The AIFELL Score as a Predictor of Coronavirus Disease 2019 (COVID-19) Severity and Progression in Hospitalized Patients

Since the beginning of the COVID-19 pandemic, SARS-CoV-2 has caused a global burden for health care systems due to high morbidity and mortality rates, leading to caseloads that episodically surpass hospital resources. Due to different disease manifestations, the triage of patients at high risk for a poor outcome continues to be a major challenge for clinicians. The AIFELL score was developed as a simple decision instrument for emergency rooms to distinguish COVID-19 patients in severe disease stages from less severe COVID-19 and non-COVID-19 cases. In the present study, we aimed to evaluate the AIFELL score as a prediction tool for clinical deterioration and disease severity in hospitalized COVID-19 patients. During the second wave of the COVID-19 pandemic in Switzerland, we analyzed consecutively hospitalized patients at the Triemli Hospital Zurich from the end of November 2020 until mid-February 2021. Statistical analyses were performed for group comparisons and to evaluate significance. AIFELL scores of patients developing severe COVID-19 stages IIb and III during hospitalization were significantly higher upon admission compared to those patients not surpassing stages I and IIa. Group comparisons indicated significantly different AIFELL scores between each stage. In conclusion, the AIFELL score at admission was useful to predict the disease severity and progression in hospitalized COVID-19 patients

Fuzzy Inspired Case based Reasoning for Hematology Malignancies Classification

Conventional approaches for collecting and reporting hematological data as well as diagnosing hematologic malignancies such as leukemia, anemia, e.t.c are based on subjective professional physician personal opinions or experiences which are influenced by human error, dependent on human-to-human judgments, time consuming processes and the blood results are non-reproducible. In the light of those human limitations identified, an automatic or semi-automatic classification and corrective method is required because it reduces the load on human observers and accuracy is not affected due to fatigue. Case-Based Reasoning (CBR) as a multi-disciplinary subject that focuses on the reuse of past experiences or cases to proffer solution to new cases was adopted and combined with the power of Fuzzy logic to design a software model that will effectively mine hematology data. This study aim at helping the medical practitioners to diagnose and provide corrective treatment to both normal patients and patients with hematology disorder at the early stage which can reduce the number of deaths. This aim is achievable by developing an intelligent expert system based on fuzzy logic and case-based reasoning for classification of hematology malignancy

Cardiac Arrhythmias

Cardiac arrhythmias are common triggers of emergency admission to cardiology or high-dependency departments. Most cases are easy to diagnose and treat, while others may present a challenge to healthcare professionals. A translational approach to arrhythmias links molecular and cellular scientific research with clinical diagnostics and therapeutic methods, which may include both pharmacological and non-pharmacologic treatments. This book presents a comprehensive overview of specific cardiac arrhythmias and discusses translational approaches to their diagnosis and treatment

Improving Retrieval Performance of Case Based Reasoning Systems by Fuzzy Clustering

Case-based reasoning (CBR), which is a classical reasoning methodology, has been put to use. Its application has allowed significant progress in resolving problems related to the diagnosis, therapy, and prediction of diseases. However, this methodology has shown some complicated problems that must be resolved, including determining a representation form for the case (complexity, uncertainty, and vagueness of medical information), preventing the case base from the infinite growth of generated medical information and selecting the best retrieval technique. These limitations have pushed researchers to think about other ways of solving problems, and we are recently witnessing the integration of CBR with other techniques such as data mining. In this article, we develop a new approach integrating clustering (Fuzzy C-Means (FCM) and K-Means) in the CBR cycle. Clustering is one of the crucial challenges and has been successfully used in many areas to develop innate structures and hidden patterns for data grouping [1]. The objective of the proposed approach is to solve the limitations of CBR and improve it, particularly in the search for similar cases (retrieval step). The approach is tested with the publicly available immunotherapy dataset. The results of the experimentations show that the integration of the FCM algorithm in the retrieval step reduces the search space (the large volume of information), resolves the problem of the vagueness of medical information, speeds up the calculation and response time, and increases the search efficiency, which further improves the performance of the retrieval step and, consequently, the CBR system

Leveraging and adapting global health systems and programs during the COVID-19 pandemic

Overview -- Surveillance, Information, and Laboratory Systems -- Workforce, Institutional, and Public Health Capacity Development -- Clinical and Health Services Delivery and Impact -- Commentaries -- About the Cover.Overview: Partnerships, Collaborations, and Investments Integral to CDC\u2019s International Response to COVID-19 / R. P. Walensky -- Global Responses to the COVID-19 Pandemic / C. H. Cassell et al. -- Surveillance, Information, and Laboratory Systems: Lessons Learned from CDC\u2019s Global COVID-19 Early Warning and Response Surveillance System / P. M. Ricks et al. -- Enhancing Respiratory Disease Surveillance to Detect COVID-19 in Shelters for Displaced Persons, Thailand\u2013Myanmar Border, 2020\u20132021 / B. Knust et al. -- Leveraging International Influenza Surveillance Systems and Programs during the COVID-19 Pandemic / P. Marcenac et al. -- Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020\u20132021 / D. C. Shih et al. -- Extending and Strengthening Routine DHIS2 Surveillance Systems for COVID-19 Responses in Sierra Leone, Sri Lanka, and Uganda / C. Kinkade et al. -- Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response / M. Mirza et al. -- Contribution of PEPFAR-Supported HIV and TB Molecular Diagnostic Networks to COVID-19 Testing Preparedness in 16 Countries / E. Rottinghaus Romano et al. -- A Nationally Representative Survey of COVID-19 in Pakistan, 2021\u20132022 / S. Aheron et al. -- SARS-CoV-2 Prevalence in Malawi Based on Data from Survey of Communities and Health Workers in 5 High-Burden Districts, October 2020 / J. Theu et al. -- Determining Gaps in Publicly Shared SARS-CoV-2 Genomic Surveillance Data by Analysis of Global Submissions / E. C. Ohlsen et al. -- Comparison of COVID-19 Pandemic Waves in 10 Countries in Southern Africa, 2020\u20132021 / J. Smith-Sreen et al. -- Using Population Mobility Patterns to Adapt COVID-19 Response Strategies in 3 East Africa Countries / R. D. Merrill et al. -- Community-Based Surveillance and Geographic Information System\u2012Linked Contact Tracing in COVID-19 Case Identification, Ghana, March\u2012June 2020 / E. Kenu et al. -- The Future of Infodemic Surveillance as Public Health Surveillance / H. Chiou et al. -- Workforce, Institutional, and Public Health Capacity Development: Continuing Contributions of Field Epidemiology Training Programs to Global COVID-19 Response / E. Bell et al. -- India Field Epidemiology Training Program Response to COVID-19 Pandemic, 2020\u20132021 / S. Singh et al. -- COVID-19 Response Roles among CDC International Public Health Emergency Management Fellowship Graduates / S. Krishnan et al. -- Exploratory Literature Review of the Role of National Public Health Institutes in COVID-19 Response / A. Zuber et al. -- Adapting Longstanding Public Health Collaborations between Government of Kenya and CDC Kenya in Response to the COVID-19 Pandemic, 2020\u20132021 / A. Herman-Roloff et al. -- Effect of Nigeria Presidential Task Force on COVID-19 Pandemic, Nigeria / O. Bolu et al. -- Use of Epidemiology Surge Support to Enhance Robustness and Expand Capacity of SARS-CoV-2 Pandemic Response, South Africa / R. Taback-Esra et al. -- Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon / E. Dokubo et al. -- Use of Project ECHO in Response to COVID-19 in Countries Supported by US President\u2019s Emergency Plan for AIDS Relief / J. Wright et al. -- Faith Community Engagement to Mitigate COVID-19 Transmission Associated with Mass Gathering, Uman, Ukraine, September 2021 / L. Erickson-Mamane et al. -- Clinical and Health Services Delivery and Impact: Effects of COVID-19 on Vaccine-Preventable Disease Surveillance Systems in the World Health Organization African Region, 2020 / J. Bigouette et al. -- CDC\u2019s COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions / H. M. Soeters et al. -- Effects of Decreased Immunization Coverage for Hepatitis B Virus Caused by COVID-19 in World Health Organization Western Pacific and African Regions, 2020 / H. J. Kabore et al. -- Past as Prologue\u2014Use of Rubella Vaccination Program Lessons to Inform COVID-19 Vaccination / M. G. Dixon et al. -- Leveraging Lessons Learned from Yellow Fever and Polio Immunization Campaigns during COVID-19 Pandemic, Ghana, 2021 / K. Amponsa-Achiano et al. -- Effectiveness of Whole-Virus COVID-19 Vaccine among Healthcare Personnel, Lima, Peru / C. S. Arriola et al. -- Leveraging HIV Program and Civil Society to Accelerate COVID-19 Vaccine Uptake, Zambia / P. Bobo et al. -- Adopting World Health Organization Multimodal Infection Prevention and Control Strategies to Respond to COVID-19, Kenya / D. Kimani et al. -- Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa / D. J. Gomes et al. -- Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020 / M. E. Peck et al. -- Sexual Violence Trends before and after Rollout of COVID-19 Mitigation Measures, Kenya / W. Ochieng et al. -- Clinical and Economic Impact of COVID-19 on Agricultural Workers, Guatemala / D. Olson et al. -- Outcomes after Acute Malnutrition Program Adaptations to COVID-19, Uganda, Ethiopia, and Somalia / T. Shragai et al. -- Commentaries: Lessons from Nigeria\u2019s Adaptation of Global Health Initiatives during the COVID-19 Pandemic / C. Ihekweazu -- About the Cover: A United Response to COVID-19\u2014an Artist\u2019s Perspective / B. Breedlove et al

Influenza vaccinology and clinical assessment

Influenza virus infection is a global health problem, causing both seasonal epidemics and episodic pandemics of influenza A which are associated with significant mortality and morbidity. The development of influenza vaccines stimulating protection against both antigenically drifted seasonal virus as well as new pandemic antigenically shifted virus would be a major advance. A vaccine that stimulates cellular immunity to conserved viral antigens is a potential area of interest, and could generate heterosubtypic immunity. I have been the lead clinician for both phase I and II studies of thenovel viral vectored vaccine MVA-NP+M1 (modified vaccinia virus Ankarra, expressing nucleoprotein and matrix protein 1), designed to induce cellular immunity to influenza A virus. In this role I have been involved in the design, ethical and regulatory approval of phase I studies of safety and immunogenicity of MVA-NP+M1, as well as recruiting and vaccinating volunteers. The phase I studies showed that the vaccine was safe and immunogenic in both young and elderly volunteers. In addition to my clinical role in the phase I studies, I performed laboratory based immunological assays of immunogenicity (ELISPOT testing) in both phase I and II studies. For the phase II study, I lead the safety challenge study as well as collecting, analysing and writing up the data from the quarantine challenge study. This phase II study showed that MVA-NP+M1 is partially protective against influenza challenge in healthy volunteers, that the challenge model to assess protection is safe and that further challenge studies are warranted. I have also initiated two separate clinical studies on influenza, one comparing early clinical features of influenza with those of malaria, both from volunteer challenge studies, while the other study was of the clinical assessment of severity of influenza during a busy winter influenza season, with particular reference to those patients requiring critical care. For both studies I conceived the idea, organised the data collection and analysed the data. These data are of use in pandemic settings in allowing the assessment of patients with influenza and in determining the appropriate setting for their care

Separator fluid volume requirements in multi-infusion settings

INTRODUCTION. Intravenous (IV) therapy is a widely used method for the administration of medication in hospitals worldwide. ICU and surgical patients in particular often require multiple IV catheters due to incompatibility of certain drugs and the high complexity of medical therapy. This increases discomfort by painful invasive procedures, the risk of infections and costs of medication and disposable considerably. When different drugs are administered through the same lumen, it is common ICU practice to flush with a neutral fluid between the administration of two incompatible drugs in order to optimally use infusion lumens. An important constraint for delivering multiple incompatible drugs is the volume of separator fluid that is sufficient to safely separate them. OBJECTIVES. In this pilot study we investigated whether the choice of separator fluid, solvent, or administration rate affects the separator volume required in a typical ICU infusion setting. METHODS. A standard ICU IV line (2m, 2ml, 1mm internal diameter) was filled with methylene blue (40 mg/l) solution and flushed using an infusion pump with separator fluid. Independent variables were solvent for methylene blue (NaCl 0.9% vs. glucose 5%), separator fluid (NaCl 0.9% vs. glucose 5%), and administration rate (50, 100, or 200 ml/h). Samples were collected using a fraction collector until <2% of the original drug concentration remained and were analyzed using spectrophotometry. RESULTS. We did not find a significant effect of administration rate on separator fluid volume. However, NaCl/G5% (solvent/separator fluid) required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). Also, G5%/G5% required significantly less separator fluid than NaCl/NaCl (3.6 ± 0.1 ml vs. 3.9 ± 0.1 ml, p <0.05). The significant decrease in required flushing volume might be due to differences in the viscosity of the solutions. However, mean differences were small and were most likely caused by human interactions with the fluid collection setup. The average required flushing volume is 3.7 ml. CONCLUSIONS. The choice of separator fluid, solvent or administration rate had no impact on the required flushing volume in the experiment. Future research should take IV line length, diameter, volume and also drug solution volumes into account in order to provide a full account of variables affecting the required separator fluid volume