Notes

Reflections from the System Key Nursing jobs Executive: Goal to guide.
This meta-analysis aims to highlight the impact of cardio-metabolic comorbidities on COVID-19 severity and mortality.

A thorough search on major online databases was done for studies describing the clinical outcomes of COVID-19 patients. We used random-effects model to compute pooled estimates for critical or fatal disease.

A total of 20,475 patients from 33 eligible studies were included. Maximum risk of development of critical or fatal COVID-19 disease was seen in patients with underlying cardiovascular disease [OR 3.44, 95% CI 2.65-4.48] followed by chronic lung disease, hypertension and diabetes mellitus. Of the total cases, 64% had one of the four comorbidities with the most prevalent being hypertension with a pooled prevalence of 27%.

Presence of comorbidities like cardiovascular disease, chronic lung disease, hypertension and diabetes mellitus led to a higher risk of development of critical or fatal COVID-19 disease, with maximum risk seen with underlying cardiovascular disease.
Presence of comorbidities like cardiovascular disease, chronic lung disease, hypertension and diabetes mellitus led to a higher risk of development of critical or fatal COVID-19 disease, with maximum risk seen with underlying cardiovascular disease.Monolithic dental prostheses fabricated from 5 mol% yttria-stabilized zirconia (5YZ) have been developed to improve the translucency of conventional 3 mol% yttria-stabilized zirconia. In this study, we aimed to evaluate the influence of airborne-particle abrasion (APA) and low-temperature degradation (LTD) on the mechanical properties of 5YZ in association with the crystalline phase transformation. In total, 120 disc-shaped specimens of two brands of 5YZ (Lava Esthetic and Katana UTML) were prepared. The specimens were divided into four groups (n = 15 for each group) (i) control, (ii) APA, (iii) LTD, and (iv) APA + LTD groups. APA was performed with 50 μm alumina particles, and LTD was induced by autoclaving at 134 °C for 50 h. The biaxial flexural strength of the specimens was assessed using a piston-on-three-ball test according to ISO 68722015, and Vickers hardness was determined using a microhardness tester. The crystalline phase was analyzed by the Rietveld refinement of X-ray diffraction patterns. APA significantly increased the flexural strength of the Lava Esthetic specimens, whereas LTD hardly affected the strength of both materials. APA and APA + LTD significantly increased the Vickers hardness of both materials. According to Rietveld analysis, the pseudocubic phase was predominant in both materials, i.e., 66 mass% and 81 mass% in the Lava Esthetic and Katana UTML specimens, respectively. APA induced the rhombohedral phase at approximately 37 mass% in both materials, while LTD induced the monoclinic phase at 2.8 mass% in the Lava Esthetic specimens and 0.9 mass% in the Katana UTML specimens. APA + LTD weakly affected the amount of the rhombohedral phase but slightly increased the amount of the monoclinic phase. These findings suggest that APA may improve the mechanical properties of 5YZ, particularly hardness, via the generation of the rhombohedral phase. In contrast, the influence of LTD on the mechanical and microstructural properties of 5YZ was limited.Previous studies resulted in the isolation of a low-virulence plaque-purified variant from the third passage (P3) in BHK-21 cells of a Tembusu virus (TMUV) isolate, suggesting the presence of viral quasispecies in the P3 culture. To confirm this notion, the fourth passage virus (P4) was prepared by infecting BHK-21 cells with P3 for isolation of more variants. We isolated 10 plaque-purified viruses. Comparative genome sequence analysis identified six of the 10 viruses as genetically different variants, which harbored a total of eight amino acid differences in the envelope, NS1, NS3, and NS5 proteins. When tested in a 2-day-old Pekin duck model, P4 caused 80 % mortality, belonging to a high-virulence TMUV strain. Out of the six genetically different variants, two presented high-virulence, one exhibited moderate-virulence, and three displayed low-virulence, causing 60 %-70 %, 40 %, and 10 % mortalities, respectively. These results demonstrate that P4 contains at least three groups of variants with distinct virulence phenotypes. Analysis of links between the eight residues and virulence of the six variants identified NS1 protein residue 183 and NS5 protein residues 275 and/or 287 as novel determinants of TMUV virulence. The analysis also provided a new clue for future studies on the molecular basis of TMUV virulence in terms of genetic interaction of different proteins. Overall, our study provides direct evidence to suggest that TMUV exists in in vitro culture of a virulent isolate as a quasispecies, which may enhance our understanding of molecular mechanism of TMUV virulence.In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). Dizocilpine antagonist On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.Collaboration between governments and non-state actors has emerged as the dominant mode of policy making to address a wide range of public and global health issues, particularly via public-private partnerships and multi-stakeholder platforms. Despite its paradigmatic status in contemporary health governance, political claims and promises of partnership approaches as more effective than state regulation have received limited attention. This study addresses this gap by tracing negotiations over a calorie reduction 'pledge' within the Public Health Responsibility Deal a public-private partnership between the UK Department of Health, food industry and civil society organisations focusing on obesity policy. It demonstrates how political claims-making by the Department of Health that a public-private partnership as an effective substitute for legislation, contrasted with protracted and conflictual negotiations with food industry business associations. Employing Erving Goffman's distinction between frontstage and ba of wider dysfunctions and conflicts of interest in partnership approaches. This suggests that there may be limited scope for effective policy innovations where commercial sector actors perceive core interests as threatened.Childhood lead exposure affects over 500,000 children under 6 years old in the US; however, only 14 states recommend regular universal blood screening. Several studies have reported on the use of predictive models to estimate lead exposure of individual children, albeit with limited success lead exposure can vary greatly among individuals, individual data is not easily accessible, and models trained in one location do not always perform well in another. We report on a novel approach that uses machine learning to accurately predict elevated Blood Lead Levels (BLLs) in large groups of children, using aggregated data. To that end, we used publicly available zip code and city/town BLL data from the states of New York (n = 1642, excluding New York City) and Massachusetts (n = 352), respectively. Five machine learning models were used to predict childhood lead exposure by using socioeconomic, housing, and water quality predictive features. The best-performing model was a Random Forest, with a 10-fold cross validation ROC AUC score of 0.91 and 0.85 for the Massachusetts and New York datasets, respectively. The model was then tested with New York City data and the results compared to measured BLLs at a borough level. The model yielded predictions in excellent agreement with measured data at a city level it predicted elevated BLL rates of 1.72% for the children in New York City, which is close to the measured value of 1.73%. Predictive models, such as the one presented here, have the potential to help identify geographical hotspots with significantly large occurrence of elevated lead blood levels in children so that limited resources may be deployed to those who are most at risk.Diarrheal disease remains a leading cause of child mortality, globally. In the Democratic Republic of the Congo (DRC), each year there are an estimated 45 million episodes of diarrhea in children under five years of age. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to develop theory-driven, evidence-based approaches to reduce diarrheal diseases among young children. The REDUCE prospective cohort study in Walungu Territory in Eastern DRC took guidance from the risks, attitudes, norms, abilities, and self-regulation model, the integrated behavioral model for water, sanitation, and hygiene (WASH), and other behavior change theories to identify psychosocial factors associated with WASH behaviors. Psychosocial factors were measured among 417 caregivers at baseline and caregiver responses to child mouthing of dirty fomites and handwashing with soap was assessed by 5-hour structured observation at the 6-month follow-up. Caregivers who agreed that their child could become sick if they put dirt in their mouth (perceived susceptibility) and caregivers that agreed they could prevent their child from playing with dirty things outside (self-efficacy) were significantly more likely to stop their child from mouthing a dirty fomite. Higher perceived susceptibility, self-efficacy, and disgust, and lower dirty reactivity, were associated with higher handwashing with soap behaviors. This study took a theory-driven and evidence-based approach to identify psychosocial factors to target for intervention development. The findings from this study informed the development of the REDUCE Baby WASH Modules that have been delivered to over 1 million people in eastern DRC.
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