Monkeypox: a systematic review of epidemiology, pathogenesis, manifestations, and outcomes

Introduction. Since May 2022, an unusually large number of new monkeypox infections-a previously rare viral zoonotic disease, mainly reported from central and western Africa has been reported globally, and the World Health Organization (WHO) declared a global health emergency in July 2022. We aimed to systematically review the monkeypox virus epidemiology, pathogenesis, transmission, presentations, and outcomes. Materials and methods. Our aim is to systematically review the epidemiology, pathogenesis, manifestations, and outcomes of Monkeypox disease. We searched the keywords in the online databases of PubMed, Embase, Scopus, and Web of Science and investigated all English articles until December 2022. In order to ascertain the findings, this study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. In order to optimize the quality, this review study benefits from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. To minimize any probable bias risk, we utilized the Newcastle-Ottawa Scale (NOS) risk assessment tool. Results. The most prevalent symptoms were rash and fever. The infection was accompanied by different complications such as, but not limited to, encephalitis (mainly in children), septicemia, bacterial cellulitis, retropharyngeal and parapharyngeal abscesses, etc. A wide range of hospitalization from 3.7% to 100% has been reported. The mortality rate ranged from 0% to 23%, which mainly occurred in infants and children. High mortality of the monkeypox rate was reported among pregnant women. The mortality rate of monkeypox is lower among women and those who received the smallpox vaccine compared to men and those who did not receive the vaccine. A wide range of the overall second-rate attack was reported, which is more pronounced in unvaccinated patients. Conclusion. In our systematic review of 35 studies on monkeypox, we cast light on the existing evidence on its epidemiology, pathogenesis, manifestation, and outcomes. Further studies are needed to elucidate the natural history of the disease in various patients’ population, as well as detailing the monkeypox attack rate

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Towards a Toolbox for Quantitative and Automatic Evaluation of 3D Trunk Motion in Patients with AIS

RÉSUMÉ: La scoliose idiopathique de l’adolescent (SIA) est une déformation en trois dimensions de la colonne vertébrale et de la cage thoracique, qui affecte l’apparence générale du tronc. Si elle n’est pas traitée, la scoliose idiopathique de l’adolescent peut évoluer pendant la poussée de croissance et réduire la qualité de vie des patients. Les méthodes existantes d’évaluation de la scoliose, qu’elles soient que ce soit par radiographie ou topographie de surface, sont toutes basées sur des acquisitions statiques. Or, la colonne vertébrale est une structure articulée, qui permet la mobilité du tronc. L’évaluation du tronc sous des conditions cinématiques permet de comprendre la rigidité de la scoliose. L’exercice d’autocorrection et le test de flexion latérale sont deux exemples de mouvements utilisés par les physiothérapeutes et les orthopédistes respectivement, pour évaluer la flexibilité du tronc. Ces informations, bien que principalement qualitatives, sont prises en compte pour la planification du traitement. Ce projet est le premier à explorer la topographie de surface dynamique pour l’évaluation quantitative de la mobilité du tronc. À l’aide de modèles d’apprentissage profond 3D pré-entraînés, nous développons une boîte à outils pour la quantification automatique de la mobilité du tronc pendant des séquences de flexion latérale et d’exercices d’autocorrection. La boîte à outils que nous proposons offre des fonctionnalités telles que la détection de repères anatomiques de la surface du dos, la segmentation anatomique de la surface du dos, la quantification des paramètres de la surface du tronc au fil du temps, et la visualisation des trajectoires des points de repère au cours d’une séquence de mouvement. Malgré certaines limites, nos expérimentations montrent des résultats prometteurs quant à l’application clinique potentielle de la méthode proposée. Dans l’ensemble, ce travail constitue un premier pas vers l’automatisation de l’évaluation quantitative dynamique du mouvement du tronc et fournit une base pour les travaux futurs dans cette direction ABSTRACT: Adolescent idiopathic scoliosis (AIS) is a 3D deformity of the spine and the ribcage, that affects the general appearance of the trunk. If left untreated, AIS can progress during growth spurt and reduce patients’ quality of life. Existing methods for assessing scoliosis, whether through radiographs or surface topography are all based on static acquisitions. However, the spine is an articulated structure allowing for the mobility of the trunk. The evaluation of the trunk under kinematic conditions provides insights on the rigidity of scoliosis. The self-correction exercise and the lateral bending test are two examples of motion used by physiotherapists and orthopedic surgeons respectively to evaluate the flexibility of the trunk. This information, although mostly qualitative, is considered for treatment planning. This project is the first to explore dynamic surface topography for the quantitative evaluation of trunk mobility. Using pre-trained 3D deep learning models, we develop a toolbox for an automatic quantification of trunk motion during sequences of lateral bending and self-correction exercises. Our proposed toolbox provides functionalities such as back surface anatomical landmark detection, back surface anatomical segmentation, quantifying trunk surface parameters over time, and visualizing landmarks’ trajectories during a motion sequence. Despite some limitations, our experiments show promising results regarding the potential clinical application of the proposed toolbox. Overall, this work is the first step toward automating dynamic quantitative evaluation of the trunk motion and provides a basis for future work in this direction

