scholarly journals Performance of national COVID-19 ‘symptom checkers’: a comparative case simulation study

2021 ◽  
Vol 28 (1) ◽  
pp. e100187
Author(s):  
Fatma Mansab ◽  
Sohail Bhatti ◽  
Daniel Goyal
Keyword(s):  
Medical Care ◽  
Simulation Study ◽  
Bacterial Pneumonia ◽  
Assessment Tools ◽  
Basic Tenet ◽  
The Us ◽  
The Usa ◽  
Case Simulation ◽  
Pandemic Response ◽  
Key Features

ObjectivesIdentifying those individuals requiring medical care is a basic tenet of the pandemic response. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online ‘symptom checkers’ used within the triage pathway.MethodsA simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical) and COVID-19 mimickers (eg, sepsis and bacterial pneumonia). The same simulations were applied to each of the four country’s symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared.ResultsThe symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77%, respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home.ConclusionOur results suggest that whilst ‘symptom checkers’ may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well-performing symptom checkers are discussed.

scholarly journals The performance of national COVID-19 ‘Symptom Checkers’: A comparative case simulation study

2020 ◽  
Author(s):  
F Mansab ◽  
S Bhatti ◽  
D Goyal
Keyword(s):  
Simulation Study ◽  
Clinical Assessment ◽  
Bacterial Pneumonia ◽  
National Level ◽  
Assessment Tools ◽  
List Type ◽  
Number Of Factors ◽  
The Us ◽  
The Usa ◽  
Key Aspects

ABSTRACTIntroductionThe response to COVID-19 differs from nation to nation. There are likely a number of factors one can attribute to such disparity, not least of which is differing healthcare models and approaches. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online ‘symptom checkers’ utilised within the triage pathway.MethodsA simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical), and COVID-19 mimickers (e.g. sepsis and bacterial pneumonia). The same simulations were applied to each of the four country’s symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared.ResultsThe symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77% respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home.ConclusionOur results suggest that whilst ‘symptom checkers’ may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well performing symptom checkers are discussed.SUMMARYWhat is already known?The availability and use of symptom checkers are increasing.Symptom checkers are currently in use at a national level to help in the healthcare response to COVID-19.There is limited evidence to support the effectiveness or safety of symptom checkers as triage tools during a pandemic response.What does this paper add?This study compares performance of symptom checkers across different countries, revealing marked variation between national symptom checkers.The symptom checkers employed by Japan and Singapore are twice as likely to triage cases onward for clinical assessment than those of the US or UK.The US and UK symptom checkers frequently triaged simulated cases of sepsis, bacterial pneumonia and severe COVID-19 to stay home with no further healthcare contact.We discuss the key aspects of the well-performing triage systems.

The 1970s: The Nuclear Relationship under the Shah

2018 ◽  
pp. 23-61
Author(s):  
Steven Hurst
Keyword(s):  
Cold War ◽  
Fuel Cycle ◽  
The Other ◽  
Nuclear Technology ◽  
National Interests ◽  
Short Period ◽  
The Us ◽  
The Usa ◽  
Key Features

The main focus of the chapter is on the period between 1974 and 1978, when the Shah sought to accelerate Iran's nuclear programme, creating tensions with the USA. This short period witnessed the emergence of a number of key features of the US-Iranian nuclear relationship: The divergence of perspectives on proliferation and the fuel cycle quickly became clear. Even in a context in which the two were Cold War allies, Iranian nationalism and ambition and American fear of proliferation produced deadlock in their nuclear negotiations. The American refusal to provide Iran with fuel cycle technology was, moreover, strongly influenced by pressure from Congress, which was able to exploit the need for its ratification of any nuclear agreement to great effect. Finally, the chapter reveals a tension between unilateralism and multilateralism that would recur in US policy, as it tried to persuade the other nuclear powers to join it in not transferring sensitive nuclear technology whilst also pursuing its own national interests and accommodating domestic pressures.

