Person Centered Medicine (RLMCP), and the International College of Person Centered Medicine (ICPCM); under the auspices of the Peruvian Association of Faculties of Medicine (ASPEFAM), the Pan American Health Organization (PAHO / WHO), and the San Marcos National University (UNMSM).

Aim: We aimed to describe the aim, data collection and content from a survey completed among pregnant women during the first peak of the COVID-19 pandemic in Denmark. Methods: The declaration of the COVID-19 pandemic in early 2020 challenged pregnant women’s mental well-being due to a concern for their unborn child and their need for healthcare services through pregnancy and birth. To explore how the COVID-19 pandemic and the intensified measures such as the lockdown of Denmark impacted pregnant women’s well-being and mental health, we conducted a questionnaire survey in the spring of 2020 when the COVID-19 pandemic was at its first peak, and the consequences for pregnant women and the unborn child were very uncertain. All women residing in Denmark and registered with an ongoing pregnancy on 24 April 2020 were invited to participate. The questionnaire included background information, variables on COVID-19 symptoms and validated batteries of questions on loneliness, anxiety, stress, quality of life, meditation and prayers. Additional questions were included to examine concerns related to pregnancy and childbirth during the pandemic. Cohort characteristics: Almost 18,000 women answered the questionnaire, which represents 60% of all invited women who experienced a national lockdown for the first time. Their median age was 30 years, and they were more likely to be multiparous. Conclusions: Data from the COVIDPregDK Study will enable us to gain valuable knowledge on how the pandemic, the intensified measures from the health authorities and the national lockdown affected pregnant women’s mental health and their concerns during the COVID-19 pandemic.

Purpose The purpose of the paper was to conduct a legal-realist assessment of the South African prison system response to COVID-19. Severely congested and ill-resourced prison systems in Africa face unprecedented challenges amplified by COVID-19. South Africa has recorded the highest COVID-19 positivity rate in Africa and, on March 15th 2020, declared a national state of disaster. The first prison system case was notified on April 6th 2020. Design/methodology/approach A legal-realist assessment of the South African prison system response to COVID-19 in the 12 months following initial case notification focused on the minimum State obligations to comply with human rights norms, and the extent to which human, health and occupational health rights of prisoners and staff were upheld during disaster measures. Findings A legal-realist account was developed, which revealed the indeterminate nature of application of South African COVID-19 government directives, ill-resourced COVID-19 mitigation measures, alarming occupational health and prison conditions and inadequate standards of health care in prisons when evaluated against the rule of law during State declaration of disaster. Originality/value This legal-realist assessment is original by virtue of its unique evaluation of the South African prison system approach to tackling COVID-19. It acknowledged State efforts, policymaking processes and outcomes and how these operated within the prison system itself. By moving beyond the deleterious impacts of the COVID-19 pandemic on the already precarious South African prison system, the authors argue for rights assurance for those who live and work in its prisons, improved infrastructure and greater substantive equality of all deprived of their liberty in South Africa.

Nobody should profit from crime; this fundamental moral principle is uncontroversial. At the level of public declaration, few people are likely to disagree with this statement; however, controversies arise when the implementation of this principle is under discussion. Numerous provisions exist that aim to strip criminals of the proceeds from their crimes, but not all aspects of this issue are immediately apparent. For example, a significant question is how to treat profits that a criminal makes from activities including recounting stories about their criminal activities, publishing books describing their actions, or creating YouTube videos presenting details about their crimes. Such profits are either treated as legitimate or are targeted by complicated legal methods of deprivation. The view presented in this paper could facilitate the ability to strip criminals from these forms of profit. This article argues that revenue accruing from knowledge gained from association with crime should be treated as indirect proceeds of crime and, as such, should be forfeited.

Information plays a vital role, both in terms of its importance for a democratic order and as a prerequisite for public participation. Many countries have made provisions for access to information in their respective constitutions. The FDRE Constitution explicitly provides that everyone has the right to seek and receive information. The Freedom of Mass Media and Access to Information Proclamation –which entered into force in 2008– gives effect to this Constitutional guarantee. Moreover, the number of laws on different environmental issues is on the rise, and the same could be said of the multilateral environmental agreements that Ethiopia has ratified. Many of the laws incorporate the right of the public to access environmental information held by public bodies. Despite the existing legal framework, there are still notable barriers to access to environmental information. By analyzing the relevant laws, the aim of this article is to contribute to the dialogue on the constitutional right of access to information with particular emphasis on the legal framework on, and the barriers to, access to environmental information within the meaning of Principle 10 of the Rio Declaration.

Patient safety in the operative and perioperative period is critically important. The consequences of anesthesia complications have a significant impact on long-term surgical outcomes, quality of life of patients, morbidity and mortality. The purpose of the study was to assess the implementation of the components of the Helsinki Declaration in the practice of Ukrainian hospitals. Materials and methods. The survey was conducted in March-June 2021 by filling out a standard Google form. The link to the survey was distributed on the official page of the Association of Anesthesiologists of Ukraine, through social networks Facebook and Instagram on the official pages of the Department of Surgery, Anesthesiology and Intensive Care of the Institute of Postgraduate Education of the Bogomolets National Medical University. A total of 174 respondents took part in the survey. According to the results, 79.3% of respondents are aware of the Helsinki Declaration on Patient Safety in Anesthesiology. Among the respondents, only 43% stated that the principles of the Helsinki Declaration had been implemented in their medical institutions, and 20.9% about plans to implement the principles in the near future. At the same time, in 36% of medical institutions the principles of the declaration are not used and their implementation is not planned. The Safe Surgery checklist is always used by 18.7% of respondents, sometimes by 18.7%, and 29.2% of respondents have never about a checklist. Only 47% of doctors have an airway table in the operating room, and only 30% document the inspection of equipment before anesthesia. Most physicians noted that they used protocols in their practice, but 10% said they mostly did not. Regarding the report of complications, only 46% of hospitals have a separate form (journal), most doctors only inform the head of complications orally. Measures to improve patient safety in medical institutions in 2012-2014 were implemented by 24.1% of respondents, in 2015-2017 by 19.1%, in 2018 – 10.6%, in 2019-2020 – 10,2% of respondents. Most of the respondents stated that the quality of the department’s work has improved and the level of patient safety has improved after the application of these principles in their work. The study showed that while significant positive steps are being taken to improve patient safety, there are still many challenges and opportunities for improvement.

Access to primary education, implemented in many nations as a fundamental right, is enshrined in the United Nations Declaration of Human Rights, Article 26(1). However, higher education requires en...

Objectives Coronavirus disease 2019 has caused a major epidemic worldwide, and lockdowns became necessary in all countries to prevent its spread. This study aimed to evaluate the effects of staying-at-home practices on the metabolic control of children and adolescents with type 1 diabetes during the pandemic period. Materials and Methods Eighty-nine patients younger than 18 years old who were diagnosed with type 1 diabetes at least one year before the declaration of the pandemic were included in the study. The last visit data of the patients before and after the declaration of the pandemic, and the frequency of presentation of diabetes-related emergencies from one year after diagnosis of type 1 diabetes to the declaration of the pandemic, and from the declaration of the pandemic to the last visit after the pandemic declaration were compared. Results The total number of patients was 89, and 48 (53.9%) were boys. The mean (± standard deviation [SD]) age at diagnosis was 8.4 ± 3.7 years (boys 7.9 ± 3.6 years; girls 8.9 ± 3.9 years). There was no statistically significant difference when the SD values of the anthropometric measurements, and the glycosylated hemoglobin (HbA1c) and lipid profile tests were compared. However, the frequency of admission to the emergency service related to diabetes was significantly different. Conclusions Although the pandemic did not significantly affect the metabolic and glycemic controls of the children with type 1 diabetes included in this study, an increase in the frequency of diabetes-related emergency admissions was noted.

Goal. The essay explores into the legal basis for combatting cyberbullying against children in the age of information technologies. The key signs of cyberbullying against children include the lack of time and geographical limits; the large scale and speed of sharing abusive information, and the unlimited audiences. Methods. To achieve this goal, an empirical study was carried out, in which 180 first-year students (aged 17 years), who study at the Educational and Scientific Institute of Law, Psychology and Innovative Education of Lviv Polytechnic National University, took part. When studying the theoretical and methodological aspects of this research problem, the following theoretical methods were employed: analysis, synthesis, generalization of data from psychological, pedagogical, scientific and methodological literature sources. Results. The phenomenon of cyberbullying against children is available in many developed countries. The research showed that children generally are well informed about the possibilities of protecting their rights in case of cyberbullying. However, the legal basis for protecting victims of cyberbullying requires the adoption of several laws. Conclusions. Most digital rights are enshrined in various UN Human Rights Resolutions that require systematization into the single codified act – The Declaration of Digital Human Rights. The need for this act is increasingly growing. In ten years, it would be difficult to think of a model democratic society. To build a legal basis in the area of e-democracy in line with international standards, it is important to adopt the laws on protection of freedom on the Internet,” and on e-democracy, which will certainly secure digital rights of children.

Problem setting. The development of information and communication technologies, digitalization of society, the transition of consumers to the sphere of electronic interaction with the seller of goods, services, works causes the need for legal support for the effective development of innovative sectors of the economy. At the same time, first of all, it is necessary to take into account the needs of innovative newly created business entities - startups, the legal nature and specifics of which do not have a common understanding in Ukraine and abroad. At the same time, startups are the main "consumers" of grant proposals and contribute to attracting additional investment, including foreign, in the economies of individual countries. That is why the European Union (hereinafter - the EU) in its policy in 2021 has set a course to maximize the incentive to establish startups in the EU as people already living in Member States and immigrants from third countries, because it is from the level of innovative entrepreneurship depends on the economic stability and potential of the future of the state. Analysis of resent researches and publications. Recent research and publications on the subject. Scientists such as S. Blank, J. Guzman., S. Stern., S. Glibko, K. A. Karbovska, TV Kotyai, L. Gulyaeva, L. Zhuk and others. The target of research is to conduct a comprehensive analysis of legal trends in the development of startups in the EU and compliance with these trends in regulations and law enforcement practices of Ukraine. Article’s main body. Today in the EU the signing of the Declaration "Startup Nations Standard" is in the final stage. By analyzing the content of this Declaration, at an early stage of development of startups it is possible to identify the following vectors of development of legal regulation of EU countries: 1) fast state registration of the startup (as a general rule - 1 day, however, in exceptional cases related to the need for additional checks - no more than a week); 2) the cost of administrative services related to registration may not exceed 100 EUR. 3) availability of effective support services for startup founders; 4) the existence of a single web portal, which has all the relevant legal information on the registration procedure, administrative fees and funding opportunities; 5) availability of electronic support system, including from other EU countries; 6) recognition of legal documents of other EU countries as confirmation of startup registration. The same Declaration provides for cooperation with non-EU countries, which includes, on the one hand, an accelerated procedure, visa issuance for persons planning to register a startup in an EU member state, which can be achieved by having a startup partner from the state. EU, or the presence of such a founder of relevant experience in conducting innovative business, and on the other - to encourage the return to the EU of startups whose founders emigrated to other countries. In addition, it is declared to reduce the tax burden and simplify administrative procedures, in order to implement the guiding principle of supporting EU business - "Think Small First". As of March 2021, the Declaration of Startup Nations Standard has been signed by 24 EU member states and only 3 countries are refraining from signing: Hungary, Bulgaria and Croatia. Conclusions and prospects of the development. The leading trends in the development of EU legislation are to simplify the procedure and "reduce" the cost of state registration of startups, digitalization of communication between their founders and government agencies, promoting a single web portal that takes into account all relevant information necessary for registration and operation of startups. about available administrative services, their cost, term of granting, actual grant offers and means of state support, etc.). Compared to the analyzed EU member states, Ukraine generally meets the requirements of the Declaration "Startup Nations Standard" on the speed and cost of state registration of startups, as well as the publication of relevant information for founders on the list of required documents and details of services. At the same time, information support for startups needs to be improved in terms of the functioning of a single web portal with up-to-date data on the opportunities for startups to receive support and other legal information necessary for their activities.

Introduction Strategies are needed to increase implementation of evidence-based tobacco dependence treatment (TDT) in health care systems in low-and middle-income countries (LMICs). Aims and Methods We conducted a two-arm cluster randomized controlled trial to compare the effectiveness of two strategies for implementing TDT guidelines in community health centers (n = 26) in Vietnam. Arm 1 included training and a tool kit (eg, reminder system) to promote and support delivery of the 4As (Ask about tobacco use, Advise to quit, Assess readiness, Assist with brief counseling) (Arm 1). Arm 2 included Arm 1 components plus a system to refer smokers to a community health worker (CHW) for more intensive counseling (4As + R). Provider surveys were conducted at baseline, 6 months, and 12 months to assess the hypothesized effect of the strategies on provider and organizational-level factors. The primary outcome was provider adoption of the 4As. Results Adoption of the 4As increased significantly across both study arms (all p < .001). Perceived organizational priority for TDT, compatibility with current workflow, and provider attitudes, norms, and self-efficacy related to TDT also improved significantly across both arms. In Arm 2 sites, 41% of smokers were referred to a CHW for additional counseling. Conclusions The study demonstrated the effectiveness of a multicomponent and multilevel strategy (ie, provider and system) for implementing evidence-based TDT in the Vietnam public health system. Combining provider-delivered brief counseling with opportunities for more in-depth counseling offered by a trained CHW may optimize outcomes and offers a potentially scalable model for increasing access to TDT in health care systems like Vietnam. Implications Improving implementation of evidence-based TDT guidelines is a necessary step toward reducing the growing burden of noncommunicable diseases and premature death in LMICs. The findings provide new evidence on the effectiveness of multilevel strategies for adapting and implementing TDT into routine care in Vietnam and offer a potentially scalable model for meeting Framework Convention on Tobacco Control Article 14 goals in other LMICs with comparable public health systems. The study also demonstrates that combining provider-delivered brief counseling with referral to a CHW for more in-depth counseling and support can optimize access to evidence-based treatment for tobacco use. Clinical trials number: NCT01967654.

Purpose: Since the declaration of the wide and progressive spread of COVID-19 as a pandemic, the health systems worldwide are facing challenges in the balance between applying recommended precautionary measures for COVID-19, while maintain providing essential routine health care to other groups like chronic diseases' patients. The current study aims to explore impact of precautionary measures of COVID-19 on chronic diseases' patients in Jeddah, Saudi Arabia. Methodology: Through an analytical cross-sectional study; a representative sample of chronic diseases' patients were selected randomly from primary health care centers in Jeddah. They were invited to respond to a valid questionnaire designed to collect data about the impact of Covid 19 pandemic measures on chronic diseases’ patients. The questionnaire is adapted from valid published questionnaires conceptualized around the impact of Covid 19 measures on chronic patients. Chi-square test was used to identify association between the health status and the independent variables. P-value

The COVID 19 pandemic was declared on the 9th of March 2020. The health crisis affected the whole world with a very high and unexpected number of infected people. The situation forced the declaration of lockdown and a worldwide health system reorganization. Surprisingly, the social distancing laws caused a reduction of urgent hospital activities not COVID 19 related. The aim of this manuscript is to analyze the reasons why fewer emergencies were described during the 2020 Italian lockdown. The Data reporting urgent Emergency Room (ER) activity, during the first three weeks of the Italian lockdown (Group 1), were analyzed and compared with the same period in 2019 (Group 2). During the study period in 2020, there was a 46,5% reduction in ER activity compared to that in 2019. Nevertheless, the hospitalization rate was higher in the 2020 then in 2019 (p

Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will globally emerge from the shadow of COVID-19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: (1) those which made an assessment as to the aerosolisation of droplets during sinus surgery, further subdivided into work which considered macroscopically visible droplets and that which considered smaller particles; (2) and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. Whilst results both highlight a range of innovative adjunctive strategies and support suction as an important variable to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery given studies have demonstrated that close adherence to PPE use is effective at preventing COVID-19 infection.

Background National testing strategy, including monitoring and evaluation, is critical in responding to HIV, sexually transmitted infections, and viral hepatitis. Community-based voluntary counselling and testing contributes to early HIV diagnoses among key populations. Countries providing community-based testing, should integrate some core data on testing and linkage to care in these services into national surveillance and monitoring and evaluation systems. This study aimed to support the integration of community-based voluntary counselling and testing data into respective national surveillance and M&E systems for those infections. Methods Preliminary consensus on indicators for the integration of community-based voluntary counselling and testing data into respective national surveillance and monitoring and evaluation systems was reached. Pilot studies were conducted in Estonia, Poland, Serbia, Slovakia, Slovenia and Spain. After pilot activities were implemented, the final consensus on indicators was reached. An analysis of the facilitators and barriers faced during pilot studies was conducted to inform the final recommendations for implementation. Results The minimum set of six indicators to be integrated into national surveillance and monitoring and evaluation systems were: number of tests, number of clients tested, reactivity rate for tests and clients, positivity (active infection) rates for tests and clients, linkage to care rates for clients with reactive and/or positive test result, proportion of all new diagnoses in a country with first reactive test result at community-based voluntary counselling and testing service. Seven additional indicators were identified. Each indicator should be disaggregated by key population, sex and age group. A list of 10 recommendations for the collection and integration of community-based voluntary counselling and testing data into national surveillance and monitoring and evaluation systems for HIV, sexually transmitted infections and viral hepatitis was identified. Conclusions Integration of some community-based voluntary counselling and testing monitoring and evaluation data into national surveillance and monitoring and evaluation systems in all pilot countries was achieved. The recommendations will support such integration in other European countries. European Centre for Prevention and Control of Diseases included questions from the minimum list of indicators into their Dublin Declaration questionnaire 2020 to contribute to evidence based community testing policies in European countries.

The embodiment of maintaining and improving health status is the declaration of a clean and healthy lifestyle policy which is then shortened to PHBS. According to the Decree of the Minister of Health of the Republic of Indonesia No. 2269/MENKES/PER/XI/2011, PHBS is a set of attitudes carried out based on an understanding of learning outcomes to create independent individuals, families, and communities in the health sector and act actively in creating a healthy society. The main problem in this study is that the percentage of household PHBS program implementation in the Pameungpeuk Health Center working area only reached 24%, quite far from the 2014 Ministry of Health Strategic Plan target, which is 70% of households that have practiced PHBS. as well as the factors supporting and inhibiting the implementation of the PHBS program in household arrangements at the Pameungeuk Health Center. The method used is descriptive qualitative with interview, observation, and documentation studies. While checking the validity of the data using data source triangulation techniques. The author found that the implementation of the household PHBS program at the Pameungpeuk Health Center was carried out through the following processes (i) the logic of the policy, (ii) the environment in which the policy was operationalized, and (iii) the ability of the policy implementer. The results showed that the implementation of the household PHBS program in the work area of the Pameungpeuk Health Center was still not optimal and several obstacles were found in its implementation, namely the lack of human resources, incomplete facilities and infrastructure, lack of training for health promotion officers, and low community support in assisting implementation. this program.

This paper aims to analyze education guarantees for children with special needs (ABK) in the Covid-19 era. The focus of the study is the phenomenon of crew members clowning on the streets of Medan City. The theory used in analyzing the data is the theory of implementation of Merilee S. Grindle's policies. This research uses a qualitative approach with a case study method. Data was collected using an open interview technique, participant observation, and documentation study. Furthermore, the data were analyzed through data reduction techniques, data display, and concluding. This study indicates that the North Sumatra government has been very responsive to inclusive education for children with special needs in the region.This is indicated by two things, namely (1) the declaration of North Sumatra as the Province of Inclusive Education since 2015 and (2) the issuance of the Governor of North Sumatra No. 29 of 2016 concerning the Implementation of Inclusive Education as a follow-up to Permendiknas Number 70 of 2009.

Background The World Health Organisation declared a global pandemic on the 11 March 2020 resulting in implementation of methods to contain viral spread, including curtailment of all elective and non-emergent interventions. Many institutions have experienced changes in rostering practices and redeployment of trainees to non-surgical services. Examinations, study days, courses, and conferences have been cancelled. These changes have the potential to significantly impact the education and training of surgical trainees. Aim To investigate the impact of the COVID-19 pandemic on training, educational, and operative experiences of Irish surgical trainees. Methods Surgical trainees were surveyed anonymously regarding changes in working and educational practices since the declaration of the COVID-19 pandemic on 11 March 2020. The survey was circulated in May 2020 to both core and higher RCSI surgical trainees, when restrictions were at level five. Questions included previous and current access to operative sessions as well as operative cases, previous and current educational activities, access to senior-led training, and access to simulation-/practical-based training methods. A repeat survey was carried out in October 2020 when restrictions were at level two. Results Overall, primary and secondary survey response rates were 29% (n = 98/340) and 19.1% (n = 65/340), respectively. At the time of circulation of the second survey, the number of operative sessions attended and cases performed had significantly improved to numbers experienced pre-pandemic (p p Conclusion Surgical training and education have been significantly impacted in light of COVID-19. This is likely to continue to fluctuate in line with subsequent waves. Significant efforts have to be made to enable trainees to meet educational and operative targets.

OBJECTIVE: We investigated the association between telework frequency and presence of non-COVID-19-related physical symptoms during the COVID-19 emergency declaration among workers in Japan. METHODS: Data were collected from 1648 workers via web-based self-reported questionnaires. Multivariate logistic regression models were used to investigate the association between telework frequency per week (0, 1-2, 3-4, and ≥5 days/week) and the presence of stiff shoulders, eyestrain, and low back pain. RESULTS: Among 917 participants, telework frequency was significantly associated with stiff shoulders (≥5 days: adjusted odds ratio [aOR] 3.02, 95% confidence interval [CI] 1.37-7.06), eyestrain (≥5 days: aOR 5.31, 95% CI 2.09-13.44), and low back pain (≥5 days: aOR 5.57, 95% CI 2.22-14.00), compared with non-teleworkers. CONCLUSIONS: Workers who abruptly began telework experienced more physical symptoms than non-teleworkers during the emergency declaration.

Thermal Detection Swing Gate Turnstile with QR Code Application. An automated health form system could be a big step forward in upgrading and updating the health information system as we enter the new normal way of life. This may assist administrators at all institutions in executing their new standard operating procedures. However, some establishments, unlike others, continue to use a manual approach to implementing health and safety protocols, such as handing out a health declaration form to be filled out, and their information may not be secure, and spreading the virus by giving and using the same pen to all clients who enter the establishment's premises. The Thermal Detection Swing Gate Turnstile with QR Code Application was created to address all of these difficulties. First, a prototype for an automated health form system that may be used by all clients, students, and employees. We made it easier for clients to use our system by including QR codes and RFID readers for students and employees. This will save them time when filling out their health declaration papers, and their data will be considerably safer because we built admin and super admin access so that only authorized persons have access to it.

From its emergence and declaration as a worldwide pandemic, coronavirus disease-2019 (COVID-19) has been associated with significant medical and logistical challenges. Initial obstacles ranged from the need to develop testing platforms to the determination of effective treatments to decrease the significant morbidity and mortality associated with the disease. Due to significant scientific breakthroughs, the most recent pressing challenge has been the distribution of vaccines against severe acute respiratory syndrome coronavirus 2 to prevent the spread of the infection across the world. Historically, the U.S. Military has been involved in immunizations delivery to prevent disease among its troops. This experience has led to the establishment of programs designed to distribute safe vaccinations to service members and beneficiaries. It is upon this infrastructure that the Air Force (AF) medical community was thrust to devise and execute COVID-19 vaccine delivery implementation across all military treatment facilities. In the AF, specialty trained allergist and immunologists provide the technical expertise for the establishment and execution of the AF immunizations program. These medical professionals have the proficiency, knowledge, and experience to run efficient mass immunization events in order to provide vaccines in a safe and rapid environment. Despite this, significant challenges attributable to the variable and novel nature of COVID-19 vaccine logistical requirements have led to unanswered questions and debate that needed resolution before and during the launch of this program. Here we describe the process for establishing a mass vaccination program for COVID-19 vaccine delivery and our experience-based problem solving approach at a large AF military treatment facility.

This article presents the ambitious potentialities in the use of digital methods and techniques for the documentation of the Nordic architectural heritage and environment. The processes of knowledge, both theoretical and practical, should not ignore the traces of the past, old buildings and traditional constructions. On the contrary, they should serve as a testimony of the past and provide a solid starting point for new, more coherent, sustainable and harmonic urban development. Since the Venice Charter in 1965 up to the more recent international documents such as the Declaration of Amsterdam in 1975 and the Madrid Document in 2011, both the verification of authenticity and understanding of architectural entities and details are getting more insight because of the current technological advancements. However, the methods for the analysis and following these noble principles and declaration articles is still not defined well enough. Each method and practical procedure with specific instruments produce also specific outputs and results, which need to be put in mutual dialogue in order to obtain useful results. These themes are studied and developed in this article by presenting chosen case studies in research projects both on the urban and singular scale with the location in Oulu, Finland.

Entrepreneurship is an integral part of the market economy. However, only recently it has been possible to analyse this cluster online. The purpose of the research paper is a qualitative analysis of indicators formed by the Federal Tax Service of Russia to characterize the activities of small and medium-sized businesses. The article presents the results of a review of the indicators of information and digital resources of the Federal Tax Service of Russia that characterize the activities of small businesses: the unified register of small and medium – sized businesses; the unified register of small and medium-sized businesses – recipients of support; the unified state register of taxpayers; the state information register of accounting (financial) reporting; the “Transparent Business” service. It is concluded that the information and statistical databases of the Federal Tax Service of Russia have a significant potential for partial formation of statistical reporting data of small and medium-sized businesses, and are also acceptable for economic and statistical analysis of the activities of both a specific entity and a group of entities.

This policy brief offers a short discussion on how workplace bullying is a human rights violation when the Universal Declaration of Human Rights is considered. Workplace bullying as an international issue should be prohibited. Higher education is particularly important in this context because there is a higher frequency of workplace bullying in higher education and higher education plausibly is in a viable position to end the lack of dignity experienced by those dealing with workplace bullying.