The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Integrated Solar Combined Cycle Power Plants: Paving the Way for Thermal Solar

<p>Integrated Solar Combined Cycle Power Plants (ISCCs), composed of a Concentrated Solar Power (CSP) plant and a Natural Gas-fired Combined Cycle (NGCC) power plant, have been recently introduced in the power generation sector as a technology with the potential to simultaneously reduce fossil fuel usage and the integration costs of solar power. This study quantifies the economic benefits of an ISCC power plant relative to a stand-alone CSP with energy storage, and a NGCC plant. A combination of tools is used to estimate the levelized cost of electricity (LCOE) and the cost of carbon abatement (CoA) for CSP, NGCC and ISCC technologies under different natural gas prices, and at several locations experiencing different ambient temperatures and solar resources. Results show that an ISCC with up to 10-15% of nameplate capacity from solar energy can be cost effective as a dispatchable electricity generation resource. Integrating the CSP into an ISCC reduces the LCOE of solar-generated electricity by 35-40% relative to a stand-alone CSP plant, and provides the additional benefit of dispatchability. An ISCC also outperforms a CSP with energy storage in terms of LCOE and CoA. The current LCOE of an ISCC is lower than that of a stand-alone NGCC when fuel price reaches 13.5 $/MMBtu, while its CoA is lower at a fuel price of 8.5$/MMBtu. Although, under low to moderate natural gas price conditions an NGCC generates electricity and abates carbon emissions at a lower cost than an ISCC; small changes in the capacity factor of an ISCC relative to the NGCC, or capital cost reductions for the CSP component have great impact tilting the balance in the ISCC's favor.</p>Thesi

Identifying Economic and Clean Strategies to Provide Electricity in Remote Rural Areas: Main-Grid Extension vs. Distributed Electricity Generation

The policy decision of extending electric power transmission lines to connect a remote area to a primary grid vs. developing local electricity generation resources must be informed by studies considering both alternatives’ economic and environmental outcomes. Such analysis must also consider the uncertainty of several factors such as fuel prices, the cost and performance of renewable and conventional power generation technologies, and the value of environmental benefits. This paper presents a method for this analysis, making two main contributions to the literature. First, it shows how to characterize the two alternatives (i.e., main-grid extension vs. local power generation) in detail for precise quantification of their capital and operating costs while guaranteeing that they are both adequate to meet forecast demand and operating reserves. Second, it shows how to properly account for the economic and environmental implications of renewable energy intermittency and uncertainty through the optimization of capital investments and hourly operations. The method is illustrated by applying this analysis method to Saudi Arabia, where the government is struggling to outline a strategy to meet residential and commercial loads reliably and sustainably in the country’s remote, scattered, isolated areas. To meet this demand, the Saudi government is considering two main alternatives: (1) extending the primary power transmission grid; or (2) installing an optimal combination of off-grid distributed generation (DG) resources, including solar PV, wind, diesel, oil, heavy fuel oil, and Li-ion batteries, to generate the electricity locally. Results suggest that under most scenarios of capital costs, fuel prices, and costs of air pollution, developing a microgrid with a large share of wind and solar power is more cost-effective than extending a primary grid 150 km or more away. Extending a primary grid powered by gas-fired combined-cycle power plants is more economical only if the load is not very high, the distance is not more than 350 km, and oil prices are relatively high compared to natural gas

Awareness of Secondary School Students regarding Basic Life Support in Abha City, Southern Saudi Arabia: A Cross-Sectional Survey