Measurement Invariance of a Universal Behavioral Screener Across Samples From the USA and Germany

2018 ◽  
Vol 34 (2) ◽  
pp. 87-100 ◽  
Author(s):  
Gino Casale ◽  
Robert J. Volpe ◽  
Brian Daniels ◽  
Thomas Hennemann ◽  
Amy M. Briesch ◽  
...  
Keyword(s):  
Measurement Invariance ◽  
Student Behavior ◽  
Cross Cultural ◽  
Cross Cultural Comparison ◽  
School Based ◽  
Cultural Research ◽  
Universal Screener ◽  
Confirmatory Factor ◽  
The Us ◽  
The Usa

Abstract. The current study examines the item and scalar equivalence of an abbreviated school-based universal screener that was cross-culturally translated and adapted from English into German. The instrument was designed to assess student behavior problems that impact classroom learning. Participants were 1,346 K-6 grade students from the US (n = 390, Mage = 9.23, 38.5% female) and Germany (n = 956, Mage = 8.04, 40.1% female). Measurement invariance was tested by multigroup confirmatory factor analysis (CFA) across students from the US and Germany. Results support full scalar invariance between students from the US and Germany (df = 266, χ2 = 790.141, Δχ2 = 6.9, p < .001, CFI = 0.976, ΔCFI = 0.000, RMSEA = 0.052, ΔRMSEA = −0.003) indicating that the factor structure, the factor loadings, and the item thresholds are comparable across samples. This finding implies that a full cross-cultural comparison including latent factor means and structural coefficients between the US and the German version of the abbreviated screener is possible. Therefore, the tool can be used in German schools as well as for cross-cultural research purposes between the US and Germany.

Sanctions of the USA and the Policy of Bank of Russia:double Blow to the National Economy

2014 ◽  
pp. 13-29 ◽  
Author(s):  
S. Glazyev
Keyword(s):  
National Security ◽  
Economic Sanctions ◽  
Capital Flight ◽  
Practical Advice ◽  
The Us ◽  
Monetary Authorities ◽  
The Usa ◽  
Simultaneous Adoption ◽  
The Eu

This article examines fundamental questions of monetary policy in the context of challenges to the national security of Russia in connection with the imposition of economic sanctions by the US and the EU. It is proved that the policy of the Russian monetary authorities, particularly the Central Bank, artificially limiting the money supply in the domestic market and pandering to the export of capital, compounds the effects of economic sanctions and plunges the economy into depression. The article presents practical advice on the transition from external to domestic sources of long-term credit with the simultaneous adoption of measures to prevent capital flight.

Possibility of Using in Russia the Experience of LED Lighting Application at the USA Airfields

2019 ◽  
pp. 71-77
Author(s):  
Vladimir V. Vorozhikhin ◽  
Eugenia L. Moreva ◽  
Vladimir G. Starovoytov ◽  
Igor G. Tyutyunnik
Keyword(s):  
Air Transportation ◽  
Improve Quality ◽  
Led Lighting ◽  
The Us ◽  
The Usa ◽  
Quality And Reliability ◽  
Lighting Application

The purpose of this paper is an investigation of LEDs illumination experience at US-based aerodromes with an assessment of its feasibility and its necessity in Russia. The following methods were used: the analysis of aerodrome lighting requirements; the review and the analysis of development features in aerodrome LEDs illumination; the experience analysis of LEDs illumination of US-based aerodromes; the deductive analysis and the assessment synthesis of feasibility and necessity of US experience in LEDs illumination at Russian-based aerodromes. The following results were achieved: – The analysis of issues and opportunities was conducted for development of LEDs illumination at US-based aerodromes and of American experts’ recommendations for its use; – The cases were taken for use and assessment of development in LEDs illumination at US-based aerodromes; – The review and the analysis were conducted in relation to a developing market of LEDs illumination at Russian-based aerodromes. The main conclusion is that the US experience will improve quality and reliability of service provided in air transportation, comfort, and safety of Russian flights, as well as competitiveness of Russian- based airports and airlines (indirectly).

Interaction of Ukrainian Diaspora and the USA Government Regarding Celebration of Ukrainian Independence Day on January 22

2018 ◽  
Vol 1 (47) ◽  
pp. 136-145
Author(s):  
Halyna Shchyhelska
Keyword(s):  
United States ◽  
House Of Representatives ◽  
The United States ◽  
100Th Anniversary ◽  
Totalitarian Regime ◽  
The Public ◽  
Us Congress ◽  
The Us ◽  
Public Consciousness ◽  
The Usa

2018 marks the 100th anniversary of the proclamation of Ukrainian independence. OnJanuary 22, 1918, the Ukrainian People’s Republic proclaimed its independence by adopting the IV Universal of the Ukrainian Central Rada, although this significant event was «wiped out» from the public consciousness on the territory of Ukraine during the years of the Soviet totalitarian regime. At the same time, January 22 was a crucial event for the Ukrainian diaspora in the USA. This article examines how American Ukrainians interacted with the USA Government institutions regarding the celebration and recognition of the Ukrainian Independence day on January 22. The attention is focused on the activities of ethnic Ukrainians in the United States, directed at the organization of the special celebration of the Ukrainian Independence anniversaries in the US Congress and cities. Drawing from the diaspora press and Congressional Records, this article argues that many members of Congress participated in the observed celebration and expressed kind feelings to the Ukrainian people, recognised their fight for freedom, during the House of Representatives and Senate sessions. Several Congressmen submitted the resolutions in the US Congress urging the President of United States to designate January 22 as «Ukrainian lndependence Day». January 22 was proclaimed Ukrainian Day by the governors of fifteen States and mayors of many cities. Keywords: January 22, Ukrainian independence day, Ukrainian diaspora, USA, interaction, Congress

scholarly journals Trends in educational mobility: How does China compare to Europe and the United States?

2019 ◽  
Vol 5 (2) ◽  
pp. 214-240
Author(s):  
Rob J Gruijters ◽  
Tak Wing Chan ◽  
John Ermisch
Keyword(s):  
Educational Opportunity ◽  
The United States ◽  
International Standards ◽  
Educational Mobility ◽  
The Us ◽  
The Usa ◽  
Economic Boom ◽  
The Uk ◽  
Large Decline ◽  
Inequality Of Educational Opportunity

Despite an impressive rise in school enrolment rates over the past few decades, there are concerns about growing inequality of educational opportunity in China. In this article, we examine the level and trend of educational mobility in China, and compare them to the situation in Germany, the Netherlands, the UK and the USA. Educational mobility is defined as the association between parents’ and children’s educational attainment. We show that China’s economic boom has been accompanied by a large decline in relative educational mobility chances, as measured by odds ratios. To elaborate, relative rates of educational mobility in China were, by international standards, quite high for those who grew up under state socialism. For the most recent cohorts, however, educational mobility rates have dropped to levels that are comparable to those of European countries, although they are still higher than the US level.

scholarly journals Sweet Corn Research around the World 2015–2020

Agronomy ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 534
Author(s):  
Pedro Revilla ◽  
Calli M. Anibas ◽  
William F. Tracy
Keyword(s):  
Sweet Corn ◽  
Starch Content ◽  
Starch Synthesis ◽  
Environmental Care ◽  
Research Activities ◽  
The Us ◽  
The World ◽  
The Usa ◽  
Basic Biology ◽  
Endosperm Starch

Modern sweet corn is distinguished from other vegetable corns by the presence of one or more recessive alleles within the maize endosperm starch synthesis pathway. This results in reduced starch content and increased sugar concentration when consumed fresh. Fresh sweet corn originated in the USA and has since been introduced in countries around the World with increasing popularity as a favored vegetable choice. Several reviews have been published recently on endosperm genetics, breeding, and physiology that focus on the basic biology and uses in the US. However, new questions concerning sustainability, environmental care, and climate change, along with the introduction of sweet corn in other countries have produced a variety of new uses and research activities. This review is a summary of the sweet corn research published during the five years preceding 2021.

scholarly journals 419. Diagnostic Utility of a Ferritin to Procalcitonin Ratio to Differentiate Patients with COVID-19 from Those with Bacterial Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S277-S277
Author(s):  
Katherine C Jankousky ◽  
Peter Hyson ◽  
Jin Huang ◽  
Daniel B Chastain ◽  
Carlos Franco-Paredes ◽  
...  
Keyword(s):  
Receiver Operating Characteristic ◽  
Host Response ◽  
Bacterial Pneumonia ◽  
Operating Characteristic ◽  
Receiver Operating Characteristic Analysis ◽  
University Hospital ◽  
Characteristic Analysis ◽  
The Us ◽  
Test Probability ◽  
Receiver Operating

Abstract Background Accurate, rapid, inexpensive biomarkers are needed to differentiate COVID-19 from bacterial pneumonia, allowing effective treatment and antibiotic stewardship. We hypothesized that the ratio of ferritin to procalcitonin (F/P) reflects greater viral activity and host response with COVID-19 pneumonia, while bacterial pneumonia would be associated with less cytolysis (lower ferritin) and more inflammation (higher procalcitonin), thus a lower F/P ratio. Methods We conducted a retrospective study of adult patients admitted to a single University hospital in the US through May 2020, during the COVID-19 pandemic. We compared F/P ratio of patients diagnosed with COVID-19 or bacterial pneumonia, excluding patients with COVID-19 and bacterial co-infections. In a logistic regression, we controlled for age, sex, body mass index (BMI), diabetes (DM), and hypertension (HTN). We used a receiver operating characteristic analysis to calculate the sensitivity and specificity of F/P values for the diagnosis of COVID-19 versus bacterial pneumonia. Results Of 218 patients with COVID-19 and 17 with bacterial pneumonia, COVID-19 patients were younger (56 vs 66 years, p=0.04), male (66% vs 24%, p=0.009), had higher BMI (31 vs 27 kg/m2, p=0.03), and similar rates of HTN (59% vs 45%, p=0.3) and DM (32% vs 18%, p=0.2). The median F/P ratio was significantly higher in patients with COVID-19 (3195 vs 860, p=0.0003, Figure 1). An F/P ratio cut-off of ≥ 1250 generated a sensitivity of 78% and a specificity of 59% to correctly classify a COVID-19 case (Figure 2). When adjusted for age, gender, BMI, DM, and HTN, a ratio ≥ of 1250 was associated with significantly greater odds of COVID-19 versus bacterial pneumonia (OR: 4.9, CI: 1.5, 16.1, p=0.009). Figure 1. Ferritin to Procalcitonin Ratios of patients with COVID-19 and patients with Bacterial Pneumonia (controls). Figure 2. Receiver Operating Characteristic Analysis of Ferritin to Procalcitonin Ratio Cut-off Values Predicting COVID-19 Diagnosis. Conclusion We observed an elevated F/P ratio in patients with COVID-19 compared to those with bacterial pneumonia. A F/P ratio ≥ 1250 provides a clinically relevant increase in pre-test probability of COVID-19. Prospective studies evaluating the discriminatory characteristics of F/P ratio in larger cohorts is warranted. Disclosures All Authors: No reported disclosures

scholarly journals Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: An International Multicenter Study

Neurosurgery ◽  
2021 ◽  
Author(s):  
Priyank Khandelwal ◽  
Fawaz Al-Mufti ◽  
Ambooj Tiwari ◽  
Amit Singla ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
African Americans ◽  
Multicenter Study ◽  
Large Vessel ◽  
Vessel Occlusion ◽  
Cross Sectional ◽  
Younger Age ◽  
The Us ◽  
The Usa ◽  
Rehabilitation Facilities ◽  
International Multicenter Study

Abstract BACKGROUND While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA.

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