Integrative analysis of short- and long-read single-cell RNA-seq to understand transcriptomic landscape changes in Non-obstructive Azoospermia

The most severe type of male infertility, known as non-obstructive azoospermia (NOA), is characterized by the absence of sperm in the ejaculate due to spermatogenesis failure. Of all NOA patients, only ~30% are ultimately given a precise diagnosis, leaving the vast majority with no clear explanation for their infertility. Genome/exome-wide studies identified a range of candidate genes responsible for proper sperm formation and testis development. However, bulk sequencing studies have limitations in studying tissue with numerous cell types. Specifically, this is problematic when investigating cellular dysfunction in the testis tissue, whether it be normal control tissue or idiopathic infertility. Alternatively, single-cell RNA sequencing (scRNA-seq) provides gene expression profiles at the level of individual cells and can overcome the limitations of bulk RNA sequencing in this regard. Gene expression data within cells are useful in providing insight into cellular programs and intrinsic biological processes. However, single genes can be comprised of various isoforms that differ in the order and composition of their respective exons, which have significant biological implications in subsequent protein translation and function. Regardless of bulk or single cell, short-read RNA-sequencing technology has limitations in revealing the gene structure, i.e., isoforms. On the other hand, long-read RNA-seq makes it possible to determine the sequence of exons in the transcript isoforms. Recently, new library preparation techniques in single-cell workflows have been developed to take advantage of both long-read RNA sequencing and short-read scRNA-seq libraries. However, computational identification of originating cells of the resultant long-reads using the short-read generated single cell barcodes is not a trivial task because of the relatively high error rate in long-reads. The human testis has been shown to have the highest RNA splicing compared to other tissues. A previous study investigating bulk proteomics of NOA tissue identified RNA splicing machinery as being among the most dysregulated compared to healthy controls. Therefore, we hypothesize that characterizing RNA isoforms on a single cell level will provide critical biologic insights to normal human spermatogenesis as well as pathologic underpinnings of dysregulated spermatogenesis present in NOA.Science, Faculty ofGraduat

Stakeholder perspectives on adoption of Integrated Project Delivery (IPD)

Projects in the Architecture, Engineering, and Construction (AEC) industry frequently perform below expectations related to a variety of metrics for success. Various reasons have been found for these persistent performance gaps; the segregation of processes, services, and actors involved in project delivery in the construction sector has been identified as a root cause. This results in a broken agency, self-interested behaviour, and uncoordinated efforts, which make it difficult to optimize a product as a system. The project delivery method is important in defining the nature of the relationships between project participants, the structure and organization of the project, and eventually the end results. Many have emphasized the need for more collaborative and integrated methods for project delivery in the AEC industry. Integrated Project Delivery (IPD) is one such method. Several studies have demonstrated that IPD outperforms conventional methods. In this thesis, I use qualitative methods to characterize environments supportive of IPD and keys to its successful implementation. I also investigate whether the contractual risk sharing framing of IPD hinder or enhance innovation adoption. Finally, I identify the factors that can impede IPD adoption for public sector projects in British Columbia. I found that while executing IPD is perceived to be beneficial in many ways, successful implementations require specific preconditions beyond educating the industry about IPD principles. Success with this method requires development of novel approaches to project planning and management, and early acculturation to collaboration across the AEC industry. IPD was found to be instrumental in addressing some of the barriers to innovation adoption; however, foundational changes to the existing policies, regulations, and programs governing the industry’s operations, and alternative business and financing models are required to alter the industry’s approach towards innovation adoption. It was also found that while IPD could improve project delivery for the public sector in British Columbia, provincial decision-making processes and procurement regulations prohibit its adoption here.Science, Faculty ofResources, Environment and Sustainability (IRES), Institute forGraduat

Assessment of alternative water systems : final report

Given the increasing demands for water conservation, some water systems have been designed to allow the use of rainwater and wastewater streams for non-potable uses within a building. Unfortunately, these alternative water systems usually encounter issues that led to them being shut off. This assessment examines the challenges and issues of several alternative water systems within the region around the University of British Columbia to inform the university on future building projects on campus. The alternative water systems were analyzed from interview questions from four case studies based on six factors that are believed to be influential to the successful implementation of an alternative water system. These factors include cost, reliability, commissioning, operations and maintenance, occupant education, and occupant perception of the water system. While the main operation (water treatment) was done very well due to regulatory pressure, many other aspects of the implementation of the alternative water system that supports the operation is somewhat lacking. Together, these factors lead to large issues that irritated occupants, or major cost in repairs to bring the system back to expected operational parameters. From the analysis, appropriate recommendations are given to support future implementation of alternative water systems at the University of British Columbia. Disclaimer: “UBC SEEDS provides students with the opportunity to share the findings of their studies, as well as their opinions, conclusions and recommendations with the UBC community. The reader should bear in mind that this is a student project/report and is not an official document of UBC. Furthermore readers should bear in mind that these reports may not reflect the current status of activities at UBC. We urge you to contact the research persons mentioned in a report or the SEEDS Coordinator about the current status of the subject matter of a project/report.”Applied Science, Faculty ofUnreviewedGraduat

Retentiveness of implant-supported metal copings using different luting agents

Background: With regard to potential retrievability of cement-retained implant restorations, the retentive strength of the luting agents is critical. The aim of this study was to evaluate the retention values of implant-supported metal copings using different luting agents. Materials and Methods: Twenty ITI implant analogs and solid abutments of 5.5-mm height were embedded vertically in autopolymerizing acrylic resin blocks. Metal copings with a loop on the occlusal surface were fabricated using base metal alloy (Rexillium III). The copings were luted using eight cements with different retention mechanisms (Panavia F2.0, Fuji Plus, Fleck′s, Poly F, Fuji I, Temp Bond, GC-free eugenol, and TempSpan) under static load of 5 kg (n=10). All specimens were incubated at 37°C for 24 hours, conditioned in artificial saliva for 7 days and thermocycled for 5000 cycles (5-55°C). The dislodging force was measured using a universal testing machine at a crosshead speed of 5 mm/min. Statistical analyses were performed using Kruskal-Wallis (α=0.05) and Mann-Whitney tests with Bonferroni correction (α=0.001). Results: Fuji Plus and TempSpan had the highest and the least mean retentive strength, respectively (320.97±161.47, 3.39±2.33). There was no significant difference between Fuji Plus, Fleck′s, Ploy F, and Panavia F2.0. These cements were superior to provisional cements and Fuji I (P<0.001) which showed statistically same retentive strength. Conclusion: Within the conditions of this study, the resin modified glass ionomer, zinc phosphate, zinc polycarboxylate, and Panavia F2.0 had statistically the same retentive quality and are recommended for definitive cementation of single implant-supported restorations. The provisional cements and glass ionomer may allow retrievability of these restorations

Performance evaluation of household water treatment systems used in Kerman for removal of cations and anions from drinking water

Abstract Increased awareness in society of the consequences of contaminants in drinking water has created a demand for household water treatment systems, which provide higher quality water, to spread. The aim of this study was to evaluate the performance of household water treatment systems used in Kerman for the removal of cations and anions. Various brands of home water treatment devices commonly used in Kerman were selected, with one device chosen from each brand for study. In cases in which the devices were used extensively, samples were selected with filters that had been changed in proper time, based on the device’s operational instructions. The samples were selected from homes in the center and four geographical directions of Kerman. Then, sampling was conducted in three stages of input and output water of each device. For each of the samples, parameters were measured, such as chloride, sulfate, bicarbonate, calcium, magnesium, hardness, sodium, nitrate and nitrite (mg/L), temperature (°C), and pH. The average removal efficiency of different parameters by 14 brands in Kerman, which include chloride ions, sulfate, bicarbonate, calcium, magnesium, sodium, nitrites, nitrates, and total hardness, was obtained at 68.48, 85, 67, 61.21, 78.97, 80.24, 32.59, 66.83, and 69.38%, respectively. The amount of sulfate, bicarbonate, chloride, calcium, magnesium, hardness, sodium, and nitrate in the output water of household water treatment systems was less than the input water of these devices, but nitrite concentration in the output of some devices was more than the input water and showed a significant difference (p > 0.05)

Using Low-Cost Sensors to Assess Fine Particulate Matter Infiltration (PM2.5) during a Wildfire Smoke Episode at a Large Inpatient Healthcare Facility

Wildfire smoke exposure is associated with a range of acute health outcomes, which can be more severe in individuals with underlying health conditions. Currently, there is limited information on the susceptibility of healthcare facilities to smoke infiltration. As part of a larger study to address this gap, a rehabilitation facility in Vancouver, Canada was outfitted with one outdoor and seven indoor low-cost fine particulate matter (PM2.5) sensors in Air Quality Eggs (EGG) during the summer of 2020. Raw measurements were calibrated using temperature, relative humidity, and dew point derived from the EGG data. The infiltration coefficient was quantified using a distributed lag model. Indoor concentrations during the smoke episode were elevated throughout the building, though non-uniformly. After censoring indoor-only peaks, the average infiltration coefficient (range) during typical days was 0.32 (0.22–0.39), compared with 0.37 (0.31–0.47) during the smoke episode, a 19% increase on average. Indoor PM2.5 concentrations quickly reflected outdoor conditions during and after the smoke episode. It is unclear whether these results will be generalizable to other years due to COVID-related changes to building operations, but some of the safety protocols may offer valuable lessons for future wildfire seasons. For example, points of building entry and exit were reduced from eight to two during the pandemic, which likely helped to protect the building from wildfire smoke infiltration. Overall, these results demonstrate the utility of indoor low-cost sensors in understanding the impacts of extreme smoke events on facilities where highly susceptible individuals are present. Furthermore, they highlight the need to employ interventions that enhance indoor air quality in such facilities during smoke events.Applied Science, Faculty ofMedicine, Faculty ofNon UBCMechanical Engineering, Department ofMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacult