•A novel humanitarian supply chain model to address people’s vulnerability is developed.•We adopt the Social Vulnerability Index to prioritize more vulnerable areas.•The optimization model considers ...both long- and medium-term decisions under multiple disasters.•The approach is validated through a rich and real case-study based on the Brazilian Humanitarian Supply Chain.•We present key insights to improve the current disaster management practice in the country.
We present a novel humanitarian supply chain approach to address disaster preparedness and build response capacity in humanitarian supply chains when people’s vulnerability matters. Our primary motivation comes from the fact that disasters in Brazil are often associated with unequal distribution of opportunities and social inequalities that end up pushing more vulnerable people to risky areas or informal settlements. Moreover, investment in disaster management has dropped over the past few years in Brazil. In this way, we wonder: how to use the somewhat limited financial budget as effectively as possible towards meeting those that need the most while addressing disaster preparedness activities? To answer this question, we develop an optimization model to address location, capacity planning, prepositioning, local procurement, and relief aid flows’ decisions. Differently from most existing research, we adopt the so-called Social Vulnerability Index (SoVI) in the objective function to build enhanced response capacity in more vulnerable areas when the lack of resources makes impassable to fulfil all victims’ needs at once. Through a rich and real case-study based on the Brazilian Humanitarian Supply Chain, we come up with critical insights that can help to improve the humanitarian supply chain practices in the country. In particular, we show that the social benefit of using SoVI is as more significant as the vulnerability increases, which reveals the importance of considering this index to design more social-effective humanitarian supply chains.
COVID-19 manifests with respiratory, systemic, and gastrointestinal (GI) symptoms.
SARS-CoV-2 RNA is detected in respiratory and fecal samples, and recent reports demonstrate viral replication in ...both the lung and intestinal tissue.2, 3, 4 Although much is known about early fecal RNA shedding, little is known about long-term shedding, especially in those with mild COVID-19. Furthermore, most reports of fecal RNA shedding do not correlate these findings with GI symptoms.
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We analyzed the dynamics of fecal RNA shedding up to 10 months after COVID-19 diagnosis in 113 individuals with mild to moderate disease. We also correlated shedding with disease symptoms.
Fecal SARS-CoV-2 RNA is detected in 49.2% 95% confidence interval, 38.2%-60.3% of participants within the first week after diagnosis. Whereas there was no ongoing oropharyngeal SARS-CoV-2 RNA shedding in subjects at 4 months, 12.7% 8.5%-18.4% of participants continued to shed SARS-CoV-2 RNA in the feces at 4 months after diagnosis and 3.8% 2.0%-7.3% shed at 7 months. Finally, we found that GI symptoms (abdominal pain, nausea, vomiting) are associated with fecal shedding of SARS-CoV-2 RNA.
The extended presence of viral RNA in feces, but not in respiratory samples, along with the association of fecal viral RNA shedding with GI symptoms suggest that SARS-CoV-2 infects the GI tract and that this infection can be prolonged in a subset of individuals with COVID-19.
This research was supported by a Stanford ChemH-IMA grant; fellowships from the AACR and NSF; and NIH R01-AI148623, R01-AI143757, and UL1TR003142.
Despite myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affecting millions of people worldwide, many clinicians lack the knowledge to appropriately diagnose or manage ME/CFS. ...Unfortunately, clinical guidance has been scarce, obsolete, or potentially harmful. Consequently, up to 91% of patients in the United States remain undiagnosed, and those diagnosed often receive inappropriate treatment. These problems are of increasing importance because after acute COVID-19, a significant percentage of people remain ill for many months with an illness similar to ME/CFS. In 2015, the US National Academy of Medicine published new evidence-based clinical diagnostic criteria that have been adopted by the US Centers for Disease Control and Prevention. Furthermore, the United States and other governments as well as major health care organizations have recently withdrawn graded exercise and cognitive-behavioral therapy as the treatment of choice for patients with ME/CFS. Recently, 21 clinicians specializing in ME/CFS convened to discuss best clinical practices for adults affected by ME/CFS. This article summarizes their top recommendations for generalist and specialist health care providers based on recent scientific progress and decades of clinical experience. There are many steps that clinicians can take to improve the health, function, and quality of life of those with ME/CFS, including those in whom ME/CFS develops after COVID-19. Patients with a lingering illness that follows acute COVID-19 who do not fully meet criteria for ME/CFS may also benefit from these approaches.
Abstract
We investigated feasibility and accuracy of an interferon-γ release assay (IGRA) for detection of T-cell responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Whole ...blood IGRA accurately distinguished between convalescent and uninfected healthy blood donors with a predominantly CD4+ T-cell response. SARS-CoV-2 IGRA may serve as a useful diagnostic tool in managing the coronavirus disease 2019 pandemic.
Abstract
Background
An immunodiagnostic assay that sensitively detects a cell-mediated immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is needed for epidemiological ...investigation and for clinical assessment of T- cell-mediated immune response to vaccines, particularly in the context of emerging variants that might escape antibody responses.
Methods
The performance of a whole blood interferon-gamma (IFN-γ) release assay (IGRA) for the detection of SARS-CoV-2 antigen-specific T cells was evaluated in coronavirus disease 2019 (COVID-19) convalescents tested serially up to 10 months post-infection and in healthy blood donors. SARS-CoV-2 IGRA was applied in contacts of households with index cases. Freshly collected blood in the lithium heparin tube was left unstimulated, stimulated with a SARS-CoV-2 peptide pool, and stimulated with mitogen.
Results
The overall sensitivity and specificity of IGRA were 84.5% (153/181; 95% confidence interval CI: 79.0–89.0) and 86.6% (123/142; 95% CI: 80.0–91.2), respectively. The sensitivity declined from 100% (16/16; 95% CI: 80.6–100) at 0.5-month post-infection to 79.5% (31/39; 95% CI: 64.4–89.2) at 10 months post-infection (P < .01). The IFN-γ response remained relatively robust at 10 months post-infection (3.8 vs 1.3 IU/mL, respectively). In 14 households, IGRA showed a positivity rate of 100% (12/12) and 65.2% (15/23), and IgG of 50.0% (6/12) and 43.5% (10/23) in index cases and contacts, respectively, exhibiting a difference of + 50% (95% CI: +25.4 to +74.6) and +21.7% (95% CI: +9.23 to +42.3), respectively. Either IGRA or IgG was positive in 100% (12/12) of index cases and 73.9% (17/23) of contacts.
Conclusions
The SARS-CoV-2 IGRA is a useful clinical diagnostic tool for assessing cell-mediated immune response to SARS-CoV-2.
SARS-CoV-2 immunodiagnostics are needed to identify infected individuals in order to understand the transmission dynamics of emerging variants and to assess vaccine response. Interferon-gamma release assay maintains sensitivity 10 months post-infection in convalescents and detects more household contacts than IgG.
Abstract
Background
The vast majority of coronavirus disease 2019 (COVID-19) disease occurs in outpatients where treatment is limited to antivirals for high-risk subgroups. Acebilustat, a leukotriene ...B4 inhibitor, has potential to reduce inflammation and symptom duration.
Methods
In a single-center trial spanning Delta and Omicron variants, outpatients were randomized to 100 mg/d of oral acebilustat or placebo for 28 days. Patients reported daily symptoms via electronic query through day 28 with phone follow-up on day 120 and collected nasal swab samples on days 1–10. The primary outcome was sustained symptom resolution to day 28. Secondary 28-day outcomes included time to first symptom resolution, area under the curve (AUC) for longitudinal daily symptom scores, duration of viral shedding through day 10, and symptoms on day 120.
Results
Sixty participants were randomized to each study arm. At enrollment, the median duration was 4 days (interquartile range, 3–5 days), and the median number of symptoms was 9 (7–11). Most patients (90%) were vaccinated, with 73% having neutralizing antibodies. A minority of participants (44%; 35% in the acebilustat arm and 53% in placebo) had sustained symptom resolution at day 28 (hazard ratio, 0.6 95% confidence interval, .34–1.04; P = .07 favoring placebo). There was no difference in the mean AUC for symptom scores over 28 days (difference in mean AUC, 9.4 95% confidence interval, −42.1 to 60.9; P = .72). Acebilustat did not affect viral shedding or symptoms at day 120.
Conclusions
Sustained symptoms through day 28 were common in this low-risk population. Despite this, leukotriene B4 antagonism with acebilustat did not shorten symptom duration in outpatients with COVID-19.
Clinical Trials Registration. NCT04662060.
Acebilustat, a leukotriene B4 inhibitor, did not improve symptom resolution in outpatients with coronavirus disease 2019. Most remained symptomatic at day 28 despite a highly vaccinated cohort. Longitudinal symptom severity may quantify disease burden more reliably than symptom duration alone.
Graphical Abstract
Graphical Abstract
Savitzky-Golay filter for reactivity calculation Suescún-Díaz, Daniel; Bonilla-Londoño, Héctor F.; Figueroa-Jimenez, Jorge H.
Journal of nuclear science and technology,
07/2016, Letnik:
53, Številka:
7
Journal Article
Recenzirano
Odprti dostop
A new filter method known as Savitzky-Golay allows the reduction of reactivity fluctuations. The filter reduces fluctuations that are found in the nuclear power signal does not attenuate to the ...reactivity value. The method can be applied with a time step of up to T = 0.01 s and a noise level of up to σ = 0.1. This formulation employs a Gram polynomial approximation of degree d = 2, to calculate the convolution coefficients by means of an analytic formula that is implemented computationally and avoids ill-conditioning issues caused by the inversion of a linear system. The results show better values in the maximum difference and the mean absolute errors of reactivity in comparison with the results reported in the literature.
Post-acute sequelae of SARS-CoV-2 (PASC), or long COVID, is characterized by persistent symptoms after acute SARS-CoV-2 infection that can vary from patient to patient. Here, we present a case series ...of four patients with a history of SARS-CoV-2 infection referred to the Post-Acute COVID-19 Syndrome (PACS) Clinic at Stanford University for evaluation of persistent symptoms, who also experienced new-onset alcohol sensitivity. Alcohol reactions and sensitivity are not well characterized in the literature as it relates to post-viral illness. While there have been some anecdotal reports of new alcohol sensitivity in PASC patients in the media, there is a paucity of published data in the medical literature about this topic. During their medical consultation, the patients self-reported new changes in their symptoms or behaviors following the use of alcohol. A new onset of alcohol sensitivities should be assessed along with other post-COVID-19 symptoms and may provide novel avenues to explore the pathobiology of illness and potential interventions.
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