Search

George Latsios,1,* Andreas Synetos,1,* Marianna Leopoulou,2 Evaggelia Stamatopoulou,3 Panagiotis Koukopoulos,4 Charalambos Parisis,5 Antonios Karanasos,1 Paraskevi Fragkou,6 Konstantinos Toutouzas,1 John Kanakakis,7 Kostas Tsioufis1 1First Department of Cardiology, National and Kapodistrian University of Athens, “Hippocration” General Hospital, Athens, Greece; 2Department of Cardiology, “Elpis” General Hospital, Athens, Greece; 3Catheterization Laboratory, University of Athens Medical School, “Attikon” University Hospital, Athens, Greece; 4Emergency Medical Service, Athens, Greece; 5 404 General Military Hospital, Larissa, Greece; 6First Department of ICU, National and Kapodistrian University of Athens, “Evaggelismos” General Hospital, Athens, Greece; 7Department of Clinical Therapeutics, National and Kapodistrian University of Athens, “Alexandra” Hospital, Athens, Greece*These authors contributed equally to this workCorrespondence: George Latsios, 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, AlexAndroupoleos 9, Athens, 11527, Email glatsios@gmail.comObjective: The aim of this study was to evaluate the level of established knowledge regarding cardiopulmonary resuscitation (CPR) during the pre-vaccine Covid-19 pandemic era of certified Basic Life Support (BLS) providers, as well as their attitude towards CPR and their willingness to provide CPR.Methods: Certified BLS providers from courses held in Athens, Greece, were asked to complete an electronic survey regarding their knowledge of and stance towards performing CPR on victims with confirmed or suspected Covid-19 infection. Their insight on BLS courses was also assessed. Answers were collected during June 2020.Results: Out of 5513 certified providers, 25.53% completed the survey. The majority (83.36%) would provide CPR to a cardiac arrest victim with possible or confirmed Covid-19 infection. Regarding the use of an automated external defibrillator, most respondents anticipated that it is equally safe as in the pre-Covid-19 period (58.24%). A more elementary level of education (p = 0.04) made rescuers more willing to provide CPR. Access to the European Resuscitation Council (ERC) or to the Greek National Public Health Organization (NPHO) guidelines was not correlated to the attitude towards resuscitation. Time since the last BLS seminar had no impact on the rescuers’ attitude (p = 0.72). All responders agreed that training in CPR during Covid-19 remains necessary.Conclusion: Certified BLS providers maintained their willingness to perform CPR in cardiac arrest victims even during the pre-vaccine, dangerous Covid-19 pandemic period. Knowledge regarding Covid-19 CPR was satisfactory; however, continuous training, focused on the revised algorithms, was considered essential.Keywords: BLS, covid-19, resuscitation, survey

This study investigates the time-series behavior of vegetable prices in the Central Market of Thessaloniki, Greece, using Recurrence Plot (RP) analysis and Recurrence Quantification Analysis (RQA), which considers non-linearities and does not necessitate stationarity of time series. The period of study was 1999–2016 for practical and research reasons. In the present work, we focus on vegetables available throughout the year, exploring the dynamics and interrelationships between their prices to avoid missing data. The study applies RP visual inspection classification, a clustering based on RQA parameters, and a classification based on the RQA analysis graphs with epochs for the first time. The aim of the paper was to investigate the grouping of products based on their price dynamical behavior. The results show that the formed groups present similarities related to their use as dishes and their way of cultivation, which apparently affect the price dynamics. The results offer insights into market behaviors, helping to inform better management strategies and policymaking and offer a possibility to predict variability of prices. This information can interest government policies in various directions, such as what products to develop for greater stability, identity for fluctuating prices, etc. In future work, a larger dataset including missing data could be included, as well as a machine-learning algorithm to classify the products based on the RQA with epochs graphs.

Abstract In this paper, we compare the dynamics of the growth rates of the original Divisia monetary aggregates, the credit card-augmented Divisia monetary aggregates, and the credit card-augmented Divisia inside monetary aggregates. This analysis is based on the methods of recurrence plots, recurrence quantification analysis, and visual boundary recurrence plots which are phase space methods designed to depict the underlying dynamics of the system under study. We identify the events that affected Divisia money growth and point out the differences among the different Divisia monetary aggregates based on the recurrence and visual boundary recurrence plots. We argue that the broad Divisia monetary aggregates could be used for monetary policy and business cycle analysis as they are exhibiting less fluctuation compared to the narrow Divisia monetary aggregates. They could positively affect policy decisions regarding environmental choices and sustainability. We also point out the changes in the monetary dynamics locating the 2008 global financial crisis and the Covid-19 pandemic.

Objective: This meta-analysis aimed to assess the prevalence of respiratory viruses among children under the special conditions of the COVID-19 pandemic. Methods: Five databases were systematically searched to assess the pooled prevalence of various respiratory viruses in different age groups, regions, seasons, and in patients with and without confirmed SARS-CoV-2 coinfection. Moreover, we looked at the virus distribution in the first and second half of the pandemic and countries with distinct economic status. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and the systematic review was registered on PROSPERO (CRD42022379297). Results: Enterovirus/rhinovirus and human respiratory syncytial virus (HRSV) were the most prevalent pathogens among children. The prevalence of HRSV increased in the second half of the pandemic. The prevailing viruses vary according to the SARS-CoV-2-coinfection status, season, region, and country´s economic status. Conclusion: This meta-analysis shows the epidemiology of respiratory viruses other than SARS-CoV-2 in children aged 0 to 12 years during the COVID-19 pandemic. Because major events, such as a pandemic, can alter epidemiology patterns, it is important to know them to improve health education measures, develop vaccines and medicines for vulnerable groups, as a guide for prevention strategies, and help with clinical decisions.

Objectives: Since the beginning of the COVID-19 pandemic, efforts have been made to contain the spread of the virus. However, the epidemiological burden of other respiratory viruses during the pandemic is unclear. We aim to address the epidemiology of respiratory viruses on adults/adolescents since the beginning of the pandemic. Methods: We systematically searched five databases and performed a meta-analysis to explore the pooled prevalence of respiratory viruses in different geographical regions, age groups, and periods and compared the prevalence between COVID-19 cases and non-COVID-19 patients. Results: Enteroviruses/rhinoviruses were highly prevalent compared to other viruses. Different viruses were dominant in different regions. No significant differences in prevalence were found between different age groups, except for human metapneumovirus. There was an increase in prevalence of non-SARS-CoV-2 viruses in the second half of the pandemic (July 2021-December 2022). Comparison of COVID-19 and non-COVID patients showed a higher prevalence in the non-COVID group, significant for influenza, seasonal coronaviruses, and human parainfluenza viruses. Conclusion: Our findings indicate that enteroviruses/rhinoviruses were less impacted by healthcare measures compared with other respiratory viruses. The relaxation of measures in the second half led to an increased pooled prevalence of infections. Several factors may explain the lower prevalence among individuals infected with COVID-19.

Abstract Multiple sclerosis (MS) is a chronic inflammatory and demyelinating autoimmune disease. MS patients deal with motor and sensory impairments, visual disabilities, cognitive disorders, and speech and language deficits. The study aimed to record, enhance, update, and delve into our present comprehension of speech deficits observed in patients with MS and the methodology (assessment tools) studies followed. The method used was a search of the literature through the databases for May 2015 until June 2022. The reviewed studies offer insight into speech impairments most exhibited by MS patients. Patients with MS face numerous communication changes concerning the phonation system (changes observed concerning speech rate, long pause duration) and lower volume. Moreover, the articulation system was affected by the lack of muscle synchronization and inaccurate pronunciations, mainly of vowels. Finally, there are changes regarding prosody (MS patients exhibited monotonous speech). Findings indicated that MS patients experience communication changes across various domains. Based on the reviewed studies, we concluded that the speech system of MS patients is impaired to some extent, and the patients face many changes that impact their conversational ability and the production of slower and inaccurate speech. These changes can affect MS patients’ quality of life.

Human immunodeficiency virus (HIV) infection represents a major cardiovascular risk factor, and the cumulative cardiovascular disease (CVD) burden among aging people living with HIV (PLWH) constitutes a leading cause of morbidity and mortality. To date, CVD risk assessment in PLWH remains challenging. Therefore, it is necessary to evaluate and stratify the cardiovascular risk in PLWH with appropriate screening and risk assessment tools and protocols to correctly identify which patients are at a higher risk for CVD and will benefit most from prevention measures and timely management. This review aims to accumulate the current evidence on the association between HIV infection and CVD, as well as the risk factors contributing to CVD in PLWH. Furthermore, considering the need for cardiovascular risk assessment in daily clinical practice, the purpose of this review is also to report the current practices and novel perspectives in cardiovascular risk assessment of PLWH and provide further insights into the development and implementation of appropriate CVD risk stratification and treatment strategies, particularly in countries with high HIV burden and limited resources.

The advent of highly sensitive molecular diagnostic techniques has improved our ability to detect viral pathogens leading to severe and often fatal infections that require admission to the Intensive Care Unit (ICU). Viral infections in the ICU have pleomorphic clinical presentations including pneumonia, acute respiratory distress syndrome, respiratory failure, central or peripheral nervous system manifestations, and viral-induced shock. Besides de novo infections, certain viruses fall into latency and can be reactivated in both immunosuppressed and immunocompetent critically ill patients. Depending on the viral strain, transmission occurs either directly through contact with infectious materials and large droplets, or indirectly through suspended air particles (airborne transmission of droplet nuclei). Many viruses can efficiently spread within hospital environment leading to in-hospital outbreaks, sometimes with high rates of mortality and morbidity, thus infection control measures are of paramount importance. Despite the advances in detecting viral pathogens, limited progress has been made in antiviral treatments, contributing to unexpectedly high rates of unfavorable outcomes. Herein, we review the most updated data on epidemiology, common clinical features, diagnosis, pathogenesis, treatment and prevention of severe community- and hospital-acquired viral infections in the ICU settings.

Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients’ clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% (n = 528), while the overall in-hospital mortality was 50.96% (n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.

Abstract We construct recurrence plots (RPs) and conduct recurrence quantification analysis (RQA) to investigate the dynamic properties of the new Center for Financial Stability (CFS) Divisia monetary aggregates for the United States. In this study, we use the latest vintage of Divisia aggregates, maintained within CFS. We use monthly data, from January 1967 to December 2020, which is a sample period that includes the extreme economic events of the 2007–2009 global financial crisis. We then make comparisons between narrow and broad Divisia money measures and find evidence of a nonlinear but reserved possible chaotic explanation of their origin. The application of RPs to broad Divisia monetary aggregates encompasses an additional drift structure around the global financial crisis in 2008. Applying the moving window RQA to the growth rates of narrow and broad Divisia monetary aggregates, we identify periods of changes in data-generating processes and associate such changes to monetary policy regimes and financial innovations that occurred during those times.

The widespread presence of autoantibodies in acute infection with SARS-CoV-2 is increasingly recognized, but the prevalence of autoantibodies in non–SARS-CoV-2 infections and critical illness has not yet been reported. We profiled IgG autoantibodies in 267 patients from 5 independent cohorts with non–SARS-CoV-2 viral, bacterial, and noninfectious critical illness. Serum samples were screened using Luminex arrays that included 58 cytokines and 55 autoantigens, many of which are associated with connective tissue diseases (CTDs). Samples positive for anti-cytokine antibodies were tested for receptor blocking activity using cell-based functional assays. Anti-cytokine antibodies were identified in > 50% of patients across all 5 acutely ill cohorts. In critically ill patients, anti-cytokine antibodies were far more common in infected versus uninfected patients. In cell-based functional assays, 11 of 39 samples positive for select anti-cytokine antibodies displayed receptor blocking activity against surface receptors for Type I IFN, GM-CSF, and IL-6. Autoantibodies against CTD-associated autoantigens were also commonly observed, including newly detected antibodies that emerged in longitudinal samples. These findings demonstrate that anti-cytokine and autoantibodies are common across different viral and nonviral infections and range in severity of illness.

Vitamin D supplementation and its impact on immunoregulation are widely investigated. We aimed to assess the prevention and treatment efficiency of vitamin D supplementation in the context of coronavirus disease 2019 (COVID-19) and any disease-related complications. For this systematic review and meta-analysis, we searched databases (PubMed, Embase, Scopus, Web of Science, The Cochrane Library, medRxiv, Cochrane COVID-19 Study Register, and ClinicalTrial.gov) for studies published between 1 November 2019 and 17 September 2021. We considered randomized trials (RCTs) as potentially eligible when patients were tested for SARS-CoV-2 infection and received vitamin D supplementation versus a placebo or standard-of-care control. A random-effects model was implemented to obtain pooled odds ratios for the effect of vitamin D supplementation on the main outcome of mortality as well as clinical outcomes. We identified a total of 5,733 articles, of which eight RCTs (657 patients) met the eligibility criteria. Although no statistically significant effects were reached, the use of vitamin D supplementation showed a trend for reduced mortality [odds ratio (OR) 0.74, 95% confidence interval (CI) 0.32–1.71, p = 0.48] compared with the control group, with even stronger effects, when vitamin D was administered repeatedly (OR 0.33, 95% CI 0.1–1.14). The mean difference for the length of hospitalization was −0.28 (95% CI −0.60 to 0.04), and the ORs were 0.41 (95% CI 0.15–1.12) and 0.52 (95% CI 0.27–1.02) for ICU admission and mechanical ventilation, respectively. In conclusion, vitamin D supplementation did not improve the clinical outcomes in COVID-19 patients, but trends of beneficial effects were observed. Further investigations are required, especially studies focusing on the daily administration of vitamin D.

Endothelial glycocalyx (EG) derangement has been associated with cardiovascular disease (CVD). Studies on EG integrity among people living with HIV (PLWH), are lacking. We conducted a prospective cohort study among treatment-naïve PLWH who received emtricitabine/tenofovir alafenamide, combined with either an integrase strand transfer inhibitor (INSTI, dolutegravir, raltegravir or elvitegravir/cobicistat), or a protease inhibitor (PI, darunavir/cobicistat). We assessed EG at baseline, 24 (±4) and 48 (±4) weeks, by measuring the perfused boundary region (PBR, inversely proportional to EG thickness), in sublingual microvessels. In total, 66 consecutive PLWH (60 (90.9%) males) with a median age (interquartile range, IQR) of 37 (12) years, were enrolled. In total, 40(60.6%) received INSTI-based regimens. The mean (standard deviation) PBR decreased significantly from 2.17 (0.29) μm at baseline to 2.04 (0.26) μm (p = 0.019), and then to 1.93 (0.3) μm (p < 0.0001) at 24 (±4) and 48 (±4) weeks, respectively. PBR did not differ among treatment groups. PLWH on INSTIs had a significant PBR reduction at 48 (±4) weeks. Smokers and PLWH with low levels of viremia experienced the greatest PBR reduction. This study is the first to report the benefit of antiretroviral treatment on EG improvement in treatment-naïve PLWH and depicts a potential bedside biomarker and therapeutic target for CVD in PLWH.

This article presents a dataset on the accumulated water flow (L/s) granted in the Antofagasta Region for each year between 1905 and 2018. We produced the dataset starting from the official public records on water rights (Registro Público de Derechos de Aprovechamiento de Aguas, RPDAA), which are free to access and available at the National Water Agency's website (Dirección General de Aguas, DGA). The initial data described 1047 individual water rights granted in the Antofagasta Region according to 65 criteria. In order to find errors in the data, inconsistencies between the data, or/and the absence of relevant information, we revised and validated the data through different methods, including a literature review and interviews to public officials. Then, we calculated the accumulated water flow (L/s) from the annual flow granted each year (1905–2018) in the two main basins of the region: the Loa River Basin, and the Salar de Atacama Basin. In doing so, we differentiated the type of water (ground or surface water) and the use of water. Thus, the data show and compare temporal variations in the allocation of ground and surface water to different water uses in the two basins. The data are useful to researchers, decision makers and to the general population interested in the processes of water distribution within the Chilean context.

The importance of fluid resuscitation therapy during the early stages of sepsis management is a well-established principle. Current Surviving Sepsis Campaign (SSC) guidelines recommend the early administration of intravenous crystalloid fluids for sepsis-related hypotension or hyperlactatemia due to tissue hypoperfusion, within the first 3 h of resuscitation and suggest using balanced solutions (BSs) instead of normal saline (NS) for the management of patients with sepsis or septic shock. Studies comparing BS versus NS administration in septic patients have demonstrated that BSs are associated with better outcomes including decreased mortality. After initial resuscitation, fluid administration has to be judicious in order to avoid fluid overload, which has been associated with increased mortality, prolonged mechanical ventilation, and worsening of acute kidney injury. The “one size fits all” approach may be “convenient” but it should be avoided. Personalized fluid management, based on patient-specific hemodynamic indices, provides the foundations for better patient outcomes in the future. Although there is a consensus on the need for adequate fluid therapy in sepsis, the type, the amount of administered fluids, and the ideal fluid resuscitation strategy remain elusive. Well-designed large randomized controlled trials are certainly needed to compare fluid choices specifically in the septic patient, as there is currently limited evidence of low quality. This review aims to summarize the physiologic principles and current scientific evidence regarding fluid management in patients with sepsis, as well as to provide a comprehensive overview of the latest data on the optimal fluid administration strategy in sepsis.

Considering medical and economic burden of coronavirus disease 2019 (COVID-19), a high COVID-19 vaccination coverage among healthcare workers (HCWs) is an urgent need. The aim of this systematic review and meta-analysis was to evaluate the intention of HCWs to accept COVID-19 vaccination and to identify related factors. We searched PubMed, MEDLINE, Scopus, Web of Science, ProQuest, CINAHL and medRxiv until July 14, 2021. The heterogeneity between results was very high; thus, we applied a random effects model to estimate pooled effects. We performed subgroup and meta-regression analysis to identify possible resources of heterogeneity. Twenty four studies, including 50 940 HCWs, met the inclusion criteria. The overall proportion of HCWs that intend to accept COVID-19 vaccination was 63.5% (95% confidence interval: 56.5%-70.2%) with a wide range among studies from 27.7% to 90.1%. The following factors were associated with increased HCWs' willingness to get vaccinated against COVID-19: male gender, older age, white HCWs, physician profession, higher education level, comorbidity among HCWs, vaccination against flu during previous season, stronger vaccine confidence, positive attitude towards a COVID-19 vaccine, fear about COVID-19, individual perceived risk about COVID-19, and contact with suspected or confirmed COVID-19 patients. The reluctance of HCWs to vaccinate against COVID-19 could diminish the trust of individuals and trigger a ripple effect in the general public. Since vaccination is a complex behavior, understanding the way that HCWs take the decision to accept or refuse COVID-19 vaccination will give us the opportunity to develop the appropriate interventions to increase COVID-19 vaccination uptake.

Background: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation dose in COVID-19. Objective: We aim to systematically assess the currently available data regarding the effects of different dosing regimens of low molecular weight heparin and/or fondaparinux (LMWH/F) on mortality risk as well as the risk of arterial/venous thrombotic events and hemorrhagic complications in confirmed COVID-19 cases. Design: We conducted a living systematic review and meta-analysis on the effects of different LMWH/F doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients. Data Sources and Methods: MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database, and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH/F among confirmed COVID-19 cases. Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between LMWH/F and mortality during the following comparisons: (1) no LMWH/F versus any LMWH/F; (2) prophylactic versus higher than prophylactic LMWH/F; (3) prophylactic versus therapeutic LMWH/F; (4) intermediate versus therapeutic LMWH/F; and (5) lower than therapeutic versus therapeutic LMWH/F. Mortality was higher in patients receiving prophylactic versus intermediate LMWH/F (OR = 2.01; 95% CI: 1.19–3.39). However, this effect was mostly driven by observational data. No associations were detected between the intensity of LMWH/F and the risk of thrombotic and hemorrhagic events, except the lower risk for hemorrhage in patients on prophylactic compared to higher LMWH/F doses. Conclusion: The risk for all-cause mortality was higher in patients receiving prophylactic LMWH/F compared to those on an intermediate dose of LMWH/F, based on observational data. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies. Registration: The study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (Registration number: CRD42021229771).

A 66 years old woman with known dilated cardiomyopathy and severely reduced ejection fraction presented with bundle branch reentrant tachycardia. Bundle branch reentrant tachycardia is an uncommon form of ventricular tachycardia incorporating both bundle branches into the reentry circuit. The diagnosis is based on electrophysiological findings and pacing maneuvres that prove participation of the His- Purkinje system in the tachycardia mechanism. Radiofrequency ablation of right bundle is proposed as the first line therapy. In our patient, the ablation imposed a high risk of complications in view of the existing conduction defects. We decided to proceed with a CRT – D implantation, which improved patient’s symptoms and diminished ventricular tachycardia episodes. As a result, biventricular pacing may serve as an alternative method to ablation treatment.

Open data portals contain valuable information for citizens and business. However, searching for information can prove to be tiresome even in portals tackling domains similar information. A typical case is the information residing in the European Commission’s portals supported by Member States aiming to facilitate service provision activities for EU citizens and businesses. The current work followed the FAIR principles (Findability, Accessibility, Interoperability, and Reuse of digital assets) as well as the GO-FAIR principles and tried to transform raw data into fair data. The innovative part of this work is the mapping of information residing in various governmental portals (Points of Single Contacts) by transforming information appearing in them in RDF format (i.e., as Linked data), in order to make them easily accessible, exchangeable, interoperable and publishable as linked open data. Mapping was performed using the semantic model of a single portal, i.e., the enriched Greek e-GIF ontology and by retrieving and analyzing raw, i.e., non-FAIR data, by defining the semantic model and by making data linkable. The Data mapping process proved to require a significant manual effort and revealed that data value remains unexplored due to poor data representation. It also highlighted the need for appropriately designing and implementing horizontal actions addressing an important number of recipients in an interoperable way.

Hydrocarbon biodegradation rates in the deep-sea have been largely determined under atmospheric pressure, which may lead to non-representative results. In this work, we aim to study the response of deep-sea microbial communities of the Eastern Mediterranean Sea (EMS) to oil contamination at in situ environmental conditions and provide representative biodegradation rates. Seawater from a 600 to 1000 m depth was collected using a high-pressure (HP) sampling device equipped with a unidirectional check-valve, without depressurization upon retrieval. The sample was then passed into a HP-reactor via a piston pump without pressure disruption and used for a time-series oil biodegradation experiment at plume concentrations, with and without dispersant application, at 10 MPa and 14 °C. The experimental results demonstrated a high capacity of indigenous microbial communities in the deep EMS for alkane degradation regardless of dispersant application (>70%), while PAHs were highly degraded when oil was dispersed (>90%) and presented very low half-lives (19.4 to 2.2 days), compared to published data. To our knowledge, this is the first emulation study of deep-sea bioremediation using undisturbed deep-sea microbial communities.

Non-recurrent congestion disrupts normal traffic operations and lowers travel time (TT) reliability, which leads to many negative consequences such as difficulties in trip planning, missed appointments, loss in productivity, and driver frustration. Traffic incidents are one of the six causes of non-recurrent congestion. Early and accurate detection helps reduce incident duration, but it remains a challenge due to the limitation of current sensor technologies. In this paper, we employ a recurrence-based technique, the Quadrant Scan, to analyse time series traffic volume data for incident detection. The data is recorded by multiple sensors along a section of urban highway. The results show that the proposed method can detect incidents better by integrating data from the multiple sensors in each direction, compared to using them individually. It can also distinguish non-recurrent traffic congestion caused by incidents from recurrent congestion. The results show that the Quadrant Scan is a promising algorithm for real-time traffic incident detection with a short delay. It could also be extended to other non-recurrent congestion types.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.AimsIn this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.MethodFrom 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.ResultsA total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.ConclusionsThis study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Background: There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. Methods: This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Findings: We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke—123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1–3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4–4.7, p = 0.006) were predictive of stroke. Interpretation: The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. Funding: None.