Background. Basic life support (BLS) is a level of medical care that is used for individuals with life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, including emergency medical technicians and paramedics, and by qualified bystanders. Vital areas of adult BLS include immediate identification of sudden cardiac arrest and activation of the emergency response system, early performance of high-quality cardiopulmonary resuscitation (CPR), and rapid defibrillation, when appropriate. Aim. To assess the awareness of secondary school students regarding BLS in Abha City, Saudi Arabia. Methodology. A descriptive cross-sectional survey was conducted targeting all accessible secondary school students in Abha City during the academic years 2018-2019. After explaining the objectives and importance of the research topic, all students in the three grades were invited to complete the study questionnaire. The questionnaire was developed by the researchers after reviewing the literature for related topics and consulting an expert for any additions or modifications. Results. The study included 761 students with ages ranging from 15 to 20 years and a mean age of 17 ± 1 years old. Male students accounted for 53.6% of the participants, and 96.7% of the participants were Saudi. Exactly 31% of the students had had a BLS training course, among which 79.2% had had training that lasted for only one day. Regarding awareness, 65% of the students had heard about BLS, and 44% knew about CPR. Exactly 52% of the students indicated that they should call the ER if there was a case with fainting. A total of 45.3% of the students reported that airway checking was the first step in CPR, and 16.7% reported that the chest compression to oral breathing ratio should be 30 to 2. Conclusions and Recommendations. In conclusion, the study revealed that poor awareness regarding BLS was present among the students. The researchers concluded that less than one-third of the students had BLS training. BLS should be taught, theoretically and practically (with simulations), to middle and high school students as BLS involves relatively simple concepts and methods

The Relationship between Work-Related Stressors and Construction Workers&rsquo; Self-Reported Injuries: A Meta-Analytic Review

Mental health concerns are surging worldwide and workers in the construction industry have been found to be particularly vulnerable to these challenges. Stress, depression, addictions, suicides, and other key indicators of poor mental health have been found to be highly prevalent among construction workers. Critically, researchers have also found a link between how stress in the workplace impacts the overall safety performance of an individual. However, the burgeoning nature of the research has stifled the determination of feasible and actionable interventions on jobsites. This paper aims to analyze the relationship between work-related stressors found on construction jobsites and self-reported injury rates of workers. To accomplish this goal, a meta-analysis methodology was used, wherein a comprehensive literature search was conducted to identify key work-related stressors and questionnaires used in the construction industry&rsquo;s safety domain to assess stress. Using a formal meta-analysis approach that leverages the findings from past studies, a more holistic determination of the relationship between work-related stressors and injury rates among workers was performed. Ninety-eight studies were reviewed, and seven were selected that fulfilled pre-determined validated inclusion criteria for eligibility in the meta-analysis. The results revealed 10 salient work-related stressors among construction workers. Of these ten, seven work-related stressors were identified as significant predictors of injury rates among workers: job control, job demand, skill demand, job certainty, social support, harassment and discrimination, and interpersonal conflicts at work. This study represents a significant first step toward formally identifying work-related stressors to improve working conditions, reduce or eliminate injuries on construction sites, and support future research

The Relationship between Work-Related Stressors and Construction Workers’ Self-Reported Injuries: A Meta-Analytic Review

Mental health concerns are surging worldwide and workers in the construction industry have been found to be particularly vulnerable to these challenges. Stress, depression, addictions, suicides, and other key indicators of poor mental health have been found to be highly prevalent among construction workers. Critically, researchers have also found a link between how stress in the workplace impacts the overall safety performance of an individual. However, the burgeoning nature of the research has stifled the determination of feasible and actionable interventions on jobsites. This paper aims to analyze the relationship between work-related stressors found on construction jobsites and self-reported injury rates of workers. To accomplish this goal, a meta-analysis methodology was used, wherein a comprehensive literature search was conducted to identify key work-related stressors and questionnaires used in the construction industry’s safety domain to assess stress. Using a formal meta-analysis approach that leverages the findings from past studies, a more holistic determination of the relationship between work-related stressors and injury rates among workers was performed. Ninety-eight studies were reviewed, and seven were selected that fulfilled pre-determined validated inclusion criteria for eligibility in the meta-analysis. The results revealed 10 salient work-related stressors among construction workers. Of these ten, seven work-related stressors were identified as significant predictors of injury rates among workers: job control, job demand, skill demand, job certainty, social support, harassment and discrimination, and interpersonal conflicts at work. This study represents a significant first step toward formally identifying work-related stressors to improve working conditions, reduce or eliminate injuries on construction sites, and support